Modulation of sagittal-plane center of pressure and force vector direction in human standing on sloped surfaces.

The multi-joint coordination responsible for maintaining upright posture in the standing human manifests in the pattern of variation of the support-surface force (F). Assessment of both the translational and rotational kinematics in the sagittal-plane requires understanding the critical relationship between the direction and location of F. Prior work demonstrated that band-pass filtered F direction and center-of-pressure (CoP) covary in time such that the F vector lines-of-action pass near a fixed point called an intersection point (IP). The height of that IP (IPz) varies systematically with the frequency of the pass band. From F measurements in able-bodied humans (n = 17) standing on various pitched surfaces, the present study also found the emergent property of an IP, with IPz located above the center of mass (CoM) at frequencies <1.75 Hz and below the CoM for higher frequencies. This property aids in maintaining upright posture for various perturbation modes within a single control structure. From purely mechanical effects, standing on a pitched surface should not change IPz, however these measurements of F show that IPz is generally closer to CoM height. This characterization of quiet standing provides simple means of assessing the complex multi-joint coordination of standing and relates directly to the physical demands of controlling the translational and rotational aspects of body posture.

Functional Resistance Training to Improve Knee Strength and Function After Acute Anterior Cruciate Ligament Reconstruction: A Case Study.

BACKGROUND: Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, "nonfunctional" training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR. HYPOTHESIS: FRT would improve knee strength and function after ACLR. STUDY DESIGN: Case report. LEVEL OF EVIDENCE: Level 5. METHODS: A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg. Thigh strength, gait mechanics, and corticospinal and spinal excitability were assessed before and immediately after the 8-week intervention. Voluntary muscle activation was evaluated immediately after the intervention. RESULTS: Knee extensor and flexor strength increased in the ACLR leg from pre- to posttraining (130 to 225 N·m [+74%] and 44 to 88 N·m [+99%], respectively) and increases in between-limb extensor and flexor strength symmetry (45% to 92% [+74%] and 47% to 72% [+65%], respectively) were also noted. After the intervention, voluntary muscle activation in the ACLR leg was 72%, compared with the non-ACLR leg at 75%. Knee angle and moment during late stance phase decreased (ie, improved) in the ACLR leg and appeared more similar to the non-ACLR leg after FRT training (18° to 14° [-23.4] and 0.07 to -0.02 N·m·kg-1·m-1 [-122.8%], respectively). Corticospinal and spinal excitability in the ACLR leg decreased (3511 to 2511 [-28.5%] and 0.42 to 0.24 [-43.7%], respectively) from pre- to posttraining. CONCLUSION: A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training. CLINICAL RELEVANCE: FRT may serve as a viable approach to improve knee strength and function after ACL reconstruction.

Evaluation of motor cortical excitability using evoked torque responses: A new tool with high reliability.

BACKGROUND: Motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) are typically recorded via surface electromyography (EMG). However, another suitable alternative may be recording torque output associated with MEPs, especially when studying multiheaded muscles (e.g. quadriceps) for which EMG may not be ideal. METHODS: We recorded the motor evoked torque elicited by TMS along with conventional EMG-based MEPs (MEPEMG) over a range of TMS intensities (100-140 % of active motor threshold [AMT]) from twenty healthy young adults on two different days. MEPs were normalized using different normalization procedures (raw, normalized to maximum voluntary isometric contraction [MVIC], and peak MEP). Additionally, motor evoked torque was normalized to TMS-evoked peripheral resting twitch torque. Intraclass correlation coefficients (ICCs) were determined for each of these variables to compute reliability. RESULTS: Motor evoked torque showed good to excellent reliability (ICC: 0.65-0.90) at TMS intensities ≥ 110 % AMT, except when normalized by peak MEP. The reliability of raw MEPEMG and MVIC normalized MEPEMG was fair to excellent only at ≥ 130 % AMT (ICC: 0.42-0.82) and at ≥ 120 % AMT (ICC: 0.41-0.83), respectively. The reliability of both MEPEMG and motor evoked torque generally increased with increasing TMS intensities, with motor evoked torque normalized to the resting twitch torque yielding the best ICC scores. COMPARISON WITH EXISTING METHODS: When compared with conventional MEPEMG, motor evoked torque offers superior and reliable estimates of corticospinal excitability, particularly when normalized to resting twitch torque. CONCLUSIONS: TMS-induced motor evoked torque can reliably be used to measure corticospinal excitability in the quadriceps muscles.

Center-of-pressure dynamics of upright standing as a function of sloped surfaces and vision.

