Muscle Elongation Research Articles

LARGE INFERIOR RECTUS RECESSION WITHOUT LOWER LID RETRACTION: TWO INCREDIBLE TECHNIQUES

Relevance. Lower lid retraction is a frequent undesirable result following inferior rectus recession operations. Especially in relatively larger amounts of recession, a special and close relationship between lower lid retractors and muscular fascia makes the complication more severe. Purpose of the study. To introduce two methods that allow wide inferior rectus recession without causing lower eyelid retraction and to evaluate the long-term results. Material and methods. There were 25 cases and 18 control group cases in first operation technique named ‘ninety percent of posterior fibers recession of inferior rectus’ which can be perform for any vertical deviation without muscle fibrosis; and 8 cases were in second operation technique which named ‘muscle elongation with both organic tissue and non-absorbable suture’. Results and conclusion. In both technique patients’ deviation corrected and all ocular movement was free. Both operation techniques, which introduces by us, does not affected lower lid retractor and operations has both effective results and no lid problem.

Calcium wave dynamics in the embryonic mouse gut mesenchyme: impact on smooth muscle differentiation

Intestinal smooth muscle differentiation is a complex physico-biological process involving several different pathways. Here, we investigate the properties of Ca2+ waves in the developing intestinal mesenchyme using GCamp6f expressing mouse embryos and investigate their relationship with smooth muscle differentiation. We find that Ca2+ waves are absent in the pre-differentiation mesenchyme and start propagating immediately following α-SMA expression. Ca2+ waves are abrogated by CaV1.2 and gap-junction blockers, but are independent of the Rho pathway. The myosine light-chain kinase inhibitor ML-7 strongly disorganized or abolished Ca2+ waves, showing that perturbation of the contractile machinery at the myosine level also affected the upstream Ca2+ handling chain. Inhibiting Ca2+ waves and contractility with CaV1.2 blockers did not perturb circular smooth muscle differentiation at early stages. At later stages, CaV1.2 blockers abolished intestinal elongation and differentiation of the longitudinal smooth muscle, leading instead to the emergence of KIT-expressing interstitial cells of Cajal at the gut periphery. CaV1.2 blockers also drove apoptosis of already differentiated, CaV1.2-expressing smooth muscle and enteric neural cells. We provide fundamental new data on Ca2+ waves in the developing murine gut and their relation to myogenesis in this organ.

The effect of third intensity zone exercises by varying the muscle elongation of the muscles of the dominant arm and the supporting leg on some physiological indicators and the performance of pushing the weight

The research aimed to prepare exercises for the third intensity area with the variation of muscle elongation of the prevailing arm muscles and the supporting leg of the weight push players, and to identify the effect of the exercises of the third intensity area by contrasting the muscle elongation of the dominant arm muscles and the supporting leg in some physiological indicators and the achievement of weight pushing, and the researcher assumed that there are statistically significant differences between the results of the pre- and post-tests for the top and the time of the signal (EMG) for each of the dominant arm muscles and the supporting leg (brachial, radial brachial of the dominant arm, and rectilinear femurs). anterior, and twin leg) at the moment of the start of the rotation phase to push the weight of the players of the experimental group, and there are statistically significant differences between the results of the pre- and post-tests to accomplish the weight push distance for the players of the experimental group, the experimental research approach was adopted by designing one experimental group with tight control of the pre- and post-tests, The limits of the research community were represented by the young players in the hammer throwing event in the Etisalat Club, who numbered (9) players for the sports season (2023/2024), all of whom were deliberately selected for the research sample by (100%) from their original community in a comprehensive inventory method to represent the experimental research group, and to measure the electrical indicators of both the dominant arm muscles and the supporting leg (brachial, radial brachial of the dominant arm, anterior femoral rectum, and leg twin) The moment the rotation phase begins to push the weight The researcher adopted the (EMG) device and to measure the achievement the test was adopted Completion of the hammer throwing event in accordance with the conditions of competition in the international law of the Athletics Federation according to its international bulletin for the year (2018), and the exercises were prepared and applied with a field experiment that began with the application of the pre-tests on (16/11/2023), and then the application of these exercises for the period from (19/11/2023) to (11/1/2024), and the completion of the experiment by applying the post-tests on (14/1/2024), then the results were processed with the (SPSS) system. Extracts and applications are formed by the fact that the third severity area exercises help with the contrast of the muscular elongation of the prevailing arm muscles and the supporting man in increasing the summit of the EMG sign and reducing its time for both the prevailing arm muscles and the supporting man (the humerus, and the Hebrew muscles of the prevailing arm, the front thighs, and the twins of the leg) in the players The moment of the start of the rotation stage to push the weight, and helps in the development of the distance of the completion of the heavy -paying the players, and it is necessary to pay attention to the coaches of the heaviness in the physiological measurement by measuring the (EMG) signals for the prevailing arm muscles and the man who supported the players to pay the weight and plan and apply the exercises according to the physiological characteristics by adopting the results of this measurement, It is necessary not to exaggerate the training loads or how much muscular elongation resistors to reduce the problem of decreasing the speed of muscle rubble in the event of an increase in the amount of these resistors.

