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Robb KA, Howe EE, Perry SD. The effects of foot orthoses and sensory facilitation on lower limb electromyography: A scoping review. Foot (Edinb) 2022; 52:101904. [PMID: 36049264 DOI: 10.1016/j.foot.2022.101904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/22/2021] [Accepted: 01/03/2022] [Indexed: 02/04/2023]
Abstract
Foot orthoses (FO) are used as a treatment for biomechanical abnormalities, overuse injuries, and neuropathologies, but study of their mechanism remains inconclusive. The neuromotor paradigm has proposed that FOs may manipulate sensory input from foot sole skin to reduce muscle activity for movement optimization. This review argues that a FO likely alters the incoming mechanical stimuli transmitted via cutaneous mechanoreceptors and nociceptors as the foot sole interfaces with the surface of the orthotic. Thus, all FOs with or without intentional sensory facilitation, likely changes sensory information from foot sole cutaneous afferents. Additionally, in light of understanding and applying knowledge pertaining to the cutaneous reflex loop circuitry, FO's increasing sensory input to the motorneuron pool can change EMG to either reflex sign (increase or decrease). The purpose of this scoping review was to synthesize FO and sensory augmentation literature and summarize how FO designs can capitalize on foot sole skin to modulate lower limb electromyography (EMG). Six database searches resulted in 30 FO studies and 22 sensory studies that included EMG as an outcome measure. Results revealed task and phase specific responses with some consistencies in EMG outcomes between testing modalities, however many inconsistencies remain. Electrical stimulation reflex research provides support for a likely sensory-to-motor factor contributing to muscle activity modulation when wearing FOs. The discussion divides trends in FO treatment modalities by desired increase or decrease in each compartment musculature. The results of this review provides a benchmark for future academics and clinicians to advance literature in support of a revised neuromotor paradigm while highlighting the importance of foot sole skin in FO design.
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Affiliation(s)
- Kelly A Robb
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON N2L 3C5, Canada.
| | - Erika E Howe
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - Stephen D Perry
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON N2L 3C5, Canada.
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2
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Goossens N, Janssens L, Caeyenberghs K, Albouy G, Brumagne S. Differences in brain processing of proprioception related to postural control in patients with recurrent non-specific low back pain and healthy controls. NEUROIMAGE-CLINICAL 2019; 23:101881. [PMID: 31163385 PMCID: PMC6545448 DOI: 10.1016/j.nicl.2019.101881] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/19/2019] [Accepted: 05/25/2019] [Indexed: 12/11/2022]
Abstract
Patients with non-specific low back pain (NSLBP) show an impaired postural control during standing and a slower performance of sit-to-stand-to-sit (STSTS) movements. Research suggests that these impairments could be due to an altered use of ankle compared to back proprioception. However, the neural correlates of these postural control impairments in NSLBP remain unclear. Therefore, we investigated brain activity during ankle and back proprioceptive processing by applying local muscle vibration during functional magnetic resonance imaging in 20 patients with NSLBP and 20 controls. Correlations between brain activity during proprioceptive processing and (Airaksinen et al., 2006) proprioceptive use during postural control, evaluated by using muscle vibration tasks during standing, and (Altmann et al., 2007) STSTS performance were examined across and between groups. Moreover, fear of movement was assessed. Results revealed that the NSLBP group performed worse on the STSTS task, and reported more fear compared to healthy controls. Unexpectedly, no group differences in proprioceptive use during postural control were found. However, the relationship between brain activity during proprioceptive processing and behavioral indices of proprioceptive use differed significantly between NSLBP and healthy control groups. Activity in the right amygdala during ankle proprioceptive processing correlated with an impaired proprioceptive use in the patients with NSLBP, but not in healthy controls. Moreover, while activity in the left superior parietal lobule, a sensory processing region, during back proprioceptive processing correlated with a better use of proprioception in the NSLBP group, it was associated with a less optimal use of proprioception in the control group. These findings suggest that functional brain changes during proprioceptive processing in patients with NSLBP may contribute to their postural control impairments.
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Affiliation(s)
- Nina Goossens
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, box 1501, Leuven 3001, Belgium.
| | - Lotte Janssens
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, box 1501, Leuven 3001, Belgium; REVAL Rehabilitation Research Center, Hasselt University, Agoralaan A, Diepenbeek 3590, Belgium
| | - Karen Caeyenberghs
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne Campus (St Patrick), Locked Bag 4115, Fitzroy, VIC 3065, Australia
| | - Geneviève Albouy
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, Leuven 3001, Belgium
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, box 1501, Leuven 3001, Belgium
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3
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The nociceptive withdrawal response of the tail in the spinalized rat employs a hybrid categorical-continuous spatial mapping strategy. Exp Brain Res 2019; 237:1551-1561. [PMID: 30927042 DOI: 10.1007/s00221-019-05527-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Complexity in movement planning, arising from diverse temporal and spatial sources, places a computational burden on the central nervous system. However, the efficacy with which humans can perform natural, highly trained movements suggests that they have evolved effective behavioral strategies that simplify the computational burden. The specific aim of our research was to use three-dimensional high-speed video to determine whether the tail nociceptive withdrawal response (NWR) to noxious heat stimuli delivered at locations that varied both circumferentially and rostral-caudally on the tail depended on the location of the stimulus in spinalized rats. In particular, we sought to determine whether the movement strategy was categorical (limited number of directions) or continuous (any variation in stimulus location results in a variation in response direction). In spinalized rats, localized, noxious heat stimuli were delivered at eight locations circumferentially around the tail and at five rostral-caudal levels. Our results demonstrate that at all rostral-caudal levels, response movement direction was bimodal regardless of circumferential stimulus location-either ~ 64° left or right of ventral. However, in spite of tight clustering, movement direction varied significantly but weakly according to circumferential location, in that responses to stimuli were more lateral for lateral stimulus locations. In contrast, changes in stimulus level strongly affected movement direction, in that a localized bend response closely matched the level of the stimulus. Together, our results demonstrate, based on movement analysis in spinalized rats, that the NWR employs a hybrid categorical-continuous strategy that may minimize the harmful consequences of noxious stimuli.
