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Lee NP, Pearson ES, Sanzo P, Klarner T. Exploring the personal stroke and rehabilitation experiences of older adults with chronic stroke during the COVID-19 pandemic: a qualitative descriptive study. Int J Qual Stud Health Well-being 2024; 19:2331431. [PMID: 38511399 PMCID: PMC10962289 DOI: 10.1080/17482631.2024.2331431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE The purpose of this study was to explore the personal stroke and rehabilitation experiences of older adults with chronic stroke living in a mid-sized Northwestern Ontario city in Canada during the COVID-19 pandemic. METHODS A qualitative descriptive approach with a constructivist worldview was used. In addition, a semi-structured interview guide was used to gather the participants' perspectives on their experiences throughout stroke recovery. Ten participants were interviewed, including six males and four females. The interviews were completed, transcribed, and analysed using inductive and deductive content analysis. Multiple steps were taken to enhance data trustworthiness. RESULTS Six main themes and eight related subthemes emerged. These included: getting help is complex, the effects of stroke are multifaceted, losing rehabilitation services during the COVID-19 pandemic, overcoming hardships but not alone, "If you don't use it, you lost it": rehabilitative success is based on one's actions, and "look at me now": the importance of taking pride in one's successes. CONCLUSIONS One unique finding was that the participants used this study as an opportunity to teach and advocate for future stroke survivors which is not often seen in qualitative stroke rehabilitation research. Future stroke research should place emphasis on both the positive and negative experiences of this population.
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Affiliation(s)
- Nicole P. Lee
- CONTACT Nicole P. Lee School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, OntarioP7B5E1, Canada
| | | | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Taryn Klarner
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
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2
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Møller H, Baxter R, Denton A, French E, Hill ME, Klarner T, Nothing GW, Quequish M, Rae J, Reinikka K, Strickland S, Taylor D. Outcomes from a collaborative project developing and evaluating a community rehabilitation worker program for Northwestern Ontario First Nations. Rural Remote Health 2023; 23:7809. [PMID: 37429740 DOI: 10.22605/rrh7809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Major inequities exist in levels of health and wellbeing, availability, and access to healthcare services between seniors of Indigenous and non-Indigenous background in Ontario. First Nations elders are 45-55% more frail than the average senior in Ontario. Additionally, needed rehabilitation services are not easily accessible or available in the first language of most First Nations elders within their home communities. A literature review demonstrated community-based rehabilitation assistant models had been successfully developed and implemented in regions facing similar equity and access challenges. Building on these findings, a needs assessment was conducted to capture unique needs and requirements in Northwestern Ontario relating to rehabilitation among First Nations elders. METHODS The needs assessment resulted in four First Nations, three Indigenous health organizations, three rehabilitation health organizations, and two academic institutions iteratively developing and evaluating curriculum for a Community Rehabilitation Worker (CRW) program in treaty territories 5, 9, and Robinson-Superior. The goal of the program is to train local CRWs, familiar with local languages and cultures, to provide rehabilitative services that support ageing in place, health, wellbeing, and quality of life for First Nations elders. The study employed a community participatory action research approach aligning with the OCAP® (Ownership, Control, Access, and Possession) framework for working with Indigenous populations. Seventeen community partners were active participants in the program development, evaluation, and adaptation of the CRW curriculum. Feedback was received through advisory committee meetings, surveys, and individual and group interviews. RESULTS All 101 participants agreed, across all curriculum modules, that (1) the time allotment was realistic; (2) instructional materials, activities, and resources were appropriate and easy to understand; (3) evaluation activities accurately measured learning; and (4) participants identifying as Indigenous felt that Indigenous culture was adequately reflected. The qualitative findings highlighted the importance of incorporating culture, spirituality, traditions, local language use, and reintegration of First Nations elders into traditional activities and community activities for both the CRW curriculum and rehabilitation efforts. The need for locally available First Nations, elder-focused mental health support, transportation options, and gathering spaces such as those commonly seen in urban areas was also highlighted. CONCLUSION The process of iteratively developing and evaluating a CRW program resulted in a Northwestern Ontario college welcoming the first cohort of students to the CRW program in March 2022. The program is co-facilitated with a First Nations Elder and includes components of local culture, language, and the reintegration of First Nations elders into community as part of the rehabilitation efforts. In addition, to appropriately support the quality of life, health, and wellbeing of First Nations elders, the project team called upon provincial and federal governments to work with First Nations to make available dedicated funding to address inequities in resources available to First Nations elders in Northwestern Ontario urban and First Nations remote communities. This included elder-focused transportation options, mental health services, and gathering places. The program implementation will be evaluated with the first cohort of CRWs for further adaptations considering potential scale and spread. As such, the project and findings may also represent a resource for others wishing to pursue similar development using participatory approaches in rural and remote communities both nationally and internationally.
