In the young and healthy shoulder, cranially directed forces during abduction are counteracted by co-contraction of the rotator cuff muscles. In this way, it is prevented that the humerus moves... Show moreIn the young and healthy shoulder, cranially directed forces during abduction are counteracted by co-contraction of the rotator cuff muscles. In this way, it is prevented that the humerus moves cranially towards the acromion, thus entrapping subacromial tissues. During ageing however, shoulder tissues are subject to marked degeneration, which particularly concerns the rotator cuff muscles. This may have two consequences. First, due to reduced contribution of the upper parts of the rotator cuff to the abduction movement, the deltoid has to compensate, which results in a more cranially, instead of mediocranially directed force. Second, reduced stabilising force by the rotator cuff may jeopardise counteraction of cranial deltoid forces. These changes could lead to cranialisation of the humerus with painful compression of subacromial tissues, as observed in patients with Subacromial Pain Syndrome (SAPS). Previous studies have shown that by co-contraction of arm adductors, humeral-head depression may be accomplished, for the purpose of unloading subacromial tissues. In this thesis, we investigated the role of adductor co-contraction in the ageing asymptomatic population and in patients with SAPS. This has resulted in eight scientific publications with which the fundaments for evidence-based therapy in SAPS have been built, with as cornerstone training of adductor co-contraction. Show less
Honing, G.H.M.; Torensma, B.; Martini, C.H.; Hoek, K.B.; Velzen, M. van; Olofsen, E.; ... ; Boon, M. 2022
Study objective: Quantitative neuromuscular monitoring is traditionally evaluated at the adductor pollicis muscle. By contrast, the TOF-Cuff compressomyograph evaluates neuromuscular block (NMB) at... Show moreStudy objective: Quantitative neuromuscular monitoring is traditionally evaluated at the adductor pollicis muscle. By contrast, the TOF-Cuff compressomyograph evaluates neuromuscular block (NMB) at the upper arm. However, compressomyography has not been fully validated against other monitoring entities. This study evaluates the agreement between NMB measured by compressomyography at the upper arm and electromyography at the adductor pollicis muscle during various levels of neuromuscular block in patients with and without obesity. Interventions: NMB was measured at the upper arm by compressomyography (TOF-Cuff) and by electromyography (GE-NMT) at the adductor pollicis. Design: Prospective, multicenter, observational study. Setting: Secondary and tertiary care hospitals' operating theatres. Patients: 200 non-obese and 50 obese patients. Measurements: During onset and offset of deep (post-tetanic-count 1-15 twitches), moderate (Train-of-Four-count 1-3 twitches) and shallow (Train-of-Four-ratio 0.01-1.0) depths of NMB were measured in obese and non-obese patients. The bias and limits of agreement of both devices were calculated using a Bland-Altman analysis for repeated measurements. Data obtained during spontaneous recovery (i.e. without the use of reversal agents) were used in the primary analyses. Main results: Data from enrolled patients yielded 942 paired post-tetanic-counts, 1175 paired train-of-four-counts and 1574 paired train-of-four ratios during spontaneous recovery. In non-obese patients, mean bias (95% CI) between the two devices was 3.405 (2.294 to 4.517) during deep NMB;-0.023 (-0.205 to 0.160) during moderate NMB and 0.312 (0.287 to 0.338) during shallow NMB. In obese patients, bias was-0.170 (-2.872 to 2.531); 0.178 (-0.202 to 0.558); 0.384 (0.299 to 0.469) for deep, moderate and shallow NMB respectively. Conclusions: There is variable disagreement between the level of NMB measured at the upper arm by compressomyography and at the adductor pollicis muscle measured by electromyography, throughout the various stages of NMB in obese and non-obese patients. Recovery of NMB on compressomyography preceded recovery on electromyography, which may have consequences for reversal and extubation decisions in clinical practice. Show less
Arends, S.; Drenthen, J.; Bergh, P. van den; Franssen, H.; Hadden, R.D.M.; Islam, B.; ... ; Cornblath, D.R. 2022
Objective: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barre syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS). Methods:... Show moreObjective: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barre syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS). Methods: Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis. Results: Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this. Conclusions: Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions. Significance: Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.(c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Show less
