Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study
Summary
Arms contribution in Sit-To-Stand (SitTS) is determined by the legs’ muscle condition. Several compensating strategies were discovered in efforts to achieve complete SitTS cycles. These findings triangulate the spinal cord injury (SCI) persons’ biomechanical measures with their subjective feeling of load borne by both their limbs throughout the SitTS approaches.
Abstract
Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants' input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% ± 7%, 16% ± 4% and 61% ± 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs' Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.
Introduction
Sit-To-Stand (SitTS) is a significant movement in a human's activity of daily living (ADL). It is also a prerequisite for basic functional activities such as standing, transferring, and walking. For patients with incomplete spinal cord injury (SCI), paraplegics in particular, SitTS exercise is a crucial activity for their functional independence1,2. This exercise is essential for independence training, which eventually helps SCI population to improve their quality of life. In order to perform a sufficient and adequate SitTS exercise, the knowledge regarding their biomechanics and muscle activity should be feasibly measurable during the training.
In a clinical rehabilitation program, SCI patients with grade American Spinal Cord Injury Association (ASIA) Impairment Scale, AIS C have a better progression and chance of recovering their motor function than those with grade AIS B, who has complete motor deficits. The SitTS performance plays an important measure in an SCI patient to indicate their motor functionality during the recovery process3. However, SCI AIS C patients require both support from the upper and lower limbs to achieve successful series of repeated SitTS movements. The upper limb support plays an important role in unloading the knees while providing adequate lifting forces and assuring the body balance during the exercise4.
The purpose of this study is to describe the biomechanical contributions of arms and legs throughout repetitive SitTS in incomplete SCI individuals. This study positions the biomechanical analysis in relation to the participants' subjective sense of their arms and legs muscle performance and feelings of 'effort and tiredness' throughout the SitTS exercise.
Many previous SitTS studies only concentrated on investigating the kinematics and kinetics aspects of the activity4,5,6,7. In a wider context of SitTS training, the development of this method which includes the instrumented standing frame (SF) and force plate analysis, could lead researchers to assess both upper and lower limb contribution of other populations such as stroke, elderly, and patients with osteoarthritis8,9,10. A previous study by Zoulias et al., instrumented custom-built hardware and software of SF presented a large frame design11. This method can be challenging to replicate. Hence this SitTS study highlighted a portable instrumented SF that can be adopted by other researchers with an existing motion analysis laboratory setup.
Protocol
Representative Results
Discussion
The current study demonstrated a bodyweight contribution in SCI individuals during SitTS exercise. This study presented SF as an essential assistive device for paraplegics to do a successful SitTS cycle. Moreover, an instrumented SF was developed to ensure the arms force can be assessed too28. The application of MMG was added in the study to observe prime SitTS muscle that helps researchers to understand SitTS performance better. Furthermore, the feedback session enabled researchers to obtain insi…
Offenlegungen
The authors have nothing to disclose.
Acknowledgements
The authors acknowledge and appreciate all the SCI volunteers who participated in this study. This research was supported by the Ministry of Higher Education, Malaysia, and the University of Malaya through Fundamental Research Grant Scheme (FRGS) Grant No. FP002-2020; FRGS/1/2020/SKK0/UM/02/1.
Materials
| Customade chair | A customade chair was built to following to the force plate's dimension. | ||
| FES RehaStim 2 | Hasomed | A device that can stimulate electrical current towards the muscle. | |
| FlexiForce A201 | Tekscan, Inc., USA | Force ranges: 0-100 lbs. (440 N) | Force sensors is used to capture arms force at standing frame. |
| Foldable standing frame | Height: 70.0 cm – 90.0 cm. | A walking frame that was bought from local medical company. | |
| Motion Analysis | Vicon Oxford, UK | A system that records kinematic and kinetics of the activity. | |
| Serial port terminal application | CoolTerm | version 1.4.6; Roger Meier's | An application to record the force sensor data. |
| Vibromyography software | BIOPAC System Inc., USA | AcqKnowledge 4.3.1 | A software to record and strore raw MMG data. It also function for offline analyses. |
| VMG transducers and BIOPAC Vibromyography system | BIOPAC System Inc., USA | BP150 and HLT100C | A device to measure muscle activity. |
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