Alpha and beta/low-gamma frequency bands may have distinct neural origin and function during post-stroke walking.

Plantarflexors provide propulsion during walking and receive input from both corticospinal and corticoreticulospinal tracts, which exhibit some frequency-specificity that allows potential differentiation of each tract's descending drive. Given that stroke may differentially affect each tract and impair the function of plantarflexors during walking; here, we examined this frequency-specificity and its relation to walking-specific measures during post-stroke walking. Fourteen individuals with chronic stroke walked on an instrumented treadmill at self-selected and fast walking speed (SSWS and FWS, respectively) while surface electromyography (sEMG) from soleus (SOL), lateral gastrocnemius (LG), and medial gastrocnemius (MG) and ground reaction forces (GRF) were collected. We calculated the intermuscular coherences (IMC; alpha, beta, and low-gamma bands between SOL-LG, SOL-MG, LG-MG) and propulsive impulse using sEMG and GRF, respectively. We examined the interlimb and intralimb IMC comparisons and their relationships with propulsive impulse and walking speed. Interlimb IMC comparisons revealed that beta LG-MG (SSWS) and low-gamma SOL-LG (FWS) IMCs were degraded on the paretic side. Intralimb IMC comparisons revealed that only alpha IMCs (both speeds) exhibited a statistically significant difference to random coherence. Further, alpha LG-MG IMC was positively correlated with propulsive impulse in the paretic limb (SSWS). Alpha and beta/low-gamma bands may have a differential functional role, which may be related to the frequency-specificity of the underlying descending drives. The persistence of alpha band in plantarflexors and its strong positive relationship with propulsive impulse suggests relative alteration of corticoreticulospinal tract after stroke. These findings imply the presence of frequency-specific descending drives to walking-specific muscles in chronic stroke.

Utilization of Inertial Measurement Units for Determining the Sequential Chain of Baseball Strike Posture.

The purpose of this study was to employ inertial measurement units (IMU) with an eye-tracking device to investigate different swing strategies between two levels of batters. The participants were 20 healthy males aged 20 to 30 years old, with ten professional and ten amateur batters. Eye gaze position, head, shoulder, trunk, and pelvis angular velocity, and ground reaction forces were recorded. The results showed that professional batters rotated segments more rhythmically and efficiently than the amateur group. Firstly, the professional group spent less time in the preparation stages. Secondly, the maximum angular velocity timing of each segment of the professional group was centralized in the swing cycle. Thirdly, the amateur group had significantly earlier gaze timing of the maximum angular velocity than the professional group. Moreover, the maximum angular velocity timing of the gaze was the earliest parameter among the five segments, and significantly earlier (at least 16.32% of cycle time) than the maximum angular velocity of the head, shoulder, trunk, and pelvis within the amateur group. The visual-motor coordination strategies were different between the two groups, which could successfully be determined by wearable instruments of IMU.

Altered Achilles tendon morphology in individuals with chronic post-stroke hemiparesis: a case report.

BACKGROUND: Individuals post-stroke walk slowly and with more effort, which puts them at higher risks for falls. The slow walking speed results from insufficient propulsive forces generated by the paretic leg. Current rehabilitative efforts to improve walking function target increasing propulsive forces, but overlook the muscle-tendon unit. CASE PRESENTATIONS: Two individuals with chronic post-stroke hemiparesis are presented. In both individuals post-stroke, paretic ankle plantarflexors presented with increased muscle tone. Gait kinetics revealed asymmetric propulsive forces, specifically, insufficient propulsive forces by the paretic legs, consistent with previous literature. Sonography revealed increased thickness of paretic Achilles tendon at the calcaneal insertion, in both stroke cases, in contrast to comparable Achilles tendon thickness between limbs in the non-neurologically impaired controls. CONCLUSION: Tendon unit integrity should be considered in individuals post-stroke who demonstrate abnormal muscle tone and insufficient propulsion during gait.

Control of vertical posture while standing on a sliding board and pushing an object.

