Selective orthotic constraint of lower limb movement during walking reveals new insights into neuromuscular adaptation.

Introduction: A concern expressed by the clinical community is that the constraint of motion provided by an ankle foot orthosis (AFO) may lead the user to become dependent on its stiffness, leading to learned non-use. To examine this, we hypothesized that using an experimental AFO-footwear combination (exAFO-FC) that constrains ankle motion during walking would result in reduced soleus and tibialis anterior EMG compared to free (exAFO-FC) and control (no AFO, footwear only) conditions. Method: A total of 14 healthy subjects walked at their preferred speed (1.34 ± 0.09 m·s-1) for 15 min, in three conditions, namely, control, free, and stop. Results: During the stance phase of walking in the stop condition, ipsilateral soleus integrated EMG (iEMG) declined linearly, culminating in a 32.1% reduction compared to the control condition in the final 5 min interval of the protocol. In contrast, ipsilateral tibialis anterior iEMG declined in a variable fashion culminating in an 11.2% reduction compared to control in the final 5 min interval. During the swing phase, the tibialis anterior iEMG increased by 6.6% compared to the control condition during the final 5 min interval. The contralateral soleus and tibialis anterior exhibited increased iEMG in the stop condition. Discussion: An AFO-FC functions as a biomechanical motion control device that influences the neural control system and alters the output of muscles experiencing constraints of motion.

Dr. Richard C. Nelson-Mentor and Visionary: Lessons Learned, Memories Forever.

Richard C. Nelson started the Biomechanics Laboratory, one of the first of its kind in the world, on the campus of the Pennsylvania State University in 1967. His vision focused on connecting the physiological and mechanical elements of human performance analysis, specifically sport performance. The lab's engaging, interdisciplinary environment supported self-designed programs of study, benefiting each individual student. Furthermore, the Biomechanics Lab became the nexus for the development of biomechanics as a field of study internationally. Richard Nelson's diplomatic skills spread the word initially through the formation of the International Society of Biomechanics. This international effort resulted in the development of national societies of biomechanics around the world, for example, the American Society of Biomechanics. Second, these efforts stimulated the concept of sport performance analysis on the international stage. Richard Nelson's passion was to analyze individual performances at the Olympic Games. This goal was finally realized, with the development of the Subcommission within the International Olympic Committee Medical Commission and biomechanical analysis projects completed at the 1984 Olympic Games in Los Angeles. Richard Nelson's vision, mentoring style, and dedication planted and nurtured the seed of biomechanics as a discipline of study around the world.

Time course of functional recovery during the first 3 mo after surgical transection and repair of nerves to the feline soleus and lateral gastrocnemius muscles.

Locomotion outcomes after peripheral nerve injury and repair in cats have been described in the literature for the period immediately following the injury (muscle denervation period) and then again for an ensuing period of long-term recovery (at 3 mo and longer) resulting in muscle self-reinnervation. Little is known about the changes in muscle activity and walking mechanics during midrecovery, i.e., the early reinnervation period that takes place between 5 and 10 wk of recovery. Here, we investigated hindlimb mechanics and electromyogram (EMG) activity of ankle extensors in six cats during level and slope walking before and every 2 wk thereafter in a 14-wk period of recovery after the soleus (SO) and lateral gastrocnemius (LG) muscle nerves in one hindlimb were surgically transected and repaired. We found that the continued increase in SO and LG EMG magnitudes and corresponding changes in hindlimb mechanics coincided with the formation of neuromuscular synapses revealed in muscle biopsies. Throughout the recovery period, EMG magnitude of SO and LG during the stance phase and the duration of the stance-related activity were load dependent, similar to those in the intact synergistic medial gastrocnemius and plantaris. These results and the fact that EMG activity of ankle extensors and locomotor mechanics during level and upslope walking recovered 14 wk after nerve transection and repair suggest that loss of the stretch reflex in self-reinnervated muscles may be compensated by the recovered force-dependent feedback in self-reinnervated muscles, by increased central drive, and by increased gain in intermuscular motion-dependent pathways from intact ankle extensors. NEW & NOTEWORTHY This study provides new evidence that the timeline for functional recovery of gait after peripheral nerve injury and repair is consistent with the time required for neuromuscular junctions to form and muscles to reach preoperative tensions. Our findings suggest that a permanent loss of autogenic stretch reflex in self-reinnervated muscles may be compensated by recovered intermuscular force-dependent and oligosynaptic length-dependent feedback and central drive to regain adequate locomotor output capabilities during level and upslope walking.

