RESEARCH PROPOSAL

SURFACE ELECTROMYOGRAPHY (EMG) ACTIVITY OF ABDOMINAL MUSCLES

DURING WHEELCHAIR’S WHEELIE
 CHAPTER 1

INTRODUCTION

1.1 Background of the Study

Wheelchair is the most important therapeutic devices in rehabilitation. The fundamental

purpose of a wheelchair is to promote mobility, inclusion and enhanced quality of life of the
user. It is a mobility device to promote inclusion and participation (Arya, 2011).The “wheelie”
is a useful skill that enables the wheelchair users to alter their positions in space and to
overcome a number of environmental obstacles (e.g., rough ground curbs) that may
otherwise limit mobility. To perform a wheelie, the wheelchair user must lift the casters off the
ground to the point where the combined center of mass (COM) of the users and wheelchair
can be balanced over the rear axles. It is surprising that the wheelie has received little
attention in the scientific literature and that only a minority of wheelchair users ever learn to
perform them (Bonaparte, et.al,2004, Kirby, et.al 2001). The Surface electromyography
(EMG) was widely used in the clinical and biomechanical studied. Surface electromyography
(EMG) is an experimental technique concerned with the development, recording and
analyzing of myoelectric signals. Myoelectric signals are formed by physiological variations in
the state of muscle fibers membranes (Konrad, 2005). It is usually detected using a pair of
recording electrodes that are connected to a different amplifier, which amplified the
difference between the signals detected from the two electrodes (Grimshaw & Burden,
2007).

1.2 Statement of the Problem

Studies regarding wheelchair are more focus on the propulsion of the wheelchair. It is
include the study of biomechanics and muscle activation of the upper limb. As a comparison,
to our knowledge study on wheelchair during wheelie is inadequate. In order to fill up the gap
that occurs, a surface electromyography (EMG) study must be done in order to investigate
activation of abdominal muscle during wheelie. Various authors have presented results of
EMGs activation of the abdominal musculature during flexing movements of the trunk
(Moraes, et. al, 2009, 2003, 1995,) which can be correlates with wheelie movement. It was
believed that during the wheelie activity there was significant activation and contraction of
abdominal muscles. Therefore, this study is beneficial in order to get scientific evidence to
include the abdominal strengthening exercise for wheelchair users.
1.3 Objectives

1.3.1 General objective

1. To investigate the activation of abdominal muscle (rectus abdominis, internal

oblique and external oblique) during wheelchair’s wheelie.

1.3.2 Specific objective

1. To compare the activation of muscle contraction between rectus abdominis,

internal oblique and external oblique during wheelchair’s wheelie.
2. To investigate pattern and type of muscle contraction during 1 – 10 seconds of
wheelchair’s wheelie.

1.4 Research hypotheses

These are the hypotheses of our research:

1. There is significance activation of abdominal muscles contraction during wheeling a
wheelchair.
2. There is significance difference of activation muscles contraction between rectus
abdominis, internal oblique and external oblique muscle during wheeling wheelchair.
3. Isometric muscle contraction is more dominant during wheeling wheelchair.

1.5 Significance of the Study

The findings of the study will establish guidelines in term of exercise protocol for
abdominal strengthening exercise for disabled people who are using wheelchair. In this
study, type of muscle contraction and which muscle dominantly work during wheelie will be
scientifically investigate. Besides that, the practice of physiotherapy requires theoretical
knowledge-based and evidence-based practice. Therefore, this study will support the need
for abdominal strengthening exercise for wheelchair user which can be used by
physiotherapists in clinical practice as a major part of rehabilitation protocol.

