A multiple-contact EMG recording array for mapping single muscle unit territories

The Efficacy and Duration of Onabotulinum Toxin A in Improving Upper Facial Expression Lines With 64-Unit Dose Optimization: A Systematic Review and Meta-Analysis With Trial Sequential Analysis of the Randomized Controlled Trials

BACKGROUND

Onabotulinumtoxin A (Onabot A) was the first treatment to be approved for aesthetic indications, namely glabellar lines (GLs), crow's feet lines (CFLs), and forehead lines (FHLs), with a cumulative dose of 64 U.

OBJECTIVES

The aim of this study was to conduct a meta-analysis to combine the available data for approved doses for GLs, CFLs, and FHLs to explore the effect and duration of simultaneous treatment with Onabot A.

METHODS

PubMed/MEDLINE, Embase, and other national clinical trial registries were searched for randomized controlled trials from January 2010 to July 2022. The meta-analysis, trial sequential analysis, and investigator-assessed time to return to nonresponder status in GLs, CFLs, and FHLs following Onabot A were plotted to elicit a cumulative dose-adjusted response curve based on Kaplan-Meier analysis with a log-rank test.

RESULTS

Fourteen randomized controlled trials were eligible for quantitative analysis. A total of 8369 subjects were recruited across the trials. The meta-analysis results show that Onabot A is very effective in reducing moderate to severe GLs, CFLs, and FHLs. The cumulative Z-curve for GLs, CFLs, and FHLs also exceeds the required information size (RIS). Kaplan-Meier analysis with a log-rank test demonstrated that simultaneous treatment of GLs, CFLs, and FHLs requires 182 days (95% CI = 179, 215 days) (P < 0.00002) to return to nonresponder status.

CONCLUSIONS

Treatment of the upper facial expression lines with Onabot A is effective, and the approved cumulative dose of 64 U gives longer-lasting effects.

LEVEL OF EVIDENCE: 1

Muscle and Limb Mechanics

Understanding of the musculoskeletal system has evolved from the collection of individual phenomena in highly selected experimental preparations under highly controlled and often unphysiological conditions. At the systems level, it is now possible to construct complete and reasonably accurate models of the kinetics and energetics of realistic muscles and to combine them to understand the dynamics of complete musculoskeletal systems performing natural behaviors. At the reductionist level, it is possible to relate most of the individual phenomena to the anatomical structures and biochemical processes that account for them. Two large challenges remain. At a systems level, neuroscience must now account for how the nervous system learns to exploit the many complex features that evolution has incorporated into muscle and limb mechanics. At a reductionist level, medicine must now account for the many forms of pathology and disability that arise from the many diseases and injuries to which this highly evolved system is inevitably prone. © 2017 American Physiological Society. Compr Physiol 7:429-462, 2017.

Methodological aspects of SEMG recordings for force estimation--a tutorial and review

Insight into the magnitude of muscle forces is important in biomechanics research, for example because muscle forces are the main determinants of joint loading. Unfortunately muscle forces cannot be calculated directly and can only be measured using invasive procedures. Therefore, estimates of muscle force based on surface EMG measurements are frequently used. This review discusses the problems associated with surface EMG in muscle force estimation and the solutions that novel methodological developments provide to this problem. First, some basic aspects of muscle activity and EMG are reviewed and related to EMG amplitude estimation. The main methodological issues in EMG amplitude estimation are precision and representativeness. Lack of precision arises directly from the stochastic nature of the EMG signal as the summation of a series of randomly occurring polyphasic motor unit potentials and the resulting random constructive and destructive (phase cancellation) superimpositions. Representativeness is an issue due the structural and functional heterogeneity of muscles. Novel methods, i.e. multi-channel monopolar EMG and high-pass filtering or whitening of conventional bipolar EMG allow substantially less variable estimates of the EMG amplitude and yield better estimates of muscle force by (1) reducing effects of phase cancellation, and (2) adequate representation of the heterogeneous activity of motor units within a muscle. With such methods, highly accurate predictions of force, even of the minute force fluctuations that occur during an isometric and isotonic contraction have been achieved. For dynamic contractions, EMG-based force estimates are confounded by the effects of muscle length and contraction velocity on force producing capacity. These contractions require EMG amplitude estimates to be combined with modeling of muscle contraction dynamics to achieve valid force predictions.

