The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot

Loss of hand function and finger dexterity are main disabilities in the upper limb after stroke. An electromyography (EMG)-driven hand robot had been developed for post-stroke rehabilitation training. The effectiveness of the hand robot assisted whole upper limb training was investigated on persons with chronic stroke (n = 10) in this work. All subjects attended a 20-session training (3–5 times/week) by using the hand robot to practice object grasp/release and arm transportation tasks. Significant motor improvements were observed in the Fugl-Meyer hand/wrist and shoulder/elbow scores (p < 0.05), and also in the Action Research Arm Test and Wolf Motor Function Test (p < 0.05). Significant reduction in spasticity of the fingers as was measured by the Modified Ashworth Score (p < 0.05). The training improved the muscle co-ordination between the antagonist muscle pair (flexor digitorum (FD) and extensor digitorum (ED)), associated with a significant reduction in the ED EMG level (p < 0.05) and a significant decrease of ED and FD co-contraction during the training (p < 0.05); the excessive muscle activities in the biceps brachii were also reduced significantly after the training (p < 0.05).     

Assessment of functional recovery in tennis elbow

Objectives: (a) To investigate changes in muscular strength, fatigue and activity in recovered tennis elbow (RTE); (b) to assess the appropriateness of EMG and strength measurements in monitoring functional recovery in tennis elbow (TE).Methods: Study included three age-matched female groups of Control (C) (n = 8, no history of musculoskeletal problems), TE (n = 7, local tenderness at the lateral epicondyle and pain with resisted wrist and middle finger extension) and RTE (n = 6, asymptomatic for at least 6 months, no lateral epicondyle tenderness). Measurements included metacarpophalangeal (MCP), wrist, shoulder and grip isometric strength and EMG measures of muscle fatigue and activity for five forearm muscles (wrist extensors and flexors).Results: Strength was greater (p < 0.05) for all measurements in C compared to RTE and TE except for MCP extension. Only MCP extension was stronger in RTE than TE. EMG revealed increased activity of extensor carpi radialis (ECR) in RTE, decreased in TE.Conclusions: Despite attenuation of pain, global upper limb weakness in RTE indicated incomplete functional recovery. Increased strength of MCP extension may protect weakened wrist extensors from further injury. Monitoring the ECR activity as well as strength measurements may provide a useful assessment of functional recovery in TE.     

Examining the reliability of the flexor carpi radialis V-wave at different levels of muscle contraction

This study examined the reliability and scaling of the flexor carpi radialis (FCR) V-wave during submaximal and maximal voluntary muscle contractions (MVC). 23 participants were tested on three separate sessions. For each session, participants performed isometric wrist flexions at five contraction levels (20, 40, 60, 80 and 100 %MVC). When the target contraction level was reached, a supramaximal electrical stimulus was applied to the median nerve in order to elicit an FCR V-wave. Across all participants, the FCR V-wave amplitude, normalized to its superimposed M-wave amplitude, increased from 0.030 ± 0.001 to 0.143 ± 0.015 (P < 0.001) as the muscle contraction increased from 20 to 100 %MVC. Contraction level did not influence the reliability of evoking the FCR V-wave, as the V-wave demonstrated both stability and consistency. With the exception of a single day main effect during the 20 %MVC condition, V:M_sup was not different across days or trials (P > 0.05) indicating measurement stability. High reliability co-efficients (0.827–0.913) at each contraction level signified measurement consistency. This study establishes that FCR V-waves can be reliably evoked during both submaximal and maximal muscle contractions and suggests the possibility for FCR V-wave recordings to be used to document neuromuscular adaptations associated with factors such as training or fatigue.     

Myoelectric manifestations of fatigue in vastus lateralis,medialis obliquus and medialis longus muscles

