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Walking for weight loss: how to maximise your daily exercise routine
Whether you’re specifically walking for weight loss or just appreciating the beauty of the outdoors, you’re doing wonders for your physical and mental health by getting outside and putting one foot in front of the other.
Dedicated gym-goers and marathon runners might raise an eyebrow at whether walking is actually a workout, but multiple studies show that walking is one of the best activities we can do for our health – and stepping up your walking routine to aid weight loss is actually super easy.
Just 30 minutes of walking, five times a week, can have a huge impact on your health. Incorporating different paces, speeds and even elements such as lunges and squats into your walk, can also be an effective way to help the pounds fall away.
“Walking helps to protect against cardiovascular diseases, cancer, bone-thinning osteoporosis and dementia,” says Dr. Melanie Wynne-Jones. “It’s also good for our mental health to get outside and see gardens or green spaces, and walking can be sociable, too.”
Ready to upgrade your walking routine? Invest in the best walking poles and best walking socks and follow our expert top tips and walking plan to help get in shape within 30 days.
(Image credit: Getty Images/iStockphoto)
Work on your walking style
Improve your technique and walking becomes a body-toning workout:
- Lengthen your spine through your neck. This will lift your head, relax your shoulders, help you go faster and ease lower back pain. “Avoid slouching your shoulders, turning your feet outwards or inwards, collapsing through the arch of your foot or just walking on your toes,” advises trainer Chris Richardson.
- Stop clenching. It’s tempting to tighten those bottom cheeks, but if you release them, you’ll get a natural sway, which helps reduce back tension. It makes your tummy area work harder, too for a core strengthening bonus!
- Shorten your stride. We know you’re keen to walk faster, but taking giant steps will overtax your leg muscles and put strain on your knee joints. Trust us, shorter really does equal more calorie-burning speed – ideal when walking for weight loss.
- Pull your tummy in towards your spine. Then keep it there but without holding your breath. Tricky at first, but combined with cardio-pumping power walking, it really does help tone up your middle.
Boost your motivation
Even when the weather is miserable, keep going with these easy tricks:
- Add great sounds to hype your calorie burning. Studies at a US university revealed that women who walked at least three times a week to music lost around 16lb in six months, whereas those who walked in silence only managed 8lb. So grab your headphones and listen to your favourite playlist while you walk.
- Head towards nature. Live near woodland? Try forest bathing – as you walk, submerge yourself in your surroundings by breathing in the aromas and focusing on the nature around you. Japanese researchers found it can reduce stress while boosting immunity and wellbeing. Plus, a study by the mental health organisation Mind showed that taking a walk in natural surroundings increased sensations of happiness in 71% of participants.
- Think about signing up to a charity walk. Not only will you raise money but it will give you a goal. Plus, joining up with a friend will keep you both motivated.
- Grab some poles. Walking poles ramp up calorie-burning by 20%, so it makes sense to use them. The right technique is key: Swing poles so that the one in your right hand strikes the ground as your left foot hits the floor, then the left-hand pole hits as your right foot strikes the ground, and so on.
Your 30-day walking for weight loss plan
This month-long walking challenge is all about maximising the activity on your daily walk to help you reap the full benefits of walking.
There are three levels. Find yours using the test and then follow the targets below. If you find that your level is too easy, switch to a more advanced one – the key thing is the consistency of your efforts.
Do the daily walks and the weekly booster walks when you can, but don’t stress, the most important things is that you enjoy your time outside! “We’ve massively over-complicated health,” says TV GP Dr Rangan Chatterjee. “We think everything needs to take a long time and a lot of effort, but a five-minute walk around the block can make a difference. Every little counts.”
If you want to up the benefits, up your pace instead. Research at America’s Duke University found that the walking speed of middle-aged people was a good guide to how well they were ageing. Slower walkers aged faster, with immune systems, lungs and even teeth in a worse condition than the faster movers.
Not sure how you fast should you go? It depends on your age and fitness, but aiming for a certain pace doesn’t have to be complicated. A good measure is that you should sweat a little bit, feel your heart rate rise but should still be able to hold a conversation. If you’re one for stats and gadgets, try to stick to 100 steps a minute (2.7mph). Check your pace by counting how many steps you take in 10 seconds and multiplying by six. Anything above 130 steps a minute would count as a vigorous walk.
Take the test:
Beginner? If your daily average is less than 5,000, opt for the Novice Level
Daily output between 5,000 and 7,500? Go for the Intermediate Level
If your daily average is 7,500+, choose the Whizz Level
(Image credit: Getty Images)
Take on our walking challenge
Novice 5,000 steps
Intermediate 7,000 steps
Whizz 7,500 steps
Novice 5,550 steps
Intermediate 7,500 steps
Whizz 8,000 steps
Novice 6,000 steps
Intermediate 8,000 steps
Whizz 9,000 steps
Novice 6,500 steps
Intermediate 8,500 steps
Whizz 10,000 steps
ADD IN THESE, TOO…
Twice a week, do two extra-brisk walks. Each should take 10-15 minutes, building up to 20-25 minutes.
Novice 1,200-1,500 steps
Intermediate 1,500 steps
Whizz 1,700 steps
Novice 1,500-1,800 steps
Intermediate 1,700 steps
Whizz 1,800 steps
Novice 1,800 steps
Intermediate 2,000 steps
Whizz 2,500 steps
Novice 2,000 steps
Intermediate 2,500 steps
Whizz 3,000 steps
(Image credit: Getty Images/iStockphoto)
Improve your weight loss results
If you want to make your workout harder, add some extra strength exercises in. “Adding these exercises to your walks will boost your muscle strength and endurance, as well as improving your balance and walking gait (the way you walk),” says Chris. Pause your walk at every 1,000 steps and aim for either 10 (Novice), 20 (Intermediate) or 30 (Whizz) repetitions of the below.
With feet shoulder-width apart, step your left leg behind you and to the right. Bend both knees, so you’re in a curtsy position. From here, jump to the side to switch the position of your legs, ending in a curtsy lunge with leg positions reversed. Split the rep count between each leg.
Stand with your feet hip-width apart. Keep your feet flat and back straight, then lower into a sitting position. Lift your arms out in front of you to balance. Hold for three seconds, push your heels into the floor and drive up to standing.
Start with your legs together. Lift your right leg over your left leg, so they’re crossed. Interlink your arms so your right elbow is underneath your left, palms touching. Squat down, hold for three seconds, switch sides and repeat.
Extinct kangaroos Sthenurus weighed 250kg and were too heavy to hop
When the extinct kangaroos lived in the Australian outback 100,000 years ago, they were three times the size as they are today and did not hop around on their hind legs, new research has found.
The 2.7 metre-tall rabbit-like face marsupials weighed as much as 250 kilograms and walked around with a heavy gait, which supported their weight on one leg at a time, according to scientists.
The study found the ‘short-face’ sthenurine ‘lacked specialised features for fast hopping’ after analysing bones from more than 140 past and present kangaroo and wallaby skeletons.
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Scientists have found the extinct kangaroos were three times the size as they are today and were not hoppers
The large modern kangaroos hop at fast speeds with a flexible backbone, sturdy tail and hands that supported their body weight but the extinct species did not have the same skeleton structure.
The giant kangaroos supported their weight using their tail as a fifth limb and had much larger hips and knees and big ankle joints, according to the study.
The lead researcher from Brown University Professor Christine Janis, said: ‘I don’t think they could have gotten that large unless they were walking,’
The large modern kangaroos hop at fast speeds with a flexible backbone, sturdy tail and hands that supported their body weight but the extinct species did not have the same skeleton structure
The giant kangaroos supported their weight using their tail as a fifth limb and had much larger hips and knees and big ankle joints compared to today’s kangaroos
The extinct species of Sthenurus had a skeleton built for walking, rather than hopping
‘If it is not possible in terms of biomechanics to hop at very slow speeds, particularly if you are a big animal, and you cannot easily do four legged locomotion, then what do you have left?’ she said.
‘People often interpret the behaviour of extinct animals as resembling that of the ones known today, but how would we interpret a giraffe or an elephant known only from the fossil record?
‘We need to consider that extinct animals may have been doing something different from any of the living forms, and the bony anatomy provides great clues.’
The 2.7 metre-tall rabbit-like face marsupials weighed as much as 250 kilograms and walked around with a heavy gait, which supported their weight on one leg at a time
Professor Rod Wells disagreed that the extinct creatures weighed 100kg, similar to the modern kangaroos
Flinders University biological sciences Professor Rod Wells disagreed that the extinct creatures weighed 240 kilograms but weighed 100kgs, the same as the modern-day red and grey kangaroos.
He told Daily Telegraph that they weighed 100 kilograms and their hopping gait supported most of their body weight on the forth toe, similar to today’s kangaroos.
‘Their feet do not appear to be feet that spread the load across the wide support of the foot as if they lived in rocks or trees,’ he told Daily Telegraph.
‘The form suggest the function related to a hopping movement.’
‘I don’t buy the argument they couldn’t hop,’ he said.
Scientists found sthenurines’ hands were also poorly suited for moving on all fours but adapted for foraging off trees
Their anatomy were ‘clearly different’, compared to today’s species, as they walked, rather than move around fast by hopping, which may have led them to become extinct about 30,000 years ago.
Or perhaps the sthenurines had issues when they carried a large pouch joey with a ‘different type of locomotion’.
But scientists also found that their hands were also poorly suited for moving on all fours but adapted for foraging off trees.
Professor Janis said the ancient species may have been unable to migrate far enough to find food as the climate became more arid.
The study was conducted by scientists at Brown University and Spain’s Universidad de Malaga in the journal PLOS ONE, which was published on Thursday.
Shaky Evidence for Signs of Functional Neurological Disorders
By David Tuller, DrPH
One of my goals next year is to write more about so-called “medically unexplained symptoms,” also known as MUS. The term MUS might be useful as a descriptive name for the large category of phenomena that lack a proven pathophysiological pathway. But in the medical literature, and in the minds of those who present themselves as experts in the field, it is framed as an actual diagnosis that can be delivered with full confidence rather than a provisional construct based on the current state of medical understanding.
Different specialties have their own sub-categories of MUS. In neurology, these are called “functional neurological disorders,” or FND. This term has generally replaced older ones for this concept, including “conversion disorders” and “psychogenic disorders. ” As with MUS overall, the evidence for these conditions has resided primarily in the absence of standard signs indicating organic dysfunction. The phrases “conversion disorder” and “psychogenic disorder” mean exactly what they say–the idea is that unexpressed psychological distress is transformed into physical symptoms, although how this “conversion” would occur is not really clear.
In contrast, FND is considered a kinder, gentler phrase. It does not automatically convey the notion of a psychiatric disorder, so the presumption is that the diagnosis is more likely to be acceptable to patients, who can resist being told they do not have an organic illness. The field of neurology has also taken to analogizing FND to “software” rather than “hardware” problems–the latter referring to known neurological disorders with recognized mechanisms. But as with MUS, FND appears to be deployed as a definitive diagnosis rather than as a tentative acknowledgement that doctors simply cannot at this moment pinpoint what the hell is going on and what is generating the troubling symptoms.
A 2018 paper—“You’ve made the diagnosis of functional neurological disorder: now what?”–generated some recent discussion on the Science For ME forum. The authors were affiliated with the neurology and/or psychiatry departments at Harvard Medical School and Brown University, and the paper appeared in Practical Neurology, a BMJ journal. The paper did not raise concerns about the epistemological foundation of the FND category but advised clinicians on how to “enhance diagnostic acceptance and address patients’ doubts.” In other words, patients apparently have a tendency to reject diagnoses that presume their symptoms do not have an organic explanation.
The paper included a statement that triggered my interest; specifically, the authors noted that “there have been significant advances in the diagnostic approach for FND, emphasising a ‘rule-in’ diagnosis based on neurological examination and semiological features.” Hm. What evidence now exists that would allow for a “rule-in” diagnosis of FND, as opposed to diagnosing it solely after ruling out other causes?
One of the cited references was a 2013 paper called “The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. ” This review, from Swiss researchers, was published by the Journal of Neurology, Neurosurgery and Psychiatry, another BMJ title. Its findings demonstrate the paucity of the evidence behind assertive pronouncements that physical symptoms must have non-organic or psychogenic origins.
Here’s part of the abstract from the review:
“Experts in the field of conversion disorder have suggested for the upcoming DSM-V edition [Diagnostic and Statistical Manual of Mental Disorders, whose fifth edition was published shortly after the review] to put less weight on the associated psychological factors and to emphasise the role of clinical findings. Indeed, a critical step in reaching a diagnosis of conversion disorder is careful bedside neurological examination, aimed at excluding organic signs and identifying ‘positive’ signs suggestive of a functional disorder. These positive signs are well known to all trained neurologists but their validity is still not established.”
The review reports a growing demand for proof of claims that symptoms are not organic beyond the clinician’s failure to identify a pathophysiological cause. Diagnoses in this domain are now expected to be based not just on the lack of evidence for known diseases but also on the presence of clinical findings purportedly characteristic of FND. As the authors write, “This distinction [between organic and functional disorders] is based on the exclusion of neurological signs pointing to a lesion of the central or peripheral nervous system, together with the identification of ‘positive signs’ known to be specific for functional symptoms.”
This emerging evidentiary demand presents neurologists and other clinicians with something of a dilemma, according to the review. As the authors note, “In the era of evidence-based medicine however, clinicians are facing a lack of proof regarding the validity of those clinical ‘positive signs.’”
First, it should be noted that clinicians faced this “lack of proof” long before “the era of evidence-based medicine.” The difference is that in previous years they presumably did not confront the same demands for documentation of these unsupported claims. Under the present circumstances, it is not clear why neurologists and psychiatrists retain such confidence in their pronouncements that some physical symptoms are of non-organic origin. This approach to medicine—making dogmatic declarations and diagnoses despite minimal or no valid evidence–is suggestive of the state of mind known as “emperor-has-no-clothes-ism.”
The review concludes that eleven studies have provided “some degree of validation” for 14 “positive” signs, such as involuntary reflexes, for FND in the categories of “weakness, sensory and gait disorders. ” Ten of these eleven studies included 23 or fewer subjects identified with FND. One study included 107 patients identified with FND. In ratings of study quality per the American Academy of Neurology’s classification system, nine of them were designated as Class III—the third out of four grades of quality. Only two included blinding. None included information on inter-rater reliability of these “positive” signs, raising the chances of inconsistencies in how data were interpreted.
According to the authors, overall these “positive” signs have low sensitivity—meaning they would miss many of those who supposedly suffer from FND. The review reports that, in contrast, these signs generally have high specificity—meaning those identified are likely to have the disorder in question. But the review’s account of its own limitations makes clear that even these findings of high specificity cannot be taken at face value.
As the authors write: “As no gold standard exists for functional weakness, sensory and gait disturbances, precise diagnostic criteria on how a diagnosis of functional disorder has been made are not always provided [in the studies reviewed] and wrong attribution of subjects could have occurred. More importantly and more likely, this could have introduced a circular reasoning bias (self-fulfilling prophecy): if the studied sign is also used in the diagnosis process, the reported specificity is overestimated.”
That passage raises a critical point. In studies included in the review, it is possible or even likely that some or many participants were diagnosed at least partly based on “positive” signs that all trained neurologists apparently interpret as suggestive of FND. If that’s the case, then it would not be surprising that assessing the presence of these same signs among these patients would result in high prevalence rates and high specificity. As the authors themselves suggest, this would mean that claims about the diagnostic usefulness of the signs were the result of a self-fulfilling prophecy.
And yet, despite these serious caveats, the study wholeheartedly recommends these signs as helpful tools for diagnosing FND. (The study makes other points as well, of course: about the need for better quality studies to further validate these and other signs for FND, etc. )
From this and related studies, it appears that some neurologists and psychiatrists are engaged in a spirited search for robust data to prove their claims about FND—even as they continue to present these claims as unchallenged knowledge, not as the hypotheses and speculations they actually are. This backward approach to science—seeking evidence for what you have already asserted as fact–strikes me as very Trumpian.
Sherlock Holmes and the curious case of the human locomotor central pattern generator
In neurologically intact humans, the same experimental procedures used in reduced animal preparations are typically too invasive to be applied. Instead, we must rely on extrapolation of observations from the animal models of locomotion to humans based on the assumption that there are fundamental similarities in common principles of motor control across vertebrates and invertebrates (Duysens and Van De Crommert 1998; Pearson 1993; Zehr et al. 2016). This approach hearkens to the “principle of parsimony” commonly attributed as “Occam’s Razor. ” William of Ockham (1287–1347) is said to have argued that whenever multiple hypotheses must be considered, we should always choose the one with the fewest and simplest set of assumptions. This relates to the underlying principle Doyle was getting at when he had Sherlock Holmes say “Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth.”
Moving forward, we operate on the simple assumption that locomotor control in nature will be recapitulated in a similar but adapted form in all species, including humans. Thus evidence obtained from one species should be observable in another species. In view of the very extensive evidence for locomotor CPGs in other animals, it would be very surprising if there was a complete lack of a CPG network in humans, and no evidence has been presented to support this (Duysens and Van De Crommert 1998; MacKay-Lyons 2002). It will be shown below that there are indeed striking similarities between other reduced animal preparations and humans with respect to the neural control of locomotion. From the key observations listed above that support and describe CPGs made from reduced animal preparations, predictions can be formed on the structure and function of CPGs in humans.
1) Some Evidence That the Isolated Spinal Cord Can Produce Rhythmic Motor Output
“The game is afoot!”
“The Adventure of the Abbey Grange” (1904)
An observation from other species to evaluate in humans is that the spinal cord can produce rhythmic activity without modulation from the brain or sensory feedback. From reduced animal studies, it has been found that CPG networks are housed within the spinal cord and, in isolation, can produce the basic patterned motor outputs required for locomotion. Definitive evidence of a spinal CPG in humans would require the demonstration of locomotor-like rhythmic movements in an isolated spinal cord with no descending input and no feedback from the periphery. Such evidence in the human spinal cord is not fully available; however, some indirect observations of rhythmic activity support the suggestion of spinal and supraspinal integration in CPGs subserving human locomotion: for example, from studying stepping responses in those with spinal cord injury, from observations of air-stepping in healthy participants, an indirect observation of sleep-related rhythmic leg movement, and in walking in human infants. These examples all have one thing in common: descending input from supraspinal centers is limited because the spinal cord is functionally isolated from the brain. These examples are some of the best evidence for CPG activity in humans.