Self-reinnervated muscles lose autogenic length feedback, but intermuscular feedback can recover functional connectivity.

In this study, we sought to identify sensory circuitry responsible for motor deficits or compensatory adaptations after peripheral nerve cut and repair. Self-reinnervation of the ankle extensor muscles abolishes the stretch reflex and increases ankle yielding during downslope walking, but it remains unknown whether this finding generalizes to other muscle groups and whether muscles become completely deafferented. In decerebrate cats at least 19 wk after nerve cut and repair, we examined the influence of quadriceps (Q) muscles' self-reinnervation on autogenic length feedback, as well as intermuscular length and force feedback, among the primary extensor muscles in the cat hindlimb. Effects of gastrocnemius and soleus self-reinnervation on intermuscular circuitry were also evaluated. We found that autogenic length feedback was lost after Q self-reinnervation, indicating that loss of the stretch reflex appears to be a generalizable consequence of muscle self-reinnervation. However, intermuscular force and length feedback, evoked from self-reinnervated muscles, was preserved in most of the interactions evaluated with similar relative inhibitory or excitatory magnitudes. These data indicate that intermuscular spinal reflex circuitry has the ability to regain functional connectivity, but the restoration is not absolute. Explanations for the recovery of intermuscular feedback are discussed, based on identified mechanisms responsible for lost autogenic length feedback. Functional implications, due to permanent loss of autogenic length feedback and potential for compensatory adaptations from preserved intermuscular feedback, are discussed.

Increased intensity and reduced frequency of EMG signals from feline self-reinnervated ankle extensors during walking do not normalize excessive lengthening.

Kinematics of cat level walking recover after elimination of length-dependent sensory feedback from the major ankle extensor muscles induced by self-reinnervation. Little is known, however, about changes in locomotor myoelectric activity of self-reinnervated muscles. We examined the myoelectric activity of self-reinnervated muscles and intact synergists to determine the extent to which patterns of muscle activity change as almost normal walking is restored following muscle self-reinnervation. Nerves to soleus (SO) and lateral gastrocnemius (LG) of six adult cats were surgically transected and repaired. Intramuscular myoelectric signals of SO, LG, medial gastrocnemius (MG), and plantaris (PL), muscle fascicle length of SO and MG, and hindlimb mechanics were recorded during level and slope (±27°) walking before and after (10-12 wk postsurgery) self-reinnervation of LG and SO. Mean myoelectric signal intensity and frequency were determined using wavelet analysis. Following SO and LG self-reinnervation, mean myoelectric signal intensity increased and frequency decreased in most conditions for SO and LG as well as for intact synergist MG (P < 0.05). Greater elongation of SO muscle-tendon unit during downslope and unchanged magnitudes of ankle extensor moment during the stance phase in all walking conditions suggested a functional deficiency of ankle extensors after self-reinnervation. Possible effects of morphological reorganization of motor units of ankle extensors and altered sensory and central inputs on the changes in myoelectric activity of self-reinnervated SO and LG are discussed.

Unexpected Fascicle Length Changes In Denervated Feline Soleus Muscle During Stance Phase Of Walking.

After surgical repair of traumatically severed peripheral nerves, associated muscles are paralyzed for weeks. Little is known about fascicle length changes in paralyzed muscles during locomotion. The aim of this study was to investigate to what extent, if any, muscle fascicles of denervated feline soleus (SO) change length during stance of walking when intact SO synergists are actively contracting. Hindlimb kinematics, SO fascicle and muscle-tendon unit (MTU) length, and EMG activity of SO, lateral gastrocnemius (LG) and medial gastrocnemius (MG) were measured during level and slope walking in adult cats. Measurements were taken before and 1-2 weeks following SO-LG denervation. Unexpectedly, SO fascicle lengthening and shortening during stance in all walking conditions were evident after denervation. The greatest SO fascicle shortening (17.3 ± 2.2% of a reference length) and least fascicle lengthening (1.5 ± 0.8%) after denervation were found during upslope walking, where MG EMG activity was greatest across slopes (P < 0.05) and greatest discrepancies between post denervation SO fascicle and MTU length changes occurred. These findings suggest that myofascial linkages between denervated SO and its active synergists might affect its fascicle length changes. Further studies are needed to directly test this suggestion.

