Spatial analysis of muscular activations in stroke survivors

We investigated the spatial patterns of electrical activity in stroke-affected muscles using the high density surface electromyogram (sEMG) grids. We acquired 128-channel sEMG signals from the impaired as well as contralateral Biceps Brachii (BB) muscles of stroke survivors and from healthy participants at various force levels from 20 to 60% of maximum voluntary contraction in an isometric non-fatiguing recording protocol. We found the spatial sEMG pattern to be consistent across force levels in healthy and stroke subjects. However, once compared across sides (left vs right in healthy and impaired vs. contralateral in stroke) we found stroke-affected sides to be significantly different in distribution pattern of sEMG from the contralateral side. The sEMG activity areas were significantly shrunk on the affected sides indicating muscle atrophy due to stroke.

Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial

Background

Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage, and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda R&D Corporation, Japan, with functional task specific training (FTST) on spatiotemporal gait parameters in stroke survivors.

Methods

A single blinded randomized control trial was performed to assess the effect of FTST and task-specific walking training with the SMA® device on spatiotemporal gait parameters. Participants (n = 50) were randomly assigned to FTST or SMA. Subjects in both groups received training 3 times per week for 6–8 weeks for a maximum of 18 training sessions. The GAITRite® system was used to collect data on subjects’ spatiotemporal gait characteristics before training (baseline), at mid-training, post-training, and at a 3-month follow-up.

Results

After training, significant improvements in gait parameters were observed in both training groups compared to baseline, including an increase in velocity and cadence, a decrease in swing time on the impaired side, a decrease in double support time, an increase in stride length on impaired and non-impaired sides, and an increase in step length on impaired and non-impaired sides. No significant differences were observed between training groups; except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials.

Conclusions

SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits.

Trial registration

This study is registered under the title “Development of walk assist device to improve community ambulation” and can be located in clinicaltrials.gov with the study identifier: NCT01994395.

Application of the F-Response for Estimating Motor Unit Number and Amplitude Distribution in Hand Muscles of Stroke Survivors

The F-response was used in this study to assess changes in the first dorsal interosseous (FDI) muscle after a hemispheric stroke. The number of motor units and their sizes were estimated bilaterally in 12 stroke survivors by recording both the compound muscle action potential (CMAP) and F wave responses. These F waves were induced by applying a large number of electrical stimuli to the ulnar nerve. The amplitude distribution of individual motor unit action potentials (MUAPs) was also compared between paretic and contralateral muscles. When averaged across all the subjects, a significantly lower motor unit number estimate was obtained for the paretic FDI muscle ( 88 ±13) compared with the contralateral side ( 139 ±11) ( ). Pooled surface MUAP amplitude analysis demonstrated a right-skewed distribution for both paretic (kurtosis 3.0) and contralateral (kurtosis 8.52) muscles. When normalized to each individual muscle's CMAP, the surface MUAP amplitude ranged from 0.22% to 4.94% (median 1.17%) of CMAP amplitude for the paretic muscle, and from 0.13% to 3.2% (median 0.62%) of CMAP amplitude for the contralateral muscle. A significant difference in MUAP outliers was also observed between the paretic and contralateral muscles. The findings of this study suggest significant motor unit loss and muscle structural reorganization after stroke.

EMG burst presence probability: a joint time-frequency representation of muscle activity and its application to onset detection

The purpose of this study was to quantify muscle activity in the time-frequency domain, therefore providing an alternative tool to measure muscle activity. This paper presents a novel method to measure muscle activity by utilizing EMG burst presence probability (EBPP) in the time-frequency domain. The EMG signal is grouped into several Mel-scale subbands, and the logarithmic power sequence is extracted from each subband. Each log-power sequence can be regarded as a dynamic process that transits between the states of EMG burst and non-burst. The hidden Markov model (HMM) was employed to elaborate this dynamic process since HMM is intrinsically advantageous in modeling the temporal correlation of EMG burst/non-burst presence. The EBPP was eventually yielded by HMM based on the criterion of maximum likelihood. Our approach achieved comparable performance with the Bonato method.

A practice of caution: spontaneous action potentials or artifactual spikes?

