Altered motor unit discharge patterns in paretic muscles of stroke survivors assessed using surface electromyography

Identifying alterations in hand movement coordination from chronic stroke survivors using a wearable high-density EMG sleeve

Objective.Non-invasive, high-density electromyography (HD-EMG) has emerged as a useful tool to collect a range of neurophysiological motor information. Recent studies have demonstrated changes in EMG features that occur after stroke, which correlate with functional ability, highlighting their potential use as biomarkers. However, previous studies have largely explored these EMG features in isolation with individual electrodes to assess gross movements, limiting their potential clinical utility. This study aims to predict hand function of stroke survivors by combining interpretable features extracted from a wearable HD-EMG forearm sleeve.Approach.Here, able-bodied (N= 7) and chronic stroke subjects (N= 7) performed 12 functional hand and wrist movements while HD-EMG was recorded using a wearable sleeve. A variety of HD-EMG features, or views, were decomposed to assess alterations in motor coordination.Main Results.Stroke subjects, on average, had higher co-contraction and reduced muscle coupling when attempting to open their hand and actuate their thumb. Additionally, muscle synergies decomposed in the stroke population were relatively preserved, with a large spatial overlap in composition of matched synergies. Alterations in synergy composition demonstrated reduced coupling between digit extensors and muscles that actuate the thumb, as well as an increase in flexor activity in the stroke group. Average synergy activations during movements revealed differences in coordination, highlighting overactivation of antagonist muscles and compensatory strategies. When combining co-contraction and muscle synergy features, the first principal component was strongly correlated with upper-extremity Fugl Meyer hand sub-score of stroke participants (R2= 0.86). Principal component embeddings of individual features revealed interpretable measures of motor coordination and muscle coupling alterations.Significance.These results demonstrate the feasibility of predicting motor function through features decomposed from a wearable HD-EMG sleeve, which could be leveraged to improve stroke research and clinical care.

Compound muscle action potential (CMAP) scan examination of paretic and contralateral muscles reveals motor unit alterations after stroke

This study presents a novel compound muscle action potential (CMAP) examination of motor unit changes in paretic muscle post stroke. CMAP scan of the first dorsal interosseous (FDI) muscle was performed bilaterally in 16 chronic stroke subjects. Various parameters were derived from the CMAP scan to examine paretic muscle changes, including CMAP amplitude, D50, step index (STEPIX) and amplitude index (AMPIX). A significant decrease in CMAP amplitude and STEPIX was observed in paretic muscles compared with contralateral muscles (CMAP amplitude: paretic (9.0±0.5) mV, contralateral (11.3±0.9) mV, P=0.024; STEPIX: paretic 101.2±7.6, contralateral 121.9±6.5, P=0.020). No significant difference in D50 and AMPIX was observed between the paretic and contralateral sides (P>0.05). The findings revealed complex paretic muscle changes including motor unit degeneration, muscle fiber denervation, reinnervation and atrophy, providing useful insights to help understand neuromuscular mechanisms associated with weakness and other functional deterioration post stroke. The CMAP scan experimental protocols and the applied processing methods are noninvasive, convenient, and automated, offering practical benefits for clinical application.

Ingersoll C, E. Norte G. Neural drive and motor unit characteristics after anterior cruciate ligament reconstruction: implications for quadriceps weakness

Purpose

The purpose of this investigation was to compare the quality of neural drive and recruited quadriceps motor units' (MU) action potential amplitude (MUAPAMP) and discharge rate (mean firing rate (MFR)) relative to recruitment threshold (RT) between individuals with anterior cruciate ligament reconstruction (ACLR) and controls.

Methods

Fourteen individuals with ACLR and 13 matched controls performed trapezoidal knee extensor contractions at 30%, 50%, 70%, and 100% of their maximal voluntary isometric contraction (MVIC). Decomposition electromyography (dEMG) and torque were recorded concurrently. The Hoffmann reflex (H-reflex) and central activation ratio (CAR) were acquired bilaterally to detail the proportion of MU pool available and volitionally activated. We examined MUAPAMP-RT and MFR-RT relationships with linear regression and extracted the regression line slope, y-intercept, and RT range for each contraction. Linear mixed effect modelling used to analyze the effect of group and limb on regression line slope and RT range.

Results

Individuals with ACLR demonstrated lower MVIC torque in the involved limb compared to uninvolved limb. There were no differences in H-reflex or CAR between groups or limbs. The ACLR involved limb demonstrated smaller mass-normalized RT range and slower MU firing rates at high contraction intensities (70% and 100% MVIC) compared to uninvolved and control limbs. The ACLR involved limb also demonstrated larger MU action potentials in the VM compared to the contralateral limb. These differences were largely attenuated with relative RT normalization.

Conclusions

These results suggest that persistent strength deficits following ACLR may be attributable to a diminished quadriceps motor neuron pool and inability to upregulate the firing rate of recruited MUs.

