Tibialis Anterior Muscle Activity Research Articles

Assistive Technology for Real-Time Fall Prevention During Walking: Evaluation of the Effect of an Intelligent Foot Orthosis

Abstract We present an intelligent foot orthosis (IFO) designed to prevent lateral falls during walking by employing a magnetorheological (MR) fluid brake. This study aims to demonstrate the feasibility of evaluating effectiveness of the proposed orthosis in fall prevention. Seventeen healthy adults underwent four conditions: (1) without IFO, (2) with IFO and current-OFF, (3) with IFO current-ON, and (4) with IFO and control-ON. Gait was assessed by three-dimensional motion capture and with ground reaction force. Postural changes on the frontal plane were measured, and the mediolateral center of gravity and center of pressure inclination angle (ML COG-COP IA) was calculated. Additionally, tibialis anterior (TA) and peroneus longus (PL) muscle activity during walking were measured using surface electromyography. Results indicate a significant increase in ML COG-COP IA in (3). No significant differences were found in muscle activity between conditions. The study suggests that the posture's deviation from the lateral fall direction in (3) is primarily due to wearing the IFO, emphasizing human postural control over muscle activity. A negative correlation between ML COG-COP IA and TA muscle activity under (4), implies that individuals with lower TA muscle activity may benefit more from IFO fall prevention. In conclusion, the study demonstrates the feasibility of preventing lateral falls in human walking using the proposed orthosis with an MR fluid brake. The general efficacy of the orthosis in lateral fall prevention is suggested, emphasizing the need for further development.

Analysis of stress response distribution in patients with lateral ankle ligament injuries: a study of neural control strategies utilizing predictive computing models.

Ankle sprains are prevalent in sports, often causing complex injuries to the lateral ligaments. Among these, anterior talofibular ligament (ATFL) injuries constitute 85%, and calcaneofibular ligament (CFL) injuries comprise 35%. Despite conservative treatment, some ankle sprain patients develop chronic lateral ankle instability (CLAI). Thus, this study aimed to investigate stress response and neural control alterations during landing in lateral ankle ligament injury patients. This study recruited twenty individuals from a Healthy group and twenty CLAI patients performed a landing task using relevant instruments to collect biomechanical data. The study constructed a finite element (FE) foot model to examine stress responses in the presence of laxity of the lateral ankle ligaments. The lateral ankle ligament was modeled as a hyperelastic composite structure with a refined representation of collagen bundles and ligament laxity was simulated by adjusting material parameters. Finally, the validity of the finite element model is verified by a high-speed dual fluoroscopic imaging system (DFIS). CLAI patients exhibited earlier Vastus medialis (p < 0.001) and tibialis anterior (p < 0.001) muscle activation during landing. The FE analysis revealed that with laxity in the ATFL, the peak von Mises stress in the fifth metatarsal was 20.74MPa, while with laxity in the CFL, it was 17.52MPa. However, when both ligaments were relaxed simultaneously, the peak von Mises stress surged to 21.93MPa. When the ATFL exhibits laxity, the CFL is subjected to a higher stress of 3.84MPa. Conversely, when the CFL displays laxity, the ATFL experiences a peak von Mises stress of 2.34MPa. This study found that changes in the laxity of the ATFL and the CFL are linked to shifts in metatarsal stress levels, potentially affecting ankle joint stability. These alterations may contribute to the progression towards CLAI in individuals with posterolateral ankle ligament injuries. Additionally, significant muscle activation pattern changes were observed in CLAI patients, suggesting altered neural control strategies post-ankle ligament injury.

Modelling of impulse activity of afferent fibers of antagonist muscles during transcutaneous electrical stimulation of the spinal cord during walking