Effects of minute oscillation stretching training on muscle and tendon stiffness and walking capability in people with type 2 diabetes.

we investigated the effects of a 10week training program (i.e., minute oscillatory stretching; MOS) on the mechanical responses and walking capability in people with type 2 diabetes (T2D). seventeen T2D patients performed maximum voluntary contractions of the plantar flexor muscles during which Achilles tendon stiffness (kT) and muscle-tendon stiffness (kM) were evaluated at different percentages of the maximum voluntary force (MVC). In addition, each participant was requested to walk at different walking speeds (i.e. 2, 3, 4, 5, and 6kmh-1) while their net energy cost of walking (Cnet), cumulative EMG activity per distance travelled (CMAPD) and kinematic parameters (step length, step frequency, the ankle/knee range of motion) were evaluated. maximum tendon elongation increased after MOS training, and kT significantly decreased (between 0 and 20% of MVC). No differences were observed for muscle elongation or kM after training. Cnet decreased after training (at the slowest tested speeds) while no changes in CMAPD were observed. Step length and ankle ROM during walking increased after training at the slowest tested speeds, while step frequency decreased; no significant effects were observed for knee ROM. these results indicate the effectiveness of 10weeks of MOS training in reducing tendon stiffness and the energy cost during walking in people with T2D. This training protocol requires no specific instrumentation, can be easily performed at home, and has a high adherence (92 ± 9%). It could, thus, be useful to mitigate mechanical tendon deterioration and improve physical behaviour in this population.

Levator palpebrae superioris lengthening in the treatment of keratopathy caused by lagophthalmos after orbital inflammation

This study aims to evaluate the efficacy of various management strategies for lagophthalmos in a 56-year-old female patient, with a focus on both non-surgical and surgical interventions. The patient underwent an array of non-surgical treatments, including artificial tears, ointments, and therapeutic contact lenses, aimed at maintaining ocular surface integrity. For surgical intervention, the study compared the outcomes of gold weight implantation (GWI), platinum weight implants, modified tarsorrhaphy (MT), and the elongation of the aponeurosis levator superioris muscle. Non-surgical management provided symptomatic relief and temporary protection of the corneal surface. Botulinum toxin A injection may result in improved eyelid closure without significant adverse effects. Surgically, GWI and platinum implants effectively reduced corneal exposure, though the latter presented fewer complications. MT proved advantageous in terms of accessibility and cost. The elongation technique showed improved aesthetic and functional outcomes, as evidenced by patient satisfaction scores.

Comparative Analysis of Eccentric Glenosphere in Reverse Total Shoulder Arthroplasty: A Computer Simulation Study.

