Randy D. Trumbower

Interactions with compliant loads alter stretch reflex gains but not intermuscular coordination

The human motor system regulates arm mechanics to produce stable postures during interactions with different physical environments. This occurs partly via involuntary mechanisms, including stretch reflexes. Previous single-joint studies demonstrated enhanced reflex sensitivity during interactions with compliant environments, suggesting reflex gain increases to enhance limb stability when that stability is not provided by the environment. This study examined whether similar changes in reflex gain are present throughout the limb following perturbations that simultaneously influence multiple joints. Furthermore, we investigated whether any observed modulation was accompanied by task-specific changes in reflex coordination across muscles, a question that cannot be addressed using single-joint perturbations. Reflexes were elicited during the maintenance of posture by perturbing the arm with a three degrees of freedom robot, configured to have isotropic stiffness of either 10 N/m (compliant) or 10 kN/m (stiff). Perturbation characteristics were matched in both environments. Reflex magnitude was quantified by the average rectified electromyogram, recorded from eight muscles crossing the elbow and shoulder. Reflex coordination was assessed using independent components analysis to compare reflex activation patterns during interactions with stiff and compliant environments. Stretch reflex sensitivity increased significantly in all muscles during interactions with the compliant environment and these changes were not due to changes in background muscle activity. However, there was no significant difference in the reflex coordination patterns observed during interactions with the stiff and compliant environments. These results suggest that reflex modulation occurred through altered use of fixed muscle coordination patterns rather than through a change in reflex coordination.

Exposure to Acute Intermittent Hypoxia Augments Somatic Motor Function in Humans With Incomplete Spinal Cord Injury

Background. Neural plasticity may contribute to motor recovery following spinal cord injury (SCI). In rat models of SCI with respiratory impairment, acute intermittent hypoxia (AIH) strengthens synaptic inputs to phrenic motor neurons, thereby improving respiratory function by a mechanism known as respiratory long-term facilitation. Similar intermittent hypoxia-induced facilitation may be feasible in somatic motor pathways in humans. Objective. Using a randomized crossover design, the authors tested the hypothesis that AIH increases ankle strength in people with incomplete SCI. Methods. Ankle strength was measured in 13 individuals with chronic, incomplete SCI before and after AIH. Voluntary ankle strength was estimated using changes in maximum isometric ankle plantar flexion torque generation and plantar flexor electromyogram activity following 15 low oxygen exposures (Fio2 = 0.09, 1-minute intervals). Results were compared with trials where subjects received sham exposure to room air. Results. AIH increased plantar flexion torque by 82 ± 33% (P < .003) immediately following AIH and was sustained above baseline for more than 90 minutes (P < .007). Increased ankle plantar flexor electromyogram activity (P = .01) correlated with increased torque (r2 = .5; P < .001). No differences in plantar flexion strength or electromyogram activity were observed in sham experiments. Conclusions. AIH elicits sustained increases in volitional somatic motor output in persons with chronic SCI. Thus, AIH has promise as a therapeutic tool to induce plasticity and enhance motor function in SCI patients.

Daily intermittent hypoxia enhances walking after chronic spinal cord injury A randomized trial

Objectives: To test the hypothesis that daily acute intermittent hypoxia (dAIH) and dAIH combined with overground walking improve walking speed and endurance in persons with chronic incomplete spinal cord injury (iSCI). Methods: Nineteen subjects completed the randomized, double-blind, placebo-controlled, crossover study. Participants received 15, 90-second hypoxic exposures (dAIH, fraction of inspired oxygen [Fio2] = 0.09) or daily normoxia (dSHAM, Fio2 = 0.21) at 60-second normoxic intervals on 5 consecutive days; dAIH was given alone or combined with 30 minutes of overground walking 1 hour later. Walking speed and endurance were quantified using 10-Meter and 6-Minute Walk Tests. The trial is registered at ClinicalTrials.gov (NCT01272349). Results: dAIH improved walking speed and endurance. Ten-Meter Walk time improved with dAIH vs dSHAM after 1 day (mean difference [MD] 3.8 seconds, 95% confidence interval [CI] 1.1–6.5 seconds, p = 0.006) and 2 weeks (MD 3.8 seconds, 95% CI 0.9–6.7 seconds, p = 0.010). Six-Minute Walk distance increased with combined dAIH + walking vs dSHAM + walking after 5 days (MD 94.4 m, 95% CI 17.5–171.3 m, p = 0.017) and 1-week follow-up (MD 97.0 m, 95% CI 20.1–173.9 m, p = 0.014). dAIH + walking increased walking distance more than dAIH after 1 day (MD 67.7 m, 95% CI 1.3–134.1 m, p = 0.046), 5 days (MD 107.0 m, 95% CI 40.6–173.4 m, p = 0.002), and 1-week follow-up (MD 136.0 m, 95% CI 65.3–206.6 m, p < 0.001). Conclusions: dAIH ± walking improved walking speed and distance in persons with chronic iSCI. The impact of dAIH is enhanced by combination with walking, demonstrating that combinatorial therapies may promote greater functional benefits in persons with iSCI. Classification of evidence: This study provides Class I evidence that transient hypoxia (through measured breathing treatments), along with overground walking training, improves walking speed and endurance after iSCI.

