Quantitative EMG analysis to investigate synergistic coactivation of ankle and knee muscles during isokinetic ankle movement. Part 2: time frequency analysis.

Fundamental to intralimb coordination in the lower extremity, ankle-knee synergy induced by motor irradiation has long been employed to secure facilitation of paralyzed muscles. This study, a companion research subsequent to the time amplitude analysis of surface electromyography in part 1, was to investigate the recruitment strategy of irradiated muscles and prime movers during ankle isokinetic contraction at different contraction speeds (30, 60, 120 and 240 degrees/s) with time frequency analysis. The results indicated the recruitment strategies of the major irradiated muscles (ipsilateral rectus femoris/ipsilateral biceps femoris) and prime movers (anterior tibialis/gastrocnemius) were time-dependent and significantly different in terms of the instantaneous median frequency. In general, the prime movers for ankle isokinetic concentric contraction demonstrated a similar recruitment strategy, irrespective of different contraction speeds. This finding is consistent with the idea of generalized motor programs that speed is one of the constraint parameters supplied to motor programs. Nevertheless, the recruitment strategies of the irradiated muscles were highly inconsistent, varying across trials at different contraction speeds, and were not relevant to those of the prime movers. In addition, the recruitment in the irradiated muscles seemly limited to motor units of low threshold, in spite of maximal voluntary contraction of the prime movers.     

Spinal reflexes and coactivation of ankle muscles during a submaximal fatiguing contraction.

This study examined the involvement of spinal mechanisms in the control of coactivation during a sustained contraction of the ankle dorsiflexors at 50% of maximal voluntary contraction. Changes in the surface electromyogram (EMG) of the tibialis anterior and of two antagonist muscles, the soleus and lateral gastrocnemius, were investigated during and after the fatigue task. Concurrently, the compound action potential (M-wave) and the Hoffmann reflex of the soleus and lateral gastrocnemius were recorded. The results showed that the torque of the ankle dorsiflexors and the average EMG of the tibialis anterior during maximal voluntary contraction declined by 40.9 +/- 17.7% (mean +/- SD; P < 0.01) and 37.0 +/- 19.9% (P < 0.01), respectively, at task failure. During the submaximal fatiguing contraction, the average EMG of both the agonist and antagonist muscles increased, leading to a nearly constant ratio at the end of the contraction when normalized to postfatigue values. In contrast to the monotonic increase in average EMG of the antagonist muscles, the excitability of their spinal reflex pathways exhibited a biphasic modulation. The amplitude of the Hoffman reflexes in the soleus and lateral gastrocnemius increased to 147.5 +/- 52.9% (P < 0.05) and 166.7 +/- 74.9% (P < 0.01), respectively, during the first 20% of the contraction and then subsequently declined to 66.3 +/- 44.8 and 74.4 +/- 44.2% of their initial values. In conclusion, the results show that antagonist coactivation did not contribute to task failure. The different changes in voluntary EMG activity and spinal reflex excitability in the antagonist muscles during the fatiguing contraction support the concept that the level of coactivation is controlled by supraspinal rather than spinal mechanisms. The findings indicate, however, that antagonist coactivation cannot simply be mediated by a central descending "common drive" to the motor neuron pools of the agonist-antagonist muscle pairs. Rather, they suggest a more subtle regulation of the drive, possibly through presynaptic mechanisms, to the motoneurons that innervate the antagonist muscles.     

Inter-relationships among anticipatory EMG activity, Hoffmann reflex amplitude and EMG reaction time during voluntary standing movement

In order to understand the process of executing a voluntary standing movement, the parameters latency (AEA-LT), duration (AEA-DUR) and amplitude (AEA-AMP) of the anticipatory electromyographic (EMG) activity (AEA) in the tibialis anterior muscle, Hoffmann (H) reflex amplitude in the soleus muscle (Sol) prior to the onset of EMG activity in that muscle, and EMG reaction time (EMG-RT) were measured during heel raising from the standing position. The following results were obtained: the three parameters of AEA correlated with EMG-RT in each subject; the average values for all nine normal subjects were r = 0.856 for AEA-DUR, r = 0.448 for AEA-LT and r = -0.215 for AEA-AMP; for the group the mean value of AEA-DUR correlated significantly with that of EMG-RT (r = 0.983, P less than 0.01), while no such significant correlation was observed for AEA-LT; the average value of the AEA-DUR in three slower EMG-RT performers (SLOW-PFM) was significantly longer (P less than 0.05) than that in three faster ones (FAST-PFM), while no significant difference in the AEA-LT was observed; and lastly the total area of the anticipatory suppression of the Sol H reflex amplitude in the SLOW-PFM was greater than that in the FAST-PFM. These results suggest that AEA-DUR, representing postural responses, rather than AEA-LT, reflecting cognitive processes, may have had a close link with EMG-RT, and that the increased suppression in Sol H reflex amplitude originated from the increased anticipatory postural requirement, thus bringing about the EMG-RT delay.     

