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Corticospinal excitability is known to be affected by afferent inflow arising from the proprioceptors during active or passive muscle movements. Also during static stretching (SS) afferent activity is enhanced, but its effect on corticospinal excitability received limited attention and has only been investigated as a single average value spread over the entire stretching period. Using transcranial magnetic stimulation (TMS) the present study was conducted to explore the time course of corticospinal excitability during 30 seconds SS. Motor evoked potentials (MEPs) after TMS were recorded from soleus (SOL) and tibialis anterior (TA) muscles in 14 participants during: a passive dynamic ankle dorsiflexion (DF), at six different time points during maximal individual SS (3, 6, 9, 18, 21 and 25 seconds into stretching), during a passive dynamic ankle plantar flexion (PF) and following SS. To explore the time course of corticospinal excitability during the static lengthened phase of a muscle stretch, the stretching protocol was repeated several times so that it was possible to collect a sufficient number of stimulations at each specific time point into SS, as well as during DF and PF. During passive DF, MEPs amplitude was greater than baseline in both TA and SOL (p =.001 and p =.005 respectively). During SS, MEPs amplitude was greater than baseline in TA (p =.006), but not in SOL. No differences between the investigated time points were found and no trend was detected throughout the stretching time. No effect in either muscle was observed during passive PF and after SS. These results could suggest that an increased activity of secondary afferents from SOL muscle spindles exert a corticomotor facilitation on TA. The muscle-nonspecific response observed during passive DF could instead be attributed to an increased activation within the sensorimotor cortical areas as a result of the awareness of the foot passive displacements. [ABSTRACT FROM AUTHOR]

Introduction: The mechanisms regulating neuromuscular control of standing balance can be influenced by visual sensory feedback and arousal. Virtual reality (VR) is a cutting-edge tool for probing the neural control of balance and its dependence on visual feedback, but whether VR induces neuromodulation akin to that seen in real environments (eyes open vs. closed or ground level vs. height platform) remains unclear. Methods: Here we monitored 20 healthy young adults (mean age 23.3 ± 3.2 years; 10 females) during four conditions of quiet standing. Two real world conditions (eyes open and eyes closed; REO and REC) preceded two eyes-open virtual 'low' (ground level; VRL) and 'high' (14 m height platform; VRH) conditions. We measured arousal via electrodermal activity and psychosocial questionnaires rating perceived fear and anxiety. We recorded surface electromyography over the right soleus, medial gastrocnemius, and tibialis anterior, and performed force plate posturography. As a proxy for modulations in neural control, we assessed lower limb reflexive muscle responses evoked by tendon vibration and electrical stimulation. Results: Physiological and perceptual indicators of fear and anxiety increased in the VRH condition. Background soleus muscle activation was not different across conditions; however, significant increases in muscle activity were observed for medial gastrocnemius and tibialis anterior in VRH relative to REO. The mean power frequency of postural sway also increased in the VRH condition relative to REO. Finally, with a fixed stimulus level across conditions, mechanically evoked reflexes remained constant, while H-reflex amplitudes decreased in strength within virtual reality. Discussion: Notably, H-reflexes were lower in the VRL condition than REO, suggesting that these ostensibly similar visual environments produce different states of reflexive balance control. In summary, we provide novel evidence that VR can be used to modulate upright postural control, but caution that standing balance in analogous real and virtual environments may involve different neural control states. [ABSTRACT FROM AUTHOR]

Simple Summary: Sepsis is a life-threatening infection usually resulting in admission to an Intensive Care Unit, and is responsible for 1 in 5 deaths worldwide. Muscle weakness is a common and early complication of sepsis that impairs short- and long-term prognoses. It is characterized by muscle fiber atrophy and mitochondrial dysfunction. In addition, sepsis induces a negative imbalance in energy homeostasis, also associated with hospital complications. However, whether this energy deficit disrupts the metabolism in skeletal muscle has never been studied. Our study compared three groups of mice (sepsis with a spontaneous energy deficit, control without an energy deficit, and control with an energy deficit) to investigate the impact of energy debt on skeletal muscle in the first 24 h of sepsis. We demonstrated that a sepsis-like energy deficit was not in itself sufficient to alter muscle fiber size or the mitochondrial population, in contrast with sepsis. Conversely, an energy deficit led to important metabolic adaptations that were not found in sepsis. Sepsis-induced myopathy is characterized by muscle fiber atrophy, mitochondrial dysfunction, and worsened outcomes. Whether whole-body energy deficit participates in the early alteration of skeletal muscle metabolism has never been investigated. Three groups were studied: "Sepsis" mice, fed ad libitum with a spontaneous decrease in caloric intake (n = 17), and "Sham" mice fed ad libitum (Sham fed (SF), n = 13) or subjected to pair-feeding (Sham pair fed (SPF), n = 12). Sepsis was induced by the intraperitoneal injection of cecal slurry in resuscitated C57BL6/J mice. The feeding of the SPF mice was restricted according to the food intake of the Sepsis mice. Energy balance was evaluated by indirect calorimetry over 24 h. The tibialis anterior cross-sectional area (TA CSA), mitochondrial function (high-resolution respirometry), and mitochondrial quality control pathways (RTqPCR and Western blot) were assessed 24 h after sepsis induction. The energy balance was positive in the SF group and negative in both the SPF and Sepsis groups. The TA CSA did not differ between the SF and SPF groups, but was reduced by 17% in the Sepsis group compared with the SPF group (p < 0.05). The complex-I-linked respiration in permeabilized soleus fibers was higher in the SPF group than the SF group (p < 0.05) and lower in the Sepsis group than the SPF group (p < 0.01). Pgc1α protein expression increased 3.9-fold in the SPF mice compared with the SF mice (p < 0.05) and remained unchanged in the Sepsis mice compared with the SPF mice; the Pgc1α mRNA expression decreased in the Sepsis compared with the SPF mice (p < 0.05). Thus, the sepsis-like energy deficit did not explain the early sepsis-induced muscle fiber atrophy and mitochondrial dysfunction, but led to specific metabolic adaptations not observed in sepsis. [ABSTRACT FROM AUTHOR]

Summary: Multiple system atrophy (MSA) and Parkinson's disease (PD) may share overlapping features particularly at early disease stage, including sleep alterations, but have profoundly different prognoses. Certain sleep phenomena and disorders of motor control are more prevalent in multiple system atrophy, such as REM sleep behaviour disorder (RBD). We quantitatively tested whether pervasive muscle activity during sleep occurs in subjects with multiple system atrophy versus Parkinson's disease. Laboratory polysomnographic studies were performed in 50 consecutive subjects with Parkinson's disease and 26 age‐ and gender‐matched subjects with multiple system atrophy at <5 years from disease onset. The distributions of normalised electromyographic activity of submentalis, wrist extensor, and tibialis anterior muscles in different wake–sleep states during the night were analysed. Subjects with multiple system atrophy had significantly higher activity of submentalis, wrist extensor, and tibialis anterior muscles than subjects with Parkinson's disease during non‐REM sleep, including separately in stages N1, N2, and N3, and during REM sleep, but not during nocturnal wakefulness. The activity of wrist extensor and tibialis anterior muscles during non‐REM sleep and the activity of tibialis anterior muscles during REM sleep were also significantly higher in subjects with multiple system atrophy and RBD than in subjects with Parkinson's disease and RBD. In conclusion, with respect to Parkinson's disease, multiple system atrophy is characterised by a pervasive and diffuse muscle overactivity that involves axial and limb muscles and occurs not only during REM sleep, but also during non‐REM sleep and between subjects with comorbid RBD. [ABSTRACT FROM AUTHOR]

Introduction: Neurological sequelae following SARS-CoV-2 infection still represent a serious concern both for neurologists and neuroscientists. In our paper, we investigated pain, myalgia, and fatigue as symptoms in long-COVID patients with an electrophysiological approach, comprising the evaluation of sympathetic skin responses (SSRs) and quantitative electromyography (qEMG). Materials and methods: Twelve patients were enrolled (mean age, 47.7 ± 11.6 years), referred to our attention because of myalgia, pain, or muscle cramps, which persisted about 6 months after the diagnosis of SARS-CoV-2 infection. They underwent conventional electroneurography (ENG), needle electromyography (EMG), and SSRs; moreover, qEMG was performed by sampling at least 20 motor unit potentials (20–30 MUPs) during weak voluntary contraction in deltoid and tibialis anterior muscles. The mean duration, amplitude, and percentage of polyphasic potentials were assessed and compared with healthy and age-matched volunteers. Results: ENG did not disclose significant changes compared to healthy subjects; needle EMG did not reveal denervation activity. In addition, qEMG showed MUPs similar to those recorded in healthy volunteers in terms of polyphasia (deltoid: p = 0.24; TA: p = 0.35), MUP area (deltoid: p = 0.45; TA: p = 0.44), mean duration (deltoid: p = 0.06; TA: p = 0.45), and amplitude (deltoid: p = 0.27; TA: p = 0.63). SSRs were not recordable from lower limbs in seven patients (58%) and from the upper ones in three of them (25%). Conclusion: Our data suggest an involvement of the autonomic system, with a focus on cholinergic efferent sympathetic activity, without any evidence of myopathic changes. [ABSTRACT FROM AUTHOR]

