Browsing by Author "Silvestre, Rony"

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    Eccentric and concentric contraction of multifidus lumborum and longissimus muscles during flexion-relaxation test using discrete wavelet transform
    (2023) Silvestre, Rony; Carlos Letelier, Juan; Perez, Marcelo; Cifre, Manuela; De la Fuente, Carlos
    Purpose Muscle activation can reflect the stability of the lumbar spine based on the electrical features and kinematics during a dynamic test. However, there is a lack of knowledge of the activation of paravertebral muscles i.e., during the flexion-relaxation test. Hence, we determine the band frequency differences between eccentric (ECC) and concentric (CON) contraction during the flexion-relaxation test in healthy untrained participants without lumbar pain, both multifidus lumborum and longissimus muscles. Methods 40 healthy participants (aged 30.6 +/- 6.9 years) were recruited. Kinematic and surface electromyography were collected to compare the ECC and CON spectral characteristics of both multifidus lumborum and longissimus. The bursts were transformed using a discrete wavelet transform (Daubechies). The band frequencies were compared through mean comparison test with alpha set to 5%. Results Both multifidus lumborum and longissimus muscles had higher intensity in ECC contraction than CON for frequency bands lower than 32 Hz (P < 0.05); meanwhile, there was a higher intensity in CON contraction than ECC for frequency bands higher than 32 or 64 Hz until 256 Hz (P < 0.05). Conclusion For both paravertebral muscles analyzed, discrete wavelet decomposition suggests that during the flexion-relaxation test there is an ECC contraction characterized by low-frequency bands compared with the CON phase characterized by medium- and higher-frequency bands both paravertebral muscles analyzed. The spectral characteristics might be a useful physiological neuromuscular reference to the pathophysiology adaptations of the paravertebral muscle contraction.
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    Effects of Elbow Crutch Locomotion on Gluteus Medius Activation During Stair Ascending
    (2022) De La Fuente Cancino, Carlos Ignacio; Neira, Alejandro; Torres, Gustavo; Silvestre, Rony; Roby, Matias; Yañez, Roberto; Herrera, Sofia; Martabit, Virgina; McKay, Isabel; Carpes, Felipe P.
    Crutches can help with the locomotion of people with walking disorders or functional limitations. However, little is known about hip muscle activation during stair ascending using different crutch locomotion patterns in people without disorders and limitations. Thus, we determined the acute effects of elbow crutch locomotion on gluteus medius (GM) activity during stair ascending. This comparative analytic cross-sectional study enrolled ten healthy men (22.0 ± 0.47 years). Participants climbed up the stairs with elbow crutches using one or two crutches, with ipsilateral or contralateral use, and after loading or unloading a limb. EMG signals were recorded from anterior, middle, and posterior portions of the GM and compared between the crutch conditions. The Kruskal–Wallis test and Dunn’s multiple comparison test were performed (α= 5%). The activation of the GM increased with the ipsilateral use of crutches, with two crutches and three points, and when all the load depended only on one limb. GM activation decreased with contralateral use and in the unload limb. In conclusion, ascending stairs with elbow crutches alters the GM activation. The more critical factors were choosing the crutches’ lateral use, the number of crutches, and if the limb is loaded or unloaded while ascending the stairs. Our findings can be helpful to increase or decrease the GM activation for those who use or will use crutches.
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    Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band-Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels
    (2024) Yanez, Roberto; Silvestre, Rony; Roby, Matias; Neira, Alejandro; Madera, Samuel; de la Fuente, Carlos
    Traditional lateral extra-articular tenodesis (LET) using fixation elements constrains medial knee rotation laxity after anterior cruciate ligament reconstruction (ACLr). However, the mechanical behavior of an LET made with an iliotibial band-intermuscular septum is unknown using different anterior cruciate ligament (ACL) reconstruction drillings and would be crucial for constraining the rotatory components of direction change movements. Thus, this study aimed to explore the maximum principal stresses and their distribution in grafts during medial knee rotation with and without iliotibial band-intermuscular septum lateral extra-articular tenodesis for the transtibial technique (TT), hybrid transtibial technique (HTT), and anteromedial portal technique (AM) in single-bundle ACLr. The maximum von Mises principal stresses and their distribution under medial knee rotation were described using a finite element model generated from a healthy knee. LET with HTT, TT, and AM decreases stress by 97%, 93%, and 86% during medial rotation compared to each technique without LET, respectively. The stress concentration for the AM portal and TT techniques was located at the femoral tunnel, and for HTT with LET, it was located across the distal thirds of the anterior aspect of the graft. In conclusion, the HTT with LET diminishes graft stress more than the HTT, TT, and AM without LET, and the TT and AM with LET during medial knee rotation. The AM portal, HTT, and TT techniques without LET show higher stress concentration patterns at the femoral tunnel, establishing a biomechanical risk of femoral tunnel enlargement when LET is not performed.