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Massé-Alarie H, Salomoni SE, Hodges PW. The nociceptive withdrawal reflex of the trunk is organized with unique muscle receptive fields and motor strategies. Eur J Neurosci 2019; 50:1932-1947. [PMID: 30746786 DOI: 10.1111/ejn.14369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/16/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
Abstract
Noxious stimuli induce a nociceptive withdrawal reflex (NWR) to protect the tissue from injury. Although the NWR was once considered as a stereotyped response, previous studies report distinct responses depending on the stimulation site and context for limbs. We aimed to determine whether noxious stimuli over the trunk produced adaptable complex NWR. We hypothesized that organization of the NWR of the trunk muscle would vary with the site of noxious input and would differ between body and spine postures, which modify the potential for specific muscles to remove threat. Fourteen participants were tested in sitting and three lumbar spine postures in side lying (neutral, flexion and extension). Noxious electrical stimuli were applied over the sacrum, spinous process of L3 and T12, lateral side of the 8th rib and anterior midline. NWR latency and amplitude were recorded with surface electromyography (EMG) electrodes over different trunk muscles. Distinct patterns of muscle activation depended on the stimulation site and were consistent with motor strategies needed to withdraw from the noxious stimuli. The NWR pattern differed between body positions, with less modulation observed in sitting than side lying. Spine posture did not affect the NWR organisation. Our results suggest the circuits controlling trunk muscle NWR presents with adaptability as a function of stimulation site and body position by utilizing the great complexity of the trunk muscle system to produce an efficient protective response. This suggests that the central nervous system (CNS) uses multiple adaptable strategies that are unique depending on which context the noxious stimuli are applied.
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Affiliation(s)
- Hugo Massé-Alarie
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Université Laval, Quebec City, Quebec, Canada
| | - Sauro E Salomoni
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul W Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Temporal Profile and Limb-specificity of Phasic Pain-Evoked Changes in Motor Excitability. Neuroscience 2018; 386:240-255. [DOI: 10.1016/j.neuroscience.2018.06.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/20/2018] [Accepted: 06/24/2018] [Indexed: 12/17/2022]
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6
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Stimulation site and phase modulation of the withdrawal reflex during gait initiation. Clin Neurophysiol 2015; 126:2282-9. [DOI: 10.1016/j.clinph.2015.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 11/23/2022]
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7
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Serrao M, Cortese F, Andersen OK, Conte C, Spaich EG, Fragiotta G, Ranavolo A, Coppola G, Perrotta A, Pierelli F. Modular organization of the head retraction responses elicited by electrical painful stimulation of the facial skin in humans. Clin Neurophysiol 2015; 126:2306-13. [PMID: 25769929 DOI: 10.1016/j.clinph.2015.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 11/25/2022]
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Zehr EP, Nakajima T, Barss T, Klarner T, Miklosovic S, Mezzarane RA, Nurse M, Komiyama T. Cutaneous stimulation of discrete regions of the sole during locomotion produces "sensory steering" of the foot. BMC Sports Sci Med Rehabil 2014; 6:33. [PMID: 25202452 PMCID: PMC4158001 DOI: 10.1186/2052-1847-6-33] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND While the neural and mechanical effects of whole nerve cutaneous stimulation on human locomotion have been previously studied, there is less information about effects evoked by activation of discrete skin regions on the sole of the foot. Electrical stimulation of discrete foot regions evokes position-modulated patterns of cutaneous reflexes in muscles acting at the ankle during standing but data during walking are lacking. Here, non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. METHODS Non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. RESULTS The results demonstrate statistically significant dynamic changes in reflex amplitudes, kinematics and foot sole pressures that are site-specific and phase-dependent. The general trends demonstrate responses producing decreased underfoot pressure at the site of stimulation. CONCLUSIONS The responses to stimulation of discrete locations on the foot sole evoke a kind of "sensory steering" that may promote balance and maintenance of locomotion through the modulation of limb loading and foot placement. These results have implications for using sensory stimulation as a therapeutic modality during gait retraining (e.g. after stroke) as well as for footwear design and implementation of foot sole contact surfaces during gait.
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Affiliation(s)
- E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada ; Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada ; Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada ; Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Japan
| | - Trevor Barss
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada ; Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada ; Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada ; Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada ; Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Stefanie Miklosovic
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada
| | - Rinaldo A Mezzarane
- Laboratory of Signal Processing and Motor Control, College of Physical Education, University of Brasília, Brasília, Brazil ; Biomedical Engineering Laboratory, EPUSP, PTC, University of São Paulo, São Paulo, Brazil ; Department of Health and Sports Sciences, Faculty of Education, Chiba University, Chiba, Japan
| | | | - Tomoyoshi Komiyama
- Department of Health and Sports Sciences, Faculty of Education, Chiba University, Chiba, Japan
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Rohrbach H, Zeiter S, Andersen OK, Wieling R, Spadavecchia C. Quantitative assessment of the nociceptive withdrawal reflex in healthy, non-medicated experimental sheep. Physiol Behav 2014; 129:181-5. [DOI: 10.1016/j.physbeh.2014.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/31/2013] [Accepted: 02/04/2014] [Indexed: 11/26/2022]
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10
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Sayenko DG, Angeli C, Harkema SJ, Edgerton VR, Gerasimenko YP. Neuromodulation of evoked muscle potentials induced by epidural spinal-cord stimulation in paralyzed individuals. J Neurophysiol 2014; 111:1088-99. [PMID: 24335213 PMCID: PMC3949232 DOI: 10.1152/jn.00489.2013] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 12/11/2013] [Indexed: 11/22/2022] Open
Abstract
Epidural stimulation (ES) of the lumbosacral spinal cord has been used to facilitate standing and voluntary movement after clinically motor-complete spinal-cord injury. It seems of importance to examine how the epidurally evoked potentials are modulated in the spinal circuitry and projected to various motor pools. We hypothesized that chronically implanted electrode arrays over the lumbosacral spinal cord can be used to assess functionally spinal circuitry linked to specific motor pools. The purpose of this study was to investigate the functional and topographic organization of compound evoked potentials induced by the stimulation. Three individuals with complete motor paralysis of the lower limbs participated in the study. The evoked potentials to epidural spinal stimulation were investigated after surgery in a supine position and in one participant, during both supine and standing, with body weight load of 60%. The stimulation was delivered with intensity from 0.5 to 10 V at a frequency of 2 Hz. Recruitment curves of evoked potentials in knee and ankle muscles were collected at three localized and two wide-field stimulation configurations. Epidural electrical stimulation of rostral and caudal areas of lumbar spinal cord resulted in a selective topographical recruitment of proximal and distal leg muscles, as revealed by both magnitude and thresholds of the evoked potentials. ES activated both afferent and efferent pathways. The components of neural pathways that can mediate motor-evoked potentials were highly dependent on the stimulation parameters and sensory conditions, suggesting a weight-bearing-induced reorganization of the spinal circuitries.
