Biomedical subjects

W Z Rymer

Publications and source records attributed to W Z Rymer.

At least 19 recordsLinked to original sources

PubMed2006

A comparison of the effects of imposed extension and flexion movements on Parkinsonian rigidity.

OBJECTIVE: To test a hypothesis that Parkinsonian rigidity is more pronounced in imposed extension than flexion movement. METHODS: Twelve Parkinsonian subjects (both "Off" and "On" medication states) and seven control subjects participated in the protocol, in which a servomotor imposed wrist flexion and extension. Rigidity was quantitatively evaluated by the rectified torque integral with time, i.e., temporal score, and by the torque integral with joint angle, i.e., work score, for extension and flexion, respectively. RESULTS: In the "Off" state, the imposed extension induced a significantly higher resistance than did flexion. Dopaminergic medication significantly reduced the temporal score associated with imposed extension, and significantly decreased the work score of both movements. Compared with controls, the scores were higher for patients in the "On" state. CONCLUSIONS: Rigidity is more readily elicited in extension movement. The distinction is not evident in clinical practice, whereas it can be clearly revealed with the application of biomechanical analyses. SIGNIFICANCE: This distinction may prove to be a standard feature of rigidity. The procedures may be helpful in diagnosis and useful in evaluating new treatments and developing rehabilitation programs.

Aged↗

PubMed2005

Reflex reciprocal facilitation of antagonist muscles in spinal cord injury.

STUDY DESIGN: Electromyographic study in complete and incomplete spinal cord injury (SCI). OBJECTIVE: To examine the changes in the pattern of reciprocal inhibition between agonist and antagonist muscles in SCI. SETTINGS: Sensory Motor Performance Program, Rehabilitation Institute of Chicago, IL, USA. METHODS: Tendon taps were delivered manually with an instrumented hammer to the tendons of the tibialis anterior and soleus muscle in positions of full-ankle dorsiflexion and plantarflexion in eight subjects with complete SCI and eight subjects with incomplete SCI. Electromyographic activity (EMG) was recorded from ankle dorsiflexor and plantarflexor muscles. Tapping force was also recorded by a force sensor mounted to the tendon hammer, indicating the stimulus onset. Measures of reflex EMG magnitude and reflex latency were obtained for both agonist and antagonist muscles. The ratio of antagonist to agonist EMG was computed based on normalized EMG. RESULTS: Substantial reflex responses occurred in both the stretched muscle and in its antagonist. The reflex in antagonist, which we term 'reciprocal facilitation (RF)', was most evident in subjects with incomplete SCI. The magnitude of RF was consistently greater than reflex responses in agonist muscles under all test conditions. The latency of the RF was comparable to that of monosynaptic reflex response. CONCLUSIONS: Following SCI, reciprocal organization of segmental reflexes at the ankle is often partially or completely suppressed, allowing reflex activation in antagonist muscles to be manifested. Possible mechanisms underlying these changes in neural organization are discussed. SPONSORSHIP: This study was supported by Spinal Cord Research Foundation, the Paralyzed Veterans of America.

Adult↗

PubMed2004

Neuromuscular reflexes contribute to knee stiffness during valgus loading.

We have previously shown that abduction angular perturbations applied to the knee consistently elicit reflex responses in knee joint musculature. Although a stabilizing role for such reflexes is widely proposed, there are as of yet no studies quantifying the contribution of these reflex responses to joint stiffness. In this study, we estimate the mechanical contributions of muscle contractions elicited by mechanical excitation of periarticular tissue receptors to medial-lateral knee joint stiffness. We hypothesize that these reflex muscle contractions will significantly increase knee joint stiffness in the adduction/abduction direction and enhance the overall stability of the knee. To assess medial-lateral joint stiffness, we applied an abducting positional deflection to the fully extended knee using a servomotor and recorded the torque response using a six degree-of-freedom load-cell. EMG activity was also recorded in both relaxed and preactivated quadriceps and hamstrings muscles with surface electrodes. A simple, linear, second-order, delayed model was used to describe the knee joint dynamics in the medial/lateral direction. Our data indicate that excitation of reflexes from periarticular tissue afferents results in a significant increase of the joint's adduction-abduction stiffness. Similar to muscle stretch reflex action, which is modulated with background activation, these reflexes also show dependence on muscle activation. The potential significance of this reflex stiffness during functional tasks was also discussed. We conclude that reflex activation of knee muscles is sufficient to enhance joint stabilization in the adduction/abduction direction, where knee medial-lateral loading arises frequently during many activities.

