Human foot form and function: variable and versatile, yet sufficiently related to predict function from form.

The human foot is a complex structure that plays an important role in our capacity for upright locomotion. Comparisons of our feet with those of our closest extinct and extant relatives have linked shape features (e.g. the longitudinal and transverse arches, heel size and toe length) to specific mechanical functions. However, foot shape varies widely across the human population, so it remains unclear if and how specific shape variants are related to locomotor mechanics. Here we constructed a statistical shape-function model (SFM) from 100 healthy participants to directly explore the relationship between the shape and function of our feet. We also examined if we could predict the joint motion and moments occurring within a person's foot during locomotion based purely on shape features. The SFM revealed that the longitudinal and transverse arches, relative foot proportions and toe shape along with their associated joint mechanics were most variable. However, each of these only accounted for small proportions of the overall variation in shape, deformation and joint mechanics, most likely owing to the high structural complexity of the foot. Nevertheless, a leave-one-out analysis showed that the SFM can accurately predict joint mechanics of a novel foot, based on its shape and deformation.

Linking muscle mechanics to the metabolic cost of human hopping.

Many models have been developed to predict metabolic energy expenditure based on biomechanical proxies of muscle function. However, current models may only perform well for select forms of locomotion, not only because the models are rarely rigorously tested across subtle and broad changes in locomotor task but also because previous research has not adequately characterised different forms of locomotion to account for the potential variability in muscle function and thus metabolic energy expenditure. To help to address the latter point, the present study imposed frequency and height constraints to hopping and quantified gross metabolic power as well as the activation requirements of medial gastrocnemius (MG), lateral gastrocnemius (GL), soleus (SOL), tibialis anterior (TA), vastus lateralis (VL), rectus femoris (RF) and biceps femoris (BF), and the work requirements of GL, SOL and VL. Gross metabolic power increased with a decrease in hop frequency and increase in hop height. There was no hop frequency or hop height effect on the mean electromyography (EMG) data of ankle musculature; however, the mean EMG of VL and RF increased with a decrease in hop frequency and that of BF increased with an increase in hop height. With a reduction in hop frequency, GL, SOL and VL fascicle shortening, fascicle shortening velocity and fascicle to MTU shortening ratio increased, whereas with an increase in hop height, only SOL fascicle shortening velocity increased. Therefore, within the constraints that we imposed, decreases in hop frequency and increases in hop height resulted in increases in metabolic power that could be explained by increases in the activation requirements of knee musculature and/or increases in the work requirements of both knee and ankle musculature.

Increased muscle force does not induce greater stretch-induced damage to calf muscles during work-matched heel drop exercise.

PURPOSE: To investigate the effect of muscle force during active stretch on quantitative and qualitative indicators of exercise-induced muscle damage (EIMD) in the medial gastrocnemius (MG) muscle. METHODS: Twelve recreationally active volunteers performed two trials of an eccentric heel drop exercise. Participants performed a single bout of low-load (body weight) and high-load (body weight + 30% body weight) exercises on separate legs. The total mechanical work output for each condition was matched between legs. Before, two hours and 48 h after each bout of eccentric exercise, electrically stimulated triceps surae twitch torque, muscle soreness, MG active fascicle length at maximum twitch torque and muscle passive stiffness were collected. Triceps surae electromyographic (EMG) activity, MG fascicle stretch and MG muscle-tendon unit (MTU) length were measured during the eccentric tasks. RESULTS: The high-load condition increased triceps surae muscle activity by 6-9%, but reduced MG fascicle stretch (p < 0.001). MTU stretch was similar between conditions. The greater muscle force during stretch did not give rise to additional torque loss (5 vs 6%) or intensify muscle soreness. CONCLUSIONS: Adding 30% body weight during eccentric contractions has a modest impact on exercise-induced muscle damage in the medial gastrocnemius muscle. These results suggest that muscle load may not be an important determinant of stretch-induced muscle damage in the human MG muscle. The muscle investigated does exhibit large pennation angles and high series elastic compliance; architectural features that likely buffer muscle fibres against stretch and damage.

The functional importance of human foot muscles for bipedal locomotion.

