Are Surface Electromyography Parameters Indicative of Post-Activation Potentiation/Post-Activation Performance Enhancement, in Terms of Twitch Potentiation and Voluntary Performance? A Systematic Review.

The aim was to identify if surface electromyography (sEMG) parameters are indicative of post-activation potentiation (PAP)/post-activation performance enhancement (PAPE), in terms of twitch potentiation and voluntary performance. Three databases were used in April 2024, with the following inclusion criteria: (a) original research, assessed in healthy human adults, and (b) sEMG parameters were measured. The exclusion criteria were (a) studies with no PAP/PAPE protocol and (b) non-randomized control trials. The following data were extracted: study characteristics/demographics, PAP/PAPE protocols, sEMG parameters, twitch/performance outcomes, and study findings. A modified physiotherapy evidence database (PEDro) scale was used for quality assessment. Fifteen randomized controlled trials (RCTs), with a total of 199 subjects, were included. The M-wave amplitude (combined with a twitch torque outcome) was shown to generally be indicative of PAP. The sEMG amplitudes (in some muscles) were found to be indicative of PAPE during ballistic movements, while a small decrease in the MdF (in certain muscles) was shown to reflect PAPE. Changes in the Hmax/Mmax ratio were found to contribute (temporally) to PAP, while the H-reflex amplitude was shown to be neither indicative of PAP nor PAPE. This review provides preliminary findings suggesting that certain sEMG parameters could be indicative of PAP/PAPE. However, due to limited studies, future research is warranted.

Mechanical and Contractile Properties of Knee Joint Muscles after Sports-Related Concussions in Women Footballers.

The purpose of this study was to determine if women footballers have an increased lack of neuromuscular control of the knee joint after a concussion compared to a healthy cohort tested with tensiomyography (TMG). Forty-one female collegiate footballers were enrolled in this study from which there were 20 with a history of sports-related concussions (SRCs) and 21 control subjects. Results from the SRC group had significantly higher Tc (ms) (z = -5.478, p = 0.000) and significantly lower Dm (mm) (z = -3.835, p = 0.000) than the control group in the case of the rectus femoris muscle. The SRC group had significantly higher Tc (ms) (z = -2.348, p = 0.016) and significantly lower Dm (mm) (z = -4.776, p = 0.000) than the control group in the case of the vastus medialis muscle. The SRC group had significantly higher Tc (ms) (z = -5.400, p = 0.000) and significantly lower Dm (mm) (z = -4.971, p = 0.000) than the control group in the case of the vastus lateralis muscle. The SRC group had significantly higher Tc (ms) (z = -5.349, p = 0.000) than the control group in the case of the biceps femoris muscle response, whereas no significant difference was found in Dm (mm) (z = -0.198, p = 0.853) between the groups. The results of the current study may have implications for current practice standards regarding the evaluation and management of concussions and can add valuable information for knee prevention programs as well.

Recovery kinetics following sprint training: resisted versus unresisted sprints.

PURPOSE: To determine the recovery kinetics of performance and exercise-induced muscle damage following different sprint-training protocols. METHODS: In a crossover design, ten male and female athletes (20.6 ± 2.4 years) performed 2 × (3 × 20 m: 2 min rest) and 1× (3 × 30 m: 3 min rest) of: (a) unresisted sprints (UST), (b) resisted sprints with 10% of body mass (BM) load (RST10), (c) resisted sprints with 20% BM load (RST20), against a control trial (no-training). RESULTS: Blood lactate (mmol/L) increased post-training versus pre-training in all sprint-training trials (6.7 ± 2.4 vs 1.2 ± 0.2, 5.6 ± 2.4 vs 1.3 ± 0.3, 7.3 ± 2.7 vs 1.2 ± 0.3, in UST, RST10, RST20, respectively), as did creatine kinase (U/L) 24 h, 48 h and 72 h post-training (UST: 251 ± 173, 238 ± 154, 209 ± 115 vs 155 ± 9, RST10: 252 ± 134, 240 ± 83, 218 ± 103 vs 164 ± 106; RST20: 237 ± 133, 323 ± 303, 262 ± 184 vs 179 ± 106, respectively). DOMS of knee-extensors (KE) and knee-flexors (KF) increased post-training up to 72 h in all sprint-training trials versus pre-training (ranging from 1.6 ± 1.3 to 3.8 ± 2.8 vs 1.0 ± 0, respectively). Eccentric torque (N m) of the KE of the non-dominant limb, decreased 24 h post-training versus pre-training in all sprint-training trials (UST: 249 ± 49 vs 266 ± 54; RST10: 229 ± 52 vs 273 ± 72; RST20: 253 ± 6 vs 262 ± 56), as did that of the KF of the dominant limb (UST: 135 ± 29 vs 144 ± 26; RST10: 130 ± 29 vs 140 ± 25; RST20: 139 ± 33 vs 142 ± 26). 10-m sprint-time (s) increased 48 h post-training versus pre-training (1.81 ± 0.15 vs 1.77 ± 0.11), and 30-m sprint-time increased 24 h, 48 h, 72 h post-training versus pre-training (4.35 ± 0.36, 4.40 ± 0.44, 4.33 ± 0.41 vs 4.21 ± 0.34, respectively), only in RST20. CONCLUSIONS: Unresisted and resisted sprint-training induces prolonged reduction of muscle strength (24 h), and sprinting performance (72 h), associated with prolonged increase of DOMS and CK (72 h).

