1
|
Paskaranandavadivel N, Varghese C, Lara J, Ramachandran S, Cheng L, Holobar A, Gharibans A, Bissett I, Collinson R, Stinear C, O'Grady G. A Novel High-Density Electromyography Probe for Evaluating Anorectal Neurophysiology: Design, Human Feasibility Study, and Validation with Trans-Sacral Magnetic Stimulation. Ann Biomed Eng 2020; 49:502-514. [PMID: 32737639 DOI: 10.1007/s10439-020-02581-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
Fecal incontinence (FI) substantially impairs quality of life and imparts a major socioeconomic burden. Anal sphincter injury and possibly pudendal nerve damage are considered common causes, however, current clinical methods for evaluating their function remain suboptimal. Electromyography (EMG) and pudendal nerve terminal latencies have been applied with some success, but are not considered standard practice due to uncertain accuracy and clinical value. In this study we developed and applied a novel anorectal high-density (HD) EMG probe in humans and pigs to acquire quantitative electrophysiological metrics of the anorectum. In the human trial we assessed somatic pathways and showed that EMG amplitude was greater for tight voluntary squeezes than light voluntary squeezes (0.03 ± 0.02 mV vs. 0.05 ± 0.03 mV). In a porcine model we applied trans-sacral magnetic stimulation to evoke extrinsically activated involuntary pathways and the resulting motor evoked potentials (MEP) were captured using the HD-EMG probe. The mean MEP amplitude at 50% magnetic stimulation intensity output (MSO) was significantly lower that the MEP amplitude at 85, 95 and 100% MSO (1.52 ± 0.50 mV vs. 3.10 ± 0.60 mV). In conclusion, the use of HD-EMG probe in conjunction with trans-sacral magnetic stimulation, for spatiotemporal mapping of anorectal EMG and MEP activity is anticipated to achieve new insights into FI and could offer improved diagnostic and prognostic biomarkers for anorectal dysfunction.
Collapse
Affiliation(s)
- Niranchan Paskaranandavadivel
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
- Department of Surgery, University of Auckland, Auckland, New Zealand.
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jaime Lara
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Shasti Ramachandran
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Vanderbilt University, Nashville, TN, USA
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Armen Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | | | - Cathy Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
2
|
Trybek P, Nowakowski M, Salowka J, Spiechowicz J, Machura L. Sample Entropy of sEMG Signals at Different Stages of Rectal Cancer Treatment. ENTROPY (BASEL, SWITZERLAND) 2018; 20:E863. [PMID: 33266587 PMCID: PMC7512423 DOI: 10.3390/e20110863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/13/2022]
Abstract
Information theory provides a spectrum of nonlinear methods capable of grasping an internal structure of a signal together with an insight into its complex nature. In this work, we discuss the usefulness of the selected entropy techniques for a description of the information carried by the surface electromyography signals during colorectal cancer treatment. The electrical activity of the external anal sphincter can serve as a potential source of knowledge of the actual state of the patient who underwent a common surgery for rectal cancer in the form of anterior or lower anterior resection. The calculation of Sample entropy parameters has been extended to multiple time scales in terms of the Multiscale Sample Entropy. The specific values of the entropy measures and their dependence on the time scales were analyzed with regard to the time elapsed since the operation, the type of surgical treatment and also the different depths of the rectum canal. The Mann-Whitney U test and Anova Friedman statistics indicate the statistically significant differences among all of stages of treatment and for all consecutive depths of rectum area for the estimated Sample Entropy. The further analysis at the multiple time scales signify the substantial differences among compared stages of treatment in the group of patients who underwent the lower anterior resection.
