Reflex Activation Of Muscles Research Articles

Influence of Stretch Speed and Arousal State on Passive Ankle Joint Mechanics.

Studies investigating the mechanisms influencing maximum passive joint range of motion (ROMmax) and stiffness have not objectively assessed the possible influence of stretch speed and/or arousal state. The purpose of this study was to assess the effects of arousal state and stretch speed on healthy individuals ROMmax, stiffness, gastrocnemius medialis, and soleus electromyographic activity (EMG). Fourteen participants performed one familiarization and then one testing session on separate days in the laboratory. In the familiarization (Session 1), participants practiced fast (30°/s ankle dorsiflexion) and slow (5°/s) plantar flexor stretches on an isokinetic dynamometer with the knee extended. In the experimental session (Session 2), they performed two slow, then two fast, stretches under three randomized arousal conditions: control (no music), arousing, and relaxing music. Dorsiflexion ROMmax, ankle joint stiffness, muscle activity during stretch, mean heart rate, and perception of arousal were measured. Perception of arousal was greater in the arousing than relaxing condition (p = 0.001). ROMmax was greater during fast (69.1° ± 7.8°) than slow stretches (64.9° ± 10.8°; p = 0.002) with no effect of arousal. Stiffness and EMG were higher at faster speeds, with a significantly greater percentage of stiffness observed in the arousing than the other conditions during faster stretches (p = 0.04). ROMmax was greater at the faster stretch speed despite greater stiffness and muscle activities being produced during the stretch. Thus, despite reflexive muscle activity and viscosity being higher during faster stretches, a greater, not lesser, ROMmax was observed. Arousal state, at least when altered by music, did not seem to affect ROMmax but somewhat influenced stiffness in the faster stretches.

Tongue reflex for speech posture control

Although there is no doubt from an empirical viewpoint that reflex mechanisms can contribute to tongue motor control in humans, there is limited neurophysiological evidence to support this idea. Previous results failing to observe any tonic stretch reflex in the tongue had reduced the likelihood of a reflex contribution in tongue motor control. The current study presents experimental evidence of a human tongue reflex in response to a sudden stretch while holding a posture for speech. The latency was relatively long (50 ms), which is possibly mediated through cortical-arc. The activation peak in a speech task was greater than in a non-speech task while background activation levels were similar in both tasks, and the peak amplitude in a speech task was not modulated by the additional task to react voluntarily to the perturbation. Computer simulations with a simplified linear mass-spring-damper model showed that the recorded muscle activation response is suited for the generation of tongue movement responses that were observed in a previous study with the appropriate timing when taking into account a possible physiological delay between reflex muscle activation and the corresponding force. Our results evidenced clearly that reflex mechanisms contribute to tongue posture stabilization for speech production.

Identification of Neural and Non-Neural Origins of Joint Hyper-Resistance Based on a Novel Neuromechanical Model.

Joint hyper-resistance is a common symptom in neurological disorders. It has both neural and non-neural origins, but it has been challenging to distinguish different origins based on clinical tests alone. Combining instrumented tests with parameter identification based on a neuromechanical model may allow us to dissociate the different origins of joint hyper-resistance in individual patients. However, this requires that the model captures the underlying mechanisms. Here, we propose a neuromechanical model that, in contrast to previously proposed models, accounts for muscle short-range stiffness (SRS) and its interaction with muscle tone and reflex activity. We collected knee angle trajectories during the pendulum test in 15 children with cerebral palsy (CP) and 5 typically developing children. We did the test in two conditions - hold and pre-movement - that have been shown to alter knee movement. We modeled the lower leg as an inverted pendulum actuated by two antagonistic Hill-type muscles extended with SRS. Reflex activity was modeled as delayed, linear feedback from muscle force. We estimated neural and non-neural parameters by optimizing the fit between simulated and measured knee angle trajectories during the hold condition. The model could fit a wide range of knee angle trajectories in the hold condition. The model with personalized parameters predicted the effect of pre-movement demonstrating that the model captured the underlying mechanism and subject-specific deficits. Our model may help with the identification of neural and non-neural origins of joint hyper-resistance and thereby opens perspectives for improved diagnosis and treatment selection in children with spastic CP, but such applications require further studies to establish the method's reliability.

