Sensorimotor Time Delay Estimation by EMG Signal Processing in People Living with Spinal Cord Injury.

Neuro mechanical time delay is inevitable in the sensorimotor control of the body due to sensory, transmission, signal processing and muscle activation delays. In essence, time delay reduces stabilization efficiency, leading to system instability (e.g., falls). For this reason, estimation of time delay in patients such as people living with spinal cord injury (SCI) can help therapists and biomechanics to design more appropriate exercise or assistive technologies in the rehabilitation procedure. In this study, we aim to estimate the muscle onset activation in SCI people by four strategies on EMG data. Seven complete SCI individuals participated in this study, and they maintained their stability during seated balance after a mechanical perturbation exerting at the level of the third thoracic vertebra between the scapulas. EMG activity of eight upper limb muscles were recorded during the stability. Two strategies based on the simple filtering (first strategy) approach and TKEO technique (second strategy) in the time domain and two other approaches of cepstral analysis (third strategy) and power spectrum (fourth strategy) in the time-frequency domain were performed in order to estimate the muscle onset. The results demonstrated that the TKEO technique could efficiently remove the electrocardiogram (ECG) and motion artifacts compared with the simple classical filtering approach. However, the first and second strategies failed to find muscle onset in several trials, which shows the weakness of these two strategies. The time-frequency techniques (cepstral analysis and power spectrum) estimated longer activation onset compared with the other two strategies in the time domain, which we associate with lower-frequency movement in the maintaining of sitting stability. In addition, no correlation was found for the muscle activation sequence nor for the estimated delay value, which is most likely caused by motion redundancy and different stabilization strategies in each participant. The estimated time delay can be used in developing a sensory motor control model of the body. It not only can help therapists and biomechanics to understand the underlying mechanisms of body, but also can be useful in developing assistive technologies based on their stability mechanism.

Does Unilateral Lower Limb Amputation Influence Ankle Joint Torque in the Intact Leg?

OBJECTIVE: To investigate ankle torque and steadiness in the intact leg of transtibial and transfemoral unilateral amputees. DESIGN: Comparative study. SETTING: Medical rehabilitation centers. PARTICIPANTS: Fifteen persons with a unilateral transfemoral amputation, 8 persons with a transtibial amputation, and 14 able-bodied male participants volunteered to participate in this study (N=37). INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Maximal isometric torque performed during ankle plantarflexion and dorsiflexion in the intact limb of amputees and in the dominant limb of able-bodied persons. The coefficient of variation (CV) of the plantarflexion torque was calculated over 5 seconds during a submaximal isometric contraction (15%) in order to assess torque steadiness. Furthermore, electromyographic activity (the root mean square amplitude) of the gastrocnemius medialis and tibialis anterior muscles was analyzed. RESULTS: Plantarflexion maximal torque was significantly higher for the able-bodied group (115±39 Nm) than for the group with a transfemoral amputation (77±34 Nm) (P<.01), and did not differ between able-bodied group and the group with a transtibial amputation (97±26 Nm) (P=.25). Furthermore, the transfemoral amputee group was 29% less steady than the able-bodied group (P=.01). However, there were no significant differences in torque steadiness between the able-bodied group and transtibial amputee group (P=.26) or between transtibial and transfemoral amputee groups (P=.27). The amputation had no significant effect between groups on dorsiflexion maximal torque (P=.10), gastrocnemius medialis electromyography (EMG) (P=.85), tibialis anterior coactivation (P=.95), and coactivation ratio (P=.75). CONCLUSION: The present study suggests that as the level of amputation progresses from below the knee to above the knee, the effect on the intact ankle is progressively more negative.

Do Older People Accurately Estimate the Length of Their First Step during Gait Initiation?

