scholarly journals Exploiting Interlimb Arm and Leg Connections for Walking Rehabilitation: A Training Intervention in Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-19 ◽  
Author(s):  
Taryn Klarner ◽  
Trevor S. Barss ◽  
Yao Sun ◽  
Chelsea Kaupp ◽  
Pamela M. Loadman ◽  
...  
Keyword(s):  
Neural Control ◽  
Cost Effective ◽  
Treadmill Walking ◽  
Reflex Modulation ◽  
Walking Ability ◽  
Cutaneous Reflex ◽  
Walking Rehabilitation ◽  
Increased Strength ◽  
Stride Duration ◽  
Cycling Training

Rhythmic arm and leg (A&L) movements share common elements of neural control. The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. The purpose of this study was to test the efficacy of A&L cycling training as a modality to improve locomotor function after stroke. Nineteen chronic stroke (>six months) participants were recruited and performed 30 minutes of A&L cycling training three times a week for five weeks. Changes in walking function were assessed with (1) clinical tests; (2) strength during isometric contractions; and (3) treadmill walking performance and cutaneous reflex modulation. A multiple baseline (3 pretests) within-subject control design was used. Data show that A&L cycling training improved clinical walking status increased strength by ~25%, improved modulation of muscle activity by ~25%, increased range of motion by ~20%, decreased stride duration, increased frequency, and improved modulation of cutaneous reflexes during treadmill walking. On most variables, the majority of participants showed a significant improvement in walking ability. These results suggest that exploiting arm and leg connections with A&L cycling training, an accessible and cost-effective training modality, could be used to improve walking ability after stroke.

scholarly journals Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation

2018 ◽  
Vol 119 (3) ◽  
pp. 1095-1112 ◽  
Author(s):  
Chelsea Kaupp ◽  
Gregory E. P. Pearcey ◽  
Taryn Klarner ◽  
Yao Sun ◽  
Hilary Cullen ◽  
...  
Keyword(s):  
Muscle Activation ◽  
Chronic Stroke ◽  
Reflex Modulation ◽  
Walking Ability ◽  
Functional Rehabilitation ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Interlimb Coupling ◽  
Before And After ◽  
Cycling Training

Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. “Normalization” of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma.NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.

scholarly journals Cutaneous reflex modulation and self-induced reflex attenuation in cerebellar patients

2015 ◽  
Vol 113 (3) ◽  
pp. 915-924 ◽  
Author(s):  
Wouter Hoogkamer ◽  
Frank Van Calenbergh ◽  
Stephan P. Swinnen ◽  
Jacques Duysens
Keyword(s):  
Muscle Activity ◽  
Neural Control ◽  
Biceps Femoris ◽  
Reflex Modulation ◽  
Neural Pathways ◽  
Common View ◽  
Control Subjects ◽  
Leg Muscles ◽  
Cutaneous Reflex ◽  
Healthy Control

Modulation of cutaneous reflexes is important in the neural control of walking, yet knowledge about underlying neural pathways is still incomplete. Recent studies have suggested that the cerebellum is involved. Here we evaluated the possible roles of the cerebellum in cutaneous reflex modulation and in attenuation of self-induced reflexes. First we checked whether leg muscle activity during walking was similar in patients with focal cerebellar lesions and in healthy control subjects. We then recorded cutaneous reflex activity in leg muscles during walking. Additionally, we compared reflexes after standard (computer triggered) stimuli with reflexes after self-induced stimuli for both groups. Biceps femoris and gastrocnemius medialis muscle activity was increased in the patient group compared with the control subjects, suggesting a coactivation strategy to reduce instability of gait. Cutaneous reflex modulation was similar between healthy control subjects and cerebellar patients, but the latter appeared less able to attenuate reflexes to self-induced stimuli. This suggests that the cerebellum is not primarily involved in cutaneous reflex modulation but that it could act in attenuation of self-induced reflex responses. The latter role in locomotion would be consistent with the common view that the cerebellum predicts sensory consequences of movement.

