Arm-plane representation of shoulder compensation during pointing movements in patients with stroke

Improvements in functional motor activities are often accompanied by motor compensations to overcome persistent motor impairment in the upper limb. Kinematic analysis is used to objectively quantify movement patterns including common motor compensations such as excessive trunk displacement during reaching. However, a common motor compensation to assist reaching, shoulder abduction, is not adequately characterized by current motion analysis approaches. We apply the arm-plane representation that accounts for the co-variation between movements of the whole arm, and investigate its ability to identify and quantify compensatory arm movements in stroke subjects when making forward arm reaches. This method has not been previously applied to the analysis of motion deficits. Sixteen adults with right post-stroke hemiparesis and eight healthy age-matched controls reached in three target directions (14 trials/target; sampling rate: 100 Hz). Arm-plane movement was validated against endpoint, joint, and trunk kinematics and compared between groups. In stroke subjects, arm-plane measures were correlated with arm impairment (Fugl-Meyer Assessment) and ability (Box and Blocks) scores and were more sensitive than clinical measures to detect mild motor impairment. Arm-plane motion analysis provides new information about motor compensations involving the co-variation of shoulder and elbow movements that may help to understand the underlying motor deficits in patients with stroke.     

Effects of finger markers on the kinematics of reaching movements in young children and adults

Kinematic studies to date have not considered in what ways surface markers may affect the performance of the analyzed motion. This neglect is particularly apparent in studies of prehensile movements involving surface markers attached to the fingers. In order to specify any such effects, a range of kinematic parameters derived from simple reach-to-grasp movements, both with and without finger markers, by 3-year old children and adults were analyzed. Finger markers affected both the spatial and temporal nature of the children's reaching performance as revealed by a more temporally segmented reaching path, an age-atypically straighter reaching path, and an increased time to establish a pincer grip. The reaching movements made by the adults were unaffected in terms of the kinematic parameters employed.     

Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain

Although deficits in the activation of abdominal muscles are present in people with low back pain (LBP), this can be modified with motor training. Training of deep abdominal muscles in isolation from the other trunk muscles, as an initial phase of training, has been shown to improve the timing of activation of the trained muscles, and reduce symptoms and recurrence of LBP. The aim of this study was to determine if training of the trunk muscles in a non-isolated manner can restore motor control of these muscles in people with LBP. Ten subjects with non-specific LBP performed a single session of training that involved three tasks: “abdominal curl up”, “side bridge” and “birdog”. Electromyographic activity (EMG) of trunk and deltoid muscles was recorded with fine-wire and surface electrodes during rapid arm movements and walking, before and immediately following the intervention. Onset of trunk muscle EMG relative to that of the prime mover (deltoid) during arm movements and the mean, standard deviation (SD) and coefficient of variation of abdominal muscle EMG during walking were calculated. There was no significant change in the times of onset of trunk muscle EMG during arm movements nor was there any change in the variability of EMG of the abdominal muscles during walking. However, the mean amplitude and SD of abdominal EMG was reduced during walking after training. The results of this study suggest that unlike isolated voluntary training, co-contraction training of the trunk muscles does not restore the motor control of the deep abdominal muscles in people with LBP after a single session of training.     

Shoulder function after constraint-induced movement therapy assessed with 3D kinematics and clinical and patient reported outcomes: A prospective cohort study

IntroductionWe hypothesised that reduced shoulder function post stroke improves during constraint-induced movement therapy and that improvement in scapula upward rotation measured with three-dimensional kinematics is associated with improvements in clinical and patient reported outcomes.MethodsThirty-seven patients were tested pre and post constraint-induced movement therapy and again at three-month follow-up. Kinematic outcome measures – with scapula upward rotation as the primary outcome – during tasks 5 (ReachLow) and 6 (ReachHigh) from the Wolf Motor Function Test were included together with clinical and patient reported outcomes. Changes in outcome measures were analysed with linear mixed models and logistic regression analysis.FindingsScapula upward rotation was reduced from 16.2° pre intervention through 15.9° post intervention to 15.6° at three-month follow-up during ReachHigh. Statistically significant reductions of <2° were also found for shoulder flexion during ReachLow and trunk lateral flexion during ReachHigh. The clinical and patient reported outcomes showed improvements post constraint-induced movement therapy, and at follow-up, the outcomes resembled post values.InterpretationThe minimal improvements in selected 3D kinematic measures of upper extremity movements did not reflect any clinically meaningful changes. Therefore, the clinical and patient reported improvements could not be related to restitution of shoulder function.     

