Surface Electromyography Measurements Research Articles

The Effect of Isometric Exercise Position on the Effectiveness of Isolated Work of the Thigh Flexor Muscles Based on the Results of the sEMG Study.

The main function of the hamstring muscles is to bend the knee joint and support the function of the hip extensors. Their frequent injuries are the result of overload related to, among others, dynamic running or jumping, and inadequate preparation for athletics activities. The asymmetry of the work of individual flexor muscle groups is clearly marked in the case of valgus or varus of the knee joint, i.e., in different positions of the lower limb. The aim of the study was to determine the position and form of a rehabilitation exercise in which an isolated group of muscles flexing the knee joint will show the greatest bioelectrical activity. The study involved 25 students of the Jagiellonian University Medical College. The students were aged 20-26. The average age was 22.9 (±1.4). The study participants included 17 women with an average age of 23.0 (±1.1) and 8 men with an average age of 22.6 (±1.9). Women constituted 68% and men 32% of all respondents. All participants agreed to participate in the study. Surface electromyography measurements in both lower limbs provided an initial number of 50 cases. The activity of the knee flexor muscles during isometric contraction with resistance was measured in correlation with three foot and lower leg settings: internal rotation, neutral position, and external rotation. The bioelectrical activity of the semitendinosus muscle is significantly higher (p < 0.01) in the internal rotation position than in the neutral position of the lower leg, while the bioelectrical activity of the biceps femoris muscle is inversely higher (p < 0.01) in the external rotation position than in the neutral position. The results are significant for both average and maximum values of muscle stimulation. During isometric contraction with resistance, the semitendinosus muscle shows the greatest bioelectrical activity in the internal rotation position of the lower leg and foot, and the biceps femoris muscle in the external rotation position of the lower leg and foot. The above information has important implicational applications when improving isolated groups of hamstrings. In the future, this may contribute to more effective rehabilitation of patients with injuries of the muscles described in the article.

Multiclass Gait Phase Classification From the Temporal Convolutional Network of Wireless Surface Electromyography Measurements

Multiclass Gait Phase Classification From the Temporal Convolutional Network of Wireless Surface Electromyography Measurements

Kinematic–kinetic compliant acetabular cup positioning based on preoperative motion tracking and musculoskeletal modeling for total hip arthroplasty

The invention of the surgical robot enabled accurate component implantation during total hip arthroplasty (THA). However, a preoperative surgical planning methodology is still lacking to determine the acetabular cup alignment considering the patient-specific hip functions during daily activities such as walking. To simultaneously avoid implant edgeloading and impingement, this study established a kinematic–kinetic compliant (KKC) acetabular cup positioning method based on preoperative gait kinematics measurement and musculoskeletal modeling. Computed tomography images around the hip joint and their biomechanical data during gait, including motion tracking and foot–ground reaction forces, were collected. Using the reconstructed pelvic and femur geometries, the patient-specific hip muscle insertions were located in the lower limb musculoskeletal model via point cloud registration. The designed cup orientation has to be within the patient-specific safe zone to prevent implant impingement, and the optimized value selected based on the time-dependent hip joint reaction force to minimize the risk of edgeloading. As a validation of the proposed musculoskeletal model, the predicted lower limb muscle activations for seven patients were correlated with their surface electromyographic measurements, and the computed hip contact force was also in quantitative agreement with data from the literature. However, the designed cup orientations were not always within the well-known Lewinnek safe zone, highlighting the importance of KKC surgical planning based on patient-specific biomechanical evaluations.

