Gamma Loop Research Articles

Gamma Loop Dysfunction as a Possible Neurophysiological Mechanism of Arthrogenic Muscle Inhibition: A Narrative Review of the Literature.

Quadriceps activation failure has been observed following various pathological conditions in a knee joint such as knee surgery, pain, effusion in knee, and osteoarthritis also could be aging matter. Those patients are unable to attain maximal quadriceps strength for a long period of time although their quadriceps itself is not damaged. This impairment is termed arthrogenic muscle inhibition (AMI). AMI has been of concern to clinicians because this weakness hinders the rehabilitation process considerably and delays recovery because strengthening protocols for the AMI could be largely ineffective. Clinically, it is important to understand neurophysiological mechanisms of the AMI to treat patients with the impairment. This is a narrative review of the literature. The purpose of this review is to understand the following: (1) Why investigations of only peripheral spinal reflexive pathways are not enough for elucidation of the mechanisms of the AMI? (2) What we know about the role of the gamma spindle system in AMI so far? (3) Could a dysfunctional gamma spindle system contribute to AMI lead neural changes in upper central nervous system? and (4) Concerns that a clinician should take into consideration when deciding whether to apply therapeutic interventions for AMI. The databases PubMed, MEDLINE, SPORTDiscus, and CINAHL were searched with the terms arthrogenic muscle inhibition (AMI), reflex inhibition, joint mechanoreceptor, gamma loop, corticospinal pathway, spinal reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers. AMI is a limiting factor in the rehabilitation of joint injury. Motor unit recruitment could be hindered in patients with AMI as a result of a dysfunctional gamma spindle system. Clinicians should understand the mechanism of AMI well in order to establish effective rehabilitation programs for AMI. Indeed, AMI is not caused by a single factor, but rather, multiple neural factors can change over time following the appearance of AMI. Therefore, multiple interventions targeting different neural pathways should be combined to achieve the ideal therapeutic goal for the treatment of AMI.

Detection of endoscopic looping during colonoscopy procedure by using embedded bending sensors.

BackgroundLooping of the colonoscope shaft during procedure is one of the most common obstacles encountered by colonoscopists. It occurs in 91% of cases with the N-sigmoid loop being the most common, occurring in 79% of cases.PurposeHerein, a novel system is developed that will give a complete three-dimensional (3D) vector image of the shaft as it passes through the colon, to aid the colonoscopist in detecting loops before they form.Patients and methodsA series of connected links spans the middle 50% of the shaft, where loops are likely to form. Two potentiometers are attached at each joint to measure angular deflection in two directions to allow for 3D positioning. This 3D positioning is converted into a 3D vector image using computer software. MATLAB software has been used to display the image on a computer monitor. For the different configuration of the colon model, the system determined the looping status.ResultsDifferent configurations (N loop, reverse gamma loop, and reverse splenic flexure) of the loops were well defined using 3D vector image.ConclusionThe novel sensory system can accurately define the various configuration of the colon during the colonoscopy procedure.

Revisiting the gamma loop in ALS.

Amyotrophic Lateral Sclerosis (ALS) is a fast progressive neurodegenerative disease characterized by muscle denervation, weakening and atrophy, which eventually culminates into death, mainly due to respiratory failure. The traditional view of ALS as a disorder affecting selectively motor neurons throughout the central nervous system has been progressively dispelled by innumerous lines of evidence indicating that other cells but motor neurons may be affected as well. Remarkably, this disorder is not limited to the motor system but rather configures as a systemic disease yielding a plethora of clinical signs. Among this broad clinical spectrum, sensory neuropathy occurring parallel to motor dysfunction is a quite frequent feature within ALS patients, which has spurred the interest of many investigators during the years. In line with this, morphological studies have confirmed that sensory neurons and axons' degeneration may occur in both ALS- experimental models and -patients. Noteworthy, this may have a nonetheless negligible role in ALS -related motor decline, as highlighted by recent studies showing that, degeneration of type I/II proprioceptive fibers is a primary source of alpha-motor neurons' death. These latter in fact, differently from gamma motor neurons, are a direct monosynaptic target of proprioceptive fibers. The present findings contribute to define a novel scenario of sensorimotor ALS pathophysiology where the gamma loop's fine connectivity may play a key role. In support to this view, in the present manuscript we provide a reappraisal on the role of single gamma loop's components in ALS.