Strategy and synergy: two levels of equilibrium control during movement. Effects of the microgravity]

Equilibrium is ensured during forward or backward upper trunk movements by displacing the hip and knee simultaneously in opposite directions. When fast movements are performed, a muscle synergy characterized by the early activation of a set of trunk, thigh and leg muscles precedes the onset of the kinematic changes. The question which is addressed concerns the possibility that two levels of equilibrium control might exist during upper trunk movements: the strategy level, which is relatively invariant, is characterized by the displacement in opposite directions of the upper and low segments, and the muscle synergy level at which the strategy is implemented, which may be adaptable to the environmental constraints. When upper trunk movements are performed under microgravity with the subject's feet fixed to the floor of the space cabin, the displacement of upper and lower body segments in opposite directions still occurs, although this is no longer necessary to maintain the equilibrium. This kinematic strategy seems to be aimed at regulating the centre of inertia position with respect to the feet. The muscle synergies associated with these kinematic changes are modified, however, under microgravity. After returning to the ground, the previous synergies do not reappear immediately, but only after a few days. This suggests that a short period of learning is needed to change the synergy. These data are compatible with the hypothesis that two levels of equilibrium control actually exist during upper trunk movements, the strategy level, which is kinematic and invariant, and the synergy level, which is adaptable to the environmental constraints through a short learning process.     

A new approach to reaching control for tetraplegic subjects

A simple upper limb control strategy to guide reaching in preparation to grasp for tetraplegic subjects is proposed. The control is based on new studies of self-paced human arm movements involving rotations about the shoulder and elbow joints. An experimental study of reaching, while grasping, by able-bodied humans, allowed us to reduce the dimensionality of the control vector from two to a single variable. This was accomplished by detailed analysis of the synergy between shoulder and elbow joint angles. This study examined only movements in teh horizontal plane. In the experiments we varied: (a) the shape of targets; (b) their position relative to the initial position of the hand; and (c) the speed of reaching. A synergy between shoulder and elbow joint angles was found in most analysed movements, and it was characterized by a scaling parameter between elbow and shoulder angular velocities. The scaling parameter was determined from the target position presented in the visual perceptive field and initial shoulder and elbow angles. The same experimental setup in studies with tetraplegics with retained shoulder movements showed that this natural synergism is preserved even though the motor and sensory components of the upper limb are reduced or absent. Tetraplegics originally showed a very different reaching pattern, but after short training sessions they developed a reaching behaviour which was similar to able-bodied subjects. The results presented can be used in the following way: a tetraplegic subject lacking elbow extension and flexion may be fitted with an assistive system which will be volitionally controlled only from ipsilateral shoulder movements. The assistive system can comprise either a motorized brace, or a functional electrical stimulation system applied to elbow flexors and extensors. With this system volitional movements at the shoulder would bring the hand into the correct position to accomplish an assisted grasping motion.     