Motor adaptation to prosthetic cycling in people with trans-tibial amputation.

The neuromusculoskeletal system interacts with the external environment via end-segments, e.g. feet. A person with trans-tibial amputation (TTAmp) has lost a foot and ankle; hence the residuum with prosthesis becomes the new end-segment. We investigated changes in kinetics and muscle activity in TTAmps during cycling with this altered interface with the environment. Nine unilateral TTAmps and nine subjects without amputation (NoAmp) pedaled at a constant torque of 15 Nm and a constant cadence of 90 rpm (~150 watts). Pedal forces and limb kinematics were used to calculate resultant joint moments. Electromyographic activity was recorded to determine its magnitude and timing. Biomechanical and EMG variables of the amputated limb were compared to those of the TTAmp sound limb and to the dominant limb in the NoAmp group using a one-way ANOVA. Results showed maximum angular displacement between the residuum and prosthesis was 4.8±1.8 deg. The amputated limb compared to sound limb and NoAmp group produced lower extensor moments averaged over the cycle about the ankle (13±2.3, 20±5.7, and 19±5.3 Nm, respectfully) and knee (8.4±5.0, 15±4.5, and 12.7±5.9 Nm, respectfully) (p<0.05). Gastrocnemius and rectus femoris peak activity in the TTAmps shifted to later in the crank cycle (by 36° and 75°, respectfully; p<0.05). These data suggest gastrocnemius was utilized as a one-joint knee flexor in combination with rectus femoris for prosthetic socket control and highlight prosthetic control as an interaction between the residuum, prosthesis and external environment.

Control of dynamic foot-ground interactions in male and female soccer athletes: females exhibit reduced dexterity and higher limb stiffness during landing.

Controlling dynamic interactions between the lower limb and ground is important for skilled locomotion and may influence injury risk in athletes. It is well known that female athletes sustain anterior cruciate ligament (ACL) tears at higher rates than male athletes, and exhibit lower extremity biomechanics thought to increase injury risk during sport maneuvers. The purpose of this study was to examine whether lower extremity dexterity (LED)--the ability to dynamically control endpoint force magnitude and direction as quantified by compressing an unstable spring with the lower limb at submaximal forces--is a potential contributing factor to the "at-risk" movement behavior exhibited by female athletes. We tested this hypothesis by comparing LED-test performance and single-limb drop jump biomechanics between 14 female and 14 male high school soccer players. We found that female athletes exhibited reduced LED-test performance (p=0.001) and higher limb stiffness during landing (p=0.008) calculated on average within 51 ms of foot contact. Females also exhibited higher coactivation at the ankle (p=0.001) and knee (p=0.02) before landing. No sex differences in sagittal plane joint angles and center of mass velocity at foot contact were observed. Collectively, our results raise the possibility that the higher leg stiffness observed in females during landing is an anticipatory behavior due in part to reduced lower extremity dexterity. The reduced lower extremity dexterity and compensatory stiffening strategy may contribute to the heightened risk of ACL injury in this population.

The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson's disease.

Gait dysfunction and postural instability are two debilitating symptoms in persons with Parkinson's disease (PD). Tai Chi exercise has recently gained attention as an attractive intervention for persons with PD because of its known potential to reduce falls and improve postural control, walking abilities, and safety at a low cost. The purpose of this report is to investigate the effect of Tai Chi exercise on dynamic postural control during gait initiation and gait performance in persons with idiopathic PD, and to determine whether these benefits could be replicated in two different environments, as complementary projects. In these two separate projects, a total of 45 participants with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi groups in both projects completed a 16-week Tai Chi exercise session, while the control groups consisted of either a placebo (i.e., Qi-Gong) or non-exercise group. Tai Chi did not significantly improve Unified Parkinson's Disease Rating Scale Part III score, selected gait initiation parameters or gait performance in either project. Combined results from both projects suggest that 16 weeks of class-based Tai Chi were ineffective in improving either gait initiation, gait performance, or reducing parkinsonian disability in this subset of persons with PD. Thus the use of short-term Tai Chi exercise should require further study before being considered a valuable therapeutic intervention for these domains in PD.

