Merging of healthy motor modules predicts reduced locomotor performance and muscle coordination complexity post-stroke

Running-induced fatigue influences lower extremity muscle synergy and related biomechanics

BACKGROUND

Fatigue changes muscle activation patterns as an adaptation strategy in multi-joint movements. However, due to groups of muscles involved in running, the across-muscle neurological regulation before and after fatigue is unclear. The central nervous system may employ low-dimensional modular structures, known as muscle synergies, to describe the muscle coordination in a multi-joint movement such as running.

RESEARCH QUESTION

This study aimed to explore the effect of fatigue on lower extremity muscle synergy and biomechanical characteristics in running.

METHOD

Twelve healthy male participants were recruited. The kinematic, kinetic, and surface electromyography data of nine muscles (i.e., gluteus maximus, biceps femoris, rectus femoris, vastus medialis, vastus lateralis, tibialis anterior, medial gastrocnemius, lateral gastrocnemius, and soleus) were synchronously recorded on a treadmill at 12 km/h before and after a load-increasing fatigue intervention. Muscle synergy was calculated by the non-negative matrix factorization algorithm. Muscle weight and activation curves were used to identify the co-activation before and after fatigue.

RESULT

Maximum ankle plantarflexion velocity, maximum knee flexion angle, and hip range of motion significantly increased after fatigue. Vertical stiffness and work in the lower extremity significantly decreased after fatigue. Six muscle synergies (SYN1-6) were clustered before and after fatigue, corresponding to four major functions in the running gait cycle. The number of muscle synergy did not change significantly after fatigue, while the muscle weights and activation curve changed.

SIGNIFICANCE

Muscle synergies were stabilized and were less affected by fatigue, corresponding to specific biomechanical functions within the running gait cycle. Meanwhile, changes in muscle weights and activation curves reflected neuromuscular adaptations to fatigue and may be associated with alterations in lower extremity kinematics during continuous movement after fatigue.

The Neuromusculoskeletal Modeling Pipeline: MATLAB-based model personalization and treatment optimization functionality for OpenSim

Neuromusculoskeletal injuries including osteoarthritis, stroke, spinal cord injury, and traumatic brain injury affect roughly 19% of the U.S. adult population. Standardized interventions have produced suboptimal functional outcomes due to the unique treatment needs of each patient. Strides have been made to utilize computational models to develop personalized treatments, but researchers and clinicians have yet to cross the "valley of death" between fundamental research and clinical usefulness. This article introduces the Neuromusculoskeletal Modeling (NMSM) Pipeline, two MATLAB-based toolsets that add Model Personalization and Treatment Optimization functionality to OpenSim. The two toolsets facilitate computational design of individualized treatments for neuromusculoskeletal impairments through the use of personalized neuromusculoskeletal models and predictive simulation. The Model Personalization toolset contains four tools for personalizing 1) joint structure models, 2) muscle-tendon models, 3) neural control models, and 4) foot-ground contact models. The Treatment Optimization toolset contains three tools for predicting and optimizing a patient's functional outcome for different treatment options using a patient's personalized neuromusculoskeletal model and direct collocation optimal control methods. Support for user-defined cost, constraint, and model modification functions facilitate simulation of a vast number of possible treatments. An NMSM Pipeline use case is presented for an individual post-stroke with impaired walking function, where the goal was to predict how the subject's neural control could be changed to improve walking speed without increasing metabolic cost. First the Model Personalization toolset was used to develop a personalized neuromusculoskeletal model of the subject starting from a generic OpenSim full-body model and experimental walking data (video motion capture, ground reaction, and electromyography) collected from the subject at his self-selected speed. Next the Treatment Optimization toolset was used with the personalized model to predict how the subject could recruit existing muscle synergies more effectively to reduce muscle activation disparities between the paretic and non-paretic legs. The software predicted that the subject could increase his walking speed by 60% without increasing his metabolic cost per unit time by modifying existing muscle synergy recruitment. This hypothetical treatment demonstrates how NMSM Pipeline tools could allow researchers working collaboratively with clinicians to develop personalized neuromusculoskeletal models of individual patients and to perform predictive simulations for designing personalized treatments that maximize a patient's post-treatment functional outcome.

An Evaluation Model for Brain Ischemia Protection in Mice by Low-Intensity Pulsed Ultrasound Stimulation Based on Functional Cortico-Muscular Coupling

(1) Background: Ischemic stroke is a major global public-health concern with complex pathogenesis. Current treatment strategies face challenges. Low-intensity pulsed ultrasound stimulation (LIPUS), a non-invasive neuromodulation technology, shows promise in treating ischemic stroke, yet its underlying mechanisms lack in-depth investigation, especially in quantitative efficacy evaluation. (2) Methods: This study aimed to develop a neuromuscular functional coupling-based dynamic time warping (DTW) model to evaluate LIPUS's neuroprotective effects in a mouse model of ischemic stroke. A bilateral carotid artery occlusion (BCAO) model in mice was established, and LIPUS treatment was given. Time- and frequency-domain analyses of local field potentials (LFPs) and electromyography (EMG) were conducted, and outcomes were quantified using a percentage-based scoring system. (3) Results: The BCAO+LIPUS group scored significantly higher than the BCAO group. (4) Conclusions: This study demonstrated that LIPUS is neuroprotective in BCAO mice and that the DTW-100 assessment evaluation model can quantify the neuroprotective effects of LIPUS.

Age-related differences in the modulation of muscle coordination complexity for goal-directed lateral stepping

Falls in older adults often occur during everyday walking activities, especially those with complex mediolateral demands. How muscle coordination is modulated to achieve these complex mediolateral demands and how age-related changes in modulation may compromise this ability are unknown. This study investigates age-related changes in the complexity of muscle coordination during a goal-directed lateral stepping task using electromyography and motor module analysis. Twenty-nine older adults (OA) and twenty-six younger adults (YA) performed habitual treadmill walking and a goal-directed lateral stepping task designed to mirror real-world tasks with increased lateral movement demands. Muscle coordination complexity was quantified using the variability accounted for by one motor module, with higher values indicating reduced complexity. Both YA and OA exhibited reduced muscle coordination complexity in the stance leg during precision stepping compared to habitual treadmill walking. This reduction was larger for OA and associated with worse walking balance. In contrast, muscle coordination complexity was not different across conditions in the stepping leg for either age group. The results of this study provide insights into age-related differences in how muscle coordination complexity is modulated to meet goal-directed lateral stepping demands during walking that may help explain increased susceptibility to falls in older adults.

Muscle synergies are largely unaffected in individuals with diabetes who do not have diabetic neuropathy

BACKGROUND

Impaired neuromuscular function in individuals with diabetes can adversely affect gait kinematics, kinetics, and electromyography, potentially increasing the risk of serious complications such as plantar ulcers and amputations. However, it remains unclear whether these changes are associated with alterations in muscle synergies. This study aims to examine muscle synergies in individuals with diabetes.

METHODS

Surface electromyography recordings were obtained from seven lower extremity muscles (vastus lateralis, rectus femoris, biceps femoris, semitendinosus, lateral gastrocnemius, soleus, and tibialis anterior) during 20 trials of barefoot walking. Eleven individuals with type 2 diabetes without diabetic neuropathy and ten age-matched controls were recruited. Variations in synergy complexity were assessed by the number of synergies needed to account for >90 % of the total variance in the electromyography data, total variance accounted for by one synergy, and total variance accounted for by four synergies. Synergy weights and activations for a four-synergy solution were compared using cosine similarity. An electromyography co-contraction index was computed for agonist and antagonist pairs of muscles.

FINDINGS

Those with diabetes did not significantly differ from controls in the number of synergies, total variance accounted for by one synergy, total variance accounted for by four synergies, or synergy composition. However, they demonstrated higher levels of variability in synergy composition similarity.

INTERPRETATION

These results indicate that, at the group level, individuals with diabetes without neuropathy employ largely similar motor control strategies as their healthy counterparts while walking, and previously reported variations in gait biomechanics in this population may be attributed to peripheral neuromuscular dysfunction.

A systematic review and meta-analysis of acupuncture's impact on hemiplegic gait recovery after stroke

OBJECTIVE

This systematic review aims to evaluate the efficacy and safety of acupuncture in alleviating gait disturbances in post-stroke hemiplegia, focusing on various gait parameters.

METHODS

A comprehensive search was conducted across PubMed, EMBASE, Cochrane Library, Web of Science, AMED, CINAHL, CBM, CNKI, and WanFang databases to identify relevant randomized controlled trials (RCTs). The included studies were independently evaluated for risk of bias using Cochrane's risk of bias tool. RevMan 5.3 was used for meta-analysis, and adverse events were collected through full-text review.

