Muscle Recruitment Strategies in a Redundant Task: Age Differences Through Network Analyses.

There are numerous studies comparing young and old adults in terms of muscle coordination in standard tasks (e.g., walking, reaching) and small variations of them. These tasks might hide differences: individuals would converge to similar behavior as they practice these throughout life. Also, we are unaware of studies that considered the muscle recruitment nested dynamics. For this reason, our study evaluated how young and old women coordinate and control the movement system while performing an unusual redundant motor control task through the network physiology approach. We acquired electromyographic signals from nine leg muscles of the dominant and non-dominant limbs during maximum voluntary isometric contractions (knee extension and flexion) and co-contraction bouts. Our results showed that young participants presented higher peak torque output, with similar EMG variability, compared to older participants. Considering firing rate frequencies, old and young women demonstrated different traits for network clustering and efficiency for the task. Age seems to affect muscle coordination at higher frequencies, even with a similar number of muscle synergies, indicating that younger women might have more integrated synergies than older women. The findings also point to differential muscle coordination adaptability.

Neurophysiological correlates of force control improvement induced by sinusoidal vibrotactile stimulation.

OBJECTIVE: An optimal level of vibrotactile stimulation has been shown to improve sensorimotor control in healthy and diseased individuals. However, the underlying neurophysiological mechanisms behind the enhanced motor performance caused by vibrotactile stimulation are yet to be fully understood. Therefore, here we aim to evaluate the effect of a cutaneous vibration on the firing behavior of motor units in a condition of improved force steadiness. APPROACH: Participants performed a visuomotor task, which consisted of low-intensity isometric contractions of the first dorsal interosseous (FDI) muscle, while sinusoidal (175 Hz) vibrotactile stimuli with different intensities were applied to the index finger. High-density surface electromyogram was recorded from the FDI muscle, and a decomposition algorithm was used to extract the motor unit spike trains. Additionally, computer simulations were performed using a multiscale neuromuscular model to provide a potential explanation for the experimental findings. MAIN RESULTS: Experimental outcomes showed that an optimal level of vibration significantly improved force steadiness (estimated as the coefficient of variation of force). The decreased force variability was accompanied by a reduction in the variability of the smoothed cumulative spike train (as an estimation of the neural drive to the muscle), and the proportion of common inputs to the FDI motor nucleus. However, the interspike interval variability did not change significantly with the vibration. A mathematical approach, together with computer simulation results suggested that vibrotactile stimulation would reduce the variance of the common synaptic input to the motor neuron pool, thereby decreasing the low frequency fluctuations of the neural drive to the muscle and force steadiness. SIGNIFICANCE: Our results demonstrate that the decreased variability in common input accounts for the enhancement in force control induced by vibrotactile stimulation.

Is the firing rate of motor units in different vastus medialis regions modulated similarly during isometric contractions?

INTRODUCTION: Previous evidence suggests the fibers of different motor units reside within distinct vastus medialis (VM) regions. It remains unknown whether the activity of these motor units may be modulated differently. Herein we assess the discharge rate of motor units detected proximodistally from the VM to address this issue. METHODS: Surface electromyograms (EMGs) were recorded proximally and distally from the VM while 10 healthy subjects performed isometric contractions. Single motor units were decomposed from surface EMGs. The smoothed discharge rates of motor units identified from the same and from different VM regions were then cross-correlated. RESULTS: During low-level contractions, the discharge rate varied more similarly for distal (cross-correlation peak; interquartile interval: 0.27-0.40) and proximal (0.28-0.52) than for proximodistal pairs of VM motor units (0.20-0.33; P = 0.006). DISCUSSION: The discharge rates of motor units from different proximodistal VM regions show less similarity in their variations than those of pairs of units either distally or proximally. Muscle Nerve 57: 279-286, 2018.

Improving the reproducibility of motor unit number index.

