Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Study on Asymmetrical EMG Activation Pattern of Selected Trunk and Thigh Muscles on Gait Velocity of Individuals With Post-Stroke Hemiparesis During Sit-to-Stand Movement

일어서기 동작시 편마비 환자의 보행 속도에 따른 체간과 하지 근 활성 형태의 비대칭성에 관한 연구

  • Park, Hyun-Ju (Dept. of Physical Therapy, The Graduate School, Daejeon University) ;
  • Oh, Duck-Won (Dept. of Physical Therapy, College of Health Science, Cheongju University) ;
  • Choi, Sung-Jin (Dept. of Rehabilitation Center, Boram Hospital) ;
  • Jang, Hyun-Jeong (Dept. of Physical Therapy, The Graduate School, Daejeon University) ;
  • Sim, Sun-Mi (Dept. of Rehabilitation Center, Youseong Wellness Hospital) ;
  • Cho, Hyuk-Shin (Dept. of Rehabilitation Center, Jooeun Raphas Hospital)
  • 박현주 (대전대학교 대학원 물리치료학과) ;
  • 오덕원 (청주대학교 보건의료대학 물리치료학과) ;
  • 최성진 (보람병원 물리치료실) ;
  • 장현정 (대전대학교 대학원 물리치료학과) ;
  • 심선미 (유성웰니스병원 물리치료실) ;
  • 조혁신 (주온라파스병원 물리치료실)
  • Received : 2011.12.06
  • Accepted : 2012.02.17
  • Published : 2012.05.21
Download PDF
⟨ Previous Next ⟩

Abstract

This study aimed to identify the asymmetry observed in the electromyography (EMG) activity patterns of selected trunk and thigh muscles between the affected and unaffected sides during the sit-to-stand movement in ambulatory patients with post-stroke hemiparesis. This study included 20 patients with post-stroke hemiparesis. The differences between stroke fast walkers (${\geq}8m/s$, 11 subjects) and stroke slow walkers (<8 m/s, 9 subjects) were compared. The activation magnitude and onset time of the multifidus, lumbar erector spinae, hamstrings, and quadriceps during the sit-to-stand movement were recorded through surface EMG. Moreover, the EMG activation magnitude and onset time ratios of each bilateral corresponding muscle from the trunk and leg were measured by dividing the relevant values of the unaffected side by those of the affected side. In all the subjects, the activation magnitudes of the multifidus, hamstring, and quadriceps on the affected side significantly decreased compared to those on the unaffected side (p<.05). The onset time of muscle activity in the affected side was markedly delayed for the multifidus and quadriceps during the task (p<.05). The activation magnitude ratios of the quadriceps were markedly decreased in the stroke slow walkers as compared to those in the stroke fast walkers. These findings indicate that the asymmetry in the multifidus, hamstring, and quadriceps muscle activation patterns in patients with post-stroke hemiparesis may be due to the excessive muscle activation in the unaffected side to compensate for the weakened muscle activity in the affected side. Our findings may provide researchers and clinicians with information that can be useful in rehabilitation therapy.

