HUMAN MOTOR PERFORMANCE IN ACTION
by Professor Oona M Scott,
School of Health and Bioscience, University of East London, England
Introduction
Instituted in 1995, we opened the first two human motor performance laboratories
in the School of Health and Bioscience at the University of East London (UEL)
in 1996. Led by Professor Oona Scott, the Human Motor Performance Group (HMPG)
currently has six researchers: Fiona Coutts, Dr Mary Cramp, Jane Culpan, Dr
Wendy Drechsler, and Roz Coombs, with Duncan Kennedy providing technical support.
Dr Helen Dawes, now at Oxford Brookes, and Dr Andrew Bateman, now at the Oliver
Zangwill Centre near Cambridge, are still in close contact as recent members
of the group.
The Group's research programme focuses on how physical activity impacts physiological
function and mitigates the effects of disease and trauma. Operating with a multi-disciplinary
team in areas of emerging science, the emphasis is on research into motion analysis,
neural control mechanisms, changes in skeletal muscle contractile properties
and neural activation together with oxygen uptake as a measure of physical fitness.
The aim of our current scientific programme is to identify patho-physiological
mechanisms contributing to motor dysfunction.
Early work (1996-2001)
There were two essential components in the Group's early work; investigating
changes in the contractile properties of skeletal muscle associated with damage
to the neural control mechanisms and establishing a motion analysis laboratory
to study recovery and restoration of
functional performance.
Figure 1: Three international students, Maria Douridas, Ngosi Onwudimegwu and Anastasia Protopapadaki,working together on their results in the Muscle Function Laboratory, School of Health and Bioscience, UEL.
Alterations in human muscle and
central control mechanisms
Mary Cramp working with Oona Scott, focused on methodologies to study physiological
changes in muscles and neural control mechanisms. Building on earlier studies1,
we established that long-term electrical stimulation results in change in strength
and fatigue resistance, and that the effects are dependent on pattern of stimulation,
uniform or mixed and muscle state2. Funded by the Stroke
Association, we studied the sequential physiological changes in muscle function
and neural control mechanisms in 50 stroke patients during the first six months
post-onset. Muscles of both paretic and non-paretic limbs were weak following
stroke. We found a close relationship between muscle weakness and walking velocity3
and that the pattern of spinal reciprocal inhibition between lower limb muscles
was related to walking ability4.
Aerobic training in head injured
subjects
At the same time, Oona Scott and Andrew Bateman were joined by Jane Culpan and
Helen Dawes and together with Dr Richard Greenwoood, Consultant Neurologist
at the Regional Neurological Rehabilitation Unit (RNRU), Homerton Hospital and
Dr Jane Powell, Clinical Psychologist at Goldsmith's College, investigated the
effects of aerobic training in brain injured patients. Completing a three year
grant-funded multi-centered randomised controlled evaluation study (n = 157),
we showed that aerobic training on a cycle ergometer significantly increased
exercise capacity during in-patient rehabilitation after acquired brain injury
(ABI) 5.
Motion analysis
Over the same period, work was begun in establishing a motion analysis system,
setting up and validating the use of the Kinemetrix Motion Analysis System ®
and Bertec force platform ® (MIE Ltd., Leeds UK) 6, 7.
Working with Fiona Coutts and Wendy Drechsler, early contributions in developing
the movement laboratory came from David Hooper (1996-1999), an internally funded
postdoctoral engineer, and Dr Matthew Morrissey (1994-2000) and enabled their
investigations into trauma and recovery following knee injury. Matthew Morrissey
developed his own research group looking at knee training after injury, transferring
to King's College London in December 2000. A comprehensive series of nine papers
have been published looking at the effects of open and closed kinetic chain
exercises and changes in gait analysis of walking and stair use at time intervals
after anterior cruciate ligament surgery.
Fiona Coutts was the key person both in developing and establishing the validity
of successive motion analysis systems and in the early work on knee trauma.
Co-author of 'Physiotherapy in orthopaedics: a problem-solving approach'8,
she drew on her extensive clinical and academic knowledge of the biomechanics
of human movement.
Current Research Interests
Each member of the Group pursues an individual area of work supported by postgraduate
research, MSc students and BSc project groups, while the overall concern has
been to (i) gain external research funding and subsequent publications, (ii)
increase international and national collaboration, and (iii) ensure completion
of PhD submissions while (iv) combining physiological, biomechanical and clinical
techniques in studying integrated function with associated neuromuscular control
systems.
The Group has support from Visiting Professors including: Dr Richard Greenwood,
RNRU, Homerton Hospital, Professor John Rothwell, Institute for Neurology and
Professor Gerta Vrbová, University College London, and has current clinical
links with Medical Consultants, Dr Richard Greenwood and Dr Anthea Lethmann,
Homerton Hospital and Dr Michael Gill, Newham General Hospital.
