TY - JOUR A1 - Schaefer, Laura A1 - Bittmann, Frank T1 - Case report BT - Individualized pulsed electromagnetic field therapy in a Long COVID patient using the adaptive force as biomarker JF - Frontiers in medicine N2 - The increasing prevalence of Long COVID is an imminent public health disaster, and established approaches have not provided adequate diagnostics or treatments. Recently, anesthetic blockade of the stellate ganglion was reported to improve Long COVID symptoms in a small case series, purportedly by "rebooting" the autonomic nervous system. Here, we present a novel diagnostic approach based on the Adaptive Force (AF), and report sustained positive outcome for one severely affected Long COVID patient using individualized pulsed electromagnetic field (PEMF) at the area C7/T1. AF reflects the capacity of the neuromuscular system to adapt adequately to external forces in an isometric holding manner. In case, maximal isometric AF (AFiso(max)) is exceeded, the muscle merges into eccentric muscle action. Thereby, the force usually increases further until maximal AF (AFmax) is reached. In case adaptation is optimal, AFiso(max) is similar to 99-100% of AFmax. This holding capacity (AFiso(max)) was found to be vulnerable to disruption by unpleasant stimulus and, hence, was regarded as functional parameter. AF was assessed by an objectified manual muscle test using a handheld device. Prior to treatment, AFiso(max) was considerably lower than AFmax for hip flexors (62 N = similar to 28% AFmax) and elbow flexors (71 N = similar to 44% AFmax); i.e., maximal holding capacity was significantly reduced, indicating dysfunctional motor control. We tested PEMF at C7/T1, identified a frequency that improved neuromuscular function, and applied it for similar to 15 min. Immediately post-treatment, AFiso(max) increased to similar to 210 N (similar to 100% AFmax) at hip and 184 N (similar to 100% AFmax) at elbow. Subjective Long COVID symptoms resolved the following day. At 4 weeks post-treatment, maximal holding capacity was still on a similarly high level as for immediately post-treatment (similar to 100% AFmax) and patient was symptom-free. At 6 months the patient's Long COVID symptoms have not returned. This case report suggests (1) AF could be a promising diagnostic for post-infectious illness, (2) AF can be used to test effective treatments for post-infectious illness, and (3) individualized PEMF may resolve post-infectious symptoms. KW - individualized pulsed electromagnetic field KW - Adaptive Force KW - muscular holding capacity KW - case report KW - Long COVID KW - post-COVID syndrome KW - muscle weakness KW - fatigue Y1 - 2023 U6 - https://doi.org/10.3389/fmed.2022.879971 SN - 2296-858X VL - 9 PB - Frontiers Media CY - Lausanne ER - TY - JOUR A1 - Schaefer, Laura A1 - Carnarius, Friederike A1 - Dech, Silas A1 - Bittmann, Frank T1 - Repeated measurements of Adaptive Force BT - maximal holding capacity differs from other maximal strength parameters and preliminary characteristics for non-professional strength vs. endurance athletes JF - Frontiers in physiology N2 - 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. KW - Adaptive Force KW - maximal isometric Adaptive Force KW - holding capacity KW - neuromuscular control KW - strength vs. endurance athletes KW - injury mechanisms KW - repeated adaptive isometric–eccentric muscle action KW - holding (HIMA) and pushing (PIMA) isometric muscle action Y1 - 2023 U6 - https://doi.org/10.3389/fphys.2023.1020954 SN - 1664-042X VL - 14 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Dech, Silas A1 - Bittmann, Frank A1 - Schaefer, Laura T1 - Muscle oxygenation level might trigger the regulation of capillary venous blood filling during fatiguing isometric muscle actions JF - Diagnostics : open access journal N2 - 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. KW - muscle oxygen saturation KW - hemoglobin amount KW - isometric muscle action KW - O2C spectrophotometer KW - capillary recruitment KW - blood flow KW - holding KW - isometric muscle action (HIMA) KW - pulling isometric muscle action (PIMA) Y1 - 2021 U6 - https://doi.org/10.3390/diagnostics11111973 SN - 2075-4418 VL - 11 IS - 11 PB - MDPI CY - Basel ER - TY - JOUR A1 - Schaefer, Laura A1 - Bittmann, Frank T1 - The adaptive force as a potential biomechanical parameter in the recovery process of patients with long COVID JF - Diagnostics N2 - 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 