Fatigue and the electromechanical efficiency of the vastus medialis and vastus lateralis muscles

Electromechanical efficiency index of skeletal muscle and its applicability: a systematic review

Introduction: The electromechanical efficiency of skeletal muscle represents the dissociation between electrical and mechanical events within a muscle. It has been widely studied, with varying methods for its measurement and calculation. For this reason, the purpose of this literature review was to integrate the available research to date and provide more insights about this measure. Methods: A systematic search of the literature was performed across three online databases: PubMed, ScienceDirect, and SPORTDiscus. This yielded 1284 reports, of which 10 met the inclusion criteria. Included studies have used different methods to measure the electromechanical efficiency (EME) index, including electromyography (EMG), mechanomyography and tensiomyography (TMG). Results: The EME index was used to assess muscle conditions such as muscle atrophy, pain syndromes, or to monitor rehabilitation in patients with knee problems, fatigue and the effects of exercise and rehabilitation. TMG has been shown to be one of the most reliable methods to obtain the EME index, but its use precludes obtaining the index during voluntary muscle contractions. Conclusion: Standardizing the EME index is crucial for its diverse applications in clinical, sport, and rehabilitation contexts. Future research should prioritize standardization of measurement protocols for establishing the most repeatable, and reliable approach that can be used for inter-individual comparisons or for assessing an individual for multiple times over a longer period. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440333 Identifier: CRD42023440333.

Neuromuscular activation of the quadriceps femoris, including the vastus intermedius, during isokinetic knee extensions

The purpose of this study was to compare the neuromuscular activation patterns of the individual muscles of the quadriceps femoris (QF), including the vastus intermedius (VI), during isokinetic concentric (CON) and eccentric (ECC) contractions. Thirteen healthy men performed maximum isokinetic CON and ECC knee extensions at angular velocities of 30, 90, and 120°/sec at knee joint angles from 80 to 180° (180° = full extension). The surface electromyographic (EMG) activities of the four individual muscles of the QF were recorded. The root mean squares of the EMG signals were normalized by the root mean square (nRMS) during CON contraction at 30°/sec. To investigate the nRMS changes, we classified the range of motion into four subcategories for each CON and ECC contraction. The nRMS of the VI was significantly higher in the flexed position during CON and ECC contractions at all velocities, and gradually decreased toward the extended positions regardless of the type of muscle contraction or angular velocity. These results suggest that the QF undergoes neuromuscular activation in a joint angle-dependent manner. In particular, the VI may contribute greatly during flexed contractions, independent of the type of contraction and angular velocity.

Development of a Real-Time Knee Extension Monitoring and Rehabilitation System: Range of Motion and Surface EMG Measurement and Evaluation

In this paper, a real-time knee extension monitoring and rehabilitation system for people, such as patients, the elderly, athletes, etc., is developed and tested. The proposed system has three major functions. The first function is two-channel surface electromyography (EMG) signal measurement and processing for the vastus lateralis (VL) and vastus medialis (VM) muscles using a developed EMG device set. The second function is the knee extension range of motion (ROM) measurement using an angle sensor device set (i.e., accelerometer sensor). Both functions are connected and parallelly processed by the NI-myRIO embedded device. Finally, the third function is the graphical user interface (GUI) using LabVIEW, where the knee rehabilitation program can be defined and flexibly set, as recommended by physical therapists and physicians. Experimental results obtained from six healthy subjects demonstrated that the proposed system can efficiently work with real-time response. It can support multiple rehabilitation users with data collection, where EMG signals with mean absolute value (MAV) and root mean square value (RMS) results and knee extension ROM data can be automatically measured and recorded based on the defined rehabilitation program. Furthermore, the proposed system is also employed in the hospital for validation and evaluation, where bio-feedback EMG and ROM data from six patients, including (a) knee osteoarthritis, (b) herniated disc, (c) knee ligament injury, (d) ischemic stroke, (e) hemorrhagic stroke, and (f) Parkinson are obtained. Such data are also collected for one month for tracking, evaluation, and treatment. With our proposed system, results indicate that the rehabilitation people can practice themselves and know their rehabilitation progress during the time of testing. The system can also evaluate (as a primary treatment) whether the therapy training is successful or not, while experts can simultaneously review the progress and set the optimal treatment program in response to the rehabilitation users. This technology can also be integrated as a part of the Internet of Things (IoT) and smart healthcare systems.

