Measuring system for in vivo recording of force systems in orthodontic treatment-concept and analysis of accuracy

The aim of our developments is three-dimensional in vivo recording of those orthodontic force systems inducing tooth movements during treatment with fixed appliances. The concept presented here is the first to permit the forces and torques of these statically multiply undetermined systems to be recorded in vivo. For this purpose the force systems transmitted to the teeth from the archwire are isolated from the respective tooth by means of divisible special-design brackets and introduced into a 3D force torque sensor via a gripping appliance. The sensor is fixed with a purpose-developed device relative to the patient's dental arch. The patient's head is positioned relative to the system by means of a bite fork as well as a forehead and chin support. Electrical measurement of the mechanical quantities is carried out by a six-axis force torque sensor with semiconductor strain gauge elements, an electronical evaluator and a mobile measuring computer (PC). Extensive calibration of the sensor system has shown that the measuring uncertainty of the electrical measuring is less than 2%. Precise spatial fixing of bracket slot and archwire in the therapeutic position is crucial to the measuring accuracy of the system, as even minimum displacements affect the force system to be measured. Movements of the measuring system up to 0.04 mm result from a therapeutic force of 1.5 N. The results of extensive in vitro studies have already demonstrated that the system developed by us is suitable for the specified in vivo measuring function.

Three-dimensional echocardiographic determination of left ventricular volumes and function by multiplane transesophageal transducer: dynamic in vitro validation and in vivo comparison with angiography and thermodilution

The goal of this study was to validate 3-dimensional echocardiography by multiplane transesophageal transducer for the determination of left ventricular volumes and ejection fraction in an in vitro experiment and to compare the method in vivo with biplane angiography and the continuous thermodilution method. In the dynamic in vitro experiment, we scanned rubber balloons in a water tank by using a pulsatile flow model. Twenty-nine measurements of volumes and ejection fractions were performed at increasing heart rates. Three-dimensional echocardiography showed a very high accuracy for volume measurements and ejection fraction calculation (correlation coefficient, standard error of estimate, and mean difference for end-diastolic volume 0.998, 2.3 mL, and 0.1 mL; for end-systolic volume 0.996, 2.7 mL, and 0.5 mL; and for ejection fraction 0.995, 1.0%, and -0.4%, respectively). However, with increasing heart rate there was progressive underestimation of ejection fraction calculation (percent error for heart rate below and above 100 bpm 0.59% and -8.6%, P < .001). In the in vivo study, left ventricular volumes and ejection fraction of 24 patients with symmetric and distorted left ventricular shape were compared with angiography results. There was good agreement for the subgroup of patients with normal left ventricular shape (mean difference +/-95% confidence interval for end-diastolic volume 5.2+/-6.7 mL, P < .05; for end-systolic volume -0.5+/-8.4 mL, P = not significant; for ejection fraction 2.4%+/-7.2%, P = not significant) and significantly more variability in the patients with left ventricular aneurysms (end-diastolic volume 23.1+/-56.4 mL, P < .01; end-systolic volume 5.6+/-41.0 mL, P = not significant; ejection fraction 4.9%+/-16.0%, P < .05). Additionally, in 20 critically ill, ventilated patients, stroke volume and cardiac output measurements were compared with measurement from continuous thermodilution. Stroke volume as well as cardiac output correlated well to thermodilution (r = 0.89 and 0.84, respectively, P < .001), although both parameters were significantly underestimated by 3-dimensional echocardiography (mean difference +/-95% confidence interval = -6.4+/-16.0 mL and -0.6+/-1.6 L/min, respectively, P < .005).

Estimation of the relationship between the noninvasively detected activity of single motor units and their characteristic pathological changes by modelling

Neuromuscular disorders are often related to specific changes in the structure of single motor units (MUs). One approach for the detection of these changes is high-spatial-resolution EMG (HSR-EMG), which allows non-invasive recording of the activity of a single MU. Early investigations with patients suffering from various neuromuscular disorders have shown that there is a distinct difference between the HSR-EMG signals of healthy volunteers, patients with muscular disorders, and patients with neuronal disorders. In this study, the relationship between typical HSR-EMG patterns and characteristic pathological changes in the structure of the MUs is considered. Therefore, a muscle model has been developed which is adapted to the physiological properties of the m. abductor pollicis brevis. The effects of the loss of single muscle fibres (muscular disorders) and the loss of entire MUs (neuronal disorders) on the HSR-EMG pattern have been simulated. These simulations show the same HSR-EMG patterns as seen in patients and healthy volunteers. As a consequence, it can be assumed that the muscle model is an appropriate tool for the simulation of HSR-EMG signals. Furthermore, the simulation results support the hypothesis that the typical changes in the HSR-EMG pattern found in patients with neuromuscular disorders can be attributed to the characteristic changes in the structure of the MUs.

