Reliability and minimal detectable change in scapulothoracic neuromuscular activity

Alterations in scapular muscle activity, including excess activation of the upper trapezius (UT) and onset latencies of the lower trapezius (LT) and serratus anterior (SA) muscles, are associated with abnormal scapular motion and shoulder impingement. Limited information exists on the reliability of neuromuscular activity to demonstrate the efficacy of interventions. The purpose of this study was to characterize the reproducibility of scapular muscle activity (mean activity, relative onset timing) over time and establish the minimal detectable change (MDC). Surface electromyography (sEMG) of the UT, LT, SA and anterior deltoid (AD) muscles in 16 adults were captured during an overhead lifting task in two sessions, one-week apart. sEMG data were also normalized to maximum isometric contraction and the relative onset and mean muscle activity during concentric and eccentric phases of the scapular muscles were calculated. Additionally, reliability of the absolute sEMG data during the lifting task and MVIC was evaluated. Both intrasession and intersession reliability of normalized and absolute mean scapular muscle activity, assessed with intraclass correlation coefficients (ICC), ranged from 0.62 to 0.99; MDC values were between 1.3% and 11.7% MVIC and 24 to 135 mV absolute sEMG. Reliability of sEMG during MVIC was ICC = 0.82–0.99, with the exception of intersession upper trapezius reliability (ICC = 0.36). Within session reliability of muscle onset times was ICC = 0.88–0.97, but between session reliability was lower with ICC = 0.43–0.73; MDC were between 39 and 237 ms. Small changes in scapular neuromuscular mean activity (>11.7% MVIC) can be interpreted as meaningful change, while change in muscle onset timing in light of specific processing parameters used in this study is more variable.     

Automatic detection of motor unit innervation zones of the external anal sphincter by multichannel surface EMG

A method to detect automatically the location of innervation zones (IZs) from 16-channel surface EMG (sEMG) recordings from the external anal sphincter (EAS) muscle is presented in order to guide episiotomy during child delivery. The new algorithm (2DCorr) is applied to individual motor unit action potential (MUAP) templates and is based on bidimensional cross correlation between the interpolated image of each MUAP template and two images obtained by flipping upside-down (around a horizontal axis) and left–right (around a vertical axis) the original one. The method was tested on 640 simulated MUAP templates of the sphincter muscle and compared with previously developed algorithms (Radon Transform, RT; Template Match, TM). Experimental signals were detected from the EAS of 150 subjects using an intra-anal probe with 16 equally spaced circumferential electrodes. The results of the three algorithms were compared with the actual IZ location (simulated signal) and with IZ location provided by visual analysis (VA) (experimental signals). For simulated signals, the inter quartile error range (IQR) between the estimated and the actual locations of the IZ was 0.20, 0.23, 0.42, and 2.32 interelectrode distances (IED) for the VA, 2DCorr, RT and TM methods respectively.     

The influence of posture variation on electromyographic signals in females obtained during maximum voluntary isometric contractions: A shoulder example

Surface electromyography (sEMG) is commonly used to estimate muscle demands in occupational tasks. To allow for comparisons, sEMG amplitude is normalized to muscle specific maximum voluntary contractions (MVCs) performed in a standardized set of postures. However, maximal sEMG amplitude in shoulder muscles is highly dependent on arm posture and therefore, normalizing task related muscular activity to standard MVCs may lead to misinterpretation of task specific muscular demands. Therefore, the purpose of this study was to investigate differences in commonly monitored shoulder muscles using normalized sEMG amplitude between maximal exertions at different hand locations and across force exertion directions relative to standard MVCs. sEMG was recorded from the middle deltoid, pectoralis major sternal head, infraspinatus, latissimus dorsi, and upper trapezius. Participants completed standardized muscle-specific MVCs and two maximal exertions in 5 hand locations (low left, low right, high left, high right, and central) in each of the four force directions (push, pull, up, and down). Peak sEMG was analyzed in the direction(s) that elicited the highest signal for each muscle. All muscles differed by location (p < 0.05). Latissimus dorsi had the greatest activation during pulls (32–135% MVC); upper trapezius and middle deltoid while exerting upwards (73–103% and 42–78% MVC, respectively); infraspinatus while pushing (38–79% MVC); and pectoralis major activation was the highest during downwards exertions (48–84% MVC). Normalization of location specific maximal exertions to standard muscle specific MVCs underestimated maximal activity across 90% of the tasks in all shoulder muscles tested, except for latissimus dorsi where amplitudes were overestimated in low right hand location. Normalization of location specific muscle activity to standard muscle specific MVCs often underestimates muscle activity in task performance and is cautioned against if the goal is to accurately estimate muscle demands.     