Symptomatic muscle herniae are an uncommon cause of chronic exercise induced leg pain. The most common site for muscle hernia is the tibialis anterior muscle. This study evaluates the outcome of a minimal incision fasciotomy in patients with a symptomatic muscle hernia of the tibialis anterior muscle, and their return to normal daily activities including sport. The study reports mid-term results in a series of 22 consecutive patients (17 males and 5 females, median age: 22 years) with a unilateral tibialis anterior MH who had undergone minimally invasive fasciotomy between 2008 and 2019. Clinical outcomes were assessed with SF-36 and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery, and the time to return to training (RTT) and to sport (RTS) were recorded. At a median follow up after surgery of 23 months, both questionnaires showed a statistically significant improvement (P < 0.005). At the latest follow up, 16 of patients (73%) had returned to pre-injury or higher levels of sport/activity. The median time to return to training and to return to sport was 7 and 11 weeks respectively. No severe complications and no recurrence of symptoms were recorded. Minimally invasive fasciotomy is effective and safe for patients suffering from muscle hernia of the tibialis anterior muscle with good results in the mid-term. IV. • Symptomatic muscle herniae (MH) are an uncommon cause of exercise induced leg pain. • The tibialis anterior muscle (TAM) is most frequently affected. • We used minimal incision fasciotomy in MH of the TAM. • Patients returned to training and sport by 7 and 11 weeks respectively, without severe complications. • Minimally invasive fasciotomy is effective in patients with MH of TAM. [ABSTRACT FROM AUTHOR]

New Findings: What is the central question of this study?Is the attenuation of the respiratory muscle metaboreflex preserved after detraining?What is the main finding and its importance?Inspiratory muscle training increased respiratory muscle strength and attenuated the respiratory muscle metaboreflex as evident by lower heart rate and blood pressure. After 5 weeks of no inspiratory muscle training (detraining), respiratory muscle strength was still elevated and the metaboreflex was still attenuated. The benefits of inspiratory muscle training persist after cessation of training, and attenuation of the respiratory metaboreflex follows changes in respiratory muscle strength. Respiratory muscle training (RMT) improves respiratory muscle (RM) strength and attenuates the RM metaboreflex. However, the time course of muscle function loss after the absence of training or 'detraining' is less known and some evidence suggest the respiratory muscles atrophy faster than other muscles. We sought to determine the RM metaboreflex in response to 5 weeks of RMT and 5 weeks of detraining. An experimental group (2F, 6M; 26 ± 4years) completed 5 weeks of RMT and tibialis anterior (TA) training (each 5 days/week at 50% of maximal inspiratory pressure (MIP) and 50% maximal isometric force, respectively) followed by 5 weeks of no training (detraining) while a control group (1F, 7M; 24 ± 1years) underwent no intervention. Prior to training (PRE), post‐training (POST) and post‐detraining (DETR), all participants underwent a loaded breathing task (LBT) to failure (60% MIP) while heart rate and mean arterial blood pressure (MAP) were measured. Five weeks of training increased RM (18 ± 9%, P < 0.001) and TA (+34 ± 19%, P < 0.001) strength and both remained elevated after 5 weeks of detraining (MIP‐POST vs. MIP‐DETR: 154 ± 31 vs. 153 ± 28 cmH2O, respectively, P = 0.853; TA‐POST vs. TA‐DETR: 86 ± 19 vs. 85 ± 16 N, respectively, P = 0.982). However, the rise in MAP during LBT was attenuated POST (−11 ± 17%, P = 0.003) and DETR (−9 ± 9%, P = 0.007) during the iso‐time LBT. The control group had no change in MIP (P = 0.33), TA strength (P = 0.385), or iso‐time MAP (P = 0.867) during LBT across all time points. In conclusion, RM and TA have similar temporal strength gains and the attenuation of the respiratory muscle metaboreflex remains after 5 weeks of detraining. [ABSTRACT FROM AUTHOR]

Objectives: To explore the feasibility of shear wave elastography for evaluating sarcopenia. Methods: The shear wave velocities (SWV) of the tibialis anterior, medial gastrocnemius, and soleus were measured in 130 subjects in the Second Affiliated Hospital of Fujian Medical University from January 2021 to June 2022. Consistency was evaluated in 20 cases using the intraclass correlation coefficient. According to the 2019 Asian Working Group for Sarcopenia（AWGS） diagnostic criteria, the patients were divided into a healthy and a sarcopenia group. The differences in SWV between the two groups were compared, and their correlation between calf muscles and muscle mass, grip strength, and pace were analyzed. The diagnostic cutoff value of calf muscle SWV for sarcopenia was obtained using receiver operating characteristic (ROC) curves, and the diagnostic efficacy of different ROC curves was compared. Results: The SWV inter‐group and intra‐group correlation coefficients of the three lower limbs muscles were all greater than 0.85. Moreover, the corresponding SWV in the sarcopenia group were significantly smaller than those in the healthy control group (P <.05). Further, SWV were positively correlated with the appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed. Finally, the SWV of the anterior tibialis and medial gastrocnemius muscles were 3.02 and 2.26 m/s, respectively, and their diagnostic efficacy for sarcopenia did not differ significantly (Z = 0.190, P =.8497). Conclusion: SWE can be used to detect the hardness of the anterior tibialis and medial gastrocnemius, calculate their muscle mass as an effective tool to evaluate sarcopenia. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine whether target width and target distance influence the planning phase of a fencing lunge (early and anticipatory postural adjustments) as well as the execution phase of a fencing lunge. Eight elite female fencers participated in the study. The displacement of the center of foot pressure, muscle activity of the tibialis anterior, and kinematics of center of mass were recorded using force plates. The results show that target width and distance have no effect on early and anticipatory postural adjustments as well as the acceleration and velocity of the center of mass at the moment of foot-off. However, a greater target distance was associated with a greater max center of mass acceleration and velocity, and larger target width resulted in a greater max center of mass acceleration during lunging (p < 0.05). We suppose that the effect of task parameters on preparing a fencing lunge may be mitigated due to the specific technique adopted by expert fencers and the ballistic nature of a fencing lunge. [ABSTRACT FROM AUTHOR]

The study aimed to compare the ankle muscles activation, biomechanics and energetics of running in male runners during submaximal level run using minimalist (MinRS) and traditional cushioned (TrdRS) running shoes. During 45-min running in MinRS and TrdRS, the ankle muscles pre- and co-activation, biomechanics, and energetics of running of 16 male endurance runners (25.5 ± 3.5 yr) were assessed using surface electromyography (tibialis anterior and gastrocnemius lateralis), instrumented treadmill and indirect calorimetry, respectively. The net energy cost of running (Cr) was similar for both conditions (P = 0.25) with a significant increase over time (P < 0.0001). Step frequency (P < 0.001), and total mechanical work (P = 0.001) were significantly higher in MinRS than in TrdRS with no evolution over time (P = 0.28 and P = 0.85, respectively). The ankle muscles pre- and co-activation during the contact phase did not differ between the two shoe conditions (P ≥ 0.33) or over time (P ≥ 0.15). In conclusion, during 45-min running, Cr and muscle pre- and co-activation were not significantly different between MinRS and TrdRS with significantly higher step frequency and total mechanical work noted in the former than in the latter. Moreover, Cr significantly increased during the 45-min trial in both shoe conditions along with no significant change over time in muscle activation and biomechanical variables. [ABSTRACT FROM AUTHOR]

Humans can inherently adapt their gait pattern in a way that minimizes the metabolic cost of transport, or walking economy, within a few steps, which is faster than any known direct physiological sensor of metabolic energy. Instead, walking economy may be indirectly sensed through mechanoreceptors that correlate with the metabolic cost per step to make such gait adaptations. We tested whether velocity feedback from tibialis anterior (TA) muscle fascicles during the early stance phase of walking could potentially act to indirectly sense walking economy. As participants walked within a range of steady-state speeds and step frequencies, we observed that TA fascicles lengthen on almost every step. Moreover, the average peak fascicle velocity experienced during lengthening reflected the metabolic cost of transport of the given walking condition. We observed that the peak TA muscle activation occurred earlier than could be explained by a short latency reflex response. The activation of the TA muscle just prior to heel strike may serve as a prediction of the magnitude of the ground collision and the associated energy exchange. In this scenario, any unexpected length change experienced by the TA fascicle would serve as an error signal to the nervous system and provide additional information about energy lost per step. Our work helps provide a biomechanical framework to understand the possible neural mechanisms underlying the rapid optimization of walking economy. [ABSTRACT FROM AUTHOR]

