Characteristics of preceding Ia activity on postactivation depression in health and disease.

Previous activation of the soleus Ia afferents causes a depression in the amplitude of the H-reflex. This mechanism is referred to as postactivation depression (PAD) and is suggested to be presynaptically mediated. With the use of a paired reflex depression paradigm (eliciting two H-reflexes with conditioning-test intervals from 80 ms to 300 ms), PAD was examined in a group of healthy individuals and a group of hemiplegic patients. Healthy individuals showed substantial depression of the test H-reflex at all intervals. Although the patient group showed substantially less depression at all intervals, increasing the interval between the two reflexes sharply reduced the depression. In a separate experiment, we varied the size of the conditioning H-reflex against a constant test H-reflex. In healthy individuals, by increasing the size of the conditioning H-reflex, the amplitude of the test H-reflex exponentially decreased. In the patient group, however, this pattern was dependent on the conditioning-test interval; increasing the size of the conditioning H-reflex caused an exponential decrease in the size of the test reflex at intervals shorter than 150 ms. This pattern was similar to that of healthy individuals. However, conducting the same protocol at a longer interval (300 ms) in these patients resulted in an abnormal pattern (instead of an exponential decrease in the size of the test reflex, exaggerated responses were observed). Fisher discriminant analysis suggested that these two patterns (which differed only in the timing between the two stimuli) were substantially different from each other. Therefore, it is suggested that the abnormal pattern of PAD in hemiplegic stroke patients could be a contributing factor for the pathophysiology of spasticity.

The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction.

Athletes who have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit persistently impaired kinematics and strength. Core stability training appears to be effective for reducing high-risk landing mechanics and preventing primary anterior cruciate ligament (ACL) injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACLR. This study aimed to investigate the effect of eight weeks of simple core stability training on core endurance, hip strength, and knee kinematics in ACLR athletes. Twenty-six male athletes (20-30 years old) with a history of ACL surgery with hamstring tendon autograft were randomly divided into training (n = 13) and control groups (n = 13). The training group performed core stability exercises for eight weeks before starting their team training; the control group did not receive any intervention. Both groups continued their regular team schedule. The core endurance, hip muscle strength, and knee kinematics were assessed by the McGill test, a hand-held dynamometer, and video-taping, respectively. Analysis of covariance test was used for data analysis. The training group showed a significant increase in core endurance, hip abductor and external rotator strength, knee flexion angle, and a significant decrease in the knee valgus angle during single-leg landing in post-training tests compared to their baseline tests (P < 0.05). Our results demonstrated that core stability exercise alters neuromuscular function to a level that is clinically acceptable and statistically significant. Because of the high incidence rate of secondary ACL injury after ACLR, it is recommended that athletes with a history of ACLR benefit from adding core stability exercises to warm-up routines or tertiary prevention programs even after completing post-operative rehabilitation. It is fast and not time-consuming to perform for athletes to reduce the risk factors of re-injury. Trial registration: This study was registered in the Iranian Registry of Clinical Trials with the number IRCT20190224042827N2, registered on 19 December 2019.

Evaluation of the Effect of Reduction Mammoplasty on Body Posture in Patients with Macromastia.

