The role of motor unit rate modulation versus recruitment in repeated submaximal voluntary contractions performed by control and spinal cord injured subjects

Motor unit activity and synaptic inputs to motoneurons in the caudal part of the injured spinal cord

Spinal cord injury (SCI) disrupts neuronal function below the lesion epicenter, causing disuse muscle atrophy. We investigated motor unit (MU) activity and synaptic inputs to motoneurons in the caudal region of the injured spinal cord. Participants with C4-C7 cervical injuries were studied. The extensor digitorum communis (EDC) muscle, which is mainly innervated by C8, was assessed for disuse muscle atrophy. Using advanced electromyography and signal-processing techniques, we examined the concurrent activation of a substantial population of MUs during force-tracking tasks. We found that in participants with SCI (n = 9), both MU discharge rates and the amplitudes of MU action potentials were significantly lower than in controls (n = 9). After SCI, MUs were recruited in a limited force range as the strength of muscle contractions increased, implying a disruption in the orderly MU recruitment pattern. Coherence analysis revealed reduced synaptic inputs to motoneurons in the delta band (0.5-5 Hz) for participants with SCI, suggesting diminished common synaptic inputs to the EDC muscle. In addition, participants with SCI exhibited greater muscle force variability. Using principal component analysis on low-frequency MU discharge rates, we found that the first common component (FCC) captured the most discharge variability in participants with SCI. The coefficients of variation (CV) of the FCC correlated with force signal CVs, suggesting force variability mainly results from common synaptic inputs to the EDC muscle after SCI. These results advance our understanding of the neurophysiology of disuse muscle atrophy in human SCI, paving the way for therapeutic interventions to restore muscle function.NEW & NOTEWORTHY This study analyzed motor unit (MU) function below the lesion epicenter in patients with spinal cord injury (SCI). We found reduced MU discharge rates and action potential amplitudes in participants with SCI compared with controls. The strength of common synaptic inputs to motoneurons was reduced in patients with SCI, with increased force variability primarily due to low-frequency oscillations of common inputs. This study enhances understanding of neurophysiological and behavioral changes in disuse muscle atrophy post-SCI.

Electromyography-Force Relation and Muscle Fiber Conduction Velocity Affected by Spinal Cord Injury

A surface electromyography (EMG) analysis was performed in this study to examine central neural and peripheral muscle changes after a spinal cord injury (SCI). A linear electrode array was used to record surface EMG signals from the biceps brachii (BB) in 15 SCI subjects and 14 matched healthy control subjects as they performed elbow flexor isometric contractions from 10% to 80% maximum voluntary contraction. Muscle fiber conduction velocity (MFCV) and BB EMG-force relation were examined. MFCV was found to be significantly slower in the SCI group than the control group, evident at all force levels. The BB EMG-force relation was well fit by quadratic functions in both groups. All healthy control EMG-force relations were best fit with positive quadratic coefficients. In contrast, the EMG-force relation in eight SCI subjects was best fit with negative quadratic coefficients, suggesting impaired EMG modulation at high forces. The alterations in MFCV and EMG-force relation after SCI suggest complex neuromuscular changes after SCI, including alterations in central neural drive and muscle properties.

Functional muscle group- and sex-specific parameters for a three-compartment controller muscle fatigue model applied to isometric contractions

The three-compartment controller with enhanced recovery (3CC-r) model of muscle fatigue has previously been validated separately for both sustained (SIC) and intermittent isometric contractions (IIC) using different objective functions, but its performance has not yet been tested against both contraction types simultaneously using a common objective function. Additionally, prior validation has been performed using common parameters at the joint level, whereas applications to many real-world tasks will require the model to be applied to agonistic and synergistic muscle groups. Lastly, parameters for the model have previously been derived for a mixed-sex cohort not considering the differece in fatigabilities between the sexes. In this work we validate the 3CC-r model using a comprehensive isometric contraction database drawn from 172 publications segregated by functional muscle group (FMG) and sex. We find that prediction errors are reduced by 19% on average when segregating the dataset by FMG alone, and by 34% when segregating by both sex and FMG. However, minimum prediction errors are found to be higher when validated against both SIC and IIC data together using torque decline as the outcome variable than when validated sequentially against hypothesized SIC intensity-endurance time curves with endurance time as the outcome variable and against raw IIC data with torque decline as the outcome variable.

Modification of a three-compartment muscle fatigue model to predict peak torque decline during intermittent tasks

This study aimed to test whether adding a rest recovery parameter, r, to the analytical three-compartment controller (3CC) fatigue model (Xia and Frey Law, 2008) will improve fatigue estimates during intermittent contractions. The 3CC muscle fatigue model uses differential equations to predict the flow of muscle between three muscle states: Resting (MR), Active (MA), and Fatigued (MF). This model uses a feedback controller to match the active state to target loads and two joint-specific parameters: F, fatigue rate controlling flow from active to fatigued compartments) and R, the recovery rate controlling flow from the fatigued to the resting compartments. This model does well to predict intensity-endurance time curves for sustained isometric tasks. However, previous studies find when rest intervals are present that the model over predicts fatigue. Intermittent rest periods would allow for the occurrence of subsequent reactive vasodilation and post-contraction hyperemia. We hypothesize a modified 3CC-r fatigue model will improve predictions of force decay during intermittent contractions with the addition of a rest recovery parameter, r, to augment recovery during rest intervals, representing muscle re-perfusion. A meta-analysis compiling intermittent fatigue data from 63 publications reporting decline in peak torque (% torque decline) were used for comparison. The original model over-predicted fatigue development from 19 to 29% torque decline; the addition of a rest multiplier significantly improved fatigue estimates to 6-10% torque decline. We conclude the addition of a rest multiplier to the three-compartment controller fatigue model provides a physiologically consistent modification for tasks involving rest intervals, resulting in improved estimates of muscle fatigue.

