Regulation of wrist stiffness by the stretch reflex

In restoring the angular position after a displacement, the role of the muscle stretch reflex was investigated by comparing the restored angular torques and angular positions in the wrist under ischaemic and non-ischaemic conditions in normal human subjects. The wrist compliance (COM), defined as the dynamic relation between the angular position and the angular torque of the joint, was calculated to quantify the changes in the restoration of a displacement after abolishing the stretch reflex by ischaemia. The elasticity from the COM-function was found to be single most important factor controlled by the stretch reflex. The elasticity that equals the static stiffness of the system increased by more than 100%, from 0.21 Nm degree-1 with abolished reflex to 0.45 Nm degree-1 with intact reflex. Our results have shown that the stretch reflex assists in the rapid return of the limb to its original position after a mechanical displacement. When the reflex was blocked by ischaemia, the perturbation displaced the limb further away from the initial position.     

Knee stability and muscle coordination in patients with anterior cruciate ligament injuries: An electromyographic approach

We present findings on the way in which to use electromyographic (EMG) measurements from muscles acting on the knee in planning rehabilitation of subjects after rupture of anterior cruciate ligament (ACL). ACL subjects demonstrated an earlier recruitment and a tendency to prolonged activity in muscles around the deficient knee as compared with a control group. Especially the hamstring lateralis and the gastrocnemius medialis (GM) muscles showed an earlier EMG onset and a longer EMG burst duration. The clinical relevance of the EMG findings was assessed by comparing the muscle coordination and relative levels of activity between a functionally excellent/good and a functionally poor ACL patient group. Significant differences between the two groups were noted in EMG onset and burst duration of the GM muscle. A rehabilitation program based on the EMG findings from the GM muscle was designed. In this program, the ACL subjects with poor stability were trained to change the EMG activity of the gastrocnemius muscles according to the recruitment pattern of the good/excellent ACL-group. We were able to train the subjects to change their muscle recruitment and to improve their knee stability. The stability of the knee joint depends on the stiffness of the muscles and ligaments around and within the knee. We discuss the importance of the gastrocnemius muscles with regard to knee joint stiffness.     

Predictions of knee and ankle moments of force in walking from EMG and kinematic data

A deterministic model was developed and validated to calculate instantaneous ankle and knee moments during walking using processed EMG from representative muscles, instantaneous joint angle as a correlate of muscle length and angular velocity as a correlate of muscle velocity, and having available total instantaneous joint moments for derivation of certain model parameters. A linear regression of the moment on specifically processed EMG, recorded while each subject performed cycled isometric calibration contractions, yielded the constants for a basic moment-EMG relationship. Using the resultant moment for optimization, the predicted moment was proportionally augmented for longer muscle lengths and reduced for shorter lengths. Similarly, the predicted moment was reduced for shortening velocities and increased if the muscle was lengthening. The plots of moments predicted using the full model and those calculated from link segment mechanics followed each other quite closely. The range of root mean square errors were: 3.2-9.5 Nm for the ankle and 4.7-13.0 Nm for the knee.     

An ankle-foot orthosis powered by artificial pneumatic muscles

We developed a pneumatically powered orthosis for the human ankle joint. The orthosis consisted of a carbon fiber shell, hinge joint, and two artificial pneumatic muscles. One artificial pneumatic muscle provided plantar flexion torque and the second one provided dorsiflexion torque. Computer software adjusted air pressure in each artificial muscle independently so that artificial muscle force was proportional to rectified low-pass-filtered electromyography (EMG) amplitude (i.e., proportional myoelectric control). Tibialis anterior EMG activated the artificial dorsiflexor and soleus EMG activated the artificial plantar flexor. We collected joint kinematic and artificial muscle force data as one healthy participant walked on a treadmill with the orthosis. Peak plantar flexor torque provided by the orthosis was 70 Nm, and peak dorsiflexor torque provided by the orthosis was 38 Nm. The orthosis could be useful for basic science studies on human locomotion or possibly for gait rehabilitation after neurological injury.     

