Lower Limb Antagonist Muscle Co-Activation and its Relationship with Gait Parameters in Cerebellar Ataxia

Mari, Silvia; Serrao, Mariano; Casali, Carlo; Conte, Carmela; Martino, Gabriele; Ranavolo, Alberto; Coppola, Gianluca; Draicchio, Francesco; Padua, Luca; Sandrini, Giorgio; Pierelli, Francesco

doi:10.1007/s12311-013-0533-4

Cited by 85 publications

(57 citation statements)

References 29 publications

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“…When the leading limb steps over an obstacle, the cocontraction of the TA and MG is greater in the stroke survivors compared with the healthy controls and also increased with increasing obstacle height (Figure 2C). The dorsiflexor (TA) strength is weakened after stroke, and the cocontraction of the antagonist (MG) might reduce the dorsiflexion range but increase the stability during the swing phase to ensure safe crossing (28). Also, the cocontraction of thigh muscles (BF and RF) is greater in the post-obstacle stance phase of the leading limb of the stroke survivors compared with the healthy controls, which is helpful to maintain balance by controlling the knee position during loading (29) (Figure 2B).…”

Section: Discussionmentioning

confidence: 99%

Alterations of Muscle Activation Pattern in Stroke Survivors during Obstacle Crossing

Chen

Mao

et al. 2017

Front. Neurol.

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ObjectiveThis study investigates changes in the neuromuscular activation pattern of the lower limb muscles in stroke survivors when crossing obstacles of three different heights.MethodsEight stroke survivors and eight age-, height-, and gender-matched healthy controls were recruited and instructed to cross over obstacles with heights of 10, 20, and 30% leg length. Surface electromyography (EMG) signals were recorded from the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (MG) of both limbs. Muscle activation signals were normalized to maximum voluntary contraction. Differences between groups and heights were compared using the root mean square of EMG, the cocontraction index of agonist and antagonist muscles, and power spectral analysis based on the mean power frequency (MPF). The correlations between the calculated variables and clinical scales such as Berg Balance Scale and Fugl-Meyer assessment (FMA) were also examined.ResultsDuring the leading limb swing phase, the activation levels of all four muscles were greater in the stroke group than the healthy controls (p < 0.05), and the TA showed increased activation level with increasing obstacle height in both groups (p < 0.05). Cocontraction between the TA and MG was higher in the stroke group during the swing phase of the leading limb and between the RF and BF during the stance phase (p < 0.05). Similarly, for the trailing limb, increased cocontractions between the two pairs of agonist and antagonist muscles were found during the stance phase in the stroke group (p < 0.05). During the crossing stride, the frequency analysis showed significantly smaller MPF values in all four lower limb muscles in the leading limb of stroke survivors compared with healthy controls (p < 0.05). Moreover, significant correlations were found between the FMA scores and the BF and TA activations in the leading limb during the swing phase (p < 0.05).ConclusionGreater activation levels of the lower limb muscles resulted in higher muscular demands for stroke survivors, which might lead to greater difficulty in maintaining balance. The increased cocontraction during obstacle crossing might be compensation for the affected stability and enable safe crossing for stroke survivors. The reduced MPF in the affected limb of the stroke group might be due to impairments in motor units or other complex neuromuscular alterations.

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Section: Discussionmentioning

confidence: 99%

Alterations of Muscle Activation Pattern in Stroke Survivors during Obstacle Crossing

Chen

Mao

et al. 2017

Front. Neurol.

