Neuromuscular impairment at different stages of human sarcopenia.

BACKGROUND: Degeneration of the motoneuron and neuromuscular junction (NMJ) and loss of motor units (MUs) contribute to age-related muscle wasting and weakness associated with sarcopenia. However, these features have not been comprehensively investigated in humans. This study aimed to compare neuromuscular system integrity and function at different stages of sarcopenia, with a particular focus on NMJ stability and MU properties. METHODS: We recruited 42 young individuals (Y) (aged 25.98 ± 4.6 years; 57% females) and 88 older individuals (aged 75.9 ± 4.7 years; 55% females). The older group underwent a sarcopenia screening according to the revised guidelines of the European Working Group on Sarcopenia in Older People 2. In all groups, knee extensor muscle force was evaluated by isometric dynamometry, muscle morphology by ultrasound and MU potential properties by intramuscular electromyography (iEMG). MU number estimate (iMUNE) and blood samples were obtained. Muscle biopsies were collected in a subgroup of 16 Y and 52 older participants. RESULTS: Thirty-nine older individuals were non-sarcopenic (NS), 31 pre-sarcopenic (PS) and 18 sarcopenic (S). A gradual decrease in quadriceps force, cross-sectional area and appendicular lean mass was observed across the different stages of sarcopenia (for all P < 0.0001). Handgrip force and the Short Physical Performance Battery score also showed a diminishing trend. iEMG analyses revealed elevated near fibre segment jitter in NS, PS and S compared with Y (Y vs. NS and S: P < 0.0001; Y vs. PS: P = 0.0169), suggestive of age-related impaired NMJ transmission. Increased C-terminal agrin fragment (P < 0.0001) and altered caveolin 3 protein expression were consistent with age-related NMJ instability in all the older groups. The iMUNE was lower in all older groups (P < 0.0001), confirming age-related loss of MUs. An age-related increase in MU potential complexity was also observed. These observations were accompanied by increased muscle denervation and axonal damage, evinced by the increase in neural cell adhesion molecule-positive fibres (Y vs. NS: P < 0.0001; Y vs. S: P = 0.02) and the increase in serum concentration of neurofilament light chain (P < 0.0001), respectively. Notably, most of these MU and NMJ parameters did not differ when comparing older individuals with or without sarcopenia. CONCLUSIONS: Alterations in MU properties, axonal damage, an altered innervation profile and NMJ instability are prominent features of the ageing of the neuromuscular system. These neuromuscular alterations are accompanied by muscle wasting and weakness; however, they appear to precede clinically diagnosed sarcopenia, as they are already detectable in older NS individuals.

Sex disparities of human neuromuscular decline in older humans.

Females typically live longer than males but, paradoxically, spend a greater number of later years in poorer health. The neuromuscular system is a critical component of the progression to frailty, and motor unit (MU) characteristics differ by sex in healthy young individuals and may adapt to ageing in a sex-specific manner due to divergent hormonal profiles. The purpose of this study was to investigate sex differences in vastus lateralis (VL) MU structure and function in early to late elderly humans. Intramuscular electromyography signals from 50 healthy older adults (M/F: 26/24) were collected from VL during standardized submaximal contractions and decomposed to quantify MU characteristics. Muscle size and neuromuscular performance were also measured. Females had higher MU firing rate (FR) than males (P = 0.025), with no difference in MU structure or neuromuscular junction transmission (NMJ) instability. All MU characteristics increased from low- to mid-level contractions (P < 0.05) without sex × level interactions. Females had smaller cross-sectional area of VL, lower strength and poorer force steadiness (P < 0.05). From early to late elderly, both sexes showed decreased neuromuscular function (P < 0.05) without sex-specific patterns. Higher VL MUFRs at normalized contraction levels previously observed in young are also apparent in old individuals, with no sex-based difference of estimates of MU structure or NMJ transmission instability. From early to late elderly, the deterioration of neuromuscular function and MU characteristics did not differ between sexes, yet function was consistently greater in males. These parallel trajectories underscore the lower initial level for older females and may offer insights into identifying critical intervention periods. KEY POINTS: Females generally exhibit an extended lifespan when compared to males, yet this is accompanied by a poorer healthspan and higher rates of frailty. In healthy young people, motor unit firing rate (MUFR) at normalized contraction intensities is widely reported to be higher in females than in age-matched males. Here we show in 50 people that older females have higher MUFR than older males with little difference in other MU parameters. The trajectory of decline from early to late elderly does not differ between sexes, yet function is consistently lower in females. These findings highlight distinguishable sex disparities in some MU characteristics and neuromuscular function, and suggest early interventions are needed for females to prevent functional deterioration to reduce the ageing health-sex paradox.

