Can kinematic parameters of 3D reach-to-target movements be used as a proxy for clinical outcome measures in chronic stroke rehabilitation? An exploratory study.

BACKGROUND: Despite numerous trials investigating robot-assisted therapy (RT) effects on upper-extremity (UE) function after stroke, few have explored the relationship between three-dimensional (3D) reach-to-target kinematics and clinical outcomes. The objectives of this study were to 1) investigate the correlation between kinematic parameters of 3D reach-to-target movements and UE clinical outcome measures, and 2) examine the degree to which differences in kinematic parameters across individuals can account for differences in clinical outcomes in response to RT. METHODS: Ten chronic stroke survivors participated in a pilot RT intervention (eighteen 1-h sessions) integrating cognitive skills training and a home-action program. Clinical outcome measures and kinematic parameters of 3D reach-to-target movements were collected pre- and post-intervention. The correlation between clinical outcomes and kinematic parameters was investigated both cross-sectionally and longitudinally (i.e., changes in response to the intervention). Changes in clinical outcomes and kinematic parameters were tested for significance in both group and subject-by-subject analyses. Potential associations between individual differences in kinematic parameters and differences in clinical outcomes were examined. RESULTS: Moderate-to-strong correlation was found between clinical measures and specific kinematic parameters when examined cross-sectionally. Weaker correlation coefficients were found longitudinally. Group analyses revealed significant changes in clinical outcome measures in response to the intervention; no significant group changes were observed in kinematic parameters. Subject-by-subject analyses revealed changes with moderate-to-large effect size in the kinematics of 3D reach-to-target movements pre- vs. post-intervention. Changes in clinical outcomes and kinematic parameters varied widely across participants. CONCLUSIONS: Large variability was observed across subjects in response to the intervention. The correlation between changes in kinematic parameters and clinical outcomes in response to the intervention was variable and not strong across parameters, suggesting no consistent change in UE motor strategies across participants. These results highlight the need to investigate the response to interventions at the individual level. This would enable the identification of clusters of individuals with common patterns of change in response to an intervention, providing an opportunity to use cluster-specific kinematic parameters as a proxy of clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02747433 . Registered on April 21st, 2016.

Temporal and spatial asymmetries during stationary cycling cause different feedforward and feedback modifications in the muscular control of the lower limbs.

Motor adaptations are useful for studying the way in which the lower limbs are controlled by the brain. However, motor adaptation paradigms for the lower limbs are typically based on locomotion tasks, where the necessity of maintaining postural stability is the main driver of adaptation and could possibly mask other underlying processes. In this study we investigated whether small temporal or spatial asymmetries can trigger motor adaptations during stationary cycling, where stability is not directly compromised. Fourteen healthy individuals participated in two experiments: in one of the experiments, the angle between the crank arms of the pedals was altered by 10° to induce a temporal asymmetry; in the other experiment, the length of the right pedal was shortened by 2.4 cm to induce a spatial asymmetry. We recorded the acceleration of the crank arms and the electromographic signals of 16 muscles (8 per leg). The analysis of the accelerometer data was used to investigate the presence of motor adaptations. Muscle synergy analysis was performed on each side to quantify changes in neuromuscular control. We found that motor adaptations are present in response to temporal asymmetries and are obtained by progressively shifting the activation patterns of two synergies on the right leg. Spatial asymmetries, on the other hand, appear to trigger a feedback-driven response that does not present an aftereffect. This response is characterized by a steplike decrease in activity in the right gastrocnemius when the asymmetry is present and likely reflects the altered task demands. NEW & NOTEWORTHY The processes driving lower limb motor adaptations are not fully clear, and previous research appears to indicate that adaptations are mainly driven by stability. We show that lower limb adaptations can be obtained also in the absence of an explicit balance threat. We also show that adaptations are present when kinematic error cannot be compensated for, suggesting the presence of intrinsic error measures regulating the timing of activation of the two legs.