Structural and pathophysiological muscle changes up to one year after post-stroke hemiplegia: a systematic review

INTRODUCTION

Muscle changes after stroke cannot be explained solely on the basis of corticospinal bundle damage. Muscle-specific changes contribute to limited functional recovery but have been poorly characterized.

EVIDENCE ACQUISITION

We conducted a systematic review of muscular changes occurring at the histological, neuromuscular and functional levels during the first year after the onset of post-stroke hemiplegia. A literature search was performed on PubMed, Embase and CINHAL databases up to November 2022 using a keyword combination comprising cerebral stroke, hemiplegic, atrophy, muscle structure, paresis, skeletal muscle fiber type, motor unit, oxidative stress, strength, motor control.

EVIDENCE SYNTHESIS

Twenty-seven trial reports were included in the review, out of 12,798 articles screened. Structural modifications described on the paretic side include atrophy, transformation of type II fibers into type I fibers, decrease in fiber diameter and apparent myofilament disorganization from the first week post-stroke up to the fourth month. Reported biochemical changes comprise the abnormal presence of lipid droplets and glycogen granules in the subsarcolemmal region during the first month post-stroke. At the neurophysiological level, studies indicate an early decrease in the number and activity of motor units, correlated with the degree of motor impairment. All these modifications were present to a lesser degree on the non-paretic side. Although only sparse data concerning the subacute stage are available, these changes seem to appear during the first two weeks post-stroke and continue up to the third or fourth month.

CONCLUSIONS

Considering these early pathophysiological changes on both the paretic and non-paretic sides, it seems crucial to promptly stimulate central and also peripheral muscular activation after stroke through specific rehabilitation programs focused on the maintenance of muscle capacities associated with neurological recovery or plasticity.

Surface EMG analysis of weakness distribution in upper limb muscles post-stroke

Weakness is a common symptom after a stroke. This study aims to depict weakness distribution among forearm muscles given that joints in the upper limb are usually driven by a group of muscles. Multi-channel electromyography (EMG) was applied to assess the muscle group, and an EMG-based index was proposed to quantify the weakness of individual muscles. By using this method, four weakness distribution patterns were observed in extensor muscles from five out of eight subjects after stroke. Complex weakness distribution patterns were observed in flexor muscles from seven out of the eight subjects when they performed grasp, tripod pinch, and hook grip. The findings can help determine the weak muscles in a clinic and facilitate the development of appropriate interventions in stroke rehabilitation targeting specific muscle weakness.

Arthrogenic muscle inhibition after anterior cruciate ligament injury: Injured and uninjured limb recovery over time

Introduction

It is well documented that marked weakness of the quadriceps is present after knee joint injury. This joint trauma induces a presynaptic reflex inhibition of musculature surrounding the joint, termed arthrogenic muscle inhibition (AMI). The extent to which anterior cruciate ligament (ACL) injury affects thigh musculature motor unit activity, which may affect restoration of thigh muscle strength after injury, is undetermined.

Methods

A randomized protocol of knee flexion and extension isometric contractions (10%-50% maximal voluntary isometric contraction) were performed for each leg on 54 subjects with electromyography array electrodes placed on the vastus medialis, vastus lateralis, semitendinosus, and biceps femoris. Longitudinal assessments for motor unit recruitment and average firing rate were acquired at 6-month intervals for 1 year post ACL injury.

Results

The ACL-injured population demonstrated smaller quadriceps and hamstrings motor unit size (assessed via motor unit action potential peak-to-peak amplitude) and altered firing rate activity in both injured and uninjured limbs compared to healthy controls. Motor unit activity remained altered compared to healthy controls at 12 months post ACL reconstruction (ACLR).

Discussion

Motor unit activity was altered after ACLR up to 12 months post-surgery. Further research is warranted to optimize rehabilitation interventions that adequately address altered motor unit activity and improve safety and success with return to sport after ACLR. In the interim, evidence based clinical reasoning with a focus on development of muscular strength and power capacity should be the impetus behind rehabilitation programming to address motor control deficits.

Applying muscle synergy analysis to forearm high-density electromyography of healthy people

Introduction

Muscle synergy is regarded as a motor control strategy deployed by the central nervous system (CNS). Clarifying the modulation of muscle synergies under different strength training modes is important for the rehabilitation of motor-impaired patients.

Methods

To represent the subtle variation of neuromuscular activities from the smaller forearm muscles during wrist motion, we proposed to apply muscle synergy analysis to preprocessed high-density electromyographic data (HDEMG). Here, modulation of muscle synergies within and across the isometric and isotonic training modes for strengthening muscles across the wrist were investigated. Surface HDEMGs were recorded from healthy subjects (N = 10). Three different HDEMG electrode configurations were used for comparison and validation of the extracted muscle synergies. The cosine of principal angles (CPA) and the Euclidian distance (ED) between synergy vectors were used to evaluate the intra- and inter-mode similarity of muscle synergies. Then, how the activation coefficients modulate the excitation of specific synergy under each mode was examined by pattern recognition. Next, for a closer look at the mode-specific synergies and the synergies shared by the two training modes, k-means clustering was applied.

