Increasing muscle activity correlations during spontaneous movements in the first six months of life.

Spontaneous muscle activity in the first months of life is an important prerequisite to developing voluntary motor skills and to adapting sensorimotor circuits and muscle tone to body and environmental changes. Even though high variability is a characteristic of early development, several studies have reported significant correlations of limb movements. These assessments were typically made based on kinematics, while the analysis of lower and upper limb muscle activity may provide additional information about maturation of the neuromuscular control. To this end, we examined the electromyographic activity of 12 muscles of the upper and lower limbs in full-term healthy infants (n = 40) aged from 1 week to six months. An increase of ipsilateral and contralateral limb muscle activity correlations with age was found in both flexors and extensors and may reflect a progressive emergence of elements of coordinative neuromuscular behaviour. Correlations between arm and leg muscle responses also increased during passive leg movements. Overall, the findings are consistent with maturation of physiologically relevant neuromuscular network connections during the course of transition from spontaneous-like to voluntary goal-directed movements during early development.

Synergistic influences of sensory and central stimuli on non-voluntary rhythmic arm movements.

In recent years, neuromodulation of the cervical spinal circuitry has become an area of interest for investigating rhythmogenesis of the human spinal cord and interaction between cervical and lumbosacral circuitries, given the involvement of rhythmic arm muscle activity in many locomotor tasks. We have previously shown that arm muscle vibrostimulation can elicit non-voluntary upper limb oscillations in unloading body conditions. Here we investigated the excitability of the cervical spinal circuitry by applying different peripheral and central stimuli in healthy humans. The rationale for applying combined stimuli is that the efficiency of only one stimulus is generally limited. We found that low-intensity electrical stimulation of the superficial arm median nerve can evoke rhythmic arm movements. Furthermore, the movements were enhanced by additional peripheral stimuli (e.g., arm muscle vibration, head turns or passive rhythmic leg movements). Finally, low-frequency transcranial magnetic stimulation of the motor cortex significantly facilitated rhythmogenesis. The findings are discussed in the general framework of a brain-spinal interface for developing adaptive central pattern generator-modulating therapies.

Effects of spinal cord stimulation on motor functions in children with cerebral palsy.

Is it possible to regulate the functional properties of abnormally developed spinal neuronal locomotor networks using transcutaneous spinal cord stimulation? This question has been studied in twenty-eight participants (∼9 yrs) with spastic cerebral palsy, and mainly Gross Motor Function Classification System for Cerebral Palsy level III. The participants were randomly assigned to two groups. The experimental group received transcutaneous spinal cord stimulation at two spinal levels (over T11 and L1 spinous processes), combined with locomotor treadmill training, whereas the participants of the control group received locomotor treadmill training only. After spinal cord stimulation in the experimental group we found an incremental increase in knee torque whereas in the control group this effect was absent. The amplitude of hip motion increased in both groups. A decrease of co-activation of hip and muscles of the lower extremities was observed in the experimental group while in the control group co-activation decreased only in hip muscles. The results support the idea that locomotor function can be improved significantly with the combination of training and transcutaneous spinal cord stimulation than with training alone.

[The Activation of Interlimb Interactions Increase the Motor Output in Legs in Healthy Subjects under the Conditions of Arm and Leg Unloading].