Weightlifting performance is related to kinematic and kinetic patterns of the hip and knee joints

The purpose of this study was to investigate the correlations between biomechanical outcome measures and weightlifting performance. Joint kinematics and kinetics of the hip, knee, and ankle were calculated while 10 subjects performed a clean at 85% of 1 repetition maximum (1RM). Kinematic and kinetic time-series patterns were extracted with principal components analysis. Discrete scores for each time-series pattern were calculated and used to determine how each pattern was related to body mass-normalized 1RM. Two hip kinematic and 2 knee kinetic patterns were significantly correlated with relative 1RM. The kinematic patterns captured hip and trunk motions during the first pull and hip joint motion during the movement transition between the first and second pulls. The first kinetic pattern captured a peak in the knee extension moment during the second pull. The second kinetic pattern captured a spatiotemporal shift in the timing and amplitude of the peak knee extension moment. The kinematic results suggest that greater lift mass was associated with steady trunk position during the first pull and less hip extension motion during the second-knee bend transition. Further, the kinetic results suggest that greater lift mass was associated with a smaller knee extensor moments during the first pull, but greater knee extension moments during the second pull, and an earlier temporal transition between knee flexion-extension moments at the beginning of the second pull. Collectively, these results highlight the importance of controlled trunk and hip motions during the first pull and rapid employment of the knee extensor muscles during the second pull in relation to weightlifting performance.     

Motor control of voluntary arm movements

The motor control of pointing and reaching-to-grasp movements was investigated using two different approaches (kinematic and modelling) in order to establish whether the type of control varies according to modifications of arm kinematics. Kinematic analysis of arm movements was performed on subjects' hand trajectories directed to large and small stimuli located at two different distances. The subjects were required either to grasp and to point to each stimulus. The kinematics of the subsequent movement, during which subject's hand came back to the starting position, were also studied. For both movements, kinematic analysis was performed on hand linear trajectories as well as on joint angular trajectories of shoulder and elbow. The second approach consisted in the parametric identification of the black box (ARMAX) model of the controller driving the arm movement. Such controller is hypothesized to work for the correct execution of the motor act. The order of the controller ARMAX model was analyzed with respect to the different experimental conditions (distal task, stimulus size and distance). Results from kinematic analysis showed that target distance and size influenced kinematic parameters both of angular and linear displacements. Nevertheless, the structure of the motor program was found to remain constant with distane and distal task, while it varied with precision requirements due to stimulus size. The estimated model order of the controller confirmed the invariance of the control law with regard to movement amplitude, whereas it was sensitive to target size.     

Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain.

This study investigated long-term effects of training on postural control using the model of deficits in activation of transversus abdominis (TrA) in people with recurrent low back pain (LBP). Nine volunteers with LBP attended four sessions for assessment and/or training (initial, two weeks, four weeks and six months). Training of repeated isolated voluntary TrA contractions were performed at the initial and two-week session with feedback from real-time ultrasound imaging. Home program involved training twice daily for four weeks. Electromyographic activity (EMG) of trunk and deltoid muscles was recorded with surface and fine-wire electrodes. Rapid arm movement and walking were performed at each session, and immediately after training on the first two sessions. Onset of trunk muscle activation relative to prime mover deltoid during arm movements, and the coefficient of variation (CV) of EMG during averaged gait cycle were calculated. Over four weeks of training, onset of TrA EMG was earlier during arm movements and CV of TrA EMG was reduced (consistent with more sustained EMG activity). Changes were retained at six months follow-up (p<0.05). These results show persistence of motor control changes following training and demonstrate that this training approach leads to motor learning of automatic postural control strategies.     

Kinematic and EMG characteristics of simple shoulder movements with proprioception and visual feedback.

The objective of this study was to determine if simple, shoulder movements use the dual control hypothesis strategy, previously demonstrated with elbow movements, and to see if this strategy also applies in the absence of visual feedback. Twenty subjects were seated with their right arm abducted to 90 degrees and externally rotated in the scapular plane. Subjects internally rotated to a target position using a custom shoulder wheel at three different speeds with and without visual feedback. Kinematics were collected with a motion analysis system and electromyographic (EMG) recordings of the pectoralis major (PECT), infraspinatus (INFRA), anterior and posterior (ADELT, PDELT) deltoid muscles were used to evaluate muscle activity patterns during movements. Kinematics changed as movement speed increased with less accuracy (p<0.01). Greater EMG activity was observed in the PECT, PDELT, and INFRA with shorter durations for the ADELT, PDELT and INFRA. Movements with only kinesthetic feedback were less accurate (p<0.01) and performed faster (p<0.01) than movements with visual feedback. EMG activity suggests no major difference in CNS control strategies in movements with and without visual feedback. Greater resolution with visual feedback enables the implementation of a dual control strategy, allowing greater movement velocity while maintaining accuracy.     