INTRODUCTION: Reproducibility is an important aspect of any method intended to be a marker of disease progression. In this study we investigated approaches for improving motor unit number index (MUNIX) reproducibility. METHODS: We used the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) to study reproducibility in healthy subjects. We tested reproducibility between test and retest of a single MUNIX from 3 different muscles (S-MUNIX) and also of the mean of a set of 3 measurements from these same muscles (M-MUNIX). RESULTS: M-MUNIX was more reproducible than S-MUNIX. The CV showed a greater improvement than the ICC in all 3 muscles. CONCLUSIONS: M-MUNIX may be a valuable approach for following motor unit loss, because it is more replicable than MUNIX. This may be especially relevant in amyotrophic lateral sclerosis patients, in whom MUNIX variability is higher than in healthy individuals. Muscle Nerve, 2016 Muscle Nerve 55: 635-638, 2017.

Twitch potentiation induced by two different modalities of neuromuscular electrical stimulation: implications for motor unit recruitment.

INTRODUCTION: We tested the hypothesis that twitch potentiation would be greater following conventional (CONV) neuromuscular electrical stimulation (50-µs pulse width and 25-Hz frequency) compared with wide-pulse high-frequency (WPHF) neuromuscular electrical stimulation (1-ms, 100-Hz) and voluntary (VOL) contractions, because of specificities in motor unit recruitment (random in CONV vs. random and orderly in WPHF vs. orderly in VOL). METHODS: A single twitch was evoked by means of tibial nerve stimulation before and 2 s after CONV, WPHF, and VOL conditioning contractions of the plantar flexors (intensity: 10% maximal voluntary contraction; duration: 10 s) in 13 young healthy subjects. RESULTS: Peak twitch increased (P<0.05) after CONV (+4.5±4.0%) and WPHF (+3.3±5.9%), with no difference between the 2 modalities, whereas no changes were observed after VOL (+0.8±2.6%). CONCLUSIONS: Our results demonstrate that presumed differences in motor unit recruitment between WPHF and CONV do not seem to influence twitch potentiation results.

Stapedial reflex and recruitment: what is the relationship with tinnitus?

Tinnitus is characterized by an auditory perception of sound, with no stimuli from the external environment. Tinnitus is an increasingly significant complaint, affecting 10-17% of the world population. As a symptom, it should always be considered with pathology in the auditory system. Our study aims to assess the relationship of this symptom with the presence of a stapedial reflex and the phenomenon of recruitment. Medical records of patients complaining of subjective tinnitus during their first consultation in the Outpatient Clinic of the Unicamp Teaching Hospital, in Brazil, between 2011 and 2012 were analyzed. We carried out a study with 65 non-randomized tinnitus individuals using questionnaires, clinical and audiological evaluations. The visual analogue scale was used to characterize the degree of disturbance caused by tinnitus. Statistical tests were performed using the IBM SPSS Statistics 19. No association was found between tinnitus and the presence of acoustic reflex or phenomenon of recruitment. We concluded that there is no relationship between tinnitus, the phenomenon of recruitment or the presence of an acoustic reflex.

Esophageal mechanosensitive mechanisms are impaired in neonates with hypoxic-ischemic encephalopathy.

OBJECTIVES: To test the hypothesis that esophageal mechanodistention in infants with hypoxic-ischemic encephalopathy (HIE) results in altered upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) responses, compared with controls. As a secondary aim, we tested the hypothesis that infants with HIE receiving therapeutic hypothermia had different aerodigestive reflex characteristics than infants with HIE who received traditional neonatal care. STUDY DESIGN: Provocative esophageal manometry was performed in 34 neonates (27 with HIE and 7 controls). Mechanodistention was performed using graded volumes of air. Peristaltic reflexes, UES contractile reflexes, and LES relaxation reflexes were analyzed for frequency, magnitude, and aberrancies. RESULTS: Infants with HIE demonstrated more rapid recruitment of responses and greater UES magnitude (P < .05). They had more frequent secondary peristalsis and lower LES nadir pressures with prolonged LES nadir durations (P < .05). Most notable were the prolonged peristaltic response durations and increases in the number of polymorphic waveforms (P < .05). Compared with infants with HIE receiving traditional care, infants with HIE treated with hypothermia had higher UES pressures and shorter peristaltic response duration (P < .05). CONCLUSIONS: Mechanodistention in infants with HIE results in upregulation of central vagal effects (ie, heightened cholinergic excitatory responses as demonstrated by exaggerated UES contractile reflex activity and heightened inhibitory responses evident by exaggerated LES relaxation reflex activity). Prolonged and poorly coordinated peristaltic responses may underlie dysfunction of aerodigestive regulation. Modulation of sensorimotor aspects of aerodigestive reflexes is altered in infants with HIE, and hypothermia may further modify such effects.

