Neurologic

Considerations
for Movement
Human movement is controlled and monitored by the
nervous system. The nature of this control is such that
many muscles may have to be activated to perform a
vigorous movement such as sprinting, or only a few
muscles may have to be activated to push a doorbell or
make a phone call.
General Organization
of the Nervous System

The nervous system consists of

two parts, the central
nervous system and the
peripheral nervous system,
both
illustrated in Figure 4-1. The
central nervous system
consists of the brain and the
spinal cord and should
beviewed as the means by
which human movement is
initiated,
controlled, and monitored.
The peripheral nervous system consists of all of the
branches of nerves that lie outside the spinal cord. The
peripheral nerves primarily responsible for muscular action
are the spinal nerves, which enter on the posterior, or
dorsal, side of the vertebral column and exit on the anterior,
or ventral, side at each vertebral level of the spinal
cord. Eight pairs of nerves enter and exit the cervical
region, 12 pairs at the thoracic region, five at the lumbar
region, five in the sacral region, and one in the coccygeal
region. The pathways of the nerves are presented for
the upper and lower extremities in Figures 4-2 and 4-3,
respectively.
STRUCTURE OF THE
MOTONEURON Motoneurons
The neuron is the functional
unit of the nervous system
that carries information to and
from the nervous system.
The structure of a neuron,
specifically the motoneuron,
warrants examination to clarify
the process of muscular
contraction. Figure 4-4 shows a
close-up view of the neuron
and the neuromuscular
junction.
The dendrites are bunched to
form small
bundles. A bundle contains
dendrites from other neurons
and may consist of dendrites
from different spinal cord
levels or different neuron pools.
The composition of the
bundle changes as dendrites
are added and subtracted.
This arrangement facilitates
cross-talk between neurons.
THE MOTOR UNIT

The structure of the motor unit

was introduced in
Chapter 3, in which we
concentrated on the action of
the
muscles in the motor unit. In
this section, we concentrate
on the nervous system portion
of the motor unit. The
neuron, cell body, dendrites,
axon, branches, and muscle
fibers constitute the motor unit
(Fig. 4-6).
When a motor unit is activated
sufficiently, all of the
muscle fibers belonging to it
contract within a few
milliseconds.
This is referred to as the all-or-
none principle.
Motor Unit Types
 Three different types of motor units exist, corresponding
to the three fiber types discussed in the previous chapter:
slow-twitch oxidative (type I or S), fast-twitch oxidative
(type IIa or FR), and fast-twitch glycolytic (type IIb or
FF). Performance and size differences are illustrated in
Figure 4-7. All three types of muscle fibers are found in all
muscles, but the proportion of fiber types within a muscle
varies. Whereas certain muscles, such as the soleus, consist
primarily of type I muscle fibers and motor units, muscles
such as the vastus lateralis are approximately 50% type I
and the remainder type II.
All of the muscle fibers in a motor unit are of the same
type. The fast-twitch glycolytic motor units (type IIb) are
innervated by very large alpha motoneurons that conduct
the impulses at very fast velocities (100 m/s), creating
rapid contraction times in the muscle (approximately 30
to 40 ms) (13).
NEURAL CONTROL OF FORCE
OUTPUT
 Chapter 3 explored a number of factors such as
muscle cross section that determines maximal
force produced by a muscle. We also stated that
the force exerted by a motor unit is determined
by the number of fibers innervated by the motor
unit and the rate at which the motor unit
discharges the impulse or action potential (19).
When a muscle is producing its maximal force, all
motor units are activated and all muscle fibers are
active.
MOTOR POOL
 Groups of neurons in the spinal cord
that innervate a single muscle are
termed a motor pool. Pool sizes
range from a few hundred to a
thousand depending on the size of
the muscle. Motor neurons in the
pool vary in electrical properties,
amplitude of the input they receive,
and in contractile properties (e.g.,
speed, force generation, and fatigue
resistance) (19).
RECRUITMENT
 The tension or force generated
by a muscle is determined by
the number of motor units
actively stimulated at the same
time and by the frequency at
which the motor units are
firing. Recruitment, the term
used to describe the order of
activation of the motor units, is
the prime mechanism for force
production in the muscle.
In running, more motor units are
recruited, with some high-threshold
units recruited for the peak output
times in the cycle. Furthermore, the
low-threshold units are recruited for
activities such as walking and
jogging, and the fast-twitch fibers
are recruited in activities such as
weight lifting (14,25). Recruitment
sequences for walking and for
different exercise intensities are
presented in Figure 4-8.
Rate Coding

