Name: quantifying arms and legs contributions during repetitive electrically-assisted sit-to-stand exercise in paraplegics: a pilot study
Uploaded: 2022-11-11T12:50:00
Description: Watch this Scientific Journal Video about Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study at JoVE.com

The authors acknowledge and appreciate&#160;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.&#160;FP002-2020;&#160;FRGS/1/2020/SKK0/UM/02/1.

The SitTS exercise and informed consent in this manuscript are described under ethical consideration by University of Malaya Medical Centre Ethics Committee (2017119-4828)12. Study procedures were explained in detail to each participant, and written informed consent was obtained before beginning the SitTS trial. This study was conducted as mixed-mode, where quantitative data were obtained using biomechanical analysis, whereas subjective scores were obtained from feedback sessions (of the participa...

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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...

Sit-To-Stand (SitTS) is a significant movement in a human&#39;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&#160;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&#39; subjective sense of their arms and legs muscle performance and feelings of &#39;effort and tiredness&#39; 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.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Customade chair</td>
			<td></td>
			<td></td>
			<td>A customade chair was built to following to the force plate&#39;s dimension.</td>
		</tr>
		<tr>
			<td>FES RehaStim 2</td>
			<td>Hasomed</td>
			<td></td>
			<td>A device that can stimulate electrical current towards the muscle.</td>
		</tr>
		<tr>
			<td>FlexiForce A201</td>
			<td>Tekscan, Inc., USA</td>
			<td>Force ranges: 0-100 lbs. (440 N)</td>
			<td>Force sensors is used to capture arms force at standing frame.</td>
		</tr>
		<tr>
			<td>Foldable standing frame</td>
			<td></td>
			<td>Height: 70.0 cm - 90.0 cm.</td>
			<td>A walking frame that was bought from local medical company.</td>
		</tr>
		<tr>
			<td>Motion Analysis</td>
			<td>Vicon Oxford, UK</td>
			<td></td>
			<td>A system that records kinematic and kinetics of the activity.</td>
		</tr>
		<tr>
			<td>Serial port terminal application</td>
			<td>CoolTerm</td>
			<td>version 1.4.6; Roger Meier&#39;s</td>
			<td>An application to record the force sensor data.</td>
		</tr>
		<tr>
			<td>Vibromyography software</td>
			<td>BIOPAC System Inc., USA</td>
			<td>AcqKnowledge 4.3.1</td>
			<td>A software to record and strore raw MMG data. It also function for offline analyses.</td>
		</tr>
		<tr>
			<td>VMG transducers and BIOPAC Vibromyography system</td>
			<td>BIOPAC System Inc., USA</td>
			<td>BP150 and HLT100C</td>
			<td>A device to measure muscle activity.</td>
		</tr>
	</tbody>
</table>

quantifying arms and legs contributions during repetitive electrically-assisted sit-to-stand exercise in paraplegics: a pilot study

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&#39; 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% &#177; 7%, 16% &#177; 4% and 61% &#177; 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs&#39; 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.

A total of 399 and 463 SitTS trials were completed without and with FES assisted correspondingly. The trials that contributed to each set are tabulated in Table 2. The participants could perform more SitTS trials with the presence of electrical stimulation on their legs, i.e., FES. Overall, both participants managed to perform more SitTS trials with the aid of FES. This suggests that FES helps in stimulating participants&#39; quadriceps to execute SitTS action in a prolonged period20</s...

Watch this Scientific Journal Video about Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study at JoVE.com

Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

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.

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 ...

