@article{EichlerRabeSalzwedeletal.2017, author = {Eichler, Sarah and Rabe, Sophie and Salzwedel, Annett and Mueller, Steffen and Stoll, Josefine and Tilgner, Nina and John, Michael and Wegscheider, Karl and Mayer, Frank and V{\"o}ller, Heinz}, title = {Effectiveness of an interactive telerehabilitation system with home-based exercise training in patients after total hip or knee replacement: study protocol for a multicenter, superiority, no-blinded randomized controlled trial}, series = {Trials}, volume = {18}, journal = {Trials}, publisher = {BioMed Central}, address = {London}, issn = {1745-6215}, doi = {10.1186/s13063-017-2173-3}, pages = {7}, year = {2017}, abstract = {Background: Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design: This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion: We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.}, language = {en} } @article{HuangGuoYangetal.2017, author = {Huang, Hongshi and Guo, Jianqiao and Yang, Jie and Jiang, Yanfang and Yu, Yuanyuan and Mueller, Steffen and Ren, Gexue and Ao, Yingfang}, title = {Isokinetic angle-specific moments and ratios characterizing hamstring and quadriceps strength in anterior cruciate ligament deficient knees}, series = {Scientific reports}, volume = {7}, journal = {Scientific reports}, publisher = {Nature Publ. Group}, address = {London}, issn = {2045-2322}, doi = {10.1038/s41598-017-06601-5}, pages = {11}, year = {2017}, abstract = {This study is intended to find more effective and robust clinical diagnostic indices to characterize muscle strength and coordination alternation following anterior cruciate ligament (ACL) rupture. To evaluate angle-specific moments and hamstring (H)/quadriceps (Q) ratios, 46 male subjects with unilateral chronic ACL-rupture performed isokinetic concentric (c), eccentric (e) quadriceps and hamstring muscle tests respectively at 60 degrees/s. Normalized moments and H/Q ratios were calculated for peak moment (PM) and 30 degrees, 40 degrees, 50 degrees, 60 degrees, 70 degrees, 80 degrees knee flexion angles. Furthermore, we introduced single-to-arithmetic-mean (SAM) and single-to-root-mean-square (SRMS) muscle co-contraction ratios, calculating them for specific angles and different contraction repetitions. Normalized PM and 40 degrees specific concentric quadriceps, concentric hamstring strength in the ACL-deficient knee were reduced significantly (P <= 0.05). Concentric angle-specific moments together with Qe/Qc ratios at 40 degrees (d = 0.766 vs. d = 0.654) identify more obvious differences than peak values in ACL ruptured limbs. Furthermore, we found SRMS-QeQc deficits at 40 degrees showed stronger effect than Qe/Qc ratios (d = 0.918 vs. d = 0.766), albeit other ratio differences remained basically the same effect size as the original H/Q ratios. All the newly defined SAM and SRMS indices could decrease variance. Overall, 40 degrees knee moments and SAM/ SRMS ratios might be new potential diagnosis indices for ACL rupture detection.}, language = {en} } @article{WochatzRabeWolteretal.2017, author = {Wochatz, Monique and Rabe, Sophie and Wolter, Martin and Engel, Tilman and Mueller, Steffen and Mayer, Frank}, title = {Muscle activity of upper and lower trapezius and serratus anterior during unloaded and maximal loaded shoulder flexion and extension}, series = {International Biomechanics}, volume = {4}, journal = {International Biomechanics}, number = {2}, publisher = {Elsevier}, address = {Amsterdam}, doi = {https://doi.org/10.1080/23335432.2017.1364668}, pages = {68 -- 76}, year = {2017}, abstract = {Altered scapular muscle activity is mostly described under unloaded and submaximal loaded conditions in impingement patients. However, there is no clear evidence on muscle activity with respect to movement phases under maximum load in healthy subjects. Therefore, this study aimed to investigate scapular muscle activity under unloaded and maximum loaded isokinetic shoulder flexion and extension in regard to the movement phase. Fourteen adults performed unloaded (continuous passive motion [CPM]) as well as maximum loaded (concentric [CON], eccentric [ECC]) isokinetic shoulder flexion (Flex) and extension (Ext). Simultaneously, scapular muscle activity was measured by EMG. Root mean square was calculated for the whole ROM and four movement phases. Data were analyzed descriptively and by two-way repeated measures ANOVA. CPMFlex resulted in a linear increase of muscle activity for all muscles. Muscle activity during CONFlex and ECCFlex resulted in either constant activity levels or in an initial increase followed by a plateau in the second half of movement. CPMExt decreased with the progression of movement, whereas CONExt and ECCExt initially decreased and either levelled off or increased in the second half of movement. Scapular muscle activity of unloaded shoulder flexion and extension changed under maximum load showing increased activity levels and an altered pattern over the course of movement.