Reliability of an ultrasound-motion capture approach to measure the lengthening behavior of the gastrocnemius medialis muscle-tendon unit, muscle belly, and Achilles tendon in vivo during gait.

PurposeHuman muscle–tendon units (MTUs) are highly plastic and undergo changes in response to specific diseases and disorders. To investigate the pathological changes and the effects of therapeutic treatments, the use of valid and reliable examination methods is of crucial importance. Therefore, in this study, a simple 3D ultrasound approach was developed and evaluated with regard to: (1) its validity in comparison to magnetic resonance imaging (MRI) for the assessment of the gastrocnemius medialis (GM) MTU, muscle belly, and Achilles tendon lengths; and (2) its reliability for static and dynamic length measurements.MethodsSixteen participants were included in the study. To evaluate the validity and reliability of the novel 3D ultrasound approach, two ultrasound measurement sessions and one MRI assessment were performed. By combining 2D ultrasound and 3D motion capture, the tissue lengths were assessed at a fixed ankle joint position and compared to the MRI measurements using Bland–Altman plots. The intra-rater and inter-rater reliability for the static and dynamic length assessments was determined using the coefficient of variation, standard error of measurement (SEM), minimal detectable change (MDC95), and intraclass correlation coefficient (ICC).ResultsThe 3D ultrasound approach slightly underestimated the length when compared with MRI by 0.7%, 1.5%, and 1.1% for the GM muscle belly, Achilles tendon, and MTU, respectively. The approach showed excellent intra-rater as well as inter-rater reliability, with high ICC (≥ 0.94), small SEM (≤ 1.3 mm), and good MDC95 (≤ 3.6 mm) values, with even better reliability found for the static length measurements.ConclusionThe proposed 3D ultrasound approach was found to be valid and reliable for the assessment of the GM MTU, muscle belly, and Achilles tendon lengths, as well as the tissue lengthening behavior, confirming its potential as a useful tool for investigating the effects of training interventions or therapeutic treatments (e.g., surgery or conservative treatments such as stretching and orthotics).Level of evidenceLevel II.

Medial gastrocnemius muscle–tendon unit ratios of young females and males

On the basis of differences in physiology, e.g., histochemical properties and spindle density, and the structural design of the cat soleus (SO) and medial gastrocnemius (MG) muscles, we hypothesized that 1) fascicle length changes during overground walking would be both muscle and slope dependent, which would have implications for the muscles' force output as well as sensory function, and that 2) muscle-tendon unit (MTU) and fascicle length changes would be different, in which case MTU length could not be used as an indicator of muscle spindle strain. To test these hypotheses, we quantified muscle fascicle length changes and compared them with length changes of the whole MTU in the SO and MG during overground walking at various slopes (0, +/- 25, +/- 50, +75, and +100%). The SO and MG were surgically instrumented with sonomicrometry crystals and fine-wire electromyogram electrodes to measure changes in muscle fascicle length and muscle activity, respectively. MTU lengths were calculated using recorded ankle and knee joint angles and a geometric model of the hindlimb. The resultant joint moments were calculated using inverse dynamics analysis to infer muscle loading. It was found that although MTU length and velocity profiles of the SO and MG appeared similar, length changes and velocities of muscle fascicles were substantially different between the two muscles. Fascicle length changes of both SO and MG were significantly affected by slope intensity acting eccentrically in downslope walking (-25 to -50%) and concentrically in upslope walking (+25 to +100%). The differences in MTU and fascicle behaviors in both the SO and MG muscles during slope walking were explained by the three distinct features of these muscles: 1) the number of joints spanned, 2) the pennation angle, and 3) the in-series elastic component. It was further suggested that the potential role of length feedback from muscle spindles is both task and muscle dependent.

O 019 - Do Botulinum Toxin-A and lower leg casting alter calf muscle and tendon lengths in children with spastic cerebral palsy?