Frequency and conduction velocity analysis of the abductor pollicis brevis muscle during early fatigue

The physiological behavior of the abductor pollicis brevis (APB) muscle during early stage of fatigue is important as a reference for future clinical assessment of a pathologically altered muscle, as e.g. in carpal tunnel syndrome. The purpose of this study was to assess changes of force and surface electromyograms (sEMG) during early stage of fatigue of the APB. Thumb abduction force and sEMG derived from a multi-electrode array were recorded during isometric contraction. Electrode placement over the innervation zone (IZ) and the muscle tendon interface were avoided. The sEMGs of two adjacent electrode pairs were selected for the analysis, which yielded (a) motor unit conduction velocities (MUCV) derived from a correlation analysis between the EMGs and (b) mean frequencies obtained by using either fast Fourier (FMF) or Wavelet Transform (WMF). Early fatigue resulted in a relative decay rate of force (?2.1%¹ s^?1), MUCV (?1.5%¹ s^?1), FMF (?4.1%¹ s^?1), WMF (?3.7%¹ s^?1) and in a change of the power spectrum shape. Lower mean frequencies were observed at greater distances from the IZ independently of fatigue. The APB muscle seems to be fast fatigable and the relative decay rate of mean frequency was significantly larger than the one of force and MUCV.     

Can surface electromyography improve surgery planning? Electromyographic assessment and intraoperative verification of the nerve bundle entry point location of the gracilis muscle

Purpose: To verify the precision of surface electromyography (sEMG) in locating the innervation zone of the gracilis muscle, by comparing the location of the IZ estimated by means of sEMG with in vivo location of the nerve bundle entry point in patients before graciloplasty procedure due to fecal incontinence. Methods: Nine patients who qualified for the graciloplasty procedure underwent sEMG on both gracilis muscle before their operations. During surgery the nerve bundle was identified by means of electrical stimulation. The distance between the proximal attachment and the nerve entry point into the muscle’s body was measured. Both measurements (sEMG and in vivo identification) were compared for each subject. Results: On average, the IZ was located 65.5 mm from the proximal attachment. The mean difference in location of the innervation zones in each individual was 10 ± 9.7 mm, maximal – 30 mm, the difference being statistically significant (p = 0.017). It was intraoperatively confirmed, that the nerve entered the muscle an average of 62 mm from the proximal attachment. The largest difference between the EMG IZ estimation and nerve bundle entry point was 5 mm (mean difference 2.8 mm, p = 0.767). Conclusion: Preoperative surface electromyography of both gracilis muscles is a safe, precise and reliable method of assessing the location of the innervation zones of the gracilis muscles. The asymmetry of the IZ location in left and right muscles may be important in context of technical aspects of the graciloplasty procedure.     

The application of independent component analysis to the multi-channel surface electromyographic signals for separation of motor unit action potential trains: part I-measuring techniques.

The purpose of this study is to examine whether or not the application of independent component analysis (ICA) is useful for separation of motor unit action potential trains (MUAPTs) from the multi-channel surface EMG (sEMG) signals. In this study, the eight-channel sEMG signals were recorded from tibialis anterior muscles during isometric dorsi-flexions at 5%, 10%, 15% and 20% maximal voluntary contraction. Recording MUAP waveforms with little time delay mounted between the channels were obtained by vertical sEMG channel arrangements to muscle fibers. The independent components estimated by FastICA were compared with the sEMG signals and the principal components calculated by principal component analysis (PCA). From our results, it was shown that FastICA could separate groups of similar MUAP waveforms of the sEMG signals separated into each independent component while PCA could not sufficiently separate the groups into the principal components. A greater reduction of interferences between different MUAP waveforms was demonstrated by the use of FastICA. Therefore, it is suggested that FastICA could provide much better discrimination of the properties of MUAPTs for sEMG signal decomposition, i.e. waveforms, discharge intervals, etc., than not only PCA but also the original sEMG signals.     