An EMG-driven musculoskeletal model to estimate muscle forces and knee joint moments in vivo

This paper examined if an electromyography (EMG) driven musculoskeletal model of the human knee could be used to predict knee moments, calculated using inverse dynamics, across a varied range of dynamic contractile conditions. Muscle-tendon lengths and moment arms of 13 muscles crossing the knee joint were determined from joint kinematics using a three-dimensional anatomical model of the lower limb. Muscle activation was determined using a second-order discrete non-linear model using rectified and low-pass filtered EMG as input. A modified Hill-type muscle model was used to calculate individual muscle forces using activation and muscle tendon lengths as inputs. The model was calibrated to six individuals by altering a set of physiologically based parameters using mathematical optimisation to match the net flexion/extension (FE) muscle moment with those measured by inverse dynamics. The model was calibrated for each subject using 5 different tasks, including passive and active FE in an isokinetic dynamometer, running, and cutting manoeuvres recorded using three-dimensional motion analysis. Once calibrated, the model was used to predict the FE moments, estimated via inverse dynamics, from over 200 isokinetic dynamometer, running and sidestepping tasks. The inverse dynamics joint moments were predicted with an average R(2) of 0.91 and mean residual error of approximately 12 Nm. A re-calibration of only the EMG-to-activation parameters revealed FE moments prediction across weeks of similar accuracy. Changing the muscle model to one that is more physiologically correct produced better predictions. The modelling method presented represents a good way to estimate in vivo muscle forces during movement tasks.     

Comparison between EMG to force processing and kinetic analysis for the calf muscle moment in walking and stepping

In EMG to force processing the force of a muscle or the corresponding muscle moment with respect to the joint is determined from EMG and muscle length by means of a model of the muscle's contractile and elastic properties. In kinetic analysis the joint moment is calculated from the ground reaction force and the positions and accelerations of the body segments by means of Newtonian equations, based on a rigid body segment model. These two fundamentally different methods have been compared by determining simultaneously the calf muscle moment and the total ankle moment in walking at slow, moderate and fast speed and in stepping up and down a low bench. As long as there is no activity of other muscles, the moments obtained by either method should be identical. The analysis was restricted to such periods, as assessed from the EMG of tibialis anterior. In each experimental condition three steps were analyzed in five subjects of 21-22 yr. In comparison with the results of kinetic analysis, EMG processing shows differences between 7 and 54 Nm r.m.s., with an average of 22 Nm r.m.s. Normalized with respect to the r.m.s. value of the moment itself, the differences amount to 0.13-0.51, with an average of 0.22. In the majority of cases there was no systematic deviation between EMG processing and kinetic analysis and the r.m.s. difference was of the same order of magnitude as determined previously in ergometer experiments.     

Active trunk stiffness increases with co-contraction.

Trunk dynamics, including stiffness, mass and damping were quantified during trunk extension exertions with and without voluntary recruitment of antagonistic co-contraction. The objective of this study was to empirically evaluate the influence of co-activation on trunk stiffness. Muscle activity associated with voluntary co-contraction has been shown to increase joint stiffness in the ankle and elbow. Although biomechanical models assume co-active recruitment causes increase trunk stiffness it has never been empirically demonstrated. Small trunk displacements invoked by pseudorandom force disturbances during trunk extension exertions were recorded from 17 subjects at two co-contraction conditions (minimal and maximal voluntary co-contraction recruitment). EMG data were recorded from eight trunk muscles as a baseline measure of co-activation. Increased EMG activity confirms that muscle recruitment patterns were different between the two co-contraction conditions. Trunk stiffness was determined from analyses of impulse response functions (IRFs) of trunk dynamics wherein the kinematics were represented as a second-order behavior. Trunk stiffness increased 37.8% (p < 0.004) from minimal to maximal co-activation. Results support the assumption used in published models of spine biomechanics that recruitment of trunk muscle co-contraction increases trunk stiffness thereby supporting conclusions from those models that co-contraction may contribute to spinal stability.     