The lower extremity dexterity test as a measure of lower extremity dynamical capability.

The capability of the lower extremity to dynamically interact with the ground is important for skilled locomotor performance. However, there is currently no test method designed to specifically quantify this sensorimotor ability, which we refer to as lower extremity dexterity. We describe a new method to quantify lower extremity dexterity, examine its reliability (n=10), and evaluate the extent to which it is associated with lower extremity strength and anthropometry in healthy young adults (n=38). The lower extremity dexterity test (LED-test)-an adaptation of the Strength-Dexterity test for the fingers-consists of using the isolated lower extremity to compress a slender spring prone to buckling at low forces. The goal of the LED-test is to sustain the highest compression force possible. Applying higher forces makes the spring increasingly unstable, thus achieving higher compression forces represents better ability to dynamically control instability at low force levels. As such, the LED-test provides a novel way to quantify the capability of the lower extremity to regulate dynamic and unstable foot-ground interactions at submaximal forces. LED-test performance ranged between 88.6 and 119.6N, test-retest reliability was excellent (ICC(2,3)=0.94), and the minimal detectable difference was 5.5N. Performance was not correlated with strength or height (r(2)≤0.053, p>0.05), and only weakly with body mass (r(2)=0.116, p=0.04). We propose that the unique lower extremity capability quantified by the LED-test could be informative of skilled locomotor performance and injury risk.

Task-dependent activity of motor unit populations in feline ankle extensor muscles.

Understanding the functional significance of the morphological diversity of mammalian skeletal muscles is limited by technical difficulties of estimating the contribution of motor units with different properties to unconstrained motor behaviours. Recently developed wavelet and principal components analysis of intramuscular myoelectric signals has linked signals with lower and higher frequency contents to the use of slower and faster motor unit populations. In this study we estimated the relative contributions of lower and higher frequency signals of cat ankle extensors (soleus, medial and lateral gastrocnemii, plantaris) during level, downslope and upslope walking and the paw-shake response. This was done using the first two myoelectric signal principal components (PCI, PCII), explaining over 90% of the signal, and an angle θ, a function of PCI/PCII, indicating the relative contribution of slower and faster motor unit populations. Mean myoelectric frequencies in all walking conditions were lowest for slow soleus (234 Hz) and highest for fast gastrocnemii (307 and 330 Hz) muscles. Motor unit populations within and across the studied muscles that demonstrated lower myoelectric frequency (suggesting slower populations) were recruited during tasks and movement phases with lower mechanical demands on the ankle extensors--during downslope and level walking and in early walking stance and paw-shake phases. With increasing mechanical demands (upslope walking, mid-phase of paw-shake cycles), motor unit populations generating higher frequency signals (suggesting faster populations) contributed progressively more. We conclude that the myoelectric frequency contents within and between feline ankle extensors vary across studied motor behaviours, with patterns that are generally consistent with muscle fibre-type composition.

Stance and swing phase detection during level and slope walking in the cat: effects of slope, injury, subject and kinematic detection method.

In quadrupeds, there have been limited comparisons of gait timing events detection (e.g., paw contact, PC and paw-off, PO) determined from kinematics and forceplates. The goal of this study was to investigate the effect of different slopes (0, -27, +27°), recovery times after ankle extensor nerve injury and repair (2, 6, 12 weeks), subjects and detection methods on accuracy of kinematically derived PC and PO timings during feline walking. Right hindlimb kinematics and ground reaction forces (GRF) of 4 cats walking along a sloped walkway with embedded forceplates were recorded. A total of 963 walking cycles were analyzed. Gait timings were determined from five kinematic methods based on displacements, velocities or accelerations of hindlimb markers. GRF based 'gold standard' timings for PC and PO were used to determine the systematic and random error of kinematic timing. Systematic errors between the kinematic methods differed significantly (p<0.05). Methods based on vertical paw peak acceleration and velocity gave the smallest systematic errors for PC and PO, respectively. The smallest random errors (standard deviations) for PC and PO were demonstrated by method based on paw horizontal displacement relative to greater trochanter: 13.4ms and 6.6ms, respectively. Effects of slope and subject on systematic errors of kinematic methods were significant, whereas effects of recovery time after nerve injury were not. It was concluded that timing of gait events can be determined consistently using kinematics, although adjustments must be made to account for the systematic error which varies according to subject and slope condition.

