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Introduction: Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. Methods: Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. Results: We included a group of 18 male (aged 24–39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. Conclusions: FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP. [ABSTRACT FROM AUTHOR]

Activities and falls monitoring systems using wearable technology have a promising future. The publicly available datasets are based on a few inertial features only acquired with an accelerometer, gyroscope, smartphone or smart Watches. The activities and falls performed are also less. In this study, a dataset is created by collecting physiological features along with inertial features which will help in developing and validating systems studying the effect of physiological features on the detection and prediction of falls and activities. The dataset consists of 7 activities and 8 falls for inertial data; 2 activities for ECG data; 6 activities for EMG data and 6 activities for GSR data. Basic body parameters like height, weight, etc. along with beats per minute, SpO2 and blood pressure are also recorded for 12 subjects. The collected data is analyzed statistically using a boxplot, pair plot, correlation heatmap and p value. The activities are classified using SVM, KNN, RF and DT. For GSR, more than 90% accuracy is achieved and for EMG, the accuracy is less than 80%. For IMU data, more than 95% accuracy is achieved. The results encourage combining inertial, physiological and basic body parameters to detect and predict falls and activities. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is a muscle disorder causing a progressive reduction of muscle mass and strength, but the mechanism of its manifestation is still partially unknown. The three main parameters to assess are: muscle strength, muscle volume or quality and low physical performance. There is not a definitive approach to assess the musculoskeletal condition of frail population and often the available tests to be performed in those clinical bedridden patients is reduced because of physical impairments. In this paper, we propose a novel instrumental multi-domain and non-invasive approach during a well-defined protocol of measurements for overcoming these limitations. A group of 28 bedridden elder people, subjected to surgery after hip fracture, was asked to perform voluntary isometric contractions at the 80% of their maximum voluntary contraction with the non-injured leg. The sensor employed before and/or during the exercise were: ultrasound to determine the muscle architecture (vastus lateralis); force acquisition with a load cell placed on the chair, giving an indication of the muscle strength; surface electromyography (EMG) for monitoring muscular electrical activity; time-domain (TD) near-infrared spectroscopy (NIRS) for evaluating muscle oxidative metabolism. Results: A personalized "report card" for each subject was created. It includes: the force diagram (both instantaneous and cumulative, expected and measured); the EMG–force diagram for a comparison between EMG derived median frequency and measured force; two graphs related to the hemodynamic parameters for muscle oxidative metabolism evaluation, i.e., oxy-, deoxy-, total-hemoglobin and tissue oxygen saturation for the whole exercise period. A table with the absolute values of the previous hemodynamic parameters during the rest and the ultrasound related parameters are also included. Conclusions: In this work, we present the union of protocols, multi-domain sensors and parameters for the evaluation of the musculoskeletal condition. The novelties are the use of sensors of different nature, i.e., force, electrical and optical, together with a new way to visualize and combine the results, by means of a concise, exhaustive and personalized medical report card for each patient. This assessment, totally non-invasive, is focused on a bedridden population, but can be extended to the monitoring of rehabilitation progresses or of the training of athletes. [ABSTRACT FROM AUTHOR]

Gait phase recognition systems based on surface electromyographic signals (EMGs) are crucial for developing advanced myoelectric control schemes that enhance the interaction between humans and lower limb assistive devices. However, machine learning models used in this context, such as Linear Discriminant Analysis (LDA) and Support Vector Machine (SVM), typically experience performance degradation when modeling the gait cycle with more than just stance and swing phases. This study introduces a generalized phasor-based feature extraction approach (PHASOR) that captures spatial myoelectric features to improve the performance of LDA and SVM in gait phase recognition. A publicly available dataset of 40 subjects was used to evaluate PHASOR against state-of-the-art feature sets in a five-phase gait recognition problem. Additionally, fully data-driven deep learning architectures, such as Rocket and Mini-Rocket, were included for comparison. The separability index (SI) and mean semi-principal axis (MSA) analyses showed mean SI and MSA metrics of 7.7 and 0.5, respectively, indicating the proposed approach's ability to effectively decode gait phases through EMG activity. The SVM classifier demonstrated the highest accuracy of 82% using a five-fold leave-one-trial-out testing approach, outperforming Rocket and Mini-Rocket. This study confirms that in gait phase recognition based on EMG signals, novel and efficient muscle synergy information feature extraction schemes, such as PHASOR, can compete with deep learning approaches that require greater processing time for feature extraction and classification. [ABSTRACT FROM AUTHOR]

The MR-induced gradient artifact affects EMG recordings during simultaneous muscle BOLD/EMG acquisitions. However, no dedicated hardware can remove the gradient artifact easily, and alternative methods are expensive and time-consuming. This study aimed to develop three denoising methods requiring different processing levels and MR-compatible hardware. At two time points, surface EMG was recorded from the lower leg of 6 participants (50:50 sex ratio, age = 26.24.6 yrs., height = 173.59.2 cm, weight = 71.511.4 kg) using a plantar flexion-based block design consisting of 30s of rest followed by 30s of flexion for 5 min, under three conditions: inside the MRI bore, with and without a BOLD sequence (3 T, BOLD sequence, GRE EPI, 10 slices, 64×64 matrix, 2 mm thickness, and TE/TR/flip = 35/3000 ms/70), and outside the MRI environment. Simultaneous BOLD/EMG recordings were denoised using average artifact subtraction with three methods of artifact template creation, each having varying timing and hardware requirements. Method M1 builds the artifact template by recording the scanner triggers coming from the MRI; M2 creates the artifact template with a constant artifact period computed as TR/[number of slices]; M3 estimates the artifact template by looking at the periodicity of the gradient artifact located in the EMG recordings. Following postprocessing, SNR analysis was performed, comparing rest-to-flexion periods, to assess the efficacy of denoising methods and to compare differences between conditions. Linear mixed-effects models showed no significant differences in the mean SNR between denoising methods (p = 0.656). Furthermore, EMG SNR measurements were significantly affected by the magnetic environment (p < 0.05) but not by muscle fatigue over time (p = 0.975). EMG recordings contaminated with gradient artifacts during simultaneous BOLD/EMG can be efficiently denoised using all proposed methods, with two methods requiring no extra hardware. With minimal post-processing, EMG can easily be performed during muscle BOLD MRI studies. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has had a significant impact on human life because of its pervasiveness across industries and its rapid development. Although AI has achieved superior performance in learning and reasoning, it encounters challenges such as substantial computational demands, privacy concerns, communication delays, and high energy consumption associated with cloud-based models. These limitations have facilitated a paradigm change in on-device AI processing, which offers enhanced privacy, reduced latency, and improved power efficiency through the direct execution of computations on devices. With advancements in neuromorphic systems, spiking neural networks (SNNs), often referred to as the next generation of AI, are currently in focus as on-device AI. These technologies aim to mimic the human brain efficiency and provide promising real-time processing with minimal energy. This study reviewed the application of SNNs in the analysis of biomedical signals (electroencephalograms, electrocardiograms, and electromyograms), and consequently, investigated the distinctive attributes and prospective future paths of SNNs models in the field of biomedical signal analysis. [ABSTRACT FROM AUTHOR]