Influence of nitrate supplementation on motor unit activity during recovery following a sustained ischemic contraction in recreationally active young males.

PURPOSE: Dietary nitrate (NO3-) supplementation enhances muscle blood flow and metabolic efficiency in hypoxia, however, its efficacy on neuromuscular function and specifically, the effect on motor unit (MU) activity is less clear. We investigated whether NO3- supplementation affected MU activity following a 3 min sustained ischemic contraction and whether this is influenced by blood flow restriction (BFR) during the recovery period. METHOD: In a randomized, double-blinded, cross-over design, 14 males (mean ± SD, 25 ± 6 years) completed two trials following 5 days of supplementation with NO3--rich (NIT) or NO3--depleted (PLA) beetroot juice to modify plasma nitrite (NO2-) concentration (482 ± 92 vs. 198 ± 48 nmol·L-1, p < 0.001). Intramuscular electromyography was used to assess MU potential (MUP) size (duration and area) and mean firing rates (MUFR) during a 3 min submaximal (25% MVC) isometric contraction with BFR. These variables were also assessed during a 90 s recovery period with the first half completed with, and the second half completed without, BFR. RESULTS: The change in MUP area and MUFR, did not differ between conditions (all p > 0.05), but NIT elicited a reduction in MUP recovery time during brief isometric contractions (p < 0.001), and during recoveries with (p = 0.002) and without (p = 0.012) BFR. CONCLUSION: These novel observations improve understanding of the effects of NO3- on the recovery of neuromuscular function post-exercise and might have implications for recovery of muscle contractile function. TRIAL REGISTRATION: The study was registered on clinicaltrials.gov with ID of NCT05993715 on August 08, 2023.

Menstrual Cycle Associated Alteration of Vastus Lateralis Motor Unit Function.

BACKGROUND: Estrogen and progesterone are the primary female sex hormones and have net excitatory and inhibitory effects, respectively, on neuronal function. Fluctuating concentrations across the menstrual cycle has led to several lines of research in relation to neuromuscular function and performance; however evidence from animal and cell culture models has yet to be demonstrated in human motor units coupled with quantification of circulating hormones. Intramuscular electromyography was used to record motor unit potentials and corresponding motor unit potential trains from the vastus lateralis of nine eumenorrheic females during the early follicular, ovulation and mid luteal phases of the menstrual cycle, alongside assessments of neuromuscular performance. Multi-level regression models were applied to explore effects of time and of contraction level. Statistical significance was accepted as p < 0.05. RESULTS: Knee extensor maximum voluntary contraction, jump power, force steadiness, and balance did not differ across the menstrual phases (all p > 0.4). Firing rate of low threshold motor units (10% maximum voluntary contraction) was lower during the ovulation and mid luteal phases (ß = - 0.82 Hz, p < 0.001), with no difference in motor unit potentials analysed from 25% maximum voluntary contraction contractions. Motor unit potentials were more complex during ovulation and mid luteal phase (p < 0.03), with no change in neuromuscular junction transmission instability (p > 0.3). CONCLUSIONS: Assessments of neuromuscular performance did not differ across the menstrual cycle. The suppression of low threshold motor unit firing rate during periods of increased progesterone may suggest a potential inhibitory effect and an alteration of recruitment strategy; however this had no discernible effect on performance. These findings highlight contraction level-dependent modulation of vastus lateralis motor unit function over the eumenorrheic cycle, occurring independently of measures of performance.

Acute adaptation of central and peripheral motor unit features to exercise-induced fatigue differs with concentric and eccentric loading.