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Affiliation(s)
- Helle Møller
- Department of Health Sciences, Lakehead University, Thunder Bay, ON P7B 5E1, Canada
| | - Robert Baxter
- Health and Social Services, Eabametoong First Nation, Eabamet Lake, ON P0T 1M0, Canada
| | - Alison Denton
- North West Regional Seniors' Care Program, St. Joseph's Care Group, Box 3251, Thunder Bay, ON P7B 5G7, Canada
| | - Esme French
- Northwestern Ontario Regional Stroke Network, Thunder Bay Regional Health Sciences Centre, 201-984 Oliver Rd, Thunder Bay, ON P7B 7C7, Canada
| | - Mary Ellen Hill
- Centre for Rural and Northern Health Research, Lakehead University, 955 Oliver Rd, Thunder Bay, ON P7B 5E1, Canada
| | - Taryn Klarner
- School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON P7B 5E1, Canada
| | - Garth W Nothing
- Bearskin Lake First Nation, Bearskin Lake, ON P0V 1E0, Canada
| | - Marlene Quequish
- North Caribou Lake First Nation, Weagamow Lake, ON P0V 2Y0, Canada
| | - Joan Rae
- Health and Social Services, Sandy Lake First Nation, Sandy Lake, ON P0V 1V0, Canada
| | - Kirsti Reinikka
- Boreal Wellness, 64 McKibbon St, Thunder Bay, ON P7B 4B2, Canada
| | - Shane Strickland
- School of Health, Negahneewin & Community Services, Confederation College, 1450 Nakina Dr, Thunder Bay, ON P7C 4W1, Canada
| | - Denise Taylor
- St. Joseph's Care Group - North West Regional Rehabilitative Care Program, Thunder Bay, ON P7B 5G7, Canada; and Northern Ontario School of Medicine University - Thunder Bay Campus, ON P7B 5E1, Canada
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Klarner T, Pearcey GEP, Sun Y, Barss TS, Zehr EP. Changing coupling between the arms and legs with slow walking speeds alters regulation of somatosensory feedback. Exp Brain Res 2020; 238:1335-1349. [PMID: 32333034 DOI: 10.1007/s00221-020-05813-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
Arm swing movement is coordinated with movement of the legs during walking, where the frequency of coordination depends on walking speed. At typical speeds, arm and leg movements, respectively, are frequency locked in a 1:1 ratio but at slow speeds this changes to a 2:1 ratio. It is unknown if the changes in interlimb ratio that accompany slow walking speeds alters regulation of somatosensory feedback. To probe the neural interactions between the arms and legs, somatosensory linkages in the form of interlimb cutaneous reflexes were examined. It was hypothesized that different interlimb frequencies and walking speeds would result in changes in the modulation of cutaneous reflexes between the arms and legs. To test this hypothesis, participants walked in four combinations of walking speed (typical, slow) and interlimb coordination (1:1, and 2:1), while cutaneous reflexes and background muscle activity were evaluated with stimulation applied to the superficial peroneal nerve at the ankle and superficial radial nerve at the wrist. Results show main effects of interlimb coordination and walking speed on cutaneous reflex modulation, effects are largest in the swing phase, and a directional coupling was observed, where changes in the frequency of arm movements had a greater effect on muscle activity in the legs compared to the reverse. Task-dependent modulation was also revealed from stimulation at local and remote sources. Understanding the underlying neural mechanisms for the organization of rhythmic arm movement, and its coordination with the legs in healthy participants, can give insight into pathological walking, and will facilitate the development of effective strategies for the rehabilitation of walking.
