Study Guide. Master of Science in Physiotherapy (Kandidatuddannelsen i fysioterapi) Assessment of muscle function and neuromuscular activity

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1 Study Guide Master of Science in Physiotherapy (Kandidatuddannelsen i fysioterapi) Assessment of muscle function and neuromuscular activity 3rd semester (5th quarter) (September 5 - September ) 1

2 Contents Contents... 2 Prerequisites... 3 Course content... 3 Aims of the course... 3 Achieved skills... 3 Teaching methods... 3 Workload... 4 Module overview... 5 Evaluation and testing... 5 Evaluation of the module... 5 Course coordinator... 5 Course secretary... 5 Lecturers... 6 Course Plan

3 Prerequisites A bachelor in sports science, physiotherapy, occupational therapy, medicine or clinical biomechanics. Course content The course will give insight into different methods and their strengths and limitations for assessment of muscle function and neuromuscular activity such as isokinetics, force plate analysis, twitch interpolation and electromyography (EMG). The course will give insight into the use of the above-mentioned methods to investigate selected physiotherapy related research questions. The course will give insight to basic analytical methods to analyze biomechanical data in relation to the above-mentioned methods The course will give hands-on experience with procedures and data sampling in the biomechanical laboratory Aims of the course The aims of the course Assessment of muscle function and neuromuscular activity are to give the students knowledge about methods used for assessment of muscle function and neuromuscular activity in physiotherapy research and in the clinical setting and how to interpret the results of such methods. Achieved skills Completion of the course will provide the student with the following skills: Theoretical, Academic skills Knowledge about basic biomechanical concepts such as; maximal muscle strength, rate of force development (RFD), torque vs force, electromyography (EMG) and normalized EMG Knowledge about methods used to assess muscle function and EMG and their strengths and limitations in physiotherapy research and in the clinic Basic knowledge on analytical methods used for assessment of muscle function and neuromuscular activity Ability to synthesize and present obtained biomechanical data Ability to read and critically scrutinize research literature on the topic of muscle function and neuromuscular activity Practical, Didactic skills Assist in set-up and collection of data in the biomechanical laboratory Ability to graphically present obtained biomechanical data Teaching methods Blended learning with a combination of of lectures, problem-based learning and laboratory exercises. 3

4 The students are expected to engage actively in discussions during lectures and exercises. Furthermore, they are expected to participate actively in laboratory experiments and participate in the preparation of work reports from the experiments. Workload 5 ECTS equivalent to approximately 138 hours of course work: Course literature and online material Scheduled lectures and course work Exam and exam preparation Total 78 hours 36 hours 24 hours 138 hours 4

5 Module overview Week 1 (36) (5/9-9/9) Week 2 (37) (12/9-16/9) Week 3 (38) (19/9-23/9) Monday Tuesday Wednesday Thursday Friday Course Twitch Muscle strength introduction and Interpolation (LH) and related Muscle strength variables (PAA) and related variables (JBT) Muscle activity and motor control (KS, CML) Muscle activity and motor control (KS) Evaluation and testing Muscle activity and motor control (KS) Questions regarding exam The course is completed with a 3 hour written exam. All aids are allowed for the exam except internet access. Grading of students will be according to 7 trins-skalaen by intern evaluation. The grade 12 is given when the student demonstrates comprehensive understanding and knowledge in relation to the content and aim of the course with only minor insufficiencies. Evaluation of the module An oral evaluation will be conducted on the last course day (together with exam questions) with the course coordinator and/or the program leader of the Master of Science Programme in Physiotherapy. Additionally, the course will be evaluated in the standardized manner of the University of Southern Denmark (i.e. electronic evaluation questionnaire via e-learn). Course coordinator Associate professor Jonas Bloch Thorlund Department of Sports Science and Clinical Biomechanics Phone: / jthorlund@health.sdu.dk Course secretary Inge Poetzsch Winsløwparken 19, III, 5000 Odense C Phone: ipoetzsch@health.sdu.dk Muscle strength and related variables (PAA, JBT) EXAM (3 hours) 5

6 Lecturers Professor Per Aagaard (PAA), Department of Sports Science and Clinical Biomechanics Assistant Professor Lars G. Hvid (LH), Department of Sports Science and Clinical Biomechanics Professor Karen Søgaard (KS), Department of Sports Science and Clinical Biomechanics PhD-student Anders Nørkjær Jørgensen (ANJ), Department of Sports Science and Clinical Biomechanics PhD-student Jacob Lindberg Nielsen (JLN), Department of Sports Science and Clinical Biomechanics Associate Professor Jonas Bloch Thorlund (JBT), Department of Sports Science and Clinical Biomechanics 6

7 Course Plan Week 1 (5/9-9/9) Day Monday, September 5 Room: Meeting room 5, building 39 (1 st floor) and biomechanical lab (lab exercise) Course introduction (JBT) Assessment of maximal contractile strength in human skeletal muscle: Basic biomechanical theory (isolated F-V & F-L relationships, muscle torque, lever arm, forcevelocity relationship etc.), isokinetic and static dynamometry, evaluating H:Q-ratio, agonist-antagonist muscle co-contraction effect on net torque, isometric leg-press (i.e. open vs. closed kinetic chain testing) (JBT) Lab work: Assessing human mechanical muscle function (contractile strength and power) in vivo (JBT) Literature: Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: - Chapter 2, pp Chapter 10, pp Aagaard P, Simonsen EB, Magnusson P, Larsson B, Dyhre-Poulsen P. A new concept for isokinetic Hamstring/Quadriceps strength ratio. Am. J. Sports Med. 26(2), , 1998 Additional: Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: - Chapter 1, pp Online learning material to chapter Day: Wednesday, September 7 Room: U72 and muscle lab Assessment of voluntary muscle activation: Basic theory behind assessment of voluntary muscle activation (muscle vs nerve stimulation), the twitch interpolation technique (electrical single/doublet/train stimulation, potentiation) (LH) Lab work: Assessment of voluntary muscle activation using interpolated twitch (LH) Literature: Shield A, Zhou S. Assessing voluntary muscle activation with the twitch interpolated technique. Sports Med 34(4): , Jakobi JM, Rice CL. Voluntary muscle activation varies with age and muscle group. J Appl Physiol 93: , Hvid LG, Strotmeyer ES, Skjodt M, Magnussen LV, Andersen M, Caserotti P. Voluntary muscle activation improves with power training and is associated with changes in gait 7

8 speed in mobility-limited older adults - A randomized controlled trial. Exp Gerontol 80: 51-56, Day Thursday, September 8 Room: U Assessment of in vivo muscle power and Rapid Force Capacity: Basic biomechanical theory (force, velocity, work and displacement), methods for assessing rapid force capacity (rate of force development: RFD) and maximal power (dynamometry, Nottingham power-rig, force plate analysis, Muscle Lab) (PAA) Clinical case Biomechanical and neuromuscular factors involved in non-contact ACL injury (PAA) Literature: Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: - Chapter 3, pp Chapter 5, pp and Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol. 93, ,2002 Holsgaard Larsen A, Caserotti P, Puggaard L, Aagaard P. Reproducibility and relationship of single-joint strength versus multiple-joint strength and power in aging individuals. Scand. J. Med. Sci. Sports 17, 43-53, 2007 Thorlund JB, Michalsik LB, Madsen K, Aagaard P. Acute fatigue-induced changes in muscle mechanical properties and neuromuscular activity in elite handball players following a handball match. Scand. J. Med. Sci. Sports 18, , 2008 Zebis MK, Andersen LL, Bencke J, Kjær M, Aagaard P. Identification of athletes at future risk of Anterior Cruciate Ligament ruptures by neuromuscular screening. Am. J. Sports Med. 37, , 2009 Bencke J, Zebis MK. The influence of gender on neuromuscular pre-activity during sidecutting. J. Electromyogr. Kinesiol. 21, , 2011 Additional: Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: - Chapter 7, pp Online learning material to chapter