Human feet have evolved to facilitate bipedal locomotion, losing an opposable digit that grasped branches in favor of a longitudinal arch (LA) that stiffens the foot and aids bipedal gait. Passive elastic structures are credited with supporting the LA, but recent evidence suggests that plantar intrinsic muscles (PIMs) within the foot actively contribute to foot stiffness. To test the functional significance of the PIMs, we compared foot and lower limb mechanics with and without a tibial nerve block that prevented contraction of these muscles. Comparisons were made during controlled limb loading, walking, and running in healthy humans. An inability to activate the PIMs caused slightly greater compression of the LA when controlled loads were applied to the lower limb by a linear actuator. However, when greater loads were experienced during ground contact in walking and running, the stiffness of the LA was not altered by the block, indicating that the PIMs' contribution to LA stiffness is minimal, probably because of their small size. With the PIMs blocked, the distal joints of the foot could not be stiffened sufficiently to provide normal push-off against the ground during late stance. This led to an increase in stride rate and compensatory power generated by the hip musculature, but no increase in the metabolic cost of transport. The results reveal that the PIMs have a minimal effect on the stiffness of the LA when absorbing high loads, but help stiffen the distal foot to aid push-off against the ground when walking or running bipedally.

Regional changes in muscle activity do not underlie the repeated bout effect in the human gastrocnemius muscle.

The repeated bout effect (RBE) confers protection following exercise-induced muscle damage. Typical signs of this protective effect are significantly less muscle soreness and faster recovery of strength after the second bout. The aim of this study was to compare regional changes in medial gastrocnemius (MG) muscle activity and mechanical hyperalgesia after repeated bouts of eccentric exercise. Twelve healthy male participants performed two bouts of eccentric heel drop exercise (separated by 7 days) while wearing a vest equivalent to 20% of their body weight. High-density MG electromyographic amplitude maps and topographical pressure pain sensitivity maps were created before, two hours (2H), and two days (2D) after both exercise bouts. Statistical parametric mapping was used to identify RBE effects on muscle activity and mechanical hyperalgesia, using pixel-level statistics when comparing maps. The results revealed a RBE, as a lower strength loss (17% less; P < .01) and less soreness (50% less; P < .01) were found after the second bout. However, different muscle regions were activated 2H and 2D after the initial bout but not following the repeated bout. Further, no overall changes in EMG distribution or mechanical hyperalgesia were found between bouts. These results indicate that muscle activation is unevenly distributed during the initial bout, possibly to maintain muscle function during localized mechanical fatigue. However, this does not reflect a strategy to confer protection during the repeated bout by activating undamaged/non-fatigued muscle areas.

Cyclic eccentric stretching induces more damage and improved subsequent protection than stretched isometric contractions in the lower limb.

PURPOSE: Controversy remains about whether exercise-induced muscle damage (EIMD) and the subsequent repeated bout effect (RBE) are caused by the stretching of an activated muscle, or the production of high force at long, but constant, muscle lengths. The aim of this study was to determine the influence of muscle fascicle stretch elicited during different muscle contraction types on the magnitude of EIMD and the RBE. METHODS: Fourteen participants performed an initial bout of lower limb exercise of the triceps surae. One leg performed sustained static contractions at a constant long muscle length (ISO), whereas the contralateral leg performed a bout of eccentric heel drop exercise (ECC). Time under tension was matched between the ECC and ISO conditions. Seven days later, both legs performed ECC. Plantar flexor twitch torque, medial gastrocnemius (MG) fascicle length and muscle soreness were assessed before, 2 h and 2 days after each exercise bout. MG fascicle length and triceps surae surface electromyography were examined across the bouts of exercise. RESULTS: We found that both ECC and ISO conditions elicited EIMD and a RBE. ISO caused less damage 2 h after the initial bout (14% less drop in twitch torque, P = 0.03) and less protection from soreness 2 days after the repeated bout (56% higher soreness, P = 0.01). No differences were found when comparing neuromechanical properties across exercise bouts. CONCLUSION: For MG, the action of stretching an active muscle seems to be more important for causing damage than a sustained contraction at a long length.

Trunk muscle activity during different types of low weighted squat exercises in normal and forefoot standing conditions.

