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8. Reduced oxygen desaturation in the vastus lateralis of chronic stroke survivors during graded muscle contractions.

Author

Hyngstrom, Allison S., Nguyen, Jennifer N., Murphy, Spencer A., Raab, Stephanie C., Schmit, Brian D., Gutterman, David D., and Durand, Matthew J.

Subjects
QUADRICEPS muscle physiology, KNEE physiology, OXYGEN saturation, STATISTICAL power analysis, T-test (Statistics), DATA analysis, STATISTICAL significance, RESEARCH funding, HEMIPLEGIA, MANN Whitney U Test, DESCRIPTIVE statistics, CHRONIC diseases, LONGITUDINAL method, INFRARED spectroscopy, ANALYSIS of variance, STATISTICS, STROKE, STROKE patients, EXERCISE tests, DATA analysis software, MUSCLE contraction, PSYCHOSOCIAL factors, DISEASE complications
Abstract

Few studies have examined changes in skeletal muscle physiology post-stroke. This study examined changes in tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscle of stroke survivors and age-matched control participants during maximal and submaximal isometric contractions of the knee extensor muscles. We hypothesized that tissue oxygen desaturation (ΔStO2) during knee extensor muscle contractions would be less in the VL in the paretic vs. the non-paretic and control legs. Ten chronic stroke survivors (>6 months post-stroke) with lower extremity muscle weakness and 10 age-matched controls completed this prospective cohort study. Maximum voluntary contractions (MVCs) of the knee extensor muscles were assessed with a Biodex dynamometer and StO2 of the VL was measured using near-infrared spectroscopy. In the paretic leg of the stroke survivors little change in StO2 of the VL was observed during an MVC (ΔStO2 = -1.7 ± 1.8%) compared to the non-paretic (ΔStO2 = -5.1 ± 6.1%; p < 0.05) and control legs (ΔStO2 = -14.4 ± 8.8%; p < 0.05 vs. paretic and non-paretic leg). These differences remained when normalizing for strength differences between the legs. Compared to controls, both the paretic and non-paretic VL showed pronounced reductions in ΔStO2 during ramp and hold contractions equal to 20%, 40%, or 60% of the MVC (p < 0.05 vs. controls at all load levels). These results indicate that oxygen desaturation in response to isometric muscle contractions is impaired in both the paretic and non-paretic leg muscle of stroke survivors compared to age-matched controls, and these differences are independent of differences in muscle strength. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Noninvasive estimation of skeletal muscle oxygen consumption rate and microvascular reactivity in chronic stroke survivors using near-infrared spectroscopy.

Author

Hyngstrom, Allison S., Nguyen, Jennifer N., Gutterman, David D., Schmit, Brian D., Klevenow, Emilie A., and Durand, Matthew J.

Subjects
NEAR infrared spectroscopy, STROKE patients, OXYGEN consumption, SKELETAL muscle, TIBIALIS anterior
Abstract

Understanding post-stroke changes in skeletal muscle oxidative metabolism and microvascular reactivity could help create therapeutic targets that optimize rehabilitative interventions. Due to disuse atrophy, we hypothesized that basal muscle oxygen consumption rate and microvascular endothelial function would be impaired in the tibialis anterior (TA) muscle of the affected leg of chronic stroke survivors compared with the nonaffected leg and versus matched controls. Fifteen chronic stroke survivors (10 females) and 15 matched controls (9 females) completed this study. A near-infrared spectroscopy oximeter measured tissue oxygen saturation (StO2) of the TA in both legs of stroke survivors and the dominant leg of controls. A cuff was placed around the thigh and inflated to 225 mmHg for 5 min while StO2 was continuously measured. The rate of change in StO2 was calculated during cuff occlusion and immediately post-cuff release. The rate of oxygen desaturation was similar between the legs of the stroke survivors (paretic –0.12 ± 0.04%·s−1 vs. nonparetic –0.16 ± 011%·s−1; P = 0.49), but the paretic leg had a reduced desaturation rate versus controls (–0.25 ± 0.18%·s−1; P = 0.007 vs. paretic leg). After cuff release, there was a greater oxygen resaturation rate in the nonparetic leg compared with the paretic leg (3.13 ± 2.08%·s−1 vs. 1.60 ± 1.11%·s−1, respectively; P = 0.01). The control leg had a similar resaturation rate versus the nonparetic leg (control = 3.41 ± 1.79%·s−1; P = 0.69) but was greater than the paretic leg (P = 0.003). The TA in the paretic leg had an impaired muscle oxygen consumption rate and reduced microvascular endothelial function compared with controls. NEW & NOTEWORTHY: Secondary consequences of stroke are not well described. In this study, we show that basal muscle oxidative consumption and microvascular endothelial function are reduced in the paretic tibialis anterior muscle of chronic stroke survivors compared with matched controls using near-infrared spectroscopy and the vascular occlusion technique. There was a moderately strong correlation between microvascular endothelial function and paretic leg strength. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Author

