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Commandeur D, Klimstra M, Brodie R, Hundza S. A Comparison of Bioelectric and Biomechanical EMG Normalization Techniques in Healthy Older and Young Adults during Walking Gait. J Funct Morphol Kinesiol 2024; 9:90. [PMID: 38804456 PMCID: PMC11163366 DOI: 10.3390/jfmk9020090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
This study compares biomechanical and bioelectric electromyography (EMG) normalization techniques across disparate age cohorts during walking to assess the impact of normalization methods on the functional interpretation of EMG data. The biomechanical method involved scaling EMG to a target absolute torque (EMGTS) from a joint-specific task and the chosen bioelectric methods were peak and mean normalization taken from the EMG signal during gait, referred to as dynamic mean and dynamic peak normalization (EMGMean and EMGPeak). The effects of normalization on EMG amplitude, activation pattern, and inter-subject variability were compared between disparate cohorts, including OLD (76.6 yrs N = 12) and YOUNG (26.6 yrs N = 12), in five lower-limb muscles. EMGPeak normalization resulted in differences between YOUNG and OLD cohorts in Biceps Femoris (BF) and Medial Gastrocnemius (MG) that were not observed with EMGMean or EMGTS normalization. EMGPeak and EMGMean normalization also demonstrated interactions between age and the phase of gait in BF that were not seen with EMGTS. Correlations showed that activation patterns across the gait cycle were similar between all methods for both age groups and the coefficient of variation comparisons found that EMGTS produced the greatest inter-subject variability. We have shown that the normalization technique can influence the interpretation of findings when comparing disparate populations, highlighting the need to carefully interpret functional differences in EMG between disparate cohorts.
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Affiliation(s)
- Drew Commandeur
- Motion and Mobility Laboratory, University of Victoria, Victoria, BC V8P 5C2, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8W 3P2, Canada
| | - Marc Klimstra
- Motion and Mobility Laboratory, University of Victoria, Victoria, BC V8P 5C2, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8W 3P2, Canada
- Canadian Sport Institute Pacific, Victoria, BC V9E 2C5, Canada;
| | - Ryan Brodie
- Canadian Sport Institute Pacific, Victoria, BC V9E 2C5, Canada;
| | - Sandra Hundza
- Motion and Mobility Laboratory, University of Victoria, Victoria, BC V8P 5C2, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8W 3P2, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada
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Butowicz CM, Golyski PR, Acasio JC, Hendershot BD. Comparing spinal loads in individuals with unilateral transtibial amputation with and without chronic low back pain: An EMG-informed approach. J Biomech 2024; 166:111966. [PMID: 38373872 DOI: 10.1016/j.jbiomech.2024.111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
Chronic low back pain (cLBP) is highly prevalent after lower limb amputation (LLA), likely due in part to biomechanical factors. Here, three-dimensional full-body kinematics and kinetics during level-ground walking, at a self-selected and three controlled speeds (1.0, 1.3, and 1.6 m/s), were collected from twenty-one persons with unilateral transtibial LLA, with (n = 9) and without cLBP (n = 12). Peak compressive, mediolateral, and anteroposterior L5-S1 spinal loads were estimated from a full-body, transtibial amputation-specific OpenSim model and compared between groups. Predicted lumbar joint torques from muscle activations were compared to inverse dynamics and predicted and measured electromyographic muscle activations were compared for model evaluation and verification. There were no group differences in compressive or anterior shear forces (p > 0.466). During intact stance, peak ipsilateral loads increased with speed to a greater extent in the cLBP group vs. no cLBP group (p=0.023), while during prosthetic stance, peak contralateral loads were larger in the no cLBP group (p=0.047) and increased to a greater extent with walking speed compared to the cLBP group (p=0.008). During intact stance, intact side external obliques had higher activations in the no cLBP group (p=0.039), and internal obliques had higher activations in the cLBP group at faster walking speeds compared to the no cLBP group. Predicted muscle activations demonstrated similar activation patterns to electromyographic-measured activations (r = 0.56-0.96), and error between inverse dynamics and simulated spinal moments was low (0.08 Nm RMS error). Persons with transtibial LLA and cLBP may adopt movement strategies during walking to reduce mediolateral shear forces at the L5-S1 joint, particularly as walking speed increases. However, future work is needed to understand the time course from pain onset to chronification and the cumulative influence of increased spinal loads over time.