Assessing aberrant muscle activity patterns via the analysis of surface EMG data collected during a functional evaluation.

BACKGROUND: Surface electromyographic (EMG) recordings collected during the performance of functional evaluations allow clinicians to assess aberrant patterns of muscle activity associated with musculoskeletal disorders. This assessment is typically achieved via visual inspection of the surface EMG data. This approach is time-consuming and leads to accurate results only when the assessment is carried out by an EMG expert. METHODS: A set of algorithms was developed to automatically evaluate aberrant patterns of muscle activity. EMG recordings collected during the performance of functional evaluations in 62 subjects (22 to 61 years old) were used to develop and characterize the algorithms. Clinical scores were generated via visual inspection by an EMG expert using an ordinal scale capturing the severity of aberrant patterns of muscle activity. The algorithms were used in a case study (i.e. the evaluation of a subject with persistent back pain following instrumented lumbar fusion who underwent lumbar hardware removal) to assess the clinical suitability of the proposed technique. RESULTS: The EMG-based algorithms produced accurate estimates of the clinical scores. Results were primarily obtained using a linear regression approach. However, when the results were not satisfactory, a regression implementation of a Random Forest was utilized, and the results compared with those obtained using a linear regression approach. The root-mean-square error of the clinical score estimates produced by the algorithms was a small fraction of the ordinal scale used to rate the severity of the aberrant patterns of muscle activity. Regression coefficients and associated 95% confidence intervals showed that the EMG-based estimates fit well the clinical scores generated by the EMG expert. When applied to the clinical case study, the algorithms appeared to capture the characteristics of the muscle activity patterns associated with persistent back pain following instrumented lumbar fusion. CONCLUSIONS: The proposed approach relies on EMG-based measures to generate accurate estimates of the severity of aberrant patterns of muscle activity. The results obtained in the case study suggest that the proposed technique is suitable to derive clinically-relevant information from EMG data collected during functional evaluations.

Kinematic and electromyographic analysis of the Askling L-Protocol for hamstring training.

Hamstring injuries are common in field sport athletes. Eccentric strength training of the hamstring muscles is an integral component of rehabilitation programs. The Askling L-Protocol comprises three exercises [extender; diver; glider] that load the hamstrings during eccentric activity. When compared to a conventional exercise-based rehabilitation program, the Askling L-Protocol has been shown to reduce the time to return to sport following hamstring injury and prevalence of injury recurrence. Nevertheless, the mechanisms behind its efficacy have yet to be studied. In this work, we conducted a kinematic and electromyographic analysis of the exercises of the Askling L-Protocol. Eleven healthy individuals performed each of the exercises while electromyographic data from four muscles (including two hamstring muscles) were recorded. Hip and knee angular displacements and velocities were also synchronously recorded using a motion capture system. We found that the L-Protocol elicits a maximal contraction (up to 60% of the MVC in the glider exercise) in the hamstring muscles at a work point similar to the swing phase of running (around 62 degrees hip flexion and 23 degrees knee flexion). No difference in the levels of activation of the hamstrings was observed between the diver and glider, regardless of the different functional role they had in the two exercises. During the extender, the hamstring muscles are stretched and minimally engaged. Finally, co-activation analysis highlighted that through the combination of passive stretch and active eccentric contraction, the hamstrings are trained to co-activate using similar structural modules employed differentially to drive the movement or stabilize it.

Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies.

BACKGROUND: The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. METHODS: ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. RESULTS: At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. CONCLUSIONS: The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®.

Correction to: Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies.

The original article [1] contains a small mistake concerning the ARTIC Team members mentioned in the Acknowledgements. The team member, Rocco Salvatore Calabrò had their name presented incorrectly. This has now been corrected in the original article.

The effects of video game therapy on balance and attention in chronic ambulatory traumatic brain injury: an exploratory study.