Effects of Preceding Transcranial Direct Current Stimulation on Movement Velocity and EMG Signal during the Back Squat Exercise

This study aimed to evaluate the effects of preceding anodal transcranial direct stimulation (a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) during the back squat exercise on movement velocity and surface electromyographic (sEMG) activity. Thirteen healthy, well-trained, male firefighters (34.72 ± 3.33 years; 178 ± 7.61 cm; 76.85 ± 11.21 kg; 26.8 ± 4.2 kg·m−2; back squat 1-repetition maximum 141.5 ± 16.3 kg) completed this randomised double-blinded sham-controlled crossover study. After familiarisation and basal measurements, participants attended the laboratory on two occasions separated by 72 h to receive either Sham or a-tDCS (current intensity of 2 mA for 20 min). Immediately after stimulation, participants completed three sets of 12 repetitions (70% of 1-RM) with three minutes of recovery between sets monitored with a linear position transducer. The sEMG of the rectus femoris (RF) and vastus lateralis (VL) of both legs were recorded. No significant differences were observed between a-tDCS and Sham interventions on mean concentric velocity at any set (p > 0.05). Velocity loss and effort index were significantly higher (p < 0.05) in set 3 compared to set 1 only in the a-tDCS group. The right-leg RM and right-leg VL elicited the greatest muscle activation during set 1 after a-tDCS and Sham, respectively (p < 0.05). Our results revealed that a-tDCS over the DLPFC might impact movement velocity or fatigue tolerance in well-trained individuals. Notwithstanding, significant differences in dominant-leg muscle activity were found both in a-tDCS and Sham.

Noninvasive Assessment of Neuromechanical Coupling and Mechanical Efficiency of Parasternal Intercostal Muscle during Inspiratory Threshold Loading

This study aims to investigate noninvasive indices of neuromechanical coupling (NMC) and mechanical efficiency (MEff) of parasternal intercostal muscles. Gold standard assessment of diaphragm NMC requires using invasive techniques, limiting the utility of this procedure. Noninvasive NMC indices of parasternal intercostal muscles can be calculated using surface mechanomyography (sMMG_para) and electromyography (sEMG_para). However, the use of sMMG_para as an inspiratory muscle mechanical output measure, and the relationships between sMMG_para, sEMG_para, and simultaneous invasive and noninvasive pressure measurements have not previously been evaluated. sEMG_para, sMMG_para, and both invasive and noninvasive measurements of pressures were recorded in twelve healthy subjects during an inspiratory loading protocol. The ratios of sMMG_para to sEMG_para, which provided muscle-specific noninvasive NMC indices of parasternal intercostal muscles, showed nonsignificant changes with increasing load, since the relationships between sMMG_para and sEMG_para were linear (R² = 0.85 (0.75-0.9)). The ratios of mouth pressure (P_mo) to sEMG_para and sMMG_para were also proposed as noninvasive indices of parasternal intercostal muscle NMC and MEff, respectively. These indices, similar to the analogous indices calculated using invasive transdiaphragmatic and esophageal pressures, showed nonsignificant changes during threshold loading, since the relationships between P_mo and both sEMG_para (R² = 0.84 (0.77-0.93)) and sMMG_para (R² = 0.89 (0.85-0.91)) were linear. The proposed noninvasive NMC and MEff indices of parasternal intercostal muscles may be of potential clinical value, particularly for the regular assessment of patients with disordered respiratory mechanics using noninvasive wearable and wireless devices.

Muscle-specific changes of lower extremities in the early period after total knee arthroplasty: Insight from tensiomyography

OBJECTIVE

This study aimed to evaluate changes in i) muscle contractile properties of both lower extremities by using tensiomyography (TMG); ii) patients' physical function, and iii) electromechanical efficiency (EME) of the gastrocnemius medialis muscle in total knee arthroplasty (TKA) patients from before to one-month after TKA.

METHODS

Twenty-six patients scheduled for TKA were included.

RESULTS

The significant muscle*time interaction was found for sustain time and maximal radial displacement (Dm) (η²≥0.219) only, whereas time*leg interaction was found for time delay and Dm (η²≥0.254) only. Post hoc analysis showed a significant decrease of Dm of vastus medialis and increase in contraction time (Tc) of both the vastus lateralis and rectus femoris muscles of the involved leg, respectively. Furthermore, reduction of knee extensors (-55.4%) and flexors (-22.2%) strength, timed up and go (-26.9%), 30s chair stand (-28.9%) and EME (-38.2%) was observed.

CONCLUSION

TKA treatment altered physical function as well as contractile properties of the main skeletal muscles surrounding the involved joint in the early period after surgery; however, alterations showed to be both limb and muscle-specific. This might provide clinicians and physiotherapist with additional information on how to adapt rehabilitation to the needs of an individual patient.

