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.     

Age impairs sit-to-walk motor performance

Sit-to-walk (STW) is a common functional and transitional task which challenges an individual's postural control systems. As aging is associated with an increased risk of falls during transitional movements, we biomechanically investigated the STW movement task in 12 healthy young and 12 healthy elderly individuals. Performance was evaluated utilizing motion analysis and two force plates. The principal finding of this study was the impaired performance of the healthy older adults. The older adults generated significantly less momentum prior to rising (p=0.011) and further delayed (p<0.001) the initiation of gait until standing more upright (p=0.036). The young adults successfully merged the component tasks shortly after seat-off and displayed significantly greater step length (p<0.001), step velocity (p<0.001), and tolerated greater separation of the center of pressure and center of mass at the end single support phase of the initial step (p=0.001). While the young adults fluidly merged the standing and walking task components, the older adults displayed a conservative movement performance during the STW task thereby limiting threats to their postural stability.     

Dynamic balance control during sit-to-stand movement: an examination with the center of mass acceleration

The purpose of this study was to establish the region of stability of balance control using the center of mass (COM) acceleration and to characterize age-related differences during sit-to-stand (STS) movement. Whole body motion data were collected from 10 young and 10 elderly subjects while performing STS at their self-selected manners. In addition, young subjects were asked to perform another block of trials with their trunk purposely bent forward prior to seat-off. With the use of a single-link-plus-foot inverted pendulum model, boundaries for the region of stability were determined based on the COM position at seat-off and its instantaneous velocity or its peak acceleration (ROSv or ROSa, respectively). No significant group differences were detected in COM velocities at seat-off. However, peak COM accelerations differed significantly between groups and conditions. This suggested that even though a similar COM momentum was observed at seat-off, this momentum was controlled differently prior to seat-off. Young and elderly subjects utilized similar strategies but with different COM acceleration profiles to perform STS. Furthermore, data from an elderly subject who complained of difficulty in STS during the experiment were located outside the forward boundary of the ROSa, demonstrating a potential use of ROSa to differentiate individuals with declined balance control ability. The ROSa could provide insights into how the COM is controlled prior to seat-off, which may allow us to better identify elderly individuals who are most likely at a risk for imbalance or falls.     

Development of functional variability during the motor learning process of a complex cyclic movement

Traditionally, movement variability is considered an indicator for sensorimotor malfunctioning. However, functional movement variability is also a result of compensation mechanisms e.g. to account for prior movement deviations and is, therefore, crucial for stable movements. The aim of this study was to analyze functional variability during motor learning of a complex cyclic task.Thirteen young participants practised riding a Pedalo® slalom until they were able to complete the task without errors. Since trunk movements are controlled with high priority, we analyzed trunk kinematics as a result parameter. Since lower extremities affect the result parameter, foot, thigh and pelvis kinematics are considered execution parameters. The movement variability for result and execution parameters was determined for the first (poor performance), an intermediate (medium performance) and the last (good performance) training sessions. Furthermore, the variability ratio (execution/result parameter) was calculated as a measure of functional variability.Movement variability of the result parameter decreased significantly with increasing expertise. In contrast, movement variability of all execution parameters increased significantly from measurements representing poor to medium performance. No change from medium to good performance was found. Functional variability increased over time in all execution parameters.Since the movement variability of all execution parameters did not decrease with increasing Pedalo performance, applying a traditional interpretation approach of movement variability would have led to completely wrong conclusions. Possible mechanisms explaining the increased movement variability are discussed. The variability ratio seems to be the only parameter that can reveal improved sensorimotor functioning during all analyzed stages of motor learning.     

