@article{SchaeferBittmann2023,
  author    = {Schaefer, Laura and Bittmann, Frank},
  title     = {The adaptive force as a potential biomechanical parameter in the recovery process of patients with long COVID},
  series = {Diagnostics},
  volume    = {13},
  journal   = {Diagnostics},
  number    = {5},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2075-4418},
  doi       = {10.3390/diagnostics13050882},
  pages     = {25},
  year      = {2023},
  abstract  = {Long COVID patients show symptoms, such as fatigue, muscle weakness and pain. Adequate diagnostics are still lacking. Investigating muscle function might be a beneficial approach. The holding capacity (maximal isometric Adaptive Force; AFisomax) was previously suggested to be especially sensitive for impairments. This longitudinal, non-clinical study aimed to investigate the AF in long COVID patients and their recovery process. AF parameters of elbow and hip flexors were assessed in 17 patients at three time points (pre: long COVID state, post: immediately after first treatment, end: recovery) by an objectified manual muscle test. The tester applied an increasing force on the limb of the patient, who had to resist isometrically for as long as possible. The intensity of 13 common symptoms were queried. At pre, patients started to lengthen their muscles at ~50\% of the maximal AF (AFmax), which was then reached during eccentric motion, indicating unstable adaptation. At post and end, AFisomax increased significantly to ~99\% and 100\% of AFmax, respectively, reflecting stable adaptation. AFmax was statistically similar for all three time points. Symptom intensity decreased significantly from pre to end. The findings revealed a substantially impaired maximal holding capacity in long COVID patients, which returned to normal function with substantial health improvement. AFisomax might be a suitable sensitive functional parameter to assess long COVID patients and to support therapy process},
  language  = {en}
}
@article{KittelMischSchmidtetal.2005,
  author    = {Kittel, Rene and Misch, K. and Schmidt, M. and Ellwanger, Siegfried and Bittmann, Frank and Badtke, Gernot},
  title     = {Specific effects of boxing on functional parameters of the locomotor system},
  year      = {2005},
  abstract  = {Problems: Boxer that take part on contests regularly are characterized by high strains on the locomotor system. Especially the area of shoulder girdle and neck can be overused by the fighting posture and standard techniques, that are often associated with non-physiological patterns. Methods: Of 11 young boxers (age 14.6 +/- 0.6 years; 7.3 +/- 0.6 training units per week) and a control group (CG) of 52 male pupils (age 15.4 +/- 0.4 years) the static of head, shoulder girdle, and pelvis was detected by somatoscopy. Additionally, cyclical rotations of the cervical spine were measured using the 3-d-motion recording system CMS70 (Zebris, Germany) and the active range of motion was analysed. Results: In comparison to the CG, head and shoulder of the boxers were ventralised more often (p<0.01). Furthermore, highly significant group differences in the bilateral position of the shoulder heights and the iliac crests were detected in the frontal plane. On average, the active maximal rotation of the boxers was decreased by 17.8 degrees (p = 0.006; d = 0.800). Discussion: Our study was able to detect significant differences in the analysed functional parameters of the locomotor system that may be explained by boxing specific strains and which are prerequisites of optimal performance. As long-term pathologic effects can not be excluded, adequate compensational exercises should be integrated in the training},
  language  = {en}
}
@article{HoffSchaeferHeinkeetal.2015,
  author    = {Hoff, Marko and Schaefer, Laura and Heinke, Nancy and Bittmann, Frank},
  title     = {Report on adaptive force, a specific neuromuscular function},
  series = {European journal of translational myology},
  volume    = {25},
  journal   = {European journal of translational myology},
  number    = {3},
  publisher = {PAGEPress},
  address   = {Pavia},
  issn      = {2037-7452},
  doi       = {10.4081/ejtm.2015.5183},
  pages     = {183 -- 189},
  year      = {2015},
  language  = {en}
}
@article{SchaeferCarnariusDechetal.2023,
  author    = {Schaefer, Laura and Carnarius, Friederike and Dech, Silas and Bittmann, Frank},
  title     = {Repeated measurements of Adaptive Force},
  series = {Frontiers in physiology},
  volume    = {14},
  journal   = {Frontiers in physiology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-042X},
  doi       = {10.3389/fphys.2023.1020954},