Adult↗

PubMed2003

Relative contributions of neural mechanisms versus muscle mechanics in promoting finger extension deficits following stroke.

The origins of impaired finger and hand function were examined in 10 stroke survivors with chronic spastic hemiparesis, with the intent of assessing whether mechanical restraint or altered neurophysiological control mechanisms are responsible for the well-known impairment of finger extension. Simultaneous extension of all four metacarpophalangeal (MCP) joints of the impaired hand was either externally imposed using a rotary actuator or attempted voluntarily by the subject. Trials were conducted both before and after administration of a local anesthetic, blocking the median and ulnar nerves at the elbow. The anesthetic was administered to reduce the activity of the muscles flexing the MCP joints, in order to distinguish mechanical from neuronal resistance to imposed MCP rotation. We found that the nerve blockade resulted in a reduction in velocity-dependent torque (P = 0.01), thereby indicating significant joint impedance due to spasticity. Blockade also produced a posture-dependent reduction in static torque in declaratively relaxed subjects (P = 0.04), suggesting some tonic flexor activity for specific hand postures. No change in either extensor isometric (P = 0.33) or isokinetic (0.53) torque was apparent, but 3 of the 10 subjects did exhibit substantial (>10 degrees ) improvement in voluntary MCP extension following the blockade. This improvement seemed largely due to a decrease in inappropriate flexor activity during the movement, rather than an increase in extensor activity. We argue that persistent and inappropriate flexor activation plays a role in limiting voluntary finger extension, and that this activation is potentially a reflection of altered supraspinal control of key spinal pathways. In all cases, this inappropriate activation was compounded by weakness, apparent in both the extensor and flexor muscles.

Biomechanical Phenomena↗

PubMed2003

Reflex muscle contractions can be elicited by valgus positional perturbations of the human knee.

Experimental evidence on the reflex responses of thigh muscles to valgus mechanical perturbations at the human knee are presented. Random step positional deflections, ranging from 5 degrees to 12 degrees at 60 degrees /s, were applied to the fully extended knees of seven healthy subjects. Subjects were instructed to maintain a constant background co-activation ( approximately 2-11% MVC) of the quadriceps and hamstring muscles prior to and during the mechanical stimulus. We found that the reflex response to sustained valgus joint deflection in the vasti muscles had longer onset latencies (range: 83-92ms) than did the stretch reflex in the same muscles (latencies: 29-31ms). This reflex EMG response consisted typically of a peak followed by sustained muscle activity throughout the step perturbation. The sustained EMG activity was dependent on the amplitude of the perturbing stimulus, but in a nonlinear manner. The long latency of the valgus response suggests that the reflex originates in nonmuscular sensory pathways, potentially from mechanoreceptors lying in periarticular tissues such as joint ligaments and capsule. Analysis of the spatial distribution of reflex responses showed an asymmetrical pattern with preferential activation of medial vs. lateral muscles of the knee. We assess whether these asymmetric reflex contractions could promote joint stability, either by inducing generalized joint stiffening, or by preferential activation of those muscles that are best suited to resist induced ligament strain.

Adult↗

PubMed2003

Windup of flexion reflexes in chronic human spinal cord injury: a marker for neuronal plateau potentials?

