Torque steadiness and muscle activation are bilaterally impaired during shoulder abduction and flexion in chronic post-stroke subjects

ObjectiveTo characterize sensorimotor control and muscle activation in the shoulder of chronic hemiparetic during abduction and flexion in maximal and submaximal isometric contractions. Furthermore, to correlate submaximal sensorimotor control with motor impairment and degree of shoulder subluxation.MethodsThirteen chronic hemiparetic post-stroke age-gender matched with healthy were included. Isometric torques were assessed using a dynamometer. Electromyographic activity of the anterior and middle deltoid, upper trapezius, pectoralis major and serratus anterior muscles were collected. Variables were calculated for torque: peak, time to target, standard deviation (SD), coefficient of variation (CV), and standard error (RMSE); for muscle activity: maximum and minimum values, range and coefficient of activation. Motor impairment was determined by Fugl-Meyer and shoulder subluxation was measured with a caliper.ResultsParetic and non-paretic limbs reduced peak and muscle activation during maximal isometric contraction. Paretic limb generated lower force when compared with non-paretic and control. Paretic and non-paretic presented higher values of SD, CV, RMSE, and CV for prime mover muscles and minimum values for all muscles during steadiness. No correlation was found between sensorimotor control, motor impairment and shoulder subluxation.ConclusionChronic hemiparetic presented bilateral deficits in sensorimotor and muscle control during maximal and submaximal shoulder abduction and flexion.     

Electromyographic instantaneous amplitude and instantaneous mean power frequency patterns across a range of motion during a concentric isokinetic muscle action of the biceps brachii.

The purpose of this study was to examine the electromyographic (EMG) instantaneous amplitude (IA) and instantaneous mean power frequency (IMPF) patterns for the biceps brachii muscle across a range of motion during maximal and submaximal concentric isokinetic muscle actions of the forearm flexors. Ten adults (mean +/- SD age = 22.0 +/- 3.4 years) performed a maximal and a submaximal [20% peak torque (PT)] concentric isokinetic forearm flexion muscle action at a velocity of 30 degrees s(-1). The surface EMG signal was detected from the biceps brachii muscle with a bipolar electrode arrangement, and the EMG IA and IMPF versus time relationships were examined for each subject using first- and second-order polynomial regression models. The results indicated that there were no consistent patterns between subjects for EMG IA or IMPF with increases in torque across the range of motion. Some of the potential nonphysiological factors that could influence the amplitude and/or frequency contents of the surface EMG signal during a dynamic muscle action include movement of the muscle fibers and innervation zone beneath the skin surface, as well as changes in muscle fiber length and the thickness of the tissue layer between the muscle and the recording electrodes. These factors may affect the EMG IA and IMPF patterns differently for each subject, thereby increasing the difficulty of drawing any general conclusions regarding the motor control strategies that increase torque across a range of motion.     

Velocity of isokinetic trunk exercises influences back muscle recruitment patterns in healthy subjects

Isokinetic exercises at different angular velocities on Cybex devices are often used for assessment and therapy in chronic low back pain patients. Little is known about the effect of velocity of movement on the muscle activity during these exercises. The purpose of this study was to investigate both relative muscle activity and ratios of local to global muscle activity at the different velocities of isokinetic movements on a Cybex dynamometer. Fifty-three healthy employees of Belgian Defence (26 male and 27 female) aged between 20 and 57 years old voluntarily performed isometric and isokinetic exercises at four different velocities. Surface electromyographic signals of different abdominal and back muscles were recorded on both sides. Both the relative muscle activity and the local to global muscle activity ratio of the back muscles were affected by changes in velocities of isokinetic exercises. The global muscle system was more influenced by changes in velocity, than the local muscle system. Abdominal relative muscle activity and ratios were not influenced by velocity of movement. This study revealed that the velocity of isokinetic extension exercises influences the recruitment of the back muscles, meaning that protocols of training programs should be adapted in function of the focus of the therapy.     

Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness

The purpose of the present study was to determine (1) if joint position sense (JPS) in subjects with shoulder stiffness (SS) differs from that in controls; (2) if, when JPS is reduced in SS, it is related to scapular muscular activities in the mid/end ranges of motion; and (3) if a person’s function is associated with his or her level of JPS. Eighteen subjects with unilateral SS and 18 controls were included. Each subject performed abduction by self-selecting an end/mid range position. The electromagnetic motion-capturing system collected kinematic data while surface electromyography collected muscle activities (upper trapezius, lower trapezius, and serratus anterior muscles). Subjects were asked to move the upper limb to the target position (end/mid range) accurately without visual guidance. Reduced JPS was observed in subjects with SS (2.7 degrees in mid range, p < 0.05). The JPS was enhanced by an increased scapula muscular activation level in the end range of motion (R = ?0.61 for SS and ?0.41 for controls) and by coordination among muscles’ activation in the mid-range of motion (R = ?0.87 for SS and R = ?0.53 for controls). Impaired JPS was also related to self-reported functional status (R = ?0.56) in subjects with SS. Shoulder JPS in subjects with chronic SS is impaired in comparison with controls. In the mid-range motion, the coordination of scapula muscular activation is related to shoulder JPS. Impaired JPS is also function-related in subjects with SS. These findings suggest that the coordination among scapula muscles’ activation were important to consider in the rehabilitation of patients with chronic SS.     