The purpose of this study was to determine whether surface electromyography (EMG) assessment of myoelectric manifestations of muscle fatigue is capable of detecting differences between the vastus lateralis and medialis muscles which are consistent with the results of previous biopsy studies. Surface EMG signals were recorded from the vastus medialis longus (VML), vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during isometric knee extension contractions at 60% and 80% of the maximum voluntary contraction (MVC) for 10 s and 60 s, respectively. Initial values and rate of change of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated. Comparisons between the two force levels revealed that the initial values of MNF for the VL muscle were greater at 80% MVC compared to 60% MVC (P < 0.01). Comparisons between the vasti muscles demonstrated lower initial values of CV for VMO compared to VL at 60% MVC (P < 0.01) and lower than VML and VL at 80% MVC (P < 0.01). In addition, initial values of MNF were higher for VL with respect to both VML and VMO at 80% MVC (P < 0.01) and initial estimates of ARV were higher for VMO compared to VML at both force levels (P < 0.01 at 60% MVC and P < 0.05 at 80% MVC). For the sustained contraction at 80% MVC, VL demonstrated a greater decrease in CV over time compared to VMO (P < 0.05).These findings suggest that surface EMG signals and their time course during sustained isometric contractions may be useful to non-invasively describe functional differences between the vasti muscles.     

Muscle fluid shift does not alter EMG global variables during sustained isometric actions

Body fluid redistribution occurs in astronauts traveling in space, potentially altering interstitial water content and hence impedance. This in turn may impact the features of electromyographic (EMG) signals measured to compare in-flight muscle function with pre- and post-flight conditions. Thus, the current study aimed at investigating the influence of similar fluid shifts on EMG spectral variables during muscle contractile activity. Ten men performed sustained isometric actions (120 s) at 20% and 60% of maximum voluntary contraction (MVC) following 1-h rest in the vertical or supine position.From single differential EMG signals, recorded from the soleus (SOL), the medial (MG) and lateral (LG) gastrocnemius muscles, initial value and rate of change over time (slope) of mean power frequency (MNF) and average rectified value (ARV) were assessed. MNF initial value showed dependence on muscle (P < 0.01), but was unaffected by body tilt. MNF rate of change increased (P < 0.001) with increased force and differed across muscles (P < 0.05), but was not influenced (P = 0.85) by altered body position. Thus, fluid shift resulting from vertical to supine tilt had no impact on myoelectrical manifestations of muscle fatigue. Furthermore, since such alteration of body fluid distribution resembles that occurring in microgravity, our findings suggest this may not be a methodological limitation, when comparing EMG fatigue indices on Earth versus in space.     

Strength training,but not endurance training,reduces motor unit discharge rate variability

This study evaluates and compares the effects of strength and endurance training on motor unit discharge rate variability and force steadiness of knee extensor muscles. Thirty sedentary healthy men (age, 26.0 ± 3.8 yrs) were randomly assigned to strength training, endurance training or a control group. Conventional endurance and strength training was performed 3 days per week, over a period of 6 weeks. Maximum voluntary contraction (MVC), time to task failure (at 30% MVC), coefficient of variation (CoV) of force and of the discharges rates of motor units from the vastus medialis obliquus and vastus lateralis were determined as subjects performed 20% and 30% MVC knee extension contractions before and after training. CoV of motor unit discharges rates was significantly reduced for both muscles following strength training (P < 0.001), but did not change in the endurance (P = 0.875) or control group (P = 0.995). CoV of force was reduced after the strength training intervention only (P < 0.01). Strength training, but not endurance training, reduces motor unit discharge rate variability and enhances force steadiness of the knee extensors. These results provide new insights into the neuromuscular adaptations that occur with different training methods.     

Endurance and strength training effects on physiological and muscular parameters during prolonged cycling

PurposeThis study investigated the effects of a combined endurance and strength training on the physiological and neuromuscular parameters during a 2-h cycling test.MethodsFourteen triathletes were assigned to an endurance-strength training group and an endurance-only training group. They performed three experimental trials before and after training: an incremental cycling test to exhaustion, a maximal concentric lower-limbs strength measurement and a 2-h cycling exercise. Physiological parameters, free cycling chosen cadence and the EMG of Vastus Lateralis (VL) and Rectus Femoris (RF) were analysed during the 2-h cycling task before and after a strength training programme of 5 weeks (three times per week).ResultsThe results showed that the maximum strength and the isometric maximal voluntary contraction (isoMVC) after training were significantly higher (P < 0.01) and lower (P < 0.01) than those before training, respectively, in endurance-strength training group and endurance-only group. The physiological variables measured during the cycling tests and the progressive increase (P < 0.01) in EMGi_(VL) and EMGi_(RF) throughout the 2-h cycling test did not differ between the two groups before and after training, except for the variation of EMGi_(VL) over the cycle time which was stabilized during the second hour of the 2-h cycling test due to training in endurance-strength training group. The decrease in free cycling chosen cadence observed in pre-training (P < 0.01) was also replaced by a steady free cycling chosen cadence for the endurance-strength training group during the second hour of exercise.ConclusionThis study confirmed the decrease in the free cycling chosen cadence with exercise duration and demonstrated that a specific combined endurance and strength training can prevent this decrease during a 2-h constant cycling exercise.     