Effects of positive end-expiratory pressure titration and recruitment maneuver on lung inflammation and hyperinflation in experimental acid aspiration-induced lung injury.

BACKGROUND: In acute lung injury positive end-expiratory pressure (PEEP) and recruitment maneuver are proposed to optimize arterial oxygenation. The aim of the study was to evaluate the impact of such a strategy on lung histological inflammation and hyperinflation in pigs with acid aspiration-induced lung injury. METHODS: Forty-seven pigs were randomly allocated in seven groups: (1) controls spontaneously breathing; (2) without lung injury, PEEP 5 cm H2O; (3) without lung injury, PEEP titration; (4) without lung injury, PEEP titration + recruitment maneuver; (5) with lung injury, PEEP 5 cm H2O; (6) with lung injury, PEEP titration; and (7) with lung injury, PEEP titration + recruitment maneuver. Acute lung injury was induced by intratracheal instillation of hydrochloric acid. PEEP titration was performed by incremental and decremental PEEP from 5 to 20 cm H2O for optimizing arterial oxygenation. Three recruitment maneuvers (pressure of 40 cm H2O maintained for 20 s) were applied to the assigned groups at each PEEP level. Proportion of lung inflammation, hemorrhage, edema, and alveolar wall disruption were recorded on each histological field. Mean alveolar area was measured in the aerated lung regions. RESULTS: Acid aspiration increased mean alveolar area and produced alveolar wall disruption, lung edema, alveolar hemorrhage, and lung inflammation. PEEP titration significantly improved arterial oxygenation but simultaneously increased lung inflammation in juxta-diaphragmatic lung regions. Recruitment maneuver during PEEP titration did not induce additional increase in lung inflammation and alveolar hyperinflation. CONCLUSION: In a porcine model of acid aspiration-induced lung injury, PEEP titration aimed at optimizing arterial oxygenation, substantially increased lung inflammation. Recruitment maneuvers further improved arterial oxygenation without additional effects on inflammation and hyperinflation.

Recruitment of motor units in the medial gastrocnemius muscle during human quiet standing: is recruitment intermittent? What triggers recruitment?

The recruitment and the rate of discharge of motor units are determinants of muscle force. Within a motoneuron pool, recruitment and rate coding of individual motor units might be controlled independently, depending on the circumstances. In this study, we tested whether, during human quiet standing, the force of the medial gastrocnemius (MG) muscle is predominantly controlled by recruitment or rate coding. If MG control during standing was mainly due to recruitment, then we further asked what the trigger mechanism is. Is it determined internally, or is it related to body kinematics? While seven healthy subjects stood quietly, intramuscular electromyograms were recorded from the MG muscle with three pairs of wire electrodes. The number of active motor units and their mean discharge rate were compared for different sway velocities and positions. Motor unit discharges occurred more frequently when the body swayed faster and forward (Pearson R = 0.63; P < 0.0001). This higher likelihood of observing motor unit potentials was explained chiefly by the recruitment of additional units. During forward body shifts, the median number of units detected increased from 3 to 11 (P < 0.0001), whereas the discharge rate changed from 8 ± 1.1 (mean ± SD) to 10 ± 0.9 pulses/s (P = 0.001). Strikingly, motor units did not discharge continuously throughout standing. They were recruited within individual, forward sways and intermittently, with a modal rate of two recruitments per second. This modal rate is consistent with previous circumstantial evidence relating the control of standing to an intrinsic, higher level planning process.

Endogenous presynaptic nitric oxide supports an anterograde signaling in the central nervous system.