NEW FINDINGS: What is the central question of this study? Conflicting evidence exists on motor unit (MU) firing rate in response to exercise-induced fatigue, possibly due to the contraction modality used: Do MU properties adapt similarly following concentric and eccentric loading? What is the main finding and its importance? MU firing rate increased following eccentric loading only despite a decline in absolute force. Force steadiness deteriorated following both loading methods. Central and peripheral MU features are altered in a contraction type-dependant manner, which is an important consideration for training interventions. ABSTRACT: Force output of muscle is partly mediated by the adjustment of motor unit (MU) firing rate (FR). Disparities in MU features in response to fatigue may be influenced by contraction type, as concentric (CON) and eccentric (ECC) contractions demand variable amounts of neural input, which alters the response to fatigue. This study aimed to determine the effects of fatigue following CON and ECC loading on MU features of the vastus lateralis (VL). High-density surface (HD-sEMG) and intramuscular (iEMG) electromyography were used to record MU potentials (MUPs) from bilateral VLs of 12 young volunteers (six females) during sustained isometric contractions at 25% and 40% of the maximum voluntary contraction (MVC), before and after completing CON and ECC weighted stepping exercise. Multi-level mixed effects linear regression models were performed with significance assumed as P < 0.05. MVC decreased in both CON and ECC legs post-exercise (P < 0.0001), as did force steadiness at both 25% and 40% MVC (P < 0.004). MU FR increased in ECC at both contraction levels (P < 0.001) but did not change in CON. FR variability increased in both legs at 25% and 40% MVC following fatigue (P < 0.01). From iEMG measures at 25% MVC, MUP shape did not change (P > 0.1) but neuromuscular junction transmission instability increased in both legs (P < 0.04), and markers of fibre membrane excitability increased following CON only (P = 0.018). These data demonstrate that central and peripheral MU features are altered following exercise-induced fatigue and differ according to exercise modality. This is important when considering interventional strategies targeting MU function.

Automatic jitter measurement in needle-detected motor unit potential trains.

In an active motor unit (MU), the time intervals between the firings of its muscle fibers vary across successive MU activations. This variability is called jitter and is increased in pathological processes that affect the neuromuscular junctions or terminal axonal segments of MUs. Traditionally, jitter has been measured using single fiber electrodes (SFEs) and a difficult and subjective manual technique. SFEs are expensive and reused, implying a potential risk of patient infection; so, they are being gradually substituted by safer, disposable, concentric needle electrodes (CNEs). As CNEs are larger, voltage contributions from individual fibers of a MU are more difficult to detect, making jitter measurement more difficult. This paper presents an automatic method to estimate jitter from trains of motor unit potentials (MUPs), for both SFE and CNE records. For a MUP train, segments of MUPs generated by single muscle fibers (SF MUP segments) are found and jitter is measured between pairs of these segments. Segments whose estimated jitter values are not reliable, according to several SF MUP segment characteristics, are excluded. The method has been tested in several simulation studies that use mathematical models of muscle fiber potentials. The results are very satisfactory in terms of jitter estimation error (less than 10% in most of the cases studied) and mean number of valid jitter estimates obtained per simulated train (greater than 1.0 in many of the cases and less than 0.5 only in the most complicated). A preliminary study with real signals was also performed, using 19 MUP trains from 3 neuropathic patients. Jitter measurements obtained by the automatic method were compared with those extracted from a commercial system (Keypoint) and the edition and supervision of an expert electromyographer. From these measurements 63% were taken from equivalent interval pair sites within the time span of the MUP trains and, as such, were considered as compatible measurements. Differences in jitter of these compatible measurements were very low (mean value of 1.3 µs, mean of absolute differences of 2.97 µs, 25% and 75% percentile intervals of -0.85 and 3.82 µs, respectively). Although new tests with larger number of real recordings are still required, the method seems promising for clinical practice.

Motor unit dysregulation following 15 days of unilateral lower limb immobilisation.

