Effect of Transcutaneous Electrical Nerve Stimulation on Gait Kinematics in Subjects with Anterior Knee Pain

Knee pain is 1 of 5 leading causes of disability by altering lower-extremity muscle function and gait mechanics. While transcutaneous electrical nerve stimulation (TENS) mitigates deficits of muscle function due to pain, it is unclear whether TENS improves gait mechanics. Each of 15 participant (24±3yrs, 71±12kg, 178±7cm) was assigned to the TENS or matched placebo group (23±2yrs, 72±14kg, 177±9cm). Participants underwent 3 different experimental saline infusion sessions (hypertonic, isotonic, control) in a counterbalanced order, separated by 48-h. Hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was infused into the infrapatellar fat pad for 50-min. No infusion was administered to the control session. Participants and investigators were blinded to the saline solution. A 20-min TENS or placebo treatment was administered, which was blinded to participants. Gait kinematic data were collected using the high-speed video (240 Hz) and force-sending tandem treadmill (1200 Hz) at each time interval (baseline, infusion, treatment, post-treatment). Functional ANOVA (α=0.05) were used to evaluate difference between 2 groups (TENS, placebo) over time. Pairwise comparison functions with 95% confidence interval were plotted to determine specific difference. Hypertonic saline infusion (pain) resulted in increased (1) ankle dorsiflexion (38-75% of stance), (2) knee valgus (20-40%), (3) knee flexion (40-90%), (4) hip adduction (72-100%), (5) hip flexion (50-90%). However, there was no group x time interaction for all kinematics. Altered gait strategies due to pain may play a role in long-term compensation that could have consequences for the joint. TENS treatment, however, did not acutely reduce the deficits in aforementioned kinematic variables.

Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy

Effects of postural stability on the transfer of learned movement control strategies

We investigated whether stability affects the learning and/or transfer of human postural control strategies. Subjects learned novel postural control strategies in a more stable standing configuration and then transferred to a less stable configuration, or vice versa. Initial learning was not affected by stability. However, transfer of learned control from one context to another was affected by the change in stability between contexts. These results suggest that in rehabilitation it is important to consider the context in which task learning occurs, as well as the context in which the task will be performed in the future.
Listed In: Biomechanical Engineering, Biomechanics, Neuroscience

Suprathreshold Galvanic Vestibular Stimulation as an analog of vestibular dysfunction

In the past we have shown that exposure to increasing amplitudes of Galvanic vestibular stimulation (GVS) induces a corresponding increasing deficit in postural control, cognition and autonomic function. Previous studies have suggested that suprathreshold GVS induces a similar pattern of postural instability as the one observed on bilateral vestibular loss. The aim of the present study was to determine whether different current intensities would affect somatosensory, visual, and vestibular sensory system similarly to patient affected by vestibular deficits. We assessed postural control in unilateral (right and left) and bilateral vestibular loss patients, an aged matched healthy control group, and during pseudorandom binaural bipolar GVS in healthy subjects at one of three current amplitudes (1 mA, 3.5 mA, 5 mA). Balance was assessed with sensory organization test (SOT) that quantifies the effectiveness of vestibular, visual and somatosensory input to postural control. Results showed that GVS significantly affects vestibular control of posture compared to baseline at all current amplitudes, whereas somatosensory and visual performance was unaffected. Vestibular patients showed a significant decrease in vestibular and visual response compared to control. Suprathreshold GVS 5 mA showed a similar large effect size to unilateral and bilateral vestibular loss patients relative to their aged matched control. NASA NCC 9-58 and NNX09AL14G

Listed In: Biomechanical Engineering, Neuroscience, Posturography

Sensorimotor adaptation to Galvanic Vestibular Stimulation: a longitudinal study

Our previous study showed that exposure to Galvanic Vestibular Stimulation (GVS) induces temporary postural deficits similar to the ones experienced by astronauts after microgravity exposure. Preliminary evidence suggests that repeated exposures to GVS might induce adaptation of sway response. We studied whether repeated exposure to pseudorandom GVS over a 3 month period facilitates the adaptation response. Twenty healthy subjects were randomly assigned into 2 groups: suprathreshold (5mA) GVS, and subthreshold (1mA). The test battery included: Romberg, sensory organization test (posturography), dynamic visual acuity, and torsional eye movement. Each test was performed with no GVS, and then with 10 min of GVS per session for 12 consecutive weeks. Sensorimotor adaptation was also measured during two follow up sessions at weeks 18 and 36. Results showed that subthreshold GVS did not affect vestibular scores. Suprathreshold GVS significantly decreased vestibular scores during the first few weeks, with postural performance returning to baseline around the 6th week of exposure. This improvement was maintained during the follow up sessions. Our results suggest that 60 min of subthreshold GVS are sufficient to elicit adaptation to the stimulus. No significant changes were shown in low-level vestibulo-ocular reflexes during torsional eye movement, or vestibulo-spinal reflexes during Romberg; confirming that adaptation only occurs at the level of the CNS. NASA NCC 9-58; NNX09AL14G
Listed In: Biomechanical Engineering, Neuroscience, Posturography

