Surface electromyography does not accurately reflect rectus femoris activity during gait: impact of speed and crouch on vasti-to-rectus crosstalk

Position paper on how technology for human motion analysis and relevant clinical applications have evolved over the past decades: Striking a balance between accuracy and convenience

BACKGROUND

Over the past decades, tremendous technological advances have emerged in human motion analysis (HMA).

RESEARCH QUESTION

How has technology for analysing human motion evolved over the past decades, and what clinical applications has it enabled?

METHODS

The literature on HMA has been extensively reviewed, focusing on three main approaches: Fully-Instrumented Gait Analysis (FGA), Wearable Sensor Analysis (WSA), and Deep-Learning Video Analysis (DVA), considering both technical and clinical aspects.

RESULTS

FGA techniques relying on data collected using stereophotogrammetric systems, force plates, and electromyographic sensors have been dramatically improved providing highly accurate estimates of the biomechanics of motion. WSA techniques have been developed with the advances in data collection at home and in community settings. DVA techniques have emerged through artificial intelligence, which has marked the last decade. Some authors have considered WSA and DVA techniques as alternatives to "traditional" HMA techniques. They have suggested that WSA and DVA techniques are destined to replace FGA.

SIGNIFICANCE

We argue that FGA, WSA, and DVA complement each other and hence should be accounted as "synergistic" in the context of modern HMA and its clinical applications. We point out that DVA techniques are especially attractive as screening techniques, WSA methods enable data collection in the home and community for extensive periods of time, and FGA does maintain superior accuracy and should be the preferred technique when a complete and highly accurate biomechanical data is required. Accordingly, we envision that future clinical applications of HMA would favour screening patients using DVA in the outpatient setting. If deemed clinically appropriate, then WSA would be used to collect data in the home and community to derive relevant information. If accurate kinetic data is needed, then patients should be referred to specialized centres where an FGA system is available, together with medical imaging and thorough clinical assessments.

Nonlinear spatio-temporal filter to reduce crosstalk in bipolar electromyogram

Objective.The wide detection volume of surface electromyogram (EMG) makes it prone to crosstalk, i.e. the signal from other muscles than the target one. Removing this perturbation from bipolar recordings is an important open problem for many applications.Approach.An innovative nonlinear spatio-temporal filter is developed to estimate the EMG generated by the target muscle by processing noisy signals from two bipolar channels, placed over the target and the crosstalk muscle, respectively. The filter is trained on some calibration data and then can be applied on new signals. Tests are provided in simulations (considering different thicknesses of the subcutaneous tissue, inter-electrode distances, locations of the EMG channels, force levels) and experiments (from pronator teres and flexor carpi radialis of 8 healthy subjects).Main results.The proposed filter allows to reduce the effect of crosstalk in all investigated conditions, with a statistically significant reduction of its root mean squared of about 20%, both in simulated and experimental data. Its performances are also superior to those of a blind source separation method applied to the same data.Significance.The proposed filter is simple to be applied and feasible in applications in which single bipolar channels are placed over the muscles of interest. It can be useful in many fields, such as in gait analysis, tests of myoelectric fatigue, rehabilitation with EMG biofeedback, clinical studies, prosthesis control.

Estimation of Lower Extremity Muscle Activity in Gait Using the Wearable Inertial Measurement Units and Neural Network

The inertial measurement unit (IMU) has become more prevalent in gait analysis. However, it can only measure the kinematics of the body segment it is attached to. Muscle behaviour is an important part of gait analysis and provides a more comprehensive overview of gait quality. Muscle behaviour can be estimated using musculoskeletal modelling or measured using an electromyogram (EMG). However, both methods can be tasking and resource intensive. A combination of IMU and neural networks (NN) has the potential to overcome this limitation. Therefore, this study proposes using NN and IMU data to estimate nine lower extremity muscle activities. Two NN were developed and investigated, namely feedforward neural network (FNN) and long short-term memory neural network (LSTM). The results show that, although both networks were able to predict muscle activities well, LSTM outperformed the conventional FNN. This study confirms the feasibility of estimating muscle activity using IMU data and NN. It also indicates the possibility of this method enabling the gait analysis to be performed outside the laboratory environment with a limited number of devices.

