Upper limb contribution during tandem gait in multiple sclerosis: An early marker of balance impairments.

Tandem gait is widely used during clinical exams to evaluate dynamic balance in chronic diseases, such as multiple sclerosis (MS). The early detection of balance impairments in MS is challenging to improve the understanding of patients' complaints. The objective was to propose two indexes to quantify the contributions and inefficiency of limb and trunk movements during tandem gait in early-stage MS patients. Fifteen patients with remitting-relapsed MS, with a median Expanded Disability Status Scale of 2.5 [0-4] were compared to 15 matched healthy participants. Three-dimensional motion analysis was performed during tandem gait to calculate spatiotemporal parameters, contribution and inefficiency indexes, based on the linear momentum of body segments. Compared to healthy participants, MS patients at the early stage of disease executed tandem gait with higher speed (p = 0.03) and increased step length (p = 0.03). The contribution indexes of upper limbs were significantly decreased during swing phase in MS patients. The inefficiency index for the upper limbs were around twice higher for MS patients compared to healthy participants. Since the additional movements concerned only light body segments and not contribute to the whole-body forward progression during tandem gait, they could reflected more both upper limb movements alterations and restoring movements to avoid loss of balance during tandem gait around swing phase in MS. These quantified indexes could be used as physical markers to quantify both the balance deterioration and the efficiency of rehabilitation program during the follow up of MS from the early stage of their disease.

Simplified stance limb kinetics patterns revealed during gait initiation in early stage of multiple sclerosis.

BACKGROUND: Although patients with an early stage of Multiple Sclerosis (MS) commonly complain about balance and gait impairments, their troubles remain misunderstood. The objective was to compare body kinematics and lower limb kinetics during gait initiation between patients with MS with an EDSS score ≤ 4 and healthy participants. METHODS: Sixteen patients with MS with a median EDSS score of 2.5 [0-4] and disease duration of 7.4 ± 4.2 years, as well as 16 healthy participants were included, and 3-D motion analysis was performed during gait initiation to calculate spatiotemporal, kinematic and kinetic parameters. FINDINGS: The center of pressure position at the beginning of the gait initiation was more anterior (p = 0.02) in patients with MS than healthy participants. The kinetic parameters of the stance limb were highly affected in patients with MS compared to healthy participants during gait initiation. The net muscular moments for each joint were significantly different during the anticipatory postural adjustment phase with smoother variations for patients with MS compared to healthy participants. INTERPRETATION: Early stage MS strongly affects the motor modulation of stance limb kinetics during the anticipatory postural adjustment of gait initiation, without alteration of the execution phase. The net muscular moments are sensitive in detecting unobservable balance impairments and can be used to assess disease progression at the early stage. These results suggest that early rehabilitation programs aimed at improving motor modulation and flexibility in gait initiation should be implemented.

Ankle dysfunction in multiple sclerosis and the effects on walking.

PURPOSE: Even in the early stage of the disease, for patients suffering from multiple sclerosis (MS), the most common and reported biomechanical alterations in the lower limb are located at the ankle joint. However, the effects of these impairments on gait deterioration should be discussed. MATERIALS AND METHODS: This review was written according to the PRISMA guidelines. The search focussed on biomechanical changes (kinetic, kinematic, and electromyographic data) at the ankle during gait in MS patients. The search was performed in the databases: Pubmed, Web of Science, and Cochrane Library. RESULTS: Eleven studies were included. The reduction in the ankle range of motion (RoM) induced by increased cocontractions of the tibialis anterior and triceps surae muscles could be a compensatory strategy to improve body-weight support and balance during the stance phase. CONCLUSIONS: Future rehabilitation programmes should consider the control of weight support at the ankle during gait training.Implications for rehabilitationThe ankle supports and stabilises the body during the stance phase of gait.The reduced ankle range of motion in multiple sclerosis (MS), even at an early stage of the disease, is due to cocontractions of tibialis anterior and triceps surae and could be a compensatory strategy to be more stable.Rehabilitation programmes for MS patients should focus on the control of body segments motion during the weight transfer above the ankle.

Chronic low back pain sufferers exhibit freezing-like behaviors when asked to move their trunk as fast as possible.