Background: Breast hypertrophy is a significant health problem with both physiological and psychological impacts on the patients' lives. Patients with macromastia adopt a corrective posture due to the effect of the breast on the center of gravity and possibly in a subconscious effort to conceal their breasts. Objective: This study aimed to evaluate whether the posture of patients with macromastia changed after the reduction of mammoplasty. Material and Methods: In this prospective study, patients with breast cup sizes C, D, and DD were scheduled for reduction mammoplasty in 3 Shiraz University Hospitals. Age, weight, height, and preoperative cup sizes of the breasts were recorded for every patient, and all patients underwent posture analysis with forceplate before and after reduction mammoplasty. Finally, the preoperative and postoperative data were compared. Results: Mean age at the time of reduction mammaplasty was 43.57±9.1; the mean pre-operation, such as weight, height, and mean the body mass index (BMI) was 76.57±10 kg, 158.28±6 cm and 30.57±4.1, respectively. The average Anterior-posterior (AP) direction velocity before and after the surgery was 0.85±0.12 cm/s and 0.79±0.098, respectively. These values were 0.83±0.09 and 0.81±0.10 for the mediolateral direction. The Detrended Fluctuation Analysis (DFA) value for the AP direction was 1.63±0.3 and 1.60±0.2 for pre-and post-surgery, respectively, which was not statistically different. The DFA value for maximum likelihood (ML) direction was 1.65±0.2 and 1.48±0.2 in pre-op and post-op, respectively, which was statistically significantly different. Conclusion: Reducing the weight of enlarged breasts can correct disturbed sagittal balance and postural sway.

The inflow of sensory information for the control of standing is graded and bidirectional.

The control of upright standing is accomplished through the integration of different sources of sensory information and by providing an appropriate motor program to control both expected and unexpected perturbations imposed on the system. However, the dynamic characteristics of postural sway and its interplay with the regulation of Ia sensory information within the spinal cord are largely unknown. Here, using a stochastic technique for analyzing the dynamics of upright standing, we demonstrate that the changes in the dynamics of postural sway were accompanied by modulation of the soleus H-reflex during quiet standing. While the causality of this relation was not established, the results showed that these changes were independent of the sway of the center of pressure and were bidirectional and purposeful. With this novel perspective, the appropriate reflex gain, which is important for balance control, can be predicted from the dynamic characteristics of postural sway. Our current findings provide the first human behavioral evidence to suggest the contribution of the spinal cord in fulfilling the desired motor programming of a complex task. This contribution is, by conventional guess, carried out through interneuronal adjustments, which are under the control of different brain areas.

Activity-dependent plasticity of spinal circuits in the developing and mature spinal cord.

Part of the development and maturation of the central nervous system (CNS) occurs through interactions with the environment. Through physical activities and interactions with the world, an animal receives considerable sensory information from various sources. These sources can be internally (proprioceptive) or externally (such as touch and pressure) generated senses. Ample evidence exists to demonstrate that the sensory information originating from large diameter afferents (Ia fibers) have an important role in inducing essential functional and morphological changes for the maturation of both the brain and the spinal cord. The Ia fibers transmit sensory information generated by muscle activity and movement. Such use or activity-dependent plastic changes occur throughout life and are one reason for the ability to acquire new skills and learn new movements. However, the extent and particularly the mechanisms of activity-dependent changes are markedly different between a developing nervous system and a mature nervous system. Understanding these mechanisms is an important step to develop strategies for regaining motor function after different injuries to the CNS. Plastic changes induced by activity occur both in the brain and spinal cord. This paper reviews the activity-dependent changes in the spinal cord neural circuits during both the developmental stages of the CNS and in adulthood.

Female athletes with ligament dominance exhibiting altered hip and ankle muscle co-contraction patterns compared to healthy individuals during single-leg landing.