Results

We observed high similarity of muscle synergies across different tasks within each training mode, but decreased similarity of muscle synergies across different training modes. Both intra- and intermode similarity of muscle synergies were consistently robust to electrode configurations regardless of the similarity metric used.

Discussion

Overall, our findings suggest that applying muscle synergy analysis to HDEMG is feasible, and that the traditional muscle synergies defined by whole-muscle components may be broadened to include sub-muscle components represented by the HDEMG channels. This work may lead to an appropriate neuromuscular analysis method for motor function evaluation in clinical settings and provide valuable insights for the prescription of rehabilitation training therapies.

Contribution of stroke-related changes in neuromuscular factors to gear ratio during isometric contraction of medial gastrocnemius muscle: A simulation study

BACKGROUND

It is not clear which neuromuscular factors are most closely associated with the loss of variable fascicle gearing after chronic stroke. The purpose of this simulation study is to determine the effects of stroke-related changes in key neuromuscular factors on the gear ratio.

METHODS

A modified Hill-type model of the medial gastrocnemius was developed to determine the gear ratio for a given muscle activation level and musculotendon length. Model parameters were then systematically adjusted to simulate known stroke-related changes in neuromuscular factors, and the gear ratio was computed for each change in the parameters. A Monte Carlo simulation was performed to understand which neuromuscular factors and fiber behavior-related parameters are most relevant to the loss of variable gearing. Dominance analyses were also conducted to quantify the relative importance of fiber behavior-related parameters on the gear ratio.

FINDINGS

The gear ratio decreases significantly with smaller pennation angle and with shorter optimal fiber length. In addition, muscle thickness and pennation angle at optimal fiber length appear to be the most important muscle architectural parameters. Dominance analyses further suggest that primary determinants of gear ratio include initial pennation angle, fiber rotation-shortening ratio, initial muscle thickness, and fiber rotation.

INTERPRETATION

Our findings provide insight that the pennation angle may play an important role for efficient muscular contraction, implying that maintaining muscle architecture and/or improving fiber/fascicle rotation could a key goal in rehabilitation interventions. Our findings will help us to better interpret altered gearing behavior in aging and pathological muscles.

Teaching Essential EMG Theory to Kinesiologists and Physical Therapists Using Analogies Visual Descriptions, and Qualitative Analysis of Biophysical Concepts

Electromyography (EMG) is a multidisciplinary field that brings together allied health (kinesiology and physical therapy) and the engineering sciences (biomedical and electrical). Since the physical sciences are used in the measurement of a biological process, the presentation of the theoretical foundations of EMG is most conveniently conducted using math and physics. However, given the multidisciplinary nature of EMG, a course will most likely include students from diverse backgrounds, with varying levels of math and physics. This is a pedagogical paper that outlines an approach for teaching foundational concepts in EMG to kinesiologists and physical therapists that uses a combination of analogies, visual descriptions, and qualitative analysis of biophysical concepts to develop an intuitive understanding for those who are new to surface EMG. The approach focuses on muscle fiber action potentials (MFAPs), motor unit action potentials (MUAPs), and compound muscle action potentials (CMAPs) because changes in these waveforms are much easier to identify and describe in comparison to the surface EMG interference pattern (IP).

Motor unit distribution and recruitment in spastic and non-spastic bilateral biceps brachii muscles of chronic stroke survivors

Objective.This study aims to characterize the motor units (MUs) distribution and recruitment pattern in the spastic and non-spastic bilateral biceps brachii muscles (BBMs) of chronic stroke survivors.Approach.High-density surface electromyography (HD-sEMG) signals were collected from both spastic and non-spastic BBMs of fourteen chronic stroke subjects during isometric elbow flexion at 10%, 30%, 50% and 100% maximal voluntary contractions (MVCs). By combining HD-sEMG decomposition and bioelectrical source imaging, MU innervation zones (MUIZs) of the decomposed MUs were first localized in the 3D space of spastic and non-spastic BBMs. The MU depth defined as the distance between the localized MUIZ and its normal projection on the skin surface was then normalized to the arm radius of each subject and averaged at given contraction level. The averaged MU depth at different contraction levels on a specific arm side (intra-side) and the bilateral depths under a specific contraction level (inter-side) were compared.Main results.The average depth of decomposed MUs increased with the contraction force and significant differences observed between 10% vs 50% (p< 0.0001), 10% vs 100% (p< 0.0001) and 30% vs 100% MVC (p= 0.0017) on the non-spastic side, indicating that larger MUs with higher recruitment threshold locate in deeper muscle regions. In contrast, no force-related difference in MU depth was observed on the spastic side, suggesting a disruption of orderly recruitment of MUs with increase of force level, or the MU denervation and the subsequent collateral reinnervation secondary to upper motor neuron lesions. Inter-side comparison demonstrated significant MU depth difference at 10% (p= 0.0048) and 100% force effort (p= 0.0026).Significance.This study represents the first effort to non-invasively characterize the MU distribution inside spastic and non-spastic bilateral BBM of chronic stroke patients by combining HD-sEMG recording, EMG signal decomposition and bioelectrical source imaging. The findings of this study advances our understanding regarding the neurophysiology of human muscles and the neuromuscular alterations following stroke. It may also offer important MU depth information for botulinum toxin injection in clinical post-stroke spasticity management.

