Fast Flexion Research Articles

AI-Based Automatic System for Assessing Upper-Limb Spasticity of Patients With Stroke Through Voluntary Movement.

Spasticity is a common complication for patients with stroke, but only few studies investigate the relation between spasticity and voluntary movement. This study proposed a novel automatic system for assessing the severity of spasticity (SS) of four upper-limb joints, including the elbow, wrist, thumb, and fingers, through voluntary movements. A wearable system which combined 19 inertial measurement units and a pressure ball was proposed to collect the kinematic and force information when the participants perform four tasks, namely cone stacking (CS), fast flexion and extension (FFE), slow ball squeezing (SBS), and fast ball squeezing (FBS). Several time and frequency domain features were extracted from the collected data, and two feature selection approaches based on recursive feature elimination were adopted to select the most influential features. The selected features were input into five machine learning techniques for assessing the SS for each joint. The results indicated that using CS task to assess the SS of elbow and fingers and using FBS task to assess the SS of thumb and wrist can reach the highest weighted-average F1-score. Furthermore, the study also concluded that FBS is the optimal task for assessing all the four upper-limb joints. The overall result shown that the proposed automatic system can assess four upper-limb joints through voluntary movements accurately, which is a breakthrough of finding the relation between spasticity and voluntary movement.

Prediction of Spasticity through Upper Limb Active Range of Motion in Stroke Survivors: A Generalized Estimating Equation Model.

We aim to study the association between spasticity and active range of motion (ROM) during four repetitive functional tasks such as cone stacking (CS), fast flexion-extension (FFE), fast ball squeezing (FBS), and slow ball squeezing (SBS), and predicted spasticity models. An experimental study with control and stroke groups was conducted in a Medical Center. A total of sixty-four participants, including healthy control (n = 22; average age (years) = 54.68 ± 9.63; male/female = 12/10) and chronic stroke survivors (n = 42; average age = 56.83 ± 11.74; male/female = 32/10) were recruited. We employed a previously developed smart glove device mounted with multiple inertial measurement unit (IMU) sensors on the upper limbs of healthy and chronic stroke individuals. The recorded ROMs were used to predict subjective spasticity through generalized estimating equations (GEE) for the affected side. The models have significant (p ≤ 0.05 *) prediction of spasticity for the elbow, thumb, index, middle, ring, and little fingers. Overall, during SBS and FFE activities, the maximum number of upper limb joints attained the greater average ROMs. For large joints, the elbow during CS and the wrist during FFE have the highest average ROMs, but smaller joints and the wrist have covered the highest average ROMs during FFE, FBS, and SBS activities. Thus, it is concluded that CS can be used for spasticity assessment of the elbow, FFE for the wrist, and SBS, FFE, and FBS activities for the thumb and finger joints in chronic stroke survivors.

Correction: Measuring 3D Hand and Finger Kinematics-A Comparison between Inertial Sensing and an Opto-Electronic Marker System.

[This corrects the article DOI: 10.1371/journal.pone.0164889.].

Effects of Different Taping Pressures with Wrist Taping on Isokinetic Strength Exertion of Wrist Dorsal and Palmar Flexion

We aimed to examine the effects of wrist taping at different pressure levels on isokinetic strength exertion of dorsal and palmar flexion. Nineteen healthy male university students were enrolled. The wrist-taping method involved winding a rigid tape around wrist joint thrice. A qualified athletic trainer adjusted taping pressures using a pressure measuring system, whose sensor was on the palmaris longus muscle tendon of the dominant wrist. Isokinetic dorsal and palmar flexion strength was measured by an isokinetic dynamometer system. Taping pressure [5, 30, 60, and 90 hPa and control (no tape)] and angular velocity [slow (60°/sec), moderate (180°/sec), and fast (300°/sec)] were considered independent variables. Peak torque (Nm) of isokinetic strength exertion was considered the dependent variable. Two-way repeated measures analysis of variance (taping pressure × angular velocity) was used to calculate the mean differences for peak torque conditions. A significant difference was found only in the main effect of angular velocity. Multiple comparison tests showed that the isokinetic strength exertion was largest in fast flexion in all taping pressure conditions for dorsal flexion, whereas it was largestin slow flexion in the control and 5-hPa conditions for palmar flexion. For palmar flexion, it was larger in slow flexion for 30-hPa. The effects of taping pressure and flexion speed on isokinetic strength exertion may differ between dorsal and palmar flexion of the same wrist.

