Application of the segment weight dynamic movement method to the normalization of gait EMG amplitude

Age-related differences in lower limb muscle activation patterns and balance control strategies while walking over a compliant surface

Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on the quality of life in the aging population. Most falls in older fallers result from unrecoverable limb collapse during falling momentum control in the single limb support (SLS) phase. To understand why older adults are more likely to fall than younger adults, we investigated age-related differences in knee extensor eccentric control, lower limb muscle activation patterns, and their relation to balance control. Ten older and ten younger healthy adults were compared during balance control while walking on a compliant surface. There was a positive correlation between knee extensor eccentric work in the perturbed leg and the swinging leg's speed and margin of stability. In comparison to younger adults, older adults demonstrated (1) less eccentric work, reduced eccentric electromyography burst duration in the perturbed leg, (2) higher postural sway during SLS, and (3) impaired swinging leg balance control. The group-specific muscle synergy showed that older adults had a prominent ankle muscle activation, while younger adults exhibited a more prominent hip muscle activation. These findings provide insight into targeted balance rehabilitation directions to improve postural stability and reduce falls in older adults.

Characterization of muscle recruitment during gait of bilateral transfemoral and through-knee persons with limb loss

Introduction: Due to loss in musculoskeletal capacity, there is an increased burden on the residual limbs of bilateral transfemoral and through-knee persons with limb loss. This reduced capacity is associated with an increased cost of walking that is detrimental to functionality. Compensatory gait strategies are adopted by this population. However, how these strategies relate to specific muscle recruitment is not known. The primary aim of this study is to characterize muscle recruitment during gait of this population. The secondary aim is to assess whether the measured kinematics can be actuated when the endurance of specific muscles is reduced and if this is the case, which alternative muscles facilitate this. Methods: 3D gait data and high-resolution magnetic resonance images were acquired from six bilateral transfemoral and through-knee persons with limb loss. Subject-specific anatomical muscle models were developed for each participant, and a validated musculoskeletal model was used to quantify muscle forces in two conditions: during normal gait (baseline) and when muscles, which were identified as functioning above a "healthy" level at baseline, have a reduced magnitude of maximum force capacity (reduced endurance simulation). To test the hypothesis that there are differences in muscle forces between the baseline trials and the simulations with reduced muscular endurance, a Bonferroni corrected two-way ANOVA with repeated measures was completed between the two states. Results: The baseline analysis showed that the hip flexors experience relatively high muscle activations during gait. The reduced endurance simulation found two scenarios. First, for 5 out of the 12 simulations, the baseline kinematics could not be reproduced with the reduced muscular capacity. Second, for 7 out of 12 cases where the baseline kinematics were achieved, this was possible with compensatory increased activation of some muscles with similar functions (p ≤ 0.003). Discussion: Evidently, due to the loss of the ankle plantar flexors, gait imposes a high demand on the flexor muscle group of the residual limb. This study highlights how the elevated cost of gait in this population manifests in muscle recruitment. To enhance functionality, it is critical to consider the mechanical demand on the hip flexors and to develop rehabilitation interventions accordingly.

Age-related differences in stepping stability following a sudden gait perturbation are associated with lower limb eccentric control of the perturbed limb

INTRODUCTION

Falls are a leading cause of severe injuries and a major threat to quality of life in older adults. Elderly fallers demonstrate insufficient eccentric quadriceps control during the weight acceptance phase of initial single limb stance. However, the functional role of eccentric control of the perturbed (leading) leg during walking balance recovery and its age-related differences have not yet been studied; thus we investigated age-related differences in eccentric control at the knee of the perturbed leg and its influence on the postural sway and stability of the trailing leg during balance recovery following unexpected surface drop perturbations.

METHODS

Ten younger and ten older healthy adults were compared during balance recovery following an 8 cm unexpected surface drop perturbation at gait initiation. Outcomes related to perturbed leg included 1) eccentric knee extensor work; 2) electromyography (EMG) peak amplitude, peak latency, and eccentric EMG burst duration of the rectus femoris (RF); and 3) knee flexion angle during the single limb support. Outcomes related to stability of the trailing leg included 4) margin of stability (MoS) at first compensatory step touchdown after the perturbation. 5) Postural sway (standard deviation of center of mass acceleration) was measured in the anterior-posterior (A-P), medio-lateral (M-L), vertical directions during the single limb support.

