Superimposing neuromuscular electrical stimulation onto voluntary contractions to improve muscle strength and mass: A systematic review.

Training and rehabilitation programmes involving neuromuscular electrical stimulation superimposed onto voluntary contractions (NMES+) have gained popularity in the last decades. Yet, there is no clear consensus on the effectiveness of such intervention. The aim of this review was to evaluate the effect of chronic exposure to NMES+ on muscle strength and mass compared to conventional volitional training or passive electrical stimulation alone. Two authors conducted an electronic search to identify randomized controlled trials that investigated the effect of NMES+ training, involved healthy participants or orthopaedic patients, detailed a well-defined NMES training protocol, and provided outcomes related to muscle strength and/or mass. The authors extracted data on participants, intervention characteristics, muscle-related outcomes, and assessed the methodological quality of the studies. A total of twenty-four studies were included in the review. The majority of these reported an increase in muscle strength following NMES+ training compared to an equivalent voluntary or passive NMES training. The highest improvements were found when NMES was superimposed on sub-maximal exercises involving both concentric and eccentric contractions. Two studies reported an increase in muscle mass after NMES+, while two other studies exhibited no differences. This review indicated that chronic exposure to NMES+ determines muscle strength improvements greater or equal compared to volitional training alone. However, differences in the methodological characteristics of the stimulation and the type of exercise associated with NMES+ revealed significant discrepancies in the results. A deeper understanding of the neurophysiological adaptations to NMES+ is crucial to fully explain the muscle-related enhancement resulting from such intervention.HighlightsNMES+ consists of simultaneously applying neuromuscular electrical stimulation while voluntarily contracting the stimulated muscle.Although a growing number of studies have suggested that intervention based on NMES+ have a strong potential in enhancing as well as preserving muscle function, there is still no clear consensus on the effectiveness of such technique.This review revealed that training based on NMES+ can induce a significant improvement of muscle strength in both healthy and orthopaedic individuals.

A Countermovement Jump for the Midterm Assessment of Force and Power Exertion After Anterior Cruciate Ligament Reconstruction.

OBJECTIVE: The aim of this study was to assess force and power exertion during a countermovement jump after anterior cruciate ligament reconstruction using either semitendinosus and gracilis or bone-patellar tendon-bone graft. DESIGN: One hundred-nineteen semitendinosus and gracilis and 146 bone-patellar tendon-bone participants performed a countermovement jump on two force platforms after 3 (T1) and 6-9 mos (T2) from surgery. Twenty-four healthy participants served as control group. Peak force of eccentric and concentric phases and peak power were obtained from the analysis of vertical components of the ground reaction forces. Asymmetry was quantified by means of limb symmetry index. RESULTS: Eccentric peak force was significantly ( P < 0.05) lower than concentric peak force in both bone-patellar tendon-bone and semitendinosus and gracilis at T1 and T2. At T1, bone-patellar tendon-bone showed higher peak power, but lower limb symmetry index in eccentric and concentric compared with semitendinosus and gracilis. At T2, bone-patellar tendon-bone showed higher peak power than semitendinosus and gracilis, although there were no differences in limb symmetry index between the two groups, which however was significantly ( P < 0.05) lower in both groups when compared with control group. CONCLUSIONS: Bone-patellar tendon-bone and semitendinosus and gracilis participants showed asymmetries in eccentric and concentric force during a countermovement jump. Bone-patellar tendon-bone showed greater asymmetries and a higher peak power respect to semitendinosus and gracilis participants.

Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction.

There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study. Three movement tasks were completed (unilateral and bilateral drop jump, and 90° pre-planned cut), while ground reaction forces and three-dimensional kinematics (250 Hz) were recorded. Compared to the bilateral drop jump and cut, the unilateral drop jump had a higher proportion of work done at the ankle (d = 0.29, p < 0.001 and d = -1.87, p < 0.001, respectively), and a lower proportion of work done at the knee during the braking phase of the task (d = 0.447, p < 0.001 and d = 1.56, p < 0.001, respectively). The ACLR group had higher peak hip moments than the non-injured controls, although the proportion of work done at the ankle, knee and hip joints were similar. Movement strategies were moderately and positively related at the ankle (rs  = 0.728, p < 0.001), knee (rs  = 0.638, p < 0.001) and hip (rs  = 0.593, p < 0.001) between the unilateral and bilateral drop jump, but there was no relationship at the ankle (rs  = 0.10, p = 0.104), knee (rs  = 0.106, p = 0.166) and hip (rs  = -0.019, p = 0.808) between the unilateral drop jump and the cut. Clinicians could therefore consider omitting one of the drop jumps from assessment batteries but should include both jumping and cutting tasks.