Axial muscle activation provides stabilization against perturbations while running

Incidence of traumatic brain injury is an important hazard in sports and recreation. Unexpected (blind-sided) impacts with other players, obstacles, and the ground can be particularly dangerous. We believe this is partially due to the lack of muscular activation which would have otherwise provided protective bracing. In this study participants were asked to run on the treadmill while undergoing perturbations applied at the waist which pulled participants in the fore-aft and lateral directions. To determine the effect of unexpected impacts, participants were given a directional audio-visual warning 0.5 s prior to the perturbation in half of the trials and were unwarned in the other half of the trials. Perturbations were given during the start of the stance phase and during the start of the flight phase to examine two distinct points within the locomotor cycle. Muscle activity was monitored in axial muscles before, during, and after the perturbations were given. We hypothesized that the presence of a warning would allow for voluntary axial muscle activity prior to and during perturbations that would provide bracing of the body, and decreased displacement and acceleration of the head compared to unwarned perturbations. Our results indicate that when a warning is given prior to perturbation, the body was displaced significantly less, and the linear acceleration of the head was also significantly lessened in response to some perturbations. The perturbations given in this study caused significant increases in axial muscle activity compared to activity present during control running. We found evidence that cervical and abdominal muscles increased activity in response to the warning and that typically the warned trials displayed a lower reflexive muscle activity response. Additionally, we found a stronger effect of the warnings on muscle activity within the perturbations given during flight phase than those given at stance phase. Results from this study support the hypothesis that knowledge regarding an impending perturbation is used by the neuromuscular system to activate relevant core musculature and provide bracing to the athlete.

The role of anticipatory and reflexive compensatory muscle activation in catching errors under load uncertainty.

This experiment investigated the role of anticipatory and reflexive compensatory neuromotor control in catching errors occurring under load uncertainty. Participants performed 64 trials of a one-handed ball catching task using visually identical balls of four different weights without knowing the weight of the ball on each trial. Anticipatory and reflexive compensatory muscle activation were recorded in five muscles (anterior deltoid, biceps brachii, wrist flexors group, triceps brachii, lumbar erector spinae) using the EMG integral. In each muscle, the anticipatory and reflexive compensatory muscle activation were compared between successful catches and catching errors for the lightest ball and the heaviest ball. Anticipatory muscle activation was not implicated in errors made with the lightest ball. However, reflexive compensatory muscle activation in the anterior deltoid, biceps brachii, and wrist flexors were implicated in errors made with the lightest ball. Specifically, catching errors with the lightest ball were characterized by elevated reflexive compensatory muscle activation. In the case of the heaviest ball, both anticipatory (anterior deltoid, wrist flexors) and reflexive compensatory muscle activation (anterior deltoid, biceps brachii, wrist flexors) were implicated in catching errors. That is, catching errors with the heaviest ball were characterized by lower anticipatory and reflexive compensatory muscle activation. Results are considered in the context of the likely influence of limb compliance in catching under load uncertainty.

Finite element human body models with active reflexive muscles suitable for sex based whiplash injury prediction.

Previous research has not produced a satisfactory resource to study reflexive muscle activity for investigating potentially injurious whiplash motions. Various experimental and computational studies are available, but none provided a comprehensive biomechanical representation of human response during rear impacts. Three objectives were addressed in the current study to develop female and male finite element human body models with active reflexive neck muscles: 1) eliminate the buckling in the lower cervical spine of the model observed in earlier active muscle controller implementations, 2) evaluate and quantify the influence of the individual features of muscle activity, and 3) evaluate and select the best model configuration that can be used for whiplash injury predictions. The current study used an open-source finite element model of the human body for injury assessment representing an average 50th percentile female anthropometry, together with the derivative 50th percentile male morphed model. Based on the head-neck kinematics and CORelation and Analyis (CORA) tool for evaluation, models with active muscle controller and parallel damping elements showed improved head-neck kinematics agreement with the volunteers over the passive models. It was concluded that this model configuration would be the most suitable for gender-based whiplash injury prediction when different impact severities are to be studied.