The physiological basis of flexion spasms in individuals after spinal cord injury (SCI) may involve alterations in the properties of spinal neurons in the flexion reflex pathways. We hypothesize that these changes would be manifested as progressive increases in reflex response with repetitive stimulus application (i.e., "windup") of the flexion reflexes. We investigated the windup of flexion reflex responses in 12 individuals with complete chronic SCI. Flexion reflexes were triggered using trains of electrical stimulation of plantar skin at variable intensities and inter-stimulus intervals. For threshold and suprathreshold stimulation, windup of both peak ankle and hip flexion torques and of integrated tibialis anterior electromyographic activity was observed consistently in all patients at inter-stimulus intervals < or =3 s. For subthreshold stimuli, facilitation of reflexes occurred only at intervals < or =1 s. Similarly, the latency of flexion reflexes decreased significantly at intervals < or =1 s. Patients that were receiving anti-spasticity medications (e.g., baclofen) had surprisingly larger windup of reflex responses than those who did not take such medications, although this difference may be related to differences of spasm frequency between the groups of subjects. The results indicate that the increase in spinal neuronal excitability following a train of electrical stimuli lasts for < or =3 s, similar to previous studies of nociceptive processing. Such long-lasting increases in flexion reflex responses suggest that cellular mechanisms such as plateau potentials in spinal motoneurons, interneurons, or both, may partially mediate spinal cord hyperexcitability in the absence of descending modulatory input.

Adult↗

PubMed2002

Muscular torque generation during imposed joint rotation: torque-angle relationships when subjects' only goal is to make a constant effort.

It is a reasonable expectation that voluntarily activated spinal motoneurons will be further excited by increases in spindle afferent activity produced by muscle stretch. Human motor behavior attributed to tonic stretch reflexes and to reflexes recruited by relatively slow joint rotation has been reported from several laboratories. We reinvestigated this issue by rotating the elbow joint over the central portion of its range while subjects focused on keeping their elbow flexion effort constant at one of three different levels and made no attempt to control the position, speed or direction of movement of their forearm. There is evidence that subjects' voluntary motor status is constant under these conditions so that any change in torque would be of involuntary origin. On average, torques rose somewhat and then fell as the elbow was flexed through a range of 80 degrees at 10, 20 and 60 degrees/s and a similar pattern occurred during elbow extension; i.e., both concentric and eccentric torque-angle profiles had roughly similar shapes and neither produced consistent stabilizing cross-range stiffness. The negative stiffness (rising torque) during the early part of a concentric movement and the negative stiffness (falling torque) during the later part of an eccentric movement would not have occurred if a stabilizing stretch reflex had been present. Positive stiffness rarely gave rise to torque changes greater than 20% in either individual or cross-subject averaged data. When angular regions of negative stiffness are combined with regions of low positive stiffness (torque change 10% or less), much of the range of motion was not well stabilized, especially during eccentric movements. The sum of the EMGs from biceps brachii, brachioradialis and brachialis showed a pattern opposite to that expected for a stretch reflex; there was an upward trend in the EMG as the elbow was flexed and a downward trend as the elbow was extended. There was little change in the shape of this EMG-angle relationship with either direction or velocity. The individual EMG-angle relationships were distinctive for each of these three elbow flexor muscles in four of the six subjects; in the remaining two, biceps was distinctive, but brachioradialis and brachialis appeared to be coupled. Although the EMGs of individual muscles were modulated over the angular range, no consistent stretch reflexes could be seen in the individual records. Thus, we could find no clear evidence for stretch reflex stabilization of human subjects maintaining a constant effort. Rather, muscle torque appears to be reflexly modulated across a much used portion of the elbow's angular range so that any appreciable stabilizing stiffness that is sustained for more than fractions of a second is associated with a change in effort.

Adult↗

PubMed2001

Impairment of voluntary control of finger motion following stroke: role of inappropriate muscle coactivation.

Subjects with chronic hemiplegia following stroke attempted to perform voluntary isometric, isokinetic, and free contractions of the extensor muscles of the metacarpophalangeal (MCP) joints. We recorded torque, metacarpophalangeal joint angle and velocity, and electromyographic (EMG) activity of the extrinsic extensors and flexors and the first dorsal interosseous (FDI). We found that voluntary MCP joint extension in hemiparetic subjects was greatly impaired in comparison with control subjects: only two of the 11 stroke subjects were able to generate even 0.21 N-m of isometric extension torque, only two could produce positive finger extension with no load, and none could develop an isokinetic concentric extension. Deficits seemed to result from a combination of coactivation of the finger flexor and extensor muscles and decreased voluntary excitation of the extensors, as normalized flexor and FDI EMG activity were greater for stroke than for control subjects (P < 0.001), but normalized extensor activity was reduced (P < 0.001).