9 Day Friday, September 9 Room: U Clinical applications of Blood Flow Restricted Exercise (Kaatsu training) (PAA) Neuromuscular plasticity to training Methods to evaluate the adaptive change in neuromuscular function induced by exercise (PAA) Analysis of Lab exercise data (JBT) Literature: Van Cutsem M, Duchateau J, Hainaut K. Changes in single motor unit behavior contribute to the increase in contraction speed after dynamic training in humans. J. Physiol , , 1998 Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol. 93, ,2002 (også på forrige undervisning) Abe T, Kearns CF, Sato Y. Muscle size and strength are increased following walk training with restricted blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol 100, , 2006 Takarad Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc 32(12), , 2000 Week 2 (12/9 16/9) Day: Monday, September 12 Room: Meeting room 5, building 39 (1 st floor) Introduction to Electromyography (KS) EMG as biofeedback for patients with shoulder impingement (CML) Group work on lab exercise protocol Literature: Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: - Chapter 10, pp Holtermann A, Roeleveld K, Mork PJ, Grönlund C, Karlsson SJ, Andersen LL, Olsen HB, Zebis MK, Sjøgaard G, Søgaard K. (2008). Selective activation of neuromuscular compartments in the human trapezius muscle. J Electromyogr Kinesiol (Dec; 104 (6):983-9.) Larsen CM, Søgaard K, Chreiteh SS, Holtermann A, Juul-Kristensen B. Neuromuscular control of scapula muscles during a voluntary task in subjects with Subacromial Impingement Syndrome. A case-control study. J Electromyogr Kinesiol (E-pub ahead of print) 9

10 Holtermann A, Mork PJ, Andersen LL, Olsen HB, Søgaard K. The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance. J Electromyogr Kinesiol Apr;20(2): Holtermann A, Roeleveld K, Mork PJ, Grönlund C, Karlsson SJ, Andersen LL, Olsen HB, Zebis MK, Sjøgaard G, Søgaard K. (2008). Selective activation of neuromuscular compartments in the human trapezius muscle. J Electromyogr Kinesiol (Dec; 104 (6):983-9.) Holtermann A,, Søgaard K, Christensen H, Dahl B, Blangsted AK. (2008) The influence of biofeedback-training on trapezius activity and rest during occupational computer work at workplace. Eur J Appl Physiol. Dec;104(6): Additional: Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: - Online learning material to chapter 10 Day: Tuesday, September 13 Room: Biomechanical lab Hands on in the laboratory. Assessment of neuromuscular activity during blood flow restricted exercise (JLN, ANJ, HBO) Group work on data overview and defining analysis protocols (KS) Literature: Karlsson JS, Roeleveld K, Grönlund C, Holtermann A, Ostlund N. Signal processing of the surface electromyogram to gain insight into neuromuscular physiology. Philos Trans A Math Phys Eng Sci Jan 28;367(1887): Week 3 (19/9-23/9) Neuromuscular activity and motor control (continued) Day: Monday, September 19 Room: Meeting room 5, building 39 (1 st floor) Introduction to EMG Analysis (HBO, KS) Group work on data analysis and preparing a power point presentation Plenum presentation of results and discussion of protocol revision and improvements. Day: Wednesday, September 21 Room: U Questions regarding exam Day: Friday, September 23 Room: XXX 3 hours Written exam 10