The aim was to evaluate the effects of different glenosphere eccentricities on impingement, range of motion (ROM), and muscle length during standard activities in reverse total shoulder arthroplasty (RSA). In this study, we utilized computational modeling techniques to create native shoulder and shoulder models undergoing RSA and simulate shoulder movements in all abduction-adduction, flexion-extension, and rotation. We tested a total of 36 different glenosphere configurations, which included three different inferior tilts (0°, +10°, +20°) and two different lateral offsets (0 mm and +4 mm), as well as six different glenosphere eccentricities (concentricity, inferior, posterior, anterior, anteroinferior, and posteroinferior). We evaluated the maximum impingement-free ROM, impingement sites, and muscle lengths. All glenosphere configurations exceeded 50% of native shoulder ROM in three planes and total global ROM. In abduction-adduction, there was no significant difference among the different glenosphere eccentricities (p > 0.05). In flexion-extension, the posteroinferior eccentricity had the maximum ROM among the different eccentricities, but no significant difference among the different glenosphere eccentricities (p > 0.05). In rotation, there was a significant difference overall, and anteroinferior eccentricity had a significant advantage over concentricity (p < 0.05). In total global ROM, anteroinferior eccentricity had a significant advantage over concentricity when lateral offset was 0 mm (p < 0.05). In all models of glenosphere eccentricities, only the elongation of the infraspinatus muscle was statistically significant (p < 0.05). Glenosphere eccentricity significantly influenced rotation, total global ROM, and the length of the subscapularis muscle. Among them, anteroinferior offset achieved the maximum ROM in abduction-adduction, rotation, and total global activities. Both anteroinferior and inferior glenoid eccentricity showed significant advantages over the concentricity in rotation and total global ROM. Basic Science Study; Computer Modeling.

Changes in echo intensity of the gastrocnemius muscle with passive ankle dorsiflexion: can echo intensity be used to assess muscle elongation?

Introduction: While shear modulus has been used as an index of muscle elongation, high costs prevent its general adoption. A more general indicator that can quantify muscle elongation non-invasively is needed to develop effective methods for stretching each muscle. The purpose of this study was to determine whether the echo intensity of the muscle changes with muscle elongation compared with the shear modulus. Methods: Sixteen healthy males (24.1 ± 2.8years) participated in the study. Shear modulus and echo intensity of the medial gastrocnemius were assessed at 20° and 10° of ankle plantar-flexion, and 0°, 10°, and 20° of ankle dorsiflexion (presented as -20°, -10°, and 0°, +10°, +20°, respectively). Shear modulus was measured using ultrasound shear wave elastography. The echo intensity was quantified using the average grayscale value of a given region of interest (RoI) in longitudinal and transverse B-mode images. Grayscale analysis was performed using two RoIs: one which included as much of the muscle as possible (maximum RoI), and a rectangular one whose size and depth was identical for all images (rectangular RoI). Pearson's correlation coefficients between either the shear modulus or echo intensity and the ankle angle and between the echo intensity and shear modulus were calculated separately for each participant. Results: Average Pearson's correlation coefficient between shear modulus and ankle angle of the participants was 0.904. The average Pearson's correlation coefficients between the echo intensity and ankle angle were estimated to be 0.797 and 0.222 for the maximum RoI and 0.698 and 0.323 for the rectangular RoI in the longitudinal and transverse images, respectively. The average Pearson's correlation coefficients between the echo intensity and shear modulus were 0.684 and 0.514 for the maximum RoI, and 0.611 and 0.409 for rectangular RoI in the longitudinal and transverse images, respectively. Discussion: The results indicate that the echo intensity in the longitudinal image of the gastrocnemius, especially when assessed using the maximum RoI, increased with muscle elongation by passive ankle dorsiflexion. Therefore, assessment of the echo intensity using the maximum RoI in the longitudinal image might be useful for quantifying the muscle elongation.

Volumetry after botulinum toxin A: the impact on abdominal wall compliance and endotracheal pressure.

Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application. A prospective study with 27 patients with a hernia defect of ≥ 10cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated. Imaging post-BTA revealed hernia width reduction of 1.9cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%. BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.

Coronal As Well As Sagittal Fascicle Dynamics Can Bring About a Gearing Effect in Muscle Elongation by Passive Lengthening.

The amount of muscle belly elongation induced by passive lengthening is often assumed to be equal to that of fascicles. But these are different if fascicles shorter than the muscle belly rotate around their attachment sites. Such discrepancy between fascicles and muscle belly length changes can be considered as gearing. As the muscle fascicle arrangement is 3D, the fascicle rotation by passive lengthening may occur in the coronal as well as the sagittal planes. Here we examined the fascicle 3D dynamics and resultant gearing during passive elongation of human medial gastrocnemius in vivo . For 16 healthy adults, we reconstructed fascicles three-dimensionally using diffusion tensor imaging and evaluated the change in fascicle length and angles in the sagittal and coronal planes during passive ankle dorsiflexion (from 20° plantar flexion to 20° dorsiflexion). Whole muscle belly elongation during passive ankle dorsiflexion was 38% greater than the fascicle elongation. Upon passive lengthening, the fascicle angle in the sagittal plane in all regions (-5.9°) and that in the coronal plane in the middle-medial (-2.7°) and distal-medial (-4.3°) regions decreased significantly. Combining the fascicle coronal and sagittal rotation significantly increased the gearing effects in the middle-medial (+10%) and distal-medial (+23%) regions. The gearing effect by fascicle sagittal and coronal rotations corresponded to 26% of fascicle elongation, accounting for 19% of whole muscle belly elongation. Fascicle rotation in the coronal and sagittal planes is responsible for passive gearing, contributing to the whole muscle belly elongation. Passive gearing can be favorable for reducing fascicle elongation for a given muscle belly elongation.

Preoperative Abdominal Muscle Elongation Facilitated Laparoscopic Intraperitoneal Onlay Mesh Repair of Complex Ventral Hernia.

Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.

Modeling of active skeletal muscles: a 3D continuum approach incorporating multiple muscle interactions.

Skeletal muscles have a highly organized hierarchical structure, whose main function is to generate forces for movement and stability. To understand the complex heterogeneous behaviors of muscles, computational modeling has advanced as a non-invasive approach to evaluate relevant mechanical quantities. Aiming to improve musculoskeletal predictions, this paper presents a framework for modeling 3D deformable muscles that includes continuum constitutive representation, parametric determination, model validation, fiber distribution estimation, and integration of multiple muscles into a system level for joint motion simulation. The passive and active muscle properties were modeled based on the strain energy approach with Hill-type hyperelastic constitutive laws. A parametric study was conducted to validate the model using experimental datasets of passive and active rabbit leg muscles. The active muscle model with calibrated material parameters was then implemented to simulate knee bending during a squat with multiple quadriceps muscles. A computational fluid dynamics (CFD) fiber simulation approach was utilized to estimate the fiber arrangements for each muscle, and a cohesive contact approach was applied to simulate the interactions among muscles. The single muscle simulation results showed that both passive and active muscle elongation responses matched the range of the testing data. The dynamic simulation of knee flexion and extension showed the predictive capability of the model for estimating the active quadriceps responses, which indicates that the presented modeling pipeline is effective and stable for simulating multiple muscle configurations. This work provided an effective framework of a 3D continuum muscle model for complex muscle behavior simulation, which will facilitate additional computational and experimental studies of skeletal muscle mechanics. This study will offer valuable insight into the future development of multiscale neuromuscular models and applications of these models to a wide variety of relevant areas such as biomechanics and clinical research.

Shear wave ultrasound elastography of the biceps brachii can be used as a precise proxy for passive elbow torque in individuals with hemiparetic stroke.

