Not All Is Lost: Old Adults Retain Flexibility in Motor Behaviour during Sit-to-Stand

Sit-to-stand is a fundamental activity of daily living, which becomes increasingly difficult with advancing age. Due to severe loss of leg strength old adults are required to change the way they rise from a chair and maintain stability. Here we examine whether old compared to young adults differently prioritize task-important performance variables and whether there are age-related differences in the use of available motor flexibility. We applied the uncontrolled manifold analysis to decompose trial-to-trial variability in joint kinematics into variability that stabilizes and destabilizes task-important performance variables. Comparing the amount of variability stabilizing and destabilizing task-important variables enabled us to identify the variable of primary importance for the task. We measured maximal isometric voluntary force of three muscle groups in the right leg. Independent of age and muscle strength, old and young adults similarly prioritized stability of the ground reaction force vector during sit-to-stand. Old compared to young adults employed greater motor flexibility, stabilizing ground reaction forces during sit-to-sand. We concluded that freeing those degrees of freedom that stabilize task-important variables is a strategy used by the aging neuromuscular system to compensate for strength deficits.     

Proximal versus distal control of two-joint planar reaching movements in the presence of neuromuscular noise

Determining how the human nervous system contends with neuro-motor noise is vital to understanding how humans achieve accurate goal-directed movements. Experimentally, people learning skilled tasks tend to reduce variability in distal joint movements more than in proximal joint movements. This suggests that they might be imposing greater control over distal joints than proximal joints. However, the reasons for this remain unclear, largely because it is not experimentally possible to directly manipulate either the noise or the control at each joint independently. Therefore, this study used a 2 degree-of-freedom torque driven arm model to determine how different combinations of noise and/or control independently applied at each joint affected the reaching accuracy and the total work required to make the movement. Signal-dependent noise was simultaneously and independently added to the shoulder and elbow torques to induce endpoint errors during planar reaching. Feedback control was then applied, independently and jointly, at each joint to reduce endpoint error due to the added neuromuscular noise. Movement direction and the inertia distribution along the arm were varied to quantify how these biomechanical variations affected the system performance. Endpoint error and total net work were computed as dependent measures. When each joint was independently subjected to noise in the absence of control, endpoint errors were more sensitive to distal (elbow) noise than to proximal (shoulder) noise for nearly all combinations of reaching direction and inertia ratio. The effects of distal noise on endpoint errors were more pronounced when inertia was distributed more toward the forearm. In contrast, the total net work decreased as mass was shifted to the upper arm for reaching movements in all directions. When noise was present at both joints and joint control was implemented, controlling the distal joint alone reduced endpoint errors more than controlling the proximal joint alone for nearly all combinations of reaching direction and inertia ratio. Applying control only at the distal joint was more effective at reducing endpoint errors when more of the mass was more proximally distributed. Likewise, controlling the distal joint alone required less total net work than controlling the proximal joint alone for nearly all combinations of reaching distance and inertia ratio. It is more efficient to reduce endpoint error and energetic cost by selectively applying control to reduce variability in the distal joint than the proximal joint. The reasons for this arise from the biomechanical configuration of the arm itself.     

The development of rhythm regularity, neuromuscular strategies, and movement smoothness during repetitive reaching in typically developing children

IntroductionThis study examined the development of paced coordinated reaching characterized by the successful entrainment of the movement to an external pacer, synchronous muscle activations and movement smoothness.MethodsThirty children, 5–10 years of age, and ten adults were instructed to repeatedly reach for and move an object from a lower shelf to an upper shelf in time to a metronome. Surface electromyography data were recorded. Amplitude and cross-correlations were calculated on three muscle pairs crossing the shoulder and elbow. A motion capture system captured the space curve accelerations of hand, forearm and upper arm segments to quantify movement smoothness.ResultsThe 5–6 year old children showed the greatest amount of temporal variability, followed by 7–10 year olds and then the adults. Correlations between muscle pairs stabilizing the shoulder girdle were higher in each group as compared to the other two muscle pairs but the correlations for all pairs were consistently higher for adults. Movement smoothness for children 9–10 years of age was closer to an adult-like pattern with respect to control of the upper arm, but the hand segment had the greatest variability across groups.ConclusionsThe increased temporal variability and decreased movement smoothness of the hand and forearm segments suggest that control of more distal musculature may be more difficult in children. The neuromuscular strategies adopted by adults were more optimal than those adopted by children as reflected by smoother and more consistent reaching.     