We studied the effect of arm movements and movements of separate arm joints on the electrophysiological and kinematic characteristics of voluntary and vibration-triggered stepping-like leg movements under the conditions of horizontal support of upper and lower limbs. The horizontal support of arms provided a significantly increase in the rate of activation of locomotor automatism by non-invasive impact on tonic sensory inputs. The addition of active arm movements during involuntary rhytmic stepping-like leg movements led to an increase in EMG activity of hip muscles and was accompanied by an increase in the amplitude of hip and shin movements. Passive arm movements had the same effect on induced leg movements. The movement of the shoulder joints led to an increase in the activity of hip muscles and an increase in the amplitude of movements of the knee and hip joints. At the same time, the movement of forearms. and wrists had similar facilitating effect on electrophysiological and kinematic characteristics of rhytmic stepping-like movements, but influenced the distal segments of legs to a greater extent. Under the conditions of sub-threshold vibration of leg muscles, voluntary arm movements led to the activation of involuntary rhytmic stepping movements. During voluntary leg movements, the addition of arm movements had a significantly smaller impact on the parameters of rhytmic stepping than during involuntary leg movements. Thus, the simultaneous movements of upper and lower limbs are an effective method of activation of neural networks connecting the rhythm generators of arms and legs. Under the conditions of arm and leg unloading, the interactions between the cervical and lumbosacral segments of the spinal cord seem to play the major role in the impact of arm movements on the patterns of leg movements. The described methods of activation of interlimb interactions can be used in the rehabilitation of post-stroke patients and patients with spinal cord injuries, Parkinson's disease and other neurological diseases.

Human cervical spinal cord circuitry activated by tonic input can generate rhythmic arm movements.

The coordination between arms and legs during human locomotion shares many features with that in quadrupeds, yet there is limited evidence for the central pattern generator for the upper limbs in humans. Here we investigated whether different types of tonic stimulation, previously used for eliciting stepping-like leg movements, may evoke nonvoluntary rhythmic arm movements. Twenty healthy subjects participated in this study. The subject was lying on the side, the trunk was fixed, and all four limbs were suspended in a gravity neutral position, allowing unrestricted low-friction limb movements in the horizontal plane. The results showed that peripheral sensory stimulation (continuous muscle vibration) and central tonic activation (postcontraction state of neuronal networks following a long-lasting isometric voluntary effort, Kohnstamm phenomenon) could evoke nonvoluntary rhythmic arm movements in most subjects. In ∼40% of subjects, tonic stimulation elicited nonvoluntary rhythmic arm movements together with rhythmic movements of suspended legs. The fact that not all participants exhibited nonvoluntary limb oscillations may reflect interindividual differences in responsiveness of spinal pattern generation circuitry to its activation. The occurrence and the characteristics of induced movements highlight the rhythmogenesis capacity of cervical neuronal circuitries, complementing the growing body of work on the quadrupedal nature of human gait.

[Are Interlimb Interactions Disturbed in Patients with Parkinson's Disease: a Study in Unloading Condition?]

During natural human locomotion neural connections characteristic for the control of quadrupedal walking are activated. The degree of interaction between the neural networks generating rhythmic movements of the upper and lower extremities, depends on the tonic state of each of these networks, adjustable by motor command in the brain. The distortion of such command in patients with Parkinson's disease (PD) may lead to disturbance of interlimb interactions. In conditions of arms and legs unloading in 17 patients with PD and 16 healthy subjects investigated the effect of limb movement of one girdle on the parameters of motor activity of the limbs of the other girdle in their combined cyclic movements. In patients the weakening of influences of active or passive arm movements, and active movements of the distal parts of the arms on voluntary leg movements was shown, while in healthy subjects the effect of arm movements on the parameters of voluntary movements was significant. The effect of arm movements on the possibility of involuntary activation of air- stepping by vibratory stimulation of the leg muscles in patients was absent, while in healthy subjects the motor activity of the arms increased the opportunity of involuntary rhythm activation. The differences in the influence of leg movements to the rhythmic movement of the upper extremities in patients and healthy subjects were revealed. The medication exhibited interlimb interaction, but it was insufficient for normalization of the state of neural networks in patients. It is concluded that in patients with PD, neural networks generating stepping rhythm are in a state of heightened tonic activity. This does not allow not only activating involuntary rhythmic movements, but also showing facilitation effect with arms to legs.

[Neurorehabilitation of Patients with Cerebral Palsy].

Cerebral palsy is one of the common diseases that cause significant motor impairments. This review deals with new methods of motor rehabilitation of children with cerebral palsy in terms of modern physiology, as well as with summarized and analyzed results of experimental studies on the effectiveness of these methods.

[Investigation of muscle tone in patients with Parkinson's disease in unloading conditions].