Is the Power Spectrum of Electromyography Signal a Feasible Tool to Estimate Muscle Fiber Composition in Patients with COPD?

A greater proportion of glycolytic muscle fibers is a manifestation of skeletal muscle dysfunction in Chronic Obstructive Pulmonary Disease (COPD). Here, we propose to use the spectral analysis of the electromyographic signal as a non-invasive approach to investigate the fiber muscle composition in COPD. We recorded the electromyographic activity of Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM) and Biceps Femoris (BF) muscles, in ten patients and ten healthy individuals, during non-fatiguing, flexion-extension leg movements. The mean (MNF) and median frequencies (MDF) were calculated, and the most common profiles of electromyographic power spectrum were characterized by using the principal component analysis. Frequency parameters showed higher values in patients with COPD than in the control group for the RF (+25% for MNF; +21% for MNF), VL (+16% for MNF; 16% for MNF) and VM (+22% for MNF; 22% for MNF) muscles during the extension movements and for the BF (+26% for MNF; 34% for MNF) muscle during flexion movements. Spectrum profiles of the COPD patients shifted towards the higher frequencies, and the changes in frequency parameters were correlated with the level of disease severity. This shift of frequencies may indicate an increase in glycolytic muscle fibers in patients with COPD. These results, along with the non-fatigable nature of the motor task and the adoption of a non-invasive method, encourage to use electromyographic spectral analysis for estimating muscle fiber composition in patients with COPD.

Biomechanical characteristics of handstand walking initiation.

BACKGROUND: The initiation in human locomotion is defined as the transition between upright stance and steady-state gait. While past literature abundantly investigated the initiation in bipedal gait, the initiation of handstand walking remains unexplored. RESEARCH QUESTION: The current study aims to characterise the centre of pressure (CoP) and centre of mass (CoM) trajectory of handstand walking initiation as well as the spatiotemporal and kinematic parameters and balance strategy of this task. Also, the study examined the CoP trajectory similarity within- and between-participants using a coefficient of multiple correlation analysis. METHODS: Nineteen gymnasts took part in this study. Handstand walking initiation trials were recorded using force plates and a stereophotogrammetric system. CoM and CoP trajectories were analysed during the Baseline, Preparation and Execution phases of the motor task. RESULTS: We found that to successfully perform the handstand walking initiation, a shift of the CoM forward and towards the stance hand is required as a result of a lateral and posterior CoP shift. All participants performed a similar CoP pattern in the mediolateral direction, whereas two anteroposterior CoP displacement strategies were identified across participants based on different timing execution of posterior CoP shift. While CoP and CoM kinematic differences were identified during the Preparation Phase due to the adopted strategy, no significant difference was found in the Execution Phase for the spatiotemporal and kinematic characteristics. SIGNIFICANCE: A better understanding of the required CoP/CoM patterns and balance control provides the basis for further neuromechanics research on the topic and could contribute to individualise training protocols to improve the learning of the task.

Non-specific chronic low back pain elicits kinematic and neuromuscular changes in walking and gait termination.

BACKGROUND: Chronic low back pain (CLBP) is associated with an increased trunk stiffness and muscle coactivation during walking. However, it is still unclear whether CLBP individuals are unable to control neuromechanically their upper body motion during a sudden termination of gait (GT), which involves a challenging balance transition from walking to standing. RESEARCH QUESTION: Does CLBP elicit neuromuscular and kinematic changes which are specific to walking and GT?. METHODS: Eleven individuals with non-specific CLBP and 11 healthy controls performed walking and sudden GT in response to an external visual cue. 3D kinematic characteristics of thorax, lumbar and pelvis were obtained, with measures of range of motion (ROM) and intra-subject variability of segmental movement being calculated. Electromyographic activity of lumbar and abdominal muscles was recorded to calculate bilateral as well as dorsoventral muscle coactivation. RESULTS: CLBP group reported greater transverse ROM of the lumbar segment during walking and GT compared to healthy controls. Thorax sagittal ROM was higher in CLBP than healthy participants during GT. Greater overall movement variability in the transverse plane was observed in the CLBP group while walking, whereas GT produced greater variability of lumbar frontal motion. CLBP participants showed higher bilateral lumbar coactivation compared to healthy participants after the stopping stimulus delivery during GT. SIGNIFICANCE: These results suggest that CLBP can elicit a wider and more variable movement of the upper body during walking and GT, especially in the transverse plane and at lumbar level. Alterations in upper body motor control appeared to depend on task, plane of motion and segmental level. Therefore, these findings should be considered by practitioners when screening before planning specific training interventions for recovery of motor control patterns in CLBP population.

