Involuntary Muscle Activity Research Articles

Synkinesis of Facial Musculature in a Patient with Facial Paralysis

Facial Synkinesis is a clinical condition that is the sequel to facial nerve paralysis which develops during nerve repair like axon myelination and regeneration. Involuntary muscle activity is accompanied by voluntary muscle activity and may involve facial and extra ocular muscles. This article describes an uncommon variation of facial Synkinesis that manifested clinically in weak voluntary chewing and frequent cheek biting in the form of mucosal erosion on the buccal mucosa. Managing a case of facial paralysis that has associated facial Synkinesis has also been discussed.

Evaluation of mirrored muscle activity in patients with Complex Regional Pain Syndrome

ObjectiveMotor dysfunction in Complex Regional Pain Syndrome (CRPS) has been associated with bilateral changes in central motor processing, suggesting abnormal coupling between the affected and unaffected limb. We evaluated the occurrence of involuntary muscle activity in a limb during voluntary movements of the contralateral limb (i.e., mirror activity) in unilaterally affected patients to examine disinhibition of contralateral motor activity in CRPS. MethodsMirror activity was examined during unimanual rhythmic flexion–extension movements of the wrist through in-depth analysis of electromyography recordings from the passive arm in 20 CRPS patients and 40 controls. ResultsThe number of mirror-epochs was comparable for both arms in both CRPS patients and controls. Mirror-epochs in the affected arm of patients were comparable to those in controls. Mirror-epochs in the unaffected arm were shorter and showed less resemblance (in terms of rhythm and timing) to activity of the homologous muscle in the moving arm compared to mirror-epochs in controls. ConclusionsNo evidence for disinhibition of contralateral motor activity was found during unimanual movement. SignificanceAlthough motor dysfunction in CRPS has been associated with bilateral changes in cortical motor processing, the present findings argue against disinhibition of interhemispheric projections to homologous muscles in the contralateral limb during unimanual movement.

Severe bruxism in a patient suffering Nasu-Hakola disease for ten years

Introduction CLINICAL HISTORY: 42 year old woman with no previous medical condition of any interest. For the last ten years she has been suffering a mental deterioration of a frontal sub cortical subtype, spasticity, hyperreflexia, bradikinesia and a parkinsonian gait which has become progressively worse over time. Multiple bone cysts have also developed with the final diagnosis being Nasu-Hakola disease. Materials and methods Four years ago, during a check up in the outpatient clinic, she had a seizure event which was finally diagnosed as a generalized epileptic associated disease and treatment with carbamazepine and levetiracetam was initiated. Periodic EEG studies show a generalized deterioration which is more notable as the disease progresses and a multifocal irritation which was limited to the posterior areas after the antiepileptic treatment. Within the last year a severe bruxism (not only sleep related) has been identified in a videoEEG study. Results Periodic EEG studies show a generalized deterioration which is more notable as the disease progresses and a multifocal irritation which was limited to the posterior. Conclusion Nasu-Hakola disease is an autosomal recessive inherited disorder (TREM2 and DAP12 gen mutation) characterized by progressive dementia and bone simptomatology with pathological fractures without pain. It has an evolution which includes personality changes, progressive amnesia, apraxia, agnosia, acalculia and disorientation. Some patients exhibit urinary or stool incontinence, convulsive attacks and pyramidal signs as with our patient. The sleep related bruxism is characterized by involuntary masticator muscle activities during sleep and is classified under somatoform disorders in the ICD-10. In the past two decades, it has been shown that it is a phenomenon regulated more within the central nervous system than peripherally with alteration in diverse neurotransmitters (serotonin and dopamine). There has been no clear relationship between Nasu-Hakola disease and bruxism. However, due to the possible central origin of sleep related bruxism, we consider this relationship a possible other condition of the Nasu-Hakola disease. Acknowledgements Nasu-Hakola disease: The first case reported by Nasu and review. Minoru Kaneko, et al. Neuropathology 2010;30,463–70. Association of genetic, psychological and behavioral factor with sleep bruxism in a Japanese population. Yuka Abe, et al. J. Sleep Res 2012;21,289–96. Genetic factors account for half of the phenotypic variance in liability to sleep-related bruxism in young adults: A nationwide finnish twin cohort study. Katariina Rintakoski, et al. Twin Research and Human Genetic 2012; 15(6),714–19. Genetic factors account for half of the phenotypic variance in liability to sleep-related bruxism in.