Relative contribution of altered neuromuscular factors to muscle activation-force relationships following chronic stroke: A simulation study

The purpose of this study was to investigate the potential effects of key neuromuscular factors on muscle activation-force relationships, thereby helping us understand abnormal EMG-force relationships often reported in chronic stroke-impaired muscles. A modified Hill-type muscle model was developed to calculate muscle force production for a given muscle activation level and musculotendon length. Model parameters used to characterize musculotendon unit properties of medial gastrocnemius were adjusted to simulate known stroke-related changes in neuromuscular factors (e.g., voluntary activation and muscle mechanical properties). The muscle activation-force slope (i.e., muscle activation over force) was computed as a function of ankle joint angle. A Monte Carlo simulation approach was implemented to understand which neuromuscular factors are closely associated with the activation-force slope. Our simulations showed that a reduction in factors linked to voluntary activation capacity and to maximum force-generating capacity may be the primary contributors that increase the activation-force slope in dorsiflexed positions, and that a narrower active force-length curve appears to be the most significant factor that increases the slope in plantar flexed positions. In addition, our Monte Carlo simulation results demonstrated that an increase in the activation-force slope is strongly correlated with a reduction in voluntary activation capacity, in the maximum force-generating capacity, and in the active force-length curve width. These findings will help us to better interpret altered EMG-force relationships following chronic stroke.

Imbalanced Subthreshold Currents Following Sepsis and Chemotherapy: A Shared Mechanism Offering a New Therapeutic Target?

Both sepsis and treatment of cancer with chemotherapy are known to cause neurologic dysfunction. The primary defects seen in both groups of patients are neuropathy and encephalopathy; the underlying mechanisms are poorly understood. Analysis of preclinical models of these disparate conditions reveal similar defects in ion channel function contributing to peripheral neuropathy. The defects in ion channel function extend to the central nervous system where lower motoneurons are affected. In motoneurons the defect involves ion channels responsible for subthreshold currents that convert steady depolarization into repetitive firing. The inability to correctly translate depolarization into steady, repetitive firing has profound effects on motor function, and could be an important contributor to weakness and fatigue experienced by both groups of patients. The possibility that disruption of function, either instead of, or in addition to neurodegeneration, may underlie weakness and fatigue leads to a novel approach to therapy. Activation of serotonin (5HT) receptors in a rat model of sepsis restores the normal balance of subthreshold currents and normal motoneuron firing. If an imbalance of subthreshold currents also occurs in other central nervous system neurons, it could contribute to encephalopathy. We hypothesize that pharmacologically restoring the proper balance of subthreshold currents might provide effective therapy for both neuropathy and encephalopathy in patients recovering from sepsis or treatment with chemotherapy.

Neuromotor control associates with muscle weakness observed with McArdle sign of multiple sclerosis

OBJECTIVE

Multiple Sclerosis (MS) is often accompanied by myelopathy, which may be associated with progressive worsening. A specific finding of MS-associated myelopathy is McArdle sign, wherein neck flexion is associated with prominent increased limb weakness relative to that detected with neck extension. In this study, we characterized neuromotor control properties of finger extensors in association with the McArdle sign.

METHODS

A custom-built device was utilized to monitor torque production of the wrist extensors with simultaneous recording of surface electromyography of the extensor digitorum. The electromyography was decomposed and analyzed via both linear and nominal regressions.

RESULTS

Linear regressions demonstrated a strong difference between groups for MS from healthy controls and other myelopathies for motor unit action potential amplitude and average firing rate (p < 0.001). Further, linear regression demonstrated good correlations of neuromotor variables to mechanical torque output (0.24 ≤ R²  ≤ 0.76). Nominal regression distinguished MS from healthy controls with an AUC of 0.87, specificity of 0.97, and sensitivity of 0.64. Nominal regression of MS from other myelopathies demonstrated an AUC of 0.88, specificity of 0.85, and sensitivity of 0.79.

INTERPRETATION

These data demonstrate the neuromotor control factors that largely determine muscle force production change with the observation of McArdle sign; these neuromotor control factors can differentiate MS from both healthy controls and other myelopathy conditions.