Rate modulation of human anconeus motor units during high-intensity dynamic elbow extensions

Investigations of high-intensity isometric fatiguing protocols report decreases in motor unit firing rates (MUFRs), but little is known regarding changes in MUFRs following fatigue induced by high-intensity dynamic contractions. Our purpose was to evaluate MUFRs of the anconeus (an accessory elbow extensor) and elbow extension power production as a function of time to task failure (TTF) during high-velocity fatiguing concentric contractions against a moderately heavy resistance. Fine-wire intramuscular electrode pairs were inserted into the anconeus to record MUs in 12 male participants (25 ± 3 yr), over repeated sessions on separate days. MUs were tracked throughout a three-stage, varying load dynamic elbow extension protocol designed to extend the task duration for >1 min thereby inducing substantial fatigue. Mean MUFRs and peak power were calculated for three relative time ranges: 0-15% TTF (beginning), 45-60% TTF (middle) and 85-100% TTF (end). Mean duration of the overall fatigue protocol was ∼80 s. Following the protocol, isometric maximum voluntary contraction (MVC), highest velocity at 35% MVC load, and peak power decreased 37, 60, and 64% compared with baseline, respectively. Data from 20 anconeus MUs tracked successfully throughout the protocol indicated a reduction in MUFRs in relation to power loss from 36 Hz/160 W (0-15% TTF) to 28 Hz/97 W (45-60% TTF) to 23 Hz/43 W (85-100% TTF). During these high-intensity maximal effort concentric contractions, anconeus MUFRs decreased substantially (>35%). Although the absolute MUFRs were higher in the present study than those reported previously for other muscles during sustained high-intensity isometric tasks, the relative decrease in MUFRs was similar between the two tasks.

Reduced voluntary drive during sustained but not during brief maximal voluntary contractions in the first dorsal interosseous weakened by spinal cord injury

In able-bodied (AB) individuals, voluntary muscle activation progressively declines during sustained contractions. However, few data are available on voluntary muscle activation during sustained contractions in muscles weakened by spinal cord injury (SCI), where greater force declines may limit task performance. SCI-related impairment of muscle activation complicates interpretation of the interpolated twitch technique commonly used to assess muscle activation. We attempted to estimate and correct for the SCI-related-superimposed twitch. Seventeen participants, both AB and with SCI (American Spinal Injury Association Impairment Scale C/D) produced brief and sustained (2-min) maximal voluntary contractions (MVCs) with the first dorsal interosseous. Force and electromyography were recorded together with superimposed (doublet) twitches. MVCs of participants with SCI were weaker than those of AB participants (20.3 N, SD 7.1 vs. 37.9 N, SD 9.5; P < 0.001); MVC-superimposed twitches were larger in participants with SCI (SCI median 10.1%, range 2.0-63.2%; AB median 4.7%, range 0.0-18.4% rest twitch; P = 0.007). No difference was found after correction for the SCI-related-superimposed twitch (median 6.7%, 0.0-17.5% rest twitch, P = 0.402). Thus during brief contractions, the maximal corticofugal output that participants with SCI could exert was similar to that of AB participants. During the sustained contraction, force decline (SCI, 58.0%, SD 15.1; AB, 57.2% SD 13.3) was similar (P = 0.887) because participants with SCI developed less peripheral (P = 0.048) but more central fatigue than AB participants. The largest change occurred at the start of the sustained contraction when the (corrected) superimposed twitches increased more in participants with SCI (SCI, 16.3% rest twitch, SD 20.8; AB, 2.7%, SD 4.7; P = 0.01). The greater reduction in muscle activation after SCI may relate to a reduced capacity to overcome fast fatigue-related excitability changes at the spinal level.

A novel functional electrical stimulation-control system for restoring motor function of post-stroke hemiplegic patients

Hemiparesis is one of the most common consequences of stroke. Advanced rehabilitation techniques are essential for restoring motor function in hemiplegic patients. Functional electrical stimulation applied to the affected limb based on myoelectric signal from the unaffected limb is a promising therapy for hemiplegia. In this study, we developed a prototype system for evaluating this novel functional electrical stimulation-control strategy. Based on surface electromyography and a vector machine model, a self-administered, multi-movement, force-modulation functional electrical stimulation-prototype system for hemiplegia was implemented. This paper discusses the hardware design, the algorithm of the system, and key points of the self-oscillation-prone system. The experimental results demonstrate the feasibility of the prototype system for further clinical trials, which is being conducted to evaluate the efficacy of the proposed rehabilitation technique.

Anomalous EMG-force relations during low-force isometric tasks in hemiparetic stroke survivors

Hemispheric brain injury resulting from a stroke is often accompanied by muscle weakness in contralateral limbs. In neurologically intact subjects, appropriate motoneuronal recruitment and rate modulation are utilized to optimize muscle force production. In the present study, we sought to determine whether weakness in an affected hand muscle in stroke survivors is partially attributable to alterations in the control of muscle activation. Specifically, our goal was to characterize whether the surface EMG amplitude was systematically larger as a function of (low) force in paretic hand muscles as compared to contralateral muscles in the same subject. We tested a multifunctional muscle, the first dorsal interosseous (FDI), in multiple directions about the second metacarpophalangeal joint in ten hemiparetic and six neurologically intact subjects. In six of the ten stroke subjects, the EMG-force slope was significantly greater on the affected side as compared to the contralateral side, as well as compared to neurologically intact subjects. An unexpected set of results was a nonlinear relation between recorded EMG and generated force commonly observed in the paretic FDI, even at very low-force levels. We discuss possible experimental as well as physiological factors that may contribute to an increased EMG-force slope, concluding that changes in motor unit (MU) control are the most likely reasons for the observed changes.

Synchronization of low- and high-threshold motor units

INTRODUCTION

We examined the degree of synchronization for both low- and high-threshold motor unit (MU) pairs at high force levels.

METHODS

MU spike trains were recorded from the quadriceps during high-force isometric leg extensions. Short-term synchronization (between -6 and 6 ms) was calculated for every unique MU pair for each contraction.