History dependence of the electromyogram: Implications for isometric steady-state EMG parameters following a lengthening or shortening contraction

Residual force enhancement (RFE) and force depression (FD) refer to an increased or decreased force following an active lengthening or shortening contraction, respectively, relative to the isometric force produced at the same activation level and muscle length. Our intent was to determine if EMG characteristics differed in the RFE or FD states compared with a purely isometric reference contraction for maximal and submaximal voluntary activation of the adductor pollicis muscle. Quantifying these alterations to EMG in history-dependent states allows for more accurate modeling approaches for movement control in the future. For maximal voluntary contractions (MVC), RFE was 6–15% (P < 0.001) and FD was 12–19% (P < 0.001). The median frequency of the EMG was not different between RFE, FD and isometric reference contractions for the 100% and 40% MVC intensities (P > 0.05). However, root mean square EMG (EMG_RMS) amplitude for the submaximal contractions was higher in the FD and lower in the RFE state, respectively (P < 0.05). For maximal contractions, EMG_RMS was lower for the FD state but was the same for the RFE state compared to the isometric reference contractions (P > 0.05). Neuromuscular efficiency (NME; force/EMG) was lower in the force depressed state and higher in the force enhanced state (P < 0.05) compared to the isometric reference contractions. EMG spectral properties were not altered between the force-enhanced and depressed states relative to the isometric reference contractions, while EMG amplitude measures were.     

Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke

Although it has been reported that strengthening exercise in stroke patients is beneficial for their motor recovery, there is little evidence about which exercise method is the better option. The purpose of this study was to compare isotonic and isokinetic exercise by surface electromyography (EMG) analysis using standardized methods.Nine stroke patients performed three sets of isotonic elbow extensions at 30% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic elbow extensions with standardization of mean angular velocity and the total amount of work for each matched set in two strengthening modes. All exercises were done by using 1-DoF planner robot to regulate exact resistive torque and speed. Surface electromyographic activity of eight muscles in the hemiplegic shoulder and elbow was recorded. Normalized root mean square (RMS) values and co-contraction index (CCI) were used for the analysis.The isokinetic mode was shown to activate the agonists of elbow extension more efficiently than the isotonic mode (normalized RMS for pooled triceps: 96.0 ± 17.0 (2nd), 87.8 ± 14.4 (3rd) in isokinetic, 80.9 ± 11.0 (2nd), 81.6 ± 12.4 (3rd) in isotonic contraction, F[1, 8] = 11.168; P = 0.010) without increasing the co-contraction of muscle pairs, implicating spasticity or synergy.     

Motor unit number estimation as a complementary test to routine electromyography in the diagnosis of amyotrophic lateral sclerosis

Electromyographic (EMG) abnormalities that reveal denervation and reinnervation caused by lower motor neuron degeneration do not reflect the number of motor units that determines muscle strength. Consequently, motor unit activity potential (MUAP) parameters do not reflect muscle dysfunction.The aim of the study was to compare the value of motor unit number estimation (MUNE) and MUAP parameters as indicators of clinical muscle dysfunction in patients with amyotrophic lateral sclerosis (ALS), and to analyze the role of MUNE as a supplement to the EMG criteria for the diagnosis of ALS.In 25 patients with ALS, MUNE by the multipoint incremental method in the abductor digiti minimi (ADM) and quantitative EMG in the first dorsal interosseous (FDI) were obtained. The Medical Research Council (MRC) scale was used to evaluate clinical muscle dysfunction. A strong correlation between the number of motor units evaluated by MUNE and ADM clinical function by the MRC scale was found (P < 0.001). An increased value of surface-detected single motor action potential was associated with a decreased MRC score for ADM (P < 0.1). No relation was found between MUAP parameters in FDI and MRC scores. Our data support the value of the MUNE method for the detection of motor unit loss in ALS, and it could be postulated that MUNE studies may be considered complementary tests for ALS in a future revision of ALS criteria.     

