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V Dietz

Publications and source records attributed to V Dietz.

At least 55 records · Page 3Linked to original sources
PubMed2001

Neuronal coordination of arm and leg movements during human locomotion.

We aimed to study the neuronal coordination of lower and upper limb muscles. We therefore evaluated the effect of small leg displacements during gait on leg and arm muscle electromyographic (EMG) activity in walking humans. During walking on a split-belt treadmill (velocity 3.5 km/h), short accelerations or decelerations were randomly applied to the right belt during the mid or end stance phase. Alternatively, trains of electrical stimuli were delivered to the right distal tibial nerve. The EMG activity of the tibialis anterior (TA), gastrocnemius medialis (GM), deltoideus (Delt), triceps (Tric) and biceps brachii (Bic) of both sides was analysed. For comparison, impulses were also applied during standing and sitting. The displacements were followed by specific patterns of right leg and bilateral arm muscle EMG responses. Most arm muscle responses appeared with a short latency (65-80 ms) and were larger in Delt and Tric than in Bic. They were strongest when deceleration impulses were released during mid stance, associated with a right compensatory TA response. A similar response pattern in arm muscles was obtained following tibial nerve stimulation. The arm muscle responses were small or absent when stimuli were applied during standing or sitting. The arm muscle responses correlated more closely with the compensatory TA than with the compensatory GM responses. The amplitude of the responses in most arm muscles correlated closely with the background EMG activity of the respective arm muscle. The observations suggest the existence of a task-dependent, flexible neuronal coupling between lower and upper limb muscles. The stronger impact of leg flexors in this interlimb coordination indicates that the neuronal control of leg flexor and extensor muscles is differentially interconnected during locomotion. The results are compatible with the assumption that the proximal arm muscle responses are associated with the swinging of the arms during gait, as a residual function of quadrupedal locomotion.

Adult↗
PubMed2001

A reliable gait phase detection system.

A new highly reliable gait phase detection system, which can be used in gait analysis applications and to control the gait cycle of a neuroprosthesis for walking, is described. The system was designed to detect in real-time the following gait phases: stance, heel-off, swing, and heel-strike. The gait phase detection system employed a gyroscope to measure the angular velocity of the foot and three force sensitive resistors to assess the forces exerted by the foot on the shoe sole during walking. A rule-based detection algorithm, which was running on a portable microprocessor board, processed the sensor signals. In the presented experimental study ten able body subjects and six subjects with impaired gait tested the device in both indoor and outdoor environments (0-25 degrees C). The subjects were asked to walk on flat and irregular surfaces, to step over small obstacles, to walk on inclined surfaces, and to ascend and descend stairs. Despite the significant variation in the individual walking styles the system achieved an overall detection reliability above 99% for both subject groups for the tasks involving walking on flat, irregular, and inclined surfaces. In the case of stair climbing and descending tasks the success rate of the system was above 99% for the able body subjects and above 96 % for the subjects with impaired gait. The experiments also showed that the gait phase detection system, unlike other similar devices, was insensitive to perturbations caused by nonwalking activities such as weight shifting between legs during standing, feet sliding, sitting down, and standing up.

Adult↗
PubMed2001

Gait disorders.

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Gait Disorders, Neurologic↗
PubMed2001

Long term effects of locomotor training in spinal humans.

The long term effects of locomotor training in patients with spinal cord injury (SCI) were studied. In patients with complete or incomplete SCI coordinated stepping movements were induced and trained by bodyweight support and standing on a moving treadmill. The leg extensor muscle EMG activity in both groups of patients increased significantly over the training period, associated with improved locomotor ability in those with incomplete SCI. During a period of more than 3 years after training, the level of leg extensor EMG remained about constant in incomplete SCI in those who regularly maintained locomotor activity. By contrast the EMG significantly fell in those with complete SCI. The results suggest a training induced plasticity of neuronal centres in the isolated spinal cord which may be of relevance for future interventional therapies.

Adolescent↗
PubMed2001

Spinal cord lesion: effects of and perspectives for treatment.

