{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T15:34:01Z","timestamp":1769182441589,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Hemophilic knee arthropathy is characterized by a loss of muscle mass and decreased strength of the quadriceps muscle. The visualization of movement aims to favor the recruitment of the motor system in the same premotor and parietal areas, as would happen with the active execution of the observed action. The aim was to evaluate changes in quadriceps activation in patients with hemophilic knee arthropathy following immersive VR visualization of knee extension movements. (2) Methods: We recruited 13 patients with severe hemophilia A and knee arthropathy. Patients underwent a 15 min session of immersive VR visualization of knee extension movements. The quadriceps muscle activation was evaluated by surface electromyography. (3) Results: After the intervention, there were no changes in the muscle activation of vastus medialis, vastus lateralis, or rectus femoris muscles. There was a large effect size of changes in rectus femoris muscle activation. Age and knee joint damage did not correlate with changes in quadriceps activation. Dominance, inhibitor development, and type of treatment were not related with post-intervention muscle activation. (4) Conclusions: A session of immersive VR visualization of knee extension movement does not modify quadriceps muscle activation. A specific protocol for patients with hemophilic knee arthropathy may be effective in improving the activation of the rectus femoris muscle.<\/jats:p>","DOI":"10.3390\/jcm10204725","type":"journal-article","created":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T22:42:18Z","timestamp":1634251338000},"page":"4725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["One Session Effects of Knee Motion Visualization Using Immersive Virtual Reality in Patients with Hemophilic Arthropathy"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2143-8477","authenticated-orcid":false,"given":"Roberto","family":"Ucero-Lozano","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, European University of Madrid, 28670 Villaviciosa de Od\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5050-1845","authenticated-orcid":false,"given":"Ra\u00fal","family":"P\u00e9rez-Llanes","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Catholic University San Antonio-UCAM, 30107 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1347-7759","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"L\u00f3pez-Pina","sequence":"additional","affiliation":[{"name":"Department of Basic Phycology and Methodology, University of Murcia, 30100 Murcia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4276-6982","authenticated-orcid":false,"given":"Rub\u00e9n","family":"Cuesta-Barriuso","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Murcia, 30100 Murcia, Spain"},{"name":"Royal Victoria Eugenia Foundation, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1055\/s-0037-1615621","article-title":"Definitions in Hemophilia","volume":"85","author":"Rosendaal","year":"2001","journal-title":"Thromb. Haemost."},{"key":"ref_2","first-page":"e1","article-title":"Guidelines for the management of hemophilia","volume":"19","author":"Srivastava","year":"2012","journal-title":"Haemophilia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1046\/j.1365-2516.2001.00563.x","article-title":"Proprioception and isometric muscular strength in haemophilic subjects","volume":"7","author":"Hilberg","year":"2001","journal-title":"Haemophilia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1182\/blood-2003-05-1457","article-title":"Joint range-of-motion limitations among young males with hemophilia: Prevalence and risk factors","volume":"103","author":"Soucie","year":"2004","journal-title":"Blood"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1056\/NEJMoa067659","article-title":"Prophylaxis versus Episodic Treatment to Prevent Joint Disease in Boys with Severe Hemophilia","volume":"357","author":"Abshire","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/hae.12058","article-title":"Progression of haemophilic arthropathy in children: A Lithuanian\u2014Danish comparative study","volume":"19","author":"Trakymiene","year":"2012","journal-title":"Haemophilia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1186\/s13075-014-0502-4","article-title":"Quadriceps arthrogenic muscle inhibition: The effects of experimental knee joint effusion on motor cortex excitability","volume":"16","author":"Rice","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1113\/expphysiol.1988.sp003147","article-title":"Pressures in normal and acutely distended human knee joints and effects on quadriceps maximal voluntary contractions","volume":"73","author":"Wood","year":"1988","journal-title":"Q. J. Exp. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.semarthrit.2009.10.001","article-title":"Quadriceps Arthrogenic Muscle Inhibition: Neural Mechanisms and Treatment Perspectives","volume":"40","author":"Rice","year":"2010","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102334","DOI":"10.1016\/j.msksp.2021.102334","article-title":"Effects of additional action observation to an exercise program in patients with chronic pain due to knee osteoarthritis: A randomized-controlled trial","volume":"52","author":"Algun","year":"2021","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20130185","DOI":"10.1098\/rstb.2013.0185","article-title":"Action observation treatment: A novel tool in neurorehabilitation","volume":"369","author":"Buccino","year":"2014","journal-title":"Philos. Trans. R. Soc. B Biol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jcm.2016.08.011","article-title":"Effects of Action Observation Therapy in Patients Recovering From Total Hip Arthroplasty Arthroplasty: A Prospective Clinical Trial","volume":"15","author":"Pirali","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_13","first-page":"570387","article-title":"Effectiveness of the Gaze Direction Recognition Task for Chronic Neck Pain and Cervical Range of Motion: A Randomized Controlled Pilot Study","volume":"2012","author":"Nobusako","year":"2012","journal-title":"Rehabil. Res. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jpain.2015.10.015","article-title":"The Efficacy of Movement Representation Techniques for Treatment of Limb Pain\u2014A Systematic Review and Meta-Analysis","volume":"17","author":"Thieme","year":"2016","journal-title":"J. Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s12984-020-00743-w","article-title":"Virtual reality-based action observation facilitates the acquisition of body-powered prosthetic control skills","volume":"17","author":"Yoshimura","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1109\/TNSRE.2020.2998123","article-title":"Observing Actions Through Immersive Virtual Reality Enhances Motor Imagery Training","volume":"28","author":"Choi","year":"2020","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hsieh, Y.-W., Lee, M.-T., Lin, Y.-H., Chuang, L.-L., Chen, C.-C., and Cheng, C.-H. (2020). Motor Cortical Activity during Observing a Video of Real Hand Movements versus Computer Graphic Hand Movements: An MEG Study. Brain Sci., 11.","DOI":"10.3390\/brainsci11010006"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/s002210100815","article-title":"Relationship between muscle output and functional MRI-measured brain activation","volume":"140","author":"Dai","year":"2001","journal-title":"Exp. Brain Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/j.1365-2516.2006.01312.x","article-title":"Hemophilia joint health score reliability study","volume":"12","author":"Hilliard","year":"2006","journal-title":"Haemophilia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S1050-6411(00)00027-4","article-title":"Development of recommendations for SEMG sensors and sensor placement procedures","volume":"10","author":"Hermens","year":"2000","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Calatayud, J., Mart\u00edn-Cuesta, J., Carrasco, J., P\u00e9rez-Alenda, S., Cruz-Montecinos, C., Andersen, L., Querol-Giner, F., and Casa\u00f1a, J. (2021). Safety, Fear and Neuromuscular Responses after a Resisted Knee Extension Performed to Failure in Patients with Severe Haemophilia. J. Clin. Med., 10.","DOI":"10.3390\/jcm10122587"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1519\/JPT.0000000000000028","article-title":"Examination of Muscle Strength and Pressure Pain Thresholds in Knee Osteoarthritis","volume":"38","author":"Skou","year":"2015","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"606287","DOI":"10.3389\/fphys.2020.606287","article-title":"Validation of mDurance, A Wearable Surface Electromyography System for Muscle Activity Assessment","volume":"11","author":"Damas","year":"2020","journal-title":"Front. Physiol."},{"key":"ref_24","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, L. Erlbaum Associates. [2nd ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3233\/BMR-2011-0298","article-title":"Electromyographic activity of the quadriceps components during the final degrees of knee extension","volume":"24","author":"Duffell","year":"2011","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3447","DOI":"10.1007\/s00221-015-4404-8","article-title":"Cortical activity differs between position- and force-control knee extension tasks","volume":"233","author":"Poortvliet","year":"2015","journal-title":"Exp. Brain Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1113\/jphysiol.1995.sp021050","article-title":"Motor effects of stimulating the human cerebellar thalamus","volume":"489","author":"Ashby","year":"1995","journal-title":"J. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.brs.2014.01.057","article-title":"Anodal Transcranial Direct Current Stimulation Alters Elbow Flexor Muscle Recruitment Strategies","volume":"7","author":"Krishnan","year":"2014","journal-title":"Brain Stimul."},{"key":"ref_29","unstructured":"(2021, July 27). Biology for Biological Engineering. Available online: http:\/\/www.soe.uoguelph.ca\/webfiles\/mleuniss\/Biomechanics\/EMG.html."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1475-925X-2-3","article-title":"Mechanomyography versus Electromyography, in monitoring the muscular fatigue","volume":"2","author":"Tarata","year":"2003","journal-title":"Biomed. Eng. Online"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"489","DOI":"10.3390\/s120100489","article-title":"A Wireless sEMG Recording System and Its Application to Muscle Fatigue Detection","volume":"12","author":"Chang","year":"2012","journal-title":"Sensors"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00221-009-1974-3","article-title":"Action observation improves motor imagery: Specific interactions between simulative processes","volume":"199","author":"Conson","year":"2009","journal-title":"Exp. Brain Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3389\/fnhum.2013.00033","article-title":"Motor resonance in left- and right-handers: Evidence for effector-independent motor representations","volume":"7","author":"Sartori","year":"2013","journal-title":"Front. Hum. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s00415-016-8309-7","article-title":"Brain plasticity in Parkinson\u2019s disease with freezing of gait induced by action observation training","volume":"264","author":"Agosta","year":"2017","journal-title":"J. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00221-010-2253-z","article-title":"Incidental action observation modulates muscle activity","volume":"203","author":"Obhi","year":"2010","journal-title":"Exp. Brain Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/20\/4725\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:14:59Z","timestamp":1760166899000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/20\/4725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,14]]},"references-count":35,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["jcm10204725"],"URL":"https:\/\/doi.org\/10.3390\/jcm10204725","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,14]]}}}