Collapse
Affiliation(s)
- Paulina Trybek
- Division of Computational Physics and Electronics, Institute of Physics, Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, 40007 Katowice, Poland
| | - Michal Nowakowski
- Department of General Surgery and Multiorgan Trauma, Jagiellonian University Medical College, 30048 Krakow, Poland
| | - Jerzy Salowka
- Department of Surgery, Stanley Dudrick Memorial Hospital, 32050 Skawina, Poland
| | - Jakub Spiechowicz
- Department of Theoretical Physics, Institute of Physics, Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, 40007 Katowice, Poland
| | - Lukasz Machura
- Division of Computational Physics and Electronics, Institute of Physics, Silesian Centre for Education and Interdisciplinary Research, University of Silesia in Katowice, 40007 Katowice, Poland
| |
Collapse
|
3
|
Multifractal characteristics of external anal sphincter based on sEMG signals. Med Eng Phys 2018; 55:9-15. [DOI: 10.1016/j.medengphy.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
|
4
|
Peng Y, Miller BD, Boone TB, Zhang Y. Modern Theories of Pelvic Floor Support : A Topical Review of Modern Studies on Structural and Functional Pelvic Floor Support from Medical Imaging, Computational Modeling, and Electromyographic Perspectives. Curr Urol Rep 2018; 19:9. [PMID: 29435856 DOI: 10.1007/s11934-018-0752-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Weakened pelvic floor support is believed to be the main cause of various pelvic floor disorders. Modern theories of pelvic floor support stress on the structural and functional integrity of multiple structures and their interplay to maintain normal pelvic floor functions. Connective tissues provide passive pelvic floor support while pelvic floor muscles provide active support through voluntary contraction. Advanced modern medical technologies allow us to comprehensively and thoroughly evaluate the interaction of supporting structures and assess both active and passive support functions. The pathophysiology of various pelvic floor disorders associated with pelvic floor weakness is now under scrutiny from the combination of (1) morphological, (2) dynamic (through computational modeling), and (3) neurophysiological perspectives. This topical review aims to update newly emerged studies assessing pelvic floor support function among these three categories. RECENT FINDINGS A literature search was performed with emphasis on (1) medical imaging studies that assess pelvic floor muscle architecture, (2) subject-specific computational modeling studies that address new topics such as modeling muscle contractions, and (3) pelvic floor neurophysiology studies that report novel devices or findings such as high-density surface electromyography techniques. We found that recent computational modeling studies are featured with more realistic soft tissue constitutive models (e.g., active muscle contraction) as well as an increasing interest in simulating surgical interventions (e.g., artificial sphincter). Diffusion tensor imaging provides a useful non-invasive tool to characterize pelvic floor muscles at the microstructural level, which can be potentially used to improve the accuracy of the simulation of muscle contraction. Studies using high-density surface electromyography anal and vaginal probes on large patient cohorts have been recently reported. Influences of vaginal delivery on the distribution of innervation zones of pelvic floor muscles are clarified, providing useful guidance for a better protection of women during delivery. We are now in a period of transition to advanced diagnostic and predictive pelvic floor medicine. Our findings highlight the application of diffusion tensor imaging, computational models with consideration of active pelvic floor muscle contraction, high-density surface electromyography, and their potential integration, as tools to push the boundary of our knowledge in pelvic floor support and better shape current clinical practice.
Collapse
Affiliation(s)
- Yun Peng
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX, 77004, USA
| | - Brandi D Miller
- Department of Urology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Timothy B Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, 360 HBS Building, 4811 Calhoun Rd., Houston, TX, 77004, USA.
| |
Collapse
|
5
|
Shiraz A, Leaker B, Mosse CA, Solomon E, Craggs M, Demosthenous A. Design of sEMG assembly to detect external anal sphincter activity: a proof of concept. Physiol Meas 2017; 38:L17-L27. [PMID: 28901946 DOI: 10.1088/1361-6579/aa8c52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Conditional trans-rectal stimulation of the pudendal nerve could provide a viable solution to treat hyperreflexive bladder in spinal cord injury. A set threshold of the amplitude estimate of the external anal sphincter surface electromyography (sEMG) may be used as the trigger signal. The efficacy of such a device should be tested in a large scale clinical trial. As such, a probe should remain in situ for several hours while patients attend to their daily routine; the recording electrodes should be designed to be large enough to maintain good contact while observing design constraints. The objective of this study was to arrive at a design for intra-anal sEMG recording electrodes for the subsequent clinical trials while deriving the possible recording and processing parameters. APPROACH Having in mind existing solutions and based on theoretical and anatomical considerations, a set of four multi-electrode probes were designed and developed. These were tested in a healthy subject and the measured sEMG traces were recorded and appropriately processed. MAIN RESULTS It was shown that while comparatively large electrodes record sEMG traces that are not sufficiently correlated with the external anal sphincter contractions, smaller electrodes may not maintain a stable electrode tissue contact. It was shown that 3 mm wide and 1 cm long electrodes with 5 mm inter-electrode spacing, in agreement with Nyquist sampling, placed 1 cm from the orifice may intra-anally record a sEMG trace sufficiently correlated with external anal sphincter activity. SIGNIFICANCE The outcome of this study can be used in any biofeedback, treatment or diagnostic application where the activity of the external anal sphincter sEMG should be detected for an extended period of time.