Squats are considered a useful basic exercise for trunk muscle activation. To gain knowledge about trunk muscle activity patterns depending on the barbell position in beginners, we examined squats with low weights in the back, front, and overhead position. METHODS: Twelve healthy adults (6 women/6 men, age: 29.1 (SD 8.0) y, height: 173.4 (6.9) cm, body mass: 70.1 (9.1) kg) randomly performed the three barbell squats in normal and in forefoot standing. Surface electromyography from external (EO) and internal oblique, rectus abdominis, and erector spinae (ES) was recorded. The centre of pressure path length (CoP) and the motion of the lumbar spine were captured. RESULTS: The overhead squat revealed the highest percent muscle activity, where EO (p = 0.009) and ES (p = 0.03) showed the greatest activity. Forefoot standing did not change overall trunk muscle activities (.05< Hedges' g <.29, 0.17 < p < 0.95) although longer CoP path length (.45 < g < 1.3, p < 0.05) was measured. CONCLUSIONS: Squat exercises with low weight are useful to activate trunk muscles. Activity increases with the difficulty of the squat by frontal or overhead loading, but not by standing on the forefoot. The low weighted squat can target well core muscle activity in training with beginners or in rehabilitation.

Effects of inspiratory muscle strength and inspiratory resistance on neck inspiratory muscle activation during controlled inspirations.

NEW FINDINGS: What is the central question of this study? What factors influence the onset and magnitude of activation of the neck inspiratory muscles during inspiration? What is the main finding and its importance? Recruitment of the sternocleidomastoid and scalene muscles during inspiration, measured by means of surface EMG, was strongly correlated with maximal inspiratory pressure. This result indicates that muscle recruitment depends on the capacity of an individual to generate inspiratory pressure. Surface measurements of neck inspiratory muscle EMG activity might complement tests currently used for the screening of respiratory-related disease. ABSTRACT: The aims of the present study were as follows: (i) to examine the relationship between the onset of recruitment of the neck inspiratory muscles and inspiratory muscle strength; and (ii) to clarify the effect of inspiratory resistance on neck inspiratory muscle activation during inspiration at specific flow rates and to specific lung volumes. Inspiratory muscle strength, as indicated by maximal inspiratory pressure (MIP), and peak inspiratory flow rate (PFR) were measured in healthy participants. Subsequently, participants inspired at target inspiratory flow rates between 20 and 100% of PFR as closely as possible, with and without artificial inspiratory resistance. Electromyographic activity (EMGRMS ) of the sternocleidomastoid and scalene muscles was measured from surface electrodes at each target flow rate for each 10% increment of forced vital capacity (FVC) between 20 and 50% of FVC. Recruitment onset for each muscle was determined from %PFR-EMGRMS curves at each lung volume (%FVC). Finally, linear regression analyses were performed for MIP and recruitment onset for each muscle at each %FVC. Recruitment onset during inspiration without inspiratory resistance was strongly correlated with MIP (r > 0.60, P < 0.040). Specifically, a lower MIP was associated with earlier muscle recruitment (i.e. recruitment at a lower flow rate), especially for the sternocleidomastoid muscle (r > 0.75, P < 0.005). Recruitment of both neck inspiratory muscles at a given flow rate was also earlier when inspiratory resistance was added (P = 0.002). These results indicate that the recruitment and activation of the neck inspiratory muscles depends on both inspiratory muscle strength and inspiratory resistance.

Tibialis anterior tendinous tissue plays a key role in energy absorption during human walking.

The elastic tendinous tissues of distal lower limb muscles can improve the economy of walking and running, amplify the power generated by a muscle and absorb energy. This paper explores the behaviour of the tibialis anterior (TA) muscle and its tendinous tissue during gait, as it absorbs energy during contact and controls foot position during swing. Simultaneous measurements of ultrasound, surface electromyography and 3D motion capture with musculoskeletal modelling from 12 healthy participants were recorded as they walked at preferred and fast walking speeds. We quantified the length changes and velocities of the TA muscle-tendon unit (MTU) and its fascicles across the stride at each speed. Fascicle length changes and velocities were relatively consistent across speeds, although the magnitude of fascicle length change differed between the deep and superficial regions. At contact, when the TA is actively generating force, the fascicles remained relatively isometric as the MTU actively lengthened, presumably stretching the TA tendinous tissue and absorbing energy. This potentially protects the muscle fibres from damage during weight acceptance and allows energy to be returned to the system later in the stride. During early swing, the fascicles and MTU both actively shortened to dorsiflex the foot, clearing the toes from the ground; however, at the fast walking velocity, the majority of shortening occurred through tendinous tissue recoil, highlighting its role in accelerating ankle dorsiflexion to power rapid foot clearance in swing.

Muscle spindles in human tibialis anterior encode muscle fascicle length changes.