Spatial reorganisation of muscle activity correlates with change in tangential force variability during isometric contractions

The aim of this study was to quantify the effects of spatial reorganisation of muscle activity on task-related and tangential components of force variability during sustained contractions. Three-dimensional forces were measured from isometric elbow flexion during submaximal contractions (50 s, 5–50% of maximal voluntary contraction (MVC)) and total excursion of the centre of pressure was extracted. Spatial electromyographic (EMG) activity was recorded from the biceps brachii muscle. The centroids of the root mean square (RMS) EMG and normalised mutual information (NMI) maps were computed to assess spatial muscle activity and spatial relationship between EMG and task-related force variability, respectively. Result showed that difference between the position of the centroids at the beginning and at the end of the contraction of the RMS EMG and the NMI maps were different in the medial–lateral direction (P < 0.05), reflecting that muscle regions modulate their activity without necessarily modulating the contribution to the task-related force variability over time. Moreover, this difference between shifts of the centroids was positively correlated with the total excursion of the centre of pressure at the higher levels of contractions (>30% MVC, R² > 0.30, P < 0.05), suggesting that changes in spatial muscle activity could impact on the modulation of tangential forces. Therefore, within-muscle adaptations do not necessarily increase force variability, and this interaction can be quantified by analysing the RMS EMG and the NMI map centroids.     

Adaptive changes in motor control of rhythmic movement after maximal eccentric actions

Effects of an exhaustive eccentric exercise (EE) on the motor control of maximal velocity rhythmic elbow extension/flexion movement (RM) were examined in eight male students. The exhaustive EE consisted of 100 maximal eccentric actions of the elbow flexor muscles. Movement range was 40–170° in EE at an angular velocity of 2 rad s^?1. A directive scaled RM of 60° with visual feedback was performed in a sitting position, with the right forearm fixed to the lever arm in horizontal plane above protractor. Surface electromyographic activity (EMG) was recorded from the biceps brachii (BB) and triceps brachii (TB) muscles. Maximal isokinetic eccentric and concentric tests and RM test were conducted before, after, 0.5 h, 2 days and 7 days after the exercise. Dynamic force production was deteriorated after EE (P < .001), and did not recover fully within 7 days. The delayed recovery phase was characterized by delayed onset of muscle soreness (DOMS) and elevated serum creatine kinase (CK) activity. The RM test revealed a delayed increase of the fatigued BB muscle EMG activity, but the maximal RM velocity could be preserved. The present results emphasize the capacity of the neuromuscular system to compensate for prolonged eccentric-induced contractile failure by optimizing antagonistic muscles coordination in a demanding rhythmic task. The underlying compensatory mechanisms could be related to increased sensitization of small diameter muscle nerve endings.     

Measurement of synergy and spasticity during functional movement of the post-stoke hemiplegic upper limb

The aim of the present study was to measure the muscle-contraction patterns of the hemiplegic upper limb using electromyography (EMG) and to investigate the relationship between muscle co-contraction and functional recovery in stroke patients presenting with synergy and spasticity. The muscle-contraction patterns of the upper limb of 12 chronic stroke patients and 10 normal volunteers were measured, and the co-contraction in the distal and proximal muscles was simultaneously quantified, while the participants performed hand-grasp and shoulder flexion tasks. The spasticity and hemiplegic arm function were evaluated, respectively, on a modified Ashworth scale (MAS) and by means of Fugl-Meyer motor assessment (FMA). The correlation between the MAS and FMA values was analyzed.Increased co-contraction (66–555%) was observed in both the proximal and distal upper limbs, and was positively correlated with spasticity of the elbow flexor (r = 0.944 on shoulder flexion, r = 0.741 on hand grasping, p < 0.01) and negatively correlated with functional recovery of the upper limb (r = ?0.670 ～ ?0.884, p < 0.05). Specific movement patterns influenced by synergy and spasticity were confirmed by EMG. These results might prove useful to the formulation of appropriate management plans such as those involving botulinum toxin injection or nerve block.     

