Warren G. Darling

Jump landing strategies in male and female college athletes and the implications of such strategies for anterior cruciate ligament injury.

Background: Female athletes are more likely than male athletes to injure the anterior cruciate ligament. Causes of this increased injury incidence in female athletes remain unclear, despite numerous investigations. Hypothesis: Female athletes will exhibit lower hamstring muscle activation and smaller knee flexion angles than male athletes during jump landings, especially when the knee muscles are fatigued. Study Design: Controlled laboratory study. Methods: Eight female and six male varsity college basketball athletes with no history of knee ligament injury performed jump landings on the dominant leg from a maximum height jump and from 25.4 cm and 50.8 cm high platforms under nonfatigued and fatigued conditions. Knee joint angle and surface electromyographic signals from the quadriceps, hamstring, and gastrocnemius muscles were recorded. Results: Women landed with greater knee flexion angles and greater knee flexion accelerations than men. Knee muscle activation patterns were generally similar in men and women. Conclusion: As compared with male college basketball players, female college basketball players did not exhibit altered knee muscle coordination characteristics that would predispose them to anterior cruciate ligament injury when landing from jumps. This conclusion is made within the parameters of this study and based on the observation that hamstring muscle activation was similar for both groups. The greater knee flexion we observed in the female subjects would be expected to decrease their risk of injury. Clinical Relevance: Factors other than those evaluated in this study need to be considered when attempting to determine the reasons underlying the increased incidence of anterior cruciate ligament injuries consistently observed in elite female athletes.

Variability of motor potentials evoked by transcranial magnetic stimulation depends on muscle activation.

The purpose of this research was to determine whether motor cortex excitability assessed using transcranial magnetic stimulation (TMS) is less variable when subjects maintain a visually controlled low-level contraction of the muscle of interest. We also examined the dependence of single motor evoked potential (MEP) amplitude on stimulation intensity and pre-stimulus muscle activation level using linear and non-linear multiple regression analysis. Eight healthy adult subjects received single pulse TMS over the left motor cortex at a point where minimal stimulation intensity was required to produce MEPs in extensor digitorum communis (EDC). Voluntary activation of the muscle was controlled by visual display of a target force (indicated by a stable line on an oscilloscope) and the isometric force produced as the subject attempted to extend the fingers (indicated by a line on the oscilloscope representing the finger extension force) while subjects were instructed to: exert zero extension force (0%) and produce forces equal to 5 and 10% of maximum voluntary finger extension under separate conditions. Relative variability (coefficient of variation) of single MEPs at a constant stimulus intensity and of pre-stimulus muscle EMG was lower during maintained 5 and 10% contractions than at 0% contraction levels. Therefore, maintaining a stable low intensity contraction helps stabilize cortical and spinal excitability. Multiple regression analyses showed that a linear dependence of single MEPs on stimulation intensity and pre-stimulus muscle activation level produced similar fits to those for a non-linear dependence on stimulus intensity and a linear dependence on pre-stimulus EMG. Thus, a simple linear method can be used to assess dependence of single MEP amplitudes on both stimulus intensity (to characterize slope of the recruitment curve) and low intensity background muscle activation level.

COORDINATION OF INDEX FINGER MOVEMENTS

The purpose of this investigation was to describe the patterns of coordination among the joint motions of the index finger, and among the EMGs of index finger muscles. Index finger movements involving all three joints were varied in speed and direction. Joint motions were recorded along with fine-wire EMG from all the muscles that insert into the index finger. We observed nearly linear relationships for angular position between the two interphalangeal (IP) joints, and between the metacarpophalangeal (MP) and proximal IP (PIP) joints regardless of movement, speed and direction. The activities of the extrinsic flexors were of similar magnitude and were highly correlated when they acted as agonists but were poorly correlated when they acted as antagonists to the movement. Extrinsic extensor muscles behaved in this way also. The activation patterns of the intrinsic musculature correlated weakly except for extension movements voluntarily limited to the IP joints. We conclude that the highly coordinated action of the extrinsic flexors during flexion contribute importantly to the linked motions of the IP joints in part because these muscles span two or all the three index finger joints. Hence, interjoint movement patterns appear not to arise solely from restraints imposed by passive tissues, especially for fast flexion movements. The weakly correlated intrinsic muscle activity does not uncouple the flexion motions at the PIP and DIP joints because these muscles exert extensor torques at both IP joints. However, the actions of the intrinsic muscles are necessary for stabilizing the MP joint in flexion postures during IP motion and in producing motions voluntarily limited to the MP joint.

Transformations between visual and kinesthetic coordinate systems in reaches to remembered object locations and orientations.