Voluntary pushing or translation perturbation of the support surface each induces a body perturbation that affects postural control. The objective of the study was to investigate anticipatory (APA) and compensatory (CPA) postural adjustments when pushing an object (that induces self-initiated perturbation) and standing on a sliding board (that induces translational perturbation). Thirteen healthy young participants were instructed to push a handle with both hands while standing on a sliding board that was either free to move in the anterior-posterior direction or stationary. Electromyographic activity (EMG) of trunk and lower extremity muscles, center of pressure (COP) displacements, and the forces exerted by the hand were recorded and analyzed during the APA and CPA phases. When the sliding board was free to move during pushing (translation perturbation), onsets of activity of ventral leg muscles and COP displacement were delayed as compared to pushing when standing on a stationary board. Moreover, magnitudes of shank muscle activity and the COP displacement were decreased. When pushing heavier weight, magnitudes of muscle activity, COP displacement, and pushing force increased. The magnitude of activity of the shank muscles during the APA and CPA phases in conditions with translational perturbation varied with the magnitude of the pushing weight. The outcome of the study suggests that the central nervous system prioritizes the pushing task while attenuates the source of additional perturbation induced by translation perturbation. These results could be used in the development of balance re-training paradigms involving pushing weight while standing on a sliding surface.

Foot force direction control during a pedaling task in individuals post-stroke.

BACKGROUND: Appropriate magnitude and directional control of foot-forces is required for successful execution of locomotor tasks. Earlier evidence suggested, following stroke, there is a potential impairment in foot-force control capabilities both during stationary force generation and locomotion. The purpose of this study was to investigate the foot-pedal surface interaction force components, in non-neurologically-impaired and stroke-impaired individuals, in order to determine how fore/aft shear-directed foot/pedal forces are controlled. METHODS: Sixteen individuals with chronic post-stroke hemiplegia and 10 age-similar non-neurologically-impaired controls performed a foot placement maintenance task under a stationary and a pedaling condition, achieving a target normal pedal force. Electromyography and force profiles were recorded. We expected generation of unduly large magnitude shear pedal forces and reduced participation of multiple muscles that can contribute forces in appropriate directions in individuals post-stroke. RESULTS: We found lower force output, inconsistent modulation of muscle activity and reduced ability to change foot force direction in the paretic limbs, but we did not observe unduly large magnitude shear pedal surface forces by the paretic limbs as we hypothesized. CONCLUSION: These findings suggested the preservation of foot-force control capabilities post-stroke under minimal upright postural control requirements. Further research must be conducted to determine whether inappropriate shear force generation will be revealed under non-seated, postural demanding conditions, where subjects have to actively control for upright body suspension.

Exploring the use of bimodal transcranial direct current stimulation to enhance movement in individuals with patellofemoral pain-A sham-controlled double blinded pilot study.

Introduction: In individuals with patellofemoral pain (PFP), addressing increased knee valgus during weight-bearing activities typically involves strengthening weak hip muscles. However, recent literature highlights the role of altered descending central control in abnormal movements associated with PFP. While transcranial direct current stimulation (tDCS) has demonstrated the capacity to enhance neuroplasticity, its application targeting the corticomotor function of gluteal muscles in PFP remains unexplored. This study aimed to investigate the effects of combining bimodal tDCS with exercise on frontal plane kinematics in individuals with PFP. The hypothesis was that bimodal tDCS, specifically targeting the corticomotor function of the gluteal muscles, would augment the effectiveness of exercise interventions in improving frontal plane kinematics compared to sham stimulation. Methods: Ten participants with PFP participated in two sessions involving either bimodal tDCS or sham stimulation, concurrently with hip strengthening exercises. Weight-bearing tasks, including single leg squat, single leg landing, single leg hopping, forward step-down, and lateral step-down, were performed and recorded before and after each session. Pain visual analog scale (VAS) scores were also documented. A one-way ANOVA with repeated measures was employed to compare kinematics, while a Friedman test was used to compare VAS across the three conditions (pre-test, post-tDCS, and post-Sham). Results: We observed no significant differences in trunk lean angle, hip and knee frontal plane projection angles, or dynamic valgus index among the three conditions during the five weight-bearing tasks. VAS scores did not differ across the three conditions. Discussion and conclusion: A single session of tDCS did not demonstrate immediate efficacy in enhancing frontal plane kinematics or relieving pain in individuals with PFP. Considering observed positive outcomes in other neurological and orthopedic populations with multi-session tDCS applications, suggesting potential cumulative effects, further research is essential to explore the effects of multi-session tDCS on weight-bearing movement and underlying neurophysiology in individuals with PFP.