Influence of haptic guidance in learning a novel visuomotor task

In (re)learning of movements, haptic guidance can be used to direct the needed adaptations in motor control. Haptic guidance influences the main driving factors of motor adaptation, execution error, and control effort in different ways. Human-control effort is dissipated in the interactions that occur during haptic guidance. Minimizing the control effort would reduce the interaction forces and result in adaptation. However, guidance also decreases the magnitude of the execution errors, which could inhibit motor adaptation. The aim of this study was to assess how different types of haptic guidance affect kinematic adaptation in a novel visuomotor task. Five groups of subjects adapted to a reaching task in which the visual representation of the hand was rotated 30°. Each group was guided by a different force field. The force fields differed in magnitude and direction in order to discern the adaptation based on execution errors and control effort. The results demonstrated that the execution error did indeed play a key role in adaptation. The more the guiding forces restricted the occurrence of execution errors, the smaller the amount and rate of adaptation. However, the force field that enlarged the execution errors did not result in an increased rate of adaptation. The presence of a small amount of adaptation in the groups who did not experience execution errors during training suggested that adaptation could be driven on a much slower rate and on the basis of minimization of control effort as was evidenced by a gradual decrease of the interaction forces during training. Remarkably, also in the group in which the subjects were passive and completely guided, a small but significant adaptation occurred. The conclusion is that both minimization of execution errors and control effort drives kinematic adaptation in a novel visuomotor task, but the latter at a much slower rate.     

Learning new gait patterns is enhanced by specificity of training rather than progression of task difficulty

The use of motor learning strategies may enhance rehabilitation outcomes of individuals with neurological injuries (e.g., stroke or cerebral palsy). A common strategy to facilitate learning of challenging tasks is to use sequential progression – i.e., initially reduce task difficulty and slowly increase task difficulty until the desired difficulty level is reached. However, the evidence related to the use of such sequential progressions to improve learning is mixed for functional skill learning tasks, especially considering situations where practice duration is limited. Here, we studied the benefits of sequential progression using a functional motor learning task that has been previously used in gait rehabilitation. Three groups of participants (N = 43) learned a novel motor task during treadmill walking using different learning strategies. Participants in the specific group (n = 21) practiced only the criterion task (i.e., matching a target template that was scaled-up by 30%) throughout the training. Participants in the sequential group (n = 11) gradually progressed to the criterion task (from 3% to 30% in increments of 3%), whereas participants in the random group (n = 11) started at 3% and progressed in random increments (involving both increases and decreases in task difficulty) to the criterion task. At the end of training, kinematic tracking performance on the criterion task was evaluated in all participants both with and without visual feedback. Results indicated that the tracking error was significantly lower in the specific group, and no differences were observed between the sequential and the random progression groups. The findings indicate that the amount of practice in the criterion task is more critical than the difficulty and variations of task practice when learning new gait patterns during treadmill walking.     

Effects of DDAVP on movement planning and execution processes in healthy young adults

This study investigated the effects of an acute dose of DDAVP on speed and consistency of planning and execution of simple and complex movements in healthy young adults. A simple reaction time task (SRT), a simple movement task (SMT), and a complex movement task (CMT) were performed with and without a 0.6 ml intranasal dose (60 micrograms) of DDAVP. Results indicated DDAVP-treated individuals planned and executed CMT and SRT tasks faster and more consistently than did placebo-treated subjects. There were nonsignificant DDAVP effects on speed and variability of both RT and MT processes involved in the SMT.     

Predictive Models to Determine Imagery Strategies Employed by Children to Judge Hand Laterality

A commonly used paradigm to study motor imagery is the hand laterality judgment task. The present study aimed to determine which strategies young children employ to successfully perform this task. Children of 5 to 8 years old (N = 92) judged laterality of back and palm view hand pictures in different rotation angles. Response accuracy and response duration were registered. Response durations of the trials with a correct judgment were fitted to a-priori defined predictive sinusoid models, representing different strategies to successfully perform the hand laterality judgment task. The first model predicted systematic changes in response duration as a function of rotation angle of the displayed hand. The second model predicted that response durations are affected by biomechanical constraints of hand rotation. If observed data could be best described by the first model, this would argue for a mental imagery strategy that does not involve motor processes to solve the task. The second model reflects a motor imagery strategy to solve the task. In line with previous research, we showed an age-related increase in response accuracy and decrease in response duration in children. Observed data for both back and palm view showed that motor imagery strategies were used to perform hand laterality judgments, but that not all the children use these strategies (appropriately) at all times. A direct comparison of response duration patterns across age sheds new light on age-related differences in the strategies employed to solve the task. Importantly, the employment of the motor imagery strategy for successful task performance did not change with age.     