 The frequency of motor unit firing can also

influence the amount of force or tension
developed by the muscle. This is known as
frequency coding or rate coding and
involves intermittent high-frequency bursts
of action potentials or impulses ranging from
three to 120 impulses per second (53).
The action potential in a motor unit can be facilitated
or inhibited by the input it receives from the many
neurons that are connecting to it within the spinal cord.
As shown in Figure 4-10 a motor unit receives synaptic
input from other neurons and from interneurons, which
are connecting branches that can be both excitatory and
inhibitory.
Sensory Receptors and Reflexes

 The body requires an input system to provide

feedback on the condition and changing
characteristics of the musculoskeletal system
and other body tissues, such as the skin.
 Another type of reflex is the
supraspinal reflex, which
brings information into the spinal cord and
processes it in
the brain. The result is a motor response.
The labyrinthine
righting reflex is an example of this type
of reflex.
This reflex is stimulated by leaning, being
upside down,
or falling out of an upright posture. The
response from
the upper centers is to stimulate a motor
response from
the neck and limbs to maintain or move to
an upright
position. This complex reflex involves many
levels of the
spinal cord and the upper centers of the
nervous system.
Examples of these various reflex actions are
presented in
Figure 4-12.
MUSCLE SPINDLE
Proprioceptors are sensory receptors in the
musculoskeletal
system that transform mechanical distortion in
the muscle or joint, such as any change in joint
position,
muscle length, and muscle tension, into nerve
impulses
that enter the spinal cord and stimulate a motor
response
(63). The muscle spindle is a proprioceptor found
in
higher abundance in the belly of the muscle lying
parallel
to the muscle fibers and actually connecting into the
fascicles via connective tissue (Fig. 4-13). The
nuclear bag fiber has a large cluster of nuclei in
its center. It is also thicker, and its fibers connect to
the
capsule and to the actual connective tissue of the
muscle fiber itself.
THE SHORTENING OF THE ENDS OF THE
THE SECONDARY AFFERENTS ARE
SPINDLE FIBERS THROUGH GAMMA INNERVATION ALLOWS TUNING
MUSCLE LENGTH SENSORS WITH SOME SENSITIVITY TO RATE OF
OF THE MUSCLE SPINDLE TO MEET THE NEEDS OF THE MOVEMENT
CHANGE IN LENGTH. FIGURE 4-15 ILLUSTRATES THE RESPONSE OF
PARAMETERS (FIG. 4-14).
THE PRIMARY AND SECONDARY AFFERENTS IN THE ABSENCE OF ANY
GAMMA INNERVATION WITH STRETCH OF THE MUSCLE, A QUICK TAP
OF THE MUSCLE, A CYCLIC STRETCH AND RELEASE, AND WITH THE
RELEASE OF THE STRETCH.
Type Ia loop
is illustrated in Figure 4-16. It is also termed autogenic
facilitation because of the facilitation of the alpha
motoneurons
of the same muscle.
The afferent
pathways, gamma pathways, and alpha pathways
are all
part of the gamma loop, which is shown in
Figure 4-17.
GOLGI TENDON ORGAN

 Another important proprioceptor

significantly influencing muscular action is
the Golgi tendon organ (GTO). This structure
monitors force or tension in the muscle. As
illustrated in Figure 4-18, the GTO lies at the
musculoskeletal junction.
TACTILE AND JOINT
SENSORY
RECEPTORS

There is limited information on

the sensory neuron input
from the tactile and joint
receptors placed in and around
the synovial joints (Fig. 4-19).
One such tactile receptor,
the Ruffini ending, lies in the
joint capsule and responds
to change in joint position and
velocity of movement of
the joint (54).
Effect of Training and Exercise

 During training of the muscular system, a

neural adaptation modifies the activation
levels and patterns of the neural input to the
muscle. In strength training, for example,
significant strength gains can be
demonstrated after approximately four
weeks of training.
The influence of
training on
both the
electromechanical
delay (EMD) and
the amount
of
electromyographic
(EMG) activity is
presented from the
work of Hakkinen
and Komi (26) in
Figure 4-20.
FLEXIBILITY EXERCISE

 Flexibility is viewed by many to be an

essential component of physical fitness and is
seen as an important component of
performance in sports such as gymnastics
and dance.
 Flexibility can be increased with a stretching
program.
This plastic deformation
is a long-term increase in the length of the muscle
and carries over from day to day (41). A model describing
the behavior of the elastic and plastic elements acting in a
stretch is presented in Figure 4-21.
Proprioceptive Neuromuscular
Facilitation
 Proprioceptive neuromuscular facilitation
(PNF) is a technique used to stimulate
relaxation of the stretched muscle so that the
joint can be moved through a greater range
of motion (36). This technique, used in
rehabilitation settings, can also be put to
good use with athletes and individuals who
have limited flexibility in certain muscle
groups, such as the hamstrings (56).
Examples of PNF exercises for the muscles of
the hip and
shoulder joint are presented in Figure 4-22.
PLYOMETRIC EXERCISE