Folz, J.; Fiacchino, D.; Nikolić, M.; Steenbergen, H. van; Kret, M.E. 2022
Affective states are expressed in an individual’s physical appearance, ranging from facial expressions and body postures, to indicators of physiological arousal (e.g., a blush). Confirming the... Show moreAffective states are expressed in an individual’s physical appearance, ranging from facial expressions and body postures, to indicators of physiological arousal (e.g., a blush). Confirming the claimed communicative function of these markers, humans are capable of distinguishing between a variety of discrete emotion displays. In an attempt to explain the underlying mechanism, characteristic bodily changes within the observer, including physiological arousal and mimicry, have been suggested to facilitate the interpretation of an expression. The current study aims to create a holistic picture of emotion perception by (1) using three different sources of emotional information (prototypical facial expressions, bodily expressions, and subtle facial cues) and (2) measuring changes in multiple physiological signals (facial electromyography, skin conductance level, skin temperature, and pupil size). While participants clearly discriminated between perceived emotional expressions, there was no overall 1–1 correspondence with their physiological responses. Some specific but robust effects were observed. Angry facial expressions were consistently responded to with a peak in skin conductance level. Furthermore, sad body expressions were associated with a drop in skin temperature. In addition to being the best recognized expression, viewing happy faces elicited congruent facial muscle responses, which supports the potential role of embodied simulation in emotion recognition. Lastly, tears were not only rated as highly emotional intense but also evoked a peak in skin conductance level in the observer. The absence of distinct physiological responses to other expressions could be explained by the lacking functionality of affect sharing in a non-interactive experimental context. Consequentially, emotional alignment in body and mind might especially take place in real social situations, which should be considered in future research. Show less
Waasdorp, R.; Mugge, W.; Vos, H.J.; Groot, J.H. de; Verweij, M.D.; Jong, N. de; ... ; Daeichin, V. 2021
Skeletal muscles generate force, enabling movement through a series of fast electro-mechanical activations coordinated by the central nervous system. Understanding the underlying mechanism of such... Show moreSkeletal muscles generate force, enabling movement through a series of fast electro-mechanical activations coordinated by the central nervous system. Understanding the underlying mechanism of such fast muscle dynamics is essential in neuromuscular diagnostics, rehabilitation medicine and sports biomechanics. The unique combination of electromyography (EMG) and ultrafast ultrasound imaging (UUI) provides valuable insights into both electrical and mechanical activity of muscle fibers simultaneously, the excitation-contraction (E-C) coupling. In this feasibility study we propose a novel non-invasive method to simultaneously track the propagation of both electrical and mechanical waves in muscles using high-density electromyography and ultrafast ultrasound imaging (5000 fps). Mechanical waves were extracted from the data through an axial tissue velocity estimator based on one-lag autocorrelation. The E-C coupling in electrically evoked twitch contractions of the Biceps Brachii in healthy participants could successfully be tracked. The excitation wave (i.e. action potential) had a velocity of 3.9 +/- 0.5ms(-1) and the subsequent mechanical (i.e. contraction) wave had a velocity of 3.5 +/- 0.9ms(-1). The experiment showed evidence that contracting sarcomeres that were already activated by the action potential (AP) pull on sarcomeres that were not yet reached by the AP, which was corroborated by simulated contractions of a newly developed multisegmental muscle fiber model, consisting of 500 sarcomeres in series. In conclusion, our method can track the electromechanical muscle dynamics with high spatio-temporal resolution. Ultimately, characterizing E-C coupling in patients with neuromuscular diseases (e.g. Duchenne or Becker muscular dystrophy) may assess contraction efficiency, monitor the progression of the disease, and determine the efficacy of new treatment options. Show less
Veeger, T.T.J.; Trigt, B. van; Hu, H.; Bruijn, S.M.; Dieen, J.H. van 2020