RESULTS

At high force levels, earlier recruited motor unit pairs (low-threshold) demonstrated relatively low levels of short-term synchronization (approximately 7.3% extra firings than would have been expected by chance). However, the magnitude of synchronization increased significantly and linearly with mean recruitment threshold (reaching 22.1% extra firings for motor unit pairs recruited above 70% MVC).

CONCLUSIONS

Three potential mechanisms that could explain the observed differences in synchronization across motor unit types are proposed and discussed.

Human spinal cord injury: motor unit properties and behaviour

Spinal cord injury (SCI) results in widespread variation in muscle function. Review of motor unit data shows that changes in the amount and balance of excitatory and inhibitory inputs after SCI alter management of motoneurons. Not only are units recruited up to higher than usual relative forces when SCI leaves few units under voluntary control, the force contribution from recruitment increases due to elevation of twitch/tetanic force ratios. Force gradation and precision are also coarser with reduced unit numbers. Maximal unit firing rates are low in hand muscles, limiting voluntary strength, but are low, normal or high in limb muscles. Unit firing rates during spasms can exceed voluntary rates, emphasizing that deficits in descending drive limit force production. SCI also changes muscle properties. Motor unit weakness and fatigability seem universal across muscles and species, increasing the muscle weakness that arises from paralysis of units, motoneuron death and sensory impairment. Motor axon conduction velocity decreases after human SCI. Muscle contractile speed is also reduced, which lowers the stimulation frequencies needed to grade force when paralysed muscles are activated with patterned electrical stimulation. This slowing does not necessarily occur in hind limb muscles after cord transection in cats and rats. The nature, duration and level of SCI underlie some of these species differences, as do variations in muscle function, daily usage, tract control and fibre-type composition. Exploring this diversity is important to promote recovery of the hand, bowel, bladder and locomotor function most wanted by people with SCI.

Motor unit

Movement is accomplished by the controlled activation of motor unit populations. Our understanding of motor unit physiology has been derived from experimental work on the properties of single motor units and from computational studies that have integrated the experimental observations into the function of motor unit populations. The article provides brief descriptions of motor unit anatomy and muscle unit properties, with more substantial reviews of motoneuron properties, motor unit recruitment and rate modulation when humans perform voluntary contractions, and the function of an entire motor unit pool. The article emphasizes the advances in knowledge on the cellular and molecular mechanisms underlying the neuromodulation of motoneuron activity and attempts to explain the discharge characteristics of human motor units in terms of these principles. A major finding from this work has been the critical role of descending pathways from the brainstem in modulating the properties and activity of spinal motoneurons. Progress has been substantial, but significant gaps in knowledge remain.

Motor unit properties from three synergistic muscles during ramp isometric elbow extensions

Many tasks require synergistic activation of muscles that possess different architectural, mechanical, and neural control properties. However, investigations of the motor unit (MU) mechanisms which modulate force are mostly restricted to individual muscles and low forces. To explore the pattern of MU recruitment and discharge behavior among three elbow extensors (lateral and long heads of the triceps brachii, and anconeus) during ramp isometric contractions, recruitment thresholds of 77 MUs in five young men were determined and corresponding MU discharge rates were tracked in 1-s epochs over forces ranging from 0 to 75 % of maximal voluntary isometric force (MVC). Across all forces, MUs in the lateral head discharged at higher rates than those in the anconeus (p < 0.001, Δ = 0.23). When all MUs were considered, recruitment thresholds in the long head of the triceps brachii were higher than the lateral head (p < 0.05, Δ = 0.70) with a trend (p = 0.08, Δ = 0.48) for higher recruitment thresholds in the long head compared with the anconeus. Together, these data indicate a potential mechanical disadvantage of the long head of the triceps brachii at 0° shoulder flexion. However, among low-threshold MUs (<10 % MVC), recruitment thresholds were lower in the anconeus than in both heads of the triceps brachii consistent with the expected twitch contractile and fiber type differences among these muscles. These findings illustrate the importance of considering synergistic relations among muscles used for a coordinated task, and the sensitivity of synergies to muscle architectural, mechanical, and possibly specific synaptic input factors.

Divergent modulation of clinical measures of volitional and reflexive motor behaviors following serotonergic medications in human incomplete spinal cord injury

Incomplete spinal cord injury (SCI) can result in profound impairments in volitional strength and reflex excitability, which contribute to loss of function. Human and animal models suggest that disruption of endogenous monoaminergic input, particularly serotonin (5-HT), from supraspinal centers contributes to this impaired motor function following SCI. In the present study, we investigated the effects of 5-HT medications on motor function in individuals with chronic (>1 year) SCI. Clinical measures of strength, spasticity/spasms, and walking ability were assessed in 12 individuals with chronic incomplete SCI following acute administration of either 8 mg cyproheptadine, a 5-HT antagonist, or 10 mg escitalopram, a selective 5-HT reuptake inhibitor (SSRI), in a double-blinded, randomized, crossover fashion. Results indicated that 5-HT medications modulated both volitional and reflexive behaviors with little change in walking performance; 5-HT antagonist medications depressed clinical measures of strength and spasticity/spasms, whereas SSRIs augmented both strength and spasticity/spasms. These changes are consistent with the dysregulation of 5-HT sensitive spinal neurons following SCI. This understanding may augment clinicians' awareness of the motor consequences of 5-HT medications.

Neural control of muscle force: indications from a simulation model

We developed a model to investigate the influence of the muscle force twitch on the simulated firing behavior of motoneurons and muscle force production during voluntary isometric contractions. The input consists of an excitatory signal common to all the motor units in the pool of a muscle, consistent with the "common drive" property. Motor units respond with a hierarchically structured firing behavior wherein at any time and force, firing rates are inversely proportional to recruitment threshold, as described by the "onion skin" property. Time- and force-dependent changes in muscle force production are introduced by varying the motor unit force twitches as a function of time or by varying the number of active motor units. A force feedback adjusts the input excitation, maintaining the simulated force at a target level. The simulations replicate motor unit behavior characteristics similar to those reported in previous empirical studies of sustained contractions: 1) the initial decrease and subsequent increase of firing rates, 2) the derecruitment and recruitment of motor units throughout sustained contractions, and 3) the continual increase in the force fluctuation caused by the progressive recruitment of larger motor units. The model cautions the use of motor unit behavior at recruitment and derecruitment without consideration of changes in the muscle force generation capacity. It describes an alternative mechanism for the reserve capacity of motor units to generate extraordinary force. It supports the hypothesis that the control of motoneurons remains invariant during force-varying and sustained isometric contractions.