In vitro thrombogenicity testing of artificial organs

Thromboembolic complications remain as one of the main problems for blood contacting artificial organs such as heart valves, bloodpumps and others. In vitro evaluation of thrombogenesis in prototypes has not previously been part of the standard evaluation of these devices. In comparison to hemolysis testing, evaluation of the thrombogenic potential is more difficult to perform because of the complexity of the blood coagulation system. We present an in vitro testing procedure that allows the accelerated examination of the thrombogenic potential of different types of blood pumps. Additionally, first results are presented that indicate the reliability of the accelerated clotting test for mechanical heart valves. Results for the centrifugal pump BioMedicus and two microaxial pumps have shown typical thrombus formation at locations such as bearings. The results indicate that the accelerated clotting test is an excellent addition to the much more expensive animal testing of artificial organs or assist devices. In vitro testing permits studies of thrombus formation to be performed at an early stage and at low costs and also facilitates a more precise investigation of device areas known to be potential hot spots for thrombus formation.

Computer assisted orthopaedic surgery with image based individual templates

Recent developments in computer assisted surgery offer promising solutions for the translation of the high accuracy of the preoperative imaging and planning into precise intraoperative surgery. Broad clinical application is hindered by high costs, additional time during intervention, problems of intraoperative man and machine interaction, and the spatially constrained arrangement of additional equipment within the operating theater. An alternative technique for computerized tomographic image based preoperative three-dimensional planning and precise surgery on bone structures using individual templates has been developed. For the preoperative customization of these mechanical tool guides, a desktop computer controlled milling device is used as a three-dimensional printer to mold the shape of small reference areas of the bone surface automatically into the body of the template. Thus, the planned position and orientation of the tool guide in spatial relation to bone is stored in a structural way and can be reproduced intraoperatively by adjusting the position of the customized contact faces of the template until the location of exact fit to the bone is found. No additional computerized equipment or time is needed during surgery. The feasibility of this approach has been shown in spine, hip, and knee surgery, and it has been applied clinically for pelvic repositioning osteotomies in acetabular dysplasia therapy.

In vitro calcification of pericardial bioprostheses

BACKGROUND AND AIM OF THE STUDY

The lifetime of bioprosthetic heart valves is limited by calcification. To investigate the calcification behavior of bioprostheses and gain insight into the etiology of valve calcification, a test protocol for accelerated valve calcification was developed. This protocol includes a pulsatile valve tester, a synthetic calcification fluid, and non-destructive radiographic assessment of calcification sites. About 40 porcine bioprostheses from different manufacturers have been investigated previously using this test protocol and showed that valves exhibited different calcification patterns and even different degrees of calcification within their leaflets. A positive correlation of calcification versus tissue anomalies/stress concentrations (r = 0.72; n = 29 valves) and lipid deposits (r = 0.81) was found. In the present study, bovine pericardial valves were investigated in comparison with porcine valves.

METHODS

Four bovine pericardial and two porcine mitral valves (Baxter) with a tissue annulus diameter (TAD) of 29 mm (one 27 mm) were investigated in parallel under identical test conditions. The valves were cyclically loaded at 300 per min with a delta p of 110 mmHg at 37 degrees C for up to 19 x 10(6) cycles. The synthetic calcification fluid was changed weekly. Sites of calcification were assessed by microradiography. Radiographs were analyzed by PC images processing with respect to the degree of calcification, defined as calcified surface area in relation to total leaflet surface area.

RESULTS

This analysis showed that, for bovine pericardial valves, the mean degree of calcification increased by 14% and 20% after 12 and 19 x 10(6) cycles, respectively. Under identical conditions, the mean degree of calcification of porcine valves increased by 28% and 37%.

CONCLUSIONS

Pericardial valves appear less prone to calcification than porcine valves. Further studies must be performed in order to prove this finding since, as recognized previously in porcine valves, other factors such as tissue or manufacturing anomalies may be as important as the tissue source itself.