Muscle spindles provide exquisitely sensitive proprioceptive information regarding joint position and movement. Through passively driven length changes in the muscle-tendon unit (MTU), muscle spindles detect joint rotations because of their in-parallel mechanical linkage to muscle fascicles. In human microneurography studies, muscle fascicles are assumed to follow the MTU and, as such, fascicle length is not measured in such studies. However, under certain mechanical conditions, compliant structures can act to decouple the fascicles, and, therefore, the spindles, from the MTU. Such decoupling may reduce the fidelity by which muscle spindles encode joint position and movement. The aim of the present study was to measure, for the first time, both the changes in firing of single muscle spindle afferents and changes in muscle fascicle length in vivo from the tibialis anterior muscle (TA) during passive rotations about the ankle. Unitary recordings were made from 15 muscle spindle afferents supplying TA via a microelectrode inserted into the common peroneal nerve. Ultrasonography was used to measure the length of an individual fascicle of TA. We saw a strong correlation between fascicle length and firing rate during passive ankle rotations of varying rates (0.1-0.5 Hz) and amplitudes (1-9°). In particular, we saw responses observed at relatively small changes in muscle length that highlight the sensitivity of the TA muscle to small length changes. This study is the first to measure spindle firing and fascicle dynamics in vivo and provides an experimental basis for further understanding the link between fascicle length, MTU length, and spindle firing patterns.NEW & NOTEWORTHY Muscle spindles are exquisitely sensitive to changes in muscle length, but recordings from human muscle spindle afferents are usually correlated with joint angle rather than muscle fascicle length. In this study, we monitored both muscle fascicle length and spindle firing from the human tibialis anterior muscle in vivo. Our findings are the first to measure these signals in vivo and provide an experimental basis for exploring this link further.

Effects of series elastic compliance on muscle force summation and the rate of force rise.

Compliant tendons permit mechanically unfavourable fascicle dynamics during fixed-end contractions. The purpose of this study was to reduce the effective compliance of tendon and investigate how small reductions in active shortening affect twitch kinetics and contractile performance in response to a second stimulus. The series elastic element (SEE) of the human triceps surae (N=15) was effectively stiffened by applying a 55 ms rotation to the ankle, through a range of 5 deg, at the onset of twitch and doublet [interstimulus interval (ISI) of 80 ms] stimulation. Ultrasonography was employed to quantify lateral gastrocnemius and soleus fascicle lengths. Rotation increased twitch torque (40-75%), rate of torque development (RTD; 124-154%) and torque-time integral (TTI; 70-110%) relative to constant-length contractions at the initial and final joint positions, yet caused only modest reductions in shortening amplitude and velocity. The torque contribution of the second pulse increased when stimulation was preceded by rotation, a finding unable to be explained on the basis of fascicle length or SEE stiffness during contraction post-rotation. A further increase in torque contribution was not demonstrated, nor was an increase in doublet TTI, when the second pulse was delivered during rotation and shortly after the initial pulse (ISI of 10 ms). The depressant effect of active shortening on subsequent torque generation suggests that compliant tendons, by affording large length changes, may limit torque summation. Our findings indicate that changes in tendon compliance shown to occur in response to resistance training or unloading are likely sufficient to considerably alter contractile performance, particularly maximal RTD.

The role of human ankle plantar flexor muscle-tendon interaction and architecture in maximal vertical jumping examined in vivo.

Humans utilise elastic tendons of lower limb muscles to store and return energy during walking, running and jumping. Anuran and insect species use skeletal structures and/or dynamics in conjunction with similarly compliant structures to amplify muscle power output during jumping. We sought to examine whether human jumpers use similar mechanisms to aid elastic energy usage in the plantar flexor muscles during maximal vertical jumping. Ten male athletes performed maximal vertical squat jumps. Three-dimensional motion capture and a musculoskeletal model were used to determine lower limb kinematics that were combined with ground reaction force data in an inverse dynamics analysis. B-mode ultrasound imaging of the lateral gastrocnemius (GAS) and soleus (SOL) muscles was used to measure muscle fascicle lengths and pennation angles during jumping. Our results highlighted that both GAS and SOL utilised stretch and recoil of their series elastic elements (SEEs) in a catapult-like fashion, which likely serves to maximise ankle joint power. The resistance of supporting of body weight allowed initial stretch of both GAS and SOL SEEs. A proximal-to-distal sequence of joint moments and decreasing effective mechanical advantage early in the extension phase of the jumping movement were observed. This facilitated a further stretch of the SEE of the biarticular GAS and delayed recoil of the SOL SEE. However, effective mechanical advantage did not increase late in the jump to aid recoil of elastic tissues.

