A more precise, repeatable and diagnostic alternative to surface electromyography - an appraisal of the clinical utility of acoustic myography

The Effect of Phonomyography Prototype for Intraoperative Neuromuscular Monitoring: A Preliminary Study

Quantitative neuromuscular monitoring, as extolled by clinical guidelines, is advocated to circumvent the complications associated with neuromuscular blockers (NMBs), such as residual neuromuscular block (rNMB). Nonetheless, the worldwide utilization of such methods remains undesirable. Phonomyography (PMG) boasts the advantages of convenience, stability, and multi-muscle recording which may be a promising monitoring method. The purpose of this preliminary study is conducting a feasibility analysis and an effectiveness evaluation of a PMG prototype under general anesthesia. A prospective observational preliminary study was conducted. Twenty-five adults who had undergone none-cardiac elective surgery were enrolled. The PMG prototype and TOF-Watch SX simultaneously recorded the pharmacodynamic properties of single bolus rocuronium at the ipsilateral adductor pollicis for each patient. For the primary outcome, the time duration to 0.9 TOF ratio of the two devices reached no statistical significance (p > 0.05). For secondary outcomes, the multi-temporal neuromuscular-monitoring measurements between the two devices also reached no statistical significance (p > 0.05). What is more, both the Spearman's and Pearson's correlation tests revealed a strong correlation across all monitoring periods between the PMG prototype and TOF-Watch SX. Additionally, Bland-Altman plots demonstrated a good agreement between the two devices. Thus, the PMG prototype was a feasible, secure, and effective neuromuscular-monitoring technique during general anesthesia and was interchangeable with TOF-Watch SX.

MMG-Based Knee Dynamic Extension Force Estimation Using Cross-Talk and IGWO-LSTM

Mechanomyography (MMG) is an important muscle physiological activity signal that can reflect the amount of motor units recruited as well as the contraction frequency. As a result, MMG can be utilized to estimate the force produced by skeletal muscle. However, cross-talk and time-series correlation severely affect MMG signal recognition in the real world. These restrict the accuracy of dynamic muscle force estimation and their interaction ability in wearable devices. To address these issues, a hypothesis that the accuracy of knee dynamic extension force estimation can be improved by using MMG signals from a single muscle with less cross-talk is first proposed. The hypothesis is then confirmed using the estimation results from different muscle signal feature combinations. Finally, a novel model (improved grey wolf optimizer optimized long short-term memory networks, i.e., IGWO-LSTM) is proposed for further improving the performance of knee dynamic extension force estimation. The experimental results demonstrate that MMG signals from a single muscle with less cross-talk have a superior ability to estimate dynamic knee extension force. In addition, the proposed IGWO-LSTM provides the best performance metrics in comparison to other state-of-the-art models. Our research is expected to not only improve the understanding of the mechanisms of quadriceps contraction but also enhance the flexibility and interaction capabilities of future rehabilitation and assistive devices.

Muscle function assessment of the hindlimbs in healthy dogs using acoustic myography

INTRODUCTION

Impaired muscle function is a frequent consequence of musculoskeletal disorders in dogs. Musculoskeletal disorders, especially stifle joint diseases, are common in dogs and assessment of muscle function in dogs is clinically relevant. Acoustic myography (AMG) is a non-invasive method to assess muscle activity. Quantifying muscle function in normal dogs could help identify clinically relevant changes in dogs with orthopaedic disease and allow targeted interventions to improve recovery in these. The objectives of the study were to characterize hindlimb muscle function in healthy dogs using AMG and to investigate the repeatability and reproducibility of AMG in dogs.

METHODS

Healthy dogs (15-40 kg) without musculoskeletal disorders were recruited and screened for eligibility to participate in the study. The muscle activity in four hindlimb muscles related to the stifle was assessed using AMG. The degree of symmetry between the hindlimbs in these dogs was investigated and the reliability of AMG was evaluated.

RESULTS AND CONCLUSIONS

The study population comprised 21 dogs. Reference intervals and symmetry indices for AMG scores of the hindlimb muscles were identified, with highest variability for the E-scores. For all AMG-scores, same-day variation was lower than between days variation, and both were lowest for S- and T-scores. Further investigation is needed to establish if AMG can enable discrimination between dogs with altered muscle function and healthy dogs.