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Affiliation(s)
- Dimitry G Sayenko
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
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11
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Peterson CL, Riley ZA, Krepkovich ET, Murray WM, Perreault EJ. Withdrawal reflexes in the upper limb adapt to arm posture and stimulus location. Muscle Nerve 2014; 49:716-23. [PMID: 23929755 DOI: 10.1002/mus.23987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 07/29/2013] [Accepted: 07/31/2013] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Withdrawal reflexes in the leg adapt in a context-appropriate manner to remove the limb from noxious stimuli, but the extent to which withdrawal reflexes adapt in the arm remains unknown. METHODS We examined the adaptability of withdrawal reflexes in response to nociceptive stimuli applied in different arm postures and to different digits. Reflexes were elicited at rest, and kinetic and electromyographic responses were recorded under isometric conditions, thereby allowing motorneuron pool excitability to be controlled. RESULTS Endpoint force changed from a posterior-lateral direction in a flexed posture to predominantly a posterior direction in a more extended posture [change in force angle (mean ± standard deviation) 35.6 ± 5.0°], and the force direction changed similarly with digit I stimulation compared with digit V (change = 22.9 ± 2.9°). CONCLUSIONS The withdrawal reflex in the human upper limb adapts in a functionally relevant manner when elicited at rest.
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Affiliation(s)
- Carrie L Peterson
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois, 60611, USA; Edward Hines, Jr., VA Hospital, Hines, IL, USA
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12
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Kutz DF, Kaulich T, Föhre W, Gerwig M, Timmann D, Kolb FP. Comparison of the classically conditioned withdrawal reflex in cerebellar patients and healthy control subjects during stance: 2. Biomechanical characteristics. Neurobiol Learn Mem 2014; 109:178-92. [PMID: 24445111 DOI: 10.1016/j.nlm.2013.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/18/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
Abstract
This study addresses cerebellar involvement in classically conditioned nociceptive lower limb withdrawal reflexes in standing humans. A preceding study compared electromyographic activities in leg muscles of eight patients with cerebellar disease (CBL) and eight age-matched controls (CTRL). The present study extends and completes that investigation by recording biomechanical signals from a strain-gauge-equipped platform during paired auditory conditioning stimuli (CS) and unconditioned stimuli (US) trials and during US-alone trials. The withdrawal reflex performance-lifting the stimulated limb (decreasing the vertical force from that leg, i.e. 'unloading') and transferring body weight to the supporting limb (increasing the vertical force from that leg, i.e. 'loading')-was quantified by the corresponding forces exerted onto the platform. The force changes were not simultaneous but occurred as a sequence of multiple force peaks at different times depending on the specific limb task (loading or unloading). Motor learning, expressed by the occurrence of conditioned responses (CR), is characterized by this sequence beginning already within the CSUS window. Loading and unloading were delayed and prolonged in CBL, resulting in incomplete rebalancing during the analysis period. Trajectory loops of the center of vertical pressure-derived from vertical forces-were also incomplete in CBL within the recording period. However, exposing CBL to a CS resulted in motor improvement reflected by shortening the time of rebalancing and by optimizing the trajectory loop. In summary, associative responses in CBL are not absent although they are less frequent and of smaller amplitude than in CTRL.
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Affiliation(s)
- D F Kutz
- Institute of Physiology, University of Munich, Pettenkoferstr. 12, 80336 München, Germany.
| | - Th Kaulich
- Institute of Physiology, University of Munich, Pettenkoferstr. 12, 80336 München, Germany.
| | - W Föhre
- Institute of Physiology, University of Munich, Pettenkoferstr. 12, 80336 München, Germany.
| | - M Gerwig
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
| | - D Timmann
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
| | - F P Kolb
- Institute of Physiology, University of Munich, Pettenkoferstr. 12, 80336 München, Germany.
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Jain TK, Wauneka C, Liu W. Unloading reaction during sudden ankle inversion in healthy adults. Gait Posture 2014; 39:529-33. [PMID: 24119321 PMCID: PMC3855029 DOI: 10.1016/j.gaitpost.2013.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 08/19/2013] [Accepted: 09/06/2013] [Indexed: 02/02/2023]
Abstract
The purpose of this research study was to determine the dynamics of early human response from sudden ankle inversion (30° tilt). Changes in vertical ground reaction forces (GRFs) following trapdoor release in a group of healthy subjects were compared to those from the similar experiments using a chair with two U shaped steel legs and matched weights of the human subjects. The experiments with the chair were further repeated with additional foam paddings at their bases to introduce visco-elastic properties to legs of the chair. Following the trapdoor release a decrease in the vertical ground reaction force under the inverting leg and subsequent increase in the supporting leg were observed in both human and chair experiments. The short onset of changes in vertical GRFs in our experiments indicate that the dynamic features of early response following trapdoor release are primarily due to mechanical events and may not be significantly affected by the neuromuscular reaction of human subjects.
