Effects of scapular retraction/protraction position and scapular elevation on shoulder girdle muscle activity during glenohumeral abduction

According to scapulohumeral rhythm, shoulder abduction is followed through scapular upward rotation to ensure joint mobility and stability. Of interest, the shoulder abduction can be performed holding the scapula in different positions and in association with scapular elevation, with possible effects on shoulder muscle activity. Therefore, the aim of the study was to analyze the activity of relevant shoulder muscles and the activity ratios between the scapulothoracic muscles, during shoulder abduction performed in different combinations of scapular position (neutral, retracted, protracted) and scapular elevation.The electromyographic activity of middle deltoid, serratus anterior, upper, middle and lower fibers of trapezius was recorded during shoulder abduction movements executed holding the scapula in neutral, retracted and protracted position, and subsequently a shoulder elevation movement. The activation of each muscle and the scapulothoracic muscles activity ratios were determined every 15 degrees, from 15° to 120° of abduction.Scapular retraction led to higher activation of the entire trapezius muscle, whereas protraction induced higher upper trapezius, middle deltoid and serratus anterior activity, along with lower activity of middle and lower trapezius. Shoulder elevation led to higher activity of the upper trapezius and middle deltoid. Moreover, it induced lower activation of the serratus anterior and middle and lower trapezius, thus leading to high ratios between the upper trapezius and the other scapulothoracic muscles, especially between 15 and 75 degrees of abduction.This study highlights that shoulder abduction performed with scapular protraction and in combination with scapular elevation leads to increased activity of the middle deltoid and upper trapezius, resulting in imbalances between the scapulothoracic muscles that could hamper the optimal scapulohumeral rhythm. The abduction performed in the aforementioned scapular conditions also induce potential reciprocal inhibition effects between the movers and stabilizers muscles of scapula, suggesting different motor control strategies of integrating a common shoulder movement with various modification of the scapular position.     

Resolving the contributions of fatigue-induced migration and scapular reorientation on the subacromial space: an orthopaedic geometric simulation analysis

Subacromial impingement occurs when tissues interposed between the humeral head and the acromion become compressed between the bones. Two fatigue-related mechanisms are suggested to contribute to this impingement: superior humeral head migration and scapular reorientation, specifically downward rotation, anterior tilt and protraction. Although both mechanisms have received attention, controversy exists regarding their relative contributions to reducing subacromial space width. This simulation study presents a three-dimensional orthopedic model for assessing the spatial relationship between the humerus and the scapula. Through incorporating empirically generated fatigue data as inputs, changes in the subacromial space associated with each mechanism acting independently and in combination were quantified. These changes were examined for three scenarios (average, impingement sparing, impingement causing) and at three humeral elevation angles (0°, 45° and 90°) in a total of 36 unique simulations. Humeral head migration generally decreased the subacromial space and scapular reorientation generally increased the space across scenarios. This strongly implies that superior humeral migration is the dominant fatigue-related mechanism associated with increasing the likelihood of impingement. The results suggest that future research should target efforts to reduce migration in industry, primarily through avoidance or modification of situations known to induce rotator cuff fatigue, such as overhead work.     

Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome

Scapular dyskinesis, characterized by scapular downward rotation syndrome (SDRS) affects scapula-humeral rhythm and results in shoulder dysfunction. Previous study has led to the recommendation of standard shrug exercise to contend with SDRS and strengthen the upper trapezius (UT) muscle. However, few researchers have examined which shrug exercise is most effective. The aim of this research was to compare scapular kinematic changes and scapular rotator muscles activity across three different shrug exercises in SDRS. The amounts of scapular downward rotation were measured by a caliper and the scapular upward rotation angle was measured using two digital inclinometers. Surface electromyography was used to measure EMG amplitude from the UT, lower trapezius (LT), serratus anterior (SA), and levator scapula (LS). Seventeen subjects with SDRS were recruited for this study. The subjects performed three shrug exercises with 30° shoulder abduction (preferred shrug, frontal shrug, and stabilization shrug). The stabilization shrug showed a significantly greater scapular upward rotation angle compared with the preferred shrug (P = 0.004) and frontal shrug (P = 0.006). The UT activity was significantly greater in the frontal shrug than in the preferred shrug (P = 0.002). The UT/LS muscle activity ratio was also significantly greater in the frontal shrug than in the preferred shrug (P = 0.004). The stabilization shrug should be preferred to enhance the upward rotation angle. In addition, the frontal shrug can be used as an effective method to increase UT activity and to decrease LS activity in SDRS.     

The effects of viscous loading of the human forearm flexors on the stability of coordination

This experiment investigated whether the stability of rhythmic unimanual movements is primarily a function of perceptual/spatial orientation or neuro-mechanical in nature. Eight participants performed rhythmic flexion and extension movements of the left wrist for 30s at a frequency of 2.25 Hz paced by an auditory metronome. Each participant performed 8 flex-on-the-beat trials and 8 extend-on-the-beat trials in one of two load conditions, loaded and unload. In the loaded condition, a servo-controlled torque motor was used to apply a small viscous load that resisted the flexion phase of the movement only. Both the amplitude and frequency of the movement generated in the loaded and unloaded conditions were statistically equivalent. However, in the loaded condition movements in which participants were required to flex-on-the-beat became less stable (more variable) while extend-on-the-beat movements remained unchanged compared with the unload condition. The small alteration in required muscle force was sufficient to result in reliable changes in movement stability even a situation where the movement kinematics were identical. These findings support the notion that muscular constraints, independent of spatial dependencies, can be sufficiently strong to reliably influence coordination in a simple unimanual task.     

Three-dimensional kinematics of the scapula and trunk,and associated scapular muscle timing in individuals with stroke

Poor scapulothoracic control is a risk for developing shoulder pathology, but has received little attention so far in individuals with stroke (IwS). Trunk and scapular kinematics and surface muscle activity were measured in 15 healthy controls and 18 IwS during a low and high forward flexion (FF). Group-differences in trunk and scapular kinematics were assessed during low and high FF using a t-test (independent samples). Differences in muscle onset and offset time relative to movement start (both FF tasks) were determined using a mixed model taking into account the different groups and muscles. Recruitment patterns per group and task were described based on significant differences between muscles. In IwS, earlier lower trapezius and late infraspinatus offset were found during low FF, as well as a later onset and earlier offset of serratus anterior. For low FF, significantly more trunk axial rotation was found in IwS during both elevation and lowering. During high FF, IwS showed significantly less scapular posterior tilt during elevation and more scapular lateral rotation during lowering. IwS demonstrated adaptive muscle timing with earlier initiation and late inactivation of lower trapezius and infraspinatus, possibly to compensate for a late activation and early deactivation of the serratus anterior and to establish as such the correct pattern of scapulothoracic movement.     

Changes in intersegmental dynamics over time due to increased leg inertia

The purpose of this study was to investigate the effects of asymmetrical loading on the intersegmental dynamics of the swing phase. Participants were asked to walk on a treadmill for 20 min under three loading conditions: (a) unloaded baseline, (b) 2 kg attached to the dominant limb’s ankle, and (c) post-load, following load removal. Sagittal plane motion data of both legs were collected and an intersegmental dynamics analysis of each swing phase was performed. Comparisons of steady-state responses across load conditions showed that absolute angular impulses of the loaded limb’s hip and knee increased significantly after load addition, and returned to baseline following load removal. Unloaded leg steady-state responses were not different across load conditions. However, after a change in leg inertia both legs experienced a period of adaptation that lasted approximately 40 strides before a steady state walking pattern was achieved. These findings suggest that the central nervous system refined the joint moments over time to account for the altered limb inertia and to maintain the underlying kinematic walking pattern. Maintaining a similar kinematic walking pattern resulted in altered moment profiles of the loaded leg, but similar moment profiles of the unloaded leg compared with the unloaded baseline condition.     

The influence of visual perception of self-motion on locomotor adaptation to unilateral limb loading

Self-perception of motion through visual stimulation may be important for adapting to locomotor conditions. Unilateral limb loading is a locomotor condition that can improve stability and reduce abnormal limb movement. In the present study, the authors investigated the effect of self-perception of motion through virtual reality (VR) on adaptation to unilateral limb loading. Healthy young adults, assigned to either a VR or a non-VR group, walked on a treadmill in the following 3 locomotor task periods--no load, loaded, and load removed. Subjects in the VR group viewed a virtual corridor during treadmill walking. Exposure to VR reduced cadence and muscle activity. During the loaded period, the swing time of the unloaded limb showed a larger increase in the VR group. When the load was removed, the swing time of the previously loaded limb and the stance time of the previously unloaded limb showed larger decrease and the swing time of the previously unloaded limb showed a smaller increase in the VR group. Lack of visual cues may cause the adoption of cautious strategies (higher muscle activity, shorter and more frequent steps, changes in the swing and stance times) when faced with situations that require adaptations. VR technology, providing such perceptual cues, has an important role in enhancing locomotor adaptation.     

When your face doesn't fit: employment discrimination against people with facial disfigurements

This study aimed to investigate the recruitment prospects of people with facial disfigurement and a contrasting group of wheelchair users, representing a functional impairment with little aesthetic impact. Three applications were made to each of 144 vacancies using three CVs and cover letters rotated around conditions in which one applicant was described as a wheelchair user, another had a noncontagious facial disfigurement, and the third (control condition) had neither. There was evidence of discrimination against people with facial disfigurement in jobs requiring high (but not low) levels of customer contact, and against wheelchair users for jobs entailing high or low‐customer contact. Aesthetic considerations, social norms, and the possibility of stigma by association are discussed as potential underlying factors.     

Determining a long term ambulatory load profile of the shoulder joint: neural networks predicting input for a musculoskeletal model

To gain more insight in the development of joint damage, a long term load profile of the shoulder joint under daily living conditions is desirable. Standard musculoskeletal models estimate joint load using kinematics and exerted force. However, the latter cannot be measured continuously in ambulatory settings, hampering the use of these models. This paper describes a method for obtaining such a load profile, by training a Neural Network (NN), using kinematics and EMG. A small data set of specified movements with known exerted forces is used in two ways. First, the model calculates several variables of joint load, and a set of Generalized Forces and Net Moments (GFNM) around the model's degrees of freedom. Second, using kinematics and EMG, an NN is trained to predict these GFNM, which can concurrently be used as input for the model, resulting in full model output independent of exerted force. The method is validated with an independent trial. The NN could predict GFNM within 10% relative RMS, compared to output of the model. The NN-model combination estimated joint reaction forces with relative RMS values of 7 to 17%, enabling the estimation of a detailed load profile of the shoulder under daily conditions.     

Deformation and failure of a heterogeneous high explosive

The deformation and failure of the pristine PBX 9501 high explosive are studied experimentally by combining Brazilian disk compression with the digital image correlation (DIC) technique. The Brazilian disk specimen was loaded by a pair of compressive forces across the diameter. The full-field deformation on the surface of the disk, during the loading process, was obtained using DIC on a series of random speckle images acquired during the test. In this series of experiments, we focused on the effect of temperature while keeping the loading speed quasi-static. Tests were conducted under three different temperatures, ?15°C, 23°C, and 50°C. For all testing conditions, it was observed that as the applied load reaches maximum, localized deformation starts at the two regions near the loading points. The localized deformation then proceeds along an irregular path toward the center of the specimen and coalesces. Finally, deformation of the Brazilian disk subjected to cyclic compressive load at ambient temperature was also measured and studied.     

Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer

Shoulder motion loss following surgical treatment of breast cancer is common and may be associated with surgery-related soft tissue changes and altered shoulder kinematics. Knowledge of short term biomechanical changes at the shoulder will inform treatment decisions and may help prevent the development of shoulder pathology. Shoulder motion loss following surgery also impacts quality of life and shoulder function, and measuring function with a shoulder-specific tool may direct rehabilitation. This study examined the short term effects of surgery on scapula kinematics and function in breast cancer survivors. Bilateral three-dimensional scapular kinematics were quantified before and after surgery for unilateral breast cancer and analyzed with repeated measures ANOVA. Shoulder function was assessed with the Shoulder Rating Questionnaire (SRQ) and analyzed with ANOVA. Subjects (n = 11) demonstrated statistically significant increases in scapula internal rotation on their involved side following surgery. An intention to treat analysis on all enrolled subjects supported this finding. The findings suggest that soft tissues restrictions impact short-term scapula motion following surgery for breast cancer. Significantly poorer shoulder function was reported for pain, recreation/athletic activities and total SRQ score after surgery. The SRQ appears sensitive enough to identify areas of life affected by changes in shoulder function following surgical intervention for breast cancer.     

Cognitive load causes kinematic changes in both elite and non-elite rowers

The current motor literature suggests that extraneous cognitive load may affect performance and kinematics in a primary motor task. A common response to increased cognitive demand, as observed in past studies, might be to reduce movement complexity and revert to previously learned movement patterns, in line with the progression-regression hypothesis. However, according to several accounts of automaticity, motor experts should be able to cope with dual task demands without detriment to their performance and kinematics. To test this, we conducted an experiment asking elite and non-elite rowers to use a rowing ergometer under conditions of varying task load. We employed single-task conditions with low cognitive load (i.e., rowing only) and dual-task conditions with high cognitive load (i.e., rowing and solving arithmetic problems). The results of the cognitive load manipulations were mostly in line with our hypotheses. Overall, participants reduced movement complexity, for example by reverting towards tighter coupling of kinematic events, in their dual-task performance as compared to single-task performance. The between-group kinematic differences were less clear. In contradiction to our hypotheses, we found no significant interaction between skill level and cognitive load, suggesting that the rowers' kinematics were affected by cognitive load irrespective of skill level. Overall, our findings contradict several past findings and automaticity theories, and suggest that attentional resources are required for optimal sports performance.     

Evaluations of People Depicted With Facial Disfigurement Compared to Those With Mobility Impairment

There are few extant studies of stereotyping of people with facial disfigurement. In the present study, two experiments (both within-participants) showed positive evaluations of people depicted as wheelchair users and, from the same participants, negative evaluations of people with facial disfigurements, compared to controls. The results of Experiment 2 suggested that implicit affective attitudes were more negative toward people with facial disfigurement than wheelchair users and were correlated with evaluation negativity. Social norms were perceived to permit more discrimination against people with facial disfigurement than against wheelchair users. These factors could help to explain the evaluative differences between the two disadvantaged groups.     

Joint range of motion entropy changes in response to load carriage in military personnel

BackgroundOveruse accounts for 82% of injuries in military personnel, and these occur predominantly in the spine and lower limbs. While non-linear analyses have shown changes in overall stability of the movement during load carriage, individual joint contributions have not been studied. The concept of entropy compensation between task, organism and environmental constraints is studied at a joint level.Research questionThe aim of this study was to investigate whether using different methods of loading by military personnel would have an effect on the sample entropy of the joint ranges of motion.MethodsEleven male reserve infantry army soldiers (age: 22 ± 2 years; height: 1.80 ± 0.06 m; mass: 89.3 ± 14.4 kg) walked an outdoor, 800 m course under 5 load conditions: unloaded, 15 kg backpack, 25 kg backpack, 15 kg webbing and backpack and 25 kg webbing and backpack. Kinematic data was recorded at 240 Hz using the Xsens motion capture system. The ranges of motion (ROM) of the spine, hips and knee were calculated for each gait cycle. Mean ROM, coefficient of variation (CV) of the ROM and the sample entropy of the ROM were compared between conditions.ResultsSpine side flexion ROM decreased significantly from the control condition in all loaded conditions, while sample entropy of the spine side flexion ROM increased in some conditions with no significant change in CV. Conversely, the hip flexion ROM increased significantly from the control, while sample entropy of the hip flexion ROM decreased.SignificanceThese results suggest that entropy compensation may propagate at a joint level. Understanding that a decrease in certainty with which a joint angle is selected, may be accompanied by an increase at a neighbouring joint. This could be significant in monitoring injuries as a result of environmental or task constraints.     

Inclined Weight-Loaded Walking at Different Speeds: Pelvis-Shoulder Coordination,Trunk Movements and Cost of Transport

Although studied at level surface, the trunk kinematics and pelvis-shoulder coordination of incline walking are unknown. The aim of this study was to evaluate the speed effects on pelvis-shoulder coordination and trunk movement and the cost of transport (C) during unloaded and loaded (25% of body mass) 15% incline walking. We collected 3-dimensional kinematic and oxygen consumption data from 10 physically active young men. The movements were analyzed in the sagittal plane (inclination and range of trunk motion) and the transverse plane (range of shoulder and pelvic girdle motion and phase difference). The rotational amplitude of the shoulder girdle decreased with load at all speeds, and it was lower at the highest speeds. The rotational amplitude of the pelvic girdle did not change with the different speeds. The phase difference was greater at optimal speed (3 km.hr^?1, at the lowest C) in the loaded and the unloaded conditions. The trunk inclination was greater with load and increased with speed, whereas the range of trunk motion was lower in the loaded condition and decreased with increasing speed. In conclusion, the load decreased the range of girdles and trunk motion, and the pelvis-shoulder coordination seemed to be critical for the incline walking performance.     

Impairment in the control of coupled cyclic movements of ipsilateral hand and foot after total callosotomy

Integrity of both cerebral hemispheres is required to control in-phase or anti-phase coupling of ipsilateral hand and foot oscillations, as shown by the impairment of these tasks when performed on the healthy side of hemiplegic patients. On this basis, coupling of hand–foot movements was analysed in a right-handed subject (ME) who underwent a total resection of the corpus callosum. Oscillations of the prone hand and foot, paced by a metronome at different frequencies, as well as EMG activity in extensor carpi radialis (ECR) and tibialis anterior (TA) muscles were analysed by measuring the average phase difference between the hand and foot movements and EMG cycles.

ME performed in-phase movements (right-hand extension coupled to right-foot dorsal flexion) at frequencies up to 3 Hz, though the hand cycle progressively lagged the foot cycle as the frequency increased. At 3 Hz the hand lag reached −142° (as compared to about 25° in healthy subjects). The lag increased even further after application of an inertial load to the hand, reaching 180° at 1.8 Hz (about 50° in healthy subjects). ME's hand lag is caused by the lack of any anticipatory reaction in hand movers. In contrast to healthy subjects, which activate the ECR earlier than the TA when the frequency increases, ME activated the ECR later than TA at all frequencies higher than 0.9 Hz.

Anti-phase movements (hand extension coupled to foot plantar flexion) were performed only upto 1 Hz in unloaded conditions. At 0.6 Hz, movements were in tight phase-opposition (3°), but at 1 Hz, the hand lag reached −34° because of a delayed ECR activation. After hand loading ME was unable to couple movements in anti-phase. In contrast, normal subjects maintain a tight anti-phase coupling up to 2.0 Hz, both with an unloaded or loaded hand. Similar deficits were observed by ME when performing in-phase and anti-phase coupling on the left side, as well as when he was blindfolded.

In normal subjects, an anticipated muscular activation of hand movers compensates for hand loading. Since this compensation must depend on monitoring the hand delay induced by loading, the absence in ME of such compensatory reaction suggests that callosal division had apparently compromised the mechanisms sustaining feedback compensation for differences in the biomechanical limb properties. They also confirm and reinforce the idea that elaboration of the afferent message, aiming at controlling the phase of the movement association, needs the co-operation of both cerebral hemispheres.     

Weighted vest effects on impact forces and joint work during vertical jump landings in men and women

Weighted vest (WV) use during vertical jump landings (VJL) does not appear to alter peak vertical ground reaction forces (GRF) or peak joint torques. However, WV effects on joint work and sex differences during VJL are not well understood. This study assessed WV effects on vertical GRF and sagittal joint work during VJL in men and women. Twelve men and 12 women performed VJL wearing a WV with zero added mass (unloaded) and with 10% body mass (loaded) while GRF and kinematic data were obtained. Mixed-model analyses of variance (α = 0.05) and effect sizes (ES) were used to assess differences between sexes and/or load conditions. Regardless of sex, greater landing height (p < 0.001; ES = 0.37) and peak vertical GRF (p = 0.001; ES 0.51) occurred when unloaded, while greater landing time (p = 0.001; ES = 0.46) and negative lower extremity work (p < 0.001; ES = 0.41) occurred when loaded through greater negative work about the hip (p = 0.001; ES = 0.27) and ankle (p = 0.020; ES = 0.27). No differences in hip (p = 0.753; ES = 0.03), knee (p = 0.588; ES = 0.07), or ankle (p = 0.580; ES = 0.09) joint displacement were detected between loaded and unloaded conditions. Men exhibited greater landing heights (p < 0.001; ES = 2.49) and greater peak vertical GRF than women (p = 0.007; ES = 1.18), though women exhibited greater negative lower extremity work (p < 0.001; ES = 1.98) than men through greater negative knee (p < 0.001; ES = 1.98) and ankle (p = 0.032; ES = 0.94) work. No sex differences were detected for joint angular displacement about the hip (p = 0.475; ES = 0.30), knee (p = 0.666; ES = 0.18), or ankle (p = 0.084; ES = 0.71). These data revealed a unique load accommodation strategy during VJL with a WV characterized by greater lower extremity joint work performed via increased joint torque despite lesser landing height and peak vertical GRF. Women appear to perform greater lower extremity joint work than men during VJL despite lesser landing height and peak vertical GRF. Current and prospective WV users should be aware of their load accommodation strategy during VJL with an external load. Women may consider developing more refined load accommodation strategies for VJL regardless of whether external loading is applied to avoid performing excessive amounts of lower extremity work.     

Frontal plane multi-segment foot kinematics in high- and low-arched females during dynamic loading tasks

The functions of the medial longitudinal arch have been the focus of much research in recent years. Several studies have shown kinematic differences between high- and low-arched runners. No literature currently compares the inter-segmental foot motion of high- and low-arched recreational athletes. The purpose of this study was to examine inter-segmental foot motion in the frontal plane during dynamic loading activities in high- and low-arched female athletes. Inter-segmental foot motions were examined in 10 high- and 10 low-arched female recreational athletes. Subjects performed five barefooted trials in each of the following randomized movements: walking, running, downward stepping and landing. Three-dimensional kinematic data were recorded. High-arched athletes had smaller peak ankle eversion angles in walking, running and downward stepping than low-arched athletes. At the rear-midfoot joint high-arched athletes reached peak eversion later in walking and downward stepping than the low-arched athletes. The high-arched athletes had smaller peak mid-forefoot eversion angles in walking, running and downward stepping than the low-arched athletes. The current findings show that differences in foot kinematics between the high- and low-arched athletes were in position and not range of motion within the foot.     

“Posture first”: Interaction between posture and locomotion in people with low back pain during unexpectedly cued modification of gait initiation motor command

The ability to adapt anticipatory postural adjustments (APAs) in response to perturbations during single-joint movements is altered in people with chronic low back pain (LBP), but a comprehensive analysis during functional motor tasks is still missing. This study aimed to compare APAs and stepping characteristics during gait initiation between people with LBP and healthy controls, both in normal (without cue occurrence) condition and when an unexpected visual cue required to switch the stepping limb. Fourteen individuals with LPB and 10 healthy controls performed gait initiation in normal and switch conditions. The postural responses were evaluated through the analysis of center of pressure, propulsive ground reaction forces, trunk and whole-body kinematics, and activation onsets of leg and back muscles. During normal gait initiation, participants with LBP exhibited similar APAs and stepping characteristics to healthy controls. In the switch condition, individuals with LBP were characterized by greater mediolateral postural stability but decreased forward body motion and propulsion before stepping. The thorax motion was associated with forward propulsion parameters in both task conditions in people with LBP but not healthy controls. No between-group differences were found in muscle activation onsets. The results suggest that postural stability is prioritized over forward locomotion in individuals with LBP. Furthermore, the condition-invariant coupling between thorax and whole-body forward propulsion in LBP suggests an adaptation in the functional use of the thorax within the postural strategy, even in poor balance conditions.