}, language = {en} } @article{CasselIntziegianniRischetal.2017, author = {Cassel, Michael and Intziegianni, Konstantina and Risch, Lucie and Mueller, Steffen and Engel, Tilman and Mayer, Frank}, title = {Physiological Tendon Thickness Adaptation in Adolescent Elite Athletes: A Longitudinal Study}, series = {Frontiers in physiology}, volume = {8}, journal = {Frontiers in physiology}, publisher = {Frontiers Research Foundation}, address = {Lausanne}, issn = {1664-042X}, doi = {10.3389/fphys.2017.00795}, pages = {599 -- 611}, year = {2017}, abstract = {Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 +/- 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean SD) and statistical testing for group differences was performed (cy = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 +/- 0.7 mm/5.6 +/- 0.7 mm) nor in controls (4.8 +/- 0.4 mm/4.9 +/- 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (Ml: 3.5 +/- 0.5 mm, M2: 3.8 +/- 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p <= 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.}, language = {en} } @article{WochatzRabeWolteretal.2017, author = {Wochatz, Monique and Rabe, Sophie and Wolter, Martin and Engel, Tilman and Mueller, Steffen and Mayer, Frank}, title = {Reproducibility of scapular muscle activity in isokinetic shoulder flexion and extension}, series = {Journal of electromyography and kinesiology}, volume = {34}, journal = {Journal of electromyography and kinesiology}, publisher = {Elsevier}, address = {Oxford}, issn = {1050-6411}, doi = {10.1016/j.jelekin.2017.04.006}, pages = {86 -- 92}, year = {2017}, abstract = {Repetitive overhead movements have been identified as a main risk factor to develop shoulder complaints with scapular muscle activity being altered. Reliable assessment of muscle activity is essential to differentiate between symptomatic and asymptomatic individuals. Therefore, the present study aimed to investigate the intra-and inter-session reliability of scapular muscle activity during maximal isokinetic shoulder flexion and extension. Eleven asymptomatic adults performed maximum effort isokinetic shoulder flexion and extension (concentric and eccentric at 60 degrees/s) in a test-retest design. Muscle activity of the upper and lower trapezius and serratus anterior was assessed by sEMG. Root Mean Square was calculated for whole ROM and single movement phases of absolute and normalized muscle activity. Absolute (Bland-Altman analysis (Bias, LoA), Minimal detectable change (MDC)) and relative reliability parameters (Intraclass correlation coefficient (ICC), coefficient of variation (CV)/test-retest variability (TRV)) were utilized for the evaluation of reproducibility. Intra-session reliability revealed ICCs between 0.56 and 0.98, averaged CVs of 18\% and average MDCs of 81 mV. Inter-session reliability resulted in ICCs between 0.13 and 0.93, averaged TRVs of 21\%, average MDCs of 15\% and systematic and random error between -8 +/- 60\% and 12 +/- 36\%. Scapular muscle activity assessed in overhead movements can be measured reliably under maximum load conditions, though variability is dependent on the movement phase. Measurement variability does not exceed magnitudes of altered scapular muscle activities as reported in previous studies. Therefore, maximum load application is a promising approach for the evaluation of changes in scapular control related to pathologies. (C) 2017 Elsevier Ltd. All rights reserved.}, language = {en} } @article{EngelMuellerKopinskietal.2017, author = {Engel, Tilman and Mueller, Juliane and Kopinski, Stephan and Reschke, Antje and Mueller, Steffen and Mayer, Frank}, title = {Unexpected walking perturbations: Reliability and validity of a new treadmill protocol to provoke muscular reflex activities at lower extremities and the trunk}, series = {Journal of biomechanics}, volume = {55}, journal = {Journal of biomechanics}, publisher = {Elsevier}, address = {Oxford}, issn = {0021-9290}, doi = {10.1016/j.jbiomech.2017.02.026}, pages = {152 -- 155}, year = {2017}, abstract = {Instrumented treadmills offer the potential to generate standardized walking perturbations, which are particularly rapid and powerful. However, technical requirements to release adequate perturbations regarding timing, duration and amplitude are demanding. This study investigated the test-retest reliability and validity of a new treadmill perturbation protocol releasing rapid and unexpected belt perturbations to provoke muscular reflex responses at lower extremities and the trunk. Fourteen healthy participants underwent two identical treadmill walking protocols, consisting of 10 superimposed one-sided belt perturbations (100 ms duration; 2 m/s amplitude), triggered by a plantar pressure insole 200 ms after heel contact. Delay, duration and amplitude of applied perturbations were recorded by 3D-motion capture. Muscular reflex responses (within 200 ms) were measured at lower extremities and the trunk (10-lead EMG). Data was analyzed descriptively (mean +/- SD). Reliability was analyzed using test-retest variability (TRV\%) and limits of agreement (LoA, bias +/- 1.96*SD). Perturbation delay was 202 14 ms, duration was 102 +/- 4 ms and amplitude was 2.1 +/- 0.01 m/s. TRV for perturbation delay, duration and amplitude ranged from 5.0\% to 5.7\%. LoA reached 3 +/- 36 ms for delay, 2 +/- 13 ms for duration and 0.0 +/- 0.3 m/s for amplitude. EMG amplitudes following perturbations ranged between 106 +/- 97\% and 909 +/- 979\% of unperturbed gait and EMG latencies between 82 +/- 14 ms and 106 +/- 16 ms. Minor differences between preset and observed perturbation characteristics and results of test-retest analysis prove a high validity with excellent reliability of the setup. Therefore, the protocol tested can be recommended to provoke muscular reflex responses at lower extremities and the trunk in perturbed walking. (C) 2017 Elsevier Ltd. All rights reserved.}, language = {en} }