An optimisation-based model for full-body upright reaching movements

An optimal simulation 3D model for full-body upright reaching movements was developed using graphic-based modelling tools (SimMechanics) to generate an inverse dynamics model of the skeleton and using parameterisation methods for a sensory motor controller. The adaptive weight coefficient of the cost function based on the final motor task error (i.e. distance between end-effector and target at the end of movement) was used to correct motor task error and physiological measurements (e.g. joint power, centre of mass displacement, etc.). The output of the simulation models using various cost functions were compared to experimental data from 15 healthy participants performing full-body upright reaching movements. The proposed method can reasonably predict full-body voluntary movements in terms of final posture, joint power, and movement of the centre of mass (COM) using simple algebraic calculations of inverse dynamics and forward kinematics instead of the complicated integrals of the forward dynamics. We found that the combination of several control strategies, i.e. minimising end-effector error, total joint power and body COM produced the best fit of the full-body reaching task.     

Manipulating the edge of instability

We investigate the integration of visual and tactile sensory input for dynamic manipulation. Our experimental data and computational modeling reveal that time-delays are as critical to task-optimal multisensory integration as sensorimotor noise. Our focus is a dynamic manipulation task "at the edge of instability." Mathematical bifurcation theory predicts that this system will exhibit well-classified low-dimensional dynamics in this regime. The task was using the thumbpad to compress a slender spring prone to buckling as far as possible, just shy of slipping. As expected from bifurcation theory, principal components analysis gives a projection of the data onto a low dimensional subspace that captures 91-97% of its variance. In this subspace, we formulate a low-order model for the brain+hand+spring dynamics based on known mechanical and neurophysiological properties of the system. By systematically occluding vision and anesthetically blocking thumbpad sensation in 12 consenting subjects, we found that vision contributed to dynamic manipulation only when thumbpad sensation was absent. The reduced ability of the model system to compress the spring with absent sensory channels closely resembled the experimental results. Moreover, we found that the model reproduced the contextual usefulness of vision only if we took account of time-delays. Our results shed light on critical features of dynamic manipulation distinct from those of static pinch, as well as the mechanism likely responsible for loss of manual dexterity and increased reliance on vision when age or neuromuscular disease increase noisiness and/or time-delays during sensorimotor integration.     

Upper extremity sensorimotor control among collegiate football players

Injuries stemming from shoulder instability are very common among athletes participating in contact sports, such as football. Previous research has shown that increased laxity negatively affects the function of the sensorimotor system potentially leading to a pathological cycle of shoulder dysfunction. Currently, there are no data detailing such effects among football players. Therefore, the purpose of this study was to examine the differences in upper extremity sensorimotor control among football players compared with that of a control group. Forty-five collegiate football players and 70 male control subjects with no previous experience in contact sports participated. All the subjects had no recent history of upper extremity injury. Each subject performed three 30-second upper extremity balance trials on each arm. The balance trials were conducted in a single-arm push-up position with the test arm in the center of a force platform and the subjects' feet on a labile device. The trials were averaged, and the differences in radial area deviation between groups were analyzed using separate 1-way analyses of variance (p < 0.05). The football players showed significantly more radial area deviation of the dominant (0.41 ± 1.23 cm2, p = 0.02) and nondominant arms (0.47 ± 1.63 cm2, p = 0.03) when compared with the control group. These results suggest that football players may have decreased sensorimotor control of the upper extremity compared with individuals with no contact sport experience. The decreased upper extremity sensorimotor control among the football players may be because of the frequent impacts accumulated during football participation. Football players may benefit from exercises that target the sensorimotor system. These findings may also be beneficial in the evaluation and treatment of various upper extremity injuries among football players.     

