Influence of age on neuromuscular control during a dynamic weight-bearing task

Neuromuscular Electrical Stimulation Primes Feedback Control During a Novel Single Leg Task

FMRI studies support that neuromuscular electrical stimulation can modulate the excitability of the somatosensory cortex. We studied whether practice and electrical stimulation of the quadriceps would enhance learning during a weight-bearing task. 20 healthy individuals (10 male) and 8 control subjects participated in a 2-day study. Day 1 consisted of a pretest, a training session, and a post-test; day 2 consisted of a pretest, 2 bouts of electrical stimulation to the quadriceps muscles, and a post-test. The single limb squat task was performed at varying knee resistance and target velocities and a random unexpected perturbation was administered. Feedforward error was calculated during a 50 ms time window before the unexpected event. Feedback error was calculated during a 150 ms window after the unexpected event. Peak error score decreased by 2.98 degrees (p < 0.001) immediately following training. Error was improved by 1.78 degrees (p < 0.001) during the feedforward phase and 1.44 degrees (p < 0.001) during the feedback phase. All subjects plateaued after day 1; except for the electrical stimulation group that showed a decrease of 1.206 degrees during the perturbed cycles (p = 0.024). Electrical stimulation triggered additional learning, beyond practice, during the unexpected event at a latency associated with the transcortical reflex.

Myotonic dystrophy type 1 alters muscle twitch properties, spinal reflexes, and perturbation-induced trans-cortical reflexes

BACKGROUND

Neurophysiologic biomarkers are needed for clinical trials of therapies for myotonic dystrophy (DM1). We characterized muscle properties, spinal reflexes (H-reflexes), and trans-cortical long-latency reflexes (LLRs) in a cohort with mild/moderate DM1.

METHODS

Twenty-four people with DM1 and 25 matched controls underwent assessment of tibial nerve H-reflexes and soleus muscle twitch properties. Quadriceps LLRs were elicited by delivering an unexpected perturbation during a single-limb squat (SLS) visuomotor tracking task.

RESULTS

DM1 was associated with decreased H-reflex depression. The efficacy of doublet stimulation was enhanced, yielding an elevated double-single twitch ratio. DM1 participants demonstrated greater error during the SLS task. DM1 individuals with the least-robust LLR responses showed the greatest loss of spinal H-reflex depression.

CONCLUSIONS

DM1 is associated with abnormalities of muscle twitch properties. Co-occurring alterations of spinal and trans-cortical reflex properties underscore the central nervous system manifestations of this disorder and may assist in gauging efficacy during clinical trials.

Age and Cognitive Stress Influences Motor Skill Acquisition, Consolidation, and Dual-Task Effect in Humans

This study examined motor skill learning using a weight-bearing and cognitive-motor dual-task that incorporated unexpected perturbations and measurements of cognitive function. Forty young and 24 older adults performed a single-limb weight bearing task with novel speed, resistance, and cognitive dual task conditions to assess motor skill acquisition, retention and transfer. Subjects performed a cognitive dual task: summing letters in one color/orientation (simple) or two colors/orientations (complex). Increased cognitive load diminished the rate of skill acquisition, decreased transfer to new conditions, and increased error rate during an unexpected perturbation; however, young adults had a dual-task benefit from cognitive load. Executive function predicted 80% of the variability in dual-task performance. Although initial learning of a weight-bearing cognitive-motor dual-task was poor, longer term goals of improved dual-task effect and retention emerged.

Effect of Surgery on Gait and Sensory Motor Performance in Patients With Cervical Spondylotic Myelopathy

BACKGROUND

Cervical spondylotic myelopathy (CSM) is a common disease of aging that leads to gait instability resulting from loss of leg sensory and motor functions. The results of surgical intervention have been studied using a variety of methods, but no test has been reported that objectively measures integrative leg motor sensory functions in CSM patients.

OBJECTIVE

To determine the feasibility of using a novel single leg squat (SLS) test to measure integrative motor sensory functions in patients with CSM before and after surgery.

METHODS

Fifteen patients with CSM were enrolled in this prospective study. Clinical data and scores from standard outcomes questionnaires were obtained before and after surgery. Patients also participated in experimental test protocols consisting of standard kinematic gait testing, the Purdue pegboard test, and the novel SLS test.