Interhemispheric difference of pallidal local field potential activity in cervical dystonia

BackgroundCervical dystonia (CD) produces involuntary neck muscle contractions that result in abnormal and often asymmetrical postures of the head and neck. Basal ganglia oscillatory activity in the 3–12 Hz band...

Medial gastrocnemius is a key muscle for involuntary alternate muscle activity of plantar flexor synergists

Redundant and/or complicated muscle activations between synergist muscles have been demonstrated during low-level sustained contractions. Identification of a key muscle for this phenomenon allows for the simplification of motor control during prolonged contraction. In this study, we have identified a key muscle for involuntary alternate muscle activity of plantar flexor muscles based on a physiological tremor sequence that was recorded over 120min. Two epochs where the muscle activity of medial gastrocnemius abruptly increased with decrease in other synergists (case ON) and vise verse (case OFF) were analyzed. Our results indicated that involuntary alternate muscle activity was associated with changes in physiological tremor of ankle angular acceleration when the muscle activity of medial gastrocnemius decreased in case OFF. In particular, the activity of the medial gastrocnemius muscle, but not the activity of other synergists, was accompanied by physiological tremor, demonstrating that the medial gastrocnemius is a key muscle for involuntary alternate muscle activity in plantar flexor synergists. In addition, weaker correlations between muscle activities and physiological tremor were found in case ON than case OFF. We suggest that, if the central nervous system can employ this unique muscle strategy, redundant and/or complicated neuromuscular activities will be reduced because of the existence of the key muscle.

Involuntary contralateral upper extremity muscle activation pattern during unilateral pinch grip following stroke

Study designRepeated measures design. IntroductionMirror activity refers to emergence of motion not only in the intended, but also in the contralateral limb. PurposeTo characterize post-stroke mirror activities across multiple muscles during unilateral pinch. MethodsChronic stroke survivors performed unilateral pinch grip using the paretic and nonparetic hand, while four muscles' EMGs were recorded for both hands. ResultsDuring the paretic hand grip, the relaxed nonparetic hand showed mirror activity that was more pronounced for the intrinsic (FDI and thenar eminence) than extrinsic muscles (FDS and EDC). During the nonparetic hand grip, mirror activity in the paretic hand was suppressed for the intrinsic than extrinsic muscles. ConclusionChronic stroke survivors' relaxed hand did not mirror the task hand's muscle activation pattern, but displayed altered muscle activation patterns depending on muscles and sides, possibly mediated by disturbed interhemispheric inhibition and relative reliance on corticospinal tracts among muscles. Level of evidenceN/A.

Independence and control of the fingers depend on direction and contraction mode

Both biomechanical and neural factors are suggested to contribute to the limited independence of finger movement and involuntary force production. The purpose of this study was to evaluate finger independence by examining the activity of the four compartments of extensor digitorum (ED) and flexor digitorum superficialis (FDS) and involuntary force production in the non-task fingers using the “enslaving effect” (EE). Twelve male participants performed a series of 5s sub-maximal exertions at 5%, 25%, 50% and 75% of maximum using isometric isotonic and ramp flexion and extension exertions. Ramp exertions were performed from 0% to 85% of each finger’s maximum force with ascending and descending phases taking 4.5s. EE was lower in flexion exertions likely due to the higher activity of the antagonist ED compartments counterbalancing the involuntary activation of the non-task FDS compartments. Minimal FDS activity was seen during extension exertions. At forces up to and including 50%, both EE and muscle activity of the non-task compartments were significantly higher in descending exertions than isotonic or ascending exertions. Up to mid-level forces, both finger proximity and contraction mode affect involuntary force production and muscle activation while only finger proximity contributed to finger independence at higher forces.