Following central motor lesions, two forms of adaptation can be observed which lead to improved mobility: (1) the development of spastic muscle tone, and (2) the activation of spinal locomotor centers induced by specific treadmill training. Tension development during spastic gait is different from that during normal gait and appears to be independent of exaggerated monosynaptic stretch reflexes. Exaggerated stretch reflexes are associated with an absence or reduction of functionally essential polysynaptic reflexes. When supraspinal control of spinal reflexes is impaired, the inhibition of monosynaptic reflexes is missing in addition to a reduced facilitation of polysynaptic reflexes. Therefore, overall leg muscle activity becomes reduced and less well modulated in patients with spasticity. Electrophysiological and histological studies have shown that a transformation of motor units takes place following central motor lesions with the consequence that regulation of muscle tone is achieved at a lower level of neuronal organization which in turn enables the patient to walk. Based on observations of the locomotor capacity of the spinal cat, recent studies have indicated that spinal locomotor centers can be activated and trained in patients with complete or incomplete paraplegia when the body is partially unloaded. However, the level of electromyographic activity in the gastrocnemius (the main antigravity muscle during gait) is considerably lower in the patients compared to healthy subjects. During the course of a daily locomotor training program, the amplitude of gastrocnemius, electromyographic activity increases significantly during the stance phase, while inappropriate tibialis anterior activation decreases. Patients with incomplete paraplegia benefit from such training programs such that their walking ability on a stationary surface improves. The pathophysiology and functional significance of spastic muscle tone and the effects of treadmill training on the locomotor pattern underlying new attempts to improve the mobility of patients with paraplegia are reviewed.

Humans↗
PubMed2001

Gait disorder in spasticity and Parkinson's disease.

The central programming, timing, and reciprocal mode of leg muscle activation during gait are basically intact in patients with spastic paresis. Exaggerated monosynaptic reflexes are associated with a loss of the functionally essential polysynaptic reflex mechanisms, both being dependent on supraspinal control. When this control is either not yet matured (small children) or impaired (spastic paresis), inhibition of monosynaptic stretch reflexes is missing in combination with a reduced facilitation of polysynaptic reflexes. A spinal or cerebral lesion associated with paresis is followed by a transformation of motor units (and most probably shortening of muscle fibers leading to muscle contracture), such that tension development in the muscle occurs in a simpler fashion. Calf muscle tension during gait is normally determined by modulated gastrocnemius or soleus EMG activity. In the spastic leg, calf muscle tension is associated with the stretching of the tonically activated muscle. This regulation of muscle tension at a lower level is efficient insofar as it enables the patient to support body weight during gait. Consequently, physiotherapeutic approaches should be applied primarily and antispastic drug therapy secondarily in mobile patients; whereas antispastic drugs may relieve muscle spasms and improve nursing care in immobilized patients.

Cerebral Palsy↗
PubMed2000

Efficient testing of motor function in spinal cord injured rats.

In experimental spinal cord injury studies, animal models are widely used to examine anatomical and functional changes after different treatments and lesion types. A variety of behavioral paradigms exists in the literature, but definitions and criteria for motor performance vary considerably. In this study, we examined the outcome and relation of tests such as the BBB open field locomotion score, footprint analysis, kinematic analysis, placing response, grid walk and narrow beam crossing following two different lesion types. The information obtained was used to design an efficient and reliable testing strategy, which includes a broad spectrum of parameters to enhance sensitivity. This approach should help to standardize modular testing procedures across different laboratories working on spinal cord injury.

Animals↗
PubMed2000

[Focus on current research: improving the mobility of paraplegic patients].