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Affiliation(s)
- Courtney M Butowicz
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
| | - Pawel R Golyski
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
| | - Julian C Acasio
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
| | - Brad D Hendershot
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
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Eskandari AH, Ghezelbash F, Shirazi-Adl A, Gagnon D, Mecheri H, Larivière C. Validation of an EMG submaximal method to calibrate a novel dynamic EMG-driven musculoskeletal model of the trunk: Effects on model estimates. J Electromyogr Kinesiol 2023; 68:102728. [PMID: 36512937 DOI: 10.1016/j.jelekin.2022.102728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/29/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multijoint EMG-assisted optimization models are reliable tools to predict muscle forces as they account for inter- and intra-individual variations in activation. However, the conventional method of normalizing EMG signals using maximum voluntary contractions (MVCs) is problematic and introduces major limitations. The sub-maximal voluntary contraction (SVC) approaches have been proposed as a remedy, but their performance against the MVC approach needs further validation particularly during dynamic tasks. METHODS To compare model outcomes between MVC and SVC approaches, nineteen healthy subjects performed a dynamic lifting task with two loading conditions. RESULTS Results demonstrated that these two approaches produced highly correlated results with relatively small absolute and relative differences (<10 %) when considering highly-aggregated model outcomes (e.g. compression forces, stability indices). Larger differences were, however, observed in estimated muscle forces. Although some model outcomes, e.g. force of abdominal muscles, were statistically different, their effect sizes remained mostly small (ηG2 ≤ 0.13) and in a few cases moderate (ηG2 ≤ 0.165). CONCLUSION The findings highlight that the MVC calibration approach can reliably be replaced by the SVC approach when the true MVC exertion is not accessible due to pain, kinesiophobia and/or the lack of proper training.
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Affiliation(s)
| | - Farshid Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - Denis Gagnon
- Department of Physical Activity Sciences, University of Sherbrooke, Canada
| | - Hakim Mecheri
- Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada
| | - Christian Larivière
- Institut de recherche Robert Sauvé en santé et en sécurité du travail, Montréal, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal (CCSMTL), Canada.
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Submaximal Electromyography-Driven Musculoskeletal Modeling of the Human Trunk during Static Tasks: Equilibrium and Stability Analyses. J Electromyogr Kinesiol 2022; 65:102664. [DOI: 10.1016/j.jelekin.2022.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022] Open
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Zelik KE, Nurse CA, Schall MC, Sesek RF, Marino MC, Gallagher S. An ergonomic assessment tool for evaluating the effect of back exoskeletons on injury risk. APPLIED ERGONOMICS 2022; 99:103619. [PMID: 34740072 PMCID: PMC9827614 DOI: 10.1016/j.apergo.2021.103619] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 06/01/2023]
Abstract
Low back disorders (LBDs) are a leading injury in the workplace. Back exoskeletons (exos) are wearable assist devices that complement traditional ergonomic controls and reduce LBD risks by alleviating musculoskeletal overexertion. However, there are currently no ergonomic assessment tools to evaluate risk for workers wearing back exos. Exo-LiFFT, an extension of the Lifting Fatigue Failure Tool, is introduced as a means to unify the etiology of LBDs with the biomechanical function of exos. We present multiple examples demonstrating how Exo-LiFFT can assess or predict the effect of exos on LBD risk without costly, time-consuming electromyography studies. For instance, using simulated and real-world material handling data we show an exo providing a 30 Nm lumbar moment is projected to reduce cumulative back damage by ∼70% and LBD risk by ∼20%. Exo-LiFFT provides a practical, efficient ergonomic assessment tool to assist safety professionals exploring back exos as part of a comprehensive occupational health program.
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Affiliation(s)
- Karl E Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN, USA; HeroWear, LLC, Nashville, TN, USA.