In this paper, a comprehensive exploration is undertaken to elucidate the utilization of Spiking Neural Networks (SNNs) within the biomedical domain. The investigation delves into the experimentally validated advantages of SNNs in comparison to alternative models like LSTM, while also critically examining the inherent limitations of SNN classifiers or algorithms. SNNs exhibit distinctive advantages that render them particularly apt for targeted applications within the biomedical field. Over time, SNNs have undergone extensive scrutiny in realms such as neuromorphic processing, Brain-Computer Interfaces (BCIs), and Disease Diagnosis. Notably, SNNs demonstrate a remarkable affinity for the processing and analysis of biomedical signals, including but not limited to electroencephalogram (EEG), electromyography (EMG), and electrocardiogram (ECG) data. This paper initiates its exploration by introducing some of the biomedical applications of EMG, such as the classification of hand gestures and motion decoding. Subsequently, the focus extends to the applications of SNNs in the analysis of EEG and ECG signals. Moreover, the paper delves into the diverse applications of SNNs in specific anatomical regions, such as the eyes and noses. In the final sections, the paper culminates with a comprehensive analysis of the field, offering insights into the advantages, disadvantages, challenges, and opportunities introduced by various SNN models in the realm of healthcare and biomedical domains. This holistic examination provides a nuanced perspective on the potential transformative impact of SNN across a spectrum of applications within the biomedical landscape. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the effectiveness of a passive back-support exosuit at reducing low back muscle fatigue during an 18-minute trunk posture maintenance task. On two separate days sixteen participants performed an 18-minute trunk posture profile that reflected trunk flexion postures observed during a challenging vascular surgery procedure. On one day they performed the procedure with the support of the exosuit, on the other day without. Test contractions were performed every three minutes to capture the time-dependent electromyographic activity of the bilateral erector spinae muscles. Time domain (amplitude) and frequency domain (median frequency) measures of erector spinae muscle fatigue were assessed. Results revealed that the exosuit significantly reduced the measures of erector spinae muscle fatigue in terms of both amplitude (6.1%) and median frequency (5.3%), demonstrating a fatigue reduction benefit of the exosuit in a realistic surgical posture maintenance task. PRACTITIONER SUMMARY: To examine the potential adoption of a back-support exosuit system in the surgical environment, this study used an 18-minute posture maintenance task that reflected trunk flexion postures observed during a vascular surgery procedure and suggests that the exosuit system can effectively reduce low back muscle fatigue during a vascular surgical procedure. [ABSTRACT FROM AUTHOR]

The objective was to investigate the effects of running shoes with midsole hollow structure span and height on the biomechanics of the lower limbs during running. We collected 21 adults with running habits who wore two pairs of running shoes with different midsole hollow structures and ran at a speed of 3.3m/s on a force-measuring treadmill. The lower limb kinematics, ground reaction force (GRF) and lower limb muscle activation characteristics were simultaneously captured by a motion capture system, a 3D force treadmill, and a surface electromyography (sEMG) system. Paired t-tests were performed on data for the two shoe conditions that fit the normal distribution assumptions; otherwise, Wilcoxon signed-rank tests were used. The statistical parameter mapping (SPM) technology was used for the analysis of 1D parameters of kinematic, dynamic, and sEMG activation characteristics. The result showed that the time to the peak impact force at touchdown of Hollow shoe2 was significantly increased (P<0.01), the maximum loading rate (P<0.01) and average loading rate (P<0.05) were significantly reduced, braking time (P<0.05), push time (P<0.05), contact time (P<0.01) of Hollow shoe2 were significantly increased compared with Hollow shoe1. Hollow shoe2 push phase of the tibialis anterior muscle activation characteristics was significantly lower (SPM, P<0.05) than Hollow shoe1. Our conclusion is that running shoes offer the solution as they have the advantage of the complex structure of the hollow midsole. [ABSTRACT FROM AUTHOR]

Background: The elbow is a common site for overuse injuries in golfers. Tendinopathies, such as medial and lateral epicondylitis, are frequently diagnosed in amateur and professional golfers. The aim of our study was to determine the effect of an ergonomic golf grip on forearm muscle activity during the five phases of the golf swing. Methods: Thirty right-handed golfers with a mean age of 32 years (range, 18–70 years) and a mean handicap of 15 (range, 0–43) performed 10 golf swings with a standard and ergonomic golf grip respectively. The mean and maximum muscle activity of the Musculus (M.) extensor carpi radialis brevis (ECRB), M. flexor carpi ulnaris (FCU), M. pronator teres (PT) and M. biceps brachii (BB) of the lead and trail arms were assessed during the five phases of the golf swing using surface electromyography (EMG). Subgroup analyses were performed regarding sex, playing ability (handicap < 10 vs. ≥10), weekly playing time (≤ 5 h, 5–20 h, > 20 h) and preexisting elbow pain during golfing (VAS < 2 vs. VAS ≥ 2). Significance was set at p < 0.05. Results: An ergonomic golf grip resulted in a reduction in muscle activity in at least one but up to three consecutive phases of the golf swing for the ECRB, FCU and PT of the lead arm and for the PT of the trail arm. Amateurs, a playing time < 20 h per week and golfers without preexisting elbow pain were factors that were associated with greater reductions in muscle activity. Conclusion: Forearm muscle activity can be decreased using an ergonomic golf grip, indicating the possible role of an ergonomic golf grip as a preventive measure against overuse syndromes such as medial and lateral epicondylitis. Trial registration number: This study was retrospectively registered at the German Clinical Trials Register DRKS-ID: DRKS00033732 (01/03/2024). [ABSTRACT FROM AUTHOR]

