Characterization of the motor units of the external anal sphincter in pregnant women with multichannel surface EMG.

INTRODUCTION AND HYPOTHESIS: Locating the innervation zones (IZs) of the external anal sphincter (EAS) is helpful to obstetricians to identify areas particularly vulnerable to episiotomy in pregnant women. The aim was to investigate the motor unit (MU) properties of the EAS during voluntary contractions. METHODS: Electromyographic signals were detected, from 478 pregnant women, by means of an intra-anal cylindrical probe carrying a circumferential array of 16 electrodes. The signals were decomposed into the constituent MU action potential trains and 5,947 templates were extracted and analyzed in order to identify the IZ position. RESULTS: MUs innervated at one end are concentrated in the dorsal portion of the sphincter, while MUs innervated in the middle are distributed symmetrically in the left and right portions of the EAS. The angular propagation velocity was estimated for each MU resulting in 260 ± 45 rad/s, corresponding to 1.8 m/s on the probe surface and to about 4 m/s at a radial depth of 10 mm from the probe surface. CONCLUSIONS: A novel method for identification and classification of MUs of the EAS is proposed and applied to a large-scale study. It is possible to distinguish MUs of the EAS in a minimally invasive way and identify their IZs. This information should be used to plan episiotomies and minimize risks of EAS denervation.

Tutorial. Surface EMG detection, conditioning and pre-processing: Best practices.

This tutorial is aimed primarily to non-engineers, using or planning to use surface electromyography (sEMG) as an assessment tool for muscle evaluation in the prevention, monitoring, assessment and rehabilitation fields. The main purpose is to explain basic concepts related to: (a) signal detection (electrodes, electrode-skin interface, noise, ECG and power line interference), (b) basic signal properties, such as amplitude and bandwidth, (c) parameters of the front-end amplifier (input impedance, noise, CMRR, bandwidth, etc.), (d) techniques for interference and artifact reduction, (e) signal filtering, (f) sampling and (g) A/D conversion, These concepts are addressed and discussed, with examples. The second purpose is to outline best practices and provide general guidelines for proper signal detection, conditioning and A/D conversion, aimed to clinical operators and biomedical engineers. Issues related to the sEMG origin and to electrode size, interelectrode distance and location, have been discussed in a previous tutorial. Issues related to signal processing for information extraction will be discussed in a subsequent tutorial.

Time and frequency domain analysis of surface myoelectric signals during electrically-elicited cramps.

OBJECTIVES: To examine if different frequencies of electrical stimulation trigger different sized cramps in the abductor hallucis muscle and to analyze their surface electromyographic (EMG) behaviour in both time and frequency domains. METHODS: Fifteen subjects were studied. Stimulation trains of 150 pulses were applied to the muscle motor point. Frequency was increased (starting from 4pps with 2-pps steps) until a cramp developed. Current intensity was 30% higher than that eliciting maximal M-waves. After the first cramp ("threshold cramp"), a 30-minute rest was provided before a second cramp ("above-threshold cramp") was elicited with a frequency increased by 50% with respect to that eliciting the first cramp. RESULTS: We found greater EMG amplitude and a compression of the power spectrum for above-threshold cramps with respect to threshold cramps. M-wave changes (ranging between small decreases of M-wave amplitude to complete M-wave disappearance) occurred and progressively increased throughout stimulation trains. Significant positive correlations were found between estimates of EMG amplitude during cramps and estimated reductions of M-wave amplitude. CONCLUSIONS: Varying frequencies of electrical stimulation triggered different sized cramps. Moreover, decreases in M-wave amplitude were observed during both threshold and above-threshold stimulations. The choice of the stimulation frequency has relevance for optimizing electrical stimulation protocols for the study of muscle cramps in both healthy and pathological subjects.

Myoelectric fatigue profiles of three knee extensor muscles.

