Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide.

Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route

Ferramenta computacional gráfica para estimação de características de sinais de eletromiografia de superfície multicanal

Dissertação (mestrado)— Universidade de Brasília, Faculdade de Tecnologia, Departamento de Engenharia Elétrica, 2013.A literatura científica na área da eletromiografia de superfície (S-EMG)vem se aprofundando recentemente e expondo as potencialidades da S-EMG na análise e investigação de problemasneuromotores, doenças e outros aspectos referentes à estrutura neuromuscular, através da análise de característicasobtidas por estimadores aplicados aos sinais de eletrodos multicanais. Apesar do uso cada vez mais difundido da S-EMG, não se verifica um aumento proporcional da quantidade de ferramentas computacionais disponíveis para profissionais que não tenham experiência específica de programação e de métodos matemáticos relacionados aos estimadores. Nesse contexto, esse trabalho propõe o desenvolvimento de uma ferramenta computacional com interface gráfica que possa ser utilizado por qualquer profissional que atue na análise de sinais de S-EMG, a partir de sinais coletados por uma matriz de eletrodos, disponibilizando recursos gráficos para a visualização do sinal no domínio do tempo e da frequência, davelocidade de condução (CV), raiz quadrática média (RMS), valor retificado médio (ARV), frequência mediana (MDF), frequência média (MNF), coeficiente de correlação (CC) e força. Foi aplicado um estudo de caso, no qual foram realizadas 2 etapas: A primeira foi realizada com a contribuição de 40 indivíduos dos quais se extraíram sinais de S-EMG, com uma matriz de 64 canais e tempo total da coleta de 90 segundos. Desses sinais escolhidos foram extraídos, utilizando-se a ferramenta desenvolvida, os estimadores ARV, CV, MDF, MNF e RMS, e em seguida, foiaplicado um teste de análise de variância nos estimadores de tal forma a verificar se os sinais pertencentes a um mesmo indivíduo são estatisticamente iguais. Asegunda etapa constituiu-se de verificar a capacidade de interpretação de gráficos, gerados pela ferramenta desenvolvida, de estimadores junto a 10 voluntários.Observou- se que o programa permitiu a aplicação de todos os estimadores necessários para o caso particular sem necessidade de manipular as equações previamente implementadas. Isso sugere que a ferramenta gráfica desenvolvida pode ser utilizada por profissionais sem treinamento em programação e na matemática por trás das características extraídas do S-EMG. E, ao possuir apenas rotinas de código aberto, a ferramenta desenvolvida torna-se atrativa tanto para se acrescentar novos recursos quanto para a sua ampla utilização em quaisquerestudos acadêmicos e científicos sobre S-EMG. ______________________________________________________________________________ ABSTRACTThe scientific literature in the area of surface electromyography (S-EMG) has recently deepened and exposing the potential of S-EMG analysis and investigation of neuromotor problems, diseases and other aspects of neuromuscular structure, by analyzing characteristics obtained by estimators applied to signals from multichannel electrodes. Despite the increasingly widespread use of S-EMG, there is not a proportional increase in the amount of computational tools available to professionals who have specific experience of programming and mathematical methods related to estimators. In this context, this work proposes the development of a computational tool with graphical user interface that can be used by any professional acting on the analysis of S-EMG signals from signals collected by an array of electrodes, providing graphics capabilities for viewing signal in the time domain and frequency, conduction velocity (CV), root mean square (RMS), average rectified value (ARV), median frequency (MDF), mean frequency (MNF), correlation coefficient (CC) and strength. We applied a case study, in which we performed two steps: The first was carried out with contributions from 40 individuals of which were extracted S-EMG signals, with an array of 64 channels and the total collection time of 90 seconds. Chosen such signals were extracted, using a tool developed, the estimators ARV, CV, MDF, MNF and RMS, and then a test was applied in the analysis of variance estimators such as to check whether the signals belonging to a same individual are statistically equal. The second step was to verify the ability of interpreting graphs generated by the tool developed estimators with 10 volunteers. It was observed that the application program has all the estimators needed for the particular case without manipulating the equations previously implemented. This suggests that the graphical tool developed can be used by professionals without training in programming and mathematics behind the features extracted from the S- EMG. And, just to have routines open source tool developed to become attractive both to add new features and to their extensive use in any scientific and academic studies on S-EMG

Using Photoplethysmography for Simple Hand Gesture Recognition

A new wearable band is developed which uses three Photoplethysmography (PPG) sensors for the purpose of hand gesture recognition (HGR). These sensors are typically used for heart rate estimation and detection of cardiovascular diseases. Heart rate estimates obtained from these sensors are disregarded when the arm is in motion on account of artifacts. This research suggests and demonstrates that these artifacts are repeatable in nature based on the gestures performed. A comparative study is made between the developed band and the Myo Armband which uses surface-Electromyography (s-EMG) for gesture recognition. Based on the results of this paper which employs supervised machine learning techniques, it can be seen that PPG can be utilized as a viable alternative modality for gesture recognition applications