A Mobile Cable-Tensioning Platform to Improve Crouch Gait in Children with Cerebral Palsy

Gait impairment represented by crouch gait is the main cause of decreases in the quality of lives of children with cerebral palsy. Various robotic rehabilitation interventions have been used to improve gait abnormalities in the sagittal plane of children with cerebral palsy, such as excessive flexion in the hip and knee joints, yet in few studies have postural improvements in the coronal plane been observed. The aim of this study was to design and validate a gait rehabilitation system using a new cable-driven mechanism applying assist in the coronal plane. We developed a mobile cable-tensioning platform that can control the magnitude and direction of the tension vector applied at the knee joints during treadmill walking, while minimizing the inertia of the worn part of the device for less obstructing the natural movement of the lower limbs. To validate the effectiveness of the proposed system, three different treadmill walking conditions were performed by four children with cerebral palsy. The experimental results showed that the system reduced hip adduction angle by an average of 4.57 ± 1.79° compared to unassisted walking. Importantly, we also observed improvements of hip joint kinematics in the sagittal plane, indicating that crouch gait can be improved by postural correction in the coronal plane. The device also improved anterior and lateral pelvic tilts during treadmill walking. The proposed cable-tensioning platform can be used as a rehabilitation system for crouch gait, and more specifically, for correcting gait posture with minimal disturbance to the voluntary movement.

Surface EMG cross talk quantified at the motor unit population level for muscles of the hand, thigh, and calf

Cross talk is an important source of error in interpreting surface electromyography (EMG) signals. Here, we aimed at characterizing cross talk for three groups of synergistic muscles by the identification of individual motor unit action potentials. Moreover, we explored whether spatial filtering (single and double differential) of the EMG signals influences the level of cross talk. Three experiments were conducted. Participants (total 25) performed isometric contractions at 10% of the maximal voluntary contraction (MVC) with digit muscles and knee extensors and at 30% MVC with plantar flexors. High-density surface EMG signals were recorded and decomposed into motor unit spike trains. For each muscle, we quantified the cross talk induced to neighboring muscles and the level of contamination by the nearby muscle activity. We also estimated the influence of cross talk on the EMG power spectrum and intermuscular correlation. Most motor units (80%) generated significant cross-talk signals to neighboring muscle EMG in monopolar recording mode, but this proportion decreased with spatial filtering (50% and 42% for single and double differential, respectively). Cross talk induced overestimations of intermuscular correlation and has a small effect on the EMG power spectrum, which indicates that cross talk is not reduced with high-pass temporal filtering. Conversely, spatial filtering reduced the cross-talk magnitude and the overestimations of intermuscular correlation, confirming to be an effective and simple technique to reduce cross talk. This paper presents a new method for the identification and quantification of cross talk at the motor unit level and clarifies the influence of cross talk on EMG interpretation for muscles with different anatomy.NEW & NOTEWORTHY We proposed a new method for the identification and quantification of cross talk at the motor unit level. We show that surface EMG cross talk can lead to physiological misinterpretations of EMG signals such as overestimations in the muscle activity and intermuscular correlation. Cross talk had little influence on the EMG power spectrum, which indicates that conventional temporal filtering cannot minimize cross talk. Spatial filter (single and double differential) effectively reduces but not abolish cross talk.

Vision Affects Gait Speed but not Patterns of Muscle Activation During Inclined Walking-A Virtual Reality Study

While walking, our locomotion is affected by and adapts to the environment based on vision- and body-based (vestibular and proprioception) cues. When transitioning to downhill walking, we modulate gait by braking to avoid uncontrolled acceleration, and when transitioning to uphill walking, we exert effort to avoid deceleration. In this study, we aimed to measure the influence of visual inputs on this behavior and on muscle activation. Specifically, we aimed to explore whether the gait speed modulations triggered by mere visual cues after transitioning to virtually inclined surface walking are accompanied by changes in muscle activation patterns typical to those triggered by veridical (gravitational) surface inclination transitions. We used an immersive virtual reality system equipped with a self-paced treadmill and projected visual scenes that allowed us to modulate physical-visual inclination congruence parametrically. Gait speed and leg muscle electromyography were measured in 12 healthy young adults. In addition, the magnitude of subjective visual verticality misperception (SVV) was measured by the rod and frame test. During virtual (non-veridical) inclination transitions, vision modulated gait speed by (i) slowing down to counteract the excepted gravitational "boost" in virtual downhill inclinations and (ii) speeding up to counteract the expected gravity resistance in virtual uphill inclinations. These gait speed modulations were reflected in muscle activation intensity changes and associated with SVV misperception. However, temporal patterns of muscle activation were not affected by virtual (visual) inclination transitions. Our results delineate the contribution of vision to locomotion and may lead to enhanced rehabilitation strategies for neurological disorders affecting movement.