The Effect of Ball Heading and Subclinical Concussion On the Neuromuscular Control Of The Lower Limb: A Systematic Review.

Background: Soccer is unique among sports because it is the only sport that involves purposeful use of the head to control, pass, or shoot the ball. Over the previous five years, a relationship between lower extremity (LE) injury and sports related concussion (SRC) has been established in various sporting populations. Athletes at the high school, collegiate, and professional levels have demonstrated a greater risk for sustaining a LE injury post SRC. The purpose of this systematic review was to examine the relationship of the SRC with the incidence of LE injuries. Methods: Ten databases were searched with the following keywords: Lower limb, ball heading, neuromuscular control, concussion, MEDLINE, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), EMBASE, and Scopus. The search was limited to English-language and peer-reviewed publications, until 15/12/2022. The PEDro scale was used for the assessment of the risk of bias among the included studies. All included papers were qualitatively analyzed. Results: A total of 834 studies were identified and 10 articles (four concussion-MSK biomechanics, six concussion-MSK injury) were included in the qualitative analyses. Included papers ranged from low to high quality. Due to the heterogeneous nature of the included study designs, quantitative meta-analysis was unable to be performed. All four of the included concussion-MSK biomechanics studies demonstrated, to some degree, that worse cognitive performance was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. Among the six injury related studies, two investigations failed to determine group differences in cognitive performance between subsequently injured and non-injured athletes. Conclusion: More research is needed to better understand the relationship of SRC and lower extremity injuries and the extent to which they are related to concussions and/or repetitive neurotrauma after ball heading sustained in soccer. Level of Evidence: 2.

The Effects of a Single Session of a Rhythmic Movement Program on Selected Biopsychological Parameters in PD Patients: A Methodological Approach.

The aim of the present study is to examine the acute effects of a specially designed musicokinetic (MSK) program for patients with Parkinson's disease (PD) on (a) anxiety levels, (b) select kinematic and kinetic parameters, and (c) frontal cortex hemodynamic responses, during gait initiation and steady-state walking. Methods: This is a blind cross-over randomized control trial (RCT) in which 13 volunteers with PD will attend a 45 min MSK program under the following conditions: (a) a synchronous learning format and (b) an asynchronous remote video-based format. Changes in gait biomechanics and frontal cortex hemodynamic responses will be examined using a 10-camera 3D motion analysis (Vicon T-series, Oxford, UK), and a functional near-infrared spectroscopy (f-NIRS-Portalite, Artinis NL) system, respectively, while anxiety levels will be evaluated using the Hamilton Anxiety Rating Scale. Expected results: Guided by the rules of music, where periodicity is distinct, our specially designed MSK program may eventually be beneficial in improving motor difficulties and, hence, reducing anxiety. The combined implementation of f-NIRS in parallel with 3D gait analysis has yet to be evaluated in Parkinsonian patients following a MSK intervention. It is expected that the aforementioned intervention, through better rhythmicity, may improve the automatization of motor control, gait kinematics, and kinetics-supported by decreased frontal cortex hemodynamic activity-which may be linked to reduced anxiety levels.

Relative Neuroadaptive Effect of Resistance Training along the Descending Neuroaxis in Older Adults.