The article describes the results of studies on the impulse activity of various groups of afferent fibers and EMG patterns of lower leg antagonist muscles when walking without, during and after transcutaneous electrical stimulation of the dorsal roots of the lower thoracic spinal cord of a person. Using a mathematical model based on the prediction of the triggering of muscle spindles, variability in the manifestation of impulse activity of various afferents tibialis anterior muscle (TA) and gastrocnemius medialis muscle (GM) when walking under different experimental conditions is shown. It was found that walking on a movable treadmill tape in the absence of spinal cord stimulation was accompanied by strong impulse activity of afferents I (Ia and Ib) and II groups GM, increased excitability of its motorneuron pool and weakening of afferent activity and excitability of TA. On the contrary, electrical stimulation of the spinal cord during walking caused strong impulsive activity of group II TA afferents and moderate — GM, while the activity of Ia fibers TA and GM decreased to moderate impulsivity, Ib afferents of the same muscles had the weakest activity, and the excitability of the GM motorneuron pool was greater than TA. During the postactivation period, walking was accompanied by increased impulses of afferent fibers of group Ib and II GM, weakening of afferent flows of Ib TA and Ia afferents GM, but along with this, afferent signals of group Ia and II to the motorneuron nucleus TA decreased to moderate impulses, and excitability of the motorneuron pool GM was higher than TA. The supposed reflex mechanisms of locomotion regulation are discussed on the basis of well-known phenomena associated with the interaction of various afferent inputs to the spinal cord neuronal apparatus in the system of lower leg antagonist muscles.

Evacuation safety effects of a lightweight elevator-type evacuation device using carbon material: Focus on plantar pressure and muscle strength.

Elevator-type evacuation devices have proven to be feasible in high-rise buildings through studies on safety performance and evacuation time. However, there is a lack of research on safety using biosignal analysis in the elderly population. A carbon material is used in this study to reduce the weight of an evacuation elevator. The impact on the human body is evaluated by conducting a satisfaction survey involving elderly and youth groups and quantitatively analyzing biological signals, including electromyography (EMG) and plantar pressure, during five repeated uses of the proposed device. The study involves 12 healthy adults in their 20s and 20 elderly individuals with no experience in using an evacuation elevator. The EMG and left and right plantar pressures are analyzed to evaluate the physical factors affected by repeated use. The experiment results showed that the normalization of EMG to maximum voluntary contraction showed a significant decrease with repeated use, especially in the right tibialis anterior muscle. Moreover, plantar pressure shows a significant difference, which decreased with repetition, and the left and right balance gradually tilted to the left. This suggests that with more repeated use, muscle tension decreases owing to adaptation, resulting in lower muscle activity and plantar pressure. Particularly, the tibialis anterior muscle experiences significant muscle activity, indicating increased load, but without any apparent danger. In the future, it will be necessary to evaluate elevators for disabled individuals.

Effect of soft tissue, range of motion and muscle strength on deep squatting

The purpose was to clarify the effects of soft tissues such as muscles and fat, range of motion of the hip, knee and ankle, knee extension and ankle dorsiflexion muscle strength and muscle activity on deep squatting. The participants were 18 healthy university students. Physical characteristics, circumference, subcutaneous fat thickness, and range of motion were measured. After that, they performed deep squatting and lower limb muscle strength was measured. Muscle activities in lower limb during performance was also measured. Statistical tests were performed on the differences between the able group and the unable group, with each item as the dependent variable. Body weight, BMI, abdominal circumference, and tibialis anterior muscle activity were significantly lower in the able group (able to perform a deep squat), than in the unable group. Additionally, range of motion of the hip flexion and ankle dorsiflexion were significantly higher in the able group than in the unable group. It was clarified that soft tissues characteristics are connected to deep squatting in addition to range of motion.

Treadmill running: how long before soft-tissue vibrations reach a steady state?

The aim of this study was to determine whether a steady state was reached over time in soft-tissue vibrations (STV) when running with different midsole hardness. Kinematics, kinetics and electromyography changes were also investigated in an attempt to be as comprehensive as possible. Forty-five physically active adults (17 females) with experience in treadmill running performed an 8.5 minutes trial at a self-selected speed with soft, medium and hard midsoles. STV of gastrocnemius muscle, kinetics, kinematics and electromyographic activity of gastrocnemius muscle and tibialis anterior were recorded for 30 seconds at minutes 0, 2, 4, 6 and 8. No time effects were found for STV, passive peak, loading rate and leg muscle activity. No significant footwear × time interactions were observed, suggesting that familiarisation is independent of midsole hardness. The fastest adjustments were an increase of foot inversion and active peak within the first 4 minutes respectively before reaching a steady state. Step frequency and vertical stiffness decreased and plateaued at minute 6. Duty factor and contact time increased whereas flight time decreased during the entire running trial. Results indicate that a familiarisation to midsole hardness is not needed for STV reliable measurements. Depending on the other biomechanical parameters assessed, we recommend at least a 6-minute running trial and a longer running trial for contact and flight times assessment.

