ABSTRACT I. INTRODUCTION. Perspective of the Study

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1 26 IJSRSE Volume 2 Issue Pint ISSN : 5 Online ISSN : 44 hemed Sec: Engineeing and echnology Compaative Analysis of Clubfoot and Nomal Calf Muscle Activity Using Electomyogaphy A Case Study Humayun Mushtaq*, Seema Chawla 2, Mohsina Mushtaq,2 Depatment of Biomedical Engineeing, DCRUS Univesity, Muthal, Hayana, India Depatment of Veteinay Science, SKUAS, Jammu and Kashm, India ABSRAC In this pape we analysed signals of Gastocnemius (GS) and Soleus (SOL) calf muscles fom a unilateal clubfoot patient (ight leg nomal and left clubfoot) duing diffeent stages (ing, f and extension) using EMG. he Raw and filteed [Root Squae (RMS) and Integated EMG (IEMG)] signals acqued fom subject wee quantified using (AcqKnowledge., BIOPAC MP systems Inc.), fo 2 seconds and output was analysed using paed sample t. Significant diffeences wee obseved between Root Squae (RMS) EMG and Integated EMG (IEMG) muscle activity of nomal and clubfoot leg duing e condis fo both GS and SOL muscles. With mamatical modelling tools, esults wee studied and was found that calf muscle activity of affected leg vaies fom nomal leg duing ing, f and extension stages. It was also studied and poved that elapses can occu even afte sugical coec (Achilles tenotomy) on se patients with accuacy of 8%. Keywods: Achilles enotomy, Clubfoot, EMG, Gastocnemius (GS), Soleus (SOL) I. INRODUCION Club foot, also known as Congenital alipes Equinovaus (CEV), is most common congenital stuctual defomity of lowe limbs, involving one (unilateal), o both (bilateal) feet. Idiopathic clubfoot is as isolated defomity of one o both limbs consisting of fou components: equines, hind foot vaus, foefoot adductus, and cavus [, 2]. he weight is shifted to lateal side of foefoot due to fact that foot is planta flexed and heel tuned inwads which cannot bea weight of body. Clubfoot may be ei pimay (idiopathic) o seconday. he etiology of clubfoot is still unknown. Matenal smoking duing pegnancy can lead to CEV []. Risk of clubfoot is moe (25%) in case a fst degee family membe (paent, siblings) is affected. Fstbon childen ae also moe likely to have EV than childen fom subsequent pegnancies. he effects of EV on infant ae limited to lowe limbs and do not involve o body systems o mental ability of affected infant. Clubfoot is usually diagnosed immediately afte bth simply by looking at foot. he heel of foot tuns inwads, foot and toes pointing down and cuve inwads. he bones ae abnomally shaped with tight tendons, muscles, and ligaments. he foot and calf muscles ae usually smalle than nomal. he calf and peoneal muscles ae pooly developed in affected limb [4]. Diagnosis is confmed by adiogaphic assessment of foot and ankle. Ultasonogaphy (USG) and Magnetic Resonance Imaging (MRI) ae o diagnostic methods. wo methods fo coecting clubfoot include: NonSugical eatment: Ponseti method, Manipula method, Funcal/ Fench/ Physioapy method and Botox method. Sugical eatment: Achilles tenotomy. he Golden standad method of teatment fo idiopathic club foot defomity is seial casting (Ponseti metho [5]. Ponseti method and Fench funcal method ae both effective in educing need fo sugey [6]. Pespective of Study ) o study impact of sugical coec on calf muscle activity by EMG analysis. 2) o identify any sot of muscula imbalance o abnomality and elapses in clubfoot patients teated with Achilles enotomy. IJSRSE6255 Received : 2 May 26 Accepted : 6 May 26 MayJune 26 [(2): 576] 57

Compaative analysis of calf muscle activity between nomal and sugically teated leg in unilateal clubfoot patient using EMG II. MEHODS AND MAERIAL 2.

his po of wok descibes study design used in this eseach as well as measuement instuments and methods used. his also involves study sample, size, settings, and selec of study goup and data collecs.

BIOPACMP System he BIOPAC MP System was used in study because it allows nealy unlimited feedom of movement and unsupassed comfot, enabling subjects to easily elax while pefoming selected tasks as pe

Main Use Inteface of AcqKnowledge. is shown in figue. Figue. EMG ecoding of selected calf muscle activity in unilateal clubfoot patient 2.

one subject, who had attended age of 27 yeas and was bon with unilateal clubfoot (ight leg nomal and left clubfoot).

