EMG biofeedback treatment of torticollis: a controlled outcome study.

Successful treatment of torticollis with electromyographic (EMG) biofeedback has been reported in a number of single case and single group studies. The present investigation represents the first controlled outcome study. Twelve torticollis patients were randomly assigned to EMG biofeedback or relaxation training and graded neck exercises (RGP). The procedure involved three sessions of baseline assessment, 15 sessions of EMG BF or RGP, 6 sessions of EMG BF or RGP plus home-management, 6 sessions of home-management alone, and follow-up 3 months after the end of treatment. A variety of outcome measures were used including physiological (EMG from the two sternocleidomastoid muscles, skin conductance level), behavioral (angle of head deviation, range of movement of the head), and self-report (depression, functional disability, body concept), therapist and "significant other" reports and independent observer assessment of videos. In both groups, neck muscle activity was reduced from pre- to posttreatment. This reduction was greater in the EMG biofeedback group. There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group. Therefore, the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects. Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of "arousal." Significant improvements of extent of head deviation, and range of movement of the head, as well as reductions of depression were present, which were not different in the two groups. At the end of treatment, no patient was asymptomatic. Any therapeutic benefit was generally maintained at follow-up. The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one. Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger samples are required.     

EMG biofeedback treatment of torticollis: A controlled outcome study

Successful treatment of torticollis with electromyographic (EMG) biofeedback has been reported in a number of single case and single group studies. The present investigation represents the first controlled outcome study. Twelve torticollis patients were randomly assigned to EMG biofeedback or relaxation training and graded neck exercises (RGP). The procedure involved three sessions of baseline assessment, 15 sessions of EMG BF or RGP, 6 sessions of EMG BF or RGP plus home-management, 6 sessions of home-management alone, and follow-up 3 months after the end of treatment. A variety of outcome measures were used including physiological (EMG from the two sternocleidomastoid muscles, skin conductance level), behavioral (angle of head deviation, range of movement of the head), and self-report (depression, functional disability, body concept), therapist and significant other reports and independent observer assessment of videos. In both groups, neck muscle activity was reduced from pre- to posttreatment. This reduction was greater in the EMG biofeedback group. There was evidence of feedback-specific neck muscle relaxation in the EMG biofeedback group. Therefore, the outcome was not due to nonspecific factors and could be attributed to feedback-specific effects. Changes in skin conductance level showed that neck muscle relaxation was not simply mediated by a general reduction of arousal. Significant improvements of extent of head deviation, and range of movement of the head, as well as reductions of depression were present, which were not different in the two groups. At the end of treatment, no patient was asymptomatic. Any therapeutic benefit was generally maintained at follow-up. The results and the procedural simplicity of RGP make the issue of cost-efficacy of EMG biofeedback a pertinent one. Further controlled outcome studies of EMG biofeedback treatment of torticollis with larger samples are required.This work was funded by grants from the Medical Research Council and the Dystonia Society.     

EMG muscle scanning: stability of hand-held surface electrodes

Electromyographic (EMG) muscle scanning measures 2-second samples of integrated muscle action potentials from individual neck and back muscles using a hand-held scanner with post-style surface electrodes separated by a fixed distance. This "scanning" technique is widely used to expeditiously assess muscle activity in the diagnosis of musculoskeletal disorders. In order to determine if the 2-second sample is sufficiently representative of electrical activity at a specific muscle site, the stability of the signal received by the hand-held scanner was measured bilaterally at six neck and back muscle sites over 40 seconds (20 2-second integration periods) in five seated subjects. Taking the overall average EMG activity as the "true" value, the mean number of 2-second integration periods required to achieve less than 5% standard error was calculated to be 1.47 for the 60 muscles tested. Only three sites required more than five integration periods. The validity of EMG scanning as a diagnostic tool is enhanced by longer integration periods.     

Role of the telencephalon in regulating the electrical activity of skeletal muscles in chick embryos

On 18-day chick embryos, studies have been made of functional properties of hyperstriatum accesorium (HA) of the telencephalon and that of neck muscles. To investigate the relationship between the HA structure and the EMG in muscles, the former was subjected to unilateral coagulation. Specific levels were established of the energy of oscilatory processes--EEG in the HA and EMG of neck muscles--as well as the relationship between them and possible role of HA structure in regulation of fast movements.     

Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles

A novel surface electromyographic (EMG) technique was recently described for the detection of deep cervical flexor muscle activity. Further investigation of this technique is warranted to ensure EMG activity from neighbouring muscles is not markedly influencing the signals recorded. This study compared deep cervical flexor (DCF) muscle activity with the activity of surrounding neck and jaw muscles during various anatomical movements of the neck and jaw in 10 volunteer subjects. DCF EMG activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid, anterior scalene, masseter and suprahyoid muscles. Positioned in supine, subjects performed isometric cranio-cervical flexion, cervical flexion, right and left cervical rotation, jaw clench and resisted jaw opening. Across all movements examined, EMG amplitude of the DCF muscles was greatest during neck movements that would require activity of the DCF muscles, particularly during cranio-cervical flexion, their primary anatomical action. The actions of jaw clench and resisted jaw opening demonstrated significantly less DCF EMG activity than the cranio-cervical flexion action (p < 0.05). Across all other movements, the neighbouring neck and jaw muscles demonstrated greatest EMG amplitude during their respective primary anatomical actions, which occurred in the absence of increased EMG amplitude recorded from the DCF muscles. The finding of substantial EMG activity of the DCF muscles only during neck actions that would require their activity, particularly cranio-cervical flexion, and not during actions involving the jaw, provide further assurance that the majority of myoelectric signals detected from the nasopharyngeal electrode are from the DCF muscles.     

Neuronal mechanisms of motor signal transmission in the thalamic ventrooral nucleus in spasmodic torticollis patients

A microelectrode technique was used to study the neuronal mechanisms of motor signal transmission in the ventrooral internus nucleus (Voi) of the motor thalamus during voluntary and involuntary pathological (dystonic) movements in patients with spasmodic torticollis. Voi cell elements proved highly reactive to various functional (mostly motor) tests. An activity analysis of 55 Voi neurons detected during nine stereotactic operations revealed, first, a difference in neuronal mechanisms of motor signal transmission for voluntary movements that do or do not involve the affected axial muscles of the neck and for passive and abnormal involuntary dystonic movements. Second, a sensory component was found to play a key role in the mechanisms of sensorimotor interactions during voluntary and involuntary dystonic head and neck movements activating the axial muscles of the neck. Third, rhythmic and synchronized activity of Voi neurons was shown to play an important role in motor signal transmission during voluntary and passive movements. The Voi nucleus was directly implicated in the mechanisms of involuntary head movements and tension of the neck muscles in spasmodic torticollis. The results can be used to identify the Voi nucleus of the thalamus during stereotactic neurosurgery in order to select the optimal destruction or stimulation target and to reduce the postoperative effects in spasmodic torticollis patients.     

Cholinergic mechanism controlling the response gain of forelimb extensor muscles to sinusoidal stimulation of macular labyrinth and neck receptors

The multiunit EMG activity of the triceps brachii was recorded in precollicular decerebrate cats during roll tilt of the animal or neck rotation at the frequencies of 0.026-0.15 Hz and at the peak amplitude of 10 degrees, leading to selective stimulation of labyrinth or neck receptors. The first harmonic component of the EMG responses to labyrinth stimulation was characterized by an increased activity during side-down tilt of the animal and a decreased activity during side-up tilt; however, just the opposite changes were elicited for the same directions of neck rotation. The peak of the responses was closely related to the extreme animal or neck displacement, thus being attributed to stimulation of position-sensitive macular labyrinth and receptors. Moreover, the modulation as well as the gain of the EMG responses were small in amplitude. Intravenous injections of an anticholinesterase at a dose which in some instances slightly decreased the extensor tonus as well as the background activity of the triceps brachii (eserine sulphate, 0.05-0.075 mg/kg), greatly enhanced the response gain of this extensor muscle to animal tilt or neck rotation at the parameters reported above. This finding was also observed in the absence of any decrease in spontaneous EMG activity of the extensor muscle after injection of the anticholinesterase. In no instance did the phase angle of the response change following these injections. The increased gain of the EMG response of the forelimb extensor muscle to sinusoidal stimulation of labyrinth and neck receptors was first observed 5-10 min after the injection and reached the highest value in about one hour. This effect, was not only time-dependent, but also state-dependent. In fact, the increase in response gain described above either did not occur or was negligible during the sudden recovery of the extensor rigidity which occurred either spontaneously or after somatosensory stimulations. The effects elicited by eserine sulphate were reversed within seconds by a 0.1-0.5 mg/kg dose of atropine sulphate, an anticholinergic drug. It is postulated that for the same labyrinthine or neck signal giving rise to excitatory vestibulospinal volleys acting on extensor motoneurons, the amplitude of the EMG modulation of limb extensor muscles depends on the activity of a cholinergic system.(ABSTRACT TRUNCATED AT 400 WORDS)     

Repeatability of electromyography and force measurements of the neck muscles in adolescents with and without headache.

