Takashi Hanakawa
Kyoto University, Japan
Francesco Lacquaniti
University of Rome Tor Vergata, Italy
Taishin Nomura
Osaka University, Japan
Front. Neurosci., 15 January 2019 | https://doi.org/10.3389/fnins.2018.01042
Visual and Vestibular Inputs Affect Muscle Synergies Responsible for Body Extension and Stabilization in Sit-to-Stand Motion
Kazunori Yoshida1*, Qi An1, Arito Yozu2, Ryosuke Chiba3, Kaoru Takakusaki3, Hiroshi Yamakawa1, Yusuke Tamura1, Atsushi Yamashita1 and Hajime Asama1
1Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
2Center of Medical Science, Ibaraki Prefectural University of Health Science, Inashiki, Japan
3Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, Asahikawa, Japan
The sit-to-stand motion is a common movement in daily life and understanding the mechanism of the sit-to-stand motion is important. Our previous study shows that four muscle synergies can characterize the sit-to-stand motion, and they have specific roles, such as upper body flexion, rising from a chair, body extension, and posture stabilization. The time-varying weight of these synergies are changed to achieve adaptive movement. However, the relationship between sensory input and the activation of the muscle synergies is not completely understood. In this paper, we aim to clarify how vestibular and visual inputs affect the muscle synergy in sit-to-stand motion. To address this, we conducted experiments as follows. Muscle activity, body kinematics, and ground reaction force were measured for the sit-to-stand motion under three different conditions: control, visual-disturbance, and vestibular-disturbance conditions. Under the control condition, the participants stood without any intervention. Under the visual-disturbance condition, the participants wore convex lens glasses and performed the sit-to-stand motion in a dark room. Under the vestibular-disturbance condition, a caloric test was performed. Muscle synergies were calculated for these three conditions using non-negative matrix factorization. We examined whether the same four muscle synergies were employed under each condition, and the changes in the time-varying coefficients were determined. These experiments were conducted on seven healthy, young participants. It was found that four muscle synergies could explain the muscle activity in the sit-to-stand motion under the three conditions. However, there were significant differences in the time-varying weight coefficients. When the visual input was disturbed, a larger amplitude was found for the muscle synergy that activated mostly in the final posture stabilization phase of the sit-to-stand motion. Under vestibular-disturbance condition, a longer activation was observed for the synergies that extended the entire body and led to posture stabilization. The results implied that during human sit-to-stand motion, visual input has less contribution to alter or correct activation of muscle synergies until the last phase. On the other hand, duration of muscle synergies after the buttocks leave are prolonged in order to adapt to the unstable condition in which sense of verticality is decreased under vestibular-disturbance.
Standing from a seated position is a fundamental daily motion. In daily life, people need to change their posture from sitting to standing to perform other activities, such as walking. The population of elderly people is increasing (World Health Organization, 2016), and many elderly people have difficulty performing sit-to-stand motion. Without the ability to perform sit-to-stand motion, human mobility is affected and quality of life decreases. Causes of inhibited movement vary, including decreased muscle force and weakened sensory input. In particular, it is known that visual, vestibular, sensorimotor, and balance function change with age (Lord and Ward, 1994). The focus of this study was human sit-to-stand motion and the analysis of how sensory inputs affect this motion.
Human sit-to-stand motion has been widely studied, and researchers have investigated the relationship between sensory input and sit-to-stand motion. Lord et al. showed that the sit-to-stand movement was affected by sensory information, such as visual input related to the motion speed (Lord et al., 2002). Scholz et al. investigated the relationship between visual or tactile input and the trajectory of the human sit-to-stand motion and revealed that the trajectory was affected by the ability to use sensory input (Scholz et al., 2001). Mourey et al. studied how age and the ability to use visual input affected the motion speed and trajectory of the center of mass during sit-to-stand motion. They revealed that the speed of the center of mass decreased under a visual-disturbance condition, particularly for elderly subjects (Mourey et al., 2000). Regarding the tactile sensation of feet, Cheng et al. showed that the vertical ground reaction force was different between people who succeeded and failed to perform the sit-to-stand motion (Cheng et al., 2014). These studies indicated that human sit-to-stand motion is affected by sensory input.
Numerous studies have been conducted to determine the effect of sensory input on human locomotion and upright postural control. Ivanenko et al. showed that the duration of the several muscle activation in human gait is controlled by tactile sensations in their feet (Ivanenko et al., 2003). Another study showed that visual information is utilized to stabilize posture and avoid obstacles during locomotion (Logan et al., 2010). Fitzpatrick et al. studied human locomotion during vestibular-disturbances and showed that the direction of travel could not be recognized correctly when vestibular input was disturbed (Fitzpatrick et al., 1999). Furthermore, Franz et al. assessed differences in walking strategies between the young and elderly, and they found that the elderly people rely more on visual information to achieve locomotion (Franz et al., 2015). Chiba et al. demonstrated that the standing posture control was affected by visual, vestibular, and tactile sensations (Chiba et al., 2013). Chiba et al. also reviewed the human standing posture control by visual, vestibular, somatosensory, and tactile inputs (Chiba et al., 2016). Kabbaligere et al. studied the effect of visual and vestibular inputs on bipedal posture tasks and they found that sensory reweighting occurred when sensory input was disturbed (Kabbaligere et al., 2017). Claeys et al. investigated how proprioception and visual information change the strategy required to maintain balance (Claeys et al., 2011). In another study, an experiment to evaluate effect of visual, vestibular, and somatosensory contributions to human control of an upright stance (Maurer et al., 2000) was conducted. The results showed that somatosensory input could compensate for other sensory input. These studies showed that sensory input is utilized to achieve motion.
To understand the mechanisms of human movement, the concept of muscle synergy has been widely acknowledged. This is based on the idea that humans do not control all their muscles individually but control sets of muscles, called "muscle synergy" (Bernshtein, 1967). Some research has shown that humans or other species use muscle synergy in various movements (Ting et al., 2015). In most of the previous studies, the muscle activity was measured and the shared muscle synergies from the different movements were extracted. Lemay et al. used muscle stimulation and measured the output force, finding that cats have several sets of synchronized muscle activation (Lemay and Grill, 2004). Torres-Oviedo et al. showed that the muscle synergy of cats was not task-specific but exhibited generality in tasks (Torres-Oviedo et al., 2006). Shared muscle synergy is also found in human manipulation tasks at various speeds (d'Avella et al., 2008) or between affected and unaffected arms of stroke patients (Cheung et al., 2009). Ivanenko et al. showed that a small set of muscle synergies could account for various forms of human locomotion (Ivanenko et al., 2004). Aoi et al. also showed that the timing of muscle synergy activation was adjusted upon contact of a human foot with the ground (Aoi et al., 2010). In terms of the neural evidence of muscle synergy, Takei et al. suggested that muscle synergy was coded in the spinal cord (Takei et al., 2017). Desrochers et al. also validated that muscle synergies for locomotion were primarily controlled by circuits of neurons within the spinal cord (Desrochers et al., 2018). Tresch et al. demonstrated that muscle activity can be divided into muscle synergies using various matrix factorization algorithms (Tresch et al., 2006). These results imply that various movements can be explained using a relatively small number of modules, such as muscle synergies. Our group analyzed muscle activation in human sit-to-stand motion, demonstrated that there are four muscle synergies in the sit-to-stand motion of humans (An et al., 2015), and found that the activation timing of these synergies differs with age (Yang et al., 2017). It was suggested that muscle synergy is controlled by a feedforward signal and sensory feedback (Cheung et al., 2005). Human movement includes feedforward control, which is learned, and feedback control, which fixes the movement based on sensory input (Kandel et al., 2013). Other researchers have investigated the relationship between sensory input and the muscle activity in movements, but the human sit-to-stand motion has rarely been studied from this point of view.