Effectiveness of force production in persons with unilateral transtibial amputation during cycling.

BACKGROUND: Few published reports exist regarding the control of the human/prosthesis interface in persons with unilateral transtibial amputation. OBJECTIVE: To investigate strategies employed by prosthetic users in controlling the human/prosthesis interface to highlight challenges associated with either the amputation or the design of the prosthesis. STUDY DESIGN: Randomized controlled trial. METHODS: Cycling was used as the locomotor task to allow for better control of task mechanics compared to walking. A group of nine cyclists with intact limbs were compared to eight cyclists with transtibial amputation (CTA) during a simulated cycling time trial. The CTA group pedaled with a stiff and flexible prosthetic foot. Reaction forces between the foot and the pedal were measured using an instrumented pedal system. The force effectiveness (FE) ratio was used as the measure of task performance. The FE ratio is the force component normal to the bicycle crank arm divided by the resultant force for both limbs and is commonly used to analyze pedaling technique. RESULTS: The CTA group was equally as effective at applying forces as the intact group. CONCLUSIONS: These data suggest that individuals with lower limb loss are able to compensate for their amputation to utilize a similar pedaling technique for locomotor performance. As global strategies, e.g. force effectiveness, appear similar between groups future research should focus on local strategies, e.g. individual joint kinematics and kinetics.

Pedaling asymmetries in cyclists with unilateral transtibial amputation: effect of prosthetic foot stiffness.

Cyclists with unilateral transtibial amputation (CTA) provide a unique model to study integration of the neuromuscular and bicycle systems while having the option to modify this integration via the properties of the prosthesis. This study included eight CTA and nine intact cyclists. The cyclists pedaled on a stationary bicycle with instrumented force pedals. The CTA group pedaled with a stiff or flexible prosthetic foot during a simulated time trial and a low difficulty condition. During the time trial condition, pedaling with the flexible foot resulted in force and work asymmetries of 11.4% and 30.5%, the stiff foot displayed 11.1% and 21.7%, and the intact group displayed 4.3% and 4.2%, respectively. Similar trends were shown in the low difficulty condition. These data suggest foot stiffness has an effect on cycling symmetry in amputees.

Short-term motor compensations to denervation of feline soleus and lateral gastrocnemius result in preservation of ankle mechanical output during locomotion.

Denervation of selected ankle extensors in animals results in locomotor changes. These changes have been suggested to permit preservation of global kinematic characteristics of the hindlimb during stance. The peak ankle joint moment is also preserved immediately after denervation of several ankle extensors in the cat, suggesting that the animal's response to peripheral nerve injury may also be aimed at preserving ankle mechanical output. We tested this hypothesis by comparing joint moments and power patterns during walking before and after denervation of soleus and lateral gastrocnemius muscles. Hindlimb kinematics, ground reaction forces and electromyographic activity of selected muscles were recorded during level, downslope (-50%) and upslope (50%) walking before and 1-3 weeks after nerve denervation. Denervation resulted in increased activity of the intact medial gastrocnemius and plantaris muscles, greater ankle dorsiflexion, smaller knee flexion, and the preservation of the peak ankle moment during stance. Surprisingly, ankle positive power generated in the propulsion phase of stance was increased (up to 50%) after denervation in all walking conditions (p < 0.05). The obtained results suggest that the short-term motor compensation to denervation of lateral gastrocnemius and soleus muscles may allow for preservation of mechanical output at the ankle. The additional mechanical energy generated at the ankle during propulsion can result, in part, from increased activity of intact synergists, the use of passive tissues around the ankle and by the tendon action of ankle two-joint muscles and crural fascia.

Locomotor changes in length and EMG activity of feline medial gastrocnemius muscle following paralysis of two synergists.