Disuse atrophy, caused by situations of unloading such as limb immobilisation, causes a rapid yet diverging reduction in skeletal muscle function when compared to muscle mass. While mechanistic insight into the loss of mass is well studied, deterioration of muscle function with a focus towards the neural input to muscle remains underexplored. This study aimed to determine the role of motor unit adaptation in disuse-induced neuromuscular deficits. Ten young, healthy male volunteers underwent 15 days of unilateral lower limb immobilisation with intramuscular electromyography (iEMG) bilaterally recorded from the vastus lateralis (VL) during knee extensor contractions normalised to maximal voluntary contraction (MVC), pre and post disuse. Muscle cross-sectional area was determined by ultrasound. Individual MUs were sampled and analysed for changes in motor unit (MU) discharge and MU potential (MUP) characteristics. VL CSA was reduced by approximately 15% which was exceeded by a two-fold decrease of 31% in muscle strength in the immobilised limb, with no change in either parameter in the non-immobilised limb. Parameters of MUP size were reduced by 11% to 24% with immobilisation, while neuromuscular junction (NMJ) transmission instability remained unchanged, and MU firing rate decreased by 8% to 11% at several contraction levels. All adaptations were observed in the immobilised limb only. These findings highlight impaired neural input following immobilisation reflected by suppressed MU firing rate which may underpin the disproportionate reductions of strength relative to muscle size. KEY POINTS: Muscle mass and function decline rapidly in situations of disuse such as bed rest and limb immobilisation. The reduction in muscle function commonly exceeds that of muscle mass, which may be associated with the dysregulation of neural input to muscle. We have used intramuscular electromyography to sample individual motor unit and near fibre potentials from the vastus lateralis following 15 days of unilateral limb immobilisation. Following disuse, the disproportionate loss of muscle strength when compared to size coincided with suppressed motor unit firing rate. These motor unit adaptations were observed at multiple contraction levels and in the immobilised limb only. Our findings demonstrate neural dysregulation as a key component of functional loss following muscle disuse in humans.

Effects of short-term unloading and active recovery on human motor unit properties, neuromuscular junction transmission and transcriptomic profile.

Electrophysiological alterations of the neuromuscular junction (NMJ) and motor unit potential (MUP) with unloading are poorly studied. We aimed to investigate these aspects and the underlying molecular mechanisms with short-term unloading and active recovery (AR). Eleven healthy males underwent a 10-day unilateral lower limb suspension (ULLS) period, followed by 21-day AR based on resistance exercise. Quadriceps femoris (QF) cross-sectional area (CSA) and isometric maximum voluntary contraction (MVC) were evaluated. Intramuscular electromyographic recordings were obtained during 10% and 25% MVC isometric contractions from the vastus lateralis (VL). Biomarkers of NMJ molecular instability (serum c-terminal agrin fragment, CAF), axonal damage (neurofilament light chain) and denervation status were assessed from blood samples and VL biopsies. NMJ and ion channel transcriptomic profiles were investigated by RNA-sequencing. QF CSA and MVC decreased with ULLS. Increased CAF and altered NMJ transcriptome with unloading suggested the emergence of NMJ molecular instability, which was not associated with impaired NMJ transmission stability. Instead, increased MUP complexity and decreased motor unit firing rates were found after ULLS. Downregulation of ion channel gene expression was found together with increased neurofilament light chain concentration and partial denervation. The AR period restored most of these neuromuscular alterations. In conclusion, the human NMJ is destabilized at the molecular level but shows functional resilience to a 10-day unloading period at least at relatively low contraction intensities. However, MUP properties are altered by ULLS, possibly due to alterations in ion channel dynamics and initial axonal damage and denervation. These changes are fully reversed by 21 days of AR. KEY POINTS: We used integrative electrophysiological and molecular approaches to comprehensively investigate changes in neuromuscular integrity and function after a 10-day unilateral lower limb suspension (ULLS), followed by 21 days of active recovery in young healthy men, with a particular focus on neuromuscular junction (NMJ) and motor unit potential (MUP) properties alterations. After 10-day ULLS, we found significant NMJ molecular alterations in the absence of NMJ transmission stability impairment. These findings suggest that the human NMJ is functionally resilient against insults and stresses induced by short-term disuse at least at relatively low contraction intensities, at which low-threshold, slow-type motor units are recruited. Intramuscular electromyography analysis revealed that unloading caused increased MUP complexity and decreased motor unit firing rates, and these alterations could be related to the observed changes in skeletal muscle ion channel pool and initial and partial signs of fibre denervation and axonal damage. The active recovery period restored these neuromuscular changes.

Training-induced improvements in knee extensor force accuracy are associated with reduced vastus lateralis motor unit firing variability.