Though, it has been shown that sensory input is utilized to achieve movement, the relationship between sensory input and the sit-to-stand motion has not been completely investigated. Our study was particularly focused on visual and vestibular inputs, and the effect of these sensory inputs on the muscle synergies in the sit-to-stand motion was clarified.
Muscle Synergy Model
As stated in the Introduction, the muscle synergy hypothesis suggests that humans do not control individual muscles, but they control a synchronized muscle activation, called muscle synergy (Bernshtein, 1967). This indicates that each synergy controls several muscles, and the synergies are controlled by the nervous system. In the synergy hypothesis, two components are defined: spatial and temporal patterns. The spatial pattern indicates the combination of the activated muscles in each synergy, whereas the temporal pattern shows the time-varying weight coefficient of the spatial patterns. The muscle synergy hypothesis suggests that the linear summation of the spatiotemporal patterns generates muscle activity. This can be expressed by the following equations:
M=WH,M=(m1,m2⋯mn)T=(m1(t0)⋯m1(tmax)⋮⋱⋮mn(t0)⋯mn(tmax)), W=(w1⋯wk)=(w11⋯w1k⋮⋱⋮wn1⋯wnk)H=(h1⋯hk)T=(h1(t0)⋯h1(tmax)⋮⋱⋮hk(t0)⋯hk(tmax)),
where M, W, and H denote the muscle activation, spatial pattern, and temporal pattern matrices, respectively. The muscle matrix M contains discrete time-varying muscle activation vectors, mi, where i (1 ≤ i ≤ n) denotes the muscle number and mi(t) represents muscle activation at time t (t0 ≤ t ≤ tmax). Each column of the spatial pattern matrix W indicates the individual spatial pattern column wj of the j-th synergy (1 ≤ j ≤ k). Its elements, wij, represent the relative muscle activation of the i-th muscle in the j-th synergy. The temporal pattern matrix H includes the vectors hj and their elements hj(t) to express the weight of the j-th synergy at time t. Non-negative matrix factorization (NNMF) was used to obtain spatiotemporal pattern matrices W and H (Lee and Seung, 1999). In this study, the norm of the vectors wj is defined as 1.0.
In various previous studies, spatial patterns were assumed to be constant during human movement. This reflects the findings that the spatial patterns are coded in the human spinal cord (Takei et al., 2017; Desrochers et al., 2018) and that the human nervous system integrates sensory information to control the timing and amplitude of these spatial patterns, i.e., the temporal patterns. In our previous study, it was found that there are four spatial patterns in the human sit-to-stand movement, and activation of each pattern is varied temporally depending on the motion strategy. It was hypothesized that sensory information is utilized to control these synergies and achieve control by changing the temporal pattern, i.e., the spatial patterns are the same under all the conditions. We investigated how visual and vestibular information affect muscle synergies.
This study was focused on the muscles that contribute to the flexion or extension of the lumbar, hip, knee, and ankle joints. The muscles considered are shown in Figure 1. The 16 muscles in the trunk and lower limbs measured from both sides of the body (Figure 1) were: tibialis anterior (TA), gastrocnemius lateralis (GAL), gastrocnemius medialis (GAM), soleus (SOL), peroneus (PER), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris long head (BFL), semitendinosus (SEMI), gluteus maximus (GMA), gluteus medius (GMD), rectus abdominis (RA), external oblique (EO), elector spine (ES), and trapezius (TRAP).
Figure 1. The measured sixteen muscles. This study focused on the muscles that contribute to the flexion or extension of the lumber, hip, knee, and ankle joints: tibialis anterior (TA), gastrocnemius lateralis (GAL), gastrocnemius medialis (GAM), soleus (SOL), peroneus (PER), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris long head (BFL), semitendinosus (SEMI), gluteus maximus (GMA), gluteus medius (GMD), rectus abdominis (RA), external oblique (EO), elector spine (ES), and trapezius (TRAP).
Experiment Procedure
To clarify the effects of visual and vestibular inputs on the muscle synergies in sit-to-stand motion, the muscle synergy structures were compared for a condition with no disturbances (control condition) and conditions with disturbed visual or vestibular inputs.
First, we measured the sit-to-stand motion of the participants under the control condition. No disturbance was added to the visual input, and the subjects were asked to open their eyes and gaze straight forward. Next, the subjects were asked to wear convex lenses (Frenzel glasses) to disturb their visual inputs under the visual-disturbance condition. The convex lenses changed the focus of the eyes, and thus, the participants could not see the surrounding environment. In addition, the light of the room was turned off to inhibit visual input. Under this condition, the participants were asked to open their eyes while standing up from a chair. Having the subjects wear convex lenses rather than simply closing their eyes prevented the weight-shift effect of the sensory information and clarified the difference between the control condition and visual-disturbance condition. A previous study suggested that several sensory inputs are utilized and integrated to recognize the environment and achieve movement (Chiba et al., 2016), and it is known that the weight of a sensory input can be adaptively changed depending on the situation (Nashner and Berthoz, 1978). If the participants closed their eyes voluntarily, this action might induce a weight shift of the sensory information. Therefore, in this study, convex lenses, and a dark room were used to inhibit the visual input to avoid the weight shift for the sensory information.
Finally, we performed caloric tests to disturb the vestibular input (vestibular-disturbance condition) (Baloh and Jen, 2011). Angular acceleration of the head movement are detected by the movement of the lymph in semicircular canals, which are used for detecting and controlling head posture. To disturb this vestibular input, icy water (0°C, 5 mL) was put in the subjects' ears to cause convection of the lymph and stimulate the semicircular canals. When a caloric test successfully modulates the vestibular input, acceleration is unable to be sensed correctly and it is known that nystagmus occurs (Peterka et al., 2004; Indovina et al., 2005; de Lahunta and Glass, 2009). In these experiments, the occurrence of nystagmus was confirmed for all the participants. Under this condition, the participants wore the convex lenses used in the visual-disturbance condition to avoid the usage of visual input. When the surrounding environment is recognized by vision, visual input is used to correct the vestibular-disturbance so that it only has a minor effect (Chiba et al., 2013). Consequently, both visual and vestibular inputs were disturbed. When the vestibular input is disturbed by caloric tests, humans are known to lean to the side where the icy water is inserted. Therefore, the differences between the left and right side of the body were analyzed under the vestibular-disturbance condition.
All the subjects performed sit-to-stand motion under the three conditions in the following order: control, visual-disturbance, and vestibular-disturbance conditions. In all the conditions, subjects were asked to sit on a chair with a height equal to their knee height and were asked to stand up at a comfortable speed. The participants placed their feet in comfortable positions. They had their arms crossed in front of their chest while performing the sit-to-stand motion. Ten trials were performed under the control and visual-disturbance conditions. Under the vestibular-disturbance condition, 2–3 trials were conducted for each participant. The number of trials differed for the participants because some of them could not finish all the trials due to dizziness.
Data Recording and Signal Processing
The muscle activity, kinematics, and reaction force were measured using a surface electromyography (EMG) sensor (MiniWaveInfinity, Cometa srl.), an optical motion capture (MAC3D, MotionAnalysis Corp.), and force plates (TF4060, TechGihan Corp.), respectively. The surface EMG was recorded at 2,000 Hz, and the data was filtered through a band-pass filter (fourth-order Butterworth filter) from 20 to 500 Hz. Subsequently, a second-order Butterworth filter with a cut-off frequency of 5.3 Hz was used to filter the surface EMG data. Individual muscle activation was normalized to 1.0 based on the maximum activation of all the trials under all the three conditions for each subject. Reflective markers were attached to the participants' bodies based on the Helen Hayes marker set. The recorded marker position data was filtered with a second-order Butterworth low-pass filter with a cut-off frequency of 6 Hz to remove the noise. Using the musculoskeletal model, Software for Interactive Musculoskeletal Modeling, SIMM (Musculographics Corp.), the joint angle data was obtained. The reaction force data was filtered through a fourth-order Butterworth low-pass filter with a cut-off frequency of 20 Hz.