Clues from those with spinal cord injury.
“It is more than possible; it is probable.”
“Silver Blaze” in The Memoirs of Sherlock Holmes (1893)
Perhaps the best examples of CPG-mediated locomotion in humans come from studying rhythmic movement in those with spinal cord injury (SCI) (Bussel et al. 1988; Calancie et al. 1994; Dietz et al. 1994a, 1998; Dimitrijevic et al. 1998; Harkema et al. 1997). This is because in this paradigm we can better assess the role of the spinal cord during reduced supraspinal regulation (Dietz et al. 1998). Following SCI, spinal circuitry below the lesion site does not become silent, but rather continues to maintain active and functional neuronal properties, although in a modified manner (de Leon et al. 2001; Edgerton et al. 2001). Although not the first observation, a case study of a patient with a clinically complete cervical SCI provides compelling evidence for a spinal CPG. Rhythmic, symmetrical, and bilateral myoclonic movements of the trunk and lower limbs, resulting in hip and knee flexion-extension at ~0.6 Hz, were recorded when the participant was placed over a treadmill (Bussel et al. 1988). This observation demonstrated that in humans, rhythmic activity could be generated within the spinal cord, without supraspinal inputs (Bussel et al. 1988). However, stimulation applied below the level of the transection, for example, by twisting the toes, could induce, slow, or interrupt the rhythmic activity (Bussel et al. 1988). Conversely, peripheral stimulation above the level of the spinal transection did not modify the myoclonus. Electrical stimulation of flexor reflex afferents from the sural nerve also affected rhythmic activity. During extensor activation, stimulation of flexor reflex afferents induced a flexion reflex that induced alternating flexor and extensor bursting activity that could be sustained for several cycles (Bussel et al. 1988). Similar activation of a spinal CPG by flexor reflex afferents was observed in cats (Duysens and Stein 1978; Jankowska et al. 1967; Pearson 1995; Seki and Yamaguchi 1997).
Other evidence comes from a patient with an incomplete injury of the cervical spinal cord (Calancie et al. 1994). Although this person had no ability to generate voluntary lower leg muscle activity, involuntary lower extremity stepping-like movements were expressed spontaneously when the patient was lying in a supine position. The movements were rhythmic with “forceful and patterned” bursts of alternating activity recorded from muscles of both legs. Peripheral feedback modified the rhythm such that movements increased with dorsiflexion of the toes and were abolished by the patient flexing the hips to 90°, rolling over, sitting up, or being moved to a standing posture (Calancie et al. 1994). However, due to the incompleteness of the lesion, this observation solicited further substantiation in patients with a complete SCI.
This evidence from incomplete SCI is supported by the presence of myoclonic rhythmic movements in six patients with complete SCI (Calancie 2006) and spontaneous motor rhythms of the legs, resembling bipedal stepping, in another patient with complete spinal cord transection (Nadeau et al. 2010). It must be noted, however, that the observation of spontaneous activity occurs more often in those with an incomplete compared with complete SCI (Harkema 2008), suggesting a strong modulatory role for supraspinal input.
Clues for CPG activity in humans have been provided by observations of rhythmic, locomotor-like movement of the lower limbs in complete SCI patients following epidural electrical stimulation of the spinal cord (Dimitrijevic et al. 1998). Tonic stimulation below the level of the injury (near L1–L3) triggered phasic bursts of rhythmic output in motoneurons for the legs. Increased stimulation amplitude resulted in increased electromyography (EMG) amplitudes and an increased frequency of rhythmic activity (Dimitrijevic et al. 1998) in a manner reminiscent of Sherrington’s early observations in the cat. This is evidence that a human spinal cord, with minimal or absent supraspinal input, can generate rhythmic movements. However, there is still the presence of modulatory sensory feedback. To address this, in subsequent studies it was shown that epidural stimulation could produce rhythmic EMG activities even when the legs were stationary and thus producing minimal step-related sensory feedback (Minassian et al. 2004). Although sensory feedback has an influence on many features of the spinal rhythm, it seems that it is not required to produce the elementary CPG activity even in humans.
A final compelling observation that argues in favor of CPG regulation taken from SCI participants is that leg muscle activity recorded during walking far exceeds in amplitude the maximum that can be achieved during a voluntary contraction (Dietz 2003; Morawietz and Moffat 2013). This important observation supports the notion that locomotor EMG is centrally driven by something more than direct output from descending supraspinal commands.
Clues from restless leg syndromes.
“Circumstantial evidence is a very tricky thing…”
“The Boscombe Valley Mystery” in The Adventures of Sherlock Holmes (1891)
Another human model where supraspinal regulation of spinal cord activity is functionally diminished is found in restless leg syndromes. These syndromes can be found in those with SCI, multiple sclerosis, sleep disruptions, and other neurological disorders (Guertin 2013). Coming on either spontaneously or during sleep, restless leg syndrome presents as rhythmic flexion and extension of the toe, ankle, knee, and hip (Clardy and Connor 2010). This clue provides evidence of a CPG because patterned rhythmic movement can still be observed despite reduced descending supraspinal regulation. In the case of those sleeping, restless leg syndromes could arise from a transient interruption in descending inhibition where spinal CPGs for locomotion are activated (Coleman et al. 1980; Chervin et al. 2003). In any case, periodic leg movements of rhythmic activity may be associated with abnormal and involuntary activation of CPG networks.
Clues from passive air-stepping.
“You have brought detection as near an exact science as it will ever be brought in this world.”
A Study in Scarlet (1887)
Under normal conditions, it is difficult to investigate CPG functioning because of the interfering interactions of feedback from the ongoing task of body weight and balance control. A way to activate and reveal rhythm generation via CPG circuits in conditions not affected by these extraneous factors is by using an air-stepping paradigm in a reduced gravity situation (Gerasimenko et al. 2010; Gurfinkel et al. 1998; Selionov et al. 2009; Sylos-Labini et al. 2014a). In this paradigm, with one leg horizontally suspended and with subjects instructed to relax and not to intervene with the induced movement, vibration of a muscle of the suspended leg can elicit cyclical hip and knee movements in both legs (Gurfinkel et al. 1998). Rhythmic EMG activity is reciprocally organized in the muscles around the hip joint with movement restricted to the hip and knee. The ankle joint is only involved if minimal loading forces are applied to the foot (Gurfinkel et al. 1998). Interlimb connections were revealed when it was also shown that cervical transcutaneous stimulation with vibration of the cervical spinal cord significantly facilitated involuntary activation of the lumbosacral locomotor-related neuronal circuitry, producing leg movements (Gorodnichev et al. 2012). The constant inflow of proprioceptive afferents, due to the vibration, is thought to have initiated and sustained activation of the spinal pattern generation circuitry (Solopova et al. 2015). One possible route for these trigger signals is through intrinsic spinal pathways mediated by presumed propriospinal interneurons linking cervical to lumbosacral regions in humans (Nathan et al. 1996).
Although rhythmic air-stepping activity evoked by vibration is not strong enough for body support and propulsion, it does support the view that the basic rhythm underlying locomotion can be generated involuntarily in humans (Gerasimenko et al. 2010; Gurfinkel et al. 1998; Selionov et al. 2009; Solopova et al. 2015; Sylos-Labini et al. 2014a). Reduced gravity also offers unique opportunities for altered locomotor conditions for gait rehabilitation while still activating pattern-generating networks (Sylos-Labini et al. 2014b).
Clues from infant walking.
“Altogether it cannot be doubted that sensational developments will follow.”
“The Adventure of the Norwood Builder” in The Return of Sherlock Holmes (1903)
Indirect evidence for a locomotor CPG also comes from studies of the automatic stepping response in human infants. Providing physical support for an infant (who is unable to walk and bear weight on its own) suspended over a treadmill can allow elicitation of rhythmic stepping movements (Yang et al. 1998). This observation supports the notion of spinally driven locomotor movements, because descending regulatory pathways involving the cerebellum and motor cortex are not fully mature in a human infant (Khater-Boidin and Duron 1991; Yang et al. 2004). Stepping movements have also been observed in anencephalic infants, further intimating the existence of CPG locomotor control centers below the level of the brain stem (Forssberg 1992). In addition, ultrasound recordings have revealed in utero images of human fetuses producing alternating primitive, steplike coordinated movement long before brain development (Ianniruberto and Tajani 1981; Kozuma et al. 1997). These data support the notion that the onset of voluntary stepping precedes development and full myelination of descending pathways from the brain, and thus that the infant stepping response is mediated by a spinal CPG mechanism.
Stepping movements in human infants are modulated by movement-related sensory feedback. Limb loading is a powerful signal for regulating the stepping pattern (Pang and Yang 2000; Yang et al. 1998). Manually adding limb load during the stance phase of gait by pushing down on the hips prolonged the stance phase (Pang and Yang 2000), whereas unloading the limb was an important cue for the transition into swing phase for forward, backward, and sideways walking (Pang and Yang 2000, 2001, 2002). Infants showed well-organized and location-specific reflex responses to mechanical disturbances during forward, backward, and sideways walking (Lamb and Yang 2000; Pang and Yang 2000, 2001). These results are consistent with the concept that sensory feedback can access and entrain CPGs subserving multiple modes of locomotion, as is found in spinalized cats.
Recordings of leg muscle activity during stepping in neonates, toddlers, preschoolers, and adults revealed that two basic patterns of stepping are retained through development (Dominici et al. 2011). The observation of a conservation of neural patterning across development is also seen in other species, including the rat, cat, macaque, and guineafowl (Dominici et al. 2011). As rudimentary movements adapt and coalesce during development, there is a conservation of locomotor patterning apparent across species. This observation supports the notion that a common ancestral neural network for central locomotor control may exist (Dominici et al. 2011).
Summary of the evidence for rhythmic motor output from the “isolated” human spinal cord.
Stepping responses in those with SCI, observations of air-stepping in healthy participants, indirect observation of sleep related rhythmic leg movement, and walking in human infants provide clues for a spinal locomotor CPG in humans. A spinal mechanism is presumed because descending input from supraspinal centers is functionally diminished. These clues are some of the strongest evidence for a spinal CPG in humans. It must be noted, however, that peripheral feedback and supraspinal inputs can never be totally removed in these models. Thus, compared with other animals, there is a more distributed “address” for where locomotor elements “live” in the human nervous system.
2) Some Evidence That Sensory Feedback is Modulated During Human Locomotion
“There is nothing more deceptive than an obvious fact.”
“The Boscombe Valley Mystery” in The Adventures of Sherlock Holmes (1892)
Although the functionally isolated spinal cord possesses impressive capacity to generate rhythmic output via CPG networks, afferent signals are a critical part of the adaptive motor control system. The timing information and reflex corrections derived from sensory feedback are essential for effective locomotion and adaptation to the environment (Grillner and Zangger 1984). Very early on, the importance of sensory feedback in the control of locomotion was acknowledged for its “regulative” role, rather than a “causative” role (Brown 1911, 1914). When Brown demonstrated that central oscillating mechanisms generated the basic stepping pattern, he also acknowledged the role of sensory input in shaping this output, commenting “there can be no question of its importance nor its suitability to augment the central mechanism” (Brown 1911, p. 318).
There is ample evidence that CPGs require sensory feedback to modulate and adapt their rhythmic output appropriately. Indeed, if step cycle durations and muscle patterns were fixed centrally and immutable, it would be impossible to adapt to changes in the external environment and we would be constrained to locomote on flat planes. To achieve effective locomotion, afferent feedback acts directly on the CPG and contributes to the modulation of its output (Duysens and Van De Crommert 1998; Van de Crommert et al. 1998). In addition, afferent feedback is also relayed to motoneurons via various reflex pathways, and these pathways themselves are under the control of the CPG (Burke et al. 2001; Zehr et al. 2004a; Zehr 2005). This way, the CPG ensures that reflex activations are facilitated at appropriate times in the step cycle and suppressed when not appropriate (phase-dependent modulation; Duysens and Van De Crommert 1998).
From evidence in other animals, sensory feedback from load, muscle stretch, and tactile cutaneous receptors provides information required by the CPG circuitry to generate functional and adaptive locomotion. Electrical stimulation at intensities that preferentially activate afferent axons from these so-called proprioceptive sensory receptors reveal they have the ability to directly access, entrain, and reset CPG output. Sensory feedback has a role in acting directly on the CPG to initiate and facilitate phase transitions in rhythmic movements (Conway et al. 1987; Duysens and Pearson 1980). For example, activating hip flexor (sartorius muscle) afferents with electrical stimulation modulated CPG activity by resetting the locomotor rhythm from flexion to extension and caused generation of flexor bursts in contralateral leg flexor muscles in the cat (Perreault et al. 1995). Flexor reflex afferents can access deeply into CPG networks to reset the step cycle to a new flexion (Jankowska et al. 1967; Schomburg et al. 1998). It must be noted, however, that in these animals with reduced descending control, sensory feedback from a single input pathway is sufficient to affect CPG activity. In intact animals, manipulation of just a single type of sensory feedback is not sufficient to modulate and reset rhythmic activity (Duysens and Stein 1978; Whelan and Pearson 1997).
Related observations are found also in human experiments where transient changes in afferent activity do increase muscle activity. However, an attempt to activate load sensory feedback during the stance phase by adding a substantial weight at the center of mass was insufficient to significantly change the stance duration of the step cycle (Stephens and Yang 1999). Therefore, it is unclear to what extent CPGs and sensory feedback are integrated in the control of rhythmic motor timing in humans. There are no studies in humans, as there are in cats, that directly evaluate the exact contribution of sensory feedback to CPG output. However, indirect methodologies allow observations to be made in an intact nervous system to evaluate how the CPG regulates afferent feedback during rhythmic movement (Burke 1999; Zehr 2005). Although patterning is not accessible directly, the effects of reflexes as indexes of CPG-related modulation are. Reflexes arising because of activation of afferent projections from receptors in skin and muscle have been studied widely and support the role of locomotor CPGs in the neural control of rhythmic human movement.
Examining reflex activity and modulation during rhythmic movement provides clues that indicate CPG regulation. Reflexes, measured as changes in muscle activity, are the response to electrical or mechanical stimulation of a sensory pathway. This approximates the input-output properties of neural control where stimulation of a given sensory input and a record of the pattern of modulation of motor output during movement are compared. This approach has been used to great effect in the quadrupedal locomotor system (Burke et al. 2001) and is also effectively used in humans (Zehr and Duysens 2004; Zehr et al. 2004a). Examining the modulation of reflexes during rhythmic movement, as an indirect indicator of CPG regulation of afferent input, provides more data from which clues for CPGs in humans have been gleaned.
Clues from task- and phase-dependent modulation of reflex amplitudes.
“It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.”
“A Scandal in Bohemia” in The Adventures of Sherlock Holmes (1892)
The presence of task- and phase-dependent modulation has been used to infer the activity of CPGs in humans. Task- and phase-dependent modulation of reflexes means that efficacy of sensory input varies depending on the timing within a behavior in which it occurs (Duysens et al. 1992; Van Wezel et al. 1997; Yang and Stein 1990; Zehr et al. 1997; Zehr and Stein 1999). An example of task-dependent modulation is depicted in . H-reflexes are progressively inhibited across different tasks from standing to walking to running (Stein and Capaday 1988). H-reflexes examined during walking also show phase-dependent modulation (Brooke et al. 1997; Zehr and Stein 1999). Over the course of the gait cycle, there is phasic modulation of the magnitude of the H-reflex and of the stretch reflex (the mechanical analog of the H-reflex). At the late stance phase, the reflexes in the soleus are facilitated, likely due to an increase in excitability via facilitation along Ia reflex pathways (Yang and Whelan 1993). Functionally, this assists in maintaining an upright position where the reflex is largest in stance phase when balance is required and smallest in the swing phase when free movement is required and when a reflex activation of soleus would counteract the flexion at the ankle (Capaday and Stein 1986; Verschueren et al. 2002).
Attenuation of reflexes under different behaviors. The cartoon subject depicted in the top row is shown performing 4 different motor tasks. Results show a corresponding decrease in H-reflex amplitude. Note that the M wave is held constant and that the M wave and H-reflex amplitude would be normalized to the maximal M wave for each condition across motor tasks to ensure stimulus constancy and proper comparison. [Adapted from Zehr (2002).]
Task- and phase-dependent modulation is also observed for modulation of cutaneous reflexes. In the cat, activation of sensory afferents of cutaneous receptors from the foot, with either direct skin stimulation or electrical stimulation of the nerves, causes a dramatic effect on the locomotor cycle. With stimulation of both the pad of the foot (Duysens and Pearson 1976) and dorsum of the foot (Forssberg et al. 1975), and in fictive locomotion of decerebrate-paralyzed cats (Guertin et al. 1995) or decerebrate cats with transected spinal cords (LaBella et al. 1992), cutaneous stimulation during the stance phase evoked prolongation of extension to delay the foot leaving the ground. Observations from these different spinal cat models confirm that cutaneous feedback pathways make direct connections with spinal cord networks by accessing excitation of the extensor half-center and promoting increased extensor activity (Pearson 2004).
In humans, the same observations of phase-dependent modulation of cutaneous feedback are confirmed. In some cases, modulation is so powerful that a reflex can completely reverse in sign. Such a phase-dependent reflex reversal is highlighted in the tibialis anterior, where in the same muscle, the sign of the reflex reverses from excitation in the early swing phase to inhibition at the stance transition (see ) (Duysens et al. 1992; Haridas and Zehr 2003; Yang and Stein 1990; Zehr et al. 1997).
Phase-dependent modulation and reversal of cutaneous reflex during locomotion in the tibialis anterior (TA). The electromyography (EMG) traces are from TA muscle and are the reflexes to tibial nerve stimulation once the background locomotor-related EMG has been subtracted. An arrow marks the excitatory reflex during swing, which becomes an inhibitory one at the swing-to-stance transitions. [Adapted from Yang and Stein (1990) and reprinted from Zehr and Stein (1999).]
