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Shiba T, Mizuta N, Hasui N, Kominami Y, Nakatani T, Taguchi J, Morioka S. Effect of bihemispheric transcranial direct current stimulation on distal upper limb function and corticospinal tract excitability in a patient with subacute stroke: a case study. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1250579. [PMID: 37732289 PMCID: PMC10507690 DOI: 10.3389/fresc.2023.1250579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
Introduction Activation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke. Methods In this single-case retrospective study, the Fugl-Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15-30 Hz, which reflects corticospinal tract excitability. Results The results indicated that bihemispheric tDCS improved the Fugl-Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke.
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Affiliation(s)
- Takahiro Shiba
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Aichi, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Yohei Kominami
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Junji Taguchi
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, Hyogo, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
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Yang H, Li B, Feng L, Zhang Z, Liu X. Effects of health qigong exercise on upper extremity muscle activity, balance function, and quality of life in stroke patients. Front Neurosci 2023; 17:1208554. [PMID: 37539378 PMCID: PMC10394517 DOI: 10.3389/fnins.2023.1208554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction This study explored the effects of Qigong exercises on upper extremity muscle activity, balance function, and quality of life in stroke patients. Methods A total of 30 stroke patients were randomly allocated to either control group or Qigong group. In the Qigong group, participants completed an intervention of Qigong Baduanjin over 8 weeks. Data on the electromyographic activities of the biceps brachii muscle, triceps brachii muscle, and muscle coordination were obtained using surface electromyography and the co-contraction ratio (CCR). Data on balance were obtained using the PK254P balance function detection system. Quality of life was measured using the brief version of the World Health Organization Quality of Life scale. Results The results for the Qigong group showed a significant difference in CCR of the triceps brachii muscle (p < 0.01). Concerning balance (assessed using the open-eye test), there was a significant decrease (p < 0.05) in Y-axis trajectory deviations and the Y-axis speed in the Qigong group. In the closed-eye test, the peripheral area of the Qigong group was significantly lower than that of the control group (p < 0.05). Significant differences were also observed in physical health (p < 0.05), psychological health (p < 0.01), environment (p < 0.01), and the total scores for quality of life (p < 0.01) in the Qigong group. Discussion We conclude that Qigong exercises improve the quality of life in stroke patients and have positive effects on the coordination of limb extremities and balance function.
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Affiliation(s)
- Huixin Yang
- Institute of Nation Traditional Sport, Harbin Sport University, Harbin, China
| | - Baolong Li
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Lin Feng
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Zhonglou Zhang
- Institute of Nation Traditional Sport, Harbin Sport University, Harbin, China
| | - Xiaolei Liu
- Chinese Traditional Regimen Exercise Intervention Research Center, Beijing Sport University, Beijing, China
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Delcamp C, Gasq D, Cormier C, Amarantini D. Corticomuscular and intermuscular coherence are correlated after stroke: a simplified motor control? Brain Commun 2023; 5:fcad187. [PMID: 37377979 PMCID: PMC10292907 DOI: 10.1093/braincomms/fcad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 05/11/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
During movement, corticomuscular coherence is a measure of central-peripheral communication, while intermuscular coherence is a measure of the amount of common central drive to the muscles. Although these two measures are modified in stroke subjects, no author has explored a correlation between them, neither in stroke subjects nor in healthy subjects. Twenty-four chronic stroke subjects and 22 healthy control subjects were included in this cohort study, and they performed 20 active elbow extension movements. The electroencephalographic and electromyographic activity of the elbow flexors and extensors were recorded. Corticomuscular and intermuscular coherence were calculated in the time-frequency domain for each limb of stroke and control subjects. Partial rank correlations were performed to study the link between these two variables. Our results showed a positive correlation between corticomuscular and intermuscular coherence only for stroke subjects, for their paretic and non-paretic limbs (P < 0.022; Rho > 0.50). These results suggest, beyond the cortical and spinal hypotheses to explain them, that stroke subjects present a form of simplification of motor control. When central-peripheral communication increases, it is less modulated and more common to the muscles involved in the active movement. This motor control simplification suggests a new way of understanding the plasticity of the neuromuscular system after stroke.