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Affiliation(s)
- Tarang Kumar Jain
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS 66160-7601, USA
| | - Clayton Wauneka
- Bioengineering Graduate Program, University of Kansas, 1520 West 15thStreet, Room 1, Eaton Hall, Lawrence, Kansas, 66405, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS 66160-7601, USA
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Experimental and model-based analysis of differences in perception of cutaneous electrical stimulation across the sole of the foot. Med Biol Eng Comput 2013; 51:999-1009. [DOI: 10.1007/s11517-013-1079-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Spadavecchia C, Haga H, Ranheim B. Concentration-dependent isoflurane effects on withdrawal reflexes in pigs and the role of the stimulation paradigm. Vet J 2012; 194:375-9. [DOI: 10.1016/j.tvjl.2012.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
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16
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Serrao M, Ranavolo A, Andersen OK, Conte C, Don R, Cortese F, Mari S, Draicchio F, Padua L, Sandrini G, Pierelli F. Adaptive behaviour of the spinal cord in the transition from quiet stance to walking. BMC Neurosci 2012; 13:80. [PMID: 22800397 PMCID: PMC3445852 DOI: 10.1186/1471-2202-13-80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modulation of nociceptive withdrawal reflex (NWR) excitability was evaluated during gait initiation in 10 healthy subjects to investigate how load- and movement-related joint inputs activate lower spinal centres in the transition from quiet stance to walking. A motion analysis system integrated with a surface EMG device was used to acquire kinematic, kinetic and EMG variables. Starting from a quiet stance, subjects were asked to walk forward, at their natural speed. The sural nerve was stimulated and EMG responses were recorded from major hip, knee and ankle muscles. Gait initiation was divided into four subphases based on centre of pressure and centre of mass behaviours, while joint displacements were used to categorise joint motion as flexion or extension. The reflex parameters were measured and compared between subphases and in relation to the joint kinematics. RESULTS The NWR was found to be subphase-dependent. NWR excitability was increased in the hip and knee flexor muscles of the starting leg, just prior to the occurrence of any movement, and in the knee flexor muscles of the same leg as soon as it was unloaded. The NWR was hip joint kinematics-dependent in a crossed manner. The excitability of the reflex was enhanced in the extensor muscles of the standing leg during the hip flexion of the starting leg, and in the hip flexors of the standing leg during the hip extension of the starting leg. No notable reflex modulation was observed in the ankle muscles. CONCLUSIONS Our findings show that the NWR is modulated during the gait initiation phase. Leg unloading and hip joint motion are the main sources of the observed modulation and work in concert to prepare and assist the starting leg in the first step while supporting the contralateral leg, thereby possibly predisposing the lower limbs to the cyclical pattern of walking.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy.
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Bank P, Peper C, Marinus J, Beek P, van Hilten J. Motor consequences of experimentally induced limb pain: A systematic review. Eur J Pain 2012; 17:145-57. [DOI: 10.1002/j.1532-2149.2012.00186.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | - C.E. Peper
- Research Institute MOVE; Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - J. Marinus
- Department of Neurology; Leiden University Medical Center; The Netherlands
| | - P.J. Beek
- Research Institute MOVE; Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - J.J. van Hilten
- Department of Neurology; Leiden University Medical Center; The Netherlands
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18
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Modulating effects of bodyweight unloading on the lower limb nociceptive withdrawal reflex during symmetrical stance. Clin Neurophysiol 2012; 123:1035-43. [DOI: 10.1016/j.clinph.2011.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 08/31/2011] [Accepted: 09/05/2011] [Indexed: 11/22/2022]
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Introducing the reflex probability maps in the quantification of nociceptive withdrawal reflex receptive fields in humans. J Electromyogr Kinesiol 2011; 21:67-76. [DOI: 10.1016/j.jelekin.2010.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 08/03/2010] [Accepted: 09/10/2010] [Indexed: 11/23/2022] Open
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Emborg J, Matjačić Z, Bendtsen JD, Spaich EG, Cikajlo I, Goljar N, Andersen OK. Design and test of a novel closed-loop system that exploits the nociceptive withdrawal reflex for swing-phase support of the hemiparetic gait. IEEE Trans Biomed Eng 2010; 58:960-70. [PMID: 21134806 DOI: 10.1109/tbme.2010.2096507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A novel closed-loop system for improving gait in hemiparetic patients by supporting the production of the swing phase using electrical stimulations evoking the nociceptive withdrawal reflex was designed. The system exploits the modular organization of the nociceptive withdrawal reflex and its stimulation site- and gait-phase modulation in order to evoke movements of the hip, knee, and ankle joints during the swing phase. A modified model-reference adaptive controller (MRAC) was designed to select the best stimulation parameters from a set of 12 combinations of four electrode locations on the sole of the foot and three different stimulation onset times between heel-off and toe-off. It was hypothesized that the MRAC system would result in a better walking pattern compared with an open-loop preprogrammed fixed pattern of stimulation (FPS) controller. Thirteen chronic or subacute hemiparetic subjects participated in a study to compare the performance of the two control schemes. Both control schemes resulted in a more functional gait compared to no stimulation (P < 0.05) with a weighted joint angle peak change of 4.0 ± 1.6 (mean ± Standard deviation) degrees and 3.1 ± 1.4 degrees for the MRAC and FPS schemes, respectively. This indicates that the MRAC scheme performed better than the FPS scheme (P < 0.001) in terms of reaching the control target.
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Affiliation(s)
- Jonas Emborg
- Integrative Neuroscience Group, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, DK-9220, Denmark.
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Biurrun Manresa JA, Hansen J, Andersen OK. Development of a data acquisition and analysis system for nociceptive withdrawal reflex and reflex receptive fields in humans. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:6619-24. [PMID: 21096727 DOI: 10.1109/iembs.2010.5627139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A system for data acquisition and analysis of nociceptive withdrawal reflex (NWR) and reflex receptive field (RRF) is introduced. The system is constituted by hardware and software components. The hardware consists of devices commonly used for electrical stimulation and electromyographic and kinematic data recording. The software comprises two different programs: Wirex, a stand-alone program developed in LabView for data acquisition, and Reflex Lab, a Matlab-based toolbox for data analysis. These programs were developed to maximize the potential of the hardware, turning it into a complete stimulation system capable of automatic quantification of NWR and RRF. In this article, a brief review of NWR and RRF analysis is presented, the system features are described in detail and its present and future applications are discussed.
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Affiliation(s)
- Jose A Biurrun Manresa
- Integrative Neuroscience group within the Center for Sensory-Motor Interaction (SMI), Dept. of Health, Science and Technology, Aalborg University, Fredrik Bajers vej 7, Aalborg Øst, 9220 Denmark.