Aged↗

PubMed2001

Identification of static and dynamic components of reflex sensitivity in spastic elbow flexors using a muscle activation model.

Static and dynamic components of the stretch reflex were studied in elbow flexors of 13 hemiparetic brain-injured individuals. Constant-velocity joint rotations were applied to the elbow, and the resulting stretch reflex torque and electromyographic responses were recorded in the biceps brachii and brachioradialis muscles. Ten elbow extension velocities between 6 and 150 deg s(-1) were applied in random order. The resulting reflex torque response was plotted as a function of elbow angle and fitted with a mathematical model designed to depict elbow flexor activation. We found that four of the six model parameters were essentially independent of test velocity. Conversely, 73% (19/26) of cases involving the other two model parameters were dependent on velocity of joint extension (p<0.05). We conclude from these results that four of the model parameters reflect the static reflex response while the two remaining velocity-dependent parameters reflect the dynamic reflex response. To describe overall velocity dependence of stretch reflexes in spastic elbow muscles, the two dynamic reflex parameters were fitted to a fractional exponential function of velocity, similar to a model previously used to describe spindle firing rate in the cat hindlimb. We found that the mean velocity exponent of the dynamic reflex parameters was 0.24 + 0.17 (s.d.) (N = 13), a value similar to that for muscle spindle velocity sensitivity in reduced animal preparations. We conclude that both static and dynamic reflex sensitivities can be measured by examining different aspects of the torque/angle relation associated with the reflex response to a large-amplitude ramp stretch of the elbow.

Adult↗

PubMed2001

Effect of muscle biomechanics on the quantification of spasticity.

The impact of muscle biomechanics on spasticity was assessed by comparison of the reflex responses of the elbow and metacarpophalangeal (MCP) flexor muscles in individuals with chronic spastic hemiplegia following stroke. Specifically, methods were developed to quantify reflex responses and to normalize these responses for comparison across different muscle groups. Stretch reflexes were elicited in the muscles of interest by constant velocity ramp-and-hold stretches at the corresponding joint. The muscles were initially passive, with the joint placed in a midrange position. Estimates of biomechanical parameters were used to convert measured reflex joint torque and joint angle into composite flexor muscle stress and stretch. We found that the stretch reflex response for the MCP muscle group had a 74% greater mean stiffness modulus than that for the elbow muscle group, and that the reflex threshold was initiated at an 80% shorter mean muscle stretch. However, we determined that initial normalized fiber length was significantly greater for the experiments involving the MCP muscles than for those involving the elbow muscles. Increasing the initial composite fiber length of the elbow flexors produced significant reduction of the reflex threshold (p<0.001), while decreasing the initial length of the MCP flexors significantly reduced their measured reflex stiffness (p<0.001). Thus, biomechanical parameters of muscle do appear to have an important effect on the stretch reflex in individuals with impairment following stroke, and this effect should be accounted for when attempting to quantify spasticity.

Aged↗

PubMed2001

Spinal interneurons that receive input from muscle afferents are differentially modulated by dorsolateral descending systems.