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    Intraoperative pivot-shift accelerometry combined with anesthesia improves the measure of rotatory knee instability in anterior cruciate ligament injury
    (2021) Caracciolo, Gastón; Yáñez, Roberto; Silvestre, Rony; De la Fuente, Carlos; Zamorano, Héctor; Ossio, Alejandra; Strömbäck, Lars; Abusleme, Sebastian; P. Carpes, Felipe
    Purpose: The knee stifness acquired following an Anterior Cruciate Ligament (ACL) injury might afect clinical knee tests, i.e., the pivot-shift maneuver. In contrast, the motor efects of spinal anesthesia could favor the identifcation of rotatory knee defciencies prior to ACL reconstruction. Hence, we hypothesized that the intra-operative pivot-shift maneuver under spinal anesthesia generates more acceleration in the lateral tibial plateau of patients with an injured ACL than without. Methods: Seventy patients with unilateral and acute ACL rupture (62 men and 8 women, IKDC of 55.1±13.8 pts) were assessed using the pivot-shift maneuver before and after receiving spinal anesthesia. A triaxial accelerometer was attached to the skin between Gerdys’ tubercle and the anterior tuberosity to measure the subluxation and reduction phases. Mixed ANOVA and multiple comparisons were performed considering the anesthesia and leg as factors (alpha=5%). Results: We found a higher acceleration in the injured leg measured under anesthesia compared to without anesthesia (5.12±1.56m.s−2 vs. 2.73±1.19m.s−2 , p<0.001), and compared to the non-injured leg (5.12±1.56m.s−2 vs. 3.45±1.35m.s−2 , p<0.001). There was a presence of signifcant interaction between leg and anesthesia conditions (p<0.001). Conclusions: The pivot-shift maneuver performed under anesthesia identifes better rotatory instability than without anesthesia because testing the pivot-shift without anesthesia underestimates the rotatory subluxation of the knee by an increased knee stifness. Thus, testing under anesthesia provides a unique opportunity to determine the rotational instability prior to ACL reconstruction.
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    Intrasession Real-time Ultrasonography Feedback Improves the Quality of Transverse Abdominis Contraction
    (2020) De la Fuente, Carlos; Silvestre, Rony; Baechler, Paula; Gemigniani, Antonia; Grunewaldt, Karol; Vassiliu, Maria; Wodehouse, Valeria; Delgado, Mauricio; Carpes, Felipe P.
    Objective: The purpose of this study was to compare changes in thickness of the transverse abdominis during performance of the hollowing exercise guided by feedback using ultrasonography images together with verbal guidance and using verbal guidance alone. We also determined the minimal detectable change and agreement between normalized pressures and muscle thickness.
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    Is the Rotatory Knee Stability Immediately Decreased Following a Competitive Soccer Match?
    (2022) Neira, Alejandro; Silvestre, Rony; Debandi, Anibal; Darras, Daniel; Cristi-Sanchez, Iver; Barra, Ignacio; Penailillo, Luis; De La Fuente, Carlos
    Fatigue induced by soccer playing increases physical efforts, which might alter the transverse knee stability, a known factor that promotes knee injuries, particularly anterior cruciate ligament injury. Thereby, primarily, we aimed to determine whether rotatory knee stability decreases immediately following a competitive soccer match in amateur players. Furthermore, we assessed the role of the preferred and non-preferred limbs to kick a ball in rotatory knee stability and the correlation between performance parameters and rotatory knee stability. We hypothesized that the knee stability decreases immediately after a competitive soccer match in amateur players. Eight healthy amateur soccer players (aged 27.2 +/- 4.7 years and with body mass index of 23.8 +/- 1.2 kg m(-2)) were included immediately before and after a competitive soccer match. The rotatory knee stability was assessed in the preferred and non-preferred limbs through the acceleration and jerk of the pivot shift maneuver and by the internal knee rotation of a pivoting landing task. Two-way repeated-measures ANOVA for factors time (before and after the soccer match) and limb (preferred and non-preferred) and multiple comparisons were performed using alpha = 5%. There was a statistical significance for the main factor time in the acceleration (5.04 vs. 6.90 ms(-2), Delta = 1.86 ms(-2), p = 0.020, eta(2) = 0.331) and jerk (18.46 vs. 32.10 ms(-2), Delta = 13.64 ms(-2), p = 0.004, eta(2) = 0.456) of the pivot shift maneuver. Rotatory stability decreases following a competitive soccer match in amateur soccer players under fatigue. Both the acceleration and jerk during the pivot shift maneuver is increased without significant internal knee rotation changes during the pivoting landing task.