Reduced motor unit discharge rates of maximal velocity dynamic contractions in response to a submaximal dynamic fatigue protocol

Fatigability is highly task dependent wherein motor unit (MU) discharge rates and recruitment thresholds are affected differently depending on whether contractions are performed at maximal or submaximal intensities. Although much is described for isometric tasks, the behavior of MU properties during the production of maximal velocity dynamic contractions following submaximal fatiguing contractions is unknown. In seven young men, we evaluated changes in MU recruitment thresholds and MU discharge rates of the anconeus muscle during both submaximal and maximal dynamic elbow extensions following a submaximal dynamic fatiguing protocol of moderate intensity to velocity task failure. Velocity and power of the maximal dynamic contractions declined ∼45 and ∼55%, respectively, but these variables were unchanged for the submaximal target velocity contractions. Discharge rates of the 12 MUs at task failure were unchanged for submaximal dynamic contractions, but were decreased ∼20% for maximal dynamic and ballistic isometric contractions at task failure. MU recruitment thresholds of submaximal dynamic contractions decreased 52% at task failure, but were similar throughout the fatiguing protocol for maximal contractions. These findings support the concept of a common neural mechanism responsible for the relative declines in MU discharge rate associated with submaximal fatigability in both isometric and dynamic contractions.

Influence of proprioceptive feedback on the firing rate and recruitment of motoneurons

We investigated the relationships of the firing rate and maximal recruitment threshold of motoneurons recorded during isometric contraction with the number of spindles in individual muscles. At force levels above 10% of maximal voluntary contraction, the firing rate was inversely related to the number of spindles in a muscle, with the slope of the relationship increasing with force. The maximal recruitment threshold of motor units increased linearly with the number of spindles in the muscle. Thus, muscles with a greater number of spindles had lower firing rates and a greater maximal recruitment threshold. These findings may be explained by a mechanical interaction between muscle fibres and adjacent spindles. During low-level (0% to 10%) voluntary contractions, muscle fibres of recruited motor units produce force twitches that activate nearby spindles to respond with an immediate excitatory feedback that reaches maximal level. As the force increases further, the twitches overlap and tend towards tetanization, the muscle fibres shorten, the spindles slacken, their excitatory firings decrease, and the net excitation to the homonymous motoneurons decreases. Motoneurons of muscles with greater number of spindles receive a greater decrease in excitation which reduces their firing rates, increases their maximal recruitment threshold, and changes the motoneuron recruitment distribution.

Central excitability contributes to supramaximal volitional contractions in human incomplete spinal cord injury

Despite greater muscle fatigue in individuals with spinal cord injury (SCI) when compared to neurologically intact subjects using neuromuscular electrical stimulation (NMES)protocols, few studies have investigated the extent of volitional fatigue in motor incomplete SCI. Using an established protocol of 20 repeated, intermittent, maximal volitional effort (MVE) contractions, we previously demonstrated that subjects with incomplete SCI unexpectedly demonstrated a 15% increase in peak knee extensor torques within the first five MVEs with minimal evidence of fatigue after 20 contraction. In the present study, we investigated potential segmental mechanisms underlying this supramaximal torque generation. Changes in twitch properties and maximum compound muscle action potentials (M-waves) were assessed prior to and following one, three and five MVEs, revealing a significant 17% increase only in maximum twitch torques after a single MVE. Despite this post-activation potentiation of the muscle, use of conventional NMES protocols to elicit repeated muscular contractions resulted in a significant decrease in evoked torque generation, suggesting limited the muscular contributions to the observed phenomenon. To evaluate potential central mechanisms underlying the augmented torques, non-linear responses to wide-pulse width (1 ms), low-intensity, variable-frequency (25–100 Hz) NMES were also tested prior to and following repeated MVEs.When variable-frequency NMES was applied following the repeated MVEs, augmented and prolonged torques were observed and accompanied by sustained quadriceps electromyographic activity often lasting > 2s after stimulus termination. Such data suggest a potential contribution of elevated spinal excitability to the reserve in volitional force generation in incomplete SCI.

Repeated maximal volitional effort contractions in human spinal cord injury: initial torque increases and reduced fatigue

BACKGROUND

Substantial data indicate greater muscle fatigue in individuals with spinal cord injury (SCI) compared with healthy control subjects when tested by using electrical stimulation protocols. Few studies have investigated the extent of volitional fatigue in motor incomplete SCI.

METHODS

Repeated, maximal volitional effort (MVE) isometric contractions of the knee extensors (KE) were performed in 14 subjects with a motor incomplete SCI and in 10 intact subjects. Subjects performed 20 repeated, intermittent MVEs (5 seconds contraction/5 seconds rest) with KE torques and thigh electromyographic (EMG) activity recorded.

RESULTS

Peak KE torques declined to 64% of baseline MVEs with repeated efforts in control subjects. Conversely, subjects with SCI increased peak torques during the first 5 contractions by 15%, with little evidence of fatigue after 20 repeated efforts. Increases in peak KE torques and the rate of torque increase during the first 5 contractions were attributed primarily to increases in quadriceps EMG activity, but not to decreased knee flexor co-activation. The observed initial increases in peak torque were dependent on the subject's volitional activation and were consistent on the same or different days, indicating little contribution of learning or accommodation to the testing conditions. Sustained MVEs did not elicit substantial increases in peak KE torques as compared to repeated intermittent efforts.

CONCLUSIONS

These data revealed a marked divergence from expected results of increased fatigability in subjects with SCI, and may be a result of complex interactions between mechanisms underlying spastic motor activity and changes in intrinsic motoneuron properties.