Miniaturized implantable rotary blood pump in atrial-aortic position supports and unloads the failing heart

The purpose of this study was to test the pump performance of a miniaturized, newly developed, implantable rotary blood pump (the diagonal pump). In a series of six sheep, the pump was interposed in an atrial-aortic connection. Heart failure was induced by serial injection of glass beads into the left coronary artery. The assistance of the non-failing heart (with pump output up to 4.5 liter/min) did not change the total cardiac output or the blood pressure of the animal. The heart was significantly unloaded as demonstrated by a drop in first derivative of the left ventricular pressure (dP/dt) max (from 1645 to 1113 mmHg/s; P = 0.0003). Because of the specific interaction between heart function and rotary blood pump performance, the pump provided considerably more flow in the failing than in the non-failing heart. Cardiac output and perfusion pressures were restored to pre-assist values in the failing heart model. The heart-rotary blood pump interaction is an ideal substrate for long-term assistance. With this miniaturized rotary blood pump, hemodynamics in a severely failing heart can be restored. Atrial cannulation, which leaves the left ventricle untouched, provides similar results as apical cannulation in the failing heart.

Implantable micropump system for augmented liver perfusion

Liver cirrhosis, a worldwide health problem, decreases the blood flow through the liver. This in turn leads to dangerous portal hypertension and decreased metabolic function within the liver. To improve this situation, a new concept is proposed which involves introducing a microaxial blood pump into the portal vein. This device is intended to increase blood flow through the liver and to enhance hepatic function. Furthermore, high pressures will be reduced to physiological levels. The microaxial pump with its single stage impeller is powered by a proximally integrated microelectric motor. The pump unit is completely immersed within the blood vessel. Heat caused by electrical and mechanical losses will be transported into the blood. In vitro optimization of the pump design was accomplished using both hydraulic and hemolysis tests.

In vitro testing of a measuring system for in vivo recording of orthodontically applied forces and moments in the multiband technique. Part II

The aim of this study was to measure in vivo the forces and moments acting therapeutically on the individual tooth in connection with the multiband technique. Securing and evaluating the planned in vivo measurements involves analysing the measuring accuracy of the system as a whole by means of corresponding in vitro investigations. Errors in determining the therapeutically effective force system may result from the electrical measurement of the mechanical quantities by the sensor system and from the fixing of the archwire in therapeutic position. The precision of this fixing is influenced by displacements induced by elasticities and mechanical tensions in the measuring system. Calibration test series have shown the sensor system to have a margin of error of less than 2%. The displacements influencing precision fixing of the archwire were determined by means of a laser position measuring system. For a maximum orthodontic force of 1.5 N, they are 0.06 mm in the least favourable case. The resulting measuring accuracy was determined analytically or graphically, depending on the key parameters. Successful in vivo studies of the therapeutically applied force systems are to be expected on the basis of these results.

MR-guided interstitial cryotherapy of the liver with a novel, nitrogen-cooled cryoprobe

The purpose of the study was to test a newly developed, MR-compatible, liquid nitrogen-cooled cryoprobe. The probe has an outer diameter of 3.5 mm and was specifically developed for percutaneous, MR-guided, interstitial cryotherapy. The probe was inserted percutaneously into the livers of 10 rabbits. The cryotherapy procedure was monitored with a surface coil in a 1.5 Tesla magnet using a gradient echo sequence. Follow-up examinations were performed 3 and 7 days after the freezing procedure using T1- and T2-weighted spin echo sequences. At 7 days the animals were sacrificed and the cryolesions were examined histologically. The cryoprobe enabled artifact-free MR imaging of the "iceball" formation during freezing of the rabbit liver. After 1 min of freezing, the iceball at the tip of the probe showed an average maximum diameter of 10.8 mm. No bleeding complications were observed during or after the freezing procedure. Histologic examination 7 days after cryotherapy confirmed that the liver lesions were the same size as had been predicted by the images of the acute iceball. This new, percutaneously inserted, MR-compatible, liquid-nitrogen cooled cryoprobe allows accurate, artifact-free MR imaging of interstitial cryotherapy.

