Muscular effort in multiple sclerosis patients during powered wheelchair manoeuvres

Muscle fatigue tracking during dynamic elbow flexion-extension movements with a varying hand load

Muscle fatigue monitoring, an important element in a fatigue risk management process, can help optimize work intensity and reduce risks for musculoskeletal injuries. An experiment was conducted to determine whether myoelectric manifestations of muscle fatigue can reflect the pace of fatigue development associated with varying load intensity. Twenty male participants performed elbow flexion-extension movements with alternating hand loads (2 kg vs. 1 kg) for 16 min. The pace of fatigue in the biceps brachii in response to load variation was quantified by electromyographic (EMG) fatigue measures collected during the dynamic elbow flexion-extension movements and periodic submaximal isometric elbow flexion trials. The isometric and dynamic EMG measures, except for the amplitude of dynamic EMG, indicated fatigue development during the 2-kg isotonic movements and partial recovery with the 1 kg load. Study results suggest the potential of EMG measures for fatigue monitoring during dynamic work tasks with varying load intensity.

Mapping wheelchair functions and their associated functional elements for stair climbing accessibility: a systematic review

PURPOSE

Wheelchair (WC) design elements are subjected to the accessibility and assistive needs of a person with locomotor disability. In order to pursue a holistic design for a stairclimbing WC, there is a need for literature review on WC functions reported for both stair climbing and plane surface movement.

METHODS

A total of 112 Research articles are reviewed for the purpose of extracting the relationship between WC design elements and the functions associated with them. Stairclimbing technologies are reviewed for their technological assessment in terms of functional elements associated with stairclimbing. Cross-functional mapping between functional elements and their dominant function is performed. Heat map for primary user needs and associated design elements is generated from cross mapping.

CONCLUSIONS

A design gap for user's functional needs is indicated from the review of literature on prototypes and products of WC. The literature in stairclimbing technology is primarily focussed on stair climbing capability and not on the other functional needs, such as safety, ride comfort, seat comfort, manoeuvrability, etc.Implications for rehabilitationFor attaining the goal of an effective rehabilitation, it is important to design and develop an assistive technology that can provide maximum accessibility and functioning for a person with disability. In case of locomotor disability, wheelchair (WC) is the most empowering tool that can assist people in both accessibility and activities of daily living. This review of literature was conducted to draw out the functions fulfilled by a WC, such as safety, comfort, propulsion for its users and the associated WC elements like seat, wheels, backrest, etc., that are required to fulfil those functions.WC being the most important technological intervention in the life of a person who cannot walk should be designed with the highest level of empathy. Therefore, each and every aspect of the user's physical and emotional needs should be catered up to the limits of engineering design. The research on stair climbing technologies has also grown exponentially, fuelled by technological growth in engineering mechanisms, ambient awareness sensors, actuators, etc. The review attempts to envelop such technologies and consolidate them on the basis of their capabilities and efficacies.The virtue of stair climbing has been realized through some novel and innovative mechanisms reviewed in this article that can be integrated with the research in field of functional elements required to carry out primary functions of a disabled person, such as safety, comfort, intuitiveness, etc. This review can help in coupling both of them in a more rational way where a designer who is designing the technology is more empathetic towards the design for accessibility. It can also help user in becoming more confident towards adapting a new assistive technology.

Muscle Fatigue When Riding a Motorcycle: A Case Study

This case study was conducted to assess muscle pattern, as measured by surface electromyography (sEMG), and its changes during a controlled superbike closed-road track training session. The sEMG signals were recorded unilaterally from biceps brachii (BB), triceps brachii (TB), anterior and posterior part of the deltoid (DA and DP respectively), flexor digitorum superficialis (FS), extensor carpi radialis (CR), extensor digitorum communis (ED) and pectoralis major (PM) during three rounds of 30 min. sEMG signals selected for analysis came from the beginning of the braking action to the way-out of the curves of interest. Considering the laps and rounds as a whole and focusing on the forearm muscles, ED was more systematically (84%) assigned to a state of fatigue than FS (44%) and CR (39%). On the opposite, the TB and DP muscles showed a predominant state of force increase (72%). Whereas the BB showed alternatively a state of fatigue or force increase depending on the side of the curve, when taking into account only the sharpest curves, it showed a predominant state of force increase. In conclusion, the fact that forearm muscles must endure a long-lasting maintenance of considerable activity levels explains why they easily got into a state of fatigue. Moreover, TB and DA are particularly relevant when cornering.