Abnormal EMG-force slope estimates in the first dorsal interosseous of hemiparetic stroke survivors

Hemispheric brain injury resulting from a stroke is often accompanied by weakness in contralateral limbs. Appropriate motoneuronal recruitment and rate modulation is necessary to optimize muscle force production utilizing residual neuromuscular elements. We sought to determine whether weakness in a hand muscle in stroke survivors is partially attributable to alterations in the control of the motor units in the affected muscles. Specifically, our goal was to characterize whether surface EMG amplitude, a gauge of neural input, was systematically larger as a function of force, in paretic muscles when compared to the contralateral muscles in the same subject, and to neurologically intact subjects. We tested the first dorsal interosseous (FDI) in five hemiparetic and six neurologically intact subjects. In four of the stroke subjects the EMG-force slope was significantly greater on the affected side as compared to the contralateral side as well as compared to neurologically intact subjects. We discuss possible experimental as well as physiological factors that may contribute to an increased slope, concluding that a combination of abnormal firing rate patterns and changes in MU control are the most likely reasons for the observed changes.

Ankle paresis in incomplete spinal cord injury: relation to corticospinal conductivity and ambulatory capacity

There is limited data on the relation of corticospinal tract conductivity to clinical measures in incomplete spinal cord injury. This study examined the relationship of muscle strength to corticospinal tract input assessed by motor evoked potentials (MEPs) during static and dynamic conditions and to gait. Dorsiflexor strength was established by manual muscle test, maximal voluntary contraction, and maximal movement velocity, the latter being acquired during auditory-paced ankle movements. MEPs were elicited during isometric contractions with constant or continuously increasing ankle joint torque. Gait was assessed by quantifying its speed and independence. Linear regression analyses showed that maximal movement velocity was related to the MEP latencies and amplitudes in the dynamic condition (R(2)(adj.) = 0.62) and to the MEP latencies in the static condition (R(2)(adj.) = 0.45). Maximal voluntary contraction was only related to the MEP latencies in the static (R(2)(adj.) = 0.45) and the dynamic condition (R(2)(adj.) = 0.21), whereas manual muscle test did not show any relationship to the MEPs. In incomplete spinal cord injury patients, the dynamic measure maximal movement velocity might be a useful clinical assessment of corticospinal tract function. Clinical studies on recovery and repair of corticospinal tract function in spinal lesions could substantially benefit from implementing dynamic measures in the clinical assessment protocol.

The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury

OBJECTIVE

To compare the effectiveness of progressively increasing stimulation intensity, progressively increasing frequency, or progressively increasing both frequency and intensity on paralyzed quadriceps femoris muscle force maintenance during repetitive activation.

DESIGN

Factorial design with different stimulation protocols as independent variables.

SETTING

A muscle performance laboratory.

PARTICIPANTS

People (N=8) with spinal cord injury (SCI) (age, 14.63+/-1.77y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Number of contractions when the peak force was 90% or more of a subject's maximal twitch force.

RESULTS

The protocol involving progressively increasing stimulation intensity and then frequency generated more successful contractions (189.88+/-53.33) than progressively increasing the frequency followed by intensity (122.75+/-26.56 contractions). Regardless of the order, progressively increasing both intensity and frequency generated more successful contractions than progressively increasing intensity (97 contractions) or frequency (62 contractions) alone.

CONCLUSIONS

Our findings suggest that during repetitive electric activation, progressively increasing both stimulation frequency and intensity can produce more successful contractions than progressively increasing only frequency or intensity. These findings can help researchers and clinicians design more effective stimulation protocols for persons with SCI during functional electric stimulation applications.

A comparison of central aspects of fatigue in submaximal and maximal voluntary contractions

Magnetic and electrical stimulation at different levels of the neuraxis show that supraspinal and spinal factors limit force production in maximal isometric efforts ("central fatigue"). In sustained maximal contractions, motoneurons become less responsive to synaptic input and descending drive becomes suboptimal. Exercise-induced activity in group III and IV muscle afferents acts supraspinally to limit motor cortical output but does not alter motor cortical responses to transcranial magnetic stimulation. "Central" and "peripheral" fatigue develop more slowly during submaximal exercise. In sustained submaximal contractions, central fatigue occurs in brief maximal efforts even with a weak ongoing contraction (<15% maximum). The presence of central fatigue when much of the available motor pathway is not engaged suggests that afferent inputs contribute to reduce voluntary activation. Small-diameter muscle afferents are likely to be activated by local activity even in sustained weak contractions. During such contractions, it is difficult to measure central fatigue, which is best demonstrated in maximal efforts. To show central fatigue in submaximal contractions, changes in motor unit firing and force output need to be characterized simultaneously. Increasing central drive recruits new motor units, but the way this occurs is likely to depend on properties of the motoneurons and the inputs they receive in the task. It is unclear whether such factors impair force production for a set level of descending drive and thus represent central fatigue. The best indication that central fatigue is important during submaximal tasks is the disproportionate increase in subjects' perceived effort when maintaining a low target force.

Effect of random interpulse interval modulation on neuromuscular fatigue

Neuromuscular endurance during electrical stimulation may be enhanced if naturally occurring motor unit firing patterns are used. Variability in the interpulse interval (IPI) distribution may enable brief periods of rest and optimization of force output. Nine individuals participated in three 3-minute fatigue protocols of the thenar muscles elicited by supramaximal stimulation of the median nerve. All protocols consisted of a mean IPI of 33.3 ms and differed only in the type of IPI modulation, which was constant (0%), random (+/-20%), or ramped from 0% to +/-20%. M-wave amplitude declined following all protocols and the reduction was smallest following the ramp protocol. There was no significant difference among the starting or final forces or between the overall force-time integrals for the three protocols. Thus, IPI variability did not improve endurance time during electrical stimulation and the M-wave amplitude was not a reliable indicator of muscle force output.

Does motoneuron adaptation contribute to muscle fatigue?