Phase dependency is a symptomatic outcome of CPG output that serves a functional role tuned to locomotor conditions, allowing smooth progression. This keeps walking safe by incorporating afferent information at appropriate times in the walking cycle. For example, as part of the “stumble corrective response” during walking, activation of the top of the swing foot (by a physical perturbation or by electrical activation of cutaneous nerves) causes a reduction in dorsiflexion, allowing the foot to move past the perturbation and not disturb locomotor progression. However, if the same input to the foot in stance yielded similar neural coordination, the person would collapse. Thus, depending on the phase, the same sensory input is transformed by CPG activity to produce functionally relevant outcomes. Control of sensory input is so finely tuned and regulated that even among functional synergists (e.g., soleus, lateral gastrocnemius, and medial gastrocnemius), the size of a reflex can vary throughout the step cycle and can reverse in sign (see ) (Zehr et al. 1997).
Subtracted electromyograms (EMGs) of tibialis anterior (TA; top left), soleus (Sol; top right), lateral gastrocnemius (LG; bottom left), and medial gastrocnemius (MG; bottom right) muscles after superficial peroneal (SP) nerve stimulation for 1 representative subject. Throughout, the stimulus artifact has been suppressed and replaced by a flat line, atop which has been placed a thick dashed line. Each trace runs from 50 ms before stimulation to 250 ms after stimulation. Note phase-dependent reflex reversals in functional synergists. [Adapted from Zehr et al. (1997).]
Clues from mechanistic study of phase-dependent reflex modulation.
“…the problem was already one of interest, but my observations soon made me realize that it was in truth much more extraordinary than would at first sight appear.”
“The Adventure of the Crooked Man” (1893)
There has been much speculation as to how phase-dependent modulation occurs during rhythmic motor tasks. Sensory feedback itself could be involved in modulating other movement-related feedback from muscle or joint receptors (Drew and Rossignol 1987; Misiaszek et al. 1998). The same inputs that generate reflex output could alter presynaptic inhibition to change the gain from muscle spindle group Ia and II and Golgi tendon organ Ib pathways. However, phase-dependent modulation is present in the hindlimb (Quevedo et al. 2005b) and forelimb of the cat (Hishinuma and Yamaguchi 1989), examined by intracellular analysis of reflex pathways underlying the stumble corrective reflex during fictive locomotion, when movement is completely absent (Andersson et al. 1978; Schomburg and Behrends 1978). The observation of phase-dependent reflex modulation in the fictive preparation means reflex modulation must be ascribed, at least in part, to spinal CPG regulation (Andersson et al. 1978; LaBella et al. 1992). Convergence of information from locomotor CPGs onto segmental interneurons within feedback pathways has been proposed as the source of the observed reflex modulation (Seki and Yamaguchi 1997). Thus, along with presynaptic inhibition, the CPG modulates the amplitude of primary afferent depolarizations in afferent reflex pathways (Gossard and Rossignol 1990).
Thus CPGs are likely responsible for regulating and balancing the overall strength of excitatory and inhibitory connections in the spinal cord that allow sensory information to be incorporated (Abraham and Loeb 1985; Andersson et al. 1978; Dietz 2002; Dietz et al. 2001; Duysens and Van De Crommert 1998; Duysens et al. 1990, 1992; Forssberg 1979; Komiyama et al. 2000; Quevedo et al. 2005a; Van Wezel et al. 1997; Yang and Stein 1990; Zehr and Duysens 2004; Zehr et al. 2004b). With intracellular recording, spinal interneurons in spinal cord circuits can be observed to participate in reflex modulation (Bui et al. 2016; Quevedo et al. 2005a). In humans there are several characteristics that reveal a central control mechanism in modulating sensory feedback for task- and phase-dependent modulation. These characteristics include that reflex modulation is independent of changes in background EMG, only occurs with active rhythmic but not passive movement, and is not influenced by feedback in other sensory pathways.
In static tasks, there is a strong linear relationship between reflex and background muscle activity, whereas during walking, reflexes are relatively uncorrelated and do not follow background activation (Haridas and Zehr 2003; Van Wezel et al. 1997; Yang and Stein 1990; Zehr et al. 1997). Such observations suggest that modulation occurs at a premotoneuronal level (Duysens and Tax 1994; Matthews 1986). An example is shown in where kinematics of knee movement were matched to locomotor amplitudes during treadmill walking (Zehr et al. 2007a). Cutaneous reflexes evoked in knee extensor muscle vastus lateralis were tightly correlated with background EMG level during voluntary knee extension but completely dissociated during walking.
Strong correlation between reflex amplitude during voluntary knee extension is absent during walking due to the modulation of presumed central pattern generator activity. EMG, electromyography. [Adapted from Zehr et al. (2007a).]
In the case of muscle afferent pathways, an increased reflex attenuation during tasks implies a premotoneuronal mechanism, because the response is independent of locomotor EMG (Stein and Capaday 1988). Most likely, it is presynaptic inhibition of Ia afferent transmission from CPGs as a mechanism for inhibition of the same pathway, because presynaptic inhibition is a major mechanism influencing spinal cord excitability during interlimb locomotor activity (Capaday and Stein 1986; Crenna and Frigo 1987; Zehr 2006).
There is more evidence that spinal CPGs are responsible for task- and phase-dependent modulation of sensory feedback during locomotion. When a CPG for rhythmic movement is not active, as in passive movements, phase-dependent modulation is absent (Brooke et al. 1999; Carroll et al. 2005). This suggests that modulation is not the result of movement-related afferent feedback, associated with the passive movement, but is driven by a central mechanism. This was confirmed with the observation that there was no effect on cutaneous reflex modulation when muscle spindle sensory receptors were activated from quadriceps muscles with patellar taps (Brooke et al. 1999). A central mechanism, such as CPG networks, is predicted to be responsible for phase-dependent modulation because reflex modulation does not occur with passive movement, nor does the interaction of other reflex pathways affect modulation (Brooke et al. 1999).
The way in which CPG neurons transform cutaneous input changes as a function of the locomotor cycle. The fact that cutaneous feedback during walking can cause a flexor response during the swing phase, and an extensor response during the stance phase, in the same muscle suggests that parallel excitatory and inhibitory cutaneous pathways could exist between cutaneous receptors and motoneuron pools (Yang and Stein 1990). Indeed, the existence of parallel excitatory and inhibitory pathways to motoneurons was revealed by analysis with poststimulus time histograms (PSTH) of single motor units from the tibialis anterior during walking (De Serres et al. 1995). With posterior tibial nerve stimulation, PSTH showed that the same motor unit was excited during swing and inhibited during the transition from swing to stance. The opening and closing of these parallel pathways depends on the phase of the rhythmic cycle where CPGs act to govern the overall strength of the excitatory and inhibitory connections in these parallel pathways (Duysens et al. 1992; Yang and Stein 1990).
Summary of the evidence from task- and phase-dependent modulation of reflex amplitudes.
The importance of the CPG is its ability not only to generate repetitive cycles but also to receive, interpret, and predict the appropriate action at each part of the step cycle. This is made possible by constant input from peripheral sources to update and sculpt CPG output. In other animals, this relationship can be directly shown, but in humans, examining task- and phase-dependent modulation of reflexes during rhythmic movement provides an indirect indicator of the relationship between CPG regulation and afferent input. In humans, these observations provide some of the main data on which the concept of spinal CPGs has been built. There are several characteristics that reveal a central control mechanism in modulating sensory feedback. These characteristics include the facts that reflexes are modulated according to the task- and phase- of movement, that reflexes are independent of changes in background EMG, that modulation only occurs with voluntary movement and not passive movement, and that modulation is not influenced by feedback in other sensory pathways. Together, these observations are evidence that a spinal CPG is responsible for the fine-tuning of sensory feedback during rhythmic movement.
3) Some Evidence for Similar Neuronal Networks Recruited into Different Rhythmic Human Motor Tasks
“You know my methods. Apply them!”
The Hound of the Baskervilles (1902)
In cats, the pattern-generating circuits for different rhythmic functions overlap with shared networks to produce the behaviors they generate. Functional temporal reversals during backward locomotion provide evidence of the adaptability of pattern generators in the control of locomotion. In the cat, backward walking is produced by a phase shift in activation of unit burst generators controlling flexion and extension of knee and hip muscles (Buford and Smith 1993). If shared circuitry for various rhythmic movements is also within the human spinal cord, it should be observed as a characteristic of human reflex modulation. Indeed, reflex modulation, as well as joint power, limb kinematics, and EMG activity in some muscles, is essentially reversed in time during backward walking (Duysens et al. 1996; Thorstensson 1986; Winter et al. 1989). Cutaneous reflexes are thought to be regulated by an equivalent neural CPG mechanism, because responses are phase-reversed in lower leg muscles such as tibialis anterior (Duysens et al. 1996).
Reflex modulation in pedaling (Brooke et al. 1997; Brown and Kukulka 1993) is similar to that in walking (Yang and Stein 1990), suggesting that related neural circuitry may be operational in both tasks (Ting et al. 1999). Similar to observations in walking, forward and backward arm cycling are also regulated by an equivalent neural mechanism, where at similar phases in the movement cycle, responses of corresponding sign and amplitude were seen regardless of movement direction (Zehr and Hundza 2005). This extended also to leg cycling, where a simple reversal in reflex patterning suggests that forward and backward leg cycling are regulated by a similar neural mechanism (Zehr et al. 2009a). In a further example, in human infants, different directions of walking are ascribed to flexible use of common locomotor spinal circuits (Lamb and Yang 2000).
Comparable coordination patterns between activities involving all four limbs moving simultaneously and rhythmically also exist. For example, during walking, creeping, and swimming, responses that are suggestive of similar CPG output in all activities have been shown (Wannier et al. 2001). Commonalities in cutaneous reflex amplitudes in arm and leg muscles were also seen across level walking, incline walking, and stair climbing (Lamont and Zehr 2006). In other quadrupedal tasks, reflexes were modulated in a similar way across walking, arm and leg cycling, and arm-assisted recumbent stepping, where similar phase-dependent modulation was observed despite differences in movement kinematics (Zehr et al. 2007a). This led to the conceptualization of relatively equivalent partitioning of the locomotor cycle across different tasks (see ). In the damaged nervous system with descending disruptions after stroke, common neural patterning from conserved subcortical regulation persisted (Klarner et al. 2014b). This was evidenced by a similarity in reflex modulation between different rhythmic tasks (see ). These findings imply that networks for arm and leg coordination could reside in subcortical areas, because damage to the brain following stroke still expressed common neural regulation (Klarner et al. 2014b).
Comparison of different human locomotor behaviors involving all 4 limbs. [Adapted from Zehr et al. (2007a).]
Ensemble grand-average subtracted reflex traces from all phases and all subjects for arm and leg (A&L) cycling and walking. Note that there is a similar pattern of cutaneous reflex modulation across tasks. Despite some changes in amplitudes, the general pattern is conserved. EMG, electromyography; TA, tibialis anterior; PD, posterior deltoid. [Adapted from Klarner et al. (2014b).]
Summary of the evidence across different rhythmic locomotor behaviors.
The “common core hypothesis” (Zehr 2005) describes the concept that neural control, evidenced by examining similarities in reflex modulation, is conserved across rhythmic arm and leg movements for different tasks such as cycling, walking, stepping, and arm and leg cycling and can be activated for different directions of action. That is, a flexible central mechanism is likely responsible for regulating various types of rhythmic movement in a similar oscillatory fashion with a common core of subcortical elements expressing neural activity to produce the basic pattern of arm and leg movement (Klarner et al. 2014b; Zehr 2005; Zehr et al. 2007a). The ability of a muscle to contribute to more than one function, with the expression of each under neural modulation, gives the control scheme flexibility and thus the capability to execute a variety of tasks (Ting et al. 1999).
4) Some Evidence of Distributed Locomotor Networks and Interlimb Connectivity in Human Locomotion
“I make a point of never having any prejudices, and of following docilely where fact may lead me.”
“The Reigate Squires” in The Memoirs of Sherlock Holmes (1893)
As outlined above, EMG and reflex studies support the role of locomotor CPGs in the neural control of rhythmic human movement. In other animals, CPG networks are distributed along the spinal cord for functional integration between the forelimbs and hindlimbs. Given the potential for evolutionary conservation, we presume that in humans, CPG networks can be found in the cervical spinal cord and produce rhythmic activity for arm swing. We would predict that, reminiscent of what is demonstrated in quadruped locomotor studies, CPGs for all limbs are interconnected in the central nervous system.
Clues from rhythmic arm activity.
“When one tries to rise above Nature one is liable to fall below it.”
“The Adventure of the Creeping Man” in The Case Book of Sherlock Holmes (1927)
The first evidence to consider is whether the arms show features of CPGs, similar to what exists for forelimbs in quadrupeds. We will see below that cervical CPG activity does regulate arm swing, and in a similar way to how lumbar spinal circuits are believed to regulate rhythmic leg movement. One limitation to the extrapolation from cats to humans is that bipeds and quadrupeds use different modes to provide propulsion during locomotion. As humans, we can walk without moving our arms, and there is no obvious reason why humans need to move their arms when they walk, yet rhythmic movements coordinated with the legs naturally emerge during walking (Ford et al. 2007; Meyns et al. 2013; Umberger 2008).
Rhythmic arm movements have been compared with a pendular motion, although arm swing is not a passive action (Ferris et al. 2006). Arm swing enhances stability by generating a horizontal torque at the upper trunk that may counteract pelvis rotation and leg progression to minimize angular momentum (Li et al. 2001; Park 2008; Umberger 2008). Arm swing movements are also affected by the legs, by forces being transferred to the arms between trunk and shoulder ligaments and muscles during walking (Pontzer et al. 2009). Indeed, it has long been believed that the natural arm movement during walking is not just a simple pendular movement resulting from leg motion, but instead is neurally integrated into movement (Elftman 1939).
Similarities between the control of legs and arms have been observed by examining coordination and electromyographic activity. Coordination patterns between the upper extremities are similar to those of the lower extremities in human bipedal locomotion, common with those of quadrupedal locomotion (Van Emmerik et al. 1998). As for EMG activity, in general, arm muscle activity is out of phase and reciprocating, as with that of the leg muscles, but with slightly more coactivation (Zehr and Kido 2001; Zehr et al. 2003b). In addition, within-arm EMG activation patterns are coordinated with contralateral arm muscles (Zehr and Kido 2001) and with EMG activation in the legs (Zehr et al. 2003b).
Also as in the legs, task- and phase-dependent reflex modulation, of both cutaneous and H-reflex pathways, is seen during rhythmic arm movement (Zehr and Chua 2000; Zehr and Kido 2001; Zehr et al. 2003a). For example, cutaneous reflexes evoked with stimulation to the median, ulnar, or radial nerve were of differing amplitude and sign during arm cycling compared with static contractions at matched positions in the cycle (see ) (Zehr and Kido 2001). Cutaneous reflex reversal can be seen in some arm muscles, in which reflexes may be excitatory during static contraction but inhibitory during arm cycling. There is also extensive task- and phase-dependent modulation of cutaneous reflexes in arm muscles during the natural arm swing of walking compared with static contractions in matched positions (Zehr et al. 2003b).
Phase-dependent modulation of cutaneous reflexes in arm muscles anterior deltoid (AD) and poster deltoid (PD) from stimulation to the superficial radial nerve during arm cycling. Cutaneous reflexes are modulated across the movement cycle (from top to bottom). [Adapted from Zehr et al. (2012).]
Muscle afferent reflexes in arm muscles also showed task- and phase-dependent modulation. In the forearm muscle flexor carpi radialis (FCR), H-reflexes evoked during arm cycling were phase modulated during rhythmic movement, independent from background EMG modulation, and modulation was not observed during static contractions at matched positions (see ) (Zehr et al. 2003a). During movement, forearm reflexes were strongly inhibited compared with the amplitude expressed during static contraction (Zehr et al. 2003a). Indicating the interactive influence of afferent feedback on this reflex pathway, H-reflex amplitudes were suppressed with both active and passive movement (Zehr et al. 2003a) as seen in the legs (Brooke et al. 1997).
Modulation of the forearm flexor H reflex by arm movement. Modulation of forearm H reflexes during arm cycling (A; light gray bars) but not during static contraction (A; black bars) and during different arm cycling tasks (B; gray bars) including bilateral arm cycling, active movement of the ipsilateral (Ipsi) or contralateral (Contra) arm, or with the ipsilateral (Ipsipassive) or contralateral (Contrapassive) arm passive. There were no differences in M-wave amplitudes or flexor carpi radialis electromyography levels (not plotted). Values are means ± SE. **P < 0.01, significant differences between static and cycling conditions. [Adapted from Zehr et al. 2003a).]
Phase- and task-dependent reflex modulation of reflex amplitude in the arms, characteristic of CPG regulation, suggests equivalent neural control mechanism for the arms and legs during rhythmic movement (Balter and Zehr 2007; Dietz 2002; Dietz et al. 2001; Zehr and Duysens 2004; Zehr and Kido 2001; Zehr et al. 2003b, 2004a, 2007c). Supporting a central locus of control for rhythmic arm movement, as seen in the legs (Brooke et al. 1999), cutaneous reflexes are not phase modulated during passive arm cycling (Carroll et al. 2006). These observations support the hypothesis that rhythmic arm movements are partly regulated by CPGs, just as for the leg (Dietz 2002; Dietz et al. 2001; Jackson 1983; Zehr and Duysens 2004). During static contractions, reflex amplitudes are highly correlated with background muscle activity, whereas during rhythmic tasks, this relationship is weak or absent, and indeed, reflex amplitudes in the arms are modulated in a manner that is independent of background EMG activity (Zehr and Kido 2001; Zehr et al. 2003a, 2003b). These results highlight the different patterns of reflex modulation between static contractions and rhythmic arm movement, reflecting the differences in their neural control. These observations also suggest premotoneuronal gating of afferent feedback by spinal rhythm-generating circuits in the arms, as described for the legs (Dietz 2002; Dietz et al. 2001; Zehr et al. 2004a).