Background

High density surface electromyogram (EMG) techniques with electrode arrays have been used to record spontaneous muscle activity, which is important, both for supporting the diagnosis of neuromuscular diseases and for laboratory based neurophysiological investigations. This short report addresses a practical issue we have experienced during recording of spontaneous muscle activity using electrode arrays from subjects with major neuromuscular disorders.

Findings

We show that recording artifacts can appear similar to spontaneous action potential spikes. Moreover, a causal filter may induce asymmetric distortions of an artifact and thus confuse it with a real action potential spike. As a consequence, for a single channel surface EMG recording, it might be difficult to judge whether a voltage transient is a real action potential or an artifact. Further investigation of the signal distributions among other channels of the array can be used to reach a more confident judgment.

Conclusions

During examination of spontaneous muscle activity using electrode arrays, caution is required for differentiation of physiological signals from artifactual spikes, which is important for accurate extraction of diagnostic or investigatory information.

Examination of Poststroke Alteration in Motor Unit Firing Behavior Using High-Density Surface EMG Decomposition

Recent advances in high-density surface electromyogram (EMG) decomposition have made it a feasible task to discriminate single motor unit activity from surface EMG interference patterns, thus providing a noninvasive approach for examination of motor unit control properties. In the current study, we applied high-density surface EMG recording and decomposition techniques to assess motor unit firing behavior alterations poststroke. Surface EMG signals were collected using a 64-channel 2-D electrode array from the paretic and contralateral first dorsal interosseous (FDI) muscles of nine hemiparetic stroke subjects at different isometric discrete contraction levels between 2 to 10 N with a 2 N increment step. Motor unit firing rates were extracted through decomposition of the high-density surface EMG signals and compared between paretic and contralateral muscles. Across the nine tested subjects, paretic FDI muscles showed decreased motor unit firing rates compared with contralateral muscles at different contraction levels. Regression analysis indicated a linear relation between the mean motor unit firing rate and the muscle contraction level for both paretic and contralateral muscles (p < 0.001), with the former demonstrating a lower increment rate (0.32 pulses per second (pps)/N) compared with the latter (0.67 pps/N). The coefficient of variation (averaged over the contraction levels) of the motor unit firing rates for the paretic muscles (0.21 ± 0.012) was significantly higher than for the contralateral muscles (0.17 ± 0.014) (p < 0.05). This study provides direct evidence of motor unit firing behavior alterations poststroke using surface EMG, which can be an important factor contributing to hemiparetic muscle weakness.

Spike sorting paradigm for classification of multi-channel recorded fasciculation potentials

BACKGROUND

Fasciculation potentials (FPs) are important in supporting the electrodiagnosis of Amyotrophic Lateral Sclerosis (ALS). If classified by shape, FPs can also be very informative for laboratory-based neurophysiological investigations of the motor units.

METHODS

This study describes a Matlab program for classification of FPs recorded by multi-channel surface electromyogram (EMG) electrodes. The program applies Principal Component Analysis on a set of features recorded from all channels. Then, it registers unsupervised and supervised classification algorithms to sort the FP samples. Qualitative and quantitative evaluation of the results is provided for the operator to assess the outcome. The algorithm facilitates manual interactive modification of the results. Classification accuracy can be improved progressively until the user is satisfied. The program makes no assumptions regarding the occurrence times of the action potentials, in keeping with the rather sporadic and irregular nature of FP firings.

RESULTS

Ten sets of experimental data recorded from subjects with ALS using a 20-channel surface electrode array were tested. A total of 11891 FPs were detected and classified into a total of 235 prototype template waveforms. Evaluation and correction of classification outcome of such a dataset with over 6000 FPs can be achieved within 1-2 days. Facilitated interactive evaluation and modification could expedite the process of gaining accurate final results.

CONCLUSION

The developed Matlab program is an efficient toolbox for classification of FPs.

Subspace based adaptive denoising of surface EMG from neurological injury patients

OBJECTIVE

After neurological injuries such as spinal cord injury, voluntary surface electromyogram (EMG) signals recorded from affected muscles are often corrupted by interferences, such as spurious involuntary spikes and background noises produced by physiological and extrinsic/accidental origins, imposing difficulties for signal processing. Conventional methods did not well address the problem caused by interferences. It is difficult to mitigate such interferences using conventional methods. The aim of this study was to develop a subspace-based denoising method to suppress involuntary background spikes contaminating voluntary surface EMG recordings.

