Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity

Mandibular kinematic and standardized surface electromyography (sEMG) characteristics of masticatory muscles of subjects with short lasting TMD of mild-moderate severity were examined.Volunteers were submitted to clinical examination and questionnaire of severity. Ten subjects with TMD (age 27.3 years, SD 7.8) and 10 control subjects without TMD, matched by age, were selected.Mandibular movements were recorded during free maximum mouth opening and closing (O–C) and unilateral, left and right, gum chewing. sEMG of the masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position, and during gum chewing. sEMG indices were obtained. Subjects with TMD, relative to control subjects, had lower relative mandibular rotation at the end of mouth opening, larger mean number of intersection between interincisal O–C paths during mastication and smaller asymmetry between working and balancing side, with participation beyond the expected of the contralateral muscles (P < 0.05, t-test). Overall, TMD subjects showed similarities with the control subjects in several kinematic parameters and the EMG indices of the static test, although some changes in the mastication were observed.     

Changes in EMG activity during clenching in chronic pain patients with unilateral temporomandibular disorders

The study assessed the differences in electromyographic (EMG) activity recorded during clenching in women with chronic unilateral temporomandibular disorders (TMDs) as compared to control subjects. Seventy-five full dentate, normo-occlusion, right-handed, similarly aged female subjects were recruited. Twenty five subjects presented with right side TMD, 25 presented with left side TMD and 25 pain-free control subjects participated. Using integrated surface EMG over a 1 s contraction, the anterior temporalis and masseter muscles were evaluated bilaterally while subjects performed maximum voluntary clenching. Lower EMG activation was observed in patients with TMD as compared to control subjects (temporalis: 195.74 ± 18.57 vs. 275.74 ± 22.11, P = 0.011; masseters: 151.09 ± 17.37 vs. 283.29 ± 31.87, P < 0.001). An asymmetry index (SAI) was calculated to determine ratios of right to left sided activation. Patients with right-sided TMD demonstrated preferential use of their left-sided muscles (SAI ?5.35 ± 4.02) whereas patients with left-sided TMD demonstrated preferential use of their right-sided muscles (SAI 6.95 ± 2.82), (P = 0.016). This unilateral reduction in temporalis and masseter activity could be considered as a specific protective functional adaptation of the neuromuscular system due to nociceptive input. The asymmetry index (SAI) may be a useful measure in discriminating patients with right vs. left-sided TMD.     

Quadriceps EMG frequency content following isometric lumbar extension exercise

A relationship exists between muscles of the lumbar spine and those of the lower extremity where the quadriceps become more inhibited after lumbar paraspinal. The purpose of this experiment was to compare surface electromyography (sEMG) total frequency content after lumbar paraspinal fatiguing exercise. Scope: 50 subjects performed fatiguing lumbar extension exercise indexed by downward shifts in median frequency calculated from lumbar paraspinal sEMG signal. Before and after each exercise set we recorded maximal, isometric knee extension torque and quadriceps central activation ratio (QI) using the superimposed burst technique while recording vastus lateralis sEMG. We calculated total frequency content of the sEMG signal (fEMG_TOTAL) as the area of the quadriceps sEMG frequency spectrum. Quadriceps fEMG_TOTAL decreased from baseline following the first and second exercise sets. There was no significant change in quadriceps sEMG median frequency among baseline and post-exercise measures. The change in fEMG_TOTAL was correlated with the change in QI following the first (r = ?0.41, P = 0.003) and second (r = ?0.32, P = 0.02) exercise sets. Conclusion: Quadriceps fEMG_TOTAL decreased following fatiguing lumbar extension exercise, in the absence of a significant change in quadriceps median frequency.     

Alternating activation is related to fatigue in lumbar muscles during sustained sitting

The aim of this study was to investigate the relation between variability in muscle activity and fatigue during a sustained low level contraction in the lumbar muscles. Twenty-five healthy participants (13 men 12 women) performed a 30 min sitting task with 5 degrees inclination of the trunk. Surface electromyographic (EMG) signals were recorded bilaterally from the lumbar muscles with 2 high density surface EMG grids of 9 × 14 electrodes. Median frequency (MDF) decrease, amplitude (RMS) increase and the rating of perceived exertion (RPE) were used as fatigue indices. Alternating activation and spatial and temporal variability were computed and relations with the fatigue indices were explored. During sitting, the mono- and bipolar RMS slightly increased while the MDF remained unchanged indicating no systematic muscle fatigue, although the average RPE increased from 6 to 13 on a scale ranging between 6 and 20. Higher frequency of alternating activation between the left and right side was associated with increased RPE (p = 0.03) and decreased MDF (p = 0.05). A tendency in the same direction was seen between increased spatial and temporal variation within the grids and increased RPE and decreased MDF. Present findings provide evidence for a relationship between variability in muscle activity and fatigue.     

