Experimental Analysis of the Use of Cranial Electromyography in Athletes and Clinical Implications
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample Description
2.2. Study Protocol
- “Symptomatic patients” (13 patients) who reported, at the time of the examination, an injured condition or discomfort during the performance of competitive activity.
- “Asymptomatic patients” (12 patients) who did not present any muscle-osteo-articular discomfort in sports practice.
- “Dysfunctional athletes” (6 patients) who were found to have craniomandibular disorders. The signs and symptoms considered to classify athletes as dysfunctional were as follows:
- -
- Pain in the preauricular area, TM joints, or chewing muscles;
- -
- Limitation or deviation of mandibular movement;
- -
- TM joint noises (clicking and crepitus) during mandibular function.
- “Functional athletes” (19 patients) who presented normal occlusion or malocclusion, but without any disorder related to it.
2.3. Functional Assessment Indices
- POC (Percentage of Overlapping Coefficient):
- BAR (Barycenter)
- TORS (Mandibular Torsion Index)
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
EMG | Electromyography |
ENG | Electroneurography |
sEMG | Surface electromyography |
POC | Percentage of Overlapping Coefficient |
POC TA | Percentage of Overlapping Coefficient of anterior temporal muscle |
POC MM | Percentage of Overlapping Coefficient of masseter muscle |
BAR | Barycenter |
TORS | Mandibular Torsion Index |
TA | Anterior temporal muscle |
MM | Masseter muscle |
TMJ | Temporo-mandibular joint |
TMD | Temporo-mandibular disorders |
References
- Le Relazioni Tra L—Assetto Posturale e L—Apparato Stomarognatico|PDF. Available online: https://it.scribd.com/document/349018926/Le-Relazioni-Tra-L-assetto-Posturale-e-L-apparato-Stomarognatico (accessed on 27 April 2022).
- Patano, A.; Cirulli, N.; Beretta, M.; Plantamura, P.; Inchingolo, A.D.; Inchingolo, A.M.; Bordea, I.R.; Malcangi, G.; Marinelli, G.; Scarano, A.; et al. Education Technology in Orthodontics and Paediatric Dentistry during the COVID-19 Pandemic: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 6056. [Google Scholar] [CrossRef] [PubMed]
- Inchingolo, F.; Tatullo, M.; Marrelli, M.; Inchingolo, A.M.; Tarullo, A.; Inchingolo, A.D.; Dipalma, G.; Podo Brunetti, S.; Tarullo, A.; Cagiano, R. Combined Occlusal and Pharmacological Therapy in the Treatment of Temporo-Mandibular Disorders. Eur. Rev. Med. Pharmcol. Sci. 2011, 15, 1296–1300. [Google Scholar]
- Dekel, E.; Nucci, L.; Weill, T.; Flores-Mir, C.; Becker, A.; Perillo, L.; Chaushu, S. Impaction of Maxillary Canines and Its Effect on the Position of Adjacent Teeth and Canine Development: A Cone-Beam Computed Tomography Study. Am. J. Orthod. Dentofac. Orthop. 2021, 159, e135–e147. [Google Scholar] [CrossRef] [PubMed]
- Di Venere, D.; Nardi, G.M.; Lacarbonara, V.; Laforgia, A.; Stefanachi, G.; Corsalini, M.; Grassi, F.R.; Rapone, B.; Pettini, F. Early Mandibular Canine-Lateral Incisor Transposition: Case Report. Oral Implantol. 2017, 10, 181–189. [Google Scholar] [CrossRef]
