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Background Hallux valgus (HV) contributes to deficits in static balance and increased fall risk in older adults. Very limited research has examined dynamic balance deficits in walking in this population. These individuals generally walk slowly, as balance challenge is lesser at slow speeds. Research question How does the dynamic balance of older adults with HV differ from healthy controls at controlled slow and fast walking speeds? Methods Nineteen older adults with HV and 13 healthy controls completed 5 continuous walking trials at 1.0 and 1.3 m·s-1 as whole body marker position and ground reaction force data were captured. Dynamic balance was evaluated using whole body center of mass (COM) and center of pressure (COP) inclination angles (IA) and duration of double support. Results There were no differences in measures of dynamic balance between older adults with and without HV at slow and fast speeds. At the faster speed, the peak sagittal plane COM-COP IA increased and the double support duration decreased, while the peak frontal plane COM-COP IA were not affected. Significance Older adults with HV do not exhibit deficits in dynamic balance during continuous walking at comfortable speeds when compared to healthy older adults.

Reduced stability while standing typically decreases the soleus muscle Hoffmann (H-) reflex amplitude, purportedly to prevent the Ia afferent signal from excessively activating spinal motor neurons during the unstable stance. H-reflex measures, however, by excluding the spindle do not reflect the actual effect of the Ia pathway (i.e. the combined effects of spindle sensitivity and Ia presynaptic inhibition) on motor neuron activation, as tendon tap reflex measures can. But the effect of stance stability on soleus muscle tendon tap reflex amplitude is largely unknown. This study examined 30 young adults (mean(s), 21(2) years) as they stood in a wide stable stance position and an unstable tandem stance with a reduced base of support. Standing body sway, the amplitude of the soleus muscle tendon tap reflex, background EMG and tap force were measured in both stances. A repeated measured design t-test was calculated for each variable. Most subjects (69%) decreased tendon tap reflex amplitude when in the tandem stance position (mean decrease 11.6%), compared to the wide stance (wide stance 0.248(0.124) mV, tandem stance 0.219(0.119) mV, p 0.05, Cohen's d = 0.24 small) with no significant differences in background soleus and tibialis anterior EMG, and tap force across the stances. There was no relationship between the modulation of the tendon tap reflex amplitude across the stances and standing body sway in the tandem stance. Results support the idea that for most subjects examined, during a less stable stance the Ia excitation of motor neurons is decreased, likely by presynaptic inhibition, thereby avoiding potential instability in the reflex loop or saturating the reflex pathway and possibly interfering with descending control of the involved spinal motor neurons.

Objective Investigate the effects of shoulder elevation on repositioning errors in upright and supine body orientations, and examine these effects on anterior and posterior deltoid muscle activation. We hypothesized decreased errors, and altered anterior and posterior deltoid activation with increasing elevation, in both orientations. Design Crossover trial. Setting University laboratory. Participants Thirty-five college-aged participants. Intervention Subjects attempted to replicate target positions of various elevation angles in upright and supine body orientations. Also, anterior and posterior deltoid activation was recorded in each shoulder position and body orientation. Main outcome measures Vector and variable repositioning errors, anterior and posterior deltoid percentage of maximal contraction. Results Vector error was greater in supine compared to upright at 90° and 110°, but not at 70°. Variable error was larger in supine than upright, but was unaffected by elevation. Anterior deltoid activation increased with elevation in the upright posture only. Posterior deltoid activation increased with elevation across postures. Conclusions Muscle activation, external torque, and cutaneous sensations may combine to provide afferent feedback, and be used with centrally-generated signals to interpret the state of the limb during movement. Clinicians may prescribe open kinetic chain exercises in the upright posture with the shoulder elevated approximately 90–100°.

