Design of a Standing Device for Children with Spinal Dysraphysm

The standing posture is one of the most important factors in the maturation of the neuromotor system, and it is an evolutionary necessity that phylogenetically makes possible the differentiation of functions between the upper and lower limbs, influencing a greater development of the latter; with a fundamental change in the shape of the foot: it increases the importance of the tarsus and metatarsus and reduces the work of the fingers, which facilitates the movement, transfer and independence of the individual in their activities of daily life. The design and production of the prototype of the device, the judgment of the experts, as well as the results of the physiotherapeutic evaluation before and after the standing program, are the threads that are woven in this research proposal. This study seeks to propose a prototype of a standing frame for pediatric patients with spina bifida. The design of a device for standing is proposed based on the individual characteristics of the users, which was evaluated by experts to later perform a case study on a standing program with this type of device in pediatric patients with spine bifida. The designed prototype seems to offer adequate conditions for maintaining standing and on some musculoskeletal conditions of the patient studied. The study concludes that assisted standing should be promoted through inexpensive, functional and continuous monitoring devices. A user-applied design is proposed and not a generic device model.

Standing on unstable surface challenges postural control of tracking tasks and modulates neuromuscular adjustments specific to task complexity

Understanding the modulations of motor control in the presence of perturbations in task conditions of varying complexity is a key element towards the design of effective perturbation-based balance exercise programs. In this study we investigated the effect of mechanical perturbations, induced by an unstable surface, on muscle activation and visuo-postural coupling, when actively tracking target motion cues of different complexity. Four postural tasks following a visual oscillating target of varying target complexity (periodic-sinusoidal vs. chaotic-Lorenz) and surface (stable-floor vs. unstable-foam) were performed. The electromyographic activity of the main plantarflexor and dorsiflexor muscles was captured. The coupling between sway and target was assessed through spectral analysis and the system’s local dynamic stability through the short-term maximum Lyapunov exponent. We found that external perturbations increased local instability and deteriorated visuo-motor coupling. Visuo-motor deterioration was greater for the chaotic target, implying that the effect of the induced perturbations depends on target complexity. There was a modulation of the neuromotor system towards amplification of muscle activity and coactivation to compensate surface-related perturbations and to ensure robust motor control. Our findings provide evidence that, in the presence of perturbations, target complexity induces specific modulations in the neuromotor system while controlling balance and posture.

The contractile patterns, anatomy and physiology of the hyoid musculature change longitudinally through infancy

All mammalian infants suckle, a fundamentally different process than drinking in adults. Infant mammal oropharyngeal anatomy is also anteroposteriorly compressed and becomes more elongate postnatally. While suckling and drinking require different patterns of muscle use and kinematics, little insight exists into how the neuromotor and anatomical systems change through the time that infants suckle. We measured the orientation, activity and contractile patterns of five muscles active during infant feeding from early infancy until weaning using a pig model. Muscles not aligned with the long axis of the body became less mediolaterally orientated with age. However, the timing of activation and the contractile patterns of those muscles exhibited little change, although variation was larger in younger infants than older infants. At both ages, there were differences in contractile patterns within muscles active during both sucking and swallowing, as well as variation among muscles during swallowing. The changes in anatomy, coupled with less variation closer to weaning and little change in muscle firing and shortening patterns suggest that the neuromotor system may be optimized to transition to solid foods. The lesser consequences of aspiration during feeding on an all-liquid diet may not necessitate the evolution of variation in neuromotor function through infancy.

Asymmetric Gait Patterns Alter the Reactive Control of Intersegmental Coordination Patterns during Walking