RESULTS

Compared to younger adults, older adults demonstrated lower eccentric knee extensor work (p = 0.034), shorter RF EMG burst duration (p < 0.01), delayed RF EMG peak latency (p = 0.01), smaller knee flexion angle (p = 0.01) and MoS (p = 0.04), and higher postural sway (M-L (p = 0.02), vertical (p < 0.01)). There was a positive correlation between eccentric work and MoS (p = 0.03) and a negative correlation between M-L postural sway and 1) RF eccentric EMG burst duration (p = 0.04), and 2) eccentric work (p = 0.01).

CONCLUSIONS

Older adults demonstrated deficits in eccentric knee extensor control in the perturbed leg during single limb support, which contributed to reduced stability of the trailing leg compensatory step and greater postural sway during balance recovery. This finding provides insight into mechanisms of fall recovery from an unexpected unilateral postural perturbation and directions for lower limb strengthening exercises for aging populations.

The Effect of Tactical Tasks and Gear on Muscle Activation of SWAT Officers

ABSTRACT

Keeler, JM, Pohl, MB, Bergstrom, HC, Thomas, JM, and Abel, MG. The effect of tactical tasks and gear on muscle activation of SWAT officers. J Strength Cond Res 36(1): 238-244, 2022-Special Weapons and Tactics (SWAT) officers perform a variety of tactical operations while wearing tactical gear. Load carriage has been shown to alter muscle activation in the torso and is also associated with lower back pain, which is a prevalent musculoskeletal injury suffered by SWAT Officers. The purpose of this study was to quantify the effect of tactical gear on muscle activation of torso musculature while performing occupational tasks. Twenty male SWAT Officers (age: 34.7 ± 4.5 years; height: 1.79 ± 0.1 m; body mass: 91.5 ± 17.3 kg) performed 4 tasks (standing, rifle walk, sitting, and shield walk) with and without gear (mass of gear: 13.8 ± 1.9 kg). Mean electromyographic amplitude was evaluated bilaterally for the erector spinae, rectus abdominis, and external oblique muscles during the trials and expressed relative to maximal voluntary isometric contraction (MVIC). Addition of gear significantly increased erector spinae mean muscle activation during the rifle walk task (mean delta: +0.16%). However, no differences in muscle activation were identified for any other muscles between gear conditions (effect size ≤ 0.15). The shield walk produced the highest mean activation for each muscle during different tasks. The dynamic tasks yielded (0.24-4.18% MVIC) greater muscle activation levels than sitting and standing tasks. Despite minimal increases in muscle activation levels with the addition of gear, load carriage is known to increase the risk of acute and chronic injury. Collectively, these findings indicate that SWAT Officers should perform most skills without gear during tactical training to simulate task-specific movement patterns but reduce the risk of musculoskeletal injury.

Surface Electromyography Study Using a Low-Cost System: Are There Neck Muscles Differences When the Passenger Is Warned during an Emergency Braking Inside an Autonomous Vehicle?

Deaths and serious injuries caused by traffic accidents is a concerning public health problem. However, the problem can be mitigated by the Autonomous Emergency Braking (AEB) system, which can avoid the impact. The market penetration of AEB is exponentially growing, and non-impact situations are expected to become more frequent. Thus, new injury patterns must be analysed, and the neck is particularly sensitive to sudden acceleration changes. Abrupt braking would be enough to be a potential risk for cervical spine injury. There is controversy about whether or not there are differences in cervical behaviour depending on whether passengers are relaxed or contract their muscles before the imminent accident. In the present manuscript, 18 volunteers were subjected to two different levels of awareness during an emergency braking test. Cervical muscles (sternocleidomastoid and trapezius) were analysed by the sEMG signal captured by means of a low-cost system. The differences observed in the muscle response according to gender and age were notable when passengers are warned. Gender differences were more significant in the post-braking phase. When passengers were relaxed, subjects older than 35 registered higher sEMG values. Meanwhile, when passengers contract their muscles, subjects who were younger than or equal to 35 years old experienced an increment in the values of the sEMG signals.

