Alternate Leg Movement Amplifies Locomotor-Like Muscle Activity in Spinal Cord Injured Persons

2005 ◽  
Vol 93 (2) ◽  
pp. 777-785 ◽  
Author(s):  
Noritaka Kawashima ◽  
Daichi Nozaki ◽  
Masaki O. Abe ◽  
Masami Akai ◽  
Kimitaka Nakazawa
Keyword(s):  
Spinal Cord ◽  
Muscle Activity ◽  
Lower Limbs ◽  
Emg Activity ◽  
Joint Movement ◽  
Experimental Conditions ◽  
Biceps Femoris Muscle ◽  
Cord Injury ◽  
Leg Movement ◽  
The Right

It is now well recognized that muscle activity can be induced even in the paralyzed lower limb muscles of persons with spinal cord injury (SCI) by imposing locomotion-like movements on both of their legs. Although the significant role of the afferent input related to hip joint movement and body load has been emphasized considerably in previous studies, the contribution of the “alternate” leg movement pattern has not been fully investigated. This study was designed to investigate to what extent the alternate leg movement influenced this “locomotor-like” muscle activity. The knee-locked leg swing movement was imposed on 10 complete SCI subjects using a gait training apparatus. The following three different experimental conditions were adopted: 1) bilateral alternate leg movement, 2) unilateral leg movement, and 3) bilateral synchronous (in-phase) leg movement. In all experimental conditions, the passive leg movement induced EMG activity in the soleus and medial head of the gastrocnemius muscles in all SCI subjects and in the biceps femoris muscle in 8 of 10 SCI subjects. On the other hand, the EMG activity was not observed in the tibialis anterior and rectus femoris muscles. The EMG level of these activated muscles, as quantified by integrating the rectified EMG activity recorded from the right leg, was significantly larger for bilateral alternate leg movement than for unilateral and bilateral synchronous movements, although the right hip and ankle joint movements were identical in all experimental conditions. In addition, the difference in the pattern of the load applied to the leg among conditions was unable to explain the enhancement of EMG activity in the bilateral alternate leg movement condition. These results suggest that the sensory information generated by alternate leg movements plays a substantial role in amplifying the induced locomotor-like muscle activity in the lower limbs.

Analgesic effect of paired associative stimulation in a tetraplegic patient with severe drug-resistant neuropathic pain: a case report

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Selja Vaalto ◽  
Anna-Lena Nyman ◽  
Anastasia Shulga
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Motor Function ◽  
Analgesic Effect ◽  
Lower Limbs ◽  
Drug Resistant ◽  
Motor Rehabilitation ◽  
Paired Associative Stimulation ◽  
Cord Injury ◽  
The Right

Abstract Objectives There is no effective evidence-based non-pharmacological treatment for severe neuropathic pain after spinal cord injury (SCI). Paired associative stimulation (PAS) has been used in motor rehabilitation of patients after SCI. In the SCI-PAS protocol for tetraplegic patients, peripheral and central nerve tracts are activated with subject-specific timing, such that ascending and descending signals appear simultaneously at the cervical level. The effect on motor rehabilitation is thought to arise via strengthening of cervical upper and lower motoneuron synapses. We have observed an analgesic effect of PAS on mild-to-moderate neuropathic pain in tetraplegic patients receiving PAS for motor rehabilitation. Here, we applied PAS to a patient with severe drug-resistant neuropathic pain. Methods The patient is a 50-year-old man who had a traumatic cervical SCI three years earlier. He has partial paresis in the upper limbs and completely plegic lower limbs. The most severe pain is located in the right upper limb and shoulder region. The pain has not responded to either pharmacological therapy or repetitive-TMS therapy targeted to either primary motor cortex or secondary somatosensory cortex. PAS was targeted to relieve pain in the right upper arm. Peripheral nerve stimulation targeted the median, ulnar, and radial nerves and was accompanied by TMS pulses to the motor representation area of abductor pollicis brevis, abductor digiti minimi, and extensor digitorum communis muscles, respectively. Results Hand motor function, especially finger abduction and extension, was already enhanced during the first therapy week. Pain decreased at the end of the second therapy week. Pain was milder especially in the evenings. Numerical rating scale scores (evening) decreased 44% and patient estimation of global impression of change was 1, subjectively indicating great benefit when compared to before therapy. Quality of sleep also improved. Conclusions The SCI-PAS protocol reduced neuropathic pain in our subject. The mechanism behind the analgesic effect may involve the modulation of nociceptive and sensory neuronal circuits at the spinal cord level. The possibility to use PAS as an adjunct treatment in drug-resistant post-SCI neuropathic pain warrants further investigation and sham-controlled studies. Patients with neuropathic pain due to SCI may benefit from PAS therapy in addition to PAS therapy-induced improvement in motor function.

