Males and females have different muscle activity patterns during gait after ACL injury and reconstruction

Kinematic and kinetic changes following anterior cruciate ligament (ACL) rupture and reconstruction (ACLR) have been fundamental to the understanding of mechanical disrupted load as it contributes to the development of posttraumatic osteoarthritis. These analyses overlook the potential contribution of muscle activity as it relates to the joint loading environment. Males and females classified as non-copers present with unique knee kinematics and kinetics after ACL injury. The purpose of this study was to perform sex-specific analyses in these individuals to explore muscle activity timing during gait after ACL rupture. Thirty-nine participants (12 females, 27 males) were enrolled. Muscle activity during gait was evaluated before and after pre-operative physical therapy, and six months after ACLR. Surface electromyography data were evaluated to determine timing (e.g., the time the muscle activity begins (‘On’) and ends (‘Off’)) for seven muscles: vastus lateralis and medialis (VL, VM), lateral and medial hamstrings (LH, MH), lateral and medial gastrocnemius (LG, MG), and soleus (SOL). General linear models with generalized estimating equations detected the effects of limb and time for muscle activity timing. Males presented with more limb asymmetries before and after pre-operative PT in the VL On (p < 0.001) and Off (p = 0.007), VM On and Off (p < 0.001), and MH off (p < 0.001), but all limb differences resolved by six months post ACLR. Changes in muscle activity in males were pervasive over time in both limbs. Females presented with no interlimb differences pre-operatively, and only involved limb VL off (p = 0.027) and VM off (p = 0.003) and the LH off in both limbs (p < 0.038) changed over time. Our data indicate that inter-limb differences in muscle activity across time points and changes in muscle activity timing over the course of physical therapy were sex specific. Males presented with more inter-limb differences in muscle activity across time points, and females presented with fewer asymmetries before and after pre-operative physical therapy. These data support that sex-specific adaptations should be taken into consideration when assessing biomechanical changes after ACLR.     

Coactivation during gait as an adaptive behavior after stroke

The aims of the present study were to quantify the impairment in ankle coactivation on the paretic and non-paretic sides of subjects with hemiparesis and to examine the relationship of ankle coactivation with postural instability, motor deficit of the paretic lower extremity and locomotor performance. Electromyography of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles were recorded bilaterally during gait in 30 subjects (62.1±9.9 years) who had suffered a recent stroke (<6 months) as well as on one side of 17 healthy controls (59.3±9.1 years) walking at very slow speed. Ankle muscle coactivation was calculated by dividing the time of overlap between MG and TA signals (threshold of 20 μV) by the duration of the gait phases of interest: stance, swing, first and second double support sub-phases and single support sub-phase. The time spent in single support and the peak plantarflexor moment of force on the paretic side were used to measure, respectively, postural stability and dynamic strength of the paretic plantarflexors. The subjects with hemiparesis demonstrated less coactivation on the paretic side during the single support sub-phase (p<0.01) and more coactivation during first and second double support sub-phases on the non-paretic side (p<0.001) compared to control values. The patients with coactivation patterns that differed the most from controls were the patients with the more severe impairments and disabilities. While the reduced coactivation on the paretic side may contribute to poor postural stability and poor locomotor performance, the presence of excessive coactivation on the non-paretic side when both limbs were in ground contact may be an adaptation to help maintain postural stability during gait.     

Role of the interaction between lumbar kinematics and accelerometer-measured physical activity in bodily pain,physical functioning and work ability among health care workers with low back pain

The aim of this study was to examine the associations of spinal kinematics and physical activity (PA) with bodily pain, physical functioning, and work ability among health care workers with low back pain (LBP). Spinal kinematics and PA were measured with a wireless Inertial Measurement Unit system (ValedoMotion®) and a waist-worn tri-axial accelerometer (Hookie AM20), respectively. Their association was assessed in relation to Work Ability Index (WAI), bodily pain and physical functioning (RAND-36) in 210 health care workers with recurrent LBP. Greater lumbar movement variability/less deterministic lumbar movement (in angular velocity) during a “Pick Up a Box” functional task was correlated with higher amounts of step counts (r = -0.29, p = 0.01) and moderate PA (r = -0.24, p = 0.03). A higher amount of PA (p = 0.03) as well as less movement control impairment (p = 0.04) and movement variability (p = 0.03) were associated with greater work ability, whilst greater vigorous PA was the only parameter to explain higher physical functioning (p = 0.02). PA and movement variability were relative to each other to explain bodily pain (p = 0.01). These findings show the importance of considering the interaction between lumbar kinematics and physical activity while planning strategies to improve bodily pain, physical functioning and work ability among health care workers with LBP.     