Upper and lower limb performance fatigability in people with multiple sclerosis investigated through surface electromyography: a pilot study

OBJECTIVE

Fatigue experienced by people with multiple sclerosis (pwMS) is multidimensional, consisting of different components, such as perceived, physical and cognitive fatigue and performance fatigability. At present, there is no gold standard to assess performance fatigability in pwMS; therefore, we aimed to determine whether, during a fatiguing task, average rectified value (ARV), mean frequency of the power spectrum (MNF), muscle fiber conduction velocity (CV) and fractal dimension (FD) of surface electromyography (sEMG) may be used as indirect indices of performance fatigability. Moreover, we analyzed whether a three-week rehabilitation program impacts on performance fatigability in pwMS, and whether a relationship between sEMG parameters and trait levels of perceived fatigability, before and after rehabilitation, does exist.

APPROACH

Twenty-one pwMS performed a 20% maximal voluntary contraction (MVC) of 1 min, and afterwards a 60% MVC held until exhaustion. sEMG signals were detected from the biceps brachii, vastus medialis and vastus lateralis. Performance fatigability was determined at entry to (t ₀) and discharge from (t ₁) rehabilitation. Perceived fatigability was measured at t ₀ and t ₂, one month after rehabilitation.

MAIN RESULTS

ARV, MNF, CV and FD rates of change showed significant changes at t ₀ and t ₁ (p  <  0.05) during the high-level contraction in the BB, but rather limited in the vastii muscles. Moreover, rehabilitation did not induce any reductions in either perceived or performance fatigability. No significant correlations between ARV, MNF, CV and FD rates of change during the 60% MVC and perceived fatigability, at t ₀ and t ₂, were found.

SIGNIFICANCE

Our findings suggest that the sEMG parameters are useful for indirectly assessing performance fatigability in pwMS during sub-maximal fatiguing contractions, particularly in the biceps brachii.

A review on crosstalk in myographic signals

PURPOSE

Crosstalk in myographic signals is a major hindrance to the understanding of local information related to individual muscle function. This review aims to analyse the problem of crosstalk in electromyography and mechanomyography.

METHODS

An initial search of the SCOPUS database using an appropriate set of keywords yielded 290 studies, and 59 potential studies were selected after all the records were screened using the eligibility criteria. This review on crosstalk revealed that signal contamination due to crosstalk remains a major challenge in the application of surface myography techniques. Various methods have been employed in previous studies to identify, quantify and reduce crosstalk in surface myographic signals.

RESULTS

Although correlation-based methods for crosstalk quantification are easy to use, there is a possibility that co-contraction could be interpreted as crosstalk. High-definition EMG has emerged as a new technique that has been successfully applied to reduce crosstalk.

CONCLUSIONS

The phenomenon of crosstalk needs to be investigated carefully because it depends on many factors related to muscle task and physiology. This review article not only provides a good summary of the literature on crosstalk in myographic signals but also discusses new directions related to techniques for crosstalk identification, quantification and reduction. The review also provides insights into muscle-related issues that impact crosstalk in myographic signals.

