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Kaya Keles, Cemre Su

Cemre Su Kaya Keles

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+49 711 685 69525
+49 711 685 63706
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Pfaffenwaldring 27
70569 Stuttgart
Germany
Raum: 00.044

Publikationen

2024
1. Sahin Erdogan, Meryem ; Sümer Arpak, Esra ; Kaya Keles, Cemre Su ; Villagra, Federico ; Ozturk Isik, Esin ; Afsar, Nazire ; Yucesoy, Can A. ; Mur, Luis A. J. ; u. a.: Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. In: European Journal of Neuroscience, European Journal of Neuroscience. (2024), S. 1–30
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  @article{SahinErdogan2024, abstract = {Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.}, author = {Sahin Erdogan, Meryem and Sümer Arpak, Esra and Kaya Keles, Cemre Su and Villagra, Federico and Ozturk Isik, Esin and Afsar, Nazire and Yucesoy, Can A. and Mur, Luis A. J. and Akanyeti, Otar and Saybasili, Hale}, doi = {10.1111/ejn.16245}, journal = {European Journal of Neuroscience}, language = {en}, month = {01}, pages = {1-30}, title = {Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking}, url = {https://onlinelibrary.wiley.com/doi/10.1111/ejn.16245}, year = 2024 }
  Link
  https://onlinelibrary.wiley.com/doi/10.1111/ejn.16245
2023
1. Kaya Keles, Cemre Su ; Hiller, Jennifer ; Zimmer, Manuela ; Ates, Filiz: In vivo assessment of tibialis anterior muscle in passive and active states using shear wave elastography. In: Gait & Posture, Gait & Posture. Bd. 106, 2023, S. 94
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  @inproceedings{Kaya2023_GP, author = {Kaya Keles, Cemre Su and Hiller, Jennifer and Zimmer, Manuela and Ates, Filiz}, doi = {10.1016/j.gaitpost.2023.07.117}, journal = {Gait & Posture}, language = {en}, pages = 94, title = {In vivo assessment of tibialis anterior muscle in passive and active states using shear wave elastography}, url = {https://doi.org/10.1016%2Fj.gaitpost.2023.07.117}, volume = 106, year = 2023 }
  Link
  https://doi.org/10.1016%2Fj.gaitpost.2023.07.117
2. Kaya Keles, Cemre Su ; Ates, Filiz: How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy—a narrative review. In: Frontiers in Bioengineering and Biotechnology, Frontiers in Bioengineering and Biotechnology. Bd. 11 (2023), S. 1287385
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  @article{KayaAtes2023_Frontiers, abstract = {This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians’ decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.}, author = {Kaya Keles, Cemre Su and Ates, Filiz}, doi = {10.3389/fbioe.2023.1287385}, journal = {Frontiers in Bioengineering and Biotechnology}, language = {en}, pages = 1287385, title = {How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy—a narrative review}, url = {https://www.frontiersin.org/articles/10.3389/fbioe.2023.1287385/full}, volume = 11, year = 2023 }
  Link
  https://www.frontiersin.org/articles/10.3389/fbioe.2023.1287385/full
2022
1. Kaya Keles, Cemre Su ; Ates, Filiz: Botulinum toxin intervention in cerebral palsy-induced spasticity management: Projected and contradictory effects on skeletal muscles. In: Toxins, Toxins. Bd. 14 (2022), Nr. 11, S. 772
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  @article{KayaAtes2022_Toxins, abstract = {Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.}, article-number = {772}, author = {Kaya Keles, Cemre Su and Ates, Filiz}, doi = {10.3390/toxins14110772}, issn = {2072-6651}, journal = {Toxins}, language = {en}, number = 11, pages = 772, pubmedid = {36356022}, title = {Botulinum toxin intervention in cerebral palsy-induced spasticity management: Projected and contradictory effects on skeletal muscles}, url = {https://www.mdpi.com/2072-6651/14/11/772}, volume = 14, year = 2022 }
  Link
  https://www.mdpi.com/2072-6651/14/11/772
2021
1. Yılmaz, Evrim O. ; Kaya, Cemre S. ; Akdeniz-Dogan, Zeynep D. ; Yucesoy, Can A.: Long-term BTX-A effects on bi-articular muscle: Higher passive force, limited length range of active force production and unchanged intermuscular interactions. In: Journal of Biomechanics, Journal of Biomechanics. Bd. 126 (2021), S. 110627
