Anterior Muscle Research Articles

Effect of passive jaw opening on the electromyographic activity of the temporalis, masseter, digastric, and infrahyoid muscles in healthy adults

ABSTRACT Objective To investigate the surface electromyography (EMG) activity of the temporalis, masseter, digastric, and infrahyoid muscles during passive jaw opening in healthy adults. Methods The EMG activity of the masseter, temporalis, digastric anterior belly, and infrahyoid muscles on the right side was recorded during the four jaw-opening tasks: active opening to 20 mm (AO20); active opening to 40 mm (AO40); passive opening to 40 mm with a rubber mouth prop on the right posterior teeth (POR40); and passive opening to 40 mm with a mouth prop on the left posterior teeth (POL40). Results The EMG amplitude of the digastric anterior belly and infrahyoid muscles in either POL40 or POR40 was significantly less than that in AO20 or AO40, respectively. Conclusion Passive jaw opening reduces the EMG activity of the digastric and infrahyoid muscles significantly and could help reduce the load on these muscles during prolonged mouth-opening conditions.

Location and elimination of Anisakis simplex third stage larvae in Atlantic herring Clupea harengus L

We here describe the location of anisakid third stage larvae in Atlantic herring Clupea harengus L. caught in the North Sea in August 2023. We further demonstrate how industrial processing (mechanical gutting, removal of entrails, head, tail, hypaxial anterior musculature and vertebral column) reduces the overall infection and worm load in the musculature. The isolated anisakid larvae were identified as Anisakis simplex sensu stricto by a combination of morphometrics and molecular methods (PCR of rDNA and mtDNA, sequencing, BLAST analysis). As a baseline we examined a total of 75 specimens of freshly caught and ungutted herring and showed a positive correlation between host size (fish length and weight) and infection level. The overall prevalence of infection was 84 %, the mean intensity 11.3 (range 1–38 parasites per fish) and the abundance 9.52. The main part of the overall worm population was associated with stomach and pyloric caeca in the body cavity (77 %) and only 5 % was found in the musculature. Larvae occurred in the hypaxial part of the musculature (21), the epaxial part (7 worms) and the caudal part (5 worms). The prevalence of muscle infection was 28 % and the mean intensity 1.6 (range 1–5) parasites per fish and abundance 0.44 parasites per fish. In order to assess the effect of industrial processing on worm occurrence in the fish we examined a total of 67 specimens of herring, from exactly the same batch, but following processing. This included removal of organs in the body cavity, cutting the lower part of the hypaxial segment but leaving the right and left musculature connected by dorsal connective tissue. Five out of these fish carried one larva (prevalence 7.5%, mean intensity 1, abundance 0.07 larvae per fish), and these worms were located in the ventral part of the anterior musculature (2), in the central part of the anterior musculature (2) and one larva in the central part of the caudal musculature. The industrial processing reduced the overall occurrence (abundance) of worms in the fish from 9.52 to 0.07 (136 times reduction) and the occurrence in the musculature from 0.44 to 0.07 (6.28 times reduction). The overall prevalence was reduced from 84 % to 7.5 % (11.2 times reduction). Muscle infection prevalence fell from 28 % to 7.5 % (3.7 times reduction). We then followed another batch of herring following a marinating process (11% NaCl for 24 h and subsequent incubation in acetic acid and vinegar) by artificially digesting the flaps during week 1–8. Although a total of 31 larvae were recovered from 144 fish examined no live nematode larvae were isolated. The importance of fish handling, processing and marination for consumer safety is discussed.

