william Z rymer | Northwestern University (original) (raw)

Papers by william Z rymer

Archives of Physical Medicine and Rehabilitation, Sep 1, 2019

Conflict of Interest: Honda R&D partially funded this project and provided SMA devices for use in... more Conflict of Interest: Honda R&D partially funded this project and provided SMA devices for use in the study. However, this group did not play any other role or influence in the design, implementation, or outcomes of the study.

Journal of Neurophysiology, May 1, 1988

Although the lesion-induced alterations in motoneuron discharge may have resulted in part from ch... more Although the lesion-induced alterations in motoneuron discharge may have resulted in part from changes in transmission in certain segmental reflex pathways, we propose that the lesion also produces an acute change in the intrinsic membrane properties of amotoneurons. Such a change could follow a reduction in the local concentration of some neuromodulator substance that normally regulates the magnitude or time course of a voltage-sensitive ionic conductance involved in repetitive discharge behavior.

Journal of Neurophysiology, May 18, 2022

We examined whether the intermittent versus the continuous adaptation to external perturbation in... more We examined whether the intermittent versus the continuous adaptation to external perturbation induces greater retention of the adapted locomotion in stroke survivors. We found that participants showed longer retention of the improved weight shift and enhanced muscle activation for the intermittent versus the continuous conditions, suggesting that repeated motor adaptation and de-adaptation to the pelvis perturbation may promote the retention of error-based motor learning for improving weight shift toward the paretic side in individuals poststroke.

Publisher, 2019

Journal of Biomechanics, 2019

Journal of Neurophysiology, Jul 1, 2023

Application of constraint force to the nonparetic leg during overground walking induced improved ... more Application of constraint force to the nonparetic leg during overground walking induced improved lateral weight shifts toward the paretic leg and enhanced muscle activity of the paretic leg during walking. In addition, one session of overground walking with constraint force might induce an increase in propulsive force of the paretic leg and an increase in self-selected overground walking speed, which might be partially due to the improvement in motor control of the paretic leg.

Neurology, Dec 19, 2018

Objective To test the hypothesis that gait training with a hip-assistive robotic exoskeleton impr... more Objective To test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke. Methods Fifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6-8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation. Results The primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029). Conclusions Gait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training. Clinicaltrials.gov identifier NCT01994395. Classification of evidence This study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.

Journal of stroke and cerebrovascular diseases, Apr 1, 2023

In addition to changes in the central nervous system, many changes can occur in the composition a... more In addition to changes in the central nervous system, many changes can occur in the composition and structure of skeletal muscles after a hemispheric stroke. The mechanical behavior of skeletal muscles is linked to the density and structural arrangement of key constituents. Yet, little is known about changes in post-stroke muscle mechanical properties such as viscoelasticity. The aim of this study was to explore the frequency-dependent changes in shear wave (SW) velocity as a potentially informative feature accompanying changes in muscle viscoelastic properties under passive and active conditions in hemiplegic stroke. We used the ultrasound SuperSonic Imaging technique to induce and measure SW propagation in the biceps brachii muscle for both the paretic and contralateral limbs in three hemiplegic stroke survivors during passive and submaximal voluntary muscle contractions. We found that for all subjects, the muscles on both the paretic and non-paretic sides demonstrated large dispersion (i.e., a change in SW phase velocities as a function of frequency within each contraction level) under both passive and active conditions, although muscles on the paretic side displayed larger dispersion. In addition, for a range of frequencies from 108-756 Hz, the SW phase velocity was higher in active nonparetic muscles compared to those of paretic side with an increase of 42% at 756 Hz. This is in contrast with the muscle response under passive condition where the SW phase velocity exhibited a 97 % increase at 765Hz on the paretic side compared to the non-paretic side. These results suggest the mechanical properties are altered for stroke-affected muscles, which may be a result of changes in the muscle extracellular matrix composition. Further, this study provides evidence that there are changes in tissue mechanical properties and that may consequently influence muscle function.