- Julià-Sánchez, S.; Álvarez-Herms, J.; Cirer-Sastre, R.; Corbi, F.; Burtscher, M. The Influence of Dental Occlusion on Dynamic Balance and Muscular Tone. Front. Physiol. 2020, 10, 1626. [Google Scholar] [CrossRef] [PubMed]
- Julià-Sánchez, S.; Álvarez-Herms, J.; Gatterer, H.; Burtscher, M.; Pagès, T.; Viscor, G. Dental Occlusion Influences the Standing Balance on an Unstable Platform. Motor Control 2015, 19, 341–354. [Google Scholar] [CrossRef] [PubMed]
- Julià-Sánchez, S.; Álvarez-Herms, J.; Gatterer, H.; Burtscher, M.; Pagès, T.; Viscor, G. The Influence of Dental Occlusion on the Body Balance in Unstable Platform Increases after High Intensity Exercise. Neurosci. Lett. 2016, 617, 116–121. [Google Scholar] [CrossRef]
- Julià-Sánchez, S.; Álvarez-Herms, J.; Burtscher, M. Dental Occlusion and Body Balance: A Question of Environmental Constraints? J. Oral Rehabil. 2019, 46, 388–397. [Google Scholar] [CrossRef]
- Solovykh, E.A.; Bugrovetskaya, O.G.; Maksimovskaya, L.N. Information Value of Functional Status of the Stomatognathic System for Postural Balance Regulation. Bull. Exp. Biol. Med. 2012, 153, 401–405. [Google Scholar] [CrossRef]
- Hrysomallis, C. Relationship between Balance Ability, Training and Sports Injury Risk. Sports Med. 2007, 37, 547–556. [Google Scholar] [CrossRef]
- Inchingolo, A.D.; Patano, A.; Coloccia, G.; Ceci, S.; Inchingolo, A.M.; Marinelli, G.; Malcangi, G.; Montenegro, V.; Laudadio, C.; Palmieri, G.; et al. Genetic Pattern, Orthodontic and Surgical Management of Multiple Supplementary Impacted Teeth in a Rare, Cleidocranial Dysplasia Patient: A Case Report. Medicina 2021, 57, 1350. [Google Scholar] [CrossRef] [PubMed]
- Greenberg, M.S.; Cohen, S.G.; Springer, P.; Kotwick, J.E.; Vegso, J.J. Mandibular Position and Upper Body Strength: A Controlled Clinical Trial. J. Am. Dent. Assoc. 1981, 103, 576–579. [Google Scholar] [CrossRef]
- Gelb, H.; Mehta, N.R.; Forgione, A.G. The Relationship between Jaw Posture and Muscular Strength in Sports Dentistry: A Reappraisal. Cranio 1996, 14, 320–325. [Google Scholar] [CrossRef] [PubMed]
- Montenegro, V.; Inchingolo, A.D.; Malcangi, G.; Limongelli, L.; Marinelli, G.; Coloccia, G.; Laudadio, C.; Patano, A.; Inchingolo, F.; Bordea, I.R.; et al. Compliance of Children with Removable Functional Appliance with Microchip Integrated during Covid-19 Pandemic: A Systematic Review. J. Biol. Regul. Homeost. Agents 2021, 35, 365–377. [Google Scholar] [CrossRef]
- Cirulli, N.; Inchingolo, A.D.; Patano, A.; Ceci, S.; Marinelli, G.; Malcangi, G.; Coloccia, G.; Montenegro, V.; Di Pede, C.; Ciocia, A.M.; et al. Innovative Application of Diathermy in Orthodontics: A Case Report. Int. J. Environ. Res. Public Health 2022, 19, 7448. [Google Scholar] [CrossRef] [PubMed]
- Abderrahman, A.B.; Rhibi, F.; Ouerghi, N.; Hackney, A.C.; Saeidi, A.; Zouhal, H. Effects of Recovery Mode during High Intensity Interval Training on Glucoregulatory Hormones and Glucose Metabolism in Response to Maximal Exercise. J. Athl. Enhanc. 2018, 7, 292. [Google Scholar] [CrossRef] [PubMed]