Parkinson's disease (PD) is a progressive neurodegenerative disorder, ones of the main symptoms of which are hypertonicity and emergent difficulties during performance of stepping movements due to increased muscle stiffness. Biomechanical (stiffness) and electrophysiological (shorting reaction) characteristics of hip and shank muscles were examined in 25 patients with mild and moderate stages of PD (1 to 3 of Hoehn & Yahr Rating Scale, 61 +/- 9 years) and 22 age-matched healthy controls in unloading leg conditions during passive flexion/extension of hip, knee and ankle joints, as well as the changes of tonic state under levodopa influence. The data obtained were compared with similar findings of healthy subjects. Essentially greater stiffness in all leg muscle groups (with the exception of foot extensors) were observed in patients as compared with healthy. During passive movements the shorting reactions (SR) in hip and shank muscles were often observed, in healthy subjects the SR were observed more rarely. In patients with PD the values of SR in extensors of hip and shank, as well as in flexor and extensor muscles of foot were essentially greater then in healthy. The medicine essentially reduced the stiffness of hip flexors and flexors and foot extensors. The SR were persisted but the frequency of its appearance was decreased in half of investigated muscles, and significant decreasing of SR amount was observed in extensors of foot. The medicine did not exert influence upon SR in proximal muscles. Thus, increasing muscle stiffness in patients with PD is manifested in uncorrected reactions on external disturbances and reflected in increasing of reflectory reaction of muscles.

Effects of transcranial magnetic stimulation during voluntary and non-voluntary stepping movements in humans.

Here, we compared motor evoked potentials (MEP) in response to transcranial magnetic stimulation of the motor cortex and the H-reflex during voluntary and vibration-induced air-stepping movements in humans. Both the MEPs (in mm biceps femoris, rectus femoris and tibialis anterior) and H-reflex (in m soleus) were significantly smaller during vibration-induced cyclic leg movements at matched amplitudes of angular motion and muscle activity. These findings highlight differences between voluntary and non-voluntary activation of the spinal pattern generator circuitry in humans, presumably due to an extra facilitatory effect of voluntary control/triggering of stepping on spinal motoneurons and interneurons. The results support the idea of active engagement of supraspinal motor areas in developing central pattern generator-modulating therapies.

[Interlimb interactions during cyclic in-phase and antiphased movements of arms and legs and their dependence on afferent influences].

Coordinated movements of arms and legs suppose the neural interaction between the generators of the rhythmics of the upper and lower extremities. In the lying position in 10 healthy subjects activity of the muscles of the upper and lower extremities was recorded when separate and joint cyclic movements of the arms and legs with different phase relationships between the movements of the limbs were performed, and under various conditions of the motor task. Antiphased active arm movements were characterized by increased muscle activity than during in-phase mode. The activity of the arm muscles under passive movements, imposed by experimenter, was significantly less than their activity when passive movements of the arms were imposed by the other arm. When loading one arm the muscle activity in the other passively moving arm increased independently from the synergy of arm movements. During motor tasks, implementing joint antiphased movements as the upper and lower extremities, compared to motor task, implementing their joint in-phase movements, there has been a significant increase in activity in the biceps brahii muscle, the tibialis anterior muscle and biceps femoris muscle. Loading of arms in these motor tasks has been accompanied by increased activity in some of the leg muscles. Increasing of frequency of rhythmic movements resulted in a significant growth of the muscle activity of the arms and legs with their cooperative movements with greater rate of rise of flexor muscles activity for arms and legs during joint antiphased movements. Thus, the spatial organization of movements and kind of afferent influences are significant factors of interlimb interaction, which, in turn, determine the type of neural interconnections that are involved in the regulation of movements.

Plasticity and modular control of locomotor patterns in neurological disorders with motor deficits.