Accessory muscle activation during the superimposed burst technique

Quadriceps muscle activation is assessed using the superimposed burst technique. This technique involves percutaneous muscle stimulation superimposed during maximal isometric volitional knee extension. It is unknown whether accessory muscle activation during maximal knee extension influences estimates of quadriceps muscle activation. Our aim was to compare accessory muscle activation while performing the superimposed burst technique using investigator delivered verbal instruction to constrain the system (CS) and a participant preferred (PP) technique. Twenty five healthy, active individuals (13M/12F, age=23.8 ± 3.35, height=72.73 ± 14.51 cm, and weight=175.29 ± 9.59 kg) were recruited for this study. All participants performed superimposed burst testing with (CS) and without (PP) verbal instruction to encourage isolated quadriceps activation during maximal isometric knee extension. The main outcome variables measured were knee extension torque, quadriceps central activation ratio and mean EMG of vastus lateralis, biceps femoris, and lumbar paraspinal muscles. There were significant differences in knee extension torque (CS=2.87 ± 0.93 Nm/kg, PP=3.40 ± 1.12 Nm/kg, p<0.001), superimposed burst torque (CS=3.40 ±0.98 Nm/kg, PP=3.75 ± 1.11 Nm/kg, p=0.002) and quadriceps CAR (CS=84.1 ± 12.0%, PP=90.2 ± 9.9%, p<0.001) between the techniques. There was also a significant difference in lumbar paraspinal EMG (CS=6.40 ± 8.52%, PP=11.86 ± 14.89%, p=0.043) between the techniques however vastus lateralis EMG was not significantly different. Patient instruction via verbal instruction to constrain proximal structures may help patient minimize confounders to knee extension torque generation while maximizing quadriceps activation.     

Strategies used to stabilize the elbow joint challenged by inverted pendulum loading

The stiffness of activated muscles may stabilize a loaded joint by preventing perturbations from causing large displacements and injuring the joint. Here the elbow muscle recruitment patterns were compared with the forearm loaded vertically (a potentially unstable inverted pendulum configuration) and with horizontal loading. Eighteen healthy subjects were studied with the forearm vertical and supinated and the elbow flexed approximately 90 degrees. In the first experiment EMG electrodes recorded activity of biceps, triceps, and brachioradialis muscles for joint torques produced (a) by voluntarily exerting a horizontal force isometrically (b) by voluntarily flexing and extending the elbow while the forearm was loaded vertically with 135N. The relationship between the EMG and the torque generated was quantified by the linear regression slope and zero-torque intercept. In a second experiment a vertical load increasing linearly with time up to 300N was applied.In experiment 1 the EMG-torque relationships for biceps and triceps had an intercept about 10% of maximum voluntary effort greater with the vertical compared to the horizontal force, the inverse was found for Brachioradialis, but the EMG-torque slopes for both agonist and antagonistic muscles were not different. In experiment 2 there were 29 trials with minimal elbow displacement and all the three muscles activated on the order of 11% of maximum activation to stabilize the elbow; 19 trials had small elbow extension and 14 trials small flexion requiring altered muscle forces for equilibrium; 7 trials ended in large unstable displacement or early termination of the test. An analysis indicate that the observed levels of muscle activation would only provide stability if the muscles' short-range stiffness was at the high end of the published range, hence the elbow was marginally stable. The stability analysis also indicated that the small elbow extension increased stability and flexion decreased stability.     

Dynamic and static control of the human knee joint in abduction-adduction

It is unclear whether humans can voluntarily control dynamic and static properties in knee abduction-adduction, which may be important in performing functional tasks and preventing injuries, whether the main load is about the abduction axis or not. A joint-driving device was used to perturb the knee in abduction-adduction at full knee extension under both passive (muscle relaxed) and active (muscle contracted in abduction or adduction) conditions. Dynamic control properties in knee abduction-adduction were characterized by joint stiffness, viscosity, and limb inertia, and quasi-static knee torque-angle relationship was characterized by knee abduction-adduction laxity and quasi-static stiffness (at a 20Nm moment). It was found that the subjects were capable of generating net abduction and adduction moment through differential co-contraction of muscles crossing the medial and lateral sides of the knee, which helped to reduce the abduction-adduction joint laxity (p< or =0.01) and increase stiffness (p<0.027) and viscous damping. Knee abduction laxity was significantly lower than adduction laxity (p=0.043) and the quasi-static abduction stiffness was significantly higher than adduction stiffness (p<0.001). The knee joint showed significantly higher stiffness and viscosity in abduction-adduction than their counterparts in knee flexion-extension at comparable levels of joint torque (p<0.05). Similar to dynamic flexion-extension properties, the system damping ratio remained constant over different levels of contraction, indicating simplified control tasks for the central nervous system; while the natural undamped frequency increased considerably with abduction-adduction muscle contraction, presumably making the knee a quicker system during strenuous tasks involving strong muscle contraction.     

