Biomedical subjects

S J Harkema

Publications and source records attributed to S J Harkema.

12 recordsLinked to original sources

PubMed2006

Effect of harness application and postural changes on cardiovascular parameters of individuals with spinal cord injury.

STUDY DESIGN: Prospective assessment of cardiovascular parameters in individuals with spinal cord injury (SCI) in response to harness application and postural changes including orthostatic stress. OBJECTIVE: To evaluate arterial blood pressure and heart rate (HR) with and without harness application during sitting, supine, and standing positions in able-bodied and SCI individuals. METHODS: Measurements were obtained in all SCI research participants (n=11) before a locomotor training intervention and compared to data with able-bodied individuals (n=9). During standing, all research participants wore a harness and were suspended by an overhead, pneumatic body weight support system. RESULTS: Resting arterial blood pressure and HR in individuals with cervical SCI were significantly lower during sitting than in thoracic SCI and able-bodied individuals (P<0.05). Orthostatic stress significantly decreased arterial blood pressure only in individuals with cervical SCI (P<0.05). Harness application had no effect on cardiovascular parameters in able-bodied individuals, whereas diastolic blood pressure was significantly increased in those with SCI. Orthostatic changes in cervical SCI when sitting were ameliorated by harness application. However, while standing with harness, individuals with cervical SCI still developed orthostatic hypotension. CONCLUSIONS: Level of injury to the spinal cord influences baseline cardiovascular parameters. Application of harness in individuals with SCI could alter baseline cardiovascular parameters and the response to orthostatic stress. This should be carefully considered when assessing effects of therapeutic interventions using body weight support in individuals with SCI.

Adult↗

PubMed2004

Muscle activation during unilateral stepping occurs in the nonstepping limb of humans with clinically complete spinal cord injury.

STUDY DESIGN: Comparison of different kinematic and loading conditions on muscle activation in clinically complete spinal cord-injured subjects stepping unilaterally with manual assistance. OBJECTIVE: To determine if rhythmic lower limb loading or movement could produce rhythmic muscle activation in the nonstepping limb of subjects with clinically complete spinal cord injury (SCI). SETTING: Human Locomotion Research Center, Department of Neurology, University of California, Los Angeles, USA. METHODS: We recorded electromyography, joint kinematics, and vertical ground reaction forces as four subjects with clinically complete SCI stepped with manual assistance and partial bodyweight support. For all trials, one limb continuously stepped while the other limb underwent different conditions, including rhythmic lower limb loading in an extended position without limb movement, rhythmic lower limb movement similar to stepping without limb loading, and no lower limb loading or movement with the leg in an extended or flexed position. RESULTS: Three subjects displayed rhythmic muscle activity in the nonstepping limb for trials with rhythmic limb loading, but no limb movement. One subject displayed rhythmic muscle activity in the nonstepping limb for trials without ipsilateral limb loading or movement. The rhythmic muscle activity in the nonstepping limb was similar to the rhythmic muscle activity during bilateral stepping. CONCLUSIONS: The human spinal cord can use sensory information about ipsilateral limb loading to increase muscle activation even when there is no limb movement. The results also indicate that movement and loading in one limb can produce rhythmic muscle activity in the other limb even when it is stationary and unloaded. These findings emphasize the importance of optimizing load-related and contralateral sensory input during gait rehabilitation after SCI.

Adult↗

PubMed2002

Recruitment of spinal motor pools during voluntary movements versus stepping after human spinal cord injury.