- Malcangi, G.; Inchingolo, A.D.; Patano, A.; Coloccia, G.; Ceci, S.; Garibaldi, M.; Inchingolo, A.M.; Piras, F.; Cardarelli, F.; Settanni, V.; et al. Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report. Appl. Sci. 2022, 12, 2657. [Google Scholar] [CrossRef]
- Ciavarella, D.; Palazzo, A.; De Lillo, A.; Lo Russo, L.; Paduano, S.; Laino, L.; Chimenti, C.; Frezza, F.; Lo Muzio, L. Influence of Vision on Masticatory Muscles Function: Surface Electromyographic Evaluation. Ann. Stomatol. 2014, 5, 61–65. [Google Scholar] [CrossRef]
- Nucci, L.; Costanzo, C.; Carfora, M.; d’Apuzzo, F.; Franchi, L.; Perillo, L. Dentoskeletal Effects of Early Class III Treatment Protocol Based on Timing of Intervention in Children. Prog. Orthod. 2021, 22, 49. [Google Scholar] [CrossRef]
- Coloccia, G.; Inchingolo, A.D.; Inchingolo, A.M.; Malcangi, G.; Montenegro, V.; Patano, A.; Marinelli, G.; Laudadio, C.; Limongelli, L.; Di Venere, D.; et al. Effectiveness of Dental and Maxillary Transverse Changes in Tooth-Borne, Bone-Borne, and Hybrid Palatal Expansion through Cone-Beam Tomography: A Systematic Review of the Literature. Medicina 2021, 57, 288. [Google Scholar] [CrossRef]
- Burdon-Sanderson, J.S.; Page, F.J.M., II. Experimental Results Relating to the Rhythmical and Excitatory Motions of the Ventricle of the Heart of the Frog, and of the Electrical Phenomena Which Accompany Them. Proc. R. Soc. Lond. 1878, 27, 410–414. [Google Scholar] [CrossRef]
- Ivanov, V.V.; Achkasov, E.E.; Markov, N.M.; Krechina, E.K. Changes of postural statusa in patients undergoing orthodontic treatment. Stomatologiia 2018, 97, 50–53. [Google Scholar] [CrossRef] [PubMed]
- Cirulli, N.; Ballini, A.; Cantore, S.; Farronato, D.; Inchingolo, F.; Dipalma, G.; Gatto, M.R.; Alessandri Bonetti, G. Mixed Dentition Space Analysis Of A Southern Italian Population: New Regression Equations For Unerupted Teeth. J. Biol. Regul. Homeost. Agents 2015, 29, 515–520. [Google Scholar] [PubMed]
- Perinetti, G.; Türp, J.C.; Primožič, J.; Di Lenarda, R.; Contardo, L. Associations between the Masticatory System and Muscle Activity of Other Body Districts. A Meta-Analysis of Surface Electromyography Studies. J. Electromyogr. Kinesiol. 2011, 21, 877–884. [Google Scholar] [CrossRef] [PubMed]
- Inchingolo, A.D.; Ceci, S.; Patano, A.; Inchingolo, A.M.; Montenegro, V.; Di Pede, C.; Malcangi, G.; Marinelli, G.; Coloccia, G.; Garibaldi, M.; et al. Elastodontic Therapy of Hyperdivergent Class II Patients Using AMCOP® Devices: A Retrospective Study. Appl. Sci. 2022, 12, 3259. [Google Scholar] [CrossRef]
- Laudadio, C.; Inchingolo, A.D.; Malcangi, G.; Limongelli, L.; Marinelli, G.; Coloccia, G.; Montenegro, V.; Patano, A.; Inchingolo, F.; Bordea, I.R.; et al. Management of Anterior Open-Bite in the Deciduous, Mixed and Permanent Dentition Stage: A Descriptive Review. J. Biol. Regul. Homeost. Agents 2021, 35, 271–281. [Google Scholar] [CrossRef]
- Montinaro, F.; Nucci, L.; Carfora, M.; d’Apuzzo, F.; Franchi, L.; Perillo, L. Modified SEC III Protocol: Vertical Control Related to Patients’ Compliance with the Chincup. Eur. J. Orthod. 2021, 43, 80–85. [Google Scholar] [CrossRef]