Altered patterns of muscle activation during performance of four functional tasks in patients with shoulder disorders: interpretation from voluntary response index.

Altered motor control of the shoulder muscles during performance of a specific motor task in patients with shoulder disorders (SDs) has been an interesting subject to researchers. This study compared shoulder muscle activation patterns by surface electromyography (sEMG), including the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) muscles, during four functional tasks in 25 patients with SDs and controls. A voluntary response index (VRI) was calculated, including magnitude and similarity index (SI), to quantify sEMG patterns during four functional tasks. Responsiveness and clinically meaningful levels of discrimination between patients and control for EMG magnitude and SI were determined. An altered pattern of motor control during four functional tasks was evident in the patients, in which greater EMG amplitude and abnormal EMG patterns were found. For SI among four functional tasks, normal subjects ranged from 0.80 to 1.00 while patients ranged from 0.70 to 0.99. High probabilities (97%) of discrimination between patients and normal subjects were found by SI method during an overhead height task (patients: 0.85-0.96, normal subjects: 0.95-1.00). Our results also suggest that an individual can be estimated to be abnormal when lower SI values are observed during the four functional tasks.     

Effects of isokinetic training of the knee extensors on high-intensity exercise performance and skeletal muscle buffering

Twenty-three subjects isokinetically trained the right and left quadriceps femoris, three times per week for 16 weeks; one group (n=13) trained at an angular velocity of 4.19 rad · s^–1 and a second group (n=10), at 1.05 rad · s^–1. A control group (n=10) performed no training. Isometric endurance time at 60% quadriceps maximum voluntary contraction (MVC), mean power output and work done (W) during all-out cycling, and the muscle buffer value (B) and carnosine concentration of biopsy samples from the vastus lateralis, were all assessed before and after training. The two training groups did not differ significantly from each other in their training response to any of these variables (P < 0.05). No significant difference in either 60% MVC endurance time or impulse [(endurance time × force) at 60% MVC] was observed for any group after the 16 week period (P > 0.05). However, the post-training increase (9%) in W during high-intensity cycling was greater in the training group than in the control group (P=0.04). NeitherB nor carnosine concentration showed any significant change following training (P=0.56 andP=0.37, respectively). It is concluded that 16 weeks of isokinetic training of the knee extensors enables subjects to do more work during high-intensity cycling. Although the precise adaptations responsible for the improved performance have yet to be identified, they are unlikely to include an increase inB.     

EMG and force production of some human shoulder muscles during isometric abduction

Surface EMG was recorded in four subjects on three different occasions from the three parts of the deltoid, the clavicular part of the pectoralis major and from the infraspinatus muscles at different angles of abduction, in the frontal and scapular plane. The integrated EMG was related to the maximum values found for each muscle or muscle part during test contractions (%EMG). Linear relations can be seen for abduction angle vs %EMG. During abduction in the scapular plane the middle and posterior parts of the deltoid muscle showed significantly less activity than in the frontal plane. A simple two dimensional model to calculate the deltoid force out of total external moment at the shoulder is presented. For the middle part of the deltoid an EMG-force relation is presented. The maximal deltoid forces found during test contractions are compared with the absolute muscle force. Also, the length-force relation for the middle part of the deltoid muscle is given between 30° and 90° of abduction.     

Effect of creatine supplementation during rapid body mass reduction on metabolism and isokinetic muscle performance capacity

Well-trained subjects (n=6) were studied before and after losing a mean 3.0%–4.3% of body mass to determine whether muscle performance could be maintained or even enhanced by dietary creatine supplementation. During a 5-day period of loss of mass the subjects were randomly assigned to a creatine or placebo supplemented diet. All the subjects were measured before and after loss of mass on both supplements for isokinetic peak torque (PT) and work at peak torque (W _PT) of knee extensors, also for intermittent high intensity working capacity of the same muscle group. The latter test consisted of submaximal isokinetic knee extensions at an angular velocity of 1.57 rad · s⁻¹ for 45 s at the rate of 30 contractions each min (submaximal work, W _{s max} ) followed by 15-s maximal effort (maximal work, W _max ). Total duration of the test was 3 min. Haematocrit was measured and haemoglobin, ammonia, lactate, glucose and urea concentrations were analysed in blood samples obtained at rest and after cessation of muscle performance tests. The results indicated that creatine supplementation in comparison with placebo treatment during rapid body mass reduction may help to maintain muscle PT and W _PT at high angular velocities, not influencing W _max and the rate of fatigue development during W _max , but affecting adversely W _{s max} . Within the limitations of the present study the reasons for the partially detrimental effect of creatine administration remain obscure, but it is suggested that impaired creatine uptake in muscle during body mass loss as well as creatine induced changes in muscle glucose and glycogen metabolism may be involved. Accepted: 18 December 1997     