BACKGROUND: Anterior cruciate ligament (ACL) injury is one of the most serious knee injuries and occurs frequently during exercise. Altered hip and ankle muscle co-contraction patterns may contribute to dynamic knee valgus and ACL injury mechanisms. Lack of dynamic control of ground reaction force (GRF) is known to be contributing factor for ACL injury by placing excessive force on passive structures. Muscle co-contraction is a dynamic mechanism for GRF absorption. Therefore, any alterations in co-contraction might be a risk factor for ACL injury. Ligament dominance is a term to define individuals who rely more on ACL ligament for GRF control. RESEARCH QUESTION: This study aimed to compare the muscle co-contraction patterns of distal and proximal knee muscles during single leg landing in female athletes with and without ligament dominance. METHODS: This is a cross-sectional study. A total of 54 female athletes were assigned to the healthy (n = 27) and ligament dominance (n = 27) group based on their Tuck Jump test scores. The electromyography activity of the gluteus medius, adductor longus, tibialis anterior, peroneus longus, medial and lateral gastrocnemius was measured by an electromyography in drop down a 30-cm-high stair. A Multivariate Analysis of Variance (MANOVA) was used for statistical analysis (p ≤ 0.05). RESULTS: The two groups demonstrated an overall significantly different muscle co-contraction patterns (P < 0.05). There was a decreased in co-contraction of proximal group and an increased co-contraction in the distal muscles in ligament dominant group. SIGNIFICANCE: The findings have provided evidence to support the notion of neuromuscular imbalances in ligament dominance deficit. These findings can be useful for the coaches and experts to design preventive exercises and modify the current programs for the people affected by ligament dominance.

Postural displacement induced by electrical stimulation; A new approach to examine postural recovery.

BACKGROUND: Controlling upright posture entails acute adjustments by the neuromuscular system to keep the center of mass (COM) within the limits of a relatively small base of support. Sudden displacement of the COM triggers several strategies and balance recovery mechanisms to prevent excessive COM displacement. NEW METHOD: We have examined and quantified a new approach to induce an internal neuromuscular perturbation in standing posture on 15 healthy individuals to provide an insight into the mechanism of loss of balance (LOB). The method comprises eliciting an H-reflex protocol while subjects are standing which produces a contraction in soleus and gastrocnemius muscles. We have also defined analytical techniques to provide biomarkers of balance control during perturbation. We used M-Max unilaterally or bilaterally and induced a forward or sideway perturbation. The vector analysis and the Equilibrium Point calculations defined here can quantify the amplitude, direction, and evolution of the perturbation. RESULTS: Clear patterns of loss of balance due to stimulation was observed. Compared to quiet standing, the density of the EPs substantially increased in the perturbation phase. Leftward stimulation produced significantly higher number of EPs compared to the bilateral stimulation condition which could be due to the fact that the left leg was the nondominant side in all our subjects. COMPARISON AND CONCLUSION: In this study we provide a proof-of-concept technique for examining recovery from perturbation. The advantage of this technique is that it provides a safe perturbation, is internally induced at the spinal cord level, and is free from other factors that might complicate the recovery analysis (e.g., locomotion and the integration of the spinal pattern generator and cutaneous pathways in mediating changes). We have shown that the perturbation induced by this method can be quantified as vectors. We have also shown that the density of instantaneous equilibrium points (EPs) could be a good biomarker for defining and examining the perturbation phase. Thus, this protocol and analysis provides a unique individual assessment of recovery which can be used to assess interventions. Finally, given that the maximal motor response is used as the perturbation (e.g., M-max) it is highly reliable and reproducible within an individual patient.

Transspinal Direct Current Stimulation Produces Persistent Plasticity in Human Motor Pathways.

The spinal cord is an integration center for descending, ascending, and segmental neural signals. Noninvasive transspinal stimulation may thus constitute an effective method for concomitant modulation of local and distal neural circuits. In this study, we established changes in cortical excitability and input/output function of corticospinal and spinal neural circuits before, at 0-15 and at 30-45 minutes after cathodal, anodal, and sham transspinal direct current stimulation (tsDCS) to the thoracic region in healthy individuals. We found that intracortical inhibition was different among stimulation polarities, however remained unchanged over time. Intracortical facilitation increased after cathodal and anodal tsDCS delivered with subjects seated, and decreased after cathodal tsDCS delivered with subjects lying supine. Both cathodal and anodal tsDCS increased corticospinal excitability, yet facilitation was larger and persisted for 30 minutes post stimulation only when cathodal tsDCS was delivered with subjects lying supine. Spinal input/output reflex function was decreased by cathodal and not anodal tsDCS. These changes may be attributed to altered spontaneous neural activity and membrane potentials of corticomotoneuronal cells by tsDCS involving similar mechanisms to those mediating motor learning. Our findings indicate that thoracic tsDCS has the ability to concomitantly alter cortical, corticospinal, and spinal motor output in humans.