Study of the Emergency Braking Test with an Autonomous Bus and the sEMG Neck Response by Means of a Low-Cost System

Nowadays, due to the advances and the increasing implementation of the autonomous braking systems in vehicles, the non-collision accident is expected to become more common than a crash when a sudden stop happens. The most common injury in this kind of accident is whiplash or cervical injury since the neck has high sensitivity to sharp deceleration. To date, biomechanical research has usually been developed inside laboratories and does not entirely represent real conditions (e.g., restraint systems or surroundings of the experiment). With the aim of knowing the possible neck effects and consequences of an automatic emergency braking inside an autonomous bus, a surface electromyography (sEMG) system built by low-cost elements and developed by us, in tandem with other devices, such as accelerometers or cameras, were used. Moreover, thanks to the collaboration of 18 participants, it was possible to study the non-collision effects in two different scenarios (braking test in which the passenger is seated and looking ahead while talking with somebody in front of him (BT1) and, a second braking test where the passenger used a smartphone (BT2) and nobody is seated in front of him talking to him). The aim was to assess the sEMG neck response in the most common situations when somebody uses some kind of transport in order to conclude which environments are riskier regarding a possible cervical injury.

Reliability of surface electromyography for the gluteus medius muscle during gait in people with and without chronic nonspecific low back pain

The purpose of this study was to determine the intratester reliability of surface electromyography (EMG) assessment of the gluteus medius muscle in healthy people and people with chronic nonspecific low back pain (CNLBP) during barefoot walking. Gluteus medius muscle activity was measured twice in 40 people without and 30 people with CNLBP approximately 7 days apart. Walking gluteus medius muscle activity was normalised to maximal voluntary isometric contractions during side-lying hip abduction with manual resistance. Good intratester reliability (ICC > 0.75) was found for mean, peak, and peak to peak amplitude for healthy people. Only mean amplitude demonstrated good intratester reliability in those with CNLBP. Peak amplitude and peak to peak amplitude of the gluteus medius muscle of those with CNLBP, and the time of peak amplitude in both groups, demonstrated moderate reliability (ICC ranged from 0.50 to 0.58). Moderate to large standard error of measurement and minimal detectable change values were reported for outcome measurements. These results suggest that potentially large levels of random error can occur between sessions. Future research can build on this study for those with pathology and attempt to establish change values for EMG that are clinically meaningful.

EMG normalization method based on grade 3 of manual muscle testing: Within- and between-day reliability of normalization tasks and application to gait analysis

Electromyography (EMG) is an important parameter in Clinical Gait Analysis (CGA), and is generally interpreted with timing of activation. EMG amplitude comparisons between individuals, muscles or days need normalization. There is no consensus on existing methods. The gold standard, maximum voluntary isometric contraction (MVIC), is not adapted to pathological populations because patients are often unable to perform an MVIC. The normalization method inspired by the isometric grade 3 of manual muscle testing (isoMMT3), which is the ability of a muscle to maintain a position against gravity, could be an interesting alternative. The aim of this study was to evaluate the within- and between-day reliability of the isoMMT3 EMG normalizing method during gait compared with the conventional MVIC method. Lower limb muscles EMG (gluteus medius, rectus femoris, tibialis anterior, semitendinosus) were recorded bilaterally in nine healthy participants (five males, aged 29.7±6.2years, BMI 22.7±3.3kgm^-2) giving a total of 18 independent legs. Three repeated measurements of the isoMMT3 and MVIC exercises were performed with an EMG recording. EMG amplitude of the muscles during gait was normalized by these two methods. This protocol was repeated one week later. Within- and between-day reliability of normalization tasks were similar for isoMMT3 and MVIC methods. Within- and between-day reliability of gait EMG normalized by isoMMT3 was higher than with MVIC normalization. These results indicate that EMG normalization using isoMMT3 is a reliable method with no special equipment needed and will support CGA interpretation. The next step will be to evaluate this method in pathological populations.

Can activities of daily living contribute to EMG normalization for gait analysis?

This study aims to examine alternative methods of normalization that effectively reflect muscle activity as compared to Maximal Voluntary Contraction (MVC). EMG data recorded from knee flexion-extension muscles in 10 control subjects during the stance phase of the gait cycle were examined by adopting different approaches of normalization: MVC, Mean and Peak Dynamic during gait cycles, (MDM and PDM, respectively), Peak Dynamic during activities of daily living (ADLs), (*PDM), and a combination of ADLs and MVC(**PDM). Intra- and inter-individual variability were calculated to determine reliability and similarity to MCV. **PDM showed excellent reliability across subjects in comparison to MVC, where variance ratio ranged from 0.43–0.99 for **PDM and 0.79–1.08 for MVC. Coefficient of variability showed a similar trend to Variance Ratio, ranging from 0.60–1.25 for **PDM and 1.97–3.92 for MVC. Both MVC and **PDM, and to some extent *PDM, demonstrated good-to-excellent relative amplitude’s matching; i.e. root mean square difference and absolute difference were both around 0.08 for Vastus medialis to about 4 for Medial gastrocnemius. It was concluded that **PDM and *PDM were reliable, **PDM mirrored MVC and thus could be used as an alternative to MVC for subjects who are unable to provide the required effort for MVC testing. Where MVC testing is not possible, *PDM is the next preferred option.