Since the first paraplegic centre was established in 1945, life expectancy and life quality of paraplegics have considerably improved. However, endeavours to enhance the mobility of these patients have been less successful. The most promising approach, functional electric stimulation of paralysed muscles, is poorly accepted by patients at present because of technical problems. This study describes current approaches which may help to improve patients' mobility. A central motor lesion is perceived by the patient as a movement disorder of the legs, e.g. a gait disorder. Neurological investigation indicates, on the basis of exaggerated tendon reflexes and increased resistance of the non-activated leg muscles to stretching, that spastic paresis underlies the movement disorder. This combination of symptoms and clinical (physical) signs suggests that the exaggerated tendon tap reflexes are responsible for muscle hypertonia and the latter causes the movement disorder. However, electromyography during movement shows that the exaggerated short latency reflexes are associated with loss or attenuation of the functionally essential polysynaptic spinal reflexes. In the event of impaired supraspinal control there is loss of monosynaptic stretch reflex inhibition combined with reduced facilitation of polysynaptic spinal reflexes. Development of tension in tonically active calf muscles in patients with spastic paresis during gait occurs independently of spinal reflex activity. From electrophysiological and histological observations it can be assumed that transformation of motor units resulting in simple and less well adapted regulation of muscle tone allows movements such as gait. The reduction of muscle tone obtained with antispastic drugs is usually associated with paresis and may therefore hamper locomotion. Locomotor training represents a new attempt to improve the mobility of patients with incomplete paraplegia. It includes activation of neuronal circuits within the spinal cord below the level of the lesion. In incomplete paraplegics a coordinated leg muscle activation pattern and corresponding leg movements can be triggered and trained in patients standing on a treadmill with partial weight support. Improvement of training of the spinal cord locomotor centre can be expected from triggering of spinal cord reflexes and regeneration of spinal tract fibres, which is expected to be possible in the near future.

Humans↗
PubMed2000

[Post-inpatient after-care of paraplegic patients: selected internal medicine aspects].

In-hospital rehabilitation of para-/tetraplegic patients is followed by the family doctor's long-term surveillance supported by annual checkups in the rehabilitation clinic. The family doctor bears a heavy burden of responsibility. Loss of sensation may cover a wide range of complications. Most of these functional disorders are the consequence of reduced physical activity and a disturbed autonomic nervous system. There is a significantly high incidence of pulmonary infection, in particular pneumonia and atelectasis, coronary heart disease, autonomic dysreflexia, urinary tract infections, kidney stones, renal and hepatic insufficiency, gallstones, constipation and ileus, as well as decubitus, osteoporosis and so on. Chronic severe pain and spasm also require optimum therapy, in view of their potential to reduce quality of life and working capacity. This article provides an overview of several relevant problems in internal medicine involving diagnosis, therapy and long-tem surveillance of patients with spinal cord injuries.

Aftercare↗
PubMed2000

From spinal shock to spasticity: neuronal adaptations to a spinal cord injury.

OBJECTIVE: To investigate the adaptational changes in excitability of spinal neuronal circuits below the level of lesion from spinal shock to spasticity in patients with spinal cord injury (SCI). METHODS: More than 6 months after an acute SCI, clinical follow-up examinations were paralleled by electrophysiologic recordings with tibial nerve stimulation (M-wave, F-wave, H-reflex, and flexor reflex). RESULTS: During spinal shock, the loss of tendon tap reflexes and flaccid muscle tone were associated with low persistence of F-waves and loss of flexor reflexes, whereas H-reflexes were already elicitable. During the transition to spasticity, the reappearance of tendon tap reflexes and muscle tone and the occurrence of spasms was associated with the recovery of F-waves and flexor reflex excitability, whereas the H-to-M ratio remained about stable over months. At later stages (2 to 6 months after SCI) when clinical signs of spasticity became established, the electrophysiologic measures showed little change. In paraplegic patients, in contrast to tetraplegic patients, M-wave and flexor reflex amplitudes even decreased. CONCLUSIONS: The late decrease in M-wave and flexor reflex amplitude in paraplegic patients suggests a secondary impairment/degeneration of premotoneuronal circuits and of motoneurons. The divergent course of clinical signs of spasticity and their probable neuronal correlates indicates the occurrence of non-neuronal changes contributing to spasticity.

Adaptation, Physiological↗
PubMed2000

Effects of changing stance conditions on anticipatory postural adjustment and reaction time to voluntary arm movement in humans.

