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1.
J Speech Lang Hear Res ; 63(10): 3293-3310, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-32910735

RESUMO

Purpose Surface electromyography (sEMG) is often used for biofeedback during swallowing rehabilitation. However, commercially available sEMG electrodes are not optimized for the head and neck area, have rigid form, and are mostly available in large medical centers. We developed an ultrathin, soft, and flexible sEMG patch, specifically designed to conform to the submental anatomy and which will be ultimately incorporated into a telehealth system. To validate this first-generation sEMG patch, we compared its safety, efficiency, and signal quality in monitoring submental muscle activity with that of widely used conventional sEMG electrodes. Method A randomized crossover design was used to compare the experimental sEMG patch with conventional (snap-on) sEMG electrodes. Participants completed the same experimental protocol with both electrodes in counterbalanced order. Swallow trials included five trials of 5- and 10-ml water. Comparisons were made on (a) signal-related factors: signal-to-noise ratio (SNR), baseline amplitude, normalized mean amplitude, and sEMG burst duration and (b) safety/preclinical factors: safety/adverse effects, efficiency of electrode placement, and satisfaction/comfort. Noninferiority and equivalence tests were used to examine signal-related factors. Paired t tests and descriptive statistics were used to examine safety/preclinical factors. Results Forty healthy adults participated (24 women, M age = 67.5 years). Signal-related factors: SNR of the experimental patch was not inferior to the SNR of the conventional electrodes (p < .0056). Similarly, baseline amplitude obtained with the experimental patch was not inferior to that obtained with conventional electrodes (p < .0001). Finally, normalized amplitude values were equivalent across swallows (5 ml: p < .025; 10 ml: p < .0012), and sEMG burst duration was also equivalent (5 ml: p < .0001; 10 ml: p < .0001). Safety/preclinical factors: The experimental patch resulted in fewer mild adverse effects. Participant satisfaction was higher with the experimental patch (p = .0476, d = 0.226). Conclusions Our new wearable sEMG patch is equivalent with widely used conventional sEMG electrodes in terms of technical performance. In addition, our patch is safe, and healthy older adults are satisfied with it. With lessons learned from the current COVID-19 pandemic, efforts to develop optimal swallowing telerehabilitation devices are more urgent than ever. Upon further validation, this new technology has the potential to improve rehabilitation and telerehabilitation efforts for patients with dysphagia. Supplemental Material https://doi.org/10.23641/asha.12915509.


Assuntos
Transtornos de Deglutição/reabilitação , Eletrodos , Eletromiografia/instrumentação , Telerreabilitação/instrumentação , Dispositivos Eletrônicos Vestíveis , Idoso , Betacoronavirus , Infecções por Coronavirus , Estudos Cross-Over , Deglutição/fisiologia , Eletromiografia/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral
2.
Nat Commun ; 11(1): 4683, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943621

RESUMO

Wearable dry electrodes are needed for long-term biopotential recordings but are limited by their imperfect compliance with the skin, especially during body movements and sweat secretions, resulting in high interfacial impedance and motion artifacts. Herein, we report an intrinsically conductive polymer dry electrode with excellent self-adhesiveness, stretchability, and conductivity. It shows much lower skin-contact impedance and noise in static and dynamic measurement than the current dry electrodes and standard gel electrodes, enabling to acquire high-quality electrocardiogram (ECG), electromyogram (EMG) and electroencephalogram (EEG) signals in various conditions such as dry and wet skin and during body movement. Hence, this dry electrode can be used for long-term healthcare monitoring in complex daily conditions. We further investigated the capabilities of this electrode in a clinical setting and realized its ability to detect the arrhythmia features of atrial fibrillation accurately, and quantify muscle activity during deep tendon reflex testing and contraction against resistance.


Assuntos
Condutividade Elétrica , Epiderme , Monitorização Fisiológica/instrumentação , Movimento (Física) , Pele , Artefatos , Impedância Elétrica , Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Eletrodos , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Eletromiografia/instrumentação , Eletromiografia/métodos , Desenho de Equipamento , Humanos , Monitorização Fisiológica/métodos , Polímeros/química , Sorbitol
3.
Sci Rep ; 10(1): 8192, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32424300