Extrinsic Laryngeal Muscle Activity and Vocal Economy in Professionally Trained Voices During Vocal Vibrato

Summary PurposeThe purpose of the present study was to determine the extrinsic laryngeal muscle activity and vocal economy during two different singing conditions (straight-tone singing vs. vibrato singing) over a physiologically relevant singing range. MethodsThirty professional singers or voice coaches participated in the study. The participants sang a sustained /a:/ vowel for approximately 5 seconds, once in straight-tone singing conditions and once more in vibrato. The target pitches were C3, F3, A3, C4, F4, A4, and C5. Surface electromyographic (sEMG) measures were performed in the infrahyoid (IH) muscle region and the suprahyoid (SH) muscle region. Contact quotient (CQ), sound pressure level (SPL), and fundamental frequencies were measured to derive the electroglottographic-based vocal economy parameter quasi-output cost ratio (QOCR). ResultssEMG measures show that IH and SH muscles significantly increased in activity with ascending pitch. IH and SH muscle activity were significantly higher when singing in vibrato than straight-tone. Moreover, SPL also increased with ascending pitch and when sung in vibrato. CQ increased and QOCR decreased as pitch ascended but did not significantly change when sung in vibrato. ConclusionSinging higher pitches were generally associated with higher extrinsic laryngeal muscle activity and lower QOCR values. When comparing the two singing conditions, the extrinsic laryngeal muscle activity was higher during vibrato, implicating that the IH and the SH muscles may contribute to rhythmic pulsations of pitch changes. Although the QOCR value did not show significant differences between the two singing conditions, a significantly high SPL during vibrato may indicate acoustical and physiological advantages while singing in vibrato.

Age- and Parkinson-related differences in trunk and lower-limb muscle activation during four balance tasks: A case-control pilot study

BackgroundPoor postural control has been reported in people with Parkinson's disease, which could be explained by the changes in muscular activation patterns related to antigravitational muscles. This study aims to measure the muscle activation of antigravitational muscles during balance tasks in individuals, with and without Parkinson's. MethodsSixteen (16) participants (9 with Parkinson's), aged ≥65 yrs., performed 2 × 30-s trials of 4 balance tasks (bipodal and semi-tandem opened eyes and closed eyes) on a force platform (center of pressure measurement); while surface electromyography measurements were obtained bilaterally on the multifidus at L5, biceps femoris and medialis gastrocnemius. Electromyography amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance task, to determine each muscle's activity level. FindingsThe Parkinson's group reported lower muscle activation than control across tasks (in mean for multifidus = 8%, biceps femoris = 16%, gastrocnemius = 7%), although not statistically significant. Parkinson's reported significantly poorer postural control than control, mainly for the center of pressure sway ellipse area (p = 0.016) from challenge balance tasks such as semi-tandem. InterpretationPoor postural control was confirmed in the Parkinson's group, but not significantly associated by the changes from muscle activation of trunk and lower limbs, during balance performance.

Benchmark and validation of state-of-the-art muscle recruitment strategies in shoulder modelling

AbstractShoulder muscle forces estimated via modelling are typically indirectly validated against measurements of glenohumeral joint reaction forces (GHJ-RF). This validation study benchmarks the outcomes of several muscle recruitment strategies against public GHJ-RF measurements. Public kinematics, electromyography, and GHJ-RF data from a selected male participant executing a 2.4 kg weight shoulder abduction task up to 92° GHJ elevation were obtained. The Delft Shoulder and Elbow Model was scaled to the participant. Muscle recruitment was solved by 1) minimising muscle activations squared (SO), 2) accounting for dynamic muscle properties (CMC) and 3) constraining muscle excitations to corresponding surface electromyography measurements (CEINMS). Moreover, the spectrum of admissible GHJ-RF in the model was determined via Markov-chain Monte Carlo stochastic sampling. The experimental GHJ-RF was compared to the resultant GHJ-RF of the different muscle recruitment strategies as well as the admissible stochastic range. From 21 to 40 degrees of humeral elevation, the experimental measurement of the GHJ-RF was outside the admissible range of the model (21 to 659% of body weight (%BW)). Joint force RMSE was between 21 (SO) and 24%BW (CEINMS). At high elevation angles, CMC (11%BW) and CEINMS (14%BW) performed better than SO (25%BW). A guide has been proposed to best select muscle recruitment strategies. At high elevation angles, CMC and CEINMS were the two most accurate methods in terms of predicted GHJ-RF. SO performed best at low elevation angles. In addition, stochastic muscle sampling highlighted the lack of consistency between the model and experimental data at low elevation angles.