Muscle tissue is prone to changes in composition and architecture following stroke. Changes in muscle tissue of the extremities are thought to increase resistance to muscle elongation or joint torque under passive conditions. These effects likely compound neuromuscular impairments, exacerbating movement function. Unfortunately, conventional rehabilitation is devoid of precise measures and relies on subjective assessments of passive joint torques. Shear wave ultrasound elastography, a tool to measure muscle mechanical properties, may be readily available for use in the rehabilitation setting as a precise measure, albeit at the muscle-tissue level. To support this postulation, we evaluated the criterion validity of shear wave ultrasound elastography of the biceps brachii; we investigated its relationship with a laboratory-based criterion measure for quantifying elbow joint torque in individuals with moderate to severe chronic stroke. Additionally, we evaluated construct validity, with the specific sub-type of hypothesis testing of known groups, by testing the difference between arms. Measurements were performed under passive conditions at seven positions spanning the arc of elbow joint flexion-extension in both arms of nine individuals with hemiparetic stroke. Surface electromyography was utilized for threshold-based confirmation of muscle quiescence. A moderate relationship between the shear wave velocity and elbow joint torque was identified, and both metrics were greater in the paretic arm. Data supports the progression toward a clinical application of shear wave ultrasound elastography in evaluating altered muscle mechanical properties in stroke, while acknowledging that undetectable muscle activation or hypertonicity may contribute to the measurement. Shear wave ultrasound elastography may augment the conventional method of manually testing joint mobility by providing a high-resolution precise value. Tissue-level measurement may also assist in identifying new therapeutic targets for patient-specific impairment-based interventions.

Dynamic Muscle Stimulation for Pain, Tenderness, and Stiffness on Upper Back Muscles: A Novel Approach and Analysis on Shear-wave Elastography

Abstract Upper back myalgia is a complaint of pain, stiffness, and tightness in the upper back muscles. It is characterized by acute or persistent neck–shoulder pain. We report the case of a 24-year-old male who presented with pain and swelling in the neck and upper back region, along with gradual restriction in cervical range of motion (ROM) for 2 months. The pretreatment assessment revealed severe tightness of the middle fibers of the trapezius and upper fibers of the rhomboid major muscle. Pretreatment elastography revealed high elasticity contrast index (ECI) values of 8.59 and 9.01, respectively, and a red region indicative of increased stiffness of the muscle fibers. The patient was treated with Naqvi’s-Dynamic Electrical Therapy Approach (Naqvi’s DELTA) which is a novel method of using interferential current with a dynamic stimulation probe for 15 min using ultrasound gel on the affected area and examining the patient for the effect of the DELTA on muscle elongation by shear wave elastography which is a unique variation in ultrasound imaging. The pre- and posttreatment findings revealed a significant reduction in stiffness of the muscle fibers, indicated by decreased ECI values of 2.14 and 0.94, respectively, in the blue region. In addition, posttreatment also had an impact on pain reduction and a significant increment in the overall cervical ROM.

Unilateral surgery for pediatric sensory exotropia: clinical characteristics and surgical results

BackgroundTo delineate the clinical characteristics and surgical outcomes of large angle sensory exotropia in pediatric patients.MethodsThe medical records of 54 large angle exotropia ≥40 PD patients aged from 1 to 18 years who were operated on between 2018 and 2021 and were followed up for 1 year were reviewed and contacted. Clinical characteristics and surgical outcomes were analyzed retrospectively. Patients were divided into two groups, group S patients had supermaximum recession resection and group E had augmented recession by lateral rectus muscle elongation with an autograft from the resected medial rectus muscle in the same eye. The clinical characteristics and results of both groups were compared.ResultsThe mean age of the studied patients with sensory exodeviation at the time of surgery was 8.3 ± 4.2 years. Mean of the duration of exotropia was 6.9 ± 2.2 years, and the mean of postoperative follow-up was 14.3 ± 4.2 months. Surgical success was achieved in 73.07% of group S and 82.14% of group E. Recurrence was more common with anterior segment pathology. Larger post-operative distant angles were strongly related to poorer visual acuities P = 0.001 and not related to the age of onset or the duration. Narrowing of the palpebral fissure improved in both groups at the last follow up P = 0.336. The limitation of abduction in both groups improved in the last follow up P = 0.145.ConclusionThe outcome of monocular surgery for sensory exotropia in children is satisfactory with no significant differences in results between lateral rectus muscle tendon autograft elongation technique and supermaximum recession resection. Recurrence is more common with anterior segment pathology. Larger post-operative distant angle of deviation is strongly related to poorer visual acuity.Clinical trial registrationThis study was retrospectively registered at clinicaltrials.gov (ID: NCT04286945) on 25-2-2020.