Probing motor dynamics at the muscle level-Acoustic myography in Parkinson's disease

Acoustic myography (AMG) noninvasively probes muscle activity. We explored whether AMG captures abnormal motor activity in patients with Parkinson's disease (PD) and how this activity is modulated by antiparkinsonian medication. Twenty patients with PD underwent AMG of the biceps, triceps, extensor carpi radialis longus, and adductor policis muscles of the more affected arm during active and passive movements, using a mobile AMG device (CURO, Denmark). AMG and assessment of motor symptoms were performed in a pragmatic off-medication state, as well as one and 3 h after oral intake of 200 mg levodopa. Three AMG parameters were calculated using the CURO analysis system. Motor efficiency was expressed by the E-score, muscle fiber recruitment by the temporal T-score, spatial summation by the S-score, and S/T ratio. Twenty age- and sex-matched healthy subjects served as controls. Group mean values were statistically compared using unpaired two-tailed adjusted t-test and ANOVA with Tukey´s correction for multiple comparison (p ≤ 0.05). For the biceps and extensor carpi radialis longus muscles, the active movement S:T ratio was lower in PD relative to healthy controls. The E-score was also lower during active and passive flexion/extension movements in the off-medication state. No significant between-group differences in the AMG scores were noted for the triceps muscle during active or passive movements. The active S:T ratio and the E-score during active elbow flexion and extension may offer a useful means to quickly assess abnormal motor activity and the effect of drug treatment in PD.

Use of acoustic myography to evaluate forelimb muscle function in retriever dogs carrying different mouth weights

OBJECTIVES

To evaluate the effect of mouth weight on gait and relative function of forelimb muscles in retriever hunting dogs as a possible explanation for biceps tendinopathy.

METHODS

Ten sound retriever dogs underwent acoustic myography, measuring efficiency (E-score), spatial summation (S-score), and temporal summation (T-score) during walk and trot on a pressure-sensitive walkway while carrying a 0 lb (0 kg), 1 lb (0.45 kg), and 3.2 lb (1.45 kg) mouth weight. Gait data included total pressure index (TPI), step length, and stance time. Statistics included a mixed effects model significant at p < 0.05.

RESULTS

Forelimb TPI increased with increasing weight. There was no significant change in individual muscle parameters in response to weight. Significance was found in between-muscle comparisons. For walk, T-score was significantly lower in triceps vs. brachiocephalicus with 1 lb, not with 3.2 lb., S-score was significantly lower in the biceps at 0, 1 lb, and triceps at 0 lb. when compared to brachiocephalicus, E-score was significantly lower in deltoideus vs. brachiocephalicus at trot with l and 3.2 lb. There was an overall significant effect of muscle on T-score at trot, but no individual muscle comparison was significant.

CONCLUSION

Forelimb load increases with mouth weight. Deltoideus had a longer contraction time in response to increasing weight at trot when compared to brachiocephalicus. The biceps muscle did not show increased work in response to increasing weight.

CLINICAL RELEVANCE

The underlying etiology of biceps tendinopathies in retriever dogs remains uncertain but is not due to increasing weight.

Assessment of Low Back Pain in Helicopter Pilots Using Electrical Bio-Impedance Technique: A Feasibility Study

Low back pain (LBP) is known to pose a serious threat to helicopter pilots. This study aimed to explore the potential of electrical bio-impedance (EBI) technique with the advantages of no radiation, non-invasiveness and low cost, which is intended to be used as a daily detection tool to assess LBP in primary aviation medical units. The LBP scales (severity) in 72 helicopter pilots were assessed using a pain questionnaire, while the bilateral impedance measurements of the lumbar muscle were carried out with a high precision EBI measurement system. Results showed that the modulus of lumbar muscle impedance increased with LBP scale whereas the phase angle decreased. For different LBP scales, significant differences were found in the modulus of lumbar muscle impedance sum on both sides (Z_sum), as well as in the modulus and phase angle of lumbar muscle impedance difference between both sides (Z_diff and ϕ_diff), respectively (P < 0.05). Moreover, Spearman’s correlation analysis manifested a strong correlation between Z_sum and LBP scale (R = 0.692, P < 0.01), an excellent correlation between Z_diff and LBP scale (R = 0.86, P < 0.01), and a desirable correlation between ϕ_diff and LBP scale (R = −0.858, P < 0.01). In addition, receiver operator characteristic analysis showed that for LBP prediction, the area under receiver operator characteristic curve of Z_sum, Z_diff, and ϕ_diff were 0.931, 0.992, and 0.965, respectively. These findings demonstrated that EBI could sensitively and accurately detect the state of lumbar muscle associated with LBP, which might be the potential tool for daily detection of LBP in primary aviation medical units.