Evaluation of Effect of Sensory Input on Muscle Synergy
In this study, the effects of visual and vestibular inputs on the spatiotemporal structure of muscle synergy were assessed. First, the spatial patterns of muscle synergy were studied to examine the utilization of similar muscle coordination. To this end, the similarities in the spatial patterns were calculated under different conditions. To begin, an average spatial pattern was obtained for each synergy in the individual conditions for each subject. Subsequently, these average spatial patterns were compared between two conditions to determine the similarity. Because spatial patterns were represented as vectors, the similarity was calculated as the correlation coefficient of the spatial pattern vectors wi and wj, as expressed in the following equation:
s(wi, wj)=∑k=1n(wki−w¯i)(wkj−w¯j)(∑k=1n(wki−w¯i)2)(∑k=1n(wkj−w¯j)2),
where i and j represents a muscle synergy number obtained from either control, visual disturbance, or vestibular disturbance condition. The similarities of the spatial patterns were calculated using the same synergy obtained from different conditions. When the value was above 0.4, the spatial patterns should be similar (Ivanenko et al., 2005). When the similarity was obtained from all the subjects, then mean and standard deviation were calculated, and a 95% confidence interval was obtained to compare to the previous similarity threshold (0.4).
To evaluate the differences in the temporal structures, their amplitude and duration were compared under different conditions. Particularly, the human sit-to-stand motion was divided into four phases and the effects of the visual and vestibular inputs on the muscle synergy were investigated based on these phases. The following are the four phases reported in the previous study: In phase 1, the upper body is flexed to generate momentum and initiate the sit-to-stand motion. In phase 2, they raise their hips from a chair and transfer momentum. In phase 3, they extend their entire body upward. In phase 4, they move their body backward to stabilize the posture. The starting times of the four phases of the sit-to-stand motion are depicted in Figure 2.
Figure 2. Four phases of the human sit-to-stand motion. In phase 1, humans flex their upper body to generate momentum and initiate the sit-to-stand motion. In phase 2, they raise their hip from the chair and transfer momentum. In phase 3, humans extend their whole body upward. In phase 4, they move their body backward to stabilize their posture.
In this study, the body trajectory and reaction force data were used to identify the starting time Ti {i = 1⋯4} and duration Di {i = 1⋯4} of each phase. Phase 1 is the beginning of the movement and its start time was decided from the marker position on the shoulder. The start of phase 1, T1, was determined by when the acceleration of the shoulder marker in the former direction exceeded a defined threshold. Phase 2 was defined as the hip rise from a chair, and thus, its start time T2 was calculated as the time when the hip reaction force became 0 N. In phase 3, the body leans forward the most and begins moving upward. Thus, the time of minimum dorsiflexion of the ankle joint was defined as the start of phase 3, T3. Finally, phase 4 was defined as the period of time for posture-stabilization after standing-up. Therefore, the time at which the maximum vertical position of the shoulder marker was achieved was set as the starting time of phase 4, T4. The end of phase 4 cannot be determined explicitly, and thus, it was determined from the period of the former phases, phases 1 to 3. Specifically, the duration of phase 4, D4, was calculated using the following equation:
D4=α(T4-T1),
where α is the ratio of the phase 4 duration to the period of phases 1–3. In this study α was set to 0.2.
The starting time and duration of the four phases are denoted as Ti {i = 1, 2, 3, 4} and Di {i = 1, 2, 3, 4}, and the average amplitude Vij of the synergy j in the phase i was obtained using the following equation:
Vij=∑TiTi+1hj(t)Di.
The average amplitude was obtained for all the synergies under the three sensory conditions. To calculate changes of the duration time of the phases, the average duration time of each phase was obtained under the control condition, denoted D^i. Subsequently, changes of the durations of the phases in the visual and vestibular-disturbance conditions were obtained as the ratio of the duration in the sensory-disturbance condition to the time in the control condition as follows:
ΔDi=DiD^i.
Note that in the above equation, the numerator, Di, indicates the duration of phase i in the visual- and vestibular-disturbance conditions, and the denominator, D^i, indicates the duration obtained in the control condition.
Both the evaluation parameters were used to examine whether the durations or amplitudes of the synergies changed due to the disturbed sensory input. One factor analysis of variance, ANOVA, was used to assess the effects of different sensory conditions on the amplitude and duration of the temporal patterns of each muscle synergy. If there was statistically significant difference (p < 0.05), then a post hoc test (Tukey's test) was employed. Analysis was performed on both sides of the subjects. To clarify the effect of the visual input, muscle synergies between the control and visual-disturbance conditions were compared. Similarly, the visual-disturbance and vestibular-disturbance conditions were compared to evaluate the effect of vestibular input.
Subjects and Ethical Statement
Our experiments were performed by seven healthy subjects (six males 20–30 years old and one female 30–40 years old). This study was carried out in accordance with the recommendations of the guidelines for studies on humans, Environmental Health and Safety Office, School of Engineering, the University of Tokyo. The protocol was approved by the Institute Review Board (IRB) of the University of Tokyo. All subjects gave written informed consent in accordance with the Declaration of Helsinki.
Typical kinematic (joint angle) and kinetic (EMG) data and the corresponding spatiotemporal pattern extracted from the subjects are shown in Figure 3. The figure also shows that these four modules activated sequentially from muscle synergy 1–4. Changes in these spatiotemporal patterns due to the disturbed sensory input were investigated.
Figure 3. Example of kinematic (joint angle) and kinetic (EMG) data are shown in the left of the figure. The extracted four muscle synergies are shown in the right of the figure. The joint angles are defined as the angle between the link and the horizontal axis. The data obtained under control, visual-disturbance, and vestibular-disturbance conditions are shown as solid, dashed, and dotted lines with circle markers, respectively. In each graph, white, gray, and black squares with diagonal lines below the horizontal axis, respectively show duration time of four phases.
The average and standard deviation of the spatial patterns of the muscle synergies are displayed in Figure 4 obtained under the control, visual-disturbance, and vestibular-disturbance conditions. The spatial patterns obtained from the left side muscles (the ipsilateral to the ear used for the caloric test) are shown in the left in Figure 4 and the spatial patterns obtained from the right side muscles (the contralateral to the ear used for the caloric test) are shown in the right side of Figure 4. Some characteristic activation was found in each synergy. In muscle synergy 1, muscles RA and EO were mostly activated to flex the lumbar joint. Muscle synergy 2 activated the TA to dorsiflex the ankle and activated the RF, VL, and VM to extend the knee joint. This synergy contributed to the rising of the hip from a chair and moving the body forward. In muscle synergy 3, the VL, VM, BFL, SEMI, GMA, GMD, and ES were activated to contribute to the extension of the knee, hip, and lumber joints to move upward. Muscle synergy 4 activated the GAL, GAM, SOL, PER, GMA, and GMD to plantarflex the ankle and extend the hip joint in the last phase of the sit-to-stand motion to decelerate the motion.
Figure 4. The average and standard deviation of the spatial patterns of the muscle synergies under three different condition are displayed. Four graphs in the left of the figure represent the spatial patterns extracted from the left side of the subjects whereas the right of the figure indicate the spatial patterns extracted from the right side. This graph is based on 120 samples in total. Each spatial pattern has specific contribution to the sit-to-stand motion. The muscle synergy 1 activates RA and EO to flex upper body. The muscle synergy 2 activates TA, VL, VM, and VM to rise hip from a chair and move forward. The muscle synergy 3 activates VL, VM, and ES to extend whole body. At last the muscle synergy 4 activates GAL, GAM, SOL, GMA, and GMD to stabilize posture. It has been shown that spatial patterns are similar regard less of different sensory condition.