Effect of knee joint angle on the neuromuscular activation of the quadriceps femoris during repetitive fatiguing contractions

We assessed the effect of knee joint angle on the EMG amplitude and frequency of the four individual muscles in the quadriceps femoris during repetitive fatiguing maximum voluntary contractions (MVCs). Fifteen healthy men and women performed two fatiguing tasks consisting of 40 MVCs in flexion (80°) and extension (140˚) (full extension = 180˚). Neuromuscular activation of the vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF) was recorded using surface electrodes, and median frequency (MF) and root mean square (RMS) of electromyographic (EMG) signals (normalized by pre-test MVCs) were calculated. MVCs significantly decreased from the 10th to the 40th repetition in both flexion and extension. The MFs of VI and VM in flexion and that of RF flexion and extension were significantly decreased after the 10th repetition. There were no significant changes in normalized EMG amplitude in any muscles specific to knee angle. Stepwise regression analysis suggested that predictive synergistic action may occur in RF/VM and RF/VI in flexion and in RF/VM in extension. This suggest that EMG MF of RF/VM is independent, but that of RF/VI and RF/VL is dependent upon knee joint angle, which may, in part, explain joint angle-specific muscle fatigue.

Mechanomyography and muscle function assessment: a review of current state and prospects

Previous studies have explored to saturation the efficacy of the conventional signal (such as electromyogram) for muscle function assessment and found its clinical impact limited. Increasing demand for reliable muscle function assessment modalities continues to prompt further investigation into other complementary alternatives. Application of mechanomyographic signal to quantify muscle performance has been proposed due to its inherent mechanical nature and ability to assess muscle function non-invasively while preserving muscular neurophysiologic information. Mechanomyogram is gaining accelerated applications in evaluating the properties of muscle under voluntary and evoked muscle contraction with prospects in clinical practices. As a complementary modality and the mechanical counterpart to electromyogram; mechanomyogram has gained significant acceptance in analysis of isometric and dynamic muscle actions. Substantial studies have also documented the effectiveness of mechanomyographic signal to assess muscle performance but none involved comprehensive appraisal of the state of the art applications with highlights on the future prospect and potential integration into the clinical practices. Motivated by the dearth of such critical review, we assessed the literature to investigate its principle of acquisition, current applications, challenges and future directions. Based on our findings, the importance of rigorous scientific and clinical validation of the signal is highlighted. It is also evident that as a robust complement to electromyogram, mechanomyographic signal may possess unprecedented potentials and further investigation will be enlightening.

Effects of diverting activity on strength, electromyographic, and mechanomyographic signals

The purpose of this study was to investigate the effects of different recovery interventions on peak torque, electromyographic (EMG), and mechanomyographic (MMG) measures. Ten (23.40 ± 1.00 years; 178.40 ± 5.03 cm; 84.80 ± 15.85 kg) recreationally trained college men performed 4 experimental visits consisting of 2 bouts of 50 maximal isokinetic leg extensions at 180°·s(-1). Between each bout of maximal exercise, 2 minutes of recovery involving one of the 4 interventions (passive, active, passive diverting, and active diverting) was completed. Electromyographic and MMG measures were collected during the preintervention and postintervention maximal isokinetic strength tests. Peak torque declined to a significantly greater degree during the postintervention test in the passive condition than the other interventions. Electromyographic amplitude decreased on the postintervention test but did not differ between conditions. There was a significant 2-way interaction for EMG mean power frequency (MPF) between time and repetitions. There was a significant decrease in EMG MPF from the first 3 to the last 3 repetitions for both the preintervention and postintervention tests. The decrease in EMG MPF from the initial to final repetitions was greater for the preintervention test than the postintervention test. Mechanomyographic amplitude significantly decreased from the initial to final repetitions regardless of time or condition. These findings suggest that active, passive diverting, and active diverting strategies provide the same extent of recovery between maximal, fatiguing isokinetic leg extension tasks, and that these strategies can be used by coaches and exercise professionals to select the most effective interset recovery strategy.

