Electromechanical delay components during skeletal muscle contraction and relaxation in patients with myotonic dystrophy type 1

Synergistic difference in the effect of stretching on electromechanical delay components

This study investigated the synergistic difference in the effect of stretching on electromechanical delay (EMD) and its components, using a simultaneous recording of electromyographic, mechanomyographic, and force signals. Twenty-six healthy men underwent plantar flexors passive stretching. Before and after stretching, the electrochemical and mechanical components of the EMD and the relaxation EMD (R-EMD) were calculated in gastrocnemius medialis (GM), lateralis (GL) and soleus (SOL) during a supramaximal motor point stimulation. Additionally, joint passive stiffness was assessed. At baseline, the mechanical components of EMD and R-EMD were longer in GM and GL than SOL (Cohen's d from 1.78 to 3.67). Stretching decreased joint passive stiffness [-22(8)%, d = -1.96] while overall lengthened the electrochemical and mechanical EMD. The mechanical R-EMD components were affected more in GM [21(2)%] and GL [22(2)%] than SOL [12(1)%], with d ranging from 0.63 to 1.81. Negative correlations between joint passive stiffness with EMD and R-EMD mechanical components were found before and after stretching in all muscles (r from -0.477 to -0.926; P from 0.007 to <0.001). These results suggest that stretching plantar flexors affected GM and GL more than SOL. Future research should calculate EMD and R-EMD to further investigate the mechanical adaptations induced by passive stretching in synergistic muscles.

A Conceptual Exploration of Hamstring Muscle-Tendon Functioning during the Late-Swing Phase of Sprinting: The Importance of Evidence-Based Hamstring Training Frameworks

An eccentrically lengthening, energy-absorbing, brake-driven model of hamstring function during the late-swing phase of sprinting has been widely touted within the existing literature. In contrast, an isometrically contracting, spring-driven model of hamstring function has recently been proposed. This theory has gained substantial traction within the applied sporting world, influencing understandings of hamstring function while sprinting, as well as the development and adoption of certain types of hamstring-specific exercises. Across the animal kingdom, both spring- and motor-driven muscle-tendon unit (MTU) functioning are frequently observed, with both models of locomotive functioning commonly utilising some degree of active muscle lengthening to draw upon force enhancement mechanisms. However, a method to accurately assess hamstring muscle-tendon functioning when sprinting does not exist. Accordingly, the aims of this review article are three-fold: (1) to comprehensively explore current terminology, theories and models surrounding muscle-tendon functioning during locomotion, (2) to relate these models to potential hamstring function when sprinting by examining a variety of hamstring-specific research and (3) to highlight the importance of developing and utilising evidence-based frameworks to guide hamstring training in athletes required to sprint. Due to the intensity of movement, large musculotendinous stretches and high mechanical loads experienced in the hamstrings when sprinting, it is anticipated that the hamstring MTUs adopt a model of functioning that has some reliance upon active muscle lengthening and muscle actuators during this particular task. However, each individual hamstring MTU is expected to adopt various combinations of spring-, brake- and motor-driven functioning when sprinting, in accordance with their architectural arrangement and activation patterns. Muscle function is intricate and dependent upon complex interactions between musculoskeletal kinematics and kinetics, muscle activation patterns and the neuromechanical regulation of tensions and stiffness, and loads applied by the environment, among other important variables. Accordingly, hamstring function when sprinting is anticipated to be unique to this particular activity. It is therefore proposed that the adoption of hamstring-specific exercises should not be founded on unvalidated claims of replicating hamstring function when sprinting, as has been suggested in the literature. Adaptive benefits may potentially be derived from a range of hamstring-specific exercises that vary in the stimuli they provide. Therefore, a more rigorous approach is to select hamstring-specific exercises based on thoroughly constructed evidence-based frameworks surrounding the specific stimulus provided by the exercise, the accompanying adaptations elicited by the exercise, and the effects of these adaptations on hamstring functioning and injury risk mitigation when sprinting.

Influence of age on force and re-lengthening dynamics after tetanic stimulation withdrawal in the tibialis anterior muscle

PURPOSE

During alternate movements across a joint, the changeover from one direction of rotation to the opposite may be influenced by the delay and rate of tension reduction and the compliance to re-lengthening of the previously active muscle group. Given the aging process may affect the above-mentioned factors, this work aimed to compare the dynamics of both the ankle torque decline and muscle re-lengthening, mirrored by mechanomyogram (MMG), in the tibialis anterior because of its important role in gait.

METHODS

During the relaxation phase, after a supramaximal 35 Hz stimulation applied at the superficial motor point, in 20 young (Y) and 20 old (O) subjects, the torque (T) and MMG dynamics characteristics were measured.

RESULTS

The T and MMG analysis provided: (I) the beginning of the decay after cessation of stimulation (T: 22.51 ± 5.92 ms [Y] and 51.35 ± 15.21 ms [O]; MMG: 27.38 ± 6.93 ms [Y] and 61.41 ± 18.42 ms [O]); (II) the maximum rate of reduction (T: - 110.4 ± 45.56 Nm/s [Y] and - 52.72 ± 32.12 Nm/s [O]; MMG: - 24.47 ± 10.95 mm/s [Y] and - 13.76 ± 6.54 mm/s [O]); (III) the muscle compliance, measuring the MMG reduction of every 10% reduction of torque (bin 20-10%: 15.69 ± 7.5[Y] and 10.8 ± 3.3 [O]; bin 10-0%: 22.12 ± 10.3 [Y] and 17.58 ± 5.6 [O]).