Keywords

References

  1. Bohannon RW, Smith MB. Interrater reliability of a modified ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-207. https://doi.org/10.1093/ptj/67.2.206
  2. Bohannon RW, Walsh S. Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke. Arch Phys Med Rehabil. 1992;73(8):721-725.
  3. Campbell FM, Ashburn AM, Pickering RM, et al. Head and pelvic movements during a dynamic reaching task in sitting: Implications for physical therapists. Arch Phys Med Rehabil. 2001;82(12): 1655-1660. https://doi.org/10.1053/apmr.2001.26818
  4. Carr JH, Shepherd RB. Stroke Rehabilitation: Guidelines for exercise and training to optimize motor skill. 1st ed. London, Butterworth-Heinemann, 2003:130-158.
  5. Cheng PT, Chen CL, Wang CM, et al. Leg muscle activation patterns of sit-to-stand movement in stroke patients. Am J Phys Med Rehabil. 2004;83(1):10-16. https://doi.org/10.1097/01.PHM.0000104665.34557.56
  6. Cram JR, Kasman GS, Holtz J. Introduction to Surface Electromyography. 1st ed. Maryland, Aspen Pub., 1998:361.
  7. Danneels LA, Coorevits PL, Cools AM, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Eur Spine J. 2002;11(1):13-19. https://doi.org/10.1007/s005860100314
  8. Davies JM, Mayston MJ, Newham DJ. Electrical and mechanical output of the knee muscles during isometric and isokinetic activity in stroke and healthy adults. Disabil Rehabil. 1996;18(2):83-90. https://doi.org/10.3109/09638289609166022
  9. Demura S, Sato S, Minami M, et al. Gender and age differences in basic ADL ability on the elderly: Comparison between the independent and the dependent elderly. J Physiol Anthropol Appl Human Sci. 2003;22(1):19-27. https://doi.org/10.2114/jpa.22.19
  10. Dickstein R, Shefi S, Marcovitz E, et al. Electromyographic activity of voluntarily activated trunk flexor and extensor muscles in post-stroke hemiparetic subjects. Clin Neurophysiol. 2004;115(4):790-796. https://doi.org/10.1016/j.clinph.2003.11.018
  11. Eng JJ, Chu KS. Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil. 2002;83(8):1138-1144. https://doi.org/10.1053/apmr.2002.33644
  12. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. https://doi.org/10.1016/0022-3956(75)90026-6
  13. Fujiwara T, Sonoda S, Okajima Y, et al. The relationship between trunk function and the findings of transcranial magnetic stimulation among patients with stroke. J Rehabil Med. 2001;33(6): 249-255. https://doi.org/10.1080/165019701753236428
  14. Goulart FR, Valls-Sole J. Patterned electromyographic activity in the sit-to-stand movement. Clin Neurophysiol. 1999;110(9):1634-1640. https://doi.org/10.1016/S1388-2457(99)00109-1
  15. Hill K, Ellis P, Bernhardt J, et al. Balance and mobility outcomes for stroke patients: A comprehensive audit. Aust J Physiother. 1997;43(3): 173-180. https://doi.org/10.1016/S0004-9514(14)60408-6
  16. Horak FB, Esselman P, Anderson ME, et al. The effects of movement velocity, mass displaced, and task certainty on associated postural adjustments made by normal and hemiplegic individuals. J Neurol Neurosurg Psychiatry. 1984;47(9):1020-1028. https://doi.org/10.1136/jnnp.47.9.1020
  17. Kim CM, Eng JJ. The relationship of lower- extremity muscle torque to locomotor performance in people with stroke. Phys Ther. 2003;83(1):49-57.
  18. Lee MY, Wong MK, Tang FT, et al. Comparison of balance responses and motor patterns during sit-to-stand task with functional mobility in stroke patients. Am J Phys Med Rehabil. 1997;76(5):401-410. https://doi.org/10.1097/00002060-199709000-00011
  19. McComas AJ, Sica RE, Upton AR, et al. Functional changes in motoneurones of hemiparetic patients. J Neurol Neurosurg Psychiatry. 1973;36(2):183-193. https://doi.org/10.1136/jnnp.36.2.183
  20. Moseley GL. Impaired trunk muscle function in sub-acute neck pain: Etiologic in the subsequent development of low back pain? Man Ther. 2004;9(3):157-163. https://doi.org/10.1016/j.math.2004.03.002
  21. Newham DJ, Hsiao SF. Knee muscle isometric strength, voluntary activation and antagonist co-contraction in the first six months after stroke. Disabil Rehabil. 2001;23(9):379-386. https://doi.org/10.1080/0963828001006656
  22. Nyberg L, Gustafson Y. Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke. 1995;26(5):838-842. https://doi.org/10.1161/01.STR.26.5.838
  23. O'Sullivan P, Tweomey L, Allison G. Dysfunction of the neuro-muscular system in the presence of low back pain-implications for physical therapy management. J Man Manip Ther. 1997;5(1):20-26. https://doi.org/10.1179/jmt.1997.5.1.20
  24. Oh DW, Kim JS, Kim SY, et al. Effect of motor imagery training on symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks in post-stroke hemiparesis. NeuroRehabilitation. 2010;26(4):307-315.
  25. Palmer E, Downes L, Ashby P. Associated postural adjustments are impaired by lesion of the cortex. Neurology. 1996;46(2):471-475. https://doi.org/10.1212/WNL.46.2.471
  26. Panjabi MM. The stabilizing system of the spine. Part I. function, dysfunction, adaptation and enhancement. J Spinal Disord. 1992;5(4):383-389. https://doi.org/10.1097/00002517-199212000-00001
  27. Patterson KK, Parafianowicz I, Danells CJ, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008;89(2): 304-310. https://doi.org/10.1016/j.apmr.2007.08.142
  28. Pereira LM, Marcucci FC, de Oliveira Menacho M, et al. Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise. J Electromyogr Kinesiol. 2011;21(2):327-332. https://doi.org/10.1016/j.jelekin.2010.10.003
  29. Perry J, Garrett M, Gronley JK et al. Classification of walking handicap in the stroke population. Stroke. 1995;26(6):982-989. https://doi.org/10.1161/01.STR.26.6.982
  30. Rosenfalck A, Andreassen S. Impaired regulation of force and firing pattern of single motor units in patients with spasticity. J Neurol Neurosurg Psychiatry. 1980;43(10):907-916. https://doi.org/10.1136/jnnp.43.10.907
  31. Roys MS. Serious stair injuries can be prevented by improved stair design. Appl Ergon. 2001;32(2): 135-139. https://doi.org/10.1016/S0003-6870(00)00049-1
  32. Slijper H, Latash M. The effects of instability and additional hand support on anticipatory postural adjustments in leg, trunk, and arm muscles during standing. Exp Brain Res. 2000;135(1):81-93. https://doi.org/10.1007/s002210000492
  33. Soderberg GL, Knutson LM. A guide for use and interpretation of kinesiologic electromyographic data. Phys Ther. 2000;80(5):485-498.
  34. Thielman G, Kaminski T, Gentile AM. Rehabilitation of reaching after stroke: Comparing 2 training protocols utilizing trunk restraint. Neurorehabil Neural Repair. 2008;22(6):697-705. https://doi.org/10.1177/1545968308315998
  35. Wagenaar RC, van Emmerik REA. Dynamics of pathological gait. Hum Mov Sci. 1994;13(3-4): 441-471. https://doi.org/10.1016/0167-9457(94)90049-3
  36. Winzeler-Mercay U, Mudie H. The nature of the effects of stroke on trunk flexor and extensor muscles during work and at rest. Disabil Rehabil. 2002;24(17):875-886. https://doi.org/10.1080/09638280210142220

Cited by

  1. The Immediate Effect of Maitland Cervical Spine Mobilization on Tone and Stiffness of Upper Limb Muscles in Chronic Stroke Patients vol.25, pp.2, 2018, https://doi.org/10.12674/ptk.2018.25.2.013
  2. 뇌졸중 환자의 앉은 자세에서 일어서기 동작 수행에 영향을 주는 다리 근 활성 비교 vol.16, pp.1, 2012, https://doi.org/10.21598/jkpnfa.2018.16.1.59