Spatial dependency of trapezius muscle activity during repetitive shoulder flexion.

The purpose of this study was to explore changes in spatial muscle activation within the three divisions of the trapezius muscle during a dynamic, cyclic task of the upper limb. Surface EMG signals were detected from thirteen healthy subjects from the upper, middle and lower divisions of the trapezius muscle at multiple electrode sites in the cephalad-caudal direction during a repetitive shoulder flexion task. Initial values and rate of change of average rectified value (ARV) and of instantaneous mean power spectral frequency (iMNF) were estimated at 45 degrees , 90 degrees and 120 degrees of shoulder flexion throughout the 5-min task. The location of the electrodes had a significant effect on initial EMG ARV for both the upper and middle division of the trapezius muscle (P<0.05). Both the rate of change and normalized rate of change of ARV were greatest for the most cranial muscle fibers of the upper division (P<0.05). Initial values and rates of change of iMNF were also affected by electrode location for the upper and lower divisions of the trapezius muscle (P<0.05). These results demonstrate that muscle activity and its changes over time depend on position within the three divisions of the trapezius muscle during a dynamic, cyclic task of the upper limb. This suggests non-uniform muscle fiber distribution and/or recruitment. The results also highlight the importance of multiple recording sites when investigating trapezius muscle function in dynamic tasks.     

Long-term electromyographic activity in upper trapezius and low back muscles of women with moderate physical activity.

The habitual activity patterns of trapezius and postural back muscles (multifidus, iliocostalis, longissimus) of 23 female subjects with moderate physical activity were studied. Bilateral surface electromyographic (sEMG) recordings from start of work until bedtime were analyzed. The activity level was calibrated as percentage of root mean square-detected muscle activity at maximal voluntary contraction (EMG(max)). Sixty-six previous trapezius recordings of women with moderate physical activity were included in some analyses to pursue the full range of variation in trapezius activity. Twenty-six of these were recorded twice, separated by 16-28 mo. Median activity level and duration of periods with sEMG activity of <0.5% EMG(max) ("rest time"; only trapezius) and exceeding 2 ("burst time"), 10, 30, and 50% EMG(max) was determined. The trapezius median activity level ranged from 0.6 to 8.8% EMG(max), burst time from 9 to 84%, and rest time from 2 to 84%. The activity patterns of the back muscles showed similar large interindividual variation. Repeated trapezius recordings of the same subject showed high consistency; intraclass correlation coefficients ranged from 0.62 to 0.79 for different sEMG variables. Periods with high sEMG amplitude were of short duration; 7% of the trapezius recordings did not present time intervals (0.2-s duration) above 50% EMG(max). The activity patterns of the postural muscles, despite large interindividual variability, were distinctly different from activity patterns of upper and lower limb muscles reported by others (e.g., mean burst time 40-50 vs. 10-20%). We conclude that postural trunk muscles show idiosyncratic activity patterns with large interindividual variation. High-threshold motor units are activated to a very minor extent.     

The effects of electrode placement and innervation zone location on the electromyographic amplitude and mean power frequency versus isometric torque relationships for the vastus lateralis muscle.

The purposes of this investigation were to examine the effects of electrode placement and innervation zone (IZ) location on: (a) the torque-related patterns of responses for absolute and normalized electromyographic (EMG) amplitude and mean power frequency (MPF) and (b) the mean absolute and normalized EMG amplitude and MPF values. In addition, the present study examined the variability between subjects for the location of the IZ for the vastus lateralis (VL). Eight men (mean+/-SD age=23.0+/-4.3yr) performed submaximal to maximal isometric muscle actions of the dominant leg extensors. During each muscle action, fifteen channels of bipolar surface EMG signals were detected from the vastus lateralis using a linear electrode array aligned with the long axis of the muscle fibers. The results indicated that there were differences among channels 1-15 for the patterns of responses and mean values for absolute and normalized EMG amplitude and MPF versus isometric torque. Thus, normalized EMG amplitude and MPF values from different individuals cannot be compared if the EMG signals were detected from different locations over the muscle. In addition, absolute and relative (to femur length) estimates of IZ location for the VL resulted in similar inter-subject variability.     