| | - Cameron A Nurse
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Mark C Schall
- Department of Industrial and Systems Engineering, Auburn University, Auburn, AL, USA
| | - Richard F Sesek
- Department of Industrial and Systems Engineering, Auburn University, Auburn, AL, USA
| | | | - Sean Gallagher
- Department of Industrial and Systems Engineering, Auburn University, Auburn, AL, USA
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Choi JH, Kim DE, Cynn HS. Comparison of Trunk Muscle Activity Between Traditional Plank Exercise and Plank Exercise With Isometric Contraction of Ankle Muscles in Subjects With Chronic Low Back Pain. J Strength Cond Res 2021; 35:2407-2413. [PMID: 31136542 DOI: 10.1519/jsc.0000000000003188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Choi, JH, Kim, DE, and Cynn, HS. Comparison of trunk muscle activity between traditional plank exercise and plank exercise with isometric contraction of ankle muscles in subjects with chronic low back pain. J Strength Cond Res 35(9): 2407-2413, 2021-This study aimed to compare the effects of 4 different ankle conditions on the activities of rectus abdominis (RA), external oblique (EO), transversus abdominis/internal oblique (TrA/IO), and erector spinae (ES) muscles during plank exercise in subjects with chronic low back pain (CLBP). Twenty-two subjects with CLBP participated in this study. The subjects performed the traditional plank and plank with 3 different ankle muscle contraction types (isometric contraction of ankle dorsiflexor, plantarflexor, and without ankle muscle contraction). Surface electromyography was used to measure the activities of RA, EO, TrA/IO, ES, tibialis anterior, and gastrocnemius muscles. A 1-way repeated-measures analysis of variance was used to assess the statistical significance of activities of the RA, EO, TrA/IO, and ES muscles. The activities of RA, EO, and TrA/IO muscles were significantly greater in the plank with isometric contraction of ankle dorsiflexor (PlankDF) than in the other 3 plank exercises. No significant difference in the activity of ES muscles was revealed during the 4 plank exercises. The activities of all abdominal muscles during PlankDF were significantly higher than those during the traditional plank, as well as during the plank with isometric contraction of ankle plantarflexor (PlankPF) and the plank without ankle muscular contraction (Plankw/o), and more than 60% of maximal voluntary isometric contraction was observed. Thus, PlankDF could be applied not only as a rehabilitation strategy for patients with decreased core stability owing to weakness of abdominal muscles but also as fitness program for improving core strength.
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Affiliation(s)
- Jung-Hoon Choi
- Rehabilitation 1-team, Severance Rehabilitation Hospital, Yonsei University Health System, Seodaemun-gu, Seoul, Republic of Korea
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of Korea
| | - Da-Eun Kim
- Department of Physical Therapy, Chonbuk National University Hospital, Jeollabuk-do, Republic of Korea ; and
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of Korea
| | - Heon-Seock Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of Korea
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Ataei G, Abedi R, Mohammadi Y, Fatouraee N. Analysing the effect of wearable lift-assist vest in squat lifting task using back muscle EMG data and musculoskeletal model. Phys Eng Sci Med 2020; 43:651-658. [PMID: 32524453 DOI: 10.1007/s13246-020-00872-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/17/2020] [Indexed: 12/17/2022]
Abstract
The most common disorders of the musculoskeletal system are low back disorders. They cause significant direct and indirect costs to different societies especially in lifting occupations. To reduce the risk of low back disorders, mechanical lifting aids have been used to decrease low back muscle forces. But there are very few direct ways to calculate muscle forces and examine the effect of personal lift-assist devices, so biomechanical models ought to be used to examine the quality of these devices for assisting back muscles in lifting tasks. The purpose of this study is to examine the effect of a designed wearable lift-assist vest (WLAV) in the reduction of erector spinae muscle forces during symmetric squat lifting tasks. Two techniques of muscle calculation were used, the electromyography-based method and the optimization-based model. The first uses electromyography data of erector spinae muscles and its linear relationship with muscle force to estimate their forces, and the second uses a developed musculoskeletal model to calculate back muscle forces using an optimization-based method. The results show that these techniques reduce the average value of erector spinae muscle forces by 45.38 (± 4.80) % and 42.03 (± 8.24) % respectively. Also, both methods indicated approximately the same behaviour in changing muscle forces during 10 to 60 degrees of trunk flexion using WLAV. The use of WLAV can help to reduce the activity of low back muscles in lifting tasks by transferring the external load effect to the assistive spring system utilized in it, so this device may help people lift for longer.
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Affiliation(s)
- Gholamreza Ataei
- Department of Radiology Technology, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Rasoul Abedi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Yousef Mohammadi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Nasser Fatouraee
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran.