Mechanomyographic responses for the biceps brachii are unable to track the declines in peak torque during 25, 50, 75, and 100 fatiguing isokinetic muscle actions

This study examined the peak torque and mechanomyographic (MMG) amplitude and mean frequency (MNF) responses during fatiguing isokinetic muscle actions. On four separate occasions, twenty men (mean ± SD age = 23 ± 3 years) performed 25, 50, 75, and 100 repeated maximal concentric isokinetic muscle actions of the dominant forearm flexors. During each muscle action, the MMG signal was detected from the biceps brachii with an accelerometer. The data were examined with linear regression and one-way repeated measures analyses of variance. The results indicated that the mean percent decline in peak torque value for the 25 repetition trial (25.6%) was significantly less than that for the 50 repetition trial (45.2%). Furthermore, the mean linear slope coefficient for the peak torque versus repetition number relationship for the 50 repetition trial was significantly less than that for the 100 repetition trial. There were no mean differences among the trials for the linear slope coefficients and y-intercepts for the MMG amplitude and MNF versus repetition number relationships. When detected with an accelerometer, the linear slope coefficients and y-intercepts for the MMG amplitude and MNF versus repetition number relationships were not sensitive enough to track the decline in muscle function during fatigue.

Mechanomyogram for muscle function assessment: a review

BACKGROUND

Mechanomyography (MMG) has been extensively applied in clinical and experimental practice to examine muscle characteristics including muscle function (MF), prosthesis and/or switch control, signal processing, physiological exercise, and medical rehabilitation. Despite several existing MMG studies of MF, there has not yet been a review of these. This study aimed to determine the current status on the use of MMG in measuring the conditions of MFs.

METHODOLOGY/PRINCIPAL FINDINGS

Five electronic databases were extensively searched for potentially eligible studies published between 2003 and 2012. Two authors independently assessed selected articles using an MS-Word based form created for this review. Several domains (name of muscle, study type, sensor type, subject's types, muscle contraction, measured parameters, frequency range, hardware and software, signal processing and statistical analysis, results, applications, authors' conclusions and recommendations for future work) were extracted for further analysis. From a total of 2184 citations 119 were selected for full-text evaluation and 36 studies of MFs were identified. The systematic results find sufficient evidence that MMG may be used for assessing muscle fatigue, strength, and balance. This review also provides reason to believe that MMG may be used to examine muscle actions during movements and for monitoring muscle activities under various types of exercise paradigms.

CONCLUSIONS/SIGNIFICANCE

Overall judging from the increasing number of articles in recent years, this review reports sufficient evidence that MMG is increasingly being used in different aspects of MF. Thus, MMG may be applied as a useful tool to examine diverse conditions of muscle activity. However, the existing studies which examined MMG for MFs were confined to a small sample size of healthy population. Therefore, future work is needed to investigate MMG, in examining MFs between a sufficient number of healthy subjects and neuromuscular patients.

Description of the Pediasuit ProtocolTM

INTRODUCTION: PediaSuit ProtocolTM is an intensive therapy with a holistic approach to the treatment of individuals with neurological disorders like cerebral palsy (CP), developmental delays, traumatic brain injuries, autism and other conditions which affect a child's motor and/or cognitive functions. OBJECTIVE: The aim of the present work is to describe the PediaSuit ProtocolTM. METHODS: The authors team remained two months observing the care provided in a clinic with physical therapists trained by the PediaSuit ProtocolTM team (USA). RESULTS: The PediaSuitTM is a therapeutic protocol which uses a suit combined with intensive physical therapy and consists of up to four hours of therapy a day, five days a week, during three or four weeks. The PediaSuit ProtocolTM is customized to fit the needs of each child, with specific functional goals, and usually involves an intensive rehabilitation program. It combines the best elements of various techniques and methods, and has a sound rationale based on exercise physiology. CONCLUSION: This protocol anticipates results obtained only with long periods of conventional physical therapy.

Correlation between mechanomyography features and passive movements in healthy and paraplegic subjects

Mechanomyography (MMG) measures both muscular contraction and stretching activities and can be used as feedback in the control of neuroprostheses with Functional Electrical Stimulation (FES). In this study we evaluated the correlation between MMG features and passive knee angular movement of rectus femoris and vastus lateralis muscles acquired from healthy volunteers (HV) and spinal cord injured volunteers (SCIV). Twelve HV and thirteen SCIV were submitted to passive and FES elicited knee extensions and in each extension, eleven windows of analysis with 0.5s length were inspected. Temporal (RMS and INT) and frequency (MF and μ3) features were extracted. Spearman correlation coefficients (p) were computed in order to check correlations between the features obtained from both MMG sensors. The correlation between MMG(MF) and MMG temporal analysis (RMS and INT) to HV was classified as positive, moderate (p from 0.635 to 0.681) and high (p from 0.859 to 0.870), and weak (positive e negative) to SCIV. These results differ from those obtained in voluntary contraction or artificially evoked by functional electrical stimulation and may be relevant in applications with closed loop control systems.