Clinical vs. bispectral index-guided propofol induction of anesthesia: A comparative study

Background:Clinically optimized focusing of drug administration to specific need of patient with bispectral index (BIS) monitoring results in reduced dose and faster recovery of consciousness. This study was planned with an aim to study and compare the conventional clinical end point or BIS on the requirement of dosage of propofol, hemodynamic effects, and BIS alterations following propofol induction.Methods:70 patients, ASA I and II, 20-60 years undergoing elective surgical procedure under general anesthesia with endotracheal intubation were selected and divided into two groups. Group A received (inj.) fentanyl (2 μg/kg), followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion till the loss of response to verbal command while group B received inj. fentanyl (2 μg/kg), followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion. The end point of hypnosis was when the BIS value was sustained for 1 min at 48±2. The patients were intubated. Total induction dose of propofol was noted in each group. The value of BIS and hemodynamic parameters (heart rate, systolic/diastolic blood pressure) were noted at the time of loss of consciousness, at the time of intubation, and 1 min after intubation, thereafter every minute for first 10 min and thereafter every 10 min till end of surgery. Any involuntary muscle activity such as jerky movements, dystonic posturing, and opisthotonos were also recorded.Results:The mean dose of propofol used in groups A and B were 1.85±0.48 mg/kg and 1.79±0.41 mg/kg, respectively. The dosage used in group B were less but not clinically significant (P=0.575). On comparing the dosage of propofol in males among the groups there was a significantly lower dosage of propofol required in group B (2.06±0.45 mg/kg and 1.83±0.32 mg/kg, respectively, P=0.016). This decrease however was not seen in female patients dosage being 1.65±0.44 mg/kg and 1.75±0.49 mg/kg, respectively (P=0.372). The hemodynamic variables including heart rate, systolic/diastolic blood pressure and BIS were comparable within the group at induction, post-induction, and intubation. However, there was a significant increase in all the parameters at postintubation readings (P<0.001).Conclusion:No significant difference in the induction dose of propofol was observed when assessed clinically (loss of verbal response) or by BIS monitoring. Traditional teaching to titrate the dose of propofol and depth of anesthesia during intubation by loss of verbal response is as good as BIS value monitoring.

Involuntary and voluntary muscle activation in children with unilateral cerebral palsy – Relationship to upper limb activity

BackgroundSpasticity and reduced strength are both primary neuromuscular impairments associated with cerebral palsy (CP). However, it is unclear whether spasticity or reduced strength is the strongest contributor to activity limitations. AimTo study whether involuntary activation of the biceps brachii muscle, in addition to reduced strength, contributes to limitations in upper limb activity in children with CP. MethodFifteen children with unilateral CP (9 males and 6 females, age range 8–17 years) participated in this study. Involuntary activation, reflecting spasticity, was studied as biceps brachii activity during passive elbow extension at four isokinetic velocities (10, 90, 180 and 300°/s). Elbow flexion peak torque, reflecting strength, was measured during maximal voluntary isometric contraction, and concurrent biceps brachii activity was registered reflecting voluntary muscle activation. Bimanual upper limb activity was assessed in the performance domain using the Assisting Hand Assessment (AHA). ResultsBoth involuntary and voluntary muscle activation were related to activity, the former negatively, but voluntary activation showed the strongest relationship (Spearmans rho = .84). Involuntary muscle activation at 10, 90 and 180°/s was negatively related to muscle strength (Spearmans rho = −.63, −.58 and −.62, respectively). ConclusionsOur results do not indicate that spasticity affects upper limb activity in addition to strength. Most likely, muscle weakness and spasticity jointly contribute to activity limitations, reflected by the strong relationship between the ability to voluntarily activate a muscle and activity performance.

Surface EMG crosstalk during phasic involuntary muscle activation in the nociceptive withdrawal reflex

The human nociceptive withdrawal reflex is typically assessed using surface electromyography (sEMG). Based on sEMG, the reflex receptive field (RRF) can be mapped. However, EMG crosstalk can cause erroneous results in the RRF determination. Single differential (SD) vs. double differential (DD) surface EMG were evaluated. Different electrode areas and inter-electrode-distances (IED) were evaluated. The reflexes were elicited by electrical stimulation of the sole of the foot. EMG was obtained from both tibialis anterior (TA) and soleus (SOL) using both surface and intramuscular EMG (iEMG). The amount of crosstalk was significantly higher in SD recordings than in DD recordings (P < 0.05). Crosstalk increased when electrode measuring area increased (P < 0.05) and when IED increased (P < 0.05). Reflex detection sensitivity decreases with increasing measuring area and increasing IED. These results stress that for determination of RRF and similar tasks, DD recordings should be applied.