Additional in-series compliance reduces muscle force summation and alters the time course of force relaxation during fixed-end contractions.

There are high mechanical demands placed on skeletal muscles in movements requiring rapid acceleration of the body or its limbs. Tendons are responsible for transmitting muscle forces, but, because of their elasticity, can manipulate the mechanics of the internal contractile apparatus. Shortening of the contractile apparatus against the stretch of tendon affects force generation according to known mechanical properties; however, the extent to which differences in tendon compliance alter force development in response to a burst of electrical impulses is unclear. To establish the influence of series compliance on force summation, we studied electrically evoked doublet contractions in the cane toad peroneus muscle in the presence and absence of a compliant artificial tendon. Additional series compliance reduced tetanic force by two-thirds, a finding predicted based on the force-length property of skeletal muscle. Doublet force and force-time integral expressed relative to the twitch were also reduced by additional series compliance. Active shortening over a larger range of the ascending limb of the force-length curve and at a higher velocity, leading to a progressive reduction in force-generating potential, could be responsible. Muscle-tendon interaction may also explain the accelerated time course of force relaxation in the presence of additional compliance. Our findings suggest that a compliant tendon limits force summation under constant-length conditions. However, high series compliance can be mechanically advantageous when a muscle-tendon unit is actively stretched, permitting muscle fibres to generate force almost isometrically, as shown during stretch-shorten cycles in locomotor activities. Restricting active shortening would likely favour rapid force development.

Reactive stepping behaviour in response to forward loss of balance predicts future falls in community-dwelling older adults.

BACKGROUND: a fall occurs when an individual experiences a loss of balance from which they are unable to recover. Assessment of balance recovery ability in older adults may therefore help to identify individuals at risk of falls. The purpose of this 12-month prospective study was to assess whether the ability to recover from a forward loss of balance with a single step across a range of lean magnitudes was predictive of falls. METHODS: two hundred and one community-dwelling older adults, aged 65-90 years, underwent baseline testing of sensori-motor function and balance recovery ability followed by 12-month prospective falls evaluation. Balance recovery ability was defined by whether participants required either single or multiple steps to recover from forward loss of balance from three lean magnitudes, as well as the maximum lean magnitude participants could recover from with a single step. RESULTS: forty-four (22%) participants experienced one or more falls during the follow-up period. Maximal recoverable lean magnitude and use of multiple steps to recover at the 15% body weight (BW) and 25%BW lean magnitudes significantly predicted a future fall (odds ratios 1.08-1.26). The Physiological Profile Assessment, an established tool that assesses variety of sensori-motor aspects of falls risk, was also predictive of falls (Odds ratios 1.22 and 1.27, respectively), whereas age, sex, postural sway and timed up and go were not predictive. CONCLUSION: reactive stepping behaviour in response to forward loss of balance and physiological profile assessment are independent predictors of a future fall in community-dwelling older adults. Exercise interventions designed to improve reactive stepping behaviour may protect against future falls.

The effect of knee flexion contracture following total knee arthroplasty on the energy cost of walking.

This study evaluated the energy cost of walking (Cw) with knee flexion contractures (FC) simulated with a knee brace, in total knee arthroplasty (TKA) recipients (n=16) and normal controls (n=15), and compared it to baseline (no brace). There was no significant difference in Cw between the groups at baseline but TKA recipients walked slower (P=0.048) and with greater knee flexion in this condition (P=0.003). Simulated FC significantly increased Cw in both groups (TKA P=0.020, control P=0.002) and this occurred when FC exceeded 20° in the TKA group and 15° in the controls. Reported perceived exertion was only significantly increased by FC in the control group (control P<0.001, TKA P=0.058). Simulated knee FCs less than 20° do not increase Cw or perceived exertion in TKA recipients.

Discharge properties of abductor hallucis before, during, and after an isometric fatigue task.