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Can Kinesio Taping® influence the electromyographic signal intensity of trunk extensor muscles in patients with chronic low back pain? A randomized controlled trial. Braz J Phys Ther 2019; 24:539-549. [PMID: 31866161 DOI: 10.1016/j.bjpt.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/10/2019] [Accepted: 12/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The evidence of the influence of Kinesio Taping® in changing electromyographic signal intensity of the lumbar musculature in patients with chronic non-specific low back pain (LBP) is very sparse. OBJECTIVES To evaluate if Kinesio Taping® changes the electromyographic signal intensity of the longissimus and iliocostalis muscles in patients with chronic non-specific LBP. METHODS Prospectively registered, three-arm randomized controlled trial with a blinded assessor. Patients were randomly allocated to the following interventions: 1) Kinesio Taping® Group (n=21), where patients received the tape according to the manufacturer's manual; 2) Placebo Group (i.e. normal surgical tape) (n=21); and 3) Non-treatment control Group (n=21). Assessments were performed at baseline, immediately after, and 30min after the intervention. The primary outcome was muscle activity of the iliocostalis and longissimus muscles as measured by surface electromyography. The secondary outcome was pain intensity (measured with a 0-10 Numerical Rating Scale). The effects of treatment were calculated using linear mixed models. RESULTS A total of 63 patients were recruited. Follow up rate was high (98.4%). Patients were mostly women with moderate levels of pain and disability. Kinesio Taping® was better than the control and placebo groups in only 4 of 96 statistical comparisons, likely reflective of type I error due to multiple comparisons. No statistically significant differences were identified for the immediate reduction in pain intensity between groups. CONCLUSION Kinesio Taping® did not change the electromyographic signal intensity of the longissimus and iliocostalis muscles or reduce pain intensity in patients with chronic low back pain. Clinicaltrials.gov: NCT02759757 (https://clinicaltrials.gov/ct2/show/NCT02759757).
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Hemming R, Sheeran L, van Deursen R, Sparkes V. Investigating differences in trunk muscle activity in non-specific chronic low back pain subgroups and no-low back pain controls during functional tasks: a case-control study. BMC Musculoskelet Disord 2019; 20:459. [PMID: 31638957 PMCID: PMC6805581 DOI: 10.1186/s12891-019-2843-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 09/20/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Trunk muscle dysfunction is often regarded as a key feature of non-specific chronic low back pain (NSCLBP) despite being poorly understood and variable with increases, decreases and no change in muscle activity reported. Differences in thoraco-lumbar kinematics have been observed in motor control impairment NSCLBP subgroups (Flexion Pattern, Active Extension Pattern) during static postures and dynamic activities. However, potential differences in muscle activity during functional tasks has not been established in these subgroups to date. METHODS A case-control study design recruited 50 NSCLBP subjects (27 Flexion Pattern, 23 Active Extension Pattern) and 28 healthy individuals. Surface electromyography determined muscle activity during functional tasks: reaching upwards, step-down, step-up, lifting and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor. Normalised (% sub-maximal voluntary contraction) mean amplitude electromyography of bilateral musculature (transversus abdominis/internal oblique, external oblique, superficial lumbar multifidus and longissimus thoracis) was analysed using Kruskal-Wallis and post-hoc Mann-Whitney U tests. RESULTS Transversus abdominis/internal oblique activity was significantly increased in the Flexion Pattern group compared to controls during stand-to-sit (p = 0.009) on the left side only. External oblique activity was significantly greater in the Active Extension Pattern group compared to controls during box lift (p = 0.016) on the right side only. Significantly greater activity was identified in the right Superficial lumbar multifidus during step up (p = 0.029), reach up (p = 0.013) and box replace (p = 0.007) in the Active Extension Pattern group compared to controls. However left-sided superficial lumbar multifidus activity was significantly greater in the Flexion Pattern group (compared to controls) only during stand-to-sit (p = 0.009). No significant differences were observed in longissimus thoracis activity bilaterally during any task. No significant differences between NSCLBP subgroups were observed. CONCLUSIONS Muscle activity in these NSCLBP subgroups appears to be highly variable during functional tasks with no clear pattern of activity identified. The findings reflect inconsistencies and variability in trunk muscle activity previously observed in these NSCLBP subgroups. Further work evaluating ratios of muscle activity and changes in muscle activity throughout task duration is warranted.
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Affiliation(s)
- Rebecca Hemming
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, 13.20 Eastgate House, 35-43 Newport Road, Cardiff, Wales, CF24 0AB, UK.