CONCLUSION

Muscle relaxation results are different in Y and O and can be monitored by a non-invasive method measuring physiological variables of torque and re-lengthening dynamics at the end of the electromechanical coupling previously induced by the neuromuscular stimulation.

Assessing Quadriceps Muscle Contraction Using a Novel Surface Mechanomyography Sensor during Two Neuromuscular Control Screening Tasks

Electromyography (EMG) is the clinical standard for capturing muscle activation data to gain insight into neuromuscular control, yet challenges surrounding data analysis limit its use during dynamic tasks. Surface mechanomyography (sMMG) sensors are novel wearable devices that measure the physical output of muscle excursion during contraction, which may offer potential easy application to assess neuromuscular control. This study aimed to investigate sMMG detection of the timing patterns of muscle contraction compared to EMG. Fifteen healthy participants (mean age = 31.7 ± 9.1 y; eight males and seven females) were donned with EMG and sMMG sensors on their right quadriceps for simultaneous data capture during bilateral deep squats, and a subset performed three sets of repeated unilateral partial squats. No significant difference in the total duration of contraction was detected by EMG and sMMG during bilateral (p = 0.822) and partial (p = 0.246) squats. sMMG and EMG timing did not differ significantly for eccentric (p = 0.414) and concentric (p = 0.462) phases of muscle contraction during bilateral squats. The sMMG magnitude of quadriceps excursion demonstrated excellent intra-session retest reliability for bilateral (ICC_3,1 = 0.962 mm) and partial (ICC_3,1 = 0.936 mm, n = 10) squats. The sMMG sensors accurately and consistently provided key quadriceps muscle performance metrics during two physical activities commonly used to assess neuromuscular control for injury prevention, rehabilitation, and exercise training.

Inducible deletion of raptor and mTOR from adult skeletal muscle impairs muscle contractility and relaxation

Skeletal muscle weakness has been associated with different pathological conditions, including sarcopenia and muscular dystrophy, and is accompanied by altered mammalian target of rapamycin (mTOR) signalling. We wanted to elucidate the functional role of mTOR in muscle contractility. Most loss-of-function studies for mTOR signalling have used the drug rapamycin to inhibit some of the signalling downstream of mTOR. However, given that rapamycin does not inhibit all mTOR signalling completely, we generated a double knockout for mTOR and for the scaffold protein of mTORC1, raptor, in skeletal muscle. We found that double knockout in mice results in a more severe phenotype compared with deletion of raptor or mTOR alone. Indeed, these animals display muscle weakness, increased fibre denervation and a slower muscle relaxation following tetanic stimulation. This is accompanied by a shift towards slow-twitch fibres and changes in the expression levels of calcium-related genes, such as Serca1 and Casq1. Double knockout mice show a decrease in calcium decay kinetics after tetanus in vivo, suggestive of a reduced calcium reuptake. In addition, RNA sequencing analysis revealed that many downregulated genes, such as Tcap and Fhod3, are linked to sarcomere organization. These results suggest a key role for mTOR signalling in maintaining proper fibre relaxation in skeletal muscle. KEY POINTS: Skeletal muscle wasting and weakness have been associated with different pathological conditions, including sarcopenia and muscular dystrophy, and are accompanied by altered mammalian target of rapamycin (mTOR) signalling. Mammalian target of rapamycin plays a crucial role in the maintenance of muscle mass and functionality. We found that the loss of both mTOR and raptor results in contractile abnormalities, with severe muscle weakness and delayed relaxation following tetanic stimulation. These results are associated with alterations in the expression of genes involved in sarcomere organization and calcium handling and with an impairment in calcium reuptake after contraction. Taken together, these results provide a mechanistic insight into the role of mTOR in muscle contractility.

Kinematics of individual muscle units in natural contractions measured in vivo using ultrafast ultrasound

OBJECTIVE

The study of human neuromechanical control at the motor unit (MU) level has predominantly focussed on electrical activity and force generation, whilst the link between these, i.e., the muscle deformation, has not been widely studied. To address this gap, we analysed the kinematics of muscle units in natural contractions.

APPROACH

We combined high-density surface electromyography (HDsEMG) and ultrafast ultrasound (US) recordings, at 1000 frames per second, from the tibialis anterior muscle to measure the motion of the muscular tissue caused by individual MU contractions. The MU discharge times were identified online by decomposition of the HDsEMG and provided as biofeedback to 12 subjects who were instructed to keep the MU active at the minimum discharge rate (9.8 ± 4.7 pulses per second; force less than 10% of the maximum). The series of discharge times were used to identify the velocity maps associated with 51 single muscle unit movements with high spatio-temporal precision, by a novel processing method on the concurrently recorded US images. From the individual MU velocity maps, we estimated the region of movement, the duration of the motion, the contraction time, and the excitation-contraction (E-C) coupling delay.