Background/Study Context: Advancing age is associated with a decrease in step length. In line with previous studies showing that older adults often overestimate their motor abilities, we investigate whether older adults overestimate the length of their first step during gait initiation. The underlying effect could be a failure to update the internal model of motor action as a function of age-related motor decline. Methods: Without taking a step, community-dwelling older women (n = 22, age range: 68-87 years) and younger women (n = 19, age range: 19-33 years) estimated the length of their first step for both preferred step length and largest step length, which were performed without endangerment. Thereafter, the participants performed real gait initiation for both types of steps. The estimated step lengths were compared to the actual step lengths. Results: Older adults judged their first step as larger than it was (mean error: 30% for the preferred step and 9% for the largest step). A fine-grained analysis showed that this effect mainly concerned those for whom an increased risk of falling was suspected. These older adults were also among those who performed the shortest steps, and they presented with a slight decrease in cognitive functioning. Younger participants underestimated their preferred step length. Overall, the estimates were more accurate for the largest steps than for the preferred-length steps. Conclusion: Step length estimation revealed powerful evidence for overestimation in older adults. Those who overestimated step length presented with more signs of motor decline. While this result sustains the idea of an insufficient actualization of the motor-action model, the explanation also refers to more global appraisal processes. Further research should explore the relevance of this task as a clinical laboratory tool for assessing gait capacity and the risk of falling.

A reliable measure of footwear upper comfort enabled by an innovative sock equipped with textile pressure sensors.

Footwear comfort is essential and pressure distribution on the foot was shown as a relevant objective measurement to assess it. However, asperities on the foot sides, especially the metatarsals and the instep, make its evaluation difficult with available equipment. Thus, a sock equipped with textile pressure sensors was designed. Results from the mechanical tests showed a high linearity of the sensor response under incremental loadings and allowed to determine the regression equation to convert voltage values into pressure measurements. The sensor response was also highly repeatable and the creep under constant loading was low. Pressure measurements on human feet associated with a perception questionnaire exhibited that significant relationships existed between pressure and comfort perceived on the first, the third and the fifth metatarsals and top of the instep. Practitioner Summary: A sock equipped with textile sensors was validated for measuring the pressure on the foot top, medial and lateral sides to evaluate footwear comfort. This device may be relevant to help individuals with low sensitivity, such as children, elderly or neuropathic, to choose the shoes that fit the best.

[Poor knowledge of treatment protocols by members of an HIV association]. / Méconnaissance du protocole de soins chez les personnes rencontrées dans une association de lutte contre le VIH.

The treatment protocol form defines all health care and treatments that are free of charge for patients living with a long-term disease in France. It is designed to facilitate the medical care of these patients. The way in which it is written impact on access and adequacy of health care. AIDES, a French HIV/AIDS/Hepatitis association, reported disparities and shortcomings in the use of this protocol. A survey was conducted among people attending this association in order to objectively demonstrate field observations. This article presents the results of this investigation designed to determine the level of knowledge of the people living with HIV and/or hepatitis in contact with the association regarding the use of this protocol. 224 people completed the questionnaire. The results confirm field observations: the appropriation of the treatment protocol by patients who participated in this survey remains limited, even within a study population in contact with a patient association. These findings raise the question of the effectiveness of the communication between health care practitioners/caregivers and patients concerning the use of this tool. More widely, the protocol drafting process needs to be reviewed: what are the respective places and roles for health stakeholders? What form of coordination between the patient, the general practitioner and the Health Insurance is required to establish an appropriate and appropriable treatment protocol?

Time-delay estimation in biomechanical stability: a scoping review.

Despite its high-level of robustness and versatility, the human sensorimotor control system regularly encounters and manages various noises, non-linearities, uncertainties, redundancies, and delays. These delays, which are critical to biomechanical stability, occur in various parts of the system and include sensory, signal transmission, CNS processing, as well as muscle activation delays. Despite the relevance of accurate estimation and prediction of the various time delays, the current literature reflects major discrepancy with regards to existing prediction and estimation methods. This scoping review was conducted with the aim of characterizing and categorizing various approaches for estimation of physiological time delays based on PRISMA guidelines. Five data bases (EMBASE, PubMed, Scopus, IEEE and Web of Science) were consulted between the years of 2000 and 2022, with a combination of four related categories of keywords. Scientific articles estimating at least one physiological time delay, experimentally or through simulations, were included. Eventually, 46 articles were identified and analyzed with 20 quantification and 16 qualification questions by two separate reviewers. Overall, the reviewed studies, experimental and analytical, employing both linear and non-linear models, reflected heterogeneity in the definition of time delay and demonstrated high variability in experimental protocols as well as the estimation of delay values. Most of the summarized articles were classified in the high-quality category, where multiple sound analytical approaches, including optimization, regression, Kalman filter and neural network in time domain or frequency domain were used. Importantly, more than 50% of the reviewed articles did not clearly define the nature of the estimated delays. This review presents and summarizes these issues and calls for a standardization of future scientific works for estimation of physiological time-delay.