The abilities of human subjects to perform reach and grasp movements to remembered locations/ orientations of a cylindrical object were studied under four conditions: (1) visual presentation of the object — reach with vision allowed; (2) visual presentation — reach while blindfolded; (3) kinesthetic presentation of the object-reach while blindfolded and (4) kinesthetic presentation-reach with vision. The results showed that subjects were very accurate in locating the object in the purely kinesthetic condition and that directional errors were low in all four conditions; but, predictable errors in reach distance occurred in conditions 1,2, and 4. The pattern of these distance errors was similar to that identified in previous research using a pointing task to a small target (i.e., overshoots of close targets, undershoots of far targets). The observation that the pattern of distance errors in condition 4 was similar to that of conditions 1 and 2 suggests that subjects transform kinesthetically defined hand locations into a visual coordinate system when vision is available during upper limb motion to a remembered kinesthetic target. The differences in orientation of the upper limb between target and reach positions in condition 3 were similar in magnitude to the errors associated with kinesthetic perceptions of arm and hand orientations in three-dimensional space reported in previous studies. However, fingertip location was specified with greater accuracy than the orientation of upper limb segments. This was apparently accomplished by compensation of variations in shoulder (arm) angles with oppositely directed variations in elbow joint angles. Subjects were also able to transform visually perceived object orientation into an appropriate hand orientation for grasp, as indicated by the relation between hand roll angle and object orientation (elevation angle). The implications of these results for control of upper limb motion to external targets are discussed.

Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting

Objectives: To (1) investigate effects of aerobic walking on motor function, cognition, and quality of life in Parkinson disease (PD), and (2) compare safety, tolerability, and fitness benefits of different forms of exercise intervention: continuous/moderate intensity vs interval/alternating between low and vigorous intensity, and individual/neighborhood vs group/facility setting. Methods: Initial design was a 6-month, 2 × 2 randomized trial of different exercise regimens in independently ambulatory patients with PD. All arms were required to exercise 3 times per week, 45 minutes per session. Results: Randomization to group/facility setting was not feasible because of logistical factors. Over the first 2 years, we randomized 43 participants to continuous or interval training. Because preliminary analyses suggested higher musculoskeletal adverse events in the interval group and lack of difference between training methods in improving fitness, the next 17 participants were allocated only to continuous training. Eighty-one percent of 60 participants completed the study with a mean attendance of 83.3% (95% confidence interval: 77.5%–89.0%), exercising at 46.8% (44.0%–49.7%) of their heart rate reserve. There were no serious adverse events. Across all completers, we observed improvements in maximum oxygen consumption, gait speed, Unified Parkinsons Disease Rating Scale sections I and III scores (particularly axial functions and rigidity), fatigue, depression, quality of life (e.g., psychological outlook), and flanker task scores (p < 0.05 to p < 0.001). Increase in maximum oxygen consumption correlated with improvements on the flanker task and quality of life (p < 0.05). Conclusions: Our preliminary study suggests that aerobic walking in a community setting is safe, well tolerated, and improves aerobic fitness, motor function, fatigue, mood, executive control, and quality of life in mild to moderate PD. Classification of evidence: This study provides Class IV evidence that in patients with PD, an aerobic exercise program improves aerobic fitness, motor function, fatigue, mood, and cognition.

White Matter Integrity Is a Stronger Predictor of Motor Function Than BOLD Response in Patients With Stroke

Objective. Neuroimaging techniques, such as diffusion tensor imaging (DTI) and blood oxygenation level–dependent (BOLD) functional magnetic resonance imaging (fMRI), provide insights into the functional reorganization of the cortical motor system after stroke. This study explores the relationship between upper extremity motor function, white matter integrity, and BOLD response of cortical motor areas. Methods. Seventeen patients met study inclusion criteria; of these 12 completed DTI assessment of white matter integrity and 9 completed fMRI assessment of motor-related activation. Primary clinical outcome measures were the Wolf Motor Function Test (WMFT) and the upper limb portion of the Fugl-Meyer (FM) motor assessment. Structural integrity of the posterior limb of the internal capsule was assessed by examining the fractional anisotropy (FA) asymmetry in the PLIC. Laterality index of motor cortical areas was measured as the BOLD response in each patient during a finger pinch task. Linear regression analyses were performed to determine whether clinical outcome was associated with structural or functional MRI measures. Results. There were strong relationships between clinical outcome measures and FA asymmetry (eg, FM score [R 2 = .655, P = .001] and WMFT asymmetry score [R 2 = .651, P < .002]) but relationships with fMRI measures were weaker. Conclusion. Clinical motor function is more closely related to the white matter integrity of the internal capsule than to BOLD response of motor areas in patients 3 to 9 months after stroke. Thus, use of DTI to assess white matter integrity in the internal capsule may provide more useful information than fMRI to interpret motor deficits following supratentorial brain injury.

Selective long-term reorganization of the corticospinal projection from the supplementary motor cortex following recovery from lateral motor cortex injury.