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Courtney CA, Durr RK, Emerson-Kavchak AJ, Witte EO, Santos MJ. Heightened flexor withdrawal responses following ACL rupture are enhanced by passive tibial translation. Clin Neurophysiol 2010; 122:1005-10. [PMID: 20875770 DOI: 10.1016/j.clinph.2010.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/17/2010] [Accepted: 07/04/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Hyperexcitability of nociceptive pathways has been demonstrated with several musculoskeletal conditions but not anterior cruciate ligament (ACL) injury. The purpose was to investigate flexor withdrawal reflex (FWR) excitability following ACL rupture and determine if painless stretch of knee joint structures enhanced reflexive responses. METHODS Ten subjects with and 10 subjects without unilateral ACL rupture were compared. FWRs were induced through sural nerve stimulus in symmetrical stance and recumbent positions, with the knee in relaxed and stressed condition. Latencies and amplitudes of hamstring electromyographic activity were analyzed. RESULTS FWR thresholds were significantly diminished (p=0.05) on the injured limb (11.8±8 mA) compared to non-injured limb (18.6±13 mA) and controls (22.5±3 mA). Anterior tibial translation resulted in increased (p=0.001) amplitude of EMG hamstring response on the injured limb (70±50%) versus control (-1±20%) and decreased latency (p=0.01) of hamstring activation (82.0±13 ms). CONCLUSIONS Individuals with ACL rupture demonstrated increased excitability of FWR responses indicated by decreased FWR threshold and reduced hamstring muscle latency. Responses were enhanced by passive stretch of the knee joint. SIGNIFICANCE Subjects with ACL rupture demonstrated hyperexcitability of nociceptive pathways on the injured limb which may trigger the FWR more readily and promote the sensation of instability at the knee.
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Affiliation(s)
- Carol A Courtney
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, United States.
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Kaulich T, Föhre W, Kutz DF, Gerwig M, Timmann D, Kolb FP. Differences in unconditioned and conditioned responses of the human withdrawal reflex during stance: muscle responses and biomechanical data. Brain Res 2010; 1326:81-95. [PMID: 20188078 DOI: 10.1016/j.brainres.2010.02.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 02/16/2010] [Accepted: 02/17/2010] [Indexed: 11/24/2022]
Abstract
The aim of this study was to characterize differences between unconditioned and classically conditioned lower limb withdrawal reflexes in young subjects during standing. Electromyographic activity in the main muscle groups and biomechanical signals from a strain-gauge-equipped platform on which subjects stood were recorded from 17 healthy subjects during unconditioned stimulus (US)-alone trials and during auditory conditioning stimuli (CS) and US trials. In US-alone trials the leg muscle activation sequence was characteristic: ipsilateral, distal muscles were activated prior to proximal muscles; contralaterally the sequence was reversed. In CSUS trials latencies were shorter. Subjects unloaded the stimulated leg and shifted body weight to the supporting leg. In US-alone and in CSUS trials leg forces on each side were inversely related and asymmetric, due to preparation for unloading, whilst conditioned responses (CR), representing the unloading preparation, were symmetric. The trajectory of the center of vertical pressure during US-alone trials moved initially forward (a preparatory balance reaction) and to the stimulation side, followed by a large lateral shift to the side of the supporting limb. During CSUS trials the forwards shift was absent but the CR (early lateral shift) represented a preponed preparatory unloading. Electrophysiological and biomechanical responses of the classically conditioned lower limb withdrawal reflex in standing subjects changed significantly in CSUS trials compared to US-alone trials with higher sensitivity in the biomechanics. These findings will serve as a basis for a subsequent study on a group of patients with cerebellar diseases in whom the success of establishing procedural processes is known to be impaired.
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Affiliation(s)
- Thomas Kaulich
- Institute of Physiology, University of Munich, Munich, Germany
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Courtney CA, Lewek MD, Witte PO, Chmell SJ, Hornby TG. Heightened Flexor Withdrawal Responses in Subjects With Knee Osteoarthritis. THE JOURNAL OF PAIN 2009; 10:1242-9. [DOI: 10.1016/j.jpain.2009.05.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 04/07/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
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Spaich EG, Emborg J, Collet T, Arendt-Nielsen L, Andersen OK. Withdrawal reflex responses evoked by repetitive painful stimulation delivered on the sole of the foot during late stance: site, phase, and frequency modulation. Exp Brain Res 2009; 194:359-68. [DOI: 10.1007/s00221-009-1705-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
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Emborg J, Spaich EG, Andersen OK. Withdrawal reflexes examined during human gait by ground reaction forces: site and gait phase dependency. Med Biol Eng Comput 2008; 47:29-39. [PMID: 18830656 DOI: 10.1007/s11517-008-0396-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 09/11/2008] [Indexed: 11/29/2022]
Abstract
The objective of this study was to investigate the modulation of the nociceptive withdrawal reflex during gait measured using Force Sensitive Resistors (FSR). Electrical stimulation was delivered to four locations on the sole of the foot at three different time points between heel-off and toe-off. Peak force changes were measured by FSRs attached to the big toe, distal to the first and fourth metatarsophalangeal joints, and the medial process of the calcaneus on both feet. Force changes were assessed in five gait sub-phases. The painful stimulation led to increased ipsilateral unloading (10 +/- 1 N) and contralateral loading (12 +/- 1 N), which were dependent on stimulation site and phase. In contrast, the hallux of the ipsilateral foot plantar flexed, thus facilitating the push-off. The highest degree of plantar flexion (23 +/- 10 N; range, 8-44 N) was seen in the second double support phase following the stimulation. Site and phase modulation of the reflex were detected in the force signals from all selected anatomical landmarks. In the kinematic responses, both site and phase modulation were observed. For stimulations near toe-off, withdrawal was primarily accomplished by ankle dorsiflexion, while the strategy for stimulations at heel-off was flexion of the knee and hip joints.
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Affiliation(s)
- Jonas Emborg
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, 9220 Aalborg, Denmark.
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Santos MJ, Liu H, Liu W. Unloading reactions in functional ankle instability. Gait Posture 2008; 27:589-94. [PMID: 17889541 DOI: 10.1016/j.gaitpost.2007.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 07/27/2007] [Accepted: 08/05/2007] [Indexed: 02/02/2023]
Abstract
Past studies have suggested that unloading reactions may be a strategy to prevent ankle sprains. This study tested unloading reactions in individuals with functional ankle instability (FAI) in order to better understand this phenomenon. We provoked unloading reactions in 20 individuals with FAI and 18 healthy controls by delivering nociceptive electrical stimulation to the lateral aspect of the ankle during standing. Ground reaction forces, lower extremity kinematics, and EMG activity of five muscles of the lower limb were recorded. Individuals with FAI demonstrated increased and faster body weight unloading after stimulation. This hyper-reactivity may partially account for the sensation of the ankle "giving way" in those with a history of severe ankle sprain and subsequent functional instability.