scholarly journals Altered modulation of sensorimotor rhythms with chronic paralysis

2017 ◽  
Vol 118 (4) ◽  
pp. 2412-2420 ◽  
Author(s):  
Stephen T. Foldes ◽  
Douglas J. Weber ◽  
Jennifer L. Collinger
Keyword(s):  
Spinal Cord ◽  
Motor Imagery ◽  
Muscle Activity ◽  
Cervical Spinal Cord ◽  
The Other ◽  
Emg Activity ◽  
Cortical Oscillations ◽  
Cord Injury ◽  
Intact Muscle ◽  
Sensorimotor Rhythms

After paralysis, the disconnection between the cortex and its peripheral targets leads to neuroplasticity throughout the nervous system. However, it is unclear how chronic paralysis specifically impacts cortical oscillations associated with attempted movement of impaired limbs. We hypothesized that μ- (8–13 Hz) and β- (15–30 Hz) event-related desynchronization (ERD) would be less modulated for individuals with hand paralysis due to cervical spinal cord injury (SCI). To test this, we compared the modulation of ERD from magnetoencephalography (MEG) during attempted and imagined grasping performed by participants with cervical SCI ( n = 12) and able-bodied controls ( n = 13). Seven participants with tetraplegia were able to generate some electromyography (EMG) activity during attempted grasping, whereas the other five were not. The peak and area of ERD were significantly decreased for individuals without volitional muscle activity when they attempted to grasp compared with able-bodied subjects and participants with SCI,with some residual EMG activity. However, no significant differences were found between subject groups during mentally simulated tasks (i.e., motor imagery) where no muscle activity or somatosensory consequences were expected. These findings suggest that individuals who are unable to produce muscle activity are capable of generating ERD when attempting to move, but the characteristics of this ERD are altered. However, for people who maintain volitional muscle activity after SCI, there are no significant differences in ERD characteristics compared with able-bodied controls. These results provide evidence that ERD is dependent on the level of intact muscle activity after SCI. NEW & NOTEWORTHY Source space MEG was used to investigate sensorimotor cortical oscillations in individuals with SCI. This study provides evidence that individuals with cervical SCI exhibit decreased ERD when they attempt to grasp if they are incapable of generating muscle activity. However, there were no significant differences in ERD between paralyzed and able-bodied participants during motor imagery. These results have important implications for the design and evaluation of new therapies, such as motor imagery and neurofeedback interventions.

scholarly journals Changes in Locomotor Muscle Activity After Treadmill Training in Subjects With Incomplete Spinal Cord Injury

2009 ◽  
Vol 101 (2) ◽  
pp. 969-979 ◽  
Author(s):  
Monica A. Gorassini ◽  
Jonathan A. Norton ◽  
Jennifer Nevett-Duchcherer ◽  
Francois D. Roy ◽  
Jaynie F. Yang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Muscle Activity ◽  
Muscle Activation ◽  
Treadmill Training ◽  
Emg Activity ◽  
Incomplete Spinal Cord Injury ◽  
Activation Patterns ◽  
Muscle Activation Patterns ◽  
Cord Injury