RESULTS

A total of 21 RCTs involving 1463 participants were included. Results showed that acupuncture combined with rehabilitation therapy (RT) significantly improved stride and step length (MD = 7.79, 95 % CI: 5.62-9.96, Z = 7.03, P < 0.00001, I² = 72 %), cadence (MD = 10.43, 95 % CI: 6.22-14.65, Z = 4.85, P < 0.00001, I² = 95 %), walking speed (MD = 12.27, 95 % CI: 9.22-15.31, Z = 7.90, P < 0.00001, I² = 91 %), hip peak flexion angle (MD = 2.71, 95 % CI: 0.94-4.49, Z = 2.99, P = 0.003, I² = 82 %), and ankle peak plantarflexion angle (MD = 2.08, 95 % CI: 1.11-3.06, Z = 4.19, P < 0.0001, I² = 0 %) compared to RT alone. It also reduced gait cycle time (MD = -0.61, 95 % CI: -0.96 to -0.26, Z = 3.44, P = 0.0006, I² = 98 %) and the proportion of double support phase (MD = -7.16, 95 % CI: -9.08 to -5.25, Z = 7.33, P < 0.00001, I² = 0 %). These improvements in gait parameters suggest enhanced mobility and functional independence for post-stroke patients. However, heterogeneity in participant characteristics and study methodologies was noted, such as variations in stroke types, curses, severity, and acupuncture protocols. The majority of RCTs exhibited moderate to high risk of bias regarding allocation concealment and blinding. Only two RCTs reported no adverse events, while the rest 19 studies did not mention adverse events.

CONCLUSION

Acupuncture appears to enhance specific aspects of hemiplegic gait, though further high-quality research is needed to fully validate its effects. Current evidence is limited by methodological weaknesses and potential biases in the included studies. Rigorous, well designed studies are needed to further validate the comprehensive effects of acupuncture on post-stroke hemiplegic gait.

Neuro-Modulation Analysis Based on Muscle Synergy Graph Neural Network in Human Locomotion

The coordination of muscles in human locomotion is commonly understood as the integration of motor modules known as muscle synergies. Recent research has delved into the adaptation of muscle synergies during the acquisition of new motor skills. However, the precise interplay between modulated muscle synergies during movement according to motion requirements remains unclear. Here, we aim to elucidate the alterations in locomotor synergies across various lower-limb motion strategies and motor tasks. Our findings reveal consistent weights of muscles in muscle synergies alongside varying timing activation aligned with specific motion requirements. It shows that spatial muscle synergies remain stable across different motor tasks, but humans adjusted the timing activation of these modules (temporal muscle synergies) to meet the motor requirements. To classify temporal muscle synergies and quantify connection weights for both self-connections and connections between muscle synergies, we employed a graph neural network. Our results demonstrate that muscle synergy 4, responsible for elevating the thigh to propel forward during the swing phase, experiences pronounced enhancement with changes in motion strategies. Furthermore, we observed a reduction in the self-connection of muscle synergy 2, implicated in stabilizing body posture, during motion tasks other than normal walking. Additionally, the connections between muscle synergy 2 and other synergies diminished, indicating more adaptation in muscle synergy 2 to achieve stabilization in more challenging motor tasks. The validity of these findings was verified through five-fold cross-validation, affirming the efficacy of our approach in elucidating neuro-modulation mechanisms in human locomotion. Our proposed methodology holds promising implications for the development of personalized training strategies, offering insights into the intricate interactions among different muscle synergies in accomplishing motor tasks.

Management Approaches to Spastic Gait Disorders

Spastic gait presents clinically as the net mechanical consequence of neurological impairments of spasticity, weakness, and abnormal synergies and their interactions with the ground reaction force in patients with upper motor neuron syndromes and with some neuromuscular diseases. It is critical to differentiate whether the primary problem is weakness or spasticity, thus better understanding different phenotypes of spastic gait disorders. Pelvic girdle abnormality plays a pivotal role in determining the clinical presentation of gait disorders, since it determines the body vector and compensatory kinetic chain reactions in the knee and ankle joints. Knee joint abnormality can be a mechanical compensation for hip and/or ankle and foot abnormality. Diagnostic nerve blocks and instrumented gait analysis may be needed for diagnosing the underlying problems and developing an individualized plan of care. A wide spectrum of treatment options has been used to manage spastic gait disorders. Some are in early and investigational stages, such as neuromodulation modalities, while others are well-developed, such as therapeutic exercise, ankle-foot orthoses, botulinum toxin treatment, and surgical interventions. Physicians and other healthcare providers who manage spastic gait disorders should be familiar with these treatment options and should employ appropriate interventions concurrently rather than serially. The most effective treatments can be selected based on careful evaluation, inputs from patients, family, and therapists, along with appropriate goal setting. Treatment plans need to be re-evaluated for effectiveness, relevance, and in concordance with disease progress. This is particularly important for patients with progressive neuromuscular diseases such as amyotrophic lateral sclerosis.

Generalizability of motor modules across walking-based and in-place tasks - a distribution-based analysis on total knee replacement patients

Introduction: There are evidences that the nervous system produces motor tasks using a low-dimensional modular organization of muscle activations, known as motor modules. Previous studies have identified characteristic motor modules across similar tasks in healthy population. This study explored the generalizability of motor modules across two families of walking-based (level-walking, downhillwalking and stair-decent), in-place ascending (sit-to-stand, squat-to-stand), and in-place descending (stand-to-sit and stand-to-squat) motor tasks in a group of six individuals undergone total knee replacement (TKR) surgery. Methods: Motor modules were extracted from the EMG data of CAMS-Knee dataset using non-negative matrix factorization technique. A distribution-based approach, employing three levels of k-means clustering, was then applied to find the shared and task-specific modules, and assess their representability among the whole task-trial data. Results and Discussion: Results indicated a four- and a seven-subcluster arrangement of the shared and task-specific motor modules, depending upon the membership criteria. The first arrangement revealed motor modules which were shared across all tasks (min coverage index: 76%; modules' distinctness range: 7.08-8.91) and the latter among tasks of the same family mainly, although there remained some interfamily shared modules (min coverage index: 81%; modules' distinctness range: 7.17-9.89). It was concluded that there are shared motor modules across walking-based and in-place tasks in TKR individuals, with their generalizability and representability depending upon the analysis method. This finding highlights the importance of the analysis method in identifying the shared motor modules, as the main building blocks of motor control.

Flexible control of motor units: is the multidimensionality of motor unit manifolds a sufficient condition?

Understanding flexibility in the neural control of movement requires identifying the distribution of common inputs to the motor units. In this study, we identified large samples of motor units from two lower limb muscles: the vastus lateralis (VL; up to 60 motor units per participant) and the gastrocnemius medialis (GM; up to 67 motor units per participant). First, we applied a linear dimensionality reduction method to assess the dimensionality of the manifolds underlying the motor unit activity. We subsequently investigated the flexibility in motor unit control under two conditions: sinusoidal contractions with torque feedback, and online control with visual feedback on motor unit firing rates. Overall, we found that the activity of GM motor units was effectively captured by a single latent factor defining a unidimensional manifold, whereas the VL motor units were better represented by three latent factors defining a multidimensional manifold. Despite this difference in dimensionality, the recruitment of motor units in the two muscles exhibited similarly low levels of flexibility. Using a spiking network model, we tested the hypothesis that dimensionality derived from factorization does not solely represent descending cortical commands but is also influenced by spinal circuitry. We demonstrated that a heterogeneous distribution of inputs to motor units, or specific configurations of recurrent inhibitory circuits, could produce a multidimensional manifold. This study clarifies an important debated issue, demonstrating that while motor unit firings of a non-compartmentalized muscle can lie in a multidimensional manifold, the CNS may still have limited capacity for flexible control of these units. KEY POINTS: To generate movement, the CNS distributes both excitatory and inhibitory inputs to the motor units. The level of flexibility in the neural control of these motor units remains a topic of debate with significant implications for identifying the smallest unit of movement control. By combining experimental data and in silico models, we demonstrated that the activity of a large sample of motor units from a single muscle can be represented by a multidimensional linear manifold; however, these units show very limited flexibility in their recruitment. The dimensionality of the linear manifold may not directly reflect the dimensionality of descending inputs but could instead relate to the organization of local spinal circuits.

Postural control of sway dynamics on an unstable surface reduces similarity in activation patterns of synergistic lower leg muscles

Introduction

Diversity of activation patterns within synergistic muscles can be important for stability control in challenging conditions. This study investigates the similarity of activation patterns within the triceps surae and quadriceps femoris muscles and the effects of unstable surface during a visually guided postural task.

Methods

Eighteen healthy adults performed a visually guided anteroposterior tracking task on both stable and unstable surfaces. Electromyographic activity of triceps surae (gastrocnemius medialis, gastrocnemius lateralis, soleus) and quadriceps femoris (vastus medialis, vastus lateralis, rectus femoris) was recorded at 1,000 Hz. Cosine similarity (CS) between muscle pairs within each muscle group was calculated to assess the similarity of activation patterns of synergistic muscles for stable and unstable conditions. To compare the CS of the muscle pairs, a linear mixed model was used. For all tests the level of significance was set to α = 0.05.

Results

Across all surface conditions, CS values within the triceps surae muscles were lower than those of the quadriceps (p < 0.001), indicating a greater diversity in activation patterns of the distal muscles. The unstable surface reduced CS values for both muscle groups (p = 0.021). No significant interaction was observed between muscle pair and surface condition (p = 0.833).