Phonomyography on Perioperative Neuromuscular Monitoring: An Overview

Complications related to neuromuscular blockade (NMB) could occur during anesthesia induction, maintenance, and emergency. It is recommended that neuromuscular monitoring techniques be utilized perioperatively to avoid adverse outcomes. However, current neuromuscular monitoring methods possess different shortcomings. They are cumbersome to use, susceptible to disturbances, and have limited alternative monitoring sites. Phonomyography (PMG) monitoring based on the acoustic signals yielded by skeletal muscle contraction is emerging as an interesting and innovative method. This technique is characterized by its convenience, stable signal quality, and multimuscle recording ability and shows great potential in the application field. This review summarizes the progression of PMG on perioperative neuromuscular monitoring chronologically and presents the merits, demerits, and challenges of PMG-based equipment, aiming at underscoring the potential of PMG-based apparatuses for neuromuscular monitoring.

The impact of water depth and speed on muscle fiber activation of healthy dogs walking in a water treadmill

BACKGROUND

Water treadmills are frequently used in the rehabilitation of dogs, for example with the purpose of re-building muscular strength after surgery. However, little is known about how different water depths and velocities affect the muscular workload during aquatic locomotion. This study used acoustic myography to assess hind limb muscle fiber activation in 25 healthy large-breed dogs walking in a water treadmill. Acoustic myography sensors were attached to the skin over the vastus lateralis of the quadriceps and the biceps femoris muscles. The dogs walked at two velocities (30 and 50 m/min) and four water depths: bottom of the pads, hock, stifle and mid-femur. Acoustic myograph signals were analyzed for changes in three muscle function parameters: efficiency/coordination (E-score) and spatial (S-score) and temporal (T-score) summation.

RESULTS

Differences between E, S, and T were statistically significant compared across different speeds (30, 50) and water levels (0, 1, 2, 3) using a one-way ANOVA with multiple comparisons (Tukey; Geisser-Greenhouse correction) as well as a two-tailed one sample t-test. At 50 m/min in water at the mid-femur, the biceps femoris was less efficient (P < 0.001) and recruited more fibers (P = 0.01) at a higher firing rate (P = 0.03) compared to working in shallower water, while the vastus lateralis was also less efficient (P < 0.01), but spatial and temporal summation did not change significantly. At 30 m/min, biceps efficiency was reduced (P < 0.01) when water was at the mid-femur compared to the bottom of the pads level. Walking in stifle- or hock-deep water did not show increased muscle activation for either muscle compared to walking in water at the bottom of the pads.

CONCLUSION

More muscle activation was required to walk in water at a depth at the level of the mid-femur compared to shallower water, and this exercise was more demanding for the biceps femoris, a muscle engaged in propulsion, than for vastus lateralis. These findings may help practitioners towards making more precise rehabilitation protocols.

Sitting for Too Long, Moving Too Little: Regular Muscle Contractions Can Reduce Muscle Stiffness During Prolonged Periods of Chair-Sitting

In modern Western societies, sedentary behavior has become a growing health concern. There is increasing evidence that prolonged sitting periods can be associated with musculoskeletal disorders. While it is generally recognized that back muscle activity is low during chair-sitting, little is known about the consequences of minor to no muscle activity on muscle stiffness. Muscle stiffness may play an important role in musculoskeletal health. This study investigated the effects of regular muscle contractions on muscle stiffness in a controlled experiment in which participants sat for 4.5 h. Neuromuscular electrical stimulation in the lumbar region of the back was applied to trigger regular muscle contractions. Using stiffness measurements and continuous motion capturing, we found that prolonged sitting periods without regular muscle contractions significantly increased back muscle stiffness. Moreover, we were able to show that regular muscle contractions can prevent those effects. Our results highlight the importance of consistent muscle activity throughout the day and may help explain why prolonged periods of chair-sitting increase the susceptibility to common pathological conditions such as low back pain.

Effect of tibial plateau levelling osteotomy and rehabilitation on muscle function in cruciate-deficient dogs evaluated with acoustic myography