Surface electromyograph activity of submental muscles during swallowing and expiratory muscle training tasks in Huntington’s disease patients

IntroductionHuntington’s disease (HD) patients have difficulty in swallowing, leading to aspiration pneumonia, which is a major cause of death. It seems possible that submental muscles that are crucial for preventing an escape of a bolus into the airway, are affected by HD, but no previous studies have investigated this.ObjectiveTo assess surface electromyograph (sEMG) activity of submental muscles during swallowing and expiratory muscle training (EMT) tasks in HD patients in comparison to healthy volunteers.MethodssEMG activities of submental muscles during saliva, water swallowing, EMT tasks performed at 25% and 75% of maximum expiratory pressure were recorded and normalised by the sEMG activity during an effortful swallow in 17 early to mid stage HD patients and 17 healthy volunteers.ResultssEMG activity was greater (p < 0.05) during EMT tasks than saliva and water swallowing, but was not significantly different between groups for saliva, water swallowing and EMT at 25%. HD patients had lower sEMG activity for EMT at 75% (p < 0.05).ConclusionDecreases in submental muscle activity were not evident in HD patients except during EMT at 75%. This suggests that relative submental muscle weakness is observed only during a high intensity task in early to mid stage HD patients.     

Impaired orofacial motor functions on chronic temporomandibular disorders

Because temporomandibular disorders (TMDs) rehabilitation continues to be a challenge, a more comprehensive picture of the orofacial functions in patients with chronic pain is required. This study assessed the orofacial functions, including surface electromyography (EMG) of dynamic rhythmic activities, in patients with moderate-severe signs and symptoms of chronic TMD. It was hypothesized that orofacial motor control differs between patients with moderate-severe chronic TMD and healthy subjects. Seventy-six subjects (46 with TMD and 30 control) answered questionnaires of severity of TMD and chewing difficulties. Orofacial functions and EMG during chewing were assessed.Standardized EMG indices were obtained by quantitative analysis of the differential EMG signals of the paired masseter and temporal muscles, and used to describe muscular action during chewing.TMD patients showed significant greater difficulty in chewing; worse orofacial scores; longer time for free mastication; a less accurate recruitment of the muscles on the working and balancing sides, reduced symmetrical mastication index (SMI) and increased standardized activity during EMG test than healthy subjects. SMI, TMD severity and orofacial myofunctional scores were correlated (P < 0.01). Impaired orofacial functions and increased activity of the muscles of balancing sides during unilateral chewing characterized the altered orofacial motor control in patients with moderate-severe chronic TMD. Implications for rehabilitation are discussed.     

Acute severe male hypo-testosteronemia affects central motor command in humans

Purpose: To indirectly evaluate the effect of androgens on neuromuscular system in humans we analyzed if an induced short-term hypogonadal state (serum total testosterone-TT < 2.3 ng/ml) may affect central drive to skeletal muscle and/or muscle neuro-mechanical performance. Methods: We compared voluntary and electrically evoked muscle sEMG signals from biceps brachii in nine hypogonadal male volunteers (Hypo) and in ten healthy controls (Cont). Serum TT and dihydrotestosterone (DHT) were assayed. Results: With respect to Hypo, Cont exhibited significantly higher median frequency content (MDF) at any angular velocity; normalized MDF [95.9% (SD = 23.3) vs 73.8% (SD = 9.3)]; muscle fiber conduction velocity (CV) from lowest to highest angular velocities; initial MDF at fatigue test [91.78 Hz (SD = 22.03) vs 70.94 Hz (SD = 11.06)] as well as was the normalized slope [−0.64 (SD = 0.14 vs −0.5 (SD = 0.11)]. In the non-fatigued state, Hypo showed a slower single twitches time to peak (TTP). In Cont, half relaxation time (HRT) decreased after fatigue while increased in Hypo (p < 0.05 between groups). A significant correlation between both TT and dihydrotestosterone with MDF and CV was found during voluntary contractions only. Conclusions: A brief exposure to very low serum TT concentration in males seem to determine a reduced excitability of the NM system which, in turn, would favor a predominant recruitment of slow twitch MUs.     