Influence of simulated neuromuscular noise on movement variability and fall risk in a 3D dynamic walking model

People at risk of falling exhibit increased gait variability, which may predict future falls. However, the causal mechanisms underlying these correlations are not well known. Increased neuronal noise associated with aging likely leads to increased gait variability, which could in turn lead to increased fall risk. This paper presents a model of how changes in neuromuscular noise independently affect gait variability and probability of falling, and aims to determine the extent to which changes in gait variability directly predict fall risk. We used a dynamic walking model that incorporates a lateral step controller to maintain lateral stability. Noise was applied to this controller to approximate neuromuscular noise in humans. Noise amplitude was varied between low amplitudes that did not induce falls and high amplitudes for which the model always fell. With increases in noise amplitude, the model fell more often and after fewer steps. Gait variability increased with noise amplitude and predicted increased probability of falling. Importantly, these relationships were not linear. At either low gait variability or very high gait variability, small increases in noise and variability affected probability of falling very little. Conversely, at intermediate noise and/or variability levels, the same small increases resulted in large increases in probability of falling. Our results validate the idea that age-related increases in neuromuscular noise likely play a direct contributing role in increasing fall risk. However, neuromuscular noise remains only one of many important factors that need to be considered. These findings have important implications for fall prevention research and practice.     

Can co-activation reduce kinematic variability? A simulation study

Impedance modulation has been suggested as a means to suppress the effects of internal ‘noise’ on movement kinematics. We investigated this hypothesis in a neuro-musculo-skeletal model. A prerequisite is that the muscle model produces realistic force variability. We found that standard Hill-type models do not predict realistic force variability in response to variability in stimulation. In contrast, a combined motor-unit pool model and a pool of parallel Hill-type motor units did produce realistic force variability as a function of target force, largely independent of how the force was transduced to the tendon. To test the main hypothesis, two versions of the latter model were simulated as an antagonistic muscle pair, controlling the position of a frictionless hinge joint, with a distal segment having realistic inertia relative to the muscle strength. Increasing the impedance through co-activation resulted in less kinematic variability, except for the lowest levels of co-activation. Model behavior in this region was affected by the noise amplitude and the inertial properties of the model. Our simulations support the idea that muscular co-activation is in principle an effective strategy to meet accuracy demands.     

Three-dimensional motion of the upper extremity joints during various activities of daily living

Highly reliable information on the range of motion (ROM) required to perform activities of daily living (ADL) is important to allow rehabilitation professionals to make appropriate clinical judgments of patients with limited ROM of the upper extremity joints. There are, however, no data available that take full account of corrections for gimbal-lock and soft tissue artifacts, which affect estimation errors for joint angles. We used an electromagnetic three-dimensional tracking system (FASTRAK) to measure the three-dimensional ROM of the upper extremity joints of healthy adults (N=20, age range 18–34) during 16 ADL movement tasks. The ROM required for the performance of each movement was shown in terms of the joint angle at the completion of the task, using a new definition of joint angle and regression analysis to compensate for estimation errors. The results of this study may be useful in setting goals for the treatment of upper extremity joint function.     

Development and validation of a 3-D model to predict knee joint loading during dynamic movement

The purpose of this study was to develop a subject-specific 3-D model of the lower extremity to predict neuromuscular control effects on 3-D knee joint loading during movements that can potentially cause injury to the anterior cruciate ligament (ACL) in the knee. The simulation consisted of a forward dynamic 3-D musculoskeletal model of the lower extremity, scaled to represent a specific subject. Inputs of the model were the initial position and velocity of the skeletal elements, and the muscle stimulation patterns. Outputs of the model were movement and ground reaction forces, as well as resultant 3-D forces and moments acting across the knee joint. An optimization method was established to find muscle stimulation patterns that best reproduced the subject's movement and ground reaction forces during a sidestepping task. The optimized model produced movements and forces that were generally within one standard deviation of the measured subject data. Resultant knee joint loading variables extracted from the optimized model were comparable to those reported in the literature. The ability of the model to successfully predict the subject's response to altered initial conditions was quantified and found acceptable for use of the model to investigate the effect of altered neuromuscular control on knee joint loading during sidestepping. Monte Carlo simulations (N = 100,000) using randomly perturbed initial kinematic conditions, based on the subject's variability, resulted in peak anterior force, valgus torque and internal torque values of 378 N, 94 Nm and 71 Nm, respectively, large enough to cause ACL rupture. We conclude that the procedures described in this paper were successful in creating valid simulations of normal movement, and in simulating injuries that are caused by perturbed neuromuscular control.     