scholarly journals Neural control of rhythmic arm cycling after stroke

2012 ◽  
Vol 108 (3) ◽  
pp. 891-905 ◽  
Author(s):  
E. Paul Zehr ◽  
Pamela M. Loadman ◽  
Sandra R. Hundza
Keyword(s):  
Neural Control ◽  
Arm Movement ◽  
Constant Current ◽  
Cycle Phase ◽  
Emg Activity ◽  
Reflex Modulation ◽  
Cutaneous Reflexes ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Modulation Pattern

Disordered reflex activity and alterations in the neural control of walking have been observed after stroke. In addition to impairments in leg movement that affect locomotor ability after stroke, significant impairments are also seen in the arms. Altered neural control in the upper limb can often lead to altered tone and spasticity resulting in impaired coordination and flexion contractures. We sought to address the extent to which the neural control of movement is disordered after stroke by examining the modulation pattern of cutaneous reflexes in arm muscles during arm cycling. Twenty-five stroke participants who were at least 6 mo postinfarction and clinically stable, performed rhythmic arm cycling while cutaneous reflexes were evoked with trains (5 × 1.0-ms pulses at 300 Hz) of constant-current electrical stimulation to the superficial radial (SR) nerve at the wrist. Both the more (MA) and less affected (LA) arms were stimulated in separate trials. Bilateral electromyography (EMG) activity was recorded from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on averaged reflexes in 12 equidistant phases of the movement cycle. Phase-modulated cutaneous reflexes were present, but altered, in both MA and LA arms after stroke. Notably, the pattern was “blunted” in the MA arm in stroke compared with control participants. Differences between stroke and control were progressively more evident moving from shoulder to wrist. The results suggest that a reduced pattern of cutaneous reflex modulation persists during rhythmic arm movement after stroke. The overall implication of this result is that the putative spinal contributions to rhythmic human arm movement remain accessible after stroke, which has translational implications for rehabilitation.

Forward and Backward Arm Cycling Are Regulated by Equivalent Neural Mechanisms

2005 ◽  
Vol 93 (1) ◽  
pp. 633-640 ◽  
Author(s):  
E. Paul Zehr ◽  
Sandra R. Hundza
Keyword(s):  
Neural Control ◽  
Arm Movement ◽  
Movement Direction ◽  
Reflex Modulation ◽  
Neural Activation ◽  
Cutaneous Reflexes ◽  
Leg Muscles ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Walking Activity

It was shown some time ago that cutaneous reflexes were phase-reversed when comparing forward and backward treadmill walking. Activity of central-pattern-generating networks (CPG) regulating neural activity for locomotion was suggested as a mechanism involved in this “program reversal.” We have been investigating the neural control of arm movements and the role for CPG mechanisms in regulating rhythmic arm cycling. The purpose of this study was to evaluate the pattern of muscle activity and reflex modulation when comparing forward and backward arm cycling. During rhythmic arm cycling (forward and backward), cutaneous reflexes were evoked with trains (5 × 1.0 ms pulses at 300 Hz) of electrical stimulation delivered to the superficial radial (SR) nerve at the wrist. Electromyographic (EMG) recordings were made bilaterally from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on specific sections of the movement cycle after phase-averaging contingent on the timing of stimulation in the movement cycle. EMG patterns for rhythmic arm cycling are similar during both forward and backward motion. Cutaneous reflex amplitudes were similarly modulated at both early and middle latency irrespective of arm cycling direction. That is, at similar phases in the movement cycle, responses of corresponding sign and amplitude were seen regardless of movement direction. The results are generally parallel to the observations seen in leg muscles after stimulation of cutaneous nerves in the foot during forward and backward walking and provide further evidence for CPG activity contributing to neural activation and reflex modulation during rhythmic arm movement.