This study was designed to extend to humans the findings of classical studies on anesthetized cats, which have examined the discharge of spinal motoneurons in response to high-frequency stimulus trains delivered to Ia afferents. Experiments were conducted on the monosynaptic pathway in the flexor carpi radialis (FCR) and soleus muscles. Subjects maintained a rhythmic discharge of a single motor unit (SMU) in either the FCR or soleus while homonymous Ia afferents were stimulated with either a single- or multipulse train. An n@IPI stimulus train had n pulses (n = 2–4) and an interpulse interval (IPI) of 1–8 ms. For each condition and motor unit, surface electromyographic (EMG) activity was averaged, and peristimulus–time histograms (PSTHs) were constructed for the SMU. The magnitude of the EMG was high for IPI = 1 ms, low for IPI = 2–3 ms, and high for IPI = 4–8 ms. SMU responses showed a similar pattern, which indicated that the increased EMG response was due to the presence of multiple peaks in a PSTH. The key results indicate that: (1) a short, high-frequency stimulus train enhances the discharge probability of a motoneuron above that observed with a single pulse; and (2) the increased motoneuron responses are significantly greater for the FCR than for the soleus muscle. © 2008 Wiley Periodicals, Inc. Muscle Nerve 38: 1604–1615, 2008

Context Joint position sense (JPS) is a key neuromuscular factor for developing and maintaining control of muscles around a joint. It is important when performing specialized tasks, especially at the shoulder. No researchers have studied how Kinesio Tape (KT) application affects JPS. Objective To investigate the effects of KT application and no tape on shoulder JPS at increasing shoulder elevations in athletes. Design Cross-sectional study. Setting University laboratory. Patients or Other Participants A total of 27 healthy athletes who did not participate in overhead sports (age = 20.44 ± 1.05 years, height = 175.02 ± 11.67 cm, mass = 70.74 ± 9.65 kg) with no previous pathologic shoulder conditions volunteered for the study. All participants were from 1 university. Intervention(s) Shoulder JPS was assessed at increasing elevations with and without KT application. Participants attempted to actively replicate 3 target positions with and without the KT and without visual guidance. Main Outcome Measure(s) We examined absolute and variable repositioning errors at increasing shoulder-elevation levels with and without KT application. Results Data revealed an interaction between tape and position for absolute error (F2,52 = 4.07, P = .02); simple effects revealed an increase in error, with KT demonstrating a 2.65° increase in error at 90° of elevation compared with no tape (t26 = 2.65, P = .01). The effect size was medium (ω2 = .135). Variable error showed no interaction of tape and position (F2,52 = .709, P = .50). Further analysis of simple effects was not needed. However, we still calculated the effect size and observed small effect sizes for tape (ω2 = .002), position (ω2 = .072), and tape by position (ω2 = .027). Conclusions At 90° of elevation, shoulder JPS was impaired by the application of KT.

Literature concerning the theoretical role of spinal reflex circuits and their sensorimotor signals in proprioceptive neuromuscular facilitation (PNF) muscle stretching techniques was examined. Reviewed data do not support the assertion commonly made in PNF literature that contraction of a stretched muscle prior to further stretch, or contraction of opposing muscles during muscle stretch, produces relaxation of the stretched muscle. Further, following contraction of a stretched muscle, inhibition of the stretch reflex response lasts only 1 s. Studies examined suggested that decreases in the response amplitude of the Hoffmann and muscle stretch reflexes following a contraction of a stretched muscle are not due to the activation of Golgi tendon organs, as commonly purported, but instead may be due to presynaptic inhibition of the muscle spindle sensory signal. The current view on the complex manner by which the spinal cord processes proprioceptive signals was discussed. The ability of acute PNF stretching procedures to often produce a joint range of motion greater than that observed with static stretching must be explained by mechanisms other than the spinal processing of proprioceptive information. Studies reviewed indicate that changes in the ability to tolerate stretch and/or the viscoelastic properties of the stretched muscle, induced by PNF procedures, are possible mechanisms.