To help reduce the gap between the cellular physiology of motoneurons (MNs) as studied "bottom-up" in animal preparations and the "top-down" study of the firing patterns of human motor units (MUs), this article addresses the question of whether motoneuron adaptation contributes to muscle fatigue. Findings are reviewed on the intracellularly recorded electrophysiology of spinal MNs as studied in vivo and in vitro using animal preparations, and the extracellularly recorded discharge of MUs as studied in conscious humans. The latter "top-down" approach, combined with kinetic measurements, has provided most of what is currently known about the neurobiology of muscle fatigue, including its task and context dependencies. It is argued that although the question addressed is still open, it should now be possible to design new "bottom-up" research paradigms using animal preparations that take advantage of what has been learned with the use of relatively noninvasive quantitative procedures in conscious humans.

Predictive model of muscle fatigue after spinal cord injury in humans

The fatigability of paralyzed muscle limits its ability to deliver physiological loads to paralyzed extremities during repetitive electrical stimulation. The purposes of this study were to determine the reliability of measuring paralyzed muscle fatigue and to develop a model to predict the temporal changes in muscle fatigue that occur after spinal cord injury (SCI). Thirty-four subjects underwent soleus fatigue testing with a modified Burke electrical stimulation fatigue protocol. The between-day reliability of this protocol was high (intraclass correlation, 0.96). We fit the fatigue index (FI) data to a quadratic-linear segmental polynomial model. FI declined rapidly (0.3854 per year) for the first 1.7 years, and more slowly (0.01 per year) thereafter. The rapid decline of FI immediately after SCI implies that a "window of opportunity" exists for the clinician if the goal is to prevent these changes. Understanding the timing of change in muscle endurance properties (and, therefore, load-generating capacity) after SCI may assist clinicians when developing therapeutic interventions to maintain musculoskeletal integrity.

A metabolic basis for impaired muscle force production and neuromuscular compensation during sprint cycling

For both different individuals and modes of locomotion, the external forces determining all-out sprinting performances fall predictably with effort duration from the burst maximums attained for 3 s to those that can be supported aerobically as trial durations extend to roughly 300 s. The common time course of this relationship suggests a metabolic basis for the decrements in the force applied to the environment. However, the mechanical and neuromuscular responses to impaired force production (i.e., muscle fatigue) are generally considered in relation to fractions of the maximum force available, or the maximum voluntary contraction (MVC). We hypothesized that these duration-dependent decrements in external force application result from a reliance on anaerobic metabolism for force production rather than the absolute force produced. We tested this idea by examining neuromuscular activity during two modes of sprint cycling with similar external force requirements but differing aerobic and anaerobic contributions to force production: one- and two-legged cycling. In agreement with previous studies, we found greater peak per leg aerobic metabolic rates [59% (+/-6 SD)] and pedal forces at VO2 peak [30% (+/-9)] during one- vs. two-legged cycling. We also determined downstroke pedal forces and neuromuscular activity by surface electromyography during 15 to 19 all-out constant load sprints lasting from 12 to 400 s for both modes of cycling. In support of our hypothesis, we found that the greater reliance on anaerobic metabolism for force production induced compensatory muscle recruitment at lower pedal forces during two- vs. one-legged sprint cycling. We conclude that impaired muscle force production and compensatory neuromuscular activity during sprinting are triggered by a reliance on anaerobic metabolism for force production.

Feedback-controlled stimulation enhances human paralyzed muscle performance

Chronically paralyzed muscle requires extensive training before it can deliver a therapeutic dose of repetitive stress to the musculoskeletal system. Neuromuscular electrical stimulation, under feedback control, may subvert the effects of fatigue, yielding more rapid and extensive adaptations to training. The purposes of this investigation were to 1) compare the effectiveness of torque feedback-controlled (FDBCK) electrical stimulation with classic open-loop constant-frequency (CONST) stimulation, and 2) ascertain which of three stimulation strategies best maintains soleus torque during repetitive stimulation. When torque declined by 10%, the FDBCK protocol modulated the base stimulation frequency in three ways: by a fixed increase, by a paired pulse (doublet) at the beginning of the stimulation train, and by a fixed decrease. The stimulation strategy that most effectively restored torque continued for successive contractions. This process repeated each time torque declined by 10%. In fresh muscle, FDBCK stimulation offered minimal advantage in maintaining peak torque or mean torque over CONST stimulation. As long-duration fatigue developed in subsequent bouts, FDBCK stimulation became most effective ( approximately 40% higher final normalized torque than CONST). The high-frequency strategy was selected approximately 90% of the time, supporting that excitation-contraction coupling compromise and not neuromuscular transmission failure contributed to fatigue of paralyzed muscle. Ideal stimulation strategies may vary according to the site of fatigue; this stimulation approach offered the advantage of online modulation of stimulation strategies in response to fatigue conditions. Based on stress-adaptation principles, FDBCK-controlled stimulation may enhance training effects in chronically paralyzed muscle.

Fatigue of muscles weakened by death of motoneurons

Weakness is a characteristic of muscles influenced by the postpolio syndrome (PPS), amyotrophic lateral sclerosis (ALS), and spinal cord injury (SCI). The strength deficits relate to changes in muscle use and to the chronic denervation that can follow the spinal motoneuron death common to these disorders. PPS, ALS, and SCI also involve variable amounts of supraspinal neuron death, the effects of which on muscle weakness remains unclear. Nevertheless, weakness of muscle itself defines the functional consequences of these disorders. A weaker muscle requires an individual to work that muscle at higher than usual intensities relative to its maximal capacity, inducing progressive fatigue and an increased sense of effort. Little evidence is available to suggest that the fatigue commonly experienced by individuals with these disorders relates to an increase in the intrinsic fatigability of the muscle fibers. The only exception is when SCI induces chronic muscle paralysis. To reduce long-term functional deficits in these disorders, studies must identify the signaling pathways that influence neuron survival and determine the factors that encourage and limit sprouting of motor axons. This may ensure that a greater proportion of the fibers in each muscle remain innervated and available for use.

