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People swing their arms unconsciously in a reciprocal manner during walking. This feature seems quite useless for locomotion at first sight. After all, people are able to walk without the arms swinging, or when the arms are making other (complex) movements (such as waving the arms or juggling). Even though the arm movements are unnecessary to walk, they do have some beneficial effects on the walking pattern. For instance, when the arms are swinging during walking, less energy is consumed compared to when they are not swinging. This positive effect of arm swinging on gait, however, does not explain what causes people to swing their arms without having to think about them. Therefore, in the current doctoral thesis, we wanted to gain more insight in the neural basis of the natural reciprocal arm swing. It is described in literature that arm muscle activation may come about by the way the nervous system is built, with interconnected Central Pattern Generators (CPGs) generating locomotion patterns. It is suggested that bipedal and quadrupedal locomotion share common spinal neuronal control mechanisms, which is based on the assumption that during evolution, man started to walk bipedally, and the circuitry, previously used for the arms during locomotion, remained operational. These CPGs generating locomotion patterns are located in the spinal cord, where they are interconnected and controlled by brainstem and cortical circuits. Some authors, however, have emphasized the direct control from the cortex. If arm swinging during gait would primarily originate from cortical contributions, one would expect this to be reflected in deteriorated or altered arm swing in persons with a cortical deficit. To this end, the studies in the current doctoral thesis have focused on children with spastic hemiplegic and diplegic Cerebral Palsy. These are the two most common types of Cerebral Palsy (CP), in which non-progressive impairment to the brain resulted in abnormal limb strength, control, and/or muscle tone. In children with hemiplegia, one side of the body is more affected than the other, while in children with diplegia the lower extremities are more affected than the upper extremities. In children with CP, systematic studies about the arm movements during walking are very scarce. Therefore in the first phase of the current doctoral thesis, different aspects of the arm behavior during walking in these children were examined.The different aspects under investigation were arm swing amplitude, arm posture, and the interlimb coordination. We found that, overall, children with CP moved their arms differently during walking and this was reflected in all three evaluated aspects. In particular, children with CP were unable to further increase their arm swing amplitude to the same extent as typically developing (TD) children when walking faster. Moreover, children with hemiplegia specifically showed increased arm swing on the non-hemiplegic side and decreased arm swing on the hemiplegic side. With respect to arm posture, both CP groups presented withand altered posture on both sides of the body. They held their hands higher and more in front of the body with their upper arm was rotated more to the posterior. Again, children with hemiplegia showed a clear asymmetry. Their hemiplegic arm was held in an even higher position. As expected, these alterations in arm swing and posture affected interlimb coordination during walking as well. Specifically, in children with hemiplegia, the hemiplegic arm impaired coordinative stability and constrained the synchronization of the limbs. In contrast, in children with diplegia, the legs limited the ability to coordinate the limb pairs, but it were the arms that affected coordinative stability.Overall these alterations and deficits seemed to be related to secondary causes, such as spasticity, muscle weakness, and compensations (for stability or angular momentum), rather than they are directly related to the primary cortical deficit. Thus, this newly obtained knowledge is crucial in order to know which aspect of the arm behavior should or should not be adapted in order to improve the overall walking pattern of a patient with CP.From the experiments of phase one, it already appeared that arm swing does not entirely depend on cortical control because, despite the difference between children with CP and TD children, the basic pattern was maintained. In the second phase of the current doctoral thesis we further explored the role of the cortex in the neural basis of the arm movements during gait. To this end, we used the forward walking (FW) and backward walking (BW). This paradigm allowed us to infer about the similarity in the neural mechanisms controlling the limbs for the different directions of walking. This has been done in earlier studies for the leg kinematics, which were found to be similar between FW and BW reversed in time, but this has not been done for the arm kinematics. Hence, this led us to investigate whether, as for leg movements during walking, the kinematical patterns of the arm movements during FW and BW would be equivalent but reversed in time. The results, indeed, demonstrated this similarity in healthy participants (i.e. TD children), and supported the idea that the neural control of the locomotor arm movements is organized in a similar way as for the