MAIN RESULTS

Individual muscle unit motions could be reliably identified from the velocity maps in 10 out of 12 subjects. The duration of the motion, total contraction time, and E-C coupling were 17.9 ± 5.3 ms, 56.6 ± 8.4 ms, and 3.8 ± 3.0 ms (n = 390 across 10 participants). The experimental measures also provided the first evidence of muscle unit twisting during voluntary contractions and MU territories with distinct split regions.

SIGNIFICANCE

The proposed method allows for the study of kinematics of individual MU twitches during natural contractions. The described measurements and characterisations open new avenues for the study of neuromechanics in healthy and pathological conditions.

Dynamic magnetic resonance imaging of muscle contraction in facioscapulohumeral muscular dystrophy

Quantitative muscle MRI (water-T2 and fat mapping) is being increasingly used to assess disease involvement in muscle disorders, while imaging techniques for assessment of the dynamic and elastic muscle properties have not yet been translated into clinics. In this exploratory study, we quantitatively characterized muscle deformation (strain) in patients affected by facioscapulohumeral muscular dystrophy (FSHD), a prevalent muscular dystrophy, by applying dynamic MRI synchronized with neuromuscular electrical stimulation (NMES). We evaluated the quadriceps muscles in 34 ambulatory patients and 13 healthy controls, at 6-to 12-month time intervals. While a subgroup of patients behaved similarly to controls, for another subgroup the median strain decreased over time (approximately 57% over 1.5 years). Dynamic MRI parameters did not correlate with quantitative MRI. Our results suggest that the evaluation of muscle contraction by NMES-MRI is feasible and could potentially be used to explore the elastic properties and monitor muscle involvement in FSHD and other neuromuscular disorders.

Static Postural Control Deficits in Adults with Myotonic Dystrophy Type 1, Steinert Disease

BACKGROUND

Myotonic dystrophy type 1 (DM1) is characterized by progressive and predominantly distal muscle atrophy and myotonia. Gait and balance impairments, resulting in falls, are frequently reported in this population. However, the extent to which individuals with DM1 rely more on a specific sensory system for balance than asymptomatic individuals (AI) is unknown.

OBJECTIVE

Evaluate postural control performance in individuals with DM1 and its dependence on vision compared to AI.

METHODS

20 participants with DM1, divided into two groups based on their diagnosis, i.e. adult and congenital phenotype, and 12 AI participants were recruited. Quiet standing postural control was assessed in two visual conditions: eyes-open and eyes-closed. The outcomes measures were center of pressure (CoP) mean velocity, CoP range of displacement in anteroposterior and mediolateral axis, and the 95% confidence ellipse's surface. Friedman and Kruskal-Wallis analysis of variance were used to compare outcomes between conditions and groups, respectively.

RESULTS

Significant group effect and condition effect were observed on postural control performance. No significant difference was observed between the two DM1 groups. The significant differences observed between the AI group and the two DM1 groups in the eyes-open condition were also observed in the eyes-closed condition.

CONCLUSIONS

The result revealed poorer postural control performance in people with DM1 compared to AI. The DM1 group also showed similar decrease in performance than AI in eyes-closed condition, suggesting no excessive visual dependency.

Investigation of surface electromyography amplitude values during stair climbing task in children with Duchenne muscular dystrophy

OBJECTIVE

The aims of this study were (a) to examine the surface electromyography (sEMG) amplitude values of the lower limb muscles during stair climbing both between different functional levels of Duchenne muscular dystrophy (DMD), in comparison with healthy children, and (b) to investigate the relationships between sEMG amplitudes and physical performance.

METHODS

sEMG amplitudes of the lower limbs of twenty-one children with DMD between levels I and III according to the Brooke Lower Extremity Functional Classification Scale and eleven healthy peers were evaluated by using sEMG during stair climbing task. Physical performance was evaluated by 6-min walk test and ascending 4-step timed performance test.

RESULTS

The lower limb sEMG amplitude values of children with DMD were statistically higher than healthy children (p < 0.001). sEMG amplitudes of the right (p = 0.01) and left (p = 0.003) biceps femoris, the right (p < 0.001) and left (p = 0.001) gastrocnemius medialis, and the right vastus lateralis (p = 0.02) muscles were higher in children with levels 2-3 than those in level 1. Moderate-to-strong relations were found between the gastrocnemius medialis and biceps femoris sEMG amplitudes and physical performance assessments (p < 0.05).

CONCLUSION

Increased sEMG amplitude values in the lower limbs during stair climbing task are thought to be caused by the effort to compensate for progressive muscle weakness and are associated with lower physical performance in children with DMD. Further, sEMG amplitude values are determined to increase as the functional level deteriorates.

CLINICAL TRIAL REGISTRATION NUMBER AND URL

NCT04287582 ( https://clinicaltrials.gov/ct2/show/NCT04287582?term=merve+bora&draw=2&rank=1 ).