Elevation and orientation of external loads influence trunk neuromuscular response and spinal forces despite identical moments at the L5–S1 level

A wide range of loading conditions involving external forces with varying magnitudes, orientations and locations are encountered in daily activities. Here we computed the effect on trunk biomechanics of changes in force location (two levels) and orientation (5 values) in 4 subjects in upright standing while maintaining identical external moment of 15 Nm, 30 N m or 45 Nm at the L5–S1. Driven by measured kinematics and gravity/external loads, the finite element models yielded substantially different trunk neuromuscular response with moderate alterations (up to 24% under 45 Nm moment) in spinal loads as the load orientation varied. Under identical moments, compression and shear forces at the L5–S1 as well as forces in extensor thoracic muscles progressively decreased as orientation of external forces varied from downward gravity (90°) all the way to upward (−25°) orientation. In contrast, forces in local lumbar muscles followed reverse trends. Under larger horizontal forces at a lower elevation, lumbar muscles were much more active whereas extensor thoracic muscle forces were greater under smaller forces at a higher elevation. Despite such differences in activity pattern, the spinal forces remained nearly identical (<6% under 45 Nm moment). The published recorded surface EMG data of extensor muscles trend-wise agreed with computed local muscle forces as horizontal load elevation varied but were overall different from results in both local and global muscles when load orientation altered. Predictions demonstrate the marked effect of external force orientation and elevation on the trunk neuromuscular response and spinal forces and questions attempts to estimate spinal loads based only on consideration of moments at a spinal level.     

Trunk muscle activation and associated lumbar spine joint shear forces under different levels of external forward force applied to the trunk.

High anterior intervertebral shear loads could cause low back injuries and therefore the neuromuscular system may actively counteract these forces. This study investigated whether, under constant moment loading relative to L3L4, an increased externally applied forward force on the trunk results in a shift in muscle activation towards the use of muscles with more backward directed lines of action, thereby reducing the increase in total joint shear force. Twelve participants isometrically resisted forward forces, applied at several locations on the trunk, while moments were held constant relative to L3L4. Surface EMG and lumbar curvature were measured, and an EMG-driven muscle model was used to calculate compression and shear forces at all lumbar intervertebral joints. Larger externally applied forward forces resulted in a flattening of the lumbar lordosis and a slightly more backward directed muscle force. Furthermore, the overall muscle activation increased. At the T12L1 to L3L4 joint, resulting joint shear forces remained small (less than 200N) because the average muscle force pulled backward relative to those joints. However, at the L5S1 joint the average muscle force pulled the trunk forward so that the increase in muscle force with increasing externally applied forward force caused a further rise in shear force (by 102.1N, SD=104.0N), resulting in a joint shear force of 1080.1N (SD=150.4N) at 50Nm moment loading. It is concluded that the response of the neuromuscular system to shear force challenges tends to increase rather than reduce the shear loading at the lumbar joint that is subjected to the highest shear forces.     

Static optimization underestimates antagonist muscle activity at the glenohumeral joint: A musculoskeletal modeling study

Static optimization is commonly employed in musculoskeletal modeling to estimate muscle and joint loading; however, the ability of this approach to predict antagonist muscle activity at the shoulder is poorly understood. Antagonist muscles, which contribute negatively to a net joint moment, are known to be important for maintaining glenohumeral joint stability. This study aimed to compare muscle and joint force predictions from a subject-specific neuromusculoskeletal model of the shoulder driven entirely by measured muscle electromyography (EMG) data with those from a musculoskeletal model employing static optimization. Four healthy adults performed six sub-maximal upper-limb contractions including shoulder abduction, adduction, flexion, extension, internal rotation and external rotation. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using both a calibrated EMG-driven neuromusculoskeletal modeling framework, and musculoskeletal model simulations that employed static optimization. The EMG-driven model predicted antagonistic muscle function for pectoralis major, latissimus dorsi and teres major during abduction and flexion; supraspinatus during adduction; middle deltoid during extension; and subscapularis, pectoralis major and latissimus dorsi during external rotation. In contrast, static optimization neural solutions showed little or no recruitment of these muscles, and preferentially activated agonistic prime movers with large moment arms. As a consequence, glenohumeral joint force calculations varied substantially between models. The findings suggest that static optimization may under-estimate the activity of muscle antagonists, and therefore, their contribution to glenohumeral joint stability.     