The source size and density determine the extent of nitric oxide (NO) diffusion which critically influences NO signaling. In the brain, NO released from postsynaptic somas following NMDA-mediated activation of neuronal nitric oxide synthase (nNOS) retrogradely affects smaller presynaptic targets. By contrast, in guinea pig trigeminal motor nucleus (TMN), NO is produced presynaptically by tiny and disperse nNOS-containing terminals that innervate large nNOS-negative motoneurons expressing the soluble guanylyl-cyclase (sGC); consequently, it is uncertain whether endogenous NO supports an anterograde signaling between pre-motor terminals and postsynaptic trigeminal motoneurons. In retrogradely labeled motoneurons, we indirectly monitored NO using triazolofluorescein (DAF-2T) fluorescence, and evaluated sGC activity by confocal cGMP immunofluorescence. Multiple fibers stimulation enhanced NO content and cGMP immunofluorescence into numerous nNOS-negative motoneurons; NOS inhibitors prevented depolarization-induced effects, whereas NO donors mimicked them. Enhance of cGMP immunofluorescence required extracellular Ca(2+), a nNOS-physiological activator, and was prevented by inhibiting sGC, silencing neuronal activity or impeding NO diffusion. In conclusion, NO released presynaptically from multiple cooperative tiny fibers attains concentrations sufficient to activate sGC in many motoneurons despite of the low source/target size ratio and source dispersion; thus, endogenous NO is an effective anterograde neuromodulator. By adjusting nNOS activation, presynaptic Ca(2+) might modulate the NO diffusion field in the TMN.

fMRI of the sensorimotor cortex in patients with traumatic brain injury after intensive rehabilitation.

For evaluating the patterns of brain activation in sensorimotor areas following motor rehabilitation, seven male patients diagnosed with TBI underwent an fMRI study before and after being subjected to motor rehabilitation. Six patients showed a reduction in the BOLD signal of their motor cortical areas during the second fMRI evaluation. A decrease in cerebellum activation was also observed in two patients. Newly activated areas, were observed in four patients after treatment. In addition, an increase in the activation of the supplementary motor area (SMA) following rehabilitation was observed in only one test subject. The findings show that motor rehabilitation in TBI patients produces a decrease in the BOLD signal for the sensorimotor areas that were activated prior to treatment. In addition, we observed the recruitment of different brain areas to compensate for functional loss due to TBI in line with the cortical reorganisation mechanism.

Distinct temporal patterns of electrical stimulation influence neural recruitment during PTZ infusion: an fMRI study.

Our working hypothesis is that constant inter-pulse interval (IPI) electrical stimulation (ES) would resonate with endogenous epileptogenic reverberating circuits, favoring seizure, while random inter-interval ES protocol would promote desynchronization of such neural networks, interfering with the abnormal recruitment of neural structures. Male Wistar rats were stereotaxically implanted with a monopolar ES carbon-fiber electrode (minimizing fMRI artifact) in the amygdala. A 7T fMRI scanner was used to evaluate brain activity during ES, fixed four pulses per second ratio, using either a periodic IPI (ES-P) or random IPI (non-periodic ES-NP) stimulation paradigm. Appropriate imaging protocols were used to compare baseline BOLD (blood oxygen level dependent) MRI with scans during ES. A second series of experiments, both without stimuli and under the same ES paradigms, were evaluated during continuous infusion of pentylenetetrazole (PTZ, 4 mg/ml/min) through an i.v. catheter. Our results show that temporal lobe activation during ES-P or ES-NP did not present any statistical differences during ES. However, during PTZ infusion, PTZ-P facilitated recruitment of the temporal lobe ipsilateral to ES while PTZ-NP showed significantly less activation ipsilateral to ES and, in turn, less inter-hemispheric differences. Altogether, our results support the hypothesis of reverberating circuits being synchronized by ES-P and desynchronized by ES-NP. Time-coded low frequency stimulation may be an interesting alternative treatment for patients with refractory epilepsy.