Passive stretching decreases muscle efficiency in balance tasks

The current study aimed to verify whether or not passive static stretching affects balance control capacity. Thirty-eight participants (19 women and 19 men) underwent a passive static stretching session, involving the knee extensor/flexor and dorsi/plantarflexor muscles, and a control session (no stretching, CTRL). Before (PRE), immediately after (POST), after 15 (POST15) and 30 min (POST30) from stretching (or rest in CTRL), balance control was evaluated under static and dynamic conditions, with open/closed eyes, and with/without somatosensory perturbation (foam under the feet). During tests, centre of pressure (CoP) sway area and perimeter and antero-posterior and medio-lateral sway mean speed were computed. Surface electromyography root mean square (sEMG RMS) was calculated from the vastus lateralis, biceps femoris, gastrocnemius medialis, and tibialis anterior muscles during MVC and during the balance tests. Hip flexion/extension and dorsi/plantarflexion range of motion (ROM), maximum voluntary contraction (MVC) and sEMG RMS during MVC were measured at the same time points. After stretching, ROM increased (≈6.5%; P<0.05), while MVC and sEMG RMS decreased (≈9% and ≈7.5%, respectively; P<0.05). Regardless of the testing condition, CoP sway area and the perimeter remained similar, while antero-posterior and medio-lateral sway mean speed decreased by ≈8% and ≈12%, respectively (P<0.05). sEMG RMS during the balance tests increased in all muscles in POST (≈7%, P<0.05). All variables recovered in POST30. No changes occurred in CTRL. Passive static stretching did not affect the overall balance control ability. However, greater muscle activation was required to maintain similar CoP sway, thus suggesting a decrease in muscle efficiency.

Effects of 4-weeks of elastic variable resistance training on the electrochemical and mechanical components of voluntary electromechanical delay durations

PURPOSE

Literature is conflicted on whether electromechanical delay durations decrease following resistance training programs. Therefore, the aim of this study is to examine the contributions and durations of the electrochemical (EMD_E-M) and mechanical (EMD_M-F) components to the overall electromechanical delay (EMD_E-F) during step isometric muscle actions following 4-weeks of structured, multi-joint, lower-body variable resistance training (VRT) program.

METHODS

Twelve men performed 4-weeks of VRT leg press training utilizing combination of steel plates (80% total load) and elastic bands (20% total load). Training consisted of 3 sets of 10 repetitions at a 10 repetition maximum load, 3 day week^-1 for 4-weeks. EMD_E-M, EMD_M-F, and EMD_E-F was measured at Baseline, Week-2, and Week-4 during voluntary step isometric muscle actions (20, 40, 60, 80, and 100% of maximal voluntary isometric contraction) from the vastus lateralis using electromyographic, mechanomyographic, and force signals.

RESULTS

The EMD_E-M, EMD_M-F, and EMD_E-F exhibited decreases in duration following 4-weeks of VRT. In addition, EMD_E-M contributed significantly less (42-47%) than EMD_M-F (53-58%) to the total duration of EMD_E-F across the 4-weeks of VRT.

CONCLUSIONS

These findings indicated that a structured, VRT program utilizing multi-joint exercise was sufficient to induce decreases in the electrochemical and mechanical processes associated with step isometric muscle contractions. In addition, the utilization of the electromyographic, mechanomyographic, and force signals were capable of quantifying electrochemical and mechanical component changes associated with voluntary muscle contraction. Thus, EMD_E-M, EMD_M-F, and EMD_E-F can be useful in quantifying physiological changes in athletic, clinical, and applied research interventions.

Multifocal Noninvasive Magnetic Stimulation of the Primary Motor Cortex in Type 1 Myotonic Dystrophy -A Proof of Concept Pilot Study

BACKGROUND

Repeated neuromuscular electrical stimulation in type 1 Myotonic Dystrophy (DM1) has previously been shown to cause an increase in strength and a decrease in hyperexcitability of the tibialis anterior muscle.

OBJECTIVE

In this proof-of-principle study our objective was to test the hypothesis that noninvasive repetitive transcranial magnetic stimulation of the primary motor cortex (M1) with a new portable wearable multifocal stimulator causes improvement in muscle function in DM1 patients.

METHODS

We performed repetitive stimulation of M1, localized by magnetic resonance imaging, with a newly developed Transcranial Rotating Permanent Magnet Stimulator (TRPMS). Using a randomized within-patient placebo-controlled double-blind TRPMS protocol, we performed unilateral active stimulation along with contralateral sham stimulation every weekday for two weeks in 6 adults. Methods for evaluation of muscle function involved electromyography (EMG), hand dynamometry and clinical assessment using the Medical Research Council scale.

RESULTS

All participants tolerated the treatment well. While there were no significant changes clinically, EMG showed significant improvement in nerve stimulus-evoked compound muscle action potential amplitude of the first dorsal interosseous muscle and a similar but non-significant trend in the trapezius muscle, after a short exercise test, with active but not sham stimulation.

CONCLUSIONS

We conclude that two-week repeated multifocal cortical stimulation with a new wearable transcranial magnetic stimulator can be safely conducted in DM1 patients to investigate potential improvement of muscle strength and activity. The results obtained, if confirmed and extended by future safety and efficacy trials with larger patient samples, could offer a potential supportive TRPMS treatment in DM1.