Functional activity characteristics of individuals with shoulder dysfunctions

Shoulder-related dysfunction affects individuals’ ability to function independently and thus decreases quality of life. Functional task assessment is a key concern for a clinician in diagnostic assessment, outcome measurement, and planning of treatment programs. The purpose of this study was to test the reliability of the FASTRAK 3-dimensional (3-D) motion analysis and surface electromyography (sEMG) systems to analyze 3-D shoulder complex movements during functional tasks and compare motion patterns between subjects with and without shoulder dysfunctions (SDs).For the test, sEMG and 3-D motion analysis systems were used to characterize the functional tasks. Twenty-five asymptomatic male subjects and 21 male subjects with right shoulder disorders performed four functional tasks which involved arm reaching and raising activities with their dominant arms. Reliability was estimated by the intraclass correlation coefficient (ICC). Motion pattern was compared between two groups using mixed analysis of variances (ANOVAs). Shoulder complex kinematics and associated muscular activities during functional tasks were reliably quantified (ICC = 0.83–0.99) from the means of three trials. Relative to the group without SDs, the group with SDs showed significant alteration in shoulder complex kinematics (3°–40°) and associated muscular activities (3–10% maximum). Scapular tipping, scapular elevation, upper trapezius muscle function, and serratus anterior muscle function may have implications in the rehabilitation of patients with SDs.     

Innervation zone shift at different levels of isometric contraction in the biceps brachii muscle

Experiments were carried out to examine whether innervation zone (IZ) location remains stable at different levels of isometric contraction in the biceps brachii muscle (BB), and to determine how the proximity of the IZ affects common surface electromyography (sEMG) parameters. Twelve subjects performed maximal (MVC) and submaximal voluntary isometric contractions at 10%, 20%, 30%, 40%, 50% and 75% of MVC. sEMG signals were recorded with a 13 rows × 5 columns grid of electrodes from the short head of BB. The IZ shifted in the proximal direction by up to 2.4 cm, depending upon the subject and electrode column. The mean shift of all the columns was 0.6 ± 0.4 cm (10% vs. 100% MVC, P < 0.001). This shift biased the average values of mean frequency (+21.8 ± 9.9 Hz, P < 0.001), root mean square (?0.16 ± 0.15 mV, P < 0.05) and conduction velocity (?1.15 ± 0.93 m/s, P < 0.01) in the channels immediately proximal to the IZ. The shift in IZ could be explained by shortening of the muscle fibers, and thus lengthening of the (distal) tendon due to increasing force. These results underline the importance of individual investigation of IZ locations before the placement of sEMG electrodes, even in isometric contractions.     

Surface EMG: The issue of electrode location

This paper contributes to clarifying the conditions under which electrode position for surface EMG detection is critical and leads to estimates of EMG variables that are different from those obtained in other nearby locations. Whereas a number of previous works outline the need to avoid the innervation zone (or the muscle belly), many authors place electrodes in the central part or bulge of the muscle of interest where the innervation zone is likely to be. Computer simulations are presented to explain the effect of the innervation zone on amplitude, frequency and conduction velocity estimates from the signal and the need to avoid placing electrodes near it. Experimental signals recorded from some superficial muscles of the limbs and trunk (abductor pollicis brevis, flexor pollicis brevis, biceps, upper trapezius, vastus medialis, vastus lateralis) were processed providing support for the findings obtained from simulations. The use of multichannel techniques is recommended to estimate the location of the innervation zone and to properly choose the optimal position of the detection point(s) allowing meaningful estimates of EMG variables during movement analysis.     

Automatic localisation of innervation zones: A simulation study of the external anal sphincter

Traumas of the innervation zone (IZ) of the external anal sphincter (EAS), e.g. during delivery, can promote the development of faecal incontinence. Recently developed probes allow high-resolution detection of EMG signals from the EAS. The analysis of pelvic floor muscles by surface EMG (in particular, the estimation of the location of the IZ) has potential applications in the diagnosis and investigation of the mechanisms of incontinence.An automatic method (based on matched filter approach) for the estimation of the IZ distribution of EAS from surface EMG is discussed and tested using an analytical model of generation of EMG signals from sphincter muscles. Simulations are performed varying length of the fibres, thickness of the mucosa, position of the motor units, and force level. Different distributions of IZs are simulated.The performance of the proposed method in the estimation of the IZ distribution is affected by surface MUAP amplitude (as the estimation made by visual inspection), by mucosa thickness (performance decreases when fibre length is higher) and by different MU distributions. However, in general the method is able to identify the position of two IZ locations and can measure asymmetry of the IZ distribution. This strengthens the potential applications of high density surface EMG in the prevention and investigation of incontinence.     