During movements, neural signals are translated into muscle fibre shortening, lengthening or they remain isometric. This study investigated cortical excitatory and inhibitory processes in relation to muscle fascicle dynamics during fixed-end rapid contractions. Fourteen adults performed submaximal and maximal ankle dorsiflexions. Single and paired pulse transcranial magnetic stimulation over the cortical representation projecting to the tibialis anterior (TA) was applied during rest, the activation and deactivation phase of contractions to test for short- (SICI) and long-interval intracortical inhibition (LICI) and intracortical facilitation (ICF). Ultrasound images were taken to measure muscle fascicle dynamics of the superficial (TASF) and deep (TADP) TA compartments. The results show significantly greater maximal shortening velocities (p = 0.003, d = 0.26, CI [4.89, 18.52]) and greater maximal fascicle shortening (p = 0.003, d = 0.86, CI [0.29, 3.13]) in TASF than TADP during submaximal dorsiflexions. Significantly lower SICI levels during activation compared to deactivation (p = 0.019, d = 1.12, CI [19.82, 1.76]) and at rest (p < 0.0001) were observed. ICF was significantly greater during activation (p = 0.03) than during rest while LICI did not modulate significantly. Maximal TASF but not TADP shortening velocity correlated with SICI levels at activation (p = 0.06) and with the rate of torque development (p = 0.02). The results suggest that SICI might be related to muscle fascicle behavior and that intracortical inhibition and excitation are phase-dependently modulated. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether altered serum and/or muscle concentrations of brain-derived neurotrophic factor (BDNF) can modify the electrophysiological properties of spinal motoneurons (MNs). This study was conducted in wild-type and Bdnf heterozygous knockout rats (HET, SD-BDNF). Rats were divided into four groups: control, knockout, control trained, and knockout trained. The latter two groups underwent moderate-intensity endurance training to increase BDNF levels in serum and/or hindlimb muscles. BDNF and other neurotrophic factors (NFs), including glial cell-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), nerve growth factor (NGF), and neurotrophin-4 (NT-4) were assessed in serum and three hindlimb muscles: the tibialis anterior (TA), medial gastrocnemius (MG), and soleus (Sol). The concentrations of tropomyosin kinase receptor B (Trk-B), interleukin-15 (IL-15), and myoglobin (MYO/MB) were also evaluated in these muscles. The electrophysiological properties of lumbar MNs were studied in vivo using whole-cell current-clamp recordings. Bdnf knockout rats had reduced levels of all studied NFs in serum but not in hindlimb muscles. Interestingly, decreased serum NF levels did not influence the electrophysiological properties of spinal MNs. Additionally, endurance training did not change the serum concentrations of any of the NFs tested but significantly increased BDNF and GDNF levels in the TA and MG muscles in both trained groups. Furthermore, the excitability of fast MNs was reduced in both groups of trained rats. Thus, changes in muscle (but not serum) concentrations of BDNF and GDNF may be critical factors that modify the excitability of spinal MNs after intense physical activity. [ABSTRACT FROM AUTHOR]

Introduction: Skeletal muscle insulin resistance (IR) plays an important role in the pathogenesis of type 2 diabetes mellitus. Skeletal muscle is a heterogeneous tissue composed of different muscle fiber types that contribute distinctly to IR development. Glucose transport shows more protection in slow-twitch muscles than in fast-twitch muscles during IR development, while the mechanisms involved remain unclear. Therefore, we investigated the role of the mitochondrial unfolded protein response (UPRmt) in the distinct resistance of two types of muscle in IR. Methods: Male Wistar rats were divided into high-fat diet (HFD) feeding and control groups. We measured glucose transport, mitochondrial respiration, UPRmt and histone methylation modification of UPRmt-related proteins to examine the UPRmt in the slow fiber-enriched soleus (Sol) and fast fiberenriched tibialis anterior (TA) under HFD conditions. Results: Our results indicate that 18 weeks of HFD can cause systemic IR, while the disturbance of Glut4-dependent glucose transport only occurred in fasttwitch muscle. The expression levels of UPRmt markers, including ATF5, HSP60 and ClpP, and the UPRmt-related mitokine MOTS-c were significantly higher in slow-twitch muscle than in fast-twitch muscle under HFD conditions. Mitochondrial respiratory function is maintained only in slow-twitch muscle. Additionally, in the Sol, histone methylation at the ATF5 promoter region was significantly higher than that in the TA after HFD feeding. Conclusion: The expression of proteins involved in glucose transport in slowtwitch muscle remains almost unaltered after HFD intervention, whereas a significant decline of these proteins was observed in fast-twitch muscle. Specific activation of the UPRmt in slow-twitch muscle, accompanied by higher mitochondrial respiratory function and MOTS-c expression, may contribute to the higher resistance to HFD in slow-twitch muscle. Notably, the different histone modifications of UPRmt regulators may underlie the specific activation of the UPRmt in different muscle types. However, future work applying genetic or pharmacological approaches should further uncover the relationship between the UPRmt and insulin resistance. [ABSTRACT FROM AUTHOR]

Capturing disease progression in amyotrophic lateral sclerosis (ALS) is challenging and refinement of progression markers is urgently needed. This study introduces new motor unit number index (MUNIX), motor unit size index (MUSIX) and compound muscle action potential (CMAP) parameters called M50, MUSIX200 and CMAP50. M50 and CMAP50 indicate the time in months from symptom onset an ALS patient needs to lose 50% of MUNIX or CMAP in relation to the mean values of controls. MUSIX200 represents the time in months until doubling of the mean MUSIX of controls. We used MUNIX parameters of Musculi abductor pollicis brevis (APB), abductor digiti minimi (ADM) and tibialis anterior (TA) of 222 ALS patients. Embedded in the D50 disease progression model, disease aggressiveness and accumulation were analyzed separately. M50, CMAP50 and MUSIX200 significantly differed among disease aggressiveness subgroups (p < 0.001) regardless of disease accumulation. ALS patients with a low M50 had a significantly shorter survival compared to high M50 (median 32 versus 74 months). M50 preceded the loss of global function (median of about 14 months). M50, CMAP50 and MUSIX200 characterize the disease course in ALS in a new way and may be applied as early measures of disease progression. [ABSTRACT FROM AUTHOR]

Previous evidence indicated that interventions with combined neuromuscular electrical stimulation (NMES) and voluntary muscle contractions could have superior effects on corticospinal excitability when the produced total force is larger than each single intervention. However, it is unclear whether the superior effects exist when the produced force is matched between the interventions. Ten able-bodied individuals performed three intervention sessions on separate days: (i) NMES–tibialis anterior (TA) stimulation; (ii) NMES+VOL–TA stimulation combined with voluntary ankle dorsiflexion; (iii) VOL–voluntary ankle dorsiflexion. Each intervention was exerted at the same total output of 20% of maximal force and applied intermittently (5 s ON / 19 s OFF) for 16 min. Motor evoked potentials (MEP) of the right TA and soleus muscles and maximum motor response (Mmax) of the common peroneal nerve were assessed: before, during, and for 30 min after each intervention. Additionally, the ankle dorsiflexion force-matching task was evaluated before and after each intervention. Consequently, the TA MEP/Mmax during NMES+VOL and VOL sessions were significantly facilitated immediately after the interventions started until the interventions were over. Compared to NMES, larger facilitation was observed during NMES+VOL and VOL sessions, but no difference was found between them. Motor control was not affected by any interventions. Although superior combined effects were not shown compared to voluntary contractions alone, low-level voluntary contractions combined with NMES resulted in facilitated corticospinal excitability compared to NMES alone. This suggests that the voluntary drive could improve the effects of NMES even during low-level contractions, even if motor control is not affected. [ABSTRACT FROM AUTHOR]

The mediolateral ankle strategy plays a crucial role in providing ankle stability in ground obstacle-avoidance behavior. This is achieved by changing basic walking patterns according to the characteristics of the obstacle. In daily life, it is more common to use step-aside movement (i.e., dodging step) for collision avoidance rather than side-stepping (i.e., widening standing base) when encountering an approaching pedestrian or bicycle. While studies have been conducted on the mediolateral ankle strategy contribution in obstacle avoidance using side-stepping, knowledge of step-aside movement is still inadequate. Therefore, we conducted an electromyography (EMG) analysis on the tibialis anterior (TA), peroneus longus (PL), and soleus (SOL) muscles, as well as measured center of pressure (CoP) displacement, and vertical ground reaction force (vGRF) of the standing leg, in order to understand the role of ankle muscles in step-aside movement during quiet standing. Fifteen healthy young men repeated twelve step-aside movements in both left and right directions. A Bayesian one-sample t-test was used to determine the sufficient step and participant counts. Multiple linear regression analysis was used to investigate the correlation between the muscle activity and CoP displacement or vGRF. The regression coefficients (β) of the left push phase and the right loading phase were tested against zero using a Bayesian one-sample t-test to identify the correlation between independent and dependent variables. We used the one-dimensional statistical parametric mapping (SPM1d) method to analyze the differences between and within the groups of EMG data based on the continuous time series. The results showed that the PL displayed a substantial contribution to the mediolateral ankle strategy during the push phase of step-aside movement, and also contributed to maintaining ankle stability during the loading phase. This suggested that screening for PL weakness and providing appropriate interventions and/or training approaches is especially critical for populations with walking stability problems. [ABSTRACT FROM AUTHOR]

Methods of isolating mitochondria commonly utilise mechanical force and shear stress to homogenize tissue followed by purification by multiple rounds of ultracentrifugation. Existing protocols can be time-consuming with some physically impairing integrity of the sensitive mitochondrial double membrane. Here, we describe a method for the recovery of intact, respiring mitochondria from murine skeletal muscle tissue and cell lines using nitrogen cavitation. This protocol results in high-yield, pure and respiring mitochondria without the need for purification gradients or ultracentrifugation. The protocol takes under an hour and requires limited specialised equipment. Our methodology is successful in extracting mitochondria of both cell extracts and skeletal muscle tissue. This represents an improved yield in comparison to many of the existing methods. Western blotting and electron microscopy demonstrate the enrichment of mitochondria with their ultrastructure well-preserved and an absence of contamination from cytoplasmic or nuclear fractions. Using respirometry analysis we show that mitochondria extracted from murine skeletal muscle cell lines (C2C12) and tibialis anterior tissue have an appropriate respiratory control ratio. These measures are indicative of healthy coupled mitochondria. Our method successfully demonstrates the rapid isolation of functional mitochondria and will benefit researchers studying mitochondrial bioenergetics as well as providing greater throughput and application for time-sensitive assays. [ABSTRACT FROM AUTHOR]