Age-related decline in voluntary force production represents one of the main contributors to the onset of physical disability in older adults and is argued to stem from adverse musculoskeletal alterations and changes along the descending neuroaxis. The neural contribution of the above is possibly indicated by disproportionate losses in voluntary activation (VA) compared to muscle mass. For young adults, resistance training (RT) induces muscular and neural adaptations over several levels of the central nervous system, contributing to increased physical performance. However, less is known about the relative neuroadaptive contribution of RT in older adults. The aim of this review was to outline the current state of the literature regarding where and to what extent neural adaptations occur along the descending neuroaxis in response to RT in older adults. We performed a literature search in PubMed, Google Scholar and Scopus. A total of 63 articles met the primary inclusion criteria and following quality analysis (PEDro) 23 articles were included. Overall, neuroadaptations in older adults seemingly favor top-down adaptations, where the preceding changes of neural drive from superior levels affect the neural output of lower levels, following RT. Moreover, older adults appear more predisposed to neural rather than morphological adaptations compared to young adults, a potentially important implication for the improved maintenance of neuromuscular function during aging.

Periodization in Anterior Cruciate Ligament Rehabilitation: New Framework Versus Old Model? A Clinical Commentary.

The physiological and psychological changes after anterior cruciate ligament reconstruction (ACLR) do not always allow a return to sport in the best condition and at the same level as before. Moreover, the number of significant re-injuries, especially in young athletes should be considered and physical therapists must develop rehabilitation strategies and increasingly specific and ecological test batteries to optimize safe return to play. The return to sport and return to play of athletes after ACLR must progress through the recovery of strength, neuromotor control, and include cardiovascular training while considering different psychological aspects. Because motor control seems to be the key to a safe return to sport, it should be associated with the progressive development of strength, and cognitive abilities should also be considered throughout rehabilitation. Periodization, the planned manipulation of training variables (load, sets, and repetitions) to maximize training adaptations while minimizing fatigue and injury, is relevant to the optimization of muscle strengthening, athletic qualities, and neurocognitive qualities of athletes during rehabilitation after ACLR. Periodized programming utilizes the principle of overload, whereby the neuromuscular system is required to adapt to unaccustomed loads. While progressive loading is a well-established and widely used concept for strengthening, the variance of volume and intensity makes periodization effective for improving athletic skills and attributes, such as muscular strength, endurance, and power, when compared with non-periodized training. The purpose of this clinical commentary is to broadly apply concepts of periodization to rehabilitation after ACLR.

A Scoping Review on Outcomes and Outcome Measurement Instruments in Rehabilitative Interventions for Patients with Haematological Malignancies Treated with Allogeneic Stem Cell Transplantation.

RATIONALE: Allogeneic hematopoietic stem cell transplantation (HSCT) is associated with increased treatment-related mortality, loss of physical vitality, and impaired quality of life. Future research will investigate the effects of multidisciplinary rehabilitative interventions in alleviating these problems. Nevertheless, published studies in this field show considerable heterogeneity in selected outcomes and the outcome measurement instruments used. The purpose of this scoping review is to provide an overview of the outcomes and outcome measurement instruments used in studies examining the effects of rehabilitative interventions for patients treated with allogeneic HSCT. METHODS: We conducted a scoping review that included randomized controlled trials, pilot studies, and feasibility studies published up to 28 February 2022. RESULTS: We included n = 39 studies, in which n = 84 different outcomes were used 227 times and n = 125 different instruments were used for the measurements. CONCLUSIONS: Research in the field of rehabilitation for patients with haematological malignancies treated with allogeneic HSCT is hampered by the excess outcomes used, the inconsistent outcome terminology, and the inconsistent use of measurement instruments in terms of setting and timing. Researchers in this field should reach a consensus with regard to the use of a common terminology for the outcomes of interest and a homogeneity when selecting measurement instruments and measurement timing methods.

The Effects of Action Observation Therapy as a Rehabilitation Tool in Parkinson's Disease Patients: A Systematic Review.