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Affiliation(s)
- Taryn Klarner
- School of Kinesiology, Lakehead University, Thunder Bay, Canada.,Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Trevor S Barss
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada. .,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada. .,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
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4
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Barss TS, Klarner T, Sun Y, Inouye K, Zehr EP. Effects of enhanced cutaneous sensory input on interlimb strength transfer of the wrist extensors. Physiol Rep 2020; 8:e14406. [PMID: 32222042 PMCID: PMC7101283 DOI: 10.14814/phy2.14406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023] Open
Abstract
The relative contribution of cutaneous sensory feedback to interlimb strength transfer remains unexplored. Therefore, this study aimed to determine the relative contribution of cutaneous afferent pathways as a substrate for cross-education by directly assessing how "enhanced" cutaneous stimulation alters ipsilateral and contralateral strength gains in the forearm. Twenty-seven right-handed participants were randomly assigned to 1-of-3 training groups and completed 6 sets of 8 repetitions 3x/week for 5 weeks. Voluntary training (TRAIN) included unilateral maximal voluntary contractions (MVCs) of the wrist extensors. Cutaneous stimulation (STIM), a sham training condition, included cutaneous stimulation (2x radiating threshold; 3sec; 50Hz) of the superficial radial (SR) nerve at the wrist. TRAIN + STIM training included MVCs of the wrist extensors with simultaneous SR stimulation. Two pre- and one posttraining session assessed the relative increase in force output during MVCs of isometric wrist extension, wrist flexion, and handgrip. Maximal voluntary muscle activation was simultaneously recorded from the flexor and extensor carpi radialis. Cutaneous reflex pathways were evaluated through stimulation of the SR nerve during graded ipsilateral contractions. Results indicate TRAIN increased force output compared with STIM in both trained (85.0 ± 6.2 Nm vs. 59.8 ± 6.1 Nm) and untrained wrist extensors (73.9 ± 3.5 Nm vs. 58.8 Nm). Providing 'enhanced' sensory input during training (TRAIN + STIM) also led to increases in strength in the trained limb compared with STIM (79.3 ± 6.3 Nm vs. 59.8 ± 6.1 Nm). However, in the untrained limb no difference occurred between TRAIN + STIM and STIM (63.0 ± 3.7 Nm vs. 58.8 Nm). This suggests when 'enhanced' input was provided independent of timing with active muscle contraction, interlimb strength transfer to the untrained wrist extensors was blocked. This indicates that the sensory volley may have interfered with the integration of appropriate sensorimotor cues required to facilitate an interlimb transfer, highlighting the importance of appropriately timed cutaneous feedback.
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Affiliation(s)
- Trevor S. Barss
- Rehabilitation Neuroscience LaboratoryUniversity of VictoriaVictoriaBCCanada
- Human Discovery ScienceInternational Collaboration on Repair Discoveries (ICORD)VancouverBCCanada
- Centre for Biomedical ResearchUniversity of VictoriaVictoriaBCCanada
| | - Taryn Klarner
- Rehabilitation Neuroscience LaboratoryUniversity of VictoriaVictoriaBCCanada
- Human Discovery ScienceInternational Collaboration on Repair Discoveries (ICORD)VancouverBCCanada
- Centre for Biomedical ResearchUniversity of VictoriaVictoriaBCCanada
- School of KinesiologyLakehead UniversityThunder BayONUSA
| | - Yao Sun
- Rehabilitation Neuroscience LaboratoryUniversity of VictoriaVictoriaBCCanada
- Human Discovery ScienceInternational Collaboration on Repair Discoveries (ICORD)VancouverBCCanada
- Centre for Biomedical ResearchUniversity of VictoriaVictoriaBCCanada
| | - Kristy Inouye
- Rehabilitation Neuroscience LaboratoryUniversity of VictoriaVictoriaBCCanada
| | - E. Paul Zehr
- Rehabilitation Neuroscience LaboratoryUniversity of VictoriaVictoriaBCCanada
- Human Discovery ScienceInternational Collaboration on Repair Discoveries (ICORD)VancouverBCCanada
- Centre for Biomedical ResearchUniversity of VictoriaVictoriaBCCanada
- Division of Medical SciencesUniversity of VictoriaBCCanada
- Zanshin Consulting Inc.VictoriaBCCanada
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5
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Abstract
"Cross-education" is the increase in strength or functional performance of an untrained limb after unilateral training. A major limitation for clinical translation from unilateral injury includes knowledge on the minimum time for the emergence of crossed effects. Therefore, the primary purpose was to characterize the time course of bilateral strength changes during both "traditional" ( n = 11) and "daily" ( n = 8) unilateral handgrip training in neurologically intact participants. Traditional training included five sets of five maximal voluntary handgrip contractions 3 times/wk for 6 wk whereas daily training included the same number of sessions and contractions but over 18 consecutive days. Three pre- and one posttest session evaluated strength, muscle activation, and reflex excitability bilaterally. Time course information was assessed by recording handgrip force for every contraction in the trained limb and from a single contraction on every third training session in the untrained limb. Six weeks of traditional training increased handgrip strength in the trained limb after the 9th session whereas the untrained limb was stronger after the 12th session. This was accompanied by increased peak muscle activation and bilateral alterations in Hoffmann reflex excitability. Daily training revealed a similar number of sessions (15) were required to induce significant strength gains in the untrained limb (7.8% compared with 12.5%) in approximately half the duration of traditional training. Therefore, minimizing rest days may improve the efficiency of unilateral training when the trained limb is not the focus. Establishing a "dose" for the time course of adaptation to strength training is paramount for effective translation to rehabilitative interventions. NEW & NOTEWORTHY Unilateral handgrip training using a "traditional" protocol (3 times/wk; 6 wk) increased strength bilaterally after 9 (trained arm) and 12 (untrained arm) sessions. "Daily" training (18 consecutive days) increased strength in the untrained limb in a similar number of training sessions, which was accomplished in approximately half the time. Within clinical populations when the focus is on the untrained limb, reducing rest days may optimize the recovery of strength.