Experimental quadriceps muscle pain impairs knee joint control during walking.

Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects. Isotonic saline (0.9%) was used as control. Surface electromyography (EMG) recordings of VM, vastus lateralis (VL), biceps femoris, and semitendinosus muscles were synchronized with the gait analyses. During experimental muscle pain, the loading response phase peak knee extensor moments were attenuated, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity of musculoskeletal problems, and it may have clinically important implications for rehabilitation and training of patients with knee pain of musculoskeletal origin.     

Electromyographic patterns of lower limb muscles during apprehensive gait in younger and older female adults

ObjectiveInvestigate the influence of apprehensive gait on activation and cocontraction of lower limb muscles of younger and older female adults.MethodsData of 17 younger (21.47 ± 2.06 yr) and 18 older women (65.33 ± 3.14 yr) were considered for this study. Participants walked on the treadmill at two different conditions: normal gait and apprehensive gait. The surface electromyographic signals (EMG) were recorded during both conditions on: rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), tibialis anterior (TA), gastrocnemius lateralis (GL), and soleus (SO).ResultsApprehensive gait promoted greater activation of thigh muscles than normal gait (F = 5.34 and p = 0.007, for significant main effect of condition; RF, p = 0.002; VM, p < 0.001; VL, p = 0.003; and BF, p = 0.001). Older adults had greater cocontraction of knee and ankle stabilizer muscles than younger women (F = 4.05 and p = 0.019, for significant main effect of groups; VM/BF, p = 0.010; TA/GL, p = 0.007; and TA/SO, p = 0.002).ConclusionApprehensive gait promoted greater activation of thigh muscles and older adults had greater cocontraction of knee and ankle stabilizer muscles. Thus, apprehensive gait may leads to increased percentage of neuromuscular capacity, which is associated with greater cocontraction and contribute to the onset of fatigue and increased risk of falling in older people.     

Motor unit firing patterns of lower leg muscles during isometric plantar flexion with flexed knee joint position

The ankle flexor and extensor muscles are essential for pedal movements associated with car driving. Neuromuscular activation of lower leg muscles is influenced by the posture during a given task, such as the flexed knee joint angle during car driving. This study aimed to investigate the influence of flexion of the knee joint on recruitment threshold-dependent motor unit activity in lower leg muscles during isometric contraction. Twenty healthy participants performed plantar flexor and dorsiflexor isometric ramp contractions at 30 % of the maximal voluntary contraction (MVC) with extended (0°) and flexed (130°) knee joint angles. High-density surface electromyograms were recorded from medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) muscles and decomposed to extract individual motor units. The torque-dependent change (Δpps /Δ%MVC) of the motor unit activity of MG (recruited at 15 %MVC) and SOL (recruited at 5 %MVC) muscles was higher with a flexed compared with an extended knee joint (p < 0.05). The torque-dependent change of TA MU did not different between the knee joint angles. The motor units within certain limited recruitment thresholds recruited to exert plantar flexion torque can be excited to compensate for the loss of MG muscle torque output with a flexed knee joint.     

Influence of chronic low back pain and fear of movement on the activation of the transversely oriented abdominal muscles during forward bending

Introduction: Chronic low back pain (CLBP) and fear of movement (kinesiophobia) are associated with an overactivation of paravertebral muscles during forward bending. This impairs spine motor control and contributes to pain perpetuation. However, the abdominal muscles activation is engaged too in spine stabilization but its modulation with kinesiophobia remains unknown. Our study tested whether CLBP and kinesiophobia affected the activation pattern of abdominal muscles during trunk flexion/extension. Methods: Surface electromyographical recordings of the internal oblique/transversus abdominis (IO/TrA) and external oblique (EO) muscles were analyzed in 12 people with CLBP and 13 pain-free subjects during low-velocity forward bending back and forth from erected posture. Tampa Scale of Kinesiophobia was also administrated. Results: IO/TrA activation, but not EO, was modulated across the phases of movement in both groups, i.e. maximal at onset of flexion and end of extension, and minimal at full flexion. In CLBP group only, IO/TrA activation was increased near to full trunk flexion and in correlation with kinesiophobia. Conclusions: The phase-dependence of IO/TrA activation during trunk flexion/extension in standing may have a role in spine motor control. The influence of kinesiophobia in CLBP should be further investigated as an important target in CLBP management.     

