Patient ratings of spasticity during daily activities are only marginally associated with long-term surface electromyography

AIM

To investigate the association between subjective spasticity ratings and objective spasticity measurement using a new tool for spasticity assessment, that is long-term surface electromyography (sEMG) recordings during daily activities. For monitoring, processing and analysis of this long-term sEMG data, a muscle activity detection algorithm was developed.

METHOD

sEMG of the rectus femoris, vastus lateralis, adductor group and semitendinosus of 14 complete spinal-cord-injured patients, in whom voluntary muscle contraction was absent, was recorded continuously during daily activities. Synchronously, subjects stored their activities in a diary and scored their experienced level of spasticity on the Visual Analogue Scale (VAS) for that particular activity. sEMG data were analysed using a high-quality burst-detection algorithm that was developed and validated within this study. Derived sEMG parameters were clustered using principal-component analysis (PCA) and used in a linear mixed model analysis to study their association with VAS.

RESULTS

VAS scores appeared significantly associated with the PCA components representing the number and the duration of bursts, but not burst amplitude. Furthermore, VAS scores were associated with the activity performed. The percentage explained variance was, however, low, that is 27-35%.

CONCLUSIONS

Patient ratings of the level of spasticity appear poorly associated with spasticity in terms of involuntary muscle activity assessed with long-term sEMG recordings. It is likely that other factors such as pain and cognitions are also incorporated in these patient ratings. Clinicians are therefore strongly advised to perform complementary objective assessments using long-term sEMG recordings.

Influence of gravity compensation on muscle activity during reach and retrieval in healthy elderly

INTRODUCTION

Arm support like gravity compensation may improve arm movements during stroke rehabilitation. It is unknown how gravity compensation affects muscle activation patterns during reach and retrieval movements. Since muscle activity during reach is represented by a component varying with movement velocity and a component supposedly counteracting gravity, we hypothesized that gravity compensation decreases the amplitude of muscle activity, but does not affect the pattern. To examine this, we compared muscle activity during well defined movements with and without gravity compensation in healthy elderly.

METHODS

Ten subjects performed reach and retrieval movements with and without gravity compensation. Muscle activity of biceps, triceps, anterior, middle and posterior parts of deltoid and upper trapezius was compared between the two conditions.

RESULTS

The level of muscle activity was lower with gravity compensation in all muscles, reaching significance in biceps, anterior deltoid and trapezius (p < or = 0.026). The muscle activation pattern did not differ between movements with and without gravity compensation (p > or = 0.662).

DISCUSSION

Gravity compensation only influenced the level of muscle activity but not the muscle activation pattern in terms of timing. Future studies should examine if the influence of gravity compensation is comparable for stroke patients. This may stimulate early and intensive training during rehabilitation.

Trapezius muscle rest time during standardised computer work – A comparison of female computer users with and without self-reported neck/shoulder complaints

Work related musculoskeletal disorders (WMSDs) in the shoulder/neck area are a common and increasing problem among European computer workers, especially women. Long-term low-level workloads with low degree of muscle rest are a potential risk factor for developing WMSDs. The purpose of the present study of female computer users (age 45-65 years) in Denmark and Sweden was to investigate if subjects with self-reported neck/shoulder complaints (cases, N=35) show less trapezius muscle relative rest time (RRT) than controls (N=44) when performing standardised short-term computer work tasks in controlled laboratory conditions. Surface electromyography (EMG) signals were recorded bilaterally from the upper trapezius muscles during a type, edit, precision and colour word stress task. Besides RRT, 10th percentile RMS values were calculated. On the average, 15 of the cases and 18 of the controls showed analysable EMG files per task. For the colour word stress task, the results showed lower RRT values and higher 10th percentile RMS amplitude levels among cases compared to controls. No such signs could be found for the other tasks performed. The present results indicate an increased motor response to a psychological stressor among subjects with self-reported neck/shoulder complaints.

Behaviour of a surface EMG based measure for motor control: motor unit action potential rate in relation to force and muscle fatigue

Surface electromyography parameters such as root-mean-square value (RMS) and median power frequency (FMED) are commonly used to assess the input of the central nervous system (CNS) to a muscle. However, RMS and FMED are influenced not only by CNS input, but also by peripheral muscle properties. The number of motor unit action potentials (MUAPs) per second, or MUAP Rate (MR), being the sum of the firing rates of the active motor units, would reflect CNS input solely. This study explored MR behaviour in relation to force and during a fatiguing contraction in comparison to RMS and FMED. In the first experiment (n=10) a step contraction of shoulder elevation force (20-100 N) was performed while multi-channel array EMG was recorded from the upper trapezius muscle. The sensitivity of MR for changes in force (1.8%/N) was almost twice as high as that of RMS (0.97%/N), indicating that MR may be more suitable for monitoring muscle force. The second experiment (n=6) consisted of a 15-min isometric contraction of the biceps brachii. MR increased considerably less than RMS (0.9% vs. 4.1%), suggesting that MR selectively reflects central motor control whereas RMS also reflects peripheral changes. These results support that, at relatively low force levels, MR is a suitable parameter for non-invasive assessment of the input of the CNS to the muscle.

Comparison of the electromyographic activity in the upper trapezius and biceps brachii muscle in subjects with muscular disorders: a pilot study

The aim of the present study was to investigate the extent to which work-related muscular disorders of the upper trapezius affect the activity of other pain-free muscles, in particular in the biceps brachii. Two groups of female subjects (age >43 years) participated in the study: seven affected subjects with self-reported disorders in the shoulder/neck region (cases) and nine healthy subjects (control group). Multi-channel electromyography (EMG) and force were recorded during maximum voluntary contractions (MVC) and during 6 min sustained contractions (at 30% MVC) of the upper trapezius and biceps brachii on the dominant side. From the EMG signals, the root mean square (RMS), median frequency (MDF) and single motor unit (MU) conduction velocity (CV) were estimated. From the force signal, the coefficient of variation was calculated. All data are presented as mean values and standard deviation. Differences between the cases and controls were found in the MVC force of the upper trapezius, which was lower in cases [253 (70) N] than in controls [357 (75) N], while the coefficient of variation of force during the sustained contraction was increased [cases 5.5 (2.2); controls 4.1 (1.9)]. The RMS (normalized to the RMS at MVC) during the 6 min sustained contractions was significantly lower in the cases than in the controls for both the upper trapezius and the biceps brachii. A tendency towards a smaller increase in the RMS with fatigue was only found in the trapezius muscle [slope: cases 6.5 (14.1) %/min, controls 10.2 (12.9) %/min]. No differences were found between the two subject groups with respect to the MDF and single MU CV in both muscles. While the lower RMS for the trapezius muscles of the cases may reflect changes at the local level, as well as in motor control, the lower biceps activity indicates a change in the central control strategies of the primarily unaffected muscle. Indications for a changed fatigability of the muscle were only found in the trapezius.