scholarly journals Poststroke Muscle Architectural Parameters of the Tibialis Anterior and the Potential Implications for Rehabilitation of Foot Drop

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
John W. Ramsay ◽  
Molly A. Wessel ◽  
Thomas S. Buchanan ◽  
Jill S. Higginson
Keyword(s):  
Tibialis Anterior ◽  
Muscle Activation ◽  
Imaging Techniques ◽  
Tibialis Anterior Muscle ◽  
Functional Mobility ◽  
Foot Drop ◽  
Neutral Position ◽  
Plantar Flexors ◽  
Fascicle Length ◽  
Bilateral Differences

Poststroke dorsiflexor weakness and paretic limb foot drop increase the risk of stumbling and falling and decrease overall functional mobility. It is of interest whether dorsiflexor muscle weakness is primarily neurological in origin or whether morphological differences also contribute to the impairment. Ten poststroke hemiparetic individuals were imaged bilaterally using noninvasive medical imaging techniques. Magnetic resonance imaging was used to identify changes in tibialis anterior muscle volume and muscle belly length. Ultrasonography was used to measure fascicle length and pennation angle in a neutral position. We found no clinically meaningful bilateral differences in any architectural parameter across all subjects, which indicates that these subjects have the muscular capacity to dorsiflex their foot. Therefore, poststroke dorsiflexor weakness is primarily neural in origin and likely due to muscle activation failure or increased spasticity of the plantar flexors. The current finding suggests that electrical stimulation methods or additional neuromuscular retraining may be more beneficial than targeting muscle strength (i.e., increasing muscle mass).

scholarly journals Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ross M. Neuman ◽  
Staci M. Shearin ◽  
Karen J. McCain ◽  
Nicholas P. Fey
Keyword(s):  
Multiple Sclerosis ◽  
Muscle Activity ◽  
Healthy Subjects ◽  
Muscle Activation ◽  
Assistive Technologies ◽  
Lower Limbs ◽  
Biomechanical Analysis ◽  
Foot Drop ◽  
Plantar Flexors ◽  
Hip Flexion

Abstract Background Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors. Methods Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability. Results For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO. Conclusions This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Interosseous Nerve Transfers for Tibialis Anterior Muscle Paralysis (Foot Drop): A Human Cadaver-Based Feasibility Study

2008 ◽  
Vol 25 (03) ◽  
pp. 203-211 ◽  
Author(s):  
Miguel Pirela-Cruz ◽  
Uel Hansen ◽  
Daniel Terreros ◽  
Alfred Rossum ◽  
Priscilla West
Keyword(s):  
Feasibility Study ◽  
Tibialis Anterior ◽  
Tibialis Anterior Muscle ◽  
Foot Drop ◽  
Human Cadaver ◽  
Muscle Paralysis ◽  
Nerve Transfers

scholarly journals Sonographic comparison of transcutaneous stimulation versus percutaneus stimulation of the tibialis anterior: a pilot study

2019 ◽  
Vol 02 (02) ◽  
pp. 093-093
Author(s):  
Sánchez Lorenzo M. ◽  
Seoane Pardo R. ◽  
Mira Llopis M. ◽  
Iannone Lado S.
Keyword(s):  
Repeated Measures ◽  
Tibialis Anterior ◽  
Tibialis Anterior Muscle ◽  
Pennation Angle ◽  
P Value ◽  
Percutaneous Technique ◽  
Neutral Position ◽  
Motor Point ◽  
Healthy Individuals ◽  
Transcutaneous Stimulation