The possibility that descending systems have differential actions on the spinal interneurons that receive input from muscle afferents was investigated. Prolonged, physiological inputs were generated by stretch of the triceps surae muscles. The resulting firing patterns of 25 lumbosacral interneurons were recorded before and during a reversible cold block of the dorsolateral white matter at the thoracic level in nonparalyzed, decerebrate preparations. The strength of group I muscle afferent input was assessed from the response to sinusoidal tendon vibration, which activated muscle spindle Ia afferents directly and tendon organ Ib afferents via the resulting reflex force. The stretch-evoked responses of interneurons with strong responses to vibration were markedly suppressed by dorsal cold block, whereas the stretch-evoked responses of interneurons with weak vibration input were enhanced. The cells most strongly activated by vibration received their primary input from Ia afferents and all of these cells were inhibited by the cold block. These results suggest that a disruption of the descending system, such as occurs in spinal cord injury, will lead to a suppression of the interneuronal pathways with group Ia input while enhancing excitability within interneuronal pathways transmitting actions from higher threshold afferents. One possible consequence of this suppression would be a decreased activity among the Ia inhibitory interneurons that mediate reciprocal inhibition, resulting in abnormal reciprocal relations between antagonists and promoting anomalous muscle cocontraction.

Animals↗

PubMed2001

Damping actions of the neuromuscular system with inertial loads: human flexor pollicis longus muscle.

Our previous work in an animal model showed that neuromuscular damping properties help maintain limb posture by effectively dissipating mechanical energy arising from disturbances. The purpose of this study was to determine whether similar damping properties were expressed in intact, normal human muscles. To review briefly, when the reflexively active soleus muscle in a decerebrate cat is coupled to an inertial load, application of a force impulse to the load results in lightly damped oscillations. By calculating the logarithmic decrement in muscle velocity following the impulse (the decrement being related to the amount of energy dissipated from the inertia), we found that damping increased with oscillation amplitude, a nonlinear property. This nonlinearity represents an automatic compensation for larger perturbations. Our findings in parallel experiments on the interphalangeal joint of the human thumb were that the long thumb flexor, the flexor pollicis longus (FPL), displayed mechanical and reflex behavior closely comparable to that reported earlier for the cat soleus, despite differences in architectural and metabolic properties between these muscles. Specifically, by selecting experimental trials that did not include voluntary interventions, we observed amplitude-dependent differences in damping in which larger amplitude movements elicited larger damping than did smaller movements. In addition, even after accounting for amplitude-dependent differences in damping, damping was found to be larger in later cycles than in the first cycle. This nonlinearity indicates that both mechanical properties of muscle and reflex mechanisms are dependent on prior movement history. We propose that this history-dependent behavior arises from the effects of prior movement on stretch reflex gain, and these effects are mediated primarily via changes in muscle spindle properties. Recordings of electromyographic activity from the FPL, during the first and second cycles of oscillation supported this postulate of a reduced reflex gain following prior motion. The functional significance of these nonlinear damping properties is that during the initial muscle stretch, the stiffness is high, which helps to preserve the initial position (although at the expense of promoting oscillation). Subsequently, the ensuing increase in damping helps suppress continuing oscillation. This sequence of varying mechanical properties is broadly analogous to the features of a predictive, or feed-forward controller, designed to produce a response that initially maintains position, and subsequently dampens oscillations. These results show that the intrinsic properties of muscle and spinal reflexes automatically provide a complex time-varying response, appropriate for maintenance of stable limb posture.

Adult↗

PubMed2001

Reflex and intrinsic changes induced by fatigue of human elbow extensor muscles.

Fatigue-induced changes in intrinsic and reflex properties of human elbow extensor muscles and the underlying mechanisms for fatigue compensation were investigated. The elbow joint was perturbed using small-amplitude and pseudorandom movement patterns while subjects maintained steady levels of mean joint extension torque. Intrinsic and reflex properties were identified simultaneously using a nonlinear delay differential equation model. Intrinsic joint properties were characterized by measures of joint stiffness, viscous damping, and limb inertia and reflex properties characterized by measures of dynamic and static reflex gains. Fatigue was induced using 15 min of intermittent voluntary isometric (submaximal) exercise, and a rest period of 10 min was taken to allow the fatigued muscles to recover from acute fatigue effects. Identical experimental and data analysis procedures were used before and after fatigue. Our findings were that after fatigue, joint stiffness was significantly reduced at higher torque levels, presumably reflecting the reduced force-generating capacity of fatigued muscles. Conversely, joint viscosity was increased after fatigue potentially because of the reduced crossbridge detachment rate and prolonged relaxation associated with intracellular acidosis accompanying fatigue. Static stretch reflex gain decreased significantly at higher torque levels after fatigue, indicating that the isometric fatiguing exercise might be associated with a preferential change in properties of spindle chain fibers and bag(2) fibers. For matched pre- and postfatigue torque levels, dynamic reflexes contributed relatively more torque after fatigue, displaying higher dynamic reflex gains and larger dynamic electromyographic responses elicited by the controlled small-amplitude position perturbations. These changes appear to counteract the fatigue-induced reductions in joint stiffness and static reflex gain. The compensatory responses could be partly due to the effects of increasing the number of active motoneurons innervating the fatiguing muscles. This shift in operating point gave rise to significant compensation for the loss of contractile force. The compensation could also be due to fusimotor adjustment, which could make the dynamic reflex gain much less sensitive to fatigue than intrinsic stiffness. In short, the reduced contribution from intrinsic stiffness to joint torque was compensated by increased contribution from dynamic stretch reflexes after fatigue.

