Denis Brunt

Variant and invariant characteristics of the sit-to-stand task in healthy elderly adults

The purpose of this study was to identify kinetic, kinematic, and electromyographic (EMG) characteristics during sit-to-stand (STS) in healthy elderly subjects that were affected by changes in movement speed or initial starting position. Eight healthy elderly adults performed the STS movement at natural and fast speeds. Their ankles were placed in either 5 degrees or 18 degrees of dorsiflexion prior to the movement. A motion analysis system, single force plate, and EMG equipment were used to collect data on ankle, knee, and hip movement, vertical ground reaction forces, vertical and horizontal velocity of the head, and EMG activity from selected muscles. The data were further described according to three specific phases of the STS movement. Two-way analyses of variance for repeated measures were used to determine which of the kinematic, kinetic, and timing variables were affected by changing the speed of the movement or the initial ankle position. When asked to stand as fast as possible, muscle onsets and movement phases were shortened. However, when expressed as a percent of total movement time, normalized extensor muscle onsets were found to be earlier during fast movement of the task, whereas the other variables were not different. Changing the initial ankle position affected muscle onsets, duration of movement phases, and joint excursion. We conclude from these data that many of the characteristics of the sit-to-stand movement are speed invariant and therefore the STS movement is for the most part programmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Principles underlying the organization of movement initiation from quiet stance

The purpose of this study was to determine common principles underlying the programming of movement initiation from quiet stance. Subjects were asked to initiate gait, step over a ruler, or to step over a 10 cm high obstacle at a self-paced speed and as fast as possible. The independent variables were initiation condition (gait initiation, stepping over a ruler or obstacle) and initiation speed (self-paced and as fast as possible). The dependent measures for the stance limb only were the latency between postural soleus (S(1)) EMG inhibition and tibialis anterior (TA) EMG onset, the duration of both TA and soleus (S(2)) activity following TA, duration and slope, impulse, and peak forces of the anterior-posterior (Fx) ground reaction force. Selected timing events were also monitored. Analysis of variance was used to determine main and interaction effects. The following results were obtained. (1) The interval from the inhibition of S(1) postural activity to the onset of TA remained invariant between all conditions. (2) The duration of TA increased and S(2) decreased with an increase in speed of initiation. There was no difference in TA and S(2) duration between the initiation conditions. (3) Time to heel-off remained invariant for all conditions. (4) Prior to heel-off all force variables increased with initiation speed but were similar between initiation conditions. After heel-off force variables were different between speeds and conditions being greater for fast speed and stepping over the obstacle. Two conclusions may be drawn from this study. First, the results indicate that gait initiation consists of two, highly coordinated motor programs. Heel-off of the stance limb is the division between these two programs. Second, our findings also suggest that gait initiation and stepping are governed by the same motor programs.

Assessment of total head excursion and resting head posture

Clinicians typically evaluate head posture and cervical range of motion in both standing and sitting positions. There are currently few quantitative data available regarding resting head posture (RHP) or total head excursion (THE), a retraction-protraction gliding range of head motion in the sagittal plane, and where the RHP lies within THE. The purposes of this study were to describe quick and simple methods to determine quantitative measurements of THE, RHP while sitting, and RHP while standing, to provide preliminary data on these postural measurements for men and women in four age categories; and to determine the effects of gender and age on these measurements. Subjects included 218 able-bodied adults. Measurements of THE, RHP while sitting, and RHP while standing were taken. A two-way multivariate analysis of variance followed by two-way analyses of variance showed only the main effect of gender to be significant (p less than .05) for each of the dependent measurements. Across the age groups, men had a greater excursion distance from retraction to protraction than women. Within THE, women held their heads more forward than men. Men held their heads farther from the vertical than women while standing. These results indicate that normal head and neck posture is different for men and women and should not be judged by the same standard. The methods used in this study are clinically advantageous in that they produce objective, quantitative measurements of THE and RHP that may be obtained quickly and with minimal equipment.