Other evidence supporting CPG contributions to rhythmic arm movements comes from measuring the size of motor-evoked potentials in response to transcranial magnetic stimulation (TMS) during rhythmic arm movement (Carroll et al. 2006). It was found that motor-evoked potentials were reduced in size compared with those recorded with tonic, voluntary contraction (Carroll et al. 2006). This suggests a reduction in the corticospinal influence during rhythmic compared with voluntary arm movement. Thus, despite highly developed corticospinal projections to the human upper limb, subcortical regions likely contribute to the control of rhythmic arm movements. Indeed, spinal motoneuron excitability, as assessed using TMS-induced motor-evoked potentials from the biceps brachii, was increased in arm cycling, showed task and phase dependency, and was modified by cycling cadence (Forman et al. 2014, 2015).
A difference between neural regulation of rhythmic human upper and lower limb movement is the degree of coupling between the limbs. Bilateral coupling between the arms compared with that between the two legs is not as strong, perhaps because of their different functional roles during bipedal walking. For the legs, reflex modulation on the ipsilateral side is dependent on contralateral active or passive leg movement where a general suppressive effect was recorded in the ipsilateral leg (Cheng et al. 1998; Collins et al. 1993). In addition, contralateral reflexes follow the movement phase of the contralateral leg, not the stimulated one (Duysens et al. 1990; Tax et al. 1995). For the arms, modulation for both cutaneous and H-reflexes on the ipsilateral side is not dependent on contralateral active or passive rhythmic arm movement (Carroll et al. 2005; Delwaide et al. 1988; Zehr et al. 2003b). Instead, reflex modulation in the arm is more dependent on the activity state of the limb in which the reflex is evoked (Carroll et al. 2005; Hundza and Zehr 2006). These findings suggest that although coupling is strong between the CPGs for each leg, the CPGs for each arm seem to be less involved in gating crossed responses (Carroll et al. 2005). Comparatively stronger coupling between legs is likely explained by differences in the functional roles of the arms vs. the legs in human bipedal walking. Although the arms can be free to act independently, it is essential to have strong leg coordination to maintain dynamic upright posture.
Clues from interlimb reflex coordination between the arms and legs.
“There is nothing more stimulating than a case where everything goes against you.”
The Hound of the Baskervilles (1902)
Evidence suggests CPGs contribute to coordination of rhythmic arm and leg movements, but to support interlimb coordination, significant connection between lumbar and cervical spinal cord CPGs actuating individual limbs is required (Swinnen and Duysens 2005). Indeed, during rhythmic arm and leg movements, arm activity contributes to the neural excitation of leg muscles, indicating neural coupling between upper and lower limbs in humans reminiscent of what is found in quadrupeds (Zehr et al. 2009b, 2016). In the following, as above, evidence will be presented from human studies to show that the arms and legs are neurologically connected. The basic idea of all the experiments presented below is to detect coupling between the arms and legs of bipeds based on indirect evidence for interlimb locomotor linkages.
Clues for the existence of interlimb connections regulating rhythmic activity of all limbs in humans will be presented across several categories of experimental evidence. Through observations of maintained coupling by changes in arm and leg mechanical interactions and evidence of a widespread network of reflexes in leg or arm muscles, there is strong support for pathways linking muscles in the arms and legs. Effects of remote rhythmic movement on motor output and reflex excitability in the opposite set of limbs also demonstrate interlimb coordination in humans. We will review different modes of evidence that probe interlimb connections for the arms and legs through spinal CPGs in humans.
“Education never ends, Watson. It is a series of lessons with the greatest for the last.”
“The Adventure of the Red Circle” in His Last Bow (1911)
A way to probe for neural interactions between the arms and legs during rhythmic movement is to study somatosensory linkages in the form of interlimb reflexes (Burke et al. 1991; Zehr et al. 2004a). For instance, interlimb coupling in humans has previously been demonstrated by evoking reflexes in one limb and observing the extent to which the movement of another limb modulates reflex expression (Massaad et al. 2014; Mezzarane et al. 2011; Zehr et al. 2003b). A possible route for these interlimb coordination signals is through intrinsic spinal pathways, made up of propriospinal interneurons, linking cervical and lumbosacral regions. There is some direct evidence in humans with supraspinal lesions and spinal cord transections (Nathan et al. 1996). Pathways connecting spinal cord segments are suggested from studying those with SCI (Calancie et al. 1996). The location of the injury in the 15 subjects studied was at the cervical level, sparing the propriospinal pathways linking the cervical and lumbar enlargements in the spinal cord. With stimulation of cutaneous (distal tibial) and muscle afferent (tibial and median) nerves, widespread responses in all limbs were evoked, identified with single motor unit recordings. Discharge of motor units was also evoked with light touch of the feet and individual hair movements (Calancie et al. 1996). Interlimb reflex properties were similar for both SCI and control groups for radial nerve stimulation at the elbow, suggesting that the neural circuitry underlying these reflexes does not develop as a result of SCI (Butler et al. 2016).
In humans with intact nervous systems, there is also indirect evidence to suggest efficacy of these interlimb pathways. It was initially shown that with noxious, high-intensity stimulation of tactile afferents in nerves from the hand (median) and foot (sural), distant motor nuclei undergo excitability changes (Delwaide et al. 1981). A reciprocal pattern of facilitation and suppression for the flexor and extensor reflexes in arm muscles emerged with sural nerve stimulation, suggesting a coordinated and functional interlimb linkage (Delwaide and Crenna 1984). A connection between the arms and legs was also found in human subjects where descending lumbosacral cord potentials were recorded intrathecally after stimulation of the median nerve at the elbow (Sarica and Ertekin 1985).
Examining cutaneous reflexes during static and rhythmic movement has revealed a widespread interlimb network. There is an extensive distribution of reflexes across many muscles in both the arms and the legs, irrespective of which limb is directly stimulated (Haridas and Zehr 2003; Zehr and Duysens 2004; Zehr et al. 2001). In humans in seated positions, strong, early latency interlimb cutaneous reflexes were documented in all limbs following stimulation to either the foot or the hand (see ) (Zehr et al. 2001). Responses were recorded from multiple ipsilateral and contralateral muscles, particularly from those that cross the ankle, wrist, and shoulder joints. These connections provide a means for the direct relay of sensory information through the nervous system that could be used to increase coordination between the arms and legs for balance and movement.
Interlimb responses to superficial peroneal nerve stimulation. Shown are the mean electromyographic responses (n = 50 sweeps) from different single subjects. Responses are shown for muscles ipsilateral (left side) and contralateral (right side) to the site of stimulation. In each trace the stimulus artifact has been blanked during the interval shown by the solid black rectangle for ipsilateral tibialis anterior. Arrows indicate the approximate anatomical location for each muscle. Individual calibration bars represent 20% maximum voluntary contraction for each muscle shown. Note that different scales are used to highlight the reflexes for each muscle because reflex amplitudes were of different sizes across muscles, and thus the size of the calibration bar is different in each graph. [Adapted from Zehr et al. (2001).]
During walking, phase-dependently modulated interlimb reflexes in leg muscles were observed after wrist stimulation (superficial radial nerve) and in arm muscles after ankle stimulation (superficial peroneal nerve) (Haridas and Zehr 2003). Compensatory responses at the ankle were reversed (see ), where stimulation at the foot caused ankle plantarflexion, and stimulation at the hand caused dorsiflexion (Haridas and Zehr 2003). Connections between the arms and legs have also been identified during other arm and leg movements, including leg cycling (Sasada et al. 2010). Responses to superficial radial nerve stimulation in the arms were evaluated, and it was found that cutaneous reflexes in arm muscles were modulated by leg cycling and further amplified with increased leg cycling frequency (Sasada et al. 2010).
Summary of the kinematic changes at the ankle with superficial peroneal nerve stimulation at the stance-swing transition for both the ipsilateral (left) and contralateral (right) sides. Solid foot represents the foot in which the response to stimulus occurred. Jagged arrow indicates site of stimulation; solid arrow indicates plantar flexion; open arrow indicates dorsiflexion. Note the changes in ankle kinematics with different sites of stimulation. [Adapted from Haridas and Zehr (2003).]
Afferent signals related to specific arm movement are crucial signals to modify leg muscle activity through linked CPGs. Phase-dependent responses found in muscles of all four limbs during rhythmic movement are modulated in a way suggestive of coupling between segmental spinal networks (Duysens et al. 1992, 1996; Haridas and Zehr 2003; Yang and Stein 1990; Zehr et al. 2003b). For example, rhythmic arm movement significantly contributed to reflex expression in the legs (Balter and Zehr 2007). The largest effect was observed during the power phase of arm and leg cycling, which is at a comparable time to heel strike in walking. The contribution from the arm at this point could be explained by a reliance on multisensory integration to ensure limb placement and safe walking.
Clues from mechanical changes in interlimb coordination.
“The authorities are excellent at amassing facts, though they do not always use them to advantage.”
“The Adventure of the Naval Treaty” in The Memoirs of Sherlock Holmes (1893)
Arm swing is coordinated with the legs, and the frequency of the relationship depends on walking speed (Craik et al. 1976; Donker et al. 2002). At most walking speeds (normal walking, jogging, running), this pattern consists of a 1:1 frequency ratio with out-of-phase arm swing where each arm is paired with its contralateral leg and synchronized with stride frequency. Even across quadrupedal tasks such as walking, creeping, and swimming, arm and leg movements remain frequency-locked with a fixed relationship (Wannier et al. 2001). The characteristics of this coordination correspond to the observation that coordination is indicative of intrinsic spinal interconnections between the upper and lower spinal CPGs that are engaged in the locomotor function (Wannier et al. 2001).
To further reveal changes in interlimb coordination due to changes in interlimb kinetics, weights were added to the wrist or ankle (Donker et al. 2002). Adding mass to the wrist during walking resulted in increased muscle activity in both arms and a decrease in the movement amplitude in only the loaded limb but did nothing to change leg kinematics or cadence. Conversely, adding load to the ankle produced increased muscle activity and movement amplitude in both arms (Donker and Beek 2002; Donker et al. 2002). These results indicate that during walking, the loading of one of the limbs induces a general reorganization, involving all participating bodily segments, presumably to maintain balance while providing rhythm constancy. Alterations in coupling patterns between upper and lower extremities are also shown with changes in walking speed and implicate interaction among CPGs. Decreasing walking velocity to relatively slow speeds at approximately <0.7–0.8 m/s causes both arms to swing minimally and in phase at twice the ipsilateral step frequency (producing a 2:1 frequency ratio) (Donker et al. 2001; Ford et al. 2007; Wagenaar and van Emmerik 2000), resulting in a change in interlimb coordination between the arms and the legs. As humans change walking speed, the nervous system adapts muscle activation patterns to modify arm swing to the appropriate frequency (Collins et al. 1993).
Coordination of arm and leg movements during human locomotion has also been evaluated by examining the effects of small leg perturbations during gait on leg and arm EMG activity (Dietz et al. 2001). During walking with split-belt treadmill accelerations or decelerations or with stimulation of the distal tibial nerve, responses were observed in arm muscles that were small or absent during standing, largest when the perturbation was applied to the stance phase, and correlated to compensatory responses in the ankle dorsiflexor tibialis anterior muscle (Dietz et al. 2001). These observations show that there is a task-dependent, flexible neuronal coupling between lower and upper limb muscles as a residual function of quadrupedal locomotion (Dietz et al. 1994b, 2001). Also, by using a split-belt paradigm and applying four different combinations of left and right speed ratios, upper and lower limb coordination was revealed. Increasing the right-side belt speed caused increased amplitude in the right limb and decreased amplitude in the left limb but increased amplitude in both upper limbs (MacLellan et al. 2013) These observations show that CPGs for the upper and lower limb regulate full body movement to maintain the rhythmic locomotor pattern.
Further support for a ascending bias in locomotor coupling was found when deliberate changes in leg cycling cadence led to modified arm cycling cadence, but voluntary changes in arm cycling cadence did not affect the legs (Sakamoto et al. 2007). This was evaluated by using a combined arm and leg cycling task where arm and leg ergometers were mechanically independent.
In addition to changes in frequency coupling and kinematic amplitudes as a result of altering interlimb coordination, changes in EMG amplitudes also emerge. Active arm movement during arm and leg recumbent stepping significantly increased involuntary activation of the leg muscles (Ferris et al. 2006; Huang and Ferris 2004). This observation was only seen when the arms were active and disappeared when the legs were externally driven. The effect of changing arm movement frequency on interlimb coupling and leg activation was also examined during recumbent stepping (Kao and Ferris 2005). Fast upper limb movement facilitated neuromuscular recruitment of lower limb muscles (Kao and Ferris 2005), likely via spinal interlimb connections from propriospinal neural circuitry (Dietz 2002; Kao and Ferris 2005).
In a final paradigm revealing interlimb connections, when participants were laid horizontally on their side with each leg suspended in an unloading exoskeleton, locomotor-like leg movements were evoked by rhythmic arm movements, reminiscent of Graham Brown’s early work (Sylos-Labini et al. 2014a). Leg movements were accompanied by EMG activity in proximal leg muscles, which were modulated over each movement cycle and displayed similar timing as in normal locomotion (Sylos-Labini et al. 2014a). In particular, movement at the shoulder increased activity of hip muscles and amplitude of hip and knee joint movements, whereas and movement of the forearms and wrists had a similar facilitating effect but with a stronger influence on distal segments (Selionov et al. 2016).
Clues from remote modulation of spinal cord excitability.
“Never trust to general impressions, my boy, but concentrate yourself upon details.”
“A Case of Identity” in The Adventures of Sherlock Holmes (1891)
Determining the specific locus mediating interlimb coordination is difficult because of the concurrent and interfering effects of rhythmic arm and leg activity. Interlimb reflex effects could result from afferent signals arising from the rhythmic movement (Haridas and Zehr 2003). To mitigate these effects, interlimb coordination has been examined by evaluating the remote effects of rhythmic movement on stationary limbs (Frigon et al. 2004). An interaction between upper limb posture and reflex transmission in the lower limb was first identified by changes in upper limb posture altering stretch reflexes in soleus, quadriceps, and biceps femoris muscles (Delwaide et al. 1977). In addition, passive flexion and extension movements at the elbow facilitated soleus H-reflex amplitudes (Hiraoka and Nagata 1999), and conversely, arm swing movements reduced soleus H-reflex amplitudes (Hiraoka 2001).
An observation of interlimb effects has also been made by systematically examining the effects of remote movement on H-reflex excitability (Frigon et al. 2004). In this paradigm, subjects performed rhythmic arm cycling while soleus H-reflexes were evoked and recorded (see ). During arm cycling, soleus H-reflexes were significantly reduced compared with amplitudes evoked when no arm movement was performed (Frigon et al. 2004). These results provided evidence of the existence of neuronal coupling between the arms and the legs (de Ruiter et al. 2010; Dietz 2002; Dragert and Zehr 2009; Frigon et al. 2004; Hundza and Zehr 2009; Hundza et al. 2012; Loadman and Zehr 2007; Mezzarane et al. 2011; Zehr et al. 2007c). The effect of arm cycling on soleus H-reflex excitability is independent from background EMG; therefore, a spinal process is presumed where suppression comes from increased segmental Ia presynaptic inhibition from arm CPG circuits (Frigon et al. 2004).
Inhibition of soleus H-reflex amplitude by arm cycling. Amplitudes during cycling (black line) and during static trials (gray line) are shown for a single subject. The gray rectangle indicates the H reflex. Control data are taken during static contraction at the same position sampled during arm cycling. [Adapted from Frigon et al. (2004).]
Subsequent studies were conducted to further evaluate and characterize this observation of modulation of soleus H-reflex amplitude induced by rhythmic arm cycling. It was found that there was phase-dependent modulation of suppression that displayed a bell-shaped modulation curve (de Ruiter et al. 2010). It also was found that soleus H-reflexes were suppressed for all arm, trunk, or leg movements, but a distinct and marked reflex modulation occurred during locomotor-like anti-phase arm swing and was maximally suppressed at a moment when the heel strike would occur (Massaad et al. 2014). Changes in arm range of motion during cycling, resulting in muscle length changes, did not alter soleus H-reflex suppression (Loadman and Zehr 2007), and an inhibitory effect was only observed with active, rhythmic arm cycling and was not apparent during passive, externally driven arm movement (Hundza et al. 2012). By varying arm cycling frequency from 0.3 to 2 Hz, a threshold of ~0.8 Hz for the interlimb modulation was discovered (Hundza and Zehr 2009). This was interpreted as a threshold frequency for effective activation of CPG elements for rhythmic arm movement that are then signaled to the lumbar spinal cord. It is worth pointing out that this frequency of 0.8 Hz is very close to the intrinsic cycle frequencies for many locomotor systems. Increased frequency of upper limb movement also enhanced the modulatory effect of arm cycling on soleus H-reflex excitability (Hundza and Zehr 2009). There was no additional effect of varying arm cycling load or by adding vibration to the arm muscles (Hundza et al. 2012). After stroke, partial preservation of the descending modulatory effects of rhythmic arm cycling on lumbosacral spinal cord excitability can be seen where arm cycling modulates the soleus H-reflex (Barzi and Zehr 2008) and stretch reflex (Mezzarane et al. 2014).
In the reverse experiment, it was shown that leg cycling also leads to suppression of H-reflexes in stationary arm muscles, including the FCR (Zehr et al. 2007c). However, the temporal resolution (i.e., number of phases analyzed) needed to detect phase-dependent modulation was lacking. In walking, when 16 phases of movement were analyzed, phase-dependent modulation of H-reflexes in FCR was evident (Domingo et al. 2014). To highlight the importance of movement-related feedback in modifying interlimb coordination, as opposed to load-related feedback, FCR H-reflex amplitudes were studied during robotic-assisted stepping with and without body weight support (Nakajima et al. 2011). Reflexes in the forearm muscles were suppressed with stepping, and suppression was seen at all phases of stepping, irrespective of whether stepping was unloaded or body weight support was provided (Nakajima et al. 2011).