Impaired foot-force direction regulation during postural loaded locomotion in individuals poststroke.

Following stroke, hemiparesis results in impaired motor control. Specifically, inappropriate direction of foot-forces during locomotion has been reported. In our previous study (Liang and Brown 2011) that examined poststroke foot-force direction during a seated, supported locomotor task, we observed that foot-force control capabilities were preserved poststroke. In this current study, we sought to better understand the mechanisms underlying the interaction of locomotor and postural control as an interactive mechanism that might interfere, poststroke, with appropriate foot-force generation. We designed an experiment in which participants performed biomechanically controlled locomotor tasks, under posturally challenged pedaling conditions while they generated mechanical output that was comparable to pedaling conditions without postural challenge, thus allowing us to monitor the strategies that the nervous system adopts when postural conditions were manipulated. We hypothesized that, with postural influence, individuals poststroke would generate inappropriate shear forces accompanied by inappropriate changes to muscle activity patterns when performing a mechanically controlled locomotor task, and would be exaggerated with increased postural loading. Sixteen individuals with chronic poststroke hemiparesis and 14 age-similar nonimpaired controls pedaled on a cycle ergometer under 1) seated supported and 2) nonseated postural loaded pedaling conditions, generating matched pedal force outputs of two effort levels. When we compared postural influence with seated pedaling, we observed increased magnitudes of forward-directed shear forces in the paretic legs associated with increased magnitude of leg extensor muscle activity, but not in controls. These findings provide evidence to support a model that describes independent controllers for posture and locomotion, but that the interaction between the two controllers is impaired poststroke.

Effects of continuous passive motion on reversing the adapted spinal circuit in humans with chronic spinal cord injury.

OBJECTIVE: To investigate the possibility of restoring the adapted spinal circuit after spinal cord injury (SCI) by means of long-term continuous passive motion (CPM) of the ankle joint. DESIGN: Randomized controlled trial with repeated measures. SETTING: Research laboratory in a general hospital. PARTICIPANTS: Individuals with motor complete SCI (N=14) were recruited from a community. INTERVENTION: CPM of the ankle joint for 1 hour a day, 5 days a week for 4 weeks. MAIN OUTCOME MEASURES: Modified Ashworth Scale (MAS) scores for evaluation of spasticity and postactivation depression (PAD) were documented prior to and after intervention. RESULTS: MAS scores improved after 4 weeks of CPM intervention, indicating a reduction in spasticity of the ankle joint. PAD was restored after 4 weeks of training. CONCLUSIONS: Passive motion of the ankle joint alone was sufficient in reversing the adapted spinal circuit, and therefore indicates that spasticity after SCI could possibly be managed by CPM intervention. The results of this study support the use of the passive mode of robot-assisted therapy for humans with complete SCI who cannot exercise actively.

Recognition of walking directional intention employed ground reaction forces and center of pressure during gait initiation.