Abstract Background and Aims Previous studies have evaluated electrostimulation of the tibialis anterior muscle via ultrasound. However, to the best of our knowledge, to date, no study has compared percutaneous stimulation compared to transcutaneous stimulation. The aim of this study was to analyze and compare the influence of percutaneous stimulation versus transcutaneous stimulation on the angle and muscle width of the proximal motor point of the tibialis anterior among healthy individuals using ultrasound. Material and Methods A longitudinal prospective study. The study variables were muscle thickness and pennation angle, measured using ultrasound. A sample of 4 healthy individuals with a mean age of 35.25 years ( ± 2.17), mean height of 1.70m ( ±  0.03) and weight of 67.35kg ( ±  6.32), participated in this study. Stimulation was performed on the tibialis anterior of the dominant leg of each individual (n = 4). The subjects were seated in a vertical position. For position 1, the knee of the dominant leg remained completely extended and the ankle was fixed in a neutral position with an orthosis comprised of Velcro straps which immobilized the ankle and forefoot joints. For position 2, the knee remained flexed 90 degrees with the foot fixed in the orthosis and supported on the floor. The proximal motor point of the tibialis anterior muscle was located. A biphasic symmetric pulse current was used with the maximum tolerated intensity. Transcutaneous stimulation was performed via a small circular electrode, and for percutaneous stimulation a filiform acupuncture needle was used. To capture the ultrasound images, the probe was placed on a system with an articulated mechanical arm and a clamp that enabled the possibility of adjusting the height and/or angle and the position marked on the skin. Normality was contrasted using the Shapiro-Wilk test and sphericity was tested using the Mauchly's test. Analysis of variance was performed (ANOVA) for repeated measures. Results The comparison of both techniques in position 1 did not show significant differences between the transcutaneous technique versus the percutaneous technique neither for the angle (F = 2.07; p-valor = 0.18), nor for the width (F =0.28; p-value = 0.60). In the case of position 2, significant differences were not found between the transcutaneous technique versus the percutaneous technique, neither for the angle (F = 0.28; p-value = 0.606) nor for the weight (F =0.11; p-value = 0.75). Conclusions The comparison of transcutaneous stimulation versus percutaneous stimulation in the proximal motor point of the tibialis anterior does not seem to show statistically significant differences for muscle width nor pennation angle.

Tibialis anterior muscle fascicle dynamics adequately represent postural sway during standing balance

2013 ◽  
Vol 115 (12) ◽  
pp. 1742-1750 ◽  
Author(s):  
James T. Day ◽  
Glen A. Lichtwark ◽  
Andrew G. Cresswell
Keyword(s):  
Tibialis Anterior ◽  
Tibialis Anterior Muscle ◽  
Sensory Information ◽  
Quiet Standing ◽  
Emg Activity ◽  
Proprioceptive Information ◽  
Fascicle Length ◽  
Muscle Fascicle ◽  
Length Changes

To maintain a stable, upright posture, the central nervous system (CNS) must integrate sensory information from multiple sources and subsequently generate corrective torque about the ankle joint. Although proprioceptive information from the muscles that cross this joint has been shown to be vital in this process, the specific source of this information remains questionable. Recent research has been focused on the potential role of tibialis anterior (TA) muscle during standing, largely due to the lack of modulation of its activity throughout the sway cycle. Ten young, healthy subjects were asked to stand normally under varying conditions, for periods of 60 s. During these trials, intramuscular electromyographic (EMG) activity and the fascicle length of three distinct anatomical regions of TA were sampled synchronously with kinematic data regarding sway position. In the quiet standing conditions, TA muscle activity was unmodulated and fascicle length changes in each region were tightly coupled with changes in sway position. In the active sway condition, more EMG activity was observed in TA and the fascicle length changes were decoupled from sway position. No regional specific differences in correlation values were observed, contrasting previous observations. The ability of the fascicles to follow sway position builds upon the suggestion that TA is well placed to provide accurate, straightforward sensory information to the CNS. As previously suggested, through reciprocal inhibition, afferent information from TA could help to regulate plantar flexor torque at relevant phases of the sway cycle. The proprioceptive role of TA appears to become complicated during more challenging conditions.

Alterations of tibialis anterior muscle activation pattern in subjects with type 2 diabetes and diabetic peripheral neuropathy

2021 ◽  
Author(s):  
Mateus Favretto ◽  
Sandra Cossul ◽  
Felipe Rettore Andreis ◽  
Luiz R. Nakamura ◽  
Marcelo Ronsoni ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Neuropathy ◽  
Isometric Contraction ◽  
Diabetic Peripheral Neuropathy ◽  
Tibialis Anterior ◽  
Muscle Activation ◽  
Tibialis Anterior Muscle ◽  
Activation Pattern ◽  
Semg Signals