Human locomotor movements exhibit considerable variability and are highly complex in terms of both neural activation and biomechanical output. The building blocks with which the central nervous system constructs these motor patterns can be preserved in patients with various sensory-motor disorders. In particular, several studies highlighted a modular burst-like organization of the muscle activity. Here we review and discuss this issue with a particular emphasis on the various examples of adaptation of locomotor patterns in patients (with large fiber neuropathy, amputees, stroke and spinal cord injury). The results highlight plasticity and different solutions to reorganize muscle patterns in both peripheral and central nervous system lesions. The findings are discussed in a general context of compensatory gait mechanisms, spatiotemporal architecture and modularity of the locomotor program.

Lack of non-voluntary stepping responses in Parkinson's disease.

The majority of research and therapeutic actions in Parkinson's disease (PD) focus on the encephalic areas, however, the potential involvement of the spinal cord in its genesis has received little attention. Here we examined spinal locomotor circuitry activation in patients with PD using various types of central and peripheral tonic stimulation and compared results to those of age-matched controls. Subjects lay on their sides with both legs suspended, allowing low-friction horizontal rotation of the limb joints. Air-stepping can be used as a unique and important model for investigating human rhythmogenesis since its manifestation is largely facilitated by the absence of external resistance. In contrast to the frequent occurrence of non-voluntary stepping responses in healthy subjects, both peripheral (muscle vibration) and central (Jendrassik maneuver, mental task, Kohnstamm phenomenon) tonic influences had little if any effect on rhythmic leg responses in PD. On the other hand, a remarkable feature of voluntary air-stepping movements in patients was a significantly higher frequency of leg oscillations than in age-matched controls. A lack of non-voluntary stepping responses was also observed after dopaminergic treatment despite the presence of prominent shortening reactions (SRs) to passive movements. We argue that the state and the rhythmogenesis capacity of the spinal circuitry are impaired in patients with PD. In particular, the results suggest impaired central pattern generator (CPG) access by sensory and central activations.

[Abnormalities in mutual influences of upper and lower limbs in patients with stroke].

Previously, in healthy subjects the common pattern of muscle activation and specifics of interlimb neuron connections during performance of rhythmic separate and simultaneous movements of arms and legs in the lying position, which reflect functional meaningful of interlimb interactions, were shown. The aim of this research was to investigate such mutual influences of upper and lower limbs during the execution of similar motor tasks by patients with stroke. In sixteen poststroke patients with different stage of hemiparesis arms movements together with or without legs movements were performed, while lying supine. It was demonstrated that the common pattern of muscle activity distribution under the execution of voluntary cyclic movements by both arms was disordered. Passive rhythmic movements of each arm caused the phased EMG activity in shoulder muscles in patients with mild hemiparesis, but no activation was observed in patients with severe paresis. The loading of nonparetic arm resulted in an increasing of activity in shoulder flexor muscles of paretic arm in patients with weak paresis (which was typical for healthy subjects), while it not exerted essential influences in patients with severe paresis. Under connecting the cyclic movements of arms with stepping movements of legs in diagonal synergy the activity in proximal muscles of both arms was decreased irrespective of the paresis degree, as it was seeing in healthy subjects. Simultaneous arms and legs movements did not change the muscle activity in non-paretic leg in both groups of patients, but in some muscles of paretic leg the activity even decreased. The results obtained revealed important features of poststroke motor disturbances, which caused the changes of interlimb interaction and in great degree depended on the level of paresis. The data of investigation can be of a great importance for developing the new methods for rehabilitative procedure in patients with stroke.

[The influence of vibration on spinal alpha-motoneurons excitability in static conditions and during evoked stepping in human].