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Affiliation(s)
- Marcio J Santos
- Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS, USA.
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Tortolero X, Masani K, Maluly C, Popovic MR. Body Movement Induced by Electrical Stimulation of Toe Muscles During Standing. Artif Organs 2007. [DOI: 10.1111/j.1525-1594.2007.00451.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Santos MJ, Liu W. Unloading reaction to electrical stimulation at neutral and supinated ankle positions. Gait Posture 2007; 26:106-12. [PMID: 16962780 DOI: 10.1016/j.gaitpost.2006.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Revised: 08/01/2006] [Accepted: 08/05/2006] [Indexed: 02/02/2023]
Abstract
An unloading reaction has been characterized as a modified flexor reflex (FR), in which the standing subjects decrease the load on the stimulated foot and increase the load on the contralateral side, but, without withdrawal of the stimulated foot. Different behavioral circumstances have been shown to modulate this reflex. It is not known whether unloading reactions can be modulated with a loaded supinated ankle position, which, in excess, may result in an ankle sprain injury. Since ankle sprain depends on the load applied to a supinated foot, our premise is that unloading reactions may protect the ankle from a sprain injury. Therefore, this study investigated how the unloading reactions were modulated during a loaded supinated ankle condition. We delivered non-nociceptive and nociceptive electrical stimulations on the lateral aspect of the ankle in standing subjects with the foot in neutral and in a supinated position. The magnitude and latencies of reflex responses were registered using kinetic and kinematic analyses and subsequently compared among the conditions. The analysis demonstrated greater reactions for the supinated ankle condition. The individuals also moved their whole body downwards and shifted the body weight to the non-stimulated foot. Therefore, this study suggested that a modified type of the classic flexion reflex, i.e., unloading reaction, may be used as a strategy to unload a supinated ankle and potentially minimize the risk of ankle sprain injuries.
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Affiliation(s)
- Marcio J Santos
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Sciences, 3901 Rainbow Boulevard, 3056 Robinson Hall, Mailstop 2002, Kansas City, KS 66160, USA.
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Kolb TFB, Lachauer S, Schoch B, Gerwig M, Timmann D, Kolb FP. Comparison of the electrically evoked leg withdrawal reflex in cerebellar patients and healthy controls. Exp Brain Res 2006; 177:493-508. [PMID: 17051385 DOI: 10.1007/s00221-006-0706-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 08/30/2006] [Indexed: 11/25/2022]
Abstract
The aim of this study was to analyze the contribution of the cerebellum in the performance of the lower limb withdrawal reflexes. This has been accomplished by comparing the electrically evoked responses in cerebellar patients (CBL) with those in sex- and age-matched healthy control subjects (CTRL). The stimulus was applied to the subjects' medial plantar nerve in four blocks of ten trials each with switching the stimulus from one leg to the other after each block. Responses of the main muscle groups (tibial muscle: TA; gastrocnemius muscle: GA; rectus femoris muscle: RF; biceps femoris muscle: BI) of both legs were recorded during each stimulus. The group of CBL patients consisted of both focally lesioned patients (CBLf) and patients presenting a diffuse degenerative pathology (CBLd). (1) For the withdrawal reflex in CTRL subjects, responses were observed in distal and proximal muscles of the ipsilateral side and corresponding concomitant responses on the side contralateral to the stimulation, whereas in CBL patients responses were restricted primarily to distal muscles, particularly the TA of the ipsilateral, i.e. the stimulated, side. (2) The sequence of activation of the different distal and proximal muscles ipsilateral to the stimulation, derived from latencies and times-to-peak, was for the CTRL group: TA-GA-BI-RF. This sequence was found also in the CBLf patients on their unaffected side. However, on their affected side CBLf patients showed very early GA activation, almost simultaneously with TA and RF activations and before BI activation. RF activation before BI activation was also found in CBLd. In the latter group, GA was activated after RF but before BI with all responses typically delayed. (3) The general pattern of the electrically evoked lower limb reflex consisted of an early, excitatory F1 component and a later, excitatory F2 component of larger amplitude observed in the CTRL subjects and the CBLd patients. In contrast to this pattern CBLf patients exhibited large F1 components followed by small F2 components. (4) The characteristic differences in the withdrawal reflex responses of cerebellar patients depended on the type of the lesion, providing evidence for an important involvement of the cerebellum in the control of the performance of withdrawal reflexes.
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Affiliation(s)
- T F B Kolb
- Institute of Physiology, University of Munich, Pettenkoferstr. 12, 80336 München, Germany
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Spaich EG, Hinge HH, Arendt-Nielsen L, Andersen OK. Modulation of the withdrawal reflex during hemiplegic gait: effect of stimulation site and gait phase. Clin Neurophysiol 2006; 117:2482-95. [PMID: 16949341 DOI: 10.1016/j.clinph.2006.07.139] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 07/03/2006] [Accepted: 07/17/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the sensitivity of the nociceptive withdrawal reflex to stimulation of different locations on the sole of the foot during hemiplegic gait. METHODS Reflexes were evoked by cutaneous electrical stimulation of 4 locations on the sole of the foot of 7 hemiplegic and 6 age-matched healthy persons. The stimuli were delivered at heel-contact, during foot-flat, at heel-off, and during mid-swing. Reflexes were recorded from muscles of the stimulated and the contralateral leg. Ankle, knee, and hip joints angles were recorded using goniometers. RESULTS In the hemiplegic persons, the size of tibialis anterior reflexes, and the latency of soleus reflexes were site- and phase-modulated. In both groups, the tibialis anterior reflexes were significantly smaller with stimulation to the fifth metatarsophalangeal joint and the heel compared with the first metatarsophalangeal joint and the arch of the foot. The tibialis anterior reflexes evoked at heel-off and mid-swing were larger in hemiplegic persons than in healthy persons. Reflexes in the proximal and contralateral limb muscles were not site-modulated during hemiplegic gait. The kinematic response at the ankle joint was also different in the two groups during mid-swing. CONCLUSIONS Hemiplegic and healthy middle-aged people presented different phase-modulation of the kinematic and muscle nociceptive reflex responses evoked by stimulation delivered on the sole of the foot. SIGNIFICANCE The results have potential application in programs to rehabilitate hemiplegic gait.