Análisis de las maniobras de reclutamiento alveolar aplicadas en siete Unidades de Cuidado Intensivo / Analysis of the alveolar recruitment maneuvers of applications in the intensive care units seven / Análise das manobras de recrutamento alveolar aplicadas em sete unidades de cuidado intensivo

Introducción: En los últimos años las maniobras de reclutamiento alveolar (MR) han despertado un interés creciente por su potencial beneficio en la protección pulmonar y se han ido introduciendo en la práctica clínica. Objetivo: Describir y analizar los conocimientos sobre las MR y su aplicación en siete Unidades de Cuidado Intensivo de la ciudad de Cali - Colombia. Materiales y métodos: Estudio descriptivo de corte transversal, con una muestra intencional de 64 profesionales que laboran en siete Unidades de Cuidado Intensivo de Cali y aplican las MR. La encuesta auto-administrada constaba de trece preguntas y el periodo de aplicación fue de dos meses. Resultados: De los 64 encuestados el 77,8% sigue una guía o protocolo para realizar las MR; el 54,7% utiliza durante la MR un nivel de Presión Positiva al Final de la Espiración (PEEP) ideal que asegure una saturación > de 90% y PaO2 > de 60 mmHg; el 42,1% acepta presiones en la vía aérea entre 35 y 50 cmH2O; el 48,4% realiza las MR con aumento progresivo de la PEEP y bajo volumen corriente. Conclusiones: Se encontró heterogeneidad en las respuestas relacionadas con el conocimiento de las MR. No existe en la actualidad un consenso acerca de cuál es la forma más eficaz y segura de aplicar una MR. Este estudio puede ser el punto de partida para un llamado de atención a la revisión de los conocimientos, competencias y habilidades que se requieren para realizar las MR.

Introduction: For the past years, alveolar recruitment maneuvers (RM) have originated a growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: Describe and analyze the knowledge of the MR and its application in seven intensive care units in the city of Cali, Colombia. Method and materials: Descriptive Cross-Sectional Study with an intentional sample of 64 professionals working in seven intensive care units and apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: To perform RM, of 64 professionals survey, 77.8% of the healthcare providers that were polled follow a protocol guide, in which 54.7% answered that during RM the ideal Positive end-expiratory pressure (PEEP) is the one which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50 cmH2O; 48.4% perform RM with a progressive increase of the PEEP and a low tidal volume. Conclusions: Regarding the knowledge related to RM, heterogeneity was found in the answers. There is currently no consensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilities that are required to perform RM.

Introdução: Nos últimos anos as manobras de recrutamento alveolar (MR) têm despertado um interesse crescente por seu potencial benéfico na proteção pulmonar e têm-se ido introduzindo na prática clínica. Objetivo: Descrever e analisar os conhecimentos sobre as MR e sua aplicação em sete Unidades de Cuidado Intensivo da cidade de Cali - Colômbia. Materiais e métodos: Estudo descritivo de corte transversal, com uma amostra intencional de 64 profissionais que trabalham em sete Unidades de Cuidado Intensivo de Cali e aplicam as MR. A enquête auto-administrada constava de treze perguntas e o período de aplicação foi de sois meses. Resultados: Dos 64 pesquisados o 77,8% segue uma guia ou protocolo para realizar as MR; o 54,7% utiliza durante a MR um nível de Pressão Expiratória Positiva Final (PEEP) ideal que segure uma saturação > de 90% e PaO2 > de 60 mmHg; o 42,1% aceita pressões na via aérea entre 35 e 50 cmH2O; o 48,4% realiza as MR com aumento progressivo da PEEP e sob o volume corrente. Conclusões: Se encontrou heterogeneidade nas respostas relacionadas com o conhecimento das MR. Não existe na atualidade um consenso acerca de qual é a forma mais eficaz e segura de aplicar uma MR. Este estudo pode ser o ponto de partida para um chamado de atenção à revisão dos conhecimentos, competências e habilidades que se requerem para realizar as MR.

Influence of gender on the EMG signal of the quadriceps femoris muscles and performance in high-intensity short-term exercise.