Changes in sEMG parameters among trunk and thigh muscles during a fatiguing bilateral isometric multi-joint task in trained and untrained subjects

This study aimed to explore changes in the electrical activity distribution among synergist muscles involved in the maintenance of this bilateral multi-joint task. It also tested relations between changes in surface electromyographic (sEMG) parameters with endurance time. Eighteen subjects, trained and untrained in hiking, performed a submaximal (50% of maximal contraction) isometric hiking test until exhaustion. The electrical activity of main superficial muscles implicated in this posture was recorded bilaterally. Trained subjects sustained the hiking position for 315 ± 82 s, versus 225 ± 68 s for untrained subjects. Patterns of electrical activity and mean power frequency (MPF) were different between populations. MPF shift in abdominal muscles was higher than in other synergists for both groups. Although typical changes in sEMG parameters were observed, few relations with endurance time were found, and for untrained subjects only. Changes in the relative contribution among synergists were observed, mainly for trained subjects. It is hypothesized that the task (a complex multi-joint posture involving numerous joints and muscles) may allow some variability in the contribution of synergist muscles during fatigue especially for the trained group. This probably explains the absence of relationship between endurance time and sEMG changes for trained subjects.     

Detection of surface electromyography recording time interval without muscle fatigue effect for biceps brachii muscle during maximum voluntary contraction

The effects of fatigue on maximum voluntary contraction (MVC) parameters were examined by using force and surface electromyography (sEMG) signals of the biceps brachii muscles (BBM) of 12 subjects. The purpose of the study was to find the sEMG time interval of the MVC recordings which is not affected by the muscle fatigue. At least 10 s of force and sEMG signals of BBM were recorded simultaneously during MVC. The subjects reached the maximum force level within 2 s by slightly increasing the force, and then contracted the BBM maximally. The time index of each sEMG and force signal were labeled with respect to the time index of the maximum force (i.e. after the time normalization, each sEMG or force signal’s 0 s time index corresponds to maximum force point). Then, the first 8 s of sEMG and force signals were divided into 0.5 s intervals. Mean force, median frequency (MF) and integrated EMG (iEMG) values were calculated for each interval. Amplitude normalization was performed by dividing the force signals to their mean values of 0 s time intervals (i.e. ?0.25 to 0.25 s). A similar amplitude normalization procedure was repeated for the iEMG and MF signals. Statistical analysis (Friedman test with Dunn’s post hoc test) was performed on the time and amplitude normalized signals (MF, iEMG). Although the ANOVA results did not give statistically significant information about the onset of the muscle fatigue, linear regression (mean force vs. time) showed a decreasing slope (Pearson-r = 0.9462, p < 0.0001) starting from the 0 s time interval. Thus, it might be assumed that the muscle fatigue starts after the 0 s time interval as the muscles cannot attain their peak force levels. This implies that the most reliable interval for MVC calculation which is not affected by the muscle fatigue is from the onset of the EMG activity to the peak force time. Mean, SD, and range of this interval (excluding 2 s gradual increase time) for 12 subjects were 2353, 1258 ms and 536–4186 ms, respectively. Exceeding this interval introduces estimation errors in the maximum amplitude calculations of MVC–sEMG studies for BBM. It was shown that, simultaneous recording of force and sEMG signals was required to calculate the maximum amplitude of the MVC–sEMG more accurately.     