BACKGROUND: Reliable measurements are needed to study the dysfunction of the neck muscles. The aim of this study was to determine the intra-tester repeatability of EMG and isometric force measurements of the neck muscles in adolescents with headache and headache-free controls. METHODS: A group of 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls were recruited. Maximal isometric neck muscle force with simultaneous recording of surface EMG from the cervical erector spinae and the sternocleidomastoideus muscles was measured twice during one day. FINDINGS: For all groups, intra-class correlation coefficients (ICC) and coefficients of variation (CV) showed acceptable repeatability of all measurements. (Force measurements: ICC 0.98-0.99, CV 0.7-3.7%; EMG measurements: ICC 0.95-0.99, CV 4.9-10.1%.) On the individual level, variation between the consecutive measurements was found to be low in all groups. INTERPRETATION: The present EMG and force measurements of neck muscles indicate acceptable intra-tester repeatability in adolescents. The repeatability was comparable in migraine- and tension-type headache and headache-free groups. The EMG and the force measurements offer the possibility to investigate neck muscle dysfunction in adolescent headache.     

EMG muscle scanning: Stability of hand-held surface electrodes

Electromyographic (EMG) muscle scanning measures 2-second samples of integrated muscle action potentials from individual neck and back muscles using a hand-held scanner with post-style surface electrodes separated by a fixed distance. This scanning technique is widely used to expeditiously assess muscle activity in the diagnosis of musculoskeletal disorders. In order to determine if the 2-second sample is sufficiently representative of electrical activity at a specific muscle site, the stability of the signal received by the hand-held scanner was measured bilaterally at six neck and back muscle sites over 40 seconds (20 2-second integration periods) in five seated subjects. Taking the overall average EMG activity as the true value, the mean number of 2-second integration periods required to achieve <5% standard error was calculated to be 1.47 for the 60 muscles tested. Only three sites required more than five integration periods. The validity of EMG scanning as a diagnostic tool is enhanced by longer integration periods     

Postural EMG activity in the soleus muscle of adult rats following thyroidectomy

An electrode array was implanted for chronic recording of EMG activity in both soleus muscles (SOL) in adult albino rats (Wistar strain) of 250 g mean body weight. After 12-13 days, surgical thyroidectomy was performed and the postural EMG activity in both SOL muscles up to 16 weeks after the operation was quantitatively compared (spikes per minute) with the EMG activity before the operation. The results showed that the EMG activity in the SOL is significantly decreased after thyroidectomy.     

Electromyography of pongid shoulder muscles III. Quadrupedal positional behavior

Electromyographic (EMG) recordings were taken from 14 shoulder muscles (or major parts of them) in a gorilla, a chimpanzee and an orangutan as they stood quadrupedally and tripedally, descended from elevated substrates, crutch-walked, and progressed quadrupedally on inclined and level substrates. In the African apes, low potentials commonly (but not always) occurred in the sternocostal pectoralis major, anterior deltoid, supraspinatus and subscapularis muscles during quadrupedal stance. The quadrupedal orangutan always exhibited low potentials in the pectoralis major muscle and EMG activity commonly occurred in her supraspinatus and subscapularis muscles. Quiescent tripedal stances were not accompanied by striking changes in EMG patterns from those which characterized quadrupedal stances. Per contra, eccentric loadings of the forelimb during descents from elevated substrates generally recruited notable EMG activity in the deltoid, supraspinatus and, to a lesser extent, infraspinatus muscles of the three pongid apes. The pectoralis major and caudal serratus anterior muscles were much more active in Pongo and Pan during these descents. Supportive segments of quadrupedal locomotive cycles were generally accompanied by EMG activity in the pectoralis major, intermediate and posterior deltoid and supraspinatus muscles. The intermediate and posterior deltoid muscles were characteristically active during pre-release of the hand and early swing phase. The cranial trapezius and supraspinatus muscles also may act during early swing phase. We conclude that the pectoralis major and perhaps the supraspinatus and subscapularis might serve regularly as postural muscles during static terrestrial quadrupedalism in pongid apes. The lack of dramatic differences between the EMG patterns exhibited during fist-walking versus knuckle-walking indicates that an evolutionary transformation from a shoulder complex like that of Pongo to ones like Pan or vice versa need not entail major changes in myological features.     