Convolutional Neural Networks to Study Contrast-Enhanced Magnetic Resonance Imaging–Based Skeletal Calf Muscle Perfusion in Peripheral Artery Disease

Peripheral artery disease (PAD) is associated with impaired blood flow in the lower extremities and histopathological changes of the skeletal calf muscles resulting in abnormal microvascular perfusion. We studied the use of convolutional neural networks (CNNs) to differentiate PAD patients from matched controls by utilizing perfusion pattern features from contrast-enhanced magnetic resonance imaging (CE-MRI) of the skeletal calf muscles. We acquired CE-MRI based skeletal calf muscle perfusion in 56 individuals (36 PAD patients, 20 matched controls). Microvascular perfusion imaging was performed post reactive hyperemia at the mid-calf level with a temporal resolution of 409 ms. We analyzed perfusion scans up to 2 minutes indexed from the local pre-contrast arrival time frame. Skeletal calf muscles including the anterior muscle (AM), lateral muscle (LM), deep posterior muscle group (DM), and the soleus (SM) and gastrocnemius muscles (GM) were segmented semi-automatically. Segmented muscles were represented as 3D DICOM stacks of CE-MRI perfusion scans for deep learning analysis. We tested several CNN models for the 3D CE-MRI perfusion stacks to classify PAD patients from matched controls. Two of the best performing CNNs (resNet and divNet) were selected to develop the final classification model. A peak accuracy of 75% was obtained for both resNet and divNet. Specificity was 80% and 94% for resNet and divNet, respectively. In conclusion, deep learning utilizing CNNs, and CE-MRI skeletal calf muscle perfusion can discriminate PAD patients from matched controls. Deep learning methods may be of interest for the study of PAD.

Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain.

Background and objective We report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block. Design A cadaveric evaluation along with aretrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. Interventions Bilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients. Main results Anatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax. Conclusion Our cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia.

Neuromuscular junction pathology is correlated with differential motor unit vulnerability in spinal and bulbar muscular atrophy

Spinal and bulbar muscular atrophy (SBMA) is an X-linked, neuromuscular neurodegenerative disease for which there is no cure. The disease is characterized by a selective decrease in fast-muscle power (e.g., tongue pressure, grip strength) accompanied by a selective loss of fast-twitch muscle fibers. However, the relationship between neuromuscular junction (NMJ) pathology and fast-twitch motor unit vulnerability has yet to be explored. In this study, we used a cross-model comparison of two mouse models of SBMA to evaluate neuromuscular junction pathology, glycolytic-to-oxidative fiber-type switching, and cytoskeletal alterations in pre- and postsynaptic termini of tibialis anterior (TA), gastrocnemius, and soleus hindlimb muscles. We observed significantly increased NMJ and myofiber pathology in fast-twitch, glycolytic motor units of the TA and gastrocnemius compared to slow-twitch, oxidative motor units of the soleus, as seen by decreased pre- and post-synaptic membrane area, decreased pre- and post-synaptic membrane colocalization, increased acetylcholine receptor compactness, a decrease in endplate area and complexity, and deficits in neurofilament heavy chain. Our data also show evidence for metabolic dysregulation and myofiber atrophy that correlate with severity of NMJ pathology. We propose a model in which the dynamic communicative relationship between the motor neuron and muscle, along with the developmental subtype of the muscle, promotes motor unit subtype specific vulnerability, metabolic alterations, and NMJ pathology.

Distribution of Kudoa thyrsites (Cnidaria, Myxozoa) myoliquefactive stages in Northeast Atlantic mackerel (Scomber scombrus) inferred from qPCR and histology

Kudoa thyrsites is a myxosporean parasite (Cnidaria, Myxozoa) that infects the skeletal and cardiac muscle of Northeast Atlantic (NEA) mackerel (Scomber scombrus). Heavy infections are associated with post-mortem myoliquefaction of the host skeletal muscle which reduces the quality of the fish product. The biological infection characteristics of the parasite in NEA mackerel are poorly known. This study examined the distribution of K. thyrsites in various organs of NEA mackerel from the northern North Sea, and elucidates the relationship between density of infection, developmental stage and parasite distribution in the musculature, and the extent of visible flesh myoliquefaction. Quantitative polymerase chain reaction (qPCR) data showed that K. thyrsites is unevenly distributed in the somatic musculature of the fish host, with highest density in the anterior ventral muscle sections—the belly flaps. A weak positive correlation was observed between the level of myoliquefaction and the parasite density in the fish host muscle. This relationship was also reflected by the amount and distribution of parasite developmental stages seen during histological examinations. Histological findings indicate an association between the dispersion of free myxospores and the level of myoliquefaction of the fish host muscle. Visceral organs were also found infected using qPCR, although at lower densities compared to the musculature.