Center of pressure palindromes reveals a wobbling standing balance in scoliotic girls.

BACKGROUND: This study characterized the center of pressure planar displacement by palindromic strings. The objective is to test if the center of pressure pathway of able-bodied girls and those with a moderate and severe scoliosis displayed similar palindromic tendencies. METHODS: The center of pressure excursions of 21 able-bodied girls were compared to 14 girls with a moderate scoliosis and 14 girls with severe one. Each girl was asked to stand upright on a force platform for 64 s. A crisscross grid of nine areas was centered around the mean center of pressure position (G) to define three other zones to use the MATLAB built-in nucleotide sequence analysis function. These were the antero-posterior extremities A, the coronal extremities C and the tilted or the four corners of the crisscross grid, T. The center of pressure positions were associated to any of the 4 zones using the GATC acronym. FINDINGS: For all groups center of pressure pattern in decreasing order was A, G, T and C. Able-bodied girls favored the A zones. Girls with moderate scoliosis displaced their center of pressure mostly in the A zones with shifts in the T sections (P ≤ 0.001). Girls with severe scoliosis, additionally displaced their center of pressure in the C zones (P ≤ 0.001). INTERPRETATION: An ankle modality characterized able-bodied girl's standing balance. Girls with a moderate scoliosis privilege the palindromic zones in the antero-posterior extremities with excursions in the corners of the base of support, girls with severe scoliosis further relied on the medio-lateral zones, suggesting a wobbling standing balance.

Cognitive-motor dual task to reveal gait impairments in multiple sclerosis patients at an early stage: A systematic review.

BACKGROUND: Multiple sclerosis can cause locomotor and cognitive impairments even at lower levels of disability, which can impact daily life. The cognitive-motor dual task is commonly used to assess everyday locomotion. Thus, this study aimed to examine the effect of cognitive-motor dual tasks on gait parameters among patients with multiple sclerosis in the early disease stages and to determine whether dual tasks could be used as a clinical test to detect locomotion impairments. METHODS: A systematic search of five databases was conducted in May 2024. The population of interest was patients with multiple sclerosis with an Expanded Disability Status Scale score of 4 or less. The following outcome measures were examined: spatiotemporal and kinematic parameters. The Newcastle-Ottawa Scale was used to assess the quality of the studies. FINDINGS: Eleven studies including 270 patients with multiple sclerosis and 221 healthy controls. Three spatiotemporal parameters were modified both in patients with multiple sclerosis and healthy controls during dual-task performance: gait speed, stride length and the double support phase. No spatiotemporal parameter was affected during dual-task performance in patients with multiple sclerosis alone. INTERPRETATION: Dual-task performance could be useful for assessing gait impairments in patients with multiple sclerosis provided that assessments and protocols are standardized. Nevertheless, the spatiotemporal parameters did not allow discrimination between patients with multiple sclerosis at an early stage and healthy controls. Three-dimensional gait analysis during dual-task performance could be a useful approach for detecting early gait impairments in patients with multiple sclerosis, assessing their progression and adjusting rehabilitation programs.

Upper limb contribution during tandem gait in multiple sclerosis: An early marker of balance impairments.