Detection of middle-ear muscle reflex activation using changes in otoacoustic emission stimulus amplitude versus absorbance: an initial investigation

Objectives The medial olivocochlear reflex (MOCR) reduces cochlear amplifier gain, which may be beneficial for hearing in noise. Additionally, measurement of the MOCR may be diagnostically useful in the audiology clinic. The MOCR can be measured as the change in transient-evoked otoacoustic emission (TEOAE) amplitude without versus with contralateral acoustic stimulation (CAS). However, CAS can activate the middle-ear muscle reflex (MEMR) which can confound the MOCR results. MEMR activation has been assessed using changes in TEOAE stimulus amplitude without versus with CAS. As an initial investigation, the current study compared detection of MEMR activation using changes in TEOAE stimulus amplitude to changes in wideband absorbance. Methods In 26 normal-hearing participants, the MEMR was measured as the change in absorbance and as the change in TEOAE stimulus amplitude without and with CAS. Percentile critical differences were developed from the test-retest measurements. Measures of agreement between MEMR detection methods were computed. Results CAS resulted in a larger number of participants exceeding the 95th percentile critical difference for absorbance compared to TEOAE stimulus amplitude (22 versus 1). Agreement between methods was low. Conclusion Initial results indicated that MEMR was detectable in a larger number of participants when using absorbance compared to TEOAE stimulus amplitude. However, future work could better equate the two methods and include measurement of MEMR thresholds to determine optimal methods for detecting MEMR activation during MOCR assessments.

Spasticity Management after Spinal Cord Injury: The Here and Now.

Spasticity is a common comorbidity of spinal cord injury (SCI) that is characterized by velocity dependent tone and spasms manifested by uninhibited reflex activity of muscles below the level of injury. For some, spasticity can be beneficial and facilitate functional standing, transfers, and some activities of daily living. For others, it may be problematic, painful, and interfere with mobility and function. This manuscript will address the anatomy and physiology of neuromuscular reflexes as well as the pathophysiology that occurs after SCI. Spasticity assessment will be discussed in terms of clinical history and findings on physical examinations, including responses to passive and active movement, deep tendon reflexes, and other long tract signs of upper motor neuron injury, as well as gait and function. Management strategies will be discussed including stretch, modalities, pharmacotherapy, neurolysis, and surgical options.

Preliminary Results From a Multicenter Study on the Use of a New Device for the Treatment of Genito Pelvic Pain Disorders

ABSTRACT Introduction Genito-pelvic pain/penetration disorder (GPPPD) causes painful sex, emotional distress, depression, as well as feelings of inadequacy and sexual frustration, which may gradually trigger problems with other domains of sexual functioning in the majority of diagnosed women. One in ten women suffers from GPPPD according to recent studies of prevalence with a wide range of psychosocial consequences. Treatment options in health care are limited. The majority of women with GPPPD do not receive appropriate treatment. Objective In this study, we will investigate the safety and preliminary evidence of the effectiveness of Crescendo Therapy System Kit (CTS) for the treatment of GPPPD. Methods A one-group pretest-posttest multicenter design was used in the current research. Main outcome measures were assessed using the Female Sexual Function Index (FSFI) domain for Sexual Pain at baseline and after 12 weeks. The collected data were tabulated and analyzed using the Statistical Package for the Social Sciences version 22 (SPSS). Quantitative data are expressed as means ± standard deviations (SDs). For the comparison of paired variables the Wilcoxon test was used. A total of 21 subjects, aged between 20 and 59 years of age (mean = 36.21 years, standard deviation (SD) = 12.29) were recruited, 11 patients completed CTS individually over 12 weeks. The inclusion criteria were as follows: Heterosexual woman aged 18 years or older, with a diagnosis of lifelong GPPPD, living in a relationship of at least 3 months, general health as evidenced by medical history. Exclusion criteria were: Absence of medical illness or use of other drugs known to interfere with sexual functioning, having received medication or psychological treatment for GPPPD in the last 6 months, medical cause, currently diagnosis post-traumatic stress disorder or psychosis/dissociative symptoms or depression or bipolar disorder.The CTS consists of 7 different exercises and an educational session online. Once the subjects finished each activity they were contacted for the next exercise with Crescendo device. Its objective is to provide patients with greater knowledge, awareness, and control of the excitation reflex and pelvic floor muscle activity using a bendable vibrator called Crescendo®. Results In the present study, there was a significant improvement score in domain of FSFI questionnaire Sexual Pain (mean pre = 0.40 (SD) = 0.61, mean post = 2.32 (SD) = 2.35, Wilcoxon test pre vs post p-value = 0.02). Conclusions In this study, we demonstrated that CTS was associated with a significant increase in the sexual pain domain score of the FSFI, with no adverse effects related to the treatment. We can conclude that CTS may have the potential to become an effective and safe treatment for patients suffering from GPPPD. Future studies with, larger group of patients, with larger follow-up and group control are needed. Disclosure Yes, this is sponsored by industry/sponsor: Mysteryvibe Clarification Industry funding only - investigator initiated and executed study

