Bilateral coordination in human infants: Stepping on a split-belt treadmill.

A motorized treadmill often elicits locomotor-like alternate stepping in 7-month-old infants who normally perform few, if any, stepping movements. The step cycle duration is a function of the speed of the treadmill. When infants were held so that each leg was on a separate treadmill belt, each of which was driven at a different speed, the overall cycle duration was intermediate between the cycle durations at the fast or slow speeds alone. Infants shortened the stance on the slow belt and increased the stance on the fast belt to maintain regularly alternating steps. Even before voluntary locomotion, both legs acted in a cooperative manner, with the dynamic status of one limb affecting the time-space behavior of the opposite limb. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of GFAP-immunoreactivity parallel the tonotopic axis in the developing dorsal cochlear nucleus

The gain of the H reflex attenuates during passive stepping and pedalling movements of the leg. We hypothesized that the kinematics of the movement indirectly reflect the receptor origin of this attenuation. In the first experiment, H reflexes were evoked in soleus at 26 points in the cycle of slow, passive pedalling movement of the leg and at 13 points with the leg static (the ankle was always immobilized). Maximum inhibition occurred as the leg moved through its most flexed position (P < 0.05). Inhibition observed in the static leg was also strongest at this position (P < 0.05). The increase in inhibition was gradual during flexion movement, with rapid reversal of this increase during extension. In the second experiment, the length of stretch of the vasti muscles was modelled. Variable pedal crank lengths and revolutions per minute (rpm) altered leg joint displacements and angular velocities. Equivalent rates of stretch of the vasti, achieved through different combinations of joint displacements and velocities, elicited equivalent attenuations of mean reflex magnitudes in the flexed leg. Reflex gain exponentially related to rate of stretch (R2 = 0.98 P < 0.01). The results imply that gain attenuation of this spinal sensorimotor path arises from spindle discharge in heteronymous extensor muscles of knee and/or hip, concomitant with movement.     

Coordination of neck and hindlimb extension during the initiation of locomotion elicited by hypothalamic stimulation

We tested the hypothesis that during the initiation of stepping elicited by hypothalamic stimulation, hindlimb extension was coordinated with head extension in the sagittal plane. Chronic stimulation electrodes (monopolar stainless-steel, 125 microm diameter) were implanted bilaterally into the perifornical hypothalamus of anaesthetized rats (N = 15) under stereotaxic control. Under freely moving and awake conditions, 18 sites which reliably elicited forward locomotion at a latency of approximately 3 s were tested in a videotaping session. The locomotor stimulation was a constant current train of 5 s duration composed of biphasic pulses at 40-50 Hz. The videotape records were digitized at a sampling rate of 6 Hz for seven points on the rat: Nose, pinnae, midpoint of inter-pinnae line, right forepaw, right hindpaw and base of tail. A characteristic pattern of coordinated movements preceded, by approximately 0.5 s, the execution of the first locomotor step. The pattern included a movement of the pelvis in the anterior or superior direction that was produced by hindlimb extension and an extension of the neck forward along the sagittal plane. There was considerable flexibility in this pattern, but it was invariant to the extent that it occurred at a variety of latencies and after several types of head movements. Associated with the coordinated extensions of the neck and hindlimbs was a lowering of the head angle which had a more variable time course. These data indicate that there is significant coupling between the systems that produce hindlimb extension and control head position when the rat prepares to step.     

Early complications in the operative treatment of patella fractures

In this study two aspects of hybrid functional electrical stimulation (FES) orthoses were investigated: joint motion constraints and FES control strategies. First, the effects of joint motion constraints on the gait of normal subjects were investigated using modern motion analysis systems, including electromyogram (EMG) and heart rate measurements. An orthosis was developed to impose joint motion constraints; the knee and ankle could be fixed or free, and the hip joint could rotate independently or coupled, according to a preset flexion-extension coupling ratio (FECR). Compared with a 1:1 hip FECR, a 2:1 hip FECR was associated with a reduced energy cost and increased speed and step length. The knee flexion during swing significantly reduced energy cost and increased walking speed. Ankle plantar flexion reduced the knee flexing moment during the early stance phase. Second, trials on 3 paraplegic subjects were conducted to implement some of these findings. It appeared that the 2:1 FECR encouraged hip flexion and made leg swing easier. A simple FES strategy increased walking speed and step length and reduced crutch force impulse using fixed orthotic joints.     