Anterior cruciate ligament reconstruction does not induce further gamma loop abnormalities on the intact side of the quadriceps femoris: A longitudinal study

This study aimed to investigate the effect of surgery on the gamma loop of the quadriceps on the side with an intact knee in patients with anterior cruciate ligament (ACL) injuries. We compared longitudinally the response of alpha motor neurons to vibration stimulation of the quadriceps on the side with an intact knee before and after ACL reconstruction. To evaluate alpha motor neuron response, we measured the maximal knee extension strength and integrated electromyography of the vastus medialis, vastus lateralis, and rectus femoris. After obtaining pre-vibration data from each subject, vibration stimulation was applied to the infrapatellar tendon, and the same measurements were performed immediately after stimulation. The results of this study showed that the response to prolonged vibration stimulation on the intact side of the quadriceps did not differ pre- and post-surgery. As vibration stimuli normally elicit a decrease in alpha motor neuron activity in normal individuals, abnormal responses to prolonged vibration stimulation of the quadriceps on the side with an intact knee might be observed in patients with ACL injuries. The abnormality of the gamma loop of the quadriceps on the side with an intact knee was probably induced by the rupture. Based on these results, we conclude that surgery does not induce further gamma loop abnormalities on the intact side of the quadriceps.

Is gamma loop dysfunction related to bilateral inhibition in anterior knee pain?

The potential relationship between bilateral quadriceps inhibition in individuals with unilateral anterior knee pain (AKP) and gamma loop dysfunction is examined in this study. Twelve individuals with unilateral AKP and 10 healthy controls were recruited. Quadriceps voluntary activation (%VA) was quantified using a triggered interpolated twitch technique. Gamma loop function was assessed through knee extension maximum voluntary isometric contractions before and after 20 minutes of 50-Hz patellar tendon vibration. The AKP group exhibited 5.7% lower %VA bilaterally compared with controls (P = 0.039, Cohen d = 0.79). After prolonged vibration, both groups exhibited an average 8.5% reduction in knee extension force in each limb (P < 0.001, Cohen d = 0.85). Significant force reductions after vibration suggest that gamma loop dysfunction was not seen in either control or AKP participants. Bilateral quadriceps inhibition in the AKP group does not appear to be associated with gamma loop dysfunction.

Psychoemotional Background of Temporomandibular Joint Dysfunction and Possible Drug Therapy

The aim of this paper was to present the etiological factors responsible for temporomandibular joint dysfunction associated with psychoemotional disorders and possible drug therapy. Etiology of this disorder is multifactorial. The term “stress” was explained, together with its influence on the human body and its long-term effects. We emphasized the significance of factors that affect individual reaction to stress and patients’ personality features favoring incorrect behavioral pattern. We also presented the mechanism of adverse effect of stress on temporomandibular muscles and joints via the limbic system and gamma loop as well as the role of temporomandibular reflexive regulation mechanisms. We explained the differences in reactivity between skeletal and masticatory muscles to stress-inducing factors resulting from different embryonic origin, morphology, and biochemical reactions during muscle contraction and presented drug therapy. Keywords: Temporomandibular joint dysfunction, depression, limbic system, stress, pharmacological treatment, occlusal splint.

Treatment of spasmodic dysphonia with a neuromodulating electrical implant.

To investigate the feasibility of an implantable electrical stimulation device to treat spasmodic dysphonia (SD) by neuromodulation of the muscle spindle gamma loop. Prospective case series. Five subjects underwent daily stimulation of the left thyroarytenoid muscle (TA) below the level of α-motor neuron activation (AMNA) for 5 consecutive days. Professional and patient voice evaluations were performed. Transcartilagenous placement of an implantable stimulation device lead was investigated in anesthetized porcine and cadaveric human models. Three of 5 subjects improved in all categories of evaluation. One subject improved in three of four categories. These four subjects described significant carryover of effect after treatment. The fifth subject evidenced improvement until contracting an upper respiratory infection on day 3. Transcartilagenous electrode placement into the porcine TA with muscle stimulation was successful. The electrode lead was passed from the cadaveric larynx to the mastoid tip in the subplatysma layer with an absence of tension. The symptoms of SD improve after electrical stimulation of the TA at levels below AMNA. This is likely through neuromodulation of the muscle spindle gamma loop. Implantation of an electrode into the TA with a postauricular implanted stimulator is feasible with modifications of an already existing device. With further investigation, such a device has the potential to deliver an alternative treatment for SD. 4.

