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Biomedical subjects

M F Levin

Publications and source records attributed to M F Levin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Recent tests of the equilibrium-point hypothesis (lambda model).

The lambda model of the equilibrium-point hypothesis (Feldman & Levin, 1995) is an approach to motor control which, like physics, is based on a logical system coordinating empirical data. The model has gone through an interesting period. On one hand, several nontrivial predictions of the model have been successfully verified in recent studies. In addition, the explanatory and predictive capacity of the model has been enhanced by its extension to multimuscle and multijoint systems. On the other hand, claims have recently appeared suggesting that the model should be abandoned. The present paper focuses on these claims and concludes that they are unfounded. Much of the experimental data that have been used to reject the model are actually consistent with it.

Electromyography↗
PubMed1997

Spatial zones for muscle coactivation and the control of postural stability.

It is hypothesized that, depending on the motor task, the angular range of a joint may be subdivided into zones in which agonist and antagonist muscles are coactive, only one group of muscles is active or neither group is active. It is further hypothesized that central commands may change the size and location of these spatial zones. We investigated whether spatial zones are used by the nervous system and how they may be changed to provide postural stability of the elbow. We compared responses to sudden unloading of the elbow flexors in neurologically normal subjects with those in patients with postural control deficits due to unilateral hemispheric and/or subcortical lesions. By studying responses in patients, we sought to determine whether the specification of zones of agonist/antagonist muscle coactivation ("coactivation zones") may be essential for postural stability. At an initial elbow angle (130 degrees; full extension is 180 degrees), flexors were pre-activated by compensating an initial load which was equal to approximately 30% of the subject's maximal isometric voluntary contraction effort. Subjects were instructed not to correct the arm displacement elicited by a sudden decrease in the load. Data from 10 trials were collected at each of 4-6 final load levels (separated by 1.5-2 Nm) in order to map out the relationship between torque and angle in each subject. The procedure was repeated from a more flexed initial position of the elbow (100 degrees). EMG activity from two elbow flexors and two elbow extensors, as well as torque, velocity and joint position were recorded. Healthy control subjects and patients with mild clinical symptoms had coactivation zones or small silent zones around the final positions established after unloading. In these subjects, final positions of the limb were stable. Voluntary movement, i.e., transition of the limb from one initial position to another, was associated with a change in the location of the zone in articular space. The presence of large silent zones in patients with moderate or severe symptoms was correlated with postural instability and oscillations about the final position of the arm after unloading. The comparison of results from healthy and hemiparetic subjects implies that the central specification of the size and the location of a coactivation zone may be fundamental for the control of posture and movement.

Adult↗
PubMed1997

Phasic and tonic stretch reflexes in muscles with few muscle spindles: human jaw-opener muscles.

We investigated phasic and tonic stretch reflexes in human jaw-opener muscles, which have few, if any, muscle spindles. Jaw-unloading reflexes were recorded for both opener and closer muscles. Surface electromyographic (EMG) activity was obtained from left and right digastric and superficial masseter muscles, and jaw orientation and torques were recorded. Unloading of jaw-opener muscles elicited a short-latency decrease in EMG activity (averaging 20 ms) followed by a short-duration silent period in these muscles and sometimes a short burst of activity in their antagonists. Similar behavior in response to unloading was observed for spindle-rich jaw-closer muscles, although the latency of the silent period was statistically shorter than that observed for jaw-opener muscles (averaging 13 ms). Control studies suggest that the jaw-opener reflex was not due to inputs from either cutaneous or periodontal mechanoreceptors. In the unloading response of the jaw openers, the tonic level of EMG activity observed after transition to the new jaw orientation was monotonically related to the residual torque and orientation. This is consistent with the idea that the tonic stretch reflex might mediate the change in muscle activation. In addition, the values of the static net joint torque and jaw orientation after the dynamic phase of unloading were related by a monotonic function resembling the invariant characteristic recorded in human limb joints. The torque-angle characteristics associated with different initial jaw orientations were similar in shape but spatially shifted, consistent with the idea that voluntary changes in jaw orientation might be associated with a change in a single parameter, which might be identified as the threshold of the tonic stretch reflex. It is suggested that functionally significant phasic and tonic stretch reflexes might not be mediated exclusively by muscle spindle afferents. Thus, the hypothesis that central modifications in the threshold of the tonic stretch reflex underlie the control of movement may be applied to the jaw system.