Cerebrospinal fluid protein changes in multiple sclerosis after dental amalgam removal

To date, limited information exists describing a relatively new stretching technique, dynamic range of motion (DROM). The purpose of this study was to compare the effects of DROM with static stretch on hamstring flexibility. Fifty-eight subjects, ranging in age from 21 to 41 years and with limited hamstring flexibility (defined as 30 degrees loss of knee extension measured with the femur held at 90 degrees of hip flexion), were randomly assigned to one of three groups. One group performed DROM 5 days a week by lying supine with the hip held in 90 degrees of flexion. The subject then actively moved the leg into knee extension (5 seconds), held the leg in end range knee extension for 5 seconds, and then slowly lowered the leg to the initial position (5 seconds). These movements were performed six times per session (30 seconds of total actual stretching time). The second group performed one 30-second static stretch, 5 days per week. The third group served as a control group and did not stretch. Before and after 6 weeks of training, flexibility of the hamstring muscles was determined in all three groups by measuring knee extension range of motion (ROM) with the femur maintained in 90 degrees of hip flexion. Data were analyzed with a 2 x 3 (test x group) two-way analysis of variance (ANOVA) with repeated measures on one variable (test) and appropriate post hoc analyses. The results of the two-way ANOVA revealed a significant interaction. Further statistical post hoc analysis of data to interpret the interaction revealed significant differences between the control group (gain = 0.70 degree) and both stretching groups, as well as a significant difference between the static stretch group (gain = 11.42 degrees) and the DROM group (gain = 4.26 degrees). The results of this study suggest that, although both static stretch and DROM will increase hamstring flexibility, a 30-second static stretch was more effective than the newer technique, DROM, for enhancing flexibility. Given the fact that a 30-second static stretch increased ROM more than two times that of DROM, the use of DROM to increase flexibility of muscle must be questioned.     

Stereotypic muscle-torque patterns are systematically adopted during acquisition of a multi-articular kicking task

Motor-control mechanisms used to learn multi-joint (kinematically indeterminate) movements, which involve the control of intersegmental dynamics, are poorly understood, because the few kinetic studies which examined them studied only a few trials performed early and late in learning. Therefore, we examined changes in movement kinematics and kinetics accompanying multi-joint movement acquisition to address the following questions: Once subjects can produce accurate movements, do motor patterns (i.e. net muscle torques) change with further learning? Are motor patterns learned using a systematic strategy? Following learning, are the same motor patterns consistently used for movement production? Subjects performed 16 blocks of 16 trials of a discrete weighted (mass = 1.674 kg) kicking movement, involving hip, knee, and ankle motion. They attempted to perform 400 ms spatially accurate movements. Kinematics were recorded for the hip, knee, ankle, and toe of the kicking leg, and inverse dynamics were used to obtain net-muscle-torque profiles. Subjects did not adopt the motor patterns initially used to produce accurate movements. With further learning, net muscle torques became less variable both within and between blocks; inter-joint dependency of muscle torques increased, as evidenced by decreased variability in the pair of muscle torques which directly affect a segment's motion (i.e. hip-knee and knee ankle muscle torques); and inter-joint relationships of muscle torques became more phase-locked, with hip and knee torques being produced simultaneously, as were knee and ankle torques. As there was a progression across blocks until the preferred motor patterns were adopted, the learned stereotypic motor patterns were systematically selected.     

Separation of hybridoma cells from their IgG product using aqueous two-phase systems