2 Compaative analysis of calf muscle activity between nomal and sugically teated leg in unilateal clubfoot patient using EMG II. MEHODS AND MAERIAL 2.2 Equipments Used in Study he equipment used duing study was Weless EMG Systems fo data acquisi shown in figue 2. his po of wok descibes study design used in this eseach as well as measuement instuments and methods used. his also involves study sample, size, settings, and selec of study goup and data collecs. he methodology followed fo caying out study is shown in Figue. Figue 2. BIOPACMP System he BIOPAC MP System was used in study because it allows nealy unlimited feedom of movement and unsupassed comfot, enabling subjects to easily elax while pefoming selected tasks as pe appoved potocol.he basic components of MP System ae shown in fig.acqknowledge is extemely flexible, giving full contol ove data collec. Data can be analysed ei while it is being acqued o afte fact. Main Use Inteface of AcqKnowledge. is shown in figue. Figue. EMG ecoding of selected calf muscle activity in unilateal clubfoot patient 2. Subject Details Due to paucity of clubfoot patients in age goup of above e yeas it was not possible to pefom EMG analysis on new bon CEV babies as y won t espond to this t, efoe study is conducted on one subject, who had attended age of 27 yeas and was bon with unilateal clubfoot (ight leg nomal and left clubfoot).he patient s medical histoy evealed that he had been opeated fo Congenital alpies Equinovaus (CEV) of left foot at an age of 6 months. (± SD) age, height and weight calculated is shown in able: Chaacteistics of Subject. Categoy Age (Yeas) Height (Cm) Weight (Kg) Male 25 ±2 52± 54.5±5.5 Figue. Main Use Inteface of AcqKnowledge. 2. Hyposis of study 2.. hee will be a nonsignificant diffeence in EMG activity of nomal (ight) and clubfoot (left) leg of unilateal clubfoot patient hee will be a nonsignificant diffeence in EMG activity of Gastocnemius (GS) and soleus (SOL) muscles of unilateal clubfoot patient duing ing, f and extension condis. 2.4 Data Acquisi EMG analysis of selected calf muscles [Gastocnemius (GS) and Soleus (SOL)] was caied out fo 2 minutes using disposable gel electodes shown in Fig 4. Nomal Intenaal Jounal of Scientific Reseach in Science, Engineeing and echnology (ijsset.com) 58

(Right) and abnomal (Left) calf muscle activity was ecoded duing ing, f and extension stages. Figue 4.

, BIOPAC systems Inc.) was set to sample ate of 2 samples pe second and acquisi dua was set fo 2 seconds.

he subject pepaa wee caied out following standad potocols fo placing electodes on subject s pe identified muscles to acque EMG simultaneously fom both legs.

he schematic placement of electodes is shown in Fig 5. Right (Nomal) Left (Clubfoot ) Figue 5. Expeimental Setup III. RESULS AND DISCUSSION In case of Raw EMG, Significant diffeence between GS.

3 (Right) and abnomal (Left) calf muscle activity was ecoded duing ing, f and extension stages. Figue 4. Disposable Gel electodes he Raw and filteed [Root Squae (RMS) and Integated EMG (IEMG)] signals acqued fom subject wee quantified using AcqKnowledge. softwae. he data acquisi softwae (AcqKnowledge., BIOPAC systems Inc.) was set to sample ate of 2 samples pe second and acquisi dua was set fo 2 seconds. Scaling paametes wee set as default value (Cal= ) and (Cal 2= ) and units wee set in millivolts. All acquisi paametes and window posis ae saved along with data when Save command is chosen. he subject pepaa wee caied out following standad potocols fo placing electodes on subject s pe identified muscles to acque EMG simultaneously fom both legs. Afte data acquisi, EMG signal was ecoded fo 2 seconds to bette undand influence of ing, f and extension condis on EMG signal of selected calf muscles of clubfoot and nomal leg. he schematic placement of electodes is shown in Fig 5. Right (Nomal) Left (Clubfoot ) Figue 5. Expeimental Setup III. RESULS AND DISCUSSION In case of Raw EMG, Significant diffeence between GS.R and GS.L muscle activity was ecoded at ing state. Nonsignificant diffeence was obseved between GS.R and GS.L muscle activity in f condi. Nonsignificant diffeence was obseved between GS.R and GS.L muscle activity in extension condi (table2). Raw EMG analysis showed nonsignificant diffeence fo SOL muscles at all e condis (ing, f and extension) between clubfoot and nomal leg. Significant diffeence was obseved between Root Squae (RMS) EMG and Integated EMG (IEMG) muscle activity of nomal and clubfoot leg duing ing, f and extension condis fo both GS and SOL muscles as shown in (tables 4) espectively. SPSS softwae (vesion 7) was used to cay out ed t t to compae esults obtained fom nomal (Right) leg and teated clubfoot (Left) leg of patient. Raw EMG ecoded fo GS and SOL muscles fo 28, 58 and 2 seconds unde e diffeent posis (ing, f and extension). (GS R + SOL R: Nomal; GS L+ SOL L: Abnomal) GSR. GSL. 767 GSR.flexio 57 n GSL.flexio n GSR. 6 GSL. ed Samples ed Diffeences ti on Eo Inteval of Diffeence ( Intenaal Jounal of Scientific Reseach in Science, Engineeing and echnology (ijsset.com) 5