The superior colliculus (SC) has been increasingly implicated in the rapid processing of evolutionarily relevant stimuli like faces, but the behavioural relevance of such processing is unclear. The SC has also been implicated in the generation of express visuomotor responses (EVR), which are very short‐latency (~80 ms) bursts of muscle activity time‐locked to visual target presentation. These observations led us to investigate the influence of faces on EVRs. We recorded upper limb muscle activity from healthy participants as they reached toward targets in the presence of a distractor. In some experiments, faces were used as stimuli. Across blocks of trials, we varied the instruction as to which stimulus served as the target or distractor. Doing so allowed us to assess the impact of instruction on muscle recruitment given identical visual stimuli. We found that responses were uniquely modulated in tasks involving high‐contrast faces, promoting reaches toward or away from a face depending on instruction. Follow‐up experiments confirmed that the phenomenon required highly salient repeated faces and was not observed to non‐facial stimuli nor to faces expressing different affects. This study extends the hypothesis that the SC mediates the EVR by demonstrating that faces impact muscle recruitment at short latencies that precede cortical activity for face perception. Our results constitute direct evidence for the behavioural relevance of face detection in the brainstem, and also implicate a role for top‐down cortical pre‐setting of the EVR depending on task context. [ABSTRACT FROM AUTHOR]

This study delves into decoding hand gestures using surface electromyography (EMG) signals collected via a precision Myo-armband sensor, leveraging machine learning algorithms. The research entails rigorous data preprocessing to extract features and labels from raw EMG data. Following partitioning into training and testing sets, four traditional machine learning models are scrutinized for their efficacy in classifying finger movements across seven distinct gestures. The analysis includes meticulous parameter optimization and five-fold cross-validation to evaluate model performance. Among the models assessed, the Random Forest emerges as the top performer, consistently delivering superior precision, recall, and F1-score values across gesture classes, with ROC-AUC scores surpassing 99%. These findings underscore the Random Forest model as the optimal classifier for our EMG dataset, promising significant advancements in healthcare rehabilitation engineering and enhancing human–computer interaction technologies. [ABSTRACT FROM AUTHOR]

Highlights Neck pain associated with helmet‐wear is an occupational health problem often observed in helicopter pilots and aircrew. Whether aircrew helmet wearing is associated with physiological and biomechanical differences between sexes is currently unknown. This study investigated neuromuscular activation patterns during different helmet‐wearing conditions. The helmet load was manipulated through a novel Helmet Balancing System (HBS) in healthy, non‐pilot male and female participants (n = 10 each, age 19–45 years) in two phases. Phase A assessed the acute effects of helmet‐wear on neck muscles activation during head movements. Phase B examined changes in muscle activity and cervical disc height after wearing a helmet for 45 min. In Phase A, muscle activity was similar between sexes in many movements, but it was higher in female participants when wearing a helmet than in males. The HBS reduced muscle activity in both sexes. In Phase B, female participants exhibited a greater level of muscular fatigue, and male participants’ cervical disc height was significantly decreased [5.7 (1.4) vs. 4.4 (1.5) mm, P < 0.001] after continuous wearing. Both sexes showed no significant change in muscle fatigue and disc height [male: 5.0 (1.3) vs. 5.2 (1.4) mm, P = 0.604] after applying HBS. These findings demonstrate sex‐specific physiological and biomechanical responses to wearing a helmet. They may indicate different postural and motor control strategies, associated with different neck pain aetiologies in male and female aircrew, the knowledge of which is important to reduce or prevent musculoskeletal injuries associated with helmet wearing. What is the central question of this study? Do sex differences exist in the neck physiological response to helmet‐wearing? What is the main finding and its importance? Sex differences exist in both the acute response and after 45 min of helmet wearing: during a given head movement, female participants’ muscle activity was greater than male participants’ and females also demonstrated greater muscular fatigue after continuous helmet‐wear than males while cervical disc height showed a significant reduction after 45 min helmet‐wear in males only. These findings could provide insight into future training or injury prevention strategy for pilots. What is the central question of this study?Do sex differences exist in the neck physiological response to helmet‐wearing?What is the main finding and its importance?Sex differences exist in both the acute response and after 45 min of helmet wearing: during a given head movement, female participants’ muscle activity was greater than male participants’ and females also demonstrated greater muscular fatigue after continuous helmet‐wear than males while cervical disc height showed a significant reduction after 45 min helmet‐wear in males only. These findings could provide insight into future training or injury prevention strategy for pilots. [ABSTRACT FROM AUTHOR]

After stroke, the poorer recovery of motor function of upper extremities compared to other body parts is a longstanding problem. Based on our recent functional MRI evidence on healthy volunteers, this perspective paper proposes systematic hand motor rehabilitation utilizing the plasticity of interhemispheric interaction between motor cortices and following its developmental rule. We first discuss the effectiveness of proprioceptive intervention on the paralyzed (immobile) hand synchronized with voluntary movement of the intact hand to induce muscle activity in the paretic hand. In healthy participants, we show that this bilateral proprioceptive-motor coupling intervention activates the bilateral motor cortices (= bilaterally active mode), facilitates interhemispheric motorcortical functional connectivity, and augments muscle activity of the passivelymoved hand. Next, we propose training both hands to perform different movements, which would be effective for stroke patients who becomes able to manage to move the paretic hand. This bilaterally different movement training may guide the motor cortices into left-right independent mode to improve interhemispheric inhibition and hand dexterity, because we have shown in healthy older adults that this training reactivates motor-cortical interhemispheric inhibition (= left-right independent mode) declined with age, and can improve hand dexterity. Transition of both motor cortices from the bilaterally active mode to the left-right independent mode is a developmental rule of hand motor function and a common feature of motor function recovery after stroke. Hence, incorporating the brain's inherent capacity for spontaneous recovery and adhering to developmental principles may be crucial considerations in designing effective rehabilitation strategies. [ABSTRACT FROM AUTHOR]