BACKGROUND CONTEXT: The effect of chronic low back pain (CLBP) on the kinematic parameters of trunk motion has received much more interest in this last decade. However, there are no descriptions of the motor strategies that occur when patients perform trunk movements in the three anatomical planes at different pace conditions. PURPOSE: To investigate motor strategies used by CLBP patients and asymptomatic people while performing different go and back trunk movements in an upright standing position. STUDY DESIGN: A comparative study. PATIENT SAMPLE: The control group (CG, n=33) included 14 men and 19 women with no history of low back pain, and the chronic low back pain group (CLBPG, n=49) included 21 men and 28 women. OUTCOME MEASURES: Kinematic data were analyzed during six trunk movements: flexion, extension, left and right lateral bendings, and rotations under two pace conditions (preferred and fast paces). METHODS: A three-dimensional optoelectronic motion analysis system was used to assess static (trunk inclinations and base of support) and dynamic (range of motion [ROM] and mean angular velocity of the trunk) parameters during the go and back phases of trunk movements. RESULTS: In the initial position, CLBPG showed a more forward-tilted trunk inclination (2.1°±1.1°, p=.013) compared with CG. The base of support was significantly higher in CG (+22.7 cm2, p=.009) during the fast pace when compared with the preferred pace. Regardless of the pace condition, ROM and mean angular velocity of the trunk were significantly lower in CLBPG for all examined movements and the pace condition did not significantly alter ROM. At the preferred pace, both groups displayed the same motor strategy: they all went faster during the second phase of movement than during the first phase. However, at the fast pace, while CG was going faster during the first phase than during the second, CLBPG maintained the same motor strategy as at the preferred pace. CONCLUSIONS: Contrary to CG who changed its motor behavior from a preferred pace to a fast pace, CLBPG exhibited freezing-like behaviors. This original result highlights the importance of studying the velocity. The use of this parameter may improve the diagnosis of CLBP patients and could be a key indicator for treatment progress and long-term monitoring.

Trunk's natural inclination influences stance limb kinetics, but not body kinematics, during gait initiation in able men.

The imposing mass of the trunk in relation to the whole body has an important impact on human motion. The objective of this study is to determine the influence of trunk's natural inclination--forward (FW) or backward (BW) with respect to the vertical--on body kinematics and stance limb kinetics during gait initiation.Twenty-five healthy males were divided based on their natural trunk inclination (FW or BW) during gait initiation. Instantaneous speed was calculated at the center of mass at the first heel strike. The antero-posterior impulse was calculated by integrating the antero-posterior ground reaction force in time. Ankle, knee, hip and thoraco-lumbar (L5) moments were calculated using inverse dynamics and only peaks of the joint moments were analyzed. Among all the investigated parameters, only joint moments present significant differences between the two groups. The knee extensor moment is 1.4 times higher (P<0.001) for the BW group, before the heel contact. At the hip, although the BW group displays a flexor moment 2.4 times higher (P<0.001) before the swing limb's heel-off, the FW group displays an extensor moment 3.1 times higher (P<0.01) during the swing phase. The three L5 extensor peaks after the toe-off are respectively 1.7 (P<0.001), 1.4 (P<0.001) and 1.7 (P<0.01) times higher for the FW group. The main results support the idea that the patterns described during steady-state gait are already observable during gait initiation. This study also provides reference data to further investigate stance limb kinetics in specific or pathologic populations during gait initiation. It will be of particular interest for elderly people, knowing that this population displays atypical trunk postures and present a high risk of falling during this forward stepping.

Human muscle fascicle behavior in agonist and antagonist isometric contractions.

INTRODUCTION: The aim of this study was to compare, at a given level of electromyographic (EMG) activity, the behavior of dorsiflexor and plantarflexor muscles as assessed via their architecture (pennation angle and fiber length) during agonist or antagonist isometric contractions. METHODS: Real-time ultrasonography and EMG activity of gastrocnemius medialis (GM) and tibialis anterior (TA) muscles were obtained while young males performed ramp isometric contractions in dorsi- and plantarflexion. RESULTS: For both muscles, at a similar level of EMG activity, fiber length was longer, and pennation angle was smaller, during antagonist than during agonist contractions. CONCLUSIONS: These results indicate that, at similar levels of EMG activity, GM and TA muscles elicit a higher mechanical output while acting as an antagonist. These findings have important implications for muscle function testing. They show that estimation of antagonistic force using the common method based on the EMG/net torque relationship yields underestimated values.

Age-related relative increases in electromyography activity and torque according to the maximal capacity during upright standing.