Recovery from perturbations during walking is primarily mediated by reactive control strategies that coordinate multiple body segments to maintain balance. Balance control is often impaired in clinical populations who walk with spatiotemporally asymmetric gait, and, as a result, rehabilitation efforts often seek to reduce asymmetries in these populations. Previous work has demonstrated that the presence of spatiotemporal asymmetries during walking does not impair the control of whole-body dynamics during perturbation recovery. However, it remains to be seen how the neuromotor system adjusts intersegmental coordination patterns to maintain invariant whole-body dynamics. Here, we determined if the neuromotor system generates stereotypical coordination patterns irrespective of the level of asymmetry or if the neuromotor system allows for variance in intersegmental coordination patterns to stabilize whole-body dynamics. Nineteen healthy participants walked on a dual-belt treadmill at a range of step length asymmetries, and they responded to unpredictable, slip-like perturbations. We used principal component analysis of segmental angular momenta to characterize intersegmental coordination patterns before, during, and after imposed perturbations. We found that two principal components were sufficient to explain ~ 95% of the variance in segmental angular momentum during both steading walking and responses to perturbations. Our results also revealed that walking with asymmetric step lengths led to changes in intersegmental coordination patterns during the perturbation and during subsequent recovery steps without affecting whole-body angular momentum. These results suggest that the nervous system allows for variance in segment-level coordination patterns to maintain invariant control of whole-body angular momentum during walking. Future studies exploring how these segmental coordination patterns change in individuals with asymmetries that result from neuromotor impairments can provide further insight into how the healthy and impaired nervous system regulates dynamic balance during walking.

Complex rehabilitation of children with neuromotor system disorders: effectiveness of pharmacopuncture

In children with diseases of neuromotor system aged from 5 to 14 during the process of complex medical rehabilitation the application of treatment with methods of pharmacopuncture showed good results. The group contained 51 patients who were treated by using conventional medical treatment. Maximal anthropometric, laboratorial and clinic recovery was detected in patients with upper and lower monopareses after the usage of pharmacopuncture in combination with Cerebrolysin.

Individualized Inter-Stimulus Interval Estimation for Neural Facilitation in Human Motor System: A Particle Filtering Approach

Quantitative understanding of the human neuromotor system is essential for the implementation of the future robotic therapeutic exercises. For this purpose, sensorimotor adaptations in voluntary and involuntary movements facilitated by peripheral stimulation and resultant motor-evoked potentials (MEP) must be well characterized. One such facilitation exercise is paired associative stimulation (PAS). However, effective inter-stimulus intervals between cortical and peripheral stimulations are highly variable between individuals due to different physiological characteristics. Past studies measured MEPs in a wide range of time by incrementally varying inter-stimulus intervals to find the optimal interval in a specific subject, which has been a time-consuming process. This paper develops a search algorithm based on particle filtering to estimate individualized inter-stimulus intervals for PAS with mechanical muscle tendon stimulation realized by a pneumatically-operated robotic neuromodulatory system. The particle filter-based method reduces the number of PAS trials 70%–80% in comparison to the conventional incremental method. An accelerometer attached to the robotic system that measures exact timings of tendon stimulation can further reduce the number of trials.

Retention of gait stability improvements over 1.5 years in older adults: effects of perturbation exposure and triceps surae neuromuscular exercise

The plantarflexors play a crucial role in recovery from sudden disturbances to gait. The objective of this study was to investigate whether medium (months)- or long(years)-term exercise-induced enhancement of triceps surae (TS) neuromuscular capacities affects older adults’ ability to retain improvements in reactive gait stability during perturbed walking acquired from perturbation training sessions. Thirty-four adult women (65 ± 7 yr) were recruited to a perturbation training group ( n = 13) or a group that additionally completed 14 wk of TS neuromuscular exercise ( n = 21), 12 of whom continued with the exercise for 1.5 yr. The margin of stability (MoS) was analyzed at touchdown of the perturbed step and the first recovery step following eight separate unexpected trip perturbations during treadmill walking. TS muscle-tendon unit mechanical properties and motor skill performance were assessed with ultrasonography and dynamometry. Two perturbation training sessions (baseline and after 14 wk) caused an improvement in the reactive gait stability to the perturbations (increased MoS) in both groups. The perturbation training group retained the reactive gait stability improvements acquired over 14 wk and over 1.5 yr, with a minor decay over time. Despite the improvements in TS capacities in the additional exercise group, no benefits for the reactive gait stability following perturbations were identified. Therefore, older adults’ neuromotor system shows rapid plasticity to repeated unexpected perturbations and an ability to retain these adaptations in reactive gait stability over a long time period, but an additional exercise-related enhancement of TS capacities seems not to further improve these effects. NEW & NOTEWORTHY Older adults’ neuromotor system shows rapid plasticity to repeated exposure to unexpected perturbations to gait and an ability to retain the majority of these adaptations in reactive recovery responses over a prolonged time period of 1.5 yr. However, an additional exercise-related enhancement of TS neuromuscular capacities is not necessarily transferred to the recovery behavior during unexpected perturbations to gait in older adults.