Simultaneous Vision and Surface Electromyography Measurements to Evaluate Masticatory Robot TMJ Reaction Forces During Mastication

Simultaneous Vision and Surface Electromyography Measurements to Evaluate Masticatory Robot TMJ Reaction Forces During Mastication

Towards standardisation of surface electromyography measurements in the horse: Bipolar electrode location

The use of surface electromyography in the field of animal locomotion has increased considerably over the past decade. However, no consensus exists on the methodology for data collection in horses. This study aimed to start the development of recommendations for bipolar electrode locations to collect surface electromyographic data from horses during dynamic tasks.Data were collected from 21 superficial muscles of three horses during trot on a treadmill using linear electrode arrays. The data were assessed both quantitatively (signal-to-noise ratio (SNR) and coefficient of variation (CoV)) and qualitatively (presence of crosstalk and activation patterns) to compare and select electrode locations for each muscle.For most muscles and horses, the highest SNR values were detected near or cranial/proximal to the central region of the muscle. Concerning the CoV, there were larger differences between muscles and horses than within muscles. Qualitatively, crosstalk was suspected to be present in the signals of twelve muscles but not in all locations in the arrays.With this study, a first attempt is made to develop recommendations for bipolar electrode locations for muscle activity measurements during dynamic contractions in horses. The results may help to improve the reliability and reproducibility of study results in equine biomechanics.

Improving repeatability of surface electromyography measurement of sit-to-stand motions by using muscle synergy

This study proposes a method to improve the measurement stability of sit-to-stand (STS) motion, one of the most important motions for human mobility. STS motion is complex and uses numerous muscles ranging from the feet to the torso. Electromyography (EMG) is often used to analyze STS motion by precisely measuring the activity of the contributing muscles. However, such measurements depend strongly on the measurement conditions, such as electrode attachment conditions, and variations in the contributing muscles and initial poses. We examined the variability caused by these conditions and explored a method to stabilize STS measurements by EMG. The proposed method adjusts measurements using data aggregation and muscle synergy computation, which leads to better comparisons or integration of motion measurements with two or more motion strategies or motions acquired over multiple EMG electrode reinstallations. The experimental results show that the proposed method improves the similarity of measurements under different conditions.

Comparison of Laryngeal Palpatory Scale (LPS), With Surface Electromyographic Measures in Patients with Muscle Tension Dysphonia.

The aim of this study was to examine the laryngeal palpatory scale (LPS) to ascertain possible correlation with neck surface electromyography (sEMG). Two otolaryngologists and one certified speech-language pathologist assessed 21 participants (seven women and 14 men; with a mean age of 42.8 years; ranged: 21 to 70 years) with muscle tension dysphonia (MTD) diagnosed with the current version of the LPS rating system. Consequently, relationships between LPS and objective measures of sEMG were evaluated using Spearman's rank correlation coefficient (r). The results show that there was a low to moderate between correlations, (statistically positive and significant in 10 correlations among the examined items/states). In conclusion, low-moderate positive correlations between sEMG and LPS ratings were found with particular strength for LPS ratings of tightness and ratings made during dynamic tasks. Further investigations can provide useful evidence for researchers and clinicians to document treatment outcomes by using LPS and sEMG in patients with MTD and leading to the more standardized care and improved information about patient progress.