Electromyography↗
PubMed1997

Central modifications of reflex parameters may underlie the fastest arm movements.

Descending and reflex pathways usually converge on common interneurons and motoneurons. This implies that active movements may result from changes in reflex parameters produced by control signals conveyed by descending systems. Specifically, according to the lambda-model, a fast change in limb position is produced by a rapid change in the threshold of the stretch reflex. Consequently, external perturbations may be ineffective in eliciting additional reflex modifications of electromyographic (EMG) patterns unless the perturbations are relatively strong. In this way, the model accounts for the relatively weak effects of perturbations on the initial agonist EMG burst (Ag1) usually observed in fast movements. On the other hand, the same model permits robust reflex modifications of the timing and shape of the Ag1 in response to strong perturbations even in the fastest movements. To test the model, we verified the suggestion that the onset time of the Ag1, even in the fastest movements, depends on proprioceptive feedback in a manner consistent with a stretch reflex. In control trials, subjects (n = 6) made fast unopposed elbow flexion movements of approximately 60 degrees (peak velocity 500-700 degrees/s) in response to an auditory signal. In random test trials, a brief (50 ms) torque of 8-15 Nm either assisting or opposing the movement was applied 50 ms after this signal. Subjects had no visual feedback and were instructed not to correct arm deflections in case of perturbations. In all subjects, the onset time of the Ag1 depended on the direction of perturbation: it was 25-60 ms less in opposing compared with assisting load conditions. Assisting torques caused, at a short latency of 37 ms, an additional antagonist EMG burst preceding the Ag1. The direction-dependent effects of the perturbation persisted when cutaneous feedback was suppressed. It was concluded that the direction-dependent changes in the onset time and duration of the Ag1 as well as the antagonist activation preceding the Ag1 resulted from stretch reflex activity elicited by the perturbations rather than from a change in the control strategy or cutaneous reflexes. The results support the hypothesis on the hierarchical scheme of sensorimotor integration in which EMG patterns and movement emerge from the modification of the thresholds and other parameters of proprioceptive reflexes by control systems.

Adult↗
PubMed1997

Effects of transcutaneous electrical nerve stimulation on the H-reflex of muscles of different fibre type composition.

Differential effects of repetitive stimulation of low threshold afferents on both the recruitment threshold and motoneuronal excitability of type I and type II motor units have been demonstrated. The present study was aimed at further investigating the differential effects of 30 minutes of transcutaneous electrical nerve stimulation (TENS) on the H-reflex amplitude (Hmax/2) of the Soleus (SO), gastrocnemius lateralis (GL) and medialis (GM) muscles. Eleven healthy subjects were tested in order to evaluate the effects of TENS on either the common peroneal (CPN), saphenous or sural nerve. The experimental session consisted of three consecutive 45 min periods. Within each of these periods, H-reflexes were recorded before, during and after the TENS was applied. It was hypothesized that repetitive low threshold afferent stimulation would either have inhibitory or facilitatory effects on the H-reflex amplitude of the SO or gastrocnemii muscles respectively. Non-parametric Friedman ANOVAs revealed a significant tendency (p < 0.05) toward inhibition of the H-reflex amplitude of the SO and GL muscle during TENS applied over either the CPN or sural nerve, as well as that of the GM during repetitive stimulation of the saphenous nerve. Although the present study failed to reveal any differential effects of TENS on the H-reflex amplitude of muscle on different fibre type content, the significant decrease in H-reflex observed on the triceps surae muscles during TENS applied over the CPN might have promising clinical outcomes for hyperreflexive subjects.

Adult↗
PubMed1996

Three-dimensional ultrasound imaging of the eye.