The similarities in the spatial patterns between the three conditions are presented in Table 1. These similarities for the control and visual-disturbance conditions are listed in Table 1A, and those for the visual-disturbance and vestibular-disturbance conditions are listed in Table 1B. These values are the average and standard deviation of the similarities in the spatial patterns in each subject. In addition to the average and standard deviation, a 95% confidence interval was also computed to evaluate the confidence level. In the previous study (Ivanenko et al., 2005), muscle synergies were considered to be similar when the coefficient of correlation between two muscle synergies was above 0.4. Our results showed that, regardless of the comparison between control and visual-disturbance conditions and between visual-disturbance and vestibular-disturbance conditions, the similarities in the spatial patterns were above 0.4, implying that the participants likely employed similar spatial patterns.
Table 1. Similarity of spatial patterns.
The amplitudes of the temporal patterns on the right and left sides were averaged in each phase of the sit-to-stand motion, and the results are displayed in Figure 5. Detailed results of the statistical tests are shown in Table 2. These results suggest that muscle synergies contributed to each phase. Muscle synergies 1 and 2 were activated in phases 1 and 2, respectively. Muscle synergy 3 was mostly activated in phases 2 and 3, and muscle synergy 4 was activated in phases 3 and 4. Based on the ANOVA and post-hoc test, the activation of muscle synergy 4 was significantly higher in phase 4 under the visual-disturbance condition than under the control condition in both sides of the body. Activation of muscle synergy 2 was significantly higher in the left side in phases 3 and 4 under the vestibular-disturbance condition than under the visual-disturbance condition. The change in the durations of the phases were calculated for each condition, and the results are shown in Figure 6. Detailed results of the statistical tests are shown in Table 3. According to the statistical tests, the durations of phases 2 and 3 were significantly longer under the vestibular-disturbance condition than under the visual-disturbance condition.
Figure 5. The average and standard deviation of the temporal patterns of the muscle synergies under three different conditions are displayed. The amplitudes of the temporal patterns were averaged in each phase of the sit-to-stand motion. The results from the left are displayed on the left of the figure, and the results from the right side are displayed in the right. This graph is based on 120 samples in total. A statistical test showed that muscle synergy 2 extracted from the left side had a larger amplitude during phases 2 and 3 under the vestibular-disturbance condition than under the visual-disturbance condition. In addition, the amplitude of the muscle synergy 4 increased under the visual-disturbance condition than under the control condition in both sides.
Table 2. Amplitudes of temporal patterns compared for each phase under the three conditions.
Figure 6. Average and standard deviation of the durations of the phases in sit-to-stand motion. The duration of phase 4 was determined by the duration of phases 1–3, and thus, it is not shown above. According to the results of the statistical test, the durations of phase 2 and 3 were significantly longer under the vestibular-disturbance condition than under the visual-disturbance condition.
Table 3. Duration of temporal patterns compared for each phase under the three conditions.
Our analysis of the spatial patterns of muscle synergies showed that the same spatial patterns may be utilized despite disturbed visual and vestibular inputs. However, the temporal structures of the muscle synergies were affected by the disturbed sensory input. When the visual input was disturbed, the amplitude of muscle synergy 4 increased in phase 4, whereas other muscle synergies did not differ significantly in any phase. Under the vestibular-disturbance condition, it was found that duration of phases 2 and 3 increased, resulting in longer activation of muscle synergies 2 and 3, which mostly activated during these two phases. Moreover, it was found that amplitude of muscle synergy 2 was larger in this condition.
Similar to our previous study (Yang et al., 2017), in which different strategies of the sit-to-stand motion were investigated, and to another study (Ivanenko et al., 2005), in which human locomotion was analyzed, the spatial patterns of muscle synergies were found to be similar. It was also reported recently (Takei et al., 2017; Desrochers et al., 2018) that this muscle coordination is coded in the spinal cord and is unchanged. Our current result also supports the findings that similar spatial patterns coded in the spinal cord can be utilized to achieve adaptive movements despite disturbed sensory input. Comparisons between the control and visual-disturbance conditions suggested that visual information is not utilized to correct muscle synergies between the beginning of the motion and body extension (phases 1–3). However, additional activation was required in the last phase, in which the body posture must be stabilized. This suggests the possibility that muscle synergies 1–3 were not only affected by visual input but that muscle synergy 4 required greater activation to compensate for the disturbed visual input. However, vestibular input primarily changed the duration of muscle synergies 2 and 3. Muscle synergies 2 and 3 contributed to the movement of the hip rising from the chair and that of whole body extension. In both movements, the vertical upward direction is needed to be recognized correctly to localize the body posture. Therefore, the sense of verticality was impaired under the vestibular-disturbance condition, and thus, without vestibular input, the participants could not raise their hips and extend their bodies as fast as under the other conditions. In other words, the duration of muscle synergies 2 and 3 was prolonged to balance in unstable conditions. This result is consistent with the results implying that neural system prolonged duration of muscle synergies to adopt a different motion strategy in locomotion under unstable conditions (Martino et al., 2015). Furthermore, it was found that the amplitude of the muscle synergy 2 increased in phases 3 and 4. This implied that vestibular input contributes to the determination of the completion time of muscle synergy 2 as well as the amplitude. Thus, impaired vestibular input results in a larger amplitude of muscle synergy 2, even in phases 3 and 4. As reported in the previous study (Fitzpatrick et al., 1999), humans cannot recognize the direction of travel under the disturbed vestibular input and could not walk straight. In our experiment, subjects could complete the sit-to-stand motion, but it required more effort to control muscle synergies due to the lacking sense of verticality. This result suggests that the vestibular sensation contributes to ensuring the movement direction during phases 2 and 3, and the duration is changed without vestibular sensation.
In this study, visual input was disturbed by Frenzel glasses and a dark room. We utilized caloric tests to disturb the vestibular input. Similar to previous reports, the subjects could utilize other sensory inputs, including the somatosensory system and proprioception, to change the weight of other sensory input (sensory reweighting) (Maurer et al., 2000; Chiba et al., 2013). In our experiment, this sensory reweighting was believed to occur. In other words, humans may rely on other sensations under visual and vestibular-disturbance conditions. Our future study will investigate how the weight of each sensory input is changed when sensory inputs are disturbed.
Human sit-to-stand motion was analyzed under different sensory input conditions, and the effects of the visual and vestibular sensory inputs on muscle synergies were studied. It was found that four similar spatial patterns of muscle coordination are utilized despite the disturbed visual and vestibular inputs. In contrast, it was revealed that the temporal structure of the muscle synergies varied with the disturbed sensory input. Our results suggest that humans do not depend much on visual input during the trunk flexion, hip raising from the chair, and entire body extension phases. However, posture stabilization required greater synergy activation under the visual-disturbance condition after the subjects completed the body extension phase. In contrast, vestibular input contributed to the sense of verticality, and the subjects utilized vestibular input to correct their posture while raising their hips from a chair and extending their bodies. One future study will examine the effects of different sensory inputs, such as the somatosensory input, proprioception, and pressure sensation of the hips and feet. Investigation of a wide range of sensory inputs would improve the understanding of the mechanisms of sit-to-stand motion.
The datasets for this manuscript are not publicly available because those contain private data. Requests to access the datasets should be directed to KY.
KY, QA, HY, YT, AtY, and HA contributed to the conception and design of this study. KY, QA, and ArY designed and performed the experiments. KY and QA analyzed the results. KY, QA, ArY, RC, and KT contributed to discussions of the results. KY and QA wrote sections of the manuscript. All authors contributed to the manuscript revision, and read and approved the submitted version.
This work was supported by JSPS KAKENHI 26120005, 16H04293, and 18H01405.
We would like to thank Editage (www.editage.jp) for English language editing.