The surface electromyographic evaluation of the Functional Reach in elderly subjects

This study proposes a comprehensive assessment of myoelectric activity of the main muscles involved in the Functional Reach (FR) test, in 24 elderly subjects. A specific protocol for the surface electromyography (sEMG) signal acquisition during FR-test was developed. Results show that anterior muscles activate following a caudo-cranial order. Tibialis Anterior (TA) is the first to be activated (−18.0 ± 16.3% of the FR-period), together with Rectus Femoris (−10.4 ± 17.9%). Then, Rectus Abdominis (19.7 ± 24.7%) and Sternocleidomastoideus (19.9 ± 15.6%) activate after the FR-start. Hamstrings, Soleus, and L4-level Erectores Spinae (posterior muscles) activate after the FR-start in this order (11.4 ± 16.8%, 17.7 ± 16.6%, and 35.2 ± 29.0%, respectively) and remain active until the movement end. The analysis of the kinematic strategies adopted by subjects revealed an association between TA-activation patterns and two kinematic strategies (hip/mixed strategy), quantified by an increase (p < 0.05) of TA-activity duration in subjects adopting the hip strategy (89.9 ± 34.5) vs. subjects adopting the mixed strategy (27.0 ± 16.8). This suggests that TA sEMG activity could be able to discriminate among kinematic strategies, providing different information on balance control. Thus, the present analysis represents the first attempt to quantify the sEMG activity during FR-test in elderly subjects, providing an early contribution in building a reference frame for balance assessment in clinical context.     

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.     

Surface electromyographic measurements on land prior to and after 90 min of submersion (swimming) are highly reliable

The purpose of this study was to investigate the reliability of surface electromyography (sEMG) measurements after submersion (swimming) for 90 min. Isometric maximal voluntary contractions (MVC) on land and in water were collected from eight muscles on the right side of the body in 12 healthy participants (6 women and 6 men). Repeated measures analyses of variance (general linear model ANOVA) showed no significant differences in the peak amplitude MVC scores between land pre and post measurements for all muscles, p > .05. The mean of the Intraclass correlation coefficient (1, 1) for land pre and land post was .985 with (95% Cl = .978–.990), for land pre and water pre .976 (95% Cl = .964–.984) and for land pre and post, water pre and post .981 (95% Cl = .974–.987). Measuring sEMG on land before and after a prolonged submersion is highly reliable without additional waterproofing when using electrodes with 57 mm diameter.     

Intramuscular fine-wire electromyography during cycling: Repeatability,normalisation and a comparison to surface electromyography

This study investigated (a) the feasibility and repeatability of intramuscular fine-wire electromyographic (fEMG) recordings from leg muscles during the repetitive, high-velocity cycling movement, (b) the influence of amplitude normalization technique on repeatability and statistical sensitivity, (c) the influence of test-retest interval duration on repeatability, and (d) differences between fEMG and surface EMG (sEMG) recordings of cycling. EMG activity of leg muscles was recorded using surface and fine-wire electrodes during one (n = 12, to investigate statistical sensitivity and compare sEMG and fEMG) or two sessions (T1 and T2, 5–20 days apart, n = 10, to investigate repeatability). fEMG recordings were feasible and there was high repeatability of fEMG recordings normalised to maximum measured EMG amplitude (MAX); mean coefficients of multiple correlation (CMC) ranged from .83 ± .13 to .88 ± .07. Data normalised to maximal (MVC) or submaximal contractions (sMVC) were less repeatable (p < .01). Statistical sensitivity was also greatest for data normalised to MAX (p < .01). Repeatability of fEMG increased with greater test-retest intervals (p < .01). The global pattern of muscle recruitment was consistent between sEMG and fEMG but sEMG recordings were characterized by additional myoelectric content. These findings support and guide the use of fEMG techniques to investigate leg muscle recruitment during cycling.     

A new parameter for quantifying the variability of surface electromyographic signals during gait: The occurrence frequency

Natural variability of myoelectric activity during walking was recently analyzed considering hundreds of strides. This allowed assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides when a muscle is recruited with that specific activation modality. Aim of present study was to propose the occurrence frequency as a new parameter for assessing sEMG-signal variability during walking. Aim was addressed by processing sEMG signals acquired from Gastrocnemius Lateralis, Tibialis Anterior, Rectus Femoris and Biceps femoris in 40 healthy subjects in order to: (1) show that occurrence frequency is not correlated with ON/OFF instants (R_mean = 0.11 ± 0.07; P > 0.05) and total time of activation (R_mean = 0.15 ± 0.08; P > 0.05); (2) confirm the above results by two handy examples of application (analysis of gender and age) which highlighted that significant (P < 0.05) gender-related and age-related differences within population were detected in occurrence frequency, but not in temporal sEMG parameters. In conclusion, present study demonstrated that occurrence frequency is able to provide further information, besides those supplied by classical temporal sEMG parameters and thus it is suitable to complement them in the evaluation of variability of myoelectric activity during walking.     