Immediate Effect of a Comprehensive Foot Mobility and Strengthening Treatment on Ankle Muscle Activation in Children with Spastic Diplegia

Foot mobility and strengthening treatment (FMST) is a routinely practiced management strategy in musculoskeletal rehabilitation to improve ankle and foot alignment and muscle function, which prevents joint deformities. The FMST may contribute to improvements in foot alignment and muscle function in children with cerebral palsy (CP). However, treatment influence on muscle imbalances and strength in children with spastic diplegic CP is not yet documented. The aim of the study was to determine the effect of FMST on tibialis anterior (TA), medial gastrocnemius (MG), peroneus longus (PL), and soleus muscle activity using electromyography (EMG) in children with spastic diplegic CP. Twenty children with spastic diplegia (mean age: 7.4 years) with GMFCS levels I, II and III were included in this pre and post-experimental (preliminary) study. Muscle activation of TA, MG, PL, and soleus was recorded using surface EMG in a standing position before and after providing the intervention. Muscle activation in RMS-EMG (mV) was calculated. Findings showed a significant increase in muscle activation of TA, MG, and PL in standing position following the intervention. The increase in soleus muscle activation in standing was not statistically significant. We hypothesized that FMST could alter the muscle recruitment pattern. Our findings showed immediate improvement in muscle activation after the intervention. Future studies should consider its carryover effect on motor performance and gait using functional outcomes.

Ankle Biomechanics During Multidirectional Landings in Athletes With Chronic Ankle Instability.

Assessing and understanding the control of the ankle during multidirectional jump landings in athletes with chronic ankle instability (CAI) would help health professionals develop interventions to reduce the risk of recurrent injuries. The aim of this study was to investigate the angle, angular velocity, and movements of the ankle joint, and the muscle activity of peroneus longus (PL), tibialis anterior (TA), and gastrocnemius (GAS) muscles during multidirectional landings in athletes with CAI. Nineteen athletes with CAI (≤25 Cumberland Ankle Instability Tool-Thai Score) participated. A Vicon Nexus motion analysis system synchronously collected data with an AMTI force plate and surface electromyography (EMG) to capture kinematics, kinetics, and muscle activity, respectively. Participants were asked to perform single-leg jump-landing tests in forward (0°), 30° diagonal, 60° diagonal, and lateral (90°) directions. Ankle joint kinematics, kinetics, and muscle activity of PL, TA, and GAS were analyzed. Repeated measure ANOVA (analysis of variance) and Friedman tests were used to analyze the main effects of the jump-landing direction. Athletes with CAI exhibited significant differences in ankle angles, angular velocities, ankle movements, and average muscle activity of GAS between directions. Greatest average EMG of GAS muscle was observed during landing in the lateral direction compared with the forward and 30° diagonal directions. Lateral and diagonal direction movements showed the greatest risks associated with recurrent ankle sprains. Impairments of neuromuscular control in both pre-landing and landing phases were observed in athletes with CAI when considered alongside previously published data. Laboratory-based observational study.

The Accuracy of Ankle Eccentric Torque Control Explains Dynamic Postural Control During the Y-Balance Test.

The Y-Balance Test (YBT), especially the posteromedial (PM) reach direction (PM-YBT), is able to identify dynamic postural control deficits in those who have ankle instability. However, there still exists a need to understand how sensorimotor function at the ankle explains the performance during the PM-YBT. The purpose of this study was to determine whether the ability to accurately control eccentric ankle torque explained PM-YBT performance. It was hypothesized that eccentric dorsiflexion/plantarflexion torque control would be positively related to the maximum reach distance (MRD) of PM-YBT. Cross-sectional study. Twelve healthy subjects performed the PM-YBT, maximum voluntary isometric contractions (MVIC) for both dorsiflexion and plantarflexion muscle strength, and then the torque control testing of the ankle. The torque control testing provided a target torque level on a screen in front of the subject and passive rotations of the ankle joint in the sagittal plane at 10 deg/sec between plantarflexion to dorsiflexion. Subjects were then instructed to eccentrically contract the dorsiflexors and plantar flexors to generate torque while the ankle joint rotated. The accuracy of torque control during eccentric dorsiflexion and plantarflexion by calculating absolute errors, the area between the target torque and the produced torque were evaluated. Tibialis anterior and soleus muscle activities were simultaneously recorded during testing. A step-wise linear regression model was used to determine the best model predicted the MRD of the PM-YBT (PM-MRD). A step-wise linear regression developed a model explaining only eccentric dorsiflexion torque control predicted higher PM-MRD score (R2 = 44%, F1,10 = 7.94, β = -0.67, p = 0.02). The accuracy of torque control during eccentric dorsiflexion predicts better performance in the PM-YBT. 3b.