BACKGROUND: Movement intentions are generally classified by Electroencephalogram (EEG) and have been used in gait initiation prediction. However, it is not easy to collect EEG data and practical in reality. Alternatively, ground reaction force (GRF) and the center of pressure (COP) is produced by the contact between the foot and the ground during a specific period of walking, which are the characteristics of evaluating gait performance RESEARCH QUESTION: The study aims to use a deep learning technique to recognize the data of the COP and GRF to classify straight walking and right turn. Second, the study aims to reveal gait characteristics that could replace EEG to predict walking directional intentions METHODS: Ten healthy male adults were instructed to stand on the force platform and self-selected to perform three conditions: standstill, straight walking, and right turn. The onset of gait initiation was evaluated by muscle activation of the right tibialis anterior, and EEG and the COP displacement evaluated the onset of gait intention. Subsequently, GRF and COP would be treated as features to classify the gait intention in the Long Short-Term Memory (LSTM) model. RESULTS: The results revealed that the onset of EEG and the COP displacement initiation were statistically significant differences between straight walking and right turn. For the classification, the average accuracy of the LSTM model with GRF and COP as features reached the highest one, 94.79 %, depending on the heel- or toe-off of the swing leg. The results indicated that gait intentions could be classified based on the GRF and COP. SIGNIFICANCE: The machine learning technique of LSTM with gait parameters can recognize the gait intention of changing walking orientation. Our model and approach would be expected to provide advanced predictions, such as exoskeleton control or pedestrian traffic flow.

Brain and Spinal Cord Adaptations Associated With Patellofemoral Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the evidence for altered cortical and spinal cord functions in individuals with patellofemoral pain (PFP). METHODS: We conducted a comprehensive search of databases to appraise and analyze the studies published prior to December 10, 2021 that examined spinal reflex excitability measured using Hoffmann reflex (H-reflex) amplitudes, corticospinal excitability measured using transcranial magnetic stimulation (TMS)-elicited motor evoked potential (MEP) amplitudes, motor threshold (MT), or stimulus-response (SR) curves, cortical reorganization assessed using TMS cortical mapping or structural magnetic resonance imaging (MRI), or functional changes of the brain assessed using functional MRI (fMRI) in individuals with PFP. RESULTS: Eight studies were eligible for analyses. While an earlier study showed that pain had no effect on the H-reflex amplitude of the quadriceps muscle, more recent evidence reported a decrease in vastus medialis (VM) H-reflex amplitude in participants with PFP. VM H-reflex amplitude was correlated with pain, chronicity, physical function, and isometric knee extensor torque production in participants with PFP. Altered corticospinal excitability was reported in participants with PFP, observed as increased MT in the VM and vastus lateralis (VL) muscles. In addition, cortical reorganization has been observed, where decreased number of cortical peaks, shifts and reduced volumes, and increased overlap of motor cortex representations for the VM, VL, and rectus femoris (RF) muscles were reported in participants with PFP. CONCLUSION: There is emerging evidence on altered cortical and spinal cord functions in individuals with PFP, however, solid conclusions cannot be drawn due to limited literature available. Further research is needed to better understand the adaptations of the brain and spinal cord in this population. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020212128.

Neurophysiological Assessments of Brain and Spinal Cord Associated with Lower Limb Functions in Children with Cerebral Palsy: A Protocol for Systematic Review and Meta-Analysis.

BACKGROUND: Task-dependent neurophysiological adaptations in people with cerebral palsy have been examined using various techniques such as functional magnetic resonance imaging, peripheral nerve stimulation in order to assess H-reflexes, and transcranial magnetic stimulation. This activity-dependent plasticity is hypothesized to improve specific gross motor function in individuals with cerebral palsy. Although these adaptations have been examined extensively, most studies examined tasks utilizing the upper limbs. The aim of this review is to assess the neurophysiological adaptations of the central nervous system in individuals with cerebral palsy during lower limb functional tasks. METHODS: A systematic review and meta-analysis will be conducted to evaluate the neurophysiological changes in the brain and spinal cord associated with lower extremity tasks in individuals with cerebral palsy. We will search within PubMed, MEDLINE, Embase, PsychINFO, and CINAHL using a predetermined search string to identify and evaluate relevant studies. Two independent reviewers will screen these studies against our inclusion criteria and risks of bias, and will extract the data from each study. A third reviewer will be used to resolve any disagreement regarding the inclusion of a study between reviewers. Randomized controlled trials as well as cross-sectional studies published in English 10 years before May 2021 that investigate the neurophysiological adaptations in the brain and spinal cord in people with cerebral palsy will be included if they meet the eligibility criteria. Primary outcomes will include scalar values of fractional anisotropy (FA), H-reflex gains or measures of amplitude, as well as motor cortex (M1) cortical excitability as measured by transcranial magnetic stimulation. DISCUSSION: Since no identifiable data will be involved in this study, no ethical approval is required. Our results will provide insight into the neurophysiological adaptations in children with cerebral palsy, which will be useful in guiding directions for clinical decision making and future development of targeted interventions in pediatrics rehabilitation for children with cerebral palsy. Systematic review registration: The protocol for this systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020215902).