Is there an association between EMG activity and temporomandibular disorders during orthotic mandibular advancement in sleep apnea patients undergoing DISE?

ABSTRACT Objective To detect whether myotatic reflex activation of masticatory muscles during drug-induced sleep endoscopy (DISE) can be an indirect marker for temporomandibular disorder (TMD) in patients suffering from obstructive sleep apnea (OSA). Methods OSA patients were prospectively recruited and underwent a complete TMD examination prior to undergoing DISE with the addition of electrodes applied over masticatory muscles. A positive activation of myotatic reflex was considered in case of an increase in muscle tone of at least 50%. Results Of the 41 patients included, 48.8% presented activation of myotatic reflex. Of these patients, 45% presented a TMD diagnosis, 40% presented pain at masticatory muscles palpation, and 15% did not report pain during clinical examination. Conclusion An increase in EMG activity during mandibular advancement is not associated with TMD presence, but it can be an indirect marker of pain in the orofacial area in OSA patients.

Reflex activity of the pubococcygeus muscle is modified throughout the estrous cycle in Wistar rats

Pubococcygeus muscle reflex activity has been reported to be driven by specialized neuronal circuitry, including the participation of spinal cord interneurons. Both the reflex and elements of the circuit are known to be sensitive to gonadal hormones, but studies using female rats have not considered the potential effects of estrous phase. Hence, in the present study we used mechanical stimulation of the clitoris to produce reflex activity, and recorded across the different phases of the estrous cycle, including the dark and light periods during each phase. Afterdischarge activity was observed only during the light and dark periods of proestrus, and during the light period of estrus coincident with the receptivity period in the rat́s reproductive behavior. Moreover, this reflex activity comprises at least five different motor unit groups with different firing patterns that are dependent on gonadal hormones variation.

What can we learn from the relationship between gait and clinical impairments in children with cerebral palsy when comparing databases?

Spastic cerebral palsy (CP) is characterized by increased joint resistance, caused by a mix of increased tissue stiffness, as well as involuntary reflex and background muscle activity. These properties can be quantified using a neuromechanical model of the musculoskeletal complex and instrumented assessment. The construct validity of the neuromechanical parameters was examined (i.e. the internal model validity, effect of knee angle, speed and age, sensitivity to patients versus controls, spasticity severity and treatment), together with the repeatability. We included 38 children with CP and 35 controls. A motor driven footplate applied two slow (15°/s) and two fast (100°/s) rotations around the ankle joint, at two different knee angles. Ankle angle, torque and EMG of the gastrocnemius (GA), soleus (SO) and tibialis anterior (TA) muscle were used to optimize a nonlinear neuromuscular model. Outcome measures were tissue stiffness, reflex and background activity for GA, SO and TA. The internal model validity showed medium to high parameter confidence and good model fits. All parameter could discriminate between patients with CP and controls according to CP pathology. Other measures of external model validity (effect of test position, speed and age) showed behaviour along the lines of current knowledge of physiology. GA/SO background activity was sensitive to spasticity severity, but reflex activity was not. Preliminary data indicated that reflex activity was reduced after spasticity treatment. The between-trial and -day repeatability was moderate to good. The large variance between patients in the ratio of stiffness and neural resistance indicates that the method could potentially contribute to patient-specific treatment selection.