Discussion

The reduced similarity of activation patterns within the synergistic triceps surae and quadriceps femoris muscles on the soft surface indicates an increased flexibility of neuromotor control for the unstable condition. The lower similarity within the synergistic triceps surae muscles suggests a higher diversity of activation patterns compared to the quadriceps femoris muscles, which may increase the flexibility of neuromotor control to meet specific joint stabilization challenges during the studied tracking task.

Motor control complexity estimation using gait measures in individuals post-stroke

Motor control impairments post-stroke significantly limit walking ability, with residual gait impairments often persisting despite rehabilitation efforts. Integrating motor control-based assessments in post-stroke gait evaluations is essential for monitoring the underlying causes of the limited functionality and enhancing recovery outcomes. This study aimed to develop motor control-based post-stroke gait evaluation techniques using common gait measures to inform and guide rehabilitation decisions. Subject-specific, forward-dynamic simulations of eight individuals with post-stroke gait undergoing a 12-weeks FastFES gait retraining program were created pre- and post-treatment to determine muscle activation patterns for muscle module analysis. The motor control complexity index was defined by the variance not accounted for by one module (VNAF1) as a summary measure of the analysis. Twenty-eight gait measures were investigated, and the relevant measures were selected using feature selection methods and fed into a multiple linear regression model to estimate the motor control complexity index. The motor control complexity of 182 gait cycles were quantified (0.164 ± 0.047). No strong relationship (quantified using Pearson correlation coefficients) was found between gait measures and the motor control complexity index. However, a combination of four gait measures from the paretic side (maximum hip abduction and knee flexion angle during swing, knee range of motion, and maximum paretic ankle power) explained most of the variation (R2 = 0.66) in motor control complexity.

60-Second Static Stretching of Lower Limb Muscles Disrupts Muscular Performance and Control in Active Male Adults

This study aimed to investigate the effects of 60-second static stretching on the neuromuscular control strategies of lower limb muscles during a squat jump (SJ), with a specific focus on changes in muscle synergy patterns, muscle weightings, and temporal activation characteristics. The muscles targeted for stretching included the quadriceps, hamstrings, and triceps surae. Electromyography (EMG) was used to assess the activity of the biceps femoris (BFL), triceps surae(TS), rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM). Twenty-five active males completed experiments under both a static stretching condition (SS) and a non-stretching condition (NS). Electromyography and non-negative matrix factorization (NMF) were employed to extract muscle synergy and the muscle weightings along with temporal activation characteristics were subsequently analyzed. The results revealed two distinct muscle synergy patterns in both the SS and NS. 60-second static stretching had no significant impact on the number of muscle synergy patterns during the squat jump. However, it significantly altered the contribution and temporal activation characteristics of individual muscles. Notably, post-stretching muscle activation levels were lower during the early phase of the jump, necessitating compensatory activation in the later phase to maintain performance. Additionally, jump heights were significantly lower in the stretched compared to the non-stretched condition.These findings suggest that while 60 seconds of static stretching before explosive movements may impair neuromuscular efficiency, ensuring proper and balanced static stretching for all muscle groups could help mitigate over-reliance on individual muscles.

The Neuromusculoskeletal Modeling Pipeline: MATLAB-based Model Personalization and Treatment Optimization Functionality for OpenSim

Neuromusculoskeletal injuries including osteoarthritis, stroke, spinal cord injury, and traumatic brain injury affect roughly 19% of the U.S. adult population. Standardized interventions have produced suboptimal functional outcomes due to the unique treatment needs of each patient. Strides have been made to utilize computational models to develop personalized treatments, but researchers and clinicians have yet to cross the "valley of death" between fundamental research and clinical usefulness. This article introduces the Neuromusculoskeletal Modeling (NMSM) Pipeline, two MATLAB-based toolsets that add Model Personalization and Treatment Optimization functionality to OpenSim. The two toolsets facilitate computational design of individualized treatments for neuromusculoskeletal impairments through the use of personalized neuromusculoskeletal models and predictive simulation. The Model Personalization toolset contains four tools for personalizing 1) joint structure models, 2) muscle-tendon models, 3) neural control models, and 4) foot-ground contact models. The Treatment Optimization toolset contains three tools for predicting and optimizing a patient's functional outcome for different treatment options using a patient's personalized neuromusculoskeletal model with direct collocation optimal control methods. Support for user-defined cost functions and model modification functions facilitate simulation of a vast number of possible treatments. An NMSM Pipeline use case is presented for an individual post-stroke with impaired walking function, where the goal was to predict how the subject's neural control could be changed to improve walking speed without increasing metabolic cost. First the Model Personalization toolset was used to develop a personalized neuromusculoskeletal model of the subject starting from a generic OpenSim full-body model and experimental walking data (video motion capture, ground reaction, and electromyography) collected from the subject at his self-selected speed. Next the Treatment Optimization toolset was used with the personalized model to predict how the subject could recruit existing muscle synergies more effectively to reduce muscle activation disparities between the paretic and non-paretic legs. The software predicted that the subject could increase his walking speed by 60% without increasing his metabolic cost per unit time by modifying existing muscle synergy recruitment. This hypothetical treatment demonstrates how NMSM Pipeline tools could allow researchers working collaboratively with clinicians to develop personalized neuromusculoskeletal models of individual patients and to perform predictive simulations for the purpose of designing personalized treatments that maximize a patient's post-treatment functional outcome.

Heteronymous feedback from quadriceps onto soleus in stroke survivors

BACKGROUND

Recent findings suggest increased excitatory heteronymous feedback from quadriceps onto soleus may contribute to abnormal coactivation of knee and ankle extensors after stroke. However, there is lack of consensus on whether persons post-stroke exhibit altered heteronymous reflexes and, when present, the origin of increased excitation (i.e. increased excitation alone and/or decreased inhibition). This study examined heteronymous excitation and inhibition from quadriceps onto soleus in paretic, nonparetic, and age-matched control limbs to determine whether increased excitation was due to excitatory and/or reduced inhibitory reflex circuits. A secondary purpose was to examine whether heteronymous reflex magnitudes were related to clinical measures of lower limb recovery, walking-speed, and dynamic balance.

METHODS

Heteronymous excitation and inhibition from quadriceps onto soleus were examined in fourteen persons post-stroke and fourteen age-matched unimpaired participants. Heteronymous feedback was elicited by femoral nerve and quadriceps muscle stimulation in separate trials while participants tonically activated soleus at 20% maximum voluntary isometric contraction. Fugl-Meyer assessment of lower extremity, 10-m walk test, and Mini-BESTest were assessed in stroke survivors.

RESULTS

Heteronymous excitation and inhibition onsets, durations, and magnitudes were not different between paretic, nonparetic or age-matched unimpaired limbs. Quadriceps stimulation elicited excitation that was half the magnitude of femoral nerve stimulation. Femoral nerve elicited paretic limb heteronymous excitation was positively correlated with walking speed but did not reach significance because only a subset of paretic limbs exhibited excitation (n = 8, Spearman r = 0.69, P = 0.058).

CONCLUSIONS

Heteronymous feedback from quadriceps onto soleus assessed in a seated posture was not impaired in persons post-stroke. Despite being unable to identify whether reduced inhibition contributes to abnormal excitation reported in prior studies, our results indicate quadriceps stimulation may allow a better estimate of heteronymous inhibition in those that exhibit exaggerated excitation. Heteronymous excitation magnitude in the paretic limb was positively correlated with self-selected walking speed suggesting paretic limb excitation at the higher end of a normal range may facilitate walking ability after stroke. Future studies are needed to identify whether heteronymous feedback from Q onto SOL is altered after stroke in upright postures and during motor tasks as a necessary next step to identify mechanisms underlying motor impairment.

Post-stroke Stiff-Knee gait: are there different types or different severity levels?

Stiff-Knee gait (SKG) commonly occurs in individuals after stroke, loosely defined as reduced peak knee flexion angle during swing. The causes of SKG are multifaceted and debated. Further, clinical interventions have not been consistently effective, possibly resulting from multiple undiagnosed subtypes of SKG. Thus, our primary goal of this study is to explore the existence of potential subtypes associated with different levels of motor control complexity. We used retrospective kinematics, kinetics and muscle activity from 50 stroke survivors and 15 healthy, age-matched controls during treadmill walking. We used a time-series kernel k-means cluster analysis based on compensatory frontal plane kinematics associated with SKG to separate participants into three groups, Cluster A (hip hiking, lowest knee flexion, highest propulsion asymmetry, lowest gait speed), Cluster B (hip hiking and hip abduction, moderate knee flexion, middle gait speed) and Cluster C (highest knee flexion, highest gait speed). The highest proportion of individuals with SKG as diagnosed by a clinician were in Cluster A, but with a substantial proportion in Cluster B, indicating that these two clusters can be considered subtypes of SKG. Despite differences in kinematics and kinetics, we did not observe fundamental differences in underlying motor control between clusters as determined by non-negative matrix factorization of measured muscle activations. We conclude that the differences between clusters were most likely attributed to the severity of gait impairment, as reflected by slower gait speed and propulsion asymmetry, rather than being a different type of SKG.