Comparative MRI assessment of three minimally invasive approaches in total hip arthroplasty

IntroductionMinimally invasive approaches (direct anterior approach: DAA; minimally invasive anterolateral: MIAL; piriformis-sparing posterior approach: PSPA) are widely used for total hip arthroplasty (THA), with a muscle-sparing objective. There are no published comparative studies of muscle damage secondary to these approaches. The aim of the present study was to compare fatty infiltration (FI) on MRI induced by DAA, MIAL and PSPA in THA 1) in the tensor fasciae latae (TFL) and sartorius muscles, 2) in the gluteal muscles, and 3) in the pelvitrochanteric muscles. HypothesisGreater FI is induced by DAA in anterior muscles, by MIAL in gluteal muscles and by PSPA in pelvitrochanteric muscles. Materials and methodsThree continuous prospective series of THA by DAA, MIAL and PSPA included 25 patients each. MRI was performed preoperatively and at 1 year postoperatively. FI was graded on the Goutallier classification in all periarticular hip muscles. Muscles showing ≥2 grade aggravation at 1 year were considered damaged. ResultsNine patients whose preoperative MRI was uninterpretable were excluded. In all, 66 patients (21 DAA, 24 MIAL and 21 PSPA) with 132 MRI scans were analyzed. TFL was damaged in 2/21 DAA patients (9.5%), 1/24 MIAL patients (4.2%) and 0/21 PSPA patients (0%). There were no sartorius lesions. The anterior third of the gluteus medius was damaged in 8/24 MIAL patients (33.3%) and the gluteus minimus in 10/24 (41.7%), compared to 1/21 DAA patients (4.8%) and 0/21 PSPA patients (0%). The mid and posterior thirds of the gluteus medius and the gluteus maximus were never damaged. The piriformis muscle was damaged in 3/21 DAA patients (14.3%), 2/24 MIAL patients (8.3%) and 2/21 PSPA patients (9.5%). The obturator internus was damaged in 4/21 DAA patients (19%), 1/24 MIAL patients (4.2%) and 16/21 PSPA patients (76.2%). The obturator externus and quadratus femoris were mainly damaged in PSPA patients: respectively, 5/21 (23.8%) and 4/21 patients (19%)). ConclusionThe muscle-sparing properties of minimally invasive hip approaches are only theoretical. In the present series, there were rare TFL lesions with DAA and MIAL. Gluteus medius and minimus lesions were frequent in MIAL. Pelvitrochanteric muscles lesions were more frequent in PSPA, but found in all 3 approaches. These findings should help guide surgeons in their choice of approach and in informing patients about the damage these minimally invasive approaches can cause. Level of evidenceIII, prospective comparative study.

Clinical and neuropsychological assessment of the condition of patients with post-mastectomy syndrome

Background. Post-mastectomy syndrome is a complex of symptoms that occurs in at least 80 % of women after treatment for breast cancer. The analysis of neurological disorders occurring in patients after antitumor treatment will increase the effectiveness of rehabilitation measures.Objective. To perform a clinical and neuropsychological assessment of the condition of patients with post-mastectomy syndrome.Design and methods. An open single-center uncontrolled study of the assessment of clinical and neuropsychological status in 45 patients with post-mastectomy syndrome was performed.Results. The components of the post-mastectomy syndrome are described, which, along with lymphedema of the upper limb, have a negative impact on the general health condition of the patients, lead to a violation of the psychosocial status, impaired adaptation and decreased life quality. In the clinical picture, a disorder of motor functions with a decrease in muscle tone, muscle strength, restriction of movements in the shoulder joint on the side of the operation, a violation of surface sensitivity on the medial surface of the shoulder was revealed.Conclusion. Studied patients developed anterior scalenus muscle syndrome (thoracic outlet syndrome), in the clinical picture manifested by pain, swelling, paresthesia and numbness of the upper limb on the side of the operation. Cerebrovascular disorders were manifested by vertebro-basilar insufficiency syndrome, which manifested in the form of headaches, dizziness, cognitive and emotional disorders.

Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial

BackgroundCausal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome.MethodsSixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome.ResultsThe results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability.ConclusionScapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up.

Chin tuck against resistance exercise with feedback to improve swallowing, eating and drinking in frail older people admitted to hospital with pneumonia: protocol for a feasibility randomised controlled study

BackgroundSwallowing difficulties (dysphagia) and community-acquired pneumonia are common in frail older people and maybe addressed through targeted training of the anterior neck musculature that affects the swallow. We have developed a swallowing exercise rehabilitation intervention (CTAR-SwiFt) by adapting a previously established swallowing exercise to ensure patient safety and ease of execution in the frail elderly population. The CTAR-SwiFt intervention consists of a feedback-enabled exercise ball that can be squeezed under the chin, with real-time feedback provided via a mobile application. The aim of this study is to evaluate the feasibility of assessing the effectiveness of the CTAR-SwiFt intervention in reducing dysphagia and community-acquired pneumonia, prior to a larger-scale multi-centre randomised controlled trial.MethodsWe will recruit 60 medically stable patients over the age of 75 years who have been admitted with a diagnosis of pneumonia to the acute frailty wards at two participating hospitals in the UK. Study participants will be randomised into one of three groups: standard care, low intensity (once daily) CTAR-SwiFt exercise or high intensity (twice daily) CTAR-SwiFt exercises. The intervention period will last for 12 weeks, the final follow-up assessment will be conducted at 24 weeks. We will assess the feasibility outcomes, including rates of participant recruitment and retention, compliance with the exercise regime and adverse incidents. Additionally, we will assess the usability and acceptability of the intervention device and the performance of different clinical outcome measures (e.g. chin tuck strength, Functional Oral Intake Scale, SWAL-QOL, EQ-5D and swallow speed). A sub-sample of study participants will complete videofluoroscopic assessments of swallowing function before and after the intervention to evaluate the physiological changes (e.g. bolus flow rates, laryngeal elevation, base-of-tongue retraction).ConclusionsBy improving the ability to swallow, using our chin tuck exercise intervention, in frail older patients admitted to hospital with pneumonia, it is anticipated that patients’ oral intake will improve. It is suggested that this will further impact clinical, patient and healthcare economic outcomes, i.e. reduce the need for supplemental feeding, improve patient satisfaction with oral intake and swallowing-related quality of life, decrease the occurrence of chest infections and reduce hospital admissions and related healthcare costs.Trial registrationISRCTN, ISRCTN12813363. Registered on 20 January 2020

Метод макромікроскопічного препарування для встановлення фетальної анатомічної мінливості структур пахвової ділянки