Principles of high-spatial-resolution surface EMG (HSR-EMG): single motor unit detection and application in the diagnosis of neuromuscular disorders

The most detailed information about the structural and functional characteristics of the muscle can be gained from the single motor unit (MU) action potential. In addition, information about the activity of a single MU is essential for the diagnosis of neuromuscular disorders. Due to the low spatial resolution of conventional bipolar surface electromyography (EMG), the resulting signal is a superposition of a large number of simultaneous active MUs. The difficulty is in separating the activity of a single MU from simultaneous active adjacent MUs. In contrast to other non-invasive EMG procedures, the high-spatial-resolution-EMG (HSR-EMG), which is based on the use of a multi-electrode array in combination with a spatial filter procedure, allows the detection of single MU activity in a non-invasive way. It opens access to the excitation spread and enables the determination of the conduction velocity in single MUs, and the localization of the endplate region. In addition, HSR-EMG detects changes in the electrical activities of the MUs which are typical in neuromuscular disorders. Using HSR-EMG it was possible to identify 97% of all investigated volunteers and patients with muscular or neuronal disorders. Therefore, HSR-EMG is suitable as a tool for the non-invasive diagnosis of neuromuscular disorders.

Abnormal postprandial duodenal chyme transport in patients with long standing insulin dependent diabetes mellitus

BACKGROUND

Patients with long standing diabetes mellitus frequently have upper gut dysmotility. Gastroparesis has been well studied, whereas detailed data on duodenal motor function are limited.

AIMS

To characterise postprandial duodenal chyme transport in such patients.

METHODS

Intraluminal multiple impedance measurement, recently introduced as a novel technique for investigation of chyme transport, was used to study postprandial duodenal chyme flow in 10 patients with long standing insulin dependent diabetes mellitus with gastroparesis, and 10 healthy volunteers.

RESULTS

Four distinct transport patterns of chyme, termed bolus transport events (BTEs), were found in both groups and could be characterised as: short distance propulsive; simple long distance propulsive; retrograde; and complex long distance propulsive. Diabetic patients had significantly lower numbers of propulsive BTEs (p < 0.01), and higher proportions of retrograde BTEs and complex long distance BTEs (p < 0.05) than control subjects, whereas the proportion of simple long distance BTEs was significantly lower (p < 0.05). The mean propagation velocities of the BTEs were similar in both groups.

CONCLUSION

Abnormal postprandial duodenal chyme transport was found in patients with long standing insulin dependent diabetes mellitus. This is characterised by transport disorganisation and may result in disturbed chyme clearance.

Diagnostic yield of noninvasive high spatial resolution electromyography in neuromuscular diseases

High Spatial Resolution electromyography (HSR-EMG), a new kind of noninvasive surface EMG based on a spatial filtering technique, was evaluated with respect to the diagnosis of neuromuscular diseases. HSR-EMG measurements were recorded from 61 healthy subjects and 72 patients with different neuromuscular diseases and analyzed quantitatively. The results indicate that a few parameters such as muscular conduction velocity, dwell time over root mean square, autocorrelation function, and chi-value are sufficient to recognize and classify specific signal alterations due to neuromuscular disorders. A diagnostic evaluation procedure calculating automatically the most probable diagnosis from the parameter results could assign the correct diagnosis to about 81% of the investigated patients and healthy subjects. Myopathic disorders were recognized with a sensitivity of 85% (specificity: 97%), neuropathic disorders with a sensitivity of 68% (specificity: 98%). We conclude that HSR-EMG shows a diagnostic validity similar to that described in literature for needle EMG. Moreover, the noninvasive technique provides the advantage of a simple and painless application.

Dynamics of esophageal bolus transport in healthy subjects studied using multiple intraluminal impedancometry

The dynamics of a bolus transport through the esophagus are largely unexplored. To study this physiological process, we applied multiple intraluminal impedancometry in 10 healthy subjects. Three different protocols were used: 1) liquid bolus administered with subject supine, 2) liquid bolus with subject upright, or 3) semisolid bolus with subject supine. Transit of different parts of a bolus (bolus head, body, and tail) was analyzed at different anatomic segments, namely the pharynx and the proximal, middle, and distal thirds of the esophagus. A characteristic pattern of bolus transport was seen in all subjects. Impedance changes related to air were observed preceding the bolus head. The bolus head propelled significantly faster than did the bolus body and tail. Pharyngeal bolus transit was significantly faster than esophageal bolus transit. Within the esophagus, bolus propulsion velocity gradually decreased. Bolus transport was significantly accelerated in the upright position and delayed with increase of bolus viscosity. In conclusion, the dynamics of a bolus transport from the pharynx into the stomach are complex. It varies within both different anatomic segments and different parts of the bolus and depends on bolus characteristics and test conditions. The spatial and temporal resolution of a bolus transport can be obtained by the impedance technique.