The objective of the study was to determine the function of the biceps femoris, quadriceps, gastrocnemius and semitendinosus muscles at the walk in dogs with unilateral clinical cruciate disease and palpable joint instability. To compare function before and after a tibial plateau levelling osteotomy (TPLO) procedure, and after six weeks of subsequent rehabilitation therapy. Fourteen adult client-owned dogs with cranial cruciate ligament deficiency (CCLD). Orthopaedic examination, temporospatial gait analysis and acoustic myography (AMG) recordings were made at three time points: before TPLO, and post-operatively at two and eight weeks. A rehabilitation program started 2 weeks after surgery and was either in-clinic along with in-home rehabilitation or in-home only. Statistics included: repeated measures ANOVA and paired t-tests. Significance was set at P<0.05. When comparing the affected versus the unaffected limb in the CCLD dogs, there were no significant differences found in AMG values between baseline and other time points for the quadriceps and semitendinosus muscles. The gastrocnemius and biceps femoris muscles had a significant change in spatial summation (S) score over time. The gastrocnemius (S) score was not significantly different to the unaffected limb by 8 weeks post TPLO. There was no significant effect of rehabilitation method on S score. Dogs with in-clinic rehabilitation regained more symmetry in thigh circumference versus in-home only. Lameness parameters improved but did not completely resolve in all dogs by week 8 post TPLO. The function of the gastrocnemius muscles in affected limbs was significantly different to normal limbs at baseline and 2 weeks post TPLO but not at 8 weeks. Thigh symmetry, but no other parameters, was improved with the addition of in-clinic rehabilitation.

Altered muscle activation in agility dogs performing warm-up exercises: an acoustic myography study

Agility is physically demanding and dogs encounter a considerable risk of injury during training and competition. Pre-performance warm-up is used routinely among human athletes to prepare the tissues for these physical demands, but in canine sports evidence for effects of warm-up is lacking. The aim of this study was to investigate the effects of warm-up in dogs on two major muscles involved in locomotion. It was hypothesised that, after warm-up, the muscles would be used more efficiently (more fibre resting time/total time), recruit fewer fibres (reduced spatial summation) and/or activated with a lower firing frequency (reduced temporal summation). The following factors ‘sex, age, weight, height, training level and agility experience’ were evaluated for their potential impact on muscle function parameters. Fourteen large (≥46 cm at the withers) agility dogs of different breeds and training levels performed a 5 min warm-up program three times, with a 2 min break between the programs for recording purposes. Acoustic myography sensors were attached on the skin over the muscles m. triceps brachii (TB) and m. gluteus superficialis (GS). Recordings of muscle activity were made, while the dogs trotted before warm-up and after each 5 min warm-up program. The dogs used TB more efficiently after 5 min (P<0.05), 10 min (P<0.05) and 15 min (P<0.001) of exercise compared to pre-warm-up values. No changes were found in the activity of GS. For well-trained dogs, TB recruited fewer muscle fibres after 10 and 15 min of warm-up compared to dogs that trained less than 1 h weekly (P<0.03). For dogs with more than 2 years of experience, GS had a lower firing frequency before and after 10 min warm-up compared to dogs with less experience. The results indicate that warm-up alters muscle activation by an increased muscular efficiency. Training level and experience have an influence on muscle function parameters.

Muscle function assessed by the non-invasive method acoustic myography (AMG) in a Danish group of healthy adults

Acoustic myography (AMG) is a non-invasive method to assess muscle function during daily activities. AMG has great scope for assessment of musculoskeletal problems. The aim of this study was to create an AMG data set for general clinical use and relate these findings to age and gender. 10 healthy subjects (5 men/5 women), in each decade from 20 to 69 years of age (n = 50), were assessed. Their clinical health was tested. AMG measurements were carried out on muscles involved in defined movements of the upper and lower extremities. Muscle performance was measured using efficiency (E-score) and fibre recruitment (temporal (T-score) and spatial (S-score) summation). AMG-measurements showed good reproducibility. In each age group, it was found that for all those daily living skills measured, there was no gender difference. A walking and stair climbing test revealed that both legs are used equally and in a balanced way in healthy subjects. Moreover, there was no change in this function with increasing age up to 69 years. However, a cycling test with loading revealed that in elderly subjects the coordination of muscle use is impaired compared to that of the younger adults. Finally, a flexion test of the arm revealed an age-related decrease in the efficiency/coordination of m.Biceps alone, and a keyboard writing test suggests no effect on m.Trapezius. This reference data set now illustrates the reproducibility and ease of use of acoustic myography in the clinic and provides a means of assessing individuals with musculoskeletal problems.

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Acoustic myography is a non-invasive, real-time and repeatable tool for assessing musculoskeletal problems in the clinic.

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A walking and stair climbing test revealed both legs to be used in a balanced way in healthy subjects, with no age effect.

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A cycling test with loading showed that coordination of muscle use was impaired with increasing age.

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A flexion test of the arm revealed an age-related decrease in the efficiency/coordination of m.Biceps alone.

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This reference data set illustrates the ease of use of this technique in the clinic for musculoskeletal problems.