Femoral Nerve Blockade is Associated with Persistent Strength Deficits at Six Months Post ACL Reconstruction in Pediatric and Adolescent Patients

Objectives:Femoral nerve blockade has become a popular method of postoperative analgesia for anterior cruciate ligament (ACL) reconstruction in pediatric and adolescent patients. Successful rehabilitation after ACL reconstruction involves return of quadriceps and hamstring strength and dynamic knee stability. The objective of this study was to compare strength and function six months after ACL reconstruction in pediatric and adolescent patients who received a femoral nerve block versus a control group of patients with no nerve block.Methods:A search of our institutional database was performed to identify patients 17 years of age or younger who underwent primary ACL reconstruction between 2001 and 2010. Revision ACL surgeries and previous contralateral and ipsilateral knee surgeries were excluded. Based on institutional protocol, the patients participated in a comprehensive rehabilitation program and underwent isokinetic strength testing (slow and fast activation) and functional testing (vertical jump, single hop, triple hop) at six months after ACL reconstruction.Results:There were 127 patients that met the inclusion criteria, including 63 patients in the NB group (32 males, 31 females) and 64 patients in the control group (26 males, 38 females). There were no significant differences between the NB group and the control group with respect to age (15.7 ± 1.4 vs. 15.5 ± 1.4, p = 0.26), sex (p = 0.29), BMI (23.7 ± 3.6 vs. 23.8 ± 3.6, p = 0.91), or type of graft used (67% patellar tendon autograft, 33% hamstring autograft vs. 70% patellar tendon autograft, 30% hamstring autograft, p = 0.85). Univariate analysis showed a significantly higher deficit at six months in the NB group with respect to fast isokinetic extension strength (17.6% vs. 11.3%, p = 0.008), as well as fast (12.8% vs. 8.3%, p = 0.029) and slow (9.9% vs. 5.5%, p = 0.029) isokinetic flexion strength. There was no difference in slow extension isokinetic strength deficit between the two groups (NB 22.1% vs. control 18.9%, p = 0.246).. With respect to function, there were no differences in deficit for vertical jump (NB 9.3% vs. control 11.3%, p = 0.267), single hop (NB 7.5% vs. control 7.6%, p = 0.970), or triple hop (NB 7.9% vs. control 6.5%, p = 0.375) between the two groups. A higher percentage of patients in the control group met criteria for return to sports at six months. (88.9% vs. 68.3%, p = 0.008).Conclusion:Pediatric and adolescent patients treated with a femoral nerve block for postoperative pain control after ACL reconstruction had significant isokinetic deficits in knee extension (quadriceps) and flexion (hamstring) strength at six months when compared to patients who did not receive a nerve block. No differences in the results of functional testing were observed between the two groups. A significantly higher percentage of patients in the group who did not receive a block were cleared to return to sports at six months following ACL reconstruction.

The role of anticipatory postural adjustments (APAs) in interlimb coordination of coupled arm movements in the parasagittal plane: I. APAs associated with fast discrete flexion and extension movements of one arm or of both arms ISO- and ANTI-directionally coupled