Differential patterns of muscle modification in women with episodic and chronic tension-type headache revealed using surface electromyographic analysis

Tension-type headache (TTH) is a prototypical disorder in which muscular factors play a key role in the pathogenesis. This study was designed to understand muscular dysfunction in patients with episodic (ETTH) and chronic TTH (CTTH) using surface electromyography analysis (SEMG). Women with frequent ETTH (n = 14), CTTH (n = 14) and age-matched controls (n = 13) were recruited. SEMG data were recorded from the masseter, sternocleidomastoid, and upper trapezius muscles during maximum voluntary contraction and sustained voluntary isometric clenching, the neck flexion endurance test and shoulder elevation for 30 s. The root mean square (RMS) and median frequency (MDF) of the SEMG signal were measured throughout the test. The fatigue index, which is the MDF slope during sustained muscle contraction, decreased significantly faster in the ETTH and CTTH groups compared with that in the control (p < 0.05). The mean absolute RMS and relative percentage values at the initial and final period during sustained isometric contraction decreased significantly in the CTTH group (p < 0.05). Furthermore, headache clinical parameters (frequency and duration) were negatively correlated with the amplitude values (p < 0.05). A different muscle firing pattern or some muscle modifications in patients with CTTH may reflect reorganization of the motor-control strategy.     

Flexion–relaxation ratio in computer workers with and without chronic neck pain

This study evaluated the flexion–relaxation phenomenon (FRP) and flexion–relaxation ratios (FR-ratios) using surface electromyography (sEMG) of the cervical extensor muscles of computer workers with and without chronic neck pain, as well as of healthy subjects who were not computer users. This study comprised 60 subjects 20–45 years of age, of which 20 were computer workers with chronic neck pain (CPG), 20 were computer workers without neck pain (NPG), and 20 were control individuals who do not use computers for work and use them less than 4 h/day for other purposes (CG). FRP and FR-ratios were analyzed using sEMG of the cervical extensors. Analysis of FR-ratios showed smaller values in the semispinalis capitis muscles of the two groups of workers compared to the control group. The reference FR-ratio (flexion relaxation ratio [FRR], defined as the maximum activity in 1 s of the re-extension/full flexion sEMG activity) was significantly higher in the computer workers with neck pain compared to the CG (CPG: 3.10, 95% confidence interval [CI95%] 2.50–3.70; NPG: 2.33, CI95% 1.93–2.74; CG: 1.99, CI95% 1.81–2.17; p < 0.001). The FR-ratios and FRR of sEMG in this study suggested that computer use could increase recruitment of the semispinalis capitis during neck extension (concentric and eccentric phases), which could explain our results. These results also suggest that the FR-ratios of the semispinalis may be a potential functional predictive neuromuscular marker of asymptomatic neck musculoskeletal disorders since even asymptomatic computer workers showed altered values. On the other hand, the FRR values of the semispinalis capitis demonstrated a good discriminative ability to detect neck pain, and such results suggested that each FR-ratio could have a different application.     

Postural stability in subjects with temporomandibular disorders and healthy controls: A comparative assessment

Purpose of the studyThe influence of the stomatognathic apparatus on body posture is a continuously discussed topic with contrasting results. The aim of this study is to analyze differences in postural stability between subjects with and without myogenous TMD.Methods25 subjects affected by myogenous TMD according with DC/TMD (6 males, 19 females; mean age 31.75 ± 6.68 years) and a healthy control group of 19 subjects (4 Males, 15 Females; mean age 27.26 ± 3.85 years) were enrolled in the study.Both groups underwent a posturo-stabilometric force platform exam under different mandibular and visual conditions. Sway area and sway velocity of the COP (Center Of foot Pressure) posturo-stabilometric parameters were evaluated and compared applying Mann-U-Whitney statistical test.ResultsThe sway area and sway velocity parameters resulted statistically significantly higher in the TMD group (sway area p < 0.01; sway velocity p < 0.05) in mandibular maximum intercuspation and rest positions with eyes open.ConclusionsThis study demonstrates a significant difference in body postural stability between subjects with myogenous TMD and healthy controls. In particular, sway area and sway velocity postural parameters are increased in these subjects.     