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  @article{Yilmaz2021_JBiomech, abstract = {Botulinum toxin type-A (BTX-A) is commonly used for spasticity management aiming at reducing joint stiffness and increasing joint range of motion in CP patients. However, previous animal studies showed acutely increased passive forces and a narrowerlength range of active force exertion (lrange) for muscles exposed. BTX-A can spread affecting mechanics of several muscles in a compartment, but it was shown acutely to diminishepimuscular myofascial force transmission (EMFT). Yet, our understanding of these effects in the long-term is limited and they need to be tested in a bi-articular muscle. The goal was to test the following hypotheses in a long-term rat model: exposure to BTX-A (i) has no effects onlrangeand passive forces of bi-articular extensor digitorum longus (EDL) muscle and (ii) diminishes EMFT. Male Wistar rats were divided into two groups: BTX-A and control (0.1 units of BTX-A or only saline was injected into the tibialis anterior). Isometric proximal and distal EDL forces were measured simultaneously, one-month post-injection. Proximally and distally lengthening the muscle showed that BTX-A causes a significantly narrowerlrange(by 14.7% distally and 32.2% proximally) and significantly increased passive muscle forces (over 2-fold both distally and proximally). Altering muscle position at constant length showed that BTX-A does not change EMFT. The findings reject both hypotheses showing that long-term exposure to BTX-A compromises bi-articular muscle’s contribution to motion for both joints and the muscle’s mechanical interaction with the surroundings remains unaffected. These effects which may compromise long-term spasticity management should be studied in CP patients.}, author = {Yılmaz, Evrim O. and Kaya, Cemre S. and Akdeniz-Dogan, Zeynep D. and Yucesoy, Can A.}, doi = {https://doi.org/10.1016/j.jbiomech.2021.110627}, issn = {0021-9290}, journal = {Journal of Biomechanics}, language = {en}, pages = 110627, title = {Long-term BTX-A effects on bi-articular muscle: Higher passive force, limited length range of active force production and unchanged intermuscular interactions}, url = {https://www.sciencedirect.com/science/article/pii/S0021929021003985}, volume = 126, year = 2021 }
  Link
  https://www.sciencedirect.com/science/article/pii/S0021929021003985
2020
1. Kaya, Cemre S. ; Yilmaz, Evrim O. ; Akdeniz-Dogan, Zeynep D. ; Yucesoy, Can A.: Long-term effects with potential clinical importance of botulinum toxin Type-A on mechanics of muscles exposed. In: Frontiers in Bioengineering and Biotechnology, Frontiers in Bioengineering and Biotechnology. Bd. 8 (2020), S. 738
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  @article{Kaya2020_Frontiers, abstract = {Botulinum toxin type-A (BTX-A) is widely used for spasticity management and mechanically aims at reducing passive resistance at the joint and widening joint range of movement. However, recent experiments on acute BTX-A effects showed that the injected rat tibialis anterior (TA) muscle's passive forces increased, and the length range of active force exertion (l(range)) did not change. Additionally, BTX-A was shown to spread into non-injected muscles in the compartment and affect their mechanics. Whether those effects persist in the long term is highly important, but unknown. The aim was to test the following hypotheses with experiments conducted in the anterior crural compartment of the rat: In the long term, BTX-A (1) maintains l(range), (2) increases passive forces of the injected TA muscle, and (3) spreads into non-injected extensor digitorum longus (EDL) and the extensor hallucis longus (EHL) muscles, also affecting their active and passive forces. Male Wistar rats were divided into two groups: BTX-A and Control (0.1 units of BTX-A or only saline was injected into the TA). Isometric forces of the muscles were measured simultaneously 1-month post-injection. The targeted TA was lengthened, whereas the non-targeted EDL and EHL were kept at