The purpose of the study was to determine a more sophisticated method of the most rational sequence of actions of dissection of the fascia, muscles, vessels and nerves of the axillary cavity in human fetuses in order to obtain standard results suitable for comparison in the age aspect. Materials and methods. The study of fetal anatomy of the structures of the axillary area was performed on 25 preparations of 4-10-month human fetuses of 81.0-375.0 mm parietal-coccygeal length using macromicroscopic dissection. Results and discussion. The axillary area is characterized by age and individual anatomical variability of the muscles that form its walls, fascia and cellular spaces, as well as vascular and nervous formations that pass in it, which is a common cause of complications during surgery. To study the fetal anatomical variability of the components of the axillary area, the algorithm of anatomical dissection of fascia, muscles, lymph nodes, blood vessels and nerves of the axilla in the human fetus is of priority importance. Adherence to the sequence of actions during the anatomical dissection of the components of the axillary area provides not only high representativeness and scientific value of the results, but also the rational use of biological material. The delta-thoracic sulcus fossa and the beak-shoulder muscle can be used to determine the topography and projection of the vascular nerve trunks of the axillary area. The obtained data on the variant anatomy of the pectoralis major and anterior dentary muscles, as well as the widest back muscle are consistent with the studies of individual authors. The study of the structure and topography of fascia, muscles, lymph nodes, nerves, arteries and veins of the axillary fossa in human fetuses from a macroscopic point of view in modern anatomy remains relevant and promising because micro- and ultramicroscopic anatomy does not provide a comprehensive answer and does not fully reveal the versatility of fetal anatomical variability, in the study of which the algorithm of anatomical dissection of the constituent formations of the axillary area becomes a priority. Conclusion. The projected and tested method of dissection of fascial-muscular and vascular-nervous formations of the axillary area in human fetuses provides a standard for obtaining data on their typical, individual and age anatomical variability. The order of actions used during the dissection of the muscles that form the walls of the axilla, fascial-cellular formations, vessels and nerves, as well as axillary lymph nodes in human fetuses preserves the naturalness of the appearance and relationships between the structures of the object of study. Macromicroscopic preparation revealed fetal anatomical variability of muscles, arterial and venous vessels and axillary nerves

Impact of sarcopenia using third lumbar and anterior thigh skeletal muscle index on clinical outcomes in liver transplantation recipient

Impact of sarcopenia using third lumbar and anterior thigh skeletal muscle index on clinical outcomes in liver transplantation recipient

МСКТ-семиотика мышц при хроническом остеомиелите бедра и голени

Introduction It is known that the function and structure of the muscles of the thigh and lower leg are closely related to the function of the lower limb, which is impaired to one degree or another in all patients with chronic osteomyelitis. However, the nature of structural changes in the muscles, which, in turn, affect the condition of the bones, has not been well studied. Purpose of the work To study the features of changes in the muscles of the thigh and lower leg in patients with chronic osteomyelitis according to MSCT data. Material and methods The study is retrospective conducted at a single centre of Evidence level IV. Multislice computed tomography (MSCT) was used in 112 patients with chronic osteomyelitis of long bones of the lower extremities to study the radiological morphology of the muscles of the thigh and lower leg, including density, muscle belly area, and anatomical features. Twenty patients had chronic osteomyelitis in the area of transosseous elements (pins). The mean age of the patients was 48.5 ± 9.8 years. Males prevailed among the patients (87.5 %). The cause of osteomyelitis in 107 cases was trauma or surgery, five patients had consequences of hematogenous osteomyelitis. Results The results of the study showed that the muscles of the thigh and lower leg in patients with chronic osteomyelitis have pronounced dystrophic changes. In 89.4 % of patients, they were manifested by an increase in the density of the anterior tibial muscle, long extensor of the toes (84.7 %), peroneal muscles (78.5 %) and a decrease in the density of the head of the gastrocnemius muscle (91.3 %). In 10.6 % of the patients, there was a decrease in the density of the anterior tibial muscle, the long extensor of the fingers. In all patients with chronic osteomyelitis of the femur, the density of the muscles of the anterior and posterior groups was reduced, except for the musculus vastus intermedius of the thigh that was characterized by fibrotic changes with an increase in density. Conclusion The data obtained indicate that radiological morphological changes in muscles occur in all patients with chronic osteomyelitis of the femur and lower leg. The most pronounced alterations in the architectonics were in the anterior tibial and gastrocnemius muscles, and the intermediate broad muscle of the thigh.

Evaluating the impact of writing surface and configuration on muscle activation level during a handwriting task: An exploratory study.