A muscle controlled finite-element model of laryngeal abduction and adduction

A three-dimensional finite-element model was developed to simulate the complex movement of the laryngeal cartilages during vocal fold abduction and adduction. The model consists of cricoid and arytenoid cartilages, as well as the intralaryngeal muscles and vocal folds. The active and passive properties of the muscles were idealised by one-dimensional elements based on the Hill theory. Its controlling input value is a time dependent stimulation rate. Optimisation loops have been carried out for the arrangement of the individual stimulation rates. Since in vivo measurements are not feasible, the developed biomechanical model shall be used to analyse the force distribution within the laryngeal muscles during phonatory manoeuvres. Simulations of abduction and adduction in different pitches of voice lead to realistic tensions of the vocal folds. The model is a first step to analyse motional vocal fold diseases and to predict the consequences of phonosurgical interventions.     

A muscle controlled finite-element model of laryngeal abduction and adduction

A three-dimensional finite-element model was developed to simulate the complex movement of the laryngeal cartilages during vocal fold abduction and adduction. The model consists of cricoid and arytenoid cartilages, as well as the intralaryngeal muscles and vocal folds. The active and passive properties of the muscles were idealised by one-dimensional elements based on the Hill theory. Its controlling input value is a time dependent stimulation rate. Optimisation loops have been carried out for the arrangement of the individual stimulation rates. Since in vivo measurements are not feasible, the developed biomechanical model shall be used to analyse the force distribution within the laryngeal muscles during phonatory manoeuvres. Simulations of abduction and adduction in different pitches of voice lead to realistic tensions of the vocal folds. The model is a first step to analyse motional vocal fold diseases and to predict the consequences of phonosurgical interventions.     

Analysis of phase detects altered timing of muscle activation in subjects with chronic shoulder pain

Optimal exercise therapy for shoulder pain is unknown due to limited information regarding specific changes in muscle function associated with pain. Timing of muscle activity with respect to movement (phase) can provide information about muscle activation patterns without requiring electromyography data normalization which is problematic in the presence of pain. The aim of this study was to determine if a phase measure is able to detect differences in the timing of shoulder muscle activation in subjects with chronic shoulder pain. Fourteen subjects with pain and 14 without pain were recruited. Electromyography from eight shoulder muscles was recorded. Approximately 20 cycles of small amplitude (∼30°) rapid shoulder flexion/extension was performed. A cross-correlation and spectrographic analysis provided a measure of phase. Welch’s t-tests were used to compare mean phase angles between groups. Subjects with chronic shoulder pain had greater variability in the relative timing of muscle activation with significant differences found in the phase angles for pectoralis major, infraspinatus, supraspinatus, upper and lower trapezius and serratus anterior. This preliminary study indicates that the examination of the timing of muscle activation using a phase measure can identify significant differences in muscle function between normal subjects and those with chronic shoulder pain.     

Intrarater reliability of 1 repetition maximum estimation in determining shoulder internal rotation muscle strength performance

The purpose of this study was to determine intrarater reliability of the 1 repetition maximum (1RM) estimation for shoulder internal rotation. The accuracy of the estimated 1RM was determined by establishing the actual 1RM. Fifteen subjects were positioned supine with the shoulder in 0 degrees abduction (position 1) and prone with the shoulder in 90 degrees abduction (position 2). Subjects were placed in both testing positions and performed resisted shoulder internal rotation. A 1RM estimation equation was used to estimate shoulder internal rotation strength. After 1 week, procedures were repeated and intrarater reliability was calculated. One week after 1RM estimation procedures were completed, the accuracy of an estimated 1RM was determined by establishing an actual 1RM. The results indicated excellent intrarater reliability for position 1 (intraclass correlation coefficient [ICC] = 0.99) and position 2 (ICC = 0.96). The correlation coefficients for accuracy indicated excellent concurrent validation was attained for position 1 (ICC = 0.99) and position 2 (ICC = 0.97). Shoulder internal rotation 1RM estimation appears to be reliable and accurate. Clinicians may use submaximal loads to estimate the 1RM and decrease the possibility of injury during actual 1RM strength testing.     