Judokas Exhibit Short Response Latency Even to Non-Judo-Specific External Perturbation: Insights Into the Involuntary Postural Control Ability in Humans.

Humans experience unanticipated external postural perturbations and recover their posture faster via involuntary responses than voluntary responses. Previous cross-sectional comparisons between athletes and untrained populations have suggested that daily motor experiences can lead to adaptations in the reflex system, but the temporal aspect of this adaptation has been unclear. Here we show that judokas have an earlier muscle activation response to even non-judo-specific external perturbations compared with an untrained population. The response latency to a backward push-and-release type postural perturbation was compared between male judokas (n = 7, career >13years, ranging from world champions to prefectural competitors) and untrained nonjudokas (n = 7). Latency was defined as the instant of tibialis anterior muscle activity onset. Judokas exhibited shorter latency (20.6 ± 7.1ms) than nonjudokas (28.3 ± 8.9ms). The rank order of latency in judokas did not correlate with their competition performance. We suggest that daily training in responding to perturbations might improve some parts of the sensorimotor pathway relating to postural response latency, and that this excellence in involuntary response is independent of athletic performance. The findings provide a novel perspective for understanding postural control ability in humans.

Effects of jaw clenching on dynamic reactive balance task performance after 1-week of jaw clenching training.

Good balance is essential for human daily life as it may help to improve the quality of life and reduce the risk of falls and associated injuries. The influence of jaw clenching on balance control has been shown under static and dynamic conditions. Nevertheless, it has not yet been investigated whether the effects are mainly associated with the dual-task situation or are caused by jaw clenching itself. Therefore, this study investigated the effects of jaw clenching on dynamic reactive balance task performance prior to and after 1 week of jaw clenching training. It was hypothesized that jaw clenching has stabilizing effects resulting in a better dynamic reactive balance performance, and these effects are not related to dual-task benefits. A total of 48 physically active and healthy adults (20 women and 28 men) were distributed into three groups, one habitual control group (HAB) and two jaw clenching groups (JAW and INT) that had to clench their jaws during the balance tasks at T1 and T2. One of those two groups, the INT group, additionally practiced the jaw clenching task for 1 week, making it familiar and implicit at T2. The HAB group did not receive any instruction regarding jaw clenching condition. Dynamic reactive balance was assessed using an oscillating platform perturbed in one of four directions in a randomized order. Kinematic and electromyographic (EMG) data were collected using a 3D motion capture system and a wireless EMG system, respectively. Dynamic reactive balance was operationalized by the damping ratio. Furthermore, the range of motion of the center of mass (CoM) in perturbation direction (RoMCoM_AP or RoMCoM_ML), as well as the velocity of CoM (VCoM) in 3D, were analyzed. The mean activity of the muscles relevant to the perturbation direction was calculated to investigate reflex activities. The results revealed that jaw clenching had no significant effects on dynamic reactive balance performance or CoM kinematics in any of these three groups, and the automation of jaw clenching in the INT group did not result in a significant change either. However, high learning effects, as revealed by the higher damping ratio values and lower VCoM at T2, were detected for the dynamic reactive balance task even without any deliberate balance training in the intervention phase. In the case of backward perturbation of the platform, the soleus activity in a short latency response phase increased for the JAW group, whereas it decreased for HAB and INT after the intervention. In the case of forward acceleration of the platform, JAW and INT showed a higher tibialis anterior muscle activity level in the medium latency response phase compared to HAB at T1. Based on these findings, it can be suggested that jaw clenching may lead to some changes in reflex activities. However, the effects are limited to anterior-posterior perturbations of the platform. Nevertheless, high learning effects may have overall overweighed the effects related to jaw clenching. Further studies with balance tasks leading to less learning effects are needed to understand the altered adaptations to a dynamic reactive balance task related to simultaneous jaw clenching. Analysis of muscle coordination (e.g., muscle synergies), instead of individual muscles, as well as other experimental designs in which the information from other sources are reduced (e.g., closed eyes), may also help to reveal jaw clenching effects.