APPROACH

The Karhunen-Loeve transform was utilized to decompose a noisy signal into a signal subspace and a noise subspace. An optimal estimate of EMG signal is derived from the signal subspace and the noise power. Specifically, this estimator is capable of making a tradeoff between interference reduction and signal distortion. Since the estimator partially relies on the estimate of noise power, an adaptive method was presented to sequentially track the variation of interference power. The proposed method was evaluated using both semi-synthetic and real surface EMG signals.

MAIN RESULTS

The experiments confirmed that the proposed method can effectively suppress interferences while keep the distortion of voluntary EMG signal in a low level. The proposed method can greatly facilitate further signal processing, such as onset detection of voluntary muscle activity.

SIGNIFICANCE

The proposed method can provide a powerful tool for suppressing background spikes and noise contaminating voluntary surface EMG signals of paretic muscles after neurological injuries, which is of great importance for their multi-purpose applications.

Anomalous EMG-force relations during low-force isometric tasks in hemiparetic stroke survivors

Hemispheric brain injury resulting from a stroke is often accompanied by muscle weakness in contralateral limbs. In neurologically intact subjects, appropriate motoneuronal recruitment and rate modulation are utilized to optimize muscle force production. In the present study, we sought to determine whether weakness in an affected hand muscle in stroke survivors is partially attributable to alterations in the control of muscle activation. Specifically, our goal was to characterize whether the surface EMG amplitude was systematically larger as a function of (low) force in paretic hand muscles as compared to contralateral muscles in the same subject. We tested a multifunctional muscle, the first dorsal interosseous (FDI), in multiple directions about the second metacarpophalangeal joint in ten hemiparetic and six neurologically intact subjects. In six of the ten stroke subjects, the EMG-force slope was significantly greater on the affected side as compared to the contralateral side, as well as compared to neurologically intact subjects. An unexpected set of results was a nonlinear relation between recorded EMG and generated force commonly observed in the paretic FDI, even at very low-force levels. We discuss possible experimental as well as physiological factors that may contribute to an increased EMG-force slope, concluding that changes in motor unit (MU) control are the most likely reasons for the observed changes.

Locomotor training modifies soleus monosynaptic motoneuron responses in human spinal cord injury

The objective of this study was to assess changes in monosynaptic motoneuron responses to stimulation of Ia afferents after locomotor training in individuals with chronic spinal cord injury (SCI). We hypothesized that locomotor training modifies the amplitude of the soleus monosynaptic motoneuron responses in a body position-dependent manner. Fifteen individuals with chronic clinical motor complete or incomplete SCI received an average of 45 locomotor training sessions. The soleus H-reflex and M-wave recruitment curves were assembled using data collected in both the right and left legs, with subjects seated and standing, before and after training. The soleus H-reflexes and M-waves, measured as peak-to-peak amplitudes, were normalized to the maximal M-wave (M(max)). Stimulation intensities were normalized to 50% M(max) stimulus intensity. A sigmoid function was also fitted to the normalized soleus H-reflexes on the ascending limb of the recruitment curve. After training, soleus H-reflex excitability was increased in both legs in AIS C subjects, and remained unchanged in AIS A-B and AIS D subjects during standing. When subjects were seated, soleus H-reflex excitability was decreased after training in many AIS C and D subjects. Changes in reflex excitability coincided with changes in stimulation intensities at H-threshold, 50% maximal H-reflex, and at maximal H-reflex, while an interaction between leg side and AIS scale for the H-reflex slope was also found. Adaptations of the intrinsic properties of soleus motoneurons and Ia afferents, the excitability profile of the soleus motoneuron pool, oligosynaptic inputs, and corticospinal inputs may all contribute to these changes. The findings of this study demonstrate that locomotor training impacts the amplitude of the monosynaptic motoneuron responses based on the demands of the motor task in people with chronic SCI.

Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury

In humans, a chronic spinal cord injury (SCI) impairs the excitability of pathways mediating early flexor reflexes and increases the excitability of late, long-lasting flexor reflexes. We hypothesized that in individuals with SCI, locomotor training will alter the behavior of these spinally mediated reflexes. Nine individuals who had either chronic clinically motor complete or incomplete SCI received an average of 44 locomotor training sessions. Flexor reflexes, elicited via sural nerve stimulation of the right or left leg, were recorded from the ipsilateral tibialis anterior (TA) muscle before and after body weight support (BWS)-assisted treadmill training. The modulation pattern of the ipsilateral TA responses following innocuous stimulation of the right foot was also recorded in 10 healthy subjects while they stepped at 25% BWS to investigate whether body unloading during walking affects the behavior of these responses. Healthy subjects did not receive treadmill training. We observed a phase-dependent modulation of early TA flexor reflexes in healthy subjects with reduced body weight during walking. The early TA flexor reflexes were increased at heel contact, progressively decreased during the stance phase, and then increased throughout the swing phase. In individuals with SCI, locomotor training induced the reappearance of early TA flexor reflexes and changed the amplitude of late TA flexor reflexes during walking. Both early and late TA flexor reflexes were modulated in a phase-dependent pattern after training. These new findings support the adaptive capability of the injured nervous system to return to a prelesion excitability and integration state.

Changes in motoneuron afterhyperpolarization duration in stroke survivors

Hemispheric brain injury resulting from a stroke is often accompanied by muscle weakness in limbs contralateral to the lesion. In the present study, we investigated whether weakness in contralesional hand muscle in stroke survivors is partially attributable to alterations in motor unit activation, including alterations in firing rate modulation range. The afterhyperpolarization (AHP) potential of a motoneuron is a primary determinant of motoneuron firing rate. We examined differences in AHP duration in motoneurons innervating paretic and less impaired (contralateral) limb muscles of hemiparetic stroke survivors as well as in control subjects. A novel surface EMG (sEMG) electrode was used to record motor units from the first dorsal interosseous muscle. The sEMG data were subsequently decomposed to derive single-motor unit events, which were then utilized to produce interval (ISI) histograms of the motoneuron discharges. A modified version of interval death rate (IDR) analysis was used to estimate AHP duration. Results from data analyses performed on both arms of 11 stroke subjects and in 7 age-matched control subjects suggest that AHP duration is significantly longer for motor units innervating paretic muscle compared with units in contralateral muscles and in units of intact subjects. These results were supported by a coefficient of variation (CV) analysis showing that paretic motor unit discharges have a lower CV than either contralateral or control units. This study suggests that after stroke biophysical changes occur at the motoneuron level, potentially contributing to lower firing rates and potentially leading to less efficient force production in paretic muscles.

Disturbances of motor unit rate modulation are prevalent in muscles of spastic-paretic stroke survivors

Stroke survivors often exhibit abnormally low motor unit firing rates during voluntary muscle activation. Our purpose was to assess the prevalence of saturation in motor unit firing rates in the spastic-paretic biceps brachii muscle of stroke survivors. To achieve this objective, we recorded the incidence and duration of impaired lower- and higher-threshold motor unit firing rate modulation in spastic-paretic, contralateral, and healthy control muscle during increases in isometric force generated by the elbow flexor muscles. Impaired firing was considered to have occurred when firing rate became constant (i.e., saturated), despite increasing force. The duration of impaired firing rate modulation in the lower-threshold unit was longer for spastic-paretic (3.9 ± 2.2 s) than for contralateral (1.4 ± 0.9 s; P < 0.001) and control (1.1 ± 1.0 s; P = 0.005) muscles. The duration of impaired firing rate modulation in the higher-threshold unit was also longer for the spastic-paretic (1.7 ± 1.6 s) than contralateral (0.3 ± 0.3 s; P = 0.007) and control (0.1 ± 0.2 s; P = 0.009) muscles. This impaired firing rate of the lower-threshold unit arose, despite an increase in the overall descending command, as shown by the recruitment of the higher-threshold unit during the time that the lower-threshold unit was saturating, and by the continuous increase in averages of the rectified EMG of the biceps brachii muscle throughout the rising phase of the contraction. These results suggest that impairments in firing rate modulation are prevalent in motor units of spastic-paretic muscle, even when the overall descending command to the muscle is increasing.