Intensive treadmill training after incomplete spinal cord injury can improve functional walking abilities. To determine the changes in muscle activation patterns that are associated with improvements in walking, we measured the electromyography (EMG) of leg muscles in 17 individuals with incomplete spinal cord injury during similar walking conditions both before and after training. Specific differences were observed between subjects that eventually gained functional improvements in overground walking (responders), compared with subjects where treadmill training was ineffective (nonresponders). Although both groups developed a more regular and less clonic EMG pattern on the treadmill, it was only the tibialis anterior and hamstring muscles in the responders that displayed increases in EMG activation. Likewise, only the responders demonstrated decreases in burst duration and cocontraction of proximal (hamstrings and quadriceps) muscle activity. Surprisingly, the proximal muscle activity in the responders, unlike nonresponders, was three- to fourfold greater than that in uninjured control subjects walking at similar speeds and level of body weight support, suggesting that the ability to modify muscle activation patterns after injury may predict the ability of subjects to further compensate in response to motor training. In summary, increases in the amount and decreases in the duration of EMG activity of specific muscles are associated with functional recovery of walking skills after treadmill training in subjects that are able to modify muscle activity patterns following incomplete spinal cord injury.

scholarly journals Metabolic Costs and Muscle Activity Patterns During Robotic- and Therapist-Assisted Treadmill Walking in Individuals With Incomplete Spinal Cord Injury

2006 ◽  
Vol 86 (11) ◽  
pp. 1466-1478 ◽  
Author(s):  
Jeffrey F Israel ◽  
Donielle D Campbell ◽  
Jennifer H Kahn ◽  
T George Hornby
Keyword(s):  
Spinal Cord ◽  
Muscle Activity ◽  
Activity Patterns ◽  
Swing Phase ◽  
Emg Activity ◽  
Robotic Device ◽  
Incomplete Spinal Cord Injury ◽  
Robotic Assisted ◽  
Cord Injury ◽  
Metabolic Costs

AbstractBackground and Purpose. Robotic devices that provide passive guidance and stabilization of the legs and trunk during treadmill stepping may increase the delivery of locomotor training to subjects with neurological injury. Lower-extremity guidance also may reduce voluntary muscle activity as compared with compliant assistance provided by therapists. The purpose of this study was to investigate differences in metabolic costs and lower-limb muscle activity patterns during robotic- and therapist-assisted treadmill walking. Subjects. Twelve ambulatory subjects with motor incomplete spinal cord injury participated. Methods. In 2 separate protocols, metabolic and electromyographic (EMG) data were collected during standing and stepping on a treadmill with therapist and robotic assistance. During robotic-assisted walking, subjects were asked to match the kinematic trajectories of the device and maximize their effort. During therapist-assisted walking, subjects walked on the treadmill with manual assistance provided as necessary. Results. Metabolic costs and swing-phase hip flexor EMG activity were significantly lower when subjects were asked to match the robotic device trajectories than with therapist-assisted walking. These differences were reduced when subjects were asked to maximize their effort during robotic-assisted stepping, although swing-phase plantar-flexor EMG activity was increased. In addition, during standing prior to therapist- or robotic-assisted stepping, metabolic costs were higher without stabilization from the robotic device. Discussion and Conclusion. Differences in metabolic costs and muscle activity patterns between therapist- and robotic-assisted standing and stepping illustrate the importance of minimizing passive guidance and stabilization provided during step training protocols.

Conception of Assistive Equipment for Rehabilitation of Patients with Spinal Cord Injury

2015 ◽  
Vol 23 ◽  
pp. 24-36
Author(s):  
Lap Nam Wong ◽  
Yue Zhen Hong ◽  
Jian Feng Sui ◽  
Rui Xu ◽  
Lin Hong Ji
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Muscle Activity ◽  
Simulation Analysis ◽  
Gluteus Maximus ◽  
Rectus Femoris ◽  
Assistive Device ◽  
Cord Injury ◽  
The Mean ◽  
The Right