Evaluation of upper limb muscle fatigue based on surface electromyography

Fatigue is believed to be a major contributory factor to occupational injuries in machine operators. The development of accurate and usable techniques to measure operator fatigue is therefore important. In this study, we used a novel method based on surface electromyography (sEMG) of the biceps brachii and the Borg scale to evaluate local muscle fatigue in the upper limb after isometric muscle action. Thirteen young males performed isometric actions with the upper limb at different force levels. sEMG activities of the biceps brachii were recorded during the actions. Borg scales were used to evaluate the subjective sensation of local fatigue of the biceps brachii after the actions. sEMG activities were analyzed using the one-third band octave method, and an equation to determine the degree of fatigue was derived based on the relationship between the variable and the Borg scale. The results showed that the relationship could be expressed by a conic curve, and could be used to evaluate muscle fatigue during machine operation.     

Use of surface electromyography to estimate neck muscle activity

This paper reviews the literature concerning the use of surface electromyography (sEMG) for the study of the neck musculature in response to work and workplace design during light work and semi-static tasks. The paper also draws upon basic research and biomechanical modeling in order to provide methodological recommendations for the use of surface electromyography in this region of the body and to identify areas which require further investigation. The paper includes review and discussion of electrode site location, methods of normalization, data reliability, and factors that can affect sEMG signals from this region, including noise, physiologic artifact, stress, visual deficiencies, and pain. General guidance for maximum exertions with the neck musculature, for sEMG normalization or other purposes, is also included.     

Differences between motor point and innervation zone locations in the biceps brachii. An exploratory consideration for the treatment of spasticity with botulinum toxin

BackgroundBotulinum toxin (BTX) acts on the neuromuscular junction which can be located by the innervation zone (IZ). Clinically, the motor point (MP) is homologous to the IZ and it is used as the injection site of BTX. Differences in the effectiveness of the application of BTX between MP and IZ locations have been determined.ObjectiveCompare the location of the MP obtained using electrical stimulation and the location of the IZ using a linear surface electrodes array on the biceps brachii muscle.MethodsThe biceps brachii muscle of twenty men was assessed. The MP was located using the torque measurement generated by electrical stimulation. The IZ was detected using a linear surface electrodes array.ResultsA difference between the MP and the IZ positions (75.8 vs. 86.5 mm, delta 10.7 mm; p = 0.003, post-hoc power 0.89) was observed.DiscussionThe magnitude of the difference between the MP and the IZ may be clinically relevant. The IZ location using surface electromyography as a guide to optimize BTX injection is proposed.     

Innervation zones location and optimal electrodes position of obliquus internus and obliquus externus abdominis muscles

The assessment of abdominal muscles has became popular in recent years because the study of “core muscles” is now considered a pivotal approach for a number of fields. The purpose of this study was to describe the innervation zone (IZ) locations and optimal electrode sites in two core muscles: the obliquus externus (OE) and the obliquus internus (OI) abdominis muscles. Twenty healthy male subjects were recruited and the IZ location was studied during a submaximal isometric contraction using multichannel surface EMG.The optimal electrode position for OI was found to be 2 cm lower the most prominent point of the anterior superior iliac spine, just medial and superior to the inguinal ligament. The optimal electrode position for OE was found to be 14 cm from the median line, lower the level of 1 cm above umbilicus, parallel to the line extending from the most inferior point of the costal margin to the opposite pubic tubercle (almost 45° with respect to the median line).Findings showed that for OI and OE muscles it is possible to provide indications for a muscle belly area suited for proper positioning of at least an electrode pair.     

