University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 2016 EMG Activity of Accessory Muscles of Breathing during Recovery Positions Joel Kramer University of North Dakota Kelsey Meyer University of North Dakota Eric Nefstead University of North Dakota Daniel Vilaubi University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Kramer, Joel; Meyer, Kelsey; Nefstead, Eric; and Vilaubi, Daniel, "EMG Activity of Accessory Muscles of Breathing during Recovery Positions" (2016). Physical Therapy Scholarly Projects. 574. https://commons.und.edu/pt-grad/574 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. EMG ACTIVITY OF ACCESSORY MUSCLES OF BREATHING DURING RECOVERY POSITIONS by Joel Kramer Kelsey Meyer Bachelor of Science in Psychology University of North Dakota, 2013 Eric N efstead Bachelor of Science in Education and Human Sciences South Dakota State University, 2013 Daniel Vilaubi Associates of Arts Mesa Community College, 2011 Bachelor of Science in Psychology Arizona State University, 2012 Bachelor of Science in Kinesiology Arizona State University, 2012 A Scholarly Project Submitted to the Graduate Faculty of the Department of Physical Therapy School of Medicine and Health Sciences University of North Dakota in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy Grand Forks, North Dakota May, 2016 This Scholarly Project, submitted by Joel Kramer, Kelsey Meyer, Eric Nefstead, and Daniel Vilaubi in partial fulfillment of the requirements for the Degree of Doctor of Physical Therapy from the University of North Dakota, has been read by the Advisor and Chairperson of Physical Therapy under whom the work has been done and is hereby approved. (Graduate School Advisor)~~ a (Chairperson, Physical ~~Therapy) 11 PERMISSION Title EMG ACTIVITY OF ACCESSORY MUSCLES OF BREATHING DURING RECOVERY POSITIONS Department Physical Therapy Degree Doctor of Physical Therapy In presenting this Scholarly Project in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the Department of Physical Therapy shall make it freely available for inspection. I further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised my work or, in his absence, by the Chairperson of the department. It is understood that any copying or publication or other use of this Scholarly Project or part thereoffor financial gain shall not be allowed without my written pennission. It is also understood that due recognition shall be given to me and the University of North Dakota in any scholarly use which may be made of any material in this Scholarly Project. \\ /10 /i6 Date /I /16 /15 Date ;:;:-~.-~ d/;c~ _.. I!/;O/lF Signature Date Signature· iii TABLE OF CONTENTS LIST OF FIGURES ...................................................................... v LIST OF TABLES ........................................................................... vi ACKNOWLEDGEMENTS ................................................................vii ABSTRACT ................................................................................. viii CHAPTER 1. INTRODUCTION .......................................................... 1 II. METHODS ................................................................... 5 a. Subjects ..................................................................... 5 b. Instrumentation ............................................................ 5 c. Procedure ................................................................... 6 d. Data Analysis .............................................................. 8 e. Statistical Analysis ......................................................... 8 III. RESULTS ..................................................................... 10 IV. DISCUSSION ............................................................... .12 V. CONCLUSION .............................................................. .16 APPENDIX. .. ..................................................................... .17 REFERENCES .............................................................................. .39 iv LIST OF FIGURES 1. Figure 1 (A and B) ............................................................................... 6 2. Figure 2 ....................................... '" ................................................... 6 v LIST OF TABLES 1. Table 1: Subject Demographics .................................................................... .10 2. Table 2: Electromyographic (EMG) activity of the accessory muscles of ventilation during different pulmonary recovery positions ............................................................ 11 3. Table 3: Pulmonary volumes observed during spirometry in four different pulmonary recovery positions ................................................................................................... 11 VI ACKNOWLEDGEMENTS The authors thank our family and friends for their continued support and guidance throughout physical therapy school, Dr, David Reiling for guidance throughout physical therapy school, as well as this research project, Dr, Renee Mabey for her assistance with data analysis and quality control ofinforrnation, the University of North Dakota Physical Therapy department for the use of their equipment and space, and the physical therapy students who donated their time to participate in this study, Signature WvfMJrSignature £~~, /t~::E ..... Signature "iZS- - Signature Vll ABSTRACT Chronic obstructive pulmonary disease (COPD) is predicted to become the third leading cause of death worldwide between 2020 and 2030. 1.2.3 Signs and symptoms of this disease can be debilitating, however techniques can be taught to decrease impairments. Suggested techniques for pulmonary recovery consist of supporting the upper extremities, supporting the head and leaning forward. The purpose of the current study was to examine the effects of recovery positions on the EMG activation of accessory muscles of respiration to decipher which recovery position is the most ideal for COPD patients. Fourteen healthy adults over the age of eighteen were recruited for this study. Bilateral EMG surface electrodes were placed on the accessory muscles of breathing including upper trapezius, sternocleidomastoid, pectoralis major (clavicular head), serratus anterior and latissimus dorsi. The subjects were randomly assigned a series of four different experimental positions: control position with the hands at the sides, standing with hands overhead, leaning forward with hands on knees and sitting with forearms and hands supported by a table. In each position, EMG activity was collected during three separate trials of maximal inspiration and maximal expiration. Results indicated a significantly higher level of bilateral EMG activity in the upper trapezius and serratus anterior in the hands on head position and of the latissimus dorsi during the hands on knees position. In conclusion, standing with hands on head and standing with hands on knees are two positions that are significantly advantageous for activating respiratory accessory muscles and could be utilized by COPD patients during respiratory recovery. V111 CHAPTER! INTRODUCTION Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe a multitude of chronic lung diseases that impair lung airflow. 1 Lung diseases typically identified under the term COPD are a leading cause of mortality and are predicted to become the third leading cause of death worldwide between 2020 and 2030. 1,2.3 COPD has a prevalence 4 estimated at 4-10% worldwide and 37% in the United States. , 5 Men, smokers and people greater than 40 years of age have the highest prevalence of COPD which dramatically 4 increases above the age of75. , 5 Risk factors include cigarette smoking, decreased activity and occupational exposures, such as organic and inorganic dusts, chemical agents and furnes. 4 Some causes can be from chronic abnormal inflammatory response oflung to noxious particles or gases that result in small airway disease, such as obstructive bronchiolitis, and parenchymal destruction, such as in emphysema. Symptoms include cough, sputum production, wheezing, but most importantly dyspnea leading to decreased activity. Likely contributing factors to dyspnea include pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. It has also been documented that a combination of these factors leads to diminished quality oflife, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death? When dyspnea is present, overall lung function can be evaluated with spirometry. Spirometry testing for patients with COPD continues to gain clinical interest as an important tool to assess disease severity, functional ability and lung capacities. Although 1 spirometry can be utilized for many pulmonary diseases, when used for dyspnea the FEV 1 was moderately correlated with patients' ratings of dyspnea (r=0.29; 95% CI, 0.22 to 0.35).6 Furthermore, spirometry has been used