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Keywords: sit-to-stand, muscle synergy, sensorimotor, visual, vestibular
Citation: Yoshida K, An Q, Yozu A, Chiba R, Takakusaki K, Yamakawa H, Tamura Y, Yamashita A and Asama H (2019) Visual and Vestibular Inputs Affect Muscle Synergies Responsible for Body Extension and Stabilization in Sit-to-Stand Motion. Front. Neurosci. 12:1042. doi: 10.3389/fnins.2018.01042
Received: 13 September 2018; Accepted: 21 December 2018;
Published: 15 January 2019.
Takashi Hanakawa, National Center of Neurology and Psychiatry, Japan
Taishin Nomura, Osaka University, Japan
Francesco Lacquaniti, University of Rome Tor Vergata, Italy
Copyright © 2019 Yoshida, An, Yozu, Chiba, Takakusaki, Yamakawa, Tamura, Yamashita and Asama. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Kazunori Yoshida, yoshida@robot.t.u-tokyo.ac.jp


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Allure Limousines is a family owned and operated, premium limousine hire service in Perth, Western Australia. We pride ourselves on providing an extremely high level of customer satisfaction for the best rates in town. We provide chauffeur driven limousines and luxury vehicles for every occasion and event including birthday celebrations, weddings, school balls, and airport and corporate transfers.
We know what it is that you expect when you book a luxury car service, and with a long background in the hospitality and associated industries we strive to exceed your expectations time and time again.
We do things a little differently at Allure Limousines, so if you have a special request that will help to make your experience extraordinary please don't hesitate to let us know and we would be happy to organise it for you.
Purchase of Belle Classic Limousines
As you may, or may not, be aware, my wife, Janine, and I have purchased Belle Limousines from John Caldwell and Sue French.
This purchase had been in the works for some time and we are were proud and excited to announce it. From the outset, it had been an absolute priority for all of us that you, our clients, were looked after and that you experience a smooth transition with the change of ownership. This was a non-negotiable for both parties.
By way of history, Janine and I established Allure Limousines more than six years ago, and since then we have gone from strength to strength. We have grown to having four modern cars and stretch limousines in our first five years of operation. We always wanted to expand into the vintage car market, so when we spoke with John in January 2020 about his possible retirement, purchasing Belle seemed like a natural, and obvious step for us to take.
Purchasing Belle Limousines provided John and Sue the opportunity to retire knowing their business was in safe hands, and gave Janine and I the opportunity to grow our business into one of the market-leaders in Perth's Wedding Car market.
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Matt Smith is one of the owners of Allure Limousines, Perth's Premier Limousine Hire Company.
It was Matt's experience when booking a limousine for his own wedding, that gave seed to the idea of starting his own limousine company.
With an extensive history in hospitality and sales, Matt knew he could offer outstanding customer service coupled with beautiful vehicles at the best possible price. And so, the Allure Limousines dream was born and here we are.
When not behind the wheel, Matt loves going to watch the Fremantle Dockers with Janine, playing with his son, hanging out with his wife or having a chat over a few beers with friends.
He also likes chilling out in front of the TV watching Sons of Anarchy, Billions and Wentworth. Matt is a big fan of musician Armin Van Buuren and his dream car is a Ferrari 812 GTS.
He'd like to share a nice medium rare fillet steak and a few beers with former American President Barack Obama and First Lady Michelle Obama and discuss their time in the White House and the current political climate in America.
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Janine Smith is the other owner of Allure Limousines and who you'll speak with for any enquiries or booking information.
Janine can provide you with a wealth of information to assist with planning your special event, and she specialises in weddings!
When she's not driving, preparing quotes or answering the phone or emails, Janine enjoys playing with their son, catching up with family and friends and reading (not that she has much time to read). Oh, and she likes spending time with Matt too and when time allows it going to watch the Fremantle Dockers together.
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Review: BoJack Horseman Season 6 (Part 1)
Logan Carney, Digital Content Director
The sixth and final season of Netflix's "BoJack Horseman" starts off strong with four memorable episodes. It ends with a cliffhanger that makes me want to time travel to Part Two of the season in January.
The show immediately picks up from where it left off in Season Five, with BoJack now in rehab trying to end his alcohol addiction. It is the main plot for episodes surrounding BoJack, but not the season as a whole. All five of the main characters, BoJack, Diane, Princess Caroline, Todd and Mr. Peanutbutter all get their own episodes surrounding their own personal struggles.
Overall, the show continues to amaze me in how it can expertly blend childish humor such as puns, alliteration and sex jokes with the heart and soul of a well-written drama. The show continues to be praised for it's portrayal of depression, and as someone who suffers from depression and anxiety, there is no show that comes close to capturing the inner struggles that someone with mental illness goes through.
In addition to that expert blend, creator Raphael Bob-Waksberg continues to change the way he tells the story. In the Princess Caroline-centered episode, Waksberg animates multiple Princess Carolines at one time to show the craziness of raising a baby. Princess Caroline has always been portrayed as the toughest character in the series, constantly being able to work through any problem, but the way the episode is told dramatically shows how she is struggling to her newest challenge.
Some more highlights of the season are found in the first five episodes. BoJack is constantly reminded of the death of Sarah Lynn while in rehab and it makes his situation all the more heartbreaking for the viewer. Diane's episode uses letters written by BoJack to beautifully transition between her problems. Mr. Peanutbutter's episode sees him and his fiance get into a fight about an affair that happened in the previous season, while his friends and family try to sneak out of their house without being noticed. Even Todd, who has typically only been used as the comedic relief, is granted an emotional episode involving his parents.
The season stayed strong throughout and continued to change the way they told their stories. One episode showed the growth of BoJack by showing him travel the country through chapters. The final episode focused on situations in previous seasons, but none of the five major characters appeared in the episode.
It was a risky move that the show pulled off. While that episode did lack a bit compared to previous episodes in the season, it was still a very emotional and funny episode. When you have an ensemble cast in any show, whether it's animated or live-action, it is tough to make it work when one of them is eliminated from an episode. Not only did this season of BoJack ignore some of the major characters in certain episodes, this final episode made it work with none of them which, proves the strong writing ability of the show's creator.
While season six's risks aren't as big as those that came before it, the season doesn't have two episodes told the same way, arguably making the season as a whole a risk. It pays off in a big way, setting up BoJack Horseman for one of the greatest final seasons in TV history. While some episodes opt for more depressing storytelling instead of its dark humor, which does cause it to lack a bit, the show is clearly setting up for a strong final season.
Review: Rex Orange County's "Pony"
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Review: Rex Orange County's "Pony"
Logan Carney
Sentry Media
Logan Carney, Sentry & CSN Co-DCM
Logan Carney is a communications major with a focus in sports and he also has a sport management minor. He is in his fourth semester at Robert Morris....


N.J. police name officers found guilty of misconduct, reversing years of secrecy
By Blake Nelson | NJ Advance Media for NJ.com and S.P. Sullivan | NJ Advance Media for NJ.com and Joe Atmonavage | NJ Advance Media for NJ.com
A Sparta officer allegedly shoved and injured a woman while off-duty.
One Bernards Township officer drove drunk.
A state trooper is accused of knowingly writing a false report.
For the first time, law enforcement agencies throughout New Jersey publicly identified those and other officers who were recently found guilty of misconduct. At least 34 people who were fired, demoted or suspended for more than five days last year were named Monday, the deadline issued by the state attorney general after a heated court battle.
The details provided about each incident vary widely, with some departments offering only a single sentence to describe the misconduct.
Police had long hidden which officers broke the rules until former state Attorney General Gurbir Grewal ordered departments to reverse course last year, shortly after a Minneapolis police officer murdered George Floyd and spurred deeper scrutiny of law enforcement nationwide.
Police unions sued over the directive, arguing that disclosures would embarrass or endanger officers who may have only made minor mistakes. The state Supreme Court ultimately ruled in favor of the plan.