In healthy human the excitability of spinal alpha-motoneurons under application of vibrostimulation (20-60 Hz) to different leg muscles was investigated both in stationary condition and during stepping movements caused by vibration in the condition of suspended leg. In 15 subjects the amplitude of H-reflex were compared under vibration of rectus femoris (RF) and biceps femoris (BF) muscles of left leg as well during vibration of rectus femoris of contralateral, motionless leg in three spatial positions: upright, supine and on right side of body with suspended left leg. In dynamic conditions the amount of H-reflex was compared during evoked and voluntary stepping at 8 intervals of step cycle. In all body positions the vibration of each ipsilateral leg muscles caused significant suppression of H-reflex, this suppression was more prominent in the air-stepping conditions. The vibration of contralateral leg RF muscle had a weak influence on the amplitude of H-reflex. In 7 subjects the muscle vibration of ipsilateral and contralateral legs generated stepping movements. During evoked "air-stepping" H-reflex had different amplitudes in different phases of step cycle. At the same time the differences between responses under voluntary and non-voluntary stepping were revealed only in stance phase. Thus, different degree of H-reflex suppression by vibration under different body position in space depends on, it seems to be, from summary afferent inflows to spinal cord interneurons, which participate in regulation of posture and locomotion. Seemingly, the increasing of spinal cord neurons excitability occurs under involuntary air-stepping in swing phase, which is necessary for activation of locomotor automatism under unloading leg conditions.

[Mutual influences of upper and lower extrimities during cyclic movements].

The possibility of muscle activation of passive arm during its cyclic movements, imposed by active movements of contralateral arm or by experimenter was studied, as well as the influence of lower extremities cyclic movements onto arm muscles activity. In addition to that the activity of legs muscles was estimated in dependence on motor task condition for arms. Ten healthy supine subjects carried out opposite movements of arms with and without stepping-like movements of both legs. The experiment included three conditions for arm movements: 1) the active movements of both arms; 2) the active movements of one arm, when other entirely passive arm participated in the movement by force; 3) passive arm movement caused by experimenter. In the condition 2) additional load on active arm was applied (30 N and 60 N). In all three conditions the experiment was carried out with arms movements only or together with legs movements. The capability of passive moving arm muscles activation depended on increasing afferent inflow from muscles of contralateral arm was demonstrated. Emerging electrical activity was modulated in the arms movements cycle and depended on the degree of active arm loading. During combined active movements of arms and legs the reduction of activity in the flexor muscles of shoulder and forearm was observed. Concomitant arms movements increased the magnitude ofelectromiographic bursts during passive stepping-like movements in the most of recorded muscles, and the same increasing was only observed in biceps femoris and tibialis anterior muscles during active legs movement. The increasing of loading of one arm caused essential augmentation of EMG-activity in the majority of recording legs muscles. The data obtained are the additional proof of existence of functionally significant neuronal interaction both between arms and between upper and lower extremities, which is evidently depend on the intraspinal neuronal connections.

Assisted leg displacements and progressive loading by a tilt table combined with FES promote gait recovery in acute stroke.

OBJECTIVE: Here we developed and tested a novel system for early motor rehabilitation in acute stroke when patients are unable to stand and walk without assistance. Stepping performance may be largely facilitated by providing treatment in the supine position on a tilt table using step-synchronized functional electrical stimulation (FES) with assisted leg movements and progressive limb loading. METHODS: Sixty-one individuals with acute stroke were randomly assigned to two groups, experimental and control. The first group received both a conventional therapy and FES-therapy combined with progressive limb loading, whereas the control group received a conventional therapy only. Changes after treatment were assessed using clinical scores and neurophysiological measurements of movement performance. RESULTS: After treatment, there was an improvement of the clinical scores, muscle forces and everyday life activity performance in both groups, however, significantly higher in the experimental group. Active rhythmic movements of the non paretic leg often provoked muscle activity in the paretic leg as well as there was a reduction of the contralateral leg muscle contraction during paretic leg movements. CONCLUSION: The developed FES and leg displacement-assisted therapy facilitates a smooth transition to walking in the vertical position and increases the patient's functional abilities and the effectiveness of rehabilitation.

[The influence of afferent inputs from the foot load receptors onto spinal alpha-motoneurons excitability in air-stepping condition].

We investigated excitability of alpha-motoneurons during voluntary and passive locomotor-like movements under air-stepping conditions during the imitation of foot loading. Limb loading notably inhibited the H-reflex during both static condition and active or passive stepping. Thus, load-related afferent inputs play an essentially role in phase-dependence H-reflex modulation. The excitability of alpha-motoneurons in the most degree is influenced by afferent inflow from foot receptors.

[The investigation of control mechanisms of stepping rhythm in human in the air-stepping conditions during passive and voluntary leg movements].

