Tibialis Anterior Vibration Research Articles

Sensory information treatment during disturbed standing posture in chronic acquired demyelinating polyneuropathies (CADP)

As proposed after stroke, the study of reactions to a sensory stimulation allows to a better understanding of postural strategies. Below, we provide the analysis in chronic acquired demyelinating polyneuropathies (CADP). Prospective study of 25 healthy subjects (57 ± 12 years, 8 M, 17 F) and 25 CADP (66 ± 14 years, 20 M, 5 F) on stabilometric platform (Techno-Concept ® , France). Proprioception was disturbed by tendon vibration on Triceps Surae (TS) and Tibialis Anterior (TA). Vision was disturbed by optokinetic flow in 4 directions (upward, downward, rightward and leftward). Groups were compared using a composite score (mean of the center of pressure's displacement [mm] recorded in the anterior, posterior, right and left directions during the stimulation [35 s]). Composite score was significantly higher in CADP for optokinetic stimulation in each direction, upward (8.4/4.7 mm, P = 0.008), downward (9.8/5 mm, P = 0.0002), rightward (7/4.8 mm, P = 0.02) and leftward (8.4/4.5 mm, P = 0.001). Moreover, the higher is the sensory impairment (low score), the more important is the value of the optokinetic composite score ( P = 0.045, r = −0.55). Despite our expectation, CADP remained sensitive to proprioceptive stimulations: no differences were observed in healthy subjects for the TS stimulation and a more important reaction during TA vibration (7.3/5.5 mm, P = 0.01). Furthermore, falls were more frequent in PDCA, explaining the loss of 26% versus 2.7% of the records; P < 0.0001, essentially in visual condition. As expected, CADP are more sensitive to visual perturbation, but remained sensitive to proprioceptive perturbations despite sensory impairment. This encourages a rehabilitation aimed at promoting the recovery of proprioceptive information rather than the compensation by visual information.

Effects of tibialis anterior vibration on postural control when exposed to support surface translations

The sensory re-weighting theory suggests unreliable inputs may be down-weighted to favor more reliable sensory information and thus maintain proper postural control. This study investigated the effects of tibialis anterior (TA) vibration on center of pressure (COP) motion in healthy individuals exposed to support surface translations to further explore the concept of sensory re-weighting. Twenty healthy young adults stood with eyes closed and arms across their chest while exposed to randomized blocks of five trials. Each trial lasted 8 s, with TA vibration either on or off. After 2 s, a sudden backward or forward translation occurred. Anterior–posterior (A/P) COP data were evaluated during the preparatory (first 2 s), perturbation (next 3 s), and recovery (last 3 s) phases to assess the effect of vibration on perturbation response features. The knowledge of an impending perturbation resulted in reduced anterior COP motion with TA vibration in the preparatory phase relative to the magnitude of anterior motion typically observed during TA vibration. During the perturbation phase, vibration did not influence COP motion. However, during the recovery phase vibration induced greater anterior COP motion than during trials without vibration. The fact that TA vibration produced differing effects on COP motion depending upon the phase of the perturbation response may suggest that the immediate context during which postural control is being regulated affects A/P COP responses to TA vibration. This indicates that proprioceptive information is likely continuously re-weighted according to the context in order to maintain effective postural control.

Changes in the Estimated Time Course of the Motoneuron Afterhyperpolarization Induced by Tendon Vibration

Group Ia afferents are activated vigorously with high-frequency tendon vibration and provide excitatory input to the agonist muscle and inhibitory input to the antagonist muscle group via inhibitory interneurons. The purpose of this experiment was to determine whether the afterhyperpolarization (AHP) time course in humans is altered in response to tendon vibration. The AHP time course is estimated using the interval death rate (IDR) analysis, a transform of the motor unit action potential train. Single motor units from tibialis anterior (TA) were recorded as subjects held low force dorsiflexor contractions for 600 s with and without vibration. The vibratory stimulus was superimposed on the low force contraction either to the tendon of the TA or the antagonist Achilles tendon. During TA tendon vibration, the time course of the AHP, as expressed by its time constant (τ), decreased from 35.5 ms in the previbration control condition to 31.3 ms during the vibration (P = 0.003) and returned to 36.3 ms after the vibration was removed (P = 0.002). The AHP τ during vibration of the antagonist Achilles tendon (38.6 ms) was greater than the previbration control condition (33.6 ms; P = 0.001). It is speculated that the reduction in AHP time constant with TA vibration may have resulted alone or in combination with a modulation of motoneuron gain, an alteration of persistent inward currents and/or the restructuring of synaptic noise. A decrease in firing probability, possibly reflecting Ia reciprocal inhibition, may have been responsible for the larger AHP time constant.