The mechanism of the compensatory increase in electromyographic activity (EMG) of a cat ankle extensor during walking shortly after paralysis of its synergists is not fully understood. It is possible that due to greater ankle flexion in stance in this situation, muscle spindles are stretched to a greater extent and, thus, contribute to the EMG enhancement. However, also changes in force feedback and central drive may play a role. The aim of the present study was to investigate the short-term (1- to 2-week post-op) effects of lateral gastrocnemius (LG) and soleus (SO) denervation on muscle fascicle and muscle–tendon unit (MTU) length changes, as well as EMG activity of the intact medial gastrocnemius (MG) muscle in stance during overground walking on level (0%), downslope (−50%, presumably enhancing stretch of ankle extensors in stance) and upslope (+50%, enhancing load on ankle extensors) surfaces. Fascicle length was measured directly using sonomicrometry, and MTU length was calculated from joint kinematics. For each slope condition, LG-SO denervation resulted in an increase in MTU stretch and peak stretch velocity of the intact MG in early stance. MG muscle fascicle stretch and peak stretch velocity were also higher than before denervation in downslope walking. Denervation significantly decreased the magnitude of MG fascicle shortening and peak shortening velocity during early stance in level and upslope walking. MG EMG magnitude in the swing and stance phases was substantially greater after denervation, with a relatively greater increase during stance of level and upslope walking. These results suggest that the fascicle length patterns of MG muscle are significantly altered when two of its synergists are in a state of paralysis. Further, the compensatory increase in MG EMG is likely mediated by enhanced MG length feedback during downslope walking, enhanced feedback from load-sensitive receptors during upslope walking and enhanced central drive in all walking conditions.

Background/Objectives: Children with cerebral palsy (CP) often develop altered muscle architecture and calf muscle contractures. Orthotic immobilization aims to provide prolonged stretch to lengthen the muscle belly and muscle-tendon unit (MTU), but immobilization may also cause atrophy. This study investigated whether immobilization combined with periods of daily muscle activation has a different effect on calf muscle properties than continuous immobilization alone. Methods: Fourteen children with CP and equinus deformity (mean age: 9.9 ± 3.0 years; GMFCS Level I: 10, II: 4) were enrolled in a 12-week randomized controlled trial. Participants were allocated to one of two groups: continuous immobilization (23 h per day) with a dynamic ankle-foot orthosis (AFO), or a combined regimen consisting of immobilization (14 h) and a daily activity phase (10 h). Gastrocnemius medialis (GM) MTU properties, including muscle belly and Achilles tendon (AT) length, fascicle length, and muscle volume, among others, were assessed four times using three-dimensional (3D) freehand ultrasound. Results: Significant within-group increases in MTU and AT lengths were observed over time at both a 90° ankle position (p < 0.01) and a more dorsiflexed ankle position (4 Nm applied torque, p < 0.01). However, no significant group × time interactions were observed for any parameter. Conclusions: Contrary to our hypothesis, combining activity and immobilization did not confer additional benefits. Nevertheless, shorter orthosis-wearing time had the same effect on the MTU and could lead to improved compliance with orthosis treatment in CP. Larger trials are needed to support our findings.

BackgroundPassive mechanical properties are important in muscle function because they are related to the muscle extensibility. Recently, the assessment of muscle shear elastic modulus using shear-wave elastographic (SWE) imaging was developed. However, reliability and validity of shear elastic modulus measurements during passive stretching remain undefined.PurposeTo investigate the reproducibility and validity of the shear elastic modulus measured by SWE imaging during passive stretching.Material and MethodsTen healthy men volunteered for this study. The shear elastic modulus of medial gastrocnemius (MG) muscle belly was measured using ultrasonic SWE imaging during passive dorsiflexion. To assess the intra-session and inter-day reliabilities, the protocol was performed twice by the same investigator with a 5-min rest period between measurement sessions and twice on two different days by the same investigator with a 1–2-week interval between the two sessions. To assess the inter-investigator reliability, the protocol was performed on the same day by two investigators with a 5-min rest between measurement sessions. In addition, B-mode ultrasonography was used to determine the displacement of myotendinous junction (MTJ) of MG during passive ankle dorsiflexion.ResultsThe intra-session, inter-day, and inter-investigator reliabilities of the method was confirmed on the basis of acceptably low coefficient of variations and substantially high intraclass correlation coefficients. In addition, a significant correlation was found between MTJ displacement and shear elastic modulus.ConclusionThese results suggested that shear elastic modulus measured using SWE imaging is a reproducible index reflecting the passive mechanical properties.

Electromechanical delay (EMD) represents a series of complex processes of converting an electrical stimulus to a mechanical response. To quantify the contribution of electrochemical and mechanical processes of EMD in the human biceps brachii muscle over a wide range of elbow joint angles, we determined the onset of muscle contraction and the beginning of force development by recording acceleration of skin surface over the muscle and elbow flexion force, respectively. Ten healthy male volunteers underwent two experimental sessions, in which submaximal paired-pulse stimuli were applied percutaneously to the resting biceps brachii muscle at 10 different elbow joint angles from 40° to 130° (0° represents full extension). The electrical stimulation induced repeatable contractions, in which the test-retest reliability of time parameters was sufficiently high (intraclass correlation coefficient=0.84-0.88). The time for electrochemical process ranged between 3.1±0.8 and 3.6±0.9 ms and was independent of elbow joint angle (P=0.64). The time for mechanical process and the total duration of EMD, however, were significantly greater at elbow flexion positions than at 40°, the most extended position in this study (P<0.05). Regression analysis revealed that at elbow flexion positions, the time for mechanical process increased significantly with decreasing the muscle-tendon length of the biceps brachii calculated from a musculoskeletal model (R=0.54, P<0.001). These results suggest that, in the human biceps brachii muscle, the prolongation of EMD at short muscle-tendon length is not attributed to the impairment of the electrochemical process of muscle contraction but to the increased slack within the muscle-tendon unit.

Flip-flops do not alter the neuromuscular function of the gastrocnemius muscle and tendon during walking in children

Traditional marker-based optical motion capture systems are costly, time-consuming to operate, and constrained by laboratory environments, limiting their broader adoption in clinical practice and naturalistic settings. Markerless motion capture based on a sums-of-Gaussians (SoG) body model is a potential alternative; however, its metrological properties for kinematic assessment during walking and slow running remain insufficiently validated. Using a conventional marker-based Vicon system as the reference, this study evaluated the reliability and concurrent validity of an SoG-based markerless system (MocapGS) for bilateral lower-limb joint range of motion (ROM) during gait. Thirty-six healthy adults completed self-selected-pace speed walking and slow running tasks while both systems synchronously acquired bilateral lower-limb kinematics. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), SEM percentage (SEM%), minimal detectable change (MDC), MDC percentage (MDC%), and root mean square error (RMSE) were used to assess reliability. Concurrent validity was evaluated using the Pearson correlation coefficient, paired-sample t-tests, and the concordance correlation coefficient (CCC) to compare the ROM. Vicon showed moderate-to-high reliability for ROM in most joints across both tasks. By contrast, the MocapGS achieved acceptable ICC values mainly for the sagittal-plane ROM at the hip and knee. The CCC analysis showed no significant agreement between the two systems. Bland-Altman plots showed systematic biases with spatially heterogeneous random errors. During walking, MocapGS systematically overestimated ROM relative to Vicon at several joint axes; the widest limits of agreement (LOA) occurred at the left knee X-axis and right hip Z-axis. During running, overestimation was consistent across all bilateral joints at the X-axis and the right hip at the Y-axis, while the widest LOA were found at the bilateral hip X-axes. These specific discrepancies highlighted the joint-axis combinations with the greatest measurement variance. In walking, the test-retest reliability of the knee flexion-extension ROM measured by the MocapGS approached that of Vicon; however, the SEM% and MDC% were generally larger for MocapGS than for Vicon. The RMSE exceeded 5 degrees for ROM in most joint planes, especially in the frontal and transverse planes and at distal joints; errors increased further during slow running. MocapGS may be used for coarse monitoring of large-magnitude changes in sagittal-plane kinematics during gait; however, it is currently unlikely to replace Vicon for clinical decision-making or detecting subtle gait changes, and its outputs should be interpreted with caution, particularly for ankle kinematics and non-sagittal-plane motion.

Clothing condition does not affect meaningful clinical interpretation in markerless motion capture

Limited research exists on the relationship between aesthetic saut de chat performance and muscle-tendon unit (MTU) characteristics of dancers. We developed a weighted parameter ranking (WPR) tool to incorporate aesthetic leaping aspects (i.e., height, peak split angle, average trunk angle and trunk angle range) for correlation with MTU properties. The purpose was to identify the relationship of saut de chat WPR and leap height with maximal plantarflexion strength, medial gastrocnemius (MG) stiffness, Achilles tendon (AT) stiffness and relative peak power (PP). Dancers (n = 18) performed maximal plantarflexion, short-range stretches and isometric ramping contractions on a dynamometer equipped with ultrasound to determine strength, MG stiffness and AT stiffness, respectively. Subjects then performed saut de chat leaps atop force platforms surrounded by motion capture cameras. A principal component analysis (PCA) was performed to compare WPR variable weightings with PCA results and rankings. Moderate–strong relationships were identified among WPR, maximal plantarflexion strength, MG stiffness and PP. Strong–very strong relationships were also identified between leap height and maximal plantarflexion strength, MG stiffness, AT stiffness, peak split angle and PP. A very strong correlation existed between PCA rankings and WPRs. Practitioners may consider developing strength and power capabilities in dancers to improve leaping.

The association of muscle and tendon elasticity with passive joint stiffness: In vivo measurements using ultrasound shear wave elastography

Can in Vivo Medial Gastrocnemius Muscle–Tendon Unit Lengths be Reliably Estimated by Two Ultrasonography Methods? A Within-Session Analysis

Medial gastrocnemius muscle and tendon interaction during gait in typically developing children and children with cerebral palsy