Motor modules are largely unaffected by pathological walking biomechanics: a simulation study

BACKGROUND

Motor module (a.k.a. muscle synergy) analysis has frequently been used to provide insight into changes in muscle coordination associated with declines in walking performance, to evaluate the effect of different rehabilitation interventions, and more recently, to control exoskeletons and prosthetic devices. However, it remains unclear whether changes in muscle coordination revealed via motor module analysis stem from abnormal walking biomechanics or neural control. This distinction has important implications for the use of motor module analysis for rehabilitation interventions and device design. Thus, this study aims to elucidate the extent to which motor modules emerge from pathological walking biomechanics, i.e. abnormal walking biomechanics commonly observed in individuals with neurological disease and/or injury.

METHODS

We conducted a series of computer simulations using OpenSim Moco to simulate pathological walking biomechanics by manipulating speed, asymmetry, and step width in a three-dimensional musculoskeletal model. We focused on these spatiotemporal metrics because they are commonly altered in individuals with Parkinson's disease, stroke survivors, etc. and have been associated with changes in motor module number and structure. We extracted motor modules using nonnegative matrix factorization from the muscle activations from each simulation. We then examined how alterations in walking biomechanics influenced the number and structure of extracted motor modules and compared the findings to previous experimental studies.

RESULTS

The motor modules identified from our simulations were similar to those identified from previously published experiments of non-pathological walking. Moreover, our findings indicate that the same motor modules can be used to generate a range of pathological-like waking biomechanics by modulating their recruitment over the gait cycle. These results contrast with experimental studies in which pathological-like walking biomechanics are accompanied by a reduction in motor module number and alterations in their structure.

CONCLUSIONS

This study highlights that pathological walking biomechanics do not necessarily require abnormal motor modules. In other words, changes in number and structure of motor modules can be a valuable indicator of alterations in neuromuscular control and may therefore be useful for guiding rehabilitation interventions and controlling exoskeletons and prosthetic devices in individuals with impaired walking function due to neurological disease or injury.

Electro-tactile modulation of muscle activation and intermuscular coordination in the human upper extremity

Electro-tactile stimulation (ETS) can be a promising aid in augmenting sensation for those with sensory deficits. Although applications of ETS have been explored, the impact of ETS on the underlying strategies of neuromuscular coordination remains largely unexplored. We investigated how ETS, alone or in the presence of mechano-tactile environment change, modulated the electromyogram (EMG) of individual muscles during force control and how the stimulation modulated the attributes of intermuscular coordination, assessed by muscle synergy analysis, in human upper extremities. ETS was applied to either the thumb or middle fingertip which had greater contact with the handle, grasped by the participant, and supported a target force match. EMGs were recorded from 11 arm muscles of 15 healthy participants during three-dimensional exploratory force control. EMGs were modeled as the linear combination of muscle co-activation patterns (the composition of muscle synergies) and their activation profiles. Individual arm muscle activation changed depending on the ETS location on the finger. The composition of muscle synergies was conserved, but synergy activation coefficients altered reflecting the effects of electro-tactile modulation. The mechano-tactile modulation tended to decrease the effects of ETS on the individual muscle activation and synergy activation magnitude. This study provides insights into sensory augmentation and its impact on intermuscular coordination in the human upper extremity.

The role of muscle synergies and task constraints on upper limb motor impairment after stroke

This study explores the role of task constraints over muscle synergies expression in the context of upper limb motor impairment after stroke. We recruited nine chronic stroke survivors with upper limb impairments and fifteen healthy controls, who performed a series of tasks designed to evoke muscle synergies through various spatial explorations. These tasks included an isometric force task, a dynamic reaching task, the clinical Fugl-Meyer (FM) assessment, and a pinch task. Electromyographic data from 16 upper limb muscles were collected during each task, alongside intermuscular coherence (IMC) measurements during the pinch task to assess neuromuscular connectivity. The findings confirm that motor impairment is inversely related to the diversity of muscle synergies, with fewer synergies and more stereotypical synergy structures observed post-stroke. The study further reveals that the nature of motor tasks significantly affects the number of identifiable muscle synergies, with less constrained tasks revealing a broader array of synergies. These findings highlight the importance of carefully selecting motor tasks in the context of clinical research and assessments to understand a patient's motor impairment, thus aiding in developing tailored rehabilitation strategies.

Differences in Ankle Neuromuscular Control Between the Preferred Speed and Fixed Speeds During Walking

Walking at the preferred speed, considered as a self-optimized gait pattern, is associated with improved energy conservation and cognitive abilities. However, the neuromuscular mechanisms underlying the benefits of the preferred walking speed remain unclear. Therefore, this study aimed to determine the differences in ankle neuromuscular control between the preferred and fixed speeds during walking. Eighteen healthy young adults were recruited to perform overground barefoot walking at the preferred speed, the prefer-matched control speed (PMCS), slower fixed speeds (1, 2, 3 and 4 km/h) and faster fixed speeds (5 and 6 km/h). Muscle synergies and intermuscular coherence were calculated using surface electromyography (EMG) signals of ankle muscles. Results showed that the preferred walking speed exhibited one less muscle synergy and higher intermuscular coherence in 8-42 Hz than the PMCS. Additionally, slow walking speeds performed more muscle synergies and weaker couplings between plantar flexors in 26-60 Hz than the preferred speed and faster fixed speeds. Our results demonstrate an impact of the preferred walking speed on ankle neuromuscular control during walking, which might influence energy consumption and brain resource occupation. Besides, the preferred walking speed and faster fixed speeds showed comparable modular control characteristics of ankle muscles, which might provide suggestions for experimental settings when examining individuals' natural neuromuscular control features.

Muscle synergy in several locomotor modes in chimpanzees and Japanese macaques, and its implications for the evolutionary origin of bipedalism through shared muscle synergies

Recent evidence indicates that human ancestors utilized a combination of quadrupedal walking, climbing, and bipedal walking. Therefore, the origin of bipedalism may be linked to underlying mechanisms supporting diverse locomotor modes. This study aimed to elucidate foundations of varied locomotor modes from the perspective of motor control by identifying muscle synergies and demonstrating similarities in synergy compositions across different locomotor modes in chimpanzees and Japanese macaques. Four muscle synergies were extracted for bipedal and quadrupedal walking in both the chimpanzees and macaques, as well as for vertical climbing in the chimpanzees. Bipedal walking synergies were generally analogous to those observed in quadrupedal walking and vertical climbing. Specifically, the bipedal walking synergies during the stance and swing phase in the chimpanzees were substitutable with those of vertical climbing and quadrupedal walking, respectively. For the macaque, not all bipedal walking synergies exhibited similarities to quadrupedal walking synergies, likely due to instability during the single support phase of bipedalism. These findings suggest that synergies from vertical climbing and quadrupedal walking might be transferred to bipedal walking, as seen in the chimpanzees, and that this sharing of synergies might form a foundation for a diverse range of locomotor capacities including bipedal walking.

Alterations of upper-extremity functional muscle networks in chronic stroke survivors

Current clinical assessment tools don't fully capture the genuine neural deficits experienced by chronic stroke survivors and, consequently, they don't fully explain motor function throughout everyday life. Towards addressing this problem, here we aimed to characterise post-stroke alterations in upper-limb control from a novel perspective to the muscle synergy by applying, for the first time, a computational approach that quantifies diverse types of functional muscle interactions (i.e. functionally-similar (redundant), -complementary (synergistic) and -independent (unique)). From single-trials of a simple forward pointing movement, we extracted networks of functionally diverse muscle interactions from chronic stroke survivors and unimpaired controls, identifying shared and group-specific modules across each interaction type (i.e. redundant, synergistic and unique). Reconciling previous studies, we found evidence for both the concurrent preservation of healthy functional modules post-stroke and muscle network structure alterations underpinned by systemic muscle interaction re-weighting and functional reorganisation across all interaction types. Cluster analysis of stroke survivors revealed two distinct patient subgroups from each interaction type that all distinguished less impaired individuals who were able to adopt novel motor patterns different to unimpaired controls from more severely impaired individuals who did not. Our work here provides a nuanced account of post-stroke functional impairment and, in doing so, paves new avenues towards progressing the clinical use case of muscle synergy analysis.

Comparison of muscle synergies in walking and pedaling: the influence of rotation direction and speed

Background

Understanding the muscle synergies shared between pedaling and walking is crucial for elucidating the mechanisms of human motor control and establishing highly individualized rehabilitation strategies. This study investigated how pedaling direction and speed influence the recruitment of walking-like muscle synergies.

Methods

Twelve healthy male participants pedaled at three speeds (60 RPM, 30 RPM, and 80 RPM) in two rotational directions (forward and backward). Additionally, they completed walking tasks at three different speeds (slow, comfortable, and fast). Surface electromyography (EMG) was recorded on 10 lower limb muscles during movement, and muscle synergies were extracted from each condition using non-negative matrix factorization. The similarities between the muscle synergies during walking and each pedaling condition were examined using cosine similarity.

Results

The results confirmed that the composition of muscle synergies during pedaling varied depending on the rotational direction and speed. Furthermore, one to three muscle synergies, similar to those observed during walking, were recruited in each pedaling condition, with specific synergies dependent on direction and speed. For instance, synergy involving the quadriceps and hip extensors was predominantly observed during pedaling at 30 RPM, regardless of the direction of rotation. Meanwhile, synergy involving the hamstrings was more pronounced during forward pedaling at 60 RPM and backward pedaling at 80 RPM.