Abductor hallucis is the largest muscle in the arch of the human foot and comprises few motor units relative to its physiological cross-sectional area. It has been described as a postural muscle, aiding in the stabilization of the longitudinal arch during stance and gait. The purpose of this study was to describe the discharge properties of abductor hallucis motor units during ramp and hold isometric contractions, as well as its discharge characteristics during fatigue. Intramuscular electromyographic recordings from abductor hallucis were made in 5 subjects; from those recordings, 42 single motor units were decomposed. Data were recorded during isometric ramp contractions at 60% maximum voluntary contraction (MVC), performed before and after a submaximal isometric contraction to failure (mean force 41.3 ± 15.3% MVC, mean duration 233 ± 116 s). Motor unit recruitment thresholds ranged from 10.3 to 54.2% MVC. No significant difference was observed between recruitment and derecruitment thresholds or their respective discharge rates for both the initial and postfatigue ramp contractions (all P > 0.25). Recruitment threshold was positively correlated with recruitment discharge rate (r = 0.47, P < 0.03). All motor units attained similar peak discharge rates (14.0 ± 0.25 pulses/s) and were not correlated with recruitment threshold. Thirteen motor units could be followed during the isometric fatigue task, with a decline in discharge rate and increase in discharge rate variability occurring in the final 25% of the task (both P < 0.05). We have shown that abductor hallucis motor units discharge relatively slowly and are considerably resistant to fatigue. These characteristics may be effective for generating and sustaining the substantial level of force that is required to stabilize the longitudinal arch during weight bearing.

Bilateral tremor responses to unilateral loading and fatiguing muscle contractions.

Although physiological tremor has been extensively studied within a single limb, tremor relationships between limbs are not well understood. Early investigations proposed that tremor in each limb is driven by CNS oscillators operating in parallel. However, recent evidence suggests that tremor in both limbs arises from shared neural inputs and is more likely to be observed under perturbed conditions. In the present study, postural tremor about the elbow joint and elbow flexor EMG activity were examined on both sides of the body in response to unilateral loading and fatiguing muscle contractions. Applying loads of 0.5, 1.0, 1.5, and 3.0 kg to a single limb increased tremor and muscle activity in the loaded limb but did not affect the unloaded limb, indicating that manipulating the inertial characteristics of a limb does not evoke bilateral tremor responses. In contrast, maximal-effort unilateral isometric contractions resulted in increased tremor and muscle activity in both the active limb and the nonactive limb without any changes in between-limb tremor or muscle coupling. When unilateral contractions were repeated intermittently, to the extent that maximum torque generation about the elbow joint declined by 50%, different tremor profiles were observed in each limb. Specifically, unilateral fatigue altered coupling between limbs and generated a bilateral response such that tremor and brachioradialis EMG decreased for the fatigued limb and increased in the contralateral nonfatigued limb. Our results demonstrate that activity in the nonactive limb may be due to a "spillover" effect rather than directly coupled neural output to both arms and that between-limb coupling for tremor and muscle activity is only altered under considerably perturbed conditions, such as fatigue-inducing contractions.

Effects of running on human Achilles tendon length-tension properties in the free and gastrocnemius components.

The elastic properties of the human Achilles tendon are important for locomotion; however, in vitro tests suggest that repeated cyclic contractions lead to tendon fatigue - an increase in length in response to stress applied. In vivo experiments have not, however, demonstrated mechanical fatigue in the Achilles tendon, possibly due to the limitations of using two-dimensional ultrasound imaging to assess tendon strain. This study used freehand three-dimensional ultrasound (3DUS) to determine whether the free Achilles tendon (calcaneus to soleus) or the gastrocnemius tendon (calcaneus to gastrocnemius) demonstrated tendon fatigue after running exercise. Participants (N=9) underwent 3DUS scans of the Achilles tendon during isometric contractions at four ankle torque levels (passive, and 14, 42 and 70 N m) before and after a 5 km run at a self-selected pace (10-14 km h(-1)). Running had a significant main effect on the length of the free Achilles tendon (P<0.01) with a small increase in length across the torque range. However, the mean lengthening effect was small (<1%) and was not accompanied by a change in free tendon stiffness. There was no significant change in the length of the gastrocnemius tendon or the free tendon cross-sectional area. While the free tendon was shown to lengthen, the lack of change in stiffness suggests the tendon exhibited mechanical creep rather than fatigue. These effects were much smaller than those predicted from in vitro experiments, possibly due to the different loading profile encountered and the ability of the tendon to repair in vivo.

The efficacy of SMART Arm training early after stroke for stroke survivors with severe upper limb disability: a protocol for a randomised controlled trial.