Mobility is the urgent requisite of post spinal cord injury (SCI) patient. Since the alternative and compensatory approach is considered as the major function of mobility assistive device for post-SCI patients, the device should possess capability to acclimate to the ‘abnormal’ gait generate by the patients who usually undergo alternative and compensatory rehabilitation in their neural circuit. The functional ability of individual should be taking into account. Yet according to the requirement of neuro-protective treatment in post-SCI rehabilitation processing, locomotor-like activity is still an essential factor to patient. This study presents a novel concept and prototype of assistive technology base on foot control strategy to take an equilibrium between mobility and gait realization. To demonstrate that foot-induced over-ground locomotor assistive method is capable of achieving locomotor-like activity (dragging step), simulation analysis and prototype preliminary experiment have been conducted. Simulation analysis show that foot-induced assistance can allow more volitional activity compare to the hip-knee-induced assistive device. Yet the input and disturbance act on such kind of device may be increased. Surface electromyography (sEMG) from muscles of lower limb (right rectus femoris, right biceps femoris and right gluteus maximus) have been recorded during the preliminary experiment, and the mean of integrated EMG (iEMG) was used as evaluation of muscle activity. The result of the testing show that the mean of iEMG in the right gluteus maximus was reduced in the swing phase when the subject moving ahead with the prototype, but no significant change in the right rectus femoris. It may imply that foot-induced over-ground locomotor assistive device can reduce the muscle activity when patient complete locomotor-like movement and retain some amount of residual recruitment of lower limb, instead of substituting arbitrarily.

scholarly journals Muscle Activity Asymmetry of the Lower Limbs During Sprinting in Elite Soccer Players

2020 ◽  
Vol 75 (1) ◽  
pp. 239-245
Author(s):  
Przemysław Pietraszewski ◽  
Artur Gołaś ◽  
Aleksander Matusiński ◽  
Sylwia Mrzygłód ◽  
Aleksandra Mostowik ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Body Height ◽  
Lower Limbs ◽  
Soccer Players ◽  
Emg Activity ◽  
Professional Soccer ◽  
Left And Right ◽  
Muscle Groups ◽  
The Right ◽  
Lh Rh

Abstract The analysis of movement patterns through EMG activity provides the opportunity to identify the muscle groups most involved in a particular exercise, and to determine the scope of inter-limb deficiencies. The aim of the present study was to investigate the effects of a side-to-side muscle activity asymmetry between the left and the right lower limb during sprinting in soccer players. Sixteen professional soccer players took part in the study. Their age, body mass and body height equaled 23.7 ± 7.6 years, 81.2 ± 10.8 kg and 179.3 ± 12.2 cm, respectively. The sprint test consisted of two maximal sprints over 30 m with a 5-min rest interval between each sprint. EMG was recorded bilaterally from the quadriceps, hamstrings and gluteal muscles. Regression analysis revealed a significant effect of a side-to-side average muscle activity asymmetry between the left and right hamstring (LH/RH) muscles during the speed tests at 5 m (p = 0.044), and 30 m (p = 0.045), as well as the left and right glutes (LG/RG) at 5 m (p = 0.044) and 30 m (p = 0.043). Our results indicate that hamstring and glute muscles should be selectively and additionally activated during resistance training in soccer players to prevent injuries and improve sprint performance.

scholarly journals Impact of glutamatergic and serotonergic neurotransmission on diaphragm muscle activity after cervical spinal hemisection

2017 ◽  
Vol 118 (3) ◽  
pp. 1732-1738 ◽  
Author(s):  
Carlos B. Mantilla ◽  
Heather M. Gransee ◽  
Wen-Zhi Zhan ◽  
Gary C. Sieck
Keyword(s):  
Spinal Cord ◽  
Nmda Receptor ◽  
Muscle Activity ◽  
Spontaneous Recovery ◽  
Cervical Spinal Cord ◽  
Diaphragm Muscle ◽  
Emg Activity ◽  
Emg Amplitude ◽  
Cord Injury ◽  
Phrenic Motoneuron