Muscle Ultrasound Shear Wave Elastography as a Non-Invasive Biomarker in Myotonia

Myotonia, i.e., delayed muscle relaxation in certain hereditary muscle disorders, can be assessed quantitatively using different techniques ranging from force measurements to electrodiagnostics. Ultrasound shear wave elastography (SWE) has been proposed as a novel tool in biomechanics and neuromuscular medicine for the non-invasive estimation of muscle elasticity and, indirectly, muscle force. The aim of this study is to provide ‘proof-of-principle’ that SWE allows a quantitative measurement of the duration of delayed muscle relaxation in myotonia in a simple clinical setting. In six myotonic muscle disorder patients and six healthy volunteers, shear wave velocities (SWV) parallel to the fiber orientation in the flexor digitorum superficialis muscle in the forearm were recorded with a temporal resolution of one per second during fist-clenching and subsequent relaxation; the relaxation time to 10% of normalized shear wave velocity (RT_0.1) was calculated. Forty-six SWE imaging sequences were acquired, yielding a mean RT_0.1 of 7.38 s in myotonic muscle disorder patients, significantly higher than in healthy volunteers (1.36 s), which is comparable to data obtained by mechanical dynamometry. SWV measurements during the baseline relaxation and voluntary contraction phases did not differ significantly between groups. We conclude that SWE is a promising, non-invasive, widely available tool for the quantitative assessment of myotonia to aid in diagnosis and therapeutic monitoring.

3D Muscle Deformation Mapping at Submaximal Isometric Contractions: Applications to Aging Muscle

3D strain or strain rate tensor mapping comprehensively captures regional muscle deformation. While compressive strain along the muscle fiber is a potential measure of the force generated, radial strains in the fiber cross-section may provide information on the material properties of the extracellular matrix. Additionally, shear strain may potentially inform on the shearing of the extracellular matrix; the latter has been hypothesized as the mechanism of lateral transmission of force. Here, we implement a novel fast MR method for velocity mapping to acquire multi-slice images at different % maximum voluntary contraction (MVC) for 3D strain mapping to explore deformation in the plantar-flexors under isometric contraction in a cohort of young and senior subjects. 3D strain rate and strain tensors were computed and eigenvalues and two invariants (maximum shear and volumetric strain) were extracted. Strain and strain rate indices (contractile and in-plane strain/strain rate, shear strain/strain rate) changed significantly with %MVC (30 and 60% MVC) and contractile and shear strain with age in the medial gastrocnemius. In the soleus, significant differences with age in contractile and shear strain were seen. Univariate regression revealed weak but significant correlation of in-plane and shear strain and shear strain rate indices to %MVC and correlation of contractile and shear strain indices to force. The ability to map strain tensor components provides unique insights into muscle physiology: with contractile strain providing an index of the force generated by the muscle fibers while the shear strain could potentially be a marker of lateral transmission of force.

Longer electromechanical delay in paretic triceps surae muscles during voluntary isometric plantarflexion torque generation in chronic hemispheric stroke survivors

Electromechanical delay (EMD) is the time delay between the onset of muscle activity and the onset of force/joint torque. This delay appears to be linked to muscular contraction efficiency. However, to our knowledge, limited evidence is available regarding the magnitude of the EMD in stroke-impaired muscles. Accordingly, this study aims to quantify the EMD in both paretic and non-paretic triceps surae muscles of chronic hemispheric stroke survivors, and to investigate whether the EMD is related to voluntary force-generating capacity in this muscle group. Nine male chronic stroke survivors were asked to perform isometric plantarflexion contractions at different force levels and at different ankle joint angles ranging from maximum plantarflexion to maximum dorsiflexion. The surface electromyograms were recorded from triceps surae muscles. The longest EMD among triceps surae muscles was chosen as the EMD for each side. Our results revealed that the EMD in paretic muscles was significantly longer than in non-paretic muscles. Moreover, both paretic and non-paretic muscles showed a negative correlation between the EMD and maximum torque-generating capacity. In addition, there was a strong positive relationship between the EMD and shear wave speed in paretic muscles as well as a negative relationship between the EMD and passive ankle joint range of motion. These findings imply that the EMD may be a useful biomarker, in part, associated with contractile and material properties in stroke-impaired muscles.

Myotonic dystrophy type 1 alters muscle twitch properties, spinal reflexes, and perturbation-induced trans-cortical reflexes

BACKGROUND

Neurophysiologic biomarkers are needed for clinical trials of therapies for myotonic dystrophy (DM1). We characterized muscle properties, spinal reflexes (H-reflexes), and trans-cortical long-latency reflexes (LLRs) in a cohort with mild/moderate DM1.

METHODS

Twenty-four people with DM1 and 25 matched controls underwent assessment of tibial nerve H-reflexes and soleus muscle twitch properties. Quadriceps LLRs were elicited by delivering an unexpected perturbation during a single-limb squat (SLS) visuomotor tracking task.

RESULTS

DM1 was associated with decreased H-reflex depression. The efficacy of doublet stimulation was enhanced, yielding an elevated double-single twitch ratio. DM1 participants demonstrated greater error during the SLS task. DM1 individuals with the least-robust LLR responses showed the greatest loss of spinal H-reflex depression.

CONCLUSIONS

DM1 is associated with abnormalities of muscle twitch properties. Co-occurring alterations of spinal and trans-cortical reflex properties underscore the central nervous system manifestations of this disorder and may assist in gauging efficacy during clinical trials.