Training multi-parameter gaits to reduce the knee adduction moment with data-driven models and haptic feedback

The purpose of this study was to evaluate gait retraining for reducing the knee adduction moment. Our primary objective was to determine whether subject-specific altered gaits aimed at reducing the knee adduction moment by 30% or more could be identified and adopted in a single session through haptic (touch) feedback training on multiple kinematic gait parameters. Nine healthy subjects performed gait retraining, in which data-driven models specific to each subject were determined through experimental trials and were used to train novel gaits involving a combination of kinematic changes to the tibia angle, foot progression and trunk sway angles. Wearable haptic devices were used on the back, knee and foot for real-time feedback. All subjects were able to adopt altered gaits requiring simultaneous changes to multiple kinematic parameters and reduced their knee adduction moments by 29-48%. Analysis of single parameter gait training showed that moving the knee medially by increasing tibia angle, increasing trunk sway and toeing in all reduced the first peak of the knee adduction moment with tibia angle changes having the most dramatic effect. These results suggest that individualized data-driven gait retraining may be a viable option for reducing the knee adduction moment as a treatment method for early-stage knee osteoarthritis patients with sufficient sensation, endurance and motor learning capabilities.     

Dynamic stability of individuals with transtibial amputation walking in destabilizing environments

Lower limb amputation substantially disrupts motor and proprioceptive function. People with lower limb amputation experience considerable impairments in walking ability, including increased fall risk. Understanding the biomechanical aspects of the gait of these patients is crucial in improving their gait function and their quality of life. In the present study, 9 persons with unilateral transtibial amputation and 13 able-bodied controls walked on a large treadmill in a Computer Assisted Rehabilitation Environment (CAREN). While walking, subjects were either not perturbed, or were perturbed either by continuous mediolateral platform movements or by continuous mediolateral movements of the visual scene. Means and standard deviations of both step lengths and step widths increased significantly during both perturbation conditions (all p<0.001) for both groups. Measures of variability, local and orbital dynamic stability of trunk movements likewise exhibited large and highly significant increases during both perturbation conditions (all p<0.001) for both groups. Patients with amputation exhibited greater step width variability (p=0.01) and greater trunk movement variability (p=0.04) during platform perturbations, but did not exhibit greater local or orbital instability than healthy controls for either perturbation conditions. Our findings suggest that, in the absence of other co-morbidities, patients with unilateral transtibial amputation appear to retain sufficient sensory and motor function to maintain overall upper body stability during walking, even when substantially challenged. Additionally, these patients did not appear to rely more heavily on visual feedback to maintain trunk stability during these walking tasks.     

Study of the scapular muscle latency and deactivation time in people with and without shoulder impingement

Changes in muscle activities are commonly associated with shoulder impingement and theoretically caused by changes in motor program strategies. The purpose of this study was to assess for differences in latencies and deactivation times of scapular muscles between subjects with and without shoulder impingement. Twenty-five healthy subjects and 24 subjects with impingement symptoms were recruited. Glenohumeral kinematic data and myoelectric activities using surface electrodes from upper trapezius (UT), lower trapezius (LT), serratus anterior (SA) and anterior fibers of deltoid were collected as subjects raised and lowered their arm in response to a visual cue. Data were collected during unloaded, loaded and after repetitive arm raising motion conditions. The variables were analyzed using 2 or 3 way mixed model ANOVAs. Subjects with impingement demonstrated significantly earlier contraction of UT while raising in the unloaded condition and an earlier deactivation of SA across all conditions during lowering of the arm. All subjects exhibited an earlier activation and delayed deactivation of LT and SA in conditions with a weight held in hand. The subjects with impingement showed some significant differences to indicate possible differences in motor control strategies. Rehabilitation measures should consider appropriate training measures to improve movement patterns and muscle control.     