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Affiliation(s)
- Trevor S Barss
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.,School of Kinesiology, Lakehead University , Thunder Bay, Ontario , Canada
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.,Division of Medical Sciences, University of Victoria , Victoria, British Columbia , Canada
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6
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Abstract
Evidence first described in reduced animal models over 100 years ago led to deductions about the control of locomotion through spinal locomotor central pattern-generating (CPG) networks. These discoveries in nature were contemporaneous with another form of deductive reasoning found in popular culture, that of Arthur Conan Doyle's detective, Sherlock Holmes. Because the invasive methods used in reduced nonhuman animal preparations are not amenable to study in humans, we are left instead with deducing from other measures and observations. Using the deductive reasoning approach of Sherlock Holmes as a metaphor for framing research into human CPGs, we speculate and weigh the evidence that should be observable in humans based on knowledge from other species. This review summarizes indirect inference to assess "observable evidence" of pattern-generating activity that leads to the logical deduction of CPG contributions to arm and leg activity during locomotion in humans. The question of where a CPG may be housed in the human nervous system remains incompletely resolved at this time. Ongoing understanding, elaboration, and application of functioning locomotor CPGs in humans is important for gait rehabilitation strategies in those with neurological injuries.
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Affiliation(s)
- Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.,Division of Medical Sciences, University of Victoria, British Columbia, Canada
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7
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Kaupp C, Pearcey GEP, Klarner T, Sun Y, Cullen H, Barss TS, Zehr EP. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation. J Neurophysiol 2017; 119:1095-1112. [PMID: 29212917 DOI: 10.1152/jn.00570.2017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. "Normalization" of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.
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Affiliation(s)
- Chelsea Kaupp
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Hilary Cullen
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - Trevor S Barss
- Human Neurophysiology Laboratory, University of Alberta , Edmonton, Alberta , Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.,Division of Medical Sciences, University of Victoria , Victoria, British Columbia , Canada
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8
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Klarner T, Barss TS, Sun Y, Kaupp C, Loadman PM, Zehr EP. Long-Term Plasticity in Reflex Excitability Induced by Five Weeks of Arm and Leg Cycling Training after Stroke. Brain Sci 2016; 6:brainsci6040054. [PMID: 27827888 PMCID: PMC5187568 DOI: 10.3390/brainsci6040054] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/22/2016] [Accepted: 10/28/2016] [Indexed: 12/21/2022] Open
Abstract
Neural connections remain partially viable after stroke, and access to these residual connections provides a substrate for training-induced plasticity. The objective of this project was to test if reflex excitability could be modified with arm and leg (A & L) cycling training. Nineteen individuals with chronic stroke (more than six months postlesion) performed 30 min of A & L cycling training three times a week for five weeks. Changes in reflex excitability were inferred from modulation of cutaneous and stretch reflexes. A multiple baseline (three pretests) within-subject control design was used. Plasticity in reflex excitability was determined as an increase in the conditioning effect of arm cycling on soleus stretch reflex amplitude on the more affected side, by the index of modulation, and by the modulation ratio between sides for cutaneous reflexes. In general, A & L cycling training induces plasticity and modifies reflex excitability after stroke.
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Affiliation(s)
- Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC V8W 3P1, Canada.
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.
- Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Trevor S Barss
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC V8W 3P1, Canada.
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.
- Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC V8W 3P1, Canada.
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.
- Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Chelsea Kaupp
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC V8W 3P1, Canada.
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.
- Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Pamela M Loadman
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC V8W 3P1, Canada.
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, BC V8W 3P1, Canada.
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.
- Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.
- Division of Medical Sciences, University of Victoria, BC V8P 5C2, Canada.
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9
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Zehr EP, Barss TS, Dragert K, Frigon A, Vasudevan EV, Haridas C, Hundza S, Kaupp C, Klarner T, Klimstra M, Komiyama T, Loadman PM, Mezzarane RA, Nakajima T, Pearcey GEP, Sun Y. Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation. Exp Brain Res 2016; 234:3059-3081. [PMID: 27421291 PMCID: PMC5071371 DOI: 10.1007/s00221-016-4715-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/27/2016] [Indexed: 11/10/2022]
Abstract
During bipedal locomotor activities, humans use elements of quadrupedal neuronal limb control. Evolutionary constraints can help inform the historical ancestry for preservation of these core control elements support transfer of the huge body of quadrupedal non-human animal literature to human rehabilitation. In particular, this has translational applications for neurological rehabilitation after neurotrauma where interlimb coordination is lost or compromised. The present state of the field supports including arm activity in addition to leg activity as a component of gait retraining after neurotrauma.