Achievements (1996-2003) include
(i) Funding from North Thames Regional Health Authority, £530k, charities
(Action Research & The Stroke Association), £230k and 12 Nuffield
and Wellcome studentships. Most recently Scientific Research Infrastructure
funding (£160k) provided for the purchase of Jaegar Oxygen uptake equipment
and Vicon's 612 motion analysis system - a cost effective solution to the problem
of capturing large amounts of data about human movement in a straightforward
yet comprehensive way.
(ii) International and national recognition, through 36 refereed publications,
22 invited presentations and numerous International and UK conference presentations.
(iii) Conference at UEL, 21-25 July 1998, with 250 delegates from a variety
of countries including scientists and therapists of international eminence,
to explore underlying issues in 'Human Motor Performance - Interaction between
Science and Therapy'. A two day scientific conference preceded two days of clinical
seminars with researchers presenting key advances in their own research and
discussing therapeutic implications with colleagues.
(iv) Supporting and encouraging young researchers with Andrew Bateman, Mary
Cramp, Helen Dawes and Wendy Drechsler awarded PhDs since 1996 and Fiona Coutts,
Rosalind Coombs and Jane Culpan due to complete in 2003/2004. This has been
complemented by 54 MSc projects completed, 22 student external publications
and 18 postgraduates known to have gone on to doctoral research.
(v) Opening new motion analysis and exercise laboratories by UEL Vice-Chancellor
Professor Mike Thorne, Vice-Chancellor of University of East London, July 2003.
Ongoing research projects
Physical intervention in individuals with acquired brain injury.
Programme of strength training
following stroke:
Having shown that physical deconditioning impacts on functional recovery, Mary
Cramp funded by the Stroke Association undertook two sequential studies of subacute
(3-12 months post-onset) ambulatory stroke survivors, one hospital based and
the other in a community leisure centre (n=16). This work enabled us to develop
a model circuit type strength-training programme which significantly improved
both muscle strength and walking function9
Limiting factors in capacity to exercise after head injury:
Helen Dawes completed her PhD in October 2000 and showed that the elevated rating
of perceived exertion seen in brain injured patients is not a significant factor
in limiting exercise capacity in individuals with acquired brain injury. Now
a senior lecturer in the School of Biological and Molecular Sciences at Oxford
Brookes University, her recent documents show a linear relationship between
heart rate and oxygen uptake during sub-maximal cycling exercise in patients
with head injury10; that increasing the workload does
not substantially effect energy costs in most patients with spasticity nor does
it increase spasticity or detrimentally affect movement11;
and additional cognitive tasks may affect performance in individuals with acquired
brain injury12.
These two combined studies of physiological and clinical measures of function
have resulted in advances in the understanding of motor control and the beneficial
effects of physical intervention early after head injury and stroke.
Figure 2: Demonstration of Vicon equipment at opening ceremony, Motion Analysis Laboratory, School of Health and Bioscience, UEL July 2003.
Changes in lumbar spine and hip
movement following hip replacement.
Fiona Coutts is currently completing her PhD thesis concerning issues around
post operative hip and lumbar spine function of patients with total hip replacement.
This study looks at the interaction of hip and lumbar spine patterns of movement
in patients at two years post total hip replacement and age, activity and gender
matched normals during four functional activities. Activities investigated include
walking, sitting to standing, bending forward in sitting and bending forward
in standing. Purchase of Vicon equipment will allow more detailed exploration
of the use of movement diagrams to compare patterns of movement generated during
these different functions in the two groups of subjects.
Quadriceps femoris muscle activation;
evaluation after major knee surgery:
Moving on from her work with Matt Morrissey, Wendy Drechsler remained at UEL
to complete her PhD with Oona Scott. Changes in maximum and submaximum voluntary
contractions together with surface EMG recordings of the knee extensors and
knee pain, swelling, stability and function were monitored in 32 patients following
ACL surgery13, 14. EMG frequency and amplitude levels
were significantly lower at both one and three months following surgery with
significant changes in the median frequency of firing at all levels of contraction.
These findings provide insight into neuromuscular adaptations after knee surgery
and a basis for development and investigation of muscle strength training after
injury.
Exercise capacity and functional
ability early after severe brain injury:
Having played a major role as assessor, data handler and co-author of the seven
papers associated with the three year aerobic training study, Jane Culpan is
completing her PhD. Her concern is to explore the relationship between exercise
capacity, mobility and function in adults with ABI. This work will then be used
to improve the prescription of exercise training by physiotherapists in the
rehabilitation of these patients.
Figure 3:Demonstration of oxygen uptake testing to determine level of fitness in the exercise laboratory of the School of Health and Bioscience, UEL.