Coupling stability during cyclic arm movements in the horizontal (transverse) plane is lower in ISO- than in ANTI-directional coupling. We proposed that such impairment arises from the interference exerted in ISO by the anticipatory postural adjustments (APAs) linked to the primary movements. To evaluate if a link between coupling stability and postural adjustments also exist for arm movements with different postural requirements, we focused on arm(s) flexion-extension in the parasagittal plane and started by analysing the APAs distribution in arm, trunk and leg muscles. Fast flexion and extension of the right arm elicited APAs in the left anterior and posterior deltoid that replicated the excitation-inhibition of the homologous prime movers; this pattern would favour ISO and contrast ANTI-coupled movements. Instead, in the left latissimus dorsi, APAs were opposite to the voluntary actions in the right latissimus dorsi, thus favouring ANTI coupling. Symmetrical APAs were also elicited in right and left erector spinae (RES, LES) and asymmetrical APAs in Ischiocruralis (RIC, LIC), while an antero-posterior force (Fy) and a moment about the vertical axis (Tz) were discharged to the ground. When fast discrete movements were ISO-coupled, APAs were symmetrical in trunk (RES, LES) and leg (RIC, LIC) muscles and a large Fy but no Tz was generated. In ANTI coupling, APAs in RES and LES remained symmetrical, whereas they became antisymmetrical in RIC and LIC. A large Tz and a small Fy were recorded. In conclusion, during parasagittal movements, APAs in are elicited in both ISO and ANTI coupling, at variance with horizontal movements where they are only present in ISO. This would suggest that the difference in coupling stability between the two modes is smaller (or even reversed) in parasagittal with respect to horizontal arm movements.

Antagonist muscle activation preceding rapid flexion movements of the elbow joint in human subjects

Our study was designed to look for interactions between fast movements and pre-existing voluntary tonic motor activity when both motor acts employ the same muscles. Five normal subjects performed a continuous sequence of two motor tasks about their right elbow joint: A tonic isometric extension (slowly increasing or decreasing) against a force transducer, followed immediately after a "go" tone by a fast isotonic flexion. The position of the lower arm was recorded using a search coil system. Signals (force, position, and surface EMGs of triceps and biceps brachii muscles) were A/D converted and sampled at 1 kHz. A premovement silence in the tonically active triceps muscle (extensor) usually preceded the fast flexion movement if the triceps' tonic force was either constant or decreased slowly. If the tonic triceps activity had been increasing before the fast flexion began, this classical picture disappeared, and the premovement silence was replaced by a phasic premovement excitation. Subjects were unaware of this transient EMG and force increase in the unintended direction. Our results demonstrate unconscious reciprocal interactions between commands governing evolving movements (and tuning the motor system accordingly) and those concerned with ongoing motor acts.

High-resolution movement EEG classification.

The aim of the contribution is to analyze possibilities of high-resolution movement classification using human EEG. For this purpose, a database of the EEG recorded during right-thumb and little-finger fast flexion movements of the experimental subjects was created. The statistical analysis of the EEG was done on the subject's basis instead of the commonly used grand averaging. Statistically significant differences between the EEG accompanying movements of both fingers were found, extending the results of other so far published works. The classifier based on hidden Markov models was able to distinguish between movement and resting states (classification score of 94–100%), but it was unable to recognize the type of the movement. This is caused by the large fraction of other (nonmovement related) EEG activities in the recorded signals. A classification method based on advanced EEG signal denoising is being currently developed to overcome this problem.

Shift from hypermetria to hypometria in multiple system atrophy: Analysis of distal and proximal movements

Dysmetria is a classical sign which designates the overshoot, also called hypermetria, and the undershoot, or hypometria, when the patient attempts to reach rapidly an aimed target. Dysmetria is typically observed in patients presenting a cerebellar dysfunction. Dysmetria of distal movements is associated with an imbalance between the timing and/or the intensity of agonist and antagonist EMG activities. So far, 1. there is only one description in human of a shift from hypermetria to hypometria for fast goal-directed single-joint movements during an aberrant recovery following a cerebellar infarction, and 2. such a shift has not been described for proximal movements. We report a patient presenting a multiple system atrophy (MSA). Initially, he exhibited a marked cerebellar syndrome. Fast wrist flexions and fast upper limb reaches in the sagittal plane were hypermetric. The distal hypermetria was associated with a delayed onset latency of the antagonist EMG activity and reduced intensities of both the agonist and the antagonist EMG activities. The proximal hypermetria was associated with a defect in the phasic spatial tuning of the EMG activities. He developed progressively severe extra-pyramidal signs. Distal hypermetria turned into hypometria, as a result of a decrease in the intensity of the agonist muscle. Proximal hypermetria turned into hypometria, as a result of the loss of directional preference of the EMG activities in proximal muscles. MSA is the second human model of a shift from hypermetria to hypometria. [Neurol Res 2002; 24: 249-258]