We assessed whether an inexpensive, three-dimensional (3D) ultrasound (US) imaging system could produce clinically useful 3D images, without causing patient discomfort. Five patients were examined. The 3D US system consisted of a transducer holder containing a mechanical motor, and a microcomputer. During data acquisition the transducer was mechanically rotated for 22 seconds, while 200 two-dimensional (2D) US images were collected and formed into a 3D image by the computer. The 3D image was viewed on the computer monitor. The 3D images correlated with the clinical and radiological findings. The new perspectives were helpful in diagnosing eye abnormalities and no patient discomfort occurred. The device was easy to use. It is concluded that, as good-quality 3D and 2D US images were produced quickly, with no patient discomfort, and the device is inexpensive, uncomplicated, and easily attached to existing ultrasound machines, it will probably be useful in clinical practice.

Adult↗
PubMed1996

Interjoint coordination during pointing movements is disrupted in spastic hemiparesis.

Approaches to the rehabilitation of movement in spastic hemiparetic patients depend on knowledge of the underlying mechanisms of movement deficits. The goals of this study were to characterize end-point trajectories and interjoint coordination of arm pointing movements to different targets on a horizontal planar surface and to correlate disruptions in motor control in the affected arm of hemiparetic subjects with the level of spasticity and the degree of functional impairment measured clinically. Arm movements were studied in six normal and 10 hemiparetic subjects. Data from the affected arms of hemiparetic subjects were compared with those from their non-affected arms and to data from the arms of normal subjects. Subjects were seated in front of a horizontal surface adjusted to the height of the sternal notch with the trunk stabilized. They made planar arm reaching movements (20 and 40 cm) to four different targets located directly in front of them and in the ipsilateral and contralateral workspace. Kinematic data from the finger, wrist, elbow and shoulder were recorded with a three-dimensional optical tracking system. Results showed that movement amplitudes were lower and movement times were significantly prolonged in the affected arms. Although trajectories were marked by deviations from smooth straight lines and characterized by increased dispersion and segmentation, even those subjects with the most severe spasticity could reach into all parts of the workspace with both their affected and non-affected arms. This indicated that movement planning in terms of extrapersonal space was unaffected in these subjects. On the other hand, the interjoint coordination of movements made into or out of the typical extensor or flexor synergies was equally disrupted. These findings suggest a bi-level control organization of pointing movements in both normal and hemiparetic subjects: the level of trajectory planning in extrapersonal space and the level specifying interjoint coordination according to the trajectory plan. Deficits in motor performance in stroke patients may be associated with problems at the second control level. This implies some strategies for the rehabilitation of stroke patients with motor disorders. Treatment aimed at improving arm function should be oriented toward restoring the normal sensorimotor relationships between the joints. We also found that while clinical spasticity scores were correlated with some aspects of motor performance, they provided little information about the movement deficit itself.

Adult↗
PubMed1996

One-trial adaptation of movement to changes in load.

1. We analyzed the rapid adaptation of elbow movement to unexpected changes in external load conditions at the elbow joint. The experimental approach was based on the lambda model, which defines control variables (CVs) setting the positional frames of reference for recruitment of flexor and extensor motoneurons. CVs may be specified by the nervous system independently of the current values of output variable such as electromyographic (EMG) activity, muscle torques, and kinematics. The CV R specifies the referent joint angle (R) at which the transition of flexor to extensor activity or vice versa can be observed during changes in the actual joint angle, theta, elicited by an external force. The other CV, the coactivation (C) command, instead of a single transition angle, defines an angular range in which flexor and extensor muscles may be simultaneously active (if C > 0) or silent (if C < 0). Changes in the R command result in shifts in the equilibrium state of the system, a dynamic process leading to EMG modifications resulting in movement or isometric force production if movement is obstructed. Fast movements are likely produced by combining the R command with a positive C command, which provides movement stability and effective energy dissipation, diminishing oscillations at the end of movement. 2. According to the model, changes in the load characteristic (e.g., from a 0 to a springlike load) influence the system's equilibrium state, leading to a positional error. This error may be corrected by a secondary movement produced by additional changes in R and C commands. In subsequent trials, the system may reproduce the CVs specified after correction in the previous trial. This behavior is called the recurrent strategy. It allows the system to adapt to the new load condition in the subsequent trials without corrections (1-trial adaptation). Alternatively, the system may reproduce the CVs specified before correction (invariant strategy). If the movement was perturbed only in a single trial, the invariant strategy allows the system to reach the target in the subsequent trials without corrections. 3. To test the assumption on the dominant role of the recurrent strategy in rapid adaptation of movement to new load conditions, we performed experiments in which subjects (n = 6) used a pivoting manipulandum and made fast 60 degrees movements to a target. After a random number of trials (5-10) with no load, we introduced opposing (experiment 1), assisting (experiment 2), or randomly varied opposing or assisting loads (experiment 3) for 5-10 trials before unexpectedly switching loads again (14-18 switches in total). The opposing or assisting torque was created by position feedback to a torque motor and was a linear function of the displacement of the manipulandum form the initial position (springlike load). Subjects were instructed to correct positional errors as soon as possible to reach the target. The EMG activity of two elbow flexors (biceps brachii and brachioradialis) and two elbow extensors (triceps brachii and anconeus), elbow position, velocity, and torque were recorded. Kinematic and EMG patterns were compared with those obtained in similar experiments in which subjects were instructed not to correct errors. 4. In 94% of the trials in which a change in the load occurred, the primary movement was in error and was followed by a corrective secondary movement. In primary movements, both the phasic and tonic levels of EMG activity as well as the kinematics were load dependent, implicating reflex and intramuscular mechanisms in the adaptation of muscle forces counteracting external loads. These mechanisms, however, were not sufficient to eliminate positional errors. 5. An undershoot error occurred in trials with an opposing load after those with no load or in trials with no load after those with an assisting load. After adaptation to a new load condition, a sudden return to the previous load condition resulted in an error of the oppo