Individual muscle contributions to push and recovery subtasks during wheelchair propulsion

Manual wheelchair propulsion places considerable physical demand on the upper extremity and is one of the primary activities associated with the high prevalence of upper extremity overuse injuries and pain among wheelchair users. As a result, recent effort has focused on determining how various propulsion techniques influence upper extremity demand during wheelchair propulsion. However, an important prerequisite for identifying the relationships between propulsion techniques and upper extremity demand is to understand how individual muscles contribute to the mechanical energetics of wheelchair propulsion. The purpose of this study was to use a forward dynamics simulation of wheelchair propulsion to quantify how individual muscles deliver, absorb and/or transfer mechanical power during propulsion. The analysis showed that muscles contribute to either push (i.e., deliver mechanical power to the handrim) or recovery (i.e., reposition the arm) subtasks, with the shoulder flexors being the primary contributors to the push and the shoulder extensors being the primary contributors to the recovery. In addition, significant activity from the shoulder muscles was required during the transition between push and recovery, which resulted in increased co-contraction and upper extremity demand. Thus, strengthening the shoulder flexors and promoting propulsion techniques that improve transition mechanics have much potential to reduce upper extremity demand and improve rehabilitation outcomes.     

Scapular orientation following repetitive prone rowing: Implications for potential subacromial impingement mechanisms

While fatigue of the rotator cuff demonstrably causes superior humeral head migration and concomitant risk of impingement, the relationship between specific muscular fatigue, scapular dyskinesis and impingement risk is less clear. The purpose of this study was to examine changes in scapular orientation following a simulated prone rowing fatiguing protocol that targeted the scapula stabilizing muscles while attempting to alleviate rotator cuff muscular demands. Scapular orientation and muscle activity were collected from participants before and immediately after the fatiguing task. This task fatigued both the stabilizing (upper and middle trapezius, and latissimus dorsi) and rotator cuff (supraspinatus, and infraspinatus) muscles. The upper extremity muscle fatigue pattern caused by the protocol did not elicit any significantly changes in three-dimensional scapular position with all post-fatigue changes being ?1° (p = 0.17–0.58). These results indicated that scapular reorientation is likely not the dominant mechanism of fatigue-induced subacromial impingement development. However, the substantial variability present in the kinematics prevents complete exclusion of scapular dyskinesis as a secondary causal mechanism of impingement.     

Interference and Shaping in Sensorimotor Adaptations with Rewards

When a perturbation is applied in a sensorimotor transformation task, subjects can adapt and maintain performance by either relying on sensory feedback, or, in the absence of such feedback, on information provided by rewards. For example, in a classical rotation task where movement endpoints must be rotated to reach a fixed target, human subjects can successfully adapt their reaching movements solely on the basis of binary rewards, although this proves much more difficult than with visual feedback. Here, we investigate such a reward-driven sensorimotor adaptation process in a minimal computational model of the task. The key assumption of the model is that synaptic plasticity is gated by the reward. We study how the learning dynamics depend on the target size, the movement variability, the rotation angle and the number of targets. We show that when the movement is perturbed for multiple targets, the adaptation process for the different targets can interfere destructively or constructively depending on the similarities between the sensory stimuli (the targets) and the overlap in their neuronal representations. Destructive interferences can result in a drastic slowdown of the adaptation. As a result of interference, the time to adapt varies non-linearly with the number of targets. Our analysis shows that these interferences are weaker if the reward varies smoothly with the subject''s performance instead of being binary. We demonstrate how shaping the reward or shaping the task can accelerate the adaptation dramatically by reducing the destructive interferences. We argue that experimentally investigating the dynamics of reward-driven sensorimotor adaptation for more than one sensory stimulus can shed light on the underlying learning rules.     