We investigated the activation of lower limb motor pools by supraspinal and spinal networks after human spinal cord injury (SCI). We compared electromyographic (EMG) activity from six muscles during voluntarily attempted non-weight-bearing single-joint movements, multijoint movements approximating stepping in a supine position, and weight-bearing stepping on a treadmill with body weight support (BWST) in seven clinically incomplete and three clinically complete SCI subjects. Seven SCI subjects had previously completed Laufband therapy (a specific step training using variable levels of body weight support and manual assistance). Significant coactivation of agonists and antagonists and multijoint flexion or extension movements of the entire limb occurred during attempts at isolated knee or ankle single-joint movements in clinically incomplete SCI subjects. Further, some muscles that were not recruited during voluntary attempts at single-joint movements were activated during voluntary step-like multijoint movements (5/16 comparisons). This suggests that the residual voluntary motor control in incomplete SCI subjects evokes more generalized motor patterns (limb flexion or extension) rather than selective activation of individual muscles. Clinically incomplete and clinically complete SCI subjects could achieve greater activation of motor pools and more reciprocal patterns of activity between agonists and antagonists during weight bearing stepping than during non-weight-bearing voluntary movements. The EMG mean amplitudes were higher during stepping than during voluntary movements in 50/60 muscles studied (p < 0.05). These results suggest that stepping with knee and hip extension and flexion and alternating lower limb loading and unloading provides proprioceptive inputs to the spinal cord that increases motor recruitment and improves reciprocity between agonists and antagonists compared to voluntary efforts.

Adolescent↗

PubMed2001

Retraining the injured spinal cord.

The present review presents a series of concepts that may be useful in developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury. First, the loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent (dorsal root ganglion) origin. Second, following a complete transection the lumbrosacral spinal cord can recover greater levels of motor performance if it has been exposed to the afferent and intraspinal activation patterns that are associated with standing and stepping. Third, the spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. Fourth, robotic assistive devices can be used to guide the kinematics of the limbs and thus expose the spinal cord to the new normal activity patterns associated with a particular motor task following spinal cord injury. In addition, such robotic assistive devices can provide immediate quantification of the limb kinematics. Fifth, the behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord. Evidence is presented that both the GABAergic and glycinergic inhibitory systems are up-regulated following complete spinal cord transection and that step training results in some aspects of these transmitter systems being down-regulated towards control levels. These concepts and observations demonstrate that (a) the spinal cord can interpret complex afferent information and generate the appropriate motor task; and (b) motor ability can be defined to a large degree by training.

Animals↗

PubMed2001

Neural plasticity after human spinal cord injury: application of locomotor training to the rehabilitation of walking.

Recovery of locomotion has been considered unattainable following a clinically complete or severe incomplete spinal cord injury even after conventional therapy. However, the locomotion of spinal animals can be improved by training that provides complex temporal patterns of sensory information related to stepping that is interpreted by the spinal cord. This review discusses the evidence that suggests human spinal networks can integrate and interpret complex sensory signals to produce functional efferent output and adapt to repetitive training. Locomotor training, a new rehabilitative approach, is based on principles that promote the movement of limbs and trunk to generate sensory information consistent with locomotion to improve the potential for the recovery of walking after neurologic injury.

Electromyography↗

PubMed2000

How the science and engineering of spaceflight contribute to understanding the plasticity of spinal cord injury.

Space programs support experimental investigations related to the unique environment of space and to the technological developments from many disciplines of both science and engineering that contribute to space studies. Furthermore, interactions between scientists, engineers and administrators, that are necessary for the success of any science mission in space, promote interdiscipline communication, understanding and interests which extend well beyond a specific mission. NASA-catalyzed collaborations have benefited the spinal cord rehabilitation program at UCLA in fundamental science and in the application of expertise and technologies originally developed for the space program. Examples of these benefits include: (1) better understanding of the role of load in maintaining healthy muscle and motor function, resulting in a spinal cord injury (SCI) rehabilitation program based on muscle/limb loading; (2) investigation of a potentially novel growth factor affected by spaceflight which may help regulate muscle mass; (3) development of implantable sensors, electronics and software to monitor and analyze long-term muscle activity in unrestrained subjects; (4) development of hardware to assist therapies applied to SCI patients; and (5) development of computer models to simulate stepping which will be used to investigate the effects of neurological deficits (muscle weakness or inappropriate activation) and to evaluate therapies to correct these deficiencies.

Animals↗

PubMed2000

Locomotor training after human spinal cord injury: a series of case studies.