RESUMO

The aim was to determine the effects of changing pulse duration and electrode size on muscle contractile properties. Thirty-six healthy young male participated in the study (age 24.8 ± 5.8 years; height 178.2 ± 0.6 cm; body mass 71.8 ± 7.3 kg; self-reported weekly moderate intensity activity 3.5 ± 1.2 h·week-1). Tensiomyography was used to assess rectus femoris (RF) and vastus medialis (VM) muscles neuromuscular properties of the dominant leg according to the electrode size (3.2-5 cm) and the stimulus length (0.2, 0.5, and 1 ms). Maximal radial displacement (Dm); Contraction time (Tc); Delay time (Td); Sustained time (Ts) and Half relaxation time (Tr) were measured. Relative and absolute reliability was quantified. To analyze the effects of the electrode and the stimulus length, a repeated-measures analysis of variance was used. Dm and Tc parameters showed for both muscles an excellent relative (0.95-0.99) and absolute reliability (1.6-4.2%). However, Ts and Tr showed low values of absolute reliability (4.4-40.9%). The duration of the stimulus length applied to the RF and VM and electrode size significantly influences muscle's contractile properties (p < 0.05; η2p = 0.09-0.60). The Dm increases substantially as the duration of the stimulus increases and with the use of the larger electrode in both muscles. However, Tc and Td are less affected by both conditions and not entirely clear. Practically, our study suggests that a stimulus pulse duration of 1 ms together with a 5 × 5 cm electrode is necessary to reach a reliable and reproducible assessment of both RF and VM muscles contractile properties.


Assuntos
Eletromiografia/instrumentação , Fenômenos Mecânicos , Contração Muscular , Adulto , Fenômenos Biomecânicos , Eletrodos , Humanos , Masculino , Músculo Quadríceps/fisiologia , Fatores de Tempo
4.
J Vis Exp ; (158)2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32391811

RESUMO

Electromyography (EMG) measures the muscle response to electrical stimulation or spontaneous activity of motor units and plays an important role in assessing neuromuscular function. Chronic recording of EMG activity reflecting a muscle's reinnervation status after nerve injury has been limited, due to the invasive nature of traditional EMG recording techniques. In this regard, an implantable system is designed for long-term, in vivo EMG recording and nerve stimulation. It has been applied and tested in a study on reinnervation of laryngeal muscles. This system consists of 1) two bipolar electrode nerve cuffs and leads for stimulating each of two nerves: the recurrent laryngeal nerve (RLN) and internal branch of the superior laryngeal nerve (SLN); 2) two EMG recording electrodes and leads for each of the two laryngeal muscles: posterior cricoarytenoid (PCA) muscle and thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex; and 3) a skin receptacle interfacing all implanted lead terminals to an external recording preamplifier and stimulator using a connection cable. The wire leads are Teflon-coated, multi-filament, type 316 stainless steel. They are coiled and can stretch during body movement of the awake animal to prevent lead breakage and electrode migration. This system is implanted during an aseptic surgery. Afterwards, baseline EMG recordings are performed before the RLN is transected in the second surgery to study muscle reinnervation. Throughout the study, multiple physiological sessions are conducted in the anesthetized animal to obtain evoked and spontaneous EMG activity that reflects the reinnervation status of laryngeal muscles. The system is compact, free of infection over the course of the study, and highly durable. This implantable system can provide a reliable platform for research in which long-term recording or nerve stimulation is required in an anesthetized or freely moving animal.


Assuntos
Eletromiografia/métodos , Monitoração Neuromuscular/métodos , Próteses e Implantes , Animais , Estimulação Elétrica , Eletrodos Implantados , Eletromiografia/instrumentação , Músculos Laríngeos/inervação , Músculos Laríngeos/fisiologia , Monitoração Neuromuscular/instrumentação , Nervo Laríngeo Recorrente/fisiologia
5.
J Electromyogr Kinesiol ; 53: 102427, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32470865

RESUMO

Because of its superficial location, surface electrodes are commonly used to record lower trapezius activity. Recent evidence, however, would suggest that surface electromyography is not a valid to record activity from other superficially placed shoulder muscles. Therefore, the aim of this study was to determine the validity of using surface electrodes to record lower trapezius activity. Ten asymptomatic subjects performed ramped isometric (0-100% maximum load) and dynamic (70% maximum load) shoulder tasks. Intramuscular electrodes were inserted into lower trapezius and rhomboid major. Surface electrodes were placed over lower trapezius around the intramuscular electrodes. Differences in the recorded activity of lower trapezius between surface and intramuscular electrodes were tested using a 2 factor repeated measures analysis of variance with factors: test and electrode type. Similarity in the recorded activity patterns between the two electrodes was tested using Pearson's correlation coefficient (r). Results indicated that there was no difference in lower trapezius activity levels (p = 0.98) or activation patterns (r ≥ 0.74) recorded by the intramuscular and surface electrodes. The results of this study indicate that any potential crosstalk contamination in the surface electrode signal is having little influence on the recorded activity from lower trapezius and therefore, support the common practice of surface electromyography to investigate lower trapezius function.