Design and Characterization of a Mckibben Pneumatic Muscle Prototype with an Embedded Capacitive Length Transducer

The McKibben muscle types are pneumatic actuators known to be intrinsically safe for their high power-to-weight ratio. For these reasons, they are suitable for robotic, biomechanical, and medical applications. In these application fields and, above all, in collaborative robotics, where safety must be ensured for human–robot interactions, the values of pressure, force, and length are necessary and must be continuously monitored and controlled. Force and pressure transducers are commercially available to be integrated into a McKibben muscle type. On the contrary, no commercial-length transducers can be adopted. This work presents a novel McKibben muscle prototype with an embedded capacitive-length transducer. The latter is a cylindrical capacitor made of a telescopic system composed of two tubes: one of its ends is connected to the muscle. A change in the length of the muscle causes a proportional change in the transducer capacitance. The paper reports in detail on the working principle of McKibben’s muscle, its fabrication, characterization, and validation of four prototype capacitive transducers. The results achieved from the experimental activities demonstrate that it is possible to control the variations of the muscle length relative to its elongation and compression for values less than 1 mm. This is the consequence of the ability to measure the transducer capacitance with a typical statistical relative indetermination better than 0.25%, which is a figure of merit for the reliability and mechanical and electrical stability of the proposed McKibben muscle prototype. Moreover, it has been demonstrated that the transducer capacitance as a function of the muscle length is linear, with maximum deviations from linearity equal to 2.44% and 5.22% during the muscle elongation and compression, respectively.

The use of lyophilized bovine pericardium (Tutopatch®) in the management of third nerve palsy following prior conventional strabismus surgery – a case series

ABSTRACT To study the secondary management of strabismus due to third nerve palsy using bovine pericardium (Tutopatch®) when previous conventional surgical therapy had failed. Review of our clinic records of selected patients with third nerve palsy, in whom residual deviation had been managed using Tutopatch® after previous surgical correction. The squint angle was measured preoperatively, and at 1 day, 3 months, and if possible 6 months postoperatively. Nine patients were enrolled in this study. One patient had mainly residual vertical deviation and was corrected with tendon elongation of the contralateral superior rectus. Three patients were operated on with tendon elongation of the lateral rectus muscle with or without medial rectus muscle resection and/or advancement (Group 1). Lateral rectus splitting after tendon elongation in addition to the resection and/or advancement of the medial rectus was performed in five patients with complete third nerve palsy (Group 2). In Group 1, the preoperative median squint angle was −20° (range −17° to −25°), which improved postoperatively to −4.5° (range −12° to +3°). In Group 2, the preoperative horizontal and vertical median squint angles were −27° (range −20° to −40°) and 0.5° (range 0° and 20°), respectively. Postoperatively, they had improved to −12.5° (range–2° to −25°), and 1.5° (range 0° to 7°), respectively. Two patients of Group 2 were re-operated due to residual exotropia. No postoperative complications were observed in any patient. In this small series several complex re-do situations of patients with third nerve palsy were evaluated in which Tutopatch® markedly improved outcomes after an initially ineffective surgical management. For better evaluation of its usefulness a study with more patients is recommended.

Dose External Compression Of Skeletal Muscle With A Support Belt Reduce Passive Muscle Elongation Stress?

Dose External Compression Of Skeletal Muscle With A Support Belt Reduce Passive Muscle Elongation Stress?