Tonic inhibitory influences of locus coeruleus on the response gain of limb extensors to sinusoidal labyrinth and neck stimulations

Previous experiments had shown that in decerebrate cats activation of limb extensor motoneurons during side-down roll tilt of the animal or side-up neck rotation depends on both an increased discharge of excitatory vestibulospinal (VS) neurons and a reduced discharge of inhibitory reticulospinal (RS) neurons of the medulla, thus leading to disinhibition of limb extensor motoneurons. The present experiments were performed to find out whether the locus coeruleus (LC) complex keeps under its tonic inhibitory control the medullary inhibitory RS neurons and, if so, whether this structure intervenes in the gain regulation of the vestibular and neck reflexes acting on the limb extensor musculature. In precollicular decerebrate cats with good postural rigidity of the four limbs, the amplitude of modulation and thus the response gain of the first harmonic component of multiunit EMG responses of limb extensors to sinusoidal stimulation of labyrinth and neck receptors (at 0.15 Hz, +/- 10 degrees) were quite small in forelimb muscles (triceps brachii) and almost negligible or absent in hindlimb muscles (triceps surae). Electrolytic lesion limited to the LC complex decreased the tonic contraction of limb extensors, but greatly increased in the forelimbs (and brought to the light in the hindlimbs) the response modulation of extensor muscles to the same parameters of labyrinth or neck stimulation. Correspondingly, the response gain increased, but no change in the phase angle of the responses was observed. Both changes in posture, as well as in response gain of the limb extensors to labyrinth and neck stimulation, fully developed some time after the LC lesion. This increase in response gain of the vestibular and neck reflexes acting on the limb extensor muscles did not depend on the decrease in postural activity following the LC lesion, since it was still obtained when an increased static stretch of the extensor muscle following passive flexion of the limb compensated for the reduced EMG activity. Moreover, the slope of the regression line relating the gain of the multiunit EMG response of the triceps brachii to animal tilt with the base frequency greatly increased following lesioning of the LC, thus indicating that for the same background discharge of the muscle the amplitude of modulation, and thus the response gain, increased significantly. The effects described above involved mainly, but not exclusively, the limbs ipsilateral to the side of the lesion.(ABSTRACT TRUNCATED AT 400 WORDS)     

Electromyographic evaluation of masseter and anterior temporalis muscles in rest position of edentulous patients with temporomandibular disorders, before and after using complete dentures with sliding plates

Objectives: This study was performed with the purpose of investigating electromyographic (EMG) activity of the anterior temporalis and masseter muscles in edentulous individuals with temporomandibular disorder (TMD), before and after using sliding plates on complete dentures in the mandibular rest position. Background: Edentulous patients may present TMD, which is characterised by pain in temporomandibular joints, masticatory and neck muscles, uncoordinated and limited mandible movements, joint sounds and an altered occlusal relationship. It is imperative to offer treatment in order to re‐establish stomatognathic system structures before submitting the individual to any definitive restorative treatment. Materials and methods: The patients were edentulous for at least 10 years. EMG recordings were made before the insertion of the dentures (0 months) and also after using the sliding plates at the fourth month, 9th month and 12th month, using computerised electromyography K6‐I/ EMG Light Channel Surface. EMG evaluations of the muscles were performed under the following clinical conditions: rest position with dentures (R1), rest position without dentures (R2), rest position with dentures post‐activity (chewing) (R3), rest position without dentures post‐activity (chewing) (R4). Results: All patients obtained remission of muscular fatigue and reduced pain in stomatognathic system structures. Temporalis muscle showed significant increase in EMG activity compared with initial values (p < 0.01). Masseter muscles showed significantly lower mean values (p < 0.01) compared with initial values. Conclusion: The sliding plates allowed the process of neuromuscular deprogramming, contributing to muscular balance of the masticatory system, and are therefore indicated to be used before the fabrication of definitive complete dentures in patients with TMD.     