Neuromechanical response of the upper body to unexpected perturbations during gait initiation in young and older adults.

BACKGROUND: Control of upper body motion deteriorates with ageing leading to impaired ability to preserve balance during gait, but little is known on the contribution of the upper body to preserve balance in response to unexpected perturbations during locomotor transitions, such as gait initiation. AIM: To investigate differences between young and older adults in the ability to modify the trunk kinematics and muscle activity following unexpected waist lateral perturbations during gait initiation. METHODS: Ten young (25 ± 2 years) and ten older adults (73 ± 5 years) initiated locomotion from stance while a lateral pull was randomly applied to the pelvis. Two force plates were used to define the feet centre-of-pressure displacement. Angular displacement of the trunk in the frontal plane was obtained through motion analysis. Surface electromyography of cervical and thoracic erector spinae muscles was recorded bilaterally. RESULTS: A lower trunk lateral bending towards the stance leg side in the preparatory phase of gait initiation was observed in older participants following perturbation. Right thoracic muscle activity was increased in response to the perturbation during the initial phase of gait initiation in young (+ 68%) but not in older participants (+ 7%). CONCLUSIONS: The age-related reduction in trunk movement could indicate a more rigid behaviour of the upper body employed by older compared to young individuals in response to unexpected perturbations preceding the initiation of stepping. Older adults' delayed activation of thoracic muscles could suggest impaired reactive mechanisms that may potentially lead to a fall in the early stages of the gait initiation.

Use of a Single Wearable Sensor to Evaluate the Effects of Gait and Pelvis Asymmetries on the Components of the Timed Up and Go Test, in Persons with Unilateral Lower Limb Amputation.

The Timed Up and Go (TUG) test quantifies physical mobility by measuring the total performance time. In this study, we quantified the single TUG subcomponents and, for the first time, explored the effects of gait cycle and pelvis asymmetries on them. Transfemoral (TF) and transtibial (TT) amputees were compared with a control group. A single wearable inertial sensor, applied to the back, captured kinematic data from the body and pelvis during the 10-m walk test and the TUG test. From these data, two categories of symmetry indexes (SI) were computed: One SI captured the differences between the antero-posterior accelerations of the two sides during the gait cycle, while another set of SI quantified the symmetry over the three-dimensional pelvis motions. Moreover, the total time of the TUG test, the time of each subcomponent, and the velocity of the turning subcomponents were measured. Only the TF amputees showed significant reductions in each SI category when compared to the controls. During the TUG test, the TF group showed a longer duration and velocity reduction mainly over the turning subtasks. However, for all the amputees there were significant correlations between the level of asymmetries and the velocity during the turning tasks. Overall, gait cycle and pelvis asymmetries had a specific detrimental effect on the turning performance instead of on linear walking.

Age differences in anticipatory and executory mechanisms of gait initiation following unexpected balance perturbations.

PURPOSE: An age-related decline in anticipatory postural mechanisms has been reported during gait initiation; however, it is unclear whether such decline may jeopardize whole-body stability following unexpected balance perturbations. This study aimed to compare young and older individuals' ability to generate postural responses and preserve stability in response to external waist perturbations delivered within gait initiation. METHODS: Ten young and ten older participants performed 10 gait initiation trials followed by 48 unperturbed and 12 perturbed trials in a random order. A stereophotogrammetric system and three force platforms were used to quantify mechanical parameters from the preparatory phase (e.g., timing and amplitude of postural adjustments) and from the stepping phase (e.g., step characteristics and dynamic stability). Activation patterns of lower leg muscles were determined by surface electromyography. RESULTS: Older participants responded to perturbation with lower increase in both magnitude (p < 0.001; η2p = 0.62) and duration (p = 0.001; η2p = 0.39) of preparatory parameters and soleus muscle activity (p < 0.001; η2p = 0.55), causing shorter (p < 0.001; η2p = 0.59) and lower (p < 0.001; η2p = 0.43) stepping, compared to young participants. Interestingly, young participants showed greater correlations between preparatory phase parameters and dynamic stability of the first step than older participants (average r of - 0.40 and - 0.06, respectively). CONCLUSION: The results suggest that young participants took more time than older to adjust the anticipatory biomechanical response to perturbation attempting to preserve balance during stepping. In contrast, older adults were unable to modify their anticipatory adjustments in response to perturbation and mainly relied on compensatory mechanisms attempting to preserve stability via a more cautious stepping strategy.

Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury.

The benefits of functional electrical stimulation during cycling (FES-cycling) have been ascertained following spinal cord injury. The instrumented pendulum test was applied to chronic paraplegic patients to investigate the effects of FES-cycling of different duration (20-min vs. 40-min) on biomechanical and electromyographic characterization of knee mobility. Seven adults with post-traumatic paraplegia attended two FES-cycling sessions, a 20-min and a 40-min one, in a random order. Knee angular excursion, stiffness and viscosity were measured using the pendulum test before and after each session. Surface electromyographic activity was recorded from the rectus femoris (RF) and biceps femoris (BF) muscles. FES-cycling led to reduced excursion (p < 0.001) and increased stiffness (p = 0.005) of the knee, which was more evident after the 20-min than 40-min session. Noteworthy, biomechanical changes were associated with an increase of muscle activity and changes in latency of muscle activity only for 20-min, with anticipated response times for RF (p < 0.001) and delayed responses for BF (p = 0.033). These results indicate that significant functional changes in knee mobility can be achieved by FES-cycling for 20 min, as evaluated by the pendulum test in patients with chronic paraplegia. The observed muscle behaviour suggests modulatory effects of exercise on spinal network aimed to partially restore automatic neuronal processes.

Modulation of spinal excitability following neuromuscular electrical stimulation superimposed to voluntary contraction.

PURPOSE: Neuromuscular electrical stimulation (NMES) superimposed on voluntary muscle contraction has been recently shown as an innovative training modality within sport and rehabilitation, but its effects on the neuromuscular system are still unclear. The aim of this study was to investigate acute responses in spinal excitability, as measured by the Hoffmann (H) reflex, and in maximal voluntary contraction (MVIC) following NMES superimposed to voluntary isometric contractions (NMES + ISO) compared to passive NMES only and to voluntary isometric contractions only (ISO). METHOD: Fifteen young adults were required to maintain an ankle plantar-flexor torque of 20% MVC for 20 repetitions during each experimental condition (NMES + ISO, NMES and ISO). Surface electromyography was used to record peak-to-peak H-reflex and motor waves following percutaneous stimulation of the posterior tibial nerve in the dominant limb. An isokinetic dynamometer was used to assess maximal voluntary contraction output of the ankle plantar flexor muscles. RESULTS: H-reflex amplitude was increased by 4.5% after the NMES + ISO condition (p < 0.05), while passive NMES and ISO conditions showed a decrease by 7.8% (p < 0.05) and no change in reflex responses, respectively. There was no change in amplitude of maximal motor wave and in MVIC torque during each experimental condition. CONCLUSION: The reported facilitation of spinal excitability following NMES + ISO could be due to a combination of greater motor neuronal and corticospinal excitability, thus suggesting that NMES superimposed onto isometric voluntary contractions may provide a more effective neuromuscular stimulus and, hence, training modality compared to NMES alone.

Quadriceps muscle compensatory activations are delayed following anterior cruciate ligament reconstruction using hamstring tendon graft.