Upper body muscle strength and endurance in relation to peak exercise capacity during cycling in healthy sedentary male subjects

The aim of this study was to investigate the relation between upper body muscle strength and endurance, and exercise capacity during an incremental cycle exercise test in sedentary healthy male subjects before and after 6 months of combined supervised group training. Exercise capacity was measured as maximal oxygen consumption (VO?peak) and maximum work rate (WR(peak)). Muscle strength and endurance of the upper body were assessed by bench press and isometric measurement of trunk extensor and flexor maximum voluntary contraction (MVC) and trunk extensor and flexor endurance. Thirty-one subjects were studied before and after the training period. Bench press and trunk extensor MVC correlated to exercise capacity at baseline and after training. Training improved VO?peak and WR(peak). The correlation between trunk extensor MVC and exercise capacity improved after training. Upper body strength may affect exercise capacity by increasing the rider's ability to generate force on the handlebar that can be transmitted to the pedals. Resistance training of the arms, chest, and trunk may help improve cycling performance.     

Kinematic measurement of the lumbar spine and pelvis in the normal population

Spinal and pelvis motion has been studied by a variety of different methods, the majority of which have a number of limitations. The present study investigated motion characteristics of the lumbar spine and pelvis using a three-dimensional optoelectronic system. The aim of our study was to determine kinematic parameters of spine and pelvis during trunk flexion, extension and lateral bending in normal, healthy subjects. Kinematic motion analysis was performed on 63 asymptomatic volunteers for four different trunk motions. This study has shown that the pelvis range of motion is affected by the gender Contribution of pelvic movement to trunk flexion was 50%, while pelvic angle was significantly higher in women. During lateral bending female subjects had statistically significant higher values of vertebral arc with respect to male subjects. During extension the contribution of pelvic movement was 45%. There was no significant difference found in total angle, pelvic angle and vertebral arc.     

Trunk Muscle Activation at the Initiation and Braking of Bilateral Shoulder Flexion Movements of Different Amplitudes

The aim of this study was to investigate if trunk muscle activation patterns during rapid bilateral shoulder flexions are affected by movement amplitude. Eleven healthy males performed shoulder flexion movements starting from a position with arms along sides (0°) to either 45°, 90° or 180°. EMG was measured bilaterally from transversus abdominis (TrA), obliquus internus (OI) with intra-muscular electrodes, and from rectus abdominis (RA), erector spinae (ES) and deltoideus with surface electrodes. 3D kinematics was recorded and inverse dynamics was used to calculate the reactive linear forces and torque about the shoulders and the linear and angular impulses. The sequencing of trunk muscle onsets at the initiation of arm movements was the same across movement amplitudes with ES as the first muscle activated, followed by TrA, RA and OI. All arm movements induced a flexion angular impulse about the shoulders during acceleration that was reversed during deceleration. Increased movement amplitude led to shortened onset latencies of the abdominal muscles and increased level of activation in TrA and ES. The activation magnitude of TrA was similar in acceleration and deceleration where the other muscles were specific to acceleration or deceleration. The findings show that arm movements need to be standardized when used as a method to evaluate trunk muscle activation patterns and that inclusion of the deceleration of the arms in the analysis allow the study of the relationship between trunk muscle activation and direction of perturbing torque during one and the same arm movement.     