The objective of the article is to recognize users' emotions by classifying facial electromyographic (EMG) signals. A biomedical signal amplifier, equipped with eight active electrodes positioned in accordance with the Facial Action Coding System, was used to record the EMG signals. These signals were registered during a procedure where users acted out various emotions: joy, sadness, surprise, disgust, anger, fear, and neutral. Recordings were made for 16 users. The mean power of the EMG signals formed the feature set. We utilized these features to train and evaluate various classifiers. In the subject-dependent model, the average classification accuracies were 96.3% for KNN, 94.9% for SVM with a linear kernel, 94.6% for SVM with a cubic kernel, and 93.8% for LDA. In the subject-independent model, the classification results varied depending on the tested user, ranging from 91.4% to 48.6% for the KNN classifier, with an average accuracy of 67.5%. The SVM with a cubic kernel performed slightly worse, achieving an average accuracy of 59.1%, followed by the SVM with a linear kernel at 53.9%, and the LDA classifier at 41.2%. Additionally, the study identified the most effective electrodes for distinguishing between pairs of emotions. [ABSTRACT FROM AUTHOR]

Muscle synergies are defined as coordinated recruitment of groups of muscles with specific activation balances and time profiles aimed at generating task-specific motor commands. While muscle synergies in postural control have been investigated primarily in reactive balance conditions, the neuromechanical contribution of muscle synergies during voluntary control of upright standing is still unclear. In this study, muscle synergies were investigated during the generation of isometric force at the trunk during the maintenance of standing posture. Participants were asked to maintain the steady-state upright standing posture while pulling forces of different magnitudes were applied at the level at the waist in eight horizontal directions. Muscle synergies were extracted by nonnegative matrix factorization from sixteen lower limb and trunk muscles. An average of 5-6 muscle synergies were sufficient to account for a wide variety of EMG waveforms associated with changes in the magnitude and direction of pulling forces. A cluster analysis partitioned the muscle synergies of the participants into a large group of clusters according to their similarity, indicating the use of a subjective combination of muscles to generate a multidirectional force vector in standing. Furthermore, we found a participant-specific distribution in the values of cosine directional tuning parameters of synergy amplitude coefficients, suggesting the existence of individual neuromechanical strategies to stabilize the whole-body posture. Our findings provide a starting point for the development of novel diagnostic tools to assess muscle coordination in postural control and lay the foundation for potential applications of muscle synergies in rehabilitation. [ABSTRACT FROM AUTHOR]

How the neuromechanics of the lower limb functional muscle groups change with running speed remains to be fully elucidated, with implications for our understanding of human locomotion, conditioning, and injury prevention. This study compared the neuromechanics (ground reaction and joint kinetics, kinematics and muscle activity) of middle‐distance athletes running on an instrumented treadmill at six wide‐ranging speeds (2.78–8.33 m·s−1). Ground reaction forces and kinematics were analyzed using inverse dynamics to calculate flexor and extensor joint torques, and positive and negative work done by these torques. Contributions of each functional muscle group to the total positive and negative work done by the limb during stance, swing, and the whole stride were quantified. During stance, the ankle plantar flexors were the major energy generator and absorber (>60%) at all speeds, but their contribution to whole stride energy generation and absorption declined with speed. Positive work by the hip extensors rose superlinearly with speed during stance (3‐fold) and especially during swing (12‐fold), becoming the biggest energy generator across the whole stride at >5 m·s−1. Knee flexor and extensor negative work also rose superlinearly with speed during swing, with the knee flexors becoming the greatest energy absorber over the whole stride at >7.22 m·s−1. Across speeds, plantar flexor peak moment and positive work accounted for 97% and 96% of the variance in step length, and swing hip extension peak moment and positive work accounted for 98% and 99% of the variance in step frequency. There were pronounced speed, phase (stance/swing), and work (positive/negative) dependent contributions of the different functional muscle groups during running, with extensive implications for conditioning and injury prevention. [ABSTRACT FROM AUTHOR]