The cuneiform nucleus and the pedunculopontine tegmental nucleus have both been suggested as possible sites for the mesencephalic locomotor region (MLR), an area from which controlled stepping on a treadmill can be elicited following electrical or chemical stimulation in a decerebrate animal. It has been shown that excitotoxic lesions of the pedunculopontine tegmental nucleus impair neither spontaneous locomotion nor locomotion induced by stimulation of the nucleus accumbens. Excitotoxic lesions of the cuneiform nucleus have not previously been investigated. Rats received either bilateral ibotenate or sham lesions of the cuneiform nucleus combined with bilateral implantation of guide cannulae aimed at the nucleus accumbens. On recovery from surgery spontaneous locomotion was tested, followed by accumbens-stimulated locomotion. For nucleus accumbens stimulation, each rat received bilateral microinjection of each of three doses of d-amphetamine (10.0, 20.0 and 30.0 micrograms) and a vehicle only injection. Locomotor activity was recorded following the injection. In comparison to the sham-lesioned group, the ibotenate-lesioned group showed no differences in either spontaneous or amphetamine-induced locomotor activity. These results suggest that, like the pedunculopontine tegmental nucleus, the cuneiform nucleus is not involved in the direct mediation of spontaneous or accumbens-induced locomotion, and thus is very unlikely to be the anatomical substrate of the MLR. The role of the cuneiform nucleus in other types of behavioural control is discussed.     

An in vitro functionally mature mouse spinal cord preparation for the study of spinal motor networks

An in vitro isolated whole spinal cord preparation has been developed in 'motor functionally mature' mice; that is mice of developmental maturity sufficient to weight-bear and walk. In balb/c mice this stage occurs at around postnatal day 10 (P10). Administration of strychnine elicited synchronous activity bilaterally in lumbar ventral roots. Rhythmic alternating locomotor-like activity could be produced by application of a combination of serotonin (5-HT), N-methyl-d-aspartate (NMDA), and dopamine in animals up to P12. Using a live cell-dead cell assay, it is demonstrated that there are primarily viable cells throughout the lumbar spinal cord. The viability of descending pathways was demonstrated with stimulation of the mid-thoracic white matter tracts. In addition, polysynaptic segmental reflexes could be elicited. Although usually absent in whole cord preparations, monosynaptic reflexes could invariably be elicited following longitudinal midline hemisection, leading to the possible explanation that there might be an active crossed pathway producing presynaptic inhibition of primary afferent terminals. The data demonstrate that this functionally mature spinal cord preparation can be used for the study of spinal cord physiology including locomotion.     

The status of human filariasis in north-western zone of Bauchi State, Nigeria

PURPOSE: To review the efficacy of nonmedicinal, noninvasive therapies in hip and knee osteoarthritis. DATA SOURCES: Search of English-language literature from 1966 through 1993 using MEDLINE by cross-referencing "osteoarthritis" (therapy subheadings) with "controlled trial," "comparative study," or "trial(s)." STUDY SELECTION: Fifteen controlled trials of diathermy (deep heat), exercise, acupuncture, transcutaneous electrical nerve stimulation, topically applied capsaicin, low-energy laser, and pulsed electromagnetic fields were found. No experimental studies of superficial heat and cold, orthotic devices, vibration, or weight loss were identified. RESULTS: Exercise reduces pain and improves function in patients with osteoarthritis of the knee. No support exists in the literature for pre-exercise ultrasound treatment. Single, well-designed studies suggest that topically applied capsaicin and laser treatment reduce pain associated with knee osteoarthritis. Data on the other three therapies were sparse (transcutaneous electrical nerve stimulation, pulsed electromagnetic fields) or inconsistent (acupuncture). CONCLUSIONS: More data are needed to determine the optimal exercise regimen for treating knee osteoarthritis and to evaluate the role of topical capsaicin, laser therapy, acupuncture, transcutaneous electrical nerve stimulation, and pulsed electromagnetic fields. No data specifically address the role of any of these therapies in hip osteoarthritis.     

Do dorsal root reflexes augment peripheral inflammation?

Efferent activity was recorded in knee joint afferents in response to mechanical stimulation of the hindlimb following induction of acute arthritis. The activity was abolished by application of lidocaine or crushing the nerve proximally and by dorsal rhizotomy but not by sympathectomy. It was concluded that this activity represents dorsal root reflexes in response to natural stimulation of the hindlimb. We propose that increased activity of articular afferents and of dorsal horn neurons during arthritis results in the pathological activation of the central terminals of primary afferents by enhancing primary afferent depolarization. Dorsal root reflexes could then release substances in the knee joint and thus contribute to the acute inflammatory response.     