leg movements. Further, in order to differentiate whether the neural control of locomotor limb movements primarily arises from a cortical source or from peripherally located networks, we determined whether an intact cortex is needed to sustain the simple kinematical reversal from FW to BW. To this end, we investigated whether in children with CP the same kinematical reversal for the arm and leg movements took place from FW to BW as in TD children. It turned out that also in children with CP the degree of similarity between the limb kinematics of FW and BW was considerable, which indicated that the neural mechanism of interlimb coordination during walking does not depend mainly on a cortical source.In summary, the above described findings have mapped the uncharted impairments of arm behavior (i.e. arm swing, arm posture and interlimb coordination deficits) arising during walking in children with CP. This knowledge can be used to aid in gait rehabilitation when attempting to implement arm movements in gait training programs. Furthermore, fundamental knowledge is gained about the possible causes (i.e. spasticity, muscle tone, compensation strategy) of the altered arm behavior in children with CP. Studying the arm behavior during FW and BW allowed us to acquire further insights in the neural mechanisms controlling locomotor arm movements (i.e. the neural mechanisms for the lower and upper limbs are organized in a similar manner). Furthermore, comparing the results of TD children with children with CP, increased our understanding where the neural control of locomotor limb movements predominantly originates from (i.e. from sites more peripherally located than the cortex such as the brain stem or the spinal cord). The insights provided by the current doctoral thesis have opened the way for further research on the implementation of arm movements in the gait rehabilitation in children with CP and on the relative contribution of the different neural areas/networks in control of locomotor limb movement
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Modèles réduits statiques appliqués à l'industrie automobile
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Walking is a relatively easy task; we can walk without thinking about how to do it. While we are able to walk without thinking about it, from a control perspective, walking is definitely not a simple task. It needs to be stable and efficient in a broad range of different conditions. Insights into the neural control of gait are important to learn us about why specific individuals (patients, elderly) experience difficulties with walking, in general or under specific conditions. With this knowledge rehabilitation and fall prevention strategies can be optimized.While it is known that there is an important role for the spinal circuitry in the neural control of gait, multiple supraspinal structures have been suggested to contribute substantially as well. Specifically, based on common gait deficits in cerebellar patients, the cerebellum can be expected to be important in the neural control of gait. So far this has been evaluated in humans, mainly during unperturbed, steady state walking. An important next step is to study the role of the cerebellum in the control of gait corrections in reaction to perturbations. In those conditions, the cerebellum can be expected to be even more involved in the control of gait, because of its function in comparing expected and real sensory signals.The objective of this thesis was to increase the understanding of the roles of the cerebellum in the control of gait corrections in reaction to perturbations, and of the localization of these functions within the cerebellum. We evaluated the role of the cerebellum in dynamic gait stability, in cutaneous reflex modulation during gait and in locomotor adaptation, all important features of neural control of gait in non-steady state conditions.In the first part, we performed three studies, focusing on the relationship between cutaneous reflex modulation and gait stability, and on the role of the cerebellum in these features. First, we studied cutaneous reflexes during backward walking in healthy controls and observed a prominent phase-dependent reflex modulation during this task. Next, we addressed the potential role of the cerebellum in the control of cutaneous reflexes. Cutaneous reflex modulation was similar between healthy controls and patients with focal cerebellar lesions, but the latter appeared less able to attenuate reflexes to self-induced stimuli. This suggests that the cerebellum is not primarily involved in cutaneous reflex modulation but that it could act in attenuation of self-induced reflex responses. The latter role in locomotion would be consistent with the common view that the cerebellum predicts sensory consequences of movement. Furthermore, biceps femoris muscle activity during the single stance phases was increased in the patient group compared to the controls. This increased activation was likely related to a co-activation strategy to reduce instability of gait. This was supported by findings in our third study, where we evaluated dynamic gait stability in patients with focal cerebellar lesions and in healthy controls. The short-term maximum Lyapunov exponent was higher in cerebellar patients, indicating reduced dynamic gait stability. Furthermore, while step width was increased and