RESULTS

The SLS test protocol was well tolerated by CSM patients and generated objective performance data over short test periods. In patients who participated in postoperative testing, the group measures of mean SLS errors decreased following surgery. Gait velocity measures followed a similar pattern of group improvement postoperatively. Practical barriers to implementing this extensive battery of tests resulted in subject attrition over time. Compared with kinematic gait testing, the SLS protocol required less space and could be effectively implemented more efficiently.

CONCLUSIONS

The SLS test provides a practical means of obtaining objective measures of leg motor sensory functions in patients with CSM. Additional testing with a larger cohort of patients is required to use SLS data to rigorously examine group treatment effects.

ABBREVIATIONS

BW, body weightCSM, cervical spondylotic myelopathymJOA, modified Japanese Orthopedic AssociationSLS, single leg squat.

Speed, resistance, and unexpected accelerations modulate feed forward and feedback control during a novel weight bearing task

We developed a method to investigate feed-forward and feedback movement control during a weight bearing visuomotor knee tracking task. We hypothesized that a systematic increase in speed and resistance would show a linear decrease in movement accuracy, while unexpected perturbations would induce a velocity-dependent decrease in movement accuracy. We determined the effects of manipulating the speed, resistance, and unexpected events on error during a functional weight bearing task. Our long term objective is to benchmark neuromuscular control performance across various groups based on age, injury, disease, rehabilitation status, and/or training. Twenty-six healthy adults between the ages of 19-45 participated in this study. The study involved a single session using a custom designed apparatus to perform a single limb weight bearing task under nine testing conditions: three movement speeds (0.2, 0.4, and 0.6Hz) in combination with three levels of brake resistance (5%, 10%, and 15% of individual's body weight). Individuals were to perform the task according to a target with a fixed trajectory across all speeds, corresponding to a∼0 (extension) to 30° (flexion) of knee motion. An increase in error occurred with speed (p<0.0001, effect size (eta²): η²=0.50) and resistance (p<0.0001, η²=0.01). Likewise, during unexpected perturbations, the ratio of perturbed/non-perturbed error increased with each increment in velocity (p<0.0014, η²=0.08), and resistance (p<0.0001, η²=0.11). The hierarchical framework of these measurements offers a standardized functional weight bearing strategy to assess impaired neuro-muscular control and/or test the efficacy of therapeutic rehabilitation interventions designed to influence neuromuscular control of the knee.

Age-related differences in movement strategies and postural control during stooping and crouching tasks

While epidemiologic data suggests that one in four older adults have difficulty performing stooping and crouching (SC) tasks, little is known about how aging affects SC performance. This study investigated differences between young and older adults in lower limb kinematics and underfoot center of pressure (COP) measures when performing a series of SC tasks. Twelve healthy younger and twelve healthy older participants performed object-retrieval tasks varying in: (1) initial lift height, (2) precision demand, and (3) duration. Whole-body center of mass (COM), underfoot COP, and hip and knee angular kinematics (maximum angles and velocities) were analyzed. Compared to younger, older participants moved slower when transitioning into and out of pick-up postures that were characterized by less hip and knee flexion. Older participants also showed a diminished ability to adapt to the changing postural demands of each set of tasks. This was especially evident during longer tasks, whereby older individuals avoided high knee flexion crouching postures that were commonly used by younger participants. Older adults also tended to exhibit faster and more frequent COP trajectory adjustments in the anterior-posterior direction. It is likely that limitations in physical characteristics such as lower limb strength and range of motion contributed to these differences.

Acute effects of muscle fatigue on anticipatory and reactive postural control in older individuals: a systematic review of the evidence

BACKGROUND

Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults. Although declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control, we sought to systematically review research studies examining this issue.

PURPOSE

The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by acute muscle fatigue in healthy older individuals.

METHODS

An extensive search was performed using the CINAHL, Scopus, PubMed, SPORTDiscus, and AgeLine databases for the period from inception of each database to June 2013. This systematic review used standardized search criteria and quality assessments via the American Academy for Cerebral Palsy and Developmental Medicine Methodology to Develop Systematic Reviews of Treatment Interventions (2008 version, revision 1.2, AACPDM, Milwaukee, Wisconsin).