The mechanism of the compensatory increase in electromyographic activity (EMG) of a cat ankle extensor during walking shortly after paralysis of its synergists is not fully understood. It is possible that due to greater ankle flexion in stance in this situation, muscle spindles are stretched to a greater extent and, thus, contribute to the EMG enhancement. However, also changes in force feedback and central drive may play a role. The aim of the present study was to investigate the short-term (1- to 2-week post-op) effects of lateral gastrocnemius (LG) and soleus (SO) denervation on muscle fascicle and muscle-tendon unit (MTU) length changes, as well as EMG activity of the intact medial gastrocnemius (MG) muscle in stance during overground walking on level (0%), downslope (-50%, presumably enhancing stretch of ankle extensors in stance) and upslope (+50%, enhancing load on ankle extensors) surfaces. Fascicle length was measured directly using sonomicrometry, and MTU length was calculated from joint kinematics. For each slope condition, LG-SO denervation resulted in an increase in MTU stretch and peak stretch velocity of the intact MG in early stance. MG muscle fascicle stretch and peak stretch velocity were also higher than before denervation in downslope walking. Denervation significantly decreased the magnitude of MG fascicle shortening and peak shortening velocity during early stance in level and upslope walking. MG EMG magnitude in the swing and stance phases was substantially greater after denervation, with a relatively greater increase during stance of level and upslope walking. These results suggest that the fascicle length patterns of MG muscle are significantly altered when two of its synergists are in a state of paralysis. Further, the compensatory increase in MG EMG is likely mediated by enhanced MG length feedback during downslope walking, enhanced feedback from load-sensitive receptors during upslope walking and enhanced central drive in all walking conditions.

The biomechanics of cycling with a transtibial amputation: Recommendations for prosthetic design and direction for future research.

People with amputations may find cycling advantageous for exercise, transportation and rehabilitation. The reciprocal nature of stationary cycling also makes it a viable model for research in motor control because the body is supported by the saddle allowing the researcher to focus on the cyclic movement of the legs without the confounding variable of balance. The purpose of this article is to provide an overview of the cycling task in intact cyclists and relate this information to understanding the challenges faced by cyclists with transtibial amputations (CTA). Ongoing research into the biomechanics of CTAs will be summarized to expose the differences between intact and CTA cycling mechanics, asymmetries between limbs of CTAs as well as neuromuscular adaptation following amputation. The article will include recommendations for prosthetic design and modification of the bicycle to improve cycling performance for CTA at all experience levels.

Distinct muscle fascicle length changes in feline medial gastrocnemius and soleus muscles during slope walking.

On the basis of differences in physiology, e.g., histochemical properties and spindle density, and the structural design of the cat soleus (SO) and medial gastrocnemius (MG) muscles, we hypothesized that 1) fascicle length changes during overground walking would be both muscle and slope dependent, which would have implications for the muscles' force output as well as sensory function, and that 2) muscle-tendon unit (MTU) and fascicle length changes would be different, in which case MTU length could not be used as an indicator of muscle spindle strain. To test these hypotheses, we quantified muscle fascicle length changes and compared them with length changes of the whole MTU in the SO and MG during overground walking at various slopes (0, +/- 25, +/- 50, +75, and +100%). The SO and MG were surgically instrumented with sonomicrometry crystals and fine-wire electromyogram electrodes to measure changes in muscle fascicle length and muscle activity, respectively. MTU lengths were calculated using recorded ankle and knee joint angles and a geometric model of the hindlimb. The resultant joint moments were calculated using inverse dynamics analysis to infer muscle loading. It was found that although MTU length and velocity profiles of the SO and MG appeared similar, length changes and velocities of muscle fascicles were substantially different between the two muscles. Fascicle length changes of both SO and MG were significantly affected by slope intensity acting eccentrically in downslope walking (-25 to -50%) and concentrically in upslope walking (+25 to +100%). The differences in MTU and fascicle behaviors in both the SO and MG muscles during slope walking were explained by the three distinct features of these muscles: 1) the number of joints spanned, 2) the pennation angle, and 3) the in-series elastic component. It was further suggested that the potential role of length feedback from muscle spindles is both task and muscle dependent.