NEW FINDINGS: What is the central question of this study? Can bilateral knee extensor force accuracy be improved following 4 weeks of unilateral force accuracy training and are there any subsequent alterations to central and/or peripheral motor unit features? What is the main finding and its importance? In the trained limb only, knee extensor force tracking accuracy improved with reduced motor unit firing rate variability in the vastus lateralis, and there was no change to neuromuscular junction transmission instability. Interventional strategies to improve force accuracy may be directed to older/clinical populations where such improvements may aid performance of daily living activities. ABSTRACT: Muscle force output during sustained submaximal isometric contractions fluctuates around an average value and is partly influenced by variation in motor unit (MU) firing rates. MU firing rate (FR) variability seemingly reduces following exercise training interventions; however, much less is known with respect to peripheral MU properties. We therefore investigated whether targeted force accuracy training could lead to improved muscle functional capacity and control, in addition to determining any alterations of individual MU features. Ten healthy participants (seven females, three males, 27 ± 6 years, 170 ± 8 cm, 69 ± 16 kg) underwent a 4-week supervised, unilateral knee extensor force accuracy training intervention. The coefficient of variation for force (FORCECoV ) and sinusoidal wave force tracking accuracy (FORCESinu ) were determined at 25% maximal voluntary contraction (MVC) pre- and post-training. Intramuscular electromyography was utilised to record individual MU potentials from the vastus lateralis (VL) muscles at 25% MVC during sustained contractions, pre- and post-training. Knee extensor muscle strength remained unchanged following training, with no improvements in unilateral leg-balance. FORCECoV and FORCESinu significantly improved in only the trained knee extensors by ∼13% (P = 0.01) and ∼30% (P < 0.0001), respectively. MU FR variability significantly reduced in the trained VL by ∼16% (n = 8; P = 0.001), with no further alterations to MU FR or neuromuscular junction transmission instability. Our results suggest muscle force control and tracking accuracy is a trainable characteristic in the knee extensors, which is likely explained by the reduction in MU FR variability which was apparent in the trained limb only.

Neuromuscular recruitment strategies of the vastus lateralis according to sex.

AIM: Despite males typically exhibiting greater muscle strength and fatigability than females, it remains unclear if there are sex-based differences in neuromuscular recruitment strategies e.g. recruitment and modulation of motor unit firing rate (MU FR) at normalized forces and during progressive increases in force. METHODS: The study includes 29 healthy male and 31 healthy female participants (18-35 years). Intramuscular electromyography (iEMG) was used to record individual motor unit potentials (MUPs) and near-fibre MUPs from the vastus lateralis (VL) during 10% and 25% maximum isometric voluntary contractions (MVC), and spike-triggered averaging was used to obtain motor unit number estimates (MUNE) of the VL. RESULTS: Males exhibited greater muscle strength (P < .001) and size (P < .001) than females, with no difference in force steadiness at 10% or 25% MVC. Females had 8.4% and 6.5% higher FR at 10% and 25% MVC, respectively (both P < .03), while the MUP area was 33% smaller in females at 10% MVC (P < .02) and 26% smaller at 25% MVC (P = .062). However, both sexes showed similar increases in MU size and FR when moving from low- to mid-level contractions. There were no sex differences in any near-fibre MUP parameters or in MUNE. CONCLUSION: In the vastus lateralis, females produce muscle force via different neuromuscular recruitment strategies to males which is characterized by smaller MUs discharging at higher rates. However, similar strategies are employed to increase force production from low- to mid-level contractions. These findings of similar proportional increases between sexes support the use of mixed sex cohorts in studies of this nature.

Lifelong exercise is associated with more homogeneous motor unit potential features across deep and superficial areas of vastus lateralis.