During Action Observation (AO), patients observe human movements that they then try to imitate physically. Until now, few studies have investigated the effectiveness of it in Parkinson's disease (PD). However, due to the diversity of interventions, it is unclear how the dose and characteristics can affect its efficiency. We investigated the AO protocols used in PD, by discussing the intervention features and the outcome measures in relation to their efficacy. A search was conducted through MEDLINE, Scopus, Cochrane, and WoS until November 2021, for RCTs with AO interventions. Participant's characteristics, treatment features, outcome measures, and main results were extracted from each study. Results were gathered into a quantitative synthesis (MD and 95% CI) for each time point. Seven studies were included in the review, with 227 participants and a mean PEDro score of 6.7. These studies reported positive effects of AO in PD patients, mainly on walking ability and typical motor signs of PD like freezing of gait. However, disagreements among authors exist, mainly due to the heterogeneity of the intervention features. In overall, AO improves functional abilities and motor control in PD patients, with the intervention dose and the characteristics of the stimulus playing a decisive role in its efficacy.

Notions of "optimal" posture are loaded with meaning. Perceptions of sitting posture among asymptomatic members of the community.

BACKGROUND: Notions of "optimal" posture are widespread in modern society and strongly interconnected with preconceived beliefs. OBJECTIVES: To quantitatively evaluate spinal posture among members of the community during habitual sitting, and when asked to assume an "optimal" posture. DESIGN: Observational study. METHODS: Marker-based kinematic analyses of the head, spine, and pelvis were conducted on 100 individuals. Habitual sitting posture and self-perceived "optimal" posture, and whether participants believed that their habitual sitting reflected an "optimal" posture, were evaluated. The Wilcoxon signed-rank test assessed angular differences between the two postures adopted. Exploratory post-hoc analyses were conducted by using the Mann-Whitney U test to assess differences between genders. RESULTS: None of the participants stated that their habitual sitting was "optimal". Statistically significant differences were observed in most of the measured angles (p < 0.001) between habitual and self-perceived "optimal" posture. In habitual sitting posture, a significant interaction with gender was found only in the thoracolumbar (p < 0.05) and pelvic (p < 0.001) angles, with small effect sizes. In self-perceived "optimal" posture females were more extended in the head, upper thoracic, lower thoracic, lumbar and pelvic (p < 0.01) regions, than the males. CONCLUSIONS: A group of young, asymptomatic participants, consistently changed their habitual sitting posture to a more upright posture when asked to assume an "optimal" sitting posture, although the amount of change observed varied between spinal regions. These findings also highlight gender differences in not just habitual sitting posture, but also the degree to which habitual sitting posture is modified when trying to assume an "optimal" sitting posture.

Periodization in Anterior Cruciate Ligament Rehabilitation: A Novel Framework.

More than 250,000 anterior cruciate ligament (ACL) injuries occur each year in the USA, and approximately 65% of these injuries undergo reconstructive surgery. Appropriate rehabilitation after ACL reconstruction can yield predictably good outcomes, with return to previous levels of activity and high knee function. At present, periodization is used at all levels of sports training. Whether conceptualized and directed by coaches, or by athletes themselves, competitors structure their training in a cyclic fashion, enabling athletes to best realize their performance goals. In practical application, sport physical therapists use periodization: postoperative "protocols" serve as rudimentary forms of periodization, albeit implemented over shorter time frames than that typically employed in preparation for competition. An ACL injury should not be considered a "simple" musculoskeletal pathology with only local mechanical or motor dysfunctions. Together with the psychological trauma and reduction in physical capacity, there is a cascade of events, including neurological insult to the central nervous system and reduction in afferences to the sensorimotor system. Rehabilitation should consider all these issues, and periodization would allow to better define and to plan aims and objectives to return athletes to their sport. Technological resources including advanced neuroimaging methods, virtual reality for injury risk screening and return to sport assessment, and interactive artificial reality-based neuromuscular training methods offer new approaches and tools to address this important biomedical problem. The cost and availability of many of these technologies will continue to decrease, providing greater availability, scientific rigor, and ultimately, utility for cost-effective and data-driven assessments.

The role of telenursing in the management of Diabetes Type 1: A randomized controlled trial.