Multi-joint biomechanics during sloped walking in patients with developmental dysplasia of the hip

BACKGROUND

Developmental dysplasia of the hip is characterized by abnormal acetabular and femoral geometries that alter joint loading and increase the risk of hip osteoarthritis. Current understanding of biomechanics in this population remains isolated to the hip and largely focused on level-ground walking, which may not capture the variable loading conditions that contribute to symptoms and intra-articular damage.

METHODS

Thirty young adult females (15 with dysplasia) underwent gait analysis during level, 10° incline, and 10° decline walking while whole-body kinematics, ground reaction forces, and electromyography (EMG) were recorded. Low back, hip, and knee joint kinematics and internal joint moments were calculated using a 15-segment model and integrated EMG was calculated within the functional phases of gait. Dependent variables (peak joint kinematics, moments, and integrated EMG) were compared across groups with a one-way ANOVA with multiple comparisons controlled for using the Benjamini-Hochberg method (α = 0.05).

FINDINGS

During level and incline walking, patients with developmental dysplasia of the hip had significantly lower trunk flexion angles, lumbar and knee extensor moments, and erector spinae activity than controls. Patients with developmental dysplasia of the hip also demonstrated reduced rectus femoris activity during loading of level walking and increased gluteus maximus activity during mid-stance of decline walking.

INTERPRETATION

Patients with developmental dysplasia of the hip adopt compensations both proximal and distal to the hip, which vary depending on the slope of walking. Furthering the understanding of multi-joint biomechanical compensations is important for understanding the mechanism of osteoarthritis development as well as secondary conditions.

Inverse modelling to reduce crosstalk in high density surface electromyogram

Surface electromyogram (EMG) has a relatively large detection volume, so that it could include contributions both from the target muscle of interest and from nearby regions (i.e., crosstalk). This interference can prevent a correct interpretation of the activity of the target muscle, limiting the use of surface EMG in many fields. To counteract the problem, selective spatial filters have been proposed, but they reduce the representativeness of the data from the target muscle. A better solution would be to discard only crosstalk from the signal recorded in monopolar configuration (thus, keeping most information on the target muscle). An inverse modelling approach is here proposed to estimate the contributions of different muscles, in order to focus on the one of interest. The method is tested with simulated monopolar EMGs from superficial nearby muscles contracted at different force levels (either including or not model perturbations and noise), showing statistically significant improvements in information extraction from the data. The median over the entire dataset of the mean squared error in representing the EMG of the muscle under the detection electrode was reduced from 11.2% to 4.4% of the signal energy (5.3% if noisy data were processed); the median bias in conduction velocity estimation (from 3 monopolar channels aligned to the muscle fibres) was decreased from 2.12 to 0.72 m/s (1.1 m/s if noisy data were processed); the median absolute error in the estimation of median frequency was reduced from 1.02 to 0.67 Hz in noise free conditions and from 1.52 to 1.45 Hz considering noisy data.

A review on crosstalk in myographic signals

PURPOSE

Crosstalk in myographic signals is a major hindrance to the understanding of local information related to individual muscle function. This review aims to analyse the problem of crosstalk in electromyography and mechanomyography.

METHODS

An initial search of the SCOPUS database using an appropriate set of keywords yielded 290 studies, and 59 potential studies were selected after all the records were screened using the eligibility criteria. This review on crosstalk revealed that signal contamination due to crosstalk remains a major challenge in the application of surface myography techniques. Various methods have been employed in previous studies to identify, quantify and reduce crosstalk in surface myographic signals.

RESULTS

Although correlation-based methods for crosstalk quantification are easy to use, there is a possibility that co-contraction could be interpreted as crosstalk. High-definition EMG has emerged as a new technique that has been successfully applied to reduce crosstalk.

CONCLUSIONS

The phenomenon of crosstalk needs to be investigated carefully because it depends on many factors related to muscle task and physiology. This review article not only provides a good summary of the literature on crosstalk in myographic signals but also discusses new directions related to techniques for crosstalk identification, quantification and reduction. The review also provides insights into muscle-related issues that impact crosstalk in myographic signals.

SIAMOC position paper on gait analysis in clinical practice: General requirements, methods and appropriateness. Results of an Italian consensus conference

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field.