Electromyographic normalization of vastus lateralis and biceps femoris co-contraction during gait of elderly females

Abstract Introduction: Analyze muscle co-contraction using electromyographic signals, which are normalized to compare individuals, muscles and studies. Maximum voluntary isometric contraction (MVIC) and peak electrical activity (PEA) during movement are the most widely used forms of normalization. Objective: Compare inter-subject variability and investigate the association between the co-contraction indices of the vastus lateralis and biceps femoris during gait, normalized by MVIC and PEA. Methods: Thirty elderly women, aged 70.33 ± 3.69 years took part. Electrical muscle activity during MVIC and gait was recorded using a Biopac MP100 electromyograph. MVIC was performed in a Biodex isokinetic dynamometer. For normalization, the signals were divided by the Root Mean Square values of MVIC and PEA of gait. Results: The coefficient of variation of non-normalized data was 69.3%, and those normalized by PEA and MVIC were 30.4% and 48.9% respectively. Linear regression analysis resulted in a prediction model: PEA = 0.04 + 0.16 x MVIC. The goodness of fit of the regression model was statistically significant (p=0.02). The confidence interval (95% CI) for the intercept was between 0.02 and 0.29 and for MVIC between 0.03 and 0.06. Conclusions: The data normalized by PEA showed less variation than those normalized by MVIC. A 100% variation in data normalized by MVIC resulted in a 16% variation in data normalized by PEA, while variation in normalization by MVIC accounts for 17% of the variation in normalization by PEA and vice versa.

Short-Term Plasticity in a Monosynaptic Reflex Pathway to Forearm Muscles after Continuous Robot-Assisted Passive Stepping

Both active and passive rhythmic limb movements reduce the amplitude of spinal cord Hoffmann (H-) reflexes in muscles of moving and distant limbs. This could have clinical utility in remote modulation of the pathologically hyperactive reflexes found in spasticity after stroke or spinal cord injury. However, such clinical translation is currently hampered by a lack of critical information regarding the minimum or effective duration of passive movement needed for modulating spinal cord excitability. We therefore investigated the H-reflex modulation in the flexor carpi radialis (FCR) muscle during and after various durations (5, 10, 15, and 30 min) of passive stepping in 11 neurologically normal subjects. Passive stepping was performed by a robotic gait trainer system (Lokomat^®) while a single pulse of electrical stimulation to the median nerve elicited H-reflexes in the FCR. The amplitude of the FCR H-reflex was significantly suppressed during passive stepping. Although 30 min of passive stepping was sufficient to elicit a persistent H-reflex suppression that lasted up to 15 min, 5 min of passive stepping was not. The duration of H-reflex suppression correlated with that of the stepping. These findings suggest that the accumulation of stepping-related afferent feedback from the leg plays a role in generating short-term interlimb plasticity in the circuitry of the FCR H-reflex.

Lower limb control and strength in runners with and without patellofemoral pain syndrome

Recreational runners with patellofemoral pain syndrome (PFPS) have been shown to present altered movement kinematics, muscle activations, and ground reaction forces (GRF) during running as well as decreased lower limb strength. However, these variables have never been concurrently evaluated in a specific cohort. Therefore, the aim of this study was to compare lower limb control variables during running in recreational runners with and without PFPS. Lower limb control during treadmill running under typical training conditions (usual shoes, foot strike pattern, and speed) was compared between runners with (n=21) and without (n=20) PFPS using lower limb kinematics, electromyographic (EMG) recordings from representative muscles (gluteus medius/maximus, quadriceps and soleus), and vertical GRF. Isometric muscle strength was also evaluated. When comparing all runners from both groups, no between-group differences were found in variables commonly associated with PFPS such as peak hip adduction, hip internal rotation, contralateral pelvic drop, EMG of gluteal and quadriceps muscles, vertical loading rate, or lower limb strength. However, runners with PFPS showed significantly higher hip adduction at toe-off, lower excursion in hip adduction during late-stance, and longer duration of soleus activation. Sub-analyses were performed for females and for rearfoot strikers (RFS), and revealed that these subgroups accounted for most of between-group differences in hip adduction kinematics. Specifically for RFS with PFPS, lower activation of gluteus medius as well as lower GRF were observed. Our results suggest that deficits reported in runners with PFPS may vary depending on gender and on foot strike pattern.