Aims of the present study were to: 1) investigate the differences between the myoelectric fatigue profiles of the vasti muscles of the quadriceps during electrically evoked contractions; 2) compare the myoelectric fatigue profiles of the vasti muscles between sedentary subjects and rowers; 3) analyze motor unit activation order during stimulation of the vasti muscles. In nine sedentary subjects and nine rowers surface EMG signals were detected during electrically elicited contractions of the following three muscles: vastus medialis obliquus (VMO), vastus lateralis (VL), and vastus medialis longus (VML). M-waves were recorded as the muscles were stimulated with both variable (increasing-decreasing) and constant stimulation intensities. Changes in M-wave conduction velocity (CV) during trains with non-constant current were adopted for the study of the motor unit recruitment order. Rates of change of myoelectric signal variables were adopted to assess myoelectric manifestations of fatigue during stimulation trains with constant current. We found that: 1) VL muscle was more fatigable than vastus medialis muscles; 2) VL and VML muscles of rowers resulted less fatigable than sedentary subjects; and 3) in the three muscles, motor units tended to be recruited in order of increasing CV and derecruited in order of decreasing CV with increasing/decreasing stimulation current.

Tutorial. Surface EMG detection in space and time: Best practices.

This tutorial is aimed to non-engineers using, or planning to use, surface electromyography (sEMG) as an assessment tool in the prevention, monitoring and rehabilitation fields. Its first purpose is to address the issues related to the origin and nature of the signal and to its detection (electrode size, distance, location) by one-dimensional (bipolar and linear arrays) and two-dimensional (grids) electrode systems while avoiding advanced mathematical, physical or physiological issues. Its second purpose is to outline best practices and provide general guidelines for proper signal detection. Issues related to the electrode-skin interface, signal conditioning and interpretation will be discussed in subsequent tutorials.

Effect of electrode location on EMG signal envelope in leg muscles during gait.

The aim of the study was to assess the variability of EMG signal envelope with electrode location during gait. Surface EMG signals were recorded from 10 healthy subjects from the tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus (SO) muscles. From TA, PL, GL and GM, signals were acquired using a two-dimensional grid of 4 x 3 electrodes (10 x 15 mm in size, as used in most gait laboratories) with 20-mm interelectrode distance in both directions. A similar grid of 3 x 3 electrodes was used for SO. EMG envelope was characterized by its peak value, area after normalization by the peak value, and time instant corresponding to the maximum. The maximum relative change in peak value with electrode location, expressed as a percentage of the peak value in the central location, was (mean+/-SD) 31+/-18% for TA, 29+/-13% for PL, 25+/-15% for GL, 14+/-8% for GM, and 26+/-14% for SO. The maximum relative change in area was 29+/-13% for TA, 73+/-40% for PL, 31+/-23% for GL, 35+/-20% for GM, 20+/-13% for SO, and in the position of maximum, computed as distance from the maximum position in the central channel, it was 5+/-10% of the gait cycle for TA, 26+/-16% for PL, 3+/-2% for GL, 3+/-1% for GM, 3+/-3% for SO. A crosstalk index, defined on the basis of the expected intervals of muscle activation for healthy subjects, indicated that estimated crosstalk was present between TA and PL, in an amount which depended on electrode location. It was concluded that the estimate of muscle activation intensity during gait from surface EMG is variable with location of the electrodes while timing of muscle activity is more robust to electrode displacement and can be reliably extracted in those cases in which crosstalk is limited. These results are valid for healthy subjects, where the level of muscular activity during gait is much lower than maximum.

[Usefulness of surface electromyography of hand muscles in the assessment of myoelectric parameters changes due to repetitive manual tasks]. / Applicazione dell'elettromiografia di superficie dei muscoli della mano nello studio delle patologie da sovraccarico biomeccanico.