Conclusion

These findings suggest that walking-like muscle synergies can be selectively recruited during pedaling, depending on the rotational direction and speed.

Muscle Synergies in Patients with Medial Knee Osteoarthritis During Level-, Ramp- and Stair Locomotion

Knee osteoarthritis (KOA) is a prevalent and severe condition with versatile effects on human locomotion, including alterations in neuromuscular control. Muscle synergies are understood as functional low-dimensional building blocks within the neuromuscular organization. To examine alterations in muscle synergy patterns during locomotion tasks in the presence of KOA, 40 participants, including 20 with medial KOA (KL-Score ≥ 2), performed level walking, as well as ramp and stair ascent and descent trials at self-selected speeds. Sixteen-Channel bilateral surface electromyography (sEMG) and marker-based motion capture data were collected. Non-negative matrix factorization (NNMF) was applied to the sEMG data for muscle synergy extraction. During level walking and descending conditions, structural changes in muscle synergy composition were observed in the KOA affected limb when compared to the unaffected side and control group. Alterations included fewer, merged synergies with prolonged activation coefficients and a higher percentage of unclassifiable synergies. No major alterations were observed during ascending conditions. No significant differences in gait speed and stride length were observed. These results indicate that muscle synergy composition can be altered in the presence of KOA regardless of age and gait speed, but not during all forms of locomotion.

Synergy in motion: Exploring the similarity and variability of muscle synergy patterns in healthy individuals

BACKGROUND

Recent studies suggest that muscle synergy patterns can be a guide for diagnosis and rehabilitation.

RESEARCH QUESTION

Does human's lower limb synergy pattern significantly change with changes in walking speed? Are there large differences in synergy patterns among different healthy individuals?

METHODS

22 healthy subjects from an open-source datasets were included. Non-negative matrix factorization was applied to identify the module composition of surface electromyography(sEMG) data, and the similarity index was adopted to quantify the overall similarity between synergy patterns.

RESULTS

Results demonstrated that healthy individuals have their own intrinsic muscle recruitment and coordination characteristics for locomotion at various speeds, additionally, their synergy patterns exhibit predictability under speed variations.

SIGNIFICANCE

This study develop reference synergy patterns for the lower limbs across 28 different walking speeds. The developed synergy patterns and the above findings may guide the study of gait synergy in rehabilitation and assistance.

Role of the Cerebellum in the Construction of Functional and Geometrical Spaces

The perceptual and motor systems appear to have a set of movement primitives that exhibit certain geometric and kinematic invariances. Complex patterns and mental representations can be produced by (re)combining some simple motor elements in various ways using basic operations, transformations, and respecting a set of laws referred to as kinematic laws of motion. For example, point-to-point hand movements are characterized by straight hand paths with single-peaked-bell-shaped velocity profiles, whereas hand speed profiles for curved trajectories are often irregular and more variable, with speed valleys and inflections extrema occurring at the peak curvature. Curvature and speed are generically related by the 2/3 power law. Mathematically, such laws can be deduced from a combination of Euclidean, affine, and equi-affine geometries, whose neural correlates have been partially detected in various brain areas including the cerebellum and the basal ganglia. The cerebellum has been found to play an important role in the control of coordination, balance, posture, and timing over the past years. It is also assumed that the cerebellum computes forward internal models in relationship with specific cortical and subcortical brain regions but its motor relationship with the perceptual space is unclear. A renewed interest in the geometrical and spatial role of the cerebellum may enable a better understanding of its specific contribution to the action-perception loop and behavior's adaptation. In this sense, we complete this overview with an innovative theoretical framework that describes a possible implementation and selection by the cerebellum of geometries adhering to different mathematical laws.

Neuromuscular Mechanisms of Motor Adaptation to Repeated Treadmill-Slip Perturbations During Stance in Healthy Young Adults

Treadmill-based repeated perturbation training (PBT) induces motor adaptation in reactive balance responses, thus lowering the risk of slip-induced falls. However, little evidence exists regarding intervention-induced changes in neuromuscular control underlying motor adaptation. Examining neuromuscular changes could be an important step in identifying key elements of adaptation and evaluating treadmill training protocols for fall prevention. Moreover, identifying the muscle synergies contributing to motor adaptation in young adults could lay the groundwork for comparison with high fall-risk populations. Thus, we aimed to investigate neuromuscular changes in reactive balance responses during stance slip-PBT. Lower limb electromyography (EMG) signals (4/leg) were recorded during ten repeated forward stance (slip-like) perturbations in twenty-six young adults. Muscle synergies were compared between early-training (slips 1-2) and late-training (slips 9-10) stages. Results showed that 5 different modes of synergies (named on dominant muscles: WTA, W , W , W , and W were recruited in both stages. 3 out of 5 synergies (WTA, W , and W showed a high similarity (r >0.97) in structure and activation between stages, whereas W and W showed a lower similarity (r <0.83) between the two stages, and the area of activation in WTA, the peak value of activation in W and the activation onset in W showed a reduction from early- to late-training stage (p <0.05). These results suggest that a block of stance slip-PBT resulted in modest changes in muscle synergies in young adults, which might explain the smaller changes seen in biomechanical variables. Future studies should examine neuromuscular changes in people at high risk of falls.

Minimum Electromyography Sensor Set Needed to Identify Age-Related Impairments in the Neuromuscular Control of Walking Using the Dynamic Motor Control Index

The dynamic motor control index is an emerging biomarker of age-related neuromuscular impairment. To date, it has been computed by quantifying the co-activity of eleven lower limb muscles. Because clinics that routinely employ electromyography typically collect from fewer muscles, a reduced muscle sensor set may improve the clinical usability of this metric of motor control. This study aimed to test if commonly used eight- and five-muscle electromyography (EMG) sensor sets produce similar dynamic motor control indices as the previously examined eleven-muscle sensor set and similarly differentiate across age subgroups. EMG data were collected during treadmill walking from 36 adults separated into young (N = 18, <35 yrs.), young-old (N = 13, 65-74 yrs.), and old-old (N = 5, ≥75 yrs.) subgroups. Dynamic motor control indices generated using the sensor set with eleven muscles correlated with the eight-muscle set (R2 = 0.70) but not the five-muscle set (R2 = 0.30). Regression models using the eleven-muscle (χ2(4) = 10.62, p = 0.031, Nagelkerke R2 = 0.297) and eight-muscle (χ2(4) = 9.418, p = 0.051, Nagelkerke R2 = 0.267) sets were significant and approaching significance, respectively, whereas the model for the five-muscle set was not significant (p = 0.663, Nagelkerke R2 = 0.073). In both the eleven-muscle (Wald χ2 = 5.16, p = 0.023, OR = 1.26) and eight-muscle models (Wald χ2 = 4.20, p = 0.04, OR = 1.19), a higher index significantly predicted being in the young group compared to the old-old group. Age-related differences in the neuromuscular control of walking can be detected using dynamic motor control indices generated using eleven- and eight-muscle sensor sets, increasing clinical usability of the dynamic motor control index.

Application of Muscle Synergies for Gait Rehabilitation After Stroke: Implications for Future Research

BACKGROUND/OBJECTIVE

Muscle synergy analysis based on machine learning has significantly advanced our understanding of the mechanisms underlying the central nervous system motor control of gait and has identified abnormal gait synergies in stroke patients through various analytical approaches. However, discrepancies in experimental conditions and computational methods have limited the clinical application of these findings. This review seeks to integrate the results of existing studies on the features of muscle synergies in stroke-related gait abnormalities and provide clinical and research insights into gait rehabilitation.

METHODS

A systematic search of Web of Science, PubMed, and Scopus was conducted, yielding 10 full-text articles for inclusion.

RESULTS

By comprehensively reviewing the consistencies and differences in the study outcomes, we emphasize the need to segment the gait cycle into specific phases (e.g., weight acceptance, push-off, foot clearance, and leg deceleration) during the treatment process of gait rehabilitation and to develop rehabilitation protocols aimed at restoring normal synergy patterns in each gait phase and fractionating reduced synergies.

CONCLUSIONS

Future research should focus on validating these protocols to improve clinical outcomes and introducing indicators to assess abnormalities in the temporal features of muscle synergies.

Understanding corticomotor mechanisms for activation of non-target muscles during unilateral isometric contractions of leg muscles after stroke

PURPOSE

Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation.

MATERIALS AND METHODS

Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion. To quantify involuntary muscle activation in non-target muscles, muscle activation was measured during contractions from the ipsilateral tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris (BF) and normalized to resting muscle activity. To provide insight into mechanisms of involuntary non-target muscle activation, TMS was applied to the contralateral hemisphere, and motor evoked potentials (MEPs) were recorded.

RESULTS

We found significant muscle activation in nearly every non-target muscle during isometric unilateral contractions. MEPs were frequently observed in non-target muscles, but greater non-target MEP amplitude was not associated with greater non-target muscle activation.

CONCLUSIONS

Our results suggest that non-target muscle activation occurs frequently in individuals with chronic stroke. The lack of association between non-target TMS responses and non-target muscle activation suggests that non-target muscle activation may have a subcortical or spinal origin. Non-target muscle activation has important clinical implications because it may impair torque production, out-of-synergy movement, and muscle activation timing.