Boerger, Timothy F, Hyngstrom, Allison S, Furlan, Julio C, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G, Harrop, James, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R, Davies, Benjamin M, Kotter, Mark R N, Koljonen, Paul A, Boerger, Timothy F, Hyngstrom, Allison S, Furlan, Julio C, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G, Harrop, James, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R, Davies, Benjamin M, Kotter, Mark R N, and Koljonen, Paul A

Abstract

Study design: Narrative review. Objective: Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. Methods: Literature search. Results: In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. Conclusions: We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.

Published
2022

19. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Author

Boerger, Timothy F; https://orcid.org/0000-0003-1587-3704, Hyngstrom, Allison S, Furlan, Julio C; https://orcid.org/0000-0002-2038-0018, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G; https://orcid.org/0000-0002-5722-6364, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R; https://orcid.org/0000-0001-5965-0305, Davies, Benjamin M; https://orcid.org/0000-0003-0591-5069, Kotter, Mark R N, Koljonen, Paul A; https://orcid.org/0000-0002-9250-653X, Boerger, Timothy F; https://orcid.org/0000-0003-1587-3704, Hyngstrom, Allison S, Furlan, Julio C; https://orcid.org/0000-0002-2038-0018, Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K, Kurpad, Shekar N, Fehlings, Michael G; https://orcid.org/0000-0002-5722-6364, Harrop, James S, Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D, Wilson, Jefferson R; https://orcid.org/0000-0001-5965-0305, Davies, Benjamin M; https://orcid.org/0000-0003-0591-5069, Kotter, Mark R N, and Koljonen, Paul A; https://orcid.org/0000-0002-9250-653X

Abstract

STUDY DESIGN Narrative review. OBJECTIVE Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. METHODS Literature search. RESULTS In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. CONCLUSIONS We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.

Published
2022

20. A Principal Components Analysis Approach to Quantifying Foot Clearance and Foot Clearance Variability.

Author

Benson, Lauren C., Cobb, Stephen C., Hyngstrom, Allison S., Keenan, Kevin G., Luo, Jake, and O'Connor, Kristian M.

Subjects
FOOT physiology, TOES, FACTOR analysis, ACCIDENTAL falls, KINEMATICS, STATISTICS, WALKING, DATA analysis, STROKE patients, PHYSIOLOGY
Abstract

Low foot clearance and high variability may be related to falls risk. Foot clearance is often defined as the local minimum in toe height during swing; however, not all strides have this local minimum. The primary purpose of this study was to identify a nondiscrete measure of foot clearance during all strides, and compare discrete and nondiscrete measures in ability to rank individuals on foot clearance and variability. Thirty-five participants (young adults [n = 10], older fallers [n = 10], older nonfallers [n = 10], and stroke survivors [n = 5]) walked overground while lower extremity 3D kinematics were recorded. Principal components analysis (PCA) of the toe height waveform yielded representation of toe height when it was closest to the ground. Spearman's rank order correlation assessed the association of foot clearance and variability between PCA and discrete variables, including the local minimum. PCA had significant (P <.05) moderate or strong associations with discrete measures of foot clearance and variability. An approximation of the discrete local minimum had a weak association with PCA and other discrete measures of foot clearance. A PCA approach to quantifying foot clearance can be used to identify the behavioral components of toe height when it is closest to the ground, even for strides without a local minimum. [ABSTRACT FROM AUTHOR]

Published
2019
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21. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Author