The aim of this project was to investigate the possible role of sEMG in the diagnosis of Carpal tunnel syndrome (CTS). The study group consisted of 37 subjects, of whom 14 (control group) were not employed in manual tasks and 23 (exposed) were engaged in repetitive and forceful manual tasks. Of the 23 exposed workers, 10 reported CTS symptoms, whereas all the subjects of the control group resulted asymptomatic. The surface electromyography signal was recorded from the abductor pollicis brevis muscle, using different levels of isometric contraction: 20% and 50% of the maximum voluntary contraction (MVC), respectively. The initial values and rate of change of the average rectified value (ARV), mean power spectral frequency (MNF) and conduction velocity (CV) were calculated. Moreover the study protocol included clinical evaluation and electrodiagnostic study of the median nerve. Data from the exposed and control group were compared. Statistically significant differences between the two groups were found for ARV initial value and for CV and MNF rate of change at 50% MVC. These parameters resulted lower in the exposed group, with the lowest values among symptomatic subjects. Possible explanations may be the loss of motor units, particularly affecting the fast and fatigable type II muscle fibers, involved in the myoelectric manifestation of fatigue. In conclusion, this technique was able to show different myoelectric patterns and manifestations of fatigue between subjects exposed and nonexposed to manual intensive work, suffering or not suffering from CTS.

Extraction of the brachialis muscle activity using HD-sEMG technique and canonical correlation analysis.

The Brachialis (BR) is placed under the Biceps Brachii (BB) deep in the upper arm. Therefore, the detection of the corresponding surface Electromyogram (sEMG) is a complex task. The BR is an important elbow flexor, but it is usually not considered in the sEMG based force estimation process. The aim of this study was to attempt to separate the two sEMG activities of the BR and the BB by using a High Density sEMG (HD-sEMG) grid placed at the upper arm and Canonical Component Analysis (CCA) technique. For this purpose, we recorded sEMG signals from seven subjects with two 8 × 4 electrode grids placed over BB and BR. Four isometric voluntary contraction levels were recorded (5, 10, 30 and 50 %MVC) for 90° elbow angle. Then using CCA and image processing tools the sources of each muscle activity were separated. Finally, the corresponding sEMG signals were reconstructed using the remaining canonical components in order to retrieve the activity of the BB and the BR muscles.

The external anal sphincter and the role of surface electromyography.

Assessment of the neuronal control of the external anal sphincter (EAS) has long been restricted to investigating patients with defecation disorders by invasive tools such as needle electromyography (EMG), while less invasive techniques have been regarded as non-suitable for diagnostic purposes. Multichannel surface EMG by means of electrode arrays applied to anal sphincter muscle records and identifies individual motor unit action potentials, their place of origin along the circumference, their repetitive firing frequency, and their progression along the muscle fibres at different levels within the anal canal. These data shed doubts on conventional knowledge about the anatomy of the EAS muscle, and confirms new concepts of anatomical differences between gender. This may eventually be transferred to a new understanding of the role of symmetry and asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence.

The puborectalis muscle.

The role of the levator ani and puborectalis muscle in preserving continence has been underestimated in the past, due predominantly to technical difficulties to investigate its proper function in healthy subjects, and its dysfunction as in patients with incontinence problems. This has recently been overcome by applying new investigational procedures such as a perineal dynamometer which measures the traction exerted by the levator ani on an intrarectal balloon catheter, or by multi-electrode arrays recording the generation of motor unit action potentials from various parts of the puborectalis muscle sling via intrarectal surface electrodes. Both techniques have the potential to provide new insights into the physiology of defecation and the pathophysiology of incontinence and constipation.

[Neuromuscular assessment of the elderly worker: the European NEW project]. / Valutazione neuromuscolare del lavoratore anziano: il Progetto Europeo NEW.

Neuromuscular problems reduce working ability of aging workers, and increase cases of work loss and accidents. For this reason, elderly people throughout Europe are forced into early retirement, and fail to be self-supporting. There is a need to identify and monitor work related neuromuscular disorders in order to reduce their consequences by monitoring the most vulnerable individuals, identify the determinants of neuromuscular aging related to occupational conditions, prevent pathologies and their evolution. Preliminary results show the possibility of identification of neuromuscular problems through non invasive techniques, some of which, recently developed within the SENIAM and PROCID Concerted Actions, can provide quantitative indices of neuromuscular performance. Substantial field tests and training initiatives are required to demonstrate if these techniques can be used outside the research labs, if there may be a European market in the fields of ergonomics and occupational health, and if they can be routinely used with standardized methodology to monitor the relationship between occupational and neuromuscular system conditions in the working environment. The objective of the European Project Neuromuscular assessment in the Elderly Worker (NEW) is to answer these questions.