KW - Adaptive Force KW - maximal isometric Adaptive Force KW - holding capacity KW - muscle function KW - long COVID fatigue KW - post COVID syndrome KW - muscle weakness KW - neuromuscular control KW - biomechanical parameter Y1 - 2023 U6 - https://doi.org/10.3390/diagnostics13050882 SN - 2075-4418 VL - 13 IS - 5 PB - MDPI CY - Basel ER - TY - JOUR A1 - Schaefer, Laura A1 - Dech, Silas A1 - Wolff, Lara L. A1 - Bittmann, Frank T1 - Emotional Imagery Influences the Adaptive Force in Young Women BT - Unpleasant Imagery Reduces Instantaneously the Muscular Holding Capacity JF - Brain Sciences N2 - 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. KW - Adaptive Force KW - maximal isometric Adaptive Force KW - holding capability KW - neuromuscular adaptation KW - motor control KW - pleasant and unpleasant imagery KW - emotions KW - emotional imagery KW - manual muscle test Y1 - 2022 U6 - https://doi.org/10.3390/brainsci12101318 SN - 2076-3425 VL - 12 IS - 10 PB - MDPI CY - Basel, Schweiz ER - TY - JOUR A1 - Schaefer, Laura A1 - Dech, Silas A1 - Bittmann, Frank T1 - Adaptive force and emotionally related imaginations BT - Preliminary results suggest a reduction of the maximal holding capacity as reaction to disgusting food imagination JF - Heliyon N2 - The link between emotions and motor control has been discussed for years. The measurement of the Adaptive Force (AF) provides the possibility to get insights into the adaptive control of the neuromuscular system in reaction to external forces. It was hypothesized that the holding isometric AF is especially vulnerable to disturbing inputs. Here, the behavior of the AF under the influence of positive (tasty) vs. negative (disgusting) food imaginations was investigated. The AF was examined in n = 12 cases using an objectified manual muscle test of the hip flexors, elbow flexors or pectoralis major muscle, performed by one of two experienced testers while the participants imagined their most tasty or most disgusting food. The reaction force and the limb position were measured by a handheld device. While the slope of force rises and the maximal AF did not differ significantly between tasty and disgusting imaginations (p > 0.05), the maximal isometric AF was significantly lower and the AF at the onset of oscillations was significantly higher under disgusting vs. tasty imaginations (both p = 0.001). A proper length tension control of muscles seems to be a crucial functional parameter of the neuromuscular system which can be impaired instantaneously by emotionally related negative imaginations. This might be a potential approach to evaluate somatic reactions to emotions. KW - Adaptive Force KW - Isometric Adaptive Force KW - Holding capacity KW - Holding KW - isometric muscle action KW - Imaginations KW - Emotions KW - Motor control KW - Functional weakness KW - Manual muscle test Y1 - 2021 U6 - https://doi.org/10.1016/j.heliyon.2021.e07827 SN - 2405-8440 VL - 7 IS - 8 PB - Elsevier CY - London ER - TY - JOUR A1 - Dech, Silas A1 - Bittmann, Frank A1 - Schaefer, Laura T1 - Muscle oxygenation and time to task failure of submaximal holding and pulling isometric muscle actions and influence of intermittent voluntary muscle twitches JF - BMC Sports Science, Medicine and Rehabilitation N2 - 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. KW - Oxygen saturation KW - Microvascular blood filling KW - Isometric contraction KW - Isometric muscle action KW - Holding isometric muscle action KW - Pulling isometric muscle action KW - Pushing isometric muscle action KW - Time to task failure KW - Muscle twitch Y1 - 2022 U6 - https://doi.org/10.1186/s13102-022-00447-9 SN - 1758-2555 VL - 55 SP - 1 EP - 10 PB - Springer Nature CY - London ER - TY - JOUR A1 - Schaefer, Laura A1 - Bittmann, Frank T1 - Case Study: Intra- and Interpersonal Coherence of Muscle and Brain Activity of Two Coupled Persons during Pushing and Holding Isometric Muscle Action JF - Brain Sciences N2 - Inter-brain synchronization is primarily investigated during social interactions but had not been examined during coupled muscle action between two persons until now. It was previously shown that mechanical muscle oscillations can develop coherent behavior between two isometrically interacting persons. This case study investigated if inter-brain synchronization appears thereby, and if differences of inter- and intrapersonal muscle and brain coherence exist regarding two