With the use of this interlimb paradigm, observations to support the idea that the interlimb mechanics underlying arm and leg coupling are preferentially expressed during rhythmic tasks came from studying subthreshold segmental Ia presynaptic inhibition conditioning (Nakajima et al. 2013). Conditioning the H-reflex with superficial radial nerve stimulation removes the suppression effect of leg cycling, and radial nerve stimulation amplifies suppression. When conditioning stimulation intensity was reduced so that there was no postsynaptic effect, it was shown that conditioning reemerged only during the rhythmic locomotor behavior (Nakajima et al. 2013). Together, these results suggest that it is a central motor command, likely from the spinal cord, as the main source of regulation.
Summary of the evidence of distributed CPG elements and interlimb connectivity.
Indirect observation from human studies supports the observation that CPG networks are distributed in cervical and lumbar spinal cord areas and are interconnected for functional interlimb locomotor integration. In the arms, as in the legs, observations of rhythmic muscle activity and task- and phase-dependent modulation of reflexes suggest that regulation is from CPGs. Between the arms and legs, there is a measurable functional neural coupling during rhythmic movement. This is shown by flexible interactions between lower and upper limb muscles from mechanical changes in interlimb coordination, the presence of task- and phase-dependent interlimb reflex modulation, and modulatory effects of remote rhythmic activity on local reflex excitability. Overall, these data suggest that interlimb coordination is apparent and contributes to the control of human locomotion.
Interlimb coordination likely arises from distributed locomotor network interactions between the cervical and lumbar CPGs. Some of this coordination clearly arises also from descending supraspinal commands along with these interactions; however, many of the observations found in neurologically intact participants are mirrored in participants with SCI and stroke with diminished descending influences. In addition, reflex effects, recorded at latencies shorter than what can be influenced by descending supraspinal commands, implicate the contribution of lower level structures such as spinal cord networks.
5) Some evidence that locomotor retraining induces recovery of walking ability
“I have seldom known a case which at first sight presented a more singular problem.”
“The Adventure of the Devil’s Foot” (1910)
As detailed above, evidence suggests that, like other animals, we humans have access to locomotor pattern generating networks that are capable of coordinating the basic walking pattern. It also appears that at least some of the neural networks responsible for producing rhythmic movement are housed within the spinal cord. We have seen that in other animals with task-specific therapy, such circuits are amenable to retraining and plastic adaptation. A major translational implication of this observation is that the evidence of related observations should be seen in humans.
From studies in other animals after spinal cord transection, evidence shows the remaining spinal pathways can be trained by using treadmill walking to facilitate positive use-dependent plasticity corresponding to enhanced recovery of walking (Barbeau and Rossignol 1987). In cats with complete spinal cord transection at T12–L1 between the forelimbs and hindlimbs, hindlimb stepping recovered after 3–4 weeks of intense daily treadmill training. Initially after the injury, cats demonstrated a poorly organized hindlimb stepping pattern, but after training, they demonstrated a “near-normal” pattern. EMG recordings from hindlimb muscles in trained spinal cats are generally similar to those from intact cats and many of the normal muscle and skin reflex responses are apparent. Furthermore, by the end of training, the cats were able to adjust the locomotor cycle to adapt to varying treadmill speeds (Barbeau and Rossignol 1987), which suggests functional recovery.
Clues from interlimb neural coupling after stroke and spinal cord injury.
“Those are the facts of the case, Doctor, and if they are of any use to your collection, I am sure that they are very heartily at your service.”
“The Adventure of The Gloria Scott” (1893)
In humans with neurotrauma, remaining neural networks are strengthened with training proposed to enable activation of spinal cord circuitry that restores normal CPG function and corresponding locomotor activity (Dobkin 2004; Langhorne et al. 2009). Caveats remain, however, about the extent to which pathways mediating arm and leg movement remain accessible after neurological damage such as SCI and stroke.
Data on interlimb responses obtained in persons with cervical SCI and stroke suggest that pathways mediating arm and leg interactions are conserved and remain accessible after neurological damage (Calancie 1991; Calancie et al. 1996; Wirz et al. 2001; Zehr and Loadman 2012; Zehr et al. 1998, 2009b). In chronic stroke, partial preservation of rhythmic patterning of arm muscle activation and neural control of spinal cord excitability during arm cycling persists in both the more and the less affected arms but is somewhat “blunted” (Zehr et al. 2012). The simplest explanation is that presumed pattern generator contributions to rhythmic human arm movement remain accessible after injury. The observation of bigger impairment of discrete reaching than of rhythmic actions after stroke also supports subcortical contributions (Leconte et al. 2016). Interlimb coupling is also partially preserved after stroke (Zehr et al. 2007b). Bilateral (but weaker on the more affected side) modulation of soleus H-reflex amplitudes during arm cycling was also evident after stroke. Subsequent experiments assessing stretch reflexes in chronic stroke participants produced bidirectional reflex modulation induced by arm cycling (Mezzarane et al. 2014). Interlimb reflex coupling is also maintained after stroke (Zehr and Loadman 2012), as deduced from cutaneous stimulation in the more affected arm or leg during walking (see ).
Single-subject example of cutaneous interlimb reflexes evoked by superficial radial nerve stimulation in the biceps femoris muscle of the more affected (MA) and less affected (LA) leg of a stroke participant. The gray rectangle highlights the middle latency response. [Adapted from Zehr and Loadman (2012).]
Thus the evidence suggests that after neurotrauma, neural pathways remain open and accessible. If the pathways are preserved after neurological injury, perhaps they are amenable to training-induced plasticity from locomotor rehabilitation exercise.
Clues from locomotor retraining interventions in humans with neurological injury.
“I can discover facts, Watson, but I cannot change them.”
“The Problem of Thor Bridge” (1922)
For other animals, step training is made possible by placing the animal over a treadmill. The ability to step with training is replicated in humans with body weight-supported treadmill training therapy (Duncan et al. 2011; Moseley et al. 2003; Senthilvelkumar et al. 2015). For this therapy, participants practice walking on a motorized treadmill with a harness system providing body weight support, and stepping movements are achieved with the help of robotic interfaces or therapists.
In humans with clinically complete SCI, there is evidence that treadmill training can improve some aspects of walking. After training in patients who were otherwise unable to voluntarily produce muscle activation, some locomotor activity with rhythmic leg muscle activation patterns could be elicited (Dietz et al. 1995, 1998; Maegele et al. 2002). Even individuals with clinically motor complete paralysis demonstrated modulated activity of distal leg muscles during assisted stepping with body weight support (Dietz 2002; Harkema et al. 1997). As training progressed, the levels of applied body weight support significantly decreased (Dietz et al. 1995) and activity in leg extensor muscles significant increased (Wirz et al. 2001). These improvements are thought to be a consequence of a reactivation of neural circuits located at the spinal level (Van de Crommert et al. 1998). Taken together, these findings support the idea that the stepping ability of clinically complete SCI subjects can improve in response to step training. However, in all of these cases, some weight support assistance was provided, and patients did not recover enough for independent walking.
Results from this therapy, where training leads to improved walking for those with neurological injury, remain positive (Dietz et al. 1998; Dobkin 2004; Duncan et al. 2011; Edgerton et al. 2001; Field-Fote 2001; Moseley et al. 2003). Yet, body weight-supported treadmill training does not fully exploit the neuronal and mechanical linkages between the arms and legs that are vital in normal human walking (Dietz and Michel 2009; Ferris et al. 2006; Klimstra et al. 2009; Zehr et al. 2009b). Normal walking involves arm movement, which we assume is regulated by spinal CPG networks that are functionally integrated with those for the legs. With body weight-supported treadmill training, the arms are typically used for postural support on parallel bars or hand rails to help bear weight from the legs (Behrman and Harkema 2000). With current therapies, the lack of involvement with the arms not only adds to the neural limitations that are already present due to the pathology, but impaired arm function may actually inhibit rhythmic stepping of the legs (Behrman and Harkema 2000). To optimize the benefits of task-dependent rehabilitation, given that the arms are linked to the legs during locomotion, it has been suggested that rehabilitation include arm movements (Behrman and Harkema 2000; Dietz 2002; Ferris et al. 2006; Klimstra et al. 2009; Zehr et al. 2009b, 2016).
Indeed, several studies have found benefits of incorporating arm movements in gait rehabilitation. In subjects with incomplete cervical SCI, when arm activity is incorporated with locomotor-like arm and leg movements, leg muscle activity is facilitated (Kawashima et al. 2008). Gait symmetry and a more normal presentation of EMG were also apparent in patients with spastic paresis when arm swings were incorporated with body weight-supported treadmill training (Visintin and Barbeau 1994). Compared directly with a paradigm that focuses on leg training alone, FES-assisted arm and leg cycling nearly doubles the improvements in overground walking capacity following SCI (Zhou et al., in press). Thus activation of cervicolumbar networks, compared with lumbar networks alone, is critical to enhancing the benefits of rehabilitation.
This strategy is also effective in people with stroke where, after arm and leg cycling training (meant to activate similar cervicolumbar neural networks as walking), plasticity (Klarner et al. 2016a) and improved neurological integrity and locomotor ability (Klarner et al. 2016b) were obtained. In this paradigm, participants with chronic stroke performed 30 min of arm and leg cycling training (at a frequency of ~0.9 Hz) 3 times a week for 5 wk (Klarner et al. 2014a).
The extent to which rhythmic arm training by itself activates interlimb CPG networks for locomotion was also recently assessed by studying chronic stroke participants before and after 5 wk of arm cycling training (Kaupp et al. 2018). Strength, assessed bilaterally via maximal voluntary isometric contractions in the legs and hands, was improved for grip and plantarflexion on the more affected side following arm cycling training. Muscle activation during arm cycling was also enhanced, and a “normalization” of cutaneous reflex modulation was observed. There was also enhanced activity in the dorsiflexor muscles on the more affected side during the swing phase of walking, and interlimb coupling was shown to be increased as assessed by modulation of soleus stretch reflex amplitudes during arm cycling after training. Improvement in clinical evaluations also resulted, showing improved walking ability and balance. These results are most easily explained by training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. At least some of this improvement was directly related to rhythmic activation of the arms, because arm cycling training alone produced similar improvements in walking capacity (Kaupp et al. 2018).
As well as maximization of the contribution of arm activity to the recovery of activity in the leg muscles, another part of the nervous system to maximize is the contribution of sensory feedback. Rehabilitation procedures for SCI patients should not only look to active locomotor CPGs from both the arms and the legs but also maximize phase-appropriate sensory signals. For example, the use of periodic stimulation to ankle muscle load afferents or stimulation to hip flexor stretch receptors could usefully entrain CPG function (Duysens and Pearson 1998).
Because training improvements after stroke or incomplete SCI in humans are partially correlated with increased corticospinal drive to muscles and/or increased activity in cortical areas (Dobkin 2004; Dobkin et al. 2004; Winchester et al. 2005), the engagement of supraspinal motor areas may also be beneficial for gait recovery (van den Brand et al. 2012). There are several ways to mimic supraspinal initiation of locomotion experimentally. For example, transcutaneous electrical stimulation of the spinal cord can be used as a noninvasive tool for activation of locomotor circuitry in humans (Gorodnichev et al. 2012). Indirect activation can also be achieved with peripheral muscle vibration, where steplike behavior is generated in those with SCI (Field-Fote et al. 2012). The addition of neuromodulators can also be used to boost lumbar CPG activation and bipedal stepping expression (Guertin 2013). Although the majority of this research is on animals, there is some evidence to suggest that the pharmacological activation of locomotor CPGs may improve function and walking speed in severely impaired individuals with SCI (Domingo et al. 2012). In this example, clonidine and cyproheptadine were administered. Interestingly the same or similar derivates of these pharmacological agents can be used to reactivate CPGs in other animals as well as in humans. The fact that the same chemical can be used to activate spinal cord circuitry points to a conservation of nervous system control across species.
Determining the exact localization of CPG elements in the human spinal cord will prove useful in the development of novel approaches for rehabilitation. With information on the exact location of a CPG, more directed therapies, such as intraspinal stimulation or epidural drug delivery, could be usefully applied to fully maximize spinal cord excitability. If we can make more definite conclusions about CPG location and the mechanisms involved in interlimb communication, more targeted approaches can be invented.
Summary of the evidence that locomotor retraining improves walking integrity consistent with CPG adaptations.
The neural control of walking is not completely similar between humans and other quadrupeds, and although walking improvements are seen with locomotor training, they are not as profound as those found in quadrupeds like the cat (Barbeau and Rossignol 1987; Lovely et al. 1986) and nonhuman primates (Eidelberg et al. 1981; Fedirchuk et al. 1998). Differences in locomotor recovery between humans and other animals suggest that adult human locomotion is certainly under more supraspinal regulation and control than that found in other animals (reviewed in Capaday 2002; Nielsen 2003; Yang and Gorassini 2006). Although this is the case, humans do benefit from exercise therapy, and to fully maximize recovery, rehabilitation programs should incorporate rhythmic arm movements. As a means of further bolstering activity, all parts of the nervous system should be activated. Including contributions from appropriately timed sensory feedback signals or adding electrical, mechanical, or chemical stimulation to nervous system function may help to further amplify the effects of rehabilitation.
KEN NORTON IS NOW FIGHTING BACK : Former Champ Is Learning to Talk Again After 1986 Car Accident
When Jackie Norton met her husband Ken on a blind date several years ago, she was pleasantly surprised.
“He was not at all what I expected,” she says. “Kenny didn’t fit the stereotype I thought of a fighter. There’s something about a fighter that looks like a fighter.”
Or walks like a fighter, or talks like a fighter.
Hearing that, Norton would get upset.
He would challenge her, “What does a fighter look like?”
Whatever it is, Jackie still says, “Kenny doesn’t have it. He’s very sensitive, very shy–and very funny.”
She speaks in the present tense. After 50 fights–even after that final, 54-second thrashing at the hands of Gerry Cooney in 1981–Norton was still all of those things. He made a clean getaway from the game, his features and his faculties intact.
But wait a minute, a stranger might say, what about the slow gait, the slurred speech?
Well, life played a very cruel trick on Norton, a blow well below the belt.
On the Sunday night of Feb. 23, 1986, Norton’s Clenet sports car crashed off the Vermont on-ramp to the Santa Monica Freeway, leaving him with a fractured skull, jaw and leg, and absolutely no recollection of what happened.
Investigators determined that neither drugs nor alcohol were involved. Norton was known as not much of a drinker, anyway. For a time, there was speculation that another car had crowded his off the ramp, but there were no witnesses and no evidence of that was ever found.
But in one violent instant, his life was changed.
“He was well-blessed, up to the accident,” Jackie says. “Ken didn’t get into boxing for the traditional reasons. He came from an upper-middle class family. He went to college. He got into boxing when he was in the Marines to stay out of Vietnam.
“The ironic part is that the blow to the head affected his speech. People think it’s from boxing, but it’s not.”
As Norton says, now he talks “how 98% of people expect an ex-fighter to talk.”
Even without his jaws wired tight, Kenneth Howard Norton remains a modern-day Man in the Iron Mask, trapped behind a facade of fate’s making, screaming to be heard and understood. It’s me in here, he pleads.
But instead of crying “foul!” Norton decided to concentrate his energy on a comeback–not like two other former heavyweight champions and adversaries, Larry Holmes and George Foreman, are trying to come back, but a comeback that would just return him to a facsimile of what he was when he left the ring.
Lying in the hospital for three weeks, stitches traversing the top of his head from one ear to the other where his skull was split open, the magnificent physique wasted away 43 pounds, “right before our eyes,” Jackie said.
Now he lifts weights, which he never did before, and has regained about half of the weight he lost with a dedicated training program limited only by the severity of the trauma to his right leg, which was broken above and below the knee.
Norton would like to run, but he knows he is lucky to walk. Above all, he wants to talk.
“It bothers me to speak like this because it’s so much different from what I was,” he said in an interview at his home in Laguna Niguel.
Jackie: “When he’s rested and on medication, he’s OK. He’s doing a lot better.”
Norton: “Some days my voice, like now, is kind of husky. Some days it’s plainer.”
Until he got his broken jaw unwired several weeks after the accident, Norton had no idea he would have a problem.
“No one did,” he said.
His first words sounded like a foreign language, and because the right side of his body was numb, he couldn’t even write notes.
“It upset me that I couldn’t communicate,” he said. “To me, when I talked it sounded clear, but not to anybody else.”
He tried speech therapy.
“I got bored with it,” he said. “We didn’t do anything different. It was easier to come home and read aloud to myself and tape it and play it back. It helps a lot more. Now I’m coherent. I know best what will help me. I think I do, anyway. I can tell I’m getting better.”
He monitors himself when he talks.
“I don’t just talk anymore. I can’t sit and have a conversation with anybody–even my kids–without listening to myself. It’s kind of a conditioned reflex now.”
Jackie: “Kenny used to say, ‘Jackie, it’s like I’m watching everything on television.’ ”
Norton: “Like a dream. Now it’s better. Each month it becomes more real. Even now it’s not perfect. I’m aware that we’re sitting here talking, but I look around . . . I don’t believe it 100%.”
Seated at the bar separating the kitchen from the family room, he said, “I haven’t had a drink since I got hurt.”
No one needs to throw a benefit for Ken Norton. He said in 1985 when he and his former manager/business partner, Jack Rodri, opened the Ken Norton Personal Management Agency–with Eric Dickerson as the only client–that he had tripled his money since retiring.
Now, in separate legal action, Norton and Dickerson are each suing Rodri for mismanaging their business affairs.
But Norton and his family appear comfortable in a large new home in the exclusive South Peak section of Laguna Niguel.
They moved there from their former home near Marina del Rey about a year ago so Norton could pursue his rehabilitation with fewer distractions.
“I just wanted to get us out of Los Angeles–that rat race,” Jackie said.
If that sounds as if she has taken on more responsibility . . .
“She took it on, and she will not relinquish it,” Norton said. “My wife now handles almost everything. I get a weekly allowance. Before I used to give out the allowance. If I come back too soon, (she says) ‘What’d you do with it?’ ”
Jackie is the mother of Norton’s younger children, Kenisha, 11, and Kene Jon, 6. His oldest son, Ken Jr., the UCLA linebacker, is from his first marriage; and Brandon, 17, is from Jackie’s first marriage.