BACKGROUND: Patients with traumatic brain injury often have balance and attentive disorders. Video game therapy (VGT) has been proposed as a new intervention to improve mobility and attention through a reward-learning approach. In this pilot randomized, controlled trial, we tested the effects of VGT, compared with a balance platform therapy (BPT), on balance, mobility and selective attention in chronic traumatic brain injury patients. METHODS: We enrolled chronic traumatic brain injury patients (n = 21) that randomly received VGT or BPT for 3 sessions per week for 6 weeks. The clinical outcome measures included: i) the Community Balance & Mobility Scale (CB&M); ii) the Unified Balance Scale (UBS); iii) the Timed Up and Go test (TUG); iv) static balance and v) selective visual attention evaluation (Go/Nogo task). RESULTS: Both groups improved in CB&M scores, but only the VGT group increased on the UBS and TUG with a between-group significance (p < 0.05). Selective attention improved significantly in the VGT group (p < 0.01). CONCLUSIONS: Video game therapy is an option for the management of chronic traumatic brain injury patients to ameliorate balance and attention deficits. TRIAL REGISTRATION: NCT01883830 , April 5 2013.

Use of Nintendo Wii Balance Board for posturographic analysis of Multiple Sclerosis patients with minimal balance impairment.

BACKGROUND: The Wii Balance Board (WBB) has been proposed as an inexpensive alternative to laboratory-grade Force Plates (FP) for the instrumented assessment of balance. Previous studies have reported a good validity and reliability of the WBB for estimating the path length of the Center of Pressure. Here we extend this analysis to 18 balance related features extracted from healthy subjects (HS) and individuals affected by Multiple Sclerosis (MS) with minimal balance impairment. METHODS: Eighteen MS patients with minimal balance impairment (Berg Balance Scale 53.3 ± 3.1) and 18 age-matched HS were recruited in this study. All subjects underwent instrumented balance tests on the FP and WBB consisting of quiet standing with the eyes open and closed. Linear correlation analysis and Bland-Altman plots were used to assess relations between path lengths estimated using the WBB and the FP. 18 features were extracted from the instrumented balance tests. Statistical analysis was used to assess significant differences between the features estimated using the WBB and the FP and between HS and MS. The Spearman correlation coefficient was used to evaluate the validity and the Intraclass Correlation Coefficient was used to assess the reliability of WBB measures with respect to the FP. Classifiers based on Support Vector Machines trained on the FP and WBB features were used to assess the ability of both devices to discriminate between HS and MS. RESULTS: We found a significant linear relation between the path lengths calculated from the WBB and the FP indicating an overestimation of these parameters in the WBB. We observed significant differences in the path lengths between FP and WBB in most conditions. However, significant differences were not found for the majority of the other features. We observed the same significant differences between the HS and MS populations across the two measurement systems. Validity and reliability were moderate-to-high for all the analyzed features. Both the FP and WBB trained classifier showed similar classification performance (>80%) when discriminating between HS and MS. CONCLUSIONS: Our results support the observation that the WBB, although not suitable for obtaining absolute measures, could be successfully used in comparative analysis of different populations.

Intermuscular coherence contributions in synergistic muscles during pedaling.

The execution of rhythmical motor tasks requires the control of multiple skeletal muscles by the Central Nervous System (CNS), and the neural mechanisms according to which the CNS manages their coordination are not completely clear yet. In this study, we analyze the distribution of the neural drive shared across muscles that work synergistically during the execution of a free pedaling task. Electromyographic (EMG) activity was recorded from eight lower limb muscles of eleven healthy untrained participants during an unconstrained pedaling exercise. The coordinated activity of the lower limb muscles was described within the framework of muscle synergies, extracted through the application of nonnegative matrix factorization. Intermuscular synchronization was assessed by calculating intermuscular coherence between pairs of EMG signals from co-active, both synergistic and non-synergistic muscles within their periods of co-activation. The spatiotemporal structure of muscle coordination during pedaling was well represented by four muscle synergies for all the subjects. Significant coherence values within the gamma band (30-60 Hz) were identified only for one out of the four extracted muscle synergies. This synergy is mainly composed of the activity of knee extensor muscles, and its function is related to the power production and crank propelling during the pedaling cycle. In addition, a significant coherence peak was found in the lower frequencies for the GAM/SOL muscle pair, possibly related to the ankle stabilizing function of these two muscles during the pedaling task. No synchronization was found either for the other extracted muscle synergies or for pairs of co-active but non-synergistic muscles. The obtained results seem to suggest the presence of intermuscular synchronization only when a functional force production is required, with the observed gamma band contribution possibly reflecting a cortical drive to synergistic muscles during pedaling.