Quadriceps H-Reflex Modulation During Pedaling

2006 ◽  
Vol 96 (1) ◽  
pp. 197-208 ◽  
Author(s):  
Birgit Larsen ◽  
Michael Voigt
Keyword(s):  
Neural Control ◽  
Vastus Lateralis ◽  
Phase Speed ◽  
Rectus Femoris ◽  
Quadriceps Muscle ◽  
H Reflex ◽  
Movement Speed ◽  
Reflex Modulation ◽  
Motor Recruitment ◽  
And Task

The main aims of this study were 1) to investigate possible phase-, speed-, and task-dependent changes in the quadriceps H-reflex during pedaling, and to achieve this, 2) to develop an optimized H-reflex recording and processing procedure for recording of quadriceps H-reflexes during movement. It was hypothesized that the behavior of the quadriceps H-reflex concerning phase, speed, and task dependency corresponds to the behavior of the soleus H-reflex during rhythmical leg movements. The applied H-reflex procedure appeared to be reliable for obtaining the quadriceps H-reflex modulation during leg movement. The vastus lateralis (VL) and rectus femoris (RF) H-reflexes showed a phase-dependent modulation during pedaling at a frequency of 80 rpm with almost parallel changes in the reflex amplitude and motor recruitment level. However, when the speed of movement was reduced from 80 to 40 revolutions per minute (rpm) and crank load simultaneously increased (i.e., a halving of the movement speed with a constant motor recruitment level), the quadriceps H-reflex modulation pattern changed significantly in relation to the pattern of motor recruitment, i.e., at 40 rpm, the reflex excitability remained high during a gradual derecruitment during power generation in downstroke. Comparison of the “operationally defined H-reflex gain function” obtained during 1) pedaling at 80 rpm and 2) isometric quadriceps contractions in sitting position showed no significant task-dependent changes in the quadriceps H-reflex. Consequently, the hypothesis was only partly corroborated, and the findings indicate differences in the neural control of the soleus and the quadriceps muscle during rhythmical movements.

scholarly journals Effect of biofeedback cycling training on functional recovery and walking ability of lower extremity in patients with stroke

2014 ◽  
Vol 30 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Huei-Ching Yang ◽  
Chia-Ling Lee ◽  
Roxane Lin ◽  
Miao-Ju Hsu ◽  
Chia-Hsin Chen ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Functional Recovery ◽  
Walking Ability ◽  
Cycling Training

Motor Cortex Activation during Mental Imagery of Walking

2013 ◽  
pp. 29-37 ◽  
Author(s):  
Yinlai Jiang ◽  
Shuoyu Wang ◽  
Renpeng Tan ◽  
Kenji Ishida ◽  
Takeshi Ando ◽  
...  
Keyword(s):  
Mental Imagery ◽  
Movement Planning ◽  
Motor Area ◽  
Active Movement ◽  
Walking Ability ◽  
Functional Near Infrared Spectroscopy ◽  
Movement Training ◽  
Person Perspective ◽  
Walking Rehabilitation ◽  
Third Person Perspective

The authors are developing a hybrid walking rehabilitation system to realize the early recovery of walking ability, which includes both active movement training using walking rehabilitation machines and neurorehabilitation using mental imaginary of walking. In this study, the authors compared the activation of the motor area during real walking (RW), virtual walking (VW), and walking observation (WO) using fNIRS (functional Near-InfraRed Spectroscopy). VW was a first-person perspective imagery in which the subjects were shown moving scenes and imagined that they were actually walking in the scenes. WO was a third-person perspective imagery in which the subjects were instructed to imagine that they were walking at the same pace as the person in the video being shown to the subjects. Based on four subjects, results showed that the oxygenated hemoglobin (oxy-Hb) in the motor area during both the VW and WO were on average higher than during the RW. This might be because it was not necessary to pay attention to the movements of the legs and feet during normal walking, whereas movement planning was required when the subjects imagined that they were walking similar to another person. There was no significant difference between the oxy-Hb during the VW and the WO. The importance of the stimulus diversity in the mental imagery of walking was suggested.

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