Physiological characterization of instrumental learning in the spinal cord using the Paw Withdrawal Learning paradigm

Following spinal cord injury (SCI), sensory and motor functions are severely disrupted yet the spinal circuitry below the injury site continues to maintain active and functional neuronal properties (Edgerton, 2004). The spinal cord is endogenously capable of several forms of adaptive plasticity, including functional re-training with exercise, instrumental, and Pavlovian learning. The paw withdrawal learning (PaWL) paradigm represents a simple spinal instrumental learning model (Jindrich 2019). Briefly, in mice whose spinal cords are completely transected (ST) at mid-thoracic (T7-T9) level, the tibialis anterior (TA) muscle is given a sub maximal threshold shock to a hind leg when the leg is extended below a 1mm imposed threshold from a baseline starting position. The contingent group mice learn to maintain the shocked leg, in a flexed position while the experimentally coupled noncontingent group of mice do not acquire the flexed position. To demonstrate the acquisition of the flexed paw hold is mediated through muscle-specific proprioceptive inputs and a time dependent modification of the spinal interneuronal network associated with the TA motor pool, we measured the TA muscle activity using acute EMG during PaWL in both Contingent stim and non-contingent stim groups. To demonstrate that TA specific sensory afferents are critical in PaWL, we blocked the proprioceptive muscle and the cutaneous afferents using Lidocaine. During PaWL, the TA muscle showed significant EMG activity when compared to medial gastrocnemius and vastus lateralis muscles. We detected greater TA muscle activity in the Contingent stim compared to the non-contingent groups. The significant increase in the EMG amplitude in the TA muscle and time-frequency and power relationships in the contingent group, but not the non-contingent group, suggests that the successful learning requires a temporal engagement of the spinal sensorimotor network. CSULA Mini-Grant 2020 and Joseph/Gomez-Pinilla R01NS056413 (Diversity Supplement) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Fascicle dynamics of the tibialis anterior muscle reflect whole-body walking economy

Humans can inherently adapt their gait pattern in a way that minimizes the metabolic cost of transport, or walking economy, within a few steps, which is faster than any known direct physiological sensor of metabolic energy. Instead, walking economy may be indirectly sensed through mechanoreceptors that correlate with the metabolic cost per step to make such gait adaptations. We tested whether velocity feedback from tibialis anterior (TA) muscle fascicles during the early stance phase of walking could potentially act to indirectly sense walking economy. As participants walked within a range of steady-state speeds and step frequencies, we observed that TA fascicles lengthen on almost every step. Moreover, the average peak fascicle velocity experienced during lengthening reflected the metabolic cost of transport of the given walking condition. We observed that the peak TA muscle activation occurred earlier than could be explained by a short latency reflex response. The activation of the TA muscle just prior to heel strike may serve as a prediction of the magnitude of the ground collision and the associated energy exchange. In this scenario, any unexpected length change experienced by the TA fascicle would serve as an error signal to the nervous system and provide additional information about energy lost per step. Our work helps provide a biomechanical framework to understand the possible neural mechanisms underlying the rapid optimization of walking economy.

Delayed response in rectus abdominis muscle following a step perturbation in subjects with and without recurrent low back pain.