Neurophysiological changes of brain and spinal cord in individuals with patellofemoral pain: a systematic review and meta-analysis protocol.

INTRODUCTION: Reduced neuromuscular control due to altered neurophysiological functions of the central nervous system has been suggested to cause movement deficits in individuals with patellofemoral pain (PFP). However, the underlying neurophysiological measures of brain and spinal cord in this population remain to be poorly understood. The purpose of this systematic review is to evaluate the evidence for altered cortical and spinal cord functions in individuals with PFP. METHODS AND ANALYSIS: The protocol for conducting the review was prepared using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will systematically search the literature that examines cortical and spinal cord functions in individuals with PFP, aged 18-45 years. The studies for cross-sectional, prospective, longitudinal, case-control and randomised control trial designs will be included from the following databases: PubMed (MEDLINE), EMBASE and Web of Science. Only studies published in English prior to 1 February 2021 will be included. The risk of bias and quality assessment will be performed using National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We will conduct meta-analysis of the data where appropriate. Narrative synthesis will be taken if a meta-analysis is not possible. ETHICS AND DISSEMINATION: This is a systematic review from the existing literature and does not require ethical approval. The results of this study will be published in a peer-reviewed journal in the field of rehabilitation medicine, sports/orthopaedic medicine or neurology, regardless of the outcome. PROSPERO REGISTRATION NUMBER: CRD42020212128.

Effects of augmented somatosensory input using vibratory insoles to improve walking in individuals with chronic post-stroke hemiparesis.

BACKGROUND: Stroke survivors suffer from hemiparesis and somatosensory impairments, which adversely impact walking performance, placing them at higher risks for trips and falls. Post-stroke, somatosensory deficits are commonly observed as impaired interpretation of afferent input and increased threshold. Diminishing or augmenting somatosensory inputs via various techniques have been demonstrated to be able to modify static and dynamic balance, postural and locomotor control in non-neurologically impaired as well as neurologically impaired individuals. RESEARCH QUESTION: We sought to investigate whether enhancing somatosensory input using vibratory insoles, can improve post-stroke gait. We hypothesized that with augmentation of somatosensory input at the soles via vibratory insoles would improve post-stroke gait via increased propulsive forces, decreased braking forces and increased ankle angle movements in the paretic legs of individuals with chronic post-stroke hemiparesis. METHODS: Fifteen individuals with chronic post-stroke hemiparesis and 15 age-similar non-neurologically impaired controls participated in this cross-sectional study. Enhanced somatosensory stimulation was delivered using a pair of tactor-embedded insoles, providing suprathreshold vibratory stimulation to the bottom of the feet. Participants walked over an instrumented treadmill with self-selected speeds, under 5 conditions: no insole in shoe (NT), insoles in shoe with no vibration (BOFF), vibration under both feet (BON), vibration under one foot only (ION, CON). Kinetics and kinematics during walking were recorded and analyzed offline. RESULTS: Suprathreshold vibratory stimulations did not alter gait kinetics under any stimulation conditions. We observed increased paretic ankle dorsiflexions in the paretic legs, when vibratory stimuli were applied unilaterally. SIGNIFICANCE: Vibratory stimulations applied at suprathreshold intensity to the bottom of the feet to augment somatosensory feedback can potentially be used as a low-cost solution to address the inadequate toe clearance during walking in people post-stroke, which is an important goal in post-stroke rehabilitation.