1.6 Delimitation of Study

In our study, participants will be recruited from the undergraduate students of

physiotherapy program.
1.7 Definition and operational terms used in this study

1.7.1 Surface electromyography (EMG) is an experimental technique concerned with

the development, recording and analyzing of myoelectric signals. Myoelectric
signals are formed by physiological variations in the state of muscle fibers
membranes (Konrad, 2005)

1.7.2 External oblique is the superficial muscle of the abdominal wall muscle which
fascicles extend inferiorly and medially (Tortora & Derrickson, 2009)

1.7.3 Internal oblique is the intermediate flat muscle of the abdominal muscle wall
which fascicles extend at right angles to those of the external oblique (Tortora &
Derrickson, 2009)

1.7.4 Rectus abdominis is a long muscle that extend the entire length of the anterior
abdominal wall, originating at the pubic crest and pubic symphysis and inserting
on the cartilage of ribs 5 -7 and the xiphoid process of the sternum (Tortora &
Derrickson,2009)

1.7.5 Wheelchair wheelie is occurs when the front wheels which in contact with the
support surface intentionally lift up from the surface while the rear wheels remain
on the surface (Kirby, et.al. 2006).

1.7.6 Isometric is the tension develops in the muscle but no mechanical work is
performed (Kisner & Colby, 2007).

1.7.7 Concentric is the overall shortening of the muscle occurs as it generates tension
and contracts against resistance (Kisner & Colby, 2007).

1.7.8 Eccentric is the overall lengthening of the muscle occurs as it develops tension
and contracts to control motion against the resistance of an outside force;
negative work is done (Kisner & Colby, 2007).

1.7.9 Cross talk is the possibility of detection signal may contain energy that emanates
from others or more distance muscle (Payton and Bartlett, 2008).
1.7.10 Normalization is useful to calibrate the EMG signal against known references. It
allows one to compare quantitatively different activities for the same muscle,
different muscle, activities on different days and different subjects for same or
different activities (Kumar & Mital, 1996).

1.7.11 Rectification is a process of eliminating negative component of the signals (half-

wave rectification) or negative parts of the wave form may be inverted forcing
them to fall on the positive side of the baseline (full-wave rectification) (Kumar &
Mital, 1996).

1.7.12 Maximum voluntary contraction (MVC) is a data point of the process EMG from
the specific task as proportion or a percentage of the peak EMG from an isometric
voluntary contraction.

1.7.13 Root mean square (RMS) is the square root of the average power of the raw
EMG calculated over specific time period.
 CHAPTER 2

REVIEW OF LITERATURE

2.1 Introduction

In the literature review, the information from the previous study regarding the
variables concluded in this study will be discussed. The information obtain from previous
study will lead to the development of the objectives and the hypotheses of this study. In
addition, certain procedures of intervention in this study will also be adapted from previous
studies. Besides, the gap in the previous study will be summarized, thus this study will also
be aimed to fulfill those gaps.

2.2 Anatomy of the abdominal muscle

The anterolateral abdominal wall is composed of skin, fascia, and four pairs of muscle
which is external oblique, internal oblique, transverse abdominis, and rectus abdominis. The
first three muscles named are arranged from superficial to deep. The external oblique is the
superficial muscle. Its fascicles extend inferiorly and medially. The internal oblique is the
intermediate flat muscles. Its fascicles extend at right angles to those of the external oblique.
The transverses abdominis is the deep muscle, with most it fascicles directed transversely
around the abdominal wall. Together, the external oblique, internal oblique, and transverses
abdominis form three layers of muscle around the abdomen. In each layer, the muscle
fascicles extend in a different direction. This is a structural arrangement that affords
considerable protection to the abdominal viscera, especially when the muscles have good
tone (Tortora & Derrickson, 2009).

The rectus abdominis muscle is a long muscle that extends the entire length of the
anterior abdominal wall, originating at the pubic crest and pubic symphysis and inserting on
the cartilages of ribs 5-7 and the xiphoid process to the sternum. The rectus abdominis is
innervated by thoracic spinal nerve of T7-T12. The anterior surface of the muscle is
interrupted by three transverse fibrous bands of tissue called tendimous intersection,
believed to be remnants of septa that separated myotomes during embryological
development. External oblique originated from inferior eight ribs and inserted at the iliac
crest and linea alba. The internal oblique muscle originated from iliac crest, inguinal ligament
and thoracolumbar fascia and insert at the cartilage of last three or four ribs and linea alba.
External and internal oblique muscles acting together (bilaterally) compress abdomen and
flex vertebral column; acting single laterally flex vertebral column, especially lumbar portion,
and rotate vertebral column. Transversus ‘abdominis muscle origin from iliac crest, inguinal
ligaments, lumbar fascia, and cartilages of inferior six ribs and inserted at the xiphoid
process, linea alba and pubis. It’s act to compress the abdomen (Tortora & Derrickson,
2009).