Assuntos
Eletromiografia/métodos , Desempenho Psicomotor/fisiologia , Ombro/fisiologia , Músculos Superficiais do Dorso/fisiologia , Adulto , Eletrodos , Eletromiografia/instrumentação , Feminino , Humanos , Contração Isométrica/fisiologia , Masculino , Adulto Jovem
6.
Muscle Nerve ; 61(6): 754-758, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32246723

RESUMO

BACKGROUND: Ultrasound was used to determine optimal needle insertion parameters and assess the vasculature of paraspinal muscles at C5-T1 spinal levels across patients with different body mass indices (BMIs). METHODS: Thirty patients underwent ultrasound examination of the cervical paraspinal muscles at the C5-T1 levels. Images were analyzed to determine the optimal distance and angle of needle insertion to reach the base of the right lamina. Color and spectral Doppler analysis were used to identify and map paraspinal blood vessels. RESULTS: Mean distances and angles varied from 35.1 mm and 17.27 degrees for the low BMI group at C5 to 65.1 mm and 9.85 degrees for the high BMI group at T1. Paraspinal blood vessel mapping revealed a random distribution of vasculature. CONCLUSIONS: Longer distances and steeper angles of needle insertion are required for patients with higher BMIs. Cervical paraspinal arteries vary in distribution and can be visualized with ultrasound.


Assuntos
Eletromiografia/métodos , Agulhas , Músculos Paraespinais/diagnóstico por imagem , Músculos Paraespinais/fisiologia , Ultrassonografia de Intervenção/métodos , Adulto , Vértebras Cervicais/diagnóstico por imagem , Eletromiografia/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
7.
Proc Natl Acad Sci U S A ; 117(14): 8135-8142, 2020 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-32205442

RESUMO

Many studies have demonstrated covariation between muscle activations during behavior, suggesting that muscles are not controlled independently. According to one common proposal, this covariation reflects simplification of task performance by the nervous system so that muscles with similar contributions to task variables are controlled together. Alternatively, this covariation might reflect regulation of low-level aspects of movements that are common across tasks, such as stresses within joints. We examined these issues by analyzing covariation patterns in quadriceps muscle activity during locomotion in rats. The three monoarticular quadriceps muscles (vastus medialis [VM], vastus lateralis [VL], and vastus intermedius [VI]) produce knee extension and so have identical contributions to task performance; the biarticular rectus femoris (RF) produces an additional hip flexion. Consistent with the proposal that muscle covariation is related to similarity of muscle actions on task variables, we found that the covariation between VM and VL was stronger than their covariations with RF. However, covariation between VM and VL was also stronger than their covariations with VI. Since all vastii have identical actions on task variables, this finding suggests that covariation between muscle activity is not solely driven by simplification of overt task performance. Instead, the preferentially strong covariation between VM and VL is consistent with the control of internal joint stresses: Since VM and VL produce opposing mediolateral forces on the patella, the high positive correlation between their activation minimizes the net mediolateral patellar force. These results provide important insights into the interpretation of muscle covariations and their role in movement control.


Assuntos
Contração Isométrica/fisiologia , Articulações/fisiologia , Modelos Neurológicos , Movimento/fisiologia , Músculo Quadríceps/inervação , Animais , Fenômenos Biomecânicos , Eletrodos Implantados , Eletromiografia/instrumentação , Feminino , Membro Posterior/inervação , Membro Posterior/fisiologia , Modelos Lineares , Músculo Quadríceps/fisiologia , Ratos
8.
J Vis Exp ; (156)2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32150167

RESUMO

Although conventional nerve conduction studies (NCS) and electromyography (EMG) are suitable for the diagnosis of neuromuscular disorders, they provide limited information about muscle fiber membrane properties and underlying disease mechanisms. Muscle velocity recovery cycles (MVRCs) illustrate how the velocity of a muscle action potential depends on the time after a preceding action potential. MVRCs are closely related to changes in membrane potential that follow an action potential, thereby providing information about muscle fiber membrane properties. MVRCs may be recorded quickly and easily by direct stimulation and recording from multi-fiber bundles in vivo. MVRCs have been helpful in understanding disease mechanisms in several neuromuscular disorders. Studies in patients with channelopathies have demonstrated the different effects of specific ion channel mutations on muscle excitability. MVRCs have been previously tested in patients with neurogenic muscles. In this prior study, muscle relative refraction period (MRRP) was prolonged, and early supernormality (ESN) and late supernormality (LSN) were reduced in patients compared to healthy controls. Thereby, MVRCs can provide in vivo evidence of membrane depolarization in intact human muscle fibers that underlie their reduced excitability. The protocol presented here describes how to record MVRCs and analyze the recordings. MVRCs can serve as a fast, simple, and useful method for revealing disease mechanisms across a broad range of neuromuscular disorders.