Functional electrical stimulation (FES) is a rehabilitation and assistive technique used for stroke survivors. FES systems mainly consist of sensors, a control algorithm, and a stimulation unit. However, there is a critical need to reassess sensing and control techniques in FES systems to enhance their efficiency. This SLR was carried out following the PRISMA 2020 statement. Four databases (PubMed, Scopus, Web of Science, Wiley Online Library) from 2010 to 2024 were searched using terms related to sensing and control strategies in FES systems. A total of 322 articles were chosen in the first stage, while only 60 of them remained after the final filtering stage. This systematic review mainly focused on sensor techniques and control strategies to deliver FES. The most commonly used sensors reported were inertial measurement units (IMUs), 45% (27); biopotential electrodes, 36.7% (22); vision-based systems, 18.3% (11); and switches, 18.3% (11). The control strategy most reported is closed-loop; however, most of the current commercial FES systems employ open-loop strategies due to their simplicity. Three main factors were identified that should be considered when choosing a sensor for gait-oriented FES systems: wearability, accuracy, and affordability. We believe that the combination of computer vision systems with artificial intelligence-based control algorithms can contribute to the development of minimally invasive and personalized FES systems for the gait rehabilitation of patients with FDS. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis is a devastating neurodegenerative disease, characterized by loss of central and peripheral motor neurons. Although the disease is clinically and genetically heterogeneous, axonal hyperexcitability is a commonly observed feature that has been suggested to reflect an early pathophysiological step linked to the neurodegenerative cascade. Therefore, it is important to clarify the mechanisms causing axonal hyperexcitability and how these relate to the clinical characteristics of patients. Measures derived directly from a nerve excitability recording are frequently used as study end points, although their biophysical basis is difficult to deduce. Mathematical models can aid in the interpretation but are reliable only when applied to group-averaged recordings. Consequently, model estimates of membrane properties cannot be compared with clinical characteristics or treatment effects in individual patients, posing a considerable limitation in heterogeneous diseases, such as amyotrophic lateral sclerosis. To address these challenges, we revisited nerve excitability using a new pattern analysis-based approach (principal component analysis). We evaluated disease-specific patterns of excitability changes and established their biophysical origins. Based on the observed patterns, we developed new compound measures of excitability that facilitate the implementation of this approach in clinical settings. We found that excitability changes in amyotrophic lateral sclerosis patients (n = 161, median disease duration = 11 months) were characterized by four unique patterns compared with controls (n = 50, age and sex matched). These four patterns were best explained by changes in resting membrane potential (modulated by Na+/K+ currents), slow potassium and sodium currents (modulated by their gating kinetics) and refractory properties of the nerve. Consequently, we were able to show that altered gating of slow potassium channels was associated with, and predictive of, the rate of progression of the disease on the amyotrophic lateral sclerosis functional rating scale. Based on these findings, we designed four composite measures that capture these properties to facilitate implementation outside this study. Our findings demonstrate that changes in nerve excitability in patients with amyotrophic lateral sclerosis are dominated by four distinct patterns, each with a distinct biophysical origin. Based on this new approach, we provide evidence that altered slow potassium-channel function might play a role in the rate of disease progression. The magnitudes of these patterns, quantified using a similar approach or our new composite measures, have potential as efficient measures to study membrane properties directly in amyotrophic lateral sclerosis patients, and thus aid prognostic stratification and trial design. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Paired‐pulse stimulation provides clinically useful information regarding sensory inhibition. When supraorbital nerve stimulation is repeated within a short interval, the response to the second stimulation is reduced to varying degrees. This magnitude of change in stimulation response can be monitored by electromyogram (EMG) or by mechanomyogram (MMG) as in this report. MMG has some advantages such as being less time consuming and lacking stimulus artifact. We compared the use of MMG and EMG to validate MMG as an effective method of assessing blink reflex paired‐pulse inhibition. Methods: Eight volunteers participated. Participants received electrical stimulation to the supraorbital nerve of each side. A paired‐pulse paradigm was employed, varying the conditioning‐test interval between 5 and 800 ms. The R1 component of the induced blink reflex was simultaneously recorded by EMG using a pair of electrodes placed on the lower eyelid and by MMG using an accelerometer placed between the electrodes. Results: The correlation coefficient of the R1 amplitude between MMG and EMG of the grand‐averaged waveforms was 0.99. The average participant r value was.91 (range.76–.99). Similar analyses were performed for the amplitude variation of the second response relative to the first response. Results correlated well, yielding r values of.97 and.86 for the grand‐averaged waveform and the average for each subject. Discussion: The present results demonstrate that MMG could be an alternative to EMG in assessing paired‐pulse inhibition of the electrical blink reflex R1 component. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Rhabdomyolysis is an etiologically heterogeneous, acute necrosis of myofibers characterized by transient marked creatine kinase (CK) elevation associated with myalgia, muscle edema, and/or weakness. The study aimed to determine the role of electrodiagnostic (EDX) testing relative to genetic testing and muscle biopsy in patients with unprovoked rhabdomyolysis in identifying an underlying myopathy. Methods: EDX database was reviewed to identify unprovoked rhabdomyolysis patients who underwent EDX testing between January 2012 and January 2022. Each patient's clinical profile, EDX findings, muscle pathology, laboratory, and genetic testing results were analyzed. Results: Of 66 patients identified, 32 had myopathic electromyography (EMG). Muscle biopsy and genetic testing were performed in 41 and 37 patients, respectively. A definitive diagnosis was achieved in 15 patients (11 myopathic EMG and 4 nonmyopathic EMG; p =.04) based on abnormal muscle biopsy (4/11 patients) or genetic testing (12/12 patients, encompassing 5 patients with normal muscle biopsy and 3 patients with nonmyopathic EMG). These included seven metabolic and eight nonmetabolic myopathies (five muscular dystrophies and three ryanodine receptor 1 [RYR1]‐myopathies). Patients were more likely to have baseline weakness (p <.01), elevated baseline CK (p <.01), and nonmetabolic myopathies (p =.03) when myopathic EMG was identified. Discussion: Myopathic EMG occurred in approximately half of patients with unprovoked rhabdomyolysis, more likely in patients with weakness and elevated CK at baseline. Although patients with myopathic EMG were more likely to have nonmetabolic myopathies, nonmyopathic EMG did not exclude myopathy, and genetic testing was primarily helpful to identify an underlying myopathy. Genetic testing should likely be first‐tier diagnostic testing following unprovoked rhabdomyolysis. [ABSTRACT FROM AUTHOR]

Most studies on sprint performance have focused on kinematics and kinetics of the musculoskeletal system for adults, with little research on the central sensorimotor transmission and processes, especially for adolescent sprinters. This study aimed to determine whether differences in the integrity of the central auditory system and audiomotor transmissions between the elite and sub-elite adolescent sprinters may affect their performance in the 100 m time. Twenty-nine adolescent junior high school students, including elite national-class and sub-elite regional-class athletes, were assessed. Visual and auditory evoked potentials (VEP and AEP) as well as electroencephalography (EEG) and electromyography (EMG) were recorded and analyzed during a sprint start. The electrophysiological results clearly reveal differences in central auditory transmission between elite and sub-elite groups, and between sexes. There were significant differences between elite and sub-elite groups, and during a sprint start, the EEG activities for elite female and male athletes showed significant time-dependent differences in peak amplitudes following the three auditory cues (ready, set, and gunshot). These findings can provide coaches with a more comprehensive consideration for sports-specific selection based on the athletes' individual conditions, e.g., sensorimotor neuroplastic training for providing precise and efficient training methods to improve young sprinters' performance. [ABSTRACT FROM AUTHOR]