| | - Liba Sheeran
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, 13.20 Eastgate House, 35-43 Newport Road, Cardiff, Wales, CF24 0AB, UK
| | - Robert van Deursen
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, 2F25A Cardigan House, Heath Campus, Cardiff, Wales, CF14 4XN, UK
| | - Valerie Sparkes
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Healthcare Sciences, Cardiff University, 13.20 Eastgate House, 35-43 Newport Road, Cardiff, Wales, CF24 0AB, UK
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Total ankle arthroplasty and ankle arthrodesis affect the biomechanics of the inner foot differently. Sci Rep 2019; 9:13334. [PMID: 31527781 PMCID: PMC6746773 DOI: 10.1038/s41598-019-50091-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/05/2019] [Indexed: 02/08/2023] Open
Abstract
Ankle arthrodesis and total ankle arthroplasty are the two primary surgeries for treatment of end-stage degenerative ankle arthritis. The biomechanical effects of them on the inner foot are insufficient to identify which is superior. This study compared biomechanical parameters among a foot treated by ankle arthrodesis, a foot treated by total ankle arthroplasty, and an intact foot using computational analysis. Validated finite element models of the three feet were developed and used to simulate the stance phase of gait. The results showed total ankle arthroplasty provides a more stable plantar pressure distribution than ankle arthrodesis. The highest contact pressure, 3.17 MPa, occurred in the medial cuneonavicular joint in the total ankle arthroplasty foot. Neither of the surgeries resulted in contact pressure increase in the subtalar joint. The peak stress in the metatarsal bones was increased in both surgical models, especially the second and third metatarsals. This study enables us to get visual to the biomechanics inside of an intact foot, and feet treated by total ankle arthroplasty and ankle arthrodesis during walking.
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Sions JM, Crippen DC, Hicks GE, Alroumi AM, Manal TJ, Pohlig RT. Exploring Neuromuscular Electrical Stimulation Intensity Effects on Multifidus Muscle Activity in Adults With Chronic Low Back Pain: An Ultrasound Imaging-Informed Investigation. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119849570. [PMID: 31205429 PMCID: PMC6535907 DOI: 10.1177/1179544119849570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 11/17/2022]
Abstract
Study design: Cross-sectional study. Background: Neuromuscular electrical stimulation (NMES) is an effective tool for stimulating multifidus muscle contractions. Ultrasound imaging (USI) is valid and reliable for quantifying multifidus activity represented by percent thickness change from a resting to contracted state. Thus, USI may be used to help determine optimal NMES intensity. Objectives: To explore NMES intensity effects on multifidus thickening in adults with chronic low back pain (CLBP). Methods: Sixty patients with CLBP participated. L4/5 multifidus ultrasound images were obtained and percent thickness change from a resting to a contracted state was determined at baseline with a limb lift and during NMES application. During NMES, the examiner recorded the intensity, in milliampere, when the multifidus first started to thicken as observed with USI. The examiner also recorded the NMES intensity that resulted in no further multifidus thickening (ie, high-tolerance group) or, in cases where maximal thickening was not observed, the NMES intensity of the submaximal contraction (ie, low-tolerance group). Differences between participants with high versus low NMES tolerance were evaluated. Results: During NMES, the multifidus began thickening at a higher intensity for the high-tolerance group (n = 39), that is, 34 mA, compared with the low-tolerance group (n = 21), that is, 32 mA (P = .001). A greater mean intensity in the high-tolerance group, that is, 62 mA, as compared to 45 mA in the low-tolerance group, resulted in a larger percent thickness change, that is, 30.89% compared to 20.60%, respectively (P < .001). Conclusions: Results provide clinicians with NMES intensity targets to facilitate multifidus muscle thickening, which provides insight into muscle activity.
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Affiliation(s)
- Jaclyn Megan Sions
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - DeJ'a Chyanna Crippen
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Gregory Evan Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Abdulmohsen Meshari Alroumi
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA.,Biomechanics and Movement Science Program, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Tara Jo Manal
- Delaware Physical Therapy Clinic, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Ryan Todd Pohlig
- Dean's Office, College of Health Sciences, University of Delaware, Newark, DE, USA
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Golabchi FN, Sapienza S, Severini G, Reaston P, Tomecek F, Demarchi D, Reaston M, Bonato P. Assessing aberrant muscle activity patterns via the analysis of surface EMG data collected during a functional evaluation. BMC Musculoskelet Disord 2019; 20:13. [PMID: 30611235 PMCID: PMC6320612 DOI: 10.1186/s12891-018-2350-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Surface electromyographic (EMG) recordings collected during the performance of functional evaluations allow clinicians to assess aberrant patterns of muscle activity associated with musculoskeletal disorders. This assessment is typically achieved via visual inspection of the surface EMG data. This approach is time-consuming and leads to accurate results only when the assessment is carried out by an EMG expert. METHODS A set of algorithms was developed to automatically evaluate aberrant patterns of muscle activity. EMG recordings collected during the performance of functional evaluations in 62 subjects (22 to 61 years old) were used to develop and characterize the algorithms. Clinical scores were generated via visual inspection by an EMG expert using an ordinal scale capturing the severity of aberrant patterns of muscle activity. The algorithms were used in a case study (i.e. the evaluation of a subject with persistent back pain following instrumented lumbar fusion who underwent lumbar hardware removal) to assess the clinical suitability of the proposed technique. RESULTS The EMG-based algorithms produced accurate estimates of the clinical scores. Results were primarily obtained using a linear regression approach. However, when the results were not satisfactory, a regression implementation of a Random Forest was utilized, and the results compared with those obtained using a linear regression approach. The root-mean-square error of the clinical score estimates produced by the algorithms was a small fraction of the ordinal scale used to rate the severity of the aberrant patterns of muscle activity. Regression coefficients and associated 95% confidence intervals showed that the EMG-based estimates fit well the clinical scores generated by the EMG expert. When applied to the clinical case study, the algorithms appeared to capture the characteristics of the muscle activity patterns associated with persistent back pain following instrumented lumbar fusion. CONCLUSIONS The proposed approach relies on EMG-based measures to generate accurate estimates of the severity of aberrant patterns of muscle activity. The results obtained in the case study suggest that the proposed technique is suitable to derive clinically-relevant information from EMG data collected during functional evaluations.