Agencies now must post online the officers' full names, the specific discipline they received and a description of what they did wrong, according to an attorney general directive.
On Monday, NJ Advance Media surveyed more than 100 websites for departments in every county, downloading and reviewing dozens of disciplinary reports. New Jersey has more than 38,000 officers across hundreds of departments, and most agencies surveyed did not report any major discipline for the approximately six-month period covered by the disclosures.
The bad behavior ranged from the relatively minor — a Camden County cop was suspended 10 days for falling asleep on the job — to the criminal.
Bernards Township officer David Martin "was convicted of DWI while on duty" and resigned, the department reported online.
Gloucester Township officer Steven Lenker was arrested in 2019 for allegedly hitting a pedestrian, and last November he pleaded guilty to reckless driving, paid a fine and had his license revoked for 30 days, according to online court records. The department reported that Lenker received a 60-day suspension.
Some reports dealt with conduct on the job.
Newark officer Richard Pacelli was suspended for 30 days for using a "chemical agent" against a prisoner while in a hospital emergency room.
"As a result of the incident he was cited for, he was provided with re-training and enhanced supervision to ensure this type of incident doesn't happen again," Newark Public Safety Director Brian O'Hara said in a statement. Pacelli "remains an employee in good standing."
Many reports were brief.
Sparta's website only says Cpl. Craig Grauerholz was suspended for 45 days for an "off-duty incident" in March of last year.
Online court records show that Grauerholz pleaded guilty to breaking the state's harassment law, which can include "striking, kicking, shoving, or other offensive touching." The Sussex County Prosecutor's Office said he shoved a woman to the ground, giving her visible "scratches and abrasions" and a possible dislocated finger, according to the complaint summons.
"We have always expected a high degree of professionalism," Sparta Lt. John Lamon wrote in an email. "We take our Officer's demeanor and conduct seriously and when an incident does occur we act swiftly."
Fairfield Chief Anthony Manna questioned whether the disclosures would subject good cops to "undue scrutiny."
One of his officers, Sgt. Christopher Niemiec, received a 20-day suspension for "mishandling his department issued service weapon."
Manna said Niemiec has not been disciplined since and is one of his best — Niemiec was once even named Officer of the Year.
"In this case, it was a one-time deal," the chief said about the suspension. "One blemish on a spreadsheet may result in this officer's name being out there."
Police were only required to identify anyone disciplined from June 15 through Dec. 31 of last year.
Atlantic City, Paterson, East Orange, Millville, Cherry Hill and Hackensack, among others, all said no officers received major discipline during that period.
Serious misconduct that occurs this year must be publicized by January 2022, and departments were ordered to issue annual reports going forward.
Grewal also wanted to identify hundreds of state troopers disciplined in the last two decades, but the top court said those punished in the past should have an opportunity to ask a judge to keep their names secret, especially since some may have been promised confidentiality.
From 2000 through 2018, the State Police issued major discipline 493 times, according to annual reports issued by the Office of Professional Standards. That total does not include some troopers who retired or resigned before they could be punished, and the State Police has a slightly broader definition of major discipline.
It was not immediately clear how many people have petitioned Superior Court Judge Ernest Caposela to keep their names secret. Court spokesman Peter McAleer did confirm that none of those appeals have been resolved.
State Police discipline reports generally lag years behind, and the 2018 review was only recently published.
Major discipline was given 27 times that year, according to the report.
One trooper was suspended for about a month for submitting false reports. A second was put on leave for more than 150 days for "domestic violence harassment," among other issues. A third was suspended for more than 520 days for a litany of problems, including crashing a vehicle while intoxicated and fleeing the scene.
None of those three were fired and the public is blocked from knowing their names.
On Monday, the agency did report 15 troopers punished last year, including Todd Portadin, who was suspended for a full year for "knowingly entering inaccurate and false information in an official report or record," disobeying an order and failing to report misconduct from another officer.
A spokesman did not immediately respond to a request for comment.
Less serious discipline remains hidden. A bill (S2656) before the Legislature would make many internal disciplinary records public, but the proposal has failed to make it out of committee.
CJ Griffin, a public records attorney who has been critical of local officials for not implementing more sweeping police reforms, said the first round of disclosures falls short of the transparency offered in many other states.
"Some of them raise more questions than answers," Griffin said about Monday's discipline reports. "And there's no way to get the answers."
Correction: An earlier version of this story said a survey showed 35 people had recently been punished, including 16 troopers. In fact, one trooper had been punished twice, according to a State Police report, and the story has been updated to note that the correct total is 34 people, including 15 troopers.
Blake Nelson can be reached at bnelson@njadvancemedia.com. Follow him on Twitter at @BCunninghamN.
S.P. Sullivan may be reached at ssullivan@njadvancemedia.com. Follow him on Twitter.
Joe Atmonavage may be reached at jatmonavage@njadvancemedia.com.
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Ukraine Protesters Turn Stun Guns On Each Other
Even as protesters in Kiev battle riot cops and call for the president's resignation, opposition factions are turning their truncheons on each other.
Oleg Shynkarenko
Updated Apr. 14, 2017 1:06PM ET / Published Jan. 30, 2014 1:00PM ET
David Mdzinarishvili/Reuters,© David Mdzinarishvili / Reuters
Even as protesters in the Ukraine are battling police on the streets of Kiev, they are also fighting amongst themselves over occupied buildings, turning their bludgeons and rubber bullets on each other.
Their confrontations are fueled, in part, by divisive political views—but the danger now is that the infighting will end up weakening the opposition, and inadvertently strengthening President Viktor Yanukovych's hand.
Yesterday, in downtown Kiev, a large crowd gathered next to the Agricultural Policy Ministry. It included members from the right-wing "Svoboda" (Freedom) party and self-declared 'Maidan self-defense' members. The activists intended to take control of the building, which had been occupied since January 24th by a more radical wing of the protest movement, the "Spilna Sprava" (Common Business) civil movement.
In a video uploaded to YouTube, a young man, wearing a checkered keffiyeh over his face, said he was a Svoboda member. His party has 10 percent of the votes in Parliament, so it has some political leverage. The most recent verbal agreement with the Yanukovych government stipulated that activists detained by police will be set free if the protesters clear occupied buildings, according to Yury Syrotyuk, the head of the Svoboda party's press office.
"We decided to clear the building, because it is a government institution and its occupation is an occasion for the state of emergency" said the young man.
As a parliamentary party, Svoboda tends to lean towards finding a compromise with Yanukovych and the police, in order to avoid the bloodshed that would be inevitable if a state of emergency were declared. In contrast, the Spilna Sprava protesters say their movement will settle for nothing less than the resignation of Ukraine's parliament and its president. The movement's leader, Olexander Danylyuk, is convinced that the negotiations with those in power are meaningless because the government does not intend to stick to its agreements. Therefore, the only acceptable tactic is to go on the attack. From the 24th to the 26th of January, Spilna Sprava activists occupied not only the Agricultural Policy Ministry, but also the Energy and Coal Industry Ministry and the Ministry of Justice. The occupation of this last building provoked the Minister of Justice, Olena Lukash, to express indignation and to threaten that if her office remained occupied, she would ask Yanukovych to declare a state of emergency.
The Svoboda protesters did manage to clear the three occupied ministries, but not without violence—at least three Spilna Sprava activists were injured by rubber bullets or live ammunition.
The very same evening, Yanukovych appeared in Parliament to persuade MPs from the majority to vote for a controversial new amnesty bill. The law decreed that all the arrested protesters will be released if activists vacate occupied buildings and roads in 15 days' time. The president reportedly told the MPs that if they didn't vote for the law, he would dissolve the parliament. This was a somewhat empty threat—the only reason that parliament can be legally dissolved is if the MPs fail to show up for work for a minimum of 30 days. Still, parliamentarians were nervous enough about his threat to vote on the bill. An alternative law proposed by the opposition, stipulating that all arrested protesters would be released with no supplementary conditions, was not even discussed.