Behavioral compensations in a positional learning and memory task by aged monkeys

The present experiment assessed learning and memory of a positional task by evaluating behavioral strategies as well as accuracy of a task in four young and four aged monkeys. They were tested in a delayed response (DR) task that has been widely used to study animal models of aging. The task consisted of two phases; an acquisition of the task and a positional memory test with five delay times (1-30 s). There was no clear difference between age groups in the number of trials needed for acquisition of the task. However, an analysis of behavior revealed differences in behavioral characteristics displayed during testing. The young monkeys showed various irrelevant behaviors during the execution of the task. In contrast, the aged monkeys consistently concentrated on the task exhibiting no behaviors irrelevant to the task. These results showed than the aged monkeys' performance was supported by a different behavioral strategy from the young monkeys. The results of the memory test were similar to those of the acquisition on the accuracy and the behavior. The aged monkeys depended on behavioral cues to preserve their positional memory, especially during the task. The present study suggests that cognitive impairments in aged monkeys can be compensated for by employing behavioral strategies.     

Mistakes can stabilise the dynamics of rock-paper-scissors games

A game of rock-paper-scissors is an interesting example of an interaction where none of the pure strategies strictly dominates all others, leading to a cyclic pattern. In this work, we consider an unstable version of rock-paper-scissors dynamics and allow individuals to make behavioural mistakes during the strategy execution. We show that such an assumption can break a cyclic relationship leading to a stable equilibrium emerging with only one strategy surviving. We consider two cases: completely random mistakes when individuals have no bias towards any strategy and a general form of mistakes. Then, we determine conditions for a strategy to dominate all other strategies. However, given that individuals who adopt a dominating strategy are still prone to behavioural mistakes in the observed behaviour, we may still observe extinct strategies. That is, behavioural mistakes in strategy execution stabilise evolutionary dynamics leading to an evolutionary stable and, potentially, mixed co-existence equilibrium.     

Mechanical energy analysis identifies compensatory strategies in disabled elders' gait

Current concepts in disablement emphasize the importance of identifying mobility impairments in aging humans to enable timely intervention and, ultimately, prevent disability. Because mobility impairments are likely to result in compensatory movement strategies, recognizing and understanding those strategies may be critical in designing effective interventions for preventing disability. We sought to determine if mechanical energy methods are useful for identifying and understanding lower extremity compensatory movement strategies due to disabilities. Aleshinski's method was used to compute mechanical energy expenditure (MEE) and mechanical energy compensation (MEC) for the sagittal plane stance leg and low-back joints of healthy elders (HE) and disabled elders (DE) during preferred speed and paced (120 steps min(-1)) gait. DE subjects expended less ankle energy in late-stance and more low-back energy in mid-stance than did the HE subjects. When controlling for walking speed, the difference in ankle MEE disappeared, but mid-stance hip MEE was significantly higher for the DE subjects. Despite increased hip and low-back MEE, the DE subjects compensated hip and low-back muscles greater then HE subjects by increasing energy transferred into the pelvis, particularly when walking faster than their self-selected speed. Increased energy transfers into the pelvis during mid-stance may be a strategy used to assist in advancing and controlling the contralateral limb's swing phase. Increased trunk energy, however, may compromise dynamic stability and increase the risk of falling. We conclude that mechanical energy methods are useful for identifying and understanding compensatory movement strategies in elders with disabilities.     

Cognitive cost of motor reorganizations associated with muscular fatigue during a repetitive pointing task

Muscular fatigue is known to impair motor performance and to catalyse the development of upper limb musculoskeletal disorders. In order to delay the deleterious effects of muscular fatigue, the central nervous system (CNS) employs compensatory strategies. The cognitive cost of such compensatory strategies was assessed in 10 male subjects who alternatively performed two dual-task protocols before and immediately after an exhaustion procedure specific to upper arm abductor musculature. The main motor tasks were an isometric force-matching and a rapid multi-joint pointing. A secondary probe reaction time (RT) task was performed during both protocols and served as an indicator of attentional demands. Overall motor task performance was maintained despite fatigue. Kinematic and electromyographic data revealed that subjects used motor reorganization during the pointing task when fatigued. The RT increased with fatigue in both dual-task protocols, but this increase was significantly higher during the pointing task than during the force-matching task.The results highlight that the motor reorganization used by the CNS under muscular fatigue states require higher attentional demands than the initial motor organization. Finally, the capacity to delay the deleterious effects of muscular fatigue seems to depend on the proportion of cognitive resources available to plan the compensatory motor strategy.     