Abstract Diabetic peripheral neuropathy (DPN) is associated with loss of motor units (MUs), which can cause changes in the activation pattern of muscle fibres. This study investigated the pattern of muscle activation using high-density surface electromyography (HD-sEMG) signals from subjects with type 2 diabetes mellitus (T2DM) and DPN. Thirty-five adults participated in the study: 12 healthy subjects (HV), 12 patients with T2DM without DPN (No-DPN) and 11 patients with T2DM with DPN (DPN). HD-sEMG signals were recorded in the tibialis anterior muscle during an isometric contraction of ankle dorsiflexion at 50% of the maximum voluntary isometric contraction (MVIC) during 30-s. The calculated HD-sEMG signals parameters were the normalised root mean square (RMS), normalised median frequency (MDF), coefficient of variation (CoV) and modified entropy (ME). The RMS increased significantly (p = 0.001) with time only for the DPN group, while the MDF decreased significantly (p < 0.01) with time for the three groups. Moreover, the ME was significantly lower (p = 0.005), and CoV was significantly higher (p = 0.003) for the DPN group than the HV group. Using HD-sEMG, we have demonstrated a reduction in the number of MU recruited by individuals with DPN. This study provides proof of concept for the clinical utility of this technique for identifying neuromuscular impairment caused by DPN.

Surgical Treatment of Complete Foot Drop: Partial Tibial Nerve Transfer to the Motor Branch of the Tibialis Anterior: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Themistocles S Protopsaltis ◽  
Yesha H Parekh
Keyword(s):  
Surgical Treatment ◽  
Tibialis Anterior ◽  
Tibial Nerve ◽  
Donor Site ◽  
Tibialis Anterior Muscle ◽  
Nerve Transfer ◽  
Ankle Dorsiflexion ◽  
Foot Drop ◽  
Great Toe ◽  
Motor Branch

Abstract This video will be demonstrating the surgical treatment of complete foot drop with partial tibial nerve transfer to the motor branch of the tibialis anterior. Foot drop occurs when there is injury to the deep peroneal nerve that results in the paralysis of the tibialis anterior muscle and subsequent loss of ankle dorsiflexion.1-5 The patient who is the subject of this video is a 27-yr-old female with a 6-mo history of foot drop. She presented with complete loss of ankle dorsiflexion and great toe extension due to traumatic fall on her left knee while running. Upon physical examination, she had all the features of complete foot drop with loss of ankle dorsiflexion and ankle eversion. She also had decreased sensation to light touch over left dorsal foot, left great toe, and left lateral lower leg. The patient has consented to this procedure. The partial tibial nerve transfer to the motor branch of tibialis anterior muscle is the preferred treatment option for foot drop as it restores ankle dorsiflexion with minimal donor site complications. At 12 mo postsurgery, she has regained 4/5 for ankle dorsiflexion on motor testing compared to the 0/5 she had preoperatively.

Length-force characteristics of in vivo human muscle reflected by supersonic shear imaging

2014 ◽  
Vol 117 (2) ◽  
pp. 153-162 ◽  
Author(s):  
Kazushige Sasaki ◽  
Sho Toyama ◽  
Naokata Ishii
Keyword(s):  
Shear Modulus ◽  
Tibialis Anterior ◽  
Muscle Force ◽  
Tibialis Anterior Muscle ◽  
Human Muscle ◽  
Joint Angles ◽  
Fascicle Length ◽  
Voluntary Contractions ◽  
Force Relationship

Recently, an ultrasound-based elastography technique has been used to measure stiffness (shear modulus) of an active human muscle along the axis of contraction. Using this technique, we explored 1) whether muscle shear modulus, like muscle force, is length dependent; and 2) whether the length dependence of muscle shear modulus is consistent between electrically elicited and voluntary contractions. From nine healthy participants, ankle joint torque and shear modulus of the tibialis anterior muscle were measured at five different ankle joint angles during tetanic contractions and during maximal voluntary contractions. Fascicle length, pennation angle, and tendon moment arm length of the tetanized tibialis anterior calculated from ultrasound images were used to reveal the length-dependent changes in muscle force and shear modulus. Over the range of joint angles examined, both force and shear modulus of the tetanized muscle increased with increasing fascicle length. Regression analysis of normalized data revealed a significant linear relationship between force and shear modulus ( R2 = 0.52, n = 45, P < 0.001). Although the length dependence of shear modulus was consistent, irrespective of contraction mode, the slope of length-shear modulus relationship was steeper during maximal voluntary contractions than during tetanic contractions. These results provide novel evidence that length-force relationship, one of the most fundamental characteristics of muscle, can be inferred from in vivo imaging of shear modulus in the tibialis anterior muscle. Furthermore, the estimation of length-force relationship may be applicable to voluntary contractions in which neural and mechanical interactions of multiple muscles are involved.

scholarly journals Muscle spindles in human tibialis anterior encode muscle fascicle length changes