Muscle Fiber Diameter and Density Alterations after Stroke Examined by Single-Fiber EMG

This study presents single-fiber electromyography (EMG) analysis for assessment of paretic muscle changes after stroke. Single-fiber action potentials (SFAPs) were recorded from the first dorsal interosseous (FDI) muscle bilaterally in 12 individuals with hemiparetic stroke. The SFAP parameters, including the negative peak duration and the peak-peak amplitude, were measured and further used to estimate muscle fiber diameter through a model based on the quadratic function. The SFAP parameters, fiber density, and muscle fiber diameter derived from the model were compared between the paretic and contralateral muscles. The results show that SFAPs recorded from the paretic muscle had significantly smaller negative peak duration than that from the contralateral muscle. As a result, the derived muscle fiber diameter of the paretic muscle was significantly smaller than that of the contralateral muscle. The fiber density of the paretic muscle was significantly higher than that of the contralateral muscle. These results provide further evidence of remodeled motor units after stroke and suggest that paretic muscle weakness can be due to both complex central and peripheral neuromuscular alterations.

Tai Chi postural training for dyskinesia rehabilitation: a study protocol for a randomised controlled trial in convalescent ischaemic stroke patients

INTRODUCTION

Acute ischaemic stroke (AIS) is not only seriously damaging to the physical and mental health of patients, but also has become a major social public health problem. Effective dyskinesia rehabilitation treatment in convalescence is of great significance for AIS patients' prognosis and quality of life. Tai Chi (TC) shows great potential in improving motor function. This trial aims to evaluate the clinical efficacy of modified TC postural training (TPT), and to explore the related central-peripheral neurotransmitter mechanisms.

METHODS/DESIGN

The proposed study will be a multicentre randomised controlled trial. The trial will randomise 120 eligible AIS patients in a 1:1 ratio to receive TPT or Bobath rehabilitation training. Each training session will last 40 min and will be implemented once a day and five times per week (from Monday to Friday) in a duration of 4 weeks. After finishing the 4-week treatment, another 3-month follow-up period will be seen. Root mean square generated from the surface electromyogram (sEMG) will be the primary outcome. Other sEMG time-domain parameters and frequency-domain parameters and clinical scales assessment will be the secondary outcomes. Peripheral blood samples will be collected at baseline and at the end of 4-week treatment, which will be used to explore the related therapeutic mechanisms. Intention-to-treat analysis and per-protocol analysis will both be implemented in this trial.

ETHICS AND DISSEMINATION

The study has been approved by Ethics Committee of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, being granted approval numbers DZMEC-KY-2020-22. The research results will be disseminated through (open access) peer-reviewed publications and presentations at conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2000032999.

Malondialdehyde as a Useful Biomarker of Low Hand Grip Strength in Community-Dwelling Stroke Patients

The assessment of muscle strength by hand grip strength (HGS) is used to evaluate muscle weakness and wasting among stroke patients. This study aimed to investigate the association of oxidative stress/oxidative damage and inflammatory biomarkers with muscle strength and wasting, as evaluated by HGS, among community-dwelling post-stroke patients. The HGS of both paretic and non-paretic limbs was negatively associated with modified Rankin scale (mRS) values. The serum levels of catalase activity and malondialdehyde (MDA), and plasma tumor necrosis factor (TNF)-α levels were significantly increased in post-stroke patients compared with non-stroke controls. Further analysis highlighted that hydrogen peroxide was positively correlated with HGS in the paretic limbs. Interestingly, an elevated MDA level, excluding advanced age and high mRS, increased the risk of low HGS in the non-paretic limbs of stroke patients. This study suggests that there is a detrimental association between MDA and muscle strength and early muscle wasting among post-stroke patients. Hence, MDA is a potentially useful biomarker of muscle weakness and wasting in post-stroke patients living in the community.

Quantifying the Peak Amplitude Distributions of Electromyogram in Bicep Brachii muscle after Stroke

The objective of this study was to quantify the differences in surface electromyogram (EMG) signal characteristics between affected and contralateral arm muscles of hemispheric stroke survivors. EMG signals were recorded from the biceps brachii muscles using single differential electrodes. Four chronic stroke subjects performed isometric elbow flexions at sub-maximal voluntary contraction levels on both the affected and contralateral limbs. The force generated on the contralateral side was matched to the force generated on the affected side. We observed different types of EMG activation on the affected side compared to the contralateral side.Specifically, two subjects showed lower RMS EMG activity on the affected side whereas two subjects showed greater EMG activity on the affected side compared to the contralateral side. Analysis of the peak amplitudes of the EMG activity showed greater number of peaks in the EMG on affected side compared to the contralateral side in all subjects. The histogram of the peak amplitudes showed greater number of smaller peak amplitudes in subjects with lower EMG activity on the affected side suggesting a reliance on smaller motor units. Our combined EMG signal analysis techniques on one set of recorded signals provides insight regarding potential mechanisms of weakness.Clinical Relevance- Decoding neural information from surface EMG signals without decomposition into individual motor units could provide clinicians with quick insight about disease progress and potential treatment.