Kinematic and neuromuscular characterization of cognitive involvement in gait control in healthy young adults

The signature of cognitive involvement in gait control has rarely been studied using both kinematic and neuromuscular features. The present study aimed to address this gap. Twenty-four healthy young adults walked on an instrumented treadmill in a virtual environment under two optic flow conditions: normal (NOF) and perturbed (POF, continuous mediolateral pseudorandom oscillations). Each condition was performed under single-task and dual-task conditions of increasing difficulty (1-, 2-, 3-back). Subjective mental workload (raw NASA-TLX), cognitive performance (mean reaction time and d-prime), kinematic (steadiness, variability, and complexity in the mediolateral and anteroposterior directions), and neuromuscular (duration and variability of motor primitives) control of gait were assessed. The cognitive performance and the number and composition of motor modules were unaffected by simultaneous walking, regardless of the optic flow condition. Kinematic and neuromuscular variability was greater under POF compared with NOF conditions. Young adults sought to counteract POF by rapidly correcting task-relevant gait fluctuations. The depletion of cognitive resources through dual-tasking led to reduced kinematic and neuromuscular variability and this occurred to the same extent regardless of simultaneous working memory (WM) load. Increasing WM load led to a prioritization of gait control in the mediolateral direction over the anteroposterior direction. The impact of POF on kinematic variability (step velocity) was reduced when a cognitive task was performed simultaneously, but this phenomenon was not modulated by WM load. Collectively, these results shed important light on how young adults adjust the processes involved in goal-directed locomotion when exposed to varying levels of task and environmental constraints.NEW & NOTEWORTHY The kinematic and neuromuscular signatures of cognitive involvement in gait control have rarely been studied jointly. We sought to address this issue using gait perturbation and dual-task paradigms. The protocol consisted of a fixed-speed treadmill walk to which visual and cognitive constraints were applied separately and together. The results revealed that young adults optimally regulated their gait to cope with these constraints by maintaining relatively stable muscle synergies and flexibly allocating attentional resources.

Muscle synergies during the walk-run and run-walk transitions

Background

Muscular synergies could represent the patterns of muscular activation used by the central nervous system (CNS) to simplify the production of movement. Studies in walking-running transitions described up to nine synergy modules, and an earlier activation of flexor and extension ankle muscular groups compared to running or walking. Our project aims to study the behaviour of muscle synergies in different stance and swing variations of walking-running (WRT) and running-walking (RWT) transitions.

Methods

Twenty-four trained men participated in this study. A variable speed protocol on a treadmill was developed to record the activity of 14 muscle during walking, running and relative transitions. The protocol was based on five ramps of 50 seconds each around ± 10 and 20% of the WRT speed. WRT and RWT were identified according to an abrupt change of the duty factor. Analysing surface electromyography using non-negative matrix factorization (NMF) we obtained synergy modules and temporal activation profiles. Alpha threshold for statistical tests set at 0.05.

Results

We described four different transition strides, two for increasing speed transitions, and two for decreasing speed transitions. Four to six synergy modules were found in each condition. According to the maximum cosine similarity results, the two identified WRT conditions shared five modules, while the two RWT conditions shared four modules. WRT and RWT overall shared 4.33 ± 0.58 modules. The activation profiles and centres of activation revealed differences among conditions.

Discussion

Transition occurred at step level, and transition strides were composed by walk-like and run-like steps. Compared with previous studies in running and walking, both transitions needed earlier activation of a comparable number of synergy modules. Synergies were affected by acceleration: during RWT the need to dissipate energy, to decrease the speed, was achieved by increasing the number of co-activating muscles. This was reflected in fewer synergy modules and different activation profiles compared to WRT. We believe that our results could be enforced in different applied fields, like clinical gait analysis, physiotherapy and rehabilitation, where plans including co-activation of specific muscular groups could be useful. Gait transitions are common in different sports, and therefore also application in training and sport science would be possible.

Kinematic-Muscular Synergies Describe Human Locomotion with a Set of Functional Synergies

Kinematics, kinetics and biomechanics of human gait are widely investigated fields of research. The biomechanics of locomotion have been described as characterizing muscle activations and synergistic control, i.e., spatial and temporal patterns of coordinated muscle groups and joints. Both kinematic synergies and muscle synergies have been extracted from locomotion data, showing that in healthy people four-five synergies underlie human locomotion; such synergies are, in general, robust across subjects and might be altered by pathological gait, depending on the severity of the impairment. In this work, for the first time, we apply the mixed matrix factorization algorithm to the locomotion data of 15 healthy participants to extract hybrid kinematic-muscle synergies and show that they allow us to directly link task space variables (i.e., kinematics) to the neural structure of muscle synergies. We show that kinematic-muscle synergies can describe the biomechanics of motion to a better extent than muscle synergies or kinematic synergies alone. Moreover, this study shows that at a functional level, modular control of the lower limb during locomotion is based on an increased number of functional synergies with respect to standard muscle synergies and accounts for different biomechanical roles that each synergy may have within the movement. Kinematic-muscular synergies may have impact in future work for a deeper understanding of modular control and neuro-motor recovery in the medical and rehabilitation fields, as they associate neural and task space variables in the same factorization. Applications include the evaluation of post-stroke, Parkinson's disease and cerebral palsy patients, and for the design and development of robotic devices and exoskeletons during walking.

Ethnokinesiology: towards a neuromechanical understanding of cultural differences in movement

Each individual's movements are sculpted by constant interactions between sensorimotor and sociocultural factors. A theoretical framework grounded in motor control mechanisms articulating how sociocultural and biological signals converge to shape movement is currently missing. Here, we propose a framework for the emerging field of ethnokinesiology aiming to provide a conceptual space and vocabulary to help bring together researchers at this intersection. We offer a first-level schema for generating and testing hypotheses about cultural differences in movement to bridge gaps between the rich observations of cross-cultural movement variations and neurophysiological and biomechanical accounts of movement. We explicitly dissociate two interacting feedback loops that determine culturally relevant movement: one governing sensorimotor tasks regulated by neural signals internal to the body, the other governing ecological tasks generated through actions in the environment producing ecological consequences. A key idea is the emergence of individual-specific and culturally influenced motor concepts in the nervous system, low-dimensional functional mappings between sensorimotor and ecological task spaces. Motor accents arise from perceived differences in motor concept topologies across cultural contexts. We apply the framework to three examples: speech, gait and grasp. Finally, we discuss how ethnokinesiological studies may inform personalized motor skill training and rehabilitation, and challenges moving forward.This article is part of the theme issue 'Minds in movement: embodied cognition in the age of artificial intelligence'.

The future of in-field sports biomechanics: wearables plus modelling compute real-time in vivo tissue loading to prevent and repair musculoskeletal injuries

This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world.

Muscle synergies in upper limb stroke rehabilitation: a scoping review

INTRODUCTION

Upper limb impairment is a common consequence of stroke, significantly affecting the quality of life and independence of survivors. This scoping review assesses the emerging field of muscle synergy analysis in enhancing upper limb rehabilitation, focusing on the comparison of various methodologies and their outcomes. It aims to standardize these approaches to improve the effectiveness of rehabilitation interventions and drive future research in the domain.

EVIDENCE ACQUISITION

Studies included in this scoping review focused on the analysis of muscle synergies during longitudinal rehabilitation of stroke survivors' upper limbs. A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases, until September 2023, and was guided by the PRISMA for scoping review framework.

EVIDENCE SYNTHESIS

Fourteen studies involving a total of 247 stroke patients were reviewed, featuring varied patient populations and rehabilitative interventions. Protocols differed among studies, with some utilizing robotic assistance and others relying on traditional therapy methods. Muscle synergy extraction was predominantly conducted using Non-Negative Matrix Factorization from electromyography data, focusing on key upper limb muscles essential for shoulder, elbow, and wrist rehabilitation. A notable observation across the studies was the heterogeneity in findings, particularly in the changes observed in the number, weightings, and temporal coefficients of muscle synergies. The studies indicated varied and complex relationships between muscle synergy variations and clinical outcomes. This diversity underscored the complexity involved in interpreting muscle coordination in the stroke population. The variability in results was also influenced by differing methodologies in muscle synergy analysis, highlighting a need for more standardized approaches to improve future research comparability and consistency.

CONCLUSIONS

The synthesis of evidence presented in this scoping review highlights the promising role of muscle synergy analysis as an indicator of motor control recovery in stroke rehabilitation. By offering a comprehensive overview of the current state of research and advocating for harmonized methodological practices in future longitudinal studies, this scoping review aspires to advance the field of upper limb rehabilitation, ensuring that post-stroke interventions are both scientifically grounded and optimally beneficial for patients.