Characterizations of reflex and nonreflex changes in spastic multiple sclerosis

BACKGROUND

Spasticity, an increased resistance of a limb to movement, is associated with functional limitations and a major source of disability in neurological disorders, including multiple sclerosis (MS) and stroke. Despite the clinical significance of spasticity in brain and spinal cord injuries, it is often not clear whether the spasticity is due to reflex or non-reflex changes.

NEW METHOD

Reflex and nonreflex properties of the human knee joint were studied in eight MS patients with spasticity and ten healthy subjects. A digitally controlled joint driving device was used to apply small-amplitude, and band-limited white-noise perturbations to the knee to manifest the reflex and nonreflex properties. The subjects were asked to maintain a steady level of background muscle torque during the perturbation. A nonlinear delay differential equation model was used to characterize the reflex and intrinsic properties of the knee in terms of phasic stretch reflex gain, tonic stretch reflex gain, joint elastic stiffness, and coefficient of viscosity.

RESULTS

It was found that joint coefficient of viscosity and tonic stretch reflex gain of the spastic MS patients were significantly lower than those of normal controls. On the other hand, spastic MS patients showed higher phasic stretch reflex gains than normal controls and a trend of increased joint stiffness.

CONCLUSIONS

Simultaneous characterizations of changes in tonic and phasic reflexes and nonreflex changes in joint elastic stiffness and viscosity in neurological disorders may help us gain insight into mechanisms underlying spasticity and develop impairment-specific treatment.

EMG-force relations during isometric contractions of the first dorsal interosseous muscle after stroke

OBJECTIVE

This study examines the electromyogram (EMG)-force relations observed in the first dorsal interosseous (FDI) muscle of hemiparetic stroke survivors.

METHODS

Fourteen stroke subjects were instructed to perform different levels of index finger abduction using their paretic and contralateral hands, respectively. Surface EMG and force signals were recorded from the FDI muscle. The EMG-force relation was constructed using linear regression of the EMG amplitude and force measurements.

RESULTS

We found that there were diverse changes in the slope of the EMG-force relations in paretic muscles compared with contralateral muscles, with significant increases and decreases being observed relative to the contralateral side. Regression analysis did not verify strong correlations between the ratio of paretic and contralateral muscle EMG-force slopes and any clinical parameters.

CONCLUSIONS

These findings suggest that there appear to be different types of processes (eg, motor unit control property changes, muscle fiber atrophy, spinal motoneuron degeneration, muscle fiber reinnervation, etc) at work post stroke that may impact the EMG-force relations and that may be present in varying degree in any given stroke survivor.

The effect of involuntary motor activity on myoelectric pattern recognition: a case study with chronic stroke patients

OBJECTIVE

This study investigates the effect of the involuntary motor activity of paretic-spastic muscles on the classification of surface electromyography (EMG) signals.

APPROACH

Two data collection sessions were designed for 8 stroke subjects to voluntarily perform 11 functional movements using their affected forearm and hand at relatively slow and fast speeds. For each stroke subject, the degree of involuntary motor activity present in the voluntary surface EMG recordings was qualitatively described from such slow and fast experimental protocols. Myoelectric pattern recognition analysis was performed using different combinations of voluntary surface EMG data recorded from the slow and fast sessions.

MAIN RESULTS

Across all tested stroke subjects, our results revealed that when involuntary surface EMG is absent or present in both the training and testing datasets, high accuracies (>96%, >98%, respectively, averaged over all the subjects) can be achieved in the classification of different movements using surface EMG signals from paretic muscles. When involuntary surface EMG was solely involved in either the training or testing datasets, the classification accuracies were dramatically reduced (<89%, <85%, respectively). However, if both the training and testing datasets contained EMG signals with the presence and absence of involuntary EMG interference, high accuracies were still achieved (>97%).

SIGNIFICANCE

The findings of this study can be used to guide the appropriate design and implementation of myoelectric pattern recognition based systems or devices toward promoting robot-aided therapy for stroke rehabilitation.