  pages     = {19},
  year      = {2023},
  abstract  = {The Adaptive Force (AF) reflects the neuromuscular capacity to adapt to external loads during holding muscle actions and is similar to motions in real life and sports. The maximal isometric AF (AFisoₘₐₓ) was considered to be the most relevant parameter and was assumed to have major importance regarding injury mechanisms and the development of musculoskeletal pain. The aim of this study was to investigate the behavior of different torque parameters over the course of 30 repeated maximal AF trials. In addition, maximal holding vs. maximal pushing isometric muscle actions were compared. A side consideration was the behavior of torques in the course of repeated AF actions when comparing strength and endurance athletes. The elbow flexors of n = 12 males (six strength/six endurance athletes, non-professionals) were measured 30 times (120 s rest) using a pneumatic device. Maximal voluntary isometric contraction (MVIC) was measured pre and post. MVIC, AFisoₘₐₓ, and AFₘₐₓ (maximal torque of one AF measurement) were evaluated regarding different considerations and statistical tests. AFₘₐₓ and AFisoₘₐₓ declined in the course of 30 trials [slope regression (mean ± standard deviation): AFₘₐₓ = -0.323 ± 0.263; AFisoₘₐₓ = -0.45 ± 0.45]. The decline from start to end amounted to -12.8\% ± 8.3\% (p < 0.001) for AFₘₐₓ and -25.41\% ± 26.40\% (p < 0.001) for AFisoₘₐₓ. AF parameters declined more in strength vs. endurance athletes. Thereby, strength athletes showed a rather stable decline for AFmax and a plateau formation for AFisoₘₐₓ after 15 trials. In contrast, endurance athletes reduced their AFₘₐₓ, especially after the first five trials, and remained on a rather similar level for AFisomax. The maximum of AFisoₘₐₓ of all 30 trials amounted 67.67\% ± 13.60\% of MVIC (p < 0.001, n = 12), supporting the hypothesis of two types of isometric muscle action (holding vs. pushing). The findings provided the first data on the behavior of torque parameters after repeated isometric-eccentric actions and revealed further insights into neuromuscular control strategies. Additionally, they highlight the importance of investigating AF parameters in athletes based on the different behaviors compared to MVIC. This is assumed to be especially relevant regarding injury mechanisms.},
  language  = {en}
}
@article{SchaeferBittmann2020,
  author    = {Schaefer, Laura and Bittmann, Frank},
  title     = {Parkinson patients without tremor show changed patterns of mechanical muscle oscillations during a specific bilateral motor task compared to controls},
  series = {Scientific Reports},
  volume    = {10},
  journal   = {Scientific Reports},
  publisher = {Macmillan Publishers Limited, part of Springer Nature},
  address   = {London},
  issn      = {2045-2322},
  doi       = {10.1038/s41598-020-57766-5},
  pages     = {16},
  year      = {2020},
  abstract  = {The pathophysiology of Parkinson's disease (PD) is still not understood. There are investigations which show a changed oscillatory behaviour of brain circuits or changes in variability of, e.g., gait parameters in PD. The aim of this study was to investigate whether or not the motor output differs between PD patients and healthy controls. Thereby, patients without tremor are investigated in the medication off state performing a special bilateral isometric motor task. The force and accelerations (ACC) were recorded as well as the Mechanomyography (MMG) of the biceps brachii, the brachioradialis and of the pectoralis major muscles using piezoelectric-sensors during the bilateral motor task at 60\% of the maximal isometric contraction. The frequency, a specific power ratio, the amplitude variation and the slope of amplitudes were analysed. The results indicate that the oscillatory behaviour of motor output in PD patients without tremor deviates from controls: thereby, the 95\%-confidence-intervals of power ratio and of amplitude variation of all signals are disjoint between PD and controls and show significant differences in group comparisons (power ratio: p = 0.000-0.004, r = 0.441-0.579; amplitude variation: p = 0.000-0.001, r = 0.37-0.67). The mean frequency shows a significant difference for ACC (p = 0.009, r = 0.43), but not for MMG. It remains open, whether this muscular output reflects changes of brain circuits and whether the results are reproducible and specific for PD.},
  language  = {en}
}
@article{SchaeferBittmann2021,
  author    = {Schaefer, Laura and Bittmann, Frank},
  title     = {Paired personal interaction reveals objective differences between pushing and holding isometric muscle action},
  series = {PLOS One},