Kinematics of fast wrist movements in manic-depressive illness chronically treated with lithium carbonate

Lithium salts have been shown to impair kinematics of fast voluntary movements during acute intoxication. The aim of the present study was to determine whether lithium carbonate affected the kinematics of fast movements in patients chronically treated and who did not exhibit signs of neurotoxicity. We analysed fast wrist flexion movements in 6 healthy subjects, in 5 patients presenting a manic-depressive illness without treatment, and in 8 patients receiving lithium carbonate for a manic-depressive disease. The mean duration of treatment was 3.9±4.1 years, the mean daily dose 837±341 mg and the mean serum level 0.95±0. 15 mEq/l. Although mean movement amplitudes were similar in the 3 groups, the variability of fast movements was increased in patients receiving lithium salts. The ratio of maximum to average velocities (VmNaveJ was significantly higher in patients treated, and their movements were temporally asymmetrical, with a ratio ofacceleration duration divided by deceleration duration being lower than in the 2 other groups. These kinematic abnormalities show that a chronic treatment with lithium salts is associated with an impairment of the cerebellar control of fast single-joint movements. [Neural Res 1998; 20: 320-326]

Analysis of single-joint rapid movements in patients with sporadic olivopontocerebellar atrophy

Patients with pure cerebellar cortical atrophy (CCA) present isolated cerebellar signs, whereas patients with sporadic olivopontocerebellar atrophy (sOPCA) present various combinations of cerebellar and extracerebellar signs. However, the differential diagnosis between these two forms of cerebellar degeneration is often a challenge for the clinician. Therefore, any test helping in this differential diagnosis might have a potential clinical interest. In this study, our goal was to investigate the adaptation to increased inertia in patients with sOPCA exhibiting combined cerebellar and pyramidal signs, during the performance of fast wrist flexions. We found that these patients exhibited a hypermetria which remained unchanged after addition of inertia, because they were unable to increase neither their agonist activity (launching force), nor their antagonist activity (braking force). This contrasts with our previous findings in patients with CCA. In these latter, the hypermetria worsened when the inertial load of the hand increased because those patients were able to increase their agonist activity, but not their antagonist activity. The adaptation to inertia might thus help to differentiate CCA and sOPCA.

Organizing principles for voluntary movement: extending single-joint rules.

1. Four subjects performed fast flexions of the elbow or shoulder over three different distances. Elbow flexions were performed both in a horizontal, single-degree-of-freedom manipulandum and in a sagittal plane with the limb unconstrained. Shoulder flexions were only performed in the sagittal plane by the unconstrained limb. We simultaneously recorded kinematic and electromyographic (EMG) patterns at the "focal" joint, that which the subject intentionally flexed, and at the other, "nonfocal" joint that the subject had been instructed to not flex. 2. Comparisons of the elbow EMG patterns across tasks show that agonist and antagonist muscles were similar in pattern but not size, reflecting the net muscle torque patterns. Comparisons at the shoulder also revealed similar EMG patterns across tasks that reflected net muscle torques. 3. Comparisons of EMG patterns across joints show that elbow and shoulder flexors behaved similarly. This was not true of the extensors. The triceps EMG burst was delayed for longer distances but the posterior deltoid had an early, distance-invariant onset. 4. Similarities in EMG reflect torque demands required at the focal joint to produce flexion and at the nonfocal joint to reduce extension induced by dynamic interactions with the focal, flexing joint. These similarities appear despite very different kinematic intentions and outcomes. This argues against a strong role for length-sensitive reflexes in their generation. 5. These results support the hypothesis that movements are controlled by muscle activation patterns that are planned for the expected torque requirements of the task. This general rule is true whether we are performing single-joint or multiple-joint movements, with or without external constraints. The similarities between single-joint and multijoint movement control may be a consequence of ontogenetic development of multijoint movement strategies that prove useful and are therefore also expressed under the constrained conditions of specialized tasks such as those performed in single-joint manipulanda.