Introductory textbooks commonly state that Golgi tendon organs (GTOs) are responsible for a reflex response that inhibits a muscle producing dangerously high tension (autogenic inhibition). Review of the relevant data from animal studies demonstrates that there is wide variability in the magnitude of, and even the presence of, GTO autogenic effects among locomotor hindlimb muscles, and that data on GTO effects under conditions of voluntary maximal muscle activation are lacking. A single available study on GTO function in humans, during a moderate contraction, surprisingly shows a reduction in autogenic inhibition during muscle-force production. Further, it is not possible to find experimental evidence supporting the idea that strength training may produce a decrease in GTO mediated autogenic inhibition, allowing greater muscle activation levels and hence greater force production.

Soleus Hoffmann-reflex (H-reflex) modulation during walking was examined in 7 young and 13 elderly adults. H-reflex size was measured in 16 equal time divisions (phases) of the step cycle. In both the elderly and the young groups, the H reflex was minimal at the time of heel contact, rose to a maximum shortly after midstance, decreased rapidly as toe-off neared, then was minimal during swing. There was a significant interaction between age group and step cycle phase (p < .05). During midstance of walking, the elderly participants had a smaller H-reflex size during two of the 16 time phases of the step cycle (p < .05), despite no significant difference in H-reflex size between the age groups while standing. The smaller H-reflex size during the stance phase of walking may reflect changes in central reflex mechanisms that may impact stretch reflex contribution to ankle extensor neural drive and ankle stiffness in elderly persons during walking.

To assess the cellular and molecular substrates for cholinergic axon growth in the adult central nervous system (CNS), we implanted grafts of control and nerve growth factor (NGF)-producing genetically modified fibroblasts within the striatum of rats. Sprouting cholinergic axonal processes that grew into grafts of NGF-producing fibroblasts were fasciculated and followed the surface of astrocytic processes for long distances within the grafts. The close and long distance anatomical relationship between the sprouted axons and the astrocytes supported previous ultrastructural evidence that astrocytes may serve as a cellular substrate for sprouting cholinergic axons in vivo. The sprouted axon processes were associated with the expression of nerve growth factor-inducible large external (NILE) glycoprotein on their surfaces. NILE expression was not seen in control grafts where there was an absence of cholinergic ingrowth. NILE has been demonstrated to play a role in axon fasciculation in a number of other neural systems. The astrocytic processes in both control and NGF-producing fibroblast grafts expressed neural cell adhesion molecule (NCAM), suggesting that NCAM-mediated adhesion may be responsible for the close relationship between the axons and astrocytes within the grafts. NGF-induced heterotypic interactions between neuronal NILE and astroglial NCAM may also be required for adult cholinergic axonal sprouting. © 1996 Wiley-Liss, Inc.

Chromaffin cells exposed to basic fibroblast growth factor (bFGF) in vitro express characteristics of sympathetic neurons, extend neurites, and become dependent on nerve growth factor (NGF) for survival. We explored whether the growth factor responsiveness of chromaffin cells could be exploited to enhance the transdifferentiation, neurite outgrowth and functional efficacy of chromaffin cells implanted into rats with unilateral 6-hydroxydopamine lesions. Cografts of neonatal chromaffin cells and fibroblasts genetically modified to produce bFGF were placed into the dopamine-depleted striatum of adult rats. Either control-transfected or NGF-producing fibroblasts were then transplanted 1 mm distal to the cograft. Chromaffin cells transdifferentiated under the influence of bFGF, as indicated by the growth of neurites and the expression of neuron-specific proteins. Distal grafts of NGF-producing fibroblasts successfully induced chromaffin neurites to traverse through the host parenchyma to the NGF source. In the absence of NGF fibroblast grafts, neither neurite extension nor good, long-term survival of the chromaffin-derived neurons was observed. Assessments of apomorphine-induced rotational behavior 2- and 4-weeks postgrafting revealed no behavioral improvements in any of the groups. These results indicate that localized sources of growth factors are effective in inducing the transdifferentiation of grafted chromaffin cells as well as the extension of chromaffin-derived neurites into the host parenchyma. Such chromaffin cell-derived neurons are, however, functionally ineffective in this rat model of Parkinson's disease. Whether the lack of behavioral improvement reflected the tropic growth of neurites to an inappropriate striatal region or the noradrenergic nature of the chromaffin cell-derived neurons remains to be clarified. Nonetheless, these results caution that promoting transdifferentiation and neurite extension from engrafted chromaffin cells may not be sufficient to achieve desired functional effects of such grafts.