Sucrose exposure during gestation lactation and postweaning periods increases the pubococcygeus muscle reflex activity in adult male rats.

Erectile dysfunction is related to metabolic alterations produced by a high carbohydrate diet, which may affect muscle activity during penile reflex in adulthood. We determined whether sucrose water consumption during gestation lactation and postweaning affects pubococcygeus muscle (Pcm) activity during urethrogenital reflex in adult male rat offspring. Twelve female rats were mated and grouped in control mothers consumed tap water and sucrose mothers consumed sucrose water during gestation lactation. Male pups were weaned and assigned into four groups (n = 6 each): those from control mothers who continued drinking tap water (CM-CO group) or sucrose water (CM-SO group) until adult life, and those from sucrose mothers who drank tap water (SM-CO group) or continued drinking sucrose water (SM-SO group) until adult life. Body weight, Pcm activity during penile stimulation by bipolar electrodes and urethrogenital reflex were analyzed. A catheter was placed into the urethra to record variations in urethral pressure after mechanical stimulation. Two-way ANOVA followed by post hoc tests were used considering P ≤ 0.05 as a significant difference. Males from the SM-SO group showed weight gain compared to the control group (P < 0.001). Also, sucrose intake promoted high Pcm activity (P < 0.0001) but reduced urethrogenital reflex duration CM-CO vs CM-SO (P = 0.02); CM-CO vs SM-CO (P = 0.01); CM-SO vs SM-SO (P < 0.003); and SM-CO vs SM-SO (P < 0.002). Our results suggest that a combination of a sucrose-rich diet during gestation lactation and postweaning modifies Pcm activation during penile reflex. The urethrogenital reflex is a spinal ejaculatory-like reflex, these rats could have penile dysfunction equivalent to premature ejaculation in men.

Movement History Influences Pendulum Test Kinematics in Children With Spastic Cerebral Palsy.

The pendulum test assesses quadriceps spasticity by dropping the lower leg of a relaxed patient from the horizontal position and observing limb movement. The first swing excursion (FS) decreases with increasing spasticity severity. Our recent simulation study suggests that the reduced initial swing results from muscle short-range stiffness and its interaction with reflex hyper-excitability. Short-range stiffness emerges from the thixotropic behavior of muscles where fiber stiffness upon stretch increases when the muscle is held isometric. Fiber stiffness might thus be higher during the first swing of the pendulum test than during consecutive swings. In addition, it has recently been suggested that muscle spindle firing reflects fiber force rather than velocity and therefore, reflex activity might depend on fiber stiffness. If this hypothesized mechanism is true, we expect to observe larger first swing excursions and reduced reflex muscle activity when the leg is moved rather than kept isometric before release, especially in patients with increased reflex activity. We performed the pendulum test in 15 children with cerebral palsy (CP) and 15 age-matched typically developing (TD) children in two conditions. In the hold condition, the leg was kept isometric in the extended position before release. In the movement condition, the leg was moved up and down before release to reduce the contribution of short-range stiffness. Knee kinematics and muscle activity were recorded. Moving the leg before release increased first swing excursion (p < 0.001) and this increase was larger in children with CP (21°) than in TD children (8°) (p < 0.005). In addition, pre-movement delayed reflex onset by 87 ms (p < 0.05) and reduced reflex activity as assessed through the area under the curve of rectus femoris electromyography (p < 0.05) in children with CP. The movement history dependence of pendulum kinematics and reflex activity supports our hypothesis that muscle short-range stiffness and its interaction with reflex hyper-excitability contribute to joint hyper-resistance in spastic CP. Our results have implications for standardizing movement history in clinical tests of spasticity and for understanding the role of spasticity in functional movements, where movement history differs from movement history in clinical tests.