constant length. Hydroxyproline analysis was done to quantify changes in the collagen content of studied muscles. Two-way ANOVA test (for muscle forces, factors: TA length and animal group) and unpaired t or Mann-Whitney U test (for l (range) and collagen content, where appropriate) were used for statistical analyses (P < 0.05). BTX-A caused significant effects. TA: active forces decreased (maximally by 75.2% at short and minimally by 48.3%, at long muscle lengths), l(range) decreased (by 22.9%), passive forces increased (by 12.3%), and collagen content increased (approximately threefold). EDL and EHL: active forces decreased (up to 66.8%), passive force increased (minimally by 62.5%), and collagen content increased (approximately twofold). Therefore, hypothesis 1 was rejected and 2 and 3 were confirmed indicating that previously reported acute BTX-A effects persist and advance in the long term. A narrower l(range) and an elevated passive resistance of the targeted muscle are unintended mechanical effects, whereas spread of BTX-A into other compartmental muscles indicates the presence of uncontrolled mechanical effects.}, author = {Kaya, Cemre S. and Yilmaz, Evrim O. and Akdeniz-Dogan, Zeynep D. and Yucesoy, Can A.}, doi = {https://doi.org/10.3389/fbioe.2020.00738}, journal = {Frontiers in Bioengineering and Biotechnology}, language = {en}, month = {06}, pages = 738, title = {{Long-term} effects with potential clinical importance of botulinum toxin {Type-A} on mechanics of muscles exposed}, url = {https://www.frontiersin.org/articles/10.3389/fbioe.2020.00738/full}, volume = 8, year = 2020 }
  Link
  https://www.frontiersin.org/articles/10.3389/fbioe.2020.00738/full
2. Kaya, Cemre S. ; Bilgili, Fuat ; Akalan, N. Ekin ; Yucesoy, Can A.: Intraoperative testing of passive and active state mechanics of spastic semitendinosus in conditions involving intermuscular mechanical interactions and gait relevant joint positions. In: Journal of Biomechanics, Journal of Biomechanics. Bd. 103 (2020), S. 109755
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  @article{Kaya2020_JBiomech, abstract = {In cerebral palsy (CP) patients suffering pathological knee joint motion, spastic muscle’s passive state forces have not been quantified intraoperatively. Besides, assessment of spastic muscle’s active state forces in conditions involving intermuscular mechanical interactions and gait relevant joint positions is lacking. Therefore, the source of flexor forces limiting joint motion remains unclear. The aim was to test the following hypotheses: (i) in both passive and active states, spastic semitendinosus (ST) per se shows its highest forces within gait relevant knee angle (KA) range and (ii) due to intermuscular mechanical interactions, the active state forces elevate. Isometric forces (seven children with CP, GMFCS-II) were measured during surgery over a range of KA from flexion to full extension, at hip angle (HA) = 45° and 20°, in four conditions: (I) passive state, (II) individual stimulation of the ST, simultaneous stimulation of the ST (III) with its synergists, and (IV) also with an antagonist. Gait analyses: intraoperative data for KA = 17–61° (HA = 45°) and KA = 0–33° (HA = 20°) represent the loading response and terminal swing, and mid/terminal stance phases of gait, respectively. Intraoperative tests: Passive forces maximally approximated half of peak force in condition II (HA = 45°). Added muscle activations did increase muscle forces significantly (HA = 45°: on average by 42.0% and 72.5%; HA = 20°: maximally by 131.8% and 123.7%, respectively in conditions III and IV, p < 0.01). In conclusion, intermuscular mechanical interactions yield elevated active state forces, which are well above passive state forces. This indicates that intermuscular mechanical interactions may be a source of high flexor forces in CP.}, author = {Kaya, Cemre S. and Bilgili, Fuat and Akalan, N. Ekin and Yucesoy, Can A.}, doi = {https://doi.org/10.1016/j.jbiomech.2020.109755}, issn = {0021-9290}, journal = {Journal of Biomechanics}, language = {en}, pages = 109755, title = {Intraoperative testing of passive and active state mechanics of spastic semitendinosus in conditions involving intermuscular mechanical interactions and gait relevant joint positions}, url = {https://www.sciencedirect.com/science/article/pii/S0021929020301718}, volume = 103, year = 2020 }