BACKGROUND: Recovery of upper limb function after stroke is poor. The acute to subacute phase after stroke is the optimal time window to promote the recovery of upper limb function. The dose and content of training provided conventionally during this phase is however, unlikely to be adequate to drive functional recovery, especially in the presence of severe motor disability. The current study concerns an approach to address this shortcoming, through evaluation of the SMART Arm, a non-robotic device that enables intensive and repetitive practice of reaching by stroke survivors with severe upper limb disability, with the aim of improving upper limb function. The outcomes of SMART Arm training with or without outcome-triggered electrical stimulation (OT-stim) to augment movement and usual therapy will be compared to usual therapy alone. METHODS/DESIGN: A prospective, assessor-blinded parallel, three-group randomised controlled trial is being conducted. Seventy-five participants with a first-ever unilateral stroke less than 4 months previously, who present with severe arm disability (three or fewer out of a possible six points on the Motor Assessment Scale [MAS] Item 6), will be recruited from inpatient rehabilitation facilities. Participants will be randomly allocated to one of three dose-matched groups: SMART Arm training with OT-stim and usual therapy; SMART Arm training without OT-stim and usual therapy; or usual therapy alone. All participants will receive 20 hours of upper limb training over four weeks. Blinded assessors will conduct four assessments: pre intervention (0-weeks), post intervention (4-weeks), 26 weeks and 52 weeks follow-up. The primary outcome measure is MAS item 6. All analyses will be based on an intention-to-treat principle. DISCUSSION: By enabling intensive and repetitive practice of a functional upper limb task during inpatient rehabilitation, SMART Arm training with or without OT-stim in combination with usual therapy, has the potential to improve recovery of upper limb function in those with severe motor disability. The immediate and long-term effects of SMART Arm training on upper limb impairment, activity and participation will be explored, in addition to the benefit of training with or without OT-stim to augment movement when compared to usual therapy alone. TRIAL REGISTRATION: ACTRN12608000457347.

Flexor hallucis brevis motor unit behavior in response to moderate increases in rate of force development.

Background: Studies on motor unit behaviour with varying rates of force development have focussed predominantly on comparisons between slow and ballistic (i.e., very fast) contractions. It remains unclear how motor units respond to less extreme changes in rates of force development. Here, we studied a small intrinsic foot muscle, flexor hallucis brevis (FHB) where the aim was to compare motor unit discharge rates and recruitment thresholds at two rates of force development. We specifically chose to investigate relatively slow to moderate rates of force development, not ballistic, as the chosen rates are more akin to those that presumably occur during daily activity. Methods: We decomposed electromyographic signals to identify motor unit action potentials obtained from indwelling fine-wire electrodes in FHB, from ten male participants. Participants performed isometric ramp-and-hold contractions from relaxed to 50% of a maximal voluntary contraction. This was done for two rates of force development; one with the ramp performed over 5 s (slow condition) and one over 2.5 s (fast condition). Recruitment thresholds and discharge rates were calculated over the ascending limb of the ramp and compared between the two ramp conditions for matched motor units. A repeated measures nested linear mixed model was used to compare these parameters statistically. A linear repeated measures correlation was used to assess any relationship between changes in recruitment threshold and mean discharge rate between the two conditions. Results: A significant increase in the initial discharge rate (i.e., at recruitment) in the fast (mean: 8.6 ±  2.4 Hz) compared to the slow (mean: 7.8 ± 2.3 Hz) condition (P = 0.027), with no changes in recruitment threshold (P = 0.588), mean discharge rate (P = 0.549) or final discharge rate (P = 0.763) was observed. However, we found substantial variability in motor unit responses within and between conditions. A small but significant negative correlation (R2 = 0.33, P = 0.003) was found between the difference in recruitment threshold and the difference in mean discharge rate between the two conditions. Conclusion: These findings suggest that as force increases for contractions with slower force development, increasing the initial discharge rate of recruited motor units produces the increase in rate of force development, without a change in their recruitment thresholds, mean or final discharge rate. However, an important finding was that for only moderate changes in rate of force development, as studied here, not all units respond similarly. This is different from what has been described in the literature for ballistic contractions in other muscle groups, where all motor units respond similarly to the increase in neural drive. Changing the discharge behaviour of a small group of motor units may be sufficient in developing force at the required rate rather than having the discharge behaviour of the entire motor unit pool change equally.