Assuntos
Potenciais de Ação , Eletromiografia/instrumentação , Potenciais da Membrana , Contração Muscular , Fibras Musculares Esqueléticas/fisiologia , Músculo Esquelético/fisiologia , Recuperação de Função Fisiológica , Humanos
9.
Clin Neurophysiol ; 131(1): 160-166, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794957

RESUMO

OBJECTIVE: When the compound muscle action potential (CMAP) is recorded in motor nerve conduction studies, the reference (E2) electrode can make a significant contribution to the CMAP. This study investigates the E2 recorded signal and its effect on CMAP measurements when E2 electrode is placed at different sites. METHODS: The CMAP was recorded using the active electrode on the muscle belly and 4 different E2 electrodes placed at distal and proximal sites. The signal recorded by each electrode was also measured using a reference electrode on the contralateral limb. Signals were recorded from the abductor pollicis brevis, abductor digiti minimi, tibialis anterior and biceps muscles. RESULTS: The E2 recorded a smaller signal when it was placed near or off the proximal tendon or muscle origin. This affected CMAP latency, duration for tibialis anterior. Contrary to expectation, initial upward deflection was noted for E2 signal. CONCLUSION: A proximal E2 position records a lower volume conducted signal and yields a CMAP that is more representative of the muscle over which the E1 (active) electrode is placed. SIGNIFICANCE: The proposed 'Proximal E2' montage may be better suited to assess pathology.


Assuntos
Potenciais de Ação/fisiologia , Eletrodos , Neurônios Motores/fisiologia , Músculo Esquelético/fisiologia , Condução Nervosa/fisiologia , Adulto , Idoso , Eletrodos/normas , Eletromiografia/instrumentação , Eletromiografia/métodos , Feminino , Humanos , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Músculo Esquelético/anatomia & histologia , Nervo Musculocutâneo/fisiologia , Nervo Fibular/fisiologia , Estatísticas não Paramétricas , Tendões/fisiologia , Nervo Ulnar/fisiologia
10.
Clin Neurophysiol ; 131(1): 243-258, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31761717

RESUMO

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on "Standards of Instrumentation of EMG" is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged. The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.


Assuntos
Amplificadores Eletrônicos , Computadores , Consenso , Eletrodos , Eletromiografia/instrumentação , Software , Potenciais de Ação , Artefatos , Comunicação , Bases de Dados como Assunto , Estimulação Elétrica/instrumentação , Eletroencefalografia , Eletromiografia/métodos , Eletromiografia/normas , Desenho de Equipamento , Ergonomia/métodos , Potenciais Somatossensoriais Evocados/fisiologia , Filtração/instrumentação , Humanos , Agulhas , Condução Nervosa , Segurança , Células Receptoras Sensoriais/fisiologia , Razão Sinal-Ruído
11.
Clin Neurophysiol ; 131(1): 265-273, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31740273

RESUMO

OBJECTIVES: Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). The Surface Potential Quantification Engine (SPiQE) is a novel analytical tool to identify fasciculation potentials from high-density surface electromyography (HDSEMG). This method was accurate on relaxed recordings amidst fluctuating noise levels. To avoid time-consuming manual exclusion of voluntary muscle activity, we developed a method capable of rapidly excluding voluntary potentials and integrating with the established SPiQE pipeline. METHODS: Six ALS patients, one patient with benign fasciculation syndrome and one patient with multifocal motor neuropathy underwent monthly thirty-minute HDSEMG from biceps and gastrocnemius. In MATLAB, we developed and compared the performance of four Active Voluntary IDentification (AVID) strategies, producing a decision aid for optimal selection. RESULTS: Assessment of 601 one-minute recordings permitted the development of sensitive, specific and screening strategies to exclude voluntary potentials. Exclusion times (0.2-13.1 minutes), processing times (10.7-49.5 seconds) and fasciculation frequencies (27.4-71.1 per minute) for 165 thirty-minute recordings were compared. The overall median fasciculation frequency was 40.5 per minute (10.6-79.4 IQR). CONCLUSION: We hereby introduce AVID as a flexible, targeted approach to exclude voluntary muscle activity from HDSEMG recordings. SIGNIFICANCE: Longitudinal quantification of fasciculations in ALS could provide unique insight into motor neuron health.