In unloading condition the degree of activation of the central stepping program was investigated during passive leg movements in healthy subjects, as well as the excitability of spinal motoneurons during passive and voluntary stepping movement. Passive stepping movements with characteristics maximally approximated to those during voluntary stepping were accomplished by experimenter. The comparison of the muscle activity bursts during voluntary and imposed movements was made. In addition to that the influence of artificially created loading onto the foot to the leg movement characteristics was analyzed. Spinal motoneuron excitability was estimated by means of evaluation of amplitude modulation of the soleus H-reflex. The changes of H-reflexes under the fixation of knee or hip joints were also studied. In majority of subjects the passive movements were accompanied by bursts of EMG activity of hip muscles (and sometimes of knee muscles), which timing during step cycle was coincided with burst timing of voluntary step cycle. In many cases the bursts of EMG activity during passive movements exceeded activity in homonymous muscles during voluntary stepping. The foot loading imitation exerted essential influence on distal parts of moving extremity during voluntary as well passive movements, that was expressed in the appearance of movements in the ankle joint and accompanied by emergence and increasing of phasic EMG activity of shank muscles. The excitability of motoneurons during passive movements was greater then during voluntary ones. The changes and modulation of H-reflex throughout the step cycle without restriction of joint mobility and during exclusion of hip joint mobility were similar. The knee joint fixation exerted the greater influence. It is supposed that imposed movements activate the same mechanisms of rhythm generation as a supraspinal commands during voluntary movements. In the conditions of passive movements the presynaptic inhibition depend on afferent influences from moving leg in the most degree then on central commands. It seems that afferent inputs from pressure receptors of foot in the condition of "air-stepping" actively interact with central program of stepping and, irrespective of type of the performing movements (voluntary or passive), form the final pattern activity.

Changes in corticospinal excitability in the reactions of forearm muscles in humans to vibration.

Transcranial magnetic stimulation was used to study changes in corticospinal excitability during vibration of the flexor and extensor muscles of the wrist in healthy humans. The ratios of muscle stimulation responses to activity levels in these muscles on contraction associated with vibration (the tonic vibratory reflex, TVR) and after vibration of antagonist muscles in isometric conditions (the antagonist vibratory reflex, AVR) were analyzed. The normalized muscle response in the wrist flexors was found to increase by 66% compared with threshold values in the direct vibratory response (TVR), by 75% in the relayed vibratory response (AVR), and by 18% on voluntary contraction. However, increases in the motor response in vibratory responses as compared with those on voluntary contraction did not reach significance, which contrasted with the responses in the forearm flexors. These results are discussed from the point of view that the motor cortex plays different roles in vibratory responses in the distal and proximal muscles.

[Early motor rehabilitation with the help of a software/hardware complex "Vertical" in acute period of stroke].

The purpose of our study was the investigation of effectiveness of restoration of lost motor functions in acute period of stroke with the help of software/hardware complex "Vertical". This complex includes a functional bed-trainer for leg movements with phase-dependent functional electrical myostimulation (FES). Fifty-five subjects (mean age 64 +/-1.5 years) were assigned randomly to two groups receiving standard rehabilitation (a control group--27 subjects) and standard rehabilitation combined with the treatment by the "Vertical" complex (FES group--28 subjects). The treatment course was started on average 9 +/- 4 days after stroke and consisted of 30 min sessions 5 days per week during 2 weeks. Outcome was assessed by a battery of scales, everyday movement abilities and biomechanical parameters before and after treatment. No significant differences were found in baseline measurements. After the treatment, there was a positive dynamics in both groups with significant improvement in scores in the FES group. Most of patients of this group (67%) had hemiparesis of mild degree compared to the control group (7%, p < 0.05) to the end of treatment. Also 89% of subjects in the FES group were able to walk without assistance after treatment as compared to the control group (p < 0.05). There was a significant improvement in ankle flexors and extensors force of the paretic leg as well as in ankle joint movements of voluntary "walking" in the supine position in the FES group (p < 0.05).