Quantification of patellar tendon reflex using portable mechanomyography and electromyography devices

Diagnostic utility of deep tendon reflex responses in rectus femoris and triceps brachii in fibromyalgia: a clinical and electrophysiological study

The aim of this study was to evaluate deep tendon reflex responses and associated electrophysiological parameters of the muscles in patients with fibromyalgia. This cross-sectional study included 38 patients with fibromyalgia and 32 age- and sex-matched controls. Deep tendon reflexes of the rectus femoris and triceps brachii were tested using a reflex hammer. Electromyographic (amplitude and duration of activation), inertial measurement unit (angular velocity, acceleration), and electromechanical (delay) analyses were performed using a surface electromyography (sEMG) device. Comparative analyses were carried out between patients and controls. Additionally, Receiver Operating Characteristic (ROC) analysis was performed to evaluate the ability of hyperreflexia in distinguishing fibromyalgia patients from controls. Hyperactive deep tendon reflexes in the right/left rectus femoris and/or triceps brachii were observed in more than 85% (ranging from 86.8 to 94.7%) of the fibromyalgia group. Patients with fibromyalgia exhibited significantly increased deep tendon reflex responses compared to controls (p < 0.001). Patients revealed significantly higher amplitude, longer duration of muscle activation, greater sagittal acceleration and angular velocity, and shorter electromechanical delay. Normalized muscle activation (right and left rectus femoris and right triceps brachii) in response to deep tendon reflex test showed acceptable ability in differentiating fibromyalgia patients from controls (Area under curve (AUC) = 0.890, 0.784 and 0.782, respectively). For the right rectus femoris, values ≤ 28.3 (clinically corresponding to normoactive/hypoactive deep tendon reflexes) appeared to rule-out fibromyalgia with 94.1% sensitivity and 61.3% specificity. Patients with fibromyalgia exhibit increased deep tendon reflex responses. Normal or decreased deep tendon reflex responses may probably be used as a rule-out criterion for fibromyalgia.

Implementation of surface mechanomyography as a novel approach for objective evaluation of phasic muscle stretch reflexes in people with type 2 diabetes

INTRODUCTION

Diabetic peripheral neuropathy is the most common complication of diabetes producing metabolic disruptions in the peripheral nervous system. Alteration in the predictable nature of tendon reflexes is the most common indicator suggesting the possibility of diabetic neuropathy. Evaluation of tendon reflexes is a part of various clinical scoring systems that assess neuropathy. The conventional reflex grading scales are subjective, lack temporal data, and have high inter-rater variability. Hence, an indigenous quantification tool was developed to evaluate the tendon reflexes in order to assess diabetic peripheral neuropathy.

MATERIALS AND METHODS

A cross-sectional study was carried out in 140 healthy volunteers and 140 patients with type 2 diabetes. The mean age of controls and diabetics (49.1 ± 8.9, 50.7 ± 7.5) years, weight (66.9 ± 9.4, 69.8 ± 11.5) kilograms and BMI (24.5 ± 3.8, 26.1 ± 4.7), respectively. All of them are subjected to evaluation of tendon reflexes using the reflex quantification tool comprised of surface mechanomyography and electrogoniometry that can provide various static and dynamic variables of tendon reflex.

RESULTS

The dynamic variables such as reflex amplitude, muscle velocity and angular velocity were significantly low in diabetic patients (p: <0.001) whereas latency and duration (p: <0.001) were prolonged. Furthermore, no significant difference was observed in the application of tendon striking force (p: 0.934) among the participants.

CONCLUSION

The current study demonstrates that the proposed reflex quantification tool provides several dynamic variables of patellar tendon reflex, which are significantly affected and altered in diabetic patients suggesting the involvement of peripheral neurons.

A Wireless 2-Channel Layered EMG/NIRS Sensor System for Local Muscular Activity Evaluation

A wireless 2-channel layered sensor system that enables electromyography (EMG) and near-infrared spectroscopy (NIRS) measurements at two local positions was developed. The layered sensor consists of a thin silver electrode and a photosensor consisting of a photoemitting diode (LED) or photodiode (PD). The EMG and NIRS signals were simultaneously measured using a pair of electrodes and photosensors for the LED and PD, respectively. Two local muscular activities are presented in detail using layered sensors. In the experiments, EMG and NIRS signals were measured for isometric constant and ramp contractions at each forearm using layered sensors. The results showed that local muscle activity analysis is possible using simultaneous EMG and NIRS signals at each local position.

Combined tendon reflex and motor evoked potential recordings in amyotrophic lateral sclerosis

OBJECTIVE

This retrospective (case-control) collaborative study evaluates tendon reflex recordings combined with transcranial magnetic stimulation motor evoked potentials recordings (T-MEPs) at lower limbs in amyotrophic lateral sclerosis (ALS).