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Affiliation(s)
- Célia Delcamp
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier, 31062 Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier, 31062 Toulouse, France
- Department of Functional Physiological Explorations, University Hospital of Toulouse, Hôpital de Rangueil, 31400 Toulouse, France
| | - Camille Cormier
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, Université Paul Sabatier, 31062 Toulouse, France
- Department of Functional Physiological Explorations, University Hospital of Toulouse, Hôpital de Rangueil, 31400 Toulouse, France
| | - David Amarantini
- Correspondence to: David Amarantini Unité ToNIC, UMR 1214, CHU PURPAN – Pavillon BAUDOT Place du Dr Joseph Baylac, 31024 Toulouse Cedex 3, France E-mail:
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Variational mode decomposition for surface and intramuscular EMG signal denoising. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Delcamp C, Cormier C, Chalard A, Amarantini D, Gasq D. Changes in intermuscular connectivity during active elbow extension reveal a functional simplification of motor control after stroke. Front Neurosci 2022; 16:940907. [PMID: 36278013 PMCID: PMC9583396 DOI: 10.3389/fnins.2022.940907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Stroke alters muscle co-activation and notably leads to exaggerated antagonist co-contraction responsible for impaired motor function. However, the mechanisms underlying this exaggerated antagonist co-contraction remain unclear. To fill this gap, the analysis of oscillatory synchronicity in electromyographic signals from synergistic muscles, also called intermuscular coherence, was a relevant tool. Objective This study compares functional intermuscular connectivity between muscle pairs of the paretic and non-paretic upper limbs of stroke subjects and the dominant limb of control subjects, concomitantly between two muscle pairs with a different functional role, through an intermuscular coherence analysis. Methods Twenty-four chronic stroke subjects and twenty-four healthy control subjects were included. Subjects performed twenty elbow extensions while kinematic data and electromyographic activity of both flexor and extensor elbow muscles were recorded. Intermuscular coherence was analyzed in the beta frequency band compared to the assessment of antagonist co-contraction. Results Intermuscular coherence was higher in the stroke subjects’ paretic limbs compared to control subjects. For stroke subjects, the intermuscular coherence of the antagonist-antagonist muscle pair (biceps brachii—brachioradialis) was higher than that of the agonist-antagonist muscle pair (triceps brachii—brachioradialis). For the paretic limb, intermuscular coherence of the antagonist-antagonist muscle pair presented a negative relationship with antagonist co-contraction. Conclusion Differences in intermuscular coherence between the paretic limbs of stroke subjects and control subjects suggest a higher common central drive during movement. Furthermore, results highlight the association between stroke-related alteration of intermuscular functional connectivity and the alteration of motor function.
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Affiliation(s)
- Célia Delcamp
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Camille Cormier
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
- Department of Functional Physiological Explorations, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Alexandre Chalard
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
| | - David Amarantini
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
- *Correspondence: David Amarantini,
| | - David Gasq
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
- Department of Functional Physiological Explorations, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
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Chen CPC, Suputtitada A, Chatkungwanson W, Seehaboot K. Anterior or Posterior Ankle Foot Orthoses for Ankle Spasticity: Which One Is Better? Brain Sci 2022; 12:brainsci12040454. [PMID: 35447984 PMCID: PMC9027033 DOI: 10.3390/brainsci12040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Ankle foot orthoses (AFOs) are commonly used by stroke patients to walk safely and efficiently. Both posterior AFOs (PAFOs) and anterior AFOs (AAFOs) are available. The objective of this study was to compare the efficacy of AAFOs and PAFOs in the treatment of ankle spasticity. Materials and Methods: A crossover design with randomization for the interventions and blinded assessors was used. Twenty patients with chronic stroke, a Modified Ashworth Scale (MAS) score of the ankle joint of 2, and a Tardieu angle ≥20 degrees were recruited. The patients were assigned to wear either an AAFO or PAFO at random and subsequently crossover to the other AFO. Results: Twenty stroke patients with ankle spasticity were recruited. The mean age was 46.60 (38−60) years. The mean time since stroke onset was 9.35 (6−15) months. It was discovered that the AAFO improved walking speed as well as the stretch reflex dynamic electromyography (dEMG) and walking dEMG amplitudes of the medial gastrocnemius muscles more significantly than the PAFO (p < 0.05). Conclusions: The AAFO had greater efficacy in reducing both static and dynamic ankle spasticity, and allowed for faster walking than the PAFO. The stretch reflex and walking dEMG amplitudes could be used for quantitative spasticity assessment.