Motor patterns and kinematics during backward walking in the pacific giant salamander: evidence for novel motor output

Kinematic and motor patterns during forward and backward walking in the salamander Dicamptodon tenebrosus were compared to determine whether the differences seen in mammals also apply to a lower vertebrate with sprawling posture and to measure the flexibility of motor output by tetrapod central pattern generators. During treadmill locomotion, electromyograms (EMGs) were recorded from hindlimb muscles of Dicamptodon while simultaneous high-speed video records documented movement of the body, thigh, and crus and allowed EMGs to be synchronized to limb movements. In forward locomotion, the trunk was lifted above the treadmill surface. The pelvic girdle and trunk underwent smooth side-to-side oscillations throughout the stride. At the beginning of the stance phase, the femur was protracted and the knee joint extended. The knee joint initially flexed in early stance and then extended as the foot pushed off in late stance, reaching maximum extension just before foot lift-off. The femur retracted steadily throughout the stance. In the swing phase, the femur rapidly protracted, and the leg was brought forward in an "overhand crawl" motion. In backward walking, the body frequently remained in contact with the treadmill surface. The pelvic girdle, trunk, and femur remained relatively still during stance phase, and most motion occurred at the knee joint. The knee joint extended throughout most of stance, as the body moved back, away from the stationary foot. The knee flexed during swing. Four of five angles showed significantly smaller ranges in backward than in forward walking. EMGs of forward walking showed that ventral muscles were coactive, beginning activity just before foot touchdown and ceasing during the middle of stance phase. Dorsal muscles were active primarily during swing. Backward locomotion showed a different pattern; all muscles except one showed primary activity during the swing phase. This pattern of muscle synergy in backward walking never was seen in forward locomotion. Also, several muscles demonstrated lower burst rectified integrated areas (RIA) or durations during backward locomotion. Multivariate statistical analysis of EMG onset and RIA completely separated forward and backward walking along the first principal component, based on higher RIAs, longer durations of muscle activity, and greater synergy between ventral muscles during early stance in forward walking. Backward walking in Dicamptodon uses a novel motor pattern not seen during forward walking in salamanders or during any other locomotor activity in previously studied tetrapods. The central neuronal mechanisms mediating locomotion in this primitive tetrapod are thus capable of considerable plasticity.     

Morphometric ultrastructural evaluation of the axonal endings in the neuromuscular junctions of pigeons after long lasting limitation of movement

To analyze the discharge patterns of the reticulospinal (R-S) neurons associated with four-limb movement, we recorded the unit spikes of 108 R-S neurons in 18 thalamic cats. (1) Unit spikes of R-S neurons exhibited alternating firings during leg movements, not only stepping on the treadmill but also upon passive flexion and extension movement by the experimenter's hand. (2) R-S neurons manifested firing patterns associated with diagonal, reciprocal and quadrupedal leg movements. About half of the neurons showed reciprocal patterns upon bilateral forelimb movements; spikes were increased when the ipsilateral forelimb was in a backward position; they were decreased when that leg was in a forward position. In contrast, the spikes were increased when the contralateral forelimb was placed forward and decreased when it was backward. About 15% of the R-S neurons showed discharge patterns correlated with quadrupedal leg movements. Firing increased when the left forelimb and right hindlimb were placed backward and the left hindlimb and right forelimb were forward. In contrast, when the position of all 4 limbs was reversed, firing rates decreased. (3) When brief touch stimulation was applied to the skin around the leg, bursting spikes were obtained; these were suppressed upon touching the skin of the contralateral limb. Even after transection of the muscle nerves, alternating firings were observed. (4) Local anesthesia to the shoulder joint resulted in a marked reduction of spontaneous discharges and alternating firings. (5) Our results indicate that afferents of joints and of cutaneous origins in individual limbs ascend to the brainstem reticular formation, that integrative action is organized as pattern generation in that region, and that this patterned information is sent to the spinal cord via the reticulospinal tracts.     