Striatal and Hippocampal Involvement in Motor Sequence Chunking Depends on the Learning Strategy

Motor sequences can be learned using an incremental approach by starting with a few elements and then adding more as training evolves (e.g., learning a piano piece); conversely, one can use a global approach and practice the whole sequence in every training session (e.g., shifting gears in an automobile). Yet, the neural correlates associated with such learning strategies in motor sequence learning remain largely unexplored to date. Here we used functional magnetic resonance imaging to measure the cerebral activity of individuals executing the same 8-element sequence after they completed a 4-days training regimen (2 sessions each day) following either a global or incremental strategy. A network comprised of striatal and fronto-parietal regions was engaged significantly regardless of the learning strategy, whereas the global training regimen led to additional cerebellar and temporal lobe recruitment. Analysis of chunking/grouping of sequence elements revealed a common prefrontal network in both conditions during the chunk initiation phase, whereas execution of chunk cores led to higher mediotemporal activity (involving the hippocampus) after global than incremental training. The novelty of our results relate to the recruitment of mediotemporal regions conditional of the learning strategy. Thus, the present findings may have clinical implications suggesting that the ability of patients with lesions to the medial temporal lobe to learn and consolidate new motor sequences may benefit from using an incremental strategy.     

Measuring dynamic stability requirements during sitting pivot transfers using stabilizing and destabilizing forces in individuals with complete motor paraplegia

Dynamic stability requirements have never been quantified when long-term manual wheelchair users transfer themselves in a seated position from an initial surface to a target surface, a functional task commonly referred to as sitting pivot transfers (SPTs). Ten individuals with spinal cord injury (SCI), who rely on a manual wheelchair for mobility, underwent a comprehensive biomechanical SPT assessment. SPTs performed toward a target seat of same height (even) and a seat 10cm higher than the initial seat (uneven), repeated three times for each task, were assessed. A dynamic equilibrium model, continuously measuring the theoretical forces required to move the center of pressure to the limit of the base of support (destabilizing force) and to neutralize the kinetic energy and stop the displacement of the center of mass at the limit of the base of support (stabilizing force) at each instance during the performance of SPTs, was used to identify the phases of greatest instability during the SPT tasks. The greatest levels of instability were reached around the time the buttocks lost contact with the initial seat and around the time the buttocks landed on the target seat (pre- and post-lift transition phases). These transition periods, characterized by the lowest destabilizing force (424.7-487.1N) and the greatest stabilizing force (24.2-33.2N), confirmed the greatest level of instability. The height of the target seat had no significant effect (p=0.278-0.739) on dynamic postural stability requirements during the SPTs. During SPTs towards even and uneven target seats, the greatest postural instability occurs during the transition phases in individuals with complete motor thoracic SCI.     

Altered corticomuscular coherence elicited by paced isotonic contractions in individuals with cerebral palsy: A case-control study

The purpose of the study was to analyze corticomuscular coherence during planning and execution of simple hand movements in individuals with cerebral palsy (CP) and healthy controls (HC).Fourteen individuals with CP and 15 HC performed voluntary paced movements (opening and closing the fist) in response to a warning signal. Simultaneous scalp EEG and surface EMG of extensor carpi radialis brevis were recorded during 15 isotonic contractions. Time–frequency corticomuscular coherence (EMG-C3/C4) before and during muscular contraction, as well as EMG intensity, onset latency and duration were analyzed.Although EMG intensity was similar in both groups, individuals with CP exhibited longer onset latency and increased duration of the muscular contraction than HC. CP also showed higher corticomuscular coherence in beta EEG band during both planning and execution of muscular contraction, as well as lower corticomuscular coherence in gamma EEG band at the beginning of the contraction as compared with HC.In conclusion, our results suggest that individuals with CP are characterized by an altered functional coupling between primary motor cortex and effector muscles during planning and execution of isotonic contractions. In addition, the usefulness of corticomuscular coherence as a research tool for exploring deficits in motor central processing in persons with early brain damage is discussed.     