- Di Venere, D.; Corsalini, M.; Nardi, G.M.; Laforgia, A.; Grassi, F.R.; Rapone, B.; Pettini, F. Obstructive Site Localization In Patients With Obstructive Sleep Apnea Syndrome: A Comparison Between Otolaryngologic Data And Cephalometric Values. Oral Implantol. 2017, 10, 295–310. [Google Scholar] [CrossRef]
- Adina, S.; Dipalma, G.; Bordea, I.R.; Lucaciu, O.; Feurdean, C.; Inchingolo, A.D.; Septimiu, R.; Malcangi, G.; Cantore, S.; Martin, D.; et al. Orthopedic Joint Stability Influences Growth and Maxillary Development: Clinical Aspects. J. Biol. Regul. Homeost. Agents 2020, 34, 747–756. [Google Scholar] [CrossRef]
- Cozzani, M.; Sadri, D.; Nucci, L.; Jamilian, P.; Pirhadirad, A.P.; Jamilian, A. The Effect of Alexander, Gianelly, Roth, and MBT Bracket Systems on Anterior Retraction: A 3-Dimensional Finite Element Study. Clin. Oral Investig. 2020, 24, 1351–1357. [Google Scholar] [CrossRef]
- Inchingolo, A.D.; Patano, A.; Coloccia, G.; Ceci, S.; Inchingolo, A.M.; Marinelli, G.; Malcangi, G.; Montenegro, V.; Laudadio, C.; Pede, C.D.; et al. The Efficacy of a New AMCOP® Elastodontic Protocol for Orthodontic Interceptive Treatment: A Case Series and Literature Overview. Int. J. Environ. Res. Public Health 2022, 19, 988. [Google Scholar] [CrossRef] [PubMed]
- Marinelli, G.; Inchingolo, A.D.; Inchingolo, A.M.; Malcangi, G.; Limongelli, L.; Montenegro, V.; Coloccia, G.; Laudadio, C.; Patano, A.; Inchingolo, F.; et al. White Spot Lesions in Orthodontics: Prevention and Treatment. A Descriptive Review. J. Biol. Regul. Homeost. Agents 2021, 35, 227–240. [Google Scholar] [CrossRef] [PubMed]
- Falla, D.; Dall’Alba, P.; Rainoldi, A.; Merletti, R.; Jull, G. Repeatability of Surface EMG Variables in the Sternocleidomastoid and Anterior Scalene Muscles. Eur. J. Appl. Physiol. 2002, 87, 542–549. [Google Scholar] [CrossRef]
- Gabriel, D.A. Reliability of SEMG Spike Parameters during Concentric Contractions. Electromyogr. Clin. Neurophysiol. 2000, 40, 423–430. [Google Scholar]
- Hogrel, J.-Y. Clinical Applications of Surface Electromyography in Neuromuscular Disorders. Neurophysiol. Clin. 2005, 35, 59–71. [Google Scholar] [CrossRef] [PubMed]
- Dimonte, M.; Inchingolo, F.; Minonne, A.; Arditi, G.; Dipalma, G. Bone SPECT in Management of Mandibular Condyle Hyperplasia. Report of a Case and Review of Literature. Minerva Stomatol. 2004, 53, 281–285. [Google Scholar]
- Ballini, A.; Cantore, S.; Scacco, S.; Perillo, L.; Scarano, A.; Aityan, S.K.; Contaldo, M.; Cd Nguyen, K.; Santacroce, L.; Syed, J.; et al. A Comparative Study on Different Stemness Gene Expression between Dental Pulp Stem Cells vs. Dental Bud Stem Cells. Eur. Rev. Med. Pharmacol. Sci. 2019, 23, 1626–1633. [Google Scholar] [CrossRef]
- Heit, T.; Derkson, C.; Bierkos, J.; Saqqur, M. The Effect of the Physiological Rest Position of the Mandible on Cerebral Blood Flow and Physical Balance: An Observational Study. Cranio 2015, 33, 195–205. [Google Scholar] [CrossRef]
- Ferrillo, M.; Marotta, N.; Giudice, A.; Calafiore, D.; Curci, C.; Fortunato, L.; Ammendolia, A.; de Sire, A. Effects of Occlusal Splints on Spinal Posture in Patients with Temporomandibular Disorders: A Systematic Review. Healthcare 2022, 10, 739. [Google Scholar] [CrossRef]
