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This study aimed to identify the functional contribution of reflexes to human motor control during posture maintenance. Continuous random force disturbances were applied at the hand while the subjects were instructed to minimize the deviation resulting from the force disturbances. The results were analyzed in the frequency domain with frequency response functions (FRFs). Two FRFs were evaluated: 1) the mechanical admittance and 2) the reflexive impedance, expressing the dynamic relation between position and muscle activation (assessed via electromyography, EMG). The reflexive impedance is a direct measure of the proprioceptive reflexes. To record all relevant dynamical characteristics of the arm, wide bandwidth signals were used as force disturbance. Distributing the power of the signal over fewer frequencies within the bandwidth improved the signal-to-noise-ratio SNR of the EMG recordings, facilitating reliable estimation of the reflexive impedance. The coherence indicated that the relation between force disturbance and EMG is linear under the given conditions and improved with the SNR. The method of designing disturbance signals and the estimation of the reflexive impedance are useful for studies aiming to quantify proprioceptive reflexes and to investigate its functionality. Index Terms--Arm admittance, electromyography (EMG), identification, proprioceptive reflexes, reflexive impedance.

This study aimed to analyse the dynamic properties of the muscle spindle feedback system of shoulder muscles during a posture task. External continuous force disturbances were applied at the hand while subjects had to minimize their hand displacements. The results were analysed using two frequency response functions (FRFs) from which the model parameters were derived, being 1) the mechanical admittance and 2) the reflexive impedance. These FRFs were analysed by a neuromusculoskeletal model that implicitly separates the reflexive feedback properties (position, velocity and acceleration feedback gains) from intrinsic muscle visco-elasticity. The results show substantial changes in estimated reflex gains under conditions of variable bandwidth of the applied force disturbance or variable degrees of external damping. Position and velocity feedback gains were relatively larger when the force disturbance contained only low frequencies. With increasing damping of the environment, acceleration feedback gain decreased, velocity feedback gain remained almost constant and position feedback gain increased. It is concluded that under the aforementioned circumstances, the reflex system increases its gains to maximize the mechanical resistance to external force disturbances while preserving sufficient stability. Index Terms--Arm admittance, electromyography, identification, proprioceptive reflexes, reflexive impedance.

Abstract Background Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions. Methods Ramp-and-Hold ankle dorsiflexion rotations of various durations were imposed using a manipulator. A one second rotation over the Range of Motion similar to the Ashworth condition was included. Tissue stiffness and viscosity and reflexive torque were estimated using a nonlinear model and compared to the Ashworth Score of nineteen stroke patients and seven controls. Results Ankle viscosity moderately increased, stiffness was indifferent and reflexive torque decreased with movement duration. Compared to controls, patients with an Ashworth Score of 1 and 2+ were significantly stiffer and had higher viscosity and patients with an Ashworth Score of 2+ showed higher reflexive torque. For the one second movement, stiffness correlated to Ashworth Score (r2 = 0.51, F = 32.7, p < 0.001) with minor uncorrelated reflexive torque. Reflexive torque correlated to Ashworth Score at shorter movement durations (r2 = 0.25, F = 11, p = 0.002). Conclusion Stroke patients were distinguished from controls by tissue stiffness and viscosity and to a lesser extent by reflexive torque from the soleus muscle. These parameters were also sensitive to discriminate patients, clinically graded by the Ashworth Score. Movement duration affected viscosity and reflexive torque which are clinically relevant parameters. Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.

Abstract Background Instead of hyper-reflexia as sole paradigm, post-stroke movement disorders are currently considered the result of a complex interplay between neuronal and muscular properties, modified by level of activity. We used a closed loop system identification technique to quantify individual contributors to wrist joint stiffness during an active posture task. Methods Continuous random torque perturbations applied to the wrist joint by a haptic manipulator had to be resisted maximally. Reflex provoking conditions were applied i.e. additional viscous loads and reduced perturbation signal bandwidth. Linear system identification and neuromuscular modeling were used to separate joint stiffness into the intrinsic resistance of the muscles including co-contraction and the reflex mediated contribution. Results Compared to an age and sex matched control group, patients showed an overall 50% drop in intrinsic elasticity while their reflexive contribution did not respond to provoking conditions. Patients showed an increased mechanical stability compared to control subjects. Conclusion Post stroke, we found active posture tasking to be dominated by: 1) muscle weakness and 2) lack of reflex adaptation. This adds to existing doubts on reflex blocking therapy as the sole paradigm to improve active task performance and draws attention to muscle strength and power recovery and the role of the inability to modulate reflexes in post stroke movement disorders.