Central motor control failure in fibromyalgia: a surface electromyography study

<p>Abstract</p> <p>Background</p> <p>Fibromyalgia (FM) is characterised by diffuse musculoskeletal pain and stiffness at multiple sites, tender points in characteristic locations, and the frequent presence of symptoms such as fatigue. The aim of this study was to assess whether the myoelectrical manifestations of fatigue in patients affected by FM are central or peripheral in origin.</p> <p>Methods</p> <p>Eight female patients aged 55.6 ± 13.6 years (FM group) and eight healthy female volunteers aged 50.3 ± 9.3 years (MCG) were studied by means of non-invasive surface electromyography (s-EMG) involving a linear array of 16 electrodes placed on the skin overlying the biceps brachii muscle, with muscle fatigue being evoked by means of voluntary and involuntary (electrically elicited) contractions. Maximal voluntary contractions (MVCs), motor unit action potential conduction velocity distributions (mean ± SD and skewness), and the mean power frequency of the spectrum (MNF) were estimated in order to assess whether there were any significant differences between the two groups and contraction types.</p> <p>Results</p> <p>The motor pattern of recruitment during voluntary contractions was altered in the FM patients, who also showed fewer myoelectrical manifestations of fatigue (normalised conduction velocity rate of changes: -0.074 ± 0.052%/s in FM vs -0.196 ± 0.133%/s in MCG; normalised MNF rate of changes: -0.29 ± 0.16%/s in FM vs -0.66 ± 0.34%/s in MCG). Mean conduction velocity distribution and skewnesses values were higher (p < 0.01) in the FM group. There were no between-group differences in the results obtained from the electrically elicited contractions.</p> <p>Conclusion</p> <p>The apparent paradox of fewer myoelectrical manifestations of fatigue in FM is the electrophysiological expression of muscle remodelling in terms of the prevalence of slow conducting fatigue-resistant type I fibres. As the only between-group differences concerned voluntary contractions, they are probably more related to central motor control failure than muscle membrane alterations, which suggests pathological muscle fibre remodelling related to altered suprasegmental control.</p

경직성 중증 뇌성마비 환아의 고관절 내전근 내 보툴리눔 독소 주사가 고관절 내전근의 경직 및 고관절 탈구에 미치는 영향: 파일럿 임상시험

학위논문(석사) -- 서울대학교대학원 : 의과대학 의학과, 2022. 8. 류주석.Introduction: Hip adductor spasticity is a contributing factor to hip dislocation in patients with cerebral palsy (CP). We hypothesized that botulinum toxin injected into the hip adductor muscles would reduce spasticity and help prevent hip dislocation. Methods: Twenty patients with bilateral spastic CP aged 2 to 10 years with gross motor function classification system level IV or V were included. Botulinum toxin was injected into the hip adductor muscles at baseline and at 6-month follow-up. Muscle activity was measured with an eight-channel surface electromyography (EMG) recorder. A hip X-ray was performed, and Reimer’s hip migration index (MI) was measured. The Wilcoxon signed-rank test was used to compare the surface EMG values of the hip muscles at baseline and follow-up. Results: The mean root mean square surface EMG value of the hip adductor muscles was significantly reduced at 1, 2, 3, and 7 months after the first injection, up to approximately 53% of the baseline. The 1-year progression of the hip MI was -0.04%. Conclusion: Repeated sessions of botulinum toxin injections at the hip adductor muscles significantly reduced muscle activity and hip displacement. A botulinum toxin injection may be used as an adjunctive treatment in the prevention of hip dislocation.배경 고관절 내전근 경직은 경직성 뇌성마비 환아에서 고관절 탈구를 일으키는 요인 중 하나다. 본 연구에서는 고관절 내전근에 보툴리눔 독소 주사를 할 경우 경직이 감소하여 고관절 탈구 예방에 도움이 될 것이라는 가설을 세우고 이를 확인하고자 하였다. 방법 만 2세에서 10세 사이의 뇌성마비 대운동 기능 분류 시스템 (GMFCS) IV 또는 V에 해당하는 양측성 경직성 뇌성마비 환아 20명을 모집하였다. 고관절 내전근에 보톡스 주사는 첫 방문 시 및 6개월 추적 관찰 시 주입하였다. 근육 긴장도는 8 채널 표면 근전도(Surface EMG)로 측정하였다. 고관절 탈구 정도는 고관절 엑스레이를 촬영을 하여 라이머의 고관절 이동 지수 (Reimer’s MI)로 측정하였다. 윌콕슨 부호 순위 검정을 이용하여 초기 및 추적 관찰 시의 표면 근전도 값을 비교하였다. 결과 보톡스 주사 후 고관절 내전근의 표면 근전도 제곱 평균 제곱근 (Root mean square, RMS) 값이 첫 방문과 비교 시 추적관찰 1, 2, 3, 7 개월 때 유의하게 감소하였고 첫 방문 시 측정한 값의 약 53% 정도로 확인되었다. 1년간 고관절 이동 지수의 변화는 -0.04%였다. 결론 고관절 내전근에 첫 보톡스 주사 후 6개월 시점에 반복 주사를 시행했을 때 근긴장도가 유의하게 감소하였고 고관절 탈구도 감소하는 경향을 보였다. 이에 보툴리눔 독소 주사는 고관절 탈구 예방에 보조적 치료로 사용될 수 있다.Chapter 1. Introduction 1 Chapter 2. Materials and Methods 3 Chapter 3. Results 10 Chapter 4. Discussion 12 Chapter 5. Conclusions 19 References 20 Tables 28 Figures 34 Abstract in Korean 38석