Multipoint surface electromyography measurement using bull’s-eye electrodes for wide-area topographic analysis

BackgroundSurface electromyography (sEMG) is primarily used to analyze individual and neighboring muscle activity. However, using a broader approach can enable simultaneous measurement of multiple muscles, which is essential for understanding muscular coordination. Using the “bull’s-eye electrode,” which allows bipolar derivation without directional dependence, enables wide-area multipoint sEMG measurements. This study aims to establish a multipoint measurement system and demonstrate its effectiveness and evaluates forearm fatigue and created topographic maps during a grasping task.MethodsNine healthy adults with no recent arm injuries or illnesses participated in this study. They performed grasping tasks using their dominant hand, while bull’s-eye electrodes recorded their muscle activity. To validate the effectiveness of the system, we calculated the root mean squares of muscle activity and entropy, an indicator of muscle activity distribution, and compared them over time.ResultsThe entropy analysis demonstrated a significant time-course effect with increased entropy over time, suggesting increased forearm muscle uniformity, which is possibly indicative of fatigue. Topographic maps visually displayed muscle activity, revealing notable intersubject variations.DiscussionBull’s-eye electrodes facilitated the capture of nine homogeneous muscle activity points, enabling the creation of topographic images. The entropy increased progressively, suggesting an adaptive muscle coordination response to fatigue. Despite some limitations, such as inadequate measurement of the forearm muscles’ belly, the system is an unconventional measurement method.ConclusionThis study established a robust system for wide-area multipoint sEMG measurements using a bull’s-eye electrode setup. This system effectively evaluates muscle fatigue and provides a comprehensive topographic view of muscle activity. These results mark a significant step towards developing a future multichannel sEMG system with enhanced measurement points and improved wearability.Trial registrationThis study was approved by the Ethics Committee of Chiba University Graduate School of Engineering (acceptance number: R4-12, Acceptance date: November 04, 2022).

Methods for automated delineation and assessment of EMG responses evoked by peripheral nerve stimulation in diagnostic and closed-loop therapeutic applications

Objective. Surface electromyography measurements of the Hoffmann (H-) reflex are essential in a wide range of neuroscientific and clinical applications. One promising emerging therapeutic application is H-reflex operant conditioning, whereby a person is trained to modulate the H-reflex, with generalized beneficial effects on sensorimotor function in chronic neuromuscular disorders. Both traditional diagnostic and novel realtime therapeutic applications rely on accurate definitions of the H-reflex and M-wave temporal bounds, which currently depend on expert case-by-case judgment. The current study automates such judgments. Approach. Our novel wavelet-based algorithm automatically determines temporal extent and amplitude of the human soleus H-reflex and M-wave. In each of 20 participants, the algorithm was trained on data from a preliminary 3 or 4 min recruitment-curve measurement. Output was evaluated on parametric fits to subsequent sessions’ recruitment curves (92 curves across all participants) and on the conditioning protocol’s subsequent baseline trials (∼1200 per participant) performed near H max. Results were compared against the original temporal bounds estimated at the time, and against retrospective estimates made by an expert 6 years later. Main results. Automatic bounds agreed well with manual estimates: 95% lay within ±2.5 ms. The resulting H-reflex magnitude estimates showed excellent agreement (97.5% average across participants) between automatic and retrospective bounds regarding which trials would be considered successful for operant conditioning. Recruitment-curve parameters also agreed well between automatic and manual methods: 95% of the automatic estimates of the current required to elicit H max fell within of the retrospective estimate; for the ‘threshold’ current that produced an M-wave 10% of maximum, this value was . Significance. Such dependable automation of M-wave and H-reflex definition should make both established and emerging H-reflex protocols considerably less vulnerable to inter-personnel variability and human error, increasing translational potential.