The ordeal of the last two years “has made us a lot closer, in some respects,” Norton said. “They were very supportive, very uplifting. If I had no one, I wouldn’t have come back as quick . . . plus my belief in the Man upstairs. I believe that if God hadn’t wanted me to live I would have died in the accident. From what I hear, I should have died.”
A year of his memory is only scattered fragments, like a tape that has been erased.
“Eleven months I don’t remember . . . 11 months afterward and maybe 2 months before,” Norton said. “It’s just gone.”
Jackie said, “He was a little frustrated because he didn’t know what happened. You tell him he was in a crash, and it just didn’t register. By the time everything started settling in and he finally realized that he’d been injured, he couldn’t walk, his mouth was wired shut . . . “
And because he couldn’t write and could barely talk through his teeth, his demands were sometimes misunderstood, even by Jackie.
“Every time I asked for water I got ice water. Can you imagine ice water on that metal? I haven’t forgotten that.”
Jackie: “I’m still hearing about it.”
He also recalled “my son (Ken Jr.) taking me to the shower once at the house, in the back room.”
Jackie: “He had to dress him, undress him, sit him in the shower. He almost had to take a shower with him.”
Norton: “It didn’t bother me. It meant a lot to me, that my son would help me that way.”
Last season, Norton tried going to a UCLA game at the Rose Bowl.
“I watched maybe half a quarter when, with the sun rays, I’d go blind–I couldn’t see anything–so I’d leave. The first year I’d listen on the radio. Couldn’t go. This year I went to every game.”
But he wasn’t in Hawaii Friday when UCLA beat Florida in the Aloha Bowl.
“I wanted (to go to) the Rose Bowl,” Norton said.
Just another frustration with which to deal, but Norton is anything but bitter.
“He’s a con act,” said Eileen Verdugo, the administrator at the Saddleback Chiropractic Facility and Rehabilitation Center, which Norton frequents. “Every time he comes in he makes wisecracks about how he can’t talk. Sometimes he leaves us in stitches. He’s really upbeat, and he’s really come a long way.”
One of his therapists, Dr. Janice Kowalski, said, “What we’re trying to do is balance the right side of his body that suffered most of the trauma with the left side. He had a significant loss of coordination in his right side. The trouble is he can’t get the signals from his brain down to his leg to tell him where it is.”
Norton is treated with a helium neon laser–kind of a space-age acupuncture process.
“Instead of using needles, we use the HNL to stimulate certain pressure points,” Kowalski said. “It balances the flow of energy in his body.”
Norton has some numbness in the leg, but “it was completely numb before,” Kowalski said. “The man is dedicated. They didn’t even think he would walk. He is now lifting the full stack of weights (with his legs).”
“Eight hundred pounds,” Norton said, proudly. “I’m a lot stronger than I used to be. I never worked with weights before. Since the accident, a lot has changed. Ninety percent of it is uphill.”
He plans to open a franchise gym in Orange County. And he has been able to drive himself wherever he wants to go for about eight months, which is earlier than he was supposed to begin driving; although he says, “We went to Palm Springs about five times that I don’t remember.”
And although he doesn’t remember the accident, he finds he is now gun shy behind the wheel.
“They’ve done that highway (to Palm Springs) different now, with that board in between (the opposing lanes), and I’m afraid now of driving in that lane. It bothers me.”
A couple of weeks ago, Norton drove into Los Angeles to see his longtime minister, Dumas A. Harshaw Jr. of the Trinity Baptist Church on Jefferson Blvd.
“Once when I was real bad my wife took me to him because I wanted to see him,” Norton said. “But I’d forgotten all that. So last week I wanted to see him again. He was surprised to see me.”
Norton said his current regimen isn’t quite like training for a fight.
“But the discipline is the same–and not giving up, to keep working.”
He hasn’t spent much time feeling sorry for himself.
“My wife said when I first became coherent I did. I’ve forgotten it. She said it made me mad at everybody.”
That phase after the accident passed quickly. Now Norton tries to be optimistic but realistic.
Jackie said that Norton told her once, “Maybe if I hadn’t had my accident, I’d try a comeback.”
She scoffs. Norton has always been sensitive about his age. The Ring Record Book gives his birth date as Aug. 9, 1943, which would make him 44. Holmes, who will try to regain his title from Mike Tyson next Jan. 22, is 38. Foreman, with five victories against journeymen in his comeback, will be 40 next month.
Norton said, “When Larry and I fought, I was 38.”
But since that was on June 9, 1978, Norton now puts himself at 47.
Jackie never saw Norton fight–not even the memorable 15-round bout in which he lost the title to Holmes on a decision.
“I was on a plane to Las Vegas during the fight to meet him afterward,” she said. “I timed it that way.
“Ken had always lied about his age, anyway, but they were saying he was too old, his legs were going, and Larry Holmes then was 10 years younger than Kenny.”
Norton: “Not 10 years. More like seven.”
Jackie: “You trying to lie about your age now?”
Norton, to the reporter: “Don’t tell how old I am.”
“My goal is to be 100%. The way I’m going now, I’m never gonna make it, but anything close is good. I’ve been trying to walk for like, what, two years? In a sense, I’m ahead of schedule, because I started walking way before anybody thought I would, (although) not to my standards.
“That’s how I run my life in general: Set the goals high. Then when you come close, you surpass what you would have done.
“I couldn’t walk. I was in a wheelchair for a long time. Then I was on the walker for a long time. Then the cane. I couldn’t use crutches because my balance was so bad. I can’t walk fast. By March, I want to run. It may not be fast, but it will be a fast jog.
“At first they thought I might die, and if I didn’t die, I wouldn’t be coherent. Then they thought even if I could talk, I’d be a cripple. Now I’m talkin’ and walkin’ and I can even chew gum at the same time.”
10 Words For Exercise and Getting In Shape
Calisthenics dates back to the early 19th century. It derives from the combination of two Greek words, kalos, meaning “beautiful,” plus sthenos, meaning “strength.” The original idea behind calisthenics was to perform systematic rhythmic exercises, usually without the aid of an apparatus, that consist of bending, twisting, swinging, kicking, and jumping as well as push-ups, sit-ups, and chin-ups. It was once believed that the exercises would develop the beauty of the human, and in particular the female, form. In the past, calisthenics was considered particularly suitable for the “physical education of girls.”
… the object of calisthenic exercises being to secure physical beauty by developing the limbs and muscles of the human frame, and make the joints flexible, thereby giving strength and power, and ensuring a graceful carriage, erect bearing, and freedom to the figure.
— Cassel’s Household Guide, 1877
It is that calisthenics increase grace and beauty. That these are not synonymous is, alas! Obvious too often when a beautiful girl attempts to move. The writer has known what it is to sit at a window before which passed a moving panorama of beauty and fashion, and while the loveliness of face was often indisputable, the gait was enough to make a mortal shudder or an angel weep.
— Alfred Schofield, The Leisure Hour, 1894
Okay, Alfred. Go take a breather. The 19th century was a time when other forms of exercise were still generally regarded as too strenuous for women. We know better, of course, and the word calisthenics has long since lost its original association with “beauty.” Today, calisthenics produces strength, endurance, flexibility, and coordination—regardless of gender—and augments the body’s general well-being by placing controllable, regular demands upon the cardiovascular system.90,000 Krasnoyarsk residents who have been severely ill with covid are taught to walk and breathe again in a special rehabilitation center
– Easy – 95, today already average – 93. You can move on!
Tatyana Deiko now has to learn to walk and even breathe. The woman fell ill with Covid in mid-June, but was admitted to the hospital only at the end of the month. As a result: a helicopter from Achinsk to the regional hospital, the red zone and a course of rehabilitation.
– Now you see who I am.Since the 14th I am on rehabilitation. And from the 14th: there is still a man in front of you from a vegetable, says Tatiana Deiko, a patient of the regional hospital.
A woman performs physical exercises with the help of modern diagnostic systems. During classes, there is not a single sensor on it. The system processes all information about the loads on the joints, movements and gait independently. Everything takes place in a playful way. On the screen, the patient sees either his own 3D model or cartoon animation.
– He, look, assesses the center of gravity, the accuracy of the movements, indicates errors in yellow.
There are seventeen patients in the rehabilitation center who have undergone severe covid. And they all depend on oxygen. Nikolai Kolpygin has been recovering from his illness for almost a month. At first, in order to walk from the ward to the physiotherapy room, the man had to often stop. One respite is enough now. However, it is still difficult for him to speak. During a conversation, saturation drops – an indicator of blood oxygen saturation.
– Of course, I don’t want anyone to get here, but it’s better to show people the red zone without embellishment.Here, I can tell you, a sanatorium, honestly, – says Nikolai Kolpygin, a patient of the regional hospital.
Every meter traversed in hospital corridors, patients have to literally win back the disease. Doctors believe that in such conditions, in addition to the mandatory rehabilitation program, a healthy emotional background is also important. Therefore, reproductions of paintings by the Krasnoyarsk artist Ulyana Kuznetsova appeared in the corridors near the chambers.
– The corridor in the rehabilitation department is a very significant and significant place.For many, going out into the hallway is a small victory. It seems to me that the corridor of the rehabilitation department has become even more energetically, let’s say, a strong point, – says Svetlana Rusal, head of the medical rehabilitation center.
The center itself has been operating for five years. Here, patients are helped, for example, with disorders of the musculoskeletal system or after operations on the spinal cord and brain. People who have had covid disease started taking over last year. Doctors say: at first it was difficult, but now the rehabilitation system works like a clock.
– It’s easier for us this year. Because we have an idea of what we are facing now and how to work with it. An individual approach, of course, to each patient and, naturally, we try to help them. Because each patient is, first of all, a person, – Irina Kozlyakova, instructor-methodologist in physiotherapy exercises.
For those who have had coronavirus and also feel some difficulties, the regional hospital promised to release a training video with recommendations and exercises.In the near future, it should appear on the website of the medical institution.
From which “foot” shall we stand? | Archive
The election of the mayor of Samara is a kind of test for parties before the March election campaign to the Provincial Duma.
Today, the main exam is being taken by United Russia, which calls itself the “party of power,” and the Russian Party of Life (RPZh), which claims this title.
Remedy for political lameness
The fact that their representatives were in the final of the mayoral elections in Samara is not accidental.Recently, Moscow has been insistently introducing the idea that the state power, relying on the only “party of power”, has begun to suffer from political limp. The second party “leg”, which is considered by the prostate cancer, is called upon to straighten the imperious “gait”.
“United Russia” members of the United Russia party announced their intention at any cost to make their fellow party member the mayor of Samara long before the start of the election campaign. This required a win-win candidate. The acting mayor Georgy Limansky appeared to be a suitable figure for United Russia.The central leadership of “EdRa” did not keep up with the price. For the sake of a hypothetical victory of its protégé, it provoked a split in the regional party organization with an unwavering hand. The Samara “United Russia” members were, to put it mildly, not happy with such a candidate. At the regional party conference, Georgy Limansky, hastily admitted to the party, barely received the required number of votes in his support.
Viktor Tarkhov, being the leader of the registrar of the Party of Life, went to the polls as a self-nominated candidate.However, during the election campaign, he not only used the RPZh brand, but also actively promoted it as a “party of workers” as opposed to the image of “EdRa” as a “party of officials.” In the March elections to the Provincial Duma, on the political soil fertilized in this way, fruits may well grow in the form of votes in favor of the Party of Life.
“Magnet” for voters
In other provinces, the results of the October legislative elections met the expectations of United Russia – first place is behind it.In Samara, according to the results of the first round, the championship was taken by the leader of the RPG. Therefore, there are still few reasons for United Russia to dream of a triumphant victory in March. Especially if, as a result, Samara residents elect a representative of the Party of Life, which is gaining political weight, to the post of mayor. And this is quite possible. In the first round, the candidate of the “party in power” received only about 10% of the votes from the list of voters and entered the second round, taking second place. “United Russia”, having made a bet on Limansky and having received such a result, have badly damaged their reputation.After the fact that they made a mess, deciding on a candidate for mayor, the Samara people could well get the impression that “United Russia” is not fighting for their interests, but serving someone’s personal interests. At least a convincing explanation for the townspeople why Georgy Limansky, whom United Russia fiercely blamed for all the troubles of Samara, suddenly turned out to be preferable to the honored party member Viktor Sazonov, was not found by United Russia.
The Samara Party of Life in March may seem nicer to the voters than “United Russia”, if only because it has not yet become famous for any political scandals.If its leader Viktor Tarkhov defeats his rival United Russia, his surname at the head of the Party of Life list in the elections to the Provincial Duma can become a magnet for voters.
Guilty without guilt
United Russia, on the other hand, will approach the March election campaign in a very shabby state. Constant showdowns in the regional political council with the scandalous removal of regional party leaders have already affected her participation in the mayor’s campaign in the provincial center.This participation is hardly noticeable and, judging by the results of the first round, is ineffective. If the United Russia party “flies” on October 22 past the mayor’s chair, it is possible that the leadership of the regional party organization will again start leapfrog and another change of milestones … Moreover, those who initially objected to Limansky’s candidacy have the most chances to get caught up in failure. In particular, Viktor Sazonov, the current secretary of the regional department. The “party in power” will spend precious time on internal party squabbles.For “life-men” this is a kind of handicap and an opportunity to “unwind” on criticism of their main competitor. Fortunately, the capital’s political strategists at this stage seem to assign the RPZh function of a “healthy” party leg, onto which the state power can gradually shift the political center of gravity.
See also:90,000 President’s subsidiary farm – Vlast – Kommersant Magazine “Kommersant Vlast” №30 from , p. 26
& nbsp President’s subsidiary
Boris Yeltsin, who returned from vacation to Moscow for a few days, almost never left his residence “Gorki-9”.It turns out that the Kremlin was restored in vain.
One of the employees of the presidential administration once boasted to a Kommersant correspondent: “I just need to look out the window to understand whether Yeltsin is working in the Kremlin or not.” In fact, it has long been Openel’s secret. The omen is simple and well-known: if there is an impressive ambulance at the back door of the 1st building of the Kremlin, it means that the president is in office. The fact is that there is no intensive care unit in the Kremlin premises: when in 1993 the renovation of the 1st building, where Yeltsin’s residence is located, was started, no one thought that in two years the president might need highly qualified medical care at any time.Therefore, in the luxurious premises, they planned only a simple medical room with supplies of aspirin and activated carbon.
Boris Yeltsin moved to the Kremlin immediately after the putsch – in September 1991. Sensing that the President of the USSR, Mikhail Gorbachev, was losing control of the country, the President of Russia, without much hesitation, presented his rights to the main Moscow residence. Gorbachev did not have the strength to resist, and he resignedly allowed his political opponent to occupy the Kremlin’s 14th corps, apparently consoling himself that he himself remained in the prestigious “secretary general zone.”
This was the name of the right wing of the third floor of the 1st building of the Kremlin, the former building of the Senate, built at the end of the 18th century by the project of Matvey Kazakov. In the Central Committee apparatus, the secretary general’s office was called in another way – “height”. Renovated at the direction of Brezhnev, this office, overlooking Red Square and the Historical Museum, was inherited by successive leaders of the Communist Party of the Soviet Union.
But Yeltsin felt himself master of the situation in the less prestigious 14th Corps, where the Supreme Soviet of the USSR was then located.In the huge building, the Russian president initially owned only three rooms: a gigantic reception room, a small office (30 square meters) and an adjoining recreation room, where Yeltsin dined, received guests and conducted confidential negotiations.
Despite modest living conditions, Yeltsin did not miss any opportunity to remind Gorbachev that his time was running out. For example, at that time it was possible to get to the Kremlin both through Spassky and Borovitsky gates (now only the second ones are open), but Yeltsin did not make the slightest effort to miss Gorbachev.The hardest part was then for the protection. She complained: “Try separating two motorcade arriving at the same time.”
Fortunately for the guards, the “dual power” did not last long: late in the evening of December 25, 1991, immediately after the signing of the Belovezhskaya Agreement, the red flag was removed from the dome of the Kremlin’s 10th corps and the Russian tricolor was raised. As it was hanged by politically illiterate workers, a red-blue-white flag was hoisted over Red Square. Fortunately, the responsible official who followed the ceremony noticed a mistake – the flag was turned over that night.
Now Yeltsin has entered the Kremlin as a full-fledged master. But with each of his actions, he tried to emphasize that he was a democratic leader and that the old order did not have long to live. After working in Gorbachev’s office for several days, Yeltsin replaced it with another, more modest one, and settled his assistants in the General Secretary’s wing.
The only one from Yeltsin’s inner circle who was located not on the presidential floor, but on the floor below, was Viktor Ilyushin. The explanation turned out to be simple: the first assistant chose for himself the former office of the head of the Council of Ministers’ affairs – the most luxurious apartments in the 1st building.
Yeltsin did not do any special repairs, only a special telephone appeared on the desk of each assistant – without a disk, but with the inscription: “President.” When the receiver was being picked up, the name of the caller flashed on the console in Yeltsin’s office. If the president was alone, the assistant could expect to be talked to, and if the conversation was not by telephone, then it was possible to arrange a personal meeting.
As a rule, one-on-one conversations took place in the president’s office; the so-called Walnut Room was used for the meetings – a hall with a large round table located next to the presidential apartments.Yeltsin invited only those closest to him — Alexander Korzhakov, Viktor Ilyushin, or Valentin Yumashev — into the small rest room adjacent to his office. In it, as a rule, he dined.
Lenin’s memorial study in the Kremlin was especially popular with the assistants. There they usually celebrated the birthdays of the staff of the apparatus. “Let’s take a bottle of vodka, a couple of sandwiches and go to Lenin’s office. They celebrated very cheerfully,” one of the participants in these feasts recalled in an interview with a Kommersant correspondent.