Simulation analysis of interference EMG during fatiguing voluntary contractions. Part II--changes in amplitude and spectral characteristics.

Capabilities of amplitude and spectral methods for information extraction from interference EMG signals were assessed through simulation and preliminary experiment. Muscle was composed of 4 types of motor units (MUs). Different hypotheses on changes in firing frequency of individual MUs, intracellular action potential (IAP) and muscle fibre propagation velocity (MFPV) during fatigue were analyzed. It was found that changes in amplitude characteristics of interference signals (root mean square, RMS, or integrated rectified value, IEMG) detected by intramuscular and surface electrodes differed. RMS and IEMG of surface detected interference signals could increase even under MU firing rate reduction and without MU synchronisation. IAP profile lengthening can affect amplitude characteristics more significantly than MU firing frequency. Thus, an increase of interference EMG amplitude is unreliable to reflect changes in the neural drive. The ratio between EMG amplitude and contraction response can hardly characterise the so-called 'neuromuscular efficiency'. The recently proposed spectral fatigue indices can be used for quantification of interference EMG signals. The indices are practically insensitive to MU firing frequency. IAP profile lengthening and decrease in MFPV enhanced the index value, while recruitment of fast fatigable MUs reduced it. Sensitivity of the indices was higher than that of indices traditionally used.     

Eccentric exercise increases EMG amplitude and force fluctuations during submaximal contractions of elbow flexor muscles.

The purpose of this study was to determine the effect of eccentric exercise on the ability to exert steady submaximal forces with muscles that cross the elbow joint. Eight subjects performed two tasks requiring isometric contraction of the right elbow flexors: a maximum voluntary contraction (MVC) and a constant-force task at four submaximal target forces (5, 20, 35, 50% MVC) while electromyography (EMG) was recorded from elbow flexor and extensor muscles. These tasks were performed before, after, and 24 h after a period of eccentric (fatigue and muscle damage) or concentric exercise (fatigue only). MVC force declined after eccentric exercise (45% decline) and remained depressed 24 h later (24%), whereas the reduced force after concentric exercise (22%) fully recovered the following day. EMG amplitude during the submaximal contractions increased in all elbow flexor muscles after eccentric exercise, with the greatest change in the biceps brachii at low forces (3-4 times larger at 5 and 20% MVC) and in the brachialis muscle at moderate forces (2 times larger at 35 and 50% MVC). Eccentric exercise resulted in a twofold increase in coactivation of the triceps brachii muscle during all submaximal contractions. Force fluctuations were larger after eccentric exercise, particularly at low forces (3-4 times larger at 5% MVC, 2 times larger at 50% MVC), with a twofold increase in physiological tremor at 8-12 Hz. These data indicate that eccentric exercise results in impaired motor control and altered neural drive to elbow flexor muscles, particularly at low forces, suggesting altered motor unit activation after eccentric exercise.     

Reliability of EMG power-spectrum and amplitude of the semitendinosus and biceps femoris muscles during ramp isometric contractions

Appropriate reliability is a necessary condition for the use of surface EMG for evaluation of hamstring muscle function in cases of knee joint pathologies or ligament injuries. The aim of the study was to investigate the test-retest reliability of power spectrum and amplitude of surface electromyographic (EMG) measurements of semitendinosus (ST) and biceps femoris (BF) during ramp isometric contractions. Eleven males performed maximum isometric contractions (MVC) of the knee flexors in two sessions, a week apart with simultaneous recording of surface EMG of the BF and ST. Intra class correlation (ICC) and standard error measurements (SEM) were applied to assess test-retest reliability of the averaged EMG (aEMG) and the median frequency (MF) over 10 levels of force, from 0% to 100% of the maximum. The ICC values ranged from 0.38 to 0.96 for the aEMG with SEM values reaching 11.37% of MVC. For the MF, the ICCs ranged from 0.44 to 0.98 (SEM range 4.49–18.19 Hz). In our set up, ramp contractions can be used to examine hamstring EMG patterns with acceptable reliability.     