The relation between limb loading and control parameters of gait initiation in persons with stroke

OBJECTIVE This study investigated the relation between limb loading and selected characteristics of gait initiation in patients after stroke. SUBJECTS AND SETTING Thirteen patients attending a rehabilitation clinic volunteered for the study. DESIGN For the description of clinical features, patients were divided into two groups dependent on the amount of body weight shared by the involved limb during stance before gait initiation. MAIN OUTCOME MEASURES Patients performed six trials of gait initiation with either their involved or noninvolved limb on a force platform. Peak ground reaction forces and bilateral tibialis anterior and gastrocnemius electromyographic (EMG) activity were used for group comparison. RESULTS All patients showed the correct loading and unloading characteristics in the vertical and medial-lateral direction during gait initiation. Strong correlations were noted between initial limb loading and ground reaction forces during gait initiation (r = .79 to .95). Changes in ground reaction forces were significantly less (p < .001) for those patients who demonstrated decreased weight bearing on their involved limb before gait initiation. These patients were also unable to generate forward momentum, as evidenced by the fore-aft ground reaction force, with the involved limb. For all patients, increased gastrocnemius activity was noted in the stance (noninvolved) limb. The data are further discussed in regard to the relationship of the interaction of bilateral EMG activity and ground reaction forces. CONCLUSION This study suggests that there is a correlation between symmetrical weight bearing and the ability to provide those forces that generate forward momentum in the initiation of gait.

Spine-board Transfer Techniques and the Unstable Cervical Spine

Study Design. A repeated-measures design using a cadaveric model was used in this preliminary investigation on the effectiveness of spine-board transfer techniques. Objectives. To compare the amount of angulation (flexion–extension) motion that results at the cervical spine during the execution of the log-roll maneuver and the lift-and-slide technique; and to examine how changes to the integrity of the cervical spine impacts the amount of motion generated during the transfer process. Summary of Background Data. Very little research has been performed to establish the efficacy of spine-board transfer techniques. Early studies have indicated that the log-roll maneuver may not be appropriate for transferring victims with thoracolumbar injuries. Also, there has not been a single study that has reported the impact of transfer techniques on the unstable cervical spine. This lack of data necessitated the present study. Methods. Four groups (with six participants each) were asked to execute the log-roll maneuver and the lift-and-slide technique on five cadavers. An electromagnetic motion analysis device was used to assess the amount of angulation motion generated at the C5–C6 segment during the execution of these transfer techniques. To examine how changes to the integrity of the cervical spine impacts the amount of motion that is produced during the transfer process, flexion–extension motion was assessed under various conditions: across a stable C5–C6 segment, after the creation of a posterior ligamentous injury, and after a complete segmental injury. Results. No significant differences in angulation motion were noted between transfer techniques. However, significant differences were noted between all three injury conditions. That is, as the severity of the injury increased, the average amount of angulation motion produced at the site of the lesion also increased, regardless of technique. Conclusion. The participants of this study were able to restrict flexion–extension motion equally well with thelog-roll maneuver as with the lift-and-slide technique. However, more research is needed to fully ascertain the effectiveness of spine-board transfer techniques.

Modulation of triceps surae H-reflexes as a function of the reflex activation history during standing and stepping