RESULTS

A total of 334 citations were found. Six studies were selected for inclusion, whereas 328 studies were excluded from the analytical review. The majority of articles (5 of 6) utilized reactive postural control paradigms. All studies incorporated extrinsic measures of muscle fatigue, such as declines in maximal voluntary contraction or available active range of motion. The most common biomechanical postural control task outcomes were spatial measures, temporal measures, and end-points of lower extremity joint kinetics.

CONCLUSION

On the basis of systematic review of relevant literature, it appears that muscle fatigue induces clear deteriorations in reactive postural control. A paucity of high-quality studies examining anticipatory postural control supports the need for further research in this area. These results should serve to heighten awareness regarding the potential negative effects of acute muscle fatigue on postural control and support the examination of muscle endurance training as a fall risk intervention in future studies.

Neuromuscular Evaluation With Single-Leg Squat Test at 6 Months After Anterior Cruciate Ligament Reconstruction

Background:

Criteria for return to unrestricted activity after anterior cruciate ligament (ACL) reconstruction varies, with some using time after surgery as the sole criterion—most often at 6 months. Patients may have residual neuromuscular deficits, which may increase the risk of ACL injury. A single-leg squat test (SLST) can dynamically assess for many of these deficits prior to return to unrestricted activity.

Hypothesis:

A significant number of patients will continue to exhibit neuromuscular deficits with SLST at 6 months after ACL reconstruction.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Patients using a standardized accelerated rehabilitation protocol at their 6-month follow-up after primary ACL reconstruction were enrolled. Evaluation included bilateral SLST, single-leg hop distance, hip abduction strength, and the subjective International Knee Documentation Committee (IKDC) score.

Results:

Thirty-three patients were enrolled. Poor performance of the operative leg SLST was found in 15 of 33 patients (45%). Of those 15 patients, 7 (45%) had concomitant poor performance of the nonoperative leg compared with 2 of 18 patients (11%) in those who demonstrated good performance in the operative leg. The poor performers were significantly older (33.6 years) than the good performers (24.2 years) (P = .007). Those with poor performance demonstrated decreased hip abduction strength (17.6 kg operative leg vs 20.5 kg nonoperative leg) (P = .024), decreased single-leg hop distance (83.3 cm operative leg vs 112.3 cm nonoperative leg) (P = .036), and lower IKDC scores (67.9 vs 82.3) (P = .001).

Conclusion:

Nearly half of patients demonstrated persistent neuromuscular deficits on SLST at 6 months, which is when many patients return to unrestricted activity. Those with poor performance were of a significantly older age, decreased hip abduction strength, decreased single-leg hop distance, and lower IKDC subjective scores.

Clinical Relevance:

The SLST can be used to identify neuromuscular risk factors for ACL rupture. Many patients at 6 months have persistent neuromuscular deficits on SLST. Caution should be used when using time alone to determine when patients can return to unrestricted activity.

Age and gender related neuromuscular changes in trunk flexion-extension

BACKGROUND

The root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from a standing position and task specific spine ranges of motion objectively assess muscle function in healthy young and middle age individuals. However, literature on neuromuscular activation and associated spine and hip kinematics in older individuals is sparse. This cross sectional study sought to examine the sex and age (<40 versus >60 years) related differences in the neuromuscular activation profiles of the lumbar extensors and the related spine and hip kinematics from healthy individuals during a standardized trunk flexion-extension task.

METHODS

Twenty five older (13 females, 60-90 years) and 24 younger (12 females, 18-40 years) healthy individuals performed trunk flexion-extension testing by holding static positions at half-flexion way and full range of motion between standing and maximum trunk flexion. The associated lumbar extensor muscle activity was derived from measurements at standing, half, and maximum flexion positions. The range of motion at the hip and lumbar spine was recorded using 3d accelerometers attached to the skin overlying the multifidus and semispinalis thoracis muscles lateral to the L5 and T4 spinous processes, respectively. Statistical calculations were performed using a permutation ANOVA with bootstrap confidence intervals.

RESULTS

The muscle activity in the half related to the maximum flexion position (half flexion relaxation ratio) was significantly smaller in older males when compared with younger males. Moreover, measurements revealed smaller activity changes from standing to the half and from half to the maximum flexion position in older compared to younger individuals. Older males displayed smaller gross trunk range of motion from standing to maximum flexion than any other group.

