@misc{HenschkeKaplickWochatzetal.2022,
  author    = {Henschke, Jakob and Kaplick, Hannes and Wochatz, Monique and Engel, Tilman},
  title     = {Assessing the validity of inertial measurement units for shoulder kinematics using a commercial sensor-software system},
  series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  publisher = {Universit{\"a}tsverlag Potsdam},
  address   = {Potsdam},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-57827},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-578278},
  pages     = {1 -- 11},
  year      = {2022},
  abstract  = {Background and Aims Wearable inertial sensors may offer additional kinematic parameters of the shoulder compared to traditional instruments such as goniometers when elaborate and time-consuming data processing procedures are undertaken. However, in clinical practice simple-real time motion analysis is required to improve clinical reasoning. Therefore, the aim was to assess the criterion validity between a portable "off-the-shelf" sensor-software system (IMU) and optical motion (Mocap) for measuring kinematic parameters during active shoulder movements. Methods 24 healthy participants (9 female, 15 male, age 29 +/- 4 years, height 177 +/- 11 cm, weight 73 +/- 14 kg) were included. Range of motion (ROM), total range of motion (TROM), peak and mean angular velocity of both systems were assessed during simple (abduction/adduction, horizontal flexion/horizontal extension, vertical flexion/extension, and external/internal rotation) and complex shoulder movements. Criterion validity was determined using intraclass-correlation coefficients (ICC), root mean square error (RMSE) and Bland and Altmann analysis (bias; upper and lower limits of agreement). Results ROM and TROM analysis revealed inconsistent validity during simple (ICC: 0.040-0.733, RMSE: 9.7 degrees-20.3 degrees, bias: 1.2 degrees-50.7 degrees) and insufficient agreement during complex shoulder movements (ICC: 0.104-0.453, RMSE: 10.1 degrees-23.3 degrees, bias: 1.0 degrees-55.9 degrees). Peak angular velocity (ICC: 0.202-0.865, RMSE: 14.6 degrees/s-26.7 degrees/s, bias: 10.2 degrees/s-29.9 degrees/s) and mean angular velocity (ICC: 0.019-0.786, RMSE:6.1 degrees/s-34.2 degrees/s, bias: 1.6 degrees/s-27.8 degrees/s) were inconsistent. Conclusions The "off-the-shelf" sensor-software system showed overall insufficient agreement with the gold standard. Further development of commercial IMU-software-solutions may increase measurement accuracy and permit their integration into everyday clinical practice.},
  language  = {en}
}
@article{MuellerMartinezValdesStolletal.2018,
  author    = {Mueller, Juliane and Martinez-Valdes, Eduardo Andr{\´e}s and Stoll, Josefine and Mueller, Steffen and Engel, Tilman and Mayer, Frank},
  title     = {Differences in neuromuscular activity of ankle stabilizing muscles during postural disturbances},
  series = {Gait \& posture},
  volume    = {61},
  journal   = {Gait \& posture},
  publisher = {Elsevier},
  address   = {Clare},
  issn      = {0966-6362},
  doi       = {10.1016/j.gaitpost.2018.01.023},
  pages     = {226 -- 231},
  year      = {2018},
  abstract  = {The purpose was to examine gender differences in ankle stabilizing muscle activation during postural disturbances. Seventeen participants (9 females: 27 +/- 2yrs., 1.69 +/- 0.1 m, 63 +/- 7 kg; 8 males: 29 +/- 2yrs., 1.81 +/- 0.1 m; 83 +/- 7 kg) were included in the study. After familiarization on a split-belt-treadmill, participants walked (1 m/s) while 15 right-sided perturbations were randomly applied 200 ms after initial heel contact. Muscle activity of M. tibialis anterior (TA), peroneus longus (PL) and gastrocnemius medialis (GM) was recorded during unperturbed and perturbed walking. The root mean square (RMS; [\%]) was analyzed within 200 ms after perturbation. Co-activation was quantified as ratio of antagonist (GM)/agonist (TA) EMG-RMS during unperturbed and perturbed walking. Time to onset was calculated (ms). Data were analyzed descriptively (mean +/- SD) followed by three-way-ANOVA (gender/condition/muscle; alpha= 0.05). Perturbed walking elicited higher EMG activity compared to normal walking for TA and PL in both genders (p < 0.000). RMS amplitude gender comparisons revealed an