The facilitatory effectiveness of spindle afferent feedback is controlled by modulation of segmental reflex excitability such that the level of muscle activation is appropriate for the task. Phase-dependent modes of reflex modulation have been well-characterized. We hypothesized that segmental reflex excitability of the triceps surae was also modulated in a manner associated with the activation history of the spindle afferents and the segmental reflex pathway during isometric contractions, standing and stepping. In the first experiment. pairs of soleus (S) H-reflexes were evoked 80 ms apart with equal strength stimuli at rest and while subjects isometrically contracted their S against loads of 10%. 20%. and 50% of their maximum voluntary efforts. The percent depression of the second H-reflex relative to the first was used as a measure of the effect of reflex activation history. At rest, the second H-reflexes were depressed an average of 73% relative to the first. The degree of depression was progressively reduced as the plantarflexion torque increased. In the second experiment, paired H-reflexes were obtained from the S and medial (MG) and lateral gastrocnemii (LG) muscles while subjects were standing and during the stance phase of step initiation. The degree of depression of the second H-reflex during standing ( > 78%) was similar in magnitude to that produced at rest in Experiment I. At the end of the stance phase of stepping. depression of the second H-reflex of all three muscles was reduced to less than 25%. We conclude that the segmental reflex excitability is modulated as a function of the reflex activation history during these tasks.

Does postural instability affect the initiation of human gait

During gait initiation (GI), decoupling of the center of mass and center of pressure allows the center of mass to fall forwards. Subjects initiated gait rapidly before and after tibial nerve block of the tibial nerve. Static single limb stability, stance limb ground reaction forces, electromyogram and temporal data were measured. It was hypothesized that postural stability would decrease post-block and that this would affect the kinetic and temporal properties of GI. Subjects had significantly decreased postural stability post-block and changes in normal gait kinetics, however, no changes were noted in ground reaction forces or relative temporal data of the GI task. The finding that GI was unaffected by diminished single leg postural instability suggests that GI is a pre-programmed task.

Braking impulse and muscle activation during unplanned gait termination in human subjects with parkinsonism

Persons with parkinsonism (PD) are known to have difficulty with both rapid force production and declination, and may not be able to adjust force levels during bimanual tasks in the upper extremity. We proposed that these deficits might underlie the problems experienced by those with PD when attempting to rapidly terminate locomotor activity. Rapid gait termination requires concomitant increases in braking impulse and decreases in propulsion impulse. We hypothesized that those with PD would be less able to modulate muscle activity and the associated braking impulse during gait termination. Muscular activity of soleus, tibialis anterior and gluteus medius, and braking impulse were compared between a group of subjects with PD and age and gender matched control subjects. Subjects with PD had similar patterns of muscular activation to control subjects although at dramatically reduced levels of amplitude. Consequently, PD subjects were unable to generate sufficient net braking impulse under time-critical conditions.

Do people with Parkinson's disease change strategy during unplanned gait termination?

In light of the movement control problems reported for patients with Parkinsons disease (PD), we examined the lower extremity control strategies used by these subjects to stop walking in planned and unplanned situations. We compared how patients with PD and age and gender-matched control subjects modulated lower extremity muscular activity and ground reaction forces during planned and unplanned stoppings. The main findings were that control subjects did not alter muscle activation from planned to unplanned stopping, relative to stance limb kinetic events; they just increased the amplitude of the response (by approximately 800%). We speculate that these data provide preliminary evidence in support of a stereotypical sequence of muscle activation for gait termination whether planned or unplanned. In contrast, subjects with PD appeared to adopt a different strategy when stopping unexpectedly compared to planned stopping. Additional data show that subjects with PD required additional steps to stop walking when stopping unexpectedly as compared to control subjects.

Control strategies for initiation of human gait are influenced by accuracy constraints

The accuracy of placement of swing limb heel-strike was used to determine strategies of motor control of the stance limb during gait initiation (GI). Subjects initiated gait as fast as possible with the swing limb heel-strike landing on either a small or large target. Stance limb ground reaction forces, electromyogram duration and temporal data for GI were measured. It was hypothesized that accuracy would affect movement speed and the rate of rise, or the slope, of the ground reaction forces that control GI. The slopes of the stance limb forces that coincide with swing limb toe-off remained invariant. However, the slopes of forces and peak forces related to swing limb heel-strike were significantly less for the small target. These initial data suggest that principles of upper extremity motor control may be generalized to the initiation of movement from upright stance.