Sixty-four channel wearable acquisition system for long-term surface electromyogram recording with electrode arrays

The use of mono- and bi-dimensional electromyogram (EMG) electrode arrays for the assessment of the neuromuscular system can provide an insight into muscle physiology not achieved with classical bipolar surface EMG. Among the advantages of multichannel EMG detection, there is a) the possibility of estimating muscle fibre conduction velocity, even during motor tasks, and b) the possibility to increase the number of detection points on a muscle, improving the performance of pattern-based EMG decomposition methods. For these reasons, the development and use of multichannel surface EMG devices and techniques were chosen as the primary goals within the European RTD Project 'Neuromuscular assessment in the elderly worker' (NEW). The specific requirements of Project NEW called for the availability of a user-friendly, small-sized EMG acquisition system for field use, suitable for multichannel EMG recording using electrode arrays from one or more muscles. A market survey established that none of the commercially available EMG acquisition systems featured all the desired specifications, nor could they be easily adapted for specific use. The paper describes the design of an innovative acquisition system for long-term multichannel EMG recording fulfilling these requirements and comprising adhesive electrode arrays for artifact-free EMG acquisition during work activity and a portable, user-friendly, battery-powered acquisition system for multichannel EMG recording and storage on a removable PCMCIA card. The system has been used extensively within Project NEW for laboratory and field tests and can find applications in other fields of basic and applied research, including ergonomics, occupational and sports medicine.

Lateral rectus EMG and contractile responses elicited by cat abducens motoneurons

Stimulation of 41 single, abducens nucleus motoneurons in the cat evoked electromyographic (EMG) and contractile responses in the ipsilateral lateral rectus muscle. Separate, bipolar, fine wire EMG recording electrodes in the global and orbital muscle layers showed that 22 muscle units were confined to the global layer, 8 to the orbital layer, and 11 units were contained in both ("bilayer") muscle layers. "Bilayer" units demonstrated significantly greater twitch (P < or = 0.002) and maximum tetanic (P < or = 0.001) tensions as well as faster fusion frequencies (P < or = 0.022) than either global or orbital units. "Bilayer" units also showed the lowest average kt values (the slope of the linear relationship between motoneuron stimulation frequency and isometric tetanic tension). "Bilayer" units were predominantly fast fatigable (FF). Global units displayed all muscle unit types including all the nontwitch (NT) units. Orbital units were identified as slow fatigable (SF) and fast fatigue resistant (FR).

A topographical analysis of spectral electromyographic data of the human masseter muscle under different functional conditions in healthy subjects

In 20 healthy subjects, 16-channel surface electromyograms (EMG) were recorded with the mandible in its postural position, during compensation for forces applied from ipsilateral, contralateral and frontal positions, and during force-constant biting on a unilaterally placed force transducer. After artefact elimination, EMG power spectra were calculated on the basis of the original EMG curves via fast Fourier transformation. Using spectral EMG characteristics, EMG maps were computed by means of an interpolation algorithm and an imaging procedure. Spectral EMG maps were demonstrated for all the test conditions. Significant differences of myoelectrical activity were verified between the 16 electrode positions. Moreover, the levels and/or the topographical distributions of spectral EMG powers differed significantly between the test conditions. During biting as well as with contralaterally and frontally applied forces, the highest EMG activity was found in the inferior third of the masseter and the lowest in the superior third. With ipsilaterally applied forces, the topographical distribution of the total EMG power was completely changed. The power maximum was frequently demonstrated in the superior, especially the posterosuperior, third of the muscle, the minimum in the inferior third. In the postural position of the mandible, EMG activity decreased from the anterior to the posterior regions of the masseter. If the bite force or the horizontally applied forces were enhanced, EMG activity increased significantly but the EMG map structures were only changed in some details. The topographical distribution of myoelectrical activity demonstrated by EMG maps characterizes the intramuscular activation patterns of distinct masseter functions.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomization tests: application to single-cell and other single-unit neuroscience experiments