Multi-channel electromyography during maximal isometric and dynamic contractions

Motor unit behavior differs between contraction types at submaximal contraction levels, however is challenging to study during maximal voluntary contractions (MVCs). With multi-channel surface electromyography (sEMG), mean physiological characteristics of the active motor units can be extracted. Two 8-electrode sEMG arrays were attached on biceps brachii muscle (one on each head) to examine behavior of sEMG variables during isometric, eccentric and concentric MVCs of elbow flexors in 36 volunteers.On average, isometric (364 ± 88 N) and eccentric (353 ± 74 N) MVCs were higher than concentric (290 ± 73 N) MVC (p < 0.001). Mean muscle fiber conduction velocity (CV) was highest during eccentric MVC (4.42 ± 0.49 m/s) than concentric (4.25 ± 0.49 m/s, p < 0.01) and isometric (4.14 ± 0.45 m/s, p < 0.001) MVCs. Furthermore, eccentric MVC showed lower sEMG amplitude at the largest elbow joint angles (120–170°) and higher CV at the smallest (70–150°) elbow joint angles (p < 0.05–0.001) than concentric MVC.The differences in CV and sEMG amplitude between the MVCs suggest that the control strategy of motor units differs between the contraction types during MVCs, and is dependent on the muscle length between the dynamic MVCs.     

Electromyographic and mechanomyographic responses across repeated maximal isometric and concentric muscle actions of the leg extensors

The purpose of the present study was to examine the patterns of responses for torque, electromyographic (EMG) amplitude, EMG mean power frequency (MPF), mechanomyographic (MMG) amplitude, and MMG MPF across 30 repeated maximal isometric (ISO) and concentric (CON) muscle actions of the leg extensors. Twelve female subjects (21.1 ± 1.4 yrs; 63.3 ± 7.4 kg) performed ISO and CON fatigue protocols with EMG and MMG signals recorded from the vastus lateralis. The relationships for torque, EMG amplitude, EMG MPF, MMG amplitude, and MMG MPF versus repetition number were examined using polynomial regression. The results indicated there were decreases (p < 0.05) across the ISO muscle actions for torque (r² = 0.95), EMG amplitude (R² = 0.44), EMG MPF (r² = 0.62), and MMG MPF (r² = 0.48), but no change in MMG amplitude (r² = 0.07). In addition, there were decreases across the CON muscle actions for torque (R² = 0.97), EMG amplitude (R² = 0.46), EMG MPF (R² = 0.86), MMG amplitude (R² = 0.44), and MMG MPF (R² = 0.80). Thus, the current findings suggested that the mechanisms of fatigue and motor control strategies used to modulate torque production were similar between maximal ISO and CON muscle actions.     

Electromyographic mapping of the erector spinae muscle with varying load and during sustained contraction

The purpose of the study was to explore changes in the spatial distribution of erector spinae electromyography amplitude during static, sustained contractions and during contractions of increasing load. Surface electromyographic (EMG) signals were detected from nine healthy subjects using a grid of 13 × 5 electrodes placed unilaterally over the lumbar erector spinae musculature. Subjects stood in a 20° forward flexed position and performed: (1) six 20-s long contractions with loads ranging from 2.5 kg to 12.5 kg (2.5 kg increments) and (2) a 6 min sustained contraction with 7.5 kg load. Root mean square (RMS) and mean power spectral frequency (MNF) were computed from the recorded EMG signals. EMG RMS increased (P < 0.0001) and MNF remained constant during contractions of increased load. During the sustained contraction, MNF decreased (P < 0.0001) and RMS did not change over time. The centroid (center of activity) of the RMS map shifted caudally (P < 0.0001) with time during the sustained contraction but did not change with varying load. These results suggest a change in the distribution of erector spinae muscle activity with fatigue and a uniform distribution of muscle activation across loads.     

Optimal whole-body vibration settings for muscle strength and power enhancement in human knee extensors

This study compared the effects of 6-week whole-body vibration (WBV) training programs with different frequency and peak-to-peak displacement settings on knee extensor muscle strength and power. The underlying mechanisms of the expected gains were also investigated. Thirty-two physically active male subjects were randomly assigned to a high-frequency/high peak-to-peak displacement group (HH; n = 12), a low-frequency/low peak-to-peak displacement group (LL; n = 10) or a sham training group (SHAM; n = 10). Maximal voluntary isometric, concentric and eccentric torque of the knee extensors, maximal voluntary isometric torque of the knee flexors, jump performance, voluntary muscle activation, and contractile properties of the knee extensors were assessed before and after the training period. Significant improvement in knee extensor eccentric voluntary torque (P < 0.01), knee flexor isometric voluntary torque (P < 0.05), and jump performance (P < 0.05) was observed only for HH group. Regardless of the group, knee extensor muscle contractile properties (P < 0.05) were enhanced. No modification was observed for voluntary muscle activation or electrical activity of agonist and antagonist muscles. We concluded that high-frequency/high peak-to-peak displacement was the most effective vibration setting to enhance knee extensor muscle strength and jump performance during a 6-week WBV training program and that these improvements were not mediated by central neural adaptations.     