Assuntos
Esclerose Amiotrófica Lateral/fisiopatologia , Eletromiografia/métodos , Fasciculação/fisiopatologia , Músculo Esquelético/fisiologia , Idoso , Técnicas de Apoio para a Decisão , Progressão da Doença , Eletrodos , Eletromiografia/instrumentação , Fasciculação/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polineuropatias/fisiopatologia , Sensibilidade e Especificidade , Fatores de Tempo
12.
Med Biol Eng Comput ; 58(1): 101-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31754980

RESUMO

Taking advantage of motion sensing technology, a quantitative assessment method for lower limbs motor function of cerebral palsy (CP) based on the gross motor function measurement (GMFM)-24 scale was explored in this study. According to the motion analysis on GMFM-24 scale, we translated the assessment problem of GMFM-24 scale into a detection problem of different motion modes including static state, fall, step, turning, alternating gait, walking, running, lifting legs, kicking balls, and jumping. The surface electromyography (sEMG) electrodes and inertial sensors were adopted to capture motion data, and a framework integrating a series of detection algorithms was presented for the assessment of lower limbs gross motor function. Two groups of participants including 8 healthy adults and 14 CP children were recruited. A self-developed data acquisition equipment integrating 24 sEMG electrodes and 9 inertial units was adopted for data acquisition. A platform based on two laser beam sensors was used to perform cross-border detection. The parameters/thresholds of motion detection algorithms were determined by the data from healthy adults, and the lower limbs gross motor function evaluation was conducted on 14 CP children. The experimental results verified the feasibility and effectiveness of the proposed quantitative assessment method. Compared to the clinical assessment score based on GMFM-24 scale, 90.1% accuracy was obtained for evaluation of 303 tasks in 14 CP children. The objective motor function assessment method proposed has potential application value for the quantitative assessment of lower limbs motor function of CP children in clinical practice. Graphical abstract The algorithm framework for the assessment of lower limbs gross motor function. Using the GMFM-24 scale as the evaluation standard, a quantitative evaluation program for the lower limbs gross motor function of CP children based on motion sensing technology was proposed.


Assuntos
Paralisia Cerebral/fisiopatologia , Eletromiografia/instrumentação , Extremidade Inferior/fisiopatologia , Atividade Motora/fisiologia , Algoritmos , Criança , Feminino , Marcha/fisiologia , Humanos , Masculino , Adulto Jovem
13.
Clin Neurophysiol ; 131(1): 259-264, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31506234

RESUMO

OBJECTIVES: Fasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas). METHODS: Thirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort. RESULTS: The mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ±â€¯0.25 mV and 3.21 ±â€¯0.88, respectively) than in those with both FP and MUS-fas (1.22 ±â€¯0.92 mV and 3.74 ±â€¯1.39, respectively; p < 0.0001 and p = 0.017, Welch's t-test). CONCLUSION: Small FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS. SIGNIFICANCE: Clinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico por imagem , Fasciculação/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/fisiopatologia , Análise de Variância , Eletromiografia/instrumentação , Eletromiografia/métodos , Fasciculação/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/fisiopatologia , Agulhas , Estudos Prospectivos , Avaliação de Sintomas/métodos , Ultrassonografia/métodos
14.
Otolaryngol Clin North Am ; 53(1): 145-156, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31648825

RESUMO

Electrical stimulation of the recurrent laryngeal nerve is a safe and promising therapeutic approach with the potentiality to overcome the shortcomings of conventional surgical glottal enlargement. Although aberrant or synkinetic reinnervation is commonly considered an unfavorable condition, particularly for recovery of vocal fold movement, its presence is essential to ensure the effective clinical performance of laryngeal pacemakers. Thus, the effective selection of patients who can profit from laryngeal pacemakers implantation demands the implementation of new diagnostic tools based on tests capable of reliably detecting the presence of viable reinnervation on at least one vocal fold.