Effect of footwear on intramuscular EMG activity of plantar flexor muscles in walking

One of the purposes of footwear is to assist locomotion, but some footwear types seem to restrict natural foot motion, which may affect the contribution of ankle plantar flexor muscles to propulsion. This study examined the effects of different footwear conditions on the activity of ankle plantar flexors during walking. Ten healthy habitually shod individuals walked overground in shoes, barefoot and in flip-flops while fine-wire electromyography (EMG) activity was recorded from flexor hallucis longus (FHL), soleus (SOL), and medial and lateral gastrocnemius (MG and LG) muscles. EMG signals were peak-normalised and analysed in the stance phase using Statistical Parametric Mapping (SPM). We found highly individual EMG patterns. Although walking with shoes required higher muscle activity for propulsion than walking barefoot or with flip-flops in most participants, this did not result in statistically significant differences in EMG amplitude between footwear conditions in any muscle (p > 0.05). Time to peak activity showed the lowest coefficient of variation in shod walking (3.5, 7.0, 8.0 and 3.4 for FHL, SOL, MG and LG, respectively). Future studies should clarify the sources and consequences of individual EMG responses to different footwear.     

Muscle fiber conduction velocity in different gait phases of early and late-stage diabetic neuropathy

We investigated the muscle fiber conduction velocity (MFCV) during gait phases of the lower limb muscles in individuals with various degrees of diabetic peripheral neuropathy (DPN). Forty-five patients were classified into severity degrees of DPN by a fuzzy model. The stages were absent (n = 11), mild (n = 14), moderate (n = 11) and severe (n = 9), with 10 matched healthy controls. While walking, all subjects had their sEMG (4 linear electrode arrays) recorded for tibialis anterior (TA), gastrocnemius medialis (GM), vastus lateralis (VL) and biceps femoris (BF). MFCV was calculated using a maximum likelihood algorithm with 30 ms standard deviation Gaussian windows. In general, individuals in the earlier stages of DPN showed lower MFCV of TA, GM and BF, whilst individuals with severe DPN presented higher MFCV of the same muscles. We observed that mild patients already showed lower MFCV of TA at early stance and swing, and lower MFCV of BF at swing. All diabetic groups showed a markedly reduction in MFCV of VL, irrespective of DPN. Severe patients presented higher MFCV mainly in distal muscles, TA at early and swing phases and GM at propulsion and midstance. The absent group already showed MFCV of VL and GM reductions at the propulsion phase and of VL at early stance. Although MFCV changes were not as progressive as the DPN was, we clearly distinguished diabetic patients from controls, and severe patients from all others.     

A Behavioral Mechanism of How Increases in Leg Strength Improve Old Adults’ Gait Speed

We examined a behavioral mechanism of how increases in leg strength improve healthy old adults’ gait speed. Leg press strength training improved maximal leg press load 40% (p = 0.001) and isometric strength in 5 group of leg muscles 32% (p = 0.001) in a randomly allocated intervention group of healthy old adults (age 74, n = 15) but not in no-exercise control group (age 74, n = 8). Gait speed increased similarly in the training (9.9%) and control (8.6%) groups (time main effect, p = 0.001). However, in the training group only, in line with the concept of biomechanical plasticity of aging gait, hip extensors and ankle plantarflexors became the only significant predictors of self-selected and maximal gait speed. The study provides the first behavioral evidence regarding a mechanism of how increases in leg strength improve healthy old adults’ gait speed.     