Electromyographic changes in work-related myalgia of the trapezius muscle.

In 11 patients, all women, 21-55 years of age, with unilateral work-related myalgia of the trapezius muscle, the right and left trapezius muscles were examined simultaneously for electromyogram (EMG) signs of localized muscle fatigue. All patients were tested with 0-kg hand load for 5 min, holding the arms straight at 90 degrees of elevation in the scapular plane. Only 4 of the patients tolerated exposure to higher load levels. They were tested with 1 kg hand load for 3 min and 2 kg hand load for 2 min, with a period of rest of 30 min between the trials. The EMG mean power frequency (MPF) and root mean square (rms) were calculated. Data were normalized with the initial value as a reference and regression analyses were performed. On both sides a decrease of MPF and an increase of rms were found with increasing time and load, i.e. classical EMG signs of localized muscle fatigue. Compared with the nonaffected side smaller changes were found on the affected side, possibly due to pain inhibition, impaired microcirculation and biochemical changes along the muscle fibres. At 0-kg hand load we found no change of MPF on either side despite subjective feelings of fatigue and pain. We interpreted these findings as an indication of reduced capacity of the affected trapezius muscle to sustain static load with early development of pain-associated local fatigue.     

Effects of horizontal shoulder abduction and adduction on the activity and strength of the scapular protractors

Increased activity of the serratus anterior (SA) muscle combined with decreased activity of the pectoralis major (PM) muscle during scapular protraction exercise is a widely used method for selective strengthening of the former muscle. However, the role played by the PM during maximal scapular protraction remains unclear. The objective of our study was to investigate the effects of horizontal shoulder abduction (decreasing PM activity) and adduction (increasing activity) on the strength and activity of the scapular protractors (the SA and PM) during maximal protraction. Twenty-nine healthy males performed maximal scapular protraction combined with horizontal shoulder abduction or adduction. The strength and activity of the PM and SA decreased significantly (both p < 0.01) during maximal scapular protraction combined with horizontal shoulder abduction, compared with maximal scapular protraction alone, but increased significantly (both p < 0.01) when maximal scapular protraction was combined with horizontal shoulder adduction. We thus conclude that the PM stabilizes the activated SA during maximal scapular protraction, which effectively increases SA activity and scapular protraction strength in the serratus punch posture.     

Immediate effects and short-term retention of multi-modal instruction compared to written only on muscle activity during the prone horizontal abduction exercise in individuals with shoulder pain

In rehabilitation, exercise instructions are multi-modal and can include a focus of increasing mean activity of a target muscle and inhibiting aberrant synergistic muscle activity, particularly during shoulder exercises, such as the prone horizontal abduction (PHA). The objective was to compare the immediate effects and short-term retention of multi-modal exercise instruction by a physical therapist written only instruction on normalized mean upper and lower trapezius muscle activity during three phases (concentric/isometric/eccentric) versus of an isotonic PHA exercise between participants with and without shoulder pain. Surface electromyography (EMG) was recorded from fourteen healthy participants and twelve participants with shoulder pain during the PHA exercise under two conditions: (1) written only instructions and (2) multi-modal instruction. Retention of multi-modal instruction on muscle activity was assessed one week later. Results demonstrate 12.8–16.0% increase in lower trapezius muscle activity during the concentric and isometric phases with multi-modal instructions in both groups. Inhibition of the upper trapezius did not occur in either group. Facilitation effects were maintained in short-term follow-up. Findings suggest that regardless of shoulder pain, multi-modal instruction by a physical therapist facilitates greater neuromuscular activity of a targeted muscle compared to written instructions alone and these effects are retained.     

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.     

The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome

PurposeThis study aimed to investigate the effect of elastic taping on kinematics, muscle activity and strength of the scapular region in baseball players with shoulder impingement.ScopeSeventeen baseball players with shoulder impingement were recruited from three amateur baseball teams. All subjects received both the elastic taping (Kinesio Tex^TM) and the placebo taping (3 M Micropore tape) over the lower trapezius muscle. We measured the 3-dimensional scapular motion, electromyographic (EMG) activities of the upper and lower trapezius, and the serratus anterior muscles during arm elevation. Strength of the lower trapezius was tested prior to and after each taping application. The results of the analyses of variance (ANOVA) with repeated measures showed that the elastic taping significantly increased the scapular posterior tilt at 30° and 60° during arm raising and increased the lower trapezius muscle activity in the 60–30° arm lowering phase (p < 0.05) in comparison to the placebo taping.ConclusionsThe elastic taping resulted in positive changes in scapular motion and muscle performance. The results supported its use as a treatment aid in managing shoulder impingement problems.