  Link
  https://www.sciencedirect.com/science/article/pii/S0021929020301718
3. Kaya, Cemre S. ; Yucesoy, Can A.: Muscle-tendon unit length-spastic muscle force data by combined intraoperative-musculoskeletal modelling work. In: Gait & Posture, Gait & Posture. Bd. 81, 2020, S. 179–180
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  @inproceedings{KayaYucesoy2020_GP, author = {Kaya, Cemre S. and Yucesoy, Can A.}, doi = {10.1016/j.gaitpost.2020.07.125}, journal = {Gait & Posture}, language = {en}, pages = {179-180}, title = {Muscle-tendon unit length-spastic muscle force data by combined intraoperative-musculoskeletal modelling work}, url = {https://doi.org/10.1016%2Fj.gaitpost.2020.07.125}, volume = 81, year = 2020 }
  Link
  https://doi.org/10.1016%2Fj.gaitpost.2020.07.125
2019
1. Kaya, Cemre S. ; Can, Utku ; Yucesoy, Can A.: Force production characteristics of spastic knee flexor muscles: Intraoperative tests and patient-specific musculoskeletal models. In: 2019 Medical Technologies Congress (TIPTEKNO), 2019 Medical Technologies Congress (TIPTEKNO) : IEEE, 2019, S. 1–3
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  @inproceedings{Kaya2019_IEEE, abstract = {In cerebral palsy, an increased pathological resistance against knee extension is observed on rest and during walking. The source of these high forces that cause the knee joint to be held in a forced flexion position is attributed to the passive and active mechanics of the spastic knee flexor muscles. However, studies directly quantifying such forces in intraoperative experiments are sparse. In this study, the force production capacities of spastic semitendinosus and gracilis muscles were measured directly by intraoperative mechanical tests, under passive and active conditions. In order to establish the relationship between those muscle level mechanical force information with the patients' gait, subject-specific musculoskeletal models were developed using OpenSim software. The results indicated that the changes in patients' operational muscle-tendon lengths seen through the gait cycle are similar to those of typically developing. Besides, high passive and active force generation is typically observed at the longer muscle-tendon lengths, and the dominant component of the total tendon forces of these targeted muscles is the active forces. Therefore, the mechanical characteristics of the spastic muscles have been shown not to importantly differ from healthy individuals, and not capable of explaining the limited joint movement observed in patients' gait.}, author = {Kaya, Cemre S. and Can, Utku and Yucesoy, Can A.}, booktitle = {2019 Medical Technologies Congress (TIPTEKNO)}, doi = {10.1109/TIPTEKNO.2019.8895001}, issn = {2687-7783}, language = {en}, pages = {1-3}, publisher = {IEEE}, title = {Force production characteristics of spastic knee flexor muscles: Intraoperative tests and patient-specific musculoskeletal models}, year = 2019 }
2. Kaya, Cemre S. ; Akdeniz Dogan, Zeynep D. ; Yucesoy, Can A.: Animal experiments reveal long-term effects with potential clinical importance of botulinum toxin type-a on mechanics of muscles exposed. In: Gait & Posture, Gait & Posture. Bd. 73, 2019, S. 120–121
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  @inproceedings{Kaya2019_GP, author = {Kaya, Cemre S. and Akdeniz Dogan, Zeynep D. and Yucesoy, Can A.}, doi = {10.1016/j.gaitpost.2019.07.063}, journal = {Gait & Posture}, language = {en}, pages = {120-121}, title = {Animal experiments reveal long-term effects with potential clinical importance of botulinum toxin type-a on mechanics of muscles exposed}, url = {https://doi.org/10.1016%2Fj.gaitpost.2019.07.063}, volume = 73, year = 2019 }
  Link
  https://doi.org/10.1016%2Fj.gaitpost.2019.07.063