An Electromyographic Analysis of Romanian, Step-Romanian, and Stiff-Leg Deadlift: Implication for Resistance Training.

The present study examined the posterior chain muscle excitation in different deadlift variations. Ten competitive bodybuilders (training seniority of 10.6 ± 1.8 years) performed the Romanian (RD), Romanian standing on a step (step-RD), and stiff-leg deadlift (SD) with an 80% 1-RM. The excitation of the gluteus maximus, gluteus medius, biceps femoris, semitendinosus, erector spinae longissimus, and iliocostalis was assessed during both the ascending and descending phases. During the ascending phase, the RMS of the gluteus maximus was greater in the step-RD than in the RD (effect size (ES): 1.70, 0.55/2.84) and SD (ES: 1.18, 0.11/2.24). Moreover, a greater RMS was found in the SD than in the RD (ES: 0.99, 0.04/1.95). The RMS of the semitendinosus was greater in the step-RD than in the RD (ES: 0.82, 0.20/1.44) and SD (ES: 3.13, 1.67/4.59). Moreover, a greater RMS was found in the RD than in the SD (ES: 1.38, 0.29/2.48). The RMS of the longissimus was greater in the step-RD than in the RD (ES: 2.12, 0.89/3.34) and SD (ES: 3.28, 1.78/4.78). The descending phase had fewer differences between the exercises. No further differences between the exercises were found. The step-RD increased the overall excitation of the posterior chain muscles, possibly because of the greater range of movement and posterior muscle elongation during the anterior flexion. Moreover, the RD appeared to target the semitendinosus more than the SD, while the latter excited the gluteus maximus more.

Muscle stiffening is associated with muscle mechanoreflex-mediated cardioacceleration.

Although the muscle mechanoreflex is an important mediator to cardiovascular regulation during exercise, its modulation factors remain relatively unknown. Therefore, the purpose of this study was to investigate the effect of muscle stiffness on the muscle mechanoreflex. Participants were divided based on their median muscle stiffness (2.00 Nm/mm) into a low group (n = 15) and a high group (n = 15), and the muscle mechanoreflex was compared between the groups. After a 15-min rest in the supine position, heart rate (HR), blood pressure (BP), stroke volume (SV), and cardiac output (CO) were measured at rest for 3min and during static passive dorsiflexion (SPD) at 20° for 1min. Following a 15-min re-rest, muscle stiffness and passive resistive torque were evaluated in the distal end of the muscle belly of the medial gastrocnemius. Peak relative changes in HR (low group: 6 ± 4% and high group: 12 ± 4%) and CO (low group: 8 ± 10% and high group: 13 ± 9%) were greater in the high group than in the low group (both, P < 0.05). A significant positive correlation was found between resistive torque during SPD and muscle stiffness and peak relative changes in HR (r = 0.51 and 0.61, both P < 0.05). However, there was no correlation between muscle elongation during SPD and peak relative changes in HR (r = -0.23, P = 0.20). These findings suggest that muscle stiffness may be modulatory factor of muscle mechanoreflex.

Design and simulation of fuzzy-based nonlinear-PID and sliding mode controllers for ankle rehabilitation soft wearable robot

Soft robotics has become an active research area due to its compliance with the natural anatomy, volume to weight ratio, and overall compatibility. However, the difficulties in controlling soft robots have remained a challenge for employing soft wearable robots for clinical applications. In this paper, a fuzzy-based nonlinear PID controller and higher-order sliding mode controllers which can maintain robustness in the presence of a disturbance signal have been designed and analysed. A simple innovative way to include pain signals in control design has been developed; the patient is actively involved by feeding the pain signal to the controller. The pain signal will be characterised into predefined categories from the physiotherapist's knowledge; a fuzzy controller is developed to generate reference force output for the controller from pain feedback and rate of change of muscle elongation. The developed models were analysed and simulated in MATLAB Simulink and Simscape's physical modelling environment.