- Bergamini, M.; Pierleoni, F.; Gizdulich, A.; Bergamini, C. Dental Occlusion and Body Posture: A Surface EMG Study. Cranio 2008, 26, 25–32. [Google Scholar] [CrossRef]
- Ferrillo, M.; Ammendolia, A.; Paduano, S.; Calafiore, D.; Marotta, N.; Migliario, M.; Fortunato, L.; Giudice, A.; Michelotti, A.; de Sire, A. Efficacy of Rehabilitation on Reducing Pain in Muscle-Related Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Back Musculoskelet. Rehabil. 2022, 1–16. [Google Scholar] [CrossRef] [PubMed]
- Deregibus, A.; Ferrillo, M.; Grazia Piancino, M.; Chiara Domini, M.; de Sire, A.; Castroflorio, T. Are Occlusal Splints Effective in Reducing Myofascial Pain in Patients with Muscle-Related Temporomandibular Disorders? A Randomized-Controlled Trial. Turk. J. Phys. Med. Rehabil. 2021, 67, 32–40. [Google Scholar] [CrossRef] [PubMed]
# | Age | Sex | Sport Practiced | Symptomatic Athletes | Asymptomatic Athletes | Dysfunctional Athletes | Functional Athletes |
---|---|---|---|---|---|---|---|
1 | 25 | M | Judo | Sport performance | Malocclusion | ||
2 | 27 | F | Football | Normocclusion | |||
3 | 18 | F | Dance | Sport performance | Malocclusion, TMJ, and auricular area pain | ||
4 | 27 | M | Football | Hip flexor muscle inflammation | Malocclusion, TMJ click, and chewing muscles contraction | ||
5 | 19 | M | Judo | Sport performance | Malocclusion, TMJ, and facial massif pain | ||
6 | 15 | M | Football | Pubalgia | Normocclusion | ||
7 | 15 | M | Football | Pubalgia | Normocclusion | ||
8 | 31 | M | Football | Sport performance | Malocclusion | ||
9 | 26 | M | Football | Lumbar muscles contraction | Normocclusion | ||
10 | 18 | F | Ping pong | Epicondylitis | Normocclusion | ||
11 | 16 | M | Football | Sport performance | Malocclusion | ||
12 | 19 | M | Football | Sport performance | Malocclusion | ||
13 | 29 | M | Football | Pubalgia | Normocclusion | ||
14 | 21 | M | Football | Pelvic rotation | Sport performance | Normocclusion | |
15 | 34 | M | Football | Sport performance | Normocclusion | ||
16 | 16 | M | Football | Pelvic rotation | Sport performance | Normocclusion | |
17 | 27 | M | Football | Quadriceps muscles strain | Normocclusion | ||
18 | 33 | M | Football | Sport performance | Mandibular fracture | ||
19 | 21 | F | Dance | Sport performance | TMJ pain | ||
20 | 19 | M | Football | Abductor muscles strain | Normocclusion | ||
21 | 24 | M | Football | Pubalgia | Normocclusion | ||
22 | 16 | M | Football | Sport performance | Normocclusion | ||
23 | 37 | M | Football | Quadriceps muscles strain | Malocclusion | ||
24 | 25 | M | Football | Sport performance | TMJ click and chewing muscles contraction | ||
25 | 32 | F | Volleyball | Rotator cuff muscles strain | Malocclusion |
# | POC TA PRE | POC TA POST | Improvement | BAR PRE | BAR POST | Improvement | TORS PRE | TORS POST | Improvement |
---|---|---|---|---|---|---|---|---|---|
1 | 0.811 | 0.818 | 1 | 0.750 | 0.905 | 1 | 0.881 | 0.892 | 1 |
2 | 0.853 | 0.892 | 1 | 0.782 | 0.878 | 1 | 0.899 | 0.927 | 1 |
3 | 0.872 | 0.859 | 0 | 0.821 | 0.852 | 1 | 0.921 | 0.889 | 1 |
4 | 0.991 | 0.898 | 0 | 0.883 | 0.969 | 1 | 0.934 | 0.916 | 0 |