Tandem gait is widely used during clinical exams to evaluate dynamic balance in chronic diseases, such as multiple sclerosis (MS). The early detection of balance impairments in MS is challenging to improve the understanding of patients' complaints. The objective was to propose two indexes to quantify the contributions and inefficiency of limb and trunk movements during tandem gait in early-stage MS patients. Fifteen patients with remitting-relapsed MS, with a median Expanded Disability Status Scale of 2.5 [0-4] were compared to 15 matched healthy participants. Three-dimensional motion analysis was performed during tandem gait to calculate spatiotemporal parameters, contribution and inefficiency indexes, based on the linear momentum of body segments. Compared to healthy participants, MS patients at the early stage of disease executed tandem gait with higher speed (p = 0.03) and increased step length (p = 0.03). The contribution indexes of upper limbs were significantly decreased during swing phase in MS patients. The inefficiency index for the upper limbs were around twice higher for MS patients compared to healthy participants. Since the additional movements concerned only light body segments and not contribute to the whole-body forward progression during tandem gait, they could reflected more both upper limb movements alterations and restoring movements to avoid loss of balance during tandem gait around swing phase in MS. These quantified indexes could be used as physical markers to quantify both the balance deterioration and the efficiency of rehabilitation program during the follow up of MS from the early stage of their disease.

Simplified stance limb kinetics patterns revealed during gait initiation in early stage of multiple sclerosis.

BACKGROUND: Although patients with an early stage of Multiple Sclerosis (MS) commonly complain about balance and gait impairments, their troubles remain misunderstood. The objective was to compare body kinematics and lower limb kinetics during gait initiation between patients with MS with an EDSS score ≤ 4 and healthy participants. METHODS: Sixteen patients with MS with a median EDSS score of 2.5 [0-4] and disease duration of 7.4 ± 4.2 years, as well as 16 healthy participants were included, and 3-D motion analysis was performed during gait initiation to calculate spatiotemporal, kinematic and kinetic parameters. FINDINGS: The center of pressure position at the beginning of the gait initiation was more anterior (p = 0.02) in patients with MS than healthy participants. The kinetic parameters of the stance limb were highly affected in patients with MS compared to healthy participants during gait initiation. The net muscular moments for each joint were significantly different during the anticipatory postural adjustment phase with smoother variations for patients with MS compared to healthy participants. INTERPRETATION: Early stage MS strongly affects the motor modulation of stance limb kinetics during the anticipatory postural adjustment of gait initiation, without alteration of the execution phase. The net muscular moments are sensitive in detecting unobservable balance impairments and can be used to assess disease progression at the early stage. These results suggest that early rehabilitation programs aimed at improving motor modulation and flexibility in gait initiation should be implemented.

A two-stage disto-proximal braking modality to interrupt gait initiation in healthy adults.

The purpose of this investigation was to determine the effect of unexpected gait termination in able-bodied participants during gait initiation on spatiotemporal and stance limb biomechanical parameters. Twenty-one healthy adults took part in this study and were divided into two groups based on the natural anterior or posterior incline of their trunk. Each participant performed 15 random trials of gait initiation: 10 trials with a Go signal and 5 with Go-&-Stop signals. Spatiotemporal parameters were assessed between the Go signal and the first heel contact. Ankle, knee, and hip joint moments were calculated in the sagittal plane. Free moment and impulse were also calculated for the stance limb. Spatiotemporal parameters were not influenced by the mean trunk inclination (p > 0.05), but participants with a forwardly-inclined trunk presented higher hip extension moments (p < 0.05). Unexpected stopping required smaller ankle and knee moments compared to the Go condition (p < 0.05). The hip extension moments appeared to be independent of gait initiation conditions (p > 0.05). The capacity of able-bodied people to interrupt their gait initiation relied on a two-stage disto-proximal braking modality involving explosive motor patterns at the ankle and hip joints. Such a pattern could be altered in vulnerable people, and further studies are needed to investigate this. This study determined a clinical method applicable as a functional protocol to assess and improve the postural control of people suffering from a lack of motor modulation during crucial transient tasks. Such tasks are essential in activities of daily living.

Corticomuscular Coherence and Motor Control Adaptations after Isometric Maximal Strength Training.