1. The effect on reaction time (RT) and anticipatory postural adjustment (APA) of unexpectedly changing stance conditions was studied using a push or pull arm movement task. The aim was to evaluate the modifiability of RT and APA by an external perturbation associated with an automatic compensatory reaction. 2. Subjects standing on a moveable platform were asked to push or pull a rigid handle as quickly and as strongly as possible in response to the 'go-signal', a visual signal from a green or red light-emitting diode. Forward and backward translations of the platform were randomly induced at four time intervals after the go-signal. In some experiments to detect unspecific arousal there were no platform translations but an acoustic signal was given before the go-signal. Surface electromyographic activity (EMG) of upper arm and lower leg muscles was analysed. 3. During the push task both RT and the duration of APA (onset of APA till the force signal indicating hand action) were shorter during backward than during forward translation. During the pull task the effect of platform translations was the reverse. The delay between go-signal and onset of APA remained constant. Consequently, RT and APA became shorter when the platform was translated in the same direction as that in which the upper body was displaced by the push or pull movement, and longer when it was translated in the opposite direction. The effects were maximal when translations were induced 250 ms after the go-signal, but a difference was detected up to 375 ms. 4. Furthermore, with forward and backward platform translations RT was shorter when the translations were induced early rather than late after the go-signal. This was associated with a shortening of the delay between the go-signal and onset of APA, while APA duration remained constant. The shortened RT was in the range of that obtained when an acoustic signal was given just before the go-signal. 5. It is concluded that (i) both the RT and the duration of APA can be modified by a translation of the support surface in a functionally appropriate way by updating the internal representation of the actual stance condition within the central nervous system. Both RT and APA are shortened when the body displacement induced by the push or pull movement and platform translation have the same direction; conversely, an inappropriate translation of the feet requires a greater APA and leads to a longer RT; (ii) both APA and RT are modifiable by platform translation for more than half the time between the go-signal and the focal push or pull movement; (iii) an unspecific effect of platform translation on RT can be identified; it may be mediated by a different neuronal substrate.

Adult↗
PubMed2000

Modulation of cutaneous reflexes by load receptor input during human walking.

To investigate the influence of load on the modulation of cutaneous reflexes, evoked by sural nerve stimulation, electromyographic activity in different leg muscles (tibialis anterior, gastrocnemius medialis (GM), biceps femoris, and soleus muscles (SO)) was recorded in healthy humans during treadmill walking with different body loads. Sural nerve stimulation was applied at two times perception threshold during different phases of the step cycle. Reflex amplitudes increased with body unloading and decreased with body loading. The reflex responses were not a simple function of the level of background activity. For example, in GM and SO, the largest reflex responses occurred during walking with body unloading, when background activity was decreased. Hence, stable ground conditions (body loading) yielded smaller reflexes. It is proposed that load receptors are involved in the regulation of cutaneous reflex responses in order to adapt the locomotor pattern to the environmental conditions.

Adult↗
PubMed2000

Stability criterion for controlling standing in able-bodied subjects.

A new stability criterion that can be used to assess the standing condition of a subject from center of pressure (CoP) measurements is presented. This criterion can be applied, for example, to control a standing prosthesis, which should allow a paraplegic subject to stand up, sit down and stand safely without using hands for support. Experiments conducted with able-bodied subjects enabled us to establish a relationship between its stability and the subject's CoP position. Four CoP stability zones were identified: high preference, low preference, undesirable and unstable zones. The high preference zone is defined as the area where the CoP is found 99% of the time during quiet standing. The area where the CoP is found during the remaining 1% of the time is called the low preference zone. The undesirable zone is defined as the CoP area where the subject is forced to change posture in order to maintain balance, and the unstable zone is defined as the CoP area in which the subject is forced to step forward, backward or sideways to maintain stability. A general model of the proposed four stability zones was derived, which can be used to compute stability zones a priori for any subject and thus allows one to assess the subject's stability condition from the CoP measurements.

Adult↗
PubMed2000

Treadmill training in incomplete spinal cord injured rats.

Treadmill training has been shown to accelerate locomotor recovery and to improve weight bearing during treadmill walking in spinal cats. In human patients treadmill training is increasingly used in rehabilitation after incomplete spinal cord injury. In this study we examined training effects in spinal cord injured rats with an incomplete dorsal lesion. Recovery was examined with an open field locomotor score, kinematic analysis on the treadmill, and several functional tests (i.e. foot print evaluation, narrow beam crossing, grid walking, open field exploratory activity). During the course of 5 weeks after the injury, a substantial amount of recovery occurred in the treadmill trained as well as in the untrained rats. If compared to the control lesioned rats, which showed a high level of spontaneous hindlimb movements at 7-14 days post lesion, no additional beneficial effect of a 5-week daily treadmill training on the locomotor outcome could be detected in the trained group. The only change observed was a slightly larger exploratory activity of the trained rats. It is probable that the spared ventral and ventro-lateral fibers allowed spontaneous recovery and 'self-training' to occur to such an extend that systematic treadmill training did not provide additional improvement.