Motor unit (MU) expansion enables rescue of denervated muscle fibres helping to ameliorate age-related muscle atrophy, with evidence to suggest master athletes are more successful at this remodelling. Electrophysiological data has suggested MUs located superficially are larger than those located deeper within young muscle. However, the effects of ageing and exercise on MU heterogeneity across deep and superficial aspects of vastus lateralis (VL) remain unclear. Intramuscular electromyography was used to record individual MU potentials (MUPs) and near fibre MUPs (NFMs) from deep and superficial regions of the VL during 25% maximum voluntary contractions, in 83 males (15 young (Y), 17 young athletes (YA), 22 old (O) and 29 master athletes (MA)). MUP size and complexity were assessed using area and number of turns, respectively. Multilevel mixed effects linear regression models were performed to investigate the effects of depth in each group. MUP area was greater in deep compared with superficial MUs in Y (p<0.001) and O (p=0.012) but not in YA (p=0.071) or MA (p=0.653). MUP amplitude and NF MUP area were greater, and MUPs were more complex in deep MUPs from Y, YA and O (all p<0.05) but did not differ across depth in MA (all p>0.07). These data suggest MU characteristics differ according to depth within the VL which may be influenced by both ageing and exercise. A more homogenous distribution of MUP size and complexity across muscle depths in older athletes may be a result of a greater degree of age-related MU adaptations.

Near-fiber electromyography.

OBJECTIVE: Describe and evaluate the concepts of near fiber electromyography (NFEMG), the features used, including near fiber motor unit potential (NFMUP) duration and dispersion, which relate to motor unit distal axonal branch and muscle fiber conduction time dispersion, and NFMUP segment jitter, a new measure of the temporal variability of neuromuscular junction transmission (NMJ), and axonal branch and muscle fibre conduction for the near fibres (i.e. NF jitter), and the methods for obtaining their values. METHODS: Trains of high-pass filtered motor unit potentials (MUPs) (i.e. NFMUP trains) were extracted from needle-detected EMG signals to assess changes in motor unit (MU) morphology and electrophysiology caused by neuromuscular disorders or ageing. Evaluations using simulated needle-detected EMG data were completed and example human data are presented. RESULTS: NFEMG feature values can be used to detect axonal sprouting, conduction slowing and NMJ transmission delay as well as changes in MU fiber diameter variability, and NF jitter. These changes can be detected prior to alterations of MU size or numbers. CONCLUSIONS: The evaluations clearly demonstrate and the example data support that NFMUP duration and dispersion reflect MU distal axonal branching, conduction slowing and NMJ transmission delay and/or MU fiber diameter variability and that NFMUP jiggle and segment jitter reflect NF jitter. SIGNIFICANCE: NFEMG can detect early changes in MU morphology and/or electrophysiology and has the potential to augment clinical diagnosis and tracking of neuromuscular disorders.

Influence of sex on the age-related adaptations of neuromuscular function and motor unit properties in elite masters athletes.

KEY POINTS: Masters athletes maintain high levels of activity into older age and allow an examination of the effects of aging dissociated from the effects of increased sedentary behaviour. Evidence suggests masters athletes are more successful at motor unit remodelling, the reinnervation of denervated fibres acting to preserve muscle fibre number, but little data are available in females. Here we used intramuscular electromyography to demonstrate that motor units sampled from the tibialis anterior show indications of remodelling from middle into older age and which does not differ between males and females. The age-related trajectory of motor unit discharge characteristic differs according to sex, with female athletes progressing to a slower firing pattern that was not observed in males. Our findings indicate motor unit remodelling from middle to older age occurs to a similar extent in male and female athletes, with discharge rates progressively slowing in females only. ABSTRACT: Motor unit (MU) remodelling acts to minimise loss of muscle fibres following denervation in older age, which may be more successful in masters athletes. Evidence suggests performance and neuromuscular function decline with age in this population, although the majority of studies have focused on males, with little available data on female athletes. Functional assessments of strength, balance and motor control were performed in 30 masters athletes (16 male) aged 44-83 years. Intramuscular needle electrodes were used to sample individual motor unit potentials (MUPs) and near-fibre MUPs in the tibialis anterior (TA) during isometric contractions at 25% maximum voluntary contraction, and used to determine discharge characteristics (firing rate, variability) and biomarkers of peripheral MU remodelling (MUP size, complexity, stability). Multilevel mixed-effects linear regression models examined effects of age and sex. All aspects of neuromuscular function deteriorated with age (P < 0.05) with no age × sex interactions, although males were stronger (P < 0.001). Indicators of MU remodelling also progressively increased with age to a similar extent in both sexes (P < 0.05), whilst MU firing rate progressively decreased with age in females (p = 0.029), with a non-significant increase in males (p = 0.092). Masters athletes exhibit age-related declines in neuromuscular function that are largely equal across males and females. Notably, they also display features of MU remodelling with advancing age, probably acting to reduce muscle fibre loss. The age trajectory of MU firing rate assessed at a single contraction level differed between sexes, which may reflect a greater tendency for females to develop a slower muscle phenotype.