Modulation of cerebral somatosensory evoked potentials arising from tibial and sural nerve stimulation during rhythmic active and passive movements of the human lower limb

The magnitudes of cerebral somatosensory evoked potentials (SEPs), following stimulation of cutaneous or muscle afferents in the upper limb, are reduced during active and passive movements of the fingers. The generalizability of such a movement effect was tested for lower limb events. We measured SEP magnitudes following activation of cutaneous (sural) and mixed (tibial) nerves during the flexion phase of active and passive rhythmic movements of the human lower limb. In eight volunteers, 150 SEPs per condition were recorded from Cz' referenced to Fpz'. Compared to stationary controls, both active and passive movements significantly depressed the early SEP components (P1-N1) [mean values, to 12.8%, 9.9% respectively for tibial nerve and to 29.6%, 25.6% for sural nerve stimulation, p < 0.05]. The attenuation was still observed when only one leg was moved and with stimulation at an earlier point in the flexion phase of movement. Visual fixation did not significantly affect P1-N1 amplitudes, compared to eyes closed. As previously shown, soleus H reflexes with stable M waves were significantly depressed during the movements (p < 0.05). The general construct may be that centripetal flow initiated from somatosensory receptors during limb movement leads to modulation of both spinal and cortical responses following large diameter cutaneous or muscle afferent activation.     

A case of progressive saccular aneurysm caused by localized dissection of descending aorta

A 37-year-old man with alcoholic polyneuropathy showed involuntary movement as intermittent flexion-extension or abduction-adduction of his toes identical to "painful legs and moving toes (PLMT)" and muscle cramps. Regarding the sequential spreading of PLMT and cramps from unilateral to contralateral leg muscles and phasic discharges observed by a needle EMG in the foot muscles during PLMT, we suppose that a spinal or supraspinal mechanism was responsible for the production of those movements. This case showed novel aspects of PLMT which was induced by sensory stimulation of the left lower leg and subsequently initiated cramps. The destruction of the lumbar sympathetic ganglion remarkably ameliorated the spontaneous PLMT and cramps, whereas sensory stimulation of the left lower leg still induced those movements. Therefore, we think that sensory inputs from peripheral nerves played a critical role in the generation of PLMT and cramps, and abnormal activities of spinal sympathetic nerves exacerbated those involuntary movements. Sensory induced PLMT may be a subgroup of this movement disorder.     

The slump test: the effects of head and lower extremity position on knee extension

Maitland's slump test is a widely used neural tissue tension test. During slump testing, terminal knee extension is assessed for signs of restricted range of motion (ROM), which may indicate impaired neural tissue mobility. A number of refinements that modify hip and ankle position has been added to the basic slump test procedure, but no research to date has measured the effects of ankle and hip position on knee extension ROM during testing. The purpose of this study was to examine the effect of neural tension-producing movements of the cervical spine and lower extremity on knee extension ROM during the slump test. Thirty-four males with no significant history of low back pain were tested in the slump position with the cervical spine flexed and extended in each of three lower extremity test positions: neutral hip rotation with the ankle in a position of subject comfort (neutral), neutral hip rotation with ankle dorsiflexion (ankle dorsiflexion), and medial hip rotation with ankle dorsiflexion. Results showed significant decreases in active knee extension ROM (F1,198 = 29.53, p < 0.0001) in the cervical flexion compared with the cervical extension conditions. Subjects also exhibited significant decreases in active knee extension ROM (F2,198 = 56.76, p < 0.0001) as they were progressed from neutral to the ankle dorsiflexion to the medial hip rotation with ankle dorsiflexion positions of the lower extremity. The results of our study indicate that limitations in terminal knee extension ROM may be considered a normal response to the inclusion of cervical flexion, ankle dorsiflexion, or medial hip rotation in the slump test in young, healthy, adult males. In addition, the presence of a cumulative effect on knee extension ROM with the simultaneous application of these motions is noted. These findings may assist clinicians when assessing knee extension ROM during slump testing.     

The effect of flumazenil on CNS oxygen toxicity in the rat

The effect of afferent cutaneous electrical stimulation on the spasticity of leg muscles was studied in 20 patients with chronic hemiplegia after stroke. Stimulation electrodes were placed over the sural nerve of the affected limb. The standard method of cutaneous stimulation, TENS with impulse frequency of 100 Hz, was applied. The tonus of the leg muscles was measured by means of an electrohydraulic measuring brace. The EMG stretch reflex activity of the tibialis anterior and triceps surae muscles was detected by surface electrodes and recorded simultaneously with the measured biomechanical parameters. In 18 out of 20 patients, a mild but statistically significant decrease in resistive torques at all frequencies of passive ankle movements was recorded following 20 min of TENS application. The decrease in resistive torque was often (but not always) accompanied by a decrease in reflex EMG activity. This effect of TENS persisted up to 45 min after the end of TENS. The results of the study support the hypothesis that TENS applied to the sural nerve may induce short-term post-stimulation inhibitory effects on the abnormally enhanced stretch reflex activity in spasticity of cerebral origin.     