Animals↗
PubMed2000

Significance of load receptor input during locomotion: a review.

A basic aspect of the neuronal control of quadrupedal locomotion of cat and of bipedal stance and gait of humans concerns the antigravity function of leg extensors. In humans proprioceptive reflexes involved in the maintenance of body equilibrium depend on the presence of contact forces opposing gravity. Extensor load receptors are thought to signal changes of the projection of body's centre of mass with respect to the feet. According to observations in the cat, this afferent input probably arises from Golgi tendon organs and represents a newly discovered function of these receptors in the regulation of stance and gait. From these experiments it can be concluded that during locomotion there is a closing of Ib inhibitory and an opening of Ib extensor facilitatory paths. In humans evidence for a significant contribution of load receptor contribution to the leg muscle activation came from immersion experiments. Compensatory leg muscle activation depends on the actual body weight. Also during gait the strength of leg extensor activation during the stance phase is load dependent. In patients with Parkinson's disease there is a reduced load sensitivity and decreased leg extensor activation, which might contribute to the movement disorder. Recent experiments in paraplegic patients show that the beneficial effects of a locomotor training critically depends on the initial degree of body unloading and reloading during the course of the training period.

Animals↗
PubMed2000

[Basic principles and therapy of spasticity].

An acute central nervous system lesion is followed by a phase of "shock" with flaccid muscle tone. After some weeks the syndrome of spastic paresis develops which is characterized by increased muscle tone and exaggerated tendon tap reflexes. During the last years it could be shown that the characteristic spastic movement disorder is mainly due to secondary changes of muscle properties which require a specific treatment. Exaggerated reflexes do only little contribute to the movement disorder.

Acute Disease↗
PubMed2000

Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography.

OBJECTIVE: To evaluate the loss of trabecular and cortical bone mineral density in radius, ulna and tibia of spinal cord injured persons with different levels of neurologic lesion after 6, 12 and 24 months of spinal cord injury (SCI). DESIGN: Prospective study in a Paraplegic Centre of the University Hospital Balgrist, Zurich. SUBJECTS AND METHODS: Twenty-nine patients (27 males, two females) were examined by the highly precise peripheral quantitative computed tomography (pQCT) soon after injury and subsequently at 6, 12 and in some cases 24 months after SCI. Using analysis of the bone mineral density (BMD), various degrees of trabecular and cortical bone loss were recognised. A rehabilitation program was started as soon as possible (1-4 weeks) after SCI. The influence of the level of neurological lesion was determined by analysis of variance (ANOVA). Spasticity was assessed by the Ashworth Scale. RESULTS: The trabecular bone mineral density of radius and ulna was significantly reduced in subjects with tetraplegia 6 months (radius 19% less, P<0.01; ulna 6% less, P>0.05) and 12 months after SCI (radius 28% less, P<0.01; ulna 15% less, P<0.05). The cortical bone density was significantly reduced 12 months after SCI (radius 3% less, P<0.05; ulna 4% less, P<0.05). No changes in BMD of trabecular or cortical bone of radius and ulna were detected in subjects with paraplegia. The trabecular BMD of tibia was significantly reduced 6 months (5% less, P<0.05) and 12 months after SCI (15% less, P<0.05) in all subjects with SCI. The cortical bone density of the tibia only was decreased after a year following SCI (7% less, P<0.05). No significant difference between both groups, subjects with paraplegia and subjects with tetraplegia was found for tibia cortical or trabecular BMD. There was no significant influence for the physical activity level or the degree of spasticity on bone mineral density in all subjects with SCI. CONCLUSIONS: Twelve months after SCI a significant decrease of BMD was found in trabecular bone in radius and in tibia of subjects with tetraplegia. In subjects paraplegia, a decrease only in tibia BMD occurred. Intensity of physical activity did not significantly influence the loss of BMD in all subjects with para- and tetraplegia. However, in some subjects regular intensive loading exercise activity in early rehabilitation (tilt table, standing) can possibly attenuate the decrease of BMD of tibia. No influence was found for the degree of spasticity on the bone loss in all subjects with SCI.

Adult↗