In vivo measurement of the series elasticity release curve of human triceps surae muscle

The force-extension characteristic of the series-elastic component of the human triceps surae muscle has been measured in vivo by means of a hydraulic controlled-release ergometer in 12 subjects. The SEC characteristic can be described by a linear relation between muscle moment and extension, with a stiffness K1, preceded by a quadratic 'toe' region at low moments. Stiffness K1 increases with the level of activation of the muscle. At an ankle moment of 100 N m, values range between 250 and 400 N m rad(-1). The elastic stretch corresponds then to about 30, which is considerable compared with the total ankle movement range. At moments of 150 and 180 N m, which correspond to the peak moments in walking and running, respectively, the elastic energy stored in the SEC was 23-37 and 31-57 J. These energy values are amply sufficient to enable the conservation of negative (eccentric) work into a subsequent phase of positive (concentric) work in both walking and running.     

Responses of human single motor units to transcranial magnetic stimulation

The authors analyse the results of 51 unicompartmental knee prostheses with 1 to 12 years follow-up (mean follow-up: 5 years). The results were evaluated using the scoring system of the "Knee Group" of the SO.B.C.O.T. (Société Belge de Chirurgie Orthopédique et de Traumatologie). This analysis demonstrates that the quality of the results depends on implant positioning. The authors suggest positioning the tibial implant parallel with the healthy plateau and slightly distal, i.e. to position the tibial implant perpendicular to the epiphyseal axis and not to the mechanical axis, as is systematically done with the usual tibial cutting guides. When this ideal positioning was respected, 77.5% of the patients had a score above 90 points (out of a possible maximum of 100 points) and 12.5% had a score between 75 and 89 points. When this condition was not respected, none of the knees obtained more than 75 points. The difference was statistically significant (p = 0.0001).     

Directional tuning of single motor units

The directional activity of whole muscles has been shown to be broadly and often multimodally tuned, raising the question of how this tuning is subserved at the level of single motor units (SMUs). Previously defined rules of SMU activation would predict that units of the same muscle (or at least of the same neuromuscular compartment) are activated homogeneously with activity peaks in the same "best" direction(s). In the present study, the best directions of SMUs in human biceps (both heads) and deltoid (anterior, medial, and posterior portions) were determined by measuring the firing rate and threshold force of units for recruitment during isometric force ramps in many different directions. For all muscles studied, neighboring motor units could have significantly different best directions, suggesting that each muscle receives multiple directional commands. Furthermore, 17% of the units sampled clearly had a second-best direction, consistent with a convergence of different directional commands onto the same motoneuron. The best directions of the units changed gradually with location in the muscle. Best directions did not cluster into separate groups, thus, not supporting the existence of clearly distinguished neuromuscular compartments. Instead, the results reveal a more gradually distributed activation of the biceps and deltoid motoneuron pools. A model is proposed in which the central control mechanism optimizes the fulfillment of the continuously changing directional force requirements of a movement by gradually recruiting and derecruiting those units ideally suited for the production of the required force vector at any given time.     

Dissociation of the electrical and contractile properties in single human motor units during fatigue

The surface EMG area often exhibits progressive enlargement during a submaximal fatiguing contraction, but the underlying reasons still remain uncertain. Fatigue-induced changes in the surface-detected motor unit action potentials (S-MUAPs) of 10 human thenar motor units (MUs) with widely differing physiological properties were examined. After 2 min of repetitive 40-Hz stimulation, the size of the S-MUAPs of all MUs increased, the magnitude of which was negatively correlated with their tetanic tension changes. These findings suggest that during muscle fatigue, in addition to reflecting recruitment of new MUs and increases in firing rates of the active MUs, the surface EMG may also be markedly influenced by changes in the S-MUAPs, especially in fast fatigable muscles.     

Organization of single motor units in feline sartorius

1. We depleted single motor units in feline sartorius muscles of glycogen by stimulating their motoneurons intracellularly. We mapped the intramuscular distribution of depleted fibers by inspecting histological cross-sections throughout the length of sartorius. 2. We selected ten depleted motor units for detailed study and quantitative analysis. Nine motor units were located in the anterior head of sartorius. One was located in a muscle whose distal half appeared to have been damaged some time before the acute experiment. A single motor unit was located in the medial head of sartorius. 3. Five motor units were composed of fast-twitch glycolytic (FG) muscle fibers, two of fast-twitch oxidative glycolytic (FOG) muscle fibers, and three of slow-twitch oxidative (SO) muscle fibers. Estimates of the numbers of depleted fibers in motor units of anterior sartorius indicated that FG motor units were larger (mean 566 fibers) than FOG and SO motor units (SO mean 190, FOG mean 156 fibers). The SO motor unit in the damaged muscle had 550 fibers. One motor unit depleted in the medial head of sartorius had 270 fibers with FG profiles. 4. Muscle fibers belonging to each anterior motor unit were never distributed throughout the whole cross-section of anterior sartorius at any proximodistal level. Furthermore, fibers were distributed nonuniformly along the proximodistal axis of the muscle. In most muscles at least a few depleted fibers were found at all proximodistal levels. However, in one normal muscle and the damaged muscle, depleted fibers were confined to the proximal end. 5. The fibers in the medial motor unit were confined to a strip that did not extend across the whole cross-section of the muscle head. Fibers within this strip were scattered quite evenly from origin to insertion. This medial FG motor unit occupied a smaller territory and contained fewer fibers than anterior motor units of the same histochemical type. 6. These results show that sartorius motor units are not distributed uniformly in the mediolateral plane; those in anterior sartorius were distributed asymmetrically in the proximodistal axis as well. This finding has important functional implications for the way in which we model force development and transmission in sartorius and other long muscles.     