The Assessment of Motor Fatigability in Persons With Multiple Sclerosis: A Systematic Review

Background. Persons with multiple sclerosis (PwMS) are often characterized by increased motor fatigability, which is a performance change on an objectively measured criterion after any type of voluntary muscle contractions. This review summarizes the existing literature to determine which protocols and outcome measures are best to detect or study motor fatigability and the underlying mechanisms in MS. Methods. Two electronic databases, PubMed and Web of Science, were searched for relevant articles published until August 2016 with a combination of multiple sclerosis, fatigability, muscle fatigue, and motor fatigue. Results. A total of 48 articles were retained for data extraction. A variety of fatigability protocols were reported; protocols showed differences in type (isometric vs concentric), duration (15 to 180 s), and number of contractions (fixed or until exhaustion). Also, 12 articles reported motor fatigability during functional movements, predominantly assessed by changes in walking speed; 11 studies evaluated the mechanisms underlying motor fatigability, using additional electrical nerve or transcranial magnetic stimulation. Three articles reported psychometrics of the outcomes. Conclusions. The disparity of protocols and outcome measures to study different aspects of motor fatigability in PwMS impedes direct comparison between data. Most protocols use maximal single-joint isometric contractions, with the advantage of high standardization. Because there is no head-to-head comparison of the different protocols and only limited information on psychometric properties of outcomes, there is currently no gold standard to assess motor fatigability. The disability level, disease phenotype, and studied limb may influence the assessment of motor fatigability in PwMS.

Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial

Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS) have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted training within a virtual learning environment. Six MS patients with upper limb impairment (motricity index ranging from 50 to 91/100) and six healthy persons completed five training bouts of three minutes each performing lifting tasks, while EMG signals of anterior deltoid and lower trapezius muscles were measured and their subjective perceptions on muscle fatigue were registered. Decreased performance and higher subjective fatigue perception were present in the MS group. Increased mean EMG amplitudes and subjective perception levels on muscle fatigue were observed in both groups. Muscle fatigue development during 15′ training has been demonstrated in the arm of MS patients, which influences the sustainability of training intensity in MS patients. To optimize the training performance, adaptivity based on the detection of MS patient's muscle fatigue could be provided by means of training program adjustment.

Validation of the comprehensive ICF core set for multiple sclerosis from the perspective of physical therapists

BACKGROUND

The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of people with MS.

OBJECTIVES

The objective of this study was to validate the Comprehensive ICF Core Set for MS from the perspective of physical therapists.

DESIGN

A 3-round survey based on the Delphi technique was used.

METHODS

Physical therapists experienced in the management of MS were asked about problems and resources of people with MS as well as environmental aspects treated by physical therapists (eg, use of assistive devices, support). Statements were linked to the ICF and compared with the Comprehensive ICF Core Set for MS.

RESULTS

Eighty physical therapists from 23 countries mentioned 2,133 issues that covered all of the ICF components. Two hundred thirty-eight ICF categories were linked to the statements. Forty-six categories in the Comprehensive ICF Core Set for MS were confirmed by physical therapists at the same level or a more specific level of classification. Nineteen additional ICF categories were reported by at least 75% of the participants.

CONCLUSIONS

The results of this study support the content and face validity of the Comprehensive ICF Core Set for MS. Areas of functioning and health that physical therapists believe should be assessed were identified. The findings of this study as well as the results of completed and ongoing validation studies will further elucidate the validity of the Comprehensive ICF Core Set for MS from different perspectives.

Surface EMG based muscle fatigue evaluation in biomechanics

In the last three decades it has become quite common to evaluate local muscle fatigue by means of surface electromyographic (sEMG) signal processing. A large number of studies have been performed yielding signal-based quantitative criteria of fatigue in primarily static but also in dynamic tasks. The non-invasive nature of this approach has been particularly appealing in areas like ergonomics and occupational biomechanics, to name just the most prominent ones. However, a correct appreciation of the findings concerned can only be obtained by judging both the scientific value and practical utility of methods while appreciating the corresponding advantages and limitations. The aim of this paper is to serve as a state of the art summary of this issue. The paper gives an overview of classical and modern signal processing methods and techniques from the standpoint of applicability to sEMG signals in fatigue-inducing situations relevant to the broad field of biomechanics. Time domain, frequency domain, time-frequency and time-scale representations, and other methods such as fractal analysis and recurrence quantification analysis are described succinctly and are illustrated with their biomechanical applications, research or clinical alike. Examples from the authors' own work are incorporated where appropriate. The future of this methodology is projected by estimating those methods that have the greatest chance to be routinely used as reliable muscle fatigue measures.