 The purpose of plyometric training is to

improve the velocity and power output in a
performance. Plyometric training has been
effective in increasing power output in
athletes in sports such as volleyball,
basketball, high jumping, long jumping,
throwing, and sprinting.
Plyometric Examples
Electromyography

 The electrical activity in the muscle can be

measured with EMG. This allows for the
measurement of the change in the
membrane potential as the action potentials
are transmitted along the fiber. The study of
muscle from this perspective can be valuable
in providing information concerning the
control of voluntary and reflexive
movements.
THE ELECTROMYOGRAM
 The electromyogram is the
profile of the electrical signal
detected by an electrode on a
muscle, that is, it is the measure of
the action potential of the
sarcolemma. The EMG signal is
complex and is the composite of
multiple action potentials of all
active motor units superimposed
on each other. Figure 4-24
illustrates the complexity of the
signal. Note that the raw signal has
both positive and negative
components.
RECORDING AN
ELECTROMYOGRAPHIC SIGNAL
SURFACE ELECTRODES CAN BE PLACED IN EITHER A
ELECTRODES MONOPOLAR
OR BIPOLAR ARRANGEMENT (FIG. 4-25).

 The EMG signal is recorded using an

electrode. An electrode, which acts
like an antenna, may be either
indwelling or on the surface.
 The indwelling electrode, which
may be either a needle or fine wire,
is placed directly in the muscle.
 Surface electrodes are placed on
the skin over a muscle and thus are
mainly used for superficial muscles;
they should not be used for deep
muscles.
Amplification of the Signal

 The EMG signal is relatively small, varying

from 10 to 5 mV. It is therefore imperative
that the signal be amplified, generally up to a
level of 1 V. The usual type is the differential
amplifier, which can amplify the EMG signal
linearly without amplifying the noise or error
in the signal.
FACTORS AFFECTING THE
ELECTROMYOGRAM
 Any of a number of factors, both physiologic and
technical, can influence the interpretation of an EMG
signal (35) (Fig. 4-26). It is essential to fully understand
these factors before a knowledgeable interpretation of
the EMG signal can be made.
ANALYZING THE SIGNAL
 Except under special
circumstances, it is difficult to
record a single action
potential. Thus, we are left
with a signal made up of
numerous action potentials
from many motor units.
 Rectification involves taking
the absolute value of the raw
signal, that is, making all
values in the signal positive. At
this point, a linear envelope
may be determined.
 Figure 4-27 illustrates the
results of these procedures.
 The EMG signal has
also been analyzed in
the frequency domain
so that the frequency
content of the signal
can be determined. In
this case, the power of
the signal is plotted as
a function of the
frequency of the signal
(Fig. 4-28).
Electromechanical Delay
 When a muscle is activated by
a signal from the nervous
system, the action potential
must travel the length of the
muscle before tension can be
developed in the muscle. Thus,
a temporal disassociation or
delay is seen between the
onset of the EMG signal and
the onset of the development
of force in the muscle. Figure
4-29 illustrates this concept.
APPLICATION OF
ELECTROMYOGRAPHY
MUSCLE FORCE–
ELECTROMYOGRAPHY RELATIONSHIP
 In isometric conditions, the
relationship between muscle force and
EMG activity is relatively linear (32,43).
That is, for a given increment in muscle
force, there is a concomitant increase
in EMG amplitude. These increases in
EMG amplitude are probably produced
by a combination of motor unit
recruitment and an increase in motor
unit firing rate. Many relationships,
however, including both linear and
curvilinear, between EMG and force
have been suggested for different
muscles (6) (Fig. 4-30).
Muscle Fatigue
 EMG has greatly enhanced the study of
muscle fatigue.
 Fatigue can result from either
peripheral (muscular) or central
(neural) mechanisms, although EMG
cannot directly determine the exact
site of the fatigue.
 This section briefly discusses local
muscle fatigue. When a motor unit
fatigues, the frequency content and
the amplitude of the EMG signal
change (3).
 The signal in the frequency domain
shifts toward the low end of the
frequency scale, and the amplitude
increases (Fig. 4-31).
Clinical Gait Analysis
 In the clinical setting, a
gait analysis often
involves EMG to
determine which muscle
group is used at a
particular phase of the
gait cycle (55).
 Figure 4-32 illustrates
typical EMG activity of
lower extremity muscle
groups during walking.
 LIMITATIONS OF
ERGONOMICS ELECTROMYOGRAPHY
 EMG has been used in  At best, EMG is a
ergonomics for many semiquantitative technique
applications. because it gives only
indirect information
regarding the strength of
the contraction of muscles.