Treatment Response to Botulinum Neurotoxin-A in Children With Cerebral Palsy Categorized by the Type of Stretch Reflex Muscle Activation.

While Botulinum NeuroToxin-A (BoNT-A) injections are frequently used to reduce the effects of hyperactive stretch reflexes in children with cerebral palsy (CP), the effects of this treatment vary strongly. Previous research, combining electromyography (EMG) with motion analysis, defined different patterns of stretch reflex muscle activation in muscles, those that reacted more to a change in velocity (velocity dependent –VD), and those that reacted more to a change in length (length dependent –LD). The aim of this study was to investigate the relation between the types of stretch reflex muscle activation in the semitendinosus with post-BoNT-A outcome as assessed passively and with 3D gait analysis in children with spastic CP. Eighteen children with spastic CP (10 bilaterally involved) between the ages of 12 and 18 years were assessed before and on average, 8 weeks post-treatment. EMG and motion analysis were used to assess the degree and type of muscle activation dependency in the semitendinosus during passive knee extensions performed at different joint angular velocities. Three-dimensional gait analysis was used to assess knee gait kinematics as a measure of functional outcome. Pre-treatment, 9 muscles were classified as VD and 9 as LD, but no differences between the groups were evident in the baseline knee gait kinematics. Post-treatment, stretch reflex muscle activation decreased significantly in both groups but the reduction was more pronounced in those muscles classified pre-treatment as VD (−72% vs. −50%, p = 0.005). In the VD group, these changes were accompanied by greater knee extension at initial contact and during the swing phase of gait. In the LD group, there was significantly increased post-treatment knee hyperextension in late stance. Although results vary between patients, the reduction of stretch reflex muscle activation in the semitendinosus generally translated to an improved functional outcome, as assessed with 3D gait analysis. However, results were less positive for those muscles with pre-treatment length-dependent type of stretch reflex muscle activation. The study demonstrates the relevance of categorizing the type of stretch reflex muscle activation as a possible predictor of treatment response.

Lumbosacral ventral root avulsion alters reflex activation of bladder, urethra, and perineal muscles during micturition in female rabbits.

To determine the effect of the lumbosacral ventral root avulsion (VRA) on the reflex activation of bladder, urethra, and activation of perineal muscles during micturition in female rabbits. We allocated 14 virgin female rabbits to evaluate, first, the gross anatomy of lumbosacral spinal cord root (n = 5) and, second, to determine the effect of VRA on perineal muscles during micturition (n = 9). We recorded cystometrograms, urethral pressure, and electromyograms of the bulbospongiosus (Bsm) and ischiocavernosus (Ism) muscles before and after the L6-S2 VRA. Standard variables were measured from each recording and analyzed to identify significant differences (P < .05). We found that the L6-S2 VRA affected directly the bladder and urethral function and reduced the duration and the frequency of the bursting of Ism and Bsm muscles during voiding. The Ism and Bsm showed a phasic activation, of different frequencies, during the voiding phase and the L6-S2 VRA inhibited the co-contraction of the Ism and Bsm-bladder-urethra. The Ism and Bsm are activated at different frequencies to trigger the voiding phase. The L6-S2 VRA affected the activity pattern of both perineal muscles. These modifications affected the bladder and urethra function. It is possible that the restoration of the activation frequency of perineal muscles contributed for an efficient bladder contraction.

Bladder and urethral dysfunction in multiparous and mature rabbits correlates with abnormal activity of pubococcygeus and bulbospongiosus muscles.