An EMG-CT method using multiple surface electrodes in the forearm

Electromyography computed tomography (EMG-CT) method is proposed for visualizing the individual muscle activities in the human forearm. An EMG conduction model was formulated for reverse-estimation of muscle activities using EMG signals obtained with multi surface electrodes. The optimization process was calculated using sequential quadratic programming by comparing the estimated EMG values from the model with the measured values. The individual muscle activities in the deep region were estimated and used to produce an EMG tomographic image. For validation of the method, isometric contractions of finger muscles were examined for three subjects, applying a flexion load (4.9, 7.4 and 9.8 N) to the proximal interphalangeal joint of the middle finger. EMG signals in the forearm were recorded during the tasks using multiple surface electrodes, which were bound around the subject’s forearm. The EMG-CT method illustrates the distribution of muscle activities within the forearm. The change in amplitude and area of activated muscles can be observed. The normalized muscle activities of all three subjects appear to increase monotonically with increases in the load. Kinesiologically, this method was able to estimate individual muscle activation values and could provide a novel tool for studying hand function and development of an examination for evaluating rehabilitation.     

Trunk muscle contributions of to L4–5 joint rotational stiffness following sudden trunk lateral bend perturbations

The purpose of this research was to investigate the contributions of individual muscles to joint rotational stiffness and total joint rotational stiffness about the lumbar spine’s L_4–5 joint prior to, and following, sudden dynamic lateral perturbations to the trunk. Kinematic and surface EMG data were collected while subjects maintained a kneeling posture on a robotic platform, while restrained so that motions caused by the perturbation were transferred to the pelvis, causing motion of the trunk and head. The robotic platform caused sudden inertial trunk lateral perturbations to the right or left, with or without timing and direction knowledge. An EMG-driven model of the lumbar spine was used to calculate the muscle forces and contributions to joint rotational stiffness during the perturbations. Data showed 95% and 106% increases in total joint rotational stiffness_, about the lateral bend and axial twist axes, when subjects had knowledge of the timing of the perturbation. Also, the contralateral muscles exhibited a significantly larger total joint rotational stiffness about the lateral bend axis, and earlier surface EMG responses, than the ipsilateral muscles. The results indicate that, when the timing of the perturbation was unknown, subjects relied more on delayed muscle forces following the perturbation to stiffen the L_4–5 joint.     

Validity and reliability of a new in vivo ankle stiffness measurement device

This investigation was designed to test the validity and reliability of a new measure of inversion/eversion ankle stiffness on a unique medial/lateral swaying cradle device utilizing a test/retest with comparison to a known standard. Ankle stiffness is essential to maintaining joint stability. Most ankle injuries occur via an inversion mechanism. To date, very little information is available regarding stiffness of the evertor muscles in the prevention of excessive inversion joint rotation. Transient oscillation data representing inversion/eversion stiffness was obtained in a bipedal weight-bearing stance with an upright posture. Using commercially available springs with stiffness of 4.80N/cm the measured value recorded by the cradle was 4.87N/cm. Mean active stiffness values of the ankle were 35.70Nm/cm (SD 9.45). The trial-to-trial reliability ICC (2,1) coefficient was 0.96 with an SEM of 2.05Nm/rad, and the day-to-day reliability ICC (2,k) coefficient was 0.93 and an SEM of 3.00Nm/rad. The results demonstrate that inversion/eversion ankle stiffness measures on this device are a valid, repeatable and consistent measure. This is relevant because the ability to accurately quantify inversion/eversion ankle stiffness will improve our understanding of biomechanical stability and factors that influence it. It will also enable identification of ankle injury risk factors that will lead to more efficient rehabilitation programs and injury prevention strategies.     