  volume    = {16},
  journal   = {PLOS One},
  number    = {5},
  publisher = {PLOS},
  address   = {San Francisco},
  issn      = {1932-6203},
  doi       = {10.1371/journal.pone.0238331},
  pages     = {21},
  year      = {2021},
  abstract  = {In sports and movement sciences isometric muscle function is usually measured by pushing against a stable resistance. However, subjectively one can hold or push isometrically. Several investigations suggest a distinction of those forms. The aim of this study was to investigate whether these two forms of isometric muscle action can be distinguished by objective parameters in an interpersonal setting. 20 subjects were grouped in 10 same sex pairs, in which one partner should perform the pushing isometric muscle action (PIMA) and the other partner executed the holding isometric muscle action (HIMA). The partners had contact at the distal forearms via an interface, which included a strain gauge and an acceleration sensor. The mechanical oscillations of the triceps brachii (MMGtri) muscle, its tendon (MTGtri) and the abdominal muscle (MMGobl) were recorded by a piezoelectric-sensor-based measurement system. Each partner performed three 15s (80\% MVIC) and two fatiguing trials (90\% MVIC) during PIMA and HIMA, respectively. Parameters to compare PIMA and HIMA were the mean frequency, the normalized mean amplitude, the amplitude variation, the power in the frequency range of 8 to 15 Hz, a special power-frequency ratio and the number of task failures during HIMA or PIMA (partner who quit the task). A "HIMA failure" occurred in 85\% of trials (p < 0.001). No significant differences between PIMA and HIMA were found for the mean frequency and normalized amplitude. The MMGobl showed significantly higher values of amplitude variation (15s: p = 0.013; fatiguing: p = 0.007) and of power-frequency-ratio (15s: p = 0.040; fatiguing: p = 0.002) during HIMA and a higher power in the range of 8 to 15 Hz during PIMA (15s: p = 0.001; fatiguing: p = 0.011). MMGtri and MTGtri showed no significant differences. Based on the findings it is suggested that a holding and a pushing isometric muscle action can be distinguished objectively, whereby a more complex neural control is assumed for HIMA.},
  language  = {en}
}
@article{BittmannBadtkeSchmidt1998,
  author    = {Bittmann, Frank and Badtke, Gernot and Schmidt, Ottmar},
  title     = {On the kinematic behaviour of the pelvis and shoulde axis as well as the height of the spine during long distance running},
  year      = {1998},
  language  = {en}
}
@article{BittmannGutschowLutheretal.2005,
  author    = {Bittmann, Frank and Gutschow, Stephan and Luther, Sven and Wessel, Niels and Kurths, J{\"u}rgen},
  title     = {On the functional relationship between postural motor balance and performance at school},
  year      = {2005},
  abstract  = {In integrated medical considerations of the biological human system, both intellectual and motor performances in a similar manner are considered as a result of the function of the nervous system. Consequently, universal minimal dysfunctions of the central nervous system may lead to both intellectual and physical anomalies. Therefore, this study tests the hypothesis that there is a connection between the balance ability as a motor parameter and school success as an intellectual parameter. A postural measuring system based on the force-moment sensor technique was used to record the postural balance regulation of 773 children (circle divide 11 +/- 1 years). The school achievement of each child was determined by school grades. Data analysis was performed by linear as well as by nonlinear time series analyses. There are highly significant differences in balance regulation between good and poor pupils recognized by several linear and nonlinear parameters. Good pupils could be discriminated from pupils with bad results in learning to 80 \%. The results support the hypothesis mentioned above. One possible explanation for the poor regulation of balance in bad learners could be a deficit in the neural maturity. In future, further developments will be targeted on higher discrimination levels, possibly in order to predict school success. On the other hand, the effects of special movement exercises on the neural development in childhood will be the focus in our further work},
  language  = {en}
}
@article{SchaeferBittmann2019,
  author    = {Schaefer, Laura and Bittmann, Frank},
  title     = {Muscular Pre-Activation Can Boost the Maximal Explosive Eccentric Adaptive Force},
  series = {Frontiers in Physiology},
  volume    = {10},
  journal   = {Frontiers in Physiology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-042X},