EMG Changes in Human Thenar Motor Units With Force Potentiation and Fatigue

Few studies have analyzed activity-induced changes in EMG activity in individual human motor units. We studied the changes in human thenar motor unit EMG that accompany the potentiation of twitch force and fatigue of tetanic force. Single motor unit EMG and force were recorded in healthy subjects in response to selective stimulation of their motor axons within the median nerve just above the elbow. Twitches were recorded before and after a series of pulse trains delivered at frequencies that varied between 5 and 100 Hz. This stimulation induced significant increases in EMG amplitude, duration, and area. However, in relative terms, all of these EMG changes were substantially smaller than the potentiation of twitch force. Another 2 min of stimulation (13 pulses at 40 Hz each second) induced additional potentiation of EMG amplitude, duration, and area, but the tetanic force from every unit declined. Thus activity-induced changes in human thenar motor unit EMG do not indicate the alterations in force or vice versa. These data suggest that different processes underlie the changes in EMG and force that occur during human thenar motor unit activity.

Central fatigue in continuous and intermittent contractions of triceps brachii

Conflicting results have been found across studies concerning the effect of rest periods on the development of central fatigue during prolonged muscle activity. Thus, the aim of the present study was to assess differences in the development of central fatigue between continuous and intermittent elbow extension fatigue tasks in the same subjects. Force and electromyographic data were collected on eight healthy volunteers. The ability to maximally activate the triceps brachii muscle was assessed by delivering trains of electrical stimulation during maximal voluntary efforts. This was done before, during, and after three fatigue tasks involving a maximal contraction in elbow extension. One short-duration ( approximately 55-s) and two long-duration (3-min) fatigue tasks were performed by all subjects on separate sessions. One 3-min task was intermittent (5-s rests every 30 s) and the other was continuous. The main findings were that the development and extent of central fatigue were task-dependent, with a greater decrease in the ability to maximally activate triceps brachii observed for the 3-min continuous task. Also, the voluntary activation (VA) ratio was found to be a more sensitive index of central fatigue than the central activation ratio (CAR). These results suggest that, when assessing central fatigue in patients, conclusions may vary depending on the continuous/intermittent nature of the task performed and the estimate of voluntary activation used.

Firing rates of motor units during strong dynamic contractions

Muscle behavior is usually studied during isometric contractions but many tasks include contractions that involve changes in muscle length. Our aim was to record motor unit action potentials and surface electromyograms (EMGs) from triceps brachii muscles during rhythmic dynamic contractions (3-s concentric, 3-s eccentric; 40 degrees/s; four subjects) performed at the highest voluntary forces subjects could exert (maximal concentric contraction) and at various submaximal intensities. Mean unit firing rates and surface EMG increased significantly with contraction intensity in both concentric and eccentric contractions, but at each intensity mean concentric values were significantly higher than eccentric values. In contrast, mean unit firing rates and surface EMGs were similar during maximal concentric and maximal isometric contractions. These data suggest muscles were activated maximally during the strongest concentric contractions but submaximally during the strongest eccentric efforts. After estimated eccentric contraction intensity was adjusted using surface EMG data, mean unit firing rates during eccentric contractions were still lower than the concentric values. Thus, protective mechanisms may limit motor unit firing rates during forceful lengthening contractions to minimize damage.

Caffeine increases time to fatigue by maintaining force and not by altering firing rates during submaximal isometric contractions

Caffeine increases time to fatigue [limit of endurance (Tlim)] during submaximal isometric contractions without altering whole muscle activation or neuromuscular junction transmission. We used 10 male volunteers in a randomized, double-blind, repeated-measures experiment to examine single motor unit firing rates during intermittent submaximal contractions and to determine whether administering caffeine increased Tlim by maintaining higher firing rates. On 2 separate days, subjects performed intermittent 50% maximal voluntary contractions of the quadriceps to Tlim, 1 h after ingesting a caffeine (6 mg/kg) or placebo capsule. Average motor unit firing rates recorded with tungsten microelectrodes were constant for the duration of contractions. Caffeine increased average Tlim by 20.5 ± 8.1% ( P < 0.05) compared with placebo conditions. This increase was due to seven subjects, termed responders, who increased Tlim significantly. Two other subjects showed no response, and a third had a shorter Tlim. Neither the increased Tlim nor the responders' performance could be explained by alterations in firing rates or other neuromuscular variables. However, the amplitude of the evoked twitch and its maximal instantaneous rate of relaxation did not decline to the same degree in the caffeine trial of the responders; this resulted in values 20 and 30% higher at the time point matching the end of the placebo trial ( P < 0.05). The amplitude of the evoked twitch and the maximal instantaneous rate of relaxation were linearly correlated (caffeine r = 0.72, placebo r = 0.80, both P < 0.001), suggesting that the increase in Tlim may be partially explained by caffeine's effects on calcium reuptake and twitch force.

Novel muscle patterns for reaching after cervical spinal cord injury: a case for motor redundancy

A fundamental issue in the neuromotor control of arm movements is whether the nervous system can use distinctly different muscle activity patterns to obtain similar kinematic outcomes. Although computer simulations have demonstrated several possible mechanical and torque solutions, there is little empirical evidence that the nervous system actually employs fundamentally different muscle patterns for the same movement, such as activating a muscle one time and not the next, or switching from a flexor to an extensor. Under typical conditions, subjects choose the same muscles for any given movement, which suggests that in order to see the capacity of the nervous system to make a different choice of muscles, the nervous system must be pushed beyond the normal circumstances. The purpose of this study, then, was to examine an atypical condition, reaching of cervical spinal cord injured (SCI) subjects who have a reduced repertoire of available distal arm muscles but otherwise a normal nervous system above the level of lesion. Electromyography and kinematics of the shoulder and elbow were examined in the SCI subjects performing a center-out task and then compared to neurologically normal control subjects. The findings showed that the SCI-injured subjects produced reaches with typical global kinematic features, such as straight finger paths, bell-shaped velocities, and joint excursions similar to control subjects. The SCI subjects, however, activated only the shoulder agonist muscle for all directions, unlike the control pattern that involved a reciprocal pattern at each joint (shoulder, elbow, and wrist). Nonetheless, the SCI subjects could activate their shoulder antagonist muscles, elbow flexors, and wrist extensor (extensor carpi radialis) for isometric tasks, but did not activate them during the reaching movements. These results demonstrate that for reaching movements, the SCI subjects used a strikingly different pattern of intact muscle activities than control subjects. Hence, the findings imply that the nervous system is capable of choosing either the control pattern or the SCI pattern. We would speculate that control subjects do not select the SCI pattern because the different choice of muscles results in kinematic features (reduced fingertip speed, multiple shoulder accelerations) other than the global features that are somehow less advantageous or efficient.