Upright postural control system exhibits dynamic behavior to produce flexible adaptations to a variety of internal and external perturbations. Understanding the range of postural adaptability in healthy individuals can index the overall state of the system and needs to be defined over various environmental and task constraints. The purpose of the current investigation was to understand the role of vision and support surface angle on the multiple time scales of control that maintain upright posture. Thirteen young, healthy adults performed quiet standing tasks on flat, inclined and declined support surfaces with either eyes open or closed. The variability of the anterior-posterior center of pressure (COP) trajectory was analyzed using linear (COPlength) and non-linear (multiscale entropy - MSE) approaches to index postural dynamics. Sway magnitude - COPlength - was greater in both sloped conditions compared to the flat support surface standing and with the removal of vision. Increased irregularity was revealed during the sloped conditions compared to flat surface standing with additional increases of COP complexity when vision was removed. Overall, a similar range of postural adaptability was revealed for both the singular and combined sensory manipulations suggesting limits to the degree of change of COP dynamics.

Effect of Ankle Angles on the Soleus H-Reflex Excitability During Standing.

This study investigated effects of ankle joint angle on the Hoffman's reflex (H-reflex) excitability during loaded (weight borne with both legs) and unloaded (full body weight borne with the contralateral leg) standing in people without neurological injuries. Soleus H-reflex/M-wave recruitment curves were examined during upright standing on three different slopes that imposed plantar flexion (-15°), dorsiflexion (+15°), and neutral (0°) angles at the ankle, with the test leg loaded and unloaded. With the leg loaded and unloaded, maximum H-reflex/maximum M-wave ratio of -15° was significantly larger than those of 0° and +15° conditions. The maximum H-reflex/maximum M-wave ratios were 51%, 43%, and 41% with loaded and 56%, 46%, and 44% with unloaded for -15°, 0°, and +15° slope conditions, respectively. Thus, limb loading/unloading had limited impact on the extent of influence that ankle angles exert on the H-reflex excitability. This suggests that task-dependent central nervous system control of reflex excitability may regulate the influence of sensory input on the spinal reflex during standing.

Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity.

BACKGROUND: Despite extensive research on falls among individuals with stroke, little is known regarding the impact of neurological conditions with comorbid diagnoses and motor functional capacity on the risk of falls in these individuals. Hence, the purpose of this study was to determine the fall risk and the contribution of reduced motor functional capacity to fall risk in individuals with stroke, dementia, and stroke plus dementia. METHODS: Data from the National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries, were analyzed for this cross-sectional study. The odds of self-reported falls within the past month in three subgroups of neurological conditions [stroke (n = 751), dementia (n = 369), and stroke plus dementia (n = 141)] were evaluated with a reference group of individuals with no stroke/dementia [i.e., controls (n = 6337)] using logistic regression models. RESULTS: The prevalence of a recent fall was significantly higher (P < .05) in the three neurological disorder groups compared with controls. After adjusting for sociodemographics, mobility device use, and other comorbidities (i.e., chronic disease, vision impairment, and major surgery), the odds of a recent fall were significantly elevated in individuals with stroke (odds ratio [OR] = 1.45), dementia (OR = 2.45), and stroke plus dementia (OR = 2.64) compared with controls. After further adjustment for the lower motor functional capacity, the elevated odds in individuals with stroke were attenuated (OR = 1.16); however, the odds remained significantly elevated in individuals with dementia (OR = 1.67) and stroke plus dementia (OR = 1.82). CONCLUSION: Findings indicate that the odds for falls in stroke survivors are elevated in the presence of comorbid dementia. Further, lower motor functional capacity accounted for increased likelihood of a fall in individuals with stroke, but it was not sufficient to account for the increased likelihood of a fall in individuals with dementia or stroke plus dementia. Thus, interventions focusing on secondary prevention of dementia and improving motor functional capacity may reduce fall risk in individuals with stroke.