BACKGROUND: Compensatory and anticipatory quadriceps activation (CQA and AQA) in response to postural perturbations are essential for functional stability of the knee. This study aimed at investigating CQA and AQA before and after anterior cruciate ligament reconstruction (ACLR) using hamstrings graft. METHODS: Twelve participants with ACLR and 12 healthy controls were exposed to 10 either unpredictable or predictable perturbations of the knee before ACLR (T1), two months (T2) and six months (T3) after surgery. Latencies of CQA and AQA in vastus lateralis (VL), rectus femoris (RF) and vastus medialis (VM) were measured. RESULTS: Latency of CQA was delayed in ACLR compared to controls at T1 for VL (105 ±â€¯25 vs. 57 ±â€¯9 ms; P < .001), RF (102 ±â€¯23 vs. 56 ±â€¯9 ms; P < .001) and VM (107 ±â€¯24 vs. 66 ±â€¯16 ms; P < .001), at T2 for VL (68 ±â€¯14 vs. 55 ±â€¯10 ms; P < .01) and at T3 for VL (105 ±â€¯22 vs. 58 ±â€¯7 ms; P < .001), RF (102 ±â€¯22 vs. 58 ±â€¯12 ms; P < .001) and VM (106 ±â€¯20 vs. 63 ±â€¯8 ms; P < .001). AQA occurred earlier in ACLR than in controls at T1 for VL (-82 ±â€¯64 vs. -14 ±â€¯11 ms; P < .05) and VM (-105 ±â€¯68 vs. -9 ±â€¯12 ms; P < .05). CONCLUSION: CQA are delayed following ACLR with hamstring graft and should be addressd by post-surgical rehabilitation.

No Relationship Between Preoperative and Early Postoperative Strength After ACL Reconstruction.

CONTEXT: All rehabilitative programs before anterior cruciate ligament (ACL) reconstructive surgery, which are focused on recovery of proprioception and muscular strength, are defined as prehabilitation. While it has shown that prehabilitation positively affects the overall outcome after ACL reconstruction, it is still controversial whether preoperatively enhancing quadriceps strength has some beneficial effect on postoperative strength, mainly during the first period. OBJECTIVE: To determine whether there is any relationship between preoperative and early postoperative quadriceps strength. DESIGN: Case control. SETTING: University research laboratory. PARTICIPANTS: Fifty-nine males (18-33 y; age: 23.69 [0.71] y) who underwent ACL reconstruction with patellar-tendon autograft were examined the day before surgery, and at 60 and 90 days after surgery. MAIN OUTCOME MEASURES: The limb symmetry index (LSI) was quantified for maximal voluntary isometric contraction of the knee extensor muscles and of the knee flexor muscles at 90° joint angle. A k-means analysis was performed on either quadriceps or hamstrings LSI before surgery to classify the patients in high and low preoperative LSI clusters. Differences in postoperative LSI were then evaluated between the high and low preoperative LSI clusters. RESULTS: Following surgery, there were no differences in the quadriceps LSI between patients with high and low preoperative quadriceps LSI. Sixty days after surgery, the hamstrings LSI was higher in patients with high than low preoperative hamstrings LSI (84.0 [13.0]% vs 75.4 [15.9]%; P < .05). CONCLUSIONS: Findings suggest that quadriceps strength deficit is related to the ACL injury and increases further after the reconstruction without any correlation between the preoperative and postoperative values. Therefore, it appears that there is no need to delay surgery in order to increase the preoperative quadriceps strength before surgery.

Timing of Muscle Activation Is Altered During Single-Leg Landing Tasks After Anterior Cruciate Ligament Reconstruction at the Time of Return to Sport.

OBJECTIVES: It is well known that alterations in landing mechanics persist for years after anterior cruciate ligament reconstruction (ACL-R). Nevertheless, existing literature is controversial in reporting successful or unsuccessful recovery of prelanding muscle activation timing after ACL-R. The study aimed at comparing myoelectric and kinematic patterns during landing tasks between ACL-R and healthy subjects. DESIGN: Cross-sectional study. SETTING: Institutional research laboratory. PATIENTS AND INTERVENTION: Fifteen male athletes after ACL-R using patellar tendon and 11 using hamstrings autograft at the time of return to sport were recruited. Fifteen healthy athletes served as control group. Participants performed 4 different single-leg landing tasks arriving onto a force plate. MAIN OUTCOME MEASURES: Electromyographic (EMG) activity of knee extensors and flexors, normalized vertical ground reaction force (vGRF), and knee angular displacement were recorded. RESULTS: In all the tasks, preimpact EMG duration was longer in ACL-R (112 ± 28 ms in the knee extensors; 200 ± 34 ms in the knee flexors) compared with healthy participants (74 ± 19 ms in the knee extensors; 153 ± 29 ms in the knee flexors; P < 0.05). Initial contact (IC) and maximum postimpact knee angle were lower in ACL-R (9 ± 7 degrees at IC; 39 ± 12 degrees at maximum flexion) compared with healthy participants (17 ± 9 degrees at IC; 52 ± 15 degrees at maximum flexion; P < 0.05). Normalized vGRF was higher in ACL-R compared with healthy participants (3.4 ± 0.5 and 2.7 ± 0.6; P < 0.05). CONCLUSIONS: At the time of return to sport, ACL-R subjects showed altered motor control strategies of single-leg landings. These alterations may lead to uncoordinated movement, hence increasing the risk of reinjury.