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“…In two recent studies investigating the spatial and temporal profiles of EMG activity in individual muscles [133] as well as in paired antagonist muscles [138], a common pattern has been shown. Specifically, a marked widening of the EMG peaks and a high level of ankle and knee joint muscles co-contraction were observed during all four gait sub-phases.…”

Section: Gait/posture In Cerebellar Disorders (Carlo Casali and Mariamentioning

confidence: 99%

Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome

Bodranghien¹,

et al. 2015

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The cerebellum is involved in sensorimotor operations, cognitive tasks and affective processes. Here, we revisit the concept of the cerebellar syndrome in the light of recent advances in our understanding of cerebellar operations. The key symptoms and signs of cerebellar dysfunction, often grouped under the generic term of ataxia, are discussed. Vertigo, dizziness, and imbalance are associated with lesions of the vestibulo-cerebellar, vestibulo-spinal, or cerebellar ocular motor systems. The cerebellum plays a major role in the online to long-term control of eye movements (control of calibration, reduction of eye instability, maintenance of ocular alignment). Ocular instability, nystagmus, saccadic intrusions, impaired smooth pursuit, impaired vestibulo-ocular reflex (VOR), and ocular misalignment are at the core of oculomotor cerebellar deficits. As a motor speech disorder, ataxic dysarthria is highly suggestive of cerebellar pathology. Regarding motor control of limbs, hypotonia, a- or dysdiadochokinesia, dysmetria, grasping deficits and various tremor phenomenologies are observed in cerebellar disorders to varying degrees. There is clear evidence that the cerebellum participates in force perception and proprioceptive sense during active movements. Gait is staggering with a wide base, and tandem gait is very often impaired in cerebellar disorders. In terms of cognitive and affective operations, impairments are found in executive functions, visual-spatial processing, linguistic function, and affective regulation (Schmahmann’s syndrome). Nonmotor linguistic deficits including disruption of articulatory and graphomotor planning, language dynamics, verbal fluency, phonological, and semantic word retrieval, expressive and receptive syntax, and various aspects of reading and writing may be impaired after cerebellar damage. The cerebellum is organized into (a) a primary sensorimotor region in the anterior lobe and adjacent part of lobule VI, (b) a second sensorimotor region in lobule VIII, and (c) cognitive and limbic regions located in the posterior lobe (lobule VI, lobule VIIA which includes crus I and crus II, and lobule VIIB). The limbic cerebellum is mainly represented in the posterior vermis. The cortico-ponto-cerebellar and cerebello-thalamocortical loops establish close functional connections between the cerebellum and the supratentorial motor, paralimbic and association cortices, and cerebellar symptoms are associated with a disruption of these loops.

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“…Conversely, subjects with cerebellar atrophies are not only impaired in managing obstacles and adapting to novel environment, they develop ataxic gait in well-learned environments and on smooth surfaces (Mari et al, 2014), implicating cerebellar processing in controlling steady-state locomotion. This clinical profile also exists in subjects with cerebellar stroke; nevertheless, gait ataxia is generally mild, from which patients recover well (Bultmann et al, 2014).…”

Section: Cerebellar Gaitmentioning

confidence: 99%

Cerebellar contribution to feedforward control of locomotion

Pisotta

Molinari

2014

Front. Hum. Neurosci.

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The cerebellum is an important contributor to feedforward control mechanisms of the central nervous system, and sequencing—the process that allows spatial and temporal relationships between events to be recognized—has been implicated as the fundamental cerebellar mode of operation. By adopting such a mode and because cerebellar activity patterns are sensitive to a variety of sensorimotor-related tasks, the cerebellum is believed to support motor and cognitive functions that are encoded in the frontal and parietal lobes of the cerebral cortex. In this model, the cerebellum is hypothesized to make predictions about the consequences of a motor or cognitive command that originates from the cortex to prepare the entire system to cope with ongoing changes. In this framework, cerebellar predictive mechanisms for locomotion are addressed, focusing on sensorial and motoric sequencing. The hypothesis that sequence recognition is the mechanism by which the cerebellum functions in gait control is presented and discussed.

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Lower Limb Antagonist Muscle Co-Activation and its Relationship with Gait Parameters in Cerebellar Ataxia

Cited by 85 publications

References 29 publications

Alterations of Muscle Activation Pattern in Stroke Survivors during Obstacle Crossing

Alterations of Muscle Activation Pattern in Stroke Survivors during Obstacle Crossing

Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome

Cerebellar contribution to feedforward control of locomotion

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