Electromyographic feedback for learning to activate thoracic inspiratory muscles

Surface electromyography (sEMG) of extradiaphragm respiratory muscles in healthy subjects: A systematic review

The aim of this systematic review was to examine procedures used and outcome measures reported from surface EMG (sEMG) of extradiaphragm inspiratory muscles in healthy people. Relevant articles were searched using the concepts "electromyography (EMG)", "respiratory muscles (sternocleidomastoid [SM], scalene, intercostal [IC] and parasternal)" and "healthy" in the electronic databases: MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and Database of Systematic Reviews, CINAHL, SPORTDiscus, LILACS, and PEDro. Twenty-five papers were included and quality assessment was performed using an adapted Downs and Black checklist. Twenty-eight percent of included papers were classified as moderate quality and the rest were low quality. The SM was the muscle most often investigated. Description of EMG techniques were often incomplete for features such as the procedure before electrode placement, description of the surface electrodes, the EMG detection mode and amplification. Of note, descriptions of the IC muscle electrode positioning varied widely. Comparison of outcomes among studies was challenging because of the very diverse EMG outcomes reported. There are many controversies regarding methods and technique used to assess sEMG of extradiaphragm inspiratory muscles. Therefore, studies with higher methodological quality utilizing standardized EMG procedures including electrode positioning will enable accurate and reliable comparison among studies of the extradiaphragm inspiratory muscles.

Development of new measurement system of thoracic excursion with biofeedback: reliability and validity

Background

Respiratory rehabilitation reduces breathlessness from patient with respiratory dysfunction. Chest expansion score, which represents the circumference magnitude of the thoracic cage, is used for a target when treating patients with respiratory disease. However, it is often difficult for patients to understand the changes in the respiratory status and be motivated for therapy continuously. We developed a new measurement system with biofeedback named BREATH which shows chest expansion scores in real time. The purpose of this study was to determine the reliability and validity of the novel system in advance of clinical application.

Methods

Three evaluators measured chest expansion in 33 healthy individuals using tape measure, which is used for the measurement traditionally, and BREATH. The wire for BREATH system was threaded over the thoracic continuously and the data was recorded automatically; whereas the tape was winded and measured each maximal expiration and inspiration timing by evaluator. All participants were performed both measurement simultaneously for three times during deep breath. In this study, we studied chest expansion score without using biofeedback data of BREATH to check the validity of the result. To confirm intra- and inter-evaluator reliability, we computed intra-class correlations (ICCs). We used Pearson’s correlation coefficient to evaluate the validity of measurement result by BREATH with reference to the tape measure results.

Results

The average (standard deviation) chest expansion scores for all, men and women by the tape measure were 5.53 (1.88), 6.40 (1.69) and 5.22 (1.39) cm, respectively, and those by BREATH were 3.89 (2.04), 4.36 (1.83) and 2.89 (1.66) cm, respectively. ICC within and among the three evaluators for BREATH and the tape measure were 0.90-0.94 and 0.85-0.94 and 0.85 and 0.82, respectively. The correlation coefficient between the two methods was 0.76-0.87.

Conclusion

The novel measurement system, BREATH, has high intra- and inter-evaluator reliabilities and validity; therefore it can lead us more effective respiratory exercise. Using its biofeedback data, this system may help patients with respiratory disease to do exercises more efficiently and clinicians to assess the respiratory exercise more accurately.

Effects of abdominal and thoracic breathing upon multiple-site electromyography and peripheral skin temperature

Peripheral finger temperature, frontalis and upper trapezius EMG, and self-report of arousal were assessed for four subjects during abdominal and thoracic breathing in a single-subject reversal design. Two subjects displayed significant differences between abdominal and thoracic breathing conditions; one for frontalis EMG, trapezius EMG, and self-report of arousal and one for trapezius EMG. Two subjects showed no significant effects. All subjects reached performance criteria during training sessions. Abdominal breathing performance during reversals was 100% and 92% of sampled breath cycles for the two subjects who showed significant change, and 65% and 42% for the two subjects who showed none. Methodological issues for measurement of breathing patterns and peripheral skin temperature are discussed.

Ventilatory conditioning by self-stimulation in rats: a pilot study

This article describes an experimental attempt to condition breathing pattern in rats. In this experiment, a freely moving rat was first rewarded by an electrical stimulation of the medial forebrain bundle whenever inspiratory duration (TI) exceeded 300 ms. A bidirectional control was then used: TIs longer than 400 ms were rewarded, and then TIs shorter than 300 ms were rewarded. The frequency of TIs longer than 300 ms increased when this event was rewarded, further increased when TIs above 400 ms were rewarded, and decreased during reversal conditioning (TI < 300 ms). At the beginning of the experiment, stimulation caused increased arousal and motor activity, but after prolonged conditioning, the brain stimulation was associated with quiet wakefulness. Although the general procedure appears to be well-suited to the experimental study of voluntary breathing, some possible improvements are suggested for further, more extensive investigations.

Performance and learning during voluntary control of breath patterns

Fourteen subjects learned to adjust their breath pattern to two target breaths displayed on a video screen, by using visual feedback, during two sessions 24 h apart. These two targets were respectively the smallest and the largest breaths of a ten-breath sample previously recorded from each subject's resting spontaneous breathing. Performances were significantly better for the large than for the small target breath. This cannot be directly inferred from current knowledge related to the control of movement time and amplitude, but rather it may be inferred from the periodic character of breathing, to the higher mental load during the small breath task, or to the presumably different frequencies of target breaths in the whole span of spontaneous breathing. In the second session, performance on the two targets levelled out as a result of learning.