To elucidate and attempt to dissociate the two mechanisms, neuromuscular and mechanical, underlying patellofemoral pain syndrome, 18 subjects, divided into two groups based on a diagnosis of patellofemoral pain syndrome and the knee Q angle, were studied. The control group was asymptomatic and exhibited a normal Q angle (mean, 8.25 degrees), whereas the other group, diagnosed as patellofemoral pain syndrome patients, reported knee pain and had an above-normal Q angle (mean, 21.05 degrees). All subjects were tested for isometric maximum knee extension at 90 degrees, 30 degrees, and 15 degrees of knee flexion while they were seated in a special restraining chair. During testing, surface electromyography at the oblique and long fibers of the vastus medialis, and at the vastus lateralis were recorded along with the knee moment of force. The integrated electromyographic signals associated with the peak torque for all of the vastus muscles, along with the vastus medialis obliquus:vastus lateralis and vastus medialis longus:vastus lateralis activity ratios showed no significant differences between groups nor between the three angles, suggesting that all vasti measured were consistently active throughout the studied range of motion. This suggests that the neural drive was not affected in the patellofemoral pain syndrome patients. However, when the five patients showing the largest Q angles were isolated, they revealed a significantly smaller vastus medialis obliquus:vastus lateralis ratio when compared to the other group. The same ratio was also significantly smaller at 15 degrees compared to 90 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

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Walking in spinal-cord-injured (SCI) subjects is usually achieved at a lower speed than in normal subjects. Study design/methods: Time and distance parameters, angular displacements of lower limbs and electromyographic (EMG) activity were measured for seven normal and seven SCI subjects at several walking speeds. Analyses of variance were used for comparing groups and speeds. Objectives: First, to measure the adaptability of SCI subjects' walking pattern to different speeds (0.1-1.0 m/s), and to compare it to that of normal subjects. Second, to characterize SCI subjects' walking pattern as compared to that of normal subjects at a matched treadmill speed (0.3 m/s). Setting: University-Based Human Gait Laboratory, Montreal, Canada. Results: SCI subjects' pattern adapted to a limited range of speeds. Longer cycle duration, flexed knee at foot contact, increased hip joint flexion at foot contact and during swing, and altered coordination of hip and knee joints were found for the SCI group. At all speeds, duration of muscle activity was longer in the SCI group and the increase in amplitude of soleus EMG activity at higher speeds was not specific to push-off. The importance of matching the walking speed of SCI and normal subjects in order to differentiate the features that are a consequence of SCI subjects' reduced walking speed rather than a direct consequence of the injury is demonstrated. Conclusions: All SCI subjects could adapt to a narrow range of speeds and only three could reach the maximal tested speed. This limited maximal speed seems to be a consequence of SCI subjects having reached their limit in increasing stride length and not being able to increase stride frequency further. This limitation in increasing stride frequency is likely because of the altered neural drive. Sponsorship: Neuroscience Network of the Canadian Centre of Excellence.

Clonidine, a noradrenergic agonist, and cyproheptadine, a serotonergic antagonist, have each been associated with improved walking in SCI subjects. Baclofen, a GABA agonist, is frequently prescribed for spasticity but its e ects on walking have not been well quanti®ed. The objective of this study was to compare the e ects of clonidine, cyproheptadine and baclofen on walking in SCI subjects with incomplete injuries. A motorized treadmill was used and harness support provided when necessary. A repeated single-subject design was employed for the twelve subjects. The greatest e ects were found in more severely disabled subjects. Cyproheptadine was associated with greatly reduced need for assistance, increases in maximum treadmill speed (MTS) and reduced clonus. Clonidine was associated with increases in MTS and a generally more upright posture. Baclofen was associated with minor changes in walking. In many cases of drug e ects, MTS increases and other changes were retained following washout of drugs. The signi®cance and implications of the drug e ects and the retention of e ects during washout periods are discussed. It is concluded that clonidine and cyproheptadine have di erent e ects but both appear useful for severely disabled SCI subjects. The e ects of baclofen on walking after spinal cord injury remains unclear.

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Neuroscience Network of the Canadian Centre of Excellence.

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Spinal cord injury is associated with multiple motor problems leading to alterations of walking behavior reflected by a reduced walking speed and changes in the kinematic and electromyographic patterns. This review presents recent developments and concepts emerging from animal and human studies aimed at enhancing recovery of walking following spinal cord injury. Locomotor training, pharmacological interven tions, and their combination have been identified as important approaches in modifying the recovery process following spinal cord injury in both animals and humans. The nervous system still presents great plasticity even several years after spinal cord injury. NEUROSCIENTIST 4:14-24, 1998