different types of isometric muscle action. Electroencephalography (EEG) and mechanomyography/mechanotendography (MMG/MTG) of right elbow extensors were recorded during six fatiguing trials of two coupled isometrically interacting participants (70% MVIC). One partner performed holding and one pushing isometric muscle action (HIMA/PIMA; tasks changed). The wavelet coherence of all signals (EEG, MMG/MTG, force, ACC) were analyzed intra- and interpersonally. The five longest coherence patches in 8–15 Hz and their weighted frequency were compared between real vs. random pairs and between HIMA vs. PIMA. Real vs. random pairs showed significantly higher coherence for intra-muscle, intra-brain, and inter-muscle-brain activity (p < 0.001 to 0.019). Inter-brain coherence was significantly higher for real vs. random pairs for EEG of right and central areas and for sub-regions of EEG left (p = 0.002 to 0.025). Interpersonal muscle-brain synchronization was significantly higher than intrapersonal one, whereby it was significantly higher for HIMA vs. PIMA. These preliminary findings indicate that inter-brain synchronization can arise during muscular interaction. It is hypothesized both partners merge into one oscillating neuromuscular system. The results reinforce the hypothesis that HIMA is characterized by more complex control strategies than PIMA. The pilot study suggests investigating the topic further to verify these results on a larger sample size. Findings could contribute to the basic understanding of motor control and is relevant for functional diagnostics such as the manual muscle test which is applied in several disciplines, e.g., neurology, physiotherapy. KW - interpersonal muscle action KW - wavelet coherence KW - inter-brain synchronization KW - inter-muscle-brain synchronization KW - electroencephalography (EEG) KW - mechanomyography (MMG) KW - holding isometric muscle action (HIMA) KW - pushing isometric muscle action (PIMA) Y1 - 2022 U6 - https://doi.org/10.3390/brainsci12060703 SN - 2076-3425 VL - 12 PB - MDPI Open Access Publishing CY - Basel, Schweiz ET - 6 ER - TY - JOUR A1 - Schaefer, Laura A1 - Löffler, Nils A1 - Klein, Julia A1 - Bittmann, Frank T1 - Mechanomyography and acceleration show interlimb asymmetries in Parkinson patients without tremor compared to controls during a unilateral motor task JF - Scientific reports N2 - 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. KW - Diseases KW - Neurology KW - Neuroscience Y1 - 2021 U6 - https://doi.org/10.1038/s41598-021-81672-z SN - 2045-2322 VL - 11 IS - 1 PB - Macmillan CY - London ER - TY - JOUR A1 - Schaefer, Laura A1 - Dech, Silas A1 - Aehle, Markus A1 - Bittmann, Frank T1 - Disgusting odours affect the characteristics of the adaptive force in contrast to neutral and pleasant odours JF - Scientific Reports N2 - The olfactomotor system is especially investigated by examining the sniffing in reaction to olfactory stimuli. The motor output of respiratory-independent muscles was seldomly considered regarding possible influences of smells. The Adaptive Force (AF) characterizes the capability of the neuromuscular system to adapt to external forces in a holding manner and was suggested to be more vulnerable to possible interfering stimuli due to the underlying complex control processes. The aim of this pilot study was to measure the effects of olfactory inputs on the AF of the hip and elbow flexors, respectively. The AF of 10 subjects was examined manually by experienced testers while smelling at sniffing sticks with neutral, pleasant or disgusting odours. The reaction force and the limb position were recorded by a handheld device. The results show, inter alia, a significantly lower maximal isometric AF and a significantly higher AF at the onset of oscillations by perceiving disgusting odours compared to pleasant or neutral odours (p < 0.001). The adaptive holding capacity seems to reflect the functionality of the neuromuscular control, which can be impaired by disgusting olfactory inputs. An undisturbed functioning neuromuscular system appears to be characterized by a proper length tension control and by an earlier onset of mutual oscillations during an external force increase. This highlights the strong connection of olfaction and motor control also regarding respiratory-independent muscles. Y1 - 2021 U6 - https://doi.org/10.1038/s41598-021-95759-0 SN - 2045-2322 VL - 11 SP - 1 EP - 16 PB - Springer Nature CY - London ER -