Adaptive trunk sway velocities following repeated perturbations in subjects with and without low back pain

Faster trunk motions could be a strategy to prevent loss of balance and fall injuries due to unexpected perturbations. However, it is unclear how trunk sway velocities can be compensated during stepping in subjects with low back pain (LBP). The purpose of this study was to investigate lower limb reaction, swing, and step times, as well as trunk sway velocities at heel strike and toe-off, following repeated step perturbations between subjects with and without LBP. There were 30 subjects with LBP and 42 control subjects who were exposed to treadmill-induced perturbations at a velocity of 0.12 m/sec for 0.62 m. The treadmill-induced steps caused subjects to walk forward for 4.90 sec after the perturbation. The groups demonstrated significant interactions on the lower limb reaction times and on the number of repeated perturbations (F = 4.83, p = 0.03) due to a decreased step time at the first perturbation (t = 2.52, p = 0.01) in the LBP group. For the trunk sway velocities, the repeated perturbations demonstrated a significant interaction between groups (F = 4.65, p = 0.03). This adaptive trunk strategy for gait stability increased step times with repeated perturbations in the LBP group. The group interactions on the trunk sway velocities also indicated a possible somatosensory integration for step time adjustments to avoid potential fall hazards. This adaptive response with repeated step perturbations could result in compensatory trunk sway for gait stability.     

Association of long non-coding RNAs NEAT1, and MALAT1 expression and pathogenesis of Behçet's disease among Egyptian patients

Behçet's disease (BD) is a chronic inflammatory disease. Immunological defects have been shown to play a significant role in the progression of BD. The serum levels of two long non-coding RNAs (lncRNAs), NEAT1 and MALAT1, were examined in patients with BD to identify their role in the disease pathogenesis. Both lncRNAs were mentioned as essential regulators of innate immune responses and have a crucial role in inflammatory diseases. Fifty patients with BD and a similar number of control individuals were involved in our study. At enrollment, data was collected from patients and controls, and the disease severity in active cases was determined using the Behçet's Disease Current Activity Form (BDCAF). Levels of the two studied biomarkers in the serum, NEAT1 and MALAT1, were investigated by quantitative RT-PCR (qRT-PCR). NEAT1 levels were significantly turned down in BD patients (fold changes = 0.77, p = 0.0001) and correlated negatively with the BDCAF (r = ?0.41; p = 0.003). On the other hand, the MALAT1 levels were significantly up-regulated in BD patients (fold changes = 2.65, p = 0.003). Serum levels of NEAT1 were significantly decreased in patients with active states than in stationary cases (0.387 versus 1.99, respectively; p = 0.01) and compared with controls (p = 0.001). Also, NEAT1 levels were significantly increased in patients with stationary states compared to controls (p = 0.03). There was a positive association between NEAT1 and MALAT1 levels among BD patients (r = 0.29, p = 0.04). Our findings demonstrate a possible role of NEAT1 and MALAT1 in the pathogenesis of BD.     

Trunk and hip muscle activity during the Balance-Dexterity task in persons with and without recurrent low back pain

Coordination of the trunk and hips is crucial for successful dynamic balance in many activities of daily living. Persons with recurrent low back pain (rLBP), both while symptomatic and during periods of symptom remission, exhibit dysfunctional muscle activation patterns and coordination of these joints. In a novel dynamic balance task where persons in remission from rLBP exhibit dissociated trunk motion, it is unknown how trunk and hip musculature are coordinated. Activation of hip and trunk muscles were acquired from nineteen persons with and without rLBP during the Balance-Dexterity Task, which involves balancing on one limb while compressing an unstable spring with the other. There were no between-group differences in activation amplitude for any muscle groups tested. In back-healthy control participants, hip and trunk muscle activation amplitudes increased proportionally in response to the added instability of the spring (R = 0.837, p < 0.001). Increases in muscle activation amplitudes in the group in remission from rLBP were not proportional (R = 0.113, p = 0.655). Instead, hip muscle activation in this group was associated with task performance, i.e. dexterous control of the spring (R = 0.676, p = 0.002). These findings highlight atypical coordination of hip and trunk musculature potentially related to task demands in persons with rLBP even during remission from pain.     

Supervised exercise with or without laser-guided feedback for people with non-specific chronic low back pain. A randomized controlled clinical trial