Boerger, Timothy F., primary, Hyngstrom, Allison S., additional, Furlan, Julio C., additional, Kalsi-Ryan, Sukhvinder, additional, Curt, Armin, additional, Kwon, Brian K., additional, Kurpad, Shekar N., additional, Fehlings, Michael G., additional, Harrop, James S., additional, Aarabi, Bizhan, additional, Rahimi-Movaghar, Vafa, additional, Guest, James D., additional, Wilson, Jefferson R., additional, Davies, Benjamin M., additional, Kotter, Mark R. N., additional, and Koljonen, Paul A., additional

Published
2022
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29. High intensity dynamic stability gait training for people with multiple sclerosis: a pilot study

Author

Adam, Mitchell D, Hornby, T George, Hyngstrom, Allison S, and Schmit, Brian D

Abstract

This report describes the initial results of an ongoing single blinded, randomized clinical trial aimed to improve mobility and balance for people with multiple sclerosis (PwMS) through high intensity dynamic stability gait training. PwMS demonstrate consistent, but relatively small improvements in mobility and balance following exercise interventions,1-2which often fall below the minimally clinically important differences (MCID) reported for other clinical populations.3Based on recommendations for other neurologic populations, more task specific interventions at higher intensities may facilitate greater improvements in mobility and balance.4

Published
2024
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41. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?

Author

Davies, Benjamin M., Kwon, Brian K., Fehlings, Michael G., Kotter, Mark R. N., Boerger, Timothy F., Hyngstrom, Allison S., Furlan, Julio C., Kalsi-Ryan, Sukhvinder, Curt, Armin, Kwon, Brian K., Kurpad, Shekar N., Fehlings, Michael G., Harrop, James S., Aarabi, Bizhan, Rahimi-Movaghar, Vafa, Guest, James D., Wilson, Jefferson R., Davies, Benjamin M., Kotter, Mark R. N., and Koljonen, Paul A.

Abstract

Study Design Narrative review.Objective Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies.Methods Literature search.Results In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed.Conclusions We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.

Published
2022
Full Text
View/download PDF

46. The Stroke-related Effects on Maximal Dynamic Hip Flexor Fatigability and Functional Implications

Author

Kuhnen, Henry R., Rybar, Megan M., Onushko, Tanya, Doyel, Ryan, Hunter, Sandra K., Schmit, Brian D., and Hyngstrom, Allison S.

Subjects
Male, Stroke, Muscle Fatigue, Humans, Female, Hip Joint, Middle Aged, Article, Muscle Contraction
Abstract

Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability.Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested.Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last set of MDVCs than the nonparetic leg (7.4%). Reduction in paretic leg MDVC torque was correlated with self-selected walking speed (r2=0.43), while reduction in MIVC torque was not (r2=0.11).Reductions in maximal dynamic torque of paretic hip flexors may be a better predictor of walking function than reductions in maximal isometric contractions.

Published
2015

48. Active properties of motoneurone dendrites: diffuse descending neuromodulation, focused local inhibition

Author

Heckman, C J, Hyngstrom, Allison S, and Johnson, Michael D

Subjects
Motor Neurons, Neurotransmitter Agents, Interneurons, Symposium Section Reports: The Cortex, Interneurones and Motoneurones in the Control of Movement, Cats, Animals, Humans, Dendrites, Synaptic Transmission
Abstract

The dendrites of spinal motoneurones are highly active, generating a strong persistent inward current (PIC) that has an enormous impact on processing of synaptic input. The PIC is subject to regulation by descending neuromodulatory systems releasing the monoamines serotonin and noradrenaline. At high monoaminergic drive levels, the PIC dominates synaptic integration, generating an intrinsic dendritic current that is as much as 5-fold larger than the current entering via synapses. Without the PIC, motoneurone excitability is very low. Presumably, this descending control of the synaptic integration via the PIC is used to adjust the excitability (gain) of motoneurones for different motor tasks. A problem with this gain control is that monoaminergic input to the cord is very diffuse, affecting many motor pools simultaneously, probably including both agonists and antagonists. The PIC is, however, exquisitely sensitive to the reciprocal inhibition mediated by length sensitive muscle spindle Ia afferents and Ia interneurones. Reciprocal inhibition is tightly focused, shared only between strict mechanical antagonists, and thus can act to 'sculpt' specific movement patterns out of a background of diffuse neuromodulation. Thus it is likely that motoneurone gain is set by the interaction between diffuse descending neuromodulation and specific and focused local synaptic inhibitory circuits.

Published
2007

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