Treatment of Focal Dystonia

Dystonia is characterized by repetitive twisting movements or abnormal postures due to involuntary muscle activity. When limited to a single body region it is called focal dystonia. Examples of focal dystonia include cervical dystonia (neck), blepharospasm (eyes), oromandibular dystonia, focal limb dystonia, and spasmodic dysphonia, which are discussed here. Once the diagnosis is established, the therapeutic plan is discussed with the patients. They are informed that there is no cure for dystonia and treatment is symptomatic. The main therapeutic option for treating focal dystonias is botulinum toxin (BoNT). There have been several attempts to characterize the procedure, the type of toxin, dosage, techniques, and combination with physical measures in each of the focal dystonia forms. The general treatment principles are similar. The affected muscles are injected at muscle sites based on evidence and experience using standard dosages based on the type of toxin used. The injections are repeated after 3 to 6months based on the individual response duration. In the uncommon event of nonresponse with BoNT, the dose and site are reassessed. Oral drug treatment could be considered as an additional option. Once the condition is thought to be medically refractory, the opinion from the deep brain stimulation (DBS) team for the suitability of the patient for DBS is taken. The successful use of DBS in cervical dystonia has led to increased acceptance for trial in other forms of focal dystonias. DBS surgery in focal dystonias other than cervical is, however, still experimental. The patients may be offered the surgery with adequate explanation of the risks and benefits. Patient education and directing the patients towards dystonia support groups and relevant websites that provide scientific information may be useful for long-term compliance and benefit.

Directional Effect on Post-Stroke Motor Overflow Characteristics

Motor overflow (MO) is an involuntary muscle activation associated with strenuous contralateral movement and may become manifested after stroke. The study was undertaken to investigate physiological correlation underlying atypical directional effect of joint movement on post-stroke MO in the affected upper limb. Thirty patients with unilateral post-stroke hemiparesis and fifteen age-matched healthy controls participated in this study. According to motor function assessed with the Fugl-Meyer arm scale, the patients were categorized into two groups of equal number with better (CVA_G; n = 15) or poorer motor functions (CVA_P; n = 15). Surface electromyography (EMG) was used to record irradiated muscle activation from eight muscles of the affected upper limb when the subjects performed maximal isometric contractions in different directions with the unaffected shoulder, elbow and wrist joints. The results showed that only MO amplitude of the CVA_G and the control groups was more sensitive to variations in direction of joint movement in the unaffected arm than the CVA_P group. The CVA_G group exhibited larger amplitudes of MO than the control analog, whereas this tendency was reversed for the CVA_P group. In terms of EMG polar plots, spatial representations of post-stroke MO were insensitive to direction of contralateral movement. The spatial representations of the CVA_G and CVA_P groups were predominated by potent flexion-abduction synergy, contrary to the typical extension adduction synergy seen in the control analog. In conclusion, post-stroke MO amplitude was subject to contralateral movement direction for healthy controls and stroke patients with better motor recovery. However, alterations in MO spatial pattern due to directional effect were not strictly related to the degree of motor deficits of the stroke victims.

Identification of EMG signals using discriminant analysis and SVM classifier

The electromyography (EMG) signal is a bioelectrical signal variation, generated in muscles during voluntary or involuntary muscle activities. The muscle activities such as contraction or relaxation are always controlled by the nervous system. The EMG signal is a complicated biomedical signal due to anatomical/physiological properties of the muscles and its noisy environment. In this paper, a classification technique is proposed to classify signals required for a prosperous arm prosthesis control by using surface EMG signals. This work uses recorded EMG signals generated by biceps and triceps muscles for four different movements. Each signal has one single pattern and it is essential to separate and classify these patterns properly. Discriminant analysis and support vector machine (SVM) classifier have been used to classify four different arm movement signals. Prior to classification, proper feature vectors are derived from the signal. The feature vectors are generated by using mean absolute value (MAV). These feature vectors are provided as inputs to the identification/classification system. Discriminant analysis using five different approaches, classification accuracy rates achieved from very good (98%) to poor (96%) by using 10-fold cross validation. SVM classifier gives a very good average accuracy rate (99%) for four movements with the classification error rate 1%. Correct classification rates of the applied techniques are very high which can be used to classify EMG signals for prosperous arm prosthesis control studies.