2017 ◽  
Vol 117 (4) ◽  
pp. 1489-1498 ◽  
Author(s):  
James Day ◽  
Leah R. Bent ◽  
Ingvars Birznieks ◽  
Vaughan G. Macefield ◽  
Andrew G. Cresswell
Keyword(s):  
Muscle Spindle ◽  
Tibialis Anterior ◽  
Tibialis Anterior Muscle ◽  
Muscle Length ◽  
Muscle Spindles ◽  
Muscle Spindle Afferents ◽  
Fascicle Length ◽  
Muscle Fascicle ◽  
Length Changes

Muscle spindles provide exquisitely sensitive proprioceptive information regarding joint position and movement. Through passively driven length changes in the muscle-tendon unit (MTU), muscle spindles detect joint rotations because of their in-parallel mechanical linkage to muscle fascicles. In human microneurography studies, muscle fascicles are assumed to follow the MTU and, as such, fascicle length is not measured in such studies. However, under certain mechanical conditions, compliant structures can act to decouple the fascicles, and, therefore, the spindles, from the MTU. Such decoupling may reduce the fidelity by which muscle spindles encode joint position and movement. The aim of the present study was to measure, for the first time, both the changes in firing of single muscle spindle afferents and changes in muscle fascicle length in vivo from the tibialis anterior muscle (TA) during passive rotations about the ankle. Unitary recordings were made from 15 muscle spindle afferents supplying TA via a microelectrode inserted into the common peroneal nerve. Ultrasonography was used to measure the length of an individual fascicle of TA. We saw a strong correlation between fascicle length and firing rate during passive ankle rotations of varying rates (0.1–0.5 Hz) and amplitudes (1–9°). In particular, we saw responses observed at relatively small changes in muscle length that highlight the sensitivity of the TA muscle to small length changes. This study is the first to measure spindle firing and fascicle dynamics in vivo and provides an experimental basis for further understanding the link between fascicle length, MTU length, and spindle firing patterns. NEW & NOTEWORTHY Muscle spindles are exquisitely sensitive to changes in muscle length, but recordings from human muscle spindle afferents are usually correlated with joint angle rather than muscle fascicle length. In this study, we monitored both muscle fascicle length and spindle firing from the human tibialis anterior muscle in vivo. Our findings are the first to measure these signals in vivo and provide an experimental basis for exploring this link further.

scholarly journals Neuromuscular Electrical Stimulation for Early Recovery of Motor Control of Ankle along with Spasticity in Stroke Patients A Prospective Randomized Controlled Study

2016 ◽  
Vol 27 (4) ◽  
pp. 121-127
Author(s):  
AK Joy ◽  
Annada Sankar Mohes ◽  
Th Bidyarani ◽  
Aten Jongkey ◽  
L Darendtajit Singh
Keyword(s):  
Electrical Stimulation ◽  
Motor Control ◽  
Tibialis Anterior ◽  
Tibialis Anterior Muscle ◽  
Neuromuscular Electrical Stimulation ◽  
Motor Power ◽  
Plantar Flexors ◽  
Stroke Patients ◽  
Early Recovery ◽  
Ankle Dorsiflexor

Abstract Background and Purpose Effect of neuromuscular electrical stimulation in acute stroke patients while stimulating only single muscle is not known. The purpose of the study is to find the influence of early neuromuscular electrical stimulation to the motor point of tibialis anterior muscle of the affected limb in achieving early motor control of the ankle with reduction in spasticity in poststroke patients. Methods One hundred and thirty-two subjects were selected between 45and 65 years of age and within 2 weeks of the first attack of stroke. They were randomly divided into study and control groups comprising 66 subjects in each group. Study group received neuromuscular electrical stimulation to tibialis anterior muscle of the affected limb, 15 minutes twice daily, 5 days a week up to 3 weeks along with conventional exercise therapy whereas control group received only exercise therapy for that period. Outcome measures include Modified Ashworth Scale for spasticity of ankle plantar flexors, motor power of ankle dorsiflexors and plantar flexors, motor control of ankle joint. They were recorded before starting treatment, after 3 weeks and at 7 weeks following starting the treatment. Results Significant improvement of spasticity was noticed after 7 weeks follow-up (p=0.014). Significant improvement also noticed in ankle dorsiflexor motor power (p<0.001), ankle motor control (p=0.007). Conclusions Neuromuscular electrical stimulation along with traditional exercise programme is superior to exercise alone for early recovery of ankle motor control, plantar-flexor spasticity and ankle dorsiflexor motor strength.

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