  doi       = {10.3389/fphys.2019.00910},
  pages     = {12},
  year      = {2019},
  abstract  = {The improvement of power is an objective in training of athletes. In order to detect effective methods of exercise, basic research is required regarding the mechanisms of muscular activity. The purpose of this study is to investigate whether or not a muscular pre-activation prior to an external impulse-like force impact has an effect on the maximal explosive eccentric Adaptive Force (xpAFeccmax). This power capability combines different probable power enhancing mechanisms. To measure the xpAFeccmax an innovative pneumatic device was used. During measuring, the subject tries to hold an isometric position as long as possible. In the moment in which the subjects' maximal isometric holding strength is exceeded, it merges into eccentric muscle action. This process is very close to motions in sports, where an adaptation of the neuromuscular system is required, e.g., force impacts caused by uneven surfaces during skiing. For investigating the effect of pre-activation on the xpAFeccmax of the quadriceps femoris muscle, n = 20 subjects had to pass three different pre-activation levels in a randomized order (level 1: 0.4 bar, level 2: 0.8 bar, level 3: 1.2 bar). After adjusting the standardized pre-pressure by pushing against the interface, an impulse-like load impacted on the distal tibia of the subject. During this, the xpAFeccmax was detected. The maximal voluntary isometric contraction (MVIC) was also measured. The torque values of the xpAFeccmax were compared with regard to the pre-activation levels. The results show a significant positive relation between the pre-activation of the quadriceps femoris muscle and the xpAFeccmax (male: p = 0.000, η2= 0.683; female: p = 0.000, η2= 0.907). The average percentage increase of torque amounted +28.15 ± 25.4\% between MVIC and xpAFeccmax with pre-pressure level 1, +12.09 ± 7.9\% for the xpAFeccmax comparing pre-pressure levels 1 vs. 2 and +2.98 ± 4.2\% comparing levels 2 and 3. A higher but not maximal muscular activation prior to a fast impacting eccentric load seems to produce an immediate increase of force outcome. Different possible physiological explanatory approaches and the use as a potential training method are discussed.},
  language  = {en}
}
@article{DechBittmannSchaefer2021,
  author    = {Dech, Silas and Bittmann, Frank and Schaefer, Laura},
  title     = {Muscle oxygenation level might trigger the regulation of capillary venous blood filling during fatiguing isometric muscle actions},
  series = {Diagnostics : open access journal},
  volume    = {11},
  journal   = {Diagnostics : open access journal},
  number    = {11},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2075-4418},
  doi       = {10.3390/diagnostics11111973},
  pages     = {17},
  year      = {2021},
  abstract  = {The regulation of oxygen and blood supply during isometric muscle actions is still unclear. Recently, two behavioral types of oxygen saturation (SvO(2)) and relative hemoglobin amount (rHb) in venous microvessels were described during a fatiguing holding isometric muscle action (HIMA) (type I: nearly parallel behavior of SvO(2) and rHb; type II: partly inverse behavior). The study aimed to ascertain an explanation of these two regulative behaviors. Twelve subjects performed one fatiguing HIMA trial with each arm by weight holding at 60\% of the maximal voluntary isometric contraction (MVIC) in a 90 \& DEG; elbow flexion. Six subjects additionally executed one fatiguing PIMA trial by pulling on an immovable resistance with 60\% of the MVIC with each side and same position. Both regulative types mentioned were found during HIMA (I: n = 7, II: n = 17) and PIMA (I: n = 3, II: n = 9). During the fatiguing measurements, rHb decreased initially and started to increase in type II at an average SvO(2)-level of 58.75 \& PLUSMN; 2.14\%. In type I, SvO(2) never reached that specific value during loading. This might indicate the existence of a threshold around 59\% which seems to trigger the increase in rHb and could explain the two behavioral types. An approach is discussed to meet the apparent incompatibility of an increased capillary blood filling (rHb) despite high intramuscular pressures which were found by other research groups during isometric muscle actions.},
  language  = {en}
}
@article{DechBittmannSchaefer2021,
  author    = {Dech, Silas and Bittmann, Frank and Schaefer, Laura},
  title     = {Muscle oxygenation level might trigger the regulation of capillary venous blood filling during fatiguing isometric muscle actions},