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Affiliation(s)
- Fatemeh Noushin Golabchi
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA 02129 USA
| | - Stefano Sapienza
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA 02129 USA
| | - Giacomo Severini
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA 02129 USA
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | | | | | - Danilo Demarchi
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | | | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA 02129 USA
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Kramer A, Kümmel J, Gollhofer A, Armbrecht G, Ritzmann R, Belavy D, Felsenberg D, Gruber M. Plyometrics Can Preserve Peak Power During 2 Months of Physical Inactivity: An RCT Including a One-Year Follow-Up. Front Physiol 2018; 9:633. [PMID: 29896116 PMCID: PMC5987003 DOI: 10.3389/fphys.2018.00633] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/11/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: Inactivity results in a marked loss of muscle function, especially in movements requiring high power, force, and rate of force development. The aim of the present study was to evaluate if jump training can prevent these deteriorating effects of physical inactivity. Methods: Performance and muscle activity during several types of jumps was assessed directly before and after 60 days of bed rest as well as during follow-up visits in 23 male participants. Participants in the jump training group (JUMP, 12 participants) trained 5-6x per week during the bed rest period in a sledge jump system that allows jumps in a horizontal position, whereas the control group (CTRL, 11 participants) did not train. Results: Performance and muscle activity considerably decreased after bed rest in the control group but not in the training group, neither for countermovement jumps (peak power CTRL -31%, JUMP +0%, group × time interaction effect p < 0.001), nor for squat jumps (peak power CTRL -35%, JUMP +1%, p < 0.001) and repetitive hops (peak force CTRL -35%, JUMP -2%, p < 0.001; rate of force development CTRL -53%, JUMP +4%, p < 0.001). The control group's performance had returned to baseline 3 months after bed rest. Conclusion: Despite the short exercise duration, the jump training successfully prevented power and strength losses throughout 2 months of bed rest.Thus, plyometrics can be recommended as an effective and efficient type of exercise for sedentary populations, preventing the deterioration of neuromuscular performance during physical inactivity.
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Affiliation(s)
- Andreas Kramer
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
| | - Jakob Kümmel
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
| | - Albert Gollhofer
- Department of Sports Science, University of Freiburg, Freiburg, Germany
| | - Gabriele Armbrecht
- Center of Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ramona Ritzmann
- Department of Sports Science, University of Freiburg, Freiburg, Germany
| | - Daniel Belavy
- Center of Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Dieter Felsenberg
- Center of Muscle and Bone Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Gruber
- Sensorimotor Performance Lab, University of Konstanz, Konstanz, Germany
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Shamsi M, Sarrafzadeh J, Jamshidi A, Arjmand N, Ghezelbash F. Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients. Clin Biomech (Bristol, Avon) 2017; 48:42-48. [PMID: 28728077 DOI: 10.1016/j.clinbiomech.2017.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/14/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Motor control exercise was claimed to improve spinal stability in patients with chronic non-specific back pain, but to investigate the effectiveness of this exercise, other outcome measures have been used rather than spinal stability itself. The aim of our study is to assess motor control exercise effects on spinal stability using a biomechanical model. METHODS Fifty-one patients were assigned to either motor control or general exercises. Before and after trainings, participants were tested for spinal stability at seven isometric tasks. Electromyography signals were recorded from ten superficial muscles, and a hybrid EMG-driven musculoskeletal model estimated spinal stability indices at each task. FINDINGS Pain and disability significantly decreased in both groups. After trainings, patients had both increase and decrease in stability depending on the task, and stability did not increase/decrease uniformly in all patients. In the motor control group, stability increased at all positions but reached to significance only at right lateral pulling. In the general exercise group, except for pulling the trunk backward, stability decreased at other positions and reached to statistical significance only at pulling the trunk forward. No significant difference between groups was found in changing stability after the intervention. INTERPRETATION Interventions yielded no significant difference in disability, pain and stability index between two groups. Significant increase of stability in the motor control group at right lateral pulling may be attributed to more activity of abdominal muscles, and significant decrease of stability in the general exercise group at forward pulling may be attributed to more optimal activity of back muscles.