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 finewire 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 mucle 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.

The function of the antagonist muscle during fast limb movements in man.

We have examined fast flexion movements of the human thumb and fast extension movements of the elbow over three different distances at a variety of speeds in order to elucidate the function of the antagonist muscle in these circumstances. All movements were of such a velocity that they showed the typical bi- or triphasic pattern of muscle activation in agonist and antagonist. Slower movements, with continuous agonist activity, were not analysed. For movements made through the same angle at different velocities, there was a linear relationship between the amount of antagonist activity needed to halt the movement and the peak velocity. However, the slope of this relationship was a function of the distance moved. Movements made through large angles showed less antagonist activity than those made through small angles at the same speed. The timing of the antagonist activity also changed as a function of both distance and speed. Fast, small movements showed earlier onset of antagonist activity than slow, large ones. Movements which were halted mechanically with the subject's prior knowledge had little or no antagonist activity, since it was no longer necessary in these conditions. The complexity of these relations indicates that the triphasic pattern of muscle activity underlying these movements can no longer be regarded as a simple immutable 'programme'. The size and timing of the bursts of muscle activity are subtly adjusted to the precise nature of the task.

Fast aiming movements with the left and right arm: evidence for two-process theories of motor control.

The kinematics of leftward and rightward movements are different. The question is raised whether these differences in both arms are best accounted for in terms of the flexion-extension dimension or the leftward-rightward dimension. In a simple step-tracking experiment the acceleration-time curves of fast flexions and extensions of the left and of the right elbow joint in a horizontal plane were recorded. The durations of individual segments of the acceleration curves are best predicted by spatial direction: that is, the differences between leftward and rightward movements are either both positive or both negative in both arms. This holds only for the first part of the movement until maximum deceleration is reached. From then on the timing is best predicted by the flexion-extension dimension. This is taken as evidence for a two-process theory of motor control according to which a central process is first in command and a lower-level, muscle-related process then takes over. Although a change which corresponds to the one observed in the time variables is not seen in the maxima of the acceleration curves, this seeming disparity can be reconciled with a two-process theory.

Supplementary motor area and other cortical areas in organization of voluntary movements in man.

1. Previous studies in man have revealed a coupling between the regional cerebral blood flow (rCBF) and the regional cerebral metabolic rate for oxygen. In normal man, increases in the regional cerebral metabolic rate for oxygen leads to proportional increases in the rCBF(34). We have measured the rCBF as an expression of the level of cortical activity simultaneously from 254 cortical regions in 28 patients with no major neurological defects, during rest and during planning and execution of a few types of learned voluntary movements with the hand. 2. We found that the rCBF increases exclusively in the supplementary motor area while subjects were programming a sequence of fast isolated movements of individual fingers, without actually executing it. 3. During execution of the same motor sequence, there were equivalent increases of the rCBF in both supplementary motor areas, but only in the contralateral primary motor area. In addition, there were more modest rCBF increases in the contralateral sensory hand area, the convexity part of the premotor area, and bilaterally in the inferior frontal region. 4. Repetitive fast flexions of the same finger or a sustained isometric muscular contraction raise the blood flow in the contralateral primary motor and sensory hand area. 5. A pure somatosensory discrimination of the shapes of objects, without any concomitant voluntary movements, also leaves the supplementary motor areas silent. 6. We conclude that the primary motor area and the part of the motor system it projects to by itself can control ongoing simple ballistic movements with the self-same body part. A sequence of different isolated finger movements requires programming in the supplementary motor areas. We suggest that the supplementary motor areas are programming areas for motor subroutines and that these areas form a queue of time-ordered motor commands before voluntary movement are executed by way of the primary motor area.