Effects of mechanical vibration of the foot sole and ankle tendons on cutaneomuscular responses in man

The modulation of cutaneomuscular responses in response to mechanical vibration applied to the foot sole and to the ankle tendons was established in ten healthy subjects. The effects of mechanical vibration applied to the skin adjacent to the tibialis anterior (TA) and Achilles tendons were examined in two subjects. With the subjects seated, mechanical vibration applied to the TA and/or Achilles tendons significantly depressed the cutaneomuscular responses in all subjects, regardless of the frequency (50, 150, 250 Hz) of vibration. Mechanical vibration applied either to the foot sole or to the skin adjacent to the tendons induced no significant effects. The demonstration that mechanical vibration applied to muscle tendons exerts an inhibitory effect on cutaneomuscular responses supports the hypothesis that receptors that mediate body kinesthesia can be used as a vehicle to alter the spinal excitability state. The data suggests that tendon vibration could be utilized in neurological disorders to induce exogenous-mediated potentiation of presynaptic inhibition.

Using spike-triggered averaging to characterize motor unit twitch vectors in the first dorsal interosseous

Earlier studies in multifunctional muscles such as the first dorsal interosseous (FDI) have demonstrated that the selection and control of motor units (MUs) can vary as a function of generated force direction. While directionally dependent motor unit recruitment and rate properties imply that there may also be differential mechanical action, this has yet to be directly demonstrated. Our objective was to determine whether there exists a range of force vectors from different motor units in the FDI muscle within individual subjects. We utilized the spike-triggered averaging (STA) method to derive force twitch estimates from single motor units. We derived MU twitch direction from the ratio of individual twitch estimates recorded concurrently from the load cell. Fifteen units from 2 subjects were used to determine MU force vectors. We were able to estimate force twitch vectors from 7-8 different MUs in each subject. The results of our study suggest that there is varied mechanical action of motor units in the FDI. It is thus possible that differential activation of individual MUs in the FDI is a function of varied mechanical action.

Examination of afterhyperpolarization duration changes in motoneurons innervating paretic muscles in stroke survivors

The after hyperpolarization (AHP) of a motoneuron is a primary determinant of motoneuron firing rate. Any increase in its duration or amplitude could alter normal motor unit (MU) firing rate properties in stroke, and potentially impact muscle force generation. The objective of this preliminary study was to examine potential differences in afterhyperpolarization (AHP) duration of motoneurons innervating paretic and contralateral limb muscles of hemiparetic stroke survivors. A novel surface EMG (sEMG) electrode was used to record from the first dorsal interosseous muscle (FDI) of three hemiparetic stroke survivors. sEMG data was decomposed to derive single motor unit (SMU) events, which were subsequently utilized to produce interval (ISI) histograms of the motor unit discharge. Interval Death Rate (IDR) analysis was then used to transform ISI histograms into death rate plots. [1] The prescribed IDR analysis method [1] involves a final transformation of death rate plots into an estimated AHP time course. The present study uses a modified method of interpreting death rate plots in order to determine AHP duration. AHP durations from this analysis are similar to durations obtained from ISI variability analysis. [2] Results from three subjects indicate that on average, motor units on the paretic side have a longer AHP duration than the contralateral side, potentially contributing to lower firing rates, and to less efficient force production in paretic muscles.

Duration of observation required in detecting fasciculation potentials in amyotrophic lateral sclerosis using high-density surface EMG

Background

High-density surface electromyography (HD-SEMG) has recently emerged as a potentially useful tool in the evaluation of amyotrophic lateral sclerosis (ALS). This study addresses a practical constraint that arises when applying HD-SEMG for supporting the diagnosis of ALS; specifically, how long the surface EMG should be recorded before one can be confident that fasciculation potentials (FPs) are absent in a muscle being tested.

Methods

HD-SEMG recordings of 29 muscles from 11 ALS patients were analyzed. We used the distribution of intervals between FPs, and estimated the observation duration needed to record from one to five FPs with a probability approaching unity. Such an approach was previously tested by Mills with a concentric needle electrode.

Results

We found that the duration of recording was up to 70 s in order to record a single FP with a probability approaching unity. Increasing recording time to 2 minutes, the probability of recording five FPs approached approximately 0.95.