This protocol demonstrates appropriate guidelines by explaining essential parts and how they're carried out in conducting a sit-to-stand experiment with the assistance of arm support and functional electrical stimulation. This technique helps manage the complexity of having a few sets up, including the instrumentation of a standing frame, functional electrical stimulation, and mechanomyography. This method can be applicable to other populations that require the setup of sit-to-stand with arm assistance.Demonstrating the procedure will be Khairul, an assistant in handling the MMG and FES setup. Adhli, an assistant in Vicon setup, and Musfirah a PhD candidate under Dr.Nur Azah Hamzaid's supervision. Begin the sit-to-stand experiment set up by arranging a chair and standing frame.To do so, design an armless chair with a height of 45 centimeters without a back rest according to the dimension of a force plate 1 embedded in the floor of the motion analysis laboratory. Next, instrument each SF leg at the bottom with an independent force sensor with a sensitivity range from 0 to 12 kilograms. Position a portable and foldable SF in front of the chair within arm's reach, and position four legs of the SF outside of force plate 2 to avoid double measurements.For motion analysis set up, enter the participant's details such as leg length, ankle width, and knee width in the system. Then, place 16 reflective markers on the participant's lower limbs with double-sided tape directly over the bilateral, anterior, and posterior of the superior iliac spine. Attach the marker over the lateral surface of the bilateral thigh and shank, and on the lateral left and right malleolus.Next, place markers over the left and right of the second metatarsal head, and on the calcaneus at the same height of the second metatarsal head. When done, instruct the participant to be seated barefoot, with the knees flexed at 90 degrees, and both feet positioned on force plate 2. Ensure the participant's head and trunk face forward while sitting upright.After placing the participant's hands on the handle of the SF, identify the rectus femoris muscle by palpating the middle and bulky area of the thigh, then place one mechanomyography, or MMG sensor per leg at the thigh area of the rectus femoris muscle bilaterally to measure the leg muscles sit-to-stand and stand-to-sit efforts. Secure the sensors with a double-sided tape and strap the sensors around the thigh to reduce the motion artifacts before connecting to the MMG device and the computer. On day one, perform a voluntary sit-to-stand exercise by turning on all setups to record the selected parameters.At the end of countdown of five seconds timed by an electronic timer, ask the participant to stand up from the stationary sitting position for three seconds before sitting back on the chair. After a rest of five seconds, continue to do sit-to-stand trials until the participant cannot perform the same routine any longer. When done, turn off all the recorded data.Give a five minute break before continuing the next set of the sit-to-stand routine to provide muscle recovery amongst sets. Once the trial is over, allow the participant to rest for at least 48 hours. On day two, place functional electrical stimulation electrodes on the quadriceps and gluteus maximus muscles to perform the FES assisted sit-to-stand exercise.For quadriceps muscle, place the first electrode horizontally about two finger widths above the knee, and the second electrode horizontally about a palm width below the hip joint. For the gluteus maximus muscle, instruct the participant to bend forward to place the first electrode vertically, closest to the hip bone, and attach the second electrode vertically, closest to the tailbone, side-by-side from the first electrode. When the electrodes are in place, attach all FES electrodes to the FES device and connect them to the FES software in the computer.Set up the FES software by selecting the pulse width of 300 and the frequency of 35 hertz. To define the FES current intensity, inquire if the participant can tolerate the current to achieve knee and hip extension. Determine the FES current amplitude through several practices before starting the actual trial.Next, start the experiment as described earlier by switching the FES on as the participant stands up and switching the FES off to let the participant sit back on the chair. Repeat the trial in sets and collect the data. Throughout the sit-to-stand action in both sessions, participant 1's arm percentage showed a higher contribution to total body weight percentage as compared to his leg percentage.In participant 1, the electrical stimulation could not provide a full extension in the right knee during the end phase of the sit-to-stand routine. The right knee angle did not reach the normal knee extension range of motion. In contrast, participant 2 exerted more strength onto her legs to bear the full body weight, with a higher contribution of leg percent during the end phase of the voluntary sit-to-stand routine.In addition, during the final set of voluntary sit-to-stand routine, participant 2 exhibited a smaller knee angle during the early stage of the movement. During event B, when the buttocks lift up was initiated, participant 1 was observed to increase arm strength to lift his upper body from the chair. Meanwhile, for participant 2, the maximum contribution of arms was detected during event B, for FES assisted sit-to-stand routine.Each step in this procedure is important and should be followed as stated. However, it is necessary to note that there can be flexibility, specifically in the initial posture of the participant. Qualitative feedback can be added in order to measure opinions and views regarding the sit-to-stand routines, stability, and fatigue from the participant's perspective.By adding this method, researchers will better understand the sit-to-stand technique's behavior with the quantitative results achieved.

Research

JoVE Journal

Engineering

Micro 3D Printing Using a Digital Projector and its Application in the Study of Soft Materials Mechanics

Buckling is a classical topic in mechanics. While buckling has long been studied as one of the major structural failure modes1, it has recently drawn new ...

Coherent anti-Stokes Raman Scattering (CARS) Microscopy Visualizes Pharmaceutical Tablets During Dissolution

Coherent anti-Stokes Raman Scattering CARS Microscopy Visualizes Pharmaceutical Tablets During Dissolution

Traditional pharmaceutical dissolution tests determine the amount of drug dissolved over time by measuring drug content in the dissolution medium. This ...

Detection and Recovery of Palladium, Gold and Cobalt Metals from the Urban Mine Using Novel Sensors/Adsorbents Designated with Nanoscale Wagon-wheel-shaped Pores

Developing low-cost, efficient processes for recovering and recycling palladium, gold and cobalt metals from urban mine remains a significant challenge in ...

Emission Spectroscopic Boundary Layer Investigation during Ablative Material Testing in Plasmatron

Ablative Thermal Protection Systems (TPS) allowed the first humans to safely return to Earth from the moon and are still considered as the only solution ...

A Robotic Platform to Study the Foreflipper of the California Sea Lion

The California sea lion (Zalophus californianus), is an agile and powerful swimmer. Unlike many successful swimmers (dolphins, tuna), they generate most ...

Challenges in Rheological Characterization of Highly Concentrated Suspensions &#8212; A Case Study for Screen-printing Silver Pastes

A comprehensive rheological characterization of highly concentrated suspensions or pastes is mandatory for a targeted product development meeting the ...

In Situ Monitoring of the Accelerated Performance Degradation of Solar Cells and Modules: A Case Study for Cu(In,Ga)Se2 Solar Cells

In Situ Monitoring of the Accelerated Performance Degradation of Solar Cells and Modules: A Case Study for CuIn,GaSe2 Solar Cells

The levelized cost of electricity (LCOE) of photovoltaic (PV) systems is determined by, among other factors, the PV module reliability. Better prediction ...

Study of Siphon Breaker Experiment and Simulation for a Research Reactor

Under the design conditions of a research reactor, the siphon phenomenon induced by pipe rupture can cause continuous outward flow of water. To prevent ...

Methods of Ex Situ and In Situ Investigations of Structural Transformations: The Case of Crystallization of Metallic Glasses

Methods of Ex Situ and In Situ Investigations of Structural Transformations: The Case of Crystallization of Metallic Glasses

We demonstrate the use of two nuclear-based analytical methods that can follow the modifications of microstructural arrangement of iron-based metallic ...

Film Control to Study Contributions of Waves to Droplet Impact Dynamics on Thin Flowing Liquid Films

Droplet impact is a very common phenomenon in nature and attracts attention due to its aesthetic fascination and wide-ranging applications. Previous ...