ACL Repair Might Induce Further Abnormality of Gamma Loop in the Intact Side of the Quadriceps Femoris

The purpose of this study was to investigate the effect of surgery on the gamma-loop in the quadriceps of patients with ACL injuries. We compared the response to vibration stimulation in subjects with ACL repair, subjects with ACL rupture, and normal subjects, by measuring the maximal strength and integrated electromyography (I-EMG) of the quadriceps. Pre-vibration data were obtained from each subject by measuring the MVC of the knee extension and the I-EMG from the vastus medialis, vastus lateralis, and rectus femoris. Vibration stimulation was applied to the infrapatellar tendon, followed immediately by repeating maximal strength and I-EMG recording. The results of this study indicated that alpha motor neuron activity of the intact side of the vastus lateralis in response to prolonged vibration stimulation was altered by surgery, but no effect was detected in the injured side. The results could suggest that abnormality of the gamma-loop existed even in the quadriceps of patients with ACL rupture since the vibration stimulus failed to elicit changes in ACL-rupture group as compared with those of normal subjects. In comparison, abnormality of the gamma-loop in the intact side of the QF was probably induced by the rupture, and further abnormality of gamma-loop was induced by surgery.

ACL repair might induce further abnormality of gamma loop in the intact side of the QF

ACL repair might induce further abnormality of gamma loop in the intact side of the QF

Acute effects of passive stretching vs vibration on the neuromuscular function of the plantar flexors

This study examined the acute effects of passive stretching (PS) vs prolonged vibration (VIB) on voluntary peak torque (PT), percent voluntary activation (%VA), peak twitch torque (PTT), passive range of motion (PROM), musculotendinous stiffness (MTS), and surface electromyographic (EMG) and mechanomyographic (MMG) amplitude of the medial gastrocnemius (MG) and soleus (SOL) muscles during isometric maximal voluntary contractions (MVCs) of the plantar flexors. Fifteen healthy men performed the isometric MVCs and PROM assessments before and after 20 min of PS, VIB, and a control (CON) conditions. There were 10% and 5% decreases in voluntary PT, non-significant 3% and 2% decreases in %VA, 9-23% decreases in EMG amplitude of the MG and SOL after the PS and VIB, respectively, with no changes after the CON. PROM increased by 19% and MTS decreased by 38% after the PS, but neither changed after the VIB or CON conditions. Both PS and VIB elicited similar neural deficits (i.e., gamma loop impairment) that may have been responsible for the strength losses. However, mechanical factors related to PROM and MTS cannot be ruled out as contributors to the stretching-induced force deficit.

An Earthworm-Like Robotic Endoscope System for Human Intestine: Design, Analysis, and Experiment

The existing endoscope brings too much discomfort to patients because its slim and rigid rod is difficult to pass through alpha, gamma loop of the human intestine. A robotic endoscope, as a novel solution, is expected to replace the current endoscope in clinic. A microrobotic endoscope based on wireless power supply was developed in this paper. This robot is mainly composed of a locomotion mechanism, a wireless power supply subsystem, and a communication subsystem. The locomotion mechanism is composed of three liner-driving cells connected with each other through a two-freedom universal joint. The wireless power supply subsystem is composed of a resonance transmit coil to transmit an alternating magnetic field, and a secondary coil to receive the power. Wireless communication system could transmit the image to the monitor, or send the control commands to the robot. The whole robot was packaged in the waterproof bellows. Activating the three driving cells under some rhythm, the robot could creep forward or backward as a worm. A mathematic model is built to express the energy coupling efficiency. Some experiments are performed to test the efficiency and the capability of energy transferring. The results show the wireless energy supply has enough power capacity. The velocity and the navigation ability in a pig intestine were measured in in vitro experiments. The results demonstrated this robot can navigate the intestine easily. In general, the wireless power supply and the wireless communication remove the need of a connecting wire and improve the motion flexibility. Meanwhile, the presented locomotion mechanism and principle have a high reliability and a good adaptability to the in vitro intestine. This research has laid a good foundation for the real application of the robotic endoscope in the future.