BACKGROUND: Literature describing differences in motor control between low back pain (LBP) patients and healthy controls is very inconsistent, which may be an indication for the existence of... Show moreBACKGROUND: Literature describing differences in motor control between low back pain (LBP) patients and healthy controls is very inconsistent, which may be an indication for the existence of subgroups. Pain-related psychological factors might play a role causing these differences.PURPOSE: To examine the relation between fear of movement and variability of kinematics and muscle activation during gait in LBP patients.STUDY DESIGN: Cross-sectional experimental design.PATIENT SAMPLE: Thirty-one Chinese LBP patients.OUTCOME MEASURES: Self-report measures: Visual Analog Score for pain; TAMPA-score; Physiologic measures: electromyography, range of motion.FUNCTIONAL MEASURES: LBP history; the physical load of profession, physical activity.METHODS: Patients were divided in high and low fear of movement groups. Participants walked on a treadmill at four speeds: very slow, slow, preferred and fast. Kinematics of the thorax and the pelvis were recorded, together with the electromyography of five bilateral trunk muscle pairs. Kinematic and electromyography data were analysed in terms of stride-to-stride pattern variability. Factor analysis was applied to assess interdependence of 11 variability measures. To test for differences between groups, a mixed-design multivariate analysis of variance was conducted.RESULTS: Kinematic variability and variability of muscle activation consistently loaded on different factors and thus represented different underlying variables. No significant Group effects on variability of kinematics and muscle activation were found (Hotelling's Trace F=0.237; 0.396, p=.959; .846, respectively). Speed significantly decreased kinematic variability and increased variability in muscle activation (Hotelling's Trace F=8.363; 4.595, p<.0001; <.0001, respectively). No significant interactions between Group and Speed were found (Hotelling's Trace F=0.204; 0.100, p=.762; .963, respectively).CONCLUSIONS: The results of this study do not support the hypothesis that variability in trunk kinematics and trunk muscle activation during gait in LBP patients are associated with fear of movement. (C) 2020 The Author(s). Published by Elsevier Inc. Show less
Vaganee, D.; Borne, S. van de; Voorham-van der Zalm, P.; Voorham, J.; Fransen, E.; Wachter, S. de 2020
Purpose To assess the validity, reliability, and feasibility of electromyography (EMG) as a tool to measure pelvic floor muscle (PFM) contractions during placement and (re)programming of the tined... Show morePurpose To assess the validity, reliability, and feasibility of electromyography (EMG) as a tool to measure pelvic floor muscle (PFM) contractions during placement and (re)programming of the tined lead electrodes in sacral neuromodulation (SNM) patients. Materials and Methods Single tertiary center, prospective study conducted between 2017 and 2019 consisting of three protocols including a total of 75 patients with overactive bladder (wet/dry) or nonobstructive urinary retention. PFM EMG was recorded using the multiple array probe (MAPLe), placed intravaginally. All stimulations (monophasic pulsed square wave, 210 mu sec, 14 Hz) were performed using Medtronic's standard SNM stimulation equipment. During lead implantation, all four lead electrodes were stimulated with fixed increasing stimulation intensities (1-2-3-5-7-10 V). During lead electrode (re)programming, five bipolar lead electrode configurations were stimulated twice up to when an electrical PFM motor response (EPFMR), sensory response, and pain response were noted (i.e., the threshold), respectively. Additionally, amplitude and latency of the EPFMRs were determined. Validity, reliability, and feasibility were statistically analyzed using the intraclass correlation coefficient, weighted Cohen's kappa and linear regression, respectively. Results Validity: EPFMRs were strongly associated with visually detected PFM motor responses (kappa= 0.90). Reliability: EPFMR amplitude (ICC = 0.99) and latency (ICC = 0.93) showed excellent repeatability. Feasibility: linear regression (EPFMR threshold = 0.18 mA + 0.76 * sensory response threshold) showed an increase in the sensory response threshold is associated with a smaller increase in EPFMR threshold, with the EPFMR occurring before or on the sensory response threshold in 83.8% of all stimulations. Conclusions Measuring PFM contractions with EMG during placement and (re)programming of lead electrodes in SNM patients is valid, reliable, and feasible. Therefore, the use of PFM EMG motor responses could be considered as a tool to assist in these procedures. Show less
Vaganee, D.; Voorham, J.; Voorham-van der Zalm, P.; Wachter, S. de 2019
The aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical... Show moreThe aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical outcome measures simultaneously, while applying active and passive tasks and multiple movement velocities to separate neural and non-neural contributors to movement disorders after stroke. Therefore, a neuromechanic assessment protocol was developed. Parameters were responsive to clinical status and had good to excellent test-retest reliability. Selective muscle activation was assessed with high measurement reliability and was significantly lower in chronic stroke patients compared to healthy participants. Longitudinally, neuromechanical parameters were combined with data on arm-hand function at six months after stroke. Paresis and diminished modulation of reflexes were associated with poor functional outcome. Changes in tissue properties were represented by a shift in wrist rest angle towards flexion and decline in passive range of motion. Increase in active range of motion and steady rest angle contributed most to prediction of functional outcome. The precision diagnostics provided by a neuromechanical assessment protocol could support clinical decision making and should be used in prediction models and as biomarkers in recovery of arm-hand function after stroke, for example by improving the selection of time-window and patients. Show less
Plomp, J.J.; Morsch, M.; Phillips, W.D.; Verschuuren, J.J.G.M. 2015
In the chronic stage of Complex Regional Pain Syndrome (CRPS), motor disturbances are common and cause significant disability. The motor dysfunction of CRPS is a poorly understood phenomenon that... Show moreIn the chronic stage of Complex Regional Pain Syndrome (CRPS), motor disturbances are common and cause significant disability. The motor dysfunction of CRPS is a poorly understood phenomenon that is characterized predominantly by a decrease or loss of voluntary muscle control. This thesis aims to obtain a better understanding of the pathophysiology underpinning the motor dysfunction of CRPS by examining the potential roles of decreased inhibition of the motor system, changes in sensory processing and problems in sensory-motor integration. In specific, characteristics of muscle activity recordings are scrutinized in order to determine whether the loss of voluntary motor control and abnormal postures in CRPS exhibit characteristics of dystonia that are associated with reduced inhibition of the motor system (i.e., excessive muscle activation and enhanced mirror activity). The potential role of impaired processing of proprioceptive information related to wrist orientation and force production is examined, as well as the involuntary and voluntary (sensory-)motor interactions between the affected and unaffected arm. Furthermore, a systematic review of the literature on the motor consequences of experimental pain in healthy humans is presented in order to gain insight into the potential role of pain-related processes in the motor and sensory and motor disturbances of CRPS. Show less
Bank, P.J.M.; Peper, C.E.; Marinus, J.; Beek, P.J.; Hilten, J.J. van 2013
The studies reported in this thesis aimed to survey the prevalence of inclusion body myositis (IBM), to describe its clinical features and course, to investigate whether the major... Show moreThe studies reported in this thesis aimed to survey the prevalence of inclusion body myositis (IBM), to describe its clinical features and course, to investigate whether the major histocompatibility complex predisposed subjects to IBM and autoimmune disorders (AID), to investigate the possible affliction of the neuromuscular junction (NMJ) and finally, to study whether the progression of IBM could be slowed down. On July 1st, 1999, the prevalence was estimated on at least 4.9.10-6 inhabitants in the Netherlands. The incidence rate increased since the 1980s. Time of onset was generally after the age of forty. Symptons at onset could be linked to weakness of the quadriceps muscles , the finger flexors or pharynbgeal muscles. Weakness showed a variable progression rate. Progression of weakness was faster when onset was over the age of 56. Ankylosis was common, but could be helpful in performing skilful movements. Ventral muscles were more frequently and severely affected than dorsal muscles, and girdle muscles were relatively spared, a specific pattern. Repetitive nerve stimulation studies showed normal compound muscle action potential patterns suggestive of normal NMJ transmission. In IBM patients a high frequency of AID was observed. Compared to controls, patients had a high frequency of HLA-antigens of the HLA-A1-B8-DR3-DR52-DQ2 complex. This high frequency could be related to IBM alone and not to the presence of AID. Lastly, in a randomized placebo controlled trial with methotrexate no important effect on weakness progression could be demonstrated. Show less