Interactions Between Limb and Environmental Mechanics Influence Stretch Reflex Sensitivity in the Human Arm

Stretch reflexes contribute to arm impedance and longer-latency stretch reflexes exhibit increased sensitivity during interactions with compliant or unstable environments. This increased sensitivity is consistent with a regulation of arm impedance to compensate for decreased stability of the environment, but the specificity of this modulation has yet to be investigated. Many tasks, such as tool use, compromise arm stability along specific directions, and stretch reflexes tuned to those directions could present an efficient mechanism for regulating arm impedance in a task-appropriate manner. To be effective, such tuning should adapt not only to the mechanical properties of the environment but to those properties in relation to the arm, which also has directionally specific mechanical properties. The purpose of this study was to investigate the specificity of stretch reflex modulation during interactions with mechanical environments that challenge arm stability. The tested environments were unstable, having the characteristics of a negative stiffness spring. These were either aligned or orthogonal to the direction of maximal endpoint stiffness for each subject. Our results demonstrate preferential increases in reflexes, elicited within 50-100 ms of perturbation onset, to perturbations applied specifically along the direction of the destabilizing environments. This increase occurred only when the magnitude of the environmental instability exceeded endpoint stiffness along the same direction. These results are consistent with task-specific reflex modulation tuned to the mechanical properties of the environment relative to those of the human arm. They demonstrate a highly adaptable, involuntary mechanism that may be used to modulate limb impedance along specific directions.

Use of Self-Selected Postures to Regulate Multi-Joint Stiffness During Unconstrained Tasks

Background The human motor system is highly redundant, having more kinematic degrees of freedom than necessary to complete a given task. Understanding how kinematic redundancies are utilized in different tasks remains a fundamental question in motor control. One possibility is that they can be used to tune the mechanical properties of a limb to the specific requirements of a task. For example, many tasks such as tool usage compromise arm stability along specific directions. These tasks only can be completed if the nervous system adapts the mechanical properties of the arm such that the arm, coupled to the tool, remains stable. The purpose of this study was to determine if posture selection is a critical component of endpoint stiffness regulation during unconstrained tasks. Methodology/Principal Findings Three-dimensional (3D) estimates of endpoint stiffness were used to quantify limb mechanics. Most previous studies examining endpoint stiffness adaptation were completed in 2D using constrained postures to maintain a non-redundant mapping between joint angles and hand location. Our hypothesis was that during unconstrained conditions, subjects would select arm postures that matched endpoint stiffness to the functional requirements of the task. The hypothesis was tested during endpoint tracking tasks in which subjects interacted with unstable haptic environments, simulated using a 3D robotic manipulator. We found that arm posture had a significant effect on endpoint tracking accuracy and that subjects selected postures that improved tracking performance. For environments in which arm posture had a large effect on tracking accuracy, the self-selected postures oriented the direction of maximal endpoint stiffness towards the direction of the unstable haptic environment. Conclusions/Significance These results demonstrate how changes in arm posture can have a dramatic effect on task performance and suggest that postural selection is a fundamental mechanism by which kinematic redundancies can be exploited to regulate arm stiffness in unconstrained tasks.

Neuromuscular constraints on muscle coordination during overground walking in persons with chronic incomplete spinal cord injury

OBJECTIVE Incomplete spinal cord injury (iSCI) disrupts motor control and limits the ability to coordinate muscles for overground walking. Inappropriate muscle activity has been proposed as a source of clinically observed walking deficits after iSCI. We hypothesized that persons with iSCI exhibit lower locomotor complexity compared to able-body (AB) controls as reflected by fewer motor modules, as well as, altered module composition and activation. METHODS Eight persons with iSCI and eight age-matched AB controls walked overground at prescribed cadences. Electromyograms of fourteen single leg muscles were recorded. Non-negative matrix factorization was used to identify the composition and activation of motor modules, which represent groups of consistently co-activated muscles that accounted for 90% of variability in muscle activity. RESULTS Motor module number, composition, and activation were significantly altered in persons with iSCI as compared to AB controls during overground walking at self-selected cadences. However, there was no significant difference in module number between persons with iSCI and AB controls when cadence and assistive device were matched. CONCLUSIONS Muscle coordination during overground walking is impaired after chronic iSCI. SIGNIFICANCE Our results are indicative of neuromuscular constraints on muscle coordination after iSCI. Altered muscle coordination contributes to person-specific gait deficits during overground walking.