Model-Based Sensitivity Analysis of EMG Clustering Index With Respect to Motor Unit Properties: Investigating Post-Stroke FDI Muscle

The objective of this study is to explore the diagnostic decision and sensitivity of the surface electromyogram (EMG) clustering index (CI) with respect to post-stroke motor unit (MU) alterations through a simulation approach by the existing motor neuron pool model and surface EMG model. In the simulation analysis, three patterns of diagnostic decisions were presented in 24 groups representing eight types in three degrees of MU alterations. Specifically, the CI decision exhibited an abnormally increased pattern for five types, an abnormally decreased pattern for two types, and an invariant pattern for one type. Furthermore, the CI diagnostic decision was found to be highly sensitive to three types because a 50% degree of alteration in these types resulted in a distinct deviation of 2.5 in the CI Z-score. The mixed CI patterns were confirmed in experimental data collected from the paretic muscles of 14 subjects with stroke, as compared to the healthy muscles of 10 control subjects. Given the simulation results as a guideline, the CI diagnostic decision could be interpreted from general neural or muscular changes into specific MU changes (in eight types). This can further promote clinical applications of the convenient surface EMG tool in examining and monitoring paretic muscle changes toward customized stroke rehabilitation.

The reliability of surface EMG derived motor unit variables

Motor unit (MU) recordings obtained from surface electromyography (sEMG) decomposition are used to investigate the neural control of muscle in response to interventions, but our understanding of the longer-term reliability of MU variables is limited. This study examined the reliability of MU variables in the flexor carpi radialis (FCR) and tibialis anterior (TA) over a three-month period. Forty college-aged participants completed isometric wrist flexion (n = 20) and dorsiflexion (n = 20). There were 3 maximal isometric voluntary contractions (MVC) and 3 ramp contractions to 60% of MVC on four separate sessions separated by a total of 13 weeks. Intraclass correlation coefficients (ICC) were calculated from a fully nested ANOVA model. Maximal force was highly reliable (ICC = 0.94-0.99). The ICC values ranged from 0.49 to 0.92 for the FCR MU variables and from 0.58 to 0.96 for the TA MU variables. All MU variables exhibited a high degree of stability of means across test session and consistency within subjects, with the exception of the number of MUs detected in the TA. Poor ICC values did not reflect poor reliability but rather, convergence towards a narrow range of physiologically normal values. Surface EMG decomposition of a large population of MUs showed no differences in common drive between FCR (0.273) and for the TA (0.267) across test sessions. Forty percent of the sampled MUs in both muscles had a common drive of 0.30 or greater, which provides indirect support for the validity of the decompositions. MU variables may be used to monitor adaptations to a longer-term intervention study.

Effects of Changes in Ankle Joint Angle on the Relation Between Plantarflexion Torque and EMG Magnitude in Major Plantar Flexors of Male Chronic Stroke Survivors

The slope of the EMG-torque relation is potentially useful as a parameter related to muscular contraction efficiency, as a greater EMG-torque slope has often been reported in stroke-impaired muscles, compared to intact muscles. One major barrier limiting the use of this parameter on a routine basis is that we do not know how the EMG-torque slope is affected by changing joint angles. Thus, the primary purpose of this study is to characterize the EMG-torque relations of triceps surae muscles at different ankle joint angles in both paretic and non-paretic limbs of chronic hemispheric stroke survivors. Nine male chronic stroke survivors were asked to perform isometric plantarflexion contractions at different contraction intensities and at five different ankle joint angles, ranging from maximum plantarflexion to maximum dorsiflexion. Our results showed that the greater slope of the EMG-torque relations was found on the paretic side compared to the non-paretic side at comparable ankle joint angles. The EMG-torque slope increased as the ankle became plantarflexed on both sides, but an increment of the EMG-torque slope (i.e., the coefficient a) was significantly greater on the paretic side. Moreover, the relative (non-paretic/paretic) coefficient a was also strongly correlated with the relative (paretic/non-paretic) maximum ankle plantarflexion torque and with shear wave speed in the medial gastrocnemius muscle. Conversely, the relative coefficient a was not well-correlated with the relative muscle thickness. Our findings suggest that muscular contraction efficiency is affected by hemispheric stroke, but in an angle-dependent and non-uniform manner. These findings may allow us to explore the relative contributions of neural factors and muscular changes to voluntary force generating-capacity after stroke.