The aim of this study was to assess the relative torque (a percentage of the maximal capacity of torque production) at the ankle joint in young and elderly adults during different postural tasks of increasing difficulty. Seven young (approximately 22 years old) and seven older (approximately 80 years old) men took part in this investigation. Maximal agonist torque was estimated from resultant and antagonist torques in both populations in plantar-flexion (PF) and dorsi-flexion (DF). The sum of PF and DF maximal agonist torques was considered as the maximal capacity of torque production. The centre of pressure (CoP) displacement was analysed during Normal Quiet Stance, Romberg and One Leg Balance. During maximal contractions and postural tasks, the electromyographic (EMG) activity was simultaneously recorded on the triceps surae and tibialis anterior muscles. We observed that the maximal capacity of torque production was negatively correlated with the CoP displacement, whatever the population and the postural tasks. The relative torque during all postural tasks was positively correlated with the CoP displacement in both populations. Moreover, older adults needed more EMG activity than young adults to produce the same torque. From this knowledge, one can assume that increasing strength in the muscles of the ankle joint may improve postural stability in older adults; this might have implications in the prevention of falls in elderly persons and in rehabilitation programs for elderly people who have already fallen.

Coactivation at the ankle joint is not sufficient to estimate agonist and antagonist mechanical contribution.

The aim of this study was to assess, via an electromyographic (EMG) biofeedback method, the mechanical contribution of both agonist and antagonist muscles during maximal voluntary contraction (MVC). We compared this original method with the MVC-EMGmax ratio and the torque/EMG relationship method, both of which are commonly used to estimate antagonist torque. The plantarflexion (PF) and dorsiflexion (DF) MVCs were measured simultaneously with EMG activity of triceps surae (TS) and tibialis anterior in 15 young adults (mean age 23 years). Antagonist torques obtained from the torque/EMG relationship and EMG biofeedback methods appeared to be similar. TS antagonist torque had a major mechanical impact on DF MVC ( approximately 42%). EMG coactivation is significantly different than normalized antagonist torque. TS antagonist torque is not negligible when maximal DF is assessed, and the EMG biofeedback method is a simple method to estimate antagonist torque.

Antagonist mechanical contribution to resultant maximal torque at the ankle joint in young and older men.

A recorded muscular torque at one joint is a resultant torque corresponding to the participation of both agonist and antagonist muscles. This study aimed to examine the effect of aging on the mechanical contributions of both plantar- and dorsi-flexors to the resultant maximal voluntary contraction (MVC) torques exerted at the ankle joint, in dorsi-flexion (DF) and plantar-flexion (PF). The estimation of isometric agonist and antagonist torques by means of an EMG biofeedback technique was made with nine young (mean age 24 years) and nine older (mean age 80 years) men. While there was a non-significant age-related decline in the measured resultant DF MVC torque (-15%; p=0.06), there was a clear decrease in the estimated agonist MVC torque exerted by the dorsi-flexors (-39%; p=0.001). The DF-to-PF resultant MVC torque ratio was significantly lower in young than in older men (0.25 vs. 0.31; p=0.006), whereas the DF-to-PF agonist MVC torque ratio was no longer different between the two populations (0.38 vs. 0.35; p>0.05). Thus, agonist MVC torques in PF and DF would be similarly affected by aging, which could not be deduced when only resultant torques were examined.

Difficult memory task during postural tasks of various difficulties in young and older people: a pilot study.

OBJECTIVE: This study examined the effects of a difficult and individually tailored additional cognitive task on postural stability and electromyographic (EMG) activities of the ankle dorsi- and plantar-flexors, in young and older individuals performing postural tasks of varying difficulties. METHODS: Eight young (mean age=24 years) and eight older (74 years) men took part in the investigation. Centre of pressure velocity and surface EMG of ankle joint muscles were both examined during various postural conditions. RESULTS: The main findings suggested that high levels of muscle activity were a characteristic of age-related declines in postural stability. Moreover, during the complex posture, the postural instability, as well as the EMG activity of the ankle joint muscles, was decreased in older adults when the difficult memory task was added. Regarding young participants, the performance in the cognitive task was significantly improved during the complex posture compared to the easy one. CONCLUSIONS: These findings showed that the execution of a second task would make it possible to improve the performance in the original task. SIGNIFICANCE: This pilot study seemed to show that, depending on age, the task of highest priority would be the cognitive one for young adults and the postural one for older people.

Effects of joint angle and age on ankle dorsi- and plantar-flexor strength.