Calibration of EMG to force for knee muscles is applicable with submaximal voluntary contractions.

PURPOSE: In this study, the influence of using submaximal isokinetic contractions about the knee compared to maximal voluntary contractions as input to obtain the calibration of an EMG-force model for knee muscles is investigated. METHODS: Isokinetic knee flexion and extension contractions were performed by healthy subjects at five different velocities and at three contraction levels (100%, 75% and 50% of MVC). Joint angle, angular velocity, joint moment and surface EMG of five knee muscles were recorded. Individual calibration values were calculated according to [C.A.M. Doorenbosch, J. Harlaar, A clinically applicable EMG-force model to quantify active stabilization of the knee after a lesion of the anterior cruciate ligament, Clinical Biomechanics 18 (2003) 142-149] for each contraction level. RESULTS: First, the output of the model, calibrated with the 100% MVC was compared to the actually exerted net knee moment at the dynamometer. Normalized root mean square errors were calculated [A.L. Hof, C.A.N. Pronk, J.A. van Best, Comparison between EMG to force processing and kinetic analysis for the calf muscle moment in walking and stepping, Journal of Biomechanics 20 (1987) 167-187] to compare the estimated moments with the actually exerted moments. Mean RMSD errors ranged from 0.06 to 0.21 for extension and from 0.12 to 0.29 for flexion at the 100% trials. Subsequently, the calibration results of the 50% and 75% MVC calibration procedures were used. A standard signal, representing a random EMG level was used as input in the EMG force model, to compare the three models. Paired samples t-tests between the 100% MVC and the 75% MVC and 50% MVC, respectively, showed no significant differences (p>0.05). CONCLUSION: The application of submaximal contractions of larger than 50% MVC is suitable to calibrate a simple EMG to force model for knee extension and flexion. This means that in clinical practice, the EMG to force model can be applied by patients who cannot exert maximal force.     

On the reflex coactivation of ankle flexor and extensor muscles induced by a sudden drop of support surface during walking in humans.

Recent studies have revealed that the stretch reflex responses of both ankle flexor and extensor muscles are coaugmented in the early stance phase of human walking, suggesting that these coaugmented reflex responses contribute to secure foot stabilization around the heel strike. To test whether the reflex responses mediated by the stretch reflex pathway are actually induced in both the ankle flexor and extensor muscles when the supportive surface is suddenly destabilized, we investigated the electromyographic (EMG) responses induced after a sudden drop of the supportive surface at the early stance phase of human walking. While subjects walked on a walkway, the specially designed movable supportive surface was unexpectedly dropped 10 mm during the early stance phase. The results showed that short-latency reflex EMG responses after the impact of the drop (<50 ms) were consistently observed in both the ankle flexor and extensor muscles in the perturbed leg. Of particular interest was that a distinct response appeared in the tibialis anterior muscle, although this muscle showed little background EMG activity during the stance phase. These results indicated that the reflex activities in the ankle muscles certainly acted when the supportive surface was unexpectedly destabilized just after the heel strike during walking. These reflex responses were most probably mediated by the facilitated stretch reflex pathways of the ankle muscles at the early stance phase and were suggested to be relevant to secure stabilization around the ankle joint during human walking.     

Femoral anteversion influences vastus medialis and gluteus medius EMG amplitude: composite hip abductor EMG amplitude ratios during isometric combined hip abduction-external rotation.

This prospective study evaluated differences in vastus medialis (VM) and gluteus medius (GM) EMG amplitude:composite hip abductor (gluteus maximus, gluteus medius, tensor fascia lata) EMG amplitude ratios among subjects with low or high relative femoral anteversion. Data were collected during the performance of a non-weight bearing, non-sagittal plane maximal volitional effort isometric combined hip abduction-external rotation maneuver. Eighteen nonimpaired athletically active females participated in this surface EMG study. Medial hip rotation (relative femoral anteversion estimate) was measured with a handheld goniometer. Subjects were grouped by medial hip rotation displacement (group 1 < or = 42 degrees =36.1+/-7 degrees and group 2 > 42 degrees =52.7+/-7 degrees ) for statistical analysis (Mann Whitney U-tests, p < 0.05). Group 2 had decreased VM (42+/-23% vs. 69+/-30%, U=19, p=0.034) and GM (62+/-25% vs. 96+/-39%, U=19, p=0.034) normalized mean peak EMG amplitude:composite mean peak hip abductor EMG amplitude ratios compared to group 1. Decreased normalized VM (-27%) and GM (-34%) EMG amplitudes among subjects with increased relative femoral anteversion suggest reduced dynamic frontal and transverse plane femoral control from these muscles, possibly contributing to the increased incidence of non-contact knee injury observed among athletic females.     