Longitudinal study of the contractile and electrical properties of single human thenar motor units

Serial motor unit number estimates have shed important light on the extent and rates of motoneuron losses in aging and amyotrophic lateral sclerosis. However, the estimates alone provide few clues to the health and functional status of surviving motor units. A reliable means for assessing the functional status of the surviving motor units would therefore by a welcome addition to our present tools for studying motor units. Examining the physiological properties of samples of motor units drawn at intervals during the course of a motoneuronal disease suffers from the important limitation that the samples may not be representative of one another. The latter problem could be circumvented by serially studying the same motor units. This study describes a noninvasive technique capable of longitudinally tracking the contractile and electrical properties of specific single thenar motor units in healthy subjects, in some instances over several years. The technique proved to be reasonably reliable and provided information on a wide range of contractile and electrical properties of motor units. Such an approach could serve as a potentially powerful and sensitive means of studying the life histories of single motor units in aging, diseases of the motoneuron, and in the latter instances, the responses of the motoneurons to treatment.     

Proximal rupture in the triceps surae a typical, but often unrecognized injury

An account is given of 12 high ruptures of the triceps surae, a traumatic lesion of the medial belly of the gastrocnemius, caused by sudden overstreching of the muscle by concomitant ankle dorsiflexion and full knee extension. In all cases the authors found characteristic clinical features. Surgical exploration in 5 of 12 cases verified the ruptures of the musculotendinous junction of the medial gastrocnemius belly. A follow-up study of 2 years showed that the surgical treatment seems to be better, especially in younger and athletic patients.     

The role of weakness of triceps surae muscles in astasia without abasia

OBJECTIVE: To investigate the role of weakness of the bilateral triceps surae muscles-the gastrocnemius and soleus muscles-in astasia without abasia and whether compensating for muscle weakness with ankle-foot orthoses improves this disability. DESIGN: Case-control study of clinical findings and before and after trial of ankle-foot orthoses. SETTING: Clinics of the departments of rehabilitation medicine of two university hospitals. PATIENTS: A stilts group consisting of 23 patients with astasia without abasia, and a non-stilts group without this phenomenon consisting of 12 patients with hereditary motor sensory neuropathy, 15 patients with lumbosacral spondylotic radiculopathy or spondylolisthesis, and 20 healthy volunteers. MAIN OUTCOME MEASURE: Clinical findings of the stilts and non-stilts groups were compared and the sensitivity and specificity of each clinical finding was calculated. The length of the centre of foot pressure (COP) while standing was measured in a bilateral below knee amputee and 16 consecutive patients in the stilts group with and without ankle-foot orthoses. RESULTS: Weakness of the triceps surae muscles was the only finding that differed significantly between the two groups and was both sensitive and specific. The amputee was unable to stand in place without dorsiflexion bumpers, which functioned similarly to the triceps surae muscle. Bilateral ankle-foot orthoses improved the COPs of 14 out of 16 patients. CONCLUSION: The main cause of astasia without abasia is weakness of the triceps surae muscles, and this disability is improved by bilateral ankle-foot orthoses.     

A longitudinal study of the pathophysiological changes in single human thenar motor units in amyotrophic lateral sclerosis

The sequence of pathophysiological changes in amyotrophic lateral sclerosis (ALS) at the single motor unit (MU) level is not well understood. Using a recently described technique, a comprehensive range of physiological properties in two thenar MUs in ALS were intensively studied. In the first MU, despite a marked decline in the ability of the subject to voluntarily recruit the MU, the physiological properties of this MU remained remarkably stable over a 2-year period. In contrast, the physiological properties of the other MU declined rapidly over 5 months despite the fact that this MU could be recruited with ease throughout the study period. These differences between the progressively dysfunctional changes in these two MUs illustrates the value of such longitudinal studies of specific MUs in improving our understanding of the evolution of changes in single motoneurons in ALS. The broader application of longitudinally tracking the pathophysiological changes of the surviving MUs may prove to be a sensitive measure of disease progression and in evaluating the effectiveness of treatments.     