Cervical dystonia (CD) causes involuntary movements and postures of the head, neck, and shoulders, as well as nonmotor symptoms including pain, mood, and sleep dysfunction, and impacts quality of life. The first-line treatment for CD is botulinum neurotoxin (BoNT) injections. The clinical presentation and diagnosis of CD, as well as where BoNT resides in the treatment landscape, is reviewed first. Next, the mechanism of action and the pharmacological differences in the available preparations of BoNT products are explained. The evidence base for motor and nonmotor efficacy and safety of the available BoNT formulations is reviewed, with attention to duration of benefit as a driver of patient satisfaction. Practical determinants of BoNT efficacy are reviewed including muscle selection, accurate muscle injection, factors related to poor or deteriorating response, and immunogenicity. BoNT represents a significant advancement in the treatment of CD. More accurate diagnosis, muscle selection and targeting, and dosing can improve outcomes with existing BoNT formulations. Further refinement of BoNT potency, duration of action, safety, and immunogenicity will help reduce unmet needs in the magnitude and duration of benefit. Additional validation of DBS and MRI-guided focused ultrasound may expand options for patients with toxin nonresponse. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the foot-ankle joint mechanics of running drills and running. Seventeen long-distance runners performed five popular running drills (A-skip, B-skip, Bounding, Heel flicks, Straight leg running) and a run at 3.88 m/s. Kinematics, kinetics and power values were calculated for the ankle, midtarsal (MT) and metatarsophalangeal (MP) joints. Electromyographic activity was recorded for the soleus, gastrocnemius medialis, lateralis and abductor hallucis muscle. The A-skip, the B-skip and the Heel flicks induced a smaller ankle (p < 0.001, ŋ2 = 0.41), MT (p < 0.001, ŋ2 = 0.43) and MP (p < 0.001, ŋ2 = 0.47) dorsiflexion peak than running. No difference was found between the running drills and running for ankle, MT and MP moment. The Bounding induces a higher positive ankle power than running (diff: 5.5 ± 7.5 J/kg, p = 0.014, d = 1.05). The A-skip (diff: 2.8 ± 2.9 J/kg, p < 0.001, d = 1.5) and the B-skip (diff: 2.7 ± 2.1 J/kg, p < 0.001, d = 1.4) induce a smaller MT positive power than running. This study offers an analysis of the mechanical behaviour of the foot-ankle complex to help track and field coaches select their running drills in an evidence-based manner. [ABSTRACT FROM AUTHOR]

Peripersonal space (PPS), as opposed to extrapersonal space (EPS), refers to the area surrounding the body within which individuals interact with objects or conspecifics. However, objects in PPS can belong to oneself or to others, which was found to influence how these objects are encoded. We analyzed the performances of motor responses in a reachability judgment task concerning self‐owned and other‐owned objects (cups) presented in PPS or EPS. EMG activities were recorded on the thumbs (flexor pollicis brevis) to detect correct and erroneous motor activations. Behavioral data showed that motor responses were shorter and longer for self‐owned cups compared to other‐owned cups in PPS and EPS, respectively. Ten percent of trials showed initial response errors, which were higher in the EPS for self‐owned cups and in the PPS for other‐owned cups. Eighty‐two percent of these errors were corrected online, with corrections being more efficient for self‐owned cups in the PPS. Overall, the data revealed that reachability judgments were faster and more accurate in the PPS, with more efficient inhibition processes in the presence of motor errors. Motor selection and correction are thus modulated by the social context of object ownership, highlighting the specific role of the PPS in encoding self‐relevant objects for action. [ABSTRACT FROM AUTHOR]

Epidermal electrophysiology is a non‐invasive method used in research and clinical practices to study the electrical activity of the brain, heart, nerves, and muscles. However, electrode/tissue interlayer materials such as ionically conducting pastes can negatively affect recordings by introducing lateral electrode‐to‐electrode ionic crosstalk and reducing spatial resolution. To overcome this issue, biocompatible, anisotropic‐conducting interlayer composites (ACI) that establish an electrically anisotropic interface with the skin are developed, enabling the application of dense cutaneous sensor arrays. High‐density, conformable electrodes are also microfabricated that adhere to the ACI and follow the curvilinear surface of the skin. The results show that ACI significantly enhances the spatial resolution of epidermal electromyography (EMG) recording compared to conductive paste, permitting the acquisition of single muscle action potentials with distinct spatial profiles. The high‐density EMG in developing mice, non‐human primates, and humans is validated. Overall, high spatial‐resolution epidermal electrophysiology enabled by ACI has the potential to advance clinical diagnostics of motor system disorders and enhance data quality for human‐computer interface applications. [ABSTRACT FROM AUTHOR]

Most BCI systems used in neurorehabilitation detect EEG features indicating motor intent based on machine learning, focusing on repetitive movements, such as limb flexion and extension. These machine learning methods require large datasets and are time consuming, making them unsuitable for same-day rehabilitation training following EEG measurements. Therefore, we propose a BMI system based on fuzzy inference that bypasses the need for specific EEG features, introducing an algorithm that allows patients to progress from measurement to training within a few hours. Additionally, we explored the integration of electromyography (EMG) with conventional EEG-based motor intention estimation to capture continuous movements, which is essential for advanced motor function training, such as skill improvement. In this study, we developed an algorithm that detects the initial movement via EEG and switches to EMG for subsequent movements. This approach ensures real-time responsiveness and effective handling of continuous movements. Herein, we report the results of this study. [ABSTRACT FROM AUTHOR]