Adult↗

PubMed2000

Flexor reflexes in chronic spinal cord injury triggered by imposed ankle rotation.

Hypersensitivity of the flexor reflexes to input from force-sensitive muscle afferents may contribute to the prevalence and severity of muscle spasms in patients with spinal cord injuries. In the present study, we triggered flexor reflexes with constant-velocity ankle movements into end-range dorsiflexion and plantarflexion positions in 8 individuals with spinal cord injuries. We found that all 8 subjects had coordinated increases in flexion torque at the hip and ankle following externally imposed plantarflexion movements at the ankle. In addition, end-range dorsiflexion movements also triggered flexor reflexes in 3 subjects, although greater loads were required to trigger such reflexes using dorsiflexion movements (compared to plantarflexion movements). These three-joint reflex torque patterns triggered by ankle movement were broadly comparable to flexion withdrawal responses elicited by electrocutaneous stimuli applied to a toe, although the amplitude of the torque response was generally lower. We conclude that excitation of muscle and joint-related afferents induced by end-range movements may be responsible for exaggerated flexion reflex responses in spinal cord injury.

Adult↗

PubMed2000

Quantitative features of the stretch response of extrinsic finger muscles in hemiparetic stroke.

Despite its potential importance in hand dysfunction, spasticity in the finger muscles following stroke has not been well described. To explore this area, we assessed the role of finger flexor spasticity, along with that of passive mechanical forces, in resisting finger movement in 13 chronic stroke subjects. Subjects were tested with a device that stretched the extrinsic finger muscles through imposed rotation of the metacarpophalangeal (MCP) joints. Both maintained and constant-velocity stretches were imposed. For the constant-velocity stretches, eight of the 13 stroke subjects exhibited strong stretch reflexes, as determined by electromyography and net work. The net work of this reflex response, calculated from the integral of the torque-angle plots, increased proportionally with increasing velocity, indicating a contribution from flexor muscle spasticity. Conversely, nine of the 13 stroke subjects did not possess distinctly greater passive, mechanical resistance to MCP rotation than control subjects. While extensor spasticity was not observed, stretch of the extrinsic finger flexors also produced some reflex activity in the finger extensors concomitant with reflex excitation of the flexors. These findings suggest that resistance to muscle stretching following stoke is mediated primarily by neurological rather than biomechanical disturbances, although changes in muscle fiber length may exaggerate the resistance.

Aged↗

PubMed2000

Deficits in the coordination of multijoint arm movements in patients with hemiparesis: evidence for disturbed control of limb dynamics.