Fatigue in complete spinal cord injury and implications on total delay

The use of neuromuscular electrical stimulation (NMES) to artificially restore movement in people with complete spinal cord injury (SCI) induces an accelerated process of muscle fatigue. Fatigue increases the time between the beginning of NMES and the onset of muscle force (Delay_TOT ). Understanding how much muscle fatigue affects the Delay_TOT in people with SCI could help in the design of closed-loop neuroprostheses that compensate for this delay, thus making the control system more stable. The aim of this study was to evaluate the impact of the extent of fatigue on Delay_TOT and peak force of the lower limbs in people with complete SCI. Fifteen men-young adults with complete SCI (paraplegia and tetraplegia) and stable health-participated in the experiment. Delay_TOT was defined as the time interval between the beginning of NMES application until the onset of muscle force. The electrical intensity of NMES applied was adjusted individually and consisted of the amplitude required to obtain a full extension of the knee (0°), considering the maximum electrically stimulated extension (MESE). Subsequently, 70% of the MESE was applied during the fatigue induction protocol. Significant differences were identified between the moments before and after the fatigue protocol, both for peak force (P ≤ .026) and Delay_TOT (P ≤ .001). The medians and interquartile range of the Delay_TOT were higher in postfatigue (199.0 ms) when compared to the moment before fatigue (146.5 ms). The medians and interquartile range of the peak force were higher in unfatigued lower limbs (0.43 kgf) when compared to the moment postfatigue (0.27 kgf). The results support the hypothesis that muscle fatigue influences the increase in Delay_TOT and decrease in force production in people with SCI. For future applications, the combined evaluation of the delay and force in SCI patients provides valuable feedback for NMES paradigms. The study will provide potentially critical muscle mechanical evidence for the investigation of the evolution of atrophy.

Characterization of Electromechanical Delay Based on a Biophysical Multi-Scale Skeletal Muscle Model

Skeletal muscles can be voluntary controlled by the somatic nervous system yielding an active contractile stress response. Thereby, the active muscle stresses are transmitted to the skeleton by a cascade of connective tissue and thus enable motion. In the context of joint perturbations as well as the assessment of the complexity of neural control, the initial phase of the muscle-tendon system's stress response has a particular importance and is analyzed by means of electromechanical delay (EMD). EMD is defined as the time lag between the stimulation of a muscle and a measurable change in force output. While EMD is believed to depend on multiple structures / phenomena, it is hard to separate their contributions experimentally. We employ a physiologically detailed, three-dimensional, multi-scale model of an idealized muscle-tendon system to analyze the influence of (i) muscle and tendon length, (ii) the material behavior of skeletal muscle and tendon tissue, (iii) the chemo-electro-mechanical behavior of the muscle fibers and (iv) neural control on EMD. Comparisons with experimental data show that simulated EMD values are within the physiological range, i.e., between 6.1 and 68.6 ms, and that the model is able to reproduce the characteristic EMD-stretch curve, yielding the minimum EMD at optimal length. Simulating consecutive recruitment of motor units increases EMD by more than 20 ms, indicating that during voluntary contractions neural control is the dominant factor determining EMD. In contrast, the muscle fiber action potential conduction velocity is found to influence EMD even of a 27 cm long muscle by not more than 3.7 ms. We further demonstrate that in conditions where only little pre-stretch is applied to a muscle-tendon system, the mechanical behavior of both muscle and tendon tissue considerably impacts EMD. Predicting EMD for different muscle and tendon lengths indicates that the anatomy of a specific muscle-tendon system is optimized for its function, i.e., shorter tendon lengths are beneficial to minimize the neural control effort for muscles primary acting as motor in concentric contractions.

Oropharyngeal dysphagia in early stages of myotonic dystrophy type 1

INTRODUCTION

Myotonic dystrophy type 1 (DM1) is a multisystemic disorder characterized mainly by skeletal muscle alterations. Although oropharyngeal dysphagia is a prominent clinical feature of DM1, it remains poorly studied in its early disease stages.

METHODS

Dysphagia was investigated in 11 presymptomatic DM1 carriers, 14 patients with DM1 and 12 age-matched healthy controls, by using fiberoptic endoscopic evaluation of swallowing (FEES) and clinical scores.

RESULTS

Scores for the FEES variables, delayed pharyngeal reflex, posterior pooling, and postswallow residue were significantly greater in patients with DM1 and in presymptomatic DM1 carriers than in healthy controls (P < 0.05); oropharyngeal dysfunction was more severe in patients than in presymptomatic carriers. Penetration/aspiration was found altered exclusively in patients with DM1 (P < 0.05).

DISCUSSION

Swallowing dysfunction occurs in presymptomatic DM1 carriers. Timely diagnosis of dysphagia in preclinical stages of the disease will aid in the timely management of presymptomatic carriers, potentially preventing medical complications. Muscle Nerve, 2019.