Examination of extrinsic foot muscles during running using mfMRI and EMG.

Over-pronation has been cited as a key contributor to many types of running injuries. However, the roles of the extrinsic foot muscles during running have not been adequately identified. The purpose of this study was to examine the muscle functional (mf) MRI and EMG responses to perturbations of the foot by running in varus, neutral and valgus wedged shoes. Ten males ran at 3.6 m/s in specially constructed shoes for 5 min with T2-weighted mfMRI collected before and after each run. The change in T2 from before to after each run characterized the level of metabolic activity in each of muscle. Kinematic and EMG data were also collected while subjects ran on a treadmill. There were no T2 differences across the three shoe conditions. In contrast, there was significantly less EMG activity in the tibialis anterior and soleus while wearing the neutral shoe. Overall, the results did not support the theory that muscle activity would increase as the degree of eversion increased. It also appears that surface EMG was more sensitive to differences between conditions than mfMRI. However, this study illustrated that mfMRI may be a useful tool for quantifying muscle activity in cases where surface EMG is inadequate.     

A non-invasive protocol to determine the personalized moment arms of knee and ankle muscles

One difficulty that comes with predicting muscular forces is the accuracy of experimental data, particularly the assessment of muscle moment arms with respect to each joint rotation axis. This paper presents a non-invasive experimental protocol to obtain the personalized muscle moment arms with respect to the ankle and knee joints. A specific pointer is used by a specialist of lower limb anatomy in order to define the local portion of the line of action of the different muscles closed to the joint on the standing subject's lower limb. With this pointer, the three-dimensional coordinates of several points representing the line of action of 12 ankle and knee muscles are collected by a Motion Analysis system. The collection is done five times by the same operator and one time by two different operators. From this data, the intra and inter operator repeatabilities are tested. Relative (ICC) and absolute (SEM) reliabilities are determined in order to evaluate the intra operator repeatability of this non-invasive protocol. The ICC values obtained are higher than 0.91 for 10 among 12 muscles. The intra operator repeatability is thus confirmed. From the records realized by the two operators, the differences are negligible. Thus, the inter operator repeatability is also confirmed. The moments arms obtained using this non-invasive experimental protocol are compared with those calculated from origin and insertion points reported in the literature, according to the work of Whites, Pierrynowskis and Kepples, respectively. The estimations obtained using the non-invasive experimental protocol are found, for some muscles, more realistic than those calculated using the literature data and are always coherent with the role of the muscles described in anatomical books.     

The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement.

The transversus abdominus muscle (TrA) has been demonstrated to be active prior to rapid movements of the upper and lower limbs. This activity is termed feed forward motivation. The lack of feed-forward activation for TrA has been demonstrated in subjects with low back pain. The measures used for investigation of TrA function have been fine-wire needle EMG. This limits the practical application of TrA study due to the cost and level of specialisation required for this technique. The objective of the current study was to investigate the validity and reliability of using a surface EMG site to replicate the findings for the feed-forward activation of TrA prior to rapid limb movement. A population of healthy, young males (n = 20) were studied and it was found that four of the subjects did not meet feed-forward criteria. These results were shown to be highly reliable after a 2-week period for the TrA/IO site only. The validity of the signal was further investigated using several functional tasks to specifically target muscles of the abdominal region. Using a cross-correlation analysis to evaluate crosstalk from adjacent muscles, it was concluded that the signal representing TrA/IO accurately demonstrates the functional activity of the muscle. This study has demonstrated a viable surface EMG method to evaluate the feed-forward activation of TrA/IO prior to rapid limb movement. This may lead to opportunities for the clinical application of this method. It was also a finding of this study that four asymptomatic subjects did not pre-activate, therefore providing a rationale for future prospective investigations on whether the lack of TrA/IO feed-forward activation is a cause or an effect of low back pain.     

Reciprocal coactivation patterns of the medial and lateral quadriceps and hamstrings during slow, medium and high speed isokinetic movements.