Collapse
Affiliation(s)
- Arsam Shiraz
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
6
|
Marco G, Alberto B, Taian V. Surface EMG and muscle fatigue: multi-channel approaches to the study of myoelectric manifestations of muscle fatigue. Physiol Meas 2017; 38:R27-R60. [DOI: 10.1088/1361-6579/aa60b9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
7
|
Romaniszyn M, Rozwadowska N, Malcher A, Kolanowski T, Walega P, Kurpisz M. Implantation of autologous muscle-derived stem cells in treatment of fecal incontinence: results of an experimental pilot study. Tech Coloproctol 2015; 19:685-96. [PMID: 26266767 PMCID: PMC4631713 DOI: 10.1007/s10151-015-1351-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/18/2015] [Indexed: 12/13/2022]
Abstract
Background The aim of this study is to present results of the implantation of autologous myoblasts into the external anal sphincter (EAS) in ten patients with fecal incontinence. Methods After anatomical and functional assessment of the patients’ EAS, a vastus lateralis muscle open biopsy was performed. Stem cells were extracted from the biopsy specimens and cultured in vitro. Cell suspensions were then administered to the EAS. Patients were scheduled for follow-up visits in 6-week intervals. Total follow-up was 12 months. Results All biopsy and cell implantation procedures were performed without complications. Nine of the patients completed a full 12-month follow-up. There was subjective improvement in six patients (66.7 %). In manometric examinations 18 weeks after implantation, squeeze anal pressures and high-pressure zone length increased in all patients, with particularly significant sphincter function recovery in five patients (55.6 %). Electromyographic (EMG) examination showed an increase in signal amplitude in all patients, detecting elevated numbers of propagating action potentials. Twelve months after implantation two patients experienced deterioration of continence, which was also reflected in the deterioration of manometric and EMG parameters. The remaining four patients (44.4 %) still described their continence as better than before implantation and retained satisfactory functional examination parameters. Conclusions Implantation of autologous myoblasts gives good short-term results not only in a subjective assessment, but also in objective functional tests. It seems that this promising technology can improve the quality of life of patients with fecal incontinence, but further study is required to achieve better and more persistent results.
Collapse
Affiliation(s)
- M Romaniszyn
- 3rd Department of General Surgery, Jagiellonian University Medical College, ul. Pradnicka 35-37, 31-202, Kraków, Poland.
| | - N Rozwadowska
- Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland
| | - A Malcher
- Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland
| | - T Kolanowski
- Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland
| | - P Walega
- 3rd Department of General Surgery, Jagiellonian University Medical College, ul. Pradnicka 35-37, 31-202, Kraków, Poland
| | - M Kurpisz
- Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland.
