Journal of Modern Rehabilitation 2017. 11(4):231-236.

The Effect of Stump Level on Activity and Fatigability of Knee Extensor Muscles
Gholamreza Olyaei, Mohammad Reza Hadian, Saeed Talebian, Shohreh Jalaie, Seyed Asadullah Arslan, Masood Abdullah Hussein


Introduction: Muscle fatigue is tiredness, in other words, loss of productive capacity of power in response to the activity. The development of fatigue during prolonged exercise may be evaluated by repeated assessments of maximal voluntary force. This study aimed to determine the effect of muscle fatigue on trans-tibial stump level in knee extensor muscles (vastus lateralis, vastus medialis, and rectus femoris) at 30 and 45 degree knee flexions by using surface electromyography.
Materials and Methods: Forty male amputees with trans-tibial amputation, aged between 18-50 years were assigned randomly in three groups; performed three isometric contractions with extended knee at 80% of the maximal voluntary contraction. Median Frequency (MDF) and Root Mean Square (RMS) values were obtained by surface electromyography from the knee extensor muscles at 30 and 45 degree knee flexions. Force values in stump and sound sides during knee flexion at 30 and 45 degree were also compared.
Results: Median frequency on sound side showed more fatigue and MDF-RMS between stump levels was short, medium, and long for knee extensor muscles at 30 and 45 degree, before and after the fatigue. No significant effect between stump and sound side was found. Vastus lateralis muscle showed more power than vastus medialis and rectus femoris muscles before fatigue. But after fatigue, rectus femoris muscle showed more power than vastus medialis and vastus lateralis.
Conclusion: Results have confirmed that trans-tibial amputees with good functional ability showed more fatigability on the sound side while stump side showed more power. Vastus lateralis muscle had maximum power on both sides. Vastus medialis and rectus femoris of long stump levels and vastus lateralis muscle of short levels were more powerful.


Muscle fatigue, Electromyography, Amputation

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Booth FW, Thomason DB. Molecular and cellular adaptation of muscle in response to exercise: perspectives of various models. Physiological Reviews. 1991; 71(2):541-85. [DOI:10.1152/physrev.1991.71.2.541]

Nybo L, Secher NH. Cerebral perturbations provoked by prolonged exercise. Progress in Neurobiology. 2004; 72(4):223-61. [DOI:10.1016/j.pneurobio.2004.03.005]

Vøllestad NK. Measurement of human muscle fatigue. Journal of Neuroscience Methods. 1997; 74(2):219-27. [DOI:10.1016/S0165-0270(97)02251-6]

Gandevia SC, Enoka RM, McComas AJ, Stuart DG, Thomas CK. Neurobiology of muscle fatigue. Fatigue. 1995; 384:515–25. [DOI:10.1007/978-1-4899-1016-5_39]

Newham D, McCarthy T, Turner J. Voluntary activation of human quadriceps during and after isokinetic exercise. Journal of Applied Physiology. 1991; 71(6):2122-6. [DOI:10.1152/jappl.1991.71.6.2122]

Engstrom B, Van de Ven C. Physiotherapy for amputees: the Roehampton approach. London: Churchill Livingstone; 1985.

Ruckley CV, Stonebridge PA, Prescott RJ. Skewflap versus long posterior flap in below-knee amputations: multicenter trial. Journal of Vascular Surgery. 1991; 13(3):423-7. [DOI:10.1067/mva.1991.25644]

Rosenman LD. Syme amputation for ischemic disease in the foot. The American Journal of Surgery. 1969; 118(2):194-9. [DOI:10.1016/0002-9610(69)90120-2]

Wang L, Buchanan TS. Prediction of joint moments using a neural network model of muscle activations from EMG signals. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2002; 10(1):30-7. [DOI:10.1109/TNSRE.2002.1021584]

Seibt R, Shnieder J. A new method for quantification of muscular force and fatigue by using surface electromyographical measurements. BioMedical Engineering OnLine. 2012; 11:55.

Saito A, Akima H. Knee joint angle affects EMG–force relationship in the vastus intermedius muscle. Journal of Electromyography and Kinesiology. 2013; 23(6):1406-12. [DOI:10.1016/j.jelekin.2013.08.009]

Talebian S, Bagheri H, Hosseini M, Olyaei GR. The investigation of median frequency changes in paraspinal muscles following fatigue. Iranian Rehabilitation Journal. 2009; 7(2):31-35.

Bilodeau M, Schindler-Ivens S, Williams D, Chandran R, Sharma S. EMG frequency content changes with increasing force and during fatigue in the quadriceps femoris muscle of men and women. Journal of Electromyography and Kinesiology. 2003; 13(1):83-92. [DOI:10.1016/S1050-6411(02)00050-0]

Wojtys EM, Wylie BB, Huston LJ. The effects of muscle fatigue on neuromuscular function and anterior tibial translation in healthy knees. The American Journal of Sports Medicine. 1996; 24(5):615-21. [DOI:10.1177/036354659602400509]

Roebroeck ME, Harlaar J, Lankhorst GJ. Reliability assessment of isometric knee extension measurements with a computer-assisted hand-held dynamometer. Archives of Physical Medicine and Rehabilitation. 1998; 79(4):442-8. [DOI:10.1016/S0003-9993(98)90147-2]

Rainoldi A, Melchiorri G, Caruso I. A method for positioning electrodes during surface EMG recordings in lower limb muscles. Journal of Neuroscience Methods. 2004; 134(1):37-43. [DOI:10.1016/j.jneumeth.2003.10.014]

Surakka J, Virtanen A, Aunola S, Maentaka K, Pekkarinen H. Reliability of knee muscle strength and fatigue measurements. Biology of Sport. 2005; 22(4):301.

Arora S, Budden S, Byrne JM, Behm DG. Effect of unilateral knee extensor fatigue on force and balance of the contralateral limb. European Journal of Applied Physiology. 2015; 115(10):2177-87. [DOI:10.1007/s00421-015-3198-5]

Pedrinelli A, Saito M, Coelho RF, Fontes RB, Guarniero R. Comparative study of the strength of the flexor and extensor muscles of the knee through isokinetic evaluation in normal subjects and patients subjected to trans-tibial amputation. Prosthetics and Orthotics International. 2002; 26(3):195-205. [DOI:10.1080/03093640208726648]

Moirenfeld I, Ayalon M, Ben Sira D, Isakov E. Isokinetic strength and endurance of the knee extensors and flexors in transtibial amputees. Prosthetics and Orthotics International. 2000; 24(3):221-5. [DOI:10.1080/03093640008726551]

Isakov E, Burger H, Gregoric M, Marincek C. Stump length as related to atrophy and strength of the thigh muscles in trans-tibial amputees. Prosthetics and Orthotics International. 1996; 20(2):96-100. [DOI:10.3109/03093649609164425]

Kapp S. Visual analysis of prosthetic gait. In: Douglas G, Smith, MD editors. Atlas of amputation and limb deficiencies: Surgical, prosthetic, and rehabilitation principles 3rd edition. Rosemont: American Academy of Orthopedic Surgeons; 2004.


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