Single channel surface electromyogram deconvolution to explore motor unit discharges

Interference surface electromyogram (EMG) reflects many bioelectric properties of active motor units (MU), which are however difficult to estimate due to the asynchronous summation of their discharges. This paper introduces a deconvolution technique to estimate the cumulative firings of MUs. Tests in simulations show that the power spectral density of the estimated MU firings has a low-frequency peak corresponding to the mean firing rate of MUs in the detection volume of the recording system, weighted by the amplitudes of MU action potentials. The peak increases in amplitude and its centroid shifts to a higher frequency when MU synchronization is simulated (mainly due to the shift of discharges of large MUs). The peak is found even at high force levels, when such a contribution does not emerge from the EMG. This result is also confirmed in preliminary applications to experimental data. Moreover, the simulated cumulative firings of MUs are estimated with a correlation above 90% (considering frequency contributions up to 150 Hz), for all force levels. The method requires a single EMG channel, thus being feasible even in applied studies using simple recording systems. It may open many potential applications, e.g., in the study of the modulation of MU firing rate induced by either fatigue or pathology and in coherency analysis. Graphical Abstract Examples of application of the deconvolution (Deconv) algorithm and comparison with the cumulative firings and the cumulated weighted firings (CWF, i.e., each firing pattern is weighted by the root mean squared amplitude of the corresponding MU action potential). Portions of data are shown on the left, the power spectral densities (PSD) on the right (Welch method applied to 3 s of data, sub-epochs of 0.5 s, mean value removed from each of them, 50% of overlap). A) Simulated signal (50% of maximal voluntary contraction, MVC) with random MU firings. B) Simulated signal (50% MVC) with a level of synchronization equal to 10%. C) Experimental data from vastus medialis at 40% MVC (data decomposed by the algorithm of Holobar and Zazula, IEEE Trans. Sig. Proc. 2007; PSD of the cumulated firings almost identical to that of CWF, as few MUs were identified).

Variation of Finger Activation Patterns Post-stroke Through Non-invasive Nerve Stimulation

Purpose: A transcutaneous proximal nerve stimulation technique utilizing an electrode grid along the nerve bundles has previously shown flexible activation of multiple fingers. This case study aimed to further demonstrate the ability of this novel stimulation technique to induce various finger grasp patterns in a stroke survivor.

Methods: An individual with chronic hemiplegia and severe hand impairment was recruited. Electrical stimulation was delivered to different pairs of an electrode grid along the ulnar and median nerves to selectively activate different finger flexor muscles, with an automated electrode switching method. The resultant individual isometric flexion forces and forearm flexor high-density electromyography (HDEMG) were acquired to evaluate the finger activation patterns. A medium and low level of overall activation were chosen to gauge the available finger patterns for both the contralateral and paretic hands. All the flexion forces were then clustered to categorize the different types of grasp patterns.

Results: Both the contralateral and paretic sides demonstrated various force clusters including single and multi-finger activation patterns. The contralateral hand showed finger activation patterns mainly centered on median nerve activation of the index, middle, and ring fingers. The paretic hand exhibited fewer total activation patterns, but still showed activation of all four fingers in some combination.

Conclusion: Our results show that electrical stimulation at multiple positions along the proximal nerve bundles can elicit a select variety of finger activation patterns even in a stroke survivor with minimal hand function. This system could be further implemented for better rehabilitative training to help induce functional grasp patterns or to help regain muscle mass.

Motor Unit Properties of the First Dorsal Interosseous in Chronic Stroke Subjects: Concentric Needle and Single Fiber EMG Analysis

The purpose of this study was to better understand changes in motor unit electrophysiological properties in people with chronic stroke based on concentric needle electromyography (EMG) and single fiber EMG recordings. The first dorsal interosseous (FDI) muscle was studied bilaterally in eleven hemiparetic stroke subjects. A significant increase in mean fiber density (FD) was found in the paretic muscle compared with the contralateral side based on single fiber EMG (1.6 ± 0.2 vs. 1.3 ± 0.1, respectively, P = 0.003). There was no statistically significant difference between the paretic and contralateral sides in most concentric needle motor unit action potential (MUAP) parameters, such as amplitude (768.7 ± 441.7 vs. 855.0 ± 289.9 μV), duration (8.9 ± 1.8 vs. 8.68 ± 0.9 ms) and size index (1.2 ± 0.5 vs. 1.1 ± 0.3) (P > 0.18), nor was there a significant difference in single fiber EMG recorded jitter (37.0 ± 9.6 vs. 39.9 ± 10.6 μs, P = 0.45). The increase in FD suggests motor units of the paretic FDI have enlarged due to collateral reinnervation. However, sprouting might be insufficient to result in a statistically significant change in the concentric needle MUAP parameters. Single fiber EMG appears more sensitive than concentric needle EMG to reflect electrophysiological changes in motor units after stroke. Both single fiber and concentric needle EMG recordings may be necessary to better understand muscle changes after stroke, which is important for development of appropriate rehabilitation strategies. The results provide further evidence that motor units are remodeled after stroke, possibly in response to a loss of motoneurons.