Motor unit firing rates during isometric voluntary contractions performed at different muscle lengths

Firing rates of motor units and surface EMG were measured from the triceps brachii muscles of able-bodied subjects during brief submaximal and maximal isometric voluntary contractions made at 5 elbow joint angles that covered the entire physiological range of muscle lengths. Muscle activation at the longest, midlength, and shortest muscle lengths, measured by twitch occlusion, averaged 98%, 97%, and 93% respectively, with each subject able to achieve complete activation during some contractions. As expected, the strongest contractions were recorded at 90° of elbow flexion. Mean motor unit firing rates and surface EMG increased with contraction intensity at each muscle length. For any given absolute contraction intensity, motor unit firing rates varied when muscle length was changed. However, mean motor unit firing rates were independent of muscle length when contractions were compared with the intensity of the maximal voluntary contraction (MVC) achieved at each joint angle.Key words: muscle activation, length–tension relationships, force–frequency relationships.

Motor unit firing during and after voluntary contractions of human thenar muscles weakened by spinal cord injury

Spinal cord injury may change both the distribution and the strength of the synaptic input within a motoneuron pool and therefore alter force gradation. Here, we have studied the relative contributions of motor unit recruitment and rate modulation to force gradation during voluntary contractions of thenar muscles performed by five individuals with chronic (>1 yr) cervical spinal cord injury. Mean +/- SD thenar unit firing rates were low during both steady-level 25% (8.3 +/- 2.2 Hz, n = 27 units) and 100% maximal voluntary contractions (MVCs, 9.2 +/- 3.1 Hz, n = 23 units). Thus modest rate modulation, or a lack of it in some units, was seen despite an average fourfold increase in integrated surface electromyographic activity and force. During ramp contractions, units were recruited at 5.7 +/- 2.5 Hz, but still only reached maximal firing rates of 12.8 +/- 4.9 Hz. Motor units were recruited up to 85% of the maximal force achieved (14.6 +/- 5.6 N). In contrast, unit recruitment in control hand muscles is largely complete by 30% MVC. Thus, during voluntary contractions of thenar muscles weakened by cervical spinal cord injury, motor unit rate modulation was limited and recruitment occurred over a wider than usual force range. Those motor units that were stopped voluntarily had significantly lower derecruitment versus recruitment thresholds. However, 8 units (24%) continued to fire long after the signal to end the voluntary contraction at a mean frequency of 5.9 +/- 0.8 Hz. The forces generated by this prolonged unit activity ranged from 0.3 to 7.2% maximum. Subjects were unable to stop this involuntary unit activity even with the help of feedback. The mechanisms that underlie this prolonged motor unit firing need to be explored further.

Changes in muscle activation can prolong the endurance time of a submaximal isometric contraction in humans

Fourteen young subjects (7 men and 7 women) performed a fatiguing isometric contraction with the elbow flexor muscles at 20% of maximal voluntary contraction (MVC) force on three occasions. Endurance time for session 3 [1,718 +/- 1,189 (SD) s] was longer than for session 1 (1,225 +/- 683 s) and session 2 (1,410 +/- 977 s). Five men and four women increased endurance time between session 1 and 3 by 60 +/- 28% (responders), whereas two men and three women did not (-3 +/- 11%; nonresponders). The MVC force was similar for the responders and nonresponders, both before and after the fatiguing contraction. Fatiguing contractions were characterized by an increase in the electromyogram (EMG) amplitude and number of bursts during the fatiguing contractions. The responders achieved a similar level of EMG at exhaustion but a reduced rate of increase in the EMG across sessions. The rate of increase in EMG across sessions declined for the nonresponders, but it remained greater than that of the responders. The increase in burst rate during the contractions declined across sessions with a negative relation between burst rate and endurance time (r = -0.42). Normalized force fluctuations increased during the fatiguing contractions, and there was a positive relation (r = 0.60) between the force fluctuations and burst rate. Changes in mean arterial pressure and heart rate during the fatiguing contraction were similar for the responders and nonresponders across the three sessions. The results indicate that those subjects who increased the endurance time of a submaximal contraction across three sessions did so by altering the level and pattern of muscle activation.

Changes in motor unit discharge rate are not associated with the amount of twitch potentiation in old men

This study examined, in nine old men (82 +/- 4 yr), whether there is an association between the magnitude of change in motor unit discharge rate and the amount of twitch potentiation after a conditioning contraction (CC). The evoked twitch force and motor unit discharge rate during isometric ramp-and-hold contractions (10-18 s) of the triceps brachii muscle at 10, 20, and 30% of the maximal voluntary contraction were determined before and 10 s, 2 min, 6 min, and 11 min after a 5-s CC at 75% maximal voluntary contraction. After the CC, there was a potentiation of twitch force (approximately twofold), and the discharge rate of the 47 sampled motor units declined (P < 0.05) an average of 1 Hz 10 s after the CC, compared with the control condition. The CC had no effect on the variability (coefficient of variation) of both force and discharge rate, as well as the electromyographic activity recorded over the triceps brachii and biceps brachii muscles. In contrast to our earlier study of young men (Klein CS, Ivanova TD, Rice CL, and Garland SJ, Neurosci Lett 316: 153-156, 2001), the magnitude of the reduction in discharge rate after the CC was not associated (r = 0.06) with the amount of twitch potentiation. These findings suggest an age-related alteration in the neural strategy for adjusting motor output to a muscle after a CC.