Venous haemodynamics in both legs after total knee replacement

We studied the effect of total knee replacement on venous flow in 110 patients. Resting venous blood flow was measured using strain-gauge plethysmography before operation, after surgery and after discharge from hospital. There was a significant reduction in mean venous capacitance (p < 0.001) and mean venous outflow (p < 0.004) affecting only the operated leg. Both improved significantly after mobilisation in the early postoperative period, returning to preoperative levels by six days after surgery and before discharge from hospital. Our findings showed that venous stasis may contribute to deep-vein thrombosis only in the first few days after total knee replacement. This would be the most important period for the use of flow-enhancing prophylactic devices. Comparison with changes in blood flow after total hip replacement identified different patterns of altered haemodynamics suggesting that there are different mechanisms of venous stasis and thrombogenesis in hip and knee arthritis and during surgery for these conditions.     

Surgical management of hip dislocation in children with arthrogryposis multiplex congenita

Arthrogryposis multiplex congenita (AMC) is a rare disease with multiple joint contractures. It is widely believed that bilaterally dislocated hips should not be reduced since movement is satisfactory and open reduction has had poor results. Since 1977 we have performed a new method of open reduction using an extensive anterolateral approach on ten hips in five children with AMC. The mean age at surgery was 31.5 months (17 to 64) and the mean follow-up was 11.8 years (3.8 to 19.5). At the final follow-up all children walked without crutches or canes. Two managed independently, one required a long leg brace and two had short leg braces because of knee and/or foot problems. The clinical results were good in eight hips and fair in two and on the Severin classification seven hips were rated as good (group I or group II). We recommend the extensive anterolateral approach for unilateral or bilateral dislocation of the hip in children with arthrogryposis or developmental dislocation of the hip.     

Effects of resistive and balance exercises on isokinetic strength in older persons

OBJECTIVE: To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years. DESIGN: Randomized 3-month clinical trial. Subjects (n = 110, mean age 80) were randomized to 4 groups in a 2 x 2 design (control, resistive, balance, combined resistive/balance). INTERVENTIONS: Resistive training involved knee extension and flexion, hip abduction and extension, and plantar and dorsiflexion using simple resistive machines and sandbags. Balance training consisted of exercises to improve postural control. The control group attended 5 health-related discussion sessions. MEASUREMENTS: Summed isokinetic moments (N m) of 8 leg movements: hip, knee and ankle flexion/extension, and hip abduction/adduction. Secondary outcomes were gait velocity and chair rise time. MAIN RESULTS: Summed peak moment increased in both resistive exercise-trained groups (13% increase in the resistive group and 21% in the combined training group, P < 0.001). The effect of resistance training was significant (MANOVA F = 21.1, P < 0.001), but balance training did not improve strength, and there was no interaction (positive or negative) between balance and resistive training. Maximal gait velocity and chair rise time did not improve. Eleven subjects (20%) had musculoskeletal complaints related to resistive training, but all were able to complete the program with modifications. CONCLUSION: Resistive training using simple equipment is an effective and acceptable method to increase overall leg strength in older persons. Resistive or balance training did not improve maximal gait velocity or chair rise time in this sample of relatively healthy older persons.     

Path integration while ignoring irrelevant movement.

Participants attempted to return to the origin of travel after following an outbound path by locomotion on foot (Experiments 1–3) or in a virtual visual environment (Experiment 4). Critical conditions interrupted the outbound path with verbal distraction or irrelevant, to-be-ignored movements. Irrelevant movement, real or virtual, had greater effects than verbal or cognitive distraction, indicating inability to ignore displacement during path integration. Effects of the irrelevant movement's direction (backward vs. rightward) and location (1st vs. 2nd leg of path) indicated that participants encoded a configural representation of the pathway and then cognitively compensated for the movement, producing errors directly related to the demands of compensation. An encoding-error model fit to the data indicated that backward movement produced downward rescaling, whereas movement that led to implied rotation (rightward on 2nd leg) produced distortions of shape and scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)