Slow Walking in Individuals with Chronic Post-Stroke Hemiparesis: Speed Mediated Effects of Gait Kinetics and Ankle Kinematics.

Post-stroke rehabilitation often aims to increase walking speeds, as faster walking is associated with improved functional status and quality of life. However, for successful community ambulation, ability to modulate (increase and decrease) walking speeds is more important than walking continuously at constant speeds. Increasing paretic propulsive forces to increase walking speed has been extensively examined; however, little is known about the mechanics of slow walking post-stroke. The primary purpose of this study was to identify the effects of increased and decreased walking speeds on post-stroke kinetics and ankle kinematics. Fifteen individuals with chronic post-stroke hemiparesis and 15 non-neurologically impaired controls walked over an instrumented treadmill under: slow, self-selected, and fast walking speeds. We examined the peak propulsive forces, propulsive impulse, peak braking forces, braking impulse, and ankle kinematics under each condition. When walking at slow walking speeds, paretic limbs were unable to reduce braking impulse and peak propulsive force or modulate ankle kinematics. Impaired modulation of paretic gait kinetics during slow walking places people post-stroke at high risks for slip-related falls. These findings suggest the need for developing gait retraining paradigms for slow walking in individuals chronically post-stroke that target the ability of the paretic limb to modulate braking forces.

Characterizing intersection variability of butterfly diagram in post-stroke gait using Kernel Density Estimation.

BACKGROUND: Center of pressure (COP) trajectory during treadmill walking have been commonly presented using the butterfly diagram to describe gait characteristics in neurologically intact and impaired individuals. However, due to the large amount of displayed information, the butterfly diagram is not an efficient solution to visualize locomotor variability. PURPOSE: The purpose of this study was to evaluate post-stroke locomotor variability by applying Kernel density estimation (KDE) on the intersections of the butterfly diagram, and to compare KDE derived metrics with conventional metrics of gait symmetry and variability. METHODS: Bilateral toe-off (TO) and initial contact (IC) points of the butterfly diagram were determined to calculate the COP symmetry index and the intersections of bilateral TOIC. Subsequently, the intersections during the walking window were used to evaluate its density and variability by Kernel density estimation. Standard deviations of step width and step length were compared between groups. RESULTS: Using the KDE surface plots we observed 4 characteristically different patterns with individuals post-stroke, which were associated with functional status quantified using walking speed and lower extremity Fugl-Meyer scores. However, locomotor variability quantified using standard deviations of step width and lengths did not differ between groups. Significance & Novelty: This paper presents a novel approach of using KDE analysis as a better and more sensitive method to characterize locomotor COP variability in individuals with post-stroke hemiparesis, compared to conventional metrics of gait symmetry and variability.

Immediate Effects of Anodal Transcranial Direct Current Stimulation on Postural Stability Using Computerized Dynamic Posturography in People With Chronic Post-stroke Hemiparesis.