Changes in activation timing of knee and ankle extensors during gait are related to changes in heteronymous spinal pathways after stroke

BACKGROUND

Extensor synergy is often observed in the paretic leg of stroke patients. Extensor synergy consists of an abnormal stereotyped co-activation of the leg extensors as patients attempt to move. As a component of this synergy, the simultaneous activation of knee and ankle extensors in the paretic leg during stance often affects gait pattern after stroke. The mechanisms involved in extensor synergy are still unclear. The first objective of this study is to compare the co-activation of knee and ankle extensors during the stance phase of gait between stroke and healthy individuals. The second objective is to explore whether this co-activation is related to changes in heteronymous spinal modulations between quadriceps and soleus muscles on the paretic side in post-stroke individuals.

METHODS

Thirteen stroke patients and ten healthy individuals participated in gait and heteronymous spinal modulation evaluations. Co-activation was measured using peak EMG activation intervals (PAI) and co-activation amplitude indexes (CAI) between knee and ankle extensors during the stance phase of gait in both groups. The evaluation of heteronymous spinal modulations was performed on the paretic leg in stroke participants and on one leg in healthy participants. This evaluation involved assessing the early facilitation and later inhibition of soleus voluntary EMG induced by femoral nerve stimulation.

RESULTS

All PAI were lower and most CAI were higher on the paretic side of stroke participants compared with the co-activation indexes among control participants. CAI and PAI were moderately correlated with increased heteronymous facilitation of soleus on the paretic side in stroke individuals.

CONCLUSIONS

Increased co-activation of knee and ankle extensors during gait is related to changes in intersegmental facilitative pathways linking quadriceps to soleus on the paretic side in stroke individuals. Malfunction of intersegmental pathways could contribute to abnormal timing of leg extensors during the stance phase of gait in hemiparetic individuals.

Influence of long-term wearing of unstable shoes on compensatory control of posture: an electromyography-based analysis

PURPOSE

This study investigated the influence of long-term wearing of unstable shoes (WUS) on compensatory postural adjustments (CPA) to an external perturbation.

METHODS

Participants were divided into two groups: one wore unstable shoes while the other wore conventional shoes for 8 weeks. The ground reaction force signal was used to calculate the anterior-posterior (AP) displacement of the centre of pressure (CoP) and the electromyographic signal of gastrocnemius medialis (GM), tibialis anterior (TA), rectus femoris (RF) and biceps femoris (BF) muscles was used to assess individual muscle activity, antagonist co-activation and reciprocal activation at the joint (TA/GM and RF/(BF+GM) pairs) and muscle group levels (ventral (TA+RF)/dorsal (GM+BF) pair) within time intervals typical for CPA. The electromyographic signal was also used to assess muscle latency. The variables described were evaluated before and after the 8-week period while wearing the unstable shoes and barefoot.

RESULTS

Long-term WUS led to: an increase of BF activity in both conditions (barefoot and wearing the unstable shoes); a decrease of GM activity; an increase of antagonist co-activation and a decrease of reciprocal activation level at the TA/GM and ventral/dorsal pairs in the unstable shoe condition. Additionally, WUS led to a decrease in CoP displacement. However, no differences were observed in muscle onset and offset.

CONCLUSION

Results suggest that the prolonged use of unstable shoes leads to increased ankle and muscle groups' antagonist co-activation levels and higher performance by the postural control system.