CONCLUSIONS

Gender and normal aging significantly affect both the activation patterns of the lumbar extensor muscles and the kinematics of the trunk during a standardized trunk flexion-extension task. Measurement results from healthy young and middle age individuals should not be used for the assessment of individuals older than 60 years of age.

Age-related differences in maintenance of balance during forward reach to the floor

BACKGROUND

Downward reaching may lead to falls in older adults, but the underlying mechanisms are poorly understood. This study assessed differences between younger and older adults in postural control and losses of balance when performing a forward reach to the floor in 2 possible real-world situations, with and without full foot contact with the floor.

METHODS

Healthy younger (n = 13) and older (n = 12) women reached as fast as possible to a target placed at their maximal forward reaching distance on floor, either standing on their whole foot or on the shortest base of support (BOS) that they were willing to perform a toe touch with.

RESULTS

Compared with younger women, older women used a 50% larger BOS when stooping down to touch their toes and had 22% less maximal forward reaching distance on the floor. Older women were twice as likely to lose their balance as younger women while performing a rapid forward floor reach (χ(2)(2) = 3.9; p < .05; relative risk = 1.91; 95% CI = 0.99-3.72). Postural sway, measured as center of pressure excursions and center of pressure root mean square error, did not differ between younger and older women anteriorly, but posteriorly, older women decreased their sway in full foot BOS and increased their sway in forefoot BOS (Age × BOS, p < .05). Leg strength was reduced in older versus younger women and was correlated with maximal reach distance (r = .65-.71).

CONCLUSIONS

Healthy older women performing a rapid maximum forward reach on the floor, particularly when using their forefoot for support, are at an increased risk for losing their balance.

Squat-to-reach task in older and young adults: kinematic and electromyographic analyses

The purpose of this study was to compare the two-dimensional kinematic and electromyographic (EMG) changes during the squat-to-reach task in older and young adults. Twenty-six older adults and thirty-three young adults were studied. A 16-channel telemetry system was used for recording muscular activity and kinematic data during two trials of a squat-to-reach task. Surface EMG data were recorded on select muscles of the trunk and the lower extremity on the dominant side. An electrogoniometer was fixed over the knee joint, and an inclinometer was fastened on the head and thigh to record kinematic data. The task was split into six movement phases based on the angular displacement and velocities of the knee joint. The mean values of the maximal displacements in the sagittal plane of the head, knee, and thigh were significantly (p<0.05) lower, but those in the frontal plane of the head and thigh were significantly (p<0.05) higher in older adults than in young adults. Thigh muscle activities were significantly (p<0.05) higher in older adults than in young adults throughout the movements. The trunk and leg muscles contracted earlier, but the hip adductors contracted later in older adults compared to young adults (p<0.05). The older adults squatted in a shallow and heel-off posture during forward reaching tasks. Therefore, older adults had increased lateral flexion of the head to compensate for insufficient knee flexion during the squat-to-reach movement and required increased activity of the posture muscles to maintain lateral stability.

Neuromuscular responses in individuals with anterior cruciate ligament repair

OBJECTIVE

Knee surgery may alter the neuromuscular response to unexpected perturbations during functional, dynamic tasks. Long latency reflexes (LLR) follow a transcortical pathway and appear to be modifiable by task demands, potentially giving them a role in neuromuscular performance. We examined LLRs of the quadriceps and hamstrings in response to unexpected perturbations in individuals with a repaired anterior cruciate ligament (ACLR) during a weight-bearing task. We also investigated the anticipatory and volitional muscle activity that preceded and followed the LLR to quantify possible reflex adaptations associated with surgical repair.

METHODS

Twelve females with ACLR and 12 healthy female controls performed a single leg squat maneuver, tracking a sinusoidal target. Random perturbations at the start of the flexion phase yielded tracking errors ("overshoot errors") and triggered compensatory reflex activity.

RESULTS

ACLR subjects demonstrated greater overshoot error and knee velocity during unexpected perturbations, increased LLR responses, and reduced absolute anticipatory, short-latency reflex, and voluntary quadriceps activity.

CONCLUSIONS

ACLR subjects showed impaired response to perturbation and a distinct EMG profile during a dynamic single leg weight-bearing task. Future research will determine the cause of neural adaptations in those with ACLR.

SIGNIFICANCE

Neuromuscular adaptations may be a viable target for post-ACL injury rehabilitation interventions.