Gamma Loop Dysfunction of the Quadriceps Femoris of Elderly Patients Hospitalized after Fall Injury

Gamma loop dysfunction may increase the risk of falls. Therefore, we evaluated gamma loop function in subjects hospitalized after fall injury and examined whether aging affects the gamma loop. Maximal voluntary contraction (strength) of knee extension and integrated electromyography (I-EMG) of the quadriceps femoris were examined to evaluate the activities of alpha motoneurons before and after 20-min vibration applied to the quadriceps femoris. Mean percentage changes were calculated as: (previbration value-postvibration value)/previbration valuex100). As strength and I-EMG of both uninjured (UG) and injured limbs (IG) of patients with a history of falls resulting in hospitalization were examined in each group, the mean percentage changes of the 4 groups were compared with those of controls [young control group (YCG) and elderly control group (ECG)]. Mean percentage changes in strength of UG and IG were significantly different from YCG but not the ECG. Mean percentage changes in I-EMG for VL (vastus lateralis) and VM (vastus medialis)in IG were significantly different from YCG. However, I-EMG of RF of IG were not significantly different from YCG. Although mean percentage changes in I-EMG of UG were not significantly different from ECG, those for VL and VM of IG were different from ECG. As the gamma loop dysfunction exited in the uninjured limbs of subjects with a history of falls resulting in hospitalization, a dysfunctional gamma loop could be a risk factor for falling. Further studies are needed to identify the effects of aging on gamma loop function.

Gamma loop dysfunction in the quadriceps femoris of patients who underwent anterior cruciate ligament reconstruction remains bilaterally

Purpose of this study was to investigate the effects of anterior cruciate ligament (ACL) repair on the gamma loop of the bilateral quadriceps femoris (QF). Maximal voluntary contraction (MVC) of knee extension and integrated electromyogram (I-EMG) of vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) were examined in uninjured and injured limbs of 18 patients and 10 normal subjects, before and after 20-min vibration applied to the QF. Mean percentage changes were calculated as: (pre-vibration value-post-vibration value)/pre-vibration value x 100. Patients were divided into two groups: short-term-group (tested </=12 months after ACL repair, n=8), long-term-group (tested >/=18 months after ACL repair, n=10). Mean percentage changes of the four groups were compared with those of controls. Results indicated that changes of MVC and I-EMG on the uninjured and injured sides in short-term-group in response to vibration were significantly different from those of controls. There were no significant differences between uninjured sides in long-term and control groups. MVC and I-EMG of VM and RF of injured side in patients in the long-term-group in response to vibration were not different from those of controls. From these results, we concluded that this abnormality of the gamma loop in both injured and uninjured sides did not recover despite ACL reconstruction. However, the abnormality in uninjured side might recover >/=18 months after repair.

Effects of graded levels of exercise on ipsilateral and contralateral post-exercise resting rectus femoris mechanomyography

Mechanomyography has shown that "resting" muscle is mechanically active, with greater activity after vigorous exercise. This experiment studied the post-exercise resting mechanomyography activity that results from different levels of exercise; the effects of exercise levels on the contralateral non-exercised limb; and the effects of resting muscle length on post-exercise resting mechanomyographic activity. Ten healthy volunteers had mechanomyography recordings over both mid-rectus femoris, at rest, before and after sets (1, 5, 10, 20, and 30 repetitions) of right leg extensions on an isokinetic dynamometer at 60 s(-1). Sets were performed a week apart, after only sedentary activity during the previous two hours. No definite threshold effect was shown. There was a linear correlation between mechanomyography and work done (R = 0.61, P < 0.01). There was a positive correlation of change of activity between the two thighs (R = 0.62, P < 0.01), with the non-exercised thigh demonstrating about half the activity of the exercised thigh. Finally, we observed that mechanomyographic activity was greater when rectus femoris muscle length was shorter (i.e. when the leg was extended versus flexed). We conclude that resting mechanomyography increases with increasing work and that there is a cross-over for increase in mechanomyography in the non-exercised leg, suggesting a neural mechanism. The greater mechanomyographic activity at shorter muscle lengths suggests that muscle that is less stretched could more freely oscillate, producing higher MMG amplitudes. Altered activity of the muscle spindle gamma loop or Golgi tendon apparatus may also play a role in altered activity with different muscle length.