4 . SOLL..flexio nsol L.flex ion. SOLL ed Samples ed Diffeences ti on.68 8 Eo Inteval of Diffeence ( CI value indicates 5% level of Significance (p<.5) able no: 2 Integated EMG ecoded fo GS and SOL muscles fo 28, 58 and 2 seconds unde e diffeent posis (ing, f and extension). (GS R + SOL R: Nomal; GS L+ SOL L: Abnomal) GSR. GSL. GSR.f GSL.f GSR. GSL ed Samples ed Diffeences 6 84 Eo 6 Inteval of Diffeence ( SOLL..f SOLL.f. SOLL ed Samples ed Diffeences 64 Eo Inteval of Diffeence (2 4 CI value indicates 5% level of Significance (p<.5) able no: Root Squae EMG ecoded fo GS and SOL muscles fo 28, 58 and 2 seconds unde e diffeent posis (ing, f and extension). (GS R + SOL R: Nomal; GS L+ SOL L: Abnomal) GSR. GSL. GSR.f GSL.f GSR. GSL ed Samples ed Diffeences Eo 6 22 Inteval of Diffeence Sig. (2 tail e... Intenaal Jounal of Scientific Reseach in Science, Engineeing and echnology (ijsset.com) 6

. SOLL..f SOLL.f. SOLL. 26.26 56.24 26 ed Samples ed Diffeences 2 45 42.7 78 Eo 2 68 2 Inteval of Diffeence 268.26 428.24 546 44.26 6.24 6 8. 8 2. 52 26. 87 5 4 Sig. (2 tail e.

CONCLUSION It is concluded fom pesent study that calf muscle activity of affected leg vaies fom nomal leg duing ing, f and extension condis in a unilateal clubfoot patient even afte sugical coec and

he esults of pesent study ae in favou of abnomal innevas as pime facto in development of such defomity.

5 . SOLL..f SOLL.f. SOLL ed Samples ed Diffeences Eo Inteval of Diffeence Sig. (2 tail e... CI value indicates 5% level of Significance (p<.5) able no: 4 IV. CONCLUSION It is concluded fom pesent study that calf muscle activity of affected leg vaies fom nomal leg duing ing, f and extension condis in a unilateal clubfoot patient even afte sugical coec and can be efficiently analysed using electomyogaphy (EMG). he study also helps in undanding muscula imbalance among clubfoot patients. he esults of pesent study ae in favou of abnomal innevas as pime facto in development of such defomity. he findings suppot oy that muscle imbalance is an etiological facto in congenital clubfoot & electophysiological studies ae useful in idiopathic clubfoot with esidual defomities afte consevative o opeative teatment. In futue Biosensos can be used in clubfoot patients that show elapses o esistance even afte consevative o opeative teatment. Peteatment and post teatment assessment of muscles in clubfoot patients duing gait analysis can be a guiding tool in teatment as well as ecuence cases. Electomyogaphy is one of pognostic factos to analyse such defomity. EMG analysis povide infoma to sugeon as well as to paents about expected esults and indicates need fo moe extensive opea o fu sugical coecs depending upon seveity of condi, a than limited pocedues which may pove inadequate. V. REFERENCES [] M. Dobbs, C. Gunett, Update on clubfoot: etiology and teatment, Clinical Othopaedics and Related Reseach, Vol. 467, pp. 465, 2. [2] M. HallajMoghadam, A. Moadi, M.H. Ebahimzadeh, Clinical outcome of posteomedial vesus posteomedial lateal elease fo clubfoot, Jounal of Pediatic Othopaedics B, Vol. 24, No., pp , 25. [] M.A. Honein, L.J. ulozzi, C.A. Mooe, Family histoy, matenal smoking and clubfoot: a indica of a geneenvonment inteac, Ameican Jounal of Epidemiology, Vol. 52, pp , 2. [4] J.C. Adams, D.L. Hablen, Outline of Othopaedics, London: Chuchill Livingstone. Gade of ecommenda: A, 2. [5] M. Dobbs, C. Gunett, Update on clubfoot: etiology and teatment, Clinical Othopaedics and Related Reseach, Vol. 467, pp. 465, 2. [6] B.S. Richads, S. Faulks, K.E. Rathjen, L.A. Kaol, C.E. Johnston, S.A. Jones, A compaison of two nonopeative methods of idiopathic clubfoot coec: Ponseti method and Fench funcal (physioapy) method, J. Bone. Joint. Sug. Am., Vol., No., pp. 22, Nov 28. VI. AUHORS Humayun Mushtaq He is pesently pusuing M.ech in Depatment of Biomedical Engineeing DCRUS Hayana India. His eseach inte fields ae Biomechanics, issue Regenea & Biomateials. Seema Chawla She is pesently woking as Assistant pofesso in Depatment of Biomedical Engineeing DCRUS, Hayana India. He field of intes ae obotics, Bioinstumenta and Haptics. Mohsina Mushtaq she is cuently pusuing Ph.D. in Depatment of Veteinay Medicine in SKUAS (J&K), India. He aeas of inte ae Public Health, thology. Intenaal Jounal of Scientific Reseach in Science, Engineeing and echnology (ijsset.com) 6

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