The application of randomization tests for statistical determination of the significance of experimental manipulations on single cells and other types of single units in neuroscience is described. Applications of standard parametric tests like analysis of variance (ANOVA) and t tests to data from single-subject experiments have been severely criticized for lack of validity and those criticisms are relevant to parametric statistical tests for data from other types of single-unit experiments. A broad class of statistical tests known as randomization tests, on the other hand, has been free of such criticism. Randomization tests have been applied to data from various types of single units in neuroscience, where their validity in the absence of random sampling makes them especially valuable. Until the advent of computers, the computational requirements of randomization tests rendered them impractical. Randomization test computer programs are now readily available. Procedures for access to a public domain program are given in the text.

In-series fiber architecture in long human muscles

The fiber architecture of adult human sartorius and gracilis muscles was examined using a combination of fiber microdissections and histological methods. Intact fibers were dissected from fascicles of muscle strips that were digested in nitric acid. All of these fibers terminate intrafascicularly by tapering to a fine strand at one or both ends. They measure 4-20 cm after correction for shrinkage. Systematic dissections of 1 cm long blocks sampled at intervals along the muscle length suggest that tapered fiber endings occur at all locations along the muscle but are most common centrally; here they accounted for up to 14% of dissected fibers in each block. Transverse sections of muscle confirm that fiber profiles with small diameters occur at all levels of the muscle but are especially common in sections more than 5 cm from its origin or insertion. The architectural arrangement demonstrated here suggests that long human muscles, like muscles in other species, are composed of relatively short, in-series fibers. This has many implications for the neural activation and force-developing behavior of these muscles that must be considered when paralyzed muscles are reanimated using electrical stimulation. Further, it may predispose long muscles to certain types of neuromuscular damage and dysfunction.

Functionally complex muscles of the cat hindlimb. V. The roles of histochemical fiber-type regionalization and mechanical heterogeneity in differential muscle activation

Several cat hindlimb muscles that exhibit differential activation (activity that is restricted to a specific region of muscle) during natural movements were studied to determine the possible roles of 1) non-uniform distribution of histochemically-identified muscle fiber-types (semitendinosus, ST; tibialis anterior, TA) or 2) mechanical heterogeneity (biceps femoris, BF; tensor fasciae latae, TFL). Using chronic recording techniques, electromyographic (EMG) activity was recorded from multiple sites of each muscle during treadmill locomotion, ear scratch, and paw shake. Standard histochemical analysis was performed on each muscle to determine fiber-type distribution. The histochemically regionalized muscles (ST and TA) were differentially active during slow locomotion; the deep regions (high in type I [SO] fibers) were active, but the superficial regions (high in type IIB [FG] fibers) were inactive. Vigorous movements (fast locomotion, ear scratch, paw shake) produced additional, synchronous activation of the superficial regions. In all movements, ST and TA activation patterns were consistent with the existence of identically timed synaptic inputs to all motoneurons within each motoneuron pool, resulting in an orderly recruitment of each whole pool. The differential activation recorded from ST and TA during slow locomotion was presumably a consequence of the non-uniform distribution of the different muscle fiber types. In contrast, differential activation of the histochemically nonregionalized, mechanically heterogeneous muscles (BF and TFL) resulted from non-synchronous activation of different muscle regions. The selective activation of BF or TFL compartments was indicative of differential synaptic inputs to, and selective recruitment of, subpopulations of the motoneuron pool, with each motoneuron subpopulation exclusively innervating physically separate regions of the muscle consistent with the regions defined by the neuromuscular territories of the major nerve branches supplying each muscle. Individual neuromuscular compartments of BF and TFL differ in their mechanical arrangements to the skeleton and in their contribution to mechanical action(s) at the hip and knee joints. Selective neural activation of mechanically distinct compartments within a mechanically heterogeneous muscle can provide highly advantageous mechanical "options" for animals that perform kinematically diverse movements. With regard to EMG recording techniques, the results of this study emphasize the need for carefully chosen EMG sampling sites and the value of knowing the muscle histochemistry, neuromuscular and musculoskeletal anatomy and possible mechanical functions prior to recording EMG.