arXiv (Cornell University), Aug 24, 2022

Population recordings of human motor units display 'onion skin' discharge patternsimplications fo... more Population recordings of human motor units display 'onion skin' discharge patternsimplications for voluntary motor control. Over the past two decades, there has been a radical transformation in our ability to extract useful biological signals from the surface electromyogram (EMG). Advances in EMG electrode design and signal processing techniques have resulted in an extraordinary capacity to identify motor unit spike trains from the surface of a muscle. These EMG grid, or high-density surface EMG (HDsEMG), recordings now provide accurate depictions of as many as 20-30 motor unit spike trains simultaneously during isometric contractions, even at high forces. Such multi-unit recordings often display an unexpected feature known as 'onion skin' behavior, in which multiple motor unit spike trains show essentially parallel and organized increases in discharge rate with increases in voluntary force, such that the earliest recruited units reach the highest discharge rates, while higher threshold units display more modest rate increases. This sequence results in an orderly pattern of discharge resembling the layers of an onion, in which discharge rate trajectories stay largely parallel and rarely cross. Our objective in this review is to explain why this pattern of discharge rates is unexpected, why it does not accurately reflect our current understanding of motoneuron electrophysiology, and why it may potentially lead to unpredicted disruption in muscle force generation. This review is aimed at the practicing clinician, or the clinician scientist. More advanced descriptions of potential electrophysiological mechanisms associated with 'onion skin' characteristics targeting the research scientist will be provided as reference material.

Frontiers in Human Neuroscience

The generation of isometric force at the hand can be mediated by activating a few motor modules. ... more The generation of isometric force at the hand can be mediated by activating a few motor modules. Stroke induces alterations in motor modules underlying steady-state isometric force generation in the human upper extremity (UE). However, how the altered motor modules impact task performance (force production) remains unclear as stroke survivors develop and converge to the three-dimensional (3D) target force. Thus, we tested whether stroke-specific motor modules would be activated from the onset of force generation and also examined how alterations in motor modules would induce changes in force representation. During 3D isometric force development, electromyographic (EMG) signals were recorded from eight major elbow and shoulder muscles in the paretic arm of 10 chronic hemispheric stroke survivors and both arms of six age-matched control participants. A non-negative matrix factorization algorithm identified motor modules in four different time windows: three “exploratory” force ramping...

Frontiers in Neurology, 2021

Frontiers in Neurology, 2020

This article addresses the potential clinical value of techniques based on surface electromyograp... more This article addresses the potential clinical value of techniques based on surface electromyography (sEMG) in rehabilitation medicine with specific focus on neurorehabilitation. Applications in exercise and sport pathophysiology, in movement analysis, in ergonomics and occupational medicine, and in a number of related fields are also considered. The contrast between the extensive scientific literature in these fields and the limited clinical applications is discussed. The "barriers" between research findings and their application are very broad, and are longstanding, cultural, educational, and technical. Cultural barriers relate to the general acceptance and use of the concept of objective measurement in a clinical setting and its role in promoting Evidence Based Medicine. Wide differences between countries exist in appropriate training in the use of such quantitative measurements in general, and in electrical measurements in particular. These differences are manifest in training programs, in degrees granted, and in academic/research career opportunities. Educational barriers are related to the background in mathematics and physics for rehabilitation clinicians, leading to insufficient basic concepts of signal interpretation, as well as to the lack of a common language with rehabilitation engineers. Technical barriers are being overcome progressively, but progress is still impacted by the lack of user-friendly equipment, insufficient market demand, gadget-like devices, relatively high equipment price and a pervasive lack of interest by manufacturers. Despite the recommendations provided by the 20-year old EU project on "Surface EMG for Non-Invasive Assessment of Muscles (SENIAM)," real international standards are still missing and there is minimal international pressure for developing and applying such standards. The need for change in training and teaching is increasingly felt in the academic world, but is much less perceived in the health delivery system and clinical environments. The rapid technological progress in the fields of sensor and measurement technology (including sEMG), assistive devices, and robotic rehabilitation, has not been driven by clinical demands. Our assertion is that the most important and urgent interventions concern enhanced education, more Campanini et al. Surface Electromyography: Barriers Limiting Use effective technology transfer, and increased academic opportunities for physiotherapists, occupational therapists, and kinesiologists.

IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2020

The purpose of this study was to determine whether activation of muscles in the paretic leg, part... more The purpose of this study was to determine whether activation of muscles in the paretic leg, particularly contributing to propulsion, and gait symmetry can be improved by applying a targeted resistance force to the pelvis in the backward direction during stance phase while walking in individuals post-stroke. Thirteen individuals post-stroke participated in two experimental sessions, which consisted of treadmill walking, with either targeted or constant resistances, together with overground walking. For the targeted condition, a resistance force was applied to the pelvis during the stance phase of the paretic leg. For the constant condition, the resistance force was applied throughout the whole gait cycle. Participants showed greater increase in medial hamstring muscle activity in the paretic leg and improved step length symmetry after the removal of targeted resistance force, compared to effects of a constant resistance force (P < 0.03). In addition, treadmill walking with the targeted resistance induced more symmetrical step length during overground walking 10 min after the treadmill walking, compared to the result of the constant resistance force (P = 0.01). Applying a targeted resistance force to the pelvis during the stance phase of the paretic leg may induce an enhanced use of the paretic leg and an improvement in gait symmetry in individuals post-stroke. These results provide evidence showing that applying a targeted resistance to the pelvis may induce a forced use of the paretic leg during walking.