Reflex gain of muscle spindle pathways during fatigue

There are conflicting observations of the effects of fatigue on the sensitivity of large diameter Ia afferents. Our goal was to characterize any fatigue-related changes in the spinal reflex pathways during fatigue. Manipulation of the Ia afferent response by vibration and tendon tap, in which the motor neuron pool is modulated by both short- and long-loop activation from muscle spindles, were elicited before and after a fatigue task. The fatigue task consisted of intermittent submaximal and maximal voluntary contractions (MVCs). Percent voluntary activation fell from 98.75% MVC to 80.92% MVC following the fatigue task as measured by the twitch interpolation technique. Voluntary contractions of the same force profile as the force produced by 30 s of vibration were produced by having participants (n = 10) follow the trajectory on a computer monitor, before and after the fatigue task. Recruitment thresholds (RTs) of voluntarily activated units showed no change during fatigue; however, units activated via the reflex pathway were recruited approximately 30% sooner during fatigue (P < 0.05). The ratio of the electrical-to-mechanical response of the tendon tap increased significantly with fatigue. Our findings of decreased RTs in response to vibration and increased EMG activity during the tendon tap following the fatigue task indicate that Ia afferent input to the motoneuron pool was increased. The decrease in MVC force indicates that during this time the descending drive was compromised. These results provide evidence that the gain of the gamma loop is increased during fatigue, indicating possible peripheral neural compensation to the motor neuron pool in order to preserve force output.

Effects of Age and ACL Reconstruction on Quadriceps Gamma Loop Function

Both aging and anterior cruciate ligament (ACL) reconstruction are associated with strength deficits, which can in turn influence performance of activities of daily living. Thus it is informative to understand mechanisms underlying strength deficits. Age-related declines in strength follow reductions in muscle fiber numbers and size, whereas strength deficits following ACL reconstruction may be caused by the loss of intraligamentous mechanoreceptors. A common link between these conditions is the gamma spindle system, or the gamma loop. Appropriately applied vibration can affect the gamma loop by causing disruption of afferent feedback to a muscle and result in decreased force capabilities. We investigated the effect of age and ACL reconstruction on gamma loop function. Maximal isometric strength (MVC) and electromyography (EMG) of the quadriceps were quantified before and after vibration stimulation of the infrapatellar tendon of 3 groups: young healthy (n=4; mean age=23.8 yrs), young ACL reconstructed (n=7; mean age=22.4 yrs), and older healthy (n=4; mean age=66.1 yrs) individuals. The quadriceps MVC, vastus lateralis EMG, vastus medialis EMG, and rectus femoris EMG declined significantly in the young healthy group following vibration stimulation to the infrapatellar tendon, which indicated an intact gamma loop. There were no changes in these variables for the old healthy and ACL reconstructed groups. Gamma loop function was impaired in both the older and ACL reconstructed groups possibly due to either decreased muscle spindle sensitivity or the loss of mechanoreceptors.

Effects Of Age And ACL Injury On Quadriceps Gamma Loop Function

Significant muscular strength deficits are recognizable in the quadriceps muscles of both aging and ACL reconstructed individuals. These strength deficits can have a significant negative impact on functional independence, so it is both clinically and theoretically important to fully understand the possible mechanisms responsible for strength decrements associated with increasing age and ACL reconstructions. It appears that the common link between the conditions of aging and ACL reconstruction may lie in the gamma spindle system, or the gamma loop. Purpose Therefore, the purpose of this study was to investigate the effects of age and ACL reconstruction on gamma loop function. Methods Differences in isometric maximal voluntary contraction (MVC) forces and quadriceps EMG activity (vastus lateralis, vastus medialis, rectus femoris) of young healthy (n = 14; mean age 23.8 yrs), young ACL reconstructed (n = 7; mean age 22.4 yrs), and older healthy individuals (n = 14; mean age 66.1 yrs) were quantified both before and after vibration stimulation application to the infrapatellar tendon using a percussion hammer (50 Hz, 30 N, 20 min). A two-way ANOVA with repeated measures was used to evaluate group and time main effects with a Bonferroni post hoc analyses. Results The young healthy group's MVC force (p = 0.001), vastus lateralis EMG (p = 0.012), vastus medialis EMG (p = 0.002), and rectus femoris EMG (p = 0.003) declined following vibration stimulation to the infrapatellar tendon, indicating an intact gamma loop, whereas both the old healthy and ACL reconstructed groups showed no decline in either force or EMG activity. Conclusion Gamma loop function was impaired in both the older and ACL reconstructed groups possibly due to the loss of mechanoreceptors in the ACL reconstructed group and decreased muscle spindle sensitivity in the older group.Table