EEG beta and gamma powers when comparing certain psychophysiological states with normal and weakened electromyogram of facial muscles

With the advancement of contemporary techniques for studies of high-frequency electroencephalograms (EEGs), possible contamination of the EEG with the electromyogram (EMG) of pericranial muscles has raised more and more concern. The aim of the present study was to demonstrate if certain EEG correlates of mental activities can be revealed in a high-frequency scalp EEG in spite of EMG contamination. Nineteen healthy women who performed similar test tasks before and after cosmetic injections of Dysport in various facial regions for reduction of the activity of facial muscles took part in the study. Inductions of emotional states with different valences, memory storing, and extraction of verbal information were used in the test tasks. The default state of rest was examined as well. During performance of the tasks, parallel registrations of the EEG from the scalp surface (19 channels) and EMG from several facial muscles (6 channels) were carried out. Changes in the spectral power in β₂ and low γ frequency bands (18–40 Hz) in EEG- and EMG-derivations after Dysport injections were analyzed. Changes in the spectral power in the same bands in pairwise comparisons for the test tasks before and after Dysport injections were also analyzed separately. It was demonstrated that Dysport injections lead to reduction of the EMG power in areas of the injections and to reduction of EEG power in the frontal and temporal derivations. However, the EEG-correlates revealed when comparing different test tasks remained qualitatively invariable as for after and before Disport injections. These facts confirm that EMG makes a noticeable contribution to the electric activity registered from the scalp in the frequency ranges greater than 18 Hz. At the same time, one can see that at least in certain experimental situations the influence of EMG does not make impossible identification of EEG-correlates of mental activity with EEG registration from the head surface at least in the β₂ and low γ frequency bands (18–40 Hz).     

Air-righting responses to chronic hindlimb suspension and ambulation recovery in adult rats.

Laouris et al. (1990) reported that the development of air-righting in growing new-born rats was clearly suppressed when their neck and/or back rotations were prevented. Thus, it is suggested that the neck and back muscles play an important role for a quick righting in response to drop from supine position. Further, we reported that an inhibiton of posture adjustment in response to head-down drop from a height of approximately 30 cm following chronic hindlimb suspension of adult rats was accompanied by a decrease of electromyogram (EMG) activity in both neck and back muscles (Kawano et al., 2002). However, it is still unclear how the air-righting performance is influenced by hindlimb suspension in adult rats. Thus, the effects of chronic hindlimb suspension of adult rats on the patterns and time of air-righting and role of neck and back muscles in the air-righting were investigated in the current study.     

Interaction between acoustic startle and habituated neck postural responses in seated subjects.

Postural and startle responses rapidly habituate with repeated exposures to the same stimulus, and the first exposure to a seated forward acceleration elicits a startle response in the neck muscles. Our goal was to examine how the acoustic startle response is integrated with the habituated neck postural response elicited by forward accelerations of seated subjects. In experiment 1, 14 subjects underwent 11 sequential forward accelerations followed by 5 additional sled accelerations combined with a startling tone (124-dB sound pressure level) initiated 18 ms after sled acceleration onset. During the acceleration-only trials, changes consistent with habituation occurred in the root-mean-square amplitude of the neck muscles and in the peak amplitude of five head and torso kinematic variables. The subsequent addition of the startling tone restored the amplitude of the neck muscles and four of the five kinematic variables but shortened onset of muscle activity by 9-12 ms. These shortened onset times were further explored in experiment 2, wherein 16 subjects underwent 11 acceleration-only trials followed by 15 combined acceleration-tone trials with interstimulus delays of 0, 13, 18, 23, and 28 ms. Onset times shortened further for the 0- and 13-ms delays but did not lengthen for the 23- and 28-ms delays. These temporal and spatial changes in EMG can be explained by a summation of the excitatory drive converging at or before the neck muscle motoneurons. The present observations suggest that habituation to repeated sled accelerations involves extinguishing the startle response and tuning the postural response to the whole body disturbance.     

Evolution of surface electromyography: From muscle electrophysiology towards neural recording and interfacing

Surface electromyography (EMG) comprises a recording of electrical activity from the body surface generated by muscle fibres during muscle contractions. Its characteristics depend on the fibre membrane potentials and the neural activation signal sent from the motor neurons to the muscles. EMG has been classically used as the primary investigation tool in kinesiology studies in a variety of applications. More recently, surface EMG techniques have evolved from single-channel methods to high-density systems with hundreds of electrodes. High-density EMG recordings can be deconvolved to estimate the discharge times of spinal motor neurons innervating the recorded muscles, with algorithms that have been developed and validated in the last two decades. Within limits and with some variability across muscles, these techniques provide a non-invasive method to study relatively large populations of motor neurons in humans. Surface EMG is thus evolving from a peripheral measure of muscle electrical activity towards a neural recording and neural interfacing signal. These advances in technology have had a major impact on our fundamental understanding of the neural control of movement and have exposed new perspectives in neurotechnologies. Here we provide an overview and perspective of modern EMG technology, as derived from past achievements, and its impact in neurophysiology and neural engineering.     