Relative or Absolute? Implications and Consequences of the Measures Adopted to Investigate Motor Overflow

ABSTRACT Motor overflow is involuntary overt movement or covert muscle activity that cooccurs with voluntary movement. Overflow is present in several pathological conditions, as well as in neurologically healthy children and older adults, and can be induced in healthy young adults under effortful conditions. This motor phenomenon may provide insight into the underlying mechanisms and kinetic characteristics of voluntary and involuntary motor control in various populations. Although often measured behaviorally using force transduction techniques, different methods of calculating and presenting such overflow data have resulted in seemingly contradictory findings, with limited discussion of the advantages and limitations of different approaches. In this article, the authors examined the relevant literature to highlight significant methodological considerations for authors and readers conducting or appraising this type of research. Issues regarding the interpretation and reporting of findings are also discussed. Researchers are encouraged to continue using behavioral measures to create well-defined variables that enable the study of the kinematic characteristics of overflow, as these may offer promising new ways forward in better characterizing and understanding this intriguing movement phenomenon.

Modulation of the basal ganglia dopaminergic system in a transgenic mouse exhibiting dystonia-like features

Dystonia is a movement disorder characterized by involuntary excessive muscle activity and abnormal postures. There are data supporting the hypothesis that basal ganglia dysfunction, and specifically dopaminergic system dysfunction, plays a role in dystonia. In the present study, we used hyperkinetic transgenic mice generated as a model of DYT1 dystonia and compared the basal ganglia dopaminergic system between transgenic mice exhibiting hyperkinesia (affected), transgenic mice not showing movement abnormalities (unaffected), and non-transgenic littermates. A decrease in the density of striatal D2 binding sites, measured by [³H]raclopride binding, and D2 mRNA expression in substantia nigra pars compacta (SNpc) was revealed in affected and unaffected transgenic mice when compared with non-transgenic. No difference in D1 receptor binding and DAT binding, measured by [³H]SCH23390 and [³H]WIN35428 binding, respectively, was found in striatum of transgenic animals. In SNpc, increased levels of DAT binding sites were observed in affected and unaffected animals compared to non-transgenic, whereas no change in DAT mRNA expression was found. Our results show selective neurochemical changes in the basal ganglia dopaminergic system, suggesting a possible involvement in the pathophysiology of dystonia-like motor hyperactivity.

The effect of attending to motor overflow on its voluntary inhibition in young and older adults

Motor overflow refers to involuntary movement or muscle activity coinciding with voluntary movement. We examined whether 16 young adults (18–30 years) and 16 older adults (50–80 years) could voluntarily inhibit overflow. Participants performed a finger pressing task, exerting 50% of their maximal force. Overflow was concurrently recorded in the non-task hand. In the first condition, participants were not made aware of their motor overflow. Then participants, though informed of it, were asked to ignore their overflow. Finally, participants were requested to inhibit overflow with, and then without visual feedback, or vice versa. Overflow was exacerbated when older adults were unaware of it, and was reduced once they were informed. For young adults there was no significant difference between these conditions. Both Age Groups could significantly reduce overflow when so requested, independent of visual feedback. Thus motor overflow can be modulated by higher order cognitive control with directed attention.

脳卒中後遺症としての痙縮に対するｉｎｔｒａｔｈｅｃａｌ ｂａｃｌｏｆｅｎ療法の有用性の検討

Baclofen, a gamma-aminobutyric acid receptorB agonist, is used to reduce symptoms of spasticity (hyperreflexia, increases in muscle tone and involuntary muscle activity). In a 25-week observational longitudinal follow-up study we assessed 4 patients who received intrathecal baclofen given by programmable pump. Clinical efficacy was assessed by the Ashworth scale related with the dose of baclofen. Compared with pretreatment values, all patients improved. Although results show the effiicacy of intrathecal baclofen (ITB) therapy for spasticity from stroke, it must be kept in mind that baclofen causes some clinically significant adverse reactions.