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Affiliation(s)
- Carl P. C. Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan;
| | - Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
- Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Correspondence: or
| | - Watchara Chatkungwanson
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Kittikorn Seehaboot
- Division of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
- Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Merlo A, Bò MC, Campanini I. Electrode Size and Placement for Surface EMG Bipolar Detection from the Brachioradialis Muscle: A Scoping Review. SENSORS 2021; 21:s21217322. [PMID: 34770627 PMCID: PMC8587451 DOI: 10.3390/s21217322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022]
Abstract
The brachioradialis muscle (BRD) is one of the main elbow flexors and is often assessed by surface electromyography (sEMG) in physiology, clinical, sports, ergonomics, and bioengineering applications. The reliability of the sEMG measurement strongly relies on the characteristics of the detection system used, because of possible crosstalk from the surrounding forearm muscles. We conducted a scoping review of the main databases to explore available guidelines of electrode placement on BRD and to map the electrode configurations used and authors’ awareness on the issues of crosstalk. One hundred and thirty-four studies were included in the review. The crosstalk was mentioned in 29 studies, although two studies only were specifically designed to assess it. One hundred and six studies (79%) did not even address the issue by generically placing the sensors above BRD, usually choosing large disposable ECG electrodes. The analysis of the literature highlights a general lack of awareness on the issues of crosstalk and the need for adequate training in the sEMG field. Three guidelines were found, whose recommendations have been compared and summarized to promote reliability in further studies. In particular, it is crucial to use miniaturized electrodes placed on a specific area over the muscle, especially when BRD activity is recorded for clinical applications.
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Affiliation(s)
- Andrea Merlo
- LAM-Motion Analysis Laboratory, S. Sebastiano Hospital, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Via Circondaria 29, 42015 Correggio, Italy;
- Merlo Bioengineering, 43100 Parma, Italy;
| | | | - Isabella Campanini
- LAM-Motion Analysis Laboratory, S. Sebastiano Hospital, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Via Circondaria 29, 42015 Correggio, Italy;
- Correspondence:
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Ranavolo A, Serrao M, Draicchio F. Critical Issues and Imminent Challenges in the Use of sEMG in Return-To-Work Rehabilitation of Patients Affected by Neurological Disorders in the Epoch of Human-Robot Collaborative Technologies. Front Neurol 2020; 11:572069. [PMID: 33414754 PMCID: PMC7783040 DOI: 10.3389/fneur.2020.572069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/30/2020] [Indexed: 01/07/2023] Open
Abstract
Patients affected by neurological pathologies with motor disorders when they are of working age have to cope with problems related to employability, difficulties in working, and premature work interruption. It has been demonstrated that suitable job accommodation plans play a beneficial role in the overall quality of life of pathological subjects. A well-designed return-to-work program should consider several recent innovations in the clinical and ergonomic fields. One of the instrument-based methods used to monitor the effectiveness of ergonomic interventions is surface electromyography (sEMG), a multi-channel, non-invasive, wireless, wearable tool, which allows in-depth analysis of motor coordination mechanisms. Although the scientific literature in this field is extensive, its use remains significantly underexploited and the state-of-the-art technology lags expectations. This is mainly attributable to technical and methodological (electrode-skin impedance, noise, electrode location, size, configuration and distance, presence of crosstalk signals, comfort issues, selection of appropriate sensor setup, sEMG amplitude normalization, definition of correct sEMG-related outcomes and normative data) and cultural limitations. The technical and methodological problems are being resolved or minimized also thanks to the possibility of using reference books and tutorials. Cultural limitations are identified in the traditional use of qualitative approaches at the expense of quantitative measurement-based monitoring methods to design and assess ergonomic interventions and train operators. To bridge the gap between the return-to-work rehabilitation and other disciplines, several teaching courses, accompanied by further electrodes and instrumentations development, should be designed at all Bachelor, Master and PhD of Science levels to enhance the best skills available among physiotherapists, occupational health and safety technicians and ergonomists.