Multimodal hand gesture recognition using single IMU and acoustic measurements at wrist

To facilitate hand gesture recognition, we investigated the use of acoustic signals with an accelerometer and gyroscope at the human wrist. As a proof-of-concept, the prototype consisted of 10 microphone units in contact with the skin placed around the wrist along with an inertial measurement unit (IMU). The gesture recognition performance was evaluated through the identification of 13 gestures used in daily life. The optimal area for acoustic sensor placement at the wrist was examined using the minimum redundancy and maximum relevance feature selection algorithm. We recruited 10 subjects to perform over 10 trials for each set of hand gestures. The accuracy was 75% for a general model with the top 25 features selected, and the intra-subject average classification accuracy was over 80% with the same features using one microphone unit at the mid-anterior wrist and an IMU. These results indicate that acoustic signatures from the human wrist can aid IMU sensing for hand gesture recognition, and the selection of a few common features for all subjects could help with building a general model. The proposed multimodal framework helps address the single IMU sensing bottleneck for hand gestures during arm movement and/or locomotion.

Emission of Biophotons and Adjustable Sounds by the Fascial System: Review and Reflections for Manual Therapy

Every body structure is wrapped in connective tissue or fascia, creating a structural continuity that gives form and function to every tissue and organ. The fascial tissue is uniformly distributed throughout the body, enveloping, interacting with and permeating blood vessels, nerves, viscera, meninges, bones and muscles, creating various layers at different depths and forming a tridimensional metabolic and mechanical matrix. This article reviews the literature on the emission of biophotons and adjustable sounds by the fascial system, because these biological changes could be a means of local and systemic cellular communication and become another assessment tool for manual (therapy) practitioners. This is the first article that discusses these topics in a single text, attempting to bring such information into an area of application that is beneficial to osteopaths, chiropractors, and manual therapists.

The relation between maximal voluntary force in m. palmaris longus and the temporal and spatial summation of muscle fiber recruitment in human subjects

This study aimed at looking at the frequency (T‐score) and the amplitude (S‐score) of fiber use during contraction of a forearm muscle, m. palmaris longus, as measured by acoustic myography (AMG). An additional aim was to relate the T‐ and S‐scores to the recorded force obtained from a hand dynamometer. The hypothesis being that temporal and spatial summation of muscle fiber contraction in a given muscle during a given movement, can together describe a given obtained force. Force measurements were carried out on 12 healthy human subjects aged 19–68 years (6 men & 6 women), while their m. palmaris longus contractile function was measured using an acoustic myography CURO device. Force production was varied from 90 to 10% of assessed maximal voluntary force (MVF), and also monitored over a 1 min period of 50% MVF. Linear regression analysis was applied to relate force to spatial and temporal summation. Muscle strength was sustained by changing the frequency and/or the number of active fibere at any given point in time. Force production, whilst stronger for men than women, was regulated in a similar fashion for both sexes and was closely correlated with the AMG T‐ and S‐scores. It is concluded that AMG is a noninvasive method which can be readily applied to accurately describe how a subject uses a given muscle during any given movement. These findings have relevance when considering training strategies in subjects with muscle trauma or disease, in the elderly, or for both amateur and top professional athletes.

The Efficacy of Intermittent Long-term Bell Boot Application for the Correction of Muscle Asymmetry in Equine Subjects

It has been proposed that manipulating proprioceptive signals of the equine distal limb as part of a rehabilitation process in cases of musculoskeletal pain or neurologic deficits can be used to correct postural control and restore normal motor programs. This trial has examined the effect of treatment with a light-weight and loose-fitting bell boot (82 g) on an imbalance of muscle gluteus superficialis function in horses as measured using acoustic myography (AMG). Eight horses were trained over a 60-minute period every 3 days for 6 weeks, a protocol based on preliminary findings. Acoustic myography measurements, recording the coordination, spatial and temporal summation of muscle contractions, were made at the start (baseline) and at the finish (week 6) after a warmup period and following a set procedure of physical activity. Walking, trotting, and cantering during a left-hand circle at the start of the trial revealed a slight but significant asymmetry between the left and right hind limb muscle, which improved successfully after 6 weeks of proprioception training. Data for the right-hand circle, which revealed no significant asymmetry, during walk, trot, and canter at the start, showed no change after 6 weeks of training at the walk and trot but developed an imbalance during cantering, the result of overcompensation. This study demonstrates that functional musculoskeletal asymmetry measured during periods of activity can not only be accurately detected using AMG but it also reveals an association between the program of proprioceptive training adopted and an improvement in muscular imbalance.