Effects of baclofen on motor units paralysed by chronic cervical spinal cord injury

Baclofen, a gamma-aminobutyric acid receptor(B) agonist, is used to reduce symptoms of spasticity (hyperreflexia, increases in muscle tone, involuntary muscle activity), but the long-term effects of sustained baclofen use on skeletal muscle properties are unclear. The aim of our study was to evaluate whether baclofen use and paralysis due to cervical spinal cord injury change the contractile properties of human thenar motor units more than paralysis alone. Evoked electromyographic activity and force were recorded in response to intraneural stimulation of single motor axons to thenar motor units. Data from three groups of motor units were compared: 23 paralysed units from spinal cord injured subjects who take baclofen and have done so for a median of 7 years, 25 paralysed units from spinal cord injured subjects who do not take baclofen (median: 10 years) and 45 units from uninjured control subjects. Paralysed motor unit properties were independent of injury duration and level. With paralysis and baclofen, the median motor unit tetanic forces were significantly weaker, twitch half-relaxation times longer and half maximal forces reached at lower frequencies than for units from uninjured subjects. The median values for these same parameters after paralysis alone were comparable to control data. Axon conduction velocities differed across groups and were slowest for paralysed units from subjects who were not taking baclofen and fastest for units from the uninjured. Greater motor unit weakness with long-term baclofen use and paralysis will make the whole muscle weaker and more fatigable. Significantly more paralysed motor units need to be excited during patterned electrical stimulation to produce any given force over time. The short-term benefits of baclofen on spasticity (e.g. management of muscle spasms that may otherwise hinder movement or social interactions) therefore have to be considered in relation to its possible long-term effects on muscle rehabilitation. Restoring the strength and speed of paralysed muscles to pre-injury levels may require more extensive therapy when baclofen is used chronically.

Effect of Diabetes on Cooling-induced Detrusor Muscle Contraction: Mediation Via Rho-kinase Activation

To investigate the possible involvement of Rho-kinase in cooling-induced contraction of the detrusor muscle. The etiology of diabetic cystopathy is not clear. It may be due to various changes in bladder innervation and/or detrusor muscle dysfunction. Because cooling of urinary bladder smooth muscle normally is a potent stimulus to micturition due to increase in muscle tone, we studied the effects of cooling on normal and diabetic bladder specimens. Urinary detrusor muscle strips isolated from rats were suspended in organ baths containing Krebs solution for isometric tension recording. Tissue responses to stepwise cooling were examined from normal and 12-week streptozocin-induced diabetic rats. We examined the effects of calcium-free, ethylene glycol bis (beta-aminoethylether)-N,N,N,N,-tetraacetic acid (1 mm)-containing Krebs solution, and the Rho-kinase inhibitor Y-27632 on the cooling responses. Stepwise cooling from 37 degrees C to 5 degrees C induced a rapid and reproducible increase in basal tone, proportional to cooling temperature. This response was more pronounced in diabetic specimens. Cooling-induced contractions were significantly inhibited in calcium-free solutions in both control and diabetic bladders. Our investigation showed that the influx of extracellular calcium is important in inducing the cooling response. The Rho-kinase inhibitor Y-27632 (1 microm) inhibited cooling (20 degrees C)-induced contraction. It reduced the response by 52.1% +/- 10.0% in control and by 70.0% +/- 12.0% in diabetic rats. Cooling-induced contractions in control and diabetic detrusor muscle preparations are highly calcium dependant. It also involves activation of Rho-kinase, which might be upregulated in the diabetic detrusor muscle. These results may help in the management of diabetes-induced incontinence due to involuntary detrusor muscle activity.

Hypertonia in childhood secondary dystonia due to cerebral palsy is associated with reflex muscle activation

It is often assumed that co-contraction of antagonist muscles is responsible for increased resistance to passive movement in hypertonic dystonia. Although co-contraction may certainly contribute to hypertonia in some patients, the role of reflex activation has never been investigated. We measured joint torque and surface electromyographic activity during passive flexion and extension movements of the elbow in 8 children with hypertonic arm dystonia due to dyskinetic cerebral palsy. In all cases, we found significant phasic electromyographic activity in the lengthening muscle, consistent with reflex activity. By correlating activation with position or velocity of the limb, we determined that some children exhibit position-dependent activation, some exhibit velocity-dependent activation, and some exhibit a mixed pattern of activation. We conclude that involuntary or reflex muscle activation in response to stretch may be a significant contributor to increased tone in hypertonic dystonia, and we conjecture that this activation may be more important than co-contraction for determining the resistance to passive movement.