11 References Textbook Richards J. Biomechanics in Clinic and Research (text book). Elsevier, 2008: Chapter 2, pp Chapter 3, pp Chapter 5, pp and Chapter 10, pp Chapter 10, pp Journal articles Abe T, Kearns CF, Sato Y. Muscle size and strength are increased following walk training with restricted blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol 100, , 2006 Bencke J, Zebis MK. The influence of gender on neuromuscular pre-activity during side-cutting. J. Electromyogr. Kinesiol. 21, , 2011 Holsgaard Larsen A, Caserotti P, Puggaard L, Aagaard P. Reproducibility and relationship of single-joint strength versus multiple-joint strength and power in aging individuals. Scand. J. Med. Sci. Sports 17, 43-53, 2007 Holtermann A, Mork PJ, Andersen LL, Olsen HB, Søgaard K. The use of EMG biofeedback for learning of selective activation of intra-muscular parts within the serratus anterior muscle: a novel approach for rehabilitation of scapular muscle imbalance. J Electromyogr Kinesiol Apr;20(2): Holtermann A, Roeleveld K, Mork PJ, Grönlund C, Karlsson SJ, Andersen LL, Olsen HB, Zebis MK, Sjøgaard G, Søgaard K. (2008). Selective activation of neuromuscular compartments in the human trapezius muscle. J Electromyogr Kinesiol (Dec; 104 (6):983-9.) Holtermann A, Søgaard K, Christensen H, Dahl B, Blangsted AK. (2008) The influence of biofeedbacktraining on trapezius activity and rest during occupational computer work at workplace. Eur J Appl Physiol. Dec;104(6): Hvid LG, Strotmeyer ES, Skjodt M, Magnussen LV, Andersen M, Caserotti P. Voluntary muscle activation improves with power training and is associated with changes in gait speed in mobilitylimited older adults - A randomized controlled trial. Exp Gerontol 80: 51-56, Karlsson JS, Roeleveld K, Grönlund C, Holtermann A, Ostlund N. Signal processing of the surface electromyogram to gain insight into neuromuscular physiology. Philos Trans A Math Phys Eng Sci Jan 28;367(1887): Larsen CM, Søgaard K, Chreiteh SS, Holtermann A, Juul-Kristensen B. Neuromuscular control of scapula muscles during a voluntary task in subjects with Subacromial Impingement Syndrome. A casecontrol study. J Electromyogr Kinesiol (E-pub ahead of print) 11

12 Jakobi JM, Rice CL. Voluntary muscle activation varies with age and muscle group. J Appl Physiol 93: , Shield A, Zhou S. Assessing voluntary muscle activation with the twitch interpolated technique. Sports Med 34(4): , Takarad Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc 32(12), , 2000 Thorlund JB, Michalsik LB, Madsen K, Aagaard P. Acute fatigue-induced changes in muscle mechanical properties and neuromuscular activity in elite handball players following a handball match. Scand. J. Med. Sci. Sports 18, , 2008 Van Cutsem M, Duchateau J, Hainaut K. Changes in single motor unit behavior contribute to the increase in contraction speed after dynamic training in humans. J. Physiol , , 1998 Zebis MK, Andersen LL, Bencke J, Kjær M, Aagaard P. Identification of athletes at future risk of Anterior Cruciate Ligament ruptures by neuromuscular screening. Am. J. Sports Med. 37, , 2009 Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Increased rate of force development and neural drive of human skeletal muscle following resistance training. J Appl Physiol. 93, ,2002 Aagaard P, Simonsen EB, Magnusson P, Larsson B, Dyhre-Poulsen P. A new concept for isokinetic Hamstring/Quadriceps strength ratio. Am. J. Sports Med. 26(2), ,

Study Guide. Master of Science in Physiotherapy (Kandidatuddannelsen i fysioterapi) Assessment of muscle function and neuromuscular activity

Study Guide. Master of Science in Physiotherapy (Kandidatuddannelsen i fysioterapi) Assessment of muscle function and neuromuscular activity Study Guide Master of Science in Physiotherapy (Kandidatuddannelsen i fysioterapi) Assessment of muscle function and neuromuscular activity 3rd semester (5th quarter) (Week 36-45 2017) (studieguiden er