Assuntos
Neuroestimuladores Implantáveis , Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/terapia , Prega Vocal/fisiopatologia , Animais , Terapia por Estimulação Elétrica/instrumentação , Eletromiografia/instrumentação , Humanos , Músculos Laríngeos/fisiopatologia , Implantação de Prótese , Resultado do Tratamento
15.
Muscle Nerve ; 61(3): 280-287, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31674675

RESUMO

INTRODUCTION: The purpose of this position statement is to clarify what constitutes an acceptable nerve conduction study (NCS) waveform in the practice of electrodiagnostic (EDx) medicine. METHODS: The American Association of Neuromuscular & Electrodiagnostic Medicine convened an expert panel to analyze the typical deficiencies of NCS waveforms seen when performed by unqualified providers and/or providers using substandard equipment and also to describe basic standards that all proper NCS waveforms should meet. RESULTS: An acceptable NCS waveform should include clearly identifiable polarity, configuration, onset, peak(s), and return to baseline. DISCUSSION: Only NCSs performed using appropriate EDx equipment and interpreted by trained physicians can accurately measure the speed of nerve conduction and amplitude of the nerve response. If these parameters cannot be clearly identified, then the waveform should be considered substandard and should not be submitted for reimbursement according to the Current Procedural Terminology guidelines of the American Medical Association.


Assuntos
Potenciais de Ação , Eletromiografia/normas , Condução Nervosa , Eletromiografia/instrumentação , Eletromiografia/métodos , Humanos , Processamento de Sinais Assistido por Computador
16.
IEEE Trans Neural Syst Rehabil Eng ; 28(1): 267-276, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675333

RESUMO

As surface electromyogram (sEMG) signals have the ability to detect human movement intention, they are commonly used to be control inputs. However, gait sub-phase classification typically requires monotonous manual labeling process, and commercial sEMG acquisition devices are quite bulky and expensive, thus current sEMG-based gait sub-phase recognition systems are complex and have poor portability. This study presents a low-cost but effective end-to-end sEMG-based gait sub-phase recognition system, which contains a wireless multi-channel signal acquisition device simultaneously collecting sEMG of thigh muscles and plantar pressure signals, and a novel neural network-based sEMG signal classifier combining long-short term memory (LSTM) with multilayer perceptron (MLP). We evaluated the system with subjects walking under five conditions: flat terrain at 5 km/h, flat terrain at 3 km/h, 20 kg backpack at 5 km/h, 20 kg shoulder bag at 5 km/h and 15° slope at 5 km/h. Experimental results show that the proposed method achieved average classification accuracies of 94.10%, 87.25%, 90.71%, 94.02%, and 87.87%, respectively, which were significantly higher than existing recognition methods. Additionally, the proposed system had a good real-time performance with low average inference time in the range of 3.25 ~ 3.31 ms.


Assuntos
Eletromiografia/instrumentação , Marcha/fisiologia , Adulto , Algoritmos , Fenômenos Biomecânicos , Custos e Análise de Custo , Eletromiografia/economia , Eletromiografia/métodos , Desenho de Equipamento , Pé/fisiologia , Humanos , Locomoção/fisiologia , Masculino , Músculo Esquelético/fisiologia , Redes Neurais de Computação , Pressão , Reprodutibilidade dos Testes , Coxa da Perna/fisiologia
17.
Surg Endosc ; 34(2): 996-1005, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31218426

RESUMO

OBJECTIVES/HYPOTHESIS: Intraoperative neuromonitoring (IONM) is a useful adjunct for recurrent laryngeal nerve (RLN) mapping and identification in transoral endoscopic thyroidectomy vestibular approach (TOETVA). This experimental study aimed to investigate the feasibility, safety, thresholds required of an endoscopic forceps that combine the function of surgical dissection and nerve stimulation. STUDY DESIGN: Prospective experimental research. METHODS: TOETVA was performed in 12 piglets, i.e., 24 RLNs and 24 vagal nerves (VN). RLNs electromyography (EMG) was recorded via endotracheal surface electrodes. Baseline EMG of VN and RLN were recorded and compared by (a) percutaneously placed monopolar stimulator probe (Group I), (b) adapted Maryland endoscopic dissector applied on nerves at its tip-end (Group II) and (c) endoscopic dissector tip-lateral applied (Group III). EMG profiles, amplitude, latency, waveform, thresholds and supra-maximal stimulation (5 mA) were analyzed. RESULTS: Application of the endoscopic device was feasible in all TOETVA and did not result in any morbidity. 24 RLNs and VNs were detected, stimulated and monitored. With increase of stimulation current, the amplitude of EMG increased, showing a dose-response curve. Mean VN stimulation thresholds were: Group I 0.28 mA, Group II 0.56 mA, Group III 0.58 mA (P1 = 0.00, P2 = 0.00, P3 = 0.11). Minimal current to evoked a maximal VN response was: Group I 0.65 mA, Group II 1.07 mA and Group III 1.14 mA (P1 = 0.00, P2 = 0.00, P3 = 0.48). Minimal current to evoke a RLN maximal response was Group I 0.6 mA, Group II 0.95 mA and Group III 1.05 mA (P1 = 0.00, P2 = 0.00, P3 = 0.31). Latency values were similar to each group. Repetitive (> 10 min) supra-maximal (> 5 mA) electrical stimulation was safe. CONCLUSIONS: The application of endoscopic stimulating dissector is simple, effective and safe way to monitor both VN and RLN function during a TOETVA animal model. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for RLN monitoring. Endoscopic instrument required higher current to evoke EMG response compared to hand probe stimulation. Tip-end required less current to evoke EMG response compared to tip-lateral mode of stimulation.