interaction between gender and condition (F = 4.6, p = 0.049) and, a triple interaction among gender, condition and muscle (F = 4.7, p = 0.02). Women presented significantly higher EMG-RMS [\%] PL amplitude than men during perturbed walking (mean difference = 209.6\%, 95\% confidence interval = -367.0 to -52.2\%, p < 0.000). Co-activation showed significant lower values for perturbed compared to normal walking (p < 0.000), without significant gender differences for both walking conditions. GM activated significantly earlier than TA and PL (p < 0.01) without significant differences between the muscle activation onsets of men and women (p = 0.7). The results reflect that activation strategies of the ankle encompassing muscles differ between genders. In provoked stumbling, higher PL EMG activity in women compared to men is present. Future studies should aim to elucidate if this specific behavior has any relationship with ankle injury occurrence between genders.},
  language  = {en}
}
@article{MuellerEngelKopinskietal.2017,
  author    = {M{\"u}ller, Juliane and Engel, Tilman and Kopinski, Stephan and Mayer, Frank and M{\"u}ller, Steffen},
  title     = {Neuromuscular trunk activation patterns in back pain patients during one-handed lifting},
  series = {World journal of orthopedics},
  volume    = {8},
  journal   = {World journal of orthopedics},
  number    = {2},
  publisher = {Baishideng Publishing Group},
  address   = {Pleasanton},
  issn      = {2218-5836},
  doi       = {10.5312/wjo.v8.i2.142},
  pages     = {142 -- 148},
  year      = {2017},
  abstract  = {AIM To analyze neuromuscular activity patterns of the trunk in healthy controls (H) and back pain patients (BPP) during one-handed lifting of light to heavy loads. METHODS RESULTS Seven subjects (3m/4f; 32 +/- 7 years; 171 +/- 7 cm; 65 +/- 11 kg) were assigned to BPP (pain grade >= 2) and 36 (13m/23f; 28 +/- 8 years; 174 +/- 10 cm; 71 +/- 12 kg) to H (pain grade <= 1). H and BPP did not differ significantly in anthropometrics (P > 0.05). All subjects were able to lift the light and middle loads, but 57\% of BPP and 22\% of H were not able to lift the heavy load (all women) chi(2) analysis revealed statistically significant differences in task failure between H vs BPP (P = 0.03). EMG-RMS ranged from 33\% +/- 10\%/30\% +/- 9\% (DL, 1 kg) to 356\% +/- 148\%/283\% +/- 80\% (VR, 20 kg) in H/BPP with no statistical difference between groups regardless of load (P > 0.05). However, the EMG-RMS of the VR was greatest in all lifting tasks for both groups and increased with heavier loads. CONCLUSION Heavier loading leads to an increase (2-to 3-fold) in trunk muscle activity with comparable patterns. Heavy loading (20 kg) leads to task failure, especially in women with back pain.},
  language  = {en}
}
@article{RischWochatzMesserschmidtetal.2017,
  author    = {Risch, Lucie and Wochatz, Monique and Messerschmidt, Janin and Engel, Tilman and Mayer, Frank and Cassel, Michael},
  title     = {Reliability of evaluating achilles tendon vascularization assessed with doppler ultrasound advanced dynamic flow},
  series = {Journal of ultrasound in medicine},
  volume    = {37},
  journal   = {Journal of ultrasound in medicine},
  number    = {3},
  publisher = {Wiley},
  address   = {Hoboken},
  issn      = {0278-4297},
  doi       = {10.1002/jum.14414},
  pages     = {737 -- 744},
  year      = {2017},
  abstract  = {The reliability of quantifying intratendinous vascularization by high-sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems. Methods-Three investigators evaluated vascularization in 67 recordings in a test-retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen kappa and Fleiss kappa coefficients (absolute), Kendall tau b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland-Altman analysis (bias and limits of agreement [LoA]). Results-Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0-1.5; bias, -1; and LoA, 3-4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0-1.9; bias, 0; and LoA, 3-5 vessels). Conclusions-The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.},
  language  = {en}
}
@misc{KuschelSonnenburgEngel2022,
  author    = {Kuschel, Luciano Bruno and Sonnenburg, Dominik and Engel, Tilman},