The effect of movement velocity and fatigue on the reciprocal coactivation of the quadriceps and hamstrings was investigated through analysis of the root mean square (RMS) and the median frequency (MDF) of surface electromyography for the vastus medialis (VM), vastus lateralis (VL), medial hamstrings (MH) and biceps femoris (BF). Fourteen subjects performed six continuous isokinetic knee extension and flexion movements at 60 degrees, 180 degrees and 300 degrees s(-1), and 30 continuous movements at 300 degrees s(-1) to examine muscular fatigue patterns. Statistical analyses revealed that the RMS activity of the VM displayed greater coactivation than the VL (P<0.01) and the BF displayed greater coactivation than the MH (P<0.0001). There was no effect of velocity on the coactivation levels of the VM, the VL, or the MH; however, there was an effect of velocity on the coactivation levels of the BF (P<0.0001). Relative to MDF activity, the MH shifted upward as velocity increased (P<0. 01) while the BF decreased between 180 and 300 degrees s(-1) (P<0. 01). Results of the muscular fatigue test indicated that the RMS activity of the VM showed a higher degree of coactivation than the VL (P<0.01) and the BF showed approximately three times the coactivation level of the MH (P<0.001). The MDF of the VL and MH shifted downward as the repetitions progressed (P<0.01) with no changes for the VM or for the BF. Results of this study suggest that during isokinetic testing, both the VM and BF have significantly greater reciprocal coactivation levels when compared to the VL and MH, respectively. In addition, these results suggest that motor unit recruitment patterns of the VM and VL and the MH and BF differ with regard to the effects of velocity and fatigue.     

Criterion validation of surface EMG variables as fatigue indicators using peak torque: a study of repetitive maximum isokinetic knee extensions.

A number of studies have been published that have used variables of the electromyogram (EMG) power spectrum during dynamic exercise. Despite these studies there is a shortage of studies of the validity of surface EMG registrations during repetitive dynamic contractions with respect to fatigue. The aim of this study was to investigate if the surface EMG variables mean frequency (MNF [Hz]) and the signal amplitude (RMS [microV]) are valid indicators of muscular fatigue (defined as "any exercise-induced reduction in the capacity to generate force or power output") during maximum repeated isokinetic knee extensions (i.e. criterion validity using peak torque). Twenty-one healthy volunteers performed 100 isokinetic knee extensions at 90 degrees s(-1). EMG signals were recorded from the vastus lateralis, the rectus femoris and the vastus medialis of the right thigh by surface electrodes. MNF and RMS of the EMG together with peak torque (PT [Nm]) were determined for each contraction. MNF showed consequently higher correlation coefficients with PT than RMS did. Positive correlations generally existed between MNF and PT. The majority of the subjects had positive correlations between RMS and PT (i.e. decreases both in PT and in RMS).In conclusion, at the individual level MNF generally - in contrast to RMS - showed good criterion validity with respect to biomechanical fatigue during dynamic maximum contractions.     

Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis.

The serratus anterior and trapezius muscles are considered to be the only upward rotators of the scapula and are very important for normal shoulder function. A variety of methods have been used to produce a maximum voluntary isometric contraction (MVIC) of these muscles for normalization of EMG data. The purpose of this study was to quantify the surface EMG activity of the serratus anterior muscle and the upper, middle, and lower parts of the trapezius during 9 manual muscle tests performed with maximum effort in 30 subjects. It was found that no one muscle test produced a MVIC for all individuals. Therefore, to perform normalization within each subject, it is suggested that the 2 or 3 tests identified in this study that produce high levels of EMG activity for each muscle be performed. The scapular protraction muscle test that is often used to normalize data for the serratus anterior muscle produced relatively low levels of EMG activity and was not found to be an optimal test. Muscle tests in which an attempt was made to de-rotate the scapula from an upwardly rotated position produced much higher levels of EMG activity in the serratus anterior muscle.     

Test-retest reliability of EMG and peak torque during repetitive maximum concentric knee extensions.