Strength training (ST) induces corticomuscular adaptations leading to enhanced strength. ST alters the agonist and antagonist muscle activations, which changes the motor control, i.e., force production stability and accuracy. This study evaluated the alteration of corticomuscular communication and motor control through the quantification of corticomuscular coherence (CMC) and absolute (AE) and variable error (VE) of the force production throughout a 3 week Maximal Strength Training (MST) intervention specifically designed to strengthen ankle plantarflexion (PF). Evaluation sessions with electroencephalography, electromyography, and torque recordings were conducted pre-training, 1 week after the training initiation, then post-training. Training effect was evaluated over the maximal voluntary isometric contractions (MVIC), the submaximal torque production, AE and VE, muscle activation, and CMC changes during submaximal contractions at 20% of the initial and daily MVIC. MVIC increased significantly throughout the training completion. For submaximal contractions, agonist muscle activation decreased over time only for the initial torque level while antagonist muscle activation, AE, and VE decreased over time for each torque level. CMC remained unaltered by the MST. Our results revealed that neurophysiological adaptations are noticeable as soon as 1 week post-training. However, CMC remained unaltered by MST, suggesting that central motor adaptations may take longer to be translated into CMC alteration.

Untreated adolescent idiopathic scoliotic girls display altered balance modalities during self-paced voluntary body sways compared to able-bodied girls.

INTRODUCTION: This study investigated self-paced voluntary oscillations of scoliotic and non-scoliotic girls. Temporal variables and frequency coherence were calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment to identify which variables best describe sway balance modalities in both groups. METHODS: Twenty-three girls with adolescent idiopathic moderate scoliosis (spinal curves to the right) formed the scoliotic group and 19 matched able-bodied girls formed the non-scoliotic group. Each girl performed self-paced voluntary medio-lateral and antero-posterior sways while standing on a force platform. Center of pressure displacements, out of plane deviation and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. RESULTS: In both sway conditions, the center of pressure excursion parameters were on average 28% higher for the scoliotic group. Factor analysis revealed that balance modalities were essentially based on frequency coherence pair interactions whereas temporal parameters play a secondary role. However, these balance modalities were altered in the scoliotic group. They relied essentially on 2 additional principal components and 3 additional variables reflecting a fine tuning of the control mechanism to maintain dynamic balance. INTERPRETATION: Scoliotic girls appear to be performing a wide ellipsoidal trajectory when performing whole body oscillations. Superfluous variables could be related to the difficulty in preserving balance during body sway tasks and could parasitize the scoliotic dynamic control balance modalities. Self-paced voluntary sways could be an appropriate complementary balance test for untreated scoliotic girls.

Standing posture and balance modalities in unilateral transfemoral and transtibial amputees.

INTRODUCTION: Lower limb amputation impairs postural performance that could be characterized by biomechanical parameters. This study is to investigate postural performance of persons with transfemoral and transtibial amputation compared to controls without amputation. METHODS: Eight transtibial, nine transfemoral and twelve able-bodied males participated in this study. Lower limb joints, pelvis and trunk angles were obtained from an optoelectronic motion analysis system to evaluate body posture parameters. The mean, range and speed of the center of pressure (CoP) in both antero-posterior and medio-lateral axes as well as the ellipse area covered by 90% of CoP and free moment were calculated using a single force-plate. RESULTS AND DISCUSSION: Differences in body posture were only noted between the non-amputee and the transtibial groups. Transtibial amputees leaned more forwardly their trunk by 3.5° compared to able-bodied (p = 0.028). The mean CoP position in transfemoral amputees was closer to the non-amputated side than transtibial amputees (p = 0.034) and as compared to the dominant side in non-amputees (p = 0.042). Factor analysis revealed three postural performance modalities. Non-amputees postural performance was characterized solely by body posture parameters. Transfemoral amputees exclusively favored a modality associated with standing balance parameters, whereas transtibial amputees exhibited a mixed modality comprising a combination of postural and balance parameters. CONCLUSION: These findings support that the level of amputation is characterized by postural performance modalities different from non-amputees. Clinicians could apply this knowledge as part of their routine rehabilitation program to enhance postural and standing balance assessments in unilateral transfemoral and transtibial amputees.

Less Than One Millimeter Under the Great Toe is Enough to Change Balance Ability in Elite Women Handball Players.