Biceps brachii myoelectric and oxygenation changes during static and sinusoidal isometric exercises

Surface myoelectric signal changes occurring during sustained isometric contractions have been extensively studied with quantitative surface electromyography (sEMG) and are described by means of some sEMG global variables in time and frequency domain (such as the median power spectral frequency). Recently, the possibility of studying local muscle O₂ saturation during exercise using non-invasive methods has been enhanced thanks to the use of near-infrared spectroscopy (NIRS). The purpose of this work was to combine NIRS and sEMG techniques to analyze the relationship between modifications of sEMG parameters and the underlying metabolic status of the exercising biceps brachii muscle. This relationship was tested under different isometric contraction modalities, namely static (ST) at 20, 40, 60 and 80%MVC and sinusoidal (SIN) at 40 ± 20 and 60 ± 20%MVC. Results clearly indicated the presence of an initial fast phase of muscle O₂ desaturation followed by a slow phase, regardless of the contraction modality. Moreover, the initial rate of muscle O₂ desaturation was related to the level of force output (R = 0.92), but it was independent on the contraction modality (p < 0.05). Similarly, changes in sEMG parameters were related to force level (Conduction Velocity-CV vs. Force: R = 0.87; sEMG Median Frequency-MDF vs. Force: R = 0.86). The high correlation found between CV-MDF and Tissue Oxygenation Index (TOI) slope (R = 0.73 and 0.72, respectively) suggests a strong relationship between NIRS and sEMG data. This study indicates that muscle O₂ demand during isometric contractions from low to high force levels is influenced by the type of active motor units and not from the type of isometric exercise modality.     

Normalizing surface electromyographic measures of the masticatory muscles: Comparison of two different methods for clinical purpose

PurposeTo compare a new normalization technique (wax pad, WAX) with the currently utilized cotton roll (COT) method in surface electromyography (sEMG) of the masticatory muscles.MethodssEMG of the masseter and anterior temporalis muscles of 23 subjects was recorded while performing two repetitions of 5 s maximum voluntary clenches (MVC) on COT and WAX. For each task, the mean value of sEMG amplitude and its coefficient of variation were calculated, and the differences between the two repetitions computed. The standard error of measurement (SEM) was calculated. For each subject and muscle, the COT-to-WAX maximum activity increment was computed. Participant preference between tasks was also recorded.ResultsWAX MVC tasks had larger maximum EMG amplitude than COT MVC tasks (P < 0.001), with COT-to-WAX maximum amplitude increments of 61% (temporalis) and 94% (masseter) (P = 0.006). WAX MVC had better test-retest repeatability than COT. For both MVC modalities, the mean amplitude (P > 0.391) and its coefficient of variation were unchanged (P > 0.180). The WAX task was the more comfortable for 18/23 subjects (P = 0.007).ConclusionWAX normalization ensures the same stability level of maximum EMG amplitude as COT normalization, but it is more repeatable, elicits larger maximum muscular contraction, and is felt to be more comfortable by subjects.     

Micro movements of the upper limb in fibromyalgia: The relation to proprioceptive accuracy and visual feedback

The purpose of this study was to explore the role of visual and proprioceptive feedback in upper limb posture control in fibromyalgia (FM) and to assess the coherence between acceleration measurements of upper limb micro movements and surface electromyography (sEMG) of shoulder muscle activity (upper trapezius and deltoid). Twenty-five female FM patients and 25 age- and sex-matched healthy controls (HCs) performed three precision motor tasks: (1) maintain a steady shoulder abduction angle of 45° while receiving visual feedback about upper arm position and supporting external loads (0.5, 1, or 2 kg), (2) maintain the same shoulder abduction angle without visual feedback (eyes closed) and no external loading, and (3) a joint position sense test (i.e., assessment of proprioceptive accuracy). Patients had more extensive increase in movement variance than HCs when visual feedback was removed (P < 0.03). Proprioceptive accuracy was related to movement variance in HCs (R ⩾ 0.59, P ⩽ 0.002), but not in patients (R ⩽ 0.25, P ⩾ 0.24). There was no difference between patients and HCs in coherence between sEMG and acceleration data. These results may indicate that FM patients are more dependent on visual feedback and less reliant on proprioceptive information for upper limb posture control compared to HCs.