Cosine tuning determines plantarflexors' activities during human upright standing and is affected by incomplete spinal cord injury

Development of a Coaching System for Functional Electrical Stimulation Rowing: A Feasibility Study in Able-Bodied Individuals

Background: Functional electrical stimulation (FES) during rowing has substantial effects on cardiovascular health in individuals with spinal cord injuries. Currently, manual stimulation control where stimulation is operated by rowers is mostly utilized. However, it takes time to obtain the skill to initiate FES at the optimal timing. The purpose of this study was to develop a coaching system that helps rowers to initiate FES at the optimal timing. Methods: The optimal range for FES application was identified based on the electromyography of the left quadriceps in 10 able-bodied individuals (AB). Then, the effects of the coaching system on the timing of button-pressing, power, and work were investigated in 7 AB. Results: Vastus lateralis (VL) activation began consistently before the seat reached the anterior-most position. Therefore, seat position at the onset of VL was used as the variable to control the switch timing in the coaching system. The results revealed significantly higher power and work outputs in the coaching than the no-coaching condition (median power coaching: 19.10 W, power no-coaching: 16.48 W, p = 0.031; median work coaching: 109.74 J, work no-coaching: 65.25 J, p = 0.047). Conclusions: The coaching system can provide the optimal timing for FES, resulting in improved performance.

Co-contraction of ankle muscle activity during quiet standing in individuals with incomplete spinal cord injury is associated with postural instability

Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), soleus and medial gastrocnemius were collected bilaterally. The iSCI-group exhibited more co-contractions than the AB-group (EO: 0.208% vs. 75.163%, p = 0.004; EC: 1.767% vs. 92.373%, p = 0.016). Furthermore, postural sway was larger during co-contractions than during no co-contraction in the iSCI-group (EO: 1.405 cm/s² vs. 0.867 cm/s², p = 0.023; EC: 1.831 cm/s² vs. 1.179 cm/s², p = 0.030), but no differences were found for the AB-group (EO: 0.393 cm/s² vs. 0.499 cm/s², p = 1.00; EC: 0.686 cm/s² vs. 0.654 cm/s², p = 1.00). To investigate the mechanism, we performed a computational simulation study using an inverted pendulum model and linear controllers. An increase of mechanical stiffness in the simulated iSCI-group resulted in increased postural sway (EO: 2.520 cm/s² vs. 1.174 cm/s², p < 0.001; EC: 4.226 cm/s² vs. 1.836 cm/s², p < 0.001), but not for the simulated AB-group (EO: 0.658 cm/s² vs. 0.658 cm/s², p = 1.00; EC: 0.943 cm/s² vs. 0.926 cm/s², p = 0.190). Thus, we demonstrated that co-contractions may be a compensatory strategy for individuals with iSCI to accommodate for decreased motor function, but co-contractions may result in increased ankle mechanical joint stiffness and consequently postural sway.

Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review

Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail-including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.

Interjoint coordination between the ankle and hip joints during quiet standing in individuals with motor incomplete spinal cord injury

Individuals with motor incomplete spinal cord injuries (iSCI) often have impaired abilities to maintain upright balance. For able-bodied (AB) individuals, the ankle and hip joint accelerations are in antiphase to minimize the postural sway during quiet standing. Here we investigated how interjoint coordination between the ankle and hip joints was affected in individuals with iSCI, leading to their larger postural sway during quiet standing. Data from 16 individuals with iSCI, 14 age- and sex-matched AB individuals, and 13 young AB individuals were analyzed. The participants performed quiet standing during which kinematic and kinetic data were recorded. Postural sway was quantified using center-of-pressure velocity and center-of-mass acceleration. Individual ankle and hip joint kinematics were quantified, and the interjoint coordination was assessed using the cancellation index (CI), goal-equivalent variance (GEV), nongoal-equivalent variance (NGEV), and uncontrolled manifold (UCM) ratio. Individuals with iSCI displayed greater postural sway compared with AB individuals. The contribution of ankle angular acceleration toward one's sway was significantly greater for those with iSCI compared with AB groups. CI and the UCM ratios were not statistically different between the groups, while GEV and NGEV were significantly greater for the iSCI group compared with the AB groups. We demonstrated that individuals with iSCI show larger postural sway compared with the AB individuals during quiet standing, primarily due to larger ankle joint acceleration. We also demonstrated that the interjoint coordination between ankle and hip joint is not affected in individuals with iSCI, which is not successfully able to reduce the large COM acceleration.NEW & NOTEWORTHY There are limited studies investigating the biomechanics of standing balance for individuals with motor incomplete spinal cord injury (iSCI). Through our study, we found that these individuals with iSCI demonstrated increased postural sway primarily due to increased ankle joint accelerations. In addition, the ankle-hip coordination was equivalent between able-bodied individuals and those with motor incomplete spinal cord injury, which was not able to reduce the large body acceleration.