Study of the relationship between muscle thickness and the conducting waves of multichannel surface electromyography

The contraction of skeletal muscle is regulated by the number of motor units (MUs) and muscle fibre types. The analysis of MU recruitment is feasible for elucidating the mechanisms of muscular contraction and diagnosing muscular diseases. Therefore, various studies using multichannel surface electromyography (EMG) have been conducted. In our previous study, we proposed a method to search for all conducting waves appearing in multichannel surface EMG quantitatively by calculating the similarity of waveforms. By examining conducting waves, it may be possible to estimate MU recruitment. However, the certainty of such results depends solely on considerations of anatomical and physiological knowledge. One quantitative evaluation of muscle thickness is its measurement using ultrasound imaging. In this study, we investigated the feasibility of conducting wave analysis by examining the relationship between conducting waves and muscle thickness which can be an indicator of muscle hypertrophy or wasting. Multichannel surface EMG and muscle thickness measurements were conducted and on the biceps brachii muscles of 20 subjects and the results were analysed. We found that the mean amplitude and velocity of the conducting waves were proportional to bicep thickness, indicating that conducting wave analysis corresponds to muscle thickness as a quantitative index.

Wearable Electronics for Surface and Needle Electromyography Measurements

Because the electromyography (EMG) signal can reflect the potential of muscle contraction controlled by neural activities, it has aroused great interest from researchers. As a result, a number of studies have been conducted around EMG. EMG-based wearable electronics are used not only in the diagnosis of neurogenic or myogenic diseases but also in sports science, rehabilitation, augmented reality, and virtual reality. This article briefly introduces the development history and background of EMG technology, then focuses on the classification of EMG and its technical mechanisms and reviews representative EMG-based wearable electronics. Finally, the challenges and development trends of EMG-based wearable electronics are also discussed. Developing devices with high specificity, adaptability, and robustness remains challenging. It has become a trend to optimize EMG signals' classification, characterization and noise cancellation algorithms for future study by combining multiple technical means. Because of the various applications of wearable electronic devices based on EMG measurements, it will have promising prospects in many fields.

Characterization of Muscle Weakness Due to Myasthenia Gravis Using Shear Wave Elastography

Myasthenia gravis (MG) is often accompanied with muscle weakness; however, little is known about mechanical adaptions of the affected muscles. As the latter can be assessed using ultrasound shear wave elastography (SWE), this study characterizes the biceps brachii muscle of 11 patients with MG and compares them with that of 14 healthy volunteers. Simultaneous SWE, elbow torque and surface electromyography measurements were performed during rest, maximal voluntary contraction (MVC) and submaximal isometric contractions (up to 25%, 50% and 75% MVC) at different elbow angles from flexion to extension. We found that, with increasing elbow angle, maximum elbow torque decreased (p < 0.001), whereas muscle stiffness increased during rest (p = 0.001), MVC (p = 0.004) and submaximal contractions (p < 0.001). Muscle stiffness increased with increasing contraction intensities during submaximal contractions (p < 0.001). In comparison to the healthy cohort, muscle stiffness of MG patients was 2.1 times higher at rest (p < 0.001) but 8.93% lower in active state (75% MVC, p = 0.044). We conclude that (i) increased muscle stiffness shown by SWE during rest might be an indicator of MG, (ii) SWE reflects muscle weakness and (iii) SWE can be used to characterize MG muscle.

Effects of Age and Lingual-Palatal Pressure Levels on Submental Surface Electromyography Measures.