BackgroundAmong the most effective therapeutic interventions in non-specific chronic low back pain (NSCLBP), clinical practice guidelines highlight exercise therapy and patient education; However, regarding the combined intervention of exercise and Pain Neuroscience Education (PNE), there is no consensus on the most effective form of exercise.ObjetiveTo find out what changes occurred after the application of two exercise modalities [Supervised Exercise (SE) and Laser-Guided Exercise (LGE)] and PNE on pain, pain pressure thresholds, disability, catastrophizing, kinesiophobia and lumbar proprioception in subjects with NSCLBP.MethodsSingle-blind randomized clinical controlled trial. 60 subjects with NSCLBP. Both groups performed a a total of 16 therapeutic exercise sessions and 8 Pain Neuroscience Education sessions. With the Laser-Guided Exercise Therapy group performing laser-guided exercises.ResultsA significant decrease was observed for pain intensity for both groups between baseline and post-intervention and the 3 month follow-up (p < 0.001). There was a significant between-group difference between baseline and post-intervention scores in terms of pain intensity and kinesiophobia in favour of the LGE group.ConclusionSupervised exercise with or without laser feedback, when combined with PNE, reduces pain intensity, disability, pain catastrophizing, kinesiophobia and improves proprioception and PPTs in patients with NSCLBP. At a 3-month follow-up, the combination of LGE plus PNE is most effective for reducing pain intensity.     

Evaluation of environmental and biological monitoring methods for toluene exposure assessment in paint industry

The aim of this study was to assess the exposure to Toluene in paint industry and to evaluate the environmental and biological monitoring techniques for the assessment of occupational exposure to this aromatic hydrocarbon. In this study, personal active and passive air sampling for toluene measurements, blood and urine sampling respectively for B-Tol and HA or U-Tol analyses for eight workers from two paint and thinner production factories were collected during four successive working days. Correlations were analyzed between biological indicators and environmental toluene exposure levels.The concentration of Toluene measured in air samples ranged from 0.2 to 414.0 ppm (mean = 59.8 ppm), with high variability of atmospheric levels between activities and between days. No significant difference was found between airborne toluene concentrations measured by the two sampling methods. The correlation between air concentrations sampled by the diffusive sampling method and the biomarkers was the best for HA (r = 0.902, p < 0.01), followed by B-Tol (r = 0.820; p < 0.01), o-Cr (r = 0.691; p < 0.01) and U-Tol (r = 0.607; p < 0.05). The correlation was better between air concentrations and urinary metabolites HA and o-Cr for exposure levels higher than 50 ppm (r = 0.931; p < 0.01), and lower than 300 ppm (r = 0.827; p < 0.01), respectively.According to our results, workers in the studied industries are highly exposed to Toluene. Given the high correlation found between toluene concentrations in samples taken on dosimeters and those actively sampled on charcoal tubes, it may be assumed that both sampling methods are valuable. Despite the influencing factors, HA was found to be a reliable biological indicator for the monitoring of occupational exposure to toluene for high exposure levels. However, B-Tol seems to be an interesting alternative, since it is more specific and showed the best correlations with airborne toluene levels.     

The influence of knee varus and valgus on quadriceps muscle activity changes induced by stretching and kneeling

This study aimed to determine the influence of knee varus (VARUS) and valgus (VALGUS) on the differences in individual quadriceps muscle (QM) activity during knee extension maximum voluntary isometric contractions (MVICs) and sit/stand transitions and on the changes in individual QM activity during sit/stand transitions after QM stretching and kneeling. Ten young healthy males each with VARUS and VALGUS were included. The electromyography signals of the vastus medialis (VM), vastus lateralis, and rectus femoris were recorded during sit/stand transitions before and after rest, stretching, and kneeling and during knee extension MVICs after rest. The individual muscle-to-total muscle activity ratio was assessed. The VARUS group exhibited a significantly higher VM muscle activity ratio in the sit-to-stand and stand-to-sit tasks than in knee extension MVICs (p = 0.004 and p = 0.044, respectively) and a tendency that the VM muscle activity ratio increased in the sit-to-stand task after stretching (p = 0.051), whereas the VALGUS group exhibited no significance. Individuals with VARUS required high VM muscle activity ratios during sit/stand transitions. Future studies should be conducted to determine whether habitual sit-to-stand exercises after QM stretching are effective in preventing knee medial osteoarthritis development in individuals with VARUS.     

Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task

Fear-avoidance beliefs, particularly the fear of lifting with a flexed spine, are associated with reduced spinal motion during object lifting. Low back pain patients thereby also showed potentially clinically relevant changes in the spatial distribution of back muscle activity, but it remains unknown whether such associations are also present in pain-free individuals. This cross-sectional observational study investigated the relationship between fear-avoidance beliefs and the spatial distribution of lumbar paraspinal muscle activity in pain-free individuals during a repetitive lifting task. Thirty participants completed two pain-related fear questionnaires and performed 25 repetitions of lifting a 5 kg-box from a lower to an upper shelf and back, while multi-channel electromyographic signals were recorded bilaterally from the lumbar erector spinae muscles. Changes in spatial distribution were defined as the differences in vertical position of the weighted centroids of muscle activity (centroid shift) between the first and last few repetitions. Linear regression analyses were performed to examine the relationships between centroid shift and fear-avoidance belief scores. Fear of lifting an object with a flexed spine was negatively associated with erector spinae activity centroid shift (R² adj. = 0.1832; p = 0.045), which might be an expression of behavioral alterations to prevent the back from possible harm.     