Optimal Identification of Muscle Synergies From Typical Sit-to-Stand Clinical Tests.

Goal: The goal of this manuscript is to investigate the optimal methods for extracting muscle synergies from a sit-to-stand test; in particular, the performance in identifying the modular structures from signals of different length is characterized. Methods: Surface electromyography signals have been recorded from instrumented sit-to-stand trials. Muscle synergies have then been extracted from signals of different duration (i.e. 5 times sit to stand and 30 seconds sit to stand) from different portions of a complete sit-to-stand-to-sit cycle. Performance have then been characterized using cross-validation procedures. Moreover, an optimal method based on a modified Akaike Information Criterion measure is applied on the signal for selecting the correct number of synergies from each trial. Results: Results show that it is possible to identify correctly muscle synergies from relatively short signals in a sit-to-stand experiment. Moreover, the information about motor control structures is identified with a higher consistency when only the sit-to-stand phase of the complete cycle is considered. Conclusions: Defining a set of optimal methods for the extraction of muscle synergies from a clnical test such as the sit-to-stand is of key relevance to ensure the applicability of any synergy-related analysis in the clinical practice, without requiring knowledge of the technical signal processing methods and the underlying features of the signal.

Subsensory stochastic electrical stimulation targeting muscle afferents alters gait control during locomotor adaptations to haptic perturbations.

Subsensory noise stimulation targeting sensory receptors has been shown to improve balance control in healthy and impaired individuals. However, the potential for application of this technique in other contexts is still unknown. Gait control and adaptation rely heavily on the input from proprioceptive organs in the muscles and joints. Here we investigated the use of subsensory noise stimulation as a means to influence motor control by altering proprioception during locomotor adaptations to forces delivered by a robot. The forces increase step length unilaterally and trigger an adaptive response that restores the original symmetry. Healthy participants performed two adaptation experiments, one with stimulation applied to the hamstring muscles and one without. We found that participants adapted faster but to a lesser extent when undergoing stimulation. We argue that this behavior is because of the dual effect that the stimulation has on the afferents encoding position and velocity in the muscle spindles.

A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures.

Background. Stroke is a leading cause of death and disability worldwide and there is a very short period of increased synaptic plasticity, fundamental in motor recovery. Thus, it is crucial to acquire data to guide the rehabilitation treatment. Promising results have been achieved with kinematics and neurophysiological data, but currently, few studies integrate these different modalities. Objectives. We explored the correlations between standardized clinical scales, kinematic data, and EEG measures 4 weeks after stroke. Methods. 26 patients were considered. Among them, 20 patients also performed the EEG study, beyond the kinematic analysis, at 4 weeks. Results. We found correlations between the Fugl-Meyer Assessment-Upper Extremity, movement duration, smoothness measures, and velocity peaks. Moreover, EEG measures showed a tendency for the healthy hemisphere to vicariate the affected one in patients characterized by better clinical conditions. Conclusions. These results suggest the relevance of kinematic (in particular movement duration and smoothness) and EEG biomarkers to evaluate post-stroke recovery. We emphasize the importance of integrating clinical data with kinematic and EEG analyses from the early stroke stages, in order to guide rehabilitation strategies to best leverage the short period of increased synaptic plasticity.

Predictive simulation of sit-to-stand based on reflexive-controllers.