Assuntos
Dissecação/instrumentação , Eletromiografia/instrumentação , Complicações Intraoperatórias/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/instrumentação , Cirurgia Endoscópica por Orifício Natural/instrumentação , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Tireoidectomia/instrumentação , Animais , Dissecação/métodos , Estimulação Elétrica/instrumentação , Estimulação Elétrica/métodos , Eletromiografia/métodos , Estudos de Viabilidade , Monitorização Neurofisiológica Intraoperatória/métodos , Masculino , Cirurgia Endoscópica por Orifício Natural/métodos , Estudo de Prova de Conceito , Estudos Prospectivos , Nervo Laríngeo Recorrente/fisiologia , Suínos , Tireoidectomia/métodos , Nervo Vago/fisiologia
18.
Anaesthesia ; 75(2): 187-195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31617199

RESUMO

The extent of neuromuscular blockade during anaesthesia is frequently measured using a train-of-four stimulus. Various monitors have been used to quantify the train-of-four, including mechanomyography, acceleromyography and electromyography. Mechanomyography is often considered to be the laboratory gold standard of measurement, but is not commercially available and has rarely been used in clinical practice. Acceleromyography is currently the most commonly used monitor in the clinical setting, whereas electromyography is not widely available. We compared a prototype electromyograph with a newly constructed mechanomyograph and a commercially available acceleromyograph monitor in 43 anesthetised patients. The mean difference (bias; 95% limits of agreement) in train-of-four ratios was 4.7 (-25.2 to 34.6) for mechanomyography vs. electromyography; 14.9 (-13.0 to 42.8) for acceleromyography vs. electromyography; and 9.8 (-31.8 to 51.3) for acceleromyography vs. mechanomyography. The mean difference (95% limits of agreement) in train-of-four ratios between opposite arms when using electromyography was -0.7 (-20.7 to 19.3). There were significantly more acceleromyography train-of-four values > 1.0 (23%) compared with electromyography or mechanomography (2-4%; p < 0.0001). Electromyography most closely resembled mechanomyographic assessment of neuromuscular blockade, whereas acceleromyography frequently produced train-of-four ratio values > 1.0, complicating the interpretation of acceleromyography results in the clinical setting.


Assuntos
Miografia/instrumentação , Miografia/métodos , Bloqueio Neuromuscular , Adulto , Idoso , Eletromiografia/instrumentação , Eletromiografia/métodos , Feminino , Humanos , Cinetocardiografia/instrumentação , Cinetocardiografia/métodos , Masculino , Pessoa de Meia-Idade , Miografia/estatística & dados numéricos , Reprodutibilidade dos Testes
19.
BMC Med Inform Decis Mak ; 19(Suppl 7): 275, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31865898

RESUMO

BACKGROUND: Internet of things is fast becoming the norm in everyday life, and integrating the Internet into medical treatment, which is increasing day by day, is of high utility to both clinical doctors and patients. While there are a number of different health-related problems encountered in daily life, muscle fatigue is a common problem encountered by many. METHODS: To facilitate muscle fatigue detection, a pulse width modulation (PWM) and ESP8266-based fatigue detection and recovery system is introduced in this paper to help alleviate muscle fatigue. The ESP8266 is employed as the main controller and communicator, and PWM technology is employed to achieve adaptive muscle recovery. Muscle fatigue can be detected by surface electromyography signals and monitored in real-time via a wireless network. RESULTS: With the help of the proposed system, human muscle fatigue status can be monitored in real-time, and the recovery vibration motor status can be optimized according to muscle activity state. DISCUSSION: Environmental factors had little effect on the response time and accuracy of the system, and the response time was stable between 1 and 2 s. As indicated by the consistent change of digital value, muscle fatigue was clearly diminished using this system. CONCLUSIONS: Experiments show that environmental factors have little effect on the response time and accuracy of the system. The response time is stably between 1 and 2 s, and, as indicated by the consistent change of digital value, our systems clearly diminishes muscle fatigue. Additionally, the experimental results show that the proposed system requires minimal power and is both sensitive and stable.