Age-related changes in upper body contribution to braking forward locomotion in women.

INTRODUCTION: Gait termination is a transitory task that requires the lower body to produce braking forces and inhibit forward propulsion. However, it is still unknown whether the upper body plays an active role in braking of gait and whether this mechanism is impaired with ageing. RESEARCH QUESTION: Do older women exhibit an impaired control of upper body segments during gait termination with respect to young women? METHODS: Ten young and 10 older women performed three gait termination trials at comfortable speed while fixing the gaze on a visual target. A 3D motion analysis system was used to measure head, trunk and pelvis angular displacement and velocity, and estimate neck, waist and hip moments through Plug-in Gait modeling. Cross-correlation analysis of kinematic waveforms between paired adjacent segments (head-trunk and trunk-pelvis) was performed to investigate upper body coordination. Surface EMG activity of erector spinae (L3), sternocleidomastoid and neck extensor muscles was recorded. Statistics was carried out by MANOVA. RESULTS: Older participants exhibited delayed peak extensor torques of neck, waist and hip compared to young participants, along with lower progression speed. Both groups showed a slight flexion of the trunk counteracted by a backward tilt of head and pelvis during braking. In addition, older women displayed a peculiar upper body coordination pattern, with the head coupling with trunk motion, as shown by cross-correlation. Older women displayed shorter lumbar erector spinae onset latency relative to last heel contact than young (16 ± 68 ms vs 92 ± 37 ms). SIGNIFICANCE: The upper body plays an active role in the braking of gait and this mechanism is impaired in older women. Moreover, the age-related coupling of head and trunk motion may produce an unbalancing effect on whole-body stability during the braking mechanism, thus leading to a higher risk of falls.

Whole body vibration of different frequencies inhibits H-reflex but does not affect voluntary activation.

This study aimed to investigate the effects of whole-body vibration (WBV) at a frequency spectrum from 20 to 50 Hz on the Hoffmann (H) reflex and the voluntary motor output of ankle plantar-flexor muscles. A single-group (n: 8), repeated measures design was adopted with four conditions: standing (no vibration), 20, 35 and 50 Hz, each lasting one minute. H-reflex of the soleus muscle, maximal voluntary contraction (MVC) and central activation ratio (CAR) of the plantar-flexors were evaluated before, 1 and 5 min after each frequency condition. H-reflex decreased by 36.7% at 20 Hz, by 28% at 35 Hz, and by 34.8% at 50 Hz after one minute from WBV compared to baseline. Neither MVC nor CAR changed after WBV at all frequency conditions. The short-term, acute inhibition of the H-reflex after WBV at 20, 35 and 50 Hz suggested that decreased excitability of spinal motoneurons is not frequency dependent. On the other hand, the lack of vibration induced effects on MVC and CAR indicated that a 1-min WBV stimulus is not sufficient to affect the voluntary motor output.

Postural Adjustments Following ACL Rupture and Reconstruction: A Longitudinal Study.

Longitudinal changes in compensatory and anticipatory postural adjustments around the knee were investigated from rupture of ACL until return to play after reconstruction. Twelve ACL-injured participants (ACL-P) were asked to respond to unpredictable and predictable perturbations before (T1), 2 (T2) and 6 months after (T3) reconstruction. Twelve healthy participants served as controls. Compensatory and anticipatory latencies of vastus lateralis (VL) and medialis (VM) were measured with respect to the arrival of perturbations. ACL-P showed delayed compensatory latencies compared to controls at T1 for VL (101±32 ms vs 63±7 ms) and VM (117±36 ms vs 75±17 ms) and at T2 for VL (94±20 ms vs 63±7 ms) and VM (94±27 ms vs 71±11 ms). ACL-P showed earlier anticipatory latencies than controls for VL at T1 (-69±44 ms vs -12±12 ms) and T2 (-46±17 ms vs -16±12 ms). At T3, ACL-P showed delayed compensatory latencies for VL (91±18 ms vs 56±21 ms) and VM (95±13 ms vs 66±4 ms), whilst anticipatory latencies were restored. Rehabilitation should address delayed compensatory responses.