Design and validation of an intelligent patient monitoring and alarm system based on a fuzzy logic process model

The process of patient care performed by an anaesthesiologist during high invasive surgery requires fundamental knowledge of the physiologic processes and a long standing experience in patient management to cope with the inter-individual variability of the patients. Biomedical engineering research improves the patient monitoring task by providing technical devices to measure a large number of a patient's vital parameters. These measurements improve the safety of the patient during the surgical procedure, because pathological states can be recognised earlier, but may also lead to an increased cognitive load of the physician. In order to reduce cognitive strain and to support intra-operative monitoring for the anaesthesiologist an intelligent patient monitoring and alarm system has been proposed and implemented which evaluates a patient's haemodynamic state on the basis of a current vital parameter constellation with a knowledge-based approach. In this paper general design aspects and evaluation of the intelligent patient monitoring and alarm system in the operating theatre are described. The validation of the inference engine of the intelligent patient monitoring and alarm system was performed in two steps. Firstly, the knowledge base was validated with real patient data which was acquired online in the operating theatre. Secondly, a research prototype of the whole system was implemented in the operating theatre. In the first step, the anaesthetists were asked to enter a state variable evaluation before a drug application or any other intervention on the patient into a recording system. These state variable evaluations were compared to those generated by the intelligent alarm system on the same vital parameter constellations. Altogether 641 state variable evaluations were entered by six different physicians. In total, the sensitivity of alarm recognition is 99.3%, the specificity is 66% and the predictability is 45%. The second step was performed using a research prototype of the system in anaesthesiological routine. The evaluation of 684 events yielded a sensitivity, specificity and predictability of the alarm recognition of more than 99%.

The Impact of 3-D Video Endoscopy on Binocular Perception and Visually Guided Manipulation

Monocular video endoscopic systems are established in the clinical routine of surgical endoscopy. The introduction of 3-D video systems could improve visualisation of the intracorporal operating site because of the stereoscopic depth information. The goal of our investigations has been to quantify the influence of this visualisation technology on visual perception, on visually controlled endoscopic manipulations, and on the intraoperative performance, including ergonomic and psychophysical aspects. These results are used to define guidelines for improvement and for the integration of such systems into clinical routine so as to achieve optimal support of the medical team.

The comparison of 2-D and 3-D video endoscopic systems showed a general improvement in the performance of endoscopic procedures. However, 30% – 50% of the users had perceptive problems with 3-D endoscopy. To study the problems quantitatively, we compared the case of stereoscopic visualisation with the real situation of direct view onto the specific objects. The users with problems had insufficient binocular depth perception of stereoscopic images for visual discrimination tasks, although their depth perception of real objects was good. Analysis of their eye movements showed significant differences compared with those of users with good binocular depth perception of stereo images. In particular, there were differences in the relation of vergence movements and accommodation. When we compared visually guided manipulations under stereoscopic video sight and direct view, we found the overall manipulative performance of all users to be the same, but the users with problems showed a lower performance in general.

The experimental design and the results are discussed in detail.

Improvement of spatial resolution in surface-EMG: a theoretical and experimental comparison of different spatial filters

The conventional bipolar surface electromyography (EMG) technique detects, due to its low spatial resolution, the superimposed electromyographic activity of a large number of motor units (MU's). In superficial muscles the isolated action potentials of the most superficial MU's can be recorded noninvasively by means of surface electrodes, if the method of spatial filtering, in connection with electrode arrays, is used. Up to now, only filters with an anisotropic transfer function have been used. As the surface potential distribution generated by the excitation of the MU's contains spatial frequencies in the anisotropic range of those filters, it can be assumed that isotropic spatial filters detect the single MU activity more effectively. In the present study, different isotropic and anisotropic filters have been compared by means of theoretical field simulations and experiments in volunteers. A tripole model for an excited MU was used as the basis for simulating the spatial extension of the filter response for each of the investigated filters. The spatial extension is an indicative of the spatial resolution. For the experimental validation, the total number of single motor units was not directly investigated, but the signal-to-noise ratio (SNR) has been determined. Therefore, the potential distribution generated on the skin surface during maximum voluntary contraction has been simultaneous spatially filtered with each of the investigated filters. The simulations show that an isotropic spatial filtering procedure reduces the spatial extension of the filter response and improves the spatial resolution of the EMG-recording arrangement in comparison to anisotropic spatial filters up to 30%. In other words, the spatial selectivity of the arrangement is increased. This improvement in the filter performance is more pronounced for MU's located close to the skin surface than for MU's more distantly located. Additionally, this theoretical improvement in selectivity depends on the direction of the excitation spread relative to the filter alignment. However, the investigations also show that isotropic filters offer an advantage, compared to anisotropic filters, only when the investigated MU is located extremely close to the filter input. The results of the simulations can be confirmed by the experimental investigations. An improvement of 11% in the SNR, relative to anisotropic spatial filters, can be established when using an isotropic spatial filter. This experimental improvement in selectivity is less than the theoretical improvement because the experimentally investigated MU's have less portion in the anisotropic range of the filters than the simulated one at best.