Model and in vivo studies on human trunk load partitioning and stability in isometric forward flexions

To resolve the trunk redundancy to determine muscle forces, spinal loads, and stability margin in isometric forward flexion tasks, combined in vivo-numerical model studies was undertaken. It was hypothesized that the passive resistance of both the ligamentous spine and the trunk musculature plays a crucial role in equilibrium and stability of the system. Fifteen healthy males performed free isometric trunk flexions of approximately 40 degrees and approximately 65 degrees +/- loads in hands while kinematics by skin markers and EMG activity of trunk muscles by surface electrodes were measured. A novel kinematics-based approach along with a nonlinear finite element model were iteratively used to calculate muscle forces and internal loads under prescribed measured postures and loads considered in vivo. Stability margin was investigated using nonlinear, linear buckling, and perturbation analyses under various postures, loads and alterations in ligamentous stiffness. Flexion postures significantly increased activity in extensor muscles when compared with standing postures while no significant change was detected in between flexed postures. Compression at the L5-S1 substantially increased from 570 and 771 N in upright posture, respectively, for +/-180 N, to 1912 and 3308 N at approximately 40 degrees flexion, and furthermore to 2332 and 3850 N at approximately 65 degrees flexion. Passive ligamentous/muscle components resisted up to 77% of the net moment. In flexion postures, the spinal stability substantially improved due both to greater passive stiffness and extensor muscle activities so that, under 180 N, no muscle stiffness was required to maintain stability. The co-activity of abdominal muscles and the muscle stiffness were of lesser concern to maintain stability in forward flexion tasks as compared with upright tasks. An injury to the passive system, on one hand, required a substantial compensatory increase in active muscle forces which further increased passive loads and, hence, the risk of injury and fatigue. On the other hand, it deteriorated the system stability which in turn could require greater additional muscle activation. This chain of events would place the entire trunk active-passive system at higher risks of injury, fatigue and instability.     

Torso flexion modulates stiffness and reflex response.

Neuromuscular factors that contribute to spinal stability include trunk stiffness from passive and active tissues as well as active feedback from reflex response in the paraspinal muscles. Trunk flexion postures are a recognized risk factor for occupational low-back pain and may influence these stabilizing control factors. Sixteen healthy adult subjects participated in an experiment to record trunk stiffness and paraspinal muscle reflex gain during voluntary isometric trunk extension exertions. The protocol was designed to achieve trunk flexion without concomitant influences of external gravitational moment, i.e., decouple the effects of trunk flexion posture from trunk moment. Systems identification analyses identified reflex gain by quantifying the relation between applied force disturbances and time-dependent EMG response in the lumbar paraspinal muscles. Trunk stiffness was characterized from a second order model describing the dynamic relation between the force disturbances versus the kinematic response of the torso. Trunk stiffness increased significantly with flexion angle and exertion level. This was attributed to passive tissue contributions to stiffness. Reflex gain declined significantly with trunk flexion angle but increased with exertion level. These trends were attributed to correlated changes in baseline EMG recruitment in the lumbar paraspinal muscles. Female subjects demonstrated greater reflex gain than males and the decline in reflex gain with flexion angle was greater in females than in males. Results reveal that torso flexion influences neuromuscular factors that control spinal stability and suggest that posture may contribute to the risk of instability injury.     

Passive muscle mechanical properties of the medial gastrocnemius in young adults with spastic cerebral palsy

Individuals with spastic cerebral palsy (SCP) exhibit restricted joint range of motion and increased joint stiffness due to structural alterations of their muscles. Little is known about which muscle–tendon structures are responsible for these alterations. The aim of this study was to compare the passive mechanics of the ankle joint and medial gastrocnemius (MG) muscle in young adults with SCP and typically developed (TD) individuals. Nine ambulant SCP (17±2 years) and ten TD individuals (18±2 years) participated in the study. Physiological cross sectional area was estimated using freehand 3D ultrasound and found to be 37% lower in the SCP group. An isokinetic dynamometer rotated the ankle through its range while joint torque and ultrasound images of the MG muscle fascicles were simultaneously measured. Mean ankle stiffness was found to be 51% higher and mean MG fascicle strain 47% lower in the SCP group. Increased resistance to passive ankle dorsiflexion in SCP appears to be related to the inability of MG muscle fascicles to elongate with increased force.