Optimal spatio-temporal filter for the reduction of crosstalk in surface electromyogram

OBJECTIVE

Crosstalk can pose limitations to the applications of surface electromyogram (EMG). Its reduction can help in the identification of the activity of specific muscles. The selectivity of different spatial filters was tested in the literature both in simulations and experiments: their performances are affected by many factors (e.g. anatomy, conduction properties of the tissues and dimension/location of the electrodes); moreover, they reduce crosstalk by decreasing the detection volume, recording data that represent only the activity of a small portion of the muscle of interest. In this study, an alternative idea is proposed, based on a spatio-temporal filter.

APPROACH

An adaptive method is applied, which filters both in time and among different channels, providing a signal that maximally preserves the energy of the EMG of interest and discards that of nearby muscles (increasing the signal to crosstalk ratio, SCR).

MAIN RESULTS

Tests with simulations and experimental data show an average increase of the SCR of about 2 dB with respect to the single or double differential data processed by the filter. This allows to reduce the bias induced by crosstalk in conduction velocity and force estimation.

SIGNIFICANCE

The method can be applied to few channels, so that it is useful in applicative studies (e.g. clinics, gate analysis, rehabilitation protocols with EMG biofeedback and prosthesis control) where limited and not selective information is usually available.

Longitudinal sequencing in intramuscular coordination: A new hypothesis of dynamic functions in the human rectus femoris muscle

The punctum fixum-punctum mobile model has been introduced in previous publications. It describes general principles of intersegmental neuromuscular succession patterns to most efficiently generate specific movement intentions. The general hypothesis of this study is that these principles—if they really do indicate a fundamental basis for efficient movement generation—should also be found in intramuscular coordination and should be indicated by “longitudinal sequencing” between fibers according to the principles of the punctum fixum-punctum mobile model. Based on this general hypothesis an operationalized model was developed for the rectus femoris muscle (RF), to exemplarily scrutinize this hypothesis for the RF. Electromyography was performed for 14 healthy male participants by using two intramuscular fine wire electrodes in the RF (placed proximal and distal), three surface electrodes over the RF (placed proximal, middle, and distal), and two surface electrodes over the antagonists (m. biceps femoris and m. semitendinosus). Three movement tasks were measured: kicking movements; deceleration after sprints; and passively induced backward accelerations of the leg. The results suggest that proximal fibers can be activated independently from distal fibers within the RF. Further, it was shown that the hypothesized function of “intramuscular longitudinal sequencing” does exist during dynamic movements. According to the punctum fixum-punctum mobile model, the activation succession between fibers changes direction (from proximal to distal or inversely) depending on the intentional context. Thus, the results seem to support the general hypothesis for the RF and could be principally in line with the operationalized “inter-fiber to tendon interaction model”.

Effect of aging on regional neuromuscular regulation within human rectus femoris muscle during stair ascent and descent

Our recent studies showed the rectus femoris (RF) muscle is regionally regulated during the level walking and this unique neuromuscular activation pattern is influenced by aging (Watanabe et al., 2014, 2016 J Biomech). We aimed to investigate and compare regional neuromuscular activation patterns along the RF muscle between the young and elderly during the stair walking. Fourteen young men (age: 20.4±1.0years) and 14 elderly men (age: 73.8±5.9years) performed the stair ascent and descent. Fifteen trials of three steps were performed for both stair ascent and descent. The spatial distribution of surface electromyography (EMG) within the RF muscle was assessed by central locus activation (CLA), which is calculated from 18 surface electrodes along the longitudinal line of the muscle. CLA was significantly moved along the muscle during the stair ascent and descent in both young and elderly (p<0.05). Significant differences in CLA were showed at the stance phase of the ascent (12.5±0.7 and 11.4±1.7cm from most proximal electrodes for the young and elderly, p<0.05) and at the swing phase of the descent (11.4±1.5 and 10.3±1.5cm from most proximal electrodes for the young and elderly, p<0.05). These results suggest that the regional neuromuscular activation within the RF muscle is affected by aging during the stair walking.

CONTRIBUTION OF MUSCLE TENSION FORCE TO MEDIAL KNEE CONTACT FORCE AT FAST WALKING SPEED

Fast walking is considered as a factor that causes pain in patients suffering from knee disorders. This study examined the effect of walking speed on the medial knee contact force and identified contributions to the muscle tension on the medial knee contact force during fast walking using musculoskeletal simulation analysis. The muscle contribution to the medial knee contact force was calculated based on the joint angles and ground reaction force for the normal and fast walking experiments of seven subjects. The muscle force and joint reaction force were used to estimate the medial knee contact force. Results showed, in average, 70% increase in medial knee contact force at the first peak and 34% increase at the second peak with a fast walking speed, compared to when they walked at a normal walking speed. The remarkable increase in the first peak was mainly contributed by the increase in the quadriceps force resisting the external knee flexion moment. In contrast, the moderate increase of second peak was contributed by the increase in the gastrocnemius muscle force. These results suggest that the increase in medial knee contact force at fast walking speeds is caused by the increased muscle force.