This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October 2017. TW was calculated as the difference in tunnel widths between the immediate and 2-year postoperative measurements. The risk factors for TW, including demographic data, concomitant meniscal injury, hip–knee–ankle angle, tibial slope, femoral and tibial tunnel position (quadrant method), and length of both tunnels, were investigated. The patients were divided twice into two groups depending on whether the femoral or tibial TW was over or less than 3 mm. Pre- and 2-year follow-up outcomes, including the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, and side-to-side difference (STSD) of anterior translation on stress radiographs, were compared between TW ≥ 3 mm and TW < 3 mm. The femoral tunnel position depth (shallow femoral tunnel position) was significantly correlated with femoral TW (adjusted R2 = 0.134). The femoral TW ≥ 3 mm group showed greater STSD of anterior translation than the femoral TW < 3 mm group. The shallow position of the femoral tunnel was correlated with the femoral TW after ACL reconstruction using a tibialis anterior allograft. A femoral TW ≥ 3 mm showed inferior postoperative knee anterior stability. [ABSTRACT FROM AUTHOR]

In the NERFACE study part I, the characteristics of muscle transcranial electrical stimulation motor evoked potentials (mTc-MEPs) recorded from the tibialis anterior (TA) muscles with surface and subcutaneous needle electrodes were compared. The aim of this study (NERFACE part II) was to investigate whether the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes in detecting mTc-MEP warnings during spinal cord monitoring. mTc-MEPs were simultaneously recorded from TA muscles with surface and subcutaneous needle electrodes. Monitoring outcomes (no warning, reversible warning, irreversible warning, complete loss of mTc-MEP amplitude) and neurological outcomes (no, transient, or permanent new motor deficits) were collected. The non-inferiority margin was 5%. In total, 210 (86.8%) out of 242 consecutive patients were included. There was a perfect agreement between both recording electrode types for the detection of mTc-MEP warnings. For both electrode types, the proportion of patients with a warning was 0.12 (25/210) (difference, 0.0% (one-sided 95% CI, 0.014)), indicating non-inferiority of the surface electrode. Moreover, reversible warnings for both electrode types were never followed by permanent new motor deficits, whereas among the 10 patients with irreversible warnings or complete loss of amplitude, more than half developed transient or permanent new motor deficits. In conclusion, the use of surface electrodes was non-inferior to the use of subcutaneous needle electrodes for the detection of mTc-MEP warnings recorded over the TA muscles. [ABSTRACT FROM AUTHOR]

Tibialis anterior (TA) muscle originates from the lateral surface of tibia and its tendon attaches to the medial cuneiform and base of the first metatarsal. The TA muscle is responsible for both dorsiflexion and inversion of the foot. We present a case of bilateral TA muscle variations that diverge slightly from the current classification systems of this muscle. Recognizing variations such as these may be important for anatomists, surgeons, podiatrists, and physicians. Following routine dissection, an accessory tendon of the TA muscle was found on both sides. Accessory tendons of the extensor hallucis longus and extensor hallucis brevis joined to form a common tendon on both sides. We believe that this unique case will help further the classification systems for the tendons of the TA and also be informative for clinical anatomists as well as physicians treating patients with pathology in this region. [ABSTRACT FROM AUTHOR]

BACKGROUND: Backward walking is considered as a newly rising method used to enhance gait abilities, but evidence remains unclear. OBJECTIVE: To identify whether backward walking with functional electrical stimulation (FES) triggered by a foot switch on the rectus femoris and tibialis anterior could be effective in improving gait parameters of stroke survivors. METHODS: This was a cross-sectional study that included fourteen subjects with chronic stroke. Three walking conditions were performed at random: backward walking with FES attached onto the rectus femoris and tibialis anterior (RF+TA), backward walking with FES attached onto the tibialis anterior (TA only), and without electrical intervention (non-FES). The Zebris was used to assess the spatiotemporal gait parameters. Each condition was measured three times and the average value was used for analysis. RESULTS: Results showed significant increases in gait speed, cadence, step length, mid-stance percentage, maximal force in the affected midfoot (p < 0.05), and significant decreases in the double stance phase in the RF+TA condition compared to the TA only and the non-FES conditions (p < 0.05). CONCLUSION: Functional electrical stimulation to the rectus femoris and tibialis anterior during backward walking could be a clinically effective method to improve gait ability of stroke survivors. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of Tibialis Anterior Tendon Transfer in treatment of cases of Dynamic Foot Supination in Relapsed Clubfoot. Methods: Pediatric Unit of Orthopedic Surgery Department, Zagazig University Hospitals. All patients fulfilling the inclusion criteria included in the study in a time period of 6 months were 12 patients. A total of 12 patients (9 males and 3 females) with 1 bilateral, 7 right feet and 4 left feet. The 9 males were (1 bilateral, 5 right foot and 3 left foot). The 3 females were (2 right foot and 1 left foot). Results: We studied 12 cases 9 males and 3 females with mean age of 4.83±0.71 to assess outcome of Tibialis Anterior Tendon Transfer in Management of Relapsed Clubfoot. Conclusion: Tibialis anterior tendon transfer has been the treatment of choice for cases of relapsed CTEV in the form of dynamic supination for years. It has a high success rate and very low post-operative complications and very low incidence of residual deformity if done correctly. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to demonstrate the sonographic appearance of acute spontaneous anterior tibialis tendon (ATT) rupture, to describe the later sonographic appearance of ATT after 4–6–8 weeks of conservative treatment, and to describe the clinical outcome of these patients. Methods: This was a retrospective study of seven patients, physically active men, aged 40–75, who presented with clinical symptoms suggesting ATT rupture. All patients were treated conservatively by case immobilization and went through a follow-up ultrasound examination 4–6–8 weeks afterwards, until clinical recovery. Two patients had ultrasound examination one year after the injury. Results: All seven patients had a complete tear of the ATT with a visible gap between the torn tendon ends seen on sonography. The mean gap size at the time of initial examination was 2 cm. There was a disruption of the normal fibrillar pattern of the tendon, with non-clear fluid accumulated in the gap between the torn tendon ends. Using real-time dynamic ultrasound revealed paradoxical movement with retraction of the torn tendon ends and increasing the distance between the torn ends. All patients were treated conservatively. Sonographic follow-up examinations after 4, 6, 8 weeks revealed restoration of the tendon continuity with good active and passive movements. All seven patients demonstrated irregular and thickened tendon with echogenic scar. Clinically, at 6–8 weeks they had good range of motion (ROM) of the ankle enabling them to resume their normal daily activity. [ABSTRACT FROM AUTHOR]

Peripheral nerve injury (PNI) is associated with considerable functional impairment. Photobiomodulation (PBM) has demonstrated positive effects regarding neuromuscular repair after PNI when applied locally to the nerve or injured muscle. However, the effects of systemic PBM with transcutaneous application over an important artery, which is also denominated vascular PBM (VPBM), remain unclear. The aim of the study was to compare the effects of VPBM with low-level laser (LLL) and light-emitting diode (LED) on gait, sensitivity and muscle morphology following a PNI. PNI was induced on Wistar rats using the sciatic nerve crushing technique. VPBM was performed over the rat's artery tail region with LED (850 nm, 40 mW, 3.2 J) and LLL (780 nm, 40 mW, 3.2 J). Gait functionality, mechanical (nociceptive) sensitivity, and morphology of the tibialis anterior muscle were evaluated at 7, 14, and 21 days after injury. An improvement in functional gait was shown in the VPBM-LLL group in all periods. Motor sensitivity was found after 14 days in the VPBM-LLL group. The left/right (L/R) muscle mass ratio revealed a reduction in muscle atrophy in the VPBM-LLL group at 7 days. Muscle fiber diameter increased in the VPBM-LED group at 14 days and increases in the cross-section area were found in the VPBM-LED and VPBM-LLL groups at 7 days. VPBM with both light sources (LED and LLL) positively modulated functioning and neuromuscular recovery following sciatic nerve injury in rats, with more pronounced results when using LLL. [ABSTRACT FROM AUTHOR]