Evidence for an exposure-response relationship between trunk flexion and impairments in trunk postural control

Prolonged trunk flexion alters passive and active trunk tissue behaviors, and exposure-response relationships between the magnitude of trunk flexion exposure and changes in these behaviors have been reported. This study assessed whether similar exposure-response relationships exist between such exposures and impairments in trunk postural control. Twelve participants (6 M, 6 F) were exposed to three distinct trunk flexion conditions (and a no-flexion control condition), involving different flexion durations with/without an external load, and which induced differing levels of passive tissue creep. Trunk postural control was assessed prior to and immediately following trunk flexion exposures, and during 10 min of standing recovery, by tracking center of pressure (COP) movements during a seated balance task. All COP-based sway measures increased following each flexion exposure. In the anteroposterior direction, these increases were larger with increasing exposure magnitude, whereas such a relationship was not evident for mediolateral sway measures. All measures were fully recovered following 10 min of standing. The present results provide evidence for an exposure-response relationship between trunk flexion exposures and impairments in trunk postural control; specifically, larger impairments following increased exposures (i.e., longer flexion duration and presence of external load). Such impairments in trunk postural control may result from some combination of reduced passive trunk stiffness and altered/delayed trunk reflex responses, and are generally consistent with prior evidence of exposure-dependent alterations in trunk mechanical and neuromuscular behaviors assessed using positional trunk perturbations. Such evidence suggests potential mechanistic pathways through which trunk flexion exposures may contribute to low-back injury risk.     

Real-time knee adduction moment feedback for gait retraining through visual and tactile displays

The external knee adduction moment (KAM) measured during gait is an indicator of tibiofemoral joint osteoarthritis progression and various strategies have been proposed to lower it. Gait retraining has been shown to be an effective, noninvasive approach for lowering the KAM. We present a new gait retraining approach in which the KAM is fed back to subjects in real-time during ambulation. A study was conducted in which 16 healthy subjects learned to alter gait patterns to lower the KAM through visual or tactile (vibration) feedback. Participants converged on a comfortable gait in just a few minutes by using the feedback to iterate on various kinematic modifications. All subjects adopted altered gait patterns with lower KAM compared with normal ambulation (average reduction of 20.7%). Tactile and visual feedbacks were equally effective for real-time training, although subjects using tactile feedback took longer to converge on an acceptable gait. This study shows that real-time feedback of the KAM can greatly increase the effectiveness and efficiency of subject-specific gait retraining compared with conventional methods.     

Functional activity characteristics of individuals with shoulder dysfunctions

Shoulder-related dysfunction affects individuals’ ability to function independently and thus decreases quality of life. Functional task assessment is a key concern for a clinician in diagnostic assessment, outcome measurement, and planning of treatment programs. The purpose of this study was to test the reliability of the FASTRAK 3-dimensional (3-D) motion analysis and surface electromyography (sEMG) systems to analyze 3-D shoulder complex movements during functional tasks and compare motion patterns between subjects with and without shoulder dysfunctions (SDs).For the test, sEMG and 3-D motion analysis systems were used to characterize the functional tasks. Twenty-five asymptomatic male subjects and 21 male subjects with right shoulder disorders performed four functional tasks which involved arm reaching and raising activities with their dominant arms. Reliability was estimated by the intraclass correlation coefficient (ICC). Motion pattern was compared between two groups using mixed analysis of variances (ANOVAs). Shoulder complex kinematics and associated muscular activities during functional tasks were reliably quantified (ICC = 0.83–0.99) from the means of three trials. Relative to the group without SDs, the group with SDs showed significant alteration in shoulder complex kinematics (3°–40°) and associated muscular activities (3–10% maximum). Scapular tipping, scapular elevation, upper trapezius muscle function, and serratus anterior muscle function may have implications in the rehabilitation of patients with SDs.     

Measuring generalization of visuomotor perturbations in wrist movements using mobile phones

Recent studies in motor control have shown that visuomotor rotations for reaching have narrow generalization functions: what we learn during movements in one direction only affects subsequent movements into close directions. Here we wanted to measure the generalization functions for wrist movement. To do so we had 7 subjects performing an experiment holding a mobile phone in their dominant hand. The mobile phone's built in acceleration sensor provided a convenient way to measure wrist movements and to run the behavioral protocol. Subjects moved a cursor on the screen by tilting the phone. Movements on the screen toward the training target were rotated and we then measured how learning of the rotation in the training direction affected subsequent movements in other directions. We find that generalization is local and similar to generalization patterns of visuomotor rotation for reaching.