Structure and Function of the Lateral Giant Neurone of the Primitive Crustacean Anaspides Tasmaniae

ABSTRACT The syncarid crustacean Anaspides tasmaniae rapidly flexes its free thoracic and abdominal segments in response to tactile stimulation of its body. This response decrements but recovers in slightly more than one hour. The fast flexion is evoked by single action potentials in the lateral of two large diameter fibres (40 μm) which lie on either side of the cord. The lateral giant fibre is made up of fused axons of 11 neurones, one in each of the last 5 thoracic and 6 abdominal ganglia. The soma of each neurone lies contralateral to the axon. Its neurite crosses that of its counterpart in the commissure and gives out dendrites into the neuropile of each hemi-ganglion. The lateral giant neurone receives input from the whole body but fires in response only to input from the fourth thoracic segment posteriorly. Both fibres respond with tactile stimulation of only one side. Since neither current nor action potentials spread from one fibre to the other, afferents must synapse with both giant neurones. The close morphological and physiological similarities of the lateral giant neurone in Anaspides to that in the crayfish (Eucarida) suggest that the lateral giant system arose in the ancestor common to syncarids and eucarids, prior to the Carboniferous.

Analysis of stereotyped voluntary movements at the elbow in patients with Parkinson's disease.

Patients with Parkinson's disease performed several different stereotyped elbow flexion tasks, and the electromyographic (EMG) patterns from biceps and triceps were compared with previously established normal standards. The EMG pattern during a smooth flexion task was almost always abnormal and was characterized by alternating activity in biceps and triceps. The EMG patterns during a fast flexion task were also usually abnormal although they were always composed of bursts of EMG activity of normal duration appearing alternately in the agonist and antagonist muscles. These bursts, associated with movements of the limb, have a superficially similar appearance to the EMG bursts seen with tremor-at-rest, but certain physiological differences are demonstrated. This study demonstrates that both slow (ramp) and fast (ballistic) movements are clearly abnormal in these patients with disease of the basal ganglia. In a task designed to investigate antagonist inhibition before agonist activity, a majority of the patients performed normally. This suggests that, contrary to previous claims, slowness of movement (akinesia/bradykinesia) is not due either to failure to relax or to rigidity of antagonist muscle.

EMG analysis of stereotyped voluntary movements in man.

EMG activity was recorded in biceps and triceps while subjects voluntarily flexed their elbows during a visual matching task. With fast flexion, the initial EMG was characterized by a triphasic pattern with a burst of activity first in biceps, then in triceps with a silent period in biceps, and finally in biceps again; these components were analysed quantitatively. Smooth flexion was characterized by continuous activity in biceps. Inhibition of tonic activity of triceps in relation to a fast flexion occurred in the 50 ms before the initiation of biceps activity. A patients with a severe pansensory neuropathy performed normally on these tasks. Physiological mechanisms underlying these patterns are analysed; an important conclusion is that the triphasic activity with fast flexion is 'centrally programmed'.

The Antennular Activities of the Hermit Crab, Pagurus Alaskensis (Benedict)

ABSTRACT The antennular activities of the hermit crab, Pagurus alaskensis, were studied with the aid of motion pictures taken at speeds of 50, 200 and 400 frames/sec. Most movements of the antennule represent one of four types of antennular activity: flicking, rotation, wiping and withdrawal. These activities are described in detail. Water resistance forces contribute to the timing and duration of some antennular movements. Flicking occurs non-rhythmically and flicks of the left and right antennules ail never synchronized. The factors which influence the mean frequency of flicking are discussed. The timing of joint movements during a flick, and the morphology of the outer flagellum and the aesthetasc hairs, appear to be adapted to facilitate splaying of the aesthetascs. It is proposed that this splaying might facilitate the chemoreceptive process by circulating water around the aesthetasc hairs. During antennular wiping the endopodites of the 3rd maxillipeds are used to remove debris caught amongst the aesthetasc hairs. Light mechanical stimulation of the aesthetascs is sufficient to elicit wiping. The antennules are reflexively withdrawn from certain stimuli either by extension or by slow or fast flexion. The functional significance of the withdrawal reflexes are discussed in relation to the stimuli involved and the form of the reflexes. Continued application of certain stimuli to the antennules, eyestalks, antennae or body results in tonic flexion withdrawal which involves postural modifications of the antennules, eyestalks and antennae.