Muscle herniation of the lower extremity, such as tibialis anterior muscle herniation (TAMH), is not a rare cause of leg pain in athletes. However, a few studies have reported surgical treatment for TAMH, and the optimal surgical procedure remains controversial. Fasciotomy was reported to be effective for patients with TAMH. However, this procedure would be associated with a risk of intraoperative injury to the superficial peroneal nerve (SPN), although no previous literature has reported this complication. This case report aimed to report a case of bilateral TAMHs in which a traumatic neuroma of the SPN developed after fasciotomy. A 16-year-old baseball player presented with painful swelling lesions of the bilateral lower extremities (1 lesion on the right, 3 lesions on the left) after sports activities. An ultrasonographic evaluation showed swelling lesions of the anterolateral parts of the bilateral lower extremities in the standing position after dashing, while these lesions were not detected in the supine position. A fasciotomy of the crural fascia was performed after conservative treatment failed. Several days after surgery, the patient presented with weakened touch sensation over the dorsal area of the left foot. At the three-month follow-up examination, a swelling lesion with hard elasticity was identified. The palpation of this lesion caused a radiating sensation in the area supplied by the SPN. He was able to return to playing baseball six months after surgery. The patient was asymptomatic without palpation of the traumatic neuroma of the SPN at the latest follow-up examination. In conclusion, the present case report suggests that orthopedic surgeons need to consider the risk of iatrogenic injury to the SPN during fasciotomy for the treatment of TAMHs. However, there may be a risk of injuring the SPN because of the many variants of the course of the SPN within the compartment of the lower extremities. [ABSTRACT FROM AUTHOR]

One of the causes of sarcopenia is that homeostasis between anabolism and catabolism breaks down due to muscle metabolism changes. Rutin has shown antioxidant and anti-inflammatory effects in various diseases, but there are few studies on the effect on muscle loss with aging. The effect of rutin on muscle loss was evaluated using dexamethasone-induced muscle loss C2C12 myoblast and mouse model. In the group treated with dexamethasone, the muscle weight of gastrocnemius (GA), tibialis anterior (TA), and extensor digitorum longus (EDL) in the mouse model were significantly decreased (p < 0.0001 in GA, p < 0.0001 in TA, and p < 0.001 in EDL) but recovered (p < 0.01 in GA, p < 0.0001 in TA, and p < 0.01 in EDL) when treated with rutin. MAFbx, MuRF1, and FOXO3 protein expression of C2C12 myoblast were significantly increased (p < 0.01 in MAFbx, p < 0.01 in MuRF1, and p < 0.01 in FOXO3) when treated with dexamethasone, but it was recovered (p < 0.01 in MAFbx, p < 0.01 in MuRF1, and p < 0.01 in FOXO3) when rutin was treated. In addition, MAFbx and FOXO3 protein expression in GA of mouse model was significantly increased (p < 0.0001 in MAFbx and p < 0.001 in FOXO3) when treated with dexamethasone, but it was also recovered (p < 0.01 in MAFbx and p < 0.001 in FOXO3) when rutin was treated. The present study shows that rutin blocks the FOXO3/MAFbx and FOXO3/MuRf1 pathways to prevent protein catabolism. Therefore, rutin could be a potential agent for muscle loss such as sarcopenia through the blocking ubiquitin-proteasome pathway associated with catabolic protein degradation. [ABSTRACT FROM AUTHOR]

Rehabilitation interventions are crucial in promoting neuroplasticity after spinal cord injury (SCI). We provided rehabilitation with a single-joint hybrid assistive limb (HAL-SJ) ankle joint unit (HAL-T) in a patient with incomplete SCI. The patient had incomplete paraplegia and SCI (neurological injury height: L1, ASIA Impairment Scale: C, ASIA motor score (R/L) L4:0/0, S1:1/0) following a rupture fracture of the first lumbar vertebra. The HAL-T consisted of a combination of ankle plantar dorsiflexion exercises in the sitting position, knee flexion, and extension exercises in the standing position, and stepping exercises in the standing position with HAL assistance. The plantar dorsiflexion angles of the left and right ankle joints and electromyograms of the tibialis anterior and gastrocnemius muscles were measured and compared using a three-dimensional motion analyzer and surface electromyography before and after HAL-T intervention. Phasic electromyographic activity was developed in the left tibialis anterior muscle during plantar dorsiflexion of the ankle joint after the intervention. No changes were observed in the left and right ankle joint angles. We experienced a case in which intervention using HAL-SJ induced muscle potentials in a patient with a spinal cord injury who was unable to perform voluntary ankle movements due to severe motor–sensory dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: several studies have reported improved neuromuscular parameters in response to whole-body vibration (WBV). This is likely achieved by modulation of the central nervous system (CNS). Reduced recruitment threshold (RT), which is the % of Maximal Voluntary Force (%MVF) at which a given Motor Unit (MU) is recruited, may be responsible for the force/power improvements observed in several studies. Methods: 14 men (25 ± 2.3 years; BMI = 23.3 ± 1.5 kgm² MVF: 319.82 ± 45.74 N) performed trapezoidal isometric contractions of the tibialis anterior (TA) at 35-50- 70 %MVF before and after three conditions: WBV, STAND (standing posture), and CNT (no intervention). The vibration was applied through a platform for targeting the TA. High-density surface electromyography (HDsEMG) recordings and analysis were used to detect changes in the RT and Discharge Rate (DR) of the MUs. Results: Mean motor unit recruitment threshold (MURT) reached 32.04 ± 3.28 % MVF before and 31.2 ± 3.72 %MVF after WBV, with no significant differences between conditions (p > 0.05). Additionally, no significant changes were found in the mean motor unit discharge rate (before WBV: 21.11 ± 2.94 pps; after WBV: 21.19 ± 2.17 pps). Discussion: The present study showed no significant changes in motor unit properties at the base of neuromuscular changes documented in previous studies. Further investigations are needed to understand motor unit responses to different vibration protocols and the chronic effect of vibration exposure on motor control strategies. [ABSTRACT FROM AUTHOR]

Muscle-recorded transcranial electrical stimulation motor-evoked potentials (mTc-MEPs) are used to assess the spinal cord integrity. They are commonly recorded with subcutaneous needle or surface electrodes, but the different characteristics of mTc-MEP signals recorded with the two types of electrodes have not been formally compared yet. In this study, mTc-MEPs were simultaneously recorded from the tibialis anterior (TA) muscles using surface and subcutaneous needle electrodes in 242 consecutive patients. Elicitability, motor thresholds, amplitude, area under the curve (AUC), signal-to-noise ratio (SNR), and the variability between mTc-MEP amplitudes were compared. Whereas amplitude and AUC were significantly higher in subcutaneous needle recordings (p < 0.01), motor thresholds and elicitability were similar for surface and subcutaneous needle recordings. Moreover, the SNRs were >2 in more than 99.5% of the surface and subcutaneous needle recordings, and the variability between consecutive amplitudes was not significantly different between the two recording electrode types (p = 0.34). Surface electrodes appear to be a good alternative to needle electrodes for spinal cord monitoring. They are non-invasive, can record signals at similar threshold intensities, have adequately high SNRs, and record signals with equivalent variability. Whether surface electrodes are non-inferior to subcutaneous needle electrodes in detecting motor warnings is investigated in part II of the NERFACE study. [ABSTRACT FROM AUTHOR]

Oxygen delivery is viewed as tightly coupled to demand in exercise below critical power because increasing oxygen delivery does not increase VO2${V_{{O_2}}}$. However, whether the 'normal' adjustment of oxygen delivery to small muscle mass exercise in the heavy intensity domain is optimal for excitation–contraction coupling is currently unknown. In 20 participants (10 female), a remote skeletal muscle (i.e. tibialis anterior) metaboreflex was (Hyperperfusion condition) or was not (Control condition) activated for 4 min during both force of contraction (experimental model 1) and muscle activation‐targeted (experimental model 2) rhythmic forearm handgrip exercise. Analysis was completed on the combined data from both experimental models. After 30 s of remote skeletal muscle metaboreflex activation, mean arterial blood pressure, forearm blood flow and muscle oxygenation were increased and remained increased until metaboreflex discontinuation. While oxygen delivery was elevated, the muscle activation to force of contraction ratio was improved. Upon metaboreflex discontinuation, forearm oxygen delivery and the muscle activation and force of contraction ratio rapidly (within 30 s) returned to control levels. These findings demonstrate that (a) the metaboreflex was effective at increasing forearm muscle oxygen delivery and oxygenation, (b) the muscle activation to force of contraction ratio was improved with increased oxygen delivery, and (c) in the heavy exercise intensity domain, the normal matching of oxygen delivery to metabolic demand is not optimal for muscle excitation–contraction coupling. These results suggest that the nature of vasoregulation in exercising muscle is such that it does not support optimal perfusion for excitation–contraction coupling. Key points: Oxygen delivery is viewed as tightly coupled to demand in exercise below critical power because increasing oxygen delivery does not increase the rate of oxygen uptake.Whether the 'normal' adjustment of oxygen delivery in small muscle mass exercise below critical power is optimal for excitation–contraction coupling is not known.Here we show in humans that increasing oxygen delivery above 'normal' improves excitation–contraction coupling.These results suggest that, in the heavy exercise intensity domain, the 'normal' matching of oxygen delivery to metabolic demand is not optimal for muscle excitation–contraction coupling.Therefore, the nature of vasoregulation in exercising muscle is such that it does not support optimal perfusion for excitation–contraction coupling. [ABSTRACT FROM AUTHOR]