5 | 0.837 | 0.759 | 1 | 0.854 | 0.872 | 1 | 0.884 | 0.849 | 0 |
6 | 0.871 | 0.851 | 0 | 0.915 | 0.916 | 1 | 0.919 | 0.913 | 1 |
7 | 0.878 | 0.884 | 1 | 0.898 | 0.916 | 1 | 0.900 | 0.919 | 0 |
8 | 0.774 | 0.856 | 1 | 0.826 | 0.866 | 1 | 0.772 | 0.885 | 1 |
9 | 0.836 | 0.880 | 1 | 0.257 | 0.165 | 0 | 0.297 | 0.341 | 0 |
10 | 0.482 | 0.868 | 1 | 0.841 | 0.746 | 1 | 0.818 | 0.920 | 1 |
11 | 0.903 | 0.895 | 0 | 0.691 | 0.931 | 1 | 0.906 | 0.908 | 0 |
12 | 0.880 | 0.904 | 1 | 0.854 | 0.899 | 1 | 0.925 | 0.922 | 0 |
13 | 0.887 | 0.883 | 0 | 0.873 | 0.931 | 1 | 0.813 | 0.928 | 1 |
14 | 0.865 | 0.887 | 1 | 0.788 | 0.827 | 1 | 0.836 | 0.862 | 1 |
15 | 0.838 | 0.842 | 1 | 0.865 | 0.882 | 1 | 0.891 | 0.903 | 1 |
16 | 0.882 | 0.867 | 0 | 0.886 | 0.851 | 0 | 0.916 | 0.909 | 0 |
17 | 0.866 | 0.867 | 1 | 0.914 | 0.896 | 1 | 0.918 | 0.889 | 1 |
18 | 0.876 | 0.874 | 0 | 0.913 | 0.913 | 0 | 0.899 | 0.904 | 0 |
19 | 0.840 | 0.830 | 0 | 0.849 | 0.873 | 0 | 0.886 | 0.913 | 1 |
20 | 0.890 | 0.887 | 0 | 0.862 | 0.875 | 1 | 0.909 | 0.913 | 0 |
21 | 0.866 | 0.862 | 0 | 0.899 | 0.926 | 1 | 0.875 | 0.911 | 1 |
22 | 0.893 | 0.898 | 1 | 0.913 | 0.909 | 0 | 0.913 | 0.909 | 0 |
23 | 0.845 | 0.846 | 1 | 0.687 | 0.848 | 1 | 0.846 | 0.909 | 1 |
24 | 0.776 | 0.812 | 1 | 0.896 | 0.901 | 1 | 0.864 | 0.870 | 1 |
25 | 0.644 | 0.701 | 1 | 0.834 | 0.826 | 0 | 0.885 | 0.903 | 1 |
Paired Differences | t | df | Sig. (2-Tailed) | ||||||
---|---|---|---|---|---|---|---|---|---|
Mean | Std. Deviation | Std. Error Mean | 95% Confidence Interval of the Difference | ||||||
Lower | Upper | ||||||||
Pair 1 | POC TA pre bite—POC TA post bite | −0.01856 | 0.084665 | 0.016933 | −0.053508 | 0.016388 | −1.096 | 24 | 0.284 |
Pair 2 | BAR pre bite—BAR post bite | −0.03288 | 0.073074 | 0.014615 | −0.063044 | −0.002716 | −2.25 | 24 | 0.034 |
Pair 3 | TORSIO N PRE BITE—TORSIO N POST BITE | −0.01988 | 0.04106 | 0.008212 | −0.036829 | −0.002931 | −2.421 | 24 | 0.023 |
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Inchingolo, A.D.; Pezzolla, C.; Patano, A.; Ceci, S.; Ciocia, A.M.; Marinelli, G.; Malcangi, G.; Montenegro, V.; Cardarelli, F.; Piras, F.; et al. Experimental Analysis of the Use of Cranial Electromyography in Athletes and Clinical Implications. Int. J. Environ. Res. Public Health 2022, 19, 7975. https://doi.org/10.3390/ijerph19137975
Inchingolo AD, Pezzolla C, Patano A, Ceci S, Ciocia AM, Marinelli G, Malcangi G, Montenegro V, Cardarelli F, Piras F, et al. Experimental Analysis of the Use of Cranial Electromyography in Athletes and Clinical Implications. International Journal of Environmental Research and Public Health. 2022; 19(13):7975. https://doi.org/10.3390/ijerph19137975
Chicago/Turabian StyleInchingolo, Alessio Danilo, Carmela Pezzolla, Assunta Patano, Sabino Ceci, Anna Maria Ciocia, Grazia Marinelli, Giuseppina Malcangi, Valentina Montenegro, Filippo Cardarelli, Fabio Piras, and et al. 2022. "Experimental Analysis of the Use of Cranial Electromyography in Athletes and Clinical Implications" International Journal of Environmental Research and Public Health 19, no. 13: 7975. https://doi.org/10.3390/ijerph19137975