BACKGROUND: Diabetes Mellitus type 1 (T1DM) is a chronic disease that requires patients' self-monitoring and self-management to achieve glucose targets and prevent complications. Telenursing implicates technology in the interaction of a specialized nurse with patients with chronic diseases in order to provide personalized care and support. OBJECTIVE: To evaluate the effect of telenursing on T1DM patients' compliance with glucose self-monitoring and glycemic control. DESIGN: Randomized controlled study. SETTINGS: Outpatient Department of Diabetes, Endocrinology and Metabolism of a University Hospital in Northern Greece. METHODS: Ninety-four T1DM patients were recruited and randomized in two groups by a random number generator. The intervention group (N = 48) was provided with telenursing services. A specialized nurse made a weekly contact via telephone motivating patients to frequently measure blood glucose and adopt a healthy lifestyle. The control group (N = 46) received standard diabetes advice and care in the clinic. The primary outcome was the effect of the intervention in glucose control and glucose variability. The secondary outcome was the effect on frequency of self-monitoring. SPSS 20.0 was used for data analysis. RESULTS: The two groups did not differ in age, sex, physical activity or initial HbA1c. In the intervention group, blood glucose significantly decreased at the end of the study in all predefined measurements, compared to control group: morning (93.18 ±â€¯13.30 mg/dl vs. 105.17 ±â€¯13.74 mg/dl, p < 0.005), pre-prandial (114.76 ±â€¯9.54 mg/dl vs. 120.84 ±â€¯4.05 mg/dl, p < 0.005), post-prandial (193.35 ±â€¯25.36 mg/dl vs. 207.84 ±â€¯18.80 mg/dl, p < 0.005), and HbA1c decreased significantly over time in the intervention group (8.3 ±â€¯0.6% at the beginning of the study vs. 7.8 ±â€¯1% at the end of the study, p = 0.03). In the intervention group there were also fewer omitted glucose measurements than in the control group. CONCLUSIONS: Patients in the intervention group achieved better glucose control and more frequent self-monitoring than patients in routine care in the clinic. The findings of our study indicate that telenursing can motivate T1DM patients to better control their disease.

Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation.

BACKGROUND: Hamstring injuries are common in many sports, including track and field. Strains occur in different parts of the hamstring muscle but very little is known about whether common hamstring loading exercises specifically load different hamstring components. The purpose of this study was to investigate muscle activation of different components of the hamstring muscle during common hamstring loading exercises. METHODS: Twenty elite female track and field athletes were recruited into this study, which had a single-sample, repeated-measures design. Each athlete performed ten hamstring loading exercises, and an electromyogram (EMG) was recorded from the biceps femoris and semitendinosus components of the hamstring. Hamstring EMG during maximal voluntary isometric contraction (MVIC) was used to normalize the mean data across ten repetitions of each exercise. An electrogoniometer synchronized to the EMG was used to determine whether peak EMG activity occurred during muscle-tendon unit lengthening, shortening, or no change in length. Mean EMG values were compared between the two recording sites for each exercise using the Student's t-test. RESULTS: The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed. CONCLUSION: Some exercises selectively activated the lateral and medial distal hamstrings. Low, medium, and high intensity exercises were demonstrated. This information enables the clinician, strength and conditioning coach and physiotherapist to better understand intensity- and muscle-specific activation during hamstring muscle rehabilitation. Therefore, these results may help in designing progressive strengthening and rehabilitation and prevention programs.

Effects of weight-shift training on balance control and weight distribution in chronic stroke: a pilot study.

PURPOSE: The objective was to evaluate the effect of weight-shift training on functional balance, weight distribution, and postural control measures during standing and forward reach tasks in subjects with chronic stroke. METHODS: Nine male subjects (mean age, 66 years; range, 60-75 years) who experienced a stroke 3 to 13 years previously participated in a 4-week training program consisting of static and dynamic balance exercises with visual feedback and gait training with wall support. Balance control was assessed before and after the intervention with clinical measures (Berg Balance Scale) and with a pressure platform for registering the center of pressure (CoP) during quiet stance (weight distribution, CoP sway area, and velocity), and during a forward reach task at shoulder and knee levels. Intervention effects were evaluated with the Wilcoxon matched-pairs test. RESULTS: After training, the group improved their Berg Balance Scale median score from 42 (range, 14-54) to 46 (20-55) (P = .01), CoP sway area [10.6 (5.0-31.4) to 3.0 (1.8-10.8) cm2; P = .01], and mean velocity [3.5 (2.4-8.0) to 1.7 (0.9-3.7) mm/s; P = .01] during quiet standing but not weight distribution (P = .59). During the forward reach tasks, most of the postural control measures such as movement time, CoP displacement, and CoP velocity were significantly (P < .05) improved after the training period for both the affected and nonaffected sides as compared to before the training period. CONCLUSION: A weight-shift training program improved balance control but not weight distribution in a group of chronic stroke subjects. Larger, randomized, and controlled studies are necessary.