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Affiliation(s)
- MohammadBagher Shamsi
- Rehabilitation and Sport Medicine Department, School of Allied Medical Sciences, Kermanshah University of Medical Sciences, Dolat Abad Street, Kermanshah, Iran.
| | - Javad Sarrafzadeh
- Physiotherapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mohseni Square, Tehran, Iran
| | - Aliashraf Jamshidi
- Physiotherapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mohseni Square, Tehran, Iran
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Farshid Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, Canada
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Characteristics of trunk control during crook-lying unilateral leg raising in different types of chronic low back pain patients. Spine (Phila Pa 1976) 2015; 40:550-9. [PMID: 25868094 DOI: 10.1097/brs.0000000000000828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional observational study. OBJECTIVE To quantitatively clarify the characteristics of trunk control during unilateral leg-raising movement in different types of nonspecific chronic low back pain (NS-CLBP) patients who were identified by aggravation of symptoms during trunk movement. SUMMARY OF BACKGROUND DATA Although there is a need to classify NS-CLBP patients for clinical decision making in physical therapy, the characteristics of trunk control during unilateral leg-raising movement in different types of NS-CLBP patients have not been quantitatively analyzed in previous studies by simultaneously measuring the lumbar spine movement, trunk muscle activity, and leg movement. METHODS Thirty NS-CLBP patients, of whom 13 were aggravated by trunk flexion (flexion group) and 17 were aggravated by trunk extension (extension group), and 30 healthy controls performed crook-lying unilateral leg-raising movement on the painful side in patient group and the dominant leg in controls. During the unilateral leg-raising movement, pressure changes produced by the movement of the lumbar lordotic curve, measured by a custom-made recording device, were used as indices of the lumbar spine movement. Trunk muscle activities were recorded by surface electromyography and diagnostic ultrasonography. The pressure changes and trunk muscle activities were statistically compared among the 3 groups. RESULTS At foot-off during unilateral leg-raising movement, the extension group demonstrated increase in pressure changes, whereas the flexion group and controls demonstrated decrease in pressure changes. Bilateral external obliques muscle activities in the extension group were significantly larger than those in the flexion group and controls (P < 0.05). CONCLUSION This study demonstrated that the characteristics of trunk control during unilateral leg-raising movement were different depending on the types of NS-CLBP patients. These results indicate that patients with NS-CLBP might select compensatory trunk control strategies subconsciously to prevent the manifestation of LBP. These results also suggest the importance of the different characteristics of trunk control during active limb movement in the clinical reasoning process for the management of different types of NS-CLBP patients. LEVEL OF EVIDENCE N/A.
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Arbeitsmedizinisch ausgerichtete Normalisierungsverfahren der Oberflächen-Elektromyographie — Ergebnisse einer standardisierten Literaturübersicht. ZENTRALBLATT FUR ARBEITSMEDIZIN ARBEITSSCHUTZ UND ERGONOMIE 2014. [DOI: 10.1007/bf03350862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reeves NP, Popovich JM, Priess MC, Cholewicki J, Choi J, Radcliffe CJ. Reliability of assessing trunk motor control using position and force tracking and stabilization tasks. J Biomech 2014; 47:44-9. [PMID: 24262851 DOI: 10.1016/j.jbiomech.2013.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/08/2013] [Accepted: 10/12/2013] [Indexed: 11/19/2022]
Abstract
System-based methods have been applied to assess trunk motor control in people with and without back pain, although the reliability of these methods has yet to be established. Therefore, the goal of this study was to quantify within- and between-day reliability using systems-based methods involving position and force tracking and stabilization tasks. Ten healthy subjects performed six tasks, involving tracking and stabilizing of trunk angular position in the sagittal plane, and trunk flexion and extension force. Tracking tasks involved following a one-dimensional, time-varying input signal displayed on a screen by changing trunk position (position tracking) or trunk force (force tracking). Stabilization tasks involved maintaining a constant trunk position (position stabilization) or constant trunk force (force stabilization) while a sagittal plane disturbance input was applied to the pelvis using a robotic platform. Time and frequency domain assessments of error (root mean square and H2 norm, respectively) were computed for each task on two separate days. Intra-class correlation coefficients (ICC) for error and coefficients of multiple correlations (CMC) for frequency response curves were used to quantify reliability of each task. Reliability for all tasks was excellent (between-day ICC≥0.8 and CMC>0.75, within-day CMC>0.85). Therefore, position and force control tasks used to assess trunk motor control can be deemed reliable.