The Effect of Short-Term Kinesiology Taping on Neuromuscular Controls in Hallux Valgus During Gait: A Study of Muscle and Kinematic Synergy

To investigate the biomechanical mechanisms underlying the pathogenesis and explore the effects of kinesiology taping (KT) on neuromuscular control in HV patients. The study population consisted of 16 young controls (YC group) and 15 patients with hallux valgus (HV group). All subjects underwent a natural velocity gait assessment. Additionally, 11 patients from the HV group received KT intervention over a period of one month, consisting of 15 sessions administered every other day. After the one-month intervention, these patients underwent a gait assessment and were included in the HV-KT group. The electromyography (EMG) and joint motion were evaluated using non-negative matrix factorization (NNMF) to compare the difference in muscle and kinematic synergy among the three groups. The center of plantar pressure (COP) and ground reaction force (GRF) were measured by the force platform. The number of synergies did not differ within the three groups, but the structure of muscle synergies and kinematic synergies differed in the HV group. The KT intervention (HV-KT group) altered the structure of synergies. The correlation between kinematic synergies and muscular synergies was lower in the HV group than in the YC group, whereas the correlation between the two increased after the KT intervention in the HV group. During gait, the HV group tended to activate more muscles around foot joints to maintain body stability. The visual analogue scale (VAS) scores, hallux valgus angle (HVA), and COP were significantly decreased after the intervention ( [Formula: see text]). HV patients exhibited altered kinematic and muscular synergies structures as well as muscle activation. Also, it weakened the balance and athletic ability of HV patients. KT intervention improved neuromuscular control to provide a better gait performance.

Synergy-Dependent Center-of-Mass Control Strategies During Sit-to-Stand Movements

The characterization, through the concept of muscle synergies, of clinical functional tests is a valid tool that has been widely adopted in the research field. While this theory has been exploited for a description of the motor control strategies underlying the biomechanical task, the biomechanical correlate of the synergistic activity is yet to be fully described. In this paper, the relationship between the activity of different synergies and the center of mass kinematic patterns has been investigated; in particular, a group of healthy subjects has been recruited to perform simple sit-to-stand tasks, and the electromyographic data has been recorded for the extraction of muscle synergies. An optimal model selection criterion has been adopted for dividing the participants by the number of synergies characterizing their own control schema. Synergistic activity has then been mapped onto the phase-space description of the center of mass kinematics, investigating whether a different number of synergies implies the exploration of different region of the phase-space itself. Results show how using an additional motor module allow for a wider trajectory in the phase-space, paving the way for the use of kinematic feedback to stimulate the activity of different synergies, with the aim of defining synergy-based rehabilitation or training protocols.

Neuromuscular Control Strategies in Basketball Shooting: Distance-Dependent Analysis of Muscle Synergies

Basketball victory relies on an athlete's skill to make precise shots at different distances. While extensive research has explored the kinematics and dynamics of different shooting distances, the specific neuromuscular control strategies involved remain elusive. This study aimed to compare the differences in muscle synergies during basketball shooting at different distances, offering insights into neuromuscular control strategies and guiding athletes' training. Ten skilled shooting right-handed male basketball players participated as subjects in this experiment. Electromyographic (EMG) data for full-phase shooting were acquired at short (3.2 m), middle (5.0 m), and long (6.8 m) distances. Non-negative matrix decomposition extracted muscle synergies (motor modules and motor primitives) during shooting. The results of this study show that all three distance shooting can be broken down into three synergies and that there were differences in the synergies between short and long distances, with differences in motor primitive 1 and motor primitive 2 at the phase of 45% - 59% (p < 0.001, t* = 4.418), and 78% - 88% (p < 0.01, t* = 4.579), respectively, and differences in the motor module 3 found in the differences in muscle weights for rectus femoris (RF) (p = 0.001, d = -2.094), and gastrocnemius lateral (GL) (p = 0.001, d = -2.083). Shooting distance doesn't affect the number of muscle synergies in basketball shooting but alters synergy patterns. During long distance shooting training, basketball players should place more emphasis on the timing and synergistic activation of upper and lower limbs, as well as core muscles.

Hand muscle synergy in chopstick use: effect of object size and weight

This study explains the role of muscle coordination in chopstick manipulation and investigates the effects of object width and weight on intrinsic and extrinsic hand muscle activity when picking up objects with chopsticks. Surface electromyography was used to measure the activity of the intrinsic and extrinsic hand muscles when picking up objects of varying widths and weights using chopsticks. The results revealed coordinated muscle activity patterns in the intrinsic and extrinsic hand muscles and coordination between them during chopstick manipulation. Object widths varying between 1 and 3 cm did not significantly affect muscle activity; however, object weight influenced muscle activity during both chopstick closing and object grasping, with greater muscle activity in the 40 g condition than in the 10 g condition. Intrinsic hand muscles were found to be involved in object grasping, regardless of object weight. These findings suggest that object weight should be considered when practicing picking up objects with chopsticks in scenarios resembling daily dining, to prevent excessive muscle activity during rehabilitation.

Altered muscle synergy structure in patients with poststroke stiff knee gait

Stiff knee gait (SKG) occurrence after a stroke is associated with various abnormal muscle activities; however, the interactions among these muscles are unclear. This study aimed to elucidate the muscle synergy characteristics during walking in patients with SKG after a stroke. This cross-sectional study included 20 patients with poststroke SKG (SKG group), 16 patients without poststroke SKG (non-SKG group), and 15 healthy adults (control group). Participants walked a 10-m distance at a comfortable speed, and electromyographic data were recorded from six lower-limb muscles. Non-negative matrix factorization was employed to derive time-varying activity (C), muscle weights (W), and the percentage of total variance accounted for (tVAF) for muscle synergies. The SKG group showed a higher tVAF than the control group. The initial stance module (including knee extensors) showed increased activity during the swing phase. The initial swing module (including hip flexors and ankle dorsiflexors) exhibited a higher activity during the single-support phase but a lower activity during the swing phase. The synergy structure in patients with SKG after stroke was simplified, with specific abnormalities in synergy activities. SKG may arise from several synergy alterations involving multiple muscles, indicating that approaches focused on controlling individual muscle activities are unsuitable.

Muscle Synergy Analysis as a Tool for Assessing the Effectiveness of Gait Rehabilitation Therapies: A Methodological Review and Perspective

According to the modular hypothesis for the control of movement, muscles are recruited in synergies, which capture muscle coordination in space, time, or both. In the last two decades, muscle synergy analysis has become a well-established framework in the motor control field and for the characterization of motor impairments in neurological patients. Altered modular control during a locomotion task has been often proposed as a potential quantitative metric for characterizing pathological conditions. Therefore, the purpose of this systematic review is to analyze the recent literature that used a muscle synergy analysis of neurological patients' locomotion as an indicator of motor rehabilitation therapy effectiveness, encompassing the key methodological elements to date. Searches for the relevant literature were made in Web of Science, PubMed, and Scopus. Most of the 15 full-text articles which were retrieved and included in this review identified an effect of the rehabilitation intervention on muscle synergies. However, the used experimental and methodological approaches varied across studies. Despite the scarcity of studies that investigated the effect of rehabilitation on muscle synergies, this review supports the utility of muscle synergies as a marker of the effectiveness of rehabilitative therapy and highlights the challenges and open issues that future works need to address to introduce the muscle synergies in the clinical practice and decisional process.

Identifying alterations in hand movement coordination from chronic stroke survivors using a wearable high-density EMG sleeve

Objective.Non-invasive, high-density electromyography (HD-EMG) has emerged as a useful tool to collect a range of neurophysiological motor information. Recent studies have demonstrated changes in EMG features that occur after stroke, which correlate with functional ability, highlighting their potential use as biomarkers. However, previous studies have largely explored these EMG features in isolation with individual electrodes to assess gross movements, limiting their potential clinical utility. This study aims to predict hand function of stroke survivors by combining interpretable features extracted from a wearable HD-EMG forearm sleeve.Approach.Here, able-bodied (N= 7) and chronic stroke subjects (N= 7) performed 12 functional hand and wrist movements while HD-EMG was recorded using a wearable sleeve. A variety of HD-EMG features, or views, were decomposed to assess alterations in motor coordination.Main Results.Stroke subjects, on average, had higher co-contraction and reduced muscle coupling when attempting to open their hand and actuate their thumb. Additionally, muscle synergies decomposed in the stroke population were relatively preserved, with a large spatial overlap in composition of matched synergies. Alterations in synergy composition demonstrated reduced coupling between digit extensors and muscles that actuate the thumb, as well as an increase in flexor activity in the stroke group. Average synergy activations during movements revealed differences in coordination, highlighting overactivation of antagonist muscles and compensatory strategies. When combining co-contraction and muscle synergy features, the first principal component was strongly correlated with upper-extremity Fugl Meyer hand sub-score of stroke participants (R2= 0.86). Principal component embeddings of individual features revealed interpretable measures of motor coordination and muscle coupling alterations.Significance.These results demonstrate the feasibility of predicting motor function through features decomposed from a wearable HD-EMG sleeve, which could be leveraged to improve stroke research and clinical care.