Sit-to-stand can be defined as a set of movements that allow humans to rise from a sitting position to a bipedal standing pose. These movements, often categorized as four distinct kinematic phases, must be coordinated for assuring personal autonomy and can be compromised by ageing or physical impairments. To solve this, rehabilitation techniques and assistive devices demand proper description of the principles that lead to the correct completion of this motor task. While the muscular dynamics of the sit-to-stand task have been analysed, the underlying neural activity remains unknown and largely inaccessible for conventional measurement systems. Predictive simulations can propose motor controllers whose plausibility is evaluated through the comparison between simulated and experimental kinematics. In the present work, we modelled an array of reflexes that originate muscle activations as a function of proprioceptive and vestibular feedback. This feedback encodes torso position, displacement velocity and acceleration of a modelled human body with 7 segments, 9 degrees of freedom, and 50 actuators. We implemented two controllers: a four-phases controller where the reflex gains and composition vary depending on the kinematic phase, and a simpler two-phases controller, where three of the kinematic phases share the same reflex gains. Gains were optimized using Covariance Matrix Adaptation. The results of the simulations reveal, for both controllers, human-like sit-to-stand movement, with joint angles and muscular activity comparable to experimental data. The results obtained with the simplified two-phases controller indicate that a simple set of reflexes could be sufficient to drive this motor task.

Forward and backward walking share the same motor modules and locomotor adaptation strategies.

Forward and backward walking are remarkably similar motor behaviors to the extent that backward walking has been described as a time-reversed version of forward walking. However, because they display different muscle activity patterns, it has been questioned if forward and backward walking share common control strategies. To investigate this point, we used a split-belt treadmill experimental paradigm designed to elicit healthy individuals' motor adaptation by changing the speed of one of the treadmill belts, while keeping the speed of the other belt constant. We applied this experimental paradigm to both forward and backward walking. We analyzed several adaptation parameters including step symmetry, stability, and energy expenditure as well as the characteristics of the synergies of lower-limb muscles. We found that forward and backward walking share the same muscle synergy modules. We showed that these modules are marked by similar patterns of adaptation driven by stability and energy consumption minimization criteria, both relying on modulating the temporal activation of the muscle synergies. Our results provide evidence that forward and backward walking are governed by the same control and adaptation mechanisms.

An Objective, Information-Based Approach for Selecting the Number of Muscle Synergies to be Extracted via Non-Negative Matrix Factorization.

Muscle synergy analysis is a useful tool for the evaluation of the motor control strategies and for the quantification of motor performance. Among the parameters that can be extracted, most of the information is included in the rank of the modular control model (i.e. the number of muscle synergies that can be used to describe the overall muscle coordination). Even though different criteria have been proposed in literature, an objective criterion for the model order selection is needed to improve reliability and repeatability of MSA results. In this paper, we propose an Akaike Information Criterion (AIC)-based method for model order selection when extracting muscle synergies via the original Gaussian Non-Negative Matrix Factorization algorithm. The traditional AIC definition has been modified based on a correction of the likelihood term, which includes signal dependent noise on the neural commands, and a Discrete Wavelet decomposition method for the proper estimation of the number of degrees of freedom of the model, reduced on a synergy-by-synergy and event-by-event basis. We tested the performance of our method in comparison with the most widespread ones, proving that our criterion is able to yield good and stable performance in selecting the correct model order in simulated EMG data. We further evaluated the performance of our AIC-based technique on two distinct experimental datasets confirming the results obtained with the synthetic signals, with performances that are stable and independent from the nature of the analysed task, from the signal quality and from the subjective EMG pre-processing steps.

Video game therapy on mobility and dual tasking in multiple sclerosis: study protocol for a randomised controlled trial.