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Affiliation(s)
- N Peter Reeves
- MSU Center for Orthopedic Research, Michigan State University, USA; Department of Osteopathic Surgical Specialties, Michigan State University, USA.
| | - John M Popovich
- MSU Center for Orthopedic Research, Michigan State University, USA; Department of Osteopathic Surgical Specialties, Michigan State University, USA
| | - M Cody Priess
- MSU Center for Orthopedic Research, Michigan State University, USA; Department of Mechanical Engineering, Michigan State University, USA
| | - Jacek Cholewicki
- MSU Center for Orthopedic Research, Michigan State University, USA; Department of Osteopathic Surgical Specialties, Michigan State University, USA
| | - Jongeun Choi
- MSU Center for Orthopedic Research, Michigan State University, USA; Department of Mechanical Engineering, Michigan State University, USA; Department of Electrical and Computer Engineering, Michigan State University, USA
| | - Clark J Radcliffe
- MSU Center for Orthopedic Research, Michigan State University, USA; Department of Mechanical Engineering, Michigan State University, USA
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Dupeyron A, Demattei C, Kouyoumdjian P, Missenard O, Micallef JP, Perrey S. Neuromuscular adaptations after a rehabilitation program in patients with chronic low back pain: case series (uncontrolled longitudinal study). BMC Musculoskelet Disord 2013; 14:277. [PMID: 24063646 PMCID: PMC3849067 DOI: 10.1186/1471-2474-14-277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 09/18/2013] [Indexed: 11/27/2022] Open
Abstract
Background To investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations. Methods Case series (uncontrolled longitudinal study). Thirty chronic patients with LBP (21 women and 19 men, mean age 42.6 ± 8.6 years, mean weight 73 ± 14 kg, mean height 174 ± 10 cm) were included. The intervention consisted in a 5-day program including therapeutic education sessions (360 min), supervised abdominal and back muscle strength exercises (240 min), general aerobic training (150 min), stretching (150 min), postural education (150 min) and aqua therapy (150 min). Feedforward activation level and reflex amplitude determined by surface electromyographic activity triggered by postural perturbations were recorded from abdominal and paraspinal muscles in unexpected and expected conditions. Subjects were tested before, just after and again one month after the rehabilitation program. Results No main intervention effect was found on feedforward activation levels and reflex amplitudes underlining the absence of changes in the way patients with LBP reacted across perturbation conditions. However, we observed a shift in the behavioral strategy between conditions, in fact feedforward activation (similar in both conditions before the program) decreased in the unexpected condition after the program, whereas reflex amplitudes became similar in both conditions. Conclusions The results suggest that a short-term rehabilitation program modifies trunk behavioral strategies during postural perturbations. These results can be useful to clinicians for explaining to patients how to adapt to daily life activities before and after rehabilitation.
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Affiliation(s)
- Arnaud Dupeyron
- Movement to Health (M2H), Montpellier-1 University, Euromov, 700, Avenue du Pic Saint-Loup, 34090, Montpellier, France.
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Donovan TE, Anderson M, Becker W, Cagna DR, Carr GB, Albouy JP, Metz J, Eichmiller F, McKee JR. Annual Review of selected dental literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2013; 110:161-210. [DOI: 10.1016/s0022-3913(13)60358-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Dufour JS, Marras WS, Knapik GG. An EMG-assisted model calibration technique that does not require MVCs. J Electromyogr Kinesiol 2013; 23:608-13. [DOI: 10.1016/j.jelekin.2013.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022] Open
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Frost LR, Gerling ME, Markic JL, Brown SH. Exploring the effect of repeated-day familiarization on the ability to generate reliable maximum voluntary muscle activation. J Electromyogr Kinesiol 2012; 22:886-92. [DOI: 10.1016/j.jelekin.2012.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/16/2012] [Accepted: 05/18/2012] [Indexed: 11/16/2022] Open
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