Delayed trunk and lower limb muscle activation is associated with balance loss and fall injuries in subjects with recurrent low back pain (LBP). This study was conducted to compare differences in the onset of muscle contractions of the trunk and lower limb muscles following a treadmill-induced step perturbation between subjects with and without LBP. Eighty-three right limb dominant individuals (43 subjects with LBP and 40 control subjects) were exposed to the perturbation (0.31m/s velocity for 0.2m). The electromyography (EMG) reaction times were analyzed during the first step following the perturbation. The EMG electrodes were placed on both sides of the trunk and lower limbs, including the rectus abdominis (RA), erector spinae (ES), tibialis anterior (TA), and gastrocnemius (GA) muscles. The group x muscle interaction was statistically significant (F = 9.44, p = 0.003). The TA muscle activation was significantly delayed compared to the RA, ES, and GA. There was a significant interaction on side x muscle (F = 4.14, p = 0.04). The RA muscles were significantly delayed on the non-dominant (t = -3.35, p = 0.001) and dominant (t = -2.53, p = 0.01) sides in the LBP group. The LBP group demonstrated a delayed reaction time on the RA muscles, which indicated poor trunk control relative to the lower limbs. The delayed bilateral RA muscle might indicate possible coordination problems relative to the ES and lower limb muscles, which may lead to potential fall hazards.

Altered Ankle Muscle Activation at 2-Year Post Achilles Tendon Repair: An Age, Gender, and Activity Level-Matched Comparison With Healthy Subjects.

The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2y postsurgery) with age, gender, and activity level-matched healthy control group subjects. Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. Level III.

The effects of surface inclination on gastrocnemius, soleus and tibialis anterior muscle activation during gait.

Inclined walking is associated with multiple musculoskeletal benefits and is considered a therapeutic exercise. Various patterns of increased and decreased muscle activation with inclined surfaces have been observed in normal muscles, with more focus on the proximal lower limb musculature. The aim of this study was to assess the differences in electromyographic activation of gastrocnemius, soleus, and tibialis anterior at various inclined surfaces during gait. Fourteen healthy male participants aged between 17-30years walked at a self-selected speed at motor driven treadmill on 0, 2 and 4 degrees of inclination. EMG activity of the muscles was recorded using the Delsys Trigno surface EMG system. Results showed that muscular activation of tibialis anterior significantly decreased with increase in the level of inclination (p< 0.05). However, soleus, gastrocnemius medialis and gastrocnemius lateralis showed no significant differences (p> 0.05) in their muscular activation, and no noticeable trends were found. Furthermore, no significant difference was found between all the muscles at ground level and inclined level 2 and 4. These differences in activation patterns found in distal extremity can be useful for designing rehabilitation protocols in sports training and for patients with neurological and musculoskeletal pathologies.

A broad and variable lumbosacral myotome map uncovered by foraminal nerve root stimulation.

The human myotome is fundamental to the diagnosis and treatment of neurological disorders. However, this map was largely constructed decades ago, and its breadth, variability, and reliability remain poorly described, limiting its practical use. The authors used a novel method to reconstruct the myotome map in patients (n = 42) undergoing placement of dorsal root ganglion electrodes for the treatment of chronic pain. They electrically stimulated nerve roots (n = 79) in the intervertebral foramina at T12-S1 and measured triggered electromyography responses. L4 and L5 stimulation resulted in quadriceps muscle (62% and 33% of stimulations, respectively) and tibialis anterior (TA) muscle (25% and 67%, respectively) activation, while S1 stimulation resulted in gastrocnemius muscle activation (46%). However, L5 and S1 both resulted in abductor hallucis (AH) muscle activation (17% and 31%), L5 stimulation resulted in gastrocnemius muscle stimulation (42%), and S1 stimulation in TA muscle activation (38%). The authors also mapped the breadth of the myotome in individual patients, finding coactivation of adductor and quadriceps, quadriceps and TA, and TA and gastrocnemius muscles under L3, L4, and both L5 and S1 stimulation, respectively. While the AH muscle was commonly activated by S1 stimulation, this rarely occurred together with TA or gastrocnemius muscle activation. Other less common coactivations were also observed throughout T12-S1 stimulation. The muscular innervation of the lumbosacral nerve roots varies significantly from the classic myotome map and between patients. Furthermore, in individual patients, each nerve root may innervate a broader range of muscles than is commonly assumed. This finding is important to prevent misdiagnosis of radicular pathologies.

Comparative effects of passive and active mode robot-assisted gait training on brain and muscular activities in sub-acute and chronic stroke.

