Present status of computer interpretation of the electrocardiogram: a 20 year overview

Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use

This article addresses the potential clinical value of techniques based on surface electromyography (sEMG) in rehabilitation medicine with specific focus on neurorehabilitation. Applications in exercise and sport pathophysiology, in movement analysis, in ergonomics and occupational medicine, and in a number of related fields are also considered. The contrast between the extensive scientific literature in these fields and the limited clinical applications is discussed. The "barriers" between research findings and their application are very broad, and are longstanding, cultural, educational, and technical. Cultural barriers relate to the general acceptance and use of the concept of objective measurement in a clinical setting and its role in promoting Evidence Based Medicine. Wide differences between countries exist in appropriate training in the use of such quantitative measurements in general, and in electrical measurements in particular. These differences are manifest in training programs, in degrees granted, and in academic/research career opportunities. Educational barriers are related to the background in mathematics and physics for rehabilitation clinicians, leading to insufficient basic concepts of signal interpretation, as well as to the lack of a common language with rehabilitation engineers. Technical barriers are being overcome progressively, but progress is still impacted by the lack of user-friendly equipment, insufficient market demand, gadget-like devices, relatively high equipment price and a pervasive lack of interest by manufacturers. Despite the recommendations provided by the 20-year old EU project on "Surface EMG for Non-Invasive Assessment of Muscles (SENIAM)," real international standards are still missing and there is minimal international pressure for developing and applying such standards. The need for change in training and teaching is increasingly felt in the academic world, but is much less perceived in the health delivery system and clinical environments. The rapid technological progress in the fields of sensor and measurement technology (including sEMG), assistive devices, and robotic rehabilitation, has not been driven by clinical demands. Our assertion is that the most important and urgent interventions concern enhanced education, more effective technology transfer, and increased academic opportunities for physiotherapists, occupational therapists, and kinesiologists.

Comparative diagnostic performance of the Telemed computer ECG program

One thousand consecutive ECG's from an ambulatory population of patients with suspected or proven cardiac disease were evaluated using two versions of the Telemed computerized ECG system. Only minor differences were found between the two programs. In version 6 vs. version 5, 87% vs. 90% of 287 normal ECG's were correctly classified and 93% vs. 96% of abnormal ECG's were correctly classified; the percent of acceptable diagnostic agreement was 86.2% and 87.4% respectively (NS). The sensitivity for arrhythmia detection, transmural inferior infarction and ST-T wave abnormalities was slightly greater in version 6. The increased sensitivity was not accompanied by decreased specificity. The sensitivity for left ventricular hypertrophy decreased from 95.2% to 91.4% in version 6 with a slight increase in specificity (95.2% to 97.0%). In conclusion, criteria changes in the most recent version of the Telemed program have not resulted in a major change in diagnostic performance. Arrhythmia detection is slightly but not significantly improved.

Electrocardiogram computer analysis. practical value of the IBM Bonner-2 (V2 MO) program

One thousand ECGs were selected from those taken from an adult population and analyzed by three cardiologists to assess the performance of the IBM Bonner-2 (V2 MO) program. The sample included 200 ECGs with 248 myocardial infarctions, 200 with conduction abnormalities, 100 with ventricular hypertrophy, 300 normals and 200 with electronic pacemakers. In the MI group, there was a total sensitivity of the program with respect to the readers of 88% (218/248) with 19 (8%) program errors and 90% (248/275) specificity. In 53 ECGs with two MI statements, the sensitivity was 89% (47/53). The sensitivity in conduction abnormalities was 93.4% (183/196) with 98.7% specificity (800/810). The sensitivity in LVH was 90% (74/81) and in RVH 83% (5/6). Among the normals, the specificity was 98.6% (289/293). The sensitivity to PVCs was 84% (56/67), to atrial fibrillation 87% (48/55), to SVCs 58.6% (17/29) and to electronic pacemakers 65% (127/196). Recognizing the limitations of this type of analysis, this study indicates that the V2 MO version compares favorably with the earlier versions of the same program and is a valuable aid in ECG interpretation with rapid acceptance by physicians.