The aim of this study was to investigate the reliability of peak torque and surface electromyography (EMG) variable's root mean square (RMS) and mean frequency (MNF) during an endurance test consisting of repetitive maximum concentric knee extensions. Muscle fatigue has been quantified in several ways, and in isokinetic testing it is based on a set of repetitive contractions. To assess test-retest reliability, two sets of 100 dynamic maximum concentric knee extensions were performed using an isokinetic dynamometer. The two series were separated by 7-8 days. The subjects relaxed during the passive flexion phase. Twenty (10 men and 10 women) clinically healthy subjects volunteered.Peak torque and EMG from rectus femoris, vastus medialis, vastus lateralis and biceps femoris were recorded. RMS and MNF were calculated from the EMG signal. The reliability was calculated with intraclass correlation coefficient ICC (1.1) and standard error of measurements (SEM). The reliability of peak torque was good (ICC=0.93) and SEM showed low values. ICC was good for absolute RMS of rectus femoris (ICC>/=0.80), vastus medialis (ICC>/=0.88) and vastus lateralis (ICC>/=0.82) and MNF of rectus femoris (ICC>/=0.82) and vastus medialis (ICC>/=0.83). Peak torque, and MNF and RMS of rectus femoris and vastus medialis are reliable variables obtained from an isokinetic endurance test of the knee extensors.     

Foot and ankle forces during an automobile collision: the influence of muscles

Muscles have a potentially important effect on lower extremity injuries during an automobile collision. Computational modeling can be a powerful tool to predict these effects and develop protective interventions. Our purpose was to determine how muscles influence peak foot and ankle forces during an automobile collision. A 2-D bilateral musculoskeletal model was constructed with seven segments. Six muscle groups were included in the right lower extremity, each represented by a Hill muscle model. Vehicle deceleration data were applied as input and the resulting movements were simulated. Three models were evaluated: no muscles (NM), minimal muscle activation at a brake pedal force of 400 N (MN), and maximal muscle activation to simulate panic braking (MX). Muscle activation always resulted in large increases in peak joint force. Peak ankle joint force was greatest for MX (10120 N), yet this model also had the lowest peak rearfoot force (629 N). Peak force on the Achilles tendon was 4.5 times greater, during MX (6446 N) compared to MN (1430 N). We conclude that (1). external and internal forces are dependent on muscles, (2). muscle activation level could exacerbate axial loading injuries, (3). external and internal forces can be inversely related once muscle properties are included.     

Differential contributions of ankle plantarflexors during submaximal isometric muscle action: A PET and EMG study

The objective of this study was to investigate the relative contributions of superficial and deep ankle plantarflexors during repetitive submaximal isometric contractions using surface electromyography (SEMG) and positron emission tomography (PET). Myoelectric signals were obtained from twelve healthy volunteers (27.3 ± 4.2 yrs). A tracer ([¹⁸F]-FDG) was injected during the exercise and PET scanning was done immediately afterwards. The examined muscles included soleus (Sol), medial gastrocnemius (MG), lateral gastrocnemius (LG), and flexor hallucis longus (FHL). It was found that isometric maximal voluntary contraction (MVC) force, muscle glucose uptake (GU) rate, and SEMG of various plantarflexors were comparable bilaterally. In terms of %EMG MVC, FHL and MG displayed the highest activity (∼34%), while LG (∼21%) had the lowest activity. Cumulative SEMG from all parts of the triceps surae (TS) muscle accounted for ∼70% of the combined EMG signal of all four plantarflexors. As for GU, the highest quantity was observed in MG (2.4 ± 0.8 μmol * 100 g⁻¹ * min⁻¹), whereas FHL (1.8 ± 0.6 μmol * 100 g⁻¹ * min⁻¹) had the lowest uptake. Cumulative GU of TS constituted nearly 80% of the combined GU. The findings of this study provide valuable reference for studies where individual muscle contributions are estimated using models and simulations.     

Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke

Although it has been reported that strengthening exercise in stroke patients is beneficial for their motor recovery, there is little evidence about which exercise method is the better option. The purpose of this study was to compare isotonic and isokinetic exercise by surface electromyography (EMG) analysis using standardized methods.Nine stroke patients performed three sets of isotonic elbow extensions at 30% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic elbow extensions with standardization of mean angular velocity and the total amount of work for each matched set in two strengthening modes. All exercises were done by using 1-DoF planner robot to regulate exact resistive torque and speed. Surface electromyographic activity of eight muscles in the hemiplegic shoulder and elbow was recorded. Normalized root mean square (RMS) values and co-contraction index (CCI) were used for the analysis.The isokinetic mode was shown to activate the agonists of elbow extension more efficiently than the isotonic mode (normalized RMS for pooled triceps: 96.0 ± 17.0 (2nd), 87.8 ± 14.4 (3rd) in isokinetic, 80.9 ± 11.0 (2nd), 81.6 ± 12.4 (3rd) in isotonic contraction, F[1, 8] = 11.168; P = 0.010) without increasing the co-contraction of muscle pairs, implicating spasticity or synergy.