A Piezoresistive Sensor to Measure Muscle Contraction and Mechanomyography

Measurement of muscle contraction is mainly achieved through electromyography (EMG) and is an area of interest for many biomedical applications, including prosthesis control and human machine interface. However, EMG has some drawbacks, and there are also alternative methods for measuring muscle activity, such as by monitoring the mechanical variations that occur during contraction. In this study, a new, simple, non-invasive sensor based on a force-sensitive resistor (FSR) which is able to measure muscle contraction is presented. The sensor, applied on the skin through a rigid dome, senses the mechanical force exerted by the underlying contracting muscles. Although FSR creep causes output drift, it was found that appropriate FSR conditioning reduces the drift by fixing the voltage across the FSR and provides voltage output proportional to force. In addition to the larger contraction signal, the sensor was able to detect the mechanomyogram (MMG), i.e., the little vibrations which occur during muscle contraction. The frequency response of the FSR sensor was found to be large enough to correctly measure the MMG. Simultaneous recordings from flexor carpi ulnaris showed a high correlation (Pearson's r > 0.9) between the FSR output and the EMG linear envelope. Preliminary validation tests on healthy subjects showed the ability of the FSR sensor, used instead of the EMG, to proportionally control a hand prosthesis, achieving comparable performances.

Crouch gait can be an effective form of forced-use/no constraint exercise for the paretic lower limb in stroke

In hemiplegic gait the paretic lower limb provides less muscle power and shows a briefer stance compared with the unaffected limb. Yet, a longer stance and a higher power can be obtained from the paretic lower limb if gait speed is increased. This supports the existence of a ‘learned non-use’ phenomenon, similar to that underlying some asymmetric impairments of the motion of the eyes and of the upper limbs. Crouch gait (CG) (bent-hip bent-knee, about 30° minimum knee flexion) might be an effective form of ‘forced-use’ treatment of the paretic lower limb. It is not known whether it also stimulates a more symmetric muscle power output. Gait analysis on a force treadmill was carried out in 12 healthy adults and seven hemiplegic patients (1–127 months after stroke, median: 1.6). Speed was imposed at 0.3 m/s. Step length and single and double stance times, sagittal joint rotations, peak positive power, and work in extension of the hip, knee, and ankle (plantar flexion), and surface electromyography (sEMG) area from extensor muscles during the generation of power were measured on either side during both erect and crouch walking. Significance was set at P less than 0.05; corrections for multiplicity were applied. Patients, compared with healthy controls, adopted in both gait modalities and on both sides a shorter step length (61–84%) as well as a shorter stance (76–90%) and swing (63–83%) time. As a rule, they also provided a higher muscular work (median: 137%, range: 77–250%) paralleled by a greater sEMG area (median: 174%, range: 75–185%). In erect gait, the generation of peak extensor power across hip, knee, and ankle joints was in general lower (83–90%) from the paretic limb and higher (98–165%) from the unaffected limb compared with control values. In CG, peak power generation across the three lower limb joints was invariably higher in hemiparetic patients: 107–177% from the paretic limb and 114–231% from the unaffected limb. When gait shifted from erect to crouch, only for hemiplegic patients, at the hip, the paretic/unaffected ratio increased significantly. For peak power, work, sEMG area, and joint rotation, the paretic/unaffected ratio increased from 55 to 85%, 56 to 72%, 68 to 91%, and 67 to 93%, respectively. CG appears to be an effective form of forced-use exercise eliciting more power and work from the paretic lower limb muscles sustained by a greater neural drive. It also seems effective in forcing a more symmetric power and work from the hip extensor muscles, but neither from the knee nor the ankle.

Acute effects of direct inhibitory pressure over the biceps brachii myotendinous junction on skeletal muscle activation and force output

Force (F) reduction is reported with myotendinous junction (MTJ) manipulation. Autogenic inhibition reflex (AIR) activation is supposed to be the main mechanism. Still, its role remains unclear. The study aimed at assessing the effects of MTJ direct inhibitory pressure (DIP) on neuromuscular activation and F in the elbow flexor (agonist) and extensor (antagonist) muscles. After maximum voluntary contraction (MVC) assessment, thirty-five participants randomly performed submaximal contractions at 20, 40, 60, and 80% MVC. Electromyographic (EMG), mechanomyographic (MMG), and F signals were recorded. Protocol was repeated under (i) DIP (10-s pressure on the biceps brachii MTJ) with the elbow at 120° (DIP₁₂₀), (ii) DIP with the elbow at 180° (DIP₁₈₀), and (iii) without DIP (Ctrl). Electromechanical delay (EMD) components, EMG and MMG root mean square (RMS), and rate of force development (RFD) were calculated. Independently from the angle, DIP induced decrements in MVC, RFD, and RMS of EMG and MMG signals and lengthened the EMD components in agonist muscles (P<0.05). The DIP-induced decrease in F output of the agonist muscles seems to be possibly due to a concomitant impairment of the neuromuscular activation and a transient decrease in stiffness. After DIP, the antagonist muscle displayed no changes; therefore, the intervention of AIR remains questionable.

Reaction time can be measured during voluntary contractions with electrode array

Reaction time (RT) is classically divided into premotor time (PMT) and electromechanical delay (EMD). However, the determination of the onset of electromyographic activity (EMG) during voluntary contraction remains questionable. In addition, the reliability of RT, PMT and EMD needs to be determined. Twelve participants performed two sessions of RT trials, separated by 5 min. RT was evaluated during voluntary isometric contractions of the elbow flexors, i.e., time between a light signal (stimulus) and the onset of the mechanical response. To assess EMD, an electrode array (64 channels) was used to accurately detect the onset of EMG activity. PMT represented the major part of the RT (~88%). Coefficients of variation were reasonably satisfactory for all parameters (range: 11·9-13·4%). The use of electrode array appears to be a relevant method to measure EMD. Moreover, sessions based on two trials are reliable enough to detect changes in RT components.