self-selected overground walking speed was decreased in the patient group while other spatio-temporal gait parameters were similar. Patients with the largest lesions in the vermis displayed the least stable gait pattern.In the second part, we focused on split-belt walking which, in the past decade, has become a popular paradigm to study the role of the cerebellum in locomotor adaptation. First, we evaluated split-belt adaptation in healthy controls and mildly ataxic patients with focal cerebellar lesions. We observed that during the split-belt adaptation experiment, patients and healthy controls globally displayed similar changes in gait parameters. However, a group difference was observed in the aftereffect of the Stance Time Symmetry: during the early phase of the post-adaptation period the relative stance times were more asymmetric for the patient group than for the control group. Patients who walked with more asymmetric relative stance times were more likely to have lesions in vermal lobules VI and Crus II. In the final study, we assessed the role of somatosensory perception in the control of split-belt walking. We observed that participants who were less able to perceive differences between belt speeds, initially walked with more asymmetric stance times during split-belt walking. This is in line with our general view that load and stretch information are important in the neural control of gait.In conclusion, the cerebellum appears important in the control in dynamic gait stability. Furthermore, our data suggests that the cerebellum is not primarily involved in cutaneous reflex modulation but that it could act in attenuation of self-induced reflex responses. Our results demonstrated that mildly ataxic cerebellar patients show no deficits in split-belt adaptation but exhibit differences in the post-adaptation period. Finally, the observed relations between speed-difference perception and gait asymmetry during split-belt walking confirmed the importance of proprioceptive information in gait control.
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Normal gait, but also more complex gait modalities (e.g. slow walking and backwards walking) are important activities of daily life. Nevertheless, they require a complex interaction between neural and mechanical factors, which becomes even more apparent when this interaction is impaired. For instance, a reduced walking speed and asymmetric gait patterns are often observed after stroke. In the past, experimental studies have contributed insights in both the mechanical and neural mechanisms underlying muscle coordination patterns during complex and pathological gait. However, to determine causal relationships between neural control and muscle activity on the one hand, and the resulting motion on the other hand, simulation studies are required. Therefore this thesis used (neuro)-musculo-skeletal models and dynamic simulations to further define these causal relationships during complex forms of gait and during hemiparetic gait after stroke.In this thesis we addressed four research topics:- Identification of differences in muscle contributions to anterior-posterior (AP) and up-down (UD) center of mass (COM) acceleration during forward walking and backward walking.- Identification of contribution of muscles and gravity to the mediolateral (ML) control of the COM during very slow walking.- Identification of adaptations in muscle contribution to COM acceleration during split-belt walking (i.e. asymmetric, limping-like walking) compared to tied-belt walking.- Identification of the contribution of an increased length and velocity feedback and altered modulation patterns to hemiparetic gait impairments. The first study examined how a gait direction reversal influences the muscle contributions to COM accelerations in AP and vertical direction. Previous studies showed that leg kinematics during backward walking is very similar to the time-reversed kinematics during forward walking. Experimental studies found that in some muscles a time-reversal in electromyography (EMG) activity is present in backward walking compared to forward walking, as well as a reversal of function at joint level (i.e. from energy generator to energy absorber, and vice versa). However, a function reversal at the level of COM control has not been investigated before. In current study, simulations of forward and backward walking at 4 km/h were generated for 10 healthy subjects. A perturbation analysis determined the contribution of the individual muscles to AP and UD COM acceleration in both conditions. Our results showed indeed both time and function reversal in muscle contributions in AP direction, i.e. muscles that accelerate the COM in forward walking become decelerators of the COM during backward walking and vice versa. In vertical direction, muscle contributions only showed a time-reversal, but their function, i.e. opposing gravity, remains the same in both walking directions. Some muscles showed direction and phase specific adjustments in contributions to COM acceleration. The fact that similar muscles can be used to achieve the majority of functional and even opposing demands during both forward and backward walking supports the idea of a common spinal mechanism (e.g. central pattern generator, CPG) responsible for both forward and backward walking. For some muscles however a time-reversal is insufficient, and additional (supraspinal) modulation is required to meet direction-specific demands.The second study analyzed how COM movement is controlled during normal speed and very slow walking, and if sagittal and ML plane control is coupled. Controlling ML COM motion during gait is very important to maintain balance, especially at very slow walking speeds. Previous simulation studies already investigated the effect of walking speed on muscle contributions in both the sagittal plane and ML direction. However, these studies did not consider speeds comparable with gait speeds seen after stroke. It therefore remains unclear how the ML COM motion is controlled and how it is coupled to sagittal plane control at these very slow speeds. In our study, simulations (n=12) were generated of very slow (1 km/h) and normal (4 km/h) walking speeds. Individual contributions of muscles and gravity to COM accelerations in AP, UD and ML direction were calculated. Our results showed that most muscle contributions decrease when walking speed decreased from normal to very slow walking. This decrease coincides in both the sagittal plan and ML direction, therefore confirming a coupled control. However, gluteus medius (GMED), the prime contributor to control in ML direction, showed an uncoupling: GMED contributions to medial accelerations of the COM decreased, while contributions to sagittal plane accelerations increased. This difference was mainly due to the direction-specific changes of the acceleration potential of GMED. While GMED contributions to ML COM control decreased at slow speed, a tight balance in ML direction is still needed to counteract the increased destabilizing effect of gravity. When walking speed increases, GMED has a unique role in maintaining ML balance, while increased contributions from other muscle are important for both propulsion, support and balance.In the third study, we investigated how asymmetric gait changes muscle contributions to COM accelerations compared to symmetric gait in healthy subjects. To induce an asymmetric gait pattern in healthy subjects, split-belt walking, with two belts running at a different speed, was used. Previous experimental studies showed that EMG activity during split-belt walking was modulated compared to symmetric, tied-belt walking. However, no studies so far documented the adaptations of the slow and fast leg muscle contributions to COM accelerations during asymmetric, limping like walking in the absence of pathology. Our study generated simulations of split-belt walking (slow leg at 1 km/h, fast leg at 4 km/h) and the corresponding tied-belt conditions in 12 healthy subjects. Subsequently, a perturbation analysis determined the individual muscle contributions to AP, UD and ML accelerations of the COM. Our results showed that the different contributions in the slow and the fast leg cannot be attributed to a simple difference in speed as most contributions differed from the corresponding tied-belt condition. Instead, we found muscle-specific alterations in contributions that increased, decreased or even reversed the asymmetry expected, based on the asymmetry between the tied-belt conditions at the corresponding speeds. These modulations induce limping-like walking in healthy subjects. Moreover, most of the asymmetry patterns observed in healthy subjects agreed with reported adaptation patterns in hemiparetic subjects after stroke. We therefore conclude that these are related with the limping itself. Exceptions were the reorganizations in GMED and biceps femoris short head, which are thought to be related to concomitant deficits rather than directly to limping.In the last study, a simulation framework was developed to investigate the contribution of increased muscle spindle feedback in combination with altered feedback modulation to hemiparetic gait patterns after stroke. A range of impairments (e.g. muscle weakness, balance problems) are thought to contribute to hemiparetic gait deficits and amongst these spasticity is commonly mentioned as an underlying cause. However, the exact contribution of spasticity is often disputed. To investigate the effect of altered neural control to gait kinematics, forward simulations were generated. To this aim, the standard musculoskeletal model was extended with a neural control model. The neural control model included muscle length and velocity feedback of plantarflexors (soleus and gastrocnemius) and quadriceps (rectus femoris and vasti). We found that both increased length and velocity feedback induced gait deviations that are often reported in hemiparetic gait. Moreover the altered modulation pattern even reinforced the effects of the increased feedback, especially during swing. Overall, this work contributes to a better fundamental understanding of how COM movement is controlled during complex modalities of gait. More specifically, we acquired a better insight in the causal relationships between individual muscle contributions and the resulting motion of the COM, and this during backward walking, very slow walking and asymmetric walking in healthy subjects. Comparing our results with hemiparetic gait patterns increased the understanding to what extent mechanical and neural mechanisms contribute to hemiparetic gait. Furthermore, the implementation of a neuro-musculo-skeletal model provides opportunities for future research on how pathological neural control influences gait.
