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    <IdentifierDoi>10.3205/25premus064</IdentifierDoi>
    <IdentifierUrn>urn:nbn:de:0183-25premus0641</IdentifierUrn>
    <ArticleType>Meeting Abstract</ArticleType>
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      <Title language="en">Electromyography of the forearm muscles during physical therapy tasks: evaluation and comparison of normalization methods</Title>
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          <Lastname>Braun</Lastname>
          <LastnameHeading>Braun</LastnameHeading>
          <Firstname>Theresa</Firstname>
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          <Affiliation>Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany</Affiliation>
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          <Affiliation>Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany</Affiliation>
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          <Affiliation>Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany</Affiliation>
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          <Affiliation>German Social Accident Insurance (DGUV), Institution for the Health and Welfare Services (BGW), Hamburg, Germany</Affiliation>
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          <Affiliation>German Social Accident Insurance (DGUV), Institution for the Health and Welfare Services (BGW), Hamburg, Germany</Affiliation>
          <Affiliation>Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany</Affiliation>
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          <Affiliation>Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany</Affiliation>
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          <Corporatename>German Medical Science GMS Publishing House</Corporatename>
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        <Address>D&#252;sseldorf</Address>
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    <SubjectGroup>
      <SubjectheadingDDB>610</SubjectheadingDDB>
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    <DatePublishedList>
      <DatePublished>20250909</DatePublished>
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    <Language>engl</Language>
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      <AltText language="en">This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.</AltText>
      <AltText language="de">Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).</AltText>
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      <Meeting>
        <MeetingId>M0625</MeetingId>
        <MeetingSequence>064</MeetingSequence>
        <MeetingName>12th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders</MeetingName>
        <MeetingTitle>PREMUS 2025</MeetingTitle>
        <MeetingSession>Oral PS 12</MeetingSession>
        <MeetingCity>T&#252;bingen</MeetingCity>
        <MeetingDate>
          <DateFrom>20250909</DateFrom>
          <DateTo>20250912</DateTo>
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    <ArticleNo>064</ArticleNo>
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      <MainHeadline>Text</MainHeadline><Pgraph><Mark1>Introduction:</Mark1> Physical therapists often experience work-related musculoskeletal disorders in the wrist and thumb <TextLink reference="1"></TextLink>. It is important to quantify the load on these structures using measurement technologies such as electromyography (EMG), which can be incorporated into the CUELA risk assessment framework developed by the Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV). Although EMG is widely used to assess muscular load, guidelines on forearm EMG normalization - critical for comparing individuals, trials, and muscles - are lacking. This work aimed to identify a normalization method for forearm EMG, including the thumb muscles, specifically tailored for field studies with physical therapists. The project is funded by the German Social Accident Insurance for the Health and Welfare Services (BGW).</Pgraph><Pgraph><Mark1>Methods:</Mark1> 15 healthy physical therapists, equipped with seven EMG sensors per forearm, performed a series of reference contractions for normalization purposes using a force gauge dynamometer. These included five maximal voluntary contractions (MVCs) across four distinct grip positions (cylinder, pincer, fingertip, and lateral grip) and four submaximal reference voluntary contractions (RVCs) in the cylinder grip at different force levels (25&#37;, 50&#37;, 75&#37; of MVC, and 100N). The normalization methods were evaluated regarding </Pgraph><Pgraph><OrderedList><ListItem level="1" levelPosition="1" numString="1.">the ability of the MVCs to elicit true maximal activation in the investigated muscles, </ListItem><ListItem level="1" levelPosition="2" numString="2.">the intra-session test-retest reliability of the reference contractions, and </ListItem><ListItem level="1" levelPosition="3" numString="3.">the practical suitability for their use in field studies.</ListItem></OrderedList></Pgraph><Pgraph><Mark1>Results:</Mark1> On average, the MVC in the cylinder grip generated the highest EMG levels across all sensors and subjects, exceeding 90&#37; of the maximum EMG recorded during any of the five MVCs. Performing the MVC in the pincer grip in addition, and taking the highest value from both, further increased the average EMG levels across all subjects for the thumb muscles (right: from 93.9&#37; to 99.5&#37;; left: from 93.2&#37; to 97.4&#37;). All reference contractions showed moderate to good reliability (intraclass correlation coefficients &#61; 0.69-0.94; &#37; standard error of measurement &#61; 9.2-32.3&#37;). When comparing the reliability of RVCs and MVCs in the cylinder grip, neither method demonstrated clear superiority over the other.</Pgraph><Pgraph><Mark1>Discussion:</Mark1> Regarding the practical suitability for the use in field studies MVCs and RVCs at 100N were found to be comparable, as the complexity, time, and equipment requirements for these normalization methods were similar. However, as opposed to RVCs, normalizing to MVCs allows muscular load to be interpreted relative to a subject&#8217;s maximal capacity. Therefore, normalization to MVCs in the cylinder grip combined with the pincer grip for thumb muscles is preferred, while normalization to RVCs at 100N is a suitable alternative for individuals unable to perform maximal contractions due to pain.</Pgraph><Pgraph><Mark1>Conclusion:</Mark1> The results provide a scientific basis for selecting an appropriate forearm EMG normalization method in field studies with physical therapists, contributing to the development of a sensor-based approach for measuring wrist&#47;thumb load.</Pgraph></TextBlock>
    <References linked="yes">
      <Reference refNo="1">
        <RefAuthor>Waller E</RefAuthor>
        <RefAuthor>Bowens A</RefAuthor>
        <RefAuthor>Washmuth N</RefAuthor>
        <RefTitle>Prevalence of and prevention for work-related upper limb disorders among physical therapists: a systematic review</RefTitle>
        <RefYear>2022</RefYear>
        <RefJournal>BMC Musculoskelet Disord</RefJournal>
        <RefPage>453</RefPage>
        <RefTotal>Waller E, Bowens A, Washmuth N. Prevalence of and prevention for work-related upper limb disorders among physical therapists: a systematic review. BMC Musculoskelet Disord. 2022 May 14;23(1):453. DOI: 10.1186&#47;s12891-022-05412-8</RefTotal>
        <RefLink>http:&#47;&#47;dx.doi.org&#47;10.1186&#47;s12891-022-05412-8</RefLink>
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