  series = {Diagnostics},
  volume    = {11},
  journal   = {Diagnostics},
  number    = {11},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2075-4418},
  doi       = {10.3390/diagnostics11111973},
  pages     = {17},
  year      = {2021},
  abstract  = {The regulation of oxygen and blood supply during isometric muscle actions is still unclear. Recently, two behavioral types of oxygen saturation (SvO2) and relative hemoglobin amount (rHb) in venous microvessels were described during a fatiguing holding isometric muscle action (HIMA) (type I: nearly parallel behavior of SvO2 and rHb; type II: partly inverse behavior). The study aimed to ascertain an explanation of these two regulative behaviors. Twelve subjects performed one fatiguing HIMA trial with each arm by weight holding at 60\% of the maximal voluntary isometric contraction (MVIC) in a 90° elbow flexion. Six subjects additionally executed one fatiguing PIMA trial by pulling on an immovable resistance with 60\% of the MVIC with each side and same position. Both regulative types mentioned were found during HIMA (I: n = 7, II: n = 17) and PIMA (I: n = 3, II: n = 9). During the fatiguing measurements, rHb decreased initially and started to increase in type II at an average SvO2-level of 58.75 ± 2.14\%. In type I, SvO2 never reached that specific value during loading. This might indicate the existence of a threshold around 59\% which seems to trigger the increase in rHb and could explain the two behavioral types. An approach is discussed to meet the apparent incompatibility of an increased capillary blood filling (rHb) despite high intramuscular pressures which were found by other research groups during isometric muscle actions.},
  language  = {en}
}
@article{DechBittmannSchaefer2022,
  author    = {Dech, Silas and Bittmann, Frank and Schaefer, Laura},
  title     = {Muscle oxygenation and time to task failure of submaximal holding and pulling isometric muscle actions and influence of intermittent voluntary muscle twitches},
  series = {BMC Sports Science, Medicine and Rehabilitation},
  volume    = {55},
  journal   = {BMC Sports Science, Medicine and Rehabilitation},
  publisher = {Springer Nature},
  address   = {London},
  issn      = {1758-2555},
  doi       = {10.1186/s13102-022-00447-9},
  pages     = {1 -- 10},
  year      = {2022},
  abstract  = {Background Isometric muscle actions can be performed either by initiating the action, e.g., pulling on an immovable resistance (PIMA), or by reacting to an external load, e.g., holding a weight (HIMA). In the present study, it was mainly examined if these modalities could be differentiated by oxygenation variables as well as by time to task failure (TTF). Furthermore, it was analyzed if variables are changed by intermittent voluntary muscle twitches during weight holding (Twitch). It was assumed that twitches during a weight holding task change the character of the isometric muscle action from reacting (≙ HIMA) to acting (≙ PIMA). Methods Twelve subjects (two drop outs) randomly performed two tasks (HIMA vs. PIMA or HIMA vs. Twitch, n = 5 each) with the elbow flexors at 60\% of maximal torque maintained until muscle failure with each arm. Local capillary venous oxygen saturation (SvO2) and relative hemoglobin amount (rHb) were measured by light spectrometry. Results Within subjects, no significant differences were found between tasks regarding the behavior of SvO2 and rHb, the slope and extent of deoxygenation (max. SvO2 decrease), SvO2 level at global rHb minimum, and time to SvO2 steady states. The TTF was significantly longer during Twitch and PIMA (incl. Twitch) compared to HIMA (p = 0.043 and 0.047, respectively). There was no substantial correlation between TTF and maximal deoxygenation independently of the task (r = - 0.13). Conclusions HIMA and PIMA seem to have a similar microvascular oxygen and blood supply. The supply might be sufficient, which is expressed by homeostatic steady states of SvO2 in all trials and increases in rHb in most of the trials. Intermittent voluntary muscle twitches might not serve as a further support but extend the TTF. A changed neuromuscular control is discussed as possible explanation.},
  language  = {en}
}
@article{SchaeferBittmann2020,
  author    = {Schaefer, Laura and Bittmann, Frank},
  title     = {Mechanotendography in Achillodynia shows reduced oscillation variability of pre-loaded Achilles tendon},
  series = {European Journal of Translational Myology (EJTM)},
  volume    = {30},
  journal   = {European Journal of Translational Myology (EJTM)},
  number    = {2},
  publisher = {Unipress},
  address   = {Padova},