Conclusions

HD-SEMG appears to be a suitable method for capturing FPs comparable to intramuscular needle EMG.

Changes of Reflex, Non-reflex and Torque Generation Properties of Spastic Ankle Plantar Flexors Induced by Intelligent Stretching

Spasticity, contracture, and muscle weakness are major sources of disability in stroke. Changes of torque-generating capacity as well as reflex and non-reflex properties of ankle plantar flexors induced by strenuous stretching in chronic hemiplegia were investigated. Twelve subjects with a unilateral stroke and 10 healthy controls underwent 30 minutes of strenuous intelligent stretching treatment. Reflex and non-reflex components of spastic hypertonia and force-generating capacity of ankle plantar flexors were investigated. Dorsiflexion (DF) range of motion (ROM) was increased (p=0.002) and passive stiffness and passive resistant torque of the spastic muscles were decreased (p=0.004 and 0.007, respectively), while reflex hyper-excitability diminished slightly but with no statistical significance. The maximal voluntary contraction (MVC) torque of the spastic ankle plantar flexors was increased after the forceful stretching treatment (p=0.041). In contrast, the stretching treatment of the healthy plantar flexors did not change any of the variables measured before and after stretching. The stroke subjects who gained more DF ROM or larger decrement of stiffness achieved greater increment of the peak torque generation after the stretching (r=0.597 with p=0.040 and r=-0.746 with p=0.005, respectively). These results suggest that the strenuous dynamic stretching could improve the force-generating capacity of spastic muscles as well as reduce the passive stiffness and increase ROM.

Computing motor unit number index of the first dorsal interosseous muscle with two different contraction tasks

Motor unit number index (MUNIX) is a recently developed novel neurophysiological technique providing an index proportional to the number of motor units in a muscle. The MUNIX is derived from maximum M wave and voluntary surface electromyogram (EMG) recordings. The objective of this study was to address a practical question for computing MUNIX in the first dorsal interosseous (FDI), a multifunctional muscle that generates torque about the second metacarpophalangeal joint, i.e., how will different lines of muscle activation influence its MUNIX estimates? To address this question, the MUNIX technique was applied in the FDI muscle of 15 neurologically intact subjects, using surface EMG signals from index finger abduction and flexion, respectively, while the maximum M wave remained the same. Across all subjects, the average MUNIX value of the FDI muscle was 228 ± 45 for index finger abduction, slightly smaller than the MUNIX estimate of 251 ± 56 for index finger flexion. Different FDI muscle activation patterns resulted in an approximately 10% difference in MUNIX estimates. The findings from this study suggest that appropriate definition of voluntary activation of the FDI muscle should be kept to ensure consistency in measurements and avoid source of error. The current study is limited by only assessing neurologically intact muscles. It is important to perform a similar analysis for patients with amyotrophic lateral sclerosis (ALS), given that ALS is the primary intention of the MUNIX method as a potential follow-up measurement for motor unit loss.

The effects of Robotic-Assisted Locomotor training on spasticity and volitional control

We studied the effects of Robotic-Assisted Locomotor (LOKOMAT) Training on spasticity and volitional control of the spastic ankle in persons with incomplete Spinal Cord Injury (SCI). LOKOMAT training was performed 3 days/week during a 1-hr period including set-up time with up to 30 minutes of training during a single session. The training was provided for 4 weeks and subjects were evaluated before and after 1, 2, and 4 weeks of training. Spasticity was charterized in terms of neuromuscular abnormalities associated with the spastic joint. A system identification technique was used to quantify the effects of LOKOMAT training on these neuromuscular abnormalities. The effect of LOKOMAT training on volitional control was determined by measuring isometric maximum voluntary contraction (MVC) of ankle extensor and flexor muscles. Our results indicated that the reflex stiffness, abnormally increases in SCI, was significantly reduced (up to 65%) following 4-weeks of LOKOMAT training. Similarly, intrinsic (muscular) stiffness, which also abnormally increases in SCI, decreased significantly (up to 60%). MVCs were increased substantially (up to 93% in extensors and 180% in flexors) following 4-week training. These findings demonstrate that LOKOMAT training is effective in reducing spasticity and improving volitional control in SCI.