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Het leren van motorische vaardigheden is een belangrijke dimensie binnen de normale ontwikkeling van elk kind of volwassene. Heel wat dagdagelijkse activiteiten, al dan niet tijdens het uitvoeren van een beroep of sport zoals typen, autorijden, fietsen of hoogspringen vergen immers een nauwkeurige coördinatie van de onderste en/of bovenste ledematen. Het leren van deze interledematen coördinatiepatronen vereist dat de uitvoerder een representatie opbouwt van de manier waarop de juiste beweging wordt uitgevoerd om dezelfde beweging later opnieuw te kunnen uitvoeren. Je moet met andere woorden in je hersenen opslaan welke beweging je hebt geleerd en hoe je die moet uitvoeren, net zoals je leert lezen of schrijven en dat blijft onthouden. Zowel vanuit onze eigen ervaring, als vanuit wetenschappelijk onderzoek weten we dat het frequent herhalen van een beweging leidt tot verbetering van de prestatie en automatisering en dus tot het scherper stellen van deze interne bewegingsrepresentatie. Ondanks het feit dat (motorisch) leren een dagelijks fenomeen is, weten we nog steeds niet eenduidig waaruit de representatie is opgebouwd: namelijk hoe en waar een beweging wordt opgeslagen. De doelstelling van dit doctoraatsproject is daarom het bestuderen van de kenmerken van de bewegingsrepresentatie die in het centraal zenuwstelsel opgeslagen wordt na het leren van coördinatiepatronen. Een manier om een bewegingsrepresentatie te bestuderen is transfer onderzoek. Onder transfer verstaat men de positieve of negatieve invloed van het verwerven van een (motorische) taak A op het uitvoeren van deze taak in een andere context (A') enerzijds of op het leren van een nieuwe vaardigheid (B) anderzijds. Bijvoorbeeld: je leert als kind volleyballen (taak A) en de vaardigheden die je hierbij leert kan je transfereren naar beachvolleybal (A' zelfde taak, andere context) of naar tennis (taak B). Het leren van je eerste taak A kan het aanleren van andere taak A' of B bevorderen of juist verstoren. Door het aanleren van een nieuw bewegingspatroon en de transfer van deze geleerde vaardigheid naar andere ledematen, wensen we na te gaan of de reorganisatie van de hersenen het toelaat om de aangeleerde skill te generaliseren naar andere condities. Positieve transfer resultaten suggereren dat de geleerde vaardigheid A op een relatief abstracte manier wordt opgeslagen in het geheugen, waarna de representatie later terug kan aangesproken worden om de taak te sturen als die door andere ledematen wordt uitgevoerd. Multiledematen coördinatiepatronen zijn taken waarbij twee of meer ledematen met elkaar gecoördineerd moeten worden en die dus een intensief leerproces vergen. Onze resultaten tonen aan dat deze bewegingen deels effector-onafhankelijk, deels effector-specifiek wordt opgeslagen. Dit betekent dat je een bewegingspatroon wel kan transfereren van de ene lichaamszijde naar de andere: bijvoorbeeld je leert een taak met je rechterarm en transfereert die naar je linkerarm omdat je het globale bewegingspatroon onafhankelijk van de ledematen hebt opgeslagen. Anderzijds betekent dat ook dat er interferentie optreedt tussen twee gelijkaardige taken als die met dezelfde effector worden uitgevoerd. Deze negatieve transfer treedt op omdat de opgeslagen effector-specifieke representatie interfereert met de opbouw van de nieuwe taak. De bewegingsrepresentatie wordt opgeslagen in onze hersenen in een parietaal-premotorisch netwerk, met lateralisatie van de activatie in de linker hemisfeer. Een betere kennis omtrent de manier waarop een beweging wordt gerepresenteerd is nuttig om trainingsprogramma's samen te stellen voor (top)sporters, maar eveneens voor het opstellen van efficiënte revalidatieprogramma's.
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