Tendon palpation during agonist contraction and antagonist co-contraction to assess wrist flexor and extensor muscle function

Bertelli, Jayme Augusto

doi:10.1016/j.main.2015.01.006

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…Some patients may have difficulties in performing fast movements, so it should be considered to perform motor execution according to the ability of the patient; however, it has been shown that stroke patients can perform relatively fast movements, and that these can be detected from the EEG (Jochumsen et al, 2015a ). For the electrical stimulation, the optimal stimulation site could be determined by EMG recordings; this could have given a more precise estimate of the muscle activation; however, it has been shown previously that manual palpation is reliable (Bertelli, 2015 ). Lastly, it should be noted that the number of subjects in this study was limited, and that only healthy subjects participated.…”

Section: Discussionmentioning

confidence: 99%

Pairing Voluntary Movement and Muscle-Located Electrical Stimulation Increases Cortical Excitability

Jochumsen

Niazi

Signal

et al. 2016

Front. Hum. Neurosci.

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Learning new motor skills has been correlated with increased cortical excitability. In this study, different location of electrical stimulation (ES), nerve, or muscle, was paired with voluntary movement to investigate if ES paired with voluntary movement (a) would increase the excitability of cortical projections to tibialis anterior and (b) if stimulation location mattered. Cortical excitability changes were quantified using motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) at varying intensities during four conditions. Twelve healthy subjects performed 50 dorsiflexions at the ankle during nerve or muscle ES at motor threshold (MTh). ES alone was delivered 50 times and the movement was performed 50 times. A significant increase in the excitability from pre- to post-intervention (P = 0.0061) and pre- to 30 min post-intervention (P = 0.017) measurements was observed when voluntary movement was paired with muscle ES located at tibialis anterior. An increase of 50 ± 57 and 28 ± 54% in the maximum MEPs was obtained for voluntary movement paired with muscle-located and nerve-located ES, respectively. The maximum MEPs for voluntary movement alone and muscle-located ES alone were −5 ± 28 and 2 ± 42%, respectively. Pairing voluntary movement with muscle-located ES increases excitability of corticospinal projections of tibialis anterior in healthy participants. This finding suggests that active participation during muscle-located ES protocols increases cortical excitability to a greater extent than stimulation alone. The next stage of this research is to investigate the effect in people with stroke. The results may have implications for motor recovery in patients with motor impairments following neurological injury.

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Section: Discussionmentioning

confidence: 99%

Pairing Voluntary Movement and Muscle-Located Electrical Stimulation Increases Cortical Excitability

Jochumsen

Niazi

Signal

et al. 2016

Front. Hum. Neurosci.

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“…The functions of the wrist flexor and extensor, which share their functions with the motions of the fingers, are partially specialized based on the fact that the physiological parameters (e.g., CSA, fiber length, etc.) of the muscles vary across flexors and extensors (Liu et al, 2014; Bertelli, 2015; Van Beek et al, in press). For human hands, individual fingers can be considered as separate but interdependent force actuators (Fahrer, 1981; Li et al, 2002; Lieu, 2008) for finger flexion and extension.…”

Section: Introductionmentioning

confidence: 99%

Multi-Finger Interaction and Synergies in Finger Flexion and Extension Force Production

Park

2017

Front. Hum. Neurosci.

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The aim of this study was to discover finger interaction indices during single-finger ramp tasks and multi-finger coordination during a steady state force production in two directions, flexion, and extension. Furthermore, the indices of anticipatory adjustment of elemental variables (i.e., finger forces) prior to a quick pulse force production were quantified. It is currently unknown whether the organization and anticipatory modulation of stability properties are affected by force directions and strengths of in multi-finger actions. We expected to observe a smaller finger independency and larger indices of multi-finger coordination during extension than during flexion due to both neural and peripheral differences between the finger flexion and extension actions. We also examined the indices of the anticipatory adjustment between different force direction conditions. The anticipatory adjustment could be a neural process, which may be affected by the properties of the muscles and by the direction of the motions. The maximal voluntary contraction (MVC) force was larger for flexion than for extension, which confirmed the fact that the strength of finger flexor muscles (e.g., flexor digitorum profundus) was larger than that of finger extensor (e.g., extensor digitorum). The analysis within the uncontrolled manifold (UCM) hypothesis was used to quantify the motor synergy of elemental variables by decomposing two sources of variances across repetitive trials, which identifies the variances in the uncontrolled manifold (VUCM) and that are orthogonal to the UCM (VORT). The presence of motor synergy and its strength were quantified by the relative amount of VUCM and VORT. The strength of motor synergies at the steady state was larger in the extension condition, which suggests that the stability property (i.e., multi-finger synergies) may be a direction specific quantity. However, the results for the existence of anticipatory adjustment; however, no difference between the directional conditions suggests that feed-forward synergy adjustment (changes in the stability property) may be at least independent of the magnitude of the task-specific apparent performance variables and its direction (e.g., flexion and extension forces).

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“…The more strongly the fingers flex, the more strongly the ECRB co-contracts. 3 This synergistic action of the ECRB with finger flexors possibly favored functional recovery. This concept of synergistic co-contraction is totally different from the established axiom that wrist extension promotes finger flexion.…”

Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 98%

“…Unfortunately, the ECRB might be paralyzed and not available for transfer in a great number of patients with tetraplegia. Our clinical method for testing the ECRB and ECRL by tendon palpation 3 was reliable because of the clinical recovery of finger flexion and preservation of wrist extension after harvesting of the nerve to the ECRB. After harvesting of the radial nerve branch to the ECRB, in case of failure of the nerve transfer, the ECRL would not be suitable as a donor to tendon transfer for finger flexion.…”

Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 99%

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Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

SPI

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OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale. RESULTS Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed. CONCLUSIONS In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.

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Tendon palpation during agonist contraction and antagonist co-contraction to assess wrist flexor and extensor muscle function

Cited by 11 publications

References 23 publications

Pairing Voluntary Movement and Muscle-Located Electrical Stimulation Increases Cortical Excitability

Pairing Voluntary Movement and Muscle-Located Electrical Stimulation Increases Cortical Excitability

Multi-Finger Interaction and Synergies in Finger Flexion and Extension Force Production

Nerve transfers for restoration of finger flexion in patients with tetraplegia

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