3. Hammouda, Mohammed ; Kaya, Cemre S. ; Yucesoy, Can A.: Development of an agent-based model to study the mechanism of effects of botulinum toxin on muscle tissue adaptation. In: 2019 Medical Technologies Congress (TIPTEKNO), 2019 Medical Technologies Congress (TIPTEKNO) : IEEE, 2019, S. 1–3
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  @inproceedings{Hammouda2019_IEEE, abstract = {Local application of botulinum toxin type-A (BTX-A) is commonly used for spasticity management in patients with cerebral palsy (CP), stroke, multiple sclerosis, as well as dystonia. However, recent studies on muscle mechanics have shown results contradictory to treatment aims (increased passive resistance, narrower joint range of motion). This is ascribed to muscle structure adaptations characterized by collagen increase, hereby this should be controlled. However, the mechanisms of these adaptations are not understood. Within this study, it is aimed to develop an agent-based model to understand these mechanisms. Based on our previous finite element analysis results, the effects of BTX-A were modeled as strain changes across the extracellular matrix of the muscle fascicle. The analyzes performed by agent-based models showed statistically significant increases in the collagen turnover, the collagen sum and the number of fibroblasts due to BTX-A.}, author = {Hammouda, Mohammed and Kaya, Cemre S. and Yucesoy, Can A.}, booktitle = {2019 Medical Technologies Congress (TIPTEKNO)}, doi = {10.1109/TIPTEKNO.2019.8895229}, issn = {2687-7783}, language = {en}, pages = {1-3}, publisher = {IEEE}, title = {Development of an agent-based model to study the mechanism of effects of botulinum toxin on muscle tissue adaptation}, year = 2019 }
4. Kaya, Cemre S. ; Bilgili, Fuat ; Akalan, N. Ekin ; Temelli, Yener ; Ates, Filiz ; Yucesoy, Can A.: Intraoperative experiments combined with gait analyses indicate that active state rather than passive dominates the spastic gracilis muscle’s joint movement limiting effect in cerebral palsy. In: Clinical Biomechanics, Clinical Biomechanics. Bd. 68 (2019), S. 151–157
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  @article{Kaya2019_CBiomech, abstract = {Background In cerebral palsy, spastic muscle's passive forces are considered to be high but have not been assessed directly. Although activated spastic muscle's force-joint angle relations were studied, this was independent of gait relevant joint positions. The aim was to test the following hypotheses intraoperatively: (i) spastic gracilis passive forces are high even in flexed knee positions, (ii) its active state forces attain high amplitudes within the gait relevant knee angle range, and (iii) increase with added activations of other muscles. Methods Isometric forces (seven children with cerebral palsy, gross motor function classification score = II) were measured during surgery from knee flexion to full extension, at hip angles of 45° and 20° and in four conditions: (I) passive state, after gracilis was stimulated (II) alone, (III) simultaneously with its synergists, and (IV) also with an antagonist. Findings Directly measured peak passive force of spastic gracilis was only a certain fraction of the peak active state forces (maximally 26%) measured in condition II. Conditions III and IV caused gracilis forces to increase (for hip angle = 45°, by 32.8% and 71.9%, and for hip angle = 20°, by 24.5% and 45.1%, respectively). Gait analyses indicated that intraoperative data for knee angles 61–17° and 33–0° (for hip angles 45° and 20°, respectively) are particularly relevant, where active state force approximates its peak values. Interpretation Active state muscular mechanics, rather than passive, of spastic gracilis present a capacity to limit joint movement. The findings can be highly relevant for diagnosis and orthopaedic surgery in individuals with cerebral palsy.}, author = {Kaya, Cemre S. and Bilgili, Fuat and Akalan, N. Ekin and Temelli, Yener and Ates, Filiz and Yucesoy, Can A.}, doi = {https://doi.org/10.1016/j.clinbiomech.2019.06.005}, issn = {0268-0033}, journal = {Clinical Biomechanics}, language = {en}, pages = {151-157}, title = {Intraoperative experiments combined with gait analyses indicate that active state rather than passive dominates the spastic gracilis muscle's joint movement limiting effect in cerebral palsy}, url = {https://www.sciencedirect.com/science/article/pii/S0268003319302116}, volume = 68, year = 2019 }