Effects Of Age And ACL Injury On Quadriceps Gamma Loop Function

Significant muscular strength deficits are recognizable in the quadriceps muscles of both aging and ACL reconstructed individuals. These strength deficits can have a significant negative impact on functional independence, so it is both clinically and theoretically important to fully understand the possible mechanisms responsible for strength decrements associated with increasing age and ACL reconstructions. It appears that the common link between the conditions of aging and ACL reconstruction may lie in the gamma spindle system, or the gamma loop. Purpose Therefore, the purpose of this study was to investigate the effects of age and ACL reconstruction on gamma loop function. Methods Differences in isometric maximal voluntary contraction (MVC) forces and quadriceps EMG activity (vastus lateralis, vastus medialis, rectus femoris) of young healthy (n = 14; mean age 23.8 yrs), young ACL reconstructed (n = 7; mean age 22.4 yrs), and older healthy individuals (n = 14; mean age 66.1 yrs) were quantified both before and after vibration stimulation application to the infrapatellar tendon using a percussion hammer (50 Hz, 30 N, 20 min). A two-way ANOVA with repeated measures was used to evaluate group and time main effects with a Bonferroni post hoc analyses. Results The young healthy group's MVC force (p = 0.001), vastus lateralis EMG (p = 0.012), vastus medialis EMG (p = 0.002), and rectus femoris EMG (p = 0.003) declined following vibration stimulation to the infrapatellar tendon, indicating an intact gamma loop, whereas both the old healthy and ACL reconstructed groups showed no decline in either force or EMG activity. Conclusion Gamma loop function was impaired in both the older and ACL reconstructed groups possibly due to the loss of mechanoreceptors in the ACL reconstructed group and decreased muscle spindle sensitivity in the older group.Table

Characterization and implementation of mechanical stimulation on isokinetic machines

This paper proposes a method to control muscular flexibility during training and rehabilitation. This method invokes muscular stretching by mechanical stimulation of the neuromuscular gamma loop. The specification and characterization of this method are based on a simulation model related to the biomechanical behaviour of muscle. This model was used to identify the parameters required for the implementation of mechanical stimulation on an isokinetic machine. A generic control architecture for this type of machine was proposed to carry out stimulation patterns that invoke muscular stretching. As validation, experimental data were obtained with the help of Multi-Iso, a machine used for training and rehabilitation of the lower limbs.

Mechanism of quadriceps femoris muscle weakness in patients with anterior cruciate ligament reconstruction.

The purpose of this study was to investigate gamma loop function in the quadriceps femoris muscle in patients who with less than 6 month-history of anterior cruciate ligament (ACL) reconstruction. For this purpose, we compared the response to vibration stimulation in 10 patients with ACL repair and 12 normal healthy subjects, by measuring the maximal voluntary isometric contraction (MVC) and integrated electromyograms (I-EMG) of the quadriceps muscles. Pre-vibration data were obtained from each subject by measuring the MVC of the knee extension and the I-EMG from the vastus medialis, vastus lateralis, and rectus femoris muscles. Vibration stimulation was applied to the infrapatellar tendons, followed immediately by repeating the MVC and I-EMG recording. Prolonged vibration resulted in a significant decrease of both MVC and I-EMG in the control group. In contrast, the same stimulus failed to elicit changes in ACL-repair group. Our results suggest the presence of abnormal gamma loop function in the quadriceps femoris muscle of patients with ACL repair, which may explain the muscle weakness often described in such patients.