  issn      = {2037-7460},
  doi       = {10.4081/ejtm.2020.8983},
  pages     = {247 -- 257},
  year      = {2020},
  abstract  = {The present study focuses on an innovative approach in measuring the mechanical oscillations of pre-loaded Achilles tendon by using Mechanotendography (MTG) during application of a short yet powerful mechanical pressure impact. This was applied on the forefoot from the plantar side in direction of dorsiflexion, while the subject stood on the ball of the forefoot on one leg. Participants with Achilles tendinopathy (AT; n = 10) were compared to healthy controls (Con; n = 10). Five trials were performed on each side of the body. For evaluation, two intervals after the impulse began (0-100ms; 30-100ms) were cut from the MTG and pressure raw signals. The intrapersonal variability between the five trials in both intervals were evaluated using the arithmetic mean and coefficient of variation of the mean correlation (Spearman rank correlation) and the normalized averaged mean distances, respectively. The AT-group showed a significantly reduced variability in MTG compared to the Con-group (from p = 0.006 to p = 0.028 for different parameters). The 95\% confidence intervals (CI) of MTG results were disjoint, whereas the 95\% CIs of the pressure signals were similar (p = 0.192 to p = 0.601). We suggest from this work that the variability of mechanical tendon oscillations could be an indicative parameter of an altered Achilles tendon functionality.},
  language  = {en}
}
@article{SchaeferBittmann2021,
  author    = {Schaefer, Laura and Bittmann, Frank},
  title     = {Mechanotendography},
  series = {European journal of translational myology : European journal ; basic applied myology ; BAM online ; myology reviews},
  journal   = {European journal of translational myology : European journal ; basic applied myology ; BAM online ; myology reviews},
  number    = {31},
  publisher = {Unipress},
  address   = {Padova, Italien},
  issn      = {2037-7460},
  doi       = {10.4081/ejtm.2021.9553},
  pages     = {10},
  year      = {2021},
  abstract  = {The mechanotendography (MTG) is a method for analyzing the mechanical oscillations of tendons during muscular actions. The aim of this investigation was to evaluate the technical reliability of a piezo-based measurement system used for MTG. The reliability measurements were performed by using audio samples played by a subwoofer. The thereby generated pressure waves were recorded by a piezo-based measurement system. An audio of 40 Hz sine oscillations and four different formerly in vivo recorded MTG-signals were converted into audio files and were used as test signals. Five trials with each audio were performed and one audio was used for repetition trials on another day. The signals' correlation was estimated by Spearman (MCC) and intraclass correlation coefficients (ICC(3,1)), Cronbach's alpha (CA) and by mean distances (MD). All parameters were compared between repetition and randomized matched signals. The repetition trials show high correlations (MCC: 0.86 ± 0.13, ICC: 0.89 ± 0.12, CA: 0.98 ± 0.03), low MD (0.03 ± 0.03V) and differ significantly from the randomized matched signals (MCC: 0.15 ± 0.10, ICC: 0.17 ± 0.09, CA: 0.37 ± 0.16, MD: 0.19 ± 0.01V) (p = 0.001 - 0.043). This speaks for an excellent reliability of the measurement system. Presuming the skin above superficial tendons oscillates adequately, we estimate this tool as valid for the application in musculoskeletal system.},
  language  = {en}
}
@article{SchaeferLoefflerKleinetal.2021,
  author    = {Schaefer, Laura and L{\"o}ffler, Nils and Klein, Julia and Bittmann, Frank},
  title     = {Mechanomyography and acceleration show interlimb asymmetries in Parkinson patients without tremor compared to controls during a unilateral motor task},
  series = {Scientific reports},
  volume    = {11},
  journal   = {Scientific reports},
  number    = {1},
  publisher = {Macmillan},
  address   = {London},
  issn      = {2045-2322},
  doi       = {10.1038/s41598-021-81672-z},
  pages     = {15},
  year      = {2021},
  abstract  = {The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson's disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70\% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p=0.001, r=0.43) and for the amplitude variation (p=0.003, r=0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p=0.013, r=0.42) and MMGbra (p=0.048, r=0.39) as well as regarding the mean frequency (p=0.004, r=0.48) and amplitude variation of MMGpect (p=0.033, r=0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p=0.022, r=0.33; CV: p=0.004, r=0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.},