The aim of this study was to investigate the influence of gender on the EMG signal of the muscles of the quadriceps femoris and the physical performance in high-intensity, short-term exercise. Fourteen volunteers (7 men = 29.1 +/- 2.8 years and 7 women = 22.6 +/- 2.9 years) performed a Wingate Test (WT) with a load of 7.5% of body mass. The variables analyzed during the WT were the Relative Peak Power (W.Kg(-1)) (RPP), Relative Mean Power (W.Kg(-1)) (RMP), Fatigue Index (%) (FI) and Peak Power Instant (s) (PPI). EMG signals of the superficial muscles of the quadriceps femoris (QF) from the right leg: rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM) were analyzed through root mean square (RMS) values and the normalized median frequency (MNF) determined using the Fast Fourier Transform (FFT). The RPP and the RMP were significantly higher in men when compared to women (9.99 +/- 0.96 vs. 7.66 +/- 1.00 W.kg(-1); 7.23 +/- 0.49 vs. 5.65 +/- 0.61 W.kg(1), P < 0.05; respectively). No significant difference between genders was found on RMS and NMF during WT (P > 0.05). Although RPP and RMP were influenced by gender, the RMS and the NMF of the superficial muscles of the QF did not show the same behavior, suggesting that other mechanisms, not related to motor unit recruitment and speed of nervous stimuli in the muscle fiber may be associated to the lower performance of women in high-intensity, short-term exercise.

Recruitment maneuver: RAMP versus CPAP pressure profile in a model of acute lung injury.

We examined whether recruitment maneuvers (RMs) with gradual increase in airway pressure (RAMP) provide better outcome than continuous positive airway pressure (CPAP) in paraquat-induced acute lung injury (ALI). Wistar rats received saline intraperitoneally (0.5 mL, CTRL) or paraquat (15 mg/kg, ALI). Twenty-four hours later lung mechanics [static elastance, viscoelastic component of elastance, resistive, viscoelastic and total pressures] were determined before and after recruitment with 40cmH2O CPAP for 40s or 40-s-long slow increase in pressure up to 40cmH2O (RAMP) followed by 0 or 5 cmH2O PEEP. Fractional area of alveolar collapse and PCIII mRNA were determined. All mechanical parameters and the fraction area of alveolar collapse were higher in ALI compared to CTRL. Only RAMP-PEEP maneuver significantly improved lung mechanics and decreased PCIII mRNA expression (53%) compared with ALI, while both RMs followed by PEEP decreased alveolar collapse. In conclusion, in the present experimental ALI model, RAMP followed by 5cm H2O PEEP yields a better outcome.

Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography.

OBJECTIVE: To present a novel algorithm for estimating recruitable alveolar collapse and hyperdistension based on electrical impedance tomography (EIT) during a decremental positive end-expiratory pressure (PEEP) titration. DESIGN: Technical note with illustrative case reports. SETTING: Respiratory intensive care unit. PATIENT: Patients with acute respiratory distress syndrome. INTERVENTIONS: Lung recruitment and PEEP titration maneuver. MEASUREMENTS AND RESULTS: Simultaneous acquisition of EIT and X-ray computerized tomography (CT) data. We found good agreement (in terms of amount and spatial location) between the collapse estimated by EIT and CT for all levels of PEEP. The optimal PEEP values detected by EIT for patients 1 and 2 (keeping lung collapse <10%) were 19 and 17 cmH(2)O, respectively. Although pointing to the same non-dependent lung regions, EIT estimates of hyperdistension represent the functional deterioration of lung units, instead of their anatomical changes, and could not be compared directly with static CT estimates for hyperinflation. CONCLUSIONS: We described an EIT-based method for estimating recruitable alveolar collapse at the bedside, pointing out its regional distribution. Additionally, we proposed a measure of lung hyperdistension based on regional lung mechanics.

Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury.

PURPOSE: To evaluate the effects of frequency and inspiratory plateau pressure (Pplat) during recruitment manoeuvres (RMs) on lung and distal organs in acute lung injury (ALI). METHODS: We studied paraquat-induced ALI rats. At 24 h, rats were anesthetized and RMs were applied using continuous positive airway pressure (CPAP, 40 cmH(2)O/40 s) or three-different sigh strategies: (a) 180 sighs/h and Pplat = 40 cmH(2)O (S180/40), (b) 10 sighs/h and Pplat = 40 cmH(2)O (S10/40), and (c) 10 sighs/h and Pplat = 20 cmH(2)O (S10/20). RESULTS: S180/40 yielded alveolar hyperinflation and increased lung and kidney epithelial cell apoptosis as well as type III procollagen (PCIII) mRNA expression. S10/40 resulted in a reduction in epithelial cell apoptosis and PCIII expression. Static elastance and alveolar collapse were higher in S10/20 than S10/40. CONCLUSIONS: The reduction in sigh frequency led to a protective effect on lung and distal organs, while the combination with reduced Pplat worsened lung mechanics and histology.

