Applications of EMG in Clinical and Sports Medicine

This second of two volumes on EMG (Electromyography) covers a wide range of clinical applications, as a complement to the methods discussed in volume 1. Topics range from gait and vibration analysis, through posture and falls prevention, to biofeedback in the treatment of neurologic swallowing impairment. The volume includes sections on back care, sports and performance medicine, gynecology/urology and orofacial function. Authors describe the procedures for their experimental studies with detailed and clear illustrations and references to the literature. The limitations of SEMG measures and methods for careful analysis are discussed. This broad compilation of articles discussing the use of EMG in both clinical and research applications demonstrates the utility of the method as a tool in a wide variety of disciplines and clinical fields

Preparation and execution of teeth clenching and foot muscle contraction influence on corticospinal hand-muscle excitability

Contraction of a muscle modulates not only the corticospinal excitability (CSE) of the contracting muscle but also that of different muscles. We investigated to what extent the CSE of a hand muscle is modulated during preparation and execution of teeth clenching and ipsilateral foot dorsiflexion either separately or in combination. Hand-muscle CSE was estimated based on motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) and recorded from the first dorsal interosseous (FDI) muscle. We found higher excitability during both preparation and execution of all the motor tasks than during mere observation of a fixation cross. As expected, the excitability was greater during the execution phase than the preparation one. Furthermore, both execution and preparation of combined motor tasks led to higher excitability than individual tasks. These results extend our current understanding of the neural interactions underlying simultaneous contraction of muscles in different body parts.Peer reviewe

Biosignal‐based human–machine interfaces for assistance and rehabilitation : a survey

As a definition, Human–Machine Interface (HMI) enables a person to interact with a device. Starting from elementary equipment, the recent development of novel techniques and unobtrusive devices for biosignals monitoring paved the way for a new class of HMIs, which take such biosignals as inputs to control various applications. The current survey aims to review the large literature of the last two decades regarding biosignal‐based HMIs for assistance and rehabilitation to outline state‐of‐the‐art and identify emerging technologies and potential future research trends. PubMed and other databases were surveyed by using specific keywords. The found studies were further screened in three levels (title, abstract, full‐text), and eventually, 144 journal papers and 37 conference papers were included. Four macrocategories were considered to classify the different biosignals used for HMI control: biopotential, muscle mechanical motion, body motion, and their combinations (hybrid systems). The HMIs were also classified according to their target application by considering six categories: prosthetic control, robotic control, virtual reality control, gesture recognition, communication, and smart environment control. An ever‐growing number of publications has been observed over the last years. Most of the studies (about 67%) pertain to the assistive field, while 20% relate to rehabilitation and 13% to assistance and rehabilitation. A moderate increase can be observed in studies focusing on robotic control, prosthetic control, and gesture recognition in the last decade. In contrast, studies on the other targets experienced only a small increase. Biopotentials are no longer the leading control signals, and the use of muscle mechanical motion signals has experienced a considerable rise, especially in prosthetic control. Hybrid technologies are promising, as they could lead to higher performances. However, they also increase HMIs’ complex-ity, so their usefulness should be carefully evaluated for the specific application

Scalp Eeg and Tms Based Electrophysiological Study of Brain Function of Motor Control in Aging

Voluntary movements of human body are controlled by the brain through corticomuscular pathways. Although neuromuscular control mechanisms of voluntary movements have been studied extensively, many remain to be learned, especially neuromuscular adaptations related to clinical conditions such as neurological disorders and aging. This research aims at a better understanding of functional connection between the brain and muscle during voluntary motor activities in aging and the extent to which this connection can be changed by training the neuromuscular system. Three research projects were conducted to achieve this aim. The analyses in the first two projects are based on comparisons of non-invasive electroencephalographic (EEG) and electromyographic (EMG) signals recorded in young and elderly individuals performing voluntary muscle contractions whereas the third project is based on transcranial magnetic stimulation (TMS). The first project examines the relationship between EEG frequency power and muscle force to identify an EEG or brain signal parameter directly related to voluntary motor action. The second project investigates further the strength of functional brain-muscle connectivity by quantifying EEG-EMG coherence and effects of aging on the connectivity. The third project identifies the representation of the biceps brachii muscle in primary motor cortex with TMS examine its excitability of corticospinal tracts, intra-cortical excitability reflecting activity of both inhibitory and facilitatory inter-neurons and inter-hemispheric inhibition. This research reveals that aging brain has impaired coupling between the central and peripheral neuromuscular systems and also significantly different intra-cortical excitability both may have an influence for weakened muscle output in the elderly. This research will contribute to a better understanding of neural mechanisms underlying voluntary movement deficit in aging and its recovery following training the neuromuscular syste

Scalp Eeg and Tms Based Electrophysiological Study of Brain Function of Motor Control in Aging