Many individuals with spinal cord injury (SCI) do not regain their ability to walk, even though it is a primary goal of rehabilitation. Mammals with thoracic spinal cord transection can relearn to step with their hind limbs on a treadmill when trained with sensory input associated with stepping. If humans have similar neural mechanisms for locomotion, then providing comparable training may promote locomotor recovery after SCI. We used locomotor training designed to provide sensory information associated with locomotion to improve stepping and walking in adults after SCI. Four adults with SCIs, with a mean postinjury time of 6 months, received locomotor training. Based on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards, subject 1 had a T5 injury classified as ASIA A, subject 2 had a T5 injury classified as ASIA C, subject 3 had a C6 injury classified as ASIA D, and subject 4 had a T9 injury classified as ASIA D. All subjects improved their stepping on a treadmill. One subject achieved overground walking, and 2 subjects improved their overground walking. Locomotor training using the response of the human spinal cord to sensory information related to locomotion may improve the potential recovery of walking after SCI.

Adult↗

PubMed1997

Acidosis has no effect on the ATP cost of contraction in cat fast- and slow-twitch skeletal muscles.

Studies of skinned fibers suggest that the rate of ATP turnover in skeletal muscle is depressed by acidosis. To examine whether this occurs in intact muscles, the ATP cost of isometric contractions was measured in ex vivo, arterially perfused cat biceps (predominantly fast-twitch) and soleus (slow-twitch) muscles under normocapnic (5% CO2) and hypercapnic (70% CO2) conditions. Hypercapnia decreased extracellular pH from 7.4 to 6.7 and intracellular pH from 7.1 to 6.5 (soleus) or 6.6 (biceps) but had no significant effect on the phosphocreatine (PCr)-to-ATP ratio in muscles at rest. The ATP cost of contraction was estimated from PCr changes, measured by gating the acquisition of 31P-nuclear magnetic resonance spectra to times before and after brief tetani (1 s at 100 Hz and 2 s at 25 Hz for biceps and soleus, respectively) or 10-s trains of twitches (2 and 1 Hz, respectively). Peak isometric force and the ATP cost of tetanic contraction (PCr/force x time integral) were not significantly different under hypercapnic compared with normocapnic conditions in either muscle (mean: 7.97 and 2.44 micromol x kg(-1) x s(-1) for biceps and soleus, respectively). Twitch force and the ATP cost per twitch decreased by nearly 50% during hypercapnic perfusion in both muscle types. The results indicate that hypercapnic acidosis has no significant effect on the ATPase rate per active myosin head in intact mammalian skeletal muscle.

Acidosis↗

PubMed1997

Effect of acidosis on control of respiration in skeletal muscle.

The relationships between oxygen consumption (Q(O2)) and calculated cytoplasmic ADP concentration ([ADP]) and the free energy of ATP hydrolysis (deltaG(ATP)) were examined in ex vivo arterially perfused cat soleus muscles during repetitive twitch stimulation under normocapnic (5% CO2) and hypercapnic (70% CO2) conditions. Hypercapnia decreased extra- and intracellular pH by over 0.5 but had no significant effect on Q(O2) or phosphocreatine (PCr)/ATP in muscles at rest. The maximum Q(O2) measured during stimulation and the rate constant for PCr recovery after stimulation both decreased during hypercapnic compared with normocapnic perfusion, but the estimated ATP/O2 was unchanged. The change in PCr and deltaG(ATP) with increasing Q(O2) was greater during hypercapnic compared with normocapnic stimulation, as expected from the decrease in maximum Q(O2). However, the relationships between Q(O2) and [ADP] and deltaG(ATP) were both shifted to the left during hypercapnia compared with normocapnia. The results show that changes in cytoplasmic adenine nucleotides and phosphate are not sufficient to explain the control of respiration in skeletal muscle. However, in the context of thermodynamic models of respiratory control, the results can be explained by increased intramitochondrial potential for ATP synthesis at low pH.

Acidosis↗

PubMed1997

Human lumbosacral spinal cord interprets loading during stepping.