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    Multiclass Support Vector Machine improves the Pivot-shift grading from Gerdy's acceleration resultant prior to the acute Anterior Cruciate Ligament surgery
    (2023) Yanez-Diaz, Roberto; Roby, Matias; Silvestre, Rony; Zamorano, Hector; Vergara, Francisco; Sandoval, Carlos; Neira, Alejandro; Yanez-Rojo, Cristobal; De la Fuente, Carlos
    Introduction: Rotatory laxity acceleration still lacks objective classification due to interval grading superposition, resulting in a biased pivot shift grading prior to the Anterior Cruciate Ligament (ACL) reconstruction. However, data analysis might help improve data grading in the operative room. Therefore, we described the improvement of the pivot-shift categorization in Gerdy's acceleration under anesthesia prior to ACL surgery using a support vector machine (SVM) classification, surgeon, and literature reference. Methods: Seventy-five patients (aged 30.3 +/- 10.2 years, and IKDC 52.0 +/- 16.5 points) with acute ACL rupture under anesthesia prior to ACL surgery were analyzed. Patients were graded with pivot-shift sign glide ( + ), clunk ( ++ ), and ( +++ ) gross by senior orthopedic surgeons. At the same time, the tri-axial tibial plateau acceleration was measured. Categorical data were statistically described, and the accelerometry and categorical data were associated ( alpha = 5%). A multiclass SVM kernel with the best accuracy trained by orthopedic surgeons and assisted from literature for missing data was compared with experienced surgeons and literature interval grading. The cubic SVM classifier achieved the best grading.Results: The intra-group proportions were different for each grading in the three compared strategies ( p < 0.001). The inter-group proportions were different for all comparisons ( p < 0.001). There were significant ( p < 0.001) associations (Tau: 0.69, -0.28, and -0.50) between the surgeon and SVM, the surgeon and interval grading, and the interval and SVM, respectively.Conclusion: The multiclass SVM classifier improves the acceleration categorization of the ( + ), ( ++ ), and ( +++ ) pivot shift sign prior to the ACL surgery in agreement with surgeon criteria.(c) 2023 Elsevier Ltd. All rights reserved.
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    Preseason multiple biomechanics testing and dimension reduction for injury risk surveillance in elite female soccer athletes: short-communication
    (2023) De la Fuente, Carlos; Silvestre, Rony; Yanez, Roberto; Roby, Matias; Soldan, Macarena; Ferrada, Wilson; Carpes, Felipe P.
    Background Injury risk is regularly assessed during the preseason in susceptible populations like female soccer players. However, multiple outcomes (high-dimensional dataset) derived from multiple testing may make pattern recognition difficult. Thus, dimension reduction and clustering may be useful for improving injury surveillance when results of multiple assessment tools are available. Aim To determine the influence of dimension reduction for pattern recognition followed by clustering on multiple biomechanical injury markers in elite female soccer players during preseason. Methdology We introduced the use of dimension reduction through linear principal component analysis (PCA), non-linear kernel principal component analysis (k-PCA), t-distributed stochastic neighbor embedding (t-sne), and uniform manifold approximation and projection (umap) for injury markers via grid search. Muscle strength, muscle function, jump technique and power, balance, muscle stiffness, exercise tolerance, and running performance were assessed in an elite female soccer team (n = 21) prior to the competitive season. Results As a result, umap facilitated the injury pattern recognition compared to PCA, k-PCA, and t-sne. One of the three patterns was related to a team subgroup with acceptable muscle conditions. In contrast, the other two patterns showed higher injury risk profiles. For our dataset, umap improved injury surveillance through multiple testing characteristics. Conclusion Dimension reduction and clustering techniques present as useful strategies to analyze subgroups of female soccer players who have different risk profiles for injury.
