Experimental assessment of pelvis slipping during postless traction for orthopaedic applications

BACKGROUND

The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative. However, whether these pads sufficiently prevent patient displacement remains unknown. Thus, this study systematically assesses the efficacy of commercial high-friction pads (PinkPad and CarePad) in restraining subject displacement, for progressively increasing traction loads and different Trendelenburg angles.

METHODS

Three healthy male subjects were recruited and tested in supine and Trendelenburg positions (5° and 10°), using a customized boot-pulley system. Ten load disks (5 kg) were dropped at 15s intervals, increasing gradually the traction load up to 50 kg. Pelvis displacement along the traction direction was measured with a motion capture system. The displacement at 50 kg of traction load was analyzed and compared across various pads and bed inclinations. Response to varying traction loads was statistically assessed with a quadratic function model.

RESULTS

Pelvis displacement at 50 kg traction load was below 60 mm for all conditions. Comparing PinkPad and CarePad, no significant differences in displacement were observed. Finally, similar displacements were observed for the supine and Trendelenburg positions.

CONCLUSIONS

Both PinkPad and CarePad exhibited nearly linear behavior under increasing traction loads, limiting displacement to 60 mm at most for 50 kg loads. Contrary to expectations, placing subjects in the Trendelenburg position did not increase adhesion.

Regional recruitment and differential behavior of motor units during postural control in older adults

Aging is associated with neuromuscular system changes that may have implications for the recruitment and firing behaviors of motor units (MUs). In previous studies, we observed that young adults recruit subpopulations of triceps surae MUs during tasks that involved leaning in five directions: common units that were active during different leaning directions and unique units that were active in only one leaning direction. Furthermore, the MU subpopulation firing behaviors [average firing rate (AFR), coefficient of variation (CoVISI), and intermittent firing] modulated with leaning direction. The purpose of this study was to examine whether older adults exhibited this regional recruitment of MUs and firing behaviors. Seventeen older adults (aged 74.8 ± 5.3 yr) stood on a force platform and maintained their center of pressure leaning in five directions. High-density surface electromyography recordings from the triceps surae were decomposed into single MU action potentials. A MU tracking analysis identified groups of MUs as being common or unique across the leaning directions. Although leaning in different directions did not affect the AFR and CoVISI of common units (P > 0.05), the unique units responded to the leaning directions by increasing AFR and CoVISI, albeit modestly (F = 18.51, P < 0.001). The unique units increased their intermittency with forward leaning (F = 9.22, P = 0.003). The mediolateral barycenter positions of MU activity in both subpopulations were found in similar locations for all leaning directions (P > 0.05). These neuromuscular changes may contribute to the reduced balance performance seen in older adults.NEW & NOTEWORTHY In this study, we observed differences in motor unit recruitment and firing behaviors of distinct subpopulations of motor units in the older adult triceps surae muscle from those observed in the young adult. Our results suggest that the older adult central nervous system may partially lose the ability to regionally recruit and differentially control motor units. This finding may be an underlying cause of balance difficulties in older adults during directionally challenging leaning tasks.

The Sensitivity of Bipolar Electromyograms to Muscle Excitation Scales With the Inter-Electrode Distance

The value of surface electromyograms (EMGs) lies in their potential to non-invasively probe the neuromuscular system. Whether muscle excitation may be accurately inferred from bipolar EMGs depends on how much the detected signal is both sensitive and specific to the excitation of the target muscle. While both are known to be a function of the inter-electrode distance (IED), specificity has been of long concern in the physiological literature. In contrast, sensitivity, at best, has been implicitly assumed. Here we provide evidence that the IED imposes a biophysical constraint on the sensitivity of surface EMG. From 20 healthy subjects, we tested the hypothesis that excessively reducing the IED limits EMGs' physiological content. We detected bipolar EMGs with IEDs varying from 5 mm to 50 mm from two skeletal muscles with distinct architectures, gastrocnemius and biceps brachii. Non-parametric statistics and Bayesian hierarchical modelling were used to evaluate the dependence of the onset of muscle excitation and signal-to-noise ratio (SNR) on the IED. Experimental results revealed that IED critically affects the sensitivity of bipolar EMGs for both muscles-indeliberately reducing the IED yields EMGs that are not representative of the whole muscle, hampering validity. Simulation results substantiate the generalization of experimental results to small and large electrodes. Based on current and previous findings, we discuss a potentially valid procedure for defining the most appