PURPOSE: To compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects.SCOPE: Nine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions.RESULTS: Perturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait.CONCLUSIONS: Healthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.
Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2–4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2–1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73–0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79–0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64–0.90 for 60-day mortality and HR 0.80, 95%CI 0.68–0.93 for 6-month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.
Skeletal muscle-related symptoms are common in both acute coronavirus disease (Covid)-19 and post-acute sequelae of Covid-19 (PASC). In this narrative review, we discuss cellular and molecular pathways that are affected and consider these in regard to skeletal muscle involvement in other conditions, such as acute respiratory distress syndrome, critical illness myopathy, and post-viral fatigue syndrome. Patients with severe Covid-19 and PASC suffer from skeletal muscle weakness and exercise intolerance. Histological sections present muscle fibre atrophy, metabolic alterations, and immune cell infiltration. Contributing factors to weakness and fatigue in patients with severe Covid-19 include systemic inflammation, disuse, hypoxaemia, and malnutrition. These factors also contribute to post-intensive care unit (ICU) syndrome and ICU-acquired weakness and likely explain a substantial part of Covid-19-acquired weakness. The skeletal muscle weakness and exercise intolerance associated with PASC are more obscure. Direct severe acute respiratory syndrome coronavirus (SARS-CoV)-2 viral infiltration into skeletal muscle or an aberrant immune system likely contribute. Similarities between skeletal muscle alterations in PASC and chronic fatigue syndrome deserve further study. Both SARS-CoV-2-specific factors and generic consequences of acute disease likely underlie the observed skeletal muscle alterations in both acute Covid-19 and PASC.
Onderzoek toont aan dat explosief spiervermogen ('muscle power') de bepalende factor is voor fysiek functioneren van ouderen. Er zijn steeds meer aanwijzingen dat het specifiek trainen van power het fysiek functioneren en zelfredzaamheid van ouderen positief beïnvloedt.Doel Dit onderzoek heeft als doel om de effectiviteit van powertraining op het fysieke functioneren en de zelfredzaamheid van ouderen vast te stellen. Resultaten Dit onderzoek loopt nog. Na afloop vind je hier de resultaten. Looptijd 17 september 2017 - 01 augustus 2024 Aanpak We ontwikkelden een interventie waarin ouderen enkele weken lang specifieke spieren trainen. We volgen ouderen die de training volgen tot twee jaar om de effecten van de training te meten ten opzichte van ouderen die geen training volgden. Zie ook http://www.powerful-ageing.nl
Het aantal migrantenouderen neemt sterk toe. Zij hebben een slechtere gezondheid dan autochtone ouderen. Zo komen chronische ziekten zoals obesitas en diabetes type 2 vaker voor. Een van de belangrijkste onderliggende oorzaken van deze ziekten is sarcopenie, verlies van spiermassa en fysiek functioneren van ouderen. Te weinig bewegen en een inadequate eiwitinname spelen een essentiële rol bij sarcopenie en daarbij ook bij chronische ziekten. Inzicht in sarcopenie, het beweegpatroon en de eiwitinname van migrantenouderen zijn onvoldoende beschikbaar. MKB-praktijken voor fysiotherapie en diëtetiek zien businesskansen om specifiek voor deze sterk groeiende doelgroep expertise op te bouwen en daarmee een groot aantal klanten te kunnen bedienen en te behouden. Het ontbreekt de praktijken echter aan de nieuwste kennis en inzichten voor een effectieve behandeling van sarcopenie bij migrantenouderen. Er zijn geen behandelprogramma’s beschikbaar die zij kunnen gebruiken. Daarnaast ondervinden zij met deze doelgroep problemen met de taal, opleidingsniveau en cultuurverschillen. Voor deze vraag van de MKB-praktijken wordt een beweeg- en voeding programma ontwikkeld speciaal gericht op de behoeften van migrantenouderen, fysiotherapeuten en diëtisten. Middels focusgroepen worden de behoeften van professionals en migrantenouderen onderzocht en voorspellers van beweeg- en voedinggedrag in kaart gebracht. Tevens wordt het fysiek functioneren, lichaams-samenstelling, beweeg- en voedingspatroon van verschillende migrantenouderen populaties geanalyseerd. Gebaseerd op deze uitkomsten wordt een nieuw beweeg en voedingsprogramma ontwikkeld om spiermassa en het fysiek functioneren van migrantenouderen te verbeteren (ProMIO programma). Hiervoor kunnen we gebruik maken van het ProMuscle programma, een succesvol voedings- en beweegprogramma voor sarcopenie uitkomsten voor ouderen. Middels een pilot studie wordt het ProMIO programma in de praktijk geëvalueerd op proces, haalbaarheid en bruikbaarheid voor de professional en migrantenouderen en wordt de effectiviteit op sarcopenie uitkomsten getoetst. De resultaten zullen worden gecommuniceerd naar de beroepenvelden en worden ingebed in het HBO-onderwijs.
The admission of patients to intensive care units (ICU) is sometimes planned after a large operation. However, most admissions are acute, because of life-threatening infections or trauma as a result of accidents. Their stay can last from a couple of days to a couple of weeks. ICU patients are often in pain, in fragile health condition, and connected to various devices such as a ventilator, intravenous drip, and monitoring equipment. The resulting lack of mobilization, makes patients lose 1-3% of muscle power for each day they are in the ICU. Within 2 weeks, patients can lose up to 50% of their muscle mass. Early mobilization of ICU patients reduces their time on a respirator and their hospital length of stay. Because of this, ICUs have started early mobilization physical therapy. However, there is a lack of solutions for patients that properly handle fear of movement, are sufficiently personalized to the possibilities and needs of the individual and motivate recurring use in this context. Meanwhile, various technological advances enable new solutions that might bring benefits for this specific use case. Hospitals are experimenting with screens and projections on walls and ceilings to improve their patients’ stay. Standalone virtual reality and mixed reality headsets have become affordable, available and easy to use. In this project, we want to investigate: How can XR-technologies help long-stay ICU patients with early mobilization, with specific attention to the issues of fear of movement, personalization to the individual’s possibilities, needs and compliance over multiple sessions? The research will be carried out in co-creation with the target group and will consist of a state-of-the-art literature review and an explorative study.