Effect of sensory inputs on the motor evoked potentials in the wrist flexor muscle during the robotic passive stepping in humans

The purpose of this study was to reveal whether the stepping-related afferent feedback modulates the motor evoked potentials (MEPs) in the wrist flexor muscle in humans. MEPs generated in flexor carpi radialis muscle (FCR) by transcranial magnetic stimulation (TMS) were recorded during robotic-assisted passive stepping and standing conditions. TMS were applied at fifteen scalp sites (3 × 5 cm grid in anterior-posterior direction and medial-lateral direction, respectively) centered on the "hot spot" which was defined as an optimal site for eliciting the MEP in FCR during passive standing task, The MEP amplitudes were measured for each stimulus sites, and then compared between different conditions. During passive stepping, the MEP amplitudes in FCR muscle were significantly increased in six adjacent stimulus sites of the hot spot, This result suggests that stepping-related afferent feedback induces expansion of excitatory area in motor cortex for FCR muscle.

Evaluation of electromyography normalisation methods for the back squat

The aim of the study was to evaluate maximal isometric (dynamometer based {MVC-NORM} and isometric squat {MIS-NORM}) and sub-maximal EMG normalisation methods (60%-NORM, 70%-NORM, 80%-NORM) for dynamic back squat exercise (DSQ-EX). The absolute reliability (limits of agreement {LOA}, coefficient of variation {CV%}), relative reliability (intra-class correlation coefficient {ICC}) and sensitivity of each method was assessed. Ten resistance-trained males attended four sessions. Session one assessed maximum back squat strength (three repetition maximum {3RM}). In the remaining three sessions Vastus lateralis (VL) and Bicep femoris (BF) EMG were measured whilst participants completed normalisation tasks and DSQ-EX sets at 65%, 75%, 85% and 95% of 3RM. MIS-NORM produced lower intra-participant CV% compared to MVC-NORM. 80%-NORM produced lower intra-participant CV% than other sub-maximal methods for VL and BF during eccentric and concentric phases. 80%-NORM also produced narrower 95% LOA results than all other normalisation methods. The MIS-NORM method displayed higher ICC values for both muscles during eccentric and concentric phases. The 60%-NORM and 70%-NORM methods were the most sensitive for VL and BF during eccentric and concentric phases. Only normalisation methods for the concentric action of the VL enhanced sensitivity compared to unnormalised EMG. Overall, dynamic normalisation methods demonstrated better absolute reliability and sensitivity for reporting VL and BF EMG within the current study compared to maximal isometric methods.

Robotic-assisted stepping modulates monosynaptic reflexes in forearm muscles in the human

Although the amplitude of the Hoffmann (H)-reflex in the forelimb muscles is known to be suppressed during rhythmic leg movement, it is unknown which factor plays a more important role in generating this suppression-movement-related afferent feedback or feedback related to body loading. To specifically explore the movement- and load-related afferent feedback, we investigated the modulation of the H-reflex in the flexor carpi radialis (FCR) muscle during robotic-assisted passive leg stepping. Passive stepping and standing were performed using a robotic gait-trainer system (Lokomat). The H-reflex in the FCR, elicited by electrical stimulation to the median nerve, was recorded at 10 different phases of the stepping cycle, as well as during quiet standing. We confirmed that the magnitude of the FCR H-reflex was suppressed significantly during passive stepping compared with during standing. The suppressive effect on the FCR H-reflex amplitude was seen at all phases of stepping, irrespective of whether the stepping was conducted with body weight loaded or unloaded. These results suggest that movement-related afferent feedback, rather than load-related afferent feedback, plays an important role in suppressing the FCR H-reflex amplitude.

Changes of muscular load with aging in the motion of pulling up disposable diapers

To elucidate how aging affects the muscular load required for pulling up pants-style disposable diapers, and why some elderly people cannot pull up the rear of their disposable diapers well, we evaluated the electromyogram (EMG) of 8 young subjects (21.5+/-1.5 years) and 7 elderly subjects (71.6+/-6.1 years). EMG was measured for four muscles--biceps brachii, deltoid, brachioradialis, and flexor carpi ulnaris. We evaluated the muscular load during a series of motions for pulling a disposable diaper up at the front and the rear of the body using an EMG-Video Synchronous Split Method. The analysis revealed that the front and the rear integral EMG of elderly subjects were both significantly larger than those of young subjects for all four muscles. For the deltoid and flexor carpi ulnaris muscles, the maximum amplitude of EMG when pulling up the rear of the disposable diapers was significantly larger in the elderly subjects than the young ones. These results suggest that the muscular load involved in pulling up the rear of disposable diapers may increase due to changes in body habitus caused by aging. Since muscular strength decreases with age, it seems likely that the elderly individuals will eventually be unable to pull up the rear of their diapers.