Morals in the Kremlin began to change from the end of 1993. First of all, the changes were explained by changes in the character of Yeltsin himself. In the former first secretary of the regional committee, regal manners began to wake up. Changed not only the manner of his communication with subordinates – she became arrogant and arrogant – but even his gaze and gait. As one of Yeltsin’s comrades-in-arms at the time recalled in an interview with a Kommersant correspondent, it was in 1993 that he fell in love with starting his speeches with the words: “I am as president… “
At the same time, the President started a grand renovation of the 1st building. The closest entourage, having caught the changes in the character of the chief, practically imposed on him a pompous imperial style, replete with stucco, gilding and furniture with bent legs. Cossack drawings were brought to light, according to which it was supposed to reconstruct the 1st building. All the old partitions inside the building were destroyed – only the outer walls were not touched. Window openings and vaulted ceilings, parquet and oak panels were removed; furniture that belonged to Stalin, Molotov, Kaganovich and other historical residents of the Kremlin was sold at auction.Lenin’s museum-apartment was transported “to a settlement” in Gorki.
Yeltsin personally watched the progress of the work. During the year, he, together with Korzhakov, Borodin and Shevchenko, walked around the restored estates, taking a keen interest in construction and giving out valuable instructions. And then FSB director Mikhail Barsukov personally searched the archives for books about the Kremlin and drawings of the Senate corps.
However, funds for repairs were regularly delayed. Employees of the Federal Security Service tell how, at the end of 1995, their New Year’s salary was delayed in order to complete the restoration of the outer walls of the building.“We were asked if we would mind if our money went to pay the builders, and we get ours later,” one of the security guards recalled in an interview with a Kommersant correspondent. The president’s bodyguards showed a love of art and agreed to the proposal. They received their salaries almost at five in the evening on December 31st.
After the renovation, most of the premises of the 1st building began to be occupied by the president’s apartments – workers and representative ones.Yeltsin’s office is a room on the second floor, measuring 7 x 14 m, with a small reception area where secretaries work.
By a strange coincidence, the footage of the presidential office is almost the same as that of the tsar’s office, located in the Grand Kremlin Palace. The furnishings in it, however, are rather modest: a 205 cm long desk, made by special order in Italy, and a conference table – behind it the president usually meets with those who come to his reception.
Through a small walk-through room, the president can go to his executive office, or, as they call him in imitation of the real White House, the Oval Hall. After renovation, the former meeting room of the USSR Council of Ministers turned into marble mansions with a fireplace and mirrors on the walls with an area of 150 sq. The Oval Hall is adjoined by a whole suite: Ambassadors, Fireplaces, Seating halls, in which Yeltsin presents his credentials to ambassadors, meets with regional leaders, and presents state awards.For meetings in an expanded format – such as, for example, “round tables” – the Catherine Hall, also located on the second floor, is used.
But there are rooms in the 1st building that very few people know about and which are rarely used lately. Firstly, this is the president’s apartment. It consists of a fairly modest bedroom, dining room and library. Since Yeltsin has spent no more than two or three hours in the Kremlin for the past year and a half, and even then not every day, an office is enough for him to work.None of the Kremlin officials with whom the Kommersant correspondent spoke could recall when the president entered his private apartments over the past year.
The only thing that was restored by collective efforts was Yeltsin’s visit to his library to record a televised address. By the way, as one of the officials who visited this room caustically remarked, “the books are perfectly matched on the spines to match the color of the floor and furniture, but hardly even one of them has been read.”
The so-called situation center, located on the first floor, is also extremely rarely used.This is a huge room with a wall-to-wall screen and a long meeting table. It was assumed that this room, stuffed with ultra-modern technology, would become a kind of center of government for the country, where various situations would be simulated and replayed – from the war in Chechnya to the repayment of debts to state employees.
But officials led by the president preferred their own offices. True, during the Chechen war, journalists were invited to the center a couple of times, and, according to one of the FSO officers, “there was no greater headache.”It took the security guards almost two days, first to disconnect and then to reconnect all the computers. All this was done for security reasons – suddenly the correspondents would spy on something secret.
Restoration in the Kremlin continues to this day. Since the spring of 1998, work has been going on in the Grand Kremlin Palace. In 1934, the Soviet government significantly spoiled the interior layout of the palace. Two halls were destroyed – Andreevsky and Alexandrovsky, in their place there was a meeting room of the Supreme Soviet.At the same time, the domed vault was turned into an ordinary ceiling, the landscape of the floor was changed, raising it to the back rows. (Three other executive rooms – Vladimirsky, Georgievsky and Ekaterininsky – suffered less damage, so they were restored during the reconstruction of the 1st building.)
Now the restorers are recreating the Andreevsky and Alexandrovsky halls using archival sketches and watercolors. The biggest problem for the restorers was the giant statue of Lenin, which stood in the arch behind the presidium stands.It was she who was insistently demanded to be removed by the democrats before the start of each session of the Congress of People’s Deputies of Russia. The congress never made such a decision – despite the prevailing hatred of Bolshevik # 1 in society. However, even if the deputies voted to remove the statue from the hall, it would remain in place. It turned out that the only possible way to get rid of the stone idol is to pull it out through the roof. So the builders had to pull Lenin out with cranes through the broken ceiling.
It is assumed that after the completion of the restoration, all the halls of the palace will be used for their intended purpose – for representative purposes. As in tsarist times, they will receive ambassadors, reward heroes and welcome dear guests.
The only thing that, perhaps, will never see the palace again is the coronation ceremony. But it was on the day of the accession to the throne of the new emperor that the maximum possible number of guests gathered in his halls – about 5 thousand.
True, the restorers promise that by 2000 all the work will be completed. So, if desired, the new president will be able to arrange inaugural celebrations in the palace. And if the old one remains, then the coronation. True, by that time Yeltsin will probably not be working in the Kremlin at all – after all, it is much closer to the Central Design Bureau from Gorki-9.
Lying stone in the Old Square
In one of the corridors of the fifth floor of the building on Staraya Square, where the Central Committee of the Communist Party of the Soviet Union was once located, and now the presidential administration, there is a huge marble slab.Everyone is already used to it: well, it’s worth it – and let it be. But how she got there and why, only old-timers know.
This plate is the memory of the secretary of the Central Committee of the CPSU, a member of the Politburo, Andrei Kirilenko. Once he needed marble for something, and he ordered a solid rectangular piece of stone. Kirilenko’s order was fulfilled – the marble block was somehow dragged to the fifth floor, to the chief’s office. But it was at this very moment that Kirilenko had a memory lapse: he did not remember anything about his order, or about what he needed the marble for.Then the workers decided to leave the marble slab not far from the office – in the hope that Kirilenko would someday remember about it. But Kirilenko never remembered.
In 1996, Kirilenko’s office was occupied by Maxim Boyko, who was then the deputy head of the administration. Having found out that the stone does not formally belong to anyone, Boyko decided to remove it from the corridor. But it quickly became clear that this was impossible: not a single lift could withstand the weight of the slab, and it was all the more impossible to manually lower this weight from the fifth floor.Boyko asked the workers how, in this case, the stone got into the building. To which one of them profoundly said: “Well, this is the boss ordered, Kirilenko, – how could you not have done it?”
Boyko had no more questions.
The stone lies there.
Among the spectators in the front row was Anna Wintour, who rarely shows emotions in public.She usually silently observes the models and is in no hurry to pass her verdict. It’s hard to tell from the impenetrable face of one of the most influential people in the fashion world whether she liked the collection or not. However, this time no one had any doubts – the “princess is not laughing” was satisfied.
Netizens reached this conclusion after numerous videos from the show were leaked to the Internet. The fashion show was completed by the fashion model Leon Dam: he appeared on the podium in a “military” leather jacket, a cap, and also in high-heeled boots.
The audience was attracted by the model’s unusual “fierce” gait: Leon walked as if he was about to rush to the enemy. Probably, the model was so strongly inspired by the message of John Galliano that he could not contain his emotions. He was the only one of all the participants in the show who got used to the role of a freedom fighter, but the public’s reaction to this action was unexpected.
Instead of watching in awe of the determined young man, the guests of the show almost went laughing. Even Anna Wintour smiled – she leaned forward to better see the amazing gait of Leon Dam.
Dozens of videos with an unusual mannequin immediately appeared on social networks. The audience christened him “the mood of autumn” and began to come up with various jokes. “When I wanted to be fashionable, but it’s cold outside, so I had to return home for my pants”, “With this look I go to school every day”, “He is a new icon of the fashion world” – commented netizens.
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Atlas Robot Learned to Walk Like a Human
Probably the most perfect bipedal robot in terms of movement is Atlas, a Boston Dynamics development that can even perform parkour elements.However, if you try to walk the way Atlas does, you will get tired after a few dozen steps: the muscles of the bent legs and constantly tense back will ache.
Researchers at the Institute for Human and Machine Cognition (IHMC) in Florida have trained multiple Atlas joints to work like humans. IEEE Spectrum talks about their work.
The human body, in contrast to the robot body, tilts with each step. The knee joints are fully extended, and we place the foot differently.The human gait is the perfect pattern of “interrupted forward falls” honed by evolution.
But it is traditionally easier for a robot to maintain balance on half-bent ones – this allows, if necessary, to instantly raise, lower or tilt the body. Researcher Robert Griffin pointed out that the vast majority of bipedal robot models try to keep the center of gravity at the same height relative to the surface. For people, this is absolutely uncharacteristic.
So in order to train Atlas to walk like a human, the team had to reshape the whole machine’s idea of balance.
The robot, which has ceased to be afraid to put a straight leg in the knee on the floor without a reserve of increasing pressure, has learned some other aspects of human gait – for example, rolling the foot from heel to toe.
Experts say that the “human gait” made Atlas not only more economical, but also more stable. In the video, he is repeatedly pushed in different directions with a stick. During the breaks, the developers clearly show the differences in the “tuning” of the joints and the mechanics of movement.
Among other things, the human gait allows the robot to better maintain balance on surfaces of different levels and inclines.
Atlas is a rare, but not the only robot that moves like a human. This was previously taught to the humanoid Durus robes. This is an excellent confirmation of the energy efficiency of the “human” approach: during the tests, DARPA Durus walked for 2.5 hours on a single battery charge.
Hi-tech + wrote earlier about another interesting two-legged robot – Aerial-Biped, which moves quickly, smoothly and does not fall.True, he uses for this not only the vestibular apparatus, but also a quadrocopter.
moderator_2635 | MTYUZ / Moscow Theater for Young Spectators
Caucasian accent 10/16/2002
For the sixth year already, the “Sachukari” festival has been held in Tbilisi through the efforts of Keti Dolidze and her associates. This time MTYUZ came with two performances by G. Yanovskaya and Kama Ginkas.
Who said that poets, writers, directors, actors are comforters? Nonsense! They are soul rippers.Jackie the Rippers, devastating and striking outright with their precise hit. But … After death comes the resurrection. Only by dying can one be resurrected.
Renew, cleanse, transform. Transformation is one of the main qualities of the “Ginkasov” theater, the transformation not even of the heroes, but of the audience – those who, in its performances, are included in the play at times too realistically. Because it doesn’t feel safe. Because the Ginkas theater is not an escape from reality, from acuteness and tragedy, from the authenticity of any feeling, but full involvement in all this.Sudden, unexpected, voluminous, polyphonic, versatile. When sometimes you still don’t know whether to cry, or laugh, or run away, because you can hardly withstand such an intensity and such closeness of what you are experiencing.
Shock. This is the only word most often said by any person after any Ginkas performance. Shock.
You can also cry after the performance in different ways. From excessive sentimentality, from a well-made melodrama, from the plot itself and the identification of actors with heroes and themselves … However, as you know, uncomfortable shoes are a good reason.And shattered nerves contribute to this reaction. But also – from sympathy, from empathy, from a sharp, explicit and clear as never before the feeling of life, the fracture of being and the soul – fracture, feeling wholeness, from shock, shock, from the fullness of feelings and the fullness of experiences. Why go to the theater or read books if you don’t see, don’t hear, don’t think and don’t feel? Having ears …
“It is important for me, through the written text, the conventionality of what is happening on stage, to wade through you so that for a second you feel the reality, the literality of what is happening without artistic tolerance.” These words from an interview with Kama Ginkas precede the program booklet and, perhaps, the performance itself, the full title of which is as follows: “K.I. from “Crime”, the game in the white room “. Screenplay by Daniel Gink, son of Ginkas and Yanovskaya. According to Dostoevsky. Oksana Mysina as Katerina Ivanovna. Children participate in the play: Vera, Petya and Lyuba Romanovs. The maximum number of spectators is 50-60 people. More in two rooms, in which the action takes place, simply does not fit. In the course of the performance, the viewer laughs, sobs, can enter into a conversation, succumb to provocations and in the end still goes into that very famous, Ginkas, white room.It makes no sense to talk about the play. It’s like in that joke when a certain Abram tries to retell how Caruso sang, whom he heard in the transmission of an acquaintance who … And so on.
Brief and uninformative: this is the monologue of Katerina Ivanovna Marmeladova, a monologue in which her whole life is twisted and twisted, like in a meat grinder. We find K.I. (or does she find us?) at the moment when she learns about the absurd catastrophe of her drunken husband, and the audience subsequently becomes guests of the commemoration.Corresponding invitations, written in pencil, uncertain and diligent, like a child’s hand, on scraps of paper are handed out to the audience. Oh no, already to the participants of the commemoration.
Ginkas destroyed the fourth wall built by Stanislavsky and threw the actors into the “armful of the audience.”
Oksana Mysina reports:
> – And on the one hand, the viewer for me is such a cage with tigers, into which they throw me, and I don’t know: what, how, how he will react: or he will spit in my face , or open up his heart.Nobody knows that. And it is on such a dangerous line that the performance exists. And my heroine exists. Because, as Ginkas told me, Katerina Ivanovna exists between the second and third heart attacks, she is beyond that edge of emotions, beyond the edge when she no longer hurts, but she is already sweet. And she knows that a little more, and it will end. And she knows it about herself. And this feeling … the feeling of insane joy that I LIVE, here I am talking to you, do you hear? I’m doing well! Everything’s fine with me! You can see that I’m doing well! I’m talking to you, so that’s all, you see me, you see: white, you see: this is white.So I live! And now she LIVES to the end. LIVES.
– There is a kind of masochism in this, otherwise you will not stand it … Like any artist …
– I’m on my knees in front of her [O K.I.]. That she is such a person. That she doesn’t sniff, doesn’t cry, doesn’t feel sorry for herself. And if I begin to feel sorry for myself at a performance, I want to sink through the earth from shame, because this is not the right … quality … And ideally it should be so that I do not cry, but everyone cries. And sometimes it happens the other way around: I cry, and everyone sits and watches: oh, the artist plays well.Or – oh, why is she suffering there. It happens in different ways. A living thing. Yesterday there was one performance, today another. It is different every time.
– Every time you react precisely to the reaction of the viewer …
– When we were rehearsing, Ginkas taught me to use everything. When we started rehearsing with Ginkas, we crawled together on our knees … I remember his eyes, from which it was impossible to tear themselves away … He rehearsed terribly funny. We both laughed so hard. He is an insanely talented person.Very open minded. Defenseless, fast, he has quick transitions, everything sparkles in his soul, and so everything hits, hits, hits, and when the rehearsal ends, he cuts it all off abruptly and says: “Everything, thanks, do dates. The rehearsal is over. ” And with such a harsh voice – and everything, as it were, cuts off the umbilical cord. Only now we were at one with him, and then he cuts off, and you remain so … alone. I always found myself crying like hail after rehearsal. I sit and think: “What did I do to him, we rehearsed so well, why did he suddenly me like that…”.And he deliberately threw me at the moment … on takeoff … So that I remembered, felt this all, this all the fragility of such fast … spatial transitions, overflows of the soul.
He has the eyes of a rabbi. No, not a dogmatist who strictly observes the law. A rabbi who has experienced the experience of God and is eternally yearning for Him. Perhaps some of the high priests had such eyes. These are the very eyes, real Jewish ones, with their “eternal longing” and bitter, but invariably sharp humor. Crazy eyes.And in these eyes you also see … the whole Holocaust, forever frozen, frozen and living, hurting constantly.
Perhaps the ancestors of Kama Ginkas were rabbis. And he himself belongs to the few, by a miracle – really, a miracle! – the rescued children from several thousand perished in the Kaunas ghetto (a Lithuanian woman carried him out of the ghetto under the hem of her dress, risking her life). But it’s not worth it on the basis of this fact alone, which is unconditional in its essence – to the delight of “Freudian anatomists” – to talk about the director’s current worldview.For any artist’s life and death are always heightened! Only the experience experienced and experienced are different. Everything affects, but not everything boils down to one thing. A symbol cannot be reduced to a sign.
The son of a doctor with the gaze of a rabbi, who seems to have combined both in his profession, he possesses a unique and rare property inherent in … perhaps geniuses. He has a BREAKTHROUGH SENSE. Where, what is the second question.
How to identify a breakout? But you can’t define it. You will feel it, you will feel it, you will experience it.Like hot or cold. And then you will comprehend. If you master …
– The fusion of you and Ginkas is very much felt in the play … And he “did not die in the actor,” and you retained your individuality. And at the same time, both of you are one, perfect!
– Feels like, huh? That’s for sure. He lives in me.
– You sometimes speak a foreign language in a play: now a couple of words in German, then in English … There is such a feeling as if the idea was also such that each person speaks a foreign language in relation to another person (“I it does not matter which Incomprehensible to be oncoming ”, from Tsvetaeva), and do not understand … everyone speaks their own language …Is there such a moment in the play?
– It seems to me that you hit it right now … Yes, this is exactly what Ginkas told me: In whatever language … Katerina Ivanovna has this absolute openness: “You understand me. Yes? You understand, right? SHE DOES NOT UNDERSTAND ANYTHING! (Oksana says, intonationally, emotionally continuing the performance …). These people do not understand anything !!! (… everyone is trying to shout. The play is over. And she is still trying to shout.)
When they go on tour, Ginkas makes Oksana play a play in the language of this country, and Oksana learns French phrases (a sensation in Avignon!), German, Finnish (and cold Finns cry like children). And surprisingly , – says Oksana, – that, in general, this performance does not need a special language.
– You know, when I do not play “K. And … ..”, I feel how my soul grows heavy, my body grows stale. After “K.I … ..” I always seem to wash … As if I am cleaning myself. And I have some kind of update starts.