Co-contraction modifies the stretch reflex elicited in muscles shortened by a joint perturbation

Simultaneous contraction of agonist and antagonist muscles acting about a joint influences joint stiffness and stability. Although several studies have shown that reflexes in the muscle lengthened by a joint perturbation are modulated during co-contraction, little attention has been given to reflex regulation in the antagonist (shortened) muscle. The goal of the present study was to determine whether co-contraction gives rise to altered reflex regulation across the joint by examining reflexes in the muscle shortened by a joint perturbation. Reflexes were recorded from electromyographic activity in elbow flexors and extensors while positional perturbations to the elbow joint were applied. Perturbations were delivered during isolated activation of the flexor or extensor muscles as well as during flexor and extensor co-contraction. Across the group, the shortening reflex in the elbow extensor switched from suppression during isolated extensor muscle activation to facilitation during co-contraction. The shortening reflex in the elbow flexor remained suppressive during co-contraction but was significantly smaller compared to the response obtained during isolated elbow flexor activation. This response in the shortened muscle was graded by the level of activation in the lengthened muscle. The lengthening reflex did not change during co-contraction. These results support the idea that reflexes are regulated across multiple muscles around a joint. We speculate that the facilitatory response in the shortened muscle arises through a fast-conducting oligosynaptic pathway involving Ib interneurons.

Improving pedal power during semireclined leg cycling

Using time-sequence analysis of EMG measurements to determine if changes in muscle activation timing, sequencing, and stimulation can improve pedaling effectiveness.

Kinematic analyses of semireclined leg cycling in able-bodied and spinal cord injured individuals.

Study design:Retrospective descriptive study.Objectives:To evaluate the leg kinematics and motion characteristics within able-bodied (AB) and spinal cord injured (SCI) individuals during stationary semireclined cycling.Setting:Functional Performance Laboratory, Connecticut, USA.Methods:Three SCI and three AB subjects participated in steady-state leg pedaling (50 revolutions per minute). The SCI group participated in electrical stimulation (FES)-induced cycling at resistances of 0, 6.25, and 12.5 Watts (W). The AB group cycled on the same ergometer without FES at resistances of 0, 60, and 120 W. Motion capture analysis recorded joint angular position, velocity, and acceleration at hip, knee, and ankle. Joint kinematics of hip, knee, and ankle were measured during steady-state leg cycling and comparisons were made between AB and SCI subjects as resistance proportionally and relatively increased.Results:Intrasubject hip and knee movement patterns showed minimal variability across resistance levels. Comparisons between AB and SCI subjects showed that the hip and knee kinematics were very similar at all resistance levels. However, ankle movement patterns appeared to increase in variability (increased dorsiflexion) with increased resistance level in AB subjects and less so with SCI subjects. Overall, the ankle kinematics for AB and SCI subjects were dissimilar at resistance levels greater than zero.Conclusions:The joint kinematics of the hip, knee, and ankle were found to be periodic, but the differences in ankle kinematics in AB and SCI subjects suggest more emphasise should be placed on the current design of the bike-pedal and subject-specific seat configurations.

Bilateral impairments in task-dependent modulation of the long-latency stretch reflex following stroke

OBJECTIVE Modulation of the long-latency reflex (LLR) is important for sensorimotor control during interaction with different mechanical loads. Transcortical pathways usually contribute to LLR modulation, but the integrity of pathways projecting to the paretic and non-paretic arms of stroke survivors is compromised. We hypothesize that disruption of transcortical reflex pathways reduces the capacity for stroke survivors to appropriately regulate the LLR bilaterally. METHODS Elbow perturbations were applied to the paretic and non-paretic arms of persons with stroke, and the dominant arm of age-matched controls as subjects interacted with Stiff or Compliant environments rendered by a linear actuator. Reflexes were quantified using surface electromyograms, recorded from biceps. RESULTS LLR amplitude was significantly larger during interaction with the Compliant load compared to the Stiff load in controls. However, there was no significant change in LLR amplitude for the paretic or non-paretic arm of stroke survivors. CONCLUSION Modulation of the LLR is altered in the paretic and non-paretic arms after stroke. SIGNIFICANCE Our results are indicative of bilateral sensorimotor impairments following stroke. The inability to regulate the LLR may contribute to bilateral deficits in tasks that require precise control of limb mechanics and stability.