Team handball is a complex intermittent sport game, which requires several motor abilities and effective postural control. Objective evaluation of stabilometric variables may be interesting to assess and improve functional parameters by postural control management. The purpose of the study was to evaluate the effects of a small additional thickness placed under the great toe (TUGT) on the Centre of Pressure (CoP) parameters in elite women handball players. Fourteen elite women handball players voluntarily participated in this study. Two conditions were compared: TUGT 0 (control) and TUGT 0.8 mm; four variables were computed from the CoP displacements. A paired T-test was performed for each variable. This study concludes that a low focal additional thickness placed under both great toes has an effect on the CoP measures used to assess postural control during an unperturbed stance. These results suggest that a low TUGT could contribute to a change in balance ability, and may be of clinical interest. This brings new perspectives in the management of athletes to prevent injury risk and optimize performance.

Determination of optimal shoe fitting for children tennis players: Effects of inner-shoe volume and upper stiffness.

The purpose of this study was to determine the optimal inner-shoe volume for children tennis players. Sixteen participants, aged from 8 to 12 years old assessed comfort of 6 shoes, which were a combination of 3 lasts (thin, medium and wide) and 2 upper constructions (flexible and stiff), while a sock equipped with textile sensors was measuring the pressure applied on their foot. The thin last was based on the proportion of an adult last. The widest shoes produced the lowest pressure on the 1st and 5th metatarsal heads, the medial midfoot and the medial and lateral heel (p < 0.05), whilst they were perceived the most comfortable for the 3rd and 5th metatarsal heads, the 5th metatarsal base and the medial and lateral heel (p < 0.05). These outcomes indicated that footwear manufacturers should design wider shoes for children than for adults.

How can the stimulation of plantar cutaneous receptors improve postural control? Review and clinical commentary.

Postural control requires constant and subconscious postural sway to manage balance and achieve postural stability. These movements of regulation are based in particular on cutaneous plantar information. The foot constitutes a functional whole that participates in the mechanisms of postural control and regulation. It represents the direct interface between the body and the ground during quiet standing, and plantar cutaneous information contributes to postural control. Upright balance mechanically depends on the gravitational torque produced by the forces of gravity and reaction of the ground. In this context, the foot behaves like a sensory system for postural regulation whose objective is to maintain a state of stability within a changing and constraining environment. There is a relation between balance improvement and the facilitation of sensory feedback related to the activation of the plantar cutaneous mechanoreceptors. From a clinical point of view, the application of additional tactile cues may have therapeutic benefits in relation to fall prevention, or to improve specific types of chronic pain.

Frequency coherence analysis of postural balance in able-bodied and in non-treated adolescent idiopathic scoliotic girls.

BACKGROUND: This study test if the frequency coherence calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment calculated during standing balance are similar between scoliotic and non-scoliotic girls and if the coherence values within each frequency band are comparable for a given group of girls. METHODS: Twenty-nine girls with adolescent idiopathic scoliosis formed the scoliotic group and 22 able-bodied girls formed the non-scoliotic group. Each girl maintained a quiet upright stance on a force plate. Three trials were performed at a sampling frequency of 64 Hz for 64 s. Mean anterio-posterior, medio-lateral center of pressure positions and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. RESULTS: The magnitude of the medio-lateral center of pressure/free-moment coherence in the low and high frequency bands was significantly different between the groups. Within each group, the magnitude of the medio-lateral center of pressure/free-moment coherence was significantly higher than the other two coherence pairs at low frequencies (P < 0.001). Factor analysis revealed that able-bodied girls exhibited a mixed standing balance modality consisting of posture (center of pressure) and proprioceptive information (free-moment). Scoliotic girls adopted an adaptive modality mostly based on proprioception information to maintain their standing balance. INTERPRETATION: Scoliotic girls systematically depend on the free-moment to modulate their antero-posterior center of pressure displacements. These results suggest a postural reeducation program aimed at improving proprioception while repositioning the mean center of pressure by postural corrections.

[Associations working to combat HIV/AIDS]. / Des associations mobilisées contre le VIH/sida.

Numerous associations play an essential role in the fight against the AIDS epidemic. Today, they continue to support patients with the human immunodeficiency virus (HIV). They work to provide support, fight against exclusion and to ensure patients' rights are respected. Communication between patients and health professionals is essential for the construction of projects optimising patient care.