Conditioning Brain Responses to Improve Quadriceps Function in an Individual With Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Persistent quadriceps weakness and activation failure are common in individuals with anterior cruciate ligament (ACL) reconstruction. A growing body of evidence indicates that this chronic quadriceps dysfunction could be partly mediated due to reduced corticospinal excitability. However, current rehabilitation approaches do not directly target corticospinal deficits, which may be critical for restoring optimal clinical outcomes after the surgery. This case study tested the feasibility of operant conditioning of torque responses evoked by transcranial magnetic stimulation (TMS) to improve quadriceps function after ACL reconstruction. HYPOTHESIS: Operant conditioning of motor evoked torque responses would improve quadriceps strength, voluntary activation, and corticospinal excitability. STUDY DESIGN: Case study and research report. LEVEL OF EVIDENCE: Level 5. METHODS: A 24-year-old male with an ACL reconstruction (6 months postsurgery) trained for 20 sessions (2-3 times per week for 8 weeks) to increase his TMS-induced motor evoked torque response (MEP torque) of the quadriceps muscles using operant conditioning principles. Knee extensor strength, voluntary quadriceps muscle activation, and quadriceps corticospinal excitability were evaluated at 3 time points: preintervention (pre), 4 weeks (mid), and immediately after the intervention (post). RESULTS: The participant was able to successfully condition (ie, increase) the quadriceps MEP torque after 1 training session, and the conditioned MEP torque gradually increased over the course of 20 training sessions to reach about 500% of the initial value at the end of training. The participant's control MEP torque values and corticospinal excitability, which were measured outside of the conditioning paradigm, also increased with training. These changes were paralleled by improvements in knee extensor strength and voluntary quadriceps muscle activation. CONCLUSION: This study shows that operant conditioning of MEP torque is a feasible approach to improving quadriceps corticospinal excitability and quadriceps function after ACL reconstruction and encourages further testing in a larger cohort of ACL-reconstructed individuals. CLINICAL RELEVANCE: Operant conditioning may serve as a potential therapeutic adjuvant for ACL rehabilitation.

Recurrence dynamics reveals differential control strategies to maintain balance on sloped surfaces.

BACKGROUND: Studies on postural control have primarily focused on the maintenance of balance in quiet upright standing on flat horizontal support surfaces that can reveal only a subset of the potential postural stability/instability configurations in everyday contexts. OBJECTIVES: Here we investigated the nature of dynamical properties of postural coordination in an upright standing task as a function of the systematic scaling of seven support surface angles, +20°, +10° dorsiflexion (+), 0 °Flat, -10°, -20°, -30°, -35° plantarflexion (-), mounted on a force plate. METHODS: The center of pressure (CoP) and virtual time-to-contact (VTC) were analyzed to examine the spatial and spatio-temporal aspects of postural coordination dynamics, respectively. Recurrence quantification analysis (RQA) was used to characterize the dynamic postural control strategies as a function of slope surface angle. RESULTS: The recurrence findings showed that on a flat surface the postural CoP dynamic are recurrent with a largely deterministic process and higher Shannon entropy compared to elevated slope angles in dorsiflexion and plantarflexion. There were asymmetrical patterns between similar slope angles for dorsiflexion and plantarflexion postures. The recurrence measures revealed that VTC operates on a higher embedding dimension than that of CoP. SIGNIFICANCE: VTC showed an enhanced sensitivity to detection of postural instability in relation to the stability boundary that was magnified on the flat surface but progressively reduced over larger surface angles for both the dorsiflexion and plantarflexion postures.

Scaling oscillatory platform frequency reveals recurrence of intermittent postural attractor states.

The study of postural control has been dominated by experiments on the maintenance of quiet upright standing balance on flat stationary support surfaces that reveal only limited modes of potential configurations of balance stability/instability. Here we examine the self-organization properties of postural coordination as revealed in a dynamic balance task with a moving platform. We scaled a control parameter (platform frequency) to investigate the evolving nature of the coupled oscillator dynamics between center of mass (CoM) and platform. Recurrent map measures were used to reveal whether episodic postural control strategies exist that can be scaled by systematically changing the magnitude of platform motion. The findings showed that at higher platform frequencies (1.2 Hz), the CoM-Platform coupling was less deterministic than lower platform frequencies and evolved to intermittent postural control strategies that oscillated between periodic-chaotic transitions to maintain upright postural balance. Collectively, the recurrence map measures indicated that quasi-static postural attractor states were progressively emerging to the changing task constraints of platform frequency in the maintenance of postural stability. It appears that several dynamic modes of intermittent coupling in postural control can interchangeably co-exist and are expressed as a function of the control parameter of platform frequency.

Postural Stability Variables for Dynamic Equilibrium.

Experiments on the maintenance of postural stability on flat stationary support surfaces (quiet standing) that show only limited modes of the potential configurations of balance stability have dominated investigations of balance in quiet upright standing. Recent studies have revealed coordination properties of the whole body in maintaining dynamic postural stability with the application of moving platform paradigms. This paper examines properties of candidate collective variables for postural control within the dynamic systems framework. Evidence is discussed in this paper for: (i) self-organization properties of dynamic postural balance; (ii) enhanced variability and entropy prior to a phase transition between center of mass and center of pressure coupling; (iii) co-existence of intermittent postural control strategies that oscillate between periodic to chaotic transitions to maintain upright postural balance. These collective findings indicate postural attractor dynamic states progressively emerge to the changing task constraints of a moving platform revealing insights into the deterministic and stochastic properties of the multiple time scales of human postural behavior.