Transparent Electrophysiological Muscle Classification From EMG Signals Using Fuzzy-Based Multiple Instance Learning.

Although a well-established body of literature has examined electrophysiological muscle classification methods and systems, ways to enhance their transparency is still an important challenge and requires further study. In this work, a transparent semi-supervised electrophysiological muscle classification system which uses needle-detected EMG signals to classify muscles as normal, myopathic, or neurogenic is proposed. The electrophysiological muscle classification (EMC) problem is naturally formulated using multiple instance learning (MIL) and needs an adaptation of standard supervised classifiers for the purpose of training and evaluating bags of instances. Here, a novel MIL-based EMC system in which the muscle classifier uses predictions based on motor unit potentials (MUPs) to infer muscle labels is described. This system uses morphological, stability, near fiber and spectral MUP features. Quantitative results obtained from applying the proposed transparent system to four electrophysiologically different groups of muscles, composed of proximal and distal hand and leg muscles, resulted in an average classification accuracy of 95.85%. The findings show the superior and stable performance of the proposed EMC system compared to previous works using other supervised, semi-supervised and unsupervised methods.

A method for editing motor unit potential trains obtained by decomposition of surface electromyographic signals.

Rather than discarding motor unit potential trains (MUPTs) because they do not meet 100% validity criteria, we describe and evaluate a novel editing routine that preserves valid discharge times, based on decreasing shape variability (variance ratio, VR) within a MUPT. The error filtered estimation (EFE) algorithm is then applied to the remaining 'high confidence' discharge times to estimate inter-discharge interval (IDI) statistics. Decomposed surface EMG data from the flexor carpi radialis recorded from 20 participants during 60% MVC wrist flexion was used. There were two levels of denoising criteria (relaxed and strict) criteria for removing MUPs to decrease the VR and increase the signal-to-noise ratio (SNR) of a MUPT. In total, VR decreased 24.88% and SNR increased 6.0% (p's < 0.05). The MUP template peak-to-peak (P-P) amplitude and P-P duration were dependent on the level of denoising (p's < 0.05). The standard error of the estimate (SEE) of the mean IDI before and after editing using the relaxed criteria (3.2% versus 3.69%), was very similar (p > 0.05). The same was true for the SEE between denoising criteria, which increased only to 5.14% for the strict criteria (p > 0.05). Editing the MUPTs resulted in a significant decrease in MUP shape variability and in the measures extracted from the MUP templates, with trivial differences between the SEE of the mean IDI between the edited and unedited MUPTs.

Average proportional consecutive interval difference accurately differentiates spontaneous activity from motor unit potentials.

INTRODUCTION: An objective method is required to detect spontaneous activity (SA) for prevalence studies in needle electromyography (EMG). Because of frequent similarities in the morphology of SA and motor unit potentials (MUP), identification of SA depends on assessment of firing regularity, which has not yet been quantitated through a modern interface. METHODS: Prospective recordings obtained from patients referred for electrodiagnostic evaluation were analyzed by using decomposition-based quantitative EMG (DQEMG) customized to calculate descriptive statistics. RESULTS: Forty-four MUP recordings (39 participants) and 80 SA recordings (62 participants) were analyzed. One hundred one of 124 recordings successfully interfaced with DQEMG. The remaining recordings were analyzed in Audacity. Average proportional consecutive interval differences differentiated SA from MUPs with 97.5% sensitivity (confidence interval [CI] 91.3%-99.7%) and 100.0% specificity (CI 92%-100%). There was substantial overlap, however, for SD and mean consecutive differences. DISCUSSION: Average proportional consecutive interval difference accurately differentiates SA from MUPs and may be useful in future prevalence studies of SA.

Human motor unit characteristics of the superior trapezius muscle with age-related comparisons.