Submental surface electromyography (sEMG) may provide information about the lingual-palatal pressure (LPP) during swallowing. However, the extent to which changes in age and LPP levels are reflected in different sEMG measures is unclear. This study aimed to understand the effects of age and different levels of submaximal LPPs on submental sEMG peak, average, and integrated values in healthy adults. Ninety community-dwelling healthy participants were categorized into three age groups (young: 20-39years, middle age: 40-59years, older: 60 ≥ years). sEMG and LPP measurements were collected concurrently. After placing the sEMG electrodes, the maximal isometric LPP was established using the Iowa oral performance instrument (IOPI) on the anterior tongue. sEMG recordings were conducted for three submaximal LPP levels, including 40%, 60%, and 80% of the maximum LPP. Two-way repeated measure ANOVAs were conducted to find the effects of age and varying LPP levels on mean sEMG peak, average, and integrated measures. A significant age by LPP level interaction was identified for sEMG peak [F (4, 172) = 4.116, p < 0.007, ηp2 = 0.087], sEMG average [F (4, 170) = 5.049, p < 0.001, ηp2 = 0.106], and sEMG integrated values [F (4, 170) = 4.179, p < 0.003, ηp2 = 0.090]. Post hoc testing demonstrated that, in general, sEMG values significantly increased with rising LPP levels, primarily for younger and middle-aged adults. Furthermore, at 80% of maximum LPP, older adults generated less sEMG average and integrated values than middle age (only significant for sEMG integrated value) and younger adults. Likewise, max LPP was lower in older adults compared with young and middle-aged groups. Submental sEMG has the potential to be incorporated into a skill-based lingual exercise paradigm to improve tongue function during swallowing. Moreover, submental sEMG can characterize some age-related subclinical changes in swallowing.

Reciprocal activation changes of lower extremity muscles caused by the abdominal hollowing maneuver in patients with unilateral lumbar disc herniation: an electromyography study

Aim: Decreased or delayed multifidus and transversus abdominis (TrA) activity, transition of the TrA from tonic to phasic activity, and increased activity in the more superficial erector spinae muscles are behaviors unique to people with lumbar disc herniation (LDH). This study investigates whether the abdominal hollowing maneuver (AHM), which activates the TrA, can improve the rates of impaired muscle reciprocal activation of the lower extremities due to unilateral LDH during walking, tandem walking, and stair climbing activities.Material and Method: The healthy and affected lower extremities of 17 patients with unilateral LDH were analyzed. The participants performed three activities and three times without the AHM. For the walking activity, the participants took a total of eight steps without deviating from their normal gait pattern. For the tandem walking activity, the participants covered the eight-step distance by performing heel-to-toe walking. For the stair climbing activity, the participants climbed a total of four steps without support from their upper extremities. The researchers visually checked the postures of the participants during all stages of the activities. The ratio of tibialis anterior (TA) and medial gastrocnemius (MGC) electromyographic values that emerged during the activities to the maximum voluntary isometric contraction (MVIC) values of these muscles was called MVIC%. Then the MVIC% values of the TA and MGC were matched, and the muscle reciprocal activation ratio ("MVIC%"-TA/"MVIC%"-MGC) was determined. While the activities were being performed, the MVIC% values of both muscles were measured separately without and with the AHM.Results: Reliability values ranged from 0.87 to 0.99, with an SEM of 2.22 to 11.98. The ICC3,1 was considered “good” or “excellent” for all muscle surface electromyography measurements. During the tandem walking activity performed with the AHM, the reciprocal activation rates of TA: MGC on the affected and healthy legs converged (p=0.010, d=0.71). However, TA: MGC reciprocal activation rates did not differ between the affected and healthy extremities in the walking (p=0.519, d=0.16) or stair climbing (p=0.180, d=0.35) activities performed with the AHM.Conclusion: According to the results of the study, integration of the AHM into tandem walking activity brought the reciprocal activation rates of both legs closer to each other and enabled them to exhibit similar behaviors, even without adherence to any exercise protocol. Therefore, tandem walking can be selected as an appropriate activity to combine with spinal stabilization exercises performed by unilateral L4-L5 radiculopathy patients using the AHM along with the task.

Model-Based Estimation of Inspiratory Effort Using Surface EMG.