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Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
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Xiao F, Yang D, Guo X, Wang Y. VMD-based denoising methods for surface electromyography signals. J Neural Eng 2019; 16:056017. [PMID: 31323653 DOI: 10.1088/1741-2552/ab33e4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Since noise is inevitably introduced during the measurement process of surface electromyographic (sEMG) signals, two novel methods for denoising based on the variational mode decomposition (VMD) method were proposed in this work. Prior to this study, there has been no literature relating to how VMD is applied to sEMG denoising. APPROACH The first proposed method uses the VMD method to decompose the signal into multiple variational mode functions (VMFs), each of which has its own center frequency and narrow band, and then the wavelet soft thresholding (WST) method is applied to each VMF. This method is termed the VMD-WST. The second proposed method uses the VMD method to decompose the signal into multiple VMFs, and then the soft interval thresholding (SIT) method is performed on each VMF, which is abbreviated as VMD-SIT. Ten healthy subjects and ten stroke patients participated in the experiment, and the sEMG signals of bicep brachii were measured and analyzed. In this paper, three methods are used for quantitative evaluation of the filtering performance: the signal-to-noise ratio (SNR), root mean square error and R-squared value. The proposed two methods (VMD-WST, VMD-SIT) are compared with the empirical mode decomposition (EMD) method and the wavelet method. MAIN RESULTS The experimental results showed that the VMD-WST and VMD-SIT methods can effectively filter the noise effect, and the denoising effects were better than the EMD method and the wavelet method. The VMD-SIT method has the best performance. SIGNIFICANCE This study provides a new means of eliminating the noise of sEMG signals based on the VMD method, and it can be applied in the fields of limb movement classification, disease diagnosis, human-machine interaction and so on.
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Affiliation(s)
- Feiyun Xiao
- School of Mechanical Engineering, Hefei University of Technology, Hefei 230009, People's Republic of China
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Mesin L. Single channel surface electromyogram deconvolution to explore motor unit discharges. Med Biol Eng Comput 2019; 57:2045-2054. [PMID: 31350669 DOI: 10.1007/s11517-019-02010-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
Abstract
Interference surface electromyogram (EMG) reflects many bioelectric properties of active motor units (MU), which are however difficult to estimate due to the asynchronous summation of their discharges. This paper introduces a deconvolution technique to estimate the cumulative firings of MUs. Tests in simulations show that the power spectral density of the estimated MU firings has a low-frequency peak corresponding to the mean firing rate of MUs in the detection volume of the recording system, weighted by the amplitudes of MU action potentials. The peak increases in amplitude and its centroid shifts to a higher frequency when MU synchronization is simulated (mainly due to the shift of discharges of large MUs). The peak is found even at high force levels, when such a contribution does not emerge from the EMG. This result is also confirmed in preliminary applications to experimental data. Moreover, the simulated cumulative firings of MUs are estimated with a correlation above 90% (considering frequency contributions up to 150 Hz), for all force levels. The method requires a single EMG channel, thus being feasible even in applied studies using simple recording systems. It may open many potential applications, e.g., in the study of the modulation of MU firing rate induced by either fatigue or pathology and in coherency analysis. Graphical Abstract Examples of application of the deconvolution (Deconv) algorithm and comparison with the cumulative firings and the cumulated weighted firings (CWF, i.e., each firing pattern is weighted by the root mean squared amplitude of the corresponding MU action potential). Portions of data are shown on the left, the power spectral densities (PSD) on the right (Welch method applied to 3 s of data, sub-epochs of 0.5 s, mean value removed from each of them, 50% of overlap). A) Simulated signal (50% of maximal voluntary contraction, MVC) with random MU firings. B) Simulated signal (50% MVC) with a level of synchronization equal to 10%. C) Experimental data from vastus medialis at 40% MVC (data decomposed by the algorithm of Holobar and Zazula, IEEE Trans. Sig. Proc. 2007; PSD of the cumulated firings almost identical to that of CWF, as few MUs were identified).
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Affiliation(s)
- Luca Mesin
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, Torino, 10129, Italy.
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