Current understanding of human motor unit (MU) control and aging is mostly derived from hand and limb muscles that have spinal motor neuron innervations. The aim here was to characterize and test whether a muscle with a shared innervation supply from brainstem and spinal MU populations would demonstrate similar age-related adaptations as those reported for other muscles. In humans, the superior trapezius (ST) muscle acts to elevate and stabilize the scapula and has primary efferent supply from the spinal accessory nerve (cranial nerve XI) located in the brainstem. We compared electrophysiological properties obtained from intramuscular and surface recordings between 10 young (22-33 yr) and 10 old (77-88 yr) men at a range of voluntary isometric contraction intensities (from 15 to 100% of maximal efforts). The old group was 41% weaker with 43% lower MU discharge frequencies compared with the young (47.2 ± 9.6 Hz young and 26.7 ± 5.8 Hz old, P < 0.05) during maximal efforts. There was no difference in MU number estimation between age groups (228 ± 105 young and 209 ± 89 old, P = 0.33). Furthermore, there were no differences in needle detected near fiber (NF) stability parameters of jitter or jiggle. The old group had lower amplitude and smaller area of the stimulated compound muscle action potential and smaller NF MU potential area with higher NF counts. Thus, despite age-related ST weakness and lower MU discharge rates, there was minimal evidence of MU loss or compensatory reinnervation.NEW & NOTEWORTHY The human superior trapezius (ST) has shared spinal and brainstem motor neuron innervation providing a unique model to explore the impact of aging on motor unit (MU) properties. Although the ST showed higher MU discharge rates compared with most spinally innervated muscles, voluntary strength and mean MU rates were lower in old compared with young at all contraction intensities. There was no age-related difference in MU number estimates with minimal electrophysiological evidence of collateral reinnervation.

Frailty phenotype and frailty index are associated with distinct neuromuscular electrophysiological characteristics in men.

NEW FINDINGS: What is the central question of this study? Human frailty is characterized by accumulated health complaints, including medical conditions, low physical and psychological function and social components. It is currently unknown whether the condition is associated with neuromuscular changes detectable by electrophysiology obtained from voluntary and involuntary muscle contractions. What is the main finding and its importance? A higher likelihood of frailty was significantly associated with a smaller size of vastus lateralis motor unit potentials during voluntary contractions and smaller compound muscle action potentials generated by electrical stimulation. Importantly, these associations were independent of age and body mass index. ABSTRACT: The purpose of this study was to determine whether neuromuscular electrophysiological characteristics that are known to underlie sarcopenia are also associated with the more complex frailty syndrome. Eighty-six men [mean (SD) age, 74 (8) years] were classed as non-frail (robust), prefrail or frail using criteria from the frailty phenotype (FP) and the frailty index (FI). The femoral nerve was stimulated maximally and the resulting compound muscle action potential amplitude (CMAP) measured over the vastus lateralis. Motor unit potential (MUP) size was assessed during voluntary contractions using intramuscular electromyography (iEMG). Logistic and negative binomial regression models determined relationships between FP and FI with CMAP and MUP sizes before and after adjustments for age and body mass index. Larger CMAP size was associated with a lower likelihood of frailty in fully adjusted models: a 1SD higher level in vastus lateralis CMAP size was associated with a 0.4 (95% confidence interval: 0.2, 0.6; P < 0.01) unit lower FI (40% of the FI range) and more than halving of the odds [odds ratio: 0.43 (95% confidence interval: 0.21, 0.90)] of having a frail/prefrail phenotype. Greater MUP size was also related to lower FI values using unadjusted and fully adjusted models. However, MUP size was not significantly related to FP in any model. Smaller MUPs and a smaller CMAP were significantly associated with a higher likelihood of frailty, independent of age and body mass index. These results relate neuromuscular electrophysiological characteristics to the complex frailty syndrome and identify motor unit remodelling as a possible contributing factor.

Improved MUP Template Estimation Using Local Time Warping and Kernel Weighted Averaging.

A motor unit potential (MUP) template, which represents the shapes of the MUPs within a MUP train, provides information related to the morphology and physiology of the sampled motor unit. This work presents an improved MUP template estimation technique that uses local time warping and kernel weighted ensemble averaging. An analysis of the algorithm, and a description of the improvements compared with spike triggered averaging is given. MUP template estimates were evaluated using simulated EMG signals with a known gold standard template for each motor unit potential train. Statistically significant reduction in template estimation error is shown, both within the baseline and duration portions of a MUP.