Electromechanical delays during a fatiguing exercise and recovery in patients with myotonic dystrophy type 1

PURPOSE

The partitioning of the electromechanical delay by an electromyographic (EMG), mechanomyographic (MMG) and force combined approach can provide further insight into the electrochemical and mechanical processes involved with skeletal muscle contraction and relaxation. The aim of the study was to monitor by this combined approach the changes in delays' electrochemical and mechanical components throughout a fatiguing task and during recovery in patients with myotonic dystrophy type 1 (DM1), who present at the skeletal muscle level fibres rearrangement, muscle weakness and myotonia, especially in the distal muscles.

METHODS

After assessing maximum voluntary contraction (MVC), 14 male patients with DM1 and 14 healthy controls (HC) performed a fatiguing exercise at 50% MVC until exhaustion. EMG, MMG, and force signals were recorded from tibialis anterior and vastus lateralis muscles. The electromechanical delay during contraction (Delay_TOT) and relaxation (R-Delay_TOT) components, EMG and MMG root mean square (RMS) and mean frequency (MF) were calculated off-line.

RESULTS

The fatiguing exercise duration was similar in both groups. In patients with DM1, delays components were significantly longer compared to HC, especially in the distal muscle during relaxation. Delays components recovered quickly from the fatiguing exercise in HC than in patients with DM1 in both muscles.

CONCLUSIONS

The alterations in delays observed in DM1 during the fatiguing exercise may indicate that also the lengthening of the electrochemical and mechanical processes during contraction and relaxation could play a role in explaining exercise intolerance in this pathology.

Correlation between stiffness and electromechanical delay components during muscle contraction and relaxation before and after static stretching

The study was aimed at assessing possible correlations of the electromechanical delay components during muscle contraction (Delay_TOT) and relaxation (R-Delay_TOT), with muscle-tendon unit (MTU), muscle, and tendon stiffness before and after static stretching (SS). Plantarflexor muscles' maximum voluntary torque (T_max) was measured in 18 male participants (age 24±3yrs; body mass 76.4±8.9kg; stature 1.78±0.09m; mean±SD). During T_max, surface electromyogram (EMG), mechanomyogram, and force signals were detected. Delay_TOT and R-Delay_TOT with their electrochemical and mechanical components were calculated. Passive torque and myotendinous junction displacement were assessed at 0°, 10° and 20° of dorsiflexion to determine MTU, muscle and tendon stiffness. The same protocol was repeated after SS. Delay_TOT, R-Delay_TOT and their mainly mechanical components correlated with MTU, muscle and tendon stiffness, both before (R² from 0.562 to 0.894; p<0.001) and after SS (R² from 0.726 to 0.955; p<0.001). SS decreased T_max (-14%; p<0.001) and lengthened almost all the Delay_TOT and R-Delay_TOT components (from +5.9% to +30.5%; p<0.05). Correlations were found only between stiffness and the mechanical components of Delay_TOT and R-Delay_TOT. Correlations persisted after SS but delays increased to a higher extent than stiffness, indicating a complexity of the relationship between stiffness and delays that will be discussed in the manuscript.

Changes in the electromechanical delay components during a fatiguing stimulation in human skeletal muscle: an EMG, MMG and force combined approach

PURPOSE

Peripheral fatigue involves electrochemical and mechanical mechanisms. An electromyographic, mechanomyographic and force combined approach may permit a kinetic evaluation of the changes at the synaptic, skeletal muscle fiber, and muscle-tendon unit level during a fatiguing stimulation.

METHODS

Surface electromyogram, mechanomyogram, force and stimulation current were detected from the gastrocnemius medialis muscle in twenty male participants during a fatiguing stimulation (twelve blocks of 35 Hz stimulations, duty cycle 9 s on/1 s off, duration 120 s). The total electromechanical delay and its three components (between stimulation current and electromyogram, synaptic component; between electromyogram and mechanomyogram signal onset, muscle fiber electrochemical component, and between mechanomyogram and force signal onset, mechanical component) were calculated. Interday reliability and sensitivity were determined.

RESULTS

After fatigue, peak force decreased by 48% (P < 0.05) and the total electromechanical delay and its synaptic, electrochemical and mechanical components lengthened from 25.8 ± 0.9, 1.47 ± 0.04, 11.2 ± 0.6, and 13.1 ± 1.3 ms to 29.0 ± 1.6, 1.56 ± 0.05, 12.4 ± 0.9, and 17.2 ± 0.6 ms, respectively (P < 0.05). During fatigue, the total electromechanical delay and the mechanical component increased significantly after the 40th second, and then remained stable. The synaptic and electrochemical components lengthened significantly after the 20th and 30th second, respectively. Interday reliability was high to very high, with an adequate level of sensitivity.

CONCLUSIONS

The kinetic evaluation of the delays during the fatiguing stimulation highlighted different onsets and kinetics, with the events at synaptic level being the first to reveal a significant elongation, followed by those at the intra-fiber level. The mechanical events, which were the most affected by fatigue, were the last to lengthen.