Haptic-motor transformations for the control of fingertip distance

Dexterous manipulation relies on modulation of digit forces as a function of digit placement. However, little is known about the sense of position of the finger pads relative to each other. We quantified subjects' ability to match perceived vertical distance between the thumb and index finger pads (dy) of the right hand (“reference” hand, Rhand) using the ipsilateral or contralateral hand (“test” hand, Thand) without vision of the hands. The Rhand digits were passively placed non-collinearly (dy = ±30 mm) or collinearly (dy = 0 mm). Subjects reproduced Rhand dy by using a congruent or inverse Thand posture. We hypothesized that matching error would be greater (a) for collinear than non-collinear digits positions, (b) when Rhand and Thand postures were not congruent, and (c) when subjects reproduced dy using the contralateral hand. Subjects made greater errors when matching collinear than non-collinear dys, when the posture of Thand and Rhand were not congruent, and when Thand was the contralateral hand. Under-estimation errors were produced only for non-collinear digits positions, when the postures of Thand and Rhand were not congruent, and when Thand was the contralateral hand. These findings indicate that perceived finger pad distance is transferred across hands less accurately than when it is reproduced within the hand and reproduced less accurately when a higher-level processing of the somatosensory feedback is required for non-congruent hand postures. We propose that erroneous representation of finger pad distance, if not compensated for between contact and onset of manipulation, might lead to manipulation performance errors.

Listed In: Neuroscience

Rhythmical Bimanual Force Production: 1:2 and 2:3 Coordination Patterns

A large number of experiments have isolated a coalition of constraints, including cortical and subcortical neural crosstalk, that influence the coordination of the two hands functioning together. Recent findings, however, have demonstrated that these constraints are minimized when integrated feedback (Lissajous feedback) is used. Two experiments were designed to determine participants’ ability to coordinate 1:2 and 2:3 rhythmical bimanual force production tasks. We hypothesized that neural crosstalk should be more easily detected and characterized in tasks where the forces required to produce the goal pattern of coordination are increased. The task was to rhythmically produce and coordinate a pattern of isometric forces. A Lissajous display illustrated the specific pattern of force requirements needed to produce the goal pattern. The results indicated very effective temporal performance of the bimanual coordination patterns. This result is similar to that observed in our earlier work with reciprocal and circling motion, but is especially informative given that the increased forces required to produce the desired bimanual coordination pattern resulted in a consistent and identifiable distortion of the left limb forces that could be attributable to the production of right hand forces. We were not able to detect distortions of the forces produced by the right limb that could be attributable to the left limb. This type of right to left limb influence, which may be attributable to asymmetrical cortical and subcortical crosstalk, was not evident in our earlier work when the bimanual coordination tasks involved movements of the limbs in a relatively frictionless environment.

Listed In: Neuroscience

Effects of cortical stimulation on sensorimotor hand functions in healthy elderly individuals

Transcranial anodal stimulation (tDCS) improves manual dexterity in healthy old adults. The underlying changes in finger force behavior for this improved dexterity have not been reported. Here, we investigated the effects of tDCS (20-min) over primary motor cortex (M1) combined with repeated practice on the Grooved pegboard test (tDCS+MP) on the fingertip forces applied to an object during grasp and manipulation. Eight right-handed able-bodied individuals (60-85 years) participated in a sham-controlled, single-blinded study. Each participant received anodal and sham intervention in two sessions at least 5-day apart. Before and after intervention, they performed a ‘key-slot’ task that required inserting a slot on an object onto a stationary bar, an isometric force production task using a pinch grip, and the Grooved pegboard test. Anodal relative to sham tDCS+MP allowed participants to better retain the improved performance on the pegboard test. For the isometric task, anodal tDCS+MP significantly increased the variability of force compared to sham tDCS+MP. More importantly, the improved retention of performance post-anodal tDCS correlated with the reduction in force angle variability on the key-slot task, but not with the change in force variability on the isometric task. Our findings suggest that anodal tDCS+MP facilitated retention of learning on a skillful manual task in healthy old adults, consistent with the role of M1 in retention of learning versus skill acquisition. Furthermore, improved force steadiness is one of the potential mechanisms through which short-term anodal tDCS during motor training yields improved performance on a functional task.
Listed In: Biomechanics, Neuroscience

Adaptive fractal analysis of postural sway

Fractal time series analysis methods are commonly used for analyzing center of pressure (COP) signals with the goal of revealing the underlying neuromuscular processes for upright stance control. The use of fractal methods is often coupled with the assumption that the COP is an instance of fractional Gaussian noise (fGn) or fractional Brownian motion (fBm). Our purpose was to evaluate the applicability of the fGn-fBm framework to the COP in light of several characteristics of COP signals revealed by a new method, adaptive fractal analysis (AFA; Riley et al., 2012). Our results showed that there are potentially three fractal scaling regions in the COP as opposed to one as expected from a pure fGn or fBm process. The scaling region at the fastest scale was anti-persistent and spanned ~30-90 msec, the intermediate was persistent and spanned ~200 msec-1.9 sec, and the slowest was anti-persistent and spanned ~5-40 sec. The intermediate fractal scaling region was the most clearly defined, but it only contributed around 11% of the total spectral energy of the COP signal, indicating that other features of the COP signal contribute more importantly to the overall dynamics. Also, more than half of the Hurst exponents estimated for the intermediate region were greater than the theoretically expected range [0,1] for fGn-fBm processes. These results suggest the fGn-fBm framework is not appropriate for modeling COP signals. ON-OFF intermittency might provide a better modeling framework for the COP, and multiscale approaches may be more appropriate for analyzing COP data.

Listed In: Neuroscience, Posturography