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Affiliation(s)
- E G Spaich
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Fredrik Bajers Vej 7-D3, DK-9220 Aalborg, Denmark.
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Nakajima T, Sakamoto M, Tazoe T, Endoh T, Komiyama T. Location specificity of plantar cutaneous reflexes involving lower limb muscles in humans. Exp Brain Res 2006; 175:514-25. [PMID: 16847613 DOI: 10.1007/s00221-006-0568-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Accepted: 05/19/2006] [Indexed: 11/26/2022]
Abstract
It is known that cutaneous reflexes in human hand muscles show strong location-specificity dependent on the digit stimulated. We hypothesized that in lower leg muscles the cutaneous reflex following tactile sensation of the plantar surface of the foot is also organized in a location-specific manner. The purpose of the present study was to test this hypothesis. Middle latency reflexes (approximately 70-110 ms, MLR) following non-noxious electrical stimulation to different locations on the plantar foot were recorded from 16 neurologically intact volunteers (15 males, 1 female). Electrical stimulation was given to the fore-medial (f-M), fore-lateral (f-L) and heel (HL) regions of the plantar surface of the right foot while the subjects performed isometric dorsiflexion (tibialis anterior, TA), plantarflexion (soleus, Sol and medial gastrocnemius, MG), eversion (peroneus longus, PL) and knee extension (vastus lateralis, VL) while sitting and standing. In the Sol and MG, an excitatory response was observed following HL stimulation, which was switched to an inhibitory response following f-M or f-L stimulation (P < 0.001). A reciprocal pattern in contrast to Sol was observed in the TA. In the PL, MLR exhibited significant excitation following both f-L and HL stimulation, which, however, was switched to an inhibitory response following f-M stimulation (P < 0.001). Moderate inhibition of the MLR was seen in the VL for all stimulated positions. Systematic stimulation along the lateral side of the plantar foot demonstrated that the reflex reversal occurred around the middle of the plantar foot in the Sol and TA. In all muscles tested, the slope of the regression line between the magnitude of the MLR and background electromyographic activity significantly decreased during standing compared with sitting except for the PL following f-L simulation. These results suggest that reflex effects from cutaneous nerves in the plantar foot onto the motoneurons innervating the lower leg muscles are organized in a highly topographic manner in humans. The organization of these reflexes may play an important role in the alteration of limb loading and/or ground contact in response to tactile sensation of the plantar foot while sitting and standing.
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Affiliation(s)
- Tsuyoshi Nakajima
- Department of movement functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki Tokorozawa, Saitama, 359-8555, Japan.
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Serrao M, Pierelli F, Don R, Ranavolo A, Cacchio A, Currà A, Sandrini G, Frascarelli M, Santilli V. Kinematic and electromyographic study of the nociceptive withdrawal reflex in the upper limbs during rest and movement. J Neurosci 2006; 26:3505-13. [PMID: 16571758 PMCID: PMC6673871 DOI: 10.1523/jneurosci.5160-05.2006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study set out to evaluate nociceptive withdrawal reflex (NWR) excitability and the corresponding mechanical response in the upper limbs during rest and movement. We used a three-dimensional motion analysis system and a surface EMG system to record, in 10 healthy subjects, the NWR in eight upper limb muscles and the corresponding mechanical response in two experimental conditions: rest and movement (reaching for, picking up, and moving a cylinder). The NWR was elicited through stimulation of the index finger with trains of pulses delivered at multiples of the pain threshold (PT). We correlated movement types (reach-to-grasp, grasp-and-lift), movement phases (acceleration, deceleration), and muscle activity types (shortening, lengthening, isometric) with the presence/absence of the NWR (reflex-muscle pattern), with NWR size values, and with the mechanical responses. At rest, when the stimulus was delivered at 4x PT, the NWR was present, in all muscles, in >90% of trials, and the mechanical response consisted of wrist adduction, elbow flexion, and shoulder anteflexion. At this stimulus intensity, during movement, the reflex-muscle pattern, reflex size, and mechanical responses were closely modulated by movement type and phase and by muscle activity type. We did not find, during movement, significant correlations with the level of EMG background activity. Our findings suggest that a complex functional adaptation of the spinal cord plays a role in modulating the NWR in the transition from rest to movement and during voluntary arm movement freely performed in three-dimensional space. Study of the upper limb NWR may provide a window onto the spinal neural control mechanisms operating during movement.
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Affiliation(s)
- Mariano Serrao
- Department of Neurology and Otolaryngology, Santa Maria Goretti Hospital, Latina, La Sapienza, University of Rome, 00185 Rome, Italy.
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Sandrini G, Serrao M, Rossi P, Romaniello A, Cruccu G, Willer JC. The lower limb flexion reflex in humans. Prog Neurobiol 2005; 77:353-95. [PMID: 16386347 DOI: 10.1016/j.pneurobio.2005.11.003] [Citation(s) in RCA: 388] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Revised: 11/08/2005] [Accepted: 11/09/2005] [Indexed: 10/25/2022]
Abstract
The flexion or flexor reflex (FR) recorded in the lower limbs in humans (LLFR) is a widely investigated neurophysiological tool. It is a polysynaptic and multisegmental spinal response that produces a withdrawal of the stimulated limb and resembles (having several features in common) the hind-paw FR in animals. The FR, in both animals and humans, is mediated by a complex circuitry modulated at spinal and supraspinal level. At rest, the LLFR (usually obtained by stimulating the sural/tibial nerve and by recording from the biceps femoris/tibial anterior muscle) appears as a double burst composed of an early, inconstantly present component, called the RII reflex, and a late, larger and stable component, called the RIII reflex. Numerous studies have shown that the afferents mediating the RII reflex are conveyed by large-diameter, low-threshold, non-nociceptive A-beta fibers, and those mediating the RIII reflex by small-diameter, high-threshold nociceptive A-delta fibers. However, several afferents, including nociceptive and non-nociceptive fibers from skin and muscles, have been found to contribute to LLFR activation. Since the threshold of the RIII reflex has been shown to correspond to the pain threshold and the size of the reflex to be related to the level of pain perception, it has been suggested that the RIII reflex might constitute a useful tool to investigate pain processing at spinal and supraspinal level, pharmacological modulation and pathological pain conditions. As stated in EFNS guidelines, the RIII reflex is the most widely used of all the nociceptive reflexes, and appears to be the most reliable in the assessment of treatment efficacy. However, the RIII reflex use in the clinical evaluation of neuropathic pain is still limited. In addition to its nocifensive function, the LLFR seems to be linked to posture and locomotion. This may be explained by the fact that its neuronal circuitry, made up of a complex pool of interneurons, is interposed in motor control and, during movements, receives both peripheral afferents (flexion reflex afferents, FRAs) and descending commands, forming a multisensorial feedback mechanism and projecting the output to motoneurons. LLFR excitability, mediated by this complex circuitry, is finely modulated in a state- and phase-dependent manner, rather as we observe in the FR in animal models. Several studies have demonstrated that LLFR excitability may be influenced by numerous physiological conditions (menstrual cycle, stress, attention, sleep and so on) and pathological states (spinal lesions, spasticity, Wallenberg's syndrome, fibromyalgia, headaches and so on). Finally, the LLFR is modulated by several drugs and neurotransmitters. In summary, study of the LLFR in humans has proved to be an interesting functional window onto the spinal and supraspinal mechanisms of pain processing and onto the spinal neural control mechanisms operating during posture and locomotion.