Disturbances of postural sway components in cannabis users.

INTRODUCTION: A prominent effect of acute cannabis use is impaired motor coordination and driving performance. However, few studies have evaluated balance in chronic cannabis users, even though density of the CB1 receptor, which mediates the psychoactive effects of cannabis, is extremely high in brain regions critically involved in this fundamental behavior. The present study measured postural sway in regular cannabis users and used rambling and trembling analysis to quantify the integrity of central and peripheral nervous system contributions to the sway signal. METHODS: Postural sway was measured in 42 regular cannabis users (CB group) and 36 non-cannabis users (N-CB group) by asking participants to stand as still as possible on a force platform in the presence and absence of motor and sensory challenges. Center of pressure (COP) path length was measured, and the COP signal was decomposed into rambling and trembling components. Exploratory correlational analyses were conducted between sway variables, cannabis use history, and neurocognitive function. RESULTS: The CB group had significantly increased path length and increased trembling in the anterior-posterior (AP) direction. Exploratory correlational analyses suggested that AP rambling was significantly inversely associated with visuo-motor processing speed. DISCUSSION: Regular cannabis use is associated with increased postural sway, and this appears to be predominantly due to the trembling component, which is believed to reflect the peripheral nervous system's contribution to the sway signal.

The role of anterior cruciate ligament in the control of posture; possible neural contribution.

The anterior cruciate ligament (ACL) is not only a mechanical structure for knee joint stability but is also a source of sensory information which could be used in the control of standing posture. It has been shown that the center of pressure (COP) time series during normal standing may be decomposed into two components which are hypothetically governed by different neural mechanisms, namely rambling and trembling. The aim of the present study was to investigate to what extent an injury to the ACL structure would affect these two control mechanisms. In this study the balance of a group of ACL deficient (ACLD) patients during double and single leg standing was examined and compared with that of a group of healthy individuals. We not only calculated the traditional measures of COP, but also decomposed this complex signal to investigate if ACL deficiency would affect the rambling and trembling components differently. The results showed that rambling was not significantly different between the two groups; however the trembling component was significantly greater for the ACLD group in both the single leg and the double leg condition. Further, there was also a component (rambling/trembling) by direction (anterior-posterior/mediolateral) interaction for both groups, indicating that the rambling component exhibited differences between directions of sway whereas the trembling component did not. This study provided evidence that the two components of postural control are differently affected by ACL deficiency, and that the rambling component is influenced by direction of sway.

Amplification of background EMG activity affects the interpretation of H-reflex gain.

In many H-reflex studies, the modulation of the H-reflex is usually compared relative to the normal EMG activity within the muscle. Such comparisons enable the investigators to infer whether the change in the amplitude of the H-reflex was independent of normally occurring muscle activity. This interpretation of the H-reflex is regarded as H-reflex gain, a popular dependent variable in human H-reflex studies. However, in many studies to date, the muscle activity level has been determined from the same EMG signal from which the H-reflex is recorded. This leads to an important methodological consideration: measuring the ongoing normal EMG activity from the same signal might result in an inaccurate measurement, since this EMG signal will need to be minimally amplified to capture the synchronous volley of the H-reflex amplitude. In this study we examined this possibility and found that comparing the EMG activity level from the seated position to standing position yields different results (on average 8.03% in the measurement of the increase of muscle activity). This difference was both dependent on the task and also on the EMG instrumentation used. To solve this problem we suggest the bifurcation of the EMG signal from the recording electrodes with differential amplification of the signal. With this method, both the naturally occurring muscle activity and the H-reflex signal are collected from the same area of the muscle and a more accurate measurement of the H-reflex gain will be yielded.