Carbon fiber insole (CFI), which is lightweight and stiff to reduce energy loss and help wearers perform better in sports, has recently been introduced. However, reports are scarce on the effects of CFI on sports performance, muscle activation, and wearing comfort. This study investigated the acute effects of CFI on sports performance, lower extremity muscle activity, and subjective comfort. Thirty young healthy males with shoe sizes between 260 and 270 mm performed various sports tasks (power generation, agility, and speed) and treadmill runs with wearable sensors under two experimental insole conditions (benchmark insole as a baseline, CFI). The results showed that, compared to the benchmark insole, CFI significantly improved sports performance in terms of power generation (~1.5%) and agility (~1%). However, it activated more of the Tibialis Anterior (~0.7%) and Gastrocnemius Medialis (~0.8%) muscles, and was perceived to be stiffer and less comfortable. These findings suggested that CFI could improve sports performance, but could cause more lower extremity muscle activation and subjective discomfort. [ABSTRACT FROM AUTHOR]

Background: The shoe's collar plays a significant role in supporting the ankle during walking. Since the protective effect of the collar requires the circular embracing of the ankle and shank, a stiffer collar might be involved with increased circumferential ankle pressure (CAP). It is not clear how collar CAP affects walking performance. Therefore, this study was aimed at examining the influence of the collar CAP on the kinematics, dynamic stability, electromyography (EMG), and plantar pressure during normal walking. Method: Sixteen healthy male participants walked on a treadmill while wearing a custom-designed high-collar shoe with 10 (low), 30 (medium), and 60 mmHg (high) CAP conditions, and the joint angles, dynamic stability index, EMG, and plantar pressure were measured. Result: While the low CAP condition did not affect the ankle range of motion (ROM), The high CAP condition restricted both the ankle sagittal and frontal ROM, whereas the medium CAP condition limited only the ankle frontal ROM. The knee and hip ROM did not differ between conditions. The dynamic stability for the high and medium CAP cases was comparable but significantly higher than that of the low CAP condition. The ankle muscle activity and corresponding co-contraction increased with increasing CAP for gastrocnemius medialis (GM), soleus (SOL), peroneus longus (PL), tibialis anterior (TA) muscles in the weight acceptance and push-off phases but not in the single limb support. Knee muscle activity, including vastus lateralis (VL) and semitendinosus (SEMI) was similar between all conditions. A higher relative pressure was observed under the lateral aspect of the heel when walking in the high CAP condition. Conclusion: The results suggest that a high-collar shoe with a high CAP may not be an appropriate choice for walking owing to the injury risk factors and limited walking efficiency. A medium CAP is associated with certain advantages and, thus, a superior choice for high-collar shoe design. [ABSTRACT FROM AUTHOR]

Locomotion requires the complex involvement of the spinal and supraspinal systems. So far, the role of vestibular input in gait has been assessed mainly with respect to gait stability. The noninvasive technique of galvanic vestibular stimulation (GVS) has been reported to decrease gait variability and increase gait speed, but the extent of its effect on spatiotemporal gait parameters is not fully known. Objective: Characterize vestibular responses during gait and determine the influence of GVS on cycle duration in healthy young participants. Methods: Fifteen right-handed individuals participated in the study. Electromyography (EMG) recordings of the bilateral soleus (SOL) and tibialis anterior muscles (TA) were performed. First, to determine stimulation intensity, an accelerometer placed on the vertex recorded the amplitude of the head tilts evoked by the GVS (1-4 mA, 200 ms) to establish a motor threshold (T). Second, while participants walked on a treadmill, GVS was applied at the onset of the stance phase during the treadmill gait with an intensity of 1 and 1.5 T with the cathode behind the right (RCathode) or left ear (LCathode). EMG traces were rectified, averaged (n = 30 stimuli), and analyzed. Latency, duration, and amplitude of vestibular responses as well as the mean duration of the gait cycles were measured. Results: GVS mainly induced long-latency responses in the right SOL, right TA and left TA. Only short-latency responses were triggered in the left SOL. Responses in the right SOL, left SOL and left TA were polarity dependent, being facilitatory with RCathode and inhibitory with LCathode, whereas responses in the right TA remained facilitatory regardless of the polarity. With the RCathode configuration, the stimulated cycle was prolonged compared with the control cycle at both 1 and 1.5 T, due to prolonged left SOL and TA EMG bursts, but no change was observed in right SOL and TA. With LCathode, GVS did not modify the cycle duration. Conclusion: During gait, a brief, low-intensity GVS pulse delivered at the right stance onset induced mainly long-latency polarity-dependent responses. Furthermore, a RCathode configuration increased the duration of the stimulated gait cycle by prolonging EMG activity on the anodic side. A similar approach could be explored to influence gait symmetry in individuals with neurological impairment. [ABSTRACT FROM AUTHOR]

This study was designed to test the hypothesis that in addition to repairing the architectural and cellular cues via regenerative medicine, the delivery of immune cues (immunotherapy) may be needed to enhance regeneration following volumetric muscle loss (VML) injury. We identified IL-10 signaling as a promising immunotherapeutic target. To explore the impact of targeting IL-10 signaling, tibialis anterior (TA) VML injuries were created and then treated in rats using autologous minced muscle (MM). Animals received either recombinant rat IL-10 or phosphate buffered saline (PBS) controls injections at the site of VML repair beginning 7 days post injury (DPI) and continuing every other day (4 injections total) until 14 DPI. At 56 DPI (study endpoint), significant improvements to TA contractile torque (82% of uninjured values & 170% of PBS values), TA mass, and myofiber size in response to IL-10 treatment were detected. Whole transcriptome analysis at 14 DPI revealed activation of IL-10 signaling, muscle hypertrophy, and lymphocytes signaling pathways. Expression of ST2, a regulatory T (Treg) cell receptor, was dramatically increased at the VML repair site in response to IL-10 treatment when compared to PBS controls. The findings suggest that the positive effect of delayed IL-10 delivery might be due to immuno-suppressive Treg cell recruitment. [ABSTRACT FROM AUTHOR]

Increasing age appears to influence several morphologic changes in major tendons. However, the effects of aging on the cross‐sectional area (CSA) of different ankle tendons are much less understood. Furthermore, potential differences in specific tendon regions along the length of the tendons have not been investigated in detail. Sixty healthy adult participants categorized by age as young (n = 20; mean ± SD age = 22.5 ± 4.5 years), middle‐age (n = 20; age = 40.6 ± 8. 0 years), or old (n = 20; age = 69.9 ± 9.1 years), from both sexes, were included. The tendon CSA of tibialis anterior (TA), tibialis posterior (TP), fibularis (FT), and Achilles (AT) was measured from T1‐weighted 1.5 T MR images in incremental intervals of 10% along its length (from proximal insertion) and compared between different age groups and sexes. The mean CSA of the AT was greater in the middle‐age group than both young and old participants (p < 0.01) and large effect sizes were observed for these differences (Cohen's d > 1). Furthermore, there was a significant difference in CSA in all three groups along the length of the different tendons. Region‐specific differences between groups were observed in the distal portion (90% and 100% of the length), in which the FT presented greater CSA comparing middle‐age to young and old (p < 0.05). In conclusion, (1) great magnitude of morpho‐structural differences was discovered in the AT; (2) there are region‐specific differences in the CSA of ankle tendons within the three groups and between them; and (3) there were no differences in tendon CSA between sexes. [ABSTRACT FROM AUTHOR]

Musculoskeletal modeling and simulation have been an emerging trend in human gait analysis. It allows the user to isolate certain biomechanical conditions and elucidate the dynamics of joints and muscles. This study used an open-source musculoskeletal modeling and simulation tool, opensim to investigate the biomechanical effect of knee brace. It collected gait data from thirty-eight participants and examined the gait spatio-temporal parameters, joint angles, and joint moments. Static optimization was performed to estimate the lower extremity muscle force. Statistical analysis was conducted to identify the difference between normal and braced gaits. The results demonstrated the feasibility of this method to investigate the interaction and coordination of lower extremity joints and muscles. The knee brace constrained the range of the motion of the knee during walking. It also changed the walking speed, step length, and stance-to-swing ratio. Several significant differences were found in the joint moments and muscle forces of the rectus femoris, gastrocnemius, soleus and tibialis anterior. Musculoskeletal modeling and simulation tool offers a less invasive and practical alternative to analyze human motion. It also provides a means to investigate the effect of medical devices such as knee brace, which can be potentially beneficial for the future design and development of such devices and for the derivation of future rehabilitation treatment to improve patient's gait. [ABSTRACT FROM AUTHOR]

Gait disturbances are common manifestations of Parkinson's disease (PD), with unmet therapeutic needs. Inertial measurement units (IMUs) are capable of monitoring gait, but they lack neurophysiological information that may be crucial for studying gait disturbances in these patients. Here, we present a machine learning approach to approximate IMU angular velocity profiles and subsequently gait events using electromyographic (EMG) channels during overground walking in patients with PD. We recorded six parkinsonian patients while they walked for at least three minutes. Patient-agnostic regression models were trained on temporally embedded EMG time series of different combinations of up to five leg muscles bilaterally (i.e., tibialis anterior, soleus, gastrocnemius medialis, gastrocnemius lateralis, and vastus lateralis). Gait events could be detected with high temporal precision (median displacement of <50 ms), low numbers of missed events (<2%), and next to no false-positive event detections (<0.1%). Swing and stance phases could thus be determined with high fidelity (median F1-score of ~0.9). Interestingly, the best performance was obtained using as few as two EMG probes placed on the left and right vastus lateralis. Our results demonstrate the practical utility of the proposed EMG-based system for gait event prediction, which allows the simultaneous acquisition of an electromyographic signal to be performed. This gait analysis approach has the potential to make additional measurement devices such as IMUs and force plates less essential, thereby reducing financial and preparation overheads and discomfort factors in gait studies. [ABSTRACT FROM AUTHOR]