Incomplete cervical spinal cord hemisection at C2 (SH) disrupts descending excitatory drive to phrenic motoneurons, paralyzing the ipsilateral diaphragm muscle. Spontaneous recovery over time is associated with increased phrenic motoneuron expression of glutamatergic N-methyl-d-aspartate (NMDA) and serotonergic 5-HT2A receptors. We hypothesized that NMDA and 5-HT2A receptor-mediated neurotransmission play a role in ipsilateral diaphragm muscle activity post-SH. Adult male Sprague-Dawley rats were implanted with bilateral diaphragm EMG electrodes for chronic EMG recordings up to 28 days post-SH (SH 28D). The extent of recovery was calculated by peak root-mean-square (RMS) EMG amplitude. In all animals, absence of ipsilateral activity was verified at 3 days post-SH. Diaphragm EMG activity was also recorded during exposure to hypoxia-hypercapnia (10% O2-5% CO2). In SH animals displaying recovery of ipsilateral diaphragm EMG activity at SH 28D, cervical spinal cord segments containing the phrenic motor nucleus (C3–C5) were surgically exposed and either the NMDA receptor antagonist d-2-amino-5-phosphonovalerate (d-AP5; 100 mM, 30 μl) or 5-HT2A receptor antagonist ketanserin (40 mM, 30 μl) was instilled intrathecally. Following d-AP5, diaphragm EMG amplitude was reduced ipsilaterally, during both eupnea (42% of pre-d-AP5 value; P = 0.007) and hypoxia-hypercapnia (31% of pre-d-AP5 value; P = 0.015), with no effect on contralateral EMG activity or in uninjured controls. Treatment with ketanserin did not change ipsilateral or contralateral RMS EMG amplitude in SH animals displaying recovery at SH 28D. Our results suggest that spinal glutamatergic NMDA receptor-mediated neurotransmission plays an important role in ipsilateral diaphragm muscle activity after cervical spinal cord injury. NEW & NOTEWORTHY Spontaneous recovery following C2 spinal hemisection (SH) is associated with increased phrenic motoneuron expression of glutamatergic and serotonergic receptors. In this study, we show that pharmacological inhibition of glutamatergic N-methyl-d-aspartate (NMDA) receptors blunts ipsilateral diaphragm activity post-SH. In contrast, pharmacological inhibition of serotonergic 5-HT2A receptors does not change diaphragm EMG activity post-SH. Our results suggest that NMDA receptor-mediated glutamatergic neurotransmission plays an important role in enhancing rhythmic respiratory-related diaphragm activity after spinal cord injury.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

scholarly journals Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Morio ◽  
Hirotsugu Miyoshi ◽  
Noboru Saeki ◽  
Yukari Toyota ◽  
Yasuo M. Tsutsumi
Keyword(s):  
Spinal Cord ◽  
General Anesthesia ◽  
Supine Position ◽  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Acute Onset ◽  
Lower Limbs ◽  
Canal Stenosis ◽  
Cord Injury ◽  
Aneurysm Repair

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

scholarly journals Rostrocaudal Distribution of the C-Fos-Immunopositive Spinal Network Defined by Muscle Activity during Locomotion

2021 ◽  
Vol 11 (1) ◽  
pp. 69
Author(s):  
Natalia Merkulyeva ◽  
Vsevolod Lyakhovetskii ◽  
Aleksandr Veshchitskii ◽  
Oleg Gorskii ◽  
Pavel Musienko
Keyword(s):  
Spinal Cord ◽  
Locomotor Activity ◽  
Control Systems ◽  
Muscle Activity ◽  
Knee Extensors ◽  
Emg Activity ◽  
Lumbosacral Spinal Cord ◽  
Adductor Muscles ◽  
Spinal Network ◽  
Hip Flexor

The optimization of multisystem neurorehabilitation protocols including electrical spinal cord stimulation and multi-directional tasks training require understanding of underlying circuits mechanisms and distribution of the neuronal network over the spinal cord. In this study we compared the locomotor activity during forward and backward stepping in eighteen adult decerebrated cats. Interneuronal spinal networks responsible for forward and backward stepping were visualized using the C-Fos technique. A bi-modal rostrocaudal distribution of C-Fos-immunopositive neurons over the lumbosacral spinal cord (peaks in the L4/L5 and L6/S1 segments) was revealed. These patterns were compared with motoneuronal pools using Vanderhorst and Holstege scheme; the location of the first peak was correspondent to the motoneurons of the hip flexors and knee extensors, an inter-peak drop was presumably attributed to the motoneurons controlling the adductor muscles. Both were better expressed in cats stepping forward and in parallel, electromyographic (EMG) activity of the hip flexor and knee extensors was higher, while EMG activity of the adductor was lower, during this locomotor mode. On the basis of the present data, which showed greater activity of the adductor muscles and the attributed interneuronal spinal network during backward stepping and according with data about greater demands on postural control systems during backward locomotion, we suppose that the locomotor networks for movements in opposite directions are at least partially different.

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