Voluntary movements of human body are controlled by the brain through corticomuscular pathways. Although neuromuscular control mechanisms of voluntary movements have been studied extensively, many remain to be learned, especially neuromuscular adaptations related to clinical conditions such as neurological disorders and aging. This research aims at a better understanding of functional connection between the brain and muscle during voluntary motor activities in aging and the extent to which this connection can be changed by training the neuromuscular system. Three research projects were conducted to achieve this aim. The analyses in the first two projects are based on comparisons of non-invasive electroencephalographic (EEG) and electromyographic (EMG) signals recorded in young and elderly individuals performing voluntary muscle contractions whereas the third project is based on transcranial magnetic stimulation (TMS). The first project examines the relationship between EEG frequency power and muscle force to identify an EEG or brain signal parameter directly related to voluntary motor action. The second project investigates further the strength of functional brain-muscle connectivity by quantifying EEG-EMG coherence and effects of aging on the connectivity. The third project identifies the representation of the biceps brachii muscle in primary motor cortex with TMS examine its excitability of corticospinal tracts, intra-cortical excitability reflecting activity of both inhibitory and facilitatory inter-neurons and inter-hemispheric inhibition. This research reveals that aging brain has impaired coupling between the central and peripheral neuromuscular systems and also significantly different intra-cortical excitability both may have an influence for weakened muscle output in the elderly. This research will contribute to a better understanding of neural mechanisms underlying voluntary movement deficit in aging and its recovery following training the neuromuscular syste

Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee

The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504–32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer’s disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentatothalamo- motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity

A Review of Non-Invasive Techniques to Detect and Predict Localised Muscle Fatigue

Muscle fatigue is an established area of research and various types of muscle fatigue have been investigated in order to fully understand the condition. This paper gives an overview of the various non-invasive techniques available for use in automated fatigue detection, such as mechanomyography, electromyography, near-infrared spectroscopy and ultrasound for both isometric and non-isometric contractions. Various signal analysis methods are compared by illustrating their applicability in real-time settings. This paper will be of interest to researchers who wish to select the most appropriate methodology for research on muscle fatigue detection or prediction, or for the development of devices that can be used in, e.g., sports scenarios to improve performance or prevent injury. To date, research on localised muscle fatigue focuses mainly on the clinical side. There is very little research carried out on the implementation of detecting/predicting fatigue using an autonomous system, although recent research on automating the process of localised muscle fatigue detection/prediction shows promising results

Cortical mapping of the neuronal circuits modulating the muscle tone. Introduction to the electrophysiological treatment of the spastic hand

L'objectiu d'aquest estudi es investigar l'organització cortical junt amb la connectivitat còrtico-subcortical en subjectes sans, com a estudi preliminar. Els mapes corticals s'han fet per TMS navegada, i els punts motors obtinguts s'han exportant per estudi tractogràfic i anàlisi de las seves connexions. El coneixement precís de la localització de l'àrea cortical motora primària i les seves connexions es la base per ser utilitzada en estudis posteriors de la reorganització cortical i sub-cortical en pacients amb infart cerebral. Aquesta reorganització es deguda a la neuroplasticitat i pot ser influenciada per els efectes neuromoduladors de la estimulació cerebral no invasiva.The purpose of this study is to investigate the motor cortex organisation together with the cortico-subcortical connectivity in healthy subjects, as a preliminary study. Cortical maps have been performed by navigated TMS and the motor points have been exported to DTI to study their subcortical connectivity. The precise knowledge of localization of the primary motor cortex area and its connectivity is the base to be used in later studies of cortical and subcortical re-organisation in stroke patients. This re-organisation is due to the neuroplascity and can be influenced by the neuromodulation effects of the non-invasive cerebral stimulation therapy by TMS

Effect of exercise induced muscle soreness on the motor control properties of the biceps brachii

The objective of this study was to note the time course changes for up to 28 days on the motor control properties of biceps brachii muscle following a bout of eccentric exercise. Eight subjects (5 male, 25-40 years of age) performed 35 maximal voluntary eccentric contractions with the non-preferred arm of the elbow flexors through 130° of extension of 90°s-1. Voluntary electromyographic (EMG) activity and motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) were recorded via surface electrodes placed over the belly of the biceps brachii muscle. Maximal isometric strength was measured at 90° elbow flexion. A simple elbow flexion/extension tracking task was used to assist visuomotor co-ordination. Subjects displayed greatest strength loss at I day (of control measures) which recovered by 21 days post-exercise. Impairment in the skilled tracking task was noticeable within hours following the exercise, and was greatest 1 day post exercise, but returned to control levels by 3 days. There were no changes in the threshold level of MEP responses to TMS but maximal MEP amplitudes increased on average (although responses were variable). No changes were observed in the EMG activity following exercise. The changes in the motor performance and corticomotor excitability occur following eccentric exercise which may be related to alterations in the pattern of afferent feedback from weakened and/or painful muscles. The implications from this suggest that coaches need to be sympathetic to the needs of the athlete when balancing physical training with skill training/developmen