Tablets are ubiquitous in workplaces and schools. However, there have been limited studies investigating the effect tablets have on the body during digital writing activities. This study investigated the biomechanical impact of writing interface design (paper, whiteboard, and tablet) and orientation (horizontal, 45°, and vertical) on tablet users. Fourteen adults (7 male, 7 female) participated in a study during which they performed simple writing tasks. Surface electromyography (sEMG) sensors were used to measure upper extremity muscle activation. Results indicate that the effects of writing surface type were most pronounced in forearm muscle activation. Specifically, in the extensor carpi radialis (ECR), where muscle activity was lower on the tablet PC surface. The effects of writing configuration were prominent in the shoulder and forearm. The activation of the flexor carpi ulnaris (FCU) and trapezius muscles was significantly lower in the 45° configuration. An exception to the efficacy of this configuration was the anterior deltoid muscle, which exhibited the lowest muscle activity in the horizontal orientation. Tablet surface and the 45° configuration resulted in the lowest muscle activation levels. Future studies should include longer experiment duration to investigate the effects of continuous writing.

Effect of Forefoot–Rearfoot and Pelvic–Scapular Weight Shifts on Lower-Limb and Lumbar Muscle Activity during Static Wall-Squat Exercises

(1) Background: The static body-weight wall-squat (SBWS) exercise is often included in the early rehabilitation stages of the lower limb. To establish its effectiveness and optimise its application, it is important to precisely quantify the muscle contribution to different versions of this exercise. (2) Methods: We analysed the electromyographic activity of lower limb and lumbar muscles during the SBWS with knees flexed at 45° by manipulating three different variables: horizontal distance of the ankles from the wall; scapular or pelvic location of the centre of pressure Cwall of the force exerted by the wall on the back; rearfoot or forefoot location of the centre of pressure CGR of the ground reaction force. (3) Results: The forefoot-to-rearfoot CGR shift significantly increased the vastus medialis, vastus lateralis, and tibialis anterior activity up to 23%, 26%, and 44% of the maximum voluntary isometric contraction (MVIC). The lumbar muscle activity was maximised (23% MVIC) shifting CGR at the forefoot, Cwall at the scapular zone, and placing the feet far from the wall. (4) Conclusions: These SBWS methods might be effective for quadriceps, tibialis anterior, and lumbar muscles strengthening in the early phase of rehabilitation intervention as soon as the patient can tolerate partial weight-bearing. The exercise appears suitable for patients with low back pain and limited lumbar muscle endurance, or quadriceps weakness and inhibition secondary to a knee injury.

Characterisation of the transient mechanical response and the electromyographical activation of lower leg muscles in whole body vibration training

The aim of this study is to characterise the transient mechanical response and the neuromuscular activation of lower limb muscles in subjects undergoing Whole Body Vibration (WBV) at different frequencies while holding two static postures, with focus on muscles involved in shaping postural responses. Twenty-five participants underwent WBV at 15, 20, 25 and 30 Hz while in hack squat or on fore feet. Surface electromyography and soft tissue accelerations were collected from Gastrocnemius Lateralis (GL), Soleus (SOL) and Tibialis Anterior (TA) muscles. Estimated displacement at muscle bellies revealed a pattern never highlighted before that differed across frequencies and postures (p < 0.001). After stimulation starts, muscle oscillation peaks, drops and further stabilises, suggesting the occurrence of a neuromuscular activation to reduce the vibration-induced oscillation. The oscillation attenuation at the SOL muscle correlated with its increased activation (rho = 0.29, p < 0.001). Furthermore, only specific WBV settings led to a significant increase in muscle contraction: WBV-induced activation of SOL and GL was maximal in fore-feet (p < 0.05) and in response to higher frequencies (30 Hz vs 15 Hz, p < 0.001). The analysis of the mechanical dynamics of lower leg muscles highlights a resonant response to WBVs, that for the SOL correlates to the increased muscle activation. Despite differing across frequencies and postures, this resonant behaviour seems to discourage the use of dynamic exercises on vibrating platforms. As for the most efficient WBV combination, calf muscle response to WBVs is maximised if those muscles are already pre-contracted and the stimulation frequencies are in the 25–30 Hz range.