METHODS

T-MEPs were recorded in 97 ALS patients distinguished according to their patellar reflex briskness. Patients' electrophysiological data were compared with values measured in 60 control patients matched for age and height. Correlations studies between parameters or with some patients' clinical characteristics were also performed.

RESULTS

The central motor conduction time yields the highest sensitivity (82%) and specificity (93%), allowing twice more upper motor neuron (UMN) dysfunction detection than clinical examination, and being more altered in late stages of the disease. The T response to MEP response amplitude ratio (T/MEP ar) is nearly as sensitive to detect ALS and better identifies abnormal hyperreflexia. It is not correlated with evolutive stage, contrarily to conduction time-related parameters. In addition, T-MEPs detect asymmetries escaping clinical examination.

CONCLUSIONS

The corticospinal conduction to lower limbs is slowed in ALS. The T/MEP ar helps deciding when patellar reflexes are abnormal in a given patient suspected of ALS.

SIGNIFICANCE

The T-MEP technique provide powerful electrophysiological biomarkers of UMN involvement in ALS. This simple and painless procedure introduces the clinically useful concept of electrophysiological hyperreflexia and might be expanded to future exploration of proximal upper limbs and bulbar territories.

A Wireless Multi-Layered EMG/MMG/NIRS Sensor for Muscular Activity Evaluation

A wireless multi-layered sensor that allows electromyography (EMG), mechanomyography (MMG) and near-infrared spectroscopy (NIRS) measurements to be carried out simultaneously is presented. The multi-layered sensor comprises a thin silver electrode, transparent piezo-film and photosensor. EMG and MMG measurements are performed using the electrode and piezo-film, respectively. NIRS measurements are performed using the photosensor. Muscular activity is then analyzed in detail using the three types of data obtained. In experiments, the EMG, MMG and NIRS signals were measured for isometric ramp contraction at the forearm and cycling exercise of the lateral vastus muscle with stepped increments of the load using the layered sensor. The results showed that it was possible to perform simultaneous EMG, MMG and NIRS measurements at a local position using the proposed sensor. It is suggested that the proposed sensor has the potential to evaluate muscular activity during exercise, although the detection of the anaerobic threshold has not been clearly addressed.

A Systematic Review of Sensor Fusion Methods Using Peripheral Bio-Signals for Human Intention Decoding

Humans learn about the environment by interacting with it. With an increasing use of computer and virtual applications as well as robotic and prosthetic devices, there is a need for intuitive interfaces that allow the user to have an embodied interaction with the devices they are controlling. Muscle-machine interfaces can provide an intuitive solution by decoding human intentions utilizing myoelectric activations. There are several different methods that can be utilized to develop MuMIs, such as electromyography, ultrasonography, mechanomyography, and near-infrared spectroscopy. In this paper, we analyze the advantages and disadvantages of different myography methods by reviewing myography fusion methods. In a systematic review following the PRISMA guidelines, we identify and analyze studies that employ the fusion of different sensors and myography techniques, while also considering interface wearability. We also explore the properties of different fusion techniques in decoding user intentions. The fusion of electromyography, ultrasonography, mechanomyography, and near-infrared spectroscopy as well as other sensing such as inertial measurement units and optical sensing methods has been of continuous interest over the last decade with the main focus decoding the user intention for the upper limb. From the systematic review, it can be concluded that the fusion of two or more myography methods leads to a better performance for the decoding of a user's intention. Furthermore, promising sensor fusion techniques for different applications were also identified based on the existing literature.

Indices reflecting muscle contraction performance during exercise based on a combined electromyography and mechanomyography approach

Electromyography (EMG) and mechanomyography (MMG) have been used to directly evaluate muscle function through the electromechanical aspect of muscle contraction. The purpose of this study was to establish new absolute indices to describe muscle contraction performance during dynamic exercise by combining EMG and displacement MMG (dMMG) measured simultaneously using our previously developed MMG/EMG hybrid transducer system. Study participants were eight healthy male non-athletes (controls) and eight male athletes. EMG and dMMG of the vastus medialis were measured for 30 s during four cycles of recumbent bicycle pedaling (30, 60, 90, and 120 W) and on passive joint movement. Total powers were calculated based on the time domain waveforms of both signals. Muscle contraction performance was verified with the slope of regression line (SRL) and the residual sum of squares (RSS) obtained from EMG and dMMG correlation. EMG and dMMG has increased with the work rate. Force and EMG were similar between groups, but dMMG showed a significant difference with load increase. Athletes had significantly higher SRL and significantly lower RSS than controls. The average value divided by SRL and RSS was higher in athletes than in controls. The indices presented by the combined approach of EMG and dMMG showed a clear contrast between the investigated groups and may be parameters that reflect muscle contraction performance during dynamic exercise.