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Affiliation(s)
- E P Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1. .,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada. .,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
| | - Trevor S Barss
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Katie Dragert
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1
| | - Alain Frigon
- Department of Pharmacology-physiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Erin V Vasudevan
- Department of Physical Therapy, SUNY Stony Brook University, Stony Brook, NY, USA
| | - Carlos Haridas
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1
| | - Sandra Hundza
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada.,Motion and Mobility Rehabilitation Laboratory, University of Victoria, Victoria, BC, Canada
| | - Chelsea Kaupp
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Marc Klimstra
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada.,Motion and Mobility Rehabilitation Laboratory, University of Victoria, Victoria, BC, Canada
| | - Tomoyoshi Komiyama
- Division of Sports and Health Science, Chiba University, Chiba, Japan.,The United Graduate School of Education, Tokyo Gakugei University, Tokyo, Japan
| | - Pamela M Loadman
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Rinaldo A Mezzarane
- Laboratory of Signal Processing and Motor Control, College of Physical Education, Universidade de Brasília-UnB, Brasília, Brazil
| | - Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Yao Sun
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, Canada, V8W 3P1.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
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10
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Nakajima T, Suzuki S, Futatsubashi G, Ohtsuska H, Mezzarane RA, Barss TS, Klarner T, Zehr EP, Komiyama T. Regionally distinct cutaneous afferent populations contribute to reflex modulation evoked by stimulation of the tibial nerve during walking. J Neurophysiol 2016; 116:183-90. [PMID: 27075541 DOI: 10.1152/jn.01011.2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/11/2016] [Indexed: 11/22/2022] Open
Abstract
During walking, cutaneous reflexes in ankle flexor muscle [tibialis anterior (TA)] evoked by tibial nerve (TIB) stimulation are predominantly facilitatory at early swing phase but reverse to suppression at late swing phase. Although the TIB innervates a large portion of the skin of the foot sole, the extent to which specific foot-sole regions contribute to the reflex reversals during walking remains unclear. Therefore, we investigated regional cutaneous contributions from discrete portions of the foot sole on reflex reversal in TA following TIB stimulation during walking. Summation effects on reflex amplitudes, when applying combined stimulation from foot-sole regions with TIB, were examined. Middle latency responses (MLRs; 70-120 ms) after TIB stimulation were strongly facilitated during the late stance to mid-swing phases and reversed to suppression just before heel (HL) strike. Both forefoot-medial (f-M) and forefoot-lateral stimulation in the foot sole induced facilitation during stance-to-swing transition phases, but HL stimulation evoked suppression during the late stance to the end of swing phases. At the stance-to-swing transition, a summation of MLR amplitude occurred only for combined f-M&TIB stimulation. However, the same was not true for the combined HL&TIB stimulation. At the swing-to-stance transition, there was a suppressive reflex summation only for HL&TIB stimulation. In contrast, this summation was not observed for the f-M&TIB stimulation. Our results suggest that reflex reversals evoked by TIB stimulation arise from distinct reflex pathways to TA produced by separate afferent populations innervating specific regions of the foot sole.
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Affiliation(s)
- Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, Tokyo, Japan;
| | - Shinya Suzuki
- Department of Integrative Physiology, Kyorin University School of Medicine, Tokyo, Japan; Division of Sports and Health Science, Chiba University, Chiba, Japan; United Graduate School of Education, Tokyo Gakugei University, Tokyo, Japan
| | - Genki Futatsubashi
- Division of Sports and Health Science, Chiba University, Chiba, Japan; United Graduate School of Education, Tokyo Gakugei University, Tokyo, Japan; Faculty of Business and Information Sciences, Jobu University, Gunma, Japan
| | - Hiroyuki Ohtsuska
- Division of Sports and Health Science, Chiba University, Chiba, Japan; Health Sciences University of Hokkaido, School of Rehabilitation Science, Hokkaido, Japan
| | - Rinaldo A Mezzarane
- Division of Sports and Health Science, Chiba University, Chiba, Japan; Laboratory of Signal Processing and Motor Control, College of Physical Education, University of Brasília, Brasília, Brazil; Biomedical Engineering Laboratory, Escola Politécnica da Universidade de São Paulo, Telecomunicações e Controle, University of São Paulo, São Paulo, Brazil
| | - Trevor S Barss
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada; Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada; Human Discovery Science, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada; and
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada; Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada; Human Discovery Science, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada; and
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada; Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada; Human Discovery Science, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada; and Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Tomoyoshi Komiyama