Neural activity states in different forms of physiological tremor. Facts and hypotheses

This paper attempts to combine (and thereby briefly review) various sets of physiological data in order to outline a qualitative model of the different states of stochastic neural activity underlying different forms of physiological tremor. Particular emphasis in put on spatial distributions of the properties of neural elements and their interconnexions, and on discharge characteristics of motor units and muscle spindle afferents including so-called early discharges and nonlinearities. It is argued that the wide variety of internal anatomical and functional structures of skeletal muscles and of their reflex organization must be considered when dealing with stability problems. Computer simulations of stochastic population models of the involved neuromuscular elements are advocated as means to investigate the relative importance of the many factors possibly contributing to stabilizing or de-stabilizing neuromuscular systems.     

An upper extremity kinematic model for evaluation of hemiparetic stroke

Quantification of rehabilitation progress is necessary for accurately assessing clinical treatments. A three-dimension (3D) upper extremity (UE) kinematic model was developed to obtain joint angles of the trunk, shoulder and elbow using a Vicon motion analysis system. Strict evaluation confirmed the system's accuracy and precision. As an example of application, the model was used to evaluate the upper extremity movement of eight hemiparetic stroke patients with spasticity, while completing a set of reaching tasks. Main outcome measures include kinematic variables of movement time, range of motion, peak angular velocity, and percentage of reach where peak velocity occurs. The model computed motion patterns in the affected and unaffected arms. The unaffected arm showed a larger range of motion and higher angular velocity than the affected arm. Frequency analysis (power spectrum) demonstrated lower frequency content for elbow angle and angular velocity in the affected limb when compared to the unaffected limb. The model can accurately quantify UE arm motion, which may aid in the assessment and planning of stroke rehabilitation, and help to shorten recovery time.     

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.     

Discriminating age and disability effects in locomotion: neuromuscular adaptations in musculoskeletal pathology.

We identified biomechanical variables indicative of lower extremity dysfunction, distinct from age-related gait adaptations, and examined interrelationships among these variables to better understand the neuromuscular adaptations in gait. Sagittal plane ankle, knee, and hip peak angles, moments, and powers and spatiotemporal parameters were acquired during preferred-speed gait in 120 subjects: 45 healthy young, 37 healthy elders, and 38 elders with functional limitations due to lower extremity musculoskeletal pathology, primarily arthritis. Multiple analysis of covariance with discriminate analysis, adjusted for gait speed, was used to identify the variables discriminating groups. Correlation analysis was used to explore interrelationships among these variables within each group. Healthy elders were discriminated (sensitivity 76%, specificity 82%) from young adults via decreased late-stance ankle plantar flexion angle, increased late-stance knee power absorption, and early-stance hip extensor power generation. Disabled elders were discriminated (sensitivity 74%, specificity 73%) from healthy elders via decreased late-stance ankle plantar flexor moment and power generation, increased early-stance ankle dorsiflexor moment, and late-stance hip flexor moment and power absorption. Relationships among variables showed a higher degree of coupling for the disabled elders compared with the healthy groups, suggesting a reduced ability to alter motor strategies. Our data suggest that, beyond age-related changes, elders with lower extremity dysfunction rely excessively on passive action of hip flexors to provide propulsion in late stance and contralateral ankle dorsiflexors to enhance stability. These findings support a growing body of evidence that gait changes with age and disablement have a neuromuscular basis, which may be informative in a motor control framework for physical therapy interventions.     