Quantitative Estimation of Muscle Shear Elastic Modulus of the Upper Trapezius with Supersonic Shear Imaging during Arm Positioning

Pain and tenderness of the upper trapezius are the major complaints among people with chronic neck and shoulder disorders. Hyper-activation and increased muscle tension of the upper trapezius during arm elevation will cause imbalance of the scapular muscle force and contribute to neck and shoulder disorders. Assessing the elasticity of the upper trapezius in different arm positions is therefore important for identifying people at risk so as to give preventive programmes or for monitoring the effectiveness of the intervention programmes for these disorders. This study aimed to establish the reliability of supersonic shear imaging (SSI) in quantifying upper trapezius elasticity/shear elastic modulus and its ability to measure the modulation of muscle elasticity during arm elevation. Twenty-eight healthy adults (15 males, 13 females; mean age = 29.6 years) were recruited to participate in the study. In each participant, the shear elastic modulus of the upper trapezius while the arm was at rest and at 30° abduction was measured by two operators and twice by operator 1 with a time interval between the measurements. The results showed excellent within- and between-session intra-operator (ICC = 0.87–0.97) and inter-observer (ICC = 0.78–0.83) reliability for the upper trapezius elasticity with the arm at rest and at 30° abduction. An increase of 55.23% of shear elastic modulus from resting to 30° abduction was observed. Our findings demonstrate the possibilities for using SSI to quantify muscle elasticity and its potential role in delineating the modulation of upper trapezius elasticity, which is essential for future studies to compare the differences in shear elastic modulus between normal elasticity and that of individuals with neck and shoulder disorders.     

Comparison of surface electromyography and myotonometric measurements during voluntary isometric contractions

Objectives: Muscle stiffness increases during muscle contraction. The purpose of this study was to determine the strength of the correlation between myotonometric measurements of muscle stiffness and surface electromyography (sEMG) measurements during various levels of voluntary isometric contractions of the biceps brachii muscle. Subjects: Eight subjects (four female; four male), with mean age of 30.6±8.23 years, volunteered to participate in this study. Methods: Myotonometer and sEMG measurements were taken simultaneously from the right biceps brachii muscle. Data were obtained: (1) at rest, (2) while the subject held a 15 lb (6.8 kg) weight isometrically and, (3) during a maximal voluntary isometric contraction. Myotonometer force–displacement curves (amount of tissue displacement to a given unit of force applied perpendicular to the muscle) were compared with sEMG measurements using Pearson’s product–moment correlation coefficients. Results: Myotonometer and sEMG measurement correlations ranged from −0.70 to −0.90. The strongest correlations to sEMG were from Myotonometer force measurements between 1.00 and 2.00 kg. Conclusions: Myotonometer and sEMG measurements were highly correlated. Tissue stiffness, as measured by the Myotonometer, appears capable of assessing changes in muscle activation levels.     

Assessment of the non-Gaussianity and non-linearity levels of simulated sEMG signals on stationary segments

The purpose of this paper was to evaluate the effects of the longitudinal single differential (LSD), the longitudinal double differential (LDD) and the normal double differential (NDD) spatial filters, the electrode shape, the inter-electrode distance (IED) on non-Gaussianity and non-linearity levels of simulated surface EMG (sEMG) signals when the maximum voluntary contraction (MVC) varied from 10% to 100% by a step of 10%. The effects of recruitment range thresholds (RR), the firing rate (FR) strategy and the peak firing rate (PFR) of motor units were also considered.A cylindrical multilayer model of the volume conductor and a model of motor unit (MU) recruitment and firing rate were used to simulate sEMG signals in a pool of 120 MUs for 5 s. Firstly, the stationarity of sEMG signals was tested by the runs, the reverse arrangements (RA) and the modified reverse arrangements (MRA) tests. Then the non-Gaussianity was characterised with bicoherence and kurtosis, and non-linearity levels was evaluated with linearity test.The kurtosis analysis showed that the sEMG signals detected by the LSD filter were the most Gaussian and those detected by the NDD filter were the least Gaussian. In addition, the sEMG signals detected by the LSD filter were the most linear. For a given filter, the sEMG signals detected by using rectangular electrodes were more Gaussian and more linear than that detected with circular electrodes. Moreover, the sEMG signals are less non-Gaussian and more linear with reverse onion-skin firing rate strategy than those with onion-skin strategy. The levels of sEMG signal Gaussianity and linearity increased with the increase of the IED, RR and PFR.