  language  = {en}
}
@article{SchaeferLoefflerKleinetal.2021,
  author    = {Schaefer, Laura and L{\"o}ffler, Nils and Klein, Julia and Bittmann, Frank},
  title     = {Mechanomyography and acceleration show interlimb asymmetries in Parkinson patients without tremor compared to controls during a unilateral motor task},
  series = {Scientific Reports},
  volume    = {11},
  journal   = {Scientific Reports},
  publisher = {Springer Nature},
  address   = {Berlin},
  issn      = {2045-2322},
  doi       = {10.1038/s41598-021-81672-z},
  pages     = {15},
  year      = {2021},
  abstract  = {The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson's disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70\% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p = 0.001, r = 0.43) and for the amplitude variation (p = 0.003, r = 0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p = 0.013, r = 0.42) and MMGbra (p = 0.048, r = 0.39) as well as regarding the mean frequency (p = 0.004, r = 0.48) and amplitude variation of MMGpect (p = 0.033, r = 0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p = 0.022, r = 0.33; CV: p = 0.004, r = 0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.},
  language  = {en}
}
@article{SchaeferHoffBittmann2017,
  author    = {Schaefer, Laura and Hoff, Marco and Bittmann, Frank},
  title     = {Measuring system and method of determining the Adaptive Force},
  series = {European journal of translational myology},
  volume    = {27},
  journal   = {European journal of translational myology},
  number    = {3},
  publisher = {Unipress},
  address   = {Padova},
  issn      = {2037-7460},
  doi       = {10.4081/ejtm.2017.6479},
  pages     = {152 -- 159},
  year      = {2017},
  abstract  = {The term Adaptive Force (AF) describes the capability of adaptation of the nerve-muscle-system to externally applied forces during isometric and eccentric muscle action. This ability plays an important role in real life motions as well as in sports. The focus of this paper is on the specific measurement method of this neuromuscular action, which can be seen as innovative. A measuring system based on the use of compressed air was constructed and evaluated for this neuromuscular function. It depends on the physical conditions of the subject, at which force level it deviates from the quasi isometric position and merges into eccentric muscle action. The device enables - in contrast to the isokinetic systems - a measure of strength without forced motion. Evaluation of the scientific quality criteria of the devices was done by measurements regarding the intra- and interrater-, the test-retest-reliability and fatiguing measurements. Comparisons of the pneumatic device with a dynamometer were also done. Looking at the mechanical evaluation, the results show a high level of consistency (r²=0.94 to 0.96). The parallel test reliability delivers a very high and significant correlation (ρ=0.976; p=0.000). Including the biological system, the concordance of three different raters is very high (p=0.001, Cronbachs alpha α=0.987). The test retest with 4 subjects over five weeks speaks for the reliability of the device in showing no statistically significant differences. These evaluations indicate that the scientific evaluation criteria are fulfilled. The specific feature of this system is that an isometric position can be maintained while the externally impacting force rises. Moreover, the device can capture concentric, static and eccentric strength values. Fields of application are performance diagnostics in sports and medicine.},
  language  = {en}
}
@article{BittmannDechAehleetal.2020,
  author    = {Bittmann, Frank and Dech, Silas and Aehle, Markus and Schaefer, Laura},
  title     = {Manual Muscle Testing—Force Profiles and Their Reproducibility},
  series = {Diagnostics},
  volume    = {10},
  journal   = {Diagnostics},
  number    = {12},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2075-4418},
  doi       = {10.3390/diagnostics10120996},
  pages     = {30},
  year      = {2020},