Organization of the sural cutaneous input regulating the discharge of triceps surae gamma-motoneurones in the cat

The organization of the cutaneous afferent influence on the discharge of gamma-motoneurones has been investigated in the decerebrated, spinal cat. gamma-Motoneurone discharges were recorded from cut nerve filaments. Time and frequency domain analyses were used to reveal the strength of coupling between gamma-motoneurone discharge and cutaneous afferents excited by natural skin stimulation. Time domain analysis (cross-correlation) was also used to reveal the sigh (facilitation or inhibition) and time course of the cutaneous influence on individual gamma-motoneurones. Mechanical stimulation of discrete areas of skin within the sural nerve field caused facilitation or inhibition of individual gamma-motoneurones supplying the gastrocnemius and soleus muscles. In a few cases, a gamma-motoneurone facilitated by stimulation at one site could be inhibited from another location. The effect of cutaneous afferent stimulation was not evident in the decerebrated cat with intact spinal cord. The intensity of facilitation and inhibition was mapped for the sural nerve field. Facilitation had focus of highest intensity to stimulation applied between the calcaneum and lateral malleolus. The focus for inhibition was either the same as for facilitation or, more frequently, tended to be lateral and dorsal to the calcaneum at the edge of the sural field. Cutaneous stimulation at the edge of the sural field could also reduce the coherence between the discharges of gamma-motoneurones, particularly at low frequencies of association (1-5 Hz), indicating disfacilitation of other sources of afferent input. The results reveal a detailed pattern of cutaneous inputs to the fusimotor system that could participate in a wide range of behavioural adjustments to stretch or contact of the skin at the heel.     

Managing equinus in children with cerebral palsy: electrical stimulation to strengthen the triceps surae muscle

A new therapeutic proposal for the management of equinus in children with cerebral palsy is to strengthen the calf muscles instead of weakening them surgically. Prior research indicates that in children with cerebral palsy the triceps surae muscle is weak and needs strengthening. Neuromuscular electrical stimulation (NMES) was used as an adjunct to physical therapy. A portable NMES unit with a hand-held remote switch stimulated an active muscle gait cycle. Results are discussed for four children, who showed improved gait, balance, posture, active and passive ankle range of motion, and foot alignment. The toe walkers became plantigrade and the equinovalgus posture of the foot decreased. Spasticity did not increase.     

Projection pattern of single corticocortical fibers from the parietal cortex to the motor cortex

Arborization of single corticocortical (CC) axons projecting from the parietal cortex to the motor cortex (Mx) was analysed using an intraaxonal staining technique in the cat. Stem axons arising from cell bodies in area 5 ramified repeatedly into numerous terminal branches in the Mx, forming 2-6 patches (0.2-0.8 mm in diameter) separated by a terminal-free gap. Axon terminals were distributed mainly in layers II and III and sparsely in layers V, VI and I. This feature is quite similar to that of thalamocortical axons and other corticocortical fibres. Thus the patchy organization may be a basic input structure for afferents of the Mx and play a role in generation of adequate motor output patterns in the Mx.     

The reorganization of motor units in motor neuron disease

We studied 78 patients with motor neuron disease (MND) using concentric needle electromyography. Analysis on weak and maximal effort was performed using our own, fully automated, computer method, EMG-LAB. In addition to the conventional parameters of single motor unit action potentials (MUAPs) and interference pattern, new criteria were applied: the range of the acting motor units and the functional recruitment order. A total of 375 muscles of MND patients and 120 control muscles were investigated. The electromyographic data were analyzed separately in five groups of muscles, classified A, B, C, D, and E according to their clinical condition. Those results allowed us to discern six neurophysiological stages (N(0,1,2,3,4,5)) from the early to the most advanced phase. It has been confirmed that reinnervation in MND is adequate to compensate for the loss of over 50% of motor neurons but it is only a transitory phase in the morbid course. At stages N(O-5), the electrophysiological data reflect structural and functional integrity of the functioning motor units. Evaluation of not only single MUAPs but also of the full range of acting motor units and their recruitment order allowed a deeper look into the underlying pathophysiological mechanisms.     

Loss of motor units in Alzheimer's disease

Little attention has been paid in the literature to the state of the peripheral nervous system (PNS) in Alzheimer's disease (AD). We conducted a comprehensive electrophysiological study in 15 AD patients looking for functional abnormalities within their PNSs. A reduction of the number of functioning motor units (MU) was found in the thenar and soleus muscles of most of these patients without enlargement of the remaining MUs territories, while the motor and sensory conduction velocities of the peripheral nerves were preserved. These results suggest dysfunction of the spinal motoneurones in patients afflicted with this condition.     

Estimation of the relationship between the noninvasively detected activity of single motor units and their characteristic pathological changes by modelling

Postoperative management of the patellofemoral patient requires the clinician to implement a program which reestablishes functional activities of daily living. This paper will discuss the postoperative management of the patellofemoral patient. Effective rehabilitation techniques are needed to progress the patient. Surgical procedures, such as a lateral retinacular release, proximal realignment, and distal realignments, are frequently utilized techniques; however, long-term clinical outcome studies are lacking. The postoperative protocols discussed utilize an evaluation-based treatment approach model. The model defines evaluation techniques, leading the clinician to a specific rehabilitation pathway. The crucial element of postoperative management focuses on a treatment and exercise approach similar to the nonoperative management. Inappropriate or overly aggressive exercises may lead to possible neurologic dysfunction or delayed muscle function. The clinician must recognize that patients may exhibit articular cartilage damage, and, thus, rehabilitation programs must be designed to minimize the potential risks of progressing this lesion.