Neuromuscular Electrical Stimulation Superimposed on Movement Early after ACL Surgery.

PURPOSE: Quadriceps weakness and asymmetrical loading of lower limbs are two major issues after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate the effectiveness of a 6-wk training protocol involving neuromuscular electrical stimulations (NMES) of the quadriceps muscle superimposed on repeated sit-to-stand-to-sit exercises (STSTS), as an additional treatment to standard rehabilitation, from the 15th to the 60th day after ACLR. METHODS: Sixty-three ACLR patients were randomly allocated to one of the three treatment groups: NMES superimposed on STSTS (NMES + STSTS), STSTS only, or no additional treatment (NAT) to standard rehabilitation. Maximal isometric strength of the knee extensor and flexor muscles was measured 60 and 180 d after surgery. Asymmetry in lower extremity loading was measured during a sit-to-stand movement at 15, 30, 60, and 180 d after surgery and during a countermovement jump 180 d after surgery by means of two adjacent force platforms placed under each foot. RESULTS: The NMES + STSTS participants showed higher muscle strength of the knee extensors, which was accompanied by lower perception of pain and higher symmetry in lower extremity loading compared with STSTS-only and NAT participants after both 60 and 180 d from surgery. Participants in the STSTS-only treatment group showed higher symmetry in lower extremity loading compared with those in the NAT group 60 d after surgery. CONCLUSIONS: These results suggest that an early intervention based on NMES superimposed to repeated STSTS exercises is effective for recovering quadriceps strength and symmetry in lower extremity loading by the time of return to sport.

Upper body accelerations during planned gait termination in young and older women.

Transitory tasks, such as gait termination, involve interactions between neural and biomechanical factors that challenge postural stability and head stabilization patterns in older adults. The aim of the study was to compare upper body patterns of acceleration during planned gait termination at different speeds between young and older women. Ten young and 10 older women were asked to carry out three gait termination trials at slow, comfortable and fast speed. A stereophotogrammetric system and a 15-body segments model were used to calculate antero-posterior whole-body Center of Mass (AP CoM) speed and to reconstruct the centroids of head, trunk and pelvis segments. RMS of three-dimensional linear accelerations were calculated for each segment and the transmission of acceleration between two segments was expressed as a percentage difference. Older women reported lower AP CoM speed and acceleration RMS of the three upper body segments than young women across the three speed conditions. A lower pelvis-to-trunk attenuation of accelerations in the transverse plane was observed in older compared to young women, and mainly in the medio-lateral direction. As possible explanations, older women may not need to reduce acceleration as young women because of their lower progression speed and the subsequent acceleration at upper body levels. On the other hand, older women may prioritize a decrease in the whole body progression speed at expense of the involvement of upper body segments. This limits the attenuation of the accelerations, particularly in the transverse plane, implying an increased dynamic unbalance in performing this transitory task.

Local vibration inhibits H-reflex but does not compromise manual dexterity and does not increase tremor.

The present work aimed at investigating the effects of local vibration on upper limb postural and kinetic tremor, on manual dexterity and on spinal reflex excitability. Previous studies have demonstrated a decrease in spinal reflex excitability and in force fluctuations in the lower limb but an increase in force fluctuation in the upper limbs. As hand steadiness is of vital importance in many daily-based tasks, and local vibration may also be applied in movement disorders, we decided to further explore this phenomenon. Ten healthy volunteers (26±3years) were tested for H reflex, postural and kinetic tremor and manual dexterity through a Purdue test. EMG was recorded from flexor carpi radialis (FCR) and extensor digitorum communis (EDC). Measurements were repeated at baseline, after a control period during which no vibration was delivered and after vibration. Intervention consisted in holding for two minutes a vibrating handle (frequency 75Hz, displacement∼7mm), control consisted in holding for two minutes the same handle powered off. Reflex excitability decreased after vibration whilst postural tremor and manual dexterity were not affected. Peak kinetic tremor frequency increased from baseline to control measurements (P=0.002). Co-activation EDC/FCR increased from control to vibration (P=0.021). These results show that two minutes local vibration lead to a decrease in spinal excitability, did not compromise manual dexterity and did not increase tremor; however, in contrast with expectations, tremor did not decrease. It is suggested that vibration activated several mechanisms with opposite effects, which resulted in a neutral outcome on postural and kinetic tremor.