The aponeuroses (sheathlike tendons) of the external oblique, internal oblique, and
transverses abdominis muscles form the rectus sheath, which enclose the rectus abdominis
muscles. The sheaths meet at the midline to form the linea alba, a tough, fibrous band that
extends from the xiphoid process of the sternum to the pubic symphysis. The posterior
abdominal wall is formed by the lumbar vertebrae, parts of the ilia of the hip bones, psaos
major, and iliacus muscle, and quadratus lumborum muscle. As a group, the muscles of the
anterolateral abdominal wall help contain and protect the abdominal viscera; flex, laterally
flex, and rotate the vertebral column at the intervertebral joints; compress the abdomen
during forced exhalation; and produce the forced required for defecation, urination, and child
birth (Tortora & Derrickson, 2009).

2.3 The prevalance

Wheeled mobility is a necessity in daily ambulation for a growing number of people. In

the Netherlands the number of wheelchair users is estimated to be around 150,000 (Van
Drongelen et al., 2002). For Europe this number may be extrapolated to a rough 3.3 million
on average elderly people. The majority of these people will use a form of manual wheelchair
propulsion. By nature of the use of the upper body and arms, a limited age-related fitness,
and the impairment itself, a wheelchair confined lifestyle will hamper individual mobility and
participation (Simmons et al, 1995). There is an estimated 2.7 million wheelchair users in the
US (Americans with Disability, 2002). In a study included 169 of wheelchair users, only 4%
were able to perform wheelies (Kirby, 2004).

2.4 Types of muscle contractions

Contraction and relaxation are under skeletal muscles responsibles. A muscle

contracts when it is stimulated, and relaxes when the contraction stops. There are three
types of contractions which is isotonic, isometric, and isokinetic. Isotonic (dynamic) is the
most familiar type of muscle contraction. As the term implies, during an isotonic contraction
the tension should be constant throughout the entire range of motion. There are two types of
isotonic contractions: concentric and eccentric. In concentric, the muscles shorten in length.
Concentric are possible only when the resistance (i.e., weight load) is less than athlete's
maximum potential. Examples of concentric contractions include the curling action of a
biceps curl, or the extending motion of a leg extension. Eccentric contraction reverse the
process of a concentric action- that is, eccentric contractions return muscles to their starting
point. During a biceps curl, the eccentric component occurs when the arm extends to the
starting point after the curl. During a leg extension, eccentric work is being done when the
legs bend at the knee towards the starting position. During an eccentric contraction, the
muscles are yielding either to the force of gravity (as in free weights) or to the force of a
machine's pull. Under such conditions, the muscle lengthens as the joint angle increases,
thus releasing a controlled tension (Bompa et. al, 2003)

In isometric contractions- the muscle develops tension without changing length.

During an isometric contraction, the application of force against an immovable object forces
the muscle to develop high tension without altering its length. For examples, is the wall are
pushed, tension is created in the muscle although they remain the same length. The tension
developed from this type of contraction is often higher than that develop during an isotonic
contraction. Isokinetics describes a contraction with constant velocity over the full range of
motion. Isokinetic work needs special equipment design to allow a constant velocity of
contraction regardless of the load. During the movement, an athlete performs both
cooncentric and eccentric contraction while the machine provides a resistance that is equal
to the force generated by the athlete. The benefit of this type of training is that it allows the
muscle to work maximally throughout the entire movement. It eliminates the "sticking point,"
or weak spot, that is present in every exercise motion (Bompa et. al, 2003)

2.5 Injuries, wheelchair user and wheelie

Prolonged manual wheelchair use can lead to repetitive strain injury (RSI) and pain of
the upper extremities. The number of manual wheelchair users experiencing pain will
increase if the hours of using the wheelchair increase. The most commonly reported of
musculoskeletal injury among the wheelchair user is the shoulder. Surveys show the
prevalence of shoulder pain to range between 31 percent and 73 percent, depending upon
the subject group. Prevalence tends to increase over time until 20 years post-injury, and then
it decreases slightly. Shoulder pain may be linked to tendinitis, impingement, or rotator cuff
tears. Although the shoulder is the most common site of musculoskeletal injury in manual
wheelchair users, elbow, wrist and hand pain are also commonly reported. The pain was
related to overuse of the arm during transfers or wheelchair propulsion (Cooper et.al., 1998).

The wheelchair wheelie is a skill performed by popping the front wheels (casters) from
the ground far enough to position the center of mass over the rear wheels, and then
maintaining balance in this position (Bonaparte, 2004). The wheelie is a useful skill that
enables wheelchair users to alter their position in space (eg:, when talking to a standing
person) and to overcome environmental obstacles (eg:, rough ground, curbs) that may
otherwise limit mobility. Surprising for some, the ability to perform wheelies may reduce the
incidence of injuries. For instance, descending a steep incline in the wheelie position reduces
the likelihood of a forward tip at the lower incline-floor transition (Kelly & Smith, 2012). The
wheelie has three distinct phases (takeoff, balance, and landing). Rear-wheel displacement
is often needed to achieve and maintain the wheelie balance position. So-called “stationary”
wheelies occur when the wheelie performer does not move the wheelchair forward or
backward more than approximately 50 cm (Bonaparte, 2001).

Bullard and Miller, 2001, reported that wheelie training improved subject’s
performances on an obstacle course. Unfortunately, most wheelchair users are unable to
perform a wheelie (Kirby et. al, 2004). There are at least 3 potential explanations for this.
Firstly, wheelchair users, many of whom are elderly, may believe the wheelie is too
dangerous or too difficult to learn. Secondly, many clinicians are unable to perform the
maneuver and may therefore lack the knowledge or confidence to teach it. Thirdly, there is
little in the literature regarding wheelie skill acquisition (Macpee et. al., 2004). A randomized
control trial study by Bonaparte et. al., 2004, found that proactive balance strategy (PBS) and
reactive balance strategy (RBS) training did not improve wheelie success rate, postural sway
or training time. Although older wheelchair users require more training time, many such users
can learn this useful skill if given the opportunity.

In a study by Koshi et. al., 2006, increased in rolling resistance, perceived difficulties
and rear-wheel displacement are reduced during stationary wheelchair wheelies. This study
was carried out by comparisons of 20 subjects perform two 30- seconds stationary wheelie in
the three different surfaces or rolling resistance (tile,5 cm thick foam, and 12.5 cm high
blocks in front and behind the rear wheels). The rear wheel displacement from a spring
loaded potentiometer and Likert scales of perceived of difficulties has been the main
outcome measure. In a study conducted by Yang et.al (2006) on the trunk and abdominal
muscle activation during propel a wheelchair revealed that the abdominal muscle activity is
significantly lower compare to the back muscle activity across the three speed condition.
Both abdominal and back muscle groups revealed significantly higher activation at early push
and pre-push stages when compared to the other three stages of the propulsion phase.

Propelling a wheelchair for longer than four minutes resulted in increased activity of
the pectoralis major muscle. Yang,et.al., 2007 suggested that flexibility training of the anterior
muscles and strength training of the posterior muscles and shoulder depressors is
recommended to protect the shoulder from developing pain and injuries due to muscle
imbalance. This study was conducted on eleven subject’s manual wheelchair user (two
women and nine men) with a spinal cord injury ranging from C6 to T10. The surface
electromyographic (sEMG) activities of six shoulder muscles were measured using a
TELEMYO 2400T (Noraxon U.S.A. Inc., Scottsdale,AZ) with a bandwidth of 15 to 500 Hz.
Electrodes were placed on anterior, middle, and posterior portions of the deltoid, the sternal
portion of pectoralis major, biceps brachii, and triceps brachii. This study found that
prolonged manual wheelchair propulsion, as fatigue occurs, would lead to changes in
propulsion temporal characteristics and an increase of muscle activity for one of the shoulder
prime movers during the push phase. However, this compensatory strategy may contribute
further to shoulder muscle imbalance during propulsion, which plays a critical role in
development of shoulder pain. For the rectus abdominis muscle activity, there is no
difference in activity between the upper and lower portions of the rectus abdominis in
exercise such as curl-up, abdominal lift and straight leg raise as prove by Lehman and
Mcgill,2001 in their study. These results do not support the belief that straight leg raises are a
necessary condition to activate the lower portion of the rectus abdominis muscle.

In a study entitled “Muscle effort of the upper extremity during pushing up and
keeping balance in a wheelie activity” conducted by Lin et.al., 2006, the whole wheelie
activities is divided into 4 phases, preparing, push-up, adjusting, and balance phases, using
the pitch angle of the wheelchair. In the preparing phase, the antagonist contracted to
prepare for the coming of agonist contraction. Until the push-up phase, muscles weren't fired
for the first forward striking to push the front casters off ground. Then, wrist muscle force,
especially the extensor, and hand holding force increased, and elbow extensor and shoulder
flexor muscles contracted at the same time to push the wheel forward. In the adjusting
phase, the wheel was pulled backward to let the center of mass back to the base of support
while EMG recordings showed muscle activities on extensors of the wrist, elbow and
shoulder joints. In the balance phase, the wrist extensors were mainly involved in holding the
hand rim. In the last two phases, the wrist flexor played an important role in rotating the
wheel backward slightly, but the wrist extensor initiated to let the wheel rotate forward
somewhat for balance keeping. However, these should accompany with the triceps to
complete the sufficient rotation angle of wheel for maintaining balance if the change of wrist
joint angle cannot provide an enough wheel rotating angle for wheelie balance. The
concentric contraction of triceps causes the elbow extension and stretches the biceps which
is an inactive and bi-articular muscle to pull the humerus flexion around the shoulder joint
and push the wheel rotated forward, and its eccentric contraction leads elbow flexion and
shoulder extension to push the wheel to rotate backward. No matter what phase it was in, the
pectoralis major and pectoralis clavic were activated to compensate the trunk control.
Consequently, this study helps us understand the pattern and timing of muscle activation in a
wheelie performing.
 CHAPTER 3

METHODOLOGY

3.1 Introduction

In this section, the focus is to describe the brief explanation design of the study,
subjects and sampling, instrumentation, ethical consideration, procedure of intervention, data
collection and data analysis.

3.2 Design of the study

In this laboratory experimental study, we will examine the Electromyography (EMG)

activity of the abdominal muscle which consist of rectus abdominis (RA), Internal oblique (IO)
and external oblique (EO). Measurement using EMG and data will be collected before, during
and after wheelchair wheelies. Research will be conducted in the Physiotherapy Research
laboratory, UiTM, Puncak Alam.

The following are the independent variables and dependent variables:

Independent variables:

1. Wheeling wheelchair

2. Pre, 1 – 10 seconds and post of wheeling wheelchair

Dependent variables:

1. Abdominal muscle activity by using EMG

2. Pattern and type of muscle contraction from 1 – 10 second

3. Dominant muscle to contract during wheelie

3.3 Subjects

3.3.1 Subjects

Samples for this study will be recruited among physiotherapy students of Faculty of
Health Sciences, Universiti Teknologi MARA (UiTM). Number of the subject is 14
which based on the study done by Yang, et.al. (2006)
 3.3.2 Inclusion criteria

Age between 18-25 years old, Male, able to wheelies wheelchair more than 10
second and consented to participate.

3.3.3 Exclusion criteria:

Have been diagnosed with musculoskeletal disorder affecting the lower limbs, upper
limb and/or back, spinal surgery, excess body fat

3.3.2 Sampling method

This study will be using convenience sampling method. It is non-probability sampling

technique where subjects are selected because of their convenience accessibility and
proximity to researcher.

3.4 Instrumentations

3.4.1 Subjects Demographic data

In this study, subjects’ demographic data will be obtained prior subjects’ participation.
The data which including age, gender, race, body mass index (BMI) and self reported
medical history (see Appendix I).

3.4.2 Surface EMG

DELSYS Myomonitor IV EMG System

3.4.3 Wheelchair

ESCO standard steels wheelchair

3.5 Ethical considerations

All subjects will be informed regarding the purpose and procedure of the study. The purpose
and the procedure of the study are verbally explained to the subjects. The hard copy of
subject’s information sheet which is contains the purpose of this study also being distributed
to the subject.

Informed consent is given to the subject prior to their recruitment into this study. This
informed consent will become proof that the subject is willing to participate in this study. The
example of informed consent is as in (Appendix III)
Last but not least, ethical approval involving human subjects will be applied from the Ethical
Committee of the Faculty of Health Sciences (see Appendix III)

3.6 Procedure of Intervention

Initially, all the subjects will be verbally informing about the experimental risks and
benefits of the study. Then, they will fill up the inform consent if they willing to participate. All
the subjects will be familiarizing with the procedures a week before the testing.
Anthropometric measurements were made and then followed by electrode placement on the
appropriate muscles (see figure 1)

Figure 1: EMG electrode placement of rectus abdominis (RA), external oblique (EO) and
internal oblique (IO) muscles.

Before positioning the electrodes over each muscle, the skin will be shaving, abrading by
fine-grade emery paper and cleaning with alcohol swab to reduce the skin impedance. The
electrodes for the RA were placed 1 cm above the umbilicus and 2 cm lateral to the midline.
For the EO, the electrodes were placed just below the rib cage and along a line connecting
the most inferior point of the costal margin and the contralateral pubic tubercle. For the IO,
electrodes were placed 1 cm medial to the anterior superior iliac spine (ASIS) and beneath a
line jointing both ASISs. The ground electrode was attached to the sternal notch (Ng, Kippers
& Richardson, 1998). After the above procedure implemented, EMG normalizing procedure
will take place. Then, measurement of EMG during 1-10 seconds of wheelchair wheelies will
be taken. Study flow is shows as appendix II.
3.6.1 EMG normalizing procedure.

With subjects lying on the mat, the following standard manual muscle test will be
performed to assess the maximum effort of each muscle:

RA: Trunk forward flexion against resistance with hips and knee flexed while lying supine
(Kendall, et,al., 1993)

EO and IO: Oblique trunk flexion and rotations against resistance with hips and knee flexed
while lying supine (Kendall, et,al., 1993)

During each test, 10 s of maximum voluntary contraction (MVC) data will be recorded and
used to normalize corresponsive muscle activity during the wheelie trials.

3.6.2 EMG data analysis.

Surface electromyographic signals were collected with a Delsys Myomonitor IV EMG System
using a bandwidth of 20 - 450 Hz. The data were then sampled and digitized on a computer
at a rate of 1000 Hz. Afterward, the data were full wave rectified and smoothed with 4th order
Butterworth low-pass filter (10 Hz cut-off). Surface electromyographic signals during wheelie
were normalized as % MVC for each muscle. Significant EMG activity was defined as activity
with intensity of at least 5% of MVC (Mulroy et al., 2004).

3.7 Data analysis

Data analysis included descriptive method which will be used to report subjects’
demographic data and health information, which is in means and standard deviations.

3.8 Budgeting

NO. ITEM QUANTITY PRICE/COST

1 Alcohol swab RM 30.00 x 1 box RM 30.00
2 Shaver RM 2.00 x 16 RM 32.00
3 Sand paper RM 10.00 x 1 RM 10.00
4 Proposal printing RM 15.00 RM 15.00
5 Photocopy RM 0.20 X 20 RM 4.00
6 Mineral water RM 1.00 X 16 RM 16.00
7 Gift for participants RM 2.50 X 16 RM 40.00
8 Stationary ( pen, paper, pencil, RM 20.00 RM 20.00
eraser, calculator, stapler, tape, and
marker )
Total RM 167.00
 3.9 Gantt’s chart

WEEK
TASK TO BE PERFORM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Title *      
Literature review * * * * *      
Justification of research *      
Research questions *      
Research objective *      
Research hypothesis *      
Definition & operational terms *      
Population and sample *      
Sample size calculation * *      
Study participants *      
Research flow (diagram) *      
Data collection procedures *      
Research tools *      
Statistical analysis * *      
Budgeting *
Ethical consideration * *      
Data collection * *
Result * *
Discussion * * * *
Research submission      *
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