Exercise science and human anatomy and physiology textbooks commonly report that type IIB muscle fibers have the largest cross-sectional area of the three fiber types. These descriptions of muscle fiber sizes do not match with the research literature examining muscle fibers in young adult nontrained humans. For men, most commonly type IIA fibers were significantly larger than other fiber types (six out of 10 cases across six different muscles). For women, either type I, or both I and IIA muscle fibers were usually significantly the largest (five out of six cases across four different muscles). In none of these reports were type IIB fibers significantly larger than both other fiber types. In 27 studies that did not include statistical comparisons of mean fiber sizes across fiber types, in no cases were type IIB or fast glycolytic fibers larger than both type I and IIA, or slow oxidative and fast oxidative glycolytic fibers. The likely reason for mistakes in textbook descriptions of human muscle fiber sizes is that animal data were presented without being labeled as such, and without any warning that there are interspecies differences in muscle fiber properties. Correct knowledge of muscle fiber sizes may facilitate interpreting training and aging adaptations.

Although adrenal medullary chromaffin cells have been used extensively for intracerebral grafting, their survival has generally been poor. Improved survival of the implanted cells has been achieved by exposing the chromaffin cells to NGF in vivo. Culture studies have shown, however, that chromaffin cells are converted into sympathetic neurons when NGF is included in the medium. The degree to which such a transdifferentiation may occur in vivo has not been determined. We assessed the effects of cografting chromaffin cells with primary fibroblasts genetically engineered to express NGF. Chromaffin cells from 10 d old rats were implanted with NGF-producing or beta- galactosidase-producing primary fibroblasts (control fibroblasts) into the striatum of 6-hydroxydopamine treated adult rats of the same strain. Eight weeks postgrafting, chromaffin cells cografted with NGF- producing fibroblasts displayed many of the features of mature sympathetic neurons such as large somata, long processes, transmitter vesicles similar to those found in neurons, and positive immunolabeling for the neuronal markers neurofilament, MAP2 and SCG10. Chromaffin- derived neuron number was also significantly enhanced in the presence of NGF-producing fibroblasts. While control fibroblasts were also found to increase chromaffin cell number above that of chromaffin cells grafted alone, the control fibroblasts did not induce neuronal transdifferentiation. These results demonstrate that chromaffin cells cografted with NGF-producing fibroblasts undergo transdifferentiation in vivo and express many characteristics of mature sympathetic neurons. The consequences of this transdifferentiation on the long term survival and function of the transplanted cells in vivo remain to be clarified.

Publisher Summary This chapter discusses the use of genetically modified cells to deliver neurotrophic factors and neurotransmitters to the brain. The strategy of using living cells as vehicles for delivering compounds to the central nervous system (CNS) has been pursued with great interest since the demonstrations in 1979 that fetal substantia nigra neurons grafted into the rat brain could functionally replace the neurotransmitter dopamine. This chapter describes some of the techniques involved in creating, characterizing, and using genetically modified cells as a method for delivering compounds to the CNS. Two representative model systems illustrate some of the techniques used to assess the in vivo functioning of cells engineered to produce either a neurotrophic factor (NGF) or neurotransmitters (acetylcholine, dopamine). Although this strategy may be pursued with a variety of cell types, the focus in a study described in the chapter was on the use of primary cells (fibroblasts), rather than established cell lines, for genetic modification because the power of the technique can be fully realized only with a cell type that will survive noninvasively for prolonged periods in the CNS.