Postural control and adaptation are influenced by preceding postural challenges

We investigated the possible consequences of two consecutive postural tasks on adaptation. Four groups (total number of 46 healthy subjects) were perturbed on two consecutive days with vibration stimulus to tibialis anterior or posterior calf muscles, or both in different orders. Postural movements were recorded with a force platform. There were three major results: (1) tibialis anterior vibration instigated postural adaptation during exposure to the vibration, but did not induce long-term adaptation from day to day, contrary to posterior calf vibration. (2) The long-term postural adaptation from day to day when the posterior calf was vibrated was not affected by prior or subsequent tibialis anterior vibration, which contrasts to other studies on motor learning. (3) Exposure to posterior calf vibration prior tibialis anterior vibration, led to changes of postural strategies and larger amount of torque variance, implying that postural strategies initiated by the gastrocnemius vibration were re-employed during the subsequent tibialis anterior stimulation. This may represent the formation of an internal model, used as feed-forward control of posture, possibly consisting of sensory reweighting. Postural perturbations need to be sufficiently difficult to withstand, in order to induce long-term learning, and postural strategies may be transferred between different postural challenges if they post different demands. Clinically, this suggests that exercises designed to rehabilitate patients should be sufficiently challenging to instigate learning processes, and spaced in order to avoid development of inappropriate postural strategies.

Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing

The purpose of this study was to examine whether postural instability observed in persons with spinal pain and in elderly persons is due to changes in proprioception and postural control strategy. The upright posture of 20 young and 20 elderly persons, with and without spinal pain, was challenged by vibrating ankle muscles (i.e. tibialis anterior, triceps surae) or paraspinal muscles. Center of pressure displacement was recorded using a force plate. Persons with spinal pain were more sensitive to triceps surae vibration and less sensitive to paraspinal vibration than persons without spinal pain. Elderly persons were more sensitive to tibialis anterior vibration than young healthy persons. These results suggest that spinal pain and aging may lead to changes in postural control by refocusing proprioceptive sensitivity from the trunk to the ankles.

The effect of aging on dynamic position sense at the ankle

The present study addressed whether dynamic position sense at the ankle—or sense of position and velocity during movement—shows a similar decline as a result of aging as previously described for static position sense and movement detection threshold. Additionally, the involvement of muscle spindle afferents in the possible age-related decline was studied. To assess dynamic position sense, blindfolded subjects had to open the hand briskly when the right ankle was rotating passively through a prescribed target angle. To assess the involvement of muscle spindles, the effect of tibialis anterior vibration was studied. The results showed that aging lead to a significant increase in deviation from the target angle at hand opening as well as in variability of performance. Vibration resulted in larger undershoot errors in the elderly compared to the young adults, suggesting that the age-related decline in performance on the dynamic position sense task is not (solely) due to muscle spindle function changes. Alternatively, this degeneration might be due to altered input from other sources of proprioceptive input, such as skin receptors. The elderly subjects did show a beneficial effect of practice with the task, which may provide solid fundaments for rehabilitation.

Human postural responses to different frequency vibrations of lower leg muscles.

We analyzed human postural responses to muscle vibration applied at four different frequencies to lower leg muscles, the lateral gastrocnemius (GA) or tibialis anterior (TA) muscles. The muscle vibrations induced changes in postural orientation characterized by the center of pressure (CoP) on the force platform surface on which the subjects were standing. Unilateral vibratory stimulation of TA induced body leaning forward and in the direction of the stimulated leg. Unilateral vibration of GA muscles induced body tilting backwards and in the opposite direction of the stimulated leg. The time course of postural responses was similar and started within 1 s after the onset of vibration by a gradual body tilt. When a new slope of the body position was reached, oscillations of body alignment occurred. When the vibrations were discontinued, this was followed by rapid recovery of the initial body position. The relationship between the magnitude of the postural response and frequency of vibration differed between TA and GA. While the magnitude of postural responses to TA vibration increased approximately linearly in the 60-100 Hz range of vibration frequency, the magnitude of response to GA vibration increased linearly only at lower frequencies of 40-60 Hz. The direction of body tilt induced by muscle vibration did not depend on the vibration frequency.

Influence of leg muscle vibration on human walking.