Lumbar muscles recruitment during resistance exercise for upper limbs.

The aim of this study was to evaluate the EMG activity of lumbar multifidus (MU), longissimus thoracis (LT) and iliocostalis (IC) muscles during an upper limb resistance exercise (biceps curl). Ten healthy males performed maximal voluntary isometric contraction (MVC) of the trunk extensors, after this, the biceps curl exercise was executed at 25%, 30%, 35% and 40% one repetition maximum during 1 min, with 10 min rest between them. EMG root mean square (RMS) and median frequency (MFreq) were calculated for each lifting and lowering of the bar during the exercise bouts, to calculate slopes and intercepts. The results showed increases in the RMS and decreases in the MFreq slopes. RMS slopes were no different between muscles, indicating similar fatigue process along the exercise irrespective of the load level. MU and LT presented higher RMS irrespective of the load level, which can be related to the specific function during the standing position. On the other hand, IC and MU presented higher MFreq intercepts compared to LT, demonstrating possible differences in the muscle fiber conduction velocity of these muscles. These findings suggest that trunk muscles are differently activate during upper limb exercises, and the fatigue process affects the lumbar muscles similarly.

Mouth Breathing Syndrome: cervical muscles recruitment during nasal inspiration before and after respiratory and postural exercises on Swiss Ball.

OBJECTIVE: This study aimed to evaluate the recruitment of cervical muscles during nasal inspiration before and after breathing and postural exercises on the Swiss Ball in children with Mouth Breathing Syndrome (MBS). METHOD: Surface electromyography from the sternocleidomastoid (SCM), sub-occipitals and upper Trapezius muscles was recorded during nasal inspiration, before and at the end of three months of the treatment. A physical therapy program consisting in muscular stretching and strengthening exercises along with naso-diaphragmatic breathing on the Swiss Ball were carried out for body posture realignment and respiratory training. Nineteen mouth breathing children, mean age of 10.6 years, both genres, were the subjects of this study. In order to establish a comparison between the eletromyographic results (normalized values) obtained from pre and post-physical therapy program it was used the Wilcoxon non-parametric test for dependent data. RESULTS: It was found a significant decrease (p<0.01) in the electromyographic activity during nasal inspiration in all tested muscles after treatment (11.3-3.6% in the SCM, 22.4-11.7% in the sub-occipitals and 8.9-3.1% in the upper Trapezius). At the end of the treatment, the assessed muscles reached lower activity electromyographic levels during nasal inspiration and they became closer of those in the quiet position. CONCLUSION: The lower activity after the physical therapy program in these muscles indicates a less effort of the accessory inspiratory muscles, probably due to a better performance of diaphragm muscle with the improvement of the body posture.

Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome.

The aim of this study was to compare the recruitment patterns and latencies of the scapular muscles, as well as the isokinetic performance of the shoulder rotators in 10 subjects with unilateral impingement syndrome who comprised the impingement group (IG) with a control group (CG) of 10 asymptomatic subjects. The recruitment patterns and latencies were evaluated by electromyographic activity during arm elevation in the scapular plane. Isokinetic work ratios of the shoulder rotator muscles were used to analyze muscular performance. A 2 x 2 ANOVA detected that muscular performance and recruitment patterns were similar for both groups and sides. However, the ANOVA revealed a significant side and group interaction, indicating that the scapular muscle latencies of the affected shoulder was greater than that of the nonaffected side only for the IG (p < .001). These findings indicated that subjects with light to moderate impingement syndrome showed late recruitment of the scapular muscles during arm elevation. However, muscular performance of the shoulder rotator muscles was not affected.