Changes in muscle activity in typically developing children walking with unilaterally induced equinus

BACKGROUND

Distinguishing changes in lower limb muscle activation during gait caused by abnormal motor control or adaptations to the presence of a fixed equinus remains a challenge. The objective of this study was to determine a threshold degree of equinus at which changes in muscle activity occur and to characterize adaptive patterns of muscle activity in typically developing children walking with unilateral induced equinus.

METHODS

Ten typically developing children were included. A customized orthosis was fitted to the right ankle. Five conditions of dorsiflexion limitation were evaluated: 10° dorsiflexion, 0°, 10°, 20° of plantar flexion and maximum plantar flexion. Muscle activity of the rectus femoris, vastus lateralis, hamstring, tibialis anterior and soleus muscles of both limbs was recorded.

FINDINGS

Significant changes in muscle activation and co-activation occurred from 10° of plantar flexion in the orthosis limb and from maximum plantar flexion in the contralateral limb. Soleus activation occurred prematurely in terminal swing and increased with the degree of equinus. Tibialis anterior activation was increased during initial and midswing and was decreased during terminal swing. From the -20° condition, hamstring activation was increased during the loading response. Vastus lateralis and rectus femoris activation was increased during stance phase. Similar changes in tibialis anterior and soleus activation occurred on the contralateral side. Changes in co-activation occurred in the soleus/tibialis anterior muscle pair in both limbs.

INTERPRETATION

This study provides indications regarding changes in muscle activity during simulation of equinus gait which should be helpful for therapeutic decision making.

Prolonged swing phase rectus femoris activity is not associated with stiff-knee gait in children with cerebral palsy: a retrospective study of 407 limbs

Prolonged swing phase rectus femoris (RF) activity has been implicated as a cause of stiff-knee gait (SKG) in children with cerebral palsy (CP) and continues to be cited as an indicator for RF intervention. The purpose of this study was to determine what, if any, association exists between abnormal RF activity during preswing, initial swing and/or midswing and SKG in children with CP. This retrospective analysis involved three examiners independently reviewing sagittal plane knee kinematic and RF surface electromyographic (EMG) data from 407 affected limbs of 234 pediatric patients with CP. Five kinematic parameters were rated by each examiner as normal or pathologic: peak knee flexion, knee range of motion during initial swing, total knee range of motion, peak knee flexion timing, and rate of knee flexion. These ratings were used to classify each limb into one of three groups: SKG, Borderline SKG, or Non-SKG. From a representative EMG tracing, RF activity was examined during: the first half of preswing, the latter 2/3 of initial swing, and midswing. Chi-squared tests were used to determine if significant associations existed between SKG and RF activation during these three subphases. There was no association between SKG and prolonged RF activity during the latter 2/3 of initial swing or during midswing. However, a significant relationship between SKG and RF activity during the first half of preswing was found (p<0.001). Neither prolonged RF activity during initial swing, nor the presence of RF activity during midswing, were associated with SKG, thus refuting these commonly held associations.

Task-dependent inhomogeneous muscle activities within the bi-articular human rectus femoris muscle

The motor nerve of the bi-articular rectus femoris muscle is generally split from the femoral nerve trunk into two sub-branches just before it reaches the distal and proximal regions of the muscle. In this study, we examined whether the regional difference in muscle activities exists within the human rectus femoris muscle during maximal voluntary isometric contractions of knee extension and hip flexion. Surface electromyographic signals were recorded from the distal, middle, and proximal regions. In addition, twitch responses were evoked by stimulating the femoral nerve with supramaximal intensity. The root mean square value of electromyographic amplitude during each voluntary task was normalized to the maximal compound muscle action potential amplitude (M-wave) for each region. The electromyographic amplitudes were significantly smaller during hip flexion than during knee extension task for all regions. There was no significant difference in the normalized electromyographic amplitude during knee extension among regions within the rectus femoris muscle, whereas those were significantly smaller in the distal than in the middle and proximal regions during hip flexion task. These results indicate that the bi-articular rectus femoris muscle is differentially controlled along the longitudinal direction and that in particular the distal region of the muscle cannot be fully activated during hip flexion.