The peroneal nerve is one of the most commonly injured nerves of the lower extremity. Nerve grafting has been shown to result in poor functional outcomes. The aim of this study was to evaluate and compare anatomical feasibility as well as axon count of the tibial nerve motor branches and the tibialis anterior motor branch for a direct nerve transfer to reconstruct ankle dorsiflexion. In an anatomical study on 26 human body donors (52 extremities) the muscular branches to the lateral (GCL) and the medial head (GCM) of the gastrocnemius muscle, the soleus muscle (S) as well as the tibialis anterior muscle (TA) were dissected, and each nerve's external diameter was measured. Nerve transfers from each of the three donor nerves (GCL, GCM, S) to the recipient nerve (TA) were performed and the distance between the achievable coaptation site and anatomic landmarks was measured. Additionally, nerve samples were taken from eight extremities, and antibody as well immunofluorescence staining were performed, primarily evaluating axon count. The average diameter of the nerve branches to the GCL was 1.49 ± 0.37, to GCM 1.5 ± 0.32, to S 1.94 ± 0.37 and to TA 1.97 ± 0.32 mm, respectively. The distance from the coaptation site to the TA muscle was 43.75 ± 12.1 using the branch to the GCL, 48.31 ± 11.32 for GCM, and 19.12 ± 11.68 mm for S, respectively. The axon count for TA was 1597.14 ± 325.94, while the donor nerves showed 297.5 ± 106.82 (GCL), 418.5 ± 62.44 (GCM), and 1101.86 ± 135.92 (S). Diameter and axon count were significantly higher for S compared to GCL as well as GCM, while regeneration distance was significantly lower. The soleus muscle branch exhibited the most appropriate axon count and nerve diameter in our study, while also reaching closest to the tibialis anterior muscle. These results indicate the soleus nerve transfer to be the favorable option for the reconstruction of ankle dorsiflexion, in comparison to the gastrocnemius muscle branches. This surgical approach can be used to achieve a biomechanically appropriate reconstruction, in contrast to tendon transfers which generally only achieve weak active dorsiflexion. [ABSTRACT FROM AUTHOR]

The conversion of skeletal muscle fiber from fast-twitch to slow-twitch is crucial for sustained contractile and stretchable events, energy homeostasis, and anti-fatigue ability. The purpose of our study was to explore the mechanism and effects of garcinol on the regulation of skeletal muscle fiber type transformation. Forty 21-day-old male C57/BL6J mice (n = 10/diet) were fed a control diet or a control diet plus garcinol at 100 mg/kg (Low Gar), 300 mg/kg (Mid Gar), or 500 mg/kg (High Gar) for 12 weeks. The tibialis anterior (TA) and soleus muscles were collected for protein and immunoprecipitation analyses. Dietary garcinol significantly downregulated (p < 0.05) fast myosin heavy chain (MyHC) expression and upregulated (p < 0.05) slow MyHC expression in the TA and soleus muscles. Garcinol significantly increased (p < 0.05) the activity of peroxisome proliferator-activated receptor gamma co-activator 1α (PGC-1α) and markedly decreased (p < 0.05) the acetylation of PGC-1α. In vitro and in vivo experiments showed that garcinol decreased (p < 0.05) lactate dehydrogenase activity and increased (p < 0.05) the activities of malate dehydrogenase and succinic dehydrogenase. In addition, the results of C2C12 myotubes showed that garcinol treatment increased (p < 0.05) the transformation of glycolytic muscle fiber to oxidative muscle fiber by 45.9%. Garcinol treatment and p300 interference reduced (p < 0.05) the expression of fast MyHC but increased (p < 0.05) the expression of slow MyHC in vitro. Moreover, the acetylation of PGC-1α was significantly decreased (p < 0.05). Garcinol promotes the transformation of skeletal muscle fibers from the fast-glycolytic type to the slow-oxidative type through the p300/PGC-1α signaling pathway in C2C12 myotubes. [ABSTRACT FROM AUTHOR]

Although neuromuscular deficits in people with chronic ankle instability (CAI) have been identified, previous researchers have mostly investigated the activation of multiple muscles in isolation. Investigating muscle synergies in people with CAI would provide information about the coordination and control of neuromuscular activation strategies and could supply important information for understanding and rehabilitating neuromuscular deficits in this population. To assess and compare muscle synergies using nonnegative matrix factorization in people with CAI and healthy control individuals as they performed different landing-cutting tasks. Cross-sectional study. Laboratory. A total of 11 people with CAI (5 men, 6 women; age = 22 ± 3 years, height = 1.68 ± 0.11 m, mass = 69.0 ± 19.1 kg) and 11 people without CAI serving as a healthy control group (5 men, 6 women; age = 23 ± 4 years, height = 1.74 ± 0.11 m, mass = 66.8 ± 15.5 kg) participated. Muscle synergies were extracted from electromyography of the lateral gastrocnemius, medial gastrocnemius, fibularis longus, soleus, and tibialis anterior (TA) muscles during anticipated and unanticipated landing-cutting tasks. The number of synergies, activation coefficients, and muscle-specific weighting coefficients were compared between groups and across tasks. The number of muscle synergies was the same for each group and task. The CAI group exhibited greater TA weighting coefficients in synergy 1 than the control group (P =.02). In addition, both groups demonstrated greater fibularis longus (P =.03) weighting coefficients in synergy 2 during the unanticipated landing-cutting task than the anticipated landing-cutting task. These results suggest that, although both groups used neuromuscular control strategies of similar complexity or dimensionality to perform the landing-cutting tasks, the CAI group displayed different muscle-specific weightings characterized by greater emphasis on TA function in synergy 1, which may reflect an effort to increase joint stability to compensate for ankle instability. [ABSTRACT FROM AUTHOR]

Arm-leg coordinated humanoid exoskeletal robots offer a solution to the ‘unnatural’ gait patterns seen in current leg-only exoskeletons, but their neuromechanical control mechanisms require further exploration.This study investigates the neuromechanical properties and modulation of cervical and lumbar central pattern generators (CPGs) across different gait training conditions.Eleven healthy adults (mean age: 25.27 ± 1.95 years; 5 females, 6 males) participated in gait analysis involving kinematics, kinetics, and electromyography during treadmill-based arm-leg interlimb coordination (TIT), robot-assisted arm-leg coordination (RIT), and robot-assisted leg-only coordination (RLT).Trunk counterrotation and shoulder, hip, and knee kinematics in RIT closely resembled those in TIT (5–10% variance) but significantly differed from RLT (30–40% variance). Electromyography revealed normalized reciprocal activation between the anterior and posterior deltoids (r = -0.48), tibialis anterior, and gastrocnemius (r = -0.68) during RIT, while RLT showed altered agonist-antagonist co-activation (r = 0.84).These findings highlight the importance of cervical and lumbar CPG interaction in natural locomotion, suggesting that arm-leg coordinated exoskeletons could improve neurorehabilitation for individuals recovering from stroke or spinal cord injury. [ABSTRACT FROM AUTHOR]

• Children exhibited insufficient posture control ability compared to young adults during dynamic postural leaning tasks. • Children exhibited significantly higher ankle muscle coactivation and lower intermuscular coherence than young adults. • Children exhibited significant differences in postural control between the forward leaning and backward returning phases. Postural control imposes higher demands on the central neural system (CNS), and age-related declines or incomplete CNS development often result in challenges performing tasks like forward postural leaning. Studies on older adults suggest increased variability in center of pressure (COP), greater muscle co-activations, and reduced corticospinal control during forward leaning tasks. However, the understanding of these features in children remains unclear. Specifically, it is uncertain whether forward leaning poses greater challenges for young children compared to adults, given the ongoing maturation of CNS during development. Understanding the distinct neuromuscular patterns observed during postural leaning could help optimize therapeutic strategies aimed at improving postural control in pediatric populations. 12 typically developing children (5.91 ± 1.37 years) and 12 healthy young adults (23.16 ± 1.52 years) participated in a dynamic leaning forward task aimed at matching a COP target in the anterior-posterior direction as steadily as possible. Participants traced a triangular trajectory involving forward leaning (FW phase) to 60 % of their maximum lean distance and backward returning (BW phase) to the neutral standing position. Surface electromyography (sEMG) from muscles including gastrocnemius medialis (GM), soleus (SOL), and tibialis anterior (TA) were collected during both phases. COP variability was assessed using the standard deviation (SD) of COP displacements. Muscle co-activation indexes (CI) for ankle plantar and dorsal flexors (SOL/TA, GM/TA) were derived from sEMG activities. Intermuscular coherence in the beta band (15–30 Hz) was also analyzed to evaluate corticospinal drive. Children exhibited a significantly greater SD of COP compared to young adults (p < 0.01) during the BW phase. They also demonstrated higher CI (p < 0.05) and reduced coherence of SOL/TA (p < 0.05) compared to young adults during this phase. No significant group differences were observed during the FW phase. Within the children's group, COP variability was significantly higher in the BW phase compared to the FW phase (p < 0.01). Moreover, children displayed greater CI (p < 0.01) and reduced coherence of SOL/TA (p < 0.01) during the BW phase compared to the FW phase. Conversely, no significant phase effects were observed in the adult group. Furthermore, sEMG measures were significantly correlated with COP variability (p < 0.05). The findings of this small study suggest that age-related differences in CNS development influence the modulation of corticospinal drive to ankle muscles (e.g., SOL/TA) during childhood, particularly supporting the existence of a separate pathway underlying the control of forward lean and backward returning. [ABSTRACT FROM AUTHOR]