Studies suggest that the human lumbosacral spinal cord can generate steplike oscillating electromyographic (EMG) patterns, but it remains unclear to what degree these efferent patterns depend on the phasic peripheral sensory information associated with bilateral limb movements and loading. We examined the role of sensory information related to lower-extremity weight bearing in modulating the efferent motor patterns of spinal-cord-injured (SCI) subjects during manually assisted stepping on a treadmill. Four nonambulatory subjects, each with a chronic thoracic spinal cord injury, and two nondisabled subjects were studied. The level of loading, EMG patterns, and kinematics of the lower limbs were studied during manually assisted or unassisted stepping on a treadmill with body weight support. The relationships among lumbosacral motor pool activity [soleus (SOL), medial gastrocnemius (MG), and tibialis anterior (TA)], limb load, muscle-tendon length, and velocity of muscle-tendon length change were examined. The EMG mean amplitude of the SOL, MG, and TA was directly related to the peak load per step on the lower limb during locomotion. The effects on the EMG amplitude were qualitatively similar in subjects with normal, partial, or no detectable supraspinal input. Responses were most consistent in the SOL and MG at load levels of < 50% of a subject's body weight. The modulation of the EMG amplitude from the SOL and MG, both across steps and within a step, was more closely associated with limb peak load than muscle-tendon stretch or the velocity of muscle-tendon stretch. Thus stretch reflexes were not the sole source of the phasic EMG activity in flexors and extensors during manually assisted stepping in SCI subjects. The EMG amplitude within a step was highly dependent on the phase of the step cycle regardless of level of load. These data suggest that level of loading on the lower limbs provides cues that enable the human lumbosacral spinal cord to modulate efferent output in a manner that may facilitate the generation of stepping. These data provide a rationale for gait rehabilitation strategies that utilize the level of load-bearing stepping to enhance the locomotor capability of SCI subjects.

Adult↗

PubMed1993

Magnetic resonance measurement of blood flow in peripheral vessels after acute exercise.

Velocity-encoded Cine magnetic resonance imaging (MRI) was used to measure blood flow in the anterior tibial artery (AT), posterior tibial artery (PT), and popliteal artery of adult human subjects (mean age 29 yr) before and after 90 s of ankle dorsiflexion exercise. Before exercise, mean flow, peak systolic velocity, and end-diastolic velocity in AT were 8.1 +/- 1.6 (SE, n = 6) ml/min, 26.9 +/- 2.6 cm/s, and -0.6 +/- 0.4 cm/s, respectively. After exercise, mean flow and peak systolic velocity in AT increased by 19-fold and 3-fold, respectively, and end-diastolic velocity increased to 8.7 +/- 1.1 cm/s. Flow in popliteal artery above its bifurcation was similar to the sum of flows in AT and PT, both before and after exercise. Flow in AT declined exponentially after exercise with a mean half-time of 4 min. The results demonstrate the utility of MR phase-encoded flow-velocity measurements for physiological studies of peripheral vascular dynamics after exercise.

Adult↗

PubMed1991

Decreased ATP cost of isometric contractions in ATP-depleted rat fast-twitch muscle.

ATP was depleted to inosine 5'-monophosphate (IMP) in gastrocnemius muscles of anesthetized rats during two consecutive bouts of intermittent tetanic stimulation (each 1 Hz at 100 Hz, 100-ms duration, for 3 min) separated by 5 min. During a subsequent 75-min recovery period, resynthesis of adenine nucleotide from IMP was inhibited in one group of muscles with hadacidin (N-formyl-N-hydroxyaminoacetate, total dose 300 mg/kg ip), an inhibitor of adenylosuccinate synthase. In vivo 31P-nuclear magnetic resonance spectra and analysis of muscle extracts confirmed that ATP was reduced by over 30% in hadacidin-treated muscles compared both with nonstimulated muscles and with identically stimulated and rested control muscles in saline-injected rats. After the recovery period, calculated [ADP] in ATP-depleted muscles was half that in controls, while phosphorylation potential [PP = ln([ATP]/[ADP] [Pi]), where Pi is inorganic phosphate] and twitch force were similar. During a final 8 min of 0.75-Hz twitch stimulation, [ADP] and the initial rate of phosphocreatine (PCr) hydrolysis were less in ATP-depleted compared with control muscles, while changes in PP and twitch force were similar in the two groups. During a final 3 min of tetanic stimulation, ATP, PCr, and pH decreased less in ATP-depleted compared with control muscles. The results indicate that the ATP cost of isometric contraction is decreased by acute ATP depletion.

Adenosine Triphosphate↗