Transitions of postural coordination as a function of frequency of the moving support platform.

This study was set-up to investigate the multi-segmental organization of human postural control in a dynamic balance task. The focus was on the coupling between the center of mass (CoM) and center of pressure (CoP) as a candidate collective variable that supports maintaining balance on a sinusoidal oscillating platform in the medial-lateral (ML) plane and was continuously scaled up and then down across a frequency range from 0.2Hz to 1.2Hz. The CoM-CoP coordination changed from in-phase to anti-phase and anti-phase to in-phase at a critical frequency (∼0.4Hz to 0.6Hz, respectively) in the scaling up or down of the support surface frequency, showed hysteresis as a function of the direction of frequency change and critical fluctuations at the transition region. There was evidence of head motion independent of CoM motion at the higher platform frequencies and a learning effect on several of the dynamic indices over 2days of practice. The findings are consistent with the hypothesis of CoM-CoP acting as an emergent collective variable that is supported by the faster time scale motions of the joints and their synergies in postural control.

Postural Stability Margins as a Function of Support Surface Slopes.

This investigation examined the effects of slope of the surface of support (35°, 30°, 20°, 10° Facing(Toe) Down, 0° Flat and 10°, 20°, 25° Facing (Toe) Up) and postural orientation on the margins of postural stability in quiet standing of young adults. The findings showed that the center of pressure-CoP (displacement, area and length) had least motion at the baseline (0° Flat) platform condition that progressively increased as a function of platform angle in both facing up and down directions. The virtual time to collision (VTC) dynamics revealed that the spatio-temporal margins to the functional stability boundary were progressively smaller and the VTC time series also more regular (SampEn-Sample Entropy) as slope angle increased. Surface slope induces a restricted stability region with lower dimension VTC dynamics that is more constrained when postural orientation is facing down the slope. These findings provide further evidence that VTC acts as a control variable in standing posture that is influenced by the emergent dynamics of the individual-environment-task interaction.

Maintenance of postural stability as a function of tilted base of support.

The experiment was set-up to investigate the mechanisms of postural control by manipulating the base of support angle, using tilted platform wedges. The primary focus was to analyze the coupling of the motion of the center of mass (CoM) and the center of pressure (CoP), and the motions of the leg joints considered as individual components and synergies. The CoM-CoP coupling (both medio-lateral and anterioposterior) was preserved (∼0°) across all tilted platform angles (35°, 30°, 20°, 10° Down, 0° Flat and 10°, 20°, 25° Up), reflecting an in-phase pattern. There was high coherence (∼1) for CoM-CoP in the lower frequency range, whereas contrarily the hip, knee and ankle pair-wise couplings had values ranging between (0.4 and 0.7) across the different platform angle conditions. These findings are consistent with the view that the local pair-wise coupled variables of Hip, Knee and Ankle motions adaptively self-organized to preserve the CoM-CoP in-phase coupling at equilibrium over the baseline (0° Flat) platform condition and all other tilted platform angles. The findings support the hypothesis of CoM-CoP coupling acting as a collective variable that provides the structural integrity of the system for upright quiet standing across the platform angle conditions.

Neural network modelling and dynamical system theory: are they relevant to study the governing dynamics of association football players?

Recent studies have explored the organization of player movements in team sports using a range of statistical tools. However, the factors that best explain the performance of association football teams remain elusive. Arguably, this is due to the high-dimensional behavioural outputs that illustrate the complex, evolving configurations typical of team games. According to dynamical system analysts, movement patterns in team sports exhibit nonlinear self-organizing features. Nonlinear processing tools (i.e. Artificial Neural Networks; ANNs) are becoming increasingly popular to investigate the coordination of participants in sports competitions. ANNs are well suited to describing high-dimensional data sets with nonlinear attributes, however, limited information concerning the processes required to apply ANNs exists. This review investigates the relative value of various ANN learning approaches used in sports performance analysis of team sports focusing on potential applications for association football. Sixty-two research sources were summarized and reviewed from electronic literature search engines such as SPORTDiscus, Google Scholar, IEEE Xplore, Scirus, ScienceDirect and Elsevier. Typical ANN learning algorithms can be adapted to perform pattern recognition and pattern classification. Particularly, dimensionality reduction by a Kohonen feature map (KFM) can compress chaotic high-dimensional datasets into low-dimensional relevant information. Such information would be useful for developing effective training drills that should enhance self-organizing coordination among players. We conclude that ANN-based qualitative analysis is a promising approach to understand the dynamical attributes of association football players.