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Affiliation(s)
- Giorgio Sandrini
- University Center for Adaptive Disorders and Headache, IRCCS C. Mondino Institute of Neurology Foundation, University of Pavia, Via Mondino 2, 27100 Pavia, Italy.
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Layne CS, Forth KE, Abercromby AFJ. Spatial factors and muscle spindle input influence the generation of neuromuscular responses to stimulation of the human foot. ACTA ASTRONAUTICA 2005; 56:809-819. [PMID: 15835006 DOI: 10.1016/j.actaastro.2005.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Removal of the mechanical pressure gradient on the soles leads to physiological adaptations that ultimately result in neuromotor degradation during spaceflight. We propose that mechanical stimulation of the soles serves to partially restore the afference associated with bipedal loading and assists in attenuating the negative neuromotor consequences of spaceflight. A dynamic foot stimulus device was used to stimulate the soles in a variety of conditions with different stimulation locations, stimulation patterns and muscle spindle input. Surface electromyography revealed the lateral side of the sole elicited the greatest neuromuscular response in ankle musculature, followed by the medial side, then the heel. These responses were modified by preceding stimulation. Neuromuscular responses were also influenced by the level of muscle spindle input. These results provide important information that can be used to guide the development of a "passive" countermeasure that relies on sole stimulation and can supplement existing exercise protocols during spaceflight.
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Affiliation(s)
- Charles S Layne
- Laboratory of Integrated Physiology, Department of Health and Human Performance, University of Houston, TX 77024-6015, USA.
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Andersen OK, Spaich EG, Madeleine P, Arendt-Nielsen L. Gradual enlargement of human withdrawal reflex receptive fields following repetitive painful stimulation. Brain Res 2005; 1042:194-204. [PMID: 15854591 DOI: 10.1016/j.brainres.2005.02.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 02/05/2005] [Accepted: 02/12/2005] [Indexed: 11/26/2022]
Abstract
Dynamic changes in the topography of the human withdrawal reflex receptive fields (RRF) were assessed by repetitive painful stimuli in 15 healthy subjects. A train of five electrical stimuli was delivered at a frequency of 3 Hz (total train duration 1.33 s). The train was delivered in random order to 10 electrode sites on the sole of the foot. Reflexes were recorded from tibialis anterior, soleus, vastus lateralis, biceps femoris, and iliopsoas (IL). The RRF changes during the stimulus train were assessed during standing with even support on both legs and while seated. The degree of temporal summation was depending on stimulation site. At the most sensitive part of the RRF, a statistically significant increase in reflex size was seen after two stimuli while four stimuli were needed to observe reflex facilitation at less sensitive electrode sites. Hence, the region from which reflexes could be evoked using the same stimulus intensity became larger through the train, that is, the RRF was gradually expanding. Reflexes evoked by stimuli four and five were of the same size. No reflex facilitation was seen at other stimulus sites outside the RRF. In all muscles except in IL, the largest reflexes were evoked when the subjects were standing. In the ankle joint, the main withdrawal pattern consisted of plantar flexion and inversion when the subjects were standing while dorsi-flexion was prevalent in the sitting position. Up to 35 degrees of knee and hip flexion were evoked often leading to a lift of the foot from the floor during standing. In conclusion, a gradual expansion of the RRF was seen in all muscles during the stimulus train. Furthermore, the motor programme task controls the reflex sensitivity within the reflex receptive field and, hence, the sensitivity of the temporal summation mechanism.
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Affiliation(s)
- Ole K Andersen
- Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7, D3, DK-9220 Aalborg, Denmark.
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Spaich EG, Arendt-Nielsen L, Andersen OK. Modulation of lower limb withdrawal reflexes during gait: a topographical study. J Neurophysiol 2004; 91:258-66. [PMID: 12968008 DOI: 10.1152/jn.00360.2003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the modulation and topography of the nociceptive withdrawal reflex elicited by painful electrical stimulation of the foot sole during gait. Fifteen healthy volunteers participated in this study. Cutaneous electrical stimulation was delivered on five locations of the foot sole after heel-contact, during foot-flat, after heel-off, and during the mid-swing phase of the gait cycle during treadmill walking. Reflexes were recorded from muscles of the ipsilateral and contralateral legs. Furthermore, the kinematic responses in the sagittal plane of the ipsilateral ankle, knee, and hip joints were recorded. Reflexes in the distal muscles showed a site-dependent modulation. The largest responses in tibialis anterior were evoked at the arch of the foot and the smallest at the heel (P < 0.05). The largest soleus responses were also elicited at the arch of the foot (P < 0.04). The EMG responses in flexors and extensors of the knee and extensors of the contralateral leg were generally not dependent on the stimulation site. The response at the three joints showed site dependency, especially during the swing phase where maximal flexion was obtained by stimulation at the arch of the foot (P < 0.05). The withdrawal reflex was modulated during the gait cycle and presented distinctive characteristics for the different muscles studied. Minimal kinematic responses were observed during stance in contrast to swing phase. Modulation of the reflex probably ensures an appropriate withdrawal but primarily secures balance and continuity of movement.
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Affiliation(s)
- Erika G Spaich
- Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7-D3, DK-9220 Aalborg, Denmark.
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