- Division of Sports and Health Science, Chiba University, Chiba, Japan; United Graduate School of Education, Tokyo Gakugei University, Tokyo, Japan
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11
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Klarner T, Barss TS, Sun Y, Kaupp C, Zehr EP. Preservation of common rhythmic locomotor control despite weakened supraspinal regulation after stroke. Front Integr Neurosci 2014; 8:95. [PMID: 25565995 PMCID: PMC4273616 DOI: 10.3389/fnint.2014.00095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/04/2014] [Indexed: 11/26/2022] Open
Abstract
The basic pattern of arm and leg movement during rhythmic locomotor tasks is supported by common central neural control from spinal and supraspinal centers in neurologically intact participants. The purpose of this study was to test the hypothesis that following a cerebrovascular accident, shared systems from interlimb cutaneous networks facilitating arm and leg coordination persist across locomotor tasks. Twelve stroke participants (>6 months post CVA) performed arm and leg (A&L) cycling using a stationary ergometer and walking on a motorized treadmill. In both tasks cutaneous reflexes were evoked via surface stimulation of the nerves innervating the dorsum of the hand (superficial radial; SR) and foot (superficial peroneal; SP) of the less affected limbs. Electromyographic (EMG) activity from the tibialis anterior, soleus, flexor carpi radialis, and posterior deltoid were recorded bilaterally with surface electrodes. Full-wave rectified and filtered EMG data were separated into eight equal parts or phases and aligned to begin with maximum knee extension for both walking and A&L cycling. At each phase of movement, background EMG data were quantified as the peak normalized response for each participant and cutaneous reflexes were quantified as the average cumulative reflex over 150 ms following stimulation. In general, background EMG was similar between walking and A&L cycling, seen especially in the distal leg muscles. Cutaneous reflexes were evident and modified in the less and more affected limbs during walking and A&L cycling and similar modulation patterns were observed suggesting activity in related control networks between tasks. After a stroke common neural patterning from conserved subcortical regulation is seen supporting the notion of a common core in locomotor tasks involving arm and leg movement. This has translational implications for rehabilitation where A&L cycling could be usefully applied to improve walking function.
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Affiliation(s)
- Taryn Klarner
- Exercise Science, Physical and Health Education, University of Victoria Victoria, BC, Canada ; Centre for Biomedical Research, University of Victoria Victoria, BC, Canada ; International Collaboration on Repair Discoveries Vancouver, BC, Canada
| | - Trevor S Barss
- Exercise Science, Physical and Health Education, University of Victoria Victoria, BC, Canada ; Centre for Biomedical Research, University of Victoria Victoria, BC, Canada ; International Collaboration on Repair Discoveries Vancouver, BC, Canada
| | - Yao Sun
- Exercise Science, Physical and Health Education, University of Victoria Victoria, BC, Canada ; Centre for Biomedical Research, University of Victoria Victoria, BC, Canada ; International Collaboration on Repair Discoveries Vancouver, BC, Canada
| | - Chelsea Kaupp
- Exercise Science, Physical and Health Education, University of Victoria Victoria, BC, Canada ; Centre for Biomedical Research, University of Victoria Victoria, BC, Canada ; International Collaboration on Repair Discoveries Vancouver, BC, Canada
| | - E Paul Zehr
- Exercise Science, Physical and Health Education, University of Victoria Victoria, BC, Canada ; Centre for Biomedical Research, University of Victoria Victoria, BC, Canada ; International Collaboration on Repair Discoveries Vancouver, BC, Canada ; Division of Medical Sciences, University of Victoria Victoria, BC, Canada
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12
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Zehr EP, Nakajima T, Barss T, Klarner T, Miklosovic S, Mezzarane RA, Nurse M, Komiyama T. Cutaneous stimulation of discrete regions of the sole during locomotion produces "sensory steering" of the foot. BMC Sports Sci Med Rehabil 2014; 6:33. [PMID: 25202452 PMCID: PMC4158001 DOI: 10.1186/2052-1847-6-33] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND While the neural and mechanical effects of whole nerve cutaneous stimulation on human locomotion have been previously studied, there is less information about effects evoked by activation of discrete skin regions on the sole of the foot. Electrical stimulation of discrete foot regions evokes position-modulated patterns of cutaneous reflexes in muscles acting at the ankle during standing but data during walking are lacking. Here, non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. METHODS Non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. RESULTS The results demonstrate statistically significant dynamic changes in reflex amplitudes, kinematics and foot sole pressures that are site-specific and phase-dependent. The general trends demonstrate responses producing decreased underfoot pressure at the site of stimulation. CONCLUSIONS The responses to stimulation of discrete locations on the foot sole evoke a kind of "sensory steering" that may promote balance and maintenance of locomotion through the modulation of limb loading and foot placement. These results have implications for using sensory stimulation as a therapeutic modality during gait retraining (e.g. after stroke) as well as for footwear design and implementation of foot sole contact surfaces during gait.