Brain injury affecting the frontal motor cortex or its descending axons often causes contralateral upper extremity paresis. Although recovery is variable, the underlying mechanisms supporting favorable motor recovery remain unclear. Because the medial wall of the cerebral hemisphere is often spared following brain injury and recent functional neuroimaging studies in patients indicate a potential role for this brain region in the recovery process, we investigated the long‐term effects of isolated lateral frontal motor cortical injury on the corticospinal projection (CSP) from intact, ipsilesional supplementary motor cortex (M2). After injury to the arm region of the primary motor (M1) and lateral premotor (LPMC) cortices, upper extremity recovery is accompanied by terminal axon plasticity in the contralateral CSP but not the ipsilateral CSP from M2. Furthermore, significant contralateral plasticity occurs only in lamina VII and dorsally within lamina IX. Thus, selective intraspinal sprouting transpires in regions containing interneurons, flexor‐related motor neurons, and motor neurons supplying intrinsic hand muscles, which all play important roles in mediating reaching and digit movements. After recovery, subsequent injury of M2 leads to reemergence of hand motor deficits. Considering the importance of the CSP in humans and the common occurrence of lateral frontal cortex injury, these findings suggest that spared supplementary motor cortex may serve as an important therapeutic target that should be considered when designing acute and long‐term postinjury patient intervention strategies aimed to enhance the motor recovery process following lateral cortical trauma. J. Comp. Neurol. 518:586–621, 2010.

Linear Summation of Cat Motor Cortex Outputs

Recruitment of movement-related muscle synergies involves the functional linking of motor cortical points. We asked how the outputs of two simultaneously stimulated motor cortical points would interact. To this end, experiments were done in ketamine-anesthetized cats. When prolonged (e.g., 500 ms) trains of intracortical microstimulation were applied in the primary motor cortex, stimulus currents as low as 10–20 μA evoked coordinated movements of the contralateral forelimb. Paw kinematics in three dimensions and the electromyographic (EMG) activity of eight muscles were simultaneously recorded. We show that the EMG outputs of two cortical points simultaneously stimulated are additive. The movements were represented as displacement vectors pointing from initial to final paw position. The displacement vectors resulting from simultaneous stimulation of two cortical points pointed in nearly the same direction as the algebraic resultant vector. Linear summation of outputs was also found when inhibition at one of the cortical points was reduced by GABAA receptor antagonists. A simple principle emerges from these results. Notwithstanding the underlying complex neuronal circuitry, motor cortex outputs combine nearly linearly in terms of movement direction and muscle activation patterns. Importantly, simultaneous activation does not change the nature of the output at each point. An additional implication is that not all possible movements need be explicitly represented in the motor cortex; a large number of different movements may be synthesized from a smaller repertoire.

Variations in soleus H-reflexes as a function of plantarflexion torque in man

The purpose of this study was to evaluate the effects of the levels of voluntary isometric contraction on the Hoffman reflex in human soleus and medial gastrocnemius (MG) muscles. H-reflexes were recorded in sixteen healthy adults at each of 16 isometric plantarflexion (pf) torque levels ranging from 0-100% of their maximum voluntary isometric contraction (MVC) and were elicited at two intensities of stimulation: (i) supramaximal for M-response and (ii) a submaximal stimulus that produced an H-reflex in soleus that was 50% of maximum H-reflex at rest. The H-reflex peak-to-peak amplitudes were linearly related to pf torque levels ranging from 0 to 50% MVC at both supramaximal and submaximal stimulus intensities. The slope of this relationship was higher for the submaximal stimulation. Beyond 60% of MVC, the soleus H-reflex amplitude showed no further increase with increasing pf torque for both stimulus intensities. Thus, beyond 50-60% of MVC the soleus H-reflex does not provide an accurate measure of soleus motor neuron pool excitability. Further experimental results showed that the H-reflex amplitude at a given torque level depended on whether torque was increasing or decreasing. When torque was increasing, the amplitude of the H-reflex was larger than when the same torque was maintained at a constant level. In contrast, if the torque was decreasing, amplitude of the reflex was lower than when torque was increasing. Therefore, variations in H-reflex amplitudes at a given torque level may be more closely correlated to the direction of the ongoing contraction than to the actual muscle force being produced at the time the H-reflex is elicited.

On the functional organization and operational principles of the motor cortex

Recent studies on the functional organization and operational principles of the motor cortex (MCx), taken together, strongly support the notion that the MCx controls the muscle synergies subserving movements in an integrated manner. For example, during pointing the shoulder, elbow and wrist muscles appear to be controlled as a coupled functional system, rather than singly and separately. The recurrent pattern of intrinsic synaptic connections between motor cortical points is likely part of the explanation for this operational principle. So too is the reduplicated, non-contiguous and intermingled representation of muscles in the MCx. A key question addressed in this article is whether the selection of movement related muscle synergies is a dynamic process involving the moment to moment functional linking of a variety of motor cortical points, or rather the selection of fixed patterns embedded in the MCx circuitry. It will be suggested that both operational principles are probably involved. We also discuss the neural mechanisms by which cortical points may be dynamically linked to synthesize movement related muscle synergies. Separate corticospinal outputs sum linearly and lead to a blending of the movements evoked by activation of each point on its own. This operational principle may simplify the synthesis of motor commands. We will discuss two possible mechanisms that may explain linear summation of outputs. We have observed that the final posture of the arm when pointing to a given spatial location is relatively independent of its starting posture. From this observation and the recurrent nature of the MCx intrinsic connectivity we hypothesize that the basic mode of operation of the MCx is to associate spatial location to final arm posture. We explain how the recurrent network connectivity operates to generate the muscle activation patterns (synergies) required to move the arm and hold it in its final position.