INTRODUCTION: Multiple sclerosis (MS) is one of the major causes of disability in young adults and affects mobility, compromising daily living activities and participation in social life. Cognitive domain is also frequently impaired in people with MS (PwMS), particularly the capacity to perform dual-task activities. Impaired cognitive processing abilities need to be treated, and motor and cognitive aspects need to be considered together. Recently, video game therapy (VGT) has been used in rehabilitation to improve motor outcomes and cognitive processing speed. The aim of this study is to test the efficacy of commercially available VGT on mobility and dual tasking in PwMS compared with standardised balance platform training (BPT). METHODS AND ANALYSIS: This will be a parallel-assignment, double-blinded, randomised control trial. Forty-eight (24 per arm) PwMS with Expanded Disability Status Scale 4-5.5 will be randomly assigned to receive 1 hour training session over 4 weeks (three sessions/week) of either: (1) VGT on commercial video game console to train balance and mobility-related activities or (2) BPT to perform balance, postural stability and weight-shifting exercises with and without visual feedback. The same assessor will evaluate outcome measures at points: before and after the 12 training sessions and at 3 months of follow-up. The primary outcome will be functional mobility, assessed by the Timed Up and Go test. We will also evaluate gait, risk of fall, fatigue and health-related quality of life as well as cognitive and psychological aspects (depression, anxiety and attentional performance) and stability through posturographic evaluation. Dual-tasking assessment will be performed combining posturographic and neuropsychological tests. Data analysis will be performed to compare the efficacy of the two treatments. ETHICS AND DISSEMINATION: Ethical approval have been granted from the local Ethics Committee. Study results will be communicated through high-quality journals and national and international conferences. TRIAL REGISTRATION NUMBER: NCT03353974.

Using functional movement tests to investigate the presence of sensorimotor impairment in amateur athletes following sport-related concussion: A prospective, longitudinal study.

OBJECTIVE: To longitudinally investigate the presence of sensorimotor impairments in amateur athletes following sport-related concussion using two functional movement tests. DESIGN: Prospective, longitudinal study. SETTING: Human movement analysis laboratory. PARTICIPANTS: Athletes who presented to a hospital emergency department and were diagnosed with sport-related concussion, and sex-, age-, and activity-matched non-concussed, control athletes. Concussed participants were assessed within one-week following sport-related concussion, upon clearance to return-to-sporting activity (RTA), and two weeks after RTA. Control participants were assessed at an initial time-point and approximately two and four weeks following their initial study assessment. MAIN OUTCOMES MEASURES: At each laboratory assessment, participants completed two functional movement tests: the Star Excursion Balance Test to evaluate anterior reach distance (normalised for leg length) and fractal dimension (centre of pressure path complexity), and the Multiple Hop Test to evaluate corrective postural strategies and time-to-stabilisation. RESULTS: Fifty concussed athletes and 50 control athletes completed the study. There were no significant differences at any study assessment between the concussion and control group on the Star Excursion Balance Test anterior reach distance or fractal dimension (centre of pressure path complexity). During the Multiple Hop Test, the concussion group used a significantly greater number of corrective postural strategies than the control group one-week following sport-related concussion and upon clearance to RTA, but not two weeks following RTA. CONCLUSION: Recently concussed athletes made a greater number of corrective postural strategies than control participants during the Multiple Hop Test upon clearance to RTA but not two weeks after RTA. The Multiple Hop Test may offer a clinically useful tool for practitioners to examine the recovery of subtle sensorimotor impairments and related RTA readiness.

Characterization of the Adaptation to Visuomotor Rotations in the Muscle Synergies Space.