Resistance training alters the sensorimotor control of vasti muscles

The present study examined and compared two modes of weight training (bodybuilding and power-lifting) on the surface EMG of vasti muscles, knee joint position sense and isometric knee extension force in 48 able-bodied subjects. Subjects were randomly allocated into either a moderate loading and repetitions (bodybuilding) training or a high loading and low repetitions (power-lifting) training, or a no training control group. Training was conducted on alternate days with individual supervision. After 8 weeks of training, subjects from both training groups showed significantly earlier EMG onset timing and higher amplitude of vastus medialis obliquus relative to vastus lateralis (p = 0.005 or <0.001), and improved knee joint position sense (p < 0.001), but no such changes were found in the control group. However, the changes were not significantly different (p > 0.05) between the two training groups. The findings suggested that the neuromotor control of the vasti muscles could be altered by regular weight training.     

Effect of pain location on spatial reorganisation of muscle activity

IntroductionWe aimed to determine whether the changes in muscle activity (in terms of both gross electromyography (EMG) and motor unit (MU) discharge characteristics) observed during pain are spatially organized with respect to pain location within a muscle which is the main contributor of the task.MethodsSurface and fine-wire EMG was recorded during matched low-force isometric plantarflexion from soleus (from four quadrants with fine-wire EMG and from the medial/lateral sides with surface EMG), both gastrocnemii heads, peroneus longus, and tibialis anterior. Four conditions were tested: two control conditions that each preceded contractions with pain induced in either the lateral (Pain_L) or medial (Pain_M) side of soleus.ResultsNeither the presence (p = 0.28) nor location (p = 0.19) of pain significantly altered gross muscle activity of any location (lateral/medial side of soleus, gastrocnemii, peroneus longus and tibialis anterior). Group data from 196 MUs show redistribution of MU activity throughout the four quadrants of soleus, irrespective of pain location. The significant decrease of MU discharge rate during pain (p < 0.0001; Pain_L: 7.3 ± 0.9–6.9 ± 1.1 Hz, Pain_M: 7.0 ± 1.1 to 6.6 ± 1.1 Hz) was similar for all quadrants of the soleus (p = 0.43), regardless of the pain location (p = 0.98). There was large inter-participant variation in respect to the characteristics of the altered MU discharge with pain.ConclusionResults from both surface and fine-wire EMG recordings do not support the hypothesis that muscle activity is reorganized in a simple systematic manner with respect to pain location.     

Unchanged H-reflex during a sustained isometric submaximal plantar flexion performed with an EMG biofeedback

The aim of this study was to assess H-reflex plasticity and activation pattern of the plantar flexors during a sustained contraction where voluntary EMG activity was controlled via an EMG biofeedback. Twelve healthy males (28.0 ± 4.8 yr) performed a sustained isometric plantar flexion while instructed to maintain summed EMG root mean square (RMS) of gastrocnemius lateralis (GL) and gastrocnemius medialis (GM) muscles fixed at a target corresponding to 80% maximal voluntary contraction torque via an EMG biofeedback. Transcutaneous electrical stimulation of the posterior tibial nerve was evoked during the contraction to obtain the maximal H-reflex amplitude to maximal M-wave amplitude ratio (H_sup/M_sup ratio) from GL, GM and soleus (SOL) muscles. Neuromuscular function was also assessed before and immediately after exercise. Results showed a decrease in SOL activation during sustained flexion (from 65.5 ± 6.4% to 42.3 ± 3.8% maximal EMG, p < 0.001), whereas summed EMG RMS of GL and GM remained constant (59.7 ± 4.8% of maximal EMG on average). No significant change in the H_sup/M_sup ratio was found for SOL, GL and GM muscles. Furthermore, it appears that the decrease in maximal voluntary contraction torque (?20.4 ± 2.9%, p < 0.001) was related to both neural and contractile impairment. Overall, these findings indicate that the balance between excitation and inhibition affecting the motoneuron pool remains constant during a sustained contraction where myoelectrical activity is controlled via an EMG biofeedback or let free to vary.