She is confused and frightened by the sense of human well-being. The well-being of the soul – otherwise its fossilization, inability to wake up – cannot be found in a real artist.No! Awakened monsters, angels, light and sinless, demons tempting and tormenting, ghosts of babies, children and old people wander in the souls of these people – imagination, sensation, experience alone is enough. And how many accompanying doubts and worries! The world is too complicated for a person who is open to him to feel comfortable in it. And to the Creator too. But otherwise – just sleep and not notice anyone and nothing: neither the world, nor oneself, nor deeds, nor actions … It is difficult, difficult to wake up, to open up in order to feel all the heaviness, horror, tragedy, disorder and at the same time the beauty and existence of the world , life … But this is probably either given or not given.
“Everything in art must hurt, otherwise it has no right to be called art” , Tsvetaeva declared uncompromisingly and unmistakably.
– And on the other hand, I understand that sitting at a train station or wallowing in the mud is absolutely not what is needed for this role. You need to be at peace, you need to detach from yourself and do only this. The life of another person. And you can do this when, with that side of your life, where you, Oksana Mysina, you have a husband, you have your car, do you have your job there? But here, in this role, irritability is not needed very much, pettiness is not needed.Here it is necessary to leave everything – let it live there somewhere and calm down, live its own life. And – to rush here, as in an ice-hole.
This is how art works. A poem, symphony, painting is also being written …
Throughout the entire performance, the feeling does not leave: NO, NOT NECESSARY! It is not clear to whom you say “no need”. Him, him (anyone), Him … her, Ginkas … Up, down, horizontally, vertically … You don’t know. More than once, in more than one country, people simply ran out in sobs, unable to bear the tension … And they returned only to bows.
– Creativity, it seems to me, is the maximum self-dissolution (not self-expression), equal to the maximum self-concentration, and in this it is similar to love. What do you think?
– Yes (smiled)? I do not know. It’s a secret. I cannot formulate this (and you cannot formulate what you are inside). Ginkas … concentration is yes … I know some tasks that were in front of me. I have a plump notebook, I can show you how we worked (pulls out a notebook). Just so you can see.We have been playing this performance for 8 years already … Here is a notebook that I filled up when we worked (disheveled, read-re-read – and therefore intimate – a thick notebook, with a lot of inserts). There she is. Here is my role, here are my notes, when after the rehearsal was left … He left me when, right? And I was leaving … and I was sitting … “I drank my stockings …”, – I swear [words from the role]. And – immediately open. “He was a good man.” All this ease in order to close this abyss, the void, the abyss that suddenly appears in it.
This is the defense of a defenseless person, this is a shield behind which there is a thin glass … Crystal ringing from the sensitive and varied reflection of the world. So varied and poignant that it is ready to crash at any moment. But that is why he lives, plays, shimmers with all shades and colors, sounds and echoes … Voices and echoes. Lightness to hide unbearable heaviness.
In a sense, Ginkas is Brodsky on stage (with whom, by the way, St. Petersburg students Tovstonogova Ginkas and Yanovskaya were friends).By the degree of ruthlessness and ambiguity, foresight and premises, by the scale of the consequences and followers, even involuntary ones. By the metaphysical nature of their performances and designs.
What is metaphysics? Is that something that lies “above the sphere of significance of things,” in the words of Schopenhauer? But Brodsky loved black and white colors, considering them the most metaphysical, be it snow and trees through which the horizon gaped and shone, old movies and so on, because black and white resembles a pen and paper. These are simply the most real – in the highest sense – colors.And also … Space and Time … Kama Ginkas likes to compromise the idea of ordinary Space by all possible means. And fills it with an excess of Time and emotions. Perhaps even this is not space, but emptiness, since space is filled with all sorts of rubbish: things, any outlines. And here, in the play, there is nothing superfluous, nothing final. Not in the environment, not in the person. White and black creates a feeling of destruction of all possible walls, and there is a feeling of some kind of other existence, in a different dimension.By the way, Brodsky considered a prison to be a lack of space, made up for by an excess of time. And if it’s about body and soul? And from which prison at the last limit is K.I. at the very end, after death? (“Well, let’s say you broke through the wall with your head. What are you going to do in the next cell?” Stanislav Jerzy Lec)
Black – darkness is nothing, color absorbs everything, all colors, all outlines. White – light is everything, a color in which the rest of the colors and outlines have not yet been born, but have already been conceived.The virtuoso set design (think about it: exactly the stage design) by Sergei Barkhin most accurately embodies the director’s idea, and it is no longer clear who and when first came up with this or that detail. Ginkas has such a peculiarity: to completely merge with actors, artists, and none of them loses himself, moreover, he finds and opens up even more.
Looking at this staircase descending from above to the deceased K.I., for some reason you recall Jacob’s staircase. Ladder to God. The rope on which she is tormented, tearing herself out of the hell of her soul, then (because during this incredible scene it is simply impossible to think about anything!) Reminds one episode from Akutagawa’s story “The Web”, in which Buddha, wanting to save one robber, stretched a silvery cobweb shining with a thin ray to him in hell.And he “grasped the web tightly with both hands and began to climb upward with all his might.” No, there was a different end. But the meaning of the rope is the same: it, apparently and invisibly, leads to paradise, because the “paradise pond” reaches “to the very depths of the underworld”.
Maybe white and black are also symbols of Purity and impurity (how stress sometimes adds, but does not change the meaning of words …)? Pasternak once said that poetry is lying under our feet, we just have to bend over and look a little. Not everyone wants to make an effort and bend over.Bend over to see Heaven later. Maybe white is also doctors, people in white, who could not have saved K.I., but others, in a white robe, would save? But in white he has an environment, an environment, and people, living ordinary people, in black. In an absurd black coat K.I., her son Kolya, daughters … So what is inside us, he brings out with the help of Sergei Barkhin’s metaphysically accurate scenography? The white that we see outside is part of our soul. Are those black clothes another part? When K.I. undresses the children (“Let everyone see !!!”), the girl, Fields, remains in a white shirt … The rest are undressed to the waist.Here it is, the soul … Naked, black and white. The soul of everyone, the soul of K.I.
She dies playing the violin. A soldier comes. Private, ordinary, soldier without a face – “death will come, she will have your eyes” . He takes the children away first. Then he takes away the violin. Then he takes things away. He takes everything away. And she is left alone. And then another music comes in.
… Or maybe metaphysics is an eternal perspective? This is the staircase that the director presented to his heroine. The Ginkas Theater is similar to a poem. Why? Speaking about his love and hatred for the theater, Kama Ginkas, in particular, said: “Because in the theater, any fact, any absurdity of life is given meaning and significance.Katerina Ivanovna died on the sidewalk without music and went to the next world without the stairs that I gave her in the play. In life, when something happens to us, thunder does not thunder and a sad motive does not play in the bushes. And in the theater it happens. And I treat this with pain, irony and love. ”
In this life, everyone has their own life (and their own death). We are all alone. But a strange feeling remains with the audience after the performance. Feeling dedicated. They usually disperse in silence, not wanting to discuss.There has just been initiation into the sacrament of the Soul. And this unites those present, merges them, leaving each with his own. Ginkas managed to drain it and leave everything as it really is.
– Right now, when we went on tour, I asked Ginkas: “Kama Mironovich, I heard that you are not going to go with us.” He says: “How am I not going! You are going and my performance is going. ” [Brodsky said the same about the books of his poems published in Russia, answering the question why he does not come himself: “my best part is already there”].I say: “Kama Mironovich, how can I play?” He says: “Well, the biggest difficulty is for you to forget how to play, and if you know everything, then why play?” I say, I know, this is the biggest acting problem when you remember everything and know how. And the biggest problem is (sighed) everything / everything today and now and every time from the beginning. And know nothing.
– Live …
– And when they are already working out one way or another – today there was 203 performance (September 28, and they played on 27, 28, 29) – when some intonational moments are already being worked out, and you hear them, and you hear that it was yesterday’s snow , inside you … (sighs with horror, as it were) … you think: “Oh, what am I doing”….And he taught me here to go to zero. Discard everything. And start over. With a partner, with yourself. Not having time to control how you do it. The tasks, they stand, tomorrow they will have to be solved again, and so every time.
The high calling and recognition of this actress is undeniable. “The actress, great in her skills, uses the whole palette of emotions, confusing, leading to emotional excitement, sometimes so funny, very funny. And the viewer follows her with pleasure … Karin Prost, “Vaucluse Maten-Dauphine Dimanche” “- You know what, I’ll tell you very honestly: I would have worked with Ginkas all my life.I would play with him whatever he gave me.
– You are very merged with him …
– And here’s the rigidity and paradox of life and theater: I play one role in him. It’s already 8 years, and he doesn’t offer me anything else.
– Doesn’t want to, or? ..
– I don’t know! I dont know. He is an artist. Large. He goes his own way. He needs people who fit this road. He selects the people he needs, so I don’t fit into his path any further.(Longing for Ginkas, how understandable it is! Longing for genius … And why did Mandelstam’s “longing for world culture” come to mind now? Perhaps this is the longing for perfection, for completeness and for the Absolute). I understand it. I am aware of this. And recently, when we were saying goodbye to him, we rehearsed a little, and I suddenly just gushed with tears. He says: “What are you?” You never cried at my rehearsals! You are the only actress who didn’t cry! Never … “I say:” Well, that’s why I cry, because I miss the time when we worked with you.This is not enough for me. ” He said: “Well, let’s do some work,” and left. (She laughed bitterly.) As always. “Let’s work some more” – and left. And that’s why I know, I learned some things, unsteady, at this performance. “Learned” is a wrong word … Well, you feel it, right?
– I see … And where do such talented children come from?
– This is the Romanov family … They have five children. Their mother is an artist, a very talented person. And four of them have already gone through our performance. We have some kind of change of dynasties here.Because the play has been going on for 8 years, these guys have been playing for four years. And Vera, the eldest, said in an interview that for three years she did not understand what she was doing there. So, I went on tour, played everything. And suddenly she seemed to wake up – everything!
– Imagine that since the time of Adam and Eve you have been given the opportunity to meet, to see any person. Who would you choose?
– Hmm … (silent for a long time …) Oh, whoever … Blind Homer (with a tinge of hidden worship).Yes … I don’t know. You took me by surprise. (Laughs.) I would like to go through the centuries. Yes, I would like to meet Michelangelo. With Leonardo da Vinci. I would like to talk to them. Maybe even shut up, look at them.
– Silence next to them …
– Yes. See … What is this … Shakespeare …
Each Dostoevsky has his own Ginkas. Next to which they are, they are silent and not silent, and actors, artists – everyone who is NEARBY is embodying their ideas. “Ginkas leads Oksana Mysina, performer KI, like a lover gentleman. His crazy, half-dead Katerina rages and attracts the audience; it seems that a deep inner connection is being established between Dostoevsky and the anxieties of today. Michel Cornot, Le Monde. So it is just right in a new way, but also right, to exclaim after the well-known cat: “I protest! … Dostoevsky is immortal!”
K.I. – O.M. tries to shout, to reach out to any person in any language.She LIVES and wants to be heard, seen. After death, she also tries to reach out … But already to Him. “I have no principles, I only have nerves,” said Akutagawa.
And can they so calmly “pass” there, if they are so madly alive? “I am calm, as if I had died. – wrote Tsvetaeva in one of her letters. – What disgusting, what squalor – this earthly life. What abandonment … “And Marina Ivanovna wrote:” I know, I’m not like that, I just tried to live. When I try to live, I seem to myself as a little seamstress who is always trying to do….something beautiful … and it doesn’t work … and then throws everything away and starts singing … by the window, behind which it is raining … “.
“Don’t forgive, well, don’t!” It is a strong woman who is screaming from powerlessness. She needs forgiveness, otherwise she would not have shouted this, and would not have fought up there, breaking through the white ceiling: “Let me go! It’s me! I’m here!” K.I. restless after death. She tries to LIVE there too. Fussy? Struggling? God hears her, and He waits. She, as Sonechka said in Dostoevsky’s novel, whom K.I., thirsts for justice (“You know nothing, you don’t know anything … – Sonechka said to Raskolnikov, – She is so unhappy, oh, how unhappy! And she is sick … She is looking for justice … She is pure. must be, and demands … And at least torture her, but she will not do an unjust. She herself does not notice how all this cannot be fair in people, and gets irritated … Like a child, like a child! She is fair, fair! “) … “Let me go! It’s me! I’m here!” – the same thirst for justice.She desperately wants justice.
… Once Dovlatov was asked what could be higher than justice. And he replied a little perplexedly: mercy. Mercy and forgiveness are what she needs!
But I really want to shout, shout with her: Let her pass! Miss HER! And you sit, sit NEARBY, and … well … you just don’t know what to do. YES LET HER LET THERE, THIS IS SHE … THIS IS SHE! THAT’S HER? “It’s me, Lord, it’s me …”. Or close your eyes, ears … Close yourself, cover yourself with your head, so as not to see, not to hear all this! And so it happens.Everything. Everything and nothing. White and black. Some kind of music or sound. Organ or trumpet – and Jericho fell? And – darkness. Silence. Nothing. Silence. Silence … And then the light – and the white room. Empty. End.
What if she was missed? Suddenly K.I. all the same they let you into Heaven, did she come in?
Don’t, don’t applaud! It seems that by this we are calling K.I. from there, if she is there…. But they are already shouting “Bravo”, and a magnificent, happy, enlightened actress with no less happy and shining children runs out … And then the play BEGINS.Bows, flowers, bows … Well, sort of like a theater … You remember that you are now in the theater … That this is a convention. However, do convention and reality contradict each other? But the actors bow, the spectators cry, smile – who is what … – flowers are handed over. And everyone is alive, thank God. Alive! Alive … Alive are also those who lived before, but did not really notice it. That is, many of us. And now it was as if he had lived anew and started anew. And he continued again. A life.
But still and again these passionate words from the romance, shouted by the dying K.Seeker: “In the midday heat in the Dagestan valley … In the midday heat in the Dagestan valley …”. It seems as if Socrates said about her: “There is a sun in every person. Just let it shine. ”
Still and still before our eyes this staircase to Heaven and the beating, beating on it, on a rope, frantic and frantically living actress, K.I. – it doesn’t matter anymore!
Days go by … And sometimes again and again you feel yourself there, in the white room, with its crazy and such real games.
K. GINKAS, from a radio interview: “” There is rapture in the battle at the dark abyss on the edge “, – this was said by Alexander Sergeevich.This is human. Do you know what it is? This is to test yourself. This is to test the possibility of immortality, the desire for flight. It is in a person if he is a person. A person is not a person until … until he has no desire to test himself. Love, genius, crime, like Raskolnikov. What am I? Something that you risk. It is present in a person. And this is your craving for the abyss, if you like, it says that you are a man. Man. This does not mean that you have to jump, no. Don’t, don’t jump! Find other ways to test yourself.But this is human. It seems to me that this is exactly what I am trying to make a performance about how to live is to try yourself, it is to test yourself in different ways. And necessarily love, necessarily. No matter how it ends. ”
And again Oksana’s words about her tears after the rehearsal come to mind. “I sit and think:“ What did I do to him, we rehearsed so well, why did he suddenly tell me so… ”. And he deliberately threw me at the moment … on takeoff … ” It would seem that the performance is over, logically finished.But not emotionally! He just remains in us at the very top of the rise of various feelings: shock, pain, sometimes unbearable, happiness and unhappiness at the same time, piercing and piercing … On takeoff. Ginkas and Oksana and we are thrown on takeoff. And only one can fly. And at the same time, you understand that at this moment those who were nearby, who played, watched, participated and participated, fly, take off and cry. Dedicated! It hurts, very much, but … on takeoff … But where is he throwing us? And in that life, in the same “cage with tigers” into which he threw his heroine.The same life from which we came to the white room and into which we leave … What kind? Different. If only not forgetful … Not heavy, not ossified afterwards. We go to revive life. And I really want to believe that we will not forget the staircase that leads to Heaven. It exists, and it is given to everyone. And you can get through. If you only walk along it, and understand that you remain in complete confusion, instability, uncomfortableness, unsteadiness – otherwise you will ossify and stop – to understand that you are already on a different scale … With love.And on takeoff.
Novomoskovsk covered with snow31.01.2018 13:02:00
Novomoskovsk covered with snow
The snow that has fallen over the last two days of January has again created problems with its cleaning for the city’s road and public utilities.
Today, January 31, 14 units of equipment from the municipal institution “Road Facilities” went out to clear the roads. Now in the city there are 7 trucks and 7 combined road vehicles (KDM), which have the ability to install various equipment, the interim chairman of the committee for road transport and communications, leading engineer Yuri Kabanov told us the details.KDM are equipped with a knife, cutting off the snow cover, and a brush, it is they who clean the roads and sidewalks from snow.
Trucks such as “ZIL”, “KamAZ” are involved in the removal of the snow mass. KDM-ki, as experts called them, can immediately shovel snow from the roadway and immerse it in the bodies of cars. The nimble “bobquets” do the same. The technician is accompanied by 10 workers who clean the pedestrian crossings after such cleaning.
Another 8 pieces of equipment, tractors, are working on cleaning “public”, not belonging to courtyards, sidewalks.
And stopping points are cleared by contractors
But the adjoining territories and sidewalks are the concern of the management companies. Unfortunately, the cleaning is not carried out as quickly there. Therefore, in snowy weather, such as today, pedestrians suffer the most. The shortage of wipers and special equipment on the streets and courtyards on such days becomes overly obvious.
In general, the residents of Novomoskov have been waiting for snow this winter and so curse it, wandering today over the snow porridge and mash on the sidewalks!
And one more point to which we draw the attention of the townspeople.During the thaw, snow caps again hang down and fall from the rooftops. We urge our fellow countrymen to be careful when passing near houses. So as not to get injured from above.
Meanwhile, according to the forecast of the Tula Center for Hydrometeorology and Environmental Monitoring, in the next day, February 1, in the Tula Region, the average daily air temperature is expected to decrease by 5-8 degrees.
Drivers are advised to be extremely careful, attentive, observe the speed limit and traffic rules.
Pedestrians with icy conditions should abandon high-heeled boots in favor of shoes with soft grooved soles. Outerwear should not hinder movement and obstruct your view, for example, with a deep hood or high collar.