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Affiliation(s)
- E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada ; Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada ; Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada ; Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Japan
| | - Trevor Barss
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada ; Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada ; Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada ; Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada ; Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Stefanie Miklosovic
- Rehabilitation Neuroscience Laboratory, University Victoria, PO Box 3010 STN CSC, Victoria, BC V8W 3P1, Canada
| | - Rinaldo A Mezzarane
- Laboratory of Signal Processing and Motor Control, College of Physical Education, University of Brasília, Brasília, Brazil ; Biomedical Engineering Laboratory, EPUSP, PTC, University of São Paulo, São Paulo, Brazil ; Department of Health and Sports Sciences, Faculty of Education, Chiba University, Chiba, Japan
| | | | - Tomoyoshi Komiyama
- Department of Health and Sports Sciences, Faculty of Education, Chiba University, Chiba, Japan
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13
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Nakajima T, Mezzarane RA, Klarner T, Barss TS, Hundza SR, Komiyama T, Zehr EP. Neural mechanisms influencing interlimb coordination during locomotion in humans: presynaptic modulation of forearm H-reflexes during leg cycling. PLoS One 2013; 8:e76313. [PMID: 24204611 PMCID: PMC3799938 DOI: 10.1371/journal.pone.0076313] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/23/2013] [Indexed: 11/19/2022] Open
Abstract
Presynaptic inhibition of transmission between Ia afferent terminals and alpha motoneurons (Ia PSI) is a major control mechanism associated with soleus H-reflex modulation during human locomotion. Rhythmic arm cycling suppresses soleus H-reflex amplitude by increasing segmental Ia PSI. There is a reciprocal organization in the human nervous system such that arm cycling modulates H-reflexes in leg muscles and leg cycling modulates H-reflexes in forearm muscles. However, comparatively little is known about mechanisms subserving the effects from leg to arm. Using a conditioning-test (C-T) stimulation paradigm, the purpose of this study was to test the hypothesis that changes in Ia PSI underlie the modulation of H-reflexes in forearm flexor muscles during leg cycling. Subjects performed leg cycling and static activation while H-reflexes were evoked in forearm flexor muscles. H-reflexes were conditioned with either electrical stimuli to the radial nerve (to increase Ia PSI; C-T interval = 20 ms) or to the superficial radial (SR) nerve (to reduce Ia PSI; C-T interval = 37-47 ms). While stationary, H-reflex amplitudes were significantly suppressed by radial nerve conditioning and facilitated by SR nerve conditioning. Leg cycling suppressed H-reflex amplitudes and the amount of this suppression was increased with radial nerve conditioning. SR conditioning stimulation removed the suppression of H-reflex amplitude resulting from leg cycling. Interestingly, these effects and interactions on H-reflex amplitudes were observed with subthreshold conditioning stimulus intensities (radial n., ∼0.6×MT; SR n., ∼ perceptual threshold) that did not have clear post synaptic effects. That is, did not evoke reflexes in the surface EMG of forearm flexor muscles. We conclude that the interaction between leg cycling and somatosensory conditioning of forearm H-reflex amplitudes is mediated by modulation of Ia PSI pathways. Overall our results support a conservation of neural control mechanisms between the arms and legs during locomotor behaviors in humans.
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Affiliation(s)
- Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, Canada
| | - Rinaldo A. Mezzarane
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, Canada
- Laboratory of Signal Processing and Motor Control, College of Physical Education, University of Brasília, Brasília, Brazil
| | - Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, Canada
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
- Centre for Biomedical Research, University of Victoria, Victoria, Canada
| | - Trevor S. Barss
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, Canada
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
- Centre for Biomedical Research, University of Victoria, Victoria, Canada
| | - Sandra R. Hundza
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
- Centre for Biomedical Research, University of Victoria, Victoria, Canada
- Motion and Mobility Laboratory, University of Victoria, Victoria, Canada
| | | | - E. Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, Canada
- Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
- Centre for Biomedical Research, University of Victoria, Victoria, Canada
- Division of Medical Sciences, University of Victoria, Victoria, Canada
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14
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Nakajima T, Barss T, Klarner T, Komiyama T, Zehr EP. Amplification of interlimb reflexes evoked by stimulating the hand simultaneously with conditioning from the foot during locomotion. BMC Neurosci 2013; 14:28. [PMID: 23497331 PMCID: PMC3605396 DOI: 10.1186/1471-2202-14-28] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
Background Widespread interlimb reflexes evoked in leg muscles by cutaneous stimulation of the hand are phase-modulated and behaviorally relevant to produce functional changes in ankle trajectory during walking. These reflexes are complementary to the segmental responses evoked by stimulation at the ankle. Despite differences in the expression of reflex amplitude based upon site of nerve stimulation, there are some common features as well, suggesting the possibility of shared interneuronal pathways. Currently little is known about integration or shared reflex systems from interlimb cutaneous networks during human locomotion. Here we investigated convergent reflex effects following cutaneous stimulation of the hand and foot during arm and leg cycling (AL) by using spatial facilitation. Participants performed AL cycling and static activation of the target muscle knee extensor vastus lateralis (VL) in 3 different randomly ordered nerve stimulation conditions: 1) superficial radial nerve (SR; input from hand); 2) superficial peroneal nerve (SP; input from foot); and, 3) combined stimulation (SR + SP). Stimuli were applied around the onset of rhythmic EMG bursts in VL corresponding to the onset of the power or leg extension phase. Results During AL cycling, small inhibitory (~80 ms) and large facilitatory reflexes (~100 ~ 150 ms) were seen in VL. The amplitudes of the facilitatory responses with SR + SP stimulation were significantly larger than those for SP or SR stimulation alone. The facilitation was also significantly larger than the simple mathematical summation of amplitudes from SP and SR trials. This indicates extra facilitation beyond what would be accounted for by serial neuronal processing and was not observed during static activation. Conclusions We conclude that AL cycling activates shared interneurons in convergent reflex pathways from cutaneous inputs innervating the hand and leg. This enhanced activity has functional implications for corrective responses during locomotion and for translation to rehabilitation after neurotrauma.