Power line interference attenuation in multi-channel sEMG signals: Algorithms and analysis.

Electromyogram (EMG) recordings are often corrupted by power line interference (PLI) even though the skin is prepared and well-designed instruments are used. This study focuses on the analysis of some of the recent and classical existing digital signal processing approaches have been used to attenuate, if not eliminate, the power line interference from EMG signals. A comparison of the signal to interference ratio (SIR) of the output signals is presented, for four methods: classical notch filter, spectral interpolation, adaptive noise canceller with phase locked loop (ANC-PLL) and adaptive filter, applied to simulated multichannel monopolar EMG signals with different SIR. The effect of each method on the shape of the EMG signals is also analyzed. The results show that ANC-PLL method gives the best output SIR and lowest shape distortion compared to the other methods. Classical notch filtering is the simplest method but some information might be lost as it removes both the interference and the EMG signals. Thus, it is obvious that notch filter has the lowest performance and it introduces distortion into the resulting signals.

Inference of motor unit recruitment order in voluntary and electrically elicited contractions.

The relationship between surface myoelectric signal parameters and the level of voluntary or electrically elicited contractions was studied in 32 experiments on the tibialis anterior muscle of 22 healthy human subjects. Contractions were performed at 20 and 80% of the maximum voluntary contraction torque. Two levels of stimulation current were used, yielding, respectively, a maximum M wave and an M wave approximately 30% of the maximum. A four-bar electrode probe was used to detect single- and double-differential signals from which mean and median frequency of the power spectrum and average muscle fiber conduction velocity were estimated. Measurements obtained from voluntary contractions showed a positive correlation between contraction levels and both conduction velocity and spectral parameters. Conduction velocity increased by 21.2 +/- 10.9% when voluntary contraction level increased from 20 to 80% of the maximal value. Spectral parameters increased by similar amounts. Tetanic electrical stimulation was applied to a muscle motor point for 20 s via surface electrodes. Rectangular current pulses with 0.1-ms width and frequencies of 20, 25, 30, 35, and 40 Hz were used. Four types of behavior were observed with increasing stimulation level: 1) the two spectral parameters and conduction velocity both increased with stimulation in 15 experiments, 2) the two spectral parameters decreased and conduction velocity increased in 8 experiments, 3) the two spectral parameters and conduction velocity both decreased in 6 experiments, and 4) the two spectral parameters increased and conduction velocity decreased in 3 experiments. Conduction velocity increased with increasing stimulation current in 72% of the experiments, indicating a recruitment order similar to that of voluntary contractions, although it decreased in the other 28% of the cases, indicating a reverse order of recruitment. Contrary to what is observed in direct stimulation of nerves, motor units are not in general recruited in reverse order of size during electrical stimulation of a muscle motor point. This discrepancy may be the result of geometric factors or a lack of correlation between axonal branch diameter and the diameter of the parent motoneuron axon. Changes of conduction velocity and spectral parameters in opposite directions may be the result of the combined effect of the motor unit recruitment order and of the different tissue filtering function associated with the geometric location of the recruited motor units within the muscle.

Myoelectric manifestations of fatigue in voluntary and electrically elicited contractions.