As a result of the law, arrested protesters will be released only on certain conditions. This amounts to hostage-taking of the protesters. Since the end of December, more than 100 protesters, including teenagers, have been thrown in jail, with the real prospect of being sentenced to 15 years or more in prison. According to many reports, police even occasionally grabbed bystanders on the street and imprisoned them, as well. Police even arrested a Dutchman recently just because he owned a tire business. The authorities confiscated all his property, including 10,000 used tires. The investigator in charge of the case said that the protesters had burned his tires at the barricades, without giving additional proof. The judge concurred, "your tires are the proof."
"The power which tries to trade imprisoned people for the administrative buildings is immoral," said opposition MP Arsen Avakov in response to the law. The leader of another splinter opposition group, "Batkivshchyna," (Motherland), said he was sure that the new law will intensify tensions in the society. This, to be sure, is the real aim of the new law. After all, the parliamentary members of the opposition are just intermediaries for the people occupying the Maidan and Grushevskogo Street.
Meanwhile, even as the Svoboda party helped clear the ministries, protesters occupied three additional buildings in Kiev—including the City Hall, the trade union building and the Ukrainian House. And eight administrative buildings in the Western Ukraine remain occupied by protesters. On Thursday morning, Yanukovych's office announced the president had gone on sick leave with an unspecified respiratory ailment. For their part, the revolutionaries say they are not going to vacate any more buildings.


EditorialWorth Noting - November 2015
Worth Noting - November 2015
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The Marion County Office of the County Engineer earned the 2015 Excellence Award for a Stormwater Program from the Florida Stormwater Association. The award is presented to stormwater programs that demonstrate innovative accomplishment and outstanding commitment to best management practices that benefit the environment and local citizenry. The stormwater program has been an integral part of Marion County's water-quality protection efforts for more than a decade. Established in 2002, the program has implemented high-profile pollution-reduction projects that include the "Monster Pipe" on State Road 40 near Silver Springs and the 31st Street stormwater retrofit project, which helped and continues to remove tons of pollutants from Silver Springs and the Silver River.
The Water Environment Federation announced the winners of the 2015 StormTV Project competition. Launched in 2012, the project recognizes, highlights and promotes the work of stormwater professionals worldwide through videos that are submitted from nonprofit organizations, government entities, consulting firms and equipment manufacturers.
Winners include:
Public Education Category: Australian Car Wash Association — "Stormwater Pollution The Dirty Truth: Home Car Washing"
Training Category: University of North Carolina Institute for the Environment and Town of Chapel Hill Stormwater Management Division — "Keep Restaurant Pollution and Profits From Going Down the Stormwater Drain"
Commercial Category: Enginuity, LLC, makers of RainReserve — "Gilardis Segment"
Programs and Projects Category: Atelier Dreiseitl, a Ramboll-Environ Company — "Bishan- Ang Mo Kio Park"
The American Public Works Association announced that seven public works professionals from North America recently earned their Certified Stormwater Managers credential. The APWA CSM certification is intended for water experts in both the public and private sectors who coordinate and implement stormwater management programs for city, county, state, provincial and federal agencies. These professionals assist in administering drainage, flood control and water-quality programs. Those receiving credentials include:
Amy C. Murray, CSM (City of Goodlettsville, Goodlettsville, Tennessee)
Bryan R. Aragon, CFM, CSM, PE (Los Alamos County, Los Alamos, New Mexico)
David M. West, CFM, PE, CSM (Mohave County - Flood Control District, Kingman, Arizona)
James H. Barse, CSM (City of Alameda, Alameda, California)
Juliana Archuleta, CSM (City of Brighton, Denver, Colorado)
Michael Hunt, CSM (Metro Water Services, Nashville, Tennessee)
Sheila Thomas-Ambat, CSM (City of Raleigh, Chapel Hill, North Carolina)
James A. "Tony" Parrott, the head of Cincinnati's drinking water, sewer and stormwater operations, was named the executive director of Louisville's Metropolitan Sewer District. Parrott is the first African-American executive director of the Metropolitan Sewer District in its 69-year history.
Timothy Chatman, stormwater compliance inspector for the Georgetown County Public Services Department, was named the 2015 Outstanding Public Works Employee by the South Carolina Chapter of the American Public Works Association. Chatman has been employed with Georgetown County for seven years.
The ASCE is offering:
Nov. 5 – Managing the Design Process: Keeping on Schedule, Within Budget and Selecting the Right Resources, New Orleans
Nov. 12 – Pumping Systems Design for Civil Engineers, Scottsdale, Arizona
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July 17-20 American Society of Agricultural and Biological Engineers 2016 Annual International Meeting, Orlando, Florida. Visit www.asabe.org.
Aug. 22-25 StormCon, Indiana Convention Center, Indianapolis, Indiana. Visit www.stormcon.com.
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Microneedling info
Microneedling Therapy Help Reduce Keloid Formation: How it is Possible?
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Keloid is an unsightly thing to look at. It is a form of scar which you don't know when to stop. Keliod is also known as keloid scar which is tough heaped up scar rises quite abruptly above the skin area. It has a purple to pink color and a smooth top.
It is irregular in shaped and may tend to enlarge progressively. The difference of which in other scars is that it does not regress over time. It is a benign fibrous growth of scar tissues in affected individuals. Keloid is a result of an irregular wound healing.
There are a number of treatment used to reduce keloid formation, these includes corticosteroids, laser therapy, cryotherapy, radiation, interferon, silicon gel, applying of pressures and medical management.
One of the most common questions asked in the forums is whether microneedling therapy is a good alternative option in treating keloid scar? Is there enough evidence-based data that could prove its efficiency in reducing scar formation? If it cannot reduce keloid scars, will it help reduce hypertrophic scars instead?
In the succeeding notes, the role of microneedling therapy on reducing keloid formation will be discussed further.
Scars No More?
The growing aesthetic awareness makes people become more conscious of their scars. They feel disappointed of their scars and seek help for aesthetic and functional improvement. However, there are certain limitations as to the extent of scar removal treatment particularly following trauma or surgery.
Despite the plethora of advocated treatment options in the clinical setting, the main goal of every doctor is to minimize the risk factors as possible. It is also important to understand the skin's anatomy and healing mechanism in terms post operative scarring. A number of therapeutic options that have been successfully tested in clinical trials.
The emerging techniques include intralesional 5-fluorouracil, intralesional cryotherapy, bleomycin and interferon. There are innovative options such as photodynamic therapy, botulinum toxin A and imiquimod 5% cream.
The potential of microneedling treatment in treating keloid scars is still considered as investigational and experimental because of insufficient evidence of peer-reviewed trials. Although, some may consider it as a treatment option, there is a need for clear-cut clinical trials that would confirm its effectiveness.
Why Keloids are Difficult to Treat?
Keloid is difficult to treat because it is impossible to remove the scars completely. More so, the exact cause why keloids occur is still unknown. It is a chronic disease and it is something that you have to deal with for the rest of your lives.
Even the current treatment modalities to reduce keloid formation is not that a guarantee of complete remission of scars. Available treatments such as laser and radiation therapy and corticosteroid injection do not give completely satisfying results.
Unlike other normal scars, keloid tends to grow outside the original boundary of the injury or cut. High risk areas for keloid formation are earlobes, lower belly and middle chest.
Even scientist does not fully understand how or why keloid scars occur, but it seem to be a genetic component. It does have a link with heredity. If a mother, aunt, uncle or anyone on the side of the family has keloid, there is a higher chance that you can get it also.
The problem with keloid is that when a person suffers a wound, the cells within the skin called fibroblast deposits the connective tissue to hold the wound to close it, creating a scar formation. As with keloids the fibroblasts continue to proliferate even though the tissues are filled already.