Trunk control in and out of an episode of recurrent low back pain in young adults during the Balance-Dexterity Task

We investigated motor control strategies utilized by individuals with recurrent low back pain (rLBP) during active pain and remission periods as well as by back-healthy controls using the Balance-Dexterity Task. Nineteen young adults with rLBP were tested first when they were in pain and then again in symptom remission, and 19 matched controls were also tested. Trunk kinematic coupling and muscle co-activation were examined while participants performed the task by standing on one leg while compressing a spring with a maximum consistent force with the other leg. We found a decreased bilateral external oblique co-activation during the spring condition of the task compared to the stable block condition in people with rLBP compared to back healthy individuals. There was also reduced trunk coupling during the spring condition of the task compared to the stable block condition in both the rLBP active and remission groups, but no group difference between rLBP and back-healthy individuals. When individuals were in active pain, they exhibited more co-activation than when they were in remission, but the co-activation during active pain was not greater than in back-healthy individuals.     

Maintaining Gait Performance by Cortical Activation during Dual-Task Interference: A Functional Near-Infrared Spectroscopy Study

In daily life, mobility requires walking while performing a cognitive or upper-extremity motor task. Although previous studies have evaluated the effects of dual tasks on gait performance, few studies have evaluated cortical activation and its association with gait disturbance during dual tasks. In this study, we simultaneously assessed gait performance and cerebral oxygenation in the bilateral prefrontal cortices (PFC), premotor cortices (PMC), and supplemental motor areas (SMA), using functional near-infrared spectroscopy, in 17 young adults performing dual tasks. Each participant was evaluated while performing normal-pace walking (NW), walking while performing a cognitive task (WCT), and walking while performing a motor task (WMT). Our results indicated that the left PFC exhibited the strongest and most sustained activation during WCT, and that NW and WMT were associated with minor increases in oxygenation levels during their initial phases. We observed increased activation in channels in the SMA and PMC during WCT and WMT. Gait data indicated that WCT and WMT both caused reductions in walking speed, but these reductions resulted from differing alterations in gait properties. WCT was associated with significant changes in cadence, stride time, and stride length, whereas WMT was associated with reductions in stride length only. During dual-task activities, increased activation of the PMC and SMA correlated with declines in gait performance, indicating a control mechanism for maintaining gait performance during dual tasks. Thus, the regulatory effects of cortical activation on gait behavior enable a second task to be performed while walking.     

Are There Age-Related Differences in the Ability to Learn Configural Responses?

Age is often associated with a decline in cognitive abilities that are important for maintaining functional independence, such as learning new skills. Many forms of motor learning appear to be relatively well preserved with age, while learning tasks that involve associative binding tend to be negatively affected. The current study aimed to determine whether age differences exist on a configural response learning task, which includes aspects of motor learning and associative binding. Young (M = 24 years) and older adults (M = 66.5 years) completed a modified version of a configural learning task. Given the requirement of associative binding in the configural relationships between responses, we predicted older adults would show significantly less learning than young adults. Older adults demonstrated lower performance (slower reaction time and lower accuracy). However, contrary to our prediction, older adults showed similar rates of learning as indexed by a configural learning score compared to young adults. These results suggest that the ability to acquire knowledge incidentally about configural response relationships is largely unaffected by cognitive aging. The configural response learning task provides insight into the task demands that constrain learning abilities in older adults.     

Assessment of brain interactivity in the motor cortex from the concept of functional connectivity and spectral analysis of fMRI data

Functional magnetic resonance imaging (fMRI) was used to assess the contributions of movement preparation and execution of a visuomotor task in a cerebral motor network. The functional connectivity of the voxel time series between brain regions in the frequency space was investigated by performing spectral analysis of fMRI time series. The regional interactivities between the two portions of the supplementary motor area (pre-SMA and SMA-proper) and the primary motor cortex (M1), defined as a seed region, were evaluated. The spectral parameter of coherence was used to describe a correlation structure in the frequency domain between two voxel-based time series and to infer the strength of the functional interaction within our presumed motor network of connections. The results showed meaningful differences of the functional interactions between the two portions of the SMA and the M1 area depending on the task conditions. This approach demonstrated the existence of a functional dissociation between the pre-SMA and SMA-proper subregions. We therefore conclude that spectral analysis is useful for identifying functional interactions of brain regions and might provide a powerful tool to quantify changes in connectivity profiles associated with various components of an experimental task.