The Effect of Fatigue on Wheelchair Users' Upper Limb Muscle Coordination Patterns in Time-Frequency and Principal...

An assessment of shoulder muscle coordination patterns is important to gain insight into muscle fatigue during wheelchair propulsion. The objective of the present study was to quantify muscle coordination changes over time during fatiguing wheelchair propulsion, as the muscles go through distinct levels of fatigue, a) non-fatigued, b) transiting to fatigue and c) fatigued to exhaustion. We recorded surface electromyography (sEMG) signals of the anterior deltoid (AD), middle deltoid (MD), posterior deltoid (PD), infraspinatus (IS), upper trapezius (UT), sternal head of the pectoralis major (PM), biceps brachii (BB), and triceps brachii (TB) during a wheelchair incremental exercise test. Nine wheelchair users with a diagnosis of spina bifida or T6-T12 spinal cord injury volunteered for the study. Oxygen uptake and SmartWheel kinetic parameters were also recorded during the test. EMG signals were processed by wavelet and principal component analysis (PCA), allowing for an assessment of how wheelchair users modify their muscle coordination patterns over time. Analyses of covariance (ANCOVA) were conducted to identify the main effect of fatigue levels on muscle coordination patterns by controlling for the effect of increased workload as covariate. A significant effect of fatigue levels on the PC1 and PC3 loading scores was found after controlling for the effect of increasing workloads (with both cases). In addition, PC3 reflects the most dominant fatigue effect on muscle coordination patterns which are not affected by increased ergometer workload. PC3 indicates muscle imbalance when muscles are fully fatigued and muscle co-contraction when muscles are beginning to fatigue. We conclude that fatigue-related changes in neuromuscular activity during wheelchair propulsion contribute to muscle imbalance and reflect a strategy of stiffening the shoulder joint.