| |
Collapse
|
8
|
Real time estimation of generation, extinction and flow of muscle fibre action potentials in high density surface EMG. Comput Biol Med 2015; 57:8-19. [DOI: 10.1016/j.compbiomed.2014.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/17/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
|
9
|
Holobar A, Farina D. Blind source identification from the multichannel surface electromyogram. Physiol Meas 2014; 35:R143-65. [PMID: 24943407 DOI: 10.1088/0967-3334/35/7/r143] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
10
|
Nowakowski M, Tomaszewski KA, Herman RM, Sałówka J, Romaniszyn M, Rubinkiewicz M, Walocha JA. Developing a new electromyography-based algorithm to diagnose the etiology of fecal incontinence. Int J Colorectal Dis 2014; 29:747-54. [PMID: 24743845 PMCID: PMC4028542 DOI: 10.1007/s00384-014-1859-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE For surface electromyography (sEMG) to become widely used in fecal incontinence (FI) etiology assessment, one would have to create a simple, step-by-step, computer-aided, electromyography-based algorithm that would become the basis for a computer-aided diagnosis (CAD) system. Thus, the aim of this work was to develop such an algorithm. METHODS Each patient included in the study underwent a structured medical interview, a general physical examination, and a proctological examination. Patients that scored more than 10 points on the fecal incontinence severity index (FISI) underwent further tests that included rectoscopy, anorectal manometry, transanal ultrasonography, multichannel sEMG, and assessment of anal reflexes. Patients with fully diagnosed FI were included into the study group. The control group consisted of healthy volunteers that scored five or less points on the FISI and had no known anal sphincters dysfunction. RESULTS Forty-nine patients were qualified to the study group (age ± SD 58.9 ± 13.8). The control group was number- and gender-matched (age ± SD 45.4 ± 15.1). The sensitivity and specificity of classification tree number I, to diagnose neurogenic FI, were 89.5 and 86 %, respectively. For patients with idiopathic FI, these values were 82 and 91 %, respectively. The sensitivity and specificity of classification tree number III, to diagnose neurogenic FI, were 84 and 78 %, respectively. For patients with idiopathic FI, these values were 78 and 87 %, respectively. CONCLUSIONS The relative simplicity and low classification costs allow to assume that algorithms based on classification trees I and III will serve to be the basis for a FI etiology CAD system.
Collapse
Affiliation(s)
- Michał Nowakowski
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | | | - Roman M. Herman
- Department of Clinical and Experimental Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Sałówka
- Department of General Surgery, Stanley Dudrick Memorial Hospital, Skawina, Poland
| | - Michał Romaniszyn
- Department of General Surgery, G. Narutowicz Specialist City Hospital, Krakow, Poland
| | - Mateusz Rubinkiewicz
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A. Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
11
|
von Tscharner V, Maurer C, Ruf F, Nigg BM. Comparison of electromyographic signals from monopolar current and potential amplifiers derived from a penniform muscle, the gastrocnemius medialis. J Electromyogr Kinesiol 2013; 23:1044-51. [PMID: 23938250 DOI: 10.1016/j.jelekin.2013.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 06/25/2013] [Accepted: 07/09/2013] [Indexed: 11/26/2022] Open
Abstract
Electromyograms (EMGs) are measured by bipolar surface electrodes that quantify potential differences. Bipolar potentials over penniform muscles may be associated with errors. Our assumption was that muscle activity can be quantified more reliably and with a higher spatial resolution using current measurements. The purpose of this work is: (a) to introduce the concept of current measurements to detect muscle activity, (b) to show the coherences observed over a segment of a typical penniform muscle, the gastrocnemius medialis where one would expect a synchronicity of the activation, and (c) to show the amount of mixing that is caused by the finite inter electrode resistance. A current amplifier was developed. EMGs were recorded at 40% of maximum voluntary contraction during isometric contractions of the gastrocnemius medialis. EMGs of twelve persons were recorded with an array of four peripheral and one central electrode. Monopolar EMGs were recorded for "all-potential", "center at current" and "all-current" conditions. Coherence revealed the similarity of signals recorded from neighboring electrodes. Coherence was high for the "all-potential", significant for the "current at center" condition and disappeared in the "all-current" condition. It was concluded that EMG array recordings strongly depends on the measurement configuration. The proposed current amplifier significantly improves spatial resolution of EMG array recordings because the inter-electrode cross talk is reduced.
Collapse
Affiliation(s)
- Vinzenz von Tscharner
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | | | | | | |
Collapse
|
12
|
Volume conductor models in surface electromyography: Applications to signal interpretation and algorithm test. Comput Biol Med 2013; 43:953-61. [DOI: 10.1016/j.compbiomed.2013.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 11/20/2022]
|