• Wavelet pooled scalogram is introduced to assess coactivation of multiple muscles. • The pooled scalogram characterizes EMG-signal content in time-frequency domain. • Significant invariants are extracted by NMF to assess time-frequency features. • Shared invariants among subjects hint physiological features in frequency domain. • This approach may improve the investigation on motor control and neural diseases. Different approaches based on surface electromyographic signals (EMG) were proposed to understand the interplay among several muscles, most of which were based on the solely EMG amplitude and neglected spectral characteristics. This study introduced an approach that quantitatively characterizes the co-activation of multiple muscles in time-frequency domain, based on the continuous wavelet transform (CWT). The pooled scalogram, defined here as the CWT-based cross-energy localization of multiple EMG signals, quantified the co-activation among several muscles in time-frequency domain. Algorithm performances were tested on 30,000 synthetic EMG signals, with different signal-to-noise ratio. Experimental sEMG were recorded from tibialis anterior, gastrocnemius lateralis, and vastus lateralis during walking of 31 young healthy subjects. Significant invariants were extracted by Non-Negative Matrix Factorization Analysis to determine time-frequency invariants. The proposed CWT approach provided an accurate prediction of co-activation timing in the synthetic signal. Analysis of experimental signals indicated population consistency in time-frequency invariants and showed that muscular co-contraction peak was identified in heel strike and in the Piper frequency band. Synthetic data demonstrated the capability of the pooled scalogram to accurately detect the timings among multiple signals. Experimental analysis suggested that when TA, GL, and VL are co-active over time, they also synchronized in frequency within the Piper band. The pooled scalogram will lead to a better understanding of the control laws underlying the motor coordination, and it could represent a marker of neurological pathologies or a quantitative evaluation of the effects of a rehabilitative process. [ABSTRACT FROM AUTHOR]

Proprioceptive neuromuscular facilitation (PNF) alone has limited effectiveness in restoring gait, while robotic-assisted gait training (RAGT) improves motor relearning through repetitive, task-specific movements. Combining PNF with robotic gait training (PRGT) may enhance locomotor recovery by promoting proprioceptive awareness and muscle activation alongside repetitive gait retraining in stroke patients.This study compares the immediate effects of PRGT and RAGT on ankle dorsiflexion and muscle activity in chronic hemiparetic stroke patients and healthy controls.Thirty participants, including 15 stroke patients and 15 healthy controls, were randomly assigned to PRGT or RAGT for a single 30-min session. Muscle activity (pectoralis major, external oblique, internal oblique/transverse abdominis, rectus femoris, tibialis anterior) was measured using electromyography, while ankle dorsiflexion angle was assessed using a dual-axis inclinometer.PRGT significantly increased muscle activations compared to RAGT in stroke patients (p < 0.05). Additionally, there was a significant difference in ankle dorsiflexion between RAGT and PRGT in both groups (p < 0.05).PRGT demonstrated superior immediate effects on muscle activation and ankle movement, suggesting that combining PNF with robotic-assisted gait training is beneficial for chronic stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Volumetric muscle loss (VML) significantly impairs the inherent regenerative ability of skeletal muscle and results in chronic functional impairment. Polysaccharides in the muscle extracellular matrix are crucial for regulating cell proliferation and differentiation. Recent studies indicate that fucoidan has beneficial effects on musculoskeletal conditions. However, the impact of fucoidan on skeletal muscle regeneration remains poorly understood. In this study, methacrylated fucoidan (FuMA) was synthesized through chemical grafting of the methacryloyl group onto fucoidan. In vitro experiments demonstrated that treatment with FuMA significantly up-regulated the expression of myogenic markers and promoted the formation of myotubes in C2C12 myoblast cells. Importantly, FuMA treatment led to a significant enhancement in mitochondrial energy metabolism of myoblasts via activation of the NRF2 antioxidant signaling pathway. To further investigate the regenerative properties in repairing skeletal muscle defects, we fabricated a dual crosslinked cryogel consisting of FuMA and methacrylated gelatin (GelMA) with a porous and interconnected structure. In a rat tibialis anterior muscle VML model, implantation of the FuMA/GelMA cryogel effectively promoted the regeneration of muscle fibers, reduced collagen deposition, and facilitated the formation of new blood vessels. Hence, polysaccharide-based cryogels represent a promising implantable biomimetic scaffold for facilitating skeletal muscle regeneration following severe injuries. [ABSTRACT FROM AUTHOR]

Mesenchymal stromal/stem cells (MSCs) and their secretome are known to exert beneficial effects in many pathological states. However, MSCs therapeutic properties can be reduced due to unsuitable in vitro maintenance conditions. Standard culture protocols neglect the fact that MSCs exist in vivo in the closest connection with the extracellular matrix (ECM), the complex protein network providing an instructive microenvironment. We found recently that conditioned medium from human endometrial MSCs cultured on cell-derived decellularized extracellular matrix (CM-dECM) is dramatically enriched in a number of paracrine factors such as GM-CSF, FGF-2, HGF, MMP-1, MCP-1, IL-6, IL-8, CXCL-1, -2, -5, -6 (Ushakov et al., 2024). Given that several upregulated molecules belong to myokines that are known to participate in skeletal muscle regeneration, we hypothesized that CM-dECM may promote restoration of damaged muscle tissue. Here, we found that CM-dECM injections into barium chloride-injured murine m. tibialis anterior caused myofiber hypertrophy and promoted angiogenesis. Besides, CM-dECM significantly contributed to progression of murine C2C12 myoblasts cell cycle suggesting that muscle repair in vivo may be connected with stimulation of resident myoblasts proliferation. In this study, a role for secretome of endometrial MSCs cultured on dECM in injured murine skeletal muscle regeneration was outlined first. Our findings demonstrate that culture on dECM may be considered as a novel preconditioning approach enhancing MSCs therapeutic potential. • Decellularized ECM (dECM) enhances secretion of myokines by endometrial MSCs. • Endometrial MSCs cultured on dECM promote murine skeletal muscle repair. • Endometrial MSCs cultured on dECM stimulate proliferation of murine C2C12 myoblasts. [ABSTRACT FROM AUTHOR]

This study aimed to better understand the coping strategy of the neuromuscular system under perturbed afferent feedback. To this end, the neuromechanical effects of transient blood flow restriction (BFR) compared to atmospheric pressure were investigated in an antagonistic muscle pair. Perceived discomfort and neuromechanical parameters (torque and high-density electromyography) were recorded during submaximal isometric ankle dorsiflexion before, during and after BFR. The tibialis anterior and gastrocnemius lateralis muscles were studied in 14 healthy young adults. Discomfort increased during BFR and decreased to baseline level afterwards. The exerted torque and the co-activation index remained constant, whereas the EMG signal energy increased significantly during BFR. Coherence analysis of the delta band remained constant, whereas the alpha band shows an increase during BFR. Median frequency and muscle fibre conduction velocity showed a positive trend during the first minutes of BFR before significantly decreasing. Both parameters exceeded baseline values after cuff deflation. Perturbed afferent feedback leads to altered neuromechanical parameters. We assume that increased central drive is required to maintain force output, resulting in changed muscle fibre activity. Glycolytic fast-switch fibres are only active for a short time due to oxygen deprivation and hyperacidity, but fatigue effects predominate in the long term. [ABSTRACT FROM AUTHOR]

Understanding muscle response to exercise is critical for optimizing training strategies. This study investigated the effects of dorsiflexion and plantar flexion exercises on T2* values in the tibialis anterior (TA) and soleus (SOL) muscles and explored their relationship with muscle cross-sectional area (MCA), strength, and perceived exertion. Forty participants were divided into two exercise protocols: 30 performed dorsiflexion, 16 performed plantar flexion, and 6 completed both. T2* values were measured pre-and post-exercise using a 1.5 T MRI scanner. MCA and muscle strength were assessed via MRI and a dynamometer, while perceived exertion was measured using the Borg scale. Results showed that TA T2* values significantly increased after dorsiflexion (9.04 ± 4.21 ms), peaking 600 s post-exercise, whereas SOL T2* changes during plantar flexion were minimal (1.29 ± 1.05 ms). A significant correlation (r = 0.41, p = 0.026) was observed between T2* changes and Borg scale scores during dorsiflexion, but not with muscle strength (r = 0.08) or MCA (r = 0.35). No significant correlations were found for the SOL during plantar flexion. General linear model analysis showed a significant main effect of dorsiflexion on T2* values (p < 0.0001) and perceived exertion within the dorsiflexion protocol (p = 0.044). These findings suggest that dorsiflexion induces greater metabolic disturbances in the TA compared to plantar flexion. The results emphasize the importance of exercise-specific approaches for assessing muscle function and highlight the role of perceived exertion in evaluating muscle response. [ABSTRACT FROM AUTHOR]