This study aimed at examining the effects of joint angle and age on the maximal voluntary contraction (MVC) torque, for the agonist and antagonist muscle groups around the ankle, i.e., the dorsi- and plantar-flexors. To this aim, neural and muscular factors were investigated in two groups of healthy men: 11 young (mean age, 24 years) and 18 older (mean age, 78 years). Plantar-flexion (PF) and dorsiflexion (DF) isometric MVC torques were measured in three different ankle joint angles and surface electromyographic activities of the triceps surae and of the tibialis anterior muscles were recorded. The main findings were that the DF-to-PF MVC torque ratio varied with joint angle and age, indicating that aging affected at different rates the two muscle groups: this ratio was always higher in older adults because of the PF strength decline with aging. Furthermore, the DF MVC torque-angle relationship appeared to be especially explained by neural factors, whereas the relationship in PF seemed to be mainly due to muscular parameters. These relationships would not be a discriminating factor between the two age groups. As a consequence, measurements at one ankle joint angle, whatever the angle, are thus enough to examine the differences within age groups and to perform a rapid assessment of the imbalance at the ankle joint.

Adaptations to long-term strength training of ankle joint muscles in old age.

The aim of this study was to enquire whether older adults, who continue plantar-flexion (PF) strength training for an additional 6-month period, would achieve further improvements in neuromuscular performance, in the ankle PFs, and in the antagonist dorsi-flexors (DFs). Twenty-three healthy older volunteers (mean age 77.4 +/- 3.7 years) took part in this investigation and 12 of them followed a 1-year strength-training program. Both neural and muscular factors were examined during isometric maximal voluntary contraction (MVC) torques in ankle PF and DF pre-training, post 6 and post 12 months. The main finding was that 6 months of additional strength training of the PFs, beyond 6 months, allowed further improvements in neuromuscular performance at the ankle joint in older adults. Indeed, during the first 6 months of progressive resistance training, there was an increase in the PF MVC torque of 11.1 +/- 19.9 N m, and then of 11.1 +/- 17.9 N m in the last 6-month period. However, it was only after 1 year that there was an improvement in the evoked contraction at rest in PF (+ 8%). The strength training of the agonist PF muscles appeared to have an impact on the maximal resultant torque in DF. However, it appeared that this gain was first due to modifications occurring in the trained PFs muscles, then, it seemed that the motor drive of the DFs per se was altered. In conclusion, long-term strength training of the PFs resulted in continued improvements in neuromuscular performance at the ankle joint in older adults, beyond the initial 6 months.

Strength training in old age: adaptation of antagonist muscles at the ankle joint.

The purpose of this study was to determine whether strength training could reduce the deficit in plantarflexion (PF) maximal voluntary contraction (MVC) torque observed in previous studies in older subjects relative to young adults. Accordingly, the effects of a 6-month strength training program on the muscle and neural properties of the major muscle groups around the ankle were examined. PF and dorsiflexion (DF) isometric MVC torques were measured and surface electromyographic activity of the triceps surae and tibialis anterior muscles was recorded. The strength training program was very effective in improving strength in PF (+24.5%), and it thus reduced the DF-to-PF MVC torque ratio; in addition, it also induced gains in DF (+7.6%). Thus, there must be an improvement in ankle joint stability. In PF, gains were due particularly to a modification of the agonist neural drive; in DF, the gains appeared to be the consequence of a reduction in antagonist coactivation. Our findings indicate that the investigation of one muscle group should always be accompanied by examination of its antagonist muscle group.

Muscular performances at the ankle joint in young and elderly men.

The effect of aging on mechanical and electromyographic characteristics of ankle joint muscles was investigated in 11 young (mean age 24 years) and 12 elderly (mean age 77 years) males. Maximal and submaximal isometric voluntary torques were measured during ankle plantarflexion and dorsiflexion. Electromyographic activities of triceps surae and tibialis anterior muscles were recorded. The elderly group developed equal maximal dorsiflexion torques (42 vs 45 N.m, p >.05), but in plantarflexion, the elderly group was weaker (80 vs 132 N.m, p <.001) and presented a decreased twitch amplitude (11 vs 16 N.m) and lower coactivation (8% vs 15%) than that of the young adults. We established a linear relationship between the percentage of coactivation and developed resultant torque. Our results showed that dorsiflexor muscles were not affected by aging, contrary to plantarflexors, in which the decline in torque was partly explained by changes intervening at the peripheral level.