Approach to computer-based medication planning and coordination support in intensive care units

Due to more and more complex diagnosis and therapy measures, the critical care of patients requires an extensive work organisation which comprises patient, doctors, nurses and external services (e.g., central laboratory). In this organisation, the documentation plays a major role for the planning and coordination of work procedures and information flow within the medical staff. Various studies in intensive care units (ICU) reveal that the complex work organisation and the related information flow are faulty. Breakdowns are often caused by a lack of coordination between doctors and nurses and by poor transparency of work procedures. A typical example is the incorrect application of a doctor's medication orders by a nurse because she might have overseen a plan modification. This intransparency increases the strain on the medical staff and might result in critical effects on the patient. One approach to design a computer support for medication planning as well as the coordination when executing medication plans is given by work flow models. This paper shows that work flow models could be used to improve deficiencies in medication planning and coordination. Furthermore, it is demonstrated how such a support can be mediated to the user through an appropriately designed user interface.

A novel implantable electromechanical ventricular assist device. First acute animal testing

A novel ventricular assist device (HIA-EMLVAD-AT1, Helmholtz Institute Aachen-Electromechanical Left Ventricular Assist Device-Animal Test Version 1), driven by a uniformly and unidirectionally rotating actuator and a patented hypocycloidic pusherplate displacement gear unit, was developed and tested in an acute animal experiment. The excellent free filling behavior of the pump chamber with a stroke volume of 65 ml is obtained by a 2:3 ejection-filling time relationship. The uniform motor rotation facilitates simple sensorless pre and afterload detection by motor current analysis. In contrast to common apical cannulation, the inlet cannula was placed via the left atrium through the mitral valve into the left ventricle. This connection mode is preferable for left ventricular recovery and preservation. Left atrial, left ventricular, and aortic pressure curves, as well as pulmonary artery flow data, were obtained. The data show very effective unloading of the natural ventricle and demonstrate the feasibility of this novel assist device. Directions for further improvement of technical features were also identified.

A new blood pump for cardiopulmonary bypass: the HiFlow centrifugal pump

Centrifugal blood pumps are considered to be generally superior to the traditionally used roller pumps in cardiopulmonary bypass. In our institute a new lightweight centrifugal sealless blood pump with a unique spherical thrust bearing and with a magnetic coupling was developed, the HiFlow. The small design makes the pump suitable for applications in complex devices or close to a patient. Hemolysis tests were carried out in which the BioMedicus pump BP-80 and a roller pump were used as reference. The centrifugal pump HiFlow showed the least blood trauma within the group of investigated pumps. In summary, the HiFlow pump concept with its low priming volume and limited contact surfaces shows great potential for clinical applications in cardiopulmonary bypass. Also, the possibility of using the pump as a short-term assist device with an option of a pulsatile driving mode was demonstrated.

Noninvasive approach to motor unit characterization: muscle structure, membrane dynamics and neuronal control

The standard surface EMG reflects the compound activity of a high number of motor units which is finally due to its low spatial resolution in the detection of the potential distribution on the skin surface. Therefore, detailed information about the structural and functional characteristics of the muscle consisting of populations of motor units, like the functional anatomy, the excitation spread or the innervation pattern cannot be obtained from the standard surface EMG. A novel noninvasive EMG-procedure with high spatial resolution (HSR-EMG) allows in contrast to the standard surface EMG even the detection of the single motor unit activity. In this way, the noninvasive determination of detailed information about the muscle structure, the membrane dynamics and the neuronal control becomes possible. First applications of the HSR-EMG have shown that especially the noninvasively measured conduction velocity of the excitation is highly affected by physiological details, like the muscle temperature, the relative muscle fibre diameter or inhomogeneities in the connective tissue forming part of the volume conductor around the muscle. From the results of the HSR-EMG investigations it can be concluded that the information about the structural and functional characteristics of the muscle as well as a deeper insight in the active state of the muscle is essential for a correct interpretation of the standard surface EMG.