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Affiliation(s)
- Tsuyoshi Nakajima
- Department of Integrative Physiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Japan
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15
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Abstract
The application of resistance during the swing phase of locomotion is a viable approach to enhance activity in the rectus femoris (RF) in patients with neurological damage. Increased muscle activity is also accompanied by changes in joint angle and stride frequency, consequently influencing joint angular velocity, making it difficult to attribute neuromuscular changes in RF to resistance. Thus, the purpose of this study was to evaluate the effects of resistance on RF activity while constraining joint trajectories. Participants walked in three resistance conditions; 0 % (no resistance), 5 and 10 % of their maximum voluntary contraction (MVC). Visual and auditory biofeedback was provided to help participants maintain the same knee joint angle and stride frequency as during baseline walking. Lower limb joint trajectories and RF activity were recorded. Increasing the resistance, while keeping joint trajectories constant with biofeedback, independently enhanced swing phase RF activity. Therefore, the observed effects in RF are related to resistance, independent of any changes in joint angle. Considering resistance also affects stride frequency, a second experiment was conducted to evaluate the independent effects of resistance and stride frequency on RF activity. Participants walked in four combinations of resistance at 0 and 10 %MVC and natural and slow stride frequency conditions. We observed significant increases in RF activity with increased resistance and decreased stride frequency, confirming the independent contribution of resistance on RF activity as well as the independent effect of stride frequency. Resistance and stride frequency may be key parameters in gait rehabilitation strategies where either of these may be manipulated to enhance swing phase flexor muscle activity in order to maximize rehabilitation outcomes.
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Affiliation(s)
- Taryn Klarner
- School of Kinesiology, University of British Columbia, Vancouver, Canada
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Klarner T, Chan HK, Wakeling JM, Lam T. Patterns of muscle coordination vary with stride frequency during weight assisted treadmill walking. Gait Posture 2010; 31:360-5. [PMID: 20097076 DOI: 10.1016/j.gaitpost.2010.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 11/20/2009] [Accepted: 01/04/2010] [Indexed: 02/02/2023]
Abstract
Partial body weight-supported treadmill training is an approach for gait rehabilitation. Variables such as stepping frequency and the amount of body weight support are key parameters manipulated during training. The purpose of this study was to quantify the extent to which body weight support and stride frequency contribute and interact to produce the coordination patterns of the leg muscles. Principal components analysis was used to provide insight into the interaction effects of these factors on electromyographical (EMG) activity during treadmill locomotion. Eight healthy subjects walked on a treadmill at 15 different combinations of weight support (0%, 20%, 40%, 60%, 100%), and stride frequency (0.40, 0.49, 0.57 Hz). Treadmill walking was performed with the Lokomat robotic gait orthosis to constrain leg kinematics. Surface EMG data were collected from several lower limb muscles. Results indicate that much of the variance in EMG activity during treadmill locomotion can be attributed to the mechanics of the locomotor task imposed by the level of body weight support and stride frequency. We also showed that body weight support and stride frequency interact in different ways to affect muscle coordination patterns. EMG coordination patterns are similar between conditions of high levels of body weight support and faster stride frequencies vs. lower levels of body weight support and slower stride frequency. Our data suggest that the interaction of body weight support and stride frequency should be taken into consideration for optimizing motor output during locomotor training.
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Affiliation(s)
- Taryn Klarner
- School of Human Kinetics, University of British Columbia, Vancouver, BC, Canada
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