Postural stability is commonly decreased in individuals with chronic post-stroke hemiparesis due to multisystemic deficits. Transcranial direct current stimulation (tDCS) is a non-invasive method to modulate cortical excitability, inducing neuroplastic changes to the targeted cortical areas and has been suggested to potentially improve motor functions in individuals with neurological impairments. The purpose of this double-blinded, sham-controlled study was to examine the acute effects of anodal tDCS over the lesioned motor cortex leg area with concurrent limits of stability training on postural control in individuals with chronic post-stroke hemiparesis. Ten individuals with chronic post-stroke hemiparesis received either anodal or sham tDCS stimulation over the lesioned leg region of the motor cortex while undergoing 20 min of postural training. The type of stimulation to receive during the first session was pseudorandomized, and the two sessions were separated by 14 days. Before and immediately after 20 min of tDCS, the 10 m walk test, the Berg Balance Scale, and dynamic posturography assessments were performed. After a single session of anodal tDCS with concurrent postural training, we observed no changes in clinical measures of balance and walking, assessed using the Berg Balance Scale and 10 m walk test. For dynamic posturography assessments, participants demonstrated improvements in adaptation responses to toes-up and toes-down perturbations, regardless of the type of tDCS received. Additionally, improved performance in the shifting center of gravity was observed during anodal tDCS. Taken together, these preliminary findings suggest that tDCS can potentially be used as a feasible approach be incorporated into the rehabilitation of chronic post-stroke individuals with issues related to postural control and fear of falling, and that multiple sessions of tDCS stimulation may be needed to improve functional measures of postural control and walking.

Calcium Pyrophosphate Deposition Disease in the Achilles Tendon.

Teaching point: The classic sonographic presentation of calcium pyrophosphate dihydrate crystal deposits in the Achilles tendon is reported.

Characteristics of medial-lateral postural control while exposed to the external perturbation in step initiation.

Controllability of posture in the medial-lateral direction is critical for balance maintenance, particularly in step initiation. The objective of the current study was to examine  the effects of external perturbation and landing orientation on medial-lateral control stability in step initiation. Eleven young healthy participants stood on the force platform and waited for the instruction of taking a step while experiencing a pendulum perturbation applied at the lateral side of the right shoulder. Eight experimental conditions were conducted by two levels of step side (right or left), two levels of perturbation (with or without), and two levels of landing orientation (forward or diagonal). The center of pressure (COP), pelvic movements, and muscle activities were recorded and analyzed as the onset of COP and pelvic movement, the COP displacement, and cocontraction and reciprocal muscle activation pattern. The temporal events of COP and pelvic movement were not significantly different in all experimental conditions. However, COP and pelvic movement were significantly later in the diagonal condition. Most of the segments showed reciprocal muscle activation patterns in relation to the perturbation released time. Subsequently, all segments showed cocontraction muscle activation patterns, which was significantly affected by step side, perturbation, and orientation. The results suggest that how the CNS initiated a step was identical with the COP then pelvic movement. The outcome highlights the importance of external perturbation and foot landing orientation effects on postural adjustments, which may provide a different approach to help step initiation.

Bilateral Assessment of the Corticospinal Pathways of the Ankle Muscles Using Navigated Transcranial Magnetic Stimulation.

Distal leg muscles receive neural input from motor cortical areas via the corticospinal tract, which is one of the main motor descending pathway in humans and can be assessed using transcranial magnetic stimulation (TMS). Given the role of distal leg muscles in upright postural and dynamic tasks, such as walking, a growing research interest in the assessment and modulation of the corticospinal tracts relative to the function of these muscles has emerged in the last decade. However, methodological parameters used in previous work have varied across studies making the interpretation of results from cross-sectional and longitudinal studies less robust. Therefore, use of a standardized TMS protocol specific to the assessment of leg muscles' corticomotor response (CMR) will allow for direct comparison of results across studies and cohorts. The objective of this paper is to present a protocol that provides the flexibility to simultaneously assess the bilateral CMR of two main ankle antagonistic muscles, the tibialis anterior and soleus, using single pulse TMS with a neuronavigation system. The present protocol is applicable while the examined muscle is either fully relaxed or isometrically contracted at a defined percentage of maximum isometric voluntary contraction. Using each subject's structural MRI with the neuronavigation system ensures accurate and precise positioning of the coil over the leg cortical representations during assessment. Given the inconsistency in CMR derived measures, this protocol also describes a standardized calculation of these measures using automated algorithms. Though this protocol is not conducted during upright postural or dynamic tasks, it can be used to assess bilaterally any pair of leg muscles, either antagonistic or synergistic, in both neurologically intact and impaired subjects.