Adult↗
PubMed1995

The relationship between control, kinematic and electromyographic variables in fast single-joint movements in humans.

Two versions of the hypothesis that discrete movements are produced by shifts in the system's equilibrium point are considered. The first suggests that shifts are monotonic and end near the peak velocity of movement, and the second presumes that they are nonmonotonic ("N-shaped") and proceed until the end of movement. The first version, in contrast to the second, predicts that movement time may be significantly reduced by opposing loads without changes in the control pattern. The purpose of the present study was to test the two hypotheses about the duration and shape of the shift in the equilibrium point based on their respective predictions concerning the effects of perturbations on kinematic and EMG patterns in fast elbow flexor movements. Subjects performed unopposed flexions of about 55-70 degrees (control trials) and, in random test trials, movements were opposed by spring-like loads generated by a torque motor. Subjects had no visual feedback and were instructed not to correct arm deflections in case of perturbations. After the end of the movement, the load was removed leading to a secondary movement to the same final position as that in control trials (equifinality). When the load was varied, the static arm positions before unloading and associated joint torques (ranging from 0 to 80-90% of maximum voluntary contraction) had a monotonic relationship. Test movements opposed by a high load (80-90% of maximal voluntary contraction) ended near the peak velocity of control movements. Phasic and tonic electromyographic patterns were load-dependent. In movements opposed by high loads, the first agonist burst was significantly prolonged and displayed a high level of tonic activity for as long as the load was maintained. In the same load conditions, the antagonist burst was suppressed during the dynamic and static phases of movement. The findings of suppression of the antagonist burst does not support the hypothesis of an N-shaped control signal. Equally, the substantial reduction in movement time by the introduction of an opposing load cannot be reconciled in this model. Instead, our data indicate that the shifts in the equilibrium point underlying fast flexor movements are of short duration, ending near the peak velocity of unopposed movement. This suggests that kinematic and electromyographic patterns represent a long-lasting oscillatory response of the system to the short-duration monotonic control pattern, external forces and proprioceptive feedback.

Adult↗
PubMed1995

Control variables and proprioceptive feedback in fast single-joint movement.