To determine the effects of blood flow restriction (BFR) on the mean firing rate (MFR) and motor unit action potential amplitude (MUAPAMP) VS. recruitment threshold (RT) relationships during fatiguing isometric elbow flexions. Ten men (24.5 ± 4.0 years) performed isometric trapezoidal contractions at 50% maximum voluntary contraction to task failure with or without BFR, on 2 separate days. For BFR, a cuff was inflated to 60% of the pressure required for full brachial artery occlusion at rest. During both visits, surface electromyography was recorded from the biceps brachii of the dominant limb and the signal was decomposed. A paired-samples t test was used to determine the number of repetitions completed between BFR and CON. ANOVAS (repetition [first, last] × condition [BFR, CON]) were used to determine differences in MFR vs. RT and MUAPAMP VS. RT relationships. Subjects completed more repetitions during CON (12 ± 4) than BFR (9 ± 2; p = 0.012). There was no significant interaction (p > 0.05) between the slopes and y-intercepts during the repetition X condition interaction for MUAPAMP VS. MFR. However, there was a main effect of repetition for the slopes of the MUAPAMP VS. RT (p = 0.041) but not the y-intercept (p = 0.964). Post hoc analysis (collapsed across condition) indicated that the slopes of the MUAPAMP VS. RT during the first repetition was less than the last repetition (first: 0.022 ± 0.003 mv/%MVC; last: 0.028 ± 0.004 mv/%MVC; p = 0.041). Blood flow restriction resulted in the same amount of higher threshold MU recruitment in approximately 75% of the repetitions. Furthermore, there was no change in MFR for either condition, even when taken to task failure. Thus, BFR training may create similar MU responses with less total work completed than training without BFR. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures. Background: The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction. Method: Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3 s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected. Results: There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit. Conclusion: The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness. Application: Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective. [ABSTRACT FROM AUTHOR]

This study examines pedaling asymmetry using the electromyogram (EMG) complexity of six bilateral lower limb muscles for chronic stroke survivors. Fifteen unilateral chronic stroke and twelve healthy participants joined passive and volitional recumbent pedaling tasks using a self-modified stationary bike with a constant speed of 25 revolutions per minute. The fuzzy approximate entropy (fApEn) was adopted in EMG complexity estimation. EMG complexity values of stroke participants during pedaling were smaller than those of healthy participants (p = 0.002). For chronic stroke participants, the complexity of paretic limbs was smaller than that of non-paretic limbs during the passive pedaling task (p = 0.005). Additionally, there was a significant correlation between clinical scores and the paretic EMG complexity during passive pedaling (p = 0.022, p = 0.028), indicating that the paretic EMG complexity during passive movement might serve as an indicator of stroke motor function status. This study suggests that EMG complexity is an appropriate quantitative tool for measuring neuromuscular characteristics in lower limb dynamic movement tasks for chronic stroke survivors. [ABSTRACT FROM AUTHOR]

A stroke represents a significant medical condition characterized by the sudden interruption of blood flow to the brain, leading to cellular damage or death. The impact of stroke on individuals can vary from mild impairments to severe disability. Treatment for stroke often focuses on gait rehabilitation. Notably, assessing muscle activation and kinematics patterns using electromyography (EMG) and stereophotogrammetry, respectively, during walking can provide information regarding pathological gait conditions. The concurrent measurement of EMG and kinematics can help in understanding disfunction in the contribution of specific muscles to different phases of gait. To this aim, complexity metrics (e.g., sample entropy; approximate entropy; spectral entropy) applied to EMG and kinematics have been demonstrated to be effective in identifying abnormal conditions. Moreover, the conditional entropy between EMG and kinematics can identify the relationship between gait data and muscle activation patterns. This study aims to utilize several machine learning classifiers to distinguish individuals with stroke from healthy controls based on kinematics and EMG complexity measures. The cubic support vector machine applied to EMG metrics delivered the best classification results reaching 99.85% of accuracy. This method could assist clinicians in monitoring the recovery of motor impairments for stroke patients. [ABSTRACT FROM AUTHOR]

Background A strong body of literature has been published outlining muscle activity differences during sports performance in groups of overhead athletes. However, there are limited studies that have directly compared the muscle activity in overhead athletes with and without history of shoulder injury during functional everyday tasks. Purpose This study aimed to identify muscle activities across fourteen upper extremity and core muscles during three functional everyday movements in athletes with and without history of shoulder injury. Study Design Cross-Sectional Study Methods Thirty-two male overhead throwing athletes (fifteen healthy and seventeen injured) were recruited and completed three everyday functional movements of high elevation, low elevation, and rotation, using their dominant arm to move an object between two fixed positions. Electromyography (EMG) was recorded for fourteen muscles including: biceps brachii, deltoids (anterior, medial, and posterior), trapezius (upper and lower), pectoralis major, latissimus dorsi, serratus anterior, infraspinatus, external obliques, and gluteus maximus (all surface electrodes) and supraspinatus (fine wire electrode). Mixed model repeated measures ANOVA and post-hoc analysis assessed mean muscle activity (%MVC) between groups and each movement phase. Results Upper trapezius elicited higher mean activity in healthy athletes during both phases of the arm rotation task (p < 0.05). No differences between groups were evident for arm elevation tasks. Qualitative analysis of muscle patterns during functional tasks reflected a temporal shift in muscle activation timings and magnitudes between athlete groups, suggesting potential compensatory mechanisms in injured athletes. [ABSTRACT FROM AUTHOR]

Electromyographic (EMG) signals are biomedical signals that represent neuromuscular activities. The EMG signal is neither stationary nor periodic and exhibits complex interference patterns of several single motor unit action potentials (SMUAPs). This study aims to characterize EMG signals concerning firing patterns and other characteristics and to identify whether these MUAP firing patterns present short-range dependencies (SRD) or long-range dependencies (LRD). To do so, we characterized 208 EMG signals in terms of the number of phases, turns and combinations of phases. Then, we performed a statistical comparison of the (more efficient) Variance-time plot against the (less bias) Log-scale diagram for the estimation of the Hurst parameter and detection of LRD. Using these estimators, we managed to detect LRD in a sample taken with needle electrodes. In contrast, the tools used for the dependence identification on signals achieved with surface electrodes did not yield conclusive results on such dependence. [ABSTRACT FROM AUTHOR]