This study provides a detailed analysis of disturbances in the kinematics and dynamics of the acceleration phase of multijoint arm movements in six patients with chronic hemiparesis. Movements of the dominant and nondominant limbs were also examined in three control subjects. Subjects performed rapid movements from a central starting point to 16 targets located equidistantly around the circumference of a circle. Support of the upper limb was provided by an air-bearing apparatus, which allowed very low friction movements in the horizontal plane. We found that patients retained the capacity to modulate, in response to target direction, the initial direction of movements performed with the paretic limb. However, in comparison to the nonparetic limb or control subjects, movements of the paretic limb were misdirected systematically. An inverse dynamics analysis revealed an abnormal spatial tuning of the muscle torque at the elbow used to initiate movements of the paretic limb. Based on electromyographic recordings, similar spatial abnormalities were also apparent in the initial activations of elbow muscles. We argue that these spatial abnormalities result from a systematic disturbance in the control signal to limb muscles that cannot be attributed to previously identified mechanisms such as weakness, spasticity mediated restraint, or stereotypic muscle activation patterns (muscle synergies). Instead, our analysis of movement dynamics and simulation studies demonstrate that the spatial abnormalities are consistent with an impaired feedforward control of the passive interaction torques which arise during multijoint movements. This impaired control is hypothesized to reflect a degradation of the internal representation of limb dynamics that occurs either as a primary consequence of brain injury or secondary to disuse.

Adult↗

PubMed2000

Stretch reflex adaptation in elbow flexors during repeated passive movements in unilateral brain-injured patients.

OBJECTIVE: To evaluate the effects of repeated, externally imposed, flexion-extension movements of the elbow on the resulting stretch reflex response in hemiparetic spastic brain-injured patients. These effects were compared within a recording session and across sessions for the same subject to determine the impact of movement history on the quantification of spastic hypertonia using the stretch reflex response. DESIGN: Twenty to 30 sequential, constant velocity flexion-extension movements were applied to the impaired elbow of our cohort, with a 10-second hold interposed between flexion and extension. Movements were applied regularly at 1-minute intervals. Changes in stretch reflex responses were monitored during the applied movements. PARTICIPANTS: We examined a convenience sample of seven hemiparetic brain-injured subjects between the ages of 26 and 60 yrs, with moderate-to-severe spastic hypertonia of elbow muscles (Ashworth score 2-4/4). Subjects participated in 2 to 9 sessions. MEASURES: Elbow torque, position, velocity, and electromyograms of the biceps, brachioradialis, and triceps muscles were recorded for each flexion and extension movement. Stretch reflex torque was calculated by subtracting passive torque from total elbow torque, recorded over large amplitude movements. A linear regression analysis quantified both the initial torque response of the stretch reflex and the ensuing adaptation of the stretch reflex during sequential movements. Intersession variability was characterized both for spastic hypertonia measures and for stretch reflex adaptation. RESULTS: Repeated, externally imposed, sequential flexion-extension movements of the elbow decreased the elbow flexor stretch reflex in six of seven subjects. The mean reduction in reflex torque after 30 movements was 50% of the initial torque values (p = .001, t test vs. 0% change). Intersession stretch reflex responses for each subject were found to vary greatly (SDs of reflex torque ranged from 0.1 to 4.0 Nm), and there were also significant variations in the degree of adaptation between subjects. CONCLUSIONS: Stretch reflex adaptation must be taken into consideration when spastic hypertonia is quantified using repeated joint motion, as is often the case. The magnitude of intersession variation in spastic hypertonia measures suggests that ideally, such measurements should be made across multiple sessions before conclusions are made regarding the efficacy of spastic hypertonia interventions. This study provides quantitative evidence that repeated joint movements may have a significant short-term beneficial effect on spastic hypertonia.

Adaptation, Physiological↗

PubMed2000

The use of basis functions in modelling joint articular surfaces: application to the knee joint.

This article introduces a new method to represent bone surface geometry for simulations of joint contact. The method uses the inner product of two basis functions to provide a mathematical representation of the joint surfaces. This method guarantees a continuous transition in the direction of the surface normals, an important property for computation of joint contact. Our formulation handles experimental data that are not evenly distributed, a common characteristic of digitized data of musculoskeletal morphologies. The method makes it possible to represent highly curved surfaces, which are encountered in many anatomical structures. The accuracy of this method is demonstrated by modeling the human knee joint. The mean relative percentage error in the representation of the patellar track surface was 0.25% (range 0-1.56%) which corresponded to an absolute error of 0.17mm (range 0-0.16mm).

Cartilage, Articular↗