The time course of muscle fiber conduction velocity and surface myoelectric signal spectral (mean and median frequency of the power spectrum) and amplitude (average rectified and root-mean-square value) parameters was studied in 20 experiments on the tibialis anterior muscle of 10 healthy human subjects during sustained isometric voluntary or electrically elicited contractions. Voluntary contractions at 20% maximal voluntary contraction (MVC) and at 80% MVC with duration of 20 s were performed at the beginning of each experiment. Tetanic electrical stimulation was then applied to the main muscle motor point for 20 s with surface electrodes at five stimulation frequencies (20, 25, 30, 35, and 40 Hz). All subjects showed myoelectric manifestations of muscle fatigue consisting of negative trends of spectral variables and conduction velocity and positive trends of amplitude variables. The main findings of this work are 1) myoelectric signal variables obtained from electrically elicited contractions show fluctuations smaller than those observed in voluntary contractions, 2) spectral variables are more sensitive to fatigue than conduction velocity and the average rectified value is more sensitive to fatigue than the root-mean-square value, 3) conduction velocity is not the only physiological factor affecting spectral variables, and 4) contractions elicited at supramaximal stimulation and frequencies greater than 30 Hz demonstrate myoelectric manifestations of muscle fatigue greater than those observed at 80% MVC sustained for the same time.

Electrically evoked myoelectric signals in back muscles: effect of side dominance.

This work had two goals, to study the effect of hand dominance on myoelectric signal variables and fatigue indexes in back muscles and to assess the repeatability of the estimates of such variables. Myoelectric manifestations of muscle fatigue were studied in the right and left longissimus dorsi muscles of five right-handed and five left-handed normal male subjects. Myoelectric signals (M waves), evoked by stimulation applied to a muscle's motor point, were detected with surface electrodes. Each test consisted of eliciting a tetanic contraction of 30 s duration with supramaximal stimulation at 25 Hz and was repeated five times on 5 different days for each subject. The mean and median frequencies of the resulting power spectra of the M waves were plotted vs. time, and fatigue indexes were obtained from the time course of these variables. Only two-thirds of the elicited contractions provided signals of sufficiently good quality to obtain reliable estimates of the mean and median frequencies. Criteria for acceptability are described. Analysis of variance and paired comparisons showed a statistically significant effect of side dominance on fatigue indexes in the right-handed subjects but not in the left-handed subjects. Normalized initial slope and other fatigue indexes based on spectral variables demonstrated myoelectric manifestations of fatigue that were greater on the dominant side. We surmise that the differences are related to the fiber type modifications associated with the unilateral usage of the upper limbs and the consequent activation of the nondominant side of the back.

Myoelectric manifestations of sternocleidomastoid and anterior scalene muscle fatigue in chronic neck pain patients.

OBJECTIVE: This study compares myoelectric manifestations of fatigue of the sternocleidomastoid (SCM) and anterior scalene (AS) muscles between 10 chronic neck pain subjects and 10 normal matched controls. METHODS: Surface electromyography (sEMG) signals were recorded from the sternal head of SCM and AS muscles bilaterally during sub-maximal isometric cervical flexion contractions at 25 and 50% of the maximum voluntary contraction (MVC). The mean frequency, average rectified value and conduction velocity of the sEMG signal were calculated to quantify myoelectric manifestations of muscle fatigue. RESULTS: For both the SCM and AS muscles, the Mann-Whitney U test indicated that the initial value and slope of the mean frequency in neck pain patients were greater than in healthy subjects (P < 0.05). This was significant both at 25 and 50% of MVC. CONCLUSIONS: These results suggest: (a) a predominance of type-II fibres in the neck pain patients and/or (b) greater fatigability of the superficial cervical flexors in neck pain patients. These results are in agreement with previous muscle biopsy studies in subjects with neck pain, which identified transformation of slow-twitch type-1 fibres to fast-twitch type-IIB fibres, as well as the clinical observation of reduced endurance in the cervical flexors in neck pain patients.

Location of innervation zones of sternocleidomastoid and scalene muscles--a basis for clinical and research electromyography applications.