Functionally complex muscles of the cat hindlimb. II. Mechanical and architectural heterogenity within the biceps femoris

The goal of this study was to analyze the architecture of the cat biceps femoris (BF), a multifunctional hamstring muscle, and to evaluate the relationships between muscle architecture, limb position, and muscle function during natural movement. The BF muscle consists of three neuromuscular compartments: anterior (BFa), middle (BFm) and posterior (BFp). Each compartment is innervated by a separate nerve branch. Nerve branch stimulation and 2-dimensional surface EMG recordings showed that individual compartment territories were discrete and non-overlapping with well-defined borders. Comparisons of the three compartments revealed consistent differences in architecture, relationship to the skeleton, and function. The BFa crossed only the hip joint and appears to function as a pure hip extensor. The BFm had equal lever arm lengths to the hip and knee joints, appears to function as a hip extensor, and may contribute to knee flexion or femoral rotation. The BFp had a greater lever arm to the knee, functions as a knee flexor, and may contribute to hip extension, femoral rotation or ankle extension. Measurements of individual fascicles from the three compartments revealed a surprising range of lengths, 3.3-12.0 cm. Microdissection of gold-stained tissue showed that fascicles from all compartments were comprised of interdigitated, short fibers (range: 0.6-5.0 cm; average 2.14 cm) arranged in-series in fascicles, running parallel to the origin-insertion axis of each muscle compartment. In regions of fiber interdigitation, the fiber endings were round and tapered (taper lengths: 1-11 mm) although flat, tapering endings like ribbons were occasionally found. As hip and knee joint angles were varied over physiological ranges corresponding to minimal to maximal muscle length, fascicles of the three compartments changed length disproportionately. Long BFa fascicles maximally lengthened 10-18%, consistent with in vivo length measures during treadmill locomotion. However, the long BFp fascicles lengthened 25-45%, and the relatively short fascicles near the BFm/BFp border maximally lengthened 45-53%. How do these unexpectedly large length changes affect sarcomere lengths? Using laser diffraction to measure sarcomeres, static fascicle and sarcomere lengths were compared in muscles that went into rigor mortis after fixing the hip and knee joint angles. Sarcomeres within the short BFm/BFp and long BFp fascicles consistently lengthened proportionately less than the whole fascicle. It remains to be determined how and where the fascicle length changes are dissipated in the connective tissue between the interdigitated muscle fibers and whether such a series-compliance operates during the large excursions over which this muscle normally works.

Architecture and consequent physiological properties of the semitendinosus muscle in domestic goats

Morphological and physiological analyses confirm that the semitendinosus muscle of goats contains two separate compartments in series, each with distinct innervation. These compartments of the muscle are in turn composed of short fibers (approximately four fibers in series in the proximal compartment and seven to eight fibers in the distal compartment) which overlap each other for more than 30% of their length, with much of the overlapping portions consisting of slender tails that terminate at one-tenth of the midfiber diameter. Groups of fibers are associated into relatively narrow bands that run end-to-end in each compartment. The data suggest that the maximum length of muscle fibers may be limited; even the fibers of parallel-fibered muscles may not scale with the dimension of the animal.