Co-creation of an exercise inventory to improve scapular stabilization and control among individuals with rotator cuff-related shoulder pain: a survey-based study amongst physiotherapists

BackgroundScapular stabilization exercises (SSE) are often included in the treatment of individuals with rotator cuff-related shoulder pain (RCRSP) to decrease pain and improve function. These SSE typically aim to strengthen the scapular muscles and optimize dynamic neuromuscular control of the scapula, which may improve overall shoulder stability and movement quality. No consensus of the recommended SSE for the management of RCRSP is available. Hence, this study aimed to consult physiotherapists to co-create an inventory of recommended SSE based on the exercise’s relevance and frequency of prescriptions for the rehabilitation of individuals with RCRSP.MethodsA group of 16 physiotherapists with experience in treating shoulder pain participated in a sequential consultation incorporating two distinct rounds of consultation focusing on SSE (modified Delphi design). In round 1, physiotherapists identified and demonstrated up to 10 SSE that they commonly recommend or use among individuals with RCRSP. The description and performance of all SSE were audio and video recorded. All SSE suggested by more than one participant in round 1 advanced to round 2. In round 2, physiotherapists rated these SSE on a 4-point Likert scale according to their perceived relevance and frequency of prescription for this population.ResultsIn round 1, out of the 25 SSE recommended by participants, 19 SSE (76.0%) were recommended by more than one physiotherapist and advanced to round 2. In round 2, 13 SSE were consensually classified (agreement ≥75%) as being relevant for the rehabilitation of individuals with RCRSP. SSE targeting the recruitment of the serratus anterior and lower trapezius muscles were considered the most relevant for the management of RCRSP, whereas SSE targeting neuromuscular scapular control were the most prescribed SSE for the management of RCRSP.ConclusionsAn inventory composed of 13 SSE was co-created by physiotherapists based on their relevance and frequency of prescription for the rehabilitation of individuals with RCRSP. When designing an exercise program, physiotherapists can use this SSE inventory to inform their exercise selection, in combination with their current knowledge on shoulder rehabilitation, as well as patients’ preferences.

Heterozygous missense variant in the\xa0TTN\xa0gene causing Tibial muscular dystrophy

BackgroundTibial muscular dystrophy (TMD), tardive, is a dominantly inherited mild degenerative disorder of anterior tibial muscles. Mutations of Titin (TTN) have been reported in patients with different phenotypes such as skeletal muscular abnormalities or complex overlapping disorders of muscles. Titin (TTN) is a large 363 exon gene that encodes an abundant protein (the longest polypeptide known in nature) expressed in the heart and skeletal muscles.MethodsDNA from peripheral blood sample was extracted, whole exome sequencing (WES) was performed, and a neuromuscular disorders related gene-filtering strategy was used to analyse the disease-causing mutations. Further, sanger sequencing was applied to confirm the variant.ResultsA novel missense variant (c.41529G > C;p.Arg13843Ser) of TTN gene was identified in a patient with lower limb weakness, occasional tongue fasciculation and mild scoliosis. This variant leads to a substitution of arginine with serine, causing structural changes in titin protein that is responsible for the TMD disease.ConclusionThe novel variant detected has widened the genetic spectrum of TTN-associated diseases, further functional studies will aid in establishing the clinical diagnosis.

The Influence of Treadmill Training on the Bioelectrical Activity of the Lower Limb Muscles in Patients with Intermittent Claudication.