A Novel Interpretation of Sample Entropy in Surface Electromyographic Examination of Complex Neuromuscular Alternations in Subacute and Chronic Stroke

The objective of this paper was to develop sample entropy (SampEn) as a novel surface electromyogram (EMG) biomarker to quantitatively examine post-stroke neuromuscular alternations. The SampEn method was performed on surface EMG interference patterns recorded from biceps brachii muscles of nine healthy control subjects, fourteen subjects with subacute stroke, and eleven subjects with chronic stroke, respectively. Measurements were collected during isometric contractions of elbow flexion at different constant force levels. By producing diagnostic decisions for individual muscles, two categories of abnormalities in some paretic muscles were discriminated in terms of abnormally increased and decreased SampEn. The efficiency of the SampEn was demonstrated by its comparable performance with a previously reported clustering index (CI) method. Mixed SampEn (or CI) patterns were observed in paretic muscles of subjects with stroke indicating complex neuromuscular changes at work as a result of a hemispheric brain lesion. Although both categories of SampEn (or CI) abnormalities were observed in both subacute and chronic stages of stroke, the underlying processes contributing to the SampEn abnormalities might vary a lot in stroke stage. The SampEn abnormalities were also found in contralateral muscles of subjects with chronic stroke indicating the necessity of applying interventions to contralateral muscles during stroke rehabilitation. Our work not only presents a novel method for quantitative examination of neuromuscular changes, but also explains the neuropathological mechanisms of motor impairments and offers guidelines for a better design of effective rehabilitation protocols toward improved motor recovery.

Motor Unit Activity during Fatiguing Isometric Muscle Contraction in Hemispheric Stroke Survivors

Enhanced muscle weakness is commonly experienced following stroke and may be accompanied by increased susceptibility to fatigue. To examine the contributions of central and peripheral factors to isometric muscle fatigue in stroke survivors, this study investigates changes in motor unit (MU) mean firing rate, and action potential duration during, and directly following, a sustained submaximal fatiguing contraction at 30% maximum voluntary contraction (MVC). A series of short contractions of the first dorsal interosseous muscle were performed pre- and post-fatigue at 20% MVC, and again following a 10-min recovery period, by 12 chronic stroke survivors. Individual MU firing times were extracted using surface EMG decomposition and used to obtain the spike-triggered average MU action potential waveforms. During the sustained fatiguing contraction, the mean rate of change in firing rate across all detected MUs was greater on the affected side (-0.02 ± 0.03 Hz/s) than on the less-affected side (-0.004 ± 0.003 Hz/s, p = 0.045). The change in firing rate immediately post-fatigue was also greater on the affected side than less-affected side (-13.5 ± 20 and 0.1 ± 19%, p = 0.04). Mean MU firing rates increased following the recovery period on the less-affected side when compared to the affected side (19.3 ± 17 and 0.5 ± 20%, respectively, p = 0.03). MU action potential duration increased post-fatigue on both sides (10.3 ± 1.2 to 11.2 ± 1.3 ms on the affected side and 9.9 ± 1.7 to 11.2 ± 1.9 ms on the less-affected side, p = 0.001 and p = 0.02, respectively), and changes in action potential duration tended to be smaller in subjects with greater impairment (p = 0.04). This study presents evidence of both central and peripheral fatigue at the MU level during isometric fatiguing contraction for the first time in stroke survivors. Together, these preliminary observations indicate that the response to an isometric fatiguing contraction differs between the affected and less-affected side post-stroke, and may suggest that central mechanisms observed here as changes in firing rate are the dominant processes leading to task failure on the affected side.

Altered Motor Unit Discharge Coherence in Paretic Muscles of Stroke Survivors

After a cerebral stroke, a series of changes at the supraspinal and spinal nervous system can alter the control of muscle activation, leading to persistent motor impairment. However, the relative contribution of these different levels of the nervous system to impaired muscle activation is not well understood. The coherence of motor unit (MU) spike trains is considered to partly reflect activities of higher level control, with different frequency band representing different levels of control. Accordingly, the objective of this study was to quantify the different sources of contribution to altered muscle activation. We examined the coherence of MU spike trains decomposed from surface electromyogram (sEMG) of the first dorsal interosseous muscle on both paretic and contralateral sides of 14 hemispheric stroke survivors. sEMG was obtained over a range of force contraction levels at 40, 50, and 60% of maximum voluntary contraction. Our results showed that MU coherence increased significantly in delta (1–4 Hz), alpha (8–12 Hz), and beta (15–30 Hz) bands on the affected side compared with the contralateral side, but was maintained at the same level in the gamma (30–60 Hz) band. In addition, no significant alteration was observed across medium–high force levels (40–60%). These results indicated that the common synaptic input to motor neurons increased on the paretic side, and the increased common input can originate from changes at multiple levels, including spinal and supraspinal levels following a stroke. All these changes can contribute to impaired activation of affected muscles in stroke survivors. Our findings also provide evidence regarding the different origins of impaired muscle activation poststroke.