Muscle & Nerve, 2020

Limb contractures are debilitating complications associated with various muscle and nervous syste... more Limb contractures are debilitating complications associated with various muscle and nervous system disorders. This report summarizes presentations at a conference at the Shirley Ryan AbilityLab in Chicago, Illinois, on April 19–20, 2018, involving researchers and physicians from diverse disciplines who convened to discuss current clinical and preclinical understanding of contractures in Duchenne muscular dystrophy, stroke, cerebral palsy, and other conditions. Presenters described changes in muscle architecture, activation, extracellular matrix, satellite cells, and muscle fiber sarcomeric structure that accompany or predispose muscles to contracture. Participants identified ongoing and future research directions that may lead to understanding of the intersecting factors that trigger contractures. These include additional studies of changes in muscle, tendon, joint, and neuronal tissues during contracture development with imaging, molecular, and physiologic approaches. Participants ...

Applied Bionics and Biomechanics, 2018

Despite the fundamental importance of muscle coordination in daily life, it is currently unclear ... more Despite the fundamental importance of muscle coordination in daily life, it is currently unclear how muscle coordination adapts when the musculoskeletal system is perturbed. In this study, we quantified the impact of selective muscle weakness on several metrics of muscle coordination. Seven healthy subjects performed 2D and 3D isometric force target matches, while electromyographic (EMG) signals were recorded from 13 elbow and shoulder muscles. Subsequently, muscle weakness was induced by a motor point block of brachialis muscle. Postblock subjects repeated the force generation tasks. We quantified muscle coordination pre- and postblock using three metrics: tuning curve preferred direction, tuning curve area, and motor modules analysis via nonnegative matrix factorization. For most muscles, the tuning direction for the 2D protocol was not substantially altered postblock, while tuning areas changed more drastically. Typically, five motor modules were identified from the 3D task, and ...

Journal of NeuroEngineering and Rehabilitation, 2019

Background Spasticity, characterized by hyperreflexia, is a motor impairment that can arise follo... more Background Spasticity, characterized by hyperreflexia, is a motor impairment that can arise following a hemispheric stroke. While the neural mechanisms underlying spasticity in chronic stroke survivors are unknown, one probable cause of hyperreflexia is increased motoneuron (MN) excitability. Potential sources of increased spinal MN excitability after a stroke include increased vestibulospinal (VS) and/or reticulospinal (RS) drive. Spasticity, as clinically assessed in stroke survivors, is highly lateralized, thus RS contributions to stroke-induced spasticity are more difficult to reconcile, as RS nuclei routinely project bilaterally to the spinal cord. Yet studies in stroke survivors suggest that there may also be changes in neuromodulation at the spinal level, indicative of RS tract influence. We hypothesize that after hemispheric stroke, alterations in the excitability of the RS nuclei affect both sides of the spinal cord, and thereby contribute to increased MN excitability on bo...

IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2019

The purpose of this study was to examine the effects of combined pelvic corrective force and visu... more The purpose of this study was to examine the effects of combined pelvic corrective force and visual feedback during treadmill walking on paretic leg muscle activity and gait characteristics in individuals with post-stroke hemiparesis. Fifteen chronic stroke participants completed visual feedback only and combined pelvic corrective force and visual feedback conditions during treadmill walking. Each condition included: 1-minute baseline, 7-minute training with visual feedback only or additional pelvic corrective force, 1-minute post training, 1-minute standing break, and another 5-minute training. EMGs from the paretic leg muscles and step length were measured. Overground walking was evaluated before treadmill walking, immediately and 10 minutes after treadmill walking. Greater increases in integrated EMG of all muscles, except vastus medialis and tibialis anterior, were observed with the application of additional pelvic corrective force compared to visual feedback only during treadmill walking. Overground walking speed significantly increased after treadmill training with combined pelvic correction force and visual feedback, but was not significant for the visual feedback only condition. Voluntary weight shifting with additional pelvic corrective force enhanced paretic leg muscle activities and improved gait characteristics during walking. Individuals with post-stroke hemiparesis could adapt feedforward control and generalize the adaptation to overground walking.