Maturation‐dependent control of vocal temporal plasticity in a songbird

Birdsong is a unique model to address learning mechanisms of the timing control of sequential behaviors, with characteristic temporal structures consisting of serial sequences of brief vocal elements (syllables) and silent intervals (gaps). Understanding the neural mechanisms for plasticity of such sequential behavior should be aided by characterization of its developmental changes. Here, we assessed the level of acute vocal plasticity between young and adult Bengalese finches, and also quantified developmental change in variability of temporal structure. Acute plasticity was tested by delivering aversive noise bursts contingent on duration of a target gap, such that birds could avoid the noise by modifying their song. We found that temporal variability of song features decreased with birds' maturation. Noise‐avoidance experiments demonstrated that maximal changes of gap durations were larger in young that in adult birds. After these young birds matured, the maximal change decreased to a similar level as adults. The variability of these target gaps also decreased as the birds matured. Such parallel changes suggest that the level of acute temporal plasticity could be predicted from ongoing temporal variability. Further, we found that young birds gradually began to stop their song at the target gap and restart from the introductory part of song, whereas adults did not. According to a synaptic chain model for timing sequence generation in premotor nuclei, adult learning would be interpreted as adaptive changes in conduction delays between chain‐to‐chain connections, whereas the learning of young birds could mainly depend on changes of the connections. © 2017 Wiley Periodicals, Inc. Develop Neurobiol 77: 995–1006, 2017     

When Money Is Not Enough: Awareness,Success, and Variability in Motor Learning

When performing a skill such as throwing a dart, many different combinations of joint motions suffice to hit the target. The motor system adapts rapidly to reduce bias in the desired outcome (i.e., the first-order moment of the error); however, the essence of skill is to produce movements with less variability (i.e., to reduce the second-order moment). It is easy to see how feedback about success or failure could sculpt performance to achieve this aim. However, it is unclear whether the dimensions responsible for success or failure need to be known explicitly by the subjects, or whether learning can proceed without explicit awareness of the movement parameters that need to change. Here, we designed a redundant, two-dimensional reaching task in which we could selectively manipulate task success and the variability of action outcomes, whilst also manipulating awareness of the dimension along which performance could be improved. Variability was manipulated either by amplifying natural errors, leaving the correlation between the executed movement and the visual feedback intact, or by adding extrinsic noise, decorrelating movement and feedback. We found that explicit, binary, feedback about success or failure was only sufficient for learning when participants were aware of the dimension along which motor behavior had to change. Without such awareness, learning was only present when extrinsic noise was added to the feedback, but not when task success or variability was manipulated in isolation; learning was also much slower. Our results highlight the importance of conscious awareness of the relevant dimension during motor learning, and suggest that higher-order moments of outcome signals are likely to play a significant role in skill learning in complex tasks.     

Theoretical contribution of the upper extremities to reducing trunk extension following a laboratory-induced slip

Slips are frequently the cause of fall-related injuries. Identifying modifiable biomechanical requirements for successful recovery is a key prerequisite to developing task-specific fall preventive training programs. The purpose of this study was to quantify the biomechanical role of the upper extremities during the initial phase of a slip resulting in trunk motion primarily in the sagittal plane. Two groups of adults were examined: adults over age 65 who fell and adults aged 18–40 who avoided falling after slipping. We hypothesized that rapid shoulder flexion could significantly reduce trunk extension velocity, that adults who slipped would implement this as a fall avoidance strategy, and that younger adults who avoided falling would use this strategy more effectively than older adults who fell. The kinematics of the 12 younger adults and eight older adults were analyzed using a three-segment conservation of momentum model developed to represent the trunk, head, and upper extremities. The model was used to estimate the possible contribution of the upper extremities to reducing trunk extension velocity. The model showed that upper extremity motion can significantly reduce trunk extension velocity. Although the upper extremities significantly reduced the trunk extension velocity of both young and older adults (p<0.027), the reduction found for the young adults, 13.6±11.4%, was significantly larger than that of the older adults (5.8±3.4%, p=0.045). Given the potential for trunk extension velocity to be reduced by rapid shoulder flexion, fall prevention interventions focused on slip-related falls may benefit from including upper extremity motion as an outcome whether through conventional or innovative strategies.