Assuntos
Eletromiografia/instrumentação , Internet das Coisas , Fadiga Muscular , Adolescente , Adulto , Eletromiografia/métodos , Humanos , Masculino , Monitorização Fisiológica , Adulto Jovem
20.
Rev. neurol. (Ed. impr.) ; 69(11): 435-441, 1 dic., 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187111

RESUMO

Introducción: Las ganglionopatías o neuronopatías sensoriales son enfermedades subagudas adquiridas del ganglio raquídeo dorsal, frecuentemente asociadas con trastornos disinmunes y paraneoplásicos, y agentes tóxicos. Los pacientes presentan alteración sensorial de distribución asimétrica y ataxia temprana. La identificación temprana es esencial, ya que pueden anunciar una neoplasia subyacente o una enfermedad autoinmune. Objetivo. Estudiar las asimetrías del potencial de acción nervioso sensitivo (SNAP) de pares de nervios y la relación de amplitud del potencial de acción sensitivomotor del nervio cubital (USMAR) con estudios electroneurofisiológicos seriados para el diagnóstico precoz de las ganglionopatías sensoriales. Pacientes y métodos: Se estudió retrospectivamente a siete pacientes con ganglionopatías sensoriales con estudios electroneurofisiológicos: cuatro casos paraneoplásicos con positividad para anticuerpos onconeuronales, uno asociado al síndrome de Sjögren y dos idiopáticos. Resultados: Los estudios electroneurofisiológicos mostraron afectación sensorial axonal en todos los casos, con asimetría mayor del 50% en la amplitud de SNAP en dos pares de nervios en cuatro casos y motor normal con USMAR < 0,71 en cinco casos. Los estudios electroneurofisiológicos seriados fueron esenciales en el diagnóstico de dos casos en el inicio de la enfermedad con síntomas sensoriales leves. Conclusiones: Este trabajo evidencia la importancia del estudio de asimetrías en la amplitud del SNAP de pares de nervios, la USMAR y los estudios electroneurofisiológicos seriados en el diagnóstico temprano de ganglionopatías sensoriales, para la consiguiente identificación de los anticuerpos disinmunes y onconeuronales con afectación del sistema nervioso periférico y la búsqueda de neoplasia oculta


Introduction: Sensory ganglionopathies or sensory neuronopathies are subacute acquired diseases of the dorsal root ganglion, frequently associated with disinmune, paraneoplastic and toxic agents. Patients present sensory alteration of asymmetric distribution and early ataxia. Early identification is essential, as they may announce an underlying neoplasia or autoimmune disease. Aim: To study asymmetries of the sensory nervous action potential (SNAP) of nerve pairs and the relationship amplitude of ulnar sensory/ulnar motor potential (USMAR) with serial electroneurophysiological studies for the early diagnosis of sensory ganglionopathies. Patients and methods: Six patients with sensory ganglionopathies were retrospectively studied with electroneurophysiological studies: four paraneoplastic cases with positivity for onconeuronal antibodies, one associated with Sjögren’s syndrome and two idiopathic. Results: Electroneurophysiological studies showed axonal sensory involvement in all cases, with asymmetry > 50% in SNAP amplitude in two pairs of nerves in four cases and normal motor with USMAR < 0.71 in five cases. Serial electroneurophysiological studies were essential in the diagnosis of two cases in the beginning of the disease with mild sensory symptoms. Conclusions: This work evidences the importance of the study of asymmetries in the amplitude of the SNAP of nerve pairs, the USMAR and the serial electroneurophysiological studies in the early diagnosis of sensory ganglionopathies, to further identification of the disinmune and onconeuronal associated antibodies with the nervous system affection to search for hidden neoplasia


Assuntos
Humanos , Polineuropatia Paraneoplásica/diagnóstico , Diagnóstico Precoce , Doenças do Sistema Nervoso/patologia , Polineuropatia Paraneoplásica/fisiopatologia , Estudos Retrospectivos , Eletrofisiologia/métodos , Diagnóstico Diferencial , Eletromiografia/instrumentação
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