OBJECTIVES: Advances in surface electromyography (sEMG) techniques provide a clear indication that refinement of electrode location relative to innervation zones (IZ) is required in order to optimise the accuracy, relevance and repeatability of the sEMG signals. The aim of this study was to identify the IZ for the sternocleidomastoid and anterior scalene muscles to provide guidelines for electrode positioning for future clinical and research applications. METHODS: Eleven volunteer subjects participated in this study. Myoelectric signals were detected from the sternal and clavicular heads of the sternocleidomastoid and the anterior scalene muscles bilaterally using a linear array of 8 electrodes during isometric cervical flexion contractions. The signals were reviewed and the IZ(s) were identified, marked on the subjects' skin and measurements were obtained relative to selected anatomical landmarks. RESULTS: The position of the IZ lay consistently around the mid-point or in the superior portion of the muscles studied. CONCLUSIONS: Results suggest that electrodes should be positioned over the lower portion of the muscle and not the mid-point, which has been commonly used in previous studies. Recommendations for sensor placement on these muscles should assist investigators and clinicians to ensure improved validity in future sEMG applications.

Electrically evoked myoelectric signals.

Electrical stimulation of the nervous system is attracting increasing attention because of the possibilities it offers for physiological investigations, clinical diagnosis, muscle function assessment, noninvasive muscle characterization, and functional control of paralyzed extremities. Parameters of the myoelectric signal evoked by surface stimulation of a muscle motor point or by stimulation of a nerve trunk by means of implanted electrodes provide information about muscle performance and properties if the stimulation artifact is properly removed or suppressed. Comparison of these parameters with those obtained during voluntary contractions provides additional insight into muscle physiology. The relationships between myoelectric signal amplitude parameters, spectral parameters, and conduction velocity are discussed with special reference to muscle fatigue. This review focuses on a few methodological aspects concerning electrical stimulation of the peripheral nervous system, detection, and processing of the electrically evoked myoelectric signals in skeletal muscles. The state of the art of the following issues is discussed: (1) properties of voluntary and electrically evoked myoelectric signals; (2) techniques for evoking and detecting myoelectric signals; (3) techniques for suppression of stimulation artifacts; (4) effect of stimulation waveforms and electrode properties; (5) signal processing techniques for electrically evoked myoelectric signals; (6) physiological significance of myoelectric signal variables; (7) order of recruitment of motor units during electrical stimulation; (8) myoelectric manifestations of fatigue in electrically stimulated muscles; (9) assessment of crosstalk by electrical stimulation; and (10) applications in sport, rehabilitation, and geriatric medicine.

A novel approach for precise simulation of the EMG signal detected by surface electrodes.

We propose a new electromyogram generation and detection model. The volume conductor is described as a nonhomogeneous (layered) and anisotropic medium constituted by muscle, fat and skin tissues. The surface potential detected in space domain is obtained from the application of a two-dimensional spatial filter to the input current density source. The effects of electrode configuration, electrode size and inclination of the fibers with respect to the detection system are included in the transfer function of the filter. Computation of the signal in space domain is performed by applying the Radon transform; this permits to draw considerations about spectral dips and clear misunderstandings in previous theoretical derivations. The effects of generation and extinction of the action potentials at the fiber end plate and at the tendons are included by modeling the source current, without any approximation of its shape, as a function of space and time and by using again the Radon transform. The approach, based on the separation of the temporal and spatial properties of the muscle fiber action potential and of the volume conductor, includes the capacitive tissue properties.

A model for the generation of synthetic intramuscular EMG signals to test decomposition algorithms.

As more and more intramuscular electromyogram (EMG) decomposition programs are being developed, there is a growing need for evaluating and comparing their performances. One way to achieve this goal is to generate synthetic EMG signals having known features. Features of interest are: the number of channels acquired (number of detection surfaces), the number of detected motor unit action potential (MUAP) trains, their time-varying firing rates, the degree of shape similarity among MUAPs belonging to the same motor unit (MU) or to different MUs, the degree of MUAP superposition, the MU activation intervals, the amount and type of additive noise. A model is proposed to generate one or more channels of intramuscular EMG starting from a library of real MUAPs represented in a 16-dimensional space using their Associated Hermite expansion. The MUAP shapes, regularity of repetition rate, degree of superposition, activation intervals, etc. may be time variable and are described quantitatively by a number of parameters which define a stochastic process (the model) with known statistical features. The desired amount of noise may be added to the synthetic signal which may then be processed by the decomposition algorithm under test to evaluate its capability of recovering the signal features.