Abstract Background Main claims of the literature are that functional recovery of the paretic upper limb is mainly defined within the first month post stroke and that rehabilitation services should preferably be applied intensively and in a task-oriented way within this particular time window. EXplaining PLastICITy after stroke (acronym EXPLICIT-stroke) aims to explore the underlying mechanisms of post stroke upper limb recovery. Two randomized single blinded trials form the core of the programme, investigating the effects of early modified Constraint-Induced Movement Therapy (modified CIMT) and EMG-triggered Neuro-Muscular Stimulation (EMG-NMS) in patients with respectively a favourable or poor probability for recovery of dexterity. Methods/design 180 participants suffering from an acute, first-ever ischemic stroke will be recruited. Functional prognosis at the end of the first week post stroke is used to stratify patient into a poor prognosis group for upper limb recovery (N = 120, A2 project) and a group with a favourable prognosis (N = 60, A1 project). Both groups will be randomized to an experimental arm receiving respectively modified CIMT (favourable prognosis) or EMG-NMS (poor prognosis) for 3 weeks or to a control arm receiving usual care. Primary outcome variable will be the Action Research Arm Test (ARAT), assessed at 1,2,3,4,5, 8, 12 and 26 weeks post stroke. To study the impact of modified CIMT or EMG-NMS on stroke recovery mechanisms i.e. neuroplasticity, compensatory movements and upper limb neuromechanics, 60 patients randomly selected from projects A1 and A2 will undergo TMS, kinematical and haptic robotic measurements within a repeated measurement design. Additionally, 30 patients from the A1 project will undergo fMRI at baseline, 5 and 26 weeks post stroke. Conclusion EXPLICIT stroke is a 5 year translational research programme which main aim is to investigate the effects of early applied intensive intervention for regaining dexterity and to explore the underlying mechanisms that are involved in regaining upper limb function after stroke. EXPLICIT-stroke will provide an answer to the key question whether therapy induced improvements are due to either a reduction of basic motor impairment by neural repair i.e. restitution of function and/or the use of behavioural compensation strategies i.e. substitution of function. EXPLICIT is registered at the Netherlands Trial Register (NTR, http://www.trialregister.nl., TC 1424)

Linear system identification methods combined with neuromechanical modeling enable the quantification of reflex gains from recorded joint angular perturbation, torque, and/or electromyography (EMG). However, the stretch reflex response as recorded by EMG consists of multiple consecutive activation volleys (M1 and M2 responses) separated by a period of reduced activity and is nonlinearly related to joint perturbation. The goal of this study is to assess to what extent linear assumptions hold when quantifying these reflexive responses. Series of ramp-and-hold angular perturbations with fixed velocity but different ramp durations (and, therefore, different amplitudes) were applied to the wrist joint of seven healthy volunteers. Evoked EMG responses were compared to the reflex response estimated from a common linear reflex model relating EMG to perturbation velocity. Model fits described the measured EMG responses best when the perturbation and M1 response durations were equivalent. With increasing perturbation duration, i.e., amplitude, EMG response increased but reflex gain decreased due to the inert period after M1, which is believed to be related to alignment of the refractory period of the motoneurons. For angular joint perturbations exceeding the M1 duration (coinciding with 2^\circ of wrist joint rotation in this study), reflex gain variation may be largely explained from a shortcoming of the linear model in describing the nonlinear reflex response, and in particular the period of low reflexive activity after M1. [ABSTRACT FROM PUBLISHER]

Background: Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions. Methods: Ramp-and-Hold ankle dorsiflexion rotations of various durations were imposed using a manipulator. A one second rotation over the Range of Motion similar to the Ashworth condition was included. Tissue stiffness and viscosity and reflexive torque were estimated using a nonlinear model and compared to the Ashworth Score of nineteen stroke patients and seven controls. Results: Ankle viscosity moderately increased, stiffness was indifferent and reflexive torque decreased with movement duration. Compared to controls, patients with an Ashworth Score of 1 and 2+ were significantly stiffer and had higher viscosity and patients with an Ashworth Score of 2+ showed higher reflexive torque. For the one second movement, stiffness correlated to Ashworth Score (r² = 0.51, F = 32.7, p < 0.001) with minor uncorrelated reflexive torque. Reflexive torque correlated to Ashworth Score at shorter movement durations (r² = 0.25, F = 11, p = 0.002). Conclusion: Stroke patients were distinguished from controls by tissue stiffness and viscosity and to a lesser extent by reflexive torque from the soleus muscle. These parameters were also sensitive to discriminate patients, clinically graded by the Ashworth Score. Movement duration affected viscosity and reflexive torque which are clinically relevant parameters. Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions. [ABSTRACT FROM AUTHOR]