To evaluate the combined effect of age and multiparity on the micturition reflex, includingpelvic floor muscle activation. Young and mature nulliparous rabbits were compared to young and mature multiparas (n = 6 per group). Cystometrograms and urethral pressure (UP) were performed while simultaneously recording the electromyogram (EMG) activity of the pubococcygeus and bulbospongiosus muscles to establish their functional correlation to urological function. Multiparity and age significantly influence the bladder and UP affecting the voiding efficiency and intercontraction interval. Such interaction also reduced the UP threshold, timing, and duration. Other bladder and urethral variables were predominantly affected only by age. Urodynamic alterations correlated with abnormal patternsor absent EMG activity of the pubococcygeus and bulbospongiosus muscles. The present findings strongly suggest that multiparity and age affects specific pelvic floor muscle reflex activation during micturition, andmay contribute to alterations in bladder and urethral function. This data broadens our understanding of the critical role of the appropriate activity of the individual pelvic floor muscles in micturition.

Repetitive Peripheral Magnetic Nerve Stimulation (rPMS) as Adjuvant Therapy Reduces Skeletal Muscle Reflex Activity.

Background: The reduction of muscle hypertonia and spasticity, as well as an increase in mobility, is an essential prerequisite for the amelioration of physiotherapeutical treatments. Repetitive peripheral magnetic nerve stimulation (rPMS) is a putative adjuvant therapy that improves the mobility of patients, but the underlying mechanism is not entirely clear.Methods: Thirty-eight participants underwent either an rPMS treatment (N = 19) with a 5 Hz stimulation protocol in the posterior tibial nerve or sham stimulation (N = 19). The stimulation took place over 5 min. The study was conducted in a pre-test post-test design with matched groups. Outcome measures were taken at the baseline and after following intervention.Results: The primary outcome was a significant reduction of the reflex activity of the soleus muscle, triggered by a computer-aided tendon-reflex impact. The pre-post differences of the tendon reflex response activity were −23.7% (P < 0.001) for the treatment group. No significant effects showed in the sham stimulation group.Conclusion: Low-frequency magnetic stimulation (5 Hz rPMS) shows a substantial reduction of the tendon reflex amplitude. It seems to be an effective procedure to reduce muscular stiffness, increase mobility, and thus, makes the therapeutic effect of neuro-rehabilitation more effective. For this reason, the 5 Hz rPMS treatment might have the potential to be used as an adjuvant therapy in the rehabilitation of gait and posture control in patients suffering from limited mobility due to spasticity. The effect observed in this study should be investigated conjoined with the presented method in patients with impaired mobility due to spasticity.

Genioglossus activation during maximal sniff manoeuvres: Is upper airway function relevant in the clinical assessment of inspiratory and expiratory muscle strength?

Genioglossus activation during maximal sniff manoeuvres: Is upper airway function relevant in the clinical assessment of inspiratory and expiratory muscle strength?

Numerical Reconstruction of Traumatic Brain Injury in Skiing and Snowboarding.

Proper evaluation of ski helmet designs and safety standards should rely on head impact conditions involved in skiing and snowboarding head injuries. To study these impacts, main crash scenarios involving head injuries are numerically replicated. Multibody models of skiers and snowboarders were developed to investigate five common crash scenarios involved in traumatic brain injury: forward and sideways skiing falls, snowboarding backward falls, collisions between users and collisions with obstacles. For each scenario, the influence of crash conditions on head impact (location, speed, linear and rotational accelerations) and risk of injury are evaluated. Crash conditions were initial velocity, user height, position and approach angle, slope steepness, obstacles, and snow stiffness. One thousand one hundred forty-nine crashes were simulated and three significant levels of impact conditions were discriminated over the investigated crash scenarios: 1) the smallest normal-to-slope impact velocities (6 km·h; 22 km·h) and peak linear accelerations (42g; 75g) were obtained during forward and sideways skiing falls; 2) snowboarding backward falls and collisions between users were associated with high normal-to-surface impact velocities (26 km·h; 32 km·h) and head accelerations (80g; 149g) above one published threshold for mild traumatic brain injury but below the pass/fail criteria of helmet standard tests; 3) collisions with obstacles were associated with high normal-to-surface impact velocities (19 km·h; 35 km·h) and the highest head accelerations (626g; 1885g). Current impact conditions of helmet standard evaluations consistently replicate collisions with obstacles, but need to be revised to better reflect other significant crash scenarios leading to traumatic brain injury.