  Link
  https://www.sciencedirect.com/science/article/pii/S0268003319302116
2018
1. Kaya, Cemre S. ; Bilgili, Fuat ; Akalan, Nazif E. ; Temelli, Yener ; Ates, Filiz ; Yucesoy, Can A.: Mechanics of spastic semitendinosus altered by intermuscular interactions elevate its contribution to pathological resistance against knee extension during gait. In: Gait & Posture, Gait & Posture. Bd. 65, 2018, S. 88–89
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  @inproceedings{Kaya2018_GP, author = {Kaya, Cemre S. and Bilgili, Fuat and Akalan, Nazif E. and Temelli, Yener and Ates, Filiz and Yucesoy, Can A.}, doi = {10.1016/j.gaitpost.2018.06.061}, journal = {Gait & Posture}, language = {en}, pages = {88-89}, title = {Mechanics of spastic semitendinosus altered by intermuscular interactions elevate its contribution to pathological resistance against knee extension during gait}, url = {https://doi.org/10.1016%2Fj.gaitpost.2018.06.061}, volume = 65, year = 2018 }
  Link
  https://doi.org/10.1016%2Fj.gaitpost.2018.06.061
2. Kaya, Cemre S. ; Temelli, Yener ; Ates, Filiz ; Yucesoy, Can A.: Effects of inter-synergistic mechanical interactions on the mechanical behaviour of activated spastic semitendinosus muscle of patients with cerebral palsy. In: Journal of the Mechanical Behavior of Biomedical Materials, Journal of the Mechanical Behavior of Biomedical Materials. Bd. 77 (2018), S. 78–84
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  @article{Kaya2018_JMBBM, abstract = {Previous physiological experiments and finite element modelling indicate that inter-synergistic epimuscular myofascial force transmission (EMFT) between co-activated muscles has a potential to affect healthy muscle's contribution to joint moment and joint range of movement. This is quite relevant for patients with cerebral palsy (CP) since, amplitude of spastic muscle's force and the joint range of force exertion are central to the joint movement limitation. Stiffness of activated spastic muscle is also a determinant for pathological joint movement. However, assessments of effects of inter-synergistic EMFT on the mechanical behaviour of spastic muscle are lacking. Those assessments require measurement during surgery of activated spastic muscle's forces directly at its tendon and as a function of joint angle. Employing this methodology, the aim was to test the following study hypotheses: added activation of semimembranosus (SM) and gracilis (GRA) muscles of patients with CP changes (1) force, (2) stiffness and (3) joint range of force exertion of activated spastic semitendinosus (ST) due to inter-synergistic EMFT. Isometric spastic ST forces were measured intraoperatively (12 limbs of 7 patients (mean age 8 years 9 months) for knee angles from flexion (120°) to full extension (0°). Conditions I and II: spastic ST was activated alone, and simultaneously with its synergists SM and GRA muscles, respectively. Condition II did increase activated spastic ST's forces significantly (by 33.3%), but did not change its stiffness and joint range of force exertion, confirming only study hypothesis 1. Therefore, we conclude that inter-synergistic EMFT affects forces exerted at spastic ST tendon, but not other characteristics of its angle-force relationship.}, author = {Kaya, Cemre S. and Temelli, Yener and Ates, Filiz and Yucesoy, Can A.}, doi = {https://doi.org/10.1016/j.jmbbm.2017.08.040}, issn = {1751-6161}, journal = {Journal of the Mechanical Behavior of Biomedical Materials}, language = {en}, pages = {78-84}, title = {Effects of inter-synergistic mechanical interactions on the mechanical behaviour of activated spastic semitendinosus muscle of patients with cerebral palsy}, url = {https://www.sciencedirect.com/science/article/pii/S1751616117303764}, volume = 77, year = 2018 }
  Link
  https://www.sciencedirect.com/science/article/pii/S1751616117303764

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