Increased trial-to-trial similarity and reduced temporal overlap of muscle synergy activation coefficients manifest during learning and with increasing movement proficiency

Muscle synergy analyses are used to enhance our understanding of motor control. Spatially fixed synergy weights coordinate multiple co-active muscles through activation commands, known as activation coefficients. To gain a more comprehensive understanding of motor learning, it is essential to understand how activation coefficients vary during a learning task and at different levels of movement proficiency. Participants walked on a line, a beam, and learned to walk on a tightrope-tasks that represent different levels of proficiency. Muscle synergies were extracted from electromyography signals across all conditions and the number of synergies was determined by the knee-point of the total variance accounted for (tVAF) curve. The results indicated that the tVAF of one synergy decreased with task proficiency, with the tightrope task resulting in the highest tVAF compared to the line and beam tasks. Furthermore, with increasing proficiency and after a learning process, trial-to-trial similarity increased and temporal overlap of synergy activation coefficients decreased. Consequently, we propose that precise adjustment and refinement of synergy activation coefficients play a pivotal role in motor learning.

Study of the internal mechanism of attention focus affecting countermovement jump performance based on muscle synergy theory

OBJECTIVE

The purpose of this study was to explain the internal mechanism of attention focus affecting performance of countermovement jump based on muscle synergy theory.

METHODS

Participants involved untrained group(N = 10) and high-level group(N = 11). Subjects performed countermovement jump with internal attention focus instruction (IF), external distal attention focus instruction (EDF), and external proximal attention focus instruction (EPF). The electromyography (EMG) signals of the dominant vastus lateralis muscle (VL), semitendinosus muscle (ST), tibial anterior muscle (TA), rectus femoris muscle (RF), and medial gastrocnemius (MG) were recorded. The non-negative matrix factorization was used to extract muscle synergy.

RESULTS

1) Attention focus did not affect countermovement jump performance and the number of muscle synergy in the high-level group (P>0.05). 2) Attention focus instructions affected the untrained group countermovement jump (P<0.05). and EDF and EPF reduced the number of muscle synergy. 3)The Cohen's d of EDF (0.269) was less than EPF (0.377) in untrained group.

CONCLUSION

For the untrained people, the improved motor performance caused by attention focus resembled the adaptive changes that occur with long-term training. The reason why an EDF is superior to EPF is that the former produces more thorough changes in muscle synergy.

Diverse Plantarflexor Module Characteristics Influence Immediate Effects of Plastic Ankle-Foot Orthosis on Gait Performance in Patients With Stroke: A Cross-sectional Study

OBJECTIVE

To investigate the immediate effects of plastic ankle-foot orthosis (AFO) on locomotor performance in patients with stroke and determine how such effects might undergo alteration when distinct plantarflexor (PF) module subtypes are considered.

DESIGN

Cross-sectional study.

SETTING

Two university hospitals.

PARTICIPANTS

Fifty-two patients with stroke and 21 of those without stroke (N=73).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Motor modules were identified through non-negative matrix factorization, and participants were classified into 3 groups: independent-normal-timing, independent-altered-timing, and merged PF modules. To assess the effects of the AFO, gait measurements reflecting locomotor performance were obtained with and without the presence of the plastic AFO for each group.

RESULTS

The independent-altered-timing group had increased paretic propulsion, greater non-paretic step length, and faster walking speed after the administration of the plastic AFO; however, these significant changes were not observed in the independent-normal-timing and merged PF module groups. Notably, patients in the independent-normal-timing and merged PF module groups exhibited longer paretic stance times.

CONCLUSION

This study suggests that the immediate effects of plastic AFO depend on the PF module subtype. These findings can potentially guide clinical decision-making regarding AFO selection for stroke rehabilitation in patients with diverse gait control characteristics.

Heteronymous feedback from quadriceps onto soleus in stroke survivors

Background

Recent findings suggest increased excitatory heteronymous feedback from quadriceps onto soleus may contribute to abnormal coactivation of knee and ankle extensors after stroke. However, there is lack of consensus on whether persons post-stroke exhibit altered heteronymous reflexes and, when present, the origin of increased excitation (i.e. increased excitation alone and/or decreased inhibition). This study examined heteronymous excitation and inhibition from quadriceps onto soleus in paretic, nonparetic, and age-matched control limbs to determine whether increased excitation was due to excitatory and/or reduced inhibitory reflex circuits. A secondary purpose was to examine whether heteronymous reflex magnitudes were related to clinical measures of lower limb recovery, walking-speed, and dynamic balance.

Methods

Heteronymous excitation and inhibition from quadriceps onto soleus were examined in fourteen persons post-stroke and fourteen age-matched unimpaired participants. Heteronymous feedback was elicited by femoral nerve and quadriceps muscle stimulation in separate trials while participants tonically activated soleus at 20% max. Fugl-Myer assessment of lower extremity, 10-meter walk test, and Mini-BESTest were assessed in stroke survivors.

Results

Heteronymous excitation and inhibition onsets, durations, and magnitudes were not different between paretic, nonparetic or age-matched unimpaired limbs. Quadriceps stimulation elicited excitation that was half the magnitude of femoral nerve stimulation. Femoral nerve elicited paretic limb heteronymous excitation was positively correlated with walking speed but did not reach significance because only a subset of paretic limbs exhibited excitation (n = 8, Spearman r = 0.69, P = 0.058).

Conclusions

Heteronymous feedback from quadriceps onto soleus assessed in a seated posture was not impaired in persons post-stroke. Despite being unable to identify whether reduced inhibition contributes to abnormal excitation reported in prior studies, our results indicate quadriceps stimulation may allow a better estimate of heteronymous inhibition in those that exhibit exaggerated excitation. Heteronymous excitation magnitude in the paretic limb was positively correlated with self-selected walking speed suggesting paretic limb excitation at the higher end of a normal range may facilitate walking ability after stroke. Future studies are needed to identify whether heteronymous feedback from Q onto SOL is altered after stroke in upright postures and during motor tasks as a necessary next step to identify mechanisms underlying motor impairment.

Transferring Sensor-Based Assessments to Clinical Practice: The Case of Muscle Synergies

Sensor-based assessments in medical practice and rehabilitation include the measurement of physiological signals such as EEG, EMG, ECG, heart rate, and NIRS, and the recording of movement kinematics and interaction forces. Such measurements are commonly employed in clinics with the aim of assessing patients' pathologies, but so far some of them have found full exploitation mainly for research purposes. In fact, even though the data they allow to gather may shed light on physiopathology and mechanisms underlying motor recovery in rehabilitation, their practical use in the clinical environment is mainly devoted to research studies, with a very reduced impact on clinical practice. This is especially the case for muscle synergies, a well-known method for the evaluation of motor control in neuroscience based on multichannel EMG recordings. In this paper, considering neuromotor rehabilitation as one of the most important scenarios for exploiting novel methods to assess motor control, the main challenges and future perspectives for the standard clinical adoption of muscle synergy analysis are reported and critically discussed.

Kinematic synergies show good consistency when extracted with a low-cost markerless device and a marker-based motion tracking system

Recently, markerless tracking systems, such as RGB-Depth cameras, have spread to overcome some of the limitations of the gold standard marker-based tracking systems. Although these systems are valuable substitutes for human motion analysis, as they guarantee higher flexibility, faster setup time and lower costs, their tracking accuracy is lower with respect to marker-based systems. Many studies quantified the error made by markerless systems in terms of body segment length estimation, articular angles, and biomechanics, concluding that they are appropriate for many clinical applications related to motion analysis. We propose an innovative approach to compare a markerless tracking system (Kinect V2) with a gold standard marker-based system (Vicon), based on motor control assessment. We quantified kinematic synergies from the tracking data of fifteen participants performing multi-directional upper limb movements. Kinematic synergy analysis decomposes the kinematic data into a reduced set of motor primitives that describe how the central nervous system coordinates motion at spatial and temporal level. Synergies were extracted with the recently released mixed-matrix factorization algorithm. Four synergies were extracted from both marker-based and markerless datasets and synergies were grouped in 6 clusters for each dataset. Cosine similarity in each cluster was ⩾0.60 in both systems, showing good consistency of synergies. Good matching was found between synergies extracted from markerless and from marker-based data, with a cosine similarity between matched synergies ⩾0.60 in 5 out 6 synergies. These results showed that the markerless sensor can be feasible for kinematic synergy analysis for gross movements, as it correctly estimates the number of synergies and in most cases also their spatial and temporal organization.

Muscle synergies are shared across fundamental subtasks in complex movements of skateboarding

A common theory of motor control posits that movement is controlled by muscle synergies. However, the behavior of these synergies during highly complex movements remains largely unexplored. Skateboarding is a hardly researched sport that requires rapid motor control to perform tricks. The objectives of this study were to investigate three key areas: (i) whether motor complexity differs between skateboard tricks, (ii) the inter-participant variability in synergies, and (iii) whether synergies are shared between different tricks. Electromyography data from eight muscles per leg were collected from seven experienced skateboarders performing three different tricks (Ollie, Kickflip, 360°-flip). Synergies were extracted using non-negative matrix factorization. The number of synergies (NoS) was determined using two criteria based on the total variance accounted for (tVAF > 90% and adding an additional synergy does not increase tVAF > 1%). In summary: (i) NoS and tVAF did not significantly differ between tricks, indicating similar motor complexity. (ii) High inter-participant variability exists across participants, potentially caused by the low number of constraints given to perform the tricks. (iii) Shared synergies were observed in every comparison of two tricks. Furthermore, each participant exhibited at least one synergy vector, which corresponds to the fundamental 'jumping' task, that was shared through all three tricks.