Sensorimotor mechanisms were studied on the basis of kinematic and electromyographic data as well as the static torque developed by the muscles as a function of joint angle. The latter relationship is known as the torque/angle characteristic. Fast single-joint movement may result from a shift in this characteristic and a change in its slope. Such movements were studied at the wrist in 9 normal and 1 deafferented subject. After training to flex the wrist to a target, subjects repeated the same movements but in random test trials movements were opposed by the load generated by linear position feedback to a torque motor. At the end of the loaded trials, the load was suddenly removed. In the second experiment, subjects made wrist movements to the target that were opposed by the load and, on random test trials, the movements were not loaded. In these test trials, the wrist arrived in a static position outside the target zone. In both experiments, subjects were instructed not to correct errors. The final torque/angle characteristics specified in the movements were reconstructed on the basis of the static wrist positions and torques before and after unloading. Normal subjects made movements by shifting the position of the torque/angle characteristic and by increasing its slope. If subjects indeed maintained the same pattern of control variables (descending commands), the same final position of the characteristic would be reproduced from trial to trial regardless of load perturbations. This assumption of equifinality was tested by comparing the final position of the wrist in nonloaded movements with that after removal of the load in loaded movements. Equifinality was observed in normal subjects. Movements in the deafferented subject were also associated with a shift of the torque/angle characteristic and a change in its slope. However, she was unable to consistently reproduce its final position. In spite of muscle coactivation, her maximal stiffness was lower than in normal subjects. In the absence of vision, the subject made movements with the load by increasing the slope of the characteristic instead of by shifting its position far enough. Load perturbation affected her final wrist position (inequifinality), which may reflect the presence of a significant hysteresis of the characteristic as a result of the absence of stretch reflexes. The deficits following deafferentation presumably result from the destruction of biomechanical and sensorimotor mechanisms including the ability of control variables to specify the positional frame of reference for afferent and descending systems.

Adult↗
PubMed1995

Thoracic manifestations of ovarian hyperstimulation syndrome.

OBJECTIVE: To determine the thoracic manifestations of severe ovarian hyperstimulation syndrome, the major serious complication of induction of superovulation with exogenous gonadotropins. PATIENTS AND METHOD: The authors reviewed the medical records and available images for 771 patients who had received gonadotropins to induce superovulation for in-vitro fertilization and embryo transfer or intrauterine insemination of concentrated sperm. The patients, ranging in age from 28 to 43 years, had been treated between October 1990 and July 1992. RESULTS: In 22 patients (3%) severe hyperstimulation syndrome was diagnosed clinically and confirmed with ultrasonography. Pleural effusion occurred in five of these (23%), one of whom required thoracentesis. Atelectasis, associated with adult respiratory distress syndrome (ARDS) and internal jugular vein thrombosis, developed in one patient, and ventilation-perfusion mismatch of uncertain cause occurred in another. CONCLUSIONS: Respiratory distress in patients with ovarian hyperstimulation syndrome is most likely due to lung restriction caused by ascites, the large cystic ovaries, or pleural or pericardial effusion. Pulmonary embolism and ARDS may rarely occur. Pulmonary manifestations, not previously well recognized, form an important part of this syndrome, and radiologic input with regard to assessment, monitoring and management are needed.

Adult↗
PubMed1994

The role of stretch reflex threshold regulation in normal and impaired motor control.

Some hypotheses suggest that stretch reflex threshold regulation may be an essential element of motor control. Disturbances in this mechanism may lead to motor dysfunction. We investigated this possibility by comparing stretch reflex threshold regulation in 11 spastic hemiparetic and 6 normal subjects. Subjects sat with their arms fully supported in a forearm and hand mold attached to a manipulandum mounted on and controlled by a torque motor. They remained completely passive while their elbow was extended from 30 degrees flexion through an arc of 100 degrees. Displacement and velocity of the forearm were measured as well as EMG signals from 2 elbow flexors and 2 elbow extensors, when the elbow flexors were stretched at each of 7 velocities. Velocities ranged from 8 to 160 degrees/s for hemiparetic subjects and from 32 to 300 degrees/s for normal subjects. Phase diagrams (velocity versus angle) were plotted and the threshold angles (lambda) for muscle activation at each velocity of stretch were used to determine the static stretch reflex threshold (lambda) and the slope (mu) of the relationship between the lambda s and velocity. Our main findings were that static and dynamic stretch reflex thresholds were decreased in spastic hemiparetic compared to normal subjects and that the thresholds depended on velocity. The static threshold value correlated with the severity of clinically measured spasticity. In addition, the range of regulation of lambda was decreased in the patients compared to normal. This may explain some of the problems of force and position regulation as well as hypertonus (and weakness) common to these patients.

Adult↗
PubMed1994

Merging different motor patterns: coordination between rhythmical and discrete single-joint movements.