Keloids lack the ability to somehow shut down the normal scarring or healing process. It keeps growing until somehow it gets turned off.
In fact, scientist does not know how to fully shut off the proliferation of fibroblast. Most of the treatment available is only partially effective. Most so, in the current treatment available, the recurrence rate is still over 50%.
This means that there is no guarantee that the scars will completely resolved.
Even doctors agree that it is something that is understudied and poorly treated. But with the rise of cosmetic surgery, more research is being done into wound healing including how to treat keloid formation.
Is microneedling a promising alternative treatment to heal keloid scar?
As of now, there is still a need for a number of clinical studies to confirm the effectiveness of microneedling treatment in dealing with keloid scars. Although, there are a number of few studies, it is still on experimental or investigational.
Nevertheless, with the increasing research on wound healing, sooner or later, scientist and medical practitioners will be able to figure out.
More so, even the standard treatment for keloid does not promise complete remission of scars. There is still probability that the scar will recur.
But one thing is for sure, microneedling therapy is a good alternative treatment in treating hypertrophic scars which is also characterized by aberrant wound healing and excessive dermal fibrosis. Both keloids and hypertrophic scars represent a great challenge for clinicians to treat.
Hypertrophic scars are defined as elevated and visible scars that do not spread into the surrounding tissues and it often regress spontaneously. It is characterized by proliferation of dermal tissues with excessive deposition of ECM or fibroblast-derived extracellular matrix proteins especially collagen for over long periods. It is also characterized by persistent fibrosis and inflammation.
Studies have shown that microneedling treatment is an effective alternative option in treating hypertrophic scars. But the effectiveness of the treatment depends on the morphological type of the scars as well as the severity of the scars present.
Is Microneedling, the Next Big Thing?
Microneedling is a promising treatment modality. Although, there is a need for further clinical studies, most of the current researches showed positive and promising results.
Reducing keloid is a challenge to clinicians. Thus, there is a need for more research to wound healing to come up with the most suitable option. Microneedling therapy is a good avenue for research and hopefully in the future we can see confirmatory results.
Abeer Shaheen,corresponding author1 Jamal Khaddam,1 and Fadi Kesh2. (2016). Risk factors of keloids in Syrians. BMC Dermatol. , 13.
Celeste C Finnerty, PhD,1,2,3 Marc G Jeschke, MD PhD,4,5,6,* Ludwik K Branski, MD,1,2 Juan P. Barret, MD PhD,7,* Peter Dziewulski, FRCS (Plast),8,9 and David N Herndon, MD1,2,3,*. (2016). Hypertrophic scarring: the greatest unmet challenge following burn injury. Lancet , 1427–1436.
Felipe Bettini Rabello,I Cleyton Dias Souza,II and Jayme Adriano Farina JúniorIII. (2014). Update on hypertrophic scar treatment. Clinics (Sao Paulo) , 565–573.
Gauglitz, G. G. (2013). Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Investig Dermatol. , 103-114.
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Home > dance > The King Dances, Birmingham Royal Ballet, Sadler's Wells
The King Dances, Birmingham Royal Ballet, Sadler's Wells | reviews, news & interviews
The King Dances, Birmingham Royal Ballet, Sadler's Wells
A striking new work about the Sun King and the origins of ballet shows BRB at its dynamic best
by Jenny GilbertSaturday, 17 October 2015
'The King Dances', a new ballet by BRB artistic director David Bintleyphoto: Bill Cooper
For an art form with a marked penchant for looking over its shoulder, it's surprising how rarely ballet has exploited its own origins story – not least given the fabled opulence and style of its leading character. The Sleeping Beauty makes a nod to Louis XIV and the court of Versailles in its final moments, but in most ballet goers' mental archive that's just about it.
Full marks to David Bintley, then, for turning a light on the Sun King and his love of dancing, and for recognising in the story a prime opportunity to create another rare thing: a glamorous showcase for the company's men. Premiered earlier this year to mark Bintley's 20 years as director of Birmingham Royal Ballet, The King Dances is emphatically not a pastiche. Both its choreography and music (of which more later) are primarily 21st-century. In structure, though, the half-hour work takes on the historical identity of Le Ballet de la nuit, a 12-hour court spectacle performed in 1653 in which the 15-year-old monarch appeared in several roles, culminating in a splendid walk-on as Apollo, the Sun god, clad head to toe in gold. Theatrical bling? Louis invented it.
For added interest, Bintley colours this dance-for-dance' sake scenario with dabs of political intrigue. The second lead role is the teenage king's dominating First Minister, Cardinal Mazaran (danced powerfully by Tyrone Singleton) who, while ostensibly protecting Louis from the Frondeurs, a section of French nobility who resisted the authority of the monarch, harboured dark ambitions of his own. Would it have helped identification if the Cardinal had worn red? Amid a sea of whirling black frock coats, it would.
Solos and group dances flow from one to another without strain
Katrina Lindsay's designs are otherwise magnificent. My, how sexy the BRB boys look under flaming torchlight in those long flowing wigs and tooled-leather coats – a far cry from the perfumed effeminacy we associate with Versailles. And Bintley's steps exploit the flare of those coats to the max in pouncing fencing moves, corkscrew leaps and travelling pirouettes. The men stamp a lot too, their feet adding another layer to Stephen Montague's percussion-rich score, a thing of beauty in itself. Hats off to the trumpet section for a heart-stopping duet accompanied by bass drum.
The most satisfying thing about The King Dances is its integrity: no single element stands above the rest, and solos and group dances flow from one to another without strain – the need to find roles for a broad swathe of the company can sometimes be all too obvious, but not here. Masking the women was a good move, emphasising their low status at court. The grotesque terrors of Louis' nightmare sport some fun penile prosthetics. Yijing Zhang is luminous as La Lune, slender as a moonbeam as she wreathes her limbs around the king. William Bracewell makes an appealingly lanky Louis, red ringlets flying. Even his final entry in that ridiculous gold suit leaves you with a lump in your throat. Vive le Roi indeed.
The evening opens with George Balanchine's Theme and Variations from 1947, a Tchaikovsky number that has become a bit of a signature for BRB: it was the first work performed by the newly renamed company in 1990 – a telling choice in that it set the barre sky-high. For this is Balanchine bending the knee to the diamond-bright classical style of St Petersburg, its ballerina role "Aurora written in lightning", in the words of the New York critic Arlene Croce. That BRB continues not only to meet the work's extreme technical challenges, but to relish them (all that smiling looked genuine) is a kite mark of quality.
Suffice to say that Momoko Hirata (pictured above) made the 90mph footwork look easy-peasy, Joseph Caley was a cheeringly boyish beau, and the supporting four couples moved as one. "Don't they all look young!" marvelled my companion. And so they do. Balanchine's work, for all its refinements, demands it.
The filling in the sandwich, what one might have expected to be the evening's highlight, turned out to be its single disappointment. Enigma Variations, Frederick Ashton's delicate fleshing-out of Edward Elgar's musical portraits of his friends and family, was over-egged and under-lit. Yes, designer Julia Trevelyan Oman's vision of Edwardian England might be oak-panelled and sepia-soaked, but Mark Jonathan's revised lighting rendered everything murky brown, the equivalent of Windsor soup. The Royal Ballet Sinfonia under Paul Murphy were hard to fault, however.
This programme plays again tonight at Sadler's Wells, then on 30 and 31 October at the Theatre Royal, Plymouth
My, how sexy the boys look under torchlight in those long flowing wigs and tooled-leather coats
The King Who Invented Ballet, BBC Four
Shadows of War, Birmingham Royal Ballet, Sadler's Wells
BBC Ballet Season
classical ballet
The "women"are masked because
Permalink Submitted by Helen Goodger (not verified) on Sat, 17/10/2015 - 22:53
The "women"are masked because they are danced by men...as in the original ballet de nuit....


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