Relationship between hamstring
and quadriceps strength: evaluation of the functional moment ratio:
Working with Mary Cramp, Ged Garbutt and Oona Scott, Rosalind Coombs, a research
assistant in sport and exercise science has just submitted her PhD thesis. Using
isokinetics, kinematic and kinetic 3D motion analysis and designing a simulation
of soccer match activity on a treadmill, she analysed H/Q ratios over a range
of motion in states of warm-up and fatigue and their relevance to a jumping
task common to soccer and basketball athletes15, 16. Comparing
the two ratios, her findings suggest that although the conventional Hcon/Qcon
ratio often used as a peak ratio and applied across all population groups is
more globally applicable, the more functional Hecc/Qcon ratio is both gender-
and sport-specific.
Overview
The Group has a broad capability for integrated physiological and motion analysis
together with the ability to measure oxygen uptake and overall fitness. They
have a vision of continuing collaboration not only with their clinical colleagues
but also across disciplines and professional groupings.
UEL's Stratford campus in the London Borough of Newham is now recognised locally,
nationally and internationally as a centre for human motor performance, and
the talk is now of shared research studies, of work alongside microbiologists
and biochemists working in research labs on the same floor, of the possible
genetic inferences on sporting prowess and of collaboration with local football
clubs, leisure centres and hospitals and even having the Olympics as a local
activity in 2012.
Key References
1. Scott, OM, Vrbová G, Hyde SA, Dubowitz V (1990). Therapeutic possibilities
of chronic low frequency electrical stimulation in children with Duchenne muscular
dystrophy. J Neurol Science 95, 171-182.
2. Cramp MC, Manuel JM, Scott OM (1995) Effects of different patterns of long
term electrical stimulation on human quadriceps femoris muscle. Journal of Physiology
483, p82.
3. Cramp M C, Scott O M, Gill M, Rothwell J C (1998) Maximum voluntary strength
and fatiguability of the quadriceps femoris muscle following stroke Physiotherapy
Vol 84 No 8 pp 401
4. Cramp M C, Gill M W, Greenwood R J, Lehman A, Rothwell J C, Scott O M (2000)
Reciprocal Ia inhibition in the first six months following stroke. Proceedings
Journal of Physiology Vol 523, 233P.
5. Bateman A, Culpan FJ, Pickering AD, Powell JH, Scott OM, Greenwood RJ. (2001)
A randomised controlled trail of aerobic training on rehablitation outcomes
after severe brain injury. Archives of Physical Medicine and Rehabilitation
Vol 82, 2, pp 174-182.
6. Thornton M J, Morrissey M C, Coutts F J. (1998) Some effects of camera placement
on the accuracy of the kinemetrix three-dimensional motion analysis system.
Clinical Biomechanics Vol 13 No 4 pp 452-454.
7. Coutts F. Gait assessment in the therapeutic environment Manual Therapy (1999)
Vol 4 No 1 pp 2-9.
8. Atkinson K, Coutts F, Hassenkamp A-M. (1999) Physiotherapy in orthopaedics:
a problem-solving approach (Churchill Livingstone, Edinburgh 1999).
9. Cramp M C, Scott O M, Rothwell J C, Greenwood R J, Lehman A, Gill M (2000)
Strength-training: a low-intensity programme for lower limb muscles of early
stroke patients. Physiotherapy Vol 86 No 11 pp 593.
10. Dawes, H., Bateman, A., Culpan, J., Scott, O., Roach, N., Wade, D. &
Greenwood, R (2003) The effect of increasing effort on movement economy during
incremental cycling exercise in individuals early after acquired brain injury.
Clinical Rehabilitation17, 528-534.
11. Dawes H, Bateman A, Scott OM, Wade D (2000) The effect of peak intensity
cycling after brain injury: a single case study. Clinical Rehabilitation 6,
14, 570 - 573
12. Dawes H, Cockburn J, Roach NK, Wade D, Bateman A, Scott OM (2003) The effect
of a perceptual cognitive task on exercise performance: The dual task condition
after brain injury. Clinical rehabilitation 17, 535 -539.
13. Morrissey M C, Drechsler W I, Morrissey D, Knight P R, Armstrong P W McAuliffe,
T B (2002) Effects of distally fixated versus nondistally fixated leg extensor
resistance training on knee pain in the early period after anterior cruciate
ligament reconstruction. Physical Therapy 82:1, 35-43.
14. Drechsler W, Morrissey M, Scott OM (2003) Quadriceps femoris function and
EMG frequency after ACL reconstruction. http://www.wcpt/abstracts
15. Coombs, R & Garbutt, G (2002) Developments in the use of the hamstring/quadriceps
ratio for the assessment of muscle balance. Journal of Sports Science and Medicine,
1, 56-62.
16. Coombs, R., Garbutt, G. & Cramp, M. (2002) Comparison of conventional
and functional hamstring-quadriceps moment ratios through a 90º range of
leg motion Journal of Sports Sciences 20, 3-4.