Subjects made fast, discrete elbow flexion movements while simultaneously producing rhythmical oscillations about initial and final visual targets embedded on a horizontal surface. Based on kinematic and electromyographic (EMG) analysis, we found that the discrete movement could start at any phase of the cyclical movement. The most likely onset time occurred when the first agonist burst started at the same moment as a rhythmical burst would have appeared. This resulted in a smooth conjugation between discrete and rhythmical movements. The initiation of the discrete movement was associated with the resetting of the phase of the rhythmical movements. Thus, the time characteristics of the two motor tasks were interdependent. A subset of trials with a uniform distribution of discrete movement onset phases could be selected in most subjects and was averaged to eliminate the cyclical component from the combined movement. Mean kinematic and EMG traces up until the peak velocity were practically identical to those of the discrete movement made alone. The averaging procedure was ineffective in eliminating the rhythmical component following the discrete movement because of the resetting of the phase of oscillation. Using the same procedure it has been shown that initiating the rhythmical movement at the same time as beginning the discrete movement did not affect the initial part of discrete movement. The whole discrete movement was not affected when subjects simultaneously terminated the ongoing rhythmical movements. Our findings are consistent with the hypothesis that although the rhythmical movement constrains the onset time of discrete movement, the latter, once initiated, proceeds independently of the ongoing rhythmical movement. We also subtracted the discrete component from the combined movement to see how the former affected the rhythmical movement. The residual pattern showed that the rhythmical movements rapidly attenuated when the discrete movement started and then apparently resumed after the peak velocity of the discrete movement. The results corroborate the hypothesis that the control signals underlying the two motor tasks cannot be applied simultaneously, since they may be associated with conflicting stability requirements. Instead, these control signals may be generated sequentially, but the resulting kinematic responses may outlast them and be superposed.

Arm↗
PubMed1994

Absence of consistent effects of repetitive transcutaneous electrical stimulation on soleus H-reflex in normal subjects.

Our purpose was to determine the effects of transcutaneous electrical nerve stimulation (TENS) on the soleus H-reflex amplitude in normal subjects. Eleven subjects were tested in five experimental sessions, the purpose of which was to compare the effects of 30 minutes of TENS delivered at either 50 or 99Hz (250 microseconds pulses) on a mixed (common peroneal nerve or CPN) versus a sensory (sural) nerve. The soleus H-reflex was elicited according to the classic protocol of Hugon (1973). Control values (Hctrl) were measured for 5 minutes prior to and for 10 minutes after the TENS was administered at twice the sensory threshold. No statistically significant session (treatment) effects (two-way ANOVAs for repeated measures; alpha = 0.05) resulted from the stimulation of the CPN or the sural nerve at 50 or 99Hz. However, although no specific trends were shown across all subjects, there was a definite tendency towards inhibition (> or = 10% Hctrl) of the H-reflex in 63% of the subjects after 30 minutes of TENS at 99Hz over the CPN, and in 50% of the subjects when TENS was applied over the sural nerve at 99Hz. The inherent variability of the H-reflex amplitude in normal subjects as well as the use of different stimulation paradigms and TENS parameters could explain the controversial findings present in the literature.

Adult↗
PubMed1994

Self-contained, inflatable penile prosthesis: magnetic resonance appearance.

The appearance of an inflatable penile prosthesis, visualized on a short tau inversion recovery sequence, is reported, in a patient who had magnetic resonance imaging for pelvic pain subsequent to radical cystoprostatectomy for bladder carcinoma. With suppression of adjacent fat signal, the prosthesis is well delineated from adjacent structures. The fluid-containing cylinders of the prosthesis are of very bright signal intensity, with the relief valve assembly of low signal intensity.

Humans↗
PubMed1994

The emerging role of magnetic resonance imaging in rheumatology.

The role of magnetic resonance imaging (MRI) in imaging the central nervous system and in orthopedic radiology is now well accepted. Numerous applications of this technique also exist in the field of rheumatology, and it is anticipated that MRI will play an important part in the evaluation of treatments for the arthritides. In addition, MRI allows noninvasive investigation of other rheumatologic problems, such as avascular necrosis, tendon disorders and myopathy. This review outlines the current applications of MRI in rheumatologic practice.

Humans↗