Robot-assisted gait training (RAGT) was initially developed based on the passive controlled (PC) mode, where the target or ideal locomotor kinematic trajectory is predefined and a patient basically 'rides' the robot instead of actively participating in the actual locomotor relearning process. A new insightful contemporary neuroscience and mechatronic evidence suggest that robotic-based locomotor relearning can be best achieved through active interactive (AI) mode rather than PC mode. The purpose of this study was to compare the pattern of gait-related cortical activity, specifically gait event-related spectral perturbations (ERSPs), and muscle activity from the tibialis anterior (TA) and clinical functional tests in subacute and chronic stroke patients during robot-assisted gait training (RAGT) in passive controlled (PC) and active interactive (AI) modes. The present study involves a two-group pretest-posttest design in which two groups (i.e., PC-RAGT group and AI-RAGT group) of 14 stroke subjects were measured to assess changes in ERSPs, the muscle activation of TA, and the clinical functional tests, following 15- 18 sessions of intervention according to the protocol of each group. Our preliminary results demonstrated that the power in the μ band (8- 12 Hz) was increased in the leg area of sensorimotor cortex (SMC) and supplementary motor area (SMA) at post-intervention as compared to pre-intervention in both groups. Such cortical neuroplasticity change was associated with TA muscle activity during gait and functional independence in functional ambulation category (FAC) and motor coordination in Fugl- Meyer Assessment for lower extremity (FMA-LE) test as well as spasticity in the modified Ashworth scale (MAS) measures. We have first developed a novel neuroimaging experimental paradigm which distinguished gait event related cortical involvement between pre- and post-intervention with PC-RAGT and AI-RAGT in individuals with subacute and chronic hemiparetic stroke.

Effectiveness of a wearable ankle-tubing gait training on ankle kinematics and motor control in hemiparetic stroke.

While excessive ankle plantarflexion is a common neuromuscular impairment resulting from insufficient coordination of selective ankle neuromotor control and kinematics during gait. We recently developed a wearable, inexpensive and sustainable wearable ankle-tubing gait training (WAGT) aimed at improving selective ankle motor control and kinematic coordination. We investigated the effects of WAGT on tibialis anterior (TA) and gastrocnemius (GCM) muscle electromyography (EMG) activity, TA: GCM muscle imbalance ratio, and ankle joint kinematics during gait in hemiparetic stroke patients. A convenience sample of 33 participants (15 non-stroke healthy adults and 18 hemiparetic stroke patients) underwent standardized electromyography and kinematic biomechanical tests under conventional gait training (CGT) and WAGT conditions. Analysis of variance (ANOVA) was used to determine the significance of differences in the TA: GCM muscle activation, muscle imbalance ratio, and ankle joint kinematics before and after the intervention and between the two groups at P < 0.05. WAGT was more effective than CGT in improving TA muscle activation (P < 0.01), TA: GCM muscle imbalance ratio (P < 0.01), and kinematic movement (P < 0.01) in adults with or without hemiparetic stroke. This study demonstrated that WAGT is relatively ease to design, wear and affordable to most clinicians and patients, hence it is suitable for many health care applications to correct gait-related movement abnormalities presented in the hemiparetic stroke patients.

Applicability of Mobile Based Electromyography Visual Biofeedback Training to Improvement of Muscle Activity and Joint Range of Motions of Stroke Patients: A Pilot Study

Abstract Background Recently, a lot of visual feedback training equipment using the electromyography in a mobile environment has been developed. These devices are small, easy to use, and inexpensive. Despite the various advantages of such equipment, it is still not widely used in the clinical field, and research on it is lacking. Objective The purpose of this study is to introduce the mobile-based electromyography visual feedback training equipment and evaluate the usability for the muscle activity improvements in stroke patients. Methods This study was conducted in 12 patient with chronic stroke. To evaluate the usability of mobile-based electromyography training equipment, this research compared the immediate effects of the traditional tactile feedback training and the mobile-based electromyography training on 12 stroke patients. The MVIC muscle activity of the tibialis anterior, quadriceps femoris and gluteus maximus as well as the range of motion of the ankle dorsiflexion, hip joint extension and knee joint extension were measured before and after intervention. Resutls As a result of this study, the tibialis anterior, quadriceps femoris, and gluteus maximus muscle activity were all significantly different in mobile-based electromyography visual feedback training. In the comparison of the effects on the range of motion, there was a significant difference in mobile-based electromyography visual feedback training only in the knee extension. Conclusions Mobile-based electromyography visual feedback training is expected to be able to improve muscle activity and range of motion in stroke patients more effectively than conventional tactile training.