The quantification of inspiratory patient effort in assisted mechanical ventilation is essential for the adjustment of ventilatory assistance and for assessing patient-ventilator interaction. The inspiratory effort is usually measured via the respiratory muscle pressure (P mus) derived from esophageal pressure (P es) measurements. As yet, no reliable non-invasive and unobtrusive alternatives exist to continuously quantify P mus. We propose a model-based approach to estimate P mus non-invasively during assisted ventilation using surface electromyographic (sEMG) measurements. The method combines the sEMG and ventilator signals to determine the lung elastance and resistance as well as the neuromechanical coupling of the respiratory muscles via a novel regression technique. Using the equation of motion, an estimate for P mus can then be calculated directly from the lung mechanical parameters and the pneumatic ventilator signals. The method was applied to data recorded from a total of 43 ventilated patients and validated against P es-derived P mus. Patient effort was quantified via the P mus pressure-time-product (PTP). The sEMG-derived PTP estimated using the proposed method was highly correlated to P es-derived PTP ([Formula: see text]), and the breath-wise deviation between the two quantities was [Formula: see text]. The estimated, sEMG-derived P mus is closely related to the P es-based reference and allows to reliably quantify inspiratory effort. The proposed technique provides a valuable tool for physicians to assess patients undergoing assisted mechanical ventilation and, thus, may support clinical decision making.

Development of a Real-Time Knee Extension Monitoring and Rehabilitation System: Range of Motion and Surface EMG Measurement and Evaluation.

In this paper, a real-time knee extension monitoring and rehabilitation system for people, such as patients, the elderly, athletes, etc., is developed and tested. The proposed system has three major functions. The first function is two-channel surface electromyography (EMG) signal measurement and processing for the vastus lateralis (VL) and vastus medialis (VM) muscles using a developed EMG device set. The second function is the knee extension range of motion (ROM) measurement using an angle sensor device set (i.e., accelerometer sensor). Both functions are connected and parallelly processed by the NI-myRIO embedded device. Finally, the third function is the graphical user interface (GUI) using LabVIEW, where the knee rehabilitation program can be defined and flexibly set, as recommended by physical therapists and physicians. Experimental results obtained from six healthy subjects demonstrated that the proposed system can efficiently work with real-time response. It can support multiple rehabilitation users with data collection, where EMG signals with mean absolute value (MAV) and root mean square value (RMS) results and knee extension ROM data can be automatically measured and recorded based on the defined rehabilitation program. Furthermore, the proposed system is also employed in the hospital for validation and evaluation, where bio-feedback EMG and ROM data from six patients, including (a) knee osteoarthritis, (b) herniated disc, (c) knee ligament injury, (d) ischemic stroke, (e) hemorrhagic stroke, and (f) Parkinson are obtained. Such data are also collected for one month for tracking, evaluation, and treatment. With our proposed system, results indicate that the rehabilitation people can practice themselves and know their rehabilitation progress during the time of testing. The system can also evaluate (as a primary treatment) whether the therapy training is successful or not, while experts can simultaneously review the progress and set the optimal treatment program in response to the rehabilitation users. This technology can also be integrated as a part of the Internet of Things (IoT) and smart healthcare systems.

Lower limb muscle fatigue after uphill walking in children with unilateral spastic cerebral palsy.

Fatigue during walking is a common complaint in cerebral palsy (CP). The primary purpose of this study is to investigate muscle fatigue from surface electromyography (sEMG) measurements after a treadmill-based fatigue protocol with increasing incline and speed in children with CP with drop foot. The secondary purpose is to investigate whether changes in sagittal kinematics of hip, knee and ankle occur after fatigue. Eighteen subjects with unilateral spastic CP performed the protocol while wearing their ankle-foot orthosis and scored their fatigue on the OMNI scale of perceived exertion. The median frequency (MF) and root mean square (RMS) were used as sEMG measures for fatigue and linear mixed effects model were applied. The MF was significantly decreased in fatigued condition, especially in the affected leg and in the tibialis anterior and peroneus longus muscle. The RMS did not change significantly in fatigued condition, while the OMNI fatigue score indicated patients felt really fatigued. No changes in sagittal kinematics of hip, knee and ankle were found using statistical non-parametric mapping. In conclusion, the current fatigue protocol seems promising in inducing fatigue in a population with CP with drop foot and it could be used to expand knowledge on muscle fatigue during walking in CP.