The adaptation to visuomotor rotations is one of the most studied paradigms of motor learning. Previous literature has presented evidence of a dependency between the process of adaptation to visuomotor rotations and the constrains dictated by the workspace of the biological actuators, the muscles, and their co-activation strategies, modeled using muscle synergies analysis. To better understand this relationship, we asked a sample of healthy individuals (N = 7) to perform two experiments aiming at characterizing the adaptation to visuomotor rotations in terms of rotations of the activation space of the muscle synergies during isometric reaching tasks. In both experiments, subjects were asked to adapt to visual rotations altering the position mapping between the force exerted on a fixed manipulandum and the movement of a cursor on a screen. In the first experiment subjects adapted to three different visuomotor rotation angles (30°, 40°, and 50° clockwise) applied to the whole experimental workspace. In the second experiment subjects adapted to a single visuomotor rotation angle (45° clockwise) applied to eight different sub-spaces of the whole workspace, while also performing movements in the rest of the unperturbed workspace. The results from the first experiment confirmed the hypothesis that visuomotor rotations induce rotations in the synergies activation workspace that are proportional to the visuomotor rotation angle. The results from the second experiment showed that rotations affecting limited sub-spaces of the whole workspace are adapted for by rotating only the synergies involved in the movement, with an angle proportional to the distance between the preferred angle of the synergy and the sub-space covered by the rotation. Moreover, we show that the activation of a synergy is only rotated when the sub-space covered by the visual perturbation is applied at the boundaries of the workspace of the synergy. We found these results to be consistent across subjects, synergies and sub-spaces. Moreover, we found a correlation between synergies and muscle rotations further confirming that the adaptation process can be well described, at the neuromuscular level, using the muscle synergies model. These results provide information on how visuomotor rotations can be used to induce a desired neuromuscular response.

Hyperalgesia and Central Sensitization in Subjects With Chronic Orofacial Pain: Analysis of Pain Thresholds and EEG Biomarkers.

Introduction: The presence of a temporomandibular disorder is one of the most frequent causes of orofacial pain (OFP). When pain continues beyond tissue healing time, it becomes chronic and may be caused, among other factors, by the sensitization of higher-order neurons. The aim of this study is to describe psychological characteristics of patients with chronic OFP, their peripheral pain threshold, and electroencephalography (EEG) recording, looking for possible signs of central sensitization (CS). Materials and methods: Twenty-four subjects with chronic OFP caused by temporomandibular disorder were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders Axis I and Axis II. Pain intensity, catastrophizing, and presence of CS were assessed through self-reported questionnaires. Pressure pain threshold (PPT) was recorded in facial and peripheral sites; EEG activity was recorded during open and closed eyes resting state and also during the pain threshold assessment. Pain thresholds and EEG recordings were compared with a cohort of pain-free age- and sex-matched healthy subjects. Results: Patients with chronic OFP showed a significant reduction in their pain threshold compared to healthy subjects in all sites assessed. Greater reduction in pain threshold was recorded in patients with more severe psychological symptoms. Decreased alpha and increased gamma activity was recorded in central and frontal regions of all subjects, although no significant differences were observed between groups. Discussion: A general reduction in PPT was recorded in people who suffer from chronic OFP. This result may be explained by sensitization of the central nervous system due to chronic pain conditions. Abnormal EEG activity was recorded during painful stimulation compared to the relaxed condition in both chronic OFP subjects and healthy controls.

Robot-Driven Locomotor Perturbations Reveal Synergy-Mediated, Context-Dependent Feedforward and Feedback Mechanisms of Adaptation.

Humans respond to mechanical perturbations that affect their gait by changing their motor control strategy. Previous work indicates that adaptation during gait is context dependent, and perturbations altering long-term stability are compensated for even at the cost of higher energy expenditure. However, it is unclear if gait adaptation is driven by unilateral or bilateral mechanisms, and what the roles of feedback and feedforward control are in the generation of compensatory responses. Here, we used a robot-based adaptation paradigm to investigate if feedback/feedforward and unilateral/bilateral contributions to locomotor adaptation are also context dependent in healthy adults. A robot was used to induce two opposite unilateral mechanical perturbations affecting the step length over multiple gait cycles. Electromyographic signals were collected and analyzed to determine how muscle synergies change in response to perturbations. The results unraveled different unilateral modulation dynamics of the muscle-synergy activations during adaptation, characterized by the combination of a slow-progressive feedforward process and a fast-reactive feedback-driven process. The relative unilateral contributions of the two processes to motor-output adjustments, however, depended on which perturbation was delivered. Overall, these observations provide evidence that, in humans, both descending and afferent drives project onto the same spinal interneuronal networks that encode locomotor muscle synergies.