We studied the effect of vibratory stimulation of different leg muscles [bilateral quadriceps (Q), hamstring (HS) muscles, triceps surae (TS), and tibialis anterior (TA)] in seven normal subjects during 1) quiet standing, 2) stepping in place movements, and 3) walking on the treadmill. The experiments were performed in a dimly illuminated room, and the subjects were given the instruction not to resist the applied perturbation. In one condition the velocity of the treadmill was controlled by a feedback from the subject's current position. In normal standing, TA vibration elicited a prominent forward body tilt, whereas HS and TS vibration elicited backward trunk or whole body inclination, respectively. Q vibration had little effect. During stepping in place, continuous HS vibration produced an involuntary forward stepping at about 0.3 m s(-1) without modifying the stepping frequency. When the subjects (with eyes closed) kept a hand contact with an external still object, they did not move forward but perceived an illusory forward leg flexion relative to the trunk. Q, TS, and TA vibration did not cause any systematic body translation nor illusory changes in body configuration. In treadmill locomotion, HS vibration produced an involuntary steplike increase of walking speed (by 0.1-0.6 m.s(-1)). Continuous vibration elicited larger speed increments than phasic stimulation during swing or stance phase. For phasic stimulation, HS vibration tended to be more effective when applied during swing than during stance phase. Q, TA, and TS vibration had little if any effect. Vibration of thigh muscles altered the walking speed depending on the direction of progression. During backward locomotion, the walking speed tended to decrease after HS vibration, whereas it significantly increased after Q vibration. Thus the influence of leg muscle vibration on stepping in place and locomotion differed significantly from that on normal posture. We suggest that the proprioceptive input from thigh muscles may convey information about the velocity of the foot movement relative to the trunk.

Assessing changes in presynaptic inhibition of I a fibres: a study in man and the cat.

1. A method to assess changes in presynaptic inhibition of I a afferent terminals in man is proposed. The soleus H reflex was facilitated by a heteronymous I a volley from quadriceps and the amount of reflex facilitation was used to estimate the size of the conditioning I a excitatory post-synaptic potential (e.p.s.p.). It is argued that the size of this e.p.s.p. as measured by the resulting amount of reflex facilitation reflects the amount of presynaptic inhibition on the corresponding I a fibres. A decrease in the reflex facilitation may then be ascribed to an increase in presynaptic inhibition of the I a fibres mediating the conditioning volley. 2. That the heteronymous I a facilitation from quadriceps to soleus is caused by a purely monosynaptic e.p.s.p. is a prerequisite for the validity of the method. Experimental evidence is therefore given in an Appendix that in man the earliest part (first 0.5 ms) of this heteronymous I a facilitation is mediated through a monosynaptic pathway. Evidence is also given that this earliest facilitation is not yet contaminated by any polysynaptic effects from I a or I b afferents. 3. The validity of the method was established in animal experiments in which presynaptic inhibition of I a fibres and post-synaptic events in motoneurones could be assessed by direct tests. It was found that the amount of test reflex facilitation produced by a conditioning I a volley was decreased when I a fibres were subjected to presynaptic inhibition but remained unchanged when the motoneurone pool in which the test reflex was elicited received pure post-synaptic inhibition. 4. In man, presynaptic inhibition of I a fibres was evoked by a short-lasting (three shocks at 200 Hz) vibration applied to the tibialis anterior tendon. Such a vibratory burst reduced the efficiency of the heteronymous I a volley in facilitating the soleus H reflex. By contrast, during a pure post-synaptic inhibition of soleus motoneurones the efficiency of the conditioning volley in facilitating the test reflex remained unchanged. It is therefore argued that the amount of heteronymous I a facilitation can indeed be used to assess the amount of ongoing presynaptic inhibition exerted onto heteronymous I a fibres from the quadriceps muscle to soleus motoneurones. 5. The short-lasting tibialis anterior vibration used here evoked a long-lasting (300-500 ms) depression of soleus and quadriceps H reflexes.(ABSTRACT TRUNCATED AT 400 WORDS)

Evidence for presynaptic inhibition of muscle spindle Ia afferents in man

A new method for estimating presynaptic inhibition of soleus (Sol) Ia fibres in man is introduced based on the assessment of the amount of facilitation produced by a preceding homonymous Ia volley onto a Sol monosynaptic reflex. It was found in animal experiments that a reduction of such Ia facilitation reflects the amount of presynaptic inhibition exerted on these Ia fibres. Since, in man, a similar reduction of homonymous Ia facilitation was found after tibialis anterior vibration, this provides evidence for presynaptic inhibition of Sol Ia fibres, elicited here by the afferent discharge due to this flexor vibration.