  title     = {Factors of muscle quality and determinants of muscle strength},
  series = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  journal   = {Zweitver{\"o}ffentlichungen der Universit{\"a}t Potsdam : Humanwissenschaftliche Reihe},
  number    = {838},
  issn      = {1866-8364},
  doi       = {10.25932/publishup-58910},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-589104},
  pages     = {29},
  year      = {2022},
  abstract  = {Muscle quality defined as the ratio of muscle strength to muscle mass disregards underlying factors which influence muscle strength. The aim of this review was to investigate the relationship of phase angle (PhA), echo intensity (EI), muscular adipose tissue (MAT), muscle fiber type, fascicle pennation angle (θf), fascicle length (lf), muscle oxidative capacity, insulin sensitivity (IS), neuromuscular activation, and motor unit to muscle strength. PubMed search was performed in 2021. The inclusion criteria were: (i) original research, (ii) human participants, (iii) adults (≥18 years). Exclusion criteria were: (i) no full-text, (ii) non-English or -German language, (iii) pathologies. Forty-one studies were identified. Nine studies found a weak-moderate negative (range r: [-0.26]-[-0.656], p < 0.05) correlation between muscle strength and EI. Four studies found a weak-moderate positive correlation (range r: 0.177-0.696, p < 0.05) between muscle strength and PhA. Two studies found a moderate-strong negative correlation (range r: [-0.446]-[-0.87], p < 0.05) between muscle strength and MAT. Two studies found a weak-strong positive correlation (range r: 0.28-0.907, p < 0.05) between θf and muscle strength. Muscle oxidative capacity was found to be a predictor of muscle strength. This review highlights that the current definition of muscle quality should be expanded upon as to encompass all possible factors of muscle quality.},
  language  = {en}
}
@article{KuschelSonnenburgEngel2022,
  author    = {Kuschel, Luciano Bruno and Sonnenburg, Dominik and Engel, Tilman},
  title     = {Factors of muscle quality and determinants of muscle strength},
  series = {Healthcare},
  volume    = {10},
  journal   = {Healthcare},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2227-9032},
  doi       = {10.3390/healthcare10101937},
  pages     = {29},
  year      = {2022},
  abstract  = {Muscle quality defined as the ratio of muscle strength to muscle mass disregards underlying factors which influence muscle strength. The aim of this review was to investigate the relationship of phase angle (PhA), echo intensity (EI), muscular adipose tissue (MAT), muscle fiber type, fascicle pennation angle (θf), fascicle length (lf), muscle oxidative capacity, insulin sensitivity (IS), neuromuscular activation, and motor unit to muscle strength. PubMed search was performed in 2021. The inclusion criteria were: (i) original research, (ii) human participants, (iii) adults (≥18 years). Exclusion criteria were: (i) no full-text, (ii) non-English or -German language, (iii) pathologies. Forty-one studies were identified. Nine studies found a weak-moderate negative (range r: [-0.26]-[-0.656], p < 0.05) correlation between muscle strength and EI. Four studies found a weak-moderate positive correlation (range r: 0.177-0.696, p < 0.05) between muscle strength and PhA. Two studies found a moderate-strong negative correlation (range r: [-0.446]-[-0.87], p < 0.05) between muscle strength and MAT. Two studies found a weak-strong positive correlation (range r: 0.28-0.907, p < 0.05) between θf and muscle strength. Muscle oxidative capacity was found to be a predictor of muscle strength. This review highlights that the current definition of muscle quality should be expanded upon as to encompass all possible factors of muscle quality.},
  language  = {en}
}
@inproceedings{KopinskiEngelCasseletal.2014,
  author    = {Kopinski, Stephan and Engel, Tilman and Cassel, Michael and Carlsohn, Anja and Mayer, Frank},
  title     = {Reliability of ultrasound measurements for subcutaneous adipose tissue in elite canoe athletes},
  series = {Medicine and science in sports and exercise : official journal of the American College of Sports Medicine},
  volume    = {46},
  booktitle = {Medicine and science in sports and exercise : official journal of the American College of Sports Medicine},
  number    = {5},
  publisher = {Lippincott Williams \& Wilkins},
  address   = {Philadelphia},
  issn      = {0195-9131},
  pages     = {539 -- 539},
  year      = {2014},
  language  = {en}
}
@article{BaritelloKhajooeiEngeletal.2020,
  author    = {Baritello, Omar and Khajooei, Mina and Engel, Tilman and Kopinski, Stephan and Quarmby, Andrew James and M{\"u}ller, Steffen and Mayer, Frank},
  title     = {Neuromuscular shoulder activity during exercises with different combinations of stable and unstable weight mass},
  series = {BMC sports science, medicine and rehabilitation},
  volume    = {12},
  journal   = {BMC sports science, medicine and rehabilitation},
  number    = {1},
  publisher = {BioMed Central},
  address   = {London},
  issn      = {2052-1847},
  doi       = {10.1186/s13102-020-00168-x},
  pages     = {14},
  year      = {2020},
  abstract  = {Background Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass (UWM) affects the muscular activity of the shoulder stabilizers. Aim of the study was to assess neuromuscular activity of dynamic shoulder stabilizers under four conditions of stable and UWM during three shoulder exercises. It was hypothesized that a combined condition of weight with UWM would elicit greater activation due to the increased stabilization demand. Methods Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 s.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different exercise conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root-mean-square values (RMS) were normalized to MVIC (\%MVIC). Differences between conditions for RMS\%MVIC, scapular stabilizer (SR: U.TA/L.TA; U.TA/SA) and contraction (CR: concentric/eccentric) ratios were analyzed (paired t-test; p <= 0.05; Bonferroni adjusted alpha = 0.008). Results PWG showed significantly greater muscle activity for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p > 0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles. Conclusion Higher weight generated greater muscle activation whereas an UWM raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an UWM increased the RMS\%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.},
  language  = {en}
}
@phdthesis{Engel2016,
  author    = {Engel, Tilman},
  title     = {Motor control strategies in response to unexpected disturbances of dynamic postural control in people with and without low back pain},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-400742},
  school      = {Universit{\"a}t Potsdam},
  pages     = {110},
  year      = {2016},
  abstract  = {Background: Low back pain (LBP) is one of the world wide leading causes of limited activity and disability. Impaired motor control has been found to be one of the possible factors related to the development or persistence of LBP. In particularly, motor control strategies seemed to be altered in situations requiring reactive responses of the trunk counteracting sudden external forces. However, muscular responses were mostly assessed in (quasi) static testing situations under simplified laboratory conditions. Comprehensive investigations in motor control strategies during dynamic everyday situations are lacking. The present research project aimed to investigate muscular compensation strategies following unexpected gait perturbations in people with and without LBP. A novel treadmill stumbling protocol was tested for its validity and reliability to provoke muscular reflex responses at the trunk and the lower extremities (study 1). Thereafter, motor control strategies in response to sudden perturbations were compared between people with LBP and asymptomatic controls (CTRL) (study 2). In accordance with more recent concepts of motor adaptation to pain, it was hypothesized that pain may have profound consequences on motor control strategies in LBP. Therefore, it was investigated whether differences in compensation strategies were either consisting of changes local to the painful area at the trunk, or also being present in remote areas such as at the lower extremities. Methods: All investigations were performed on a custom build split-belt treadmill simulating trip-like events by unexpected rapid deceleration impulses (amplitude: 2 m/s; duration: 100 ms; 200 ms after heel contact) at 1m/s baseline velocity. A total number of 5 (study 1) and 15 (study 2) right sided perturbations were applied during walking trials. Muscular activities were assessed by surface electromyography (EMG), recorded at 12 trunk muscles and 10 (study 1) respectively 5 (study 2) leg muscles. EMG latencies of muscle onset [ms] were retrieved by a semi-automatic detection method. EMG amplitudes (root mean square (RMS)) were assessed within 200 ms post perturbation, normalized to full strides prior to any perturbation [RMS\%]. Latency and amplitude investigations were performed for each muscle individually, as well as for pooled data of muscles grouped by location. Characteristic pain intensity scores (CPIS; 0-100 points, von Korff) based on mean intensity ratings reported for current, worst and average pain over the last three months were used to allocate participants into LBP (≥30 points) or CTRL (≤10 points). Test-retest reproducibility between measurements was determined by a compilation of measures of reliability. Differences in muscular activities between LBP and CTRL were analysed descriptively for individual muscles; differences based on grouped muscles were statistically tested by using a multivariate analysis of variance (MANOVA, α =0.05). Results: Thirteen individuals were included into the analysis of study 1. EMG latencies revealed reflex muscle activities following the perturbation (mean: 89 ms). Respective EMG amplitudes were on average 5-fold of those assessed in unperturbed strides, though being characterized by a high inter-subject variability. Test-retest reliability of muscle latencies showed a high reproducibility, both for muscles at the trunk and legs. In contrast, reproducibility of amplitudes was only weak to moderate for individual muscles, but increased when being assessed as a location specific outcome summary of grouped muscles. Seventy-six individuals were eligible for data analysis in study 2. Group allocation according to CPIS resulted in n=25 for LBP and n=29 for CTRL. Descriptive analysis of activity onsets revealed longer delays for all muscles within LBP compared to CTRL (trunk muscles: mean 10 ms; leg muscles: mean 3 ms). Onset latencies of grouped muscles revealed statistically significant differences between LBP and CTRL for right (p=0.009) and left (p=0.007) abdominal muscle groups. EMG amplitude analysis showed a high variability in activation levels between individuals, independent of group assignment or location. Statistical testing of grouped muscles indicated no significant difference in amplitudes between LBP and CTRL. Discussion: The present research project could show that perturbed treadmill walking is suitable to provoke comprehensive reflex responses at the trunk and lower extremities, both in terms of sudden onsets and amplitudes of reflex activity. Moreover, it could demonstrate that sudden loadings under dynamic conditions provoke an altered reflex timing of muscles surrounding the trunk in people with LBP compared to CTRL. In line with previous investigations, compensation strategies seemed to be deployed in a task specific manner, with differences between LBP and CTRL being evident predominately at ventral sides. No muscular alterations exceeding the trunk could be found when being assessed under the automated task of locomotion. While rehabilitation programs tailored towards LBP are still under debate, it is tempting to urge the implementation of dynamic sudden loading incidents of the trunk to enhance motor control and thereby to improve spinal protection. Moreover, in respect to the consistently observed task specificity of muscular compensation strategies, such a rehabilitation program should be rich in variety.},
  language  = {en}
}
@misc{CasselIntziegianniRischetal.2017,
  author    = {Cassel, Michael and Intziegianni, Konstantina and Risch, Lucie and M{\"u}ller, Steffen and Engel, Tilman and Mayer, Frank},
  title     = {Physiological Tendon Thickness Adaptation in Adolescent Elite Athletes},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-403823},
  pages     = {8},
  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 (α = 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 (M1: 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}
}