Torque-EMG-velocity relationship in female workers with chronic neck muscle pain

The present study investigated the effect of chronic neck muscle pain (defined as trapezius myalgia) on neck/shoulder muscle function during concentric, eccentric and static contraction. Forty-two female office workers with trapezius myalgia (MYA) and 20 healthy matched controls (CON) participated. Isokinetic (-60, 60 and 180 degrees s(-1)) and static maximal voluntary shoulder abductions were performed in a Biodex dynamometer, and electromyography (EMG) obtained in the trapezius and deltoideus muscles. Muscle thickness in the trapezius was measured with ultrasound. Pain and perceived exertion were registered before and after the dynamometer test. The main findings were that shoulder abduction torque (at -60 and 60 degrees s(-1)) and trapezius EMG amplitude (at -60, 0 and 60 degrees s(-1)) were significantly lower in MYA compared with CON (p<0.001-0.05). Deltoideus EMG and trapezius muscle thickness were not significantly different between the groups. While perceived exertion increased in both groups in response to the test (p<0.0001), pain increased in MYA only (p<0.0001). In conclusion, having trapezius myalgia was associated with decreased strength capacity and lowered activity of the painful trapezius muscle. The most consistent differences-in terms of both torque and EMG-were found during slow concentric and eccentric contractions. Activity of the synergistic pain free deltoideus muscle was not significantly lower, indicating specific inhibitory feedback of the painful trapezius muscle only. Parallel increase in pain and perceived exertion among MYA were observed in response to the maximal contractions, emphasizing that heavy physical exertion provokes pain increase only in conditions of myalgia.     

Knee stability and muscle coordination in patients with anterior cruciate ligament injuries: An electromyographic approach

We present findings on the way in which to use electromyographic (EMG) measurements from muscles acting on the knee in planning rehabilitation of subjects after rupture of anterior cruciate ligament (ACL). ACL subjects demonstrated an earlier recruitment and a tendency to prolonged activity in muscles around the deficient knee as compared with a control group. Especially the hamstring lateralis and the gastrocnemius medialis (GM) muscles showed an earlier EMG onset and a longer EMG burst duration. The clinical relevance of the EMG findings was assessed by comparing the muscle coordination and relative levels of activity between a functionally excellent/good and a functionally poor ACL patient group. Significant differences between the two groups were noted in EMG onset and burst duration of the GM muscle. A rehabilitation program based on the EMG findings from the GM muscle was designed. In this program, the ACL subjects with poor stability were trained to change the EMG activity of the gastrocnemius muscles according to the recruitment pattern of the good/excellent ACL-group. We were able to train the subjects to change their muscle recruitment and to improve their knee stability. The stability of the knee joint depends on the stiffness of the muscles and ligaments around and within the knee. We discuss the importance of the gastrocnemius muscles with regard to knee joint stiffness.     

Rapid neck muscle adaptation alters the head kinematics of aware and unaware subjects undergoing multiple whiplash-like perturbations

To examine whether habituation confounds the study of whiplash injury using human subjects, we quantified changes in the magnitude and temporal development of the neck muscle electromyogram and peak linear and angular head/torso kinematics of subjects exposed to sequential whiplash-like perturbations. Forty-four seated subjects (23F, 21M) underwent 11 consecutive forward horizontal perturbations (peak sled acceleration=1.5 g). Electromyographic (EMG) activity was recorded over the sternocleidomastoid (SCM) and cervical paraspinal (PARA) muscles with surface electrodes, and head and torso kinematics were measured using linear and angular accelerometers and a 3D motion analysis system. EMG onset occurred at reflex latencies (67-75 ms in SCM) and did not vary with repeated perturbations. EMG amplitude was significantly attenuated by the second perturbation in PARA muscles and by the third perturbation in SCM muscles. The mean decrement in EMG amplitude between the first trial and the mean of the last five trials was between 41% and 64%. Related kinematic changes ranged from a 21% increase in head extension angle to a 29% decrease in forward acceleration at the forehead, and were also significantly different by the second exposure in some variables. Although a wider range of perturbation intensities and inter-perturbation intervals need to be studied, the significant changes observed in both muscle and kinematic variables by the second perturbation indicated that habituation was a potential confounder of whiplash injury studies using repeated perturbations of human subjects.