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    Role of Lateral Ankle Ligaments in Vertical Stability of the Fibula: A Cadaveric Model
    (2023) Filippi, Jorge; Gutierrez, Paulina; Quezada, Jose; Massri-Pugin, Jafet; Bastias, Gonzalo F.; Melo, Rodrigo; Vidal, Catalina; Silvestre, Rony
    Background: In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane.
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    Steadiness training improves the quadriceps strength and self-reported outcomes in persistent quadriceps weakness following nine months of anterior cruciate ligament reconstruction and failed conventional physiotherapy
    (2022) De la Fuente, Carlos; Stoelben, Karine J. V.; Silvestre, Rony; Yanez, Roberto; Cheyre, Jorge; Guadagnin, Eliane C.; Carpes, Felipe P.
    Background
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    Supraspinatus activation precedes the infraspinatus muscle during the shoulder abduction in different levels of handgrip strengths
    (2022) Torres, Jorge; Droppelmann, Guillermo; Silvestre, Rony; De la Fuente, Carlos
    Purpose It is unknown whether the effect of increased distal stabilization can trigger the onset of the supraspinatus and infraspinatus muscles, and if handgrip strength levels can elicit early proximal shoulder stabilization. Hence, we aimed to compare the electromyography activation of the Supraspinatus and Infraspinatus muscles during the abduction motion with handgrip strength in different levels (0%, 30%, and 60%) of maximal voluntary isometric contraction (MVIC). Methods Twenty participants were submitted to abduction shoulder movement with three different handgrip strengths (0%, 30%, and 60%) using electromyography. The onset of Supraspinatus and Infraspinatus muscles was measured. A Friedman's test was used to compare handgrip conditions and the onset between muscles. Then, multiple comparisons were performed. All alpha errors were set to 5%. Results There was an anticipated onset for Supraspinatus muscle at 0% of the MVIC {- 0.554 [- 0.657 to - 0.497] ms vs. - 0.098 [- 0.264 to 0.108] ms, p < 0.001}, at 30% of the MVIC {- 0.560 [- 0.628 to - 0.521] ms vs. - 0.125 [- 0.243 to - 0.031] ms, p < 0.001), and at 60% of the MVIC {- 0.543 [- 0.573 to - 0.514] ms vs. - 0.215 [- 0.325 to - 0.017] ms, p = 0.001}. Conclusion Shoulder abduction with handgrip triggers the onset of the Supraspinatus and Infraspinatus muscles. The Supraspinatus muscle elicits an anticipated onset. Two stabilizing strategies are suggested; the internal rotation instability capable be induced by the deltoid muscles (abduction movement) and from the wrist flexor-pronator muscles (handgrip). Both tasks are counteracted and anticipated by the action of the Supraspinatus and Infraspinatus muscles.
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    Unique case study: Impact of single-session neuromuscular biofeedback on motor unit properties following 12 days of Achilles tendon surgical repair
    (2024) De la Fuente, Carlos; Silvestre, Rony; Botello, Julio; Neira, Alejandro; Soldan, Macarena; Carpes, Felipe P.
    We explored the first evidence of a single-session neuromuscular biofeedback effect on motor unit properties, neuromuscular activation, and the Achilles tendon (AT) length 12 days after undergoing AT surgical repair. We hypothesized that immediate neuromuscular biofeedback enhances motor unit properties and activation without causing AT lengthening. After 12 days AT surgical repair, Medial Gastrocnemius (MG) motor unit decomposition was performed on a 58-year-old male before and after a neuromuscular biofeedback intervention (surface electromyography (sEMG) and ultrasonography), involving unressited plantar flexion. The analysis included motor unit population properties, sEMG amplitude, force paradigm, and AT length. There were increased MG motor unit recruitment, peak and average firing rate, coefficient of variation, and sEMG amplitude, and decreased recruitment and derecruitment threshold in the repaired AT limb. The non-injured limb increased the motor unit recruitment, and decreased the coefficient of variation, peak and average firing rate, inter-pulse interval, derecruitment threshold and sEMG amplitude. The AT length experienced -0.4 and 0.3 cm changes in the repaired AT and non-injured limb, respectively. This single-session neuromuscular biofeedback 12 days after AT surgery shows evidence of enhanced motor unit properties and activation without signs of AT lengthening when unresisted plantar flexion is performed in the repaired AT limb.