Purpose: People with both pronated feet and anterior cruciate ligament repair may benefit from walking on sand as a therapeutic option. The consequences of walking on sand on the muscular activity and gait biomechanics of these people are not well understood. This study aims to determine how sand training affects gait... [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our study aimed to determine the impact of pelvic floor muscle training (PFMT) on sphincter function and overall well-being in patients who underwent low anterior resection (LAR) and diverting ileostomy due to rectal cancer. For this purpose, anal electromyography (aEMG), low anterior resection syndrome (LARS) score, and the European Organization for Research and Treatment of Cancer quality-of-life questionnaires (EORTC-QLQ)-C30 (generic for cancer) and CR29 (specific to colorectal cancer) were used. The primary endpoint of our study is to determine the effect of PFMT on sphincter function by aEMG, the secondary endpoint is to evaluate the effect on quality-of-life using the LARS score, EORTC-QLQ-C30 and CR-29 questionnaires. METHODS: Conducted between January 2017 and April 2018 at a tertiary hospital's general surgery clinic, the study included 32 patients between the ages of 18 and 75 who underwent low anterior resection and diverting ileostomy surgery. The patients were divided into two: the Study Group (SG), which started PFMT after surgery, and the Control Group (CG), which was not subjected to additional exercises. Six months after closure of the diverting ileostomy, both groups were evaluated with aEMG, LARS scores, and EORTC-QLQ-C30 and CR-29. RESULTS: aEMG duration values were significantly lower in the SG (17.6 m/sec vs. 19.9 m/sec; p=0.001). Additionally, a significant decrease in SG, major LARS rates (12.5% vs. 62.5%; p=0.004) and LARS scores (23.1 vs. 30.0; p=0.003) was observed. While there was no significant difference between the groups in EORTC-QLQ C30, increased sexual interest and decreased fecal incontinence were observed in SG in EORTC-QLQ-CR29. CONCLUSION: PFMT significantly improves LARS scores, quality-of-life questionnaires and aEMG parameters, positioning PFMT as an accessible, non-invasive, easy-to-use first-line treatment option in the treatment of LARS. [ABSTRACT FROM AUTHOR]

Abstract Background Sarcopenia is a muscle disorder causing a progressive reduction of muscle mass and strength, but the mechanism of its manifestation is still partially unknown. The three main parameters to assess are: muscle strength, muscle volume or quality and low physical performance. There is not a definitive approach to assess the musculoskeletal condition of frail population and often the available tests to be performed in those clinical bedridden patients is reduced because of physical impairments. In this paper, we propose a novel instrumental multi-domain and non-invasive approach during a well-defined protocol of measurements for overcoming these limitations. A group of 28 bedridden elder people, subjected to surgery after hip fracture, was asked to perform voluntary isometric contractions at the 80% of their maximum voluntary contraction with the non-injured leg. The sensor employed before and/or during the exercise were: ultrasound to determine the muscle architecture (vastus lateralis); force acquisition with a load cell placed on the chair, giving an indication of the muscle strength; surface electromyography (EMG) for monitoring muscular electrical activity; time-domain (TD) near-infrared spectroscopy (NIRS) for evaluating muscle oxidative metabolism. Results A personalized “report card” for each subject was created. It includes: the force diagram (both instantaneous and cumulative, expected and measured); the EMG–force diagram for a comparison between EMG derived median frequency and measured force; two graphs related to the hemodynamic parameters for muscle oxidative metabolism evaluation, i.e., oxy-, deoxy-, total-hemoglobin and tissue oxygen saturation for the whole exercise period. A table with the absolute values of the previous hemodynamic parameters during the rest and the ultrasound related parameters are also included. Conclusions In this work, we present the union of protocols, multi-domain sensors and parameters for the evaluation of the musculoskeletal condition. The novelties are the use of sensors of different nature, i.e., force, electrical and optical, together with a new way to visualize and combine the results, by means of a concise, exhaustive and personalized medical report card for each patient. This assessment, totally non-invasive, is focused on a bedridden population, but can be extended to the monitoring of rehabilitation progresses or of the training of athletes.

Abstract Background The elbow is a common site for overuse injuries in golfers. Tendinopathies, such as medial and lateral epicondylitis, are frequently diagnosed in amateur and professional golfers. The aim of our study was to determine the effect of an ergonomic golf grip on forearm muscle activity during the five phases of the golf swing. Methods Thirty right-handed golfers with a mean age of 32 years (range, 18–70 years) and a mean handicap of 15 (range, 0–43) performed 10 golf swings with a standard and ergonomic golf grip respectively. The mean and maximum muscle activity of the Musculus (M.) extensor carpi radialis brevis (ECRB), M. flexor carpi ulnaris (FCU), M. pronator teres (PT) and M. biceps brachii (BB) of the lead and trail arms were assessed during the five phases of the golf swing using surface electromyography (EMG). Subgroup analyses were performed regarding sex, playing ability (handicap 20 h) and preexisting elbow pain during golfing (VAS

Purpose: People with both pronated feet and anterior cruciate ligament repair may benefit from walking on sand as a therapeutic option. The consequences of walking on sand on the muscular activity and gait biomechanics of these people are not well understood. This study aims to determine how sand training affects gait mechanics in individuals with both anterior cruciate ligament repair and pronated foot. Methods: The intervention and control groups included 28 adult males with pronated feet, where anterior cruciate ligament repair was randomly performed. The walking task was done on an 18-meter walkway at a consistent velocity. Muscle activities and ground reaction forces (GRF) were recorded using an electromyography system and a Bertec force plate, respectively. Results: Group-by-time interactions were significant for anterior and posterior reaction forces (P

This paper presents Part 2 of a study that investigated the effects of an 8-week (3x/week) underwater treadmill (UT) walking intervention on knee osteoarthritis (KOA) outcomes in 6 adults with KOA (62.7 ± 14.2 years). The Knee Outcome Survey (KOS) for activities of daily living and muscle activity during a 10-m walk and a 20 cm step down were measured before and after the intervention. The following KOS measures improved after the UT walking program (p < 0.05; g > 0.8): stiffness, swelling, weakness, walking, going up stairs, going downstairs, kneeling on the front of the knee, squatting, and sitting with the knee bent. Knee flexion excursion during stance of walking increased after the UT walking intervention (p = .01). Co-activation between the tibialis anterior and medial gastrocnemius decreased during the 20 cm step down (p = .04). The findings of this study support using the WWE as a model for UT walking interventions in KOA. [ABSTRACT FROM AUTHOR]