Validity of different EMG analysis methods to identify aerobic and anaerobic thresholds in speed skaters

Purpose: This study aimed to assess the validity of the first (EMGth1) and second (EMGth2) breakpoints in the EMG signal during skating. Scope: Ten well-trained long track speed skaters performed a maximal incremental skating test on a slide board. EMG signals from six lower limb muscles were recorded during the last 15 s of each stage and converted to Root Mean Square for determination EMGth1 and EMGth2 using mathematical (2 and 3 linear regressions) and visual methods. Conclusions: EMGth1 had a low detection rate (<50%) while EMGth2 could be identified visually in > 80% of cases, in 85% of cases using 2-lines and 63% using 3-lines regression. Quads (VL + VM) and Gluts (GM + GMd) had the highest EMGth2 detection rate for all methods (>70%). EMGth2 from Quads and Gluts detected by the 2-lines and 3-lines regression were not different than the second ventilatory threshold (VT2) (p > 0.05), while the visual method overestimated VT2 (p < 0.01). EMGth2 detected from Quads by the 2-lines regression method presented better correlation with VT2 stage (r = 0.91), lowest bias, and limit of agreement. We conclude that EMG is a valid non-invasive method to detect VT2 during skating when using a mathematical method to determine EMGth2.     

Lambert-Eaton myasthenia syndrome: specified description of a response pattern to low-frequency repetitive nerve stimulation

ObjectiveWe aimed to specify and quantify the characteristics of the decrement in low-frequency repetitive nerve stimulation response in Lambert-Eaton myasthenia syndrome (LEMS) and compare it to those of myasthenia gravis (MG).Patients and MethodsWe retrospectively reviewed 18 patients with LEMS and 24 patients with MG. Ten consecutive stimulations were applied at 3 Hz to the abductor pollicis brevis. We determined the position of the smallest wave in the stimulation sequence, and we calculated the decrement and recovery.ResultsThe median sequential order of the minimum wave was 8 in the LEMS group and 5 in the MG group (p < 0.001). The median decrement in the LEMS group was 36.7%, while that in the MG group was 21.0% (p = 0.047). The recovery percentage was 1.4% in the LEMS group and 3.5% in the MG group (p = 0.001). The area under the curve for the sequential order of the minimum wave was 0.90, and the reciprocal optimum cut-off point was 6.5.ConclusionsWe elucidated a pattern with a delayed nadir and subsequent poor recovery, featuring a low-frequency decrement; furthermore, we determined the most likely sequential order of the minimum wave in patients with LEMS, and the indicator was useful for differentiation.     

Differential activation of the plantar flexor muscles in balance control across different feet orientations on the ground

The ankle plantar flexor muscles act synergistically to control quiet and dynamic body balance. Previous research has shown that the medial (MG) and lateral (LG) gastrocnemii, and soleus (SOL) are differentially activated as a function of motor task requirements. In the present investigation, we evaluated modulation of the plantar flexors' activation from feet orientation on the ground in an upright stance and the ensuing reactive response to a perturbation. A single group of young participants (n = 24) was evaluated in a task requiring initial stabilization of body balance against a backward pulling load (5% or 10% of body weight) attached to their trunk, and then the balance was suddenly perturbed, releasing the load. Four feet orientations were compared: parallel (0°), outward orientation at 15° and 30°, and the preferred orientation (M = 10.5°). Results revealed a higher activation magnitude of SOL compared to MG-LG when sustaining quiet balance against the 10% load. In the generation of reactive responses, MG was characterized by earlier, steeper, and proportionally higher activation than LG-SOL. Feet orientation at 30° led to higher muscular activation than the other orientations, while the activation relationship across muscles was unaffected by feet orientation. Our results support the conclusion of task-specific differential modulation of the plantar flexor muscles for balance control.