  abstract  = {The manual muscle test (MMT) is a flexible diagnostic tool, which is used in many disciplines, applied in several ways. The main problem is the subjectivity of the test. The MMT in the version of a "break test" depends on the tester's force rise and the patient's ability to resist the applied force. As a first step, the investigation of the reproducibility of the testers' force profile is required for valid application. The study examined the force profiles of n = 29 testers (n = 9 experiences (Exp), n = 8 little experienced (LitExp), n = 12 beginners (Beg)). The testers performed 10 MMTs according to the test of hip flexors, but against a fixed leg to exclude the patient's reaction. A handheld device recorded the temporal course of the applied force. The results show significant differences between Exp and Beg concerning the starting force (padj = 0.029), the ratio of starting to maximum force (padj = 0.005) and the normalized mean Euclidean distances between the 10 trials (padj = 0.015). The slope is significantly higher in Exp vs. LitExp (p = 0.006) and Beg (p = 0.005). The results also indicate that experienced testers show inter-tester differences and partly even a low intra-tester reproducibility. This highlights the necessity of an objective MMT-assessment. Furthermore, an agreement on a standardized force profile is required. A suggestion for this is given.},
  language  = {en}
}
@article{BittmannDechSchaefer2023,
  author    = {Bittmann, Frank and Dech, Silas and Schaefer, Laura},
  title     = {How to confuse motor control},
  series = {Life : open access journal},
  volume    = {13},
  journal   = {Life : open access journal},
  number    = {4},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2075-1729},
  doi       = {10.3390/life13040911},
  pages     = {18},
  year      = {2023},
  abstract  = {Adaptation to external forces relies on a well-functioning proprioceptive system including muscle spindle afferents. Muscle length and tension control in reaction to external forces is most important regarding the Adaptive Force (AF). This study investigated the effect of different procedures, which are assumed to influence the function of muscle spindles, on the AF. Elbow flexors of 12 healthy participants (n = 19 limbs) were assessed by an objectified manual muscle test (MMT) with different procedures: regular MMT, MMT after precontraction (self-estimated 20\% MVIC) in lengthened position with passive return to test position (CL), and MMT after CL with a second precontraction in test position (CL-CT). During regular MMTs, muscles maintained their length up to 99.7\% +/- 1.0\% of the maximal AF (AF(max)). After CL, muscles started to lengthen at 53.0\% +/- 22.5\% of AF(max). For CL-CT, muscles were again able to maintain the static position up to 98.3\% +/- 5.5\% of AF(max). AFiso(max) differed highly significantly between CL vs. CL-CT and regular MMT. CL was assumed to generate a slack of muscle spindles, which led to a substantial reduction of the holding capacity. This was immediately erased by a precontraction in the test position. The results substantiate that muscle spindle sensitivity seems to play an important role for neuromuscular functioning and musculoskeletal stability.},
  language  = {en}
}
@article{SchaeferDechWolffetal.2022,
  author    = {Schaefer, Laura and Dech, Silas and Wolff, Lara Luisa and Bittmann, Frank},
  title     = {Emotional Imagery Influences the Adaptive Force in Young Women},
  series = {Brain Sciences},
  volume    = {12},
  journal   = {Brain Sciences},
  number    = {10},
  publisher = {MDPI},
  address   = {Basel, Schweiz},
  issn      = {2076-3425},
  doi       = {10.3390/brainsci12101318},
  pages     = {23},
  year      = {2022},
  abstract  = {The link between emotions and motor function has been known for decades but is still not clarified. The Adaptive Force (AF) describes the neuromuscular capability to adapt to increasing forces and was suggested to be especially vulnerable to interfering inputs. This study investigated the influence of pleasant an unpleasant food imagery on the manually assessed AF of elbow and hip flexors objectified by a handheld device in 12 healthy women. The maximal isometric AF was significantly reduced during unpleasant vs. pleasant imagery and baseline (p < 0.001, dz = 0.98-1.61). During unpleasant imagery, muscle lengthening started at 59.00 ± 22.50\% of maximal AF, in contrast to baseline and pleasant imagery, during which the isometric position could be maintained mostly during the entire force increase up to ~97.90 ± 5.00\% of maximal AF. Healthy participants showed an immediately impaired holding function triggered by unpleasant imagery, presumably related to negative emotions. Hence, AF seems to be suitable to test instantaneously the effect of emotions on motor function. Since musculoskeletal complaints can result from muscular instability, the findings provide insights into the understanding of the causal chain of linked musculoskeletal pain and mental stress. A case example (current stress vs. positive imagery) suggests that the approach presented in this study might have future implications for psychomotor diagnostics and therapeutics.},
  language  = {en}
}