Aim: Intermittent claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), presenting as ischemic leg muscle pain and gait dysfunction. The aim of this study was to evaluate the changes in bioelectrical activity of the lower limb muscles activity in claudicating patients over a 12-week period of supervised treadmill training and to verify the hypothesis as to which muscles of lower limbs are activated by training treatment—the proximal, as compensatory mechanism, or the distal, which are the most ischemic. Methods: The study comprised 45 patients aged 60–70 years (height 168.8 ± 6.8 cm, weight 78.9 ± 9.2 kg) with PAD and unilateral intermittent claudication (Fontaine stage IIa/IIb), who participated in a 12-week supervised treadmill training program. Surface electromyography (sEMG) of the gastrocnemius lateralis (GaL), gastrocnemius medialis (GaM), tibialis anterior (TA), biceps femoris (BF), rectus femoris (RF) and gluteus medius (GM) muscles in the claudicated leg were continuously measured during the treadmill test. The average mean amplitude and mean amplitude range of the sEMG signal were analyzed. Results: During the treadmill test, after 12 weeks of training, the average mean amplitude of the GM (105 ± 43 vs. 74 ± 38%, p = 0.000008, ES = 0.76), BF (41 ± 22 vs. 33 ± 12%, p = 0.006, ES = 0.45) and GaM (134 ± 50 vs. 114 ± 30%, p = 0.007, ES = 0.48) muscles was significantly lower compared with baseline. The mean amplitude range was significantly decreased after 12 weeks of training in the GM (229 ± 64 vs. 181 ± 62%, p = 0.008, ES = 0.77) and BF (110 ± 69 vs. 84 ± 31%, p = 0.0002, ES = 0.48) muscles. After 12 weeks of training, the mean amplitude range of the TA muscle was significantly higher compared with baseline (104 ± 46 vs. 131 ± 53%, p = 0.001, ES = 0.54), but without significant changes in the average mean amplitude value. The most favorable changes, suggesting the lowest muscle fatigue and the highest walking capacity, were found in patients with the longest walking time. Conclusions: The obtained results may suggest that after 12 weeks of treadmill training, beneficial changes occurred in both the proximal and distal muscles. Therefore, greater foot plantar flexion and stronger push-off as well as greater hip extension may be considered the main mechanisms of observed gait pattern improvement. It may also be suggested that the therapy of gait alterations in patients with PAD should be focused not only on calf muscle pump improvement, but also on proximal hip extensor strengthening.

Quantitative electrophysiological assessments as predictive markers of lower limb motor recovery after spinal cord injury: a pilot study with an adaptive trial design

Study designObservational, cohort study.Objectives(1) Determine the feasibility and relevance of assessing corticospinal, sensory, and spinal pathways early after traumatic spinal cord injury (SCI) in a rehabilitation setting. (2) Validate whether electrophysiological and magnetic resonance imaging (MRI) measures taken early after SCI could identify preserved neural pathways, which could then guide therapy.SettingIntensive functional rehabilitation hospital (IFR).MethodsFive individuals with traumatic SCI and eight controls were recruited. The lower extremity motor score (LEMS), electrical perceptual threshold (EPT) at the S2 dermatome, soleus (SOL) H-reflex, and motor evoked potentials (MEPs) in the tibialis anterior (TA) muscle were assessed during the stay in IFR and in the chronic stage (>6 months post-SCI). Control participants were only assessed once. Feasibility criteria included the absence of adverse events, adequate experimental session duration, and complete dataset gathering. The relationship between electrophysiological data collected in IFR and LEMS in the chronic phase was studied. The admission MRI was used to calculate the maximal spinal cord compression (MSCC).ResultsNo adverse events occurred, but a complete dataset could not be collected for all subjects due to set-up configuration limitations and time constraints. EPT measured at IFR correlated with LEMS in the chronic phases (r = −0.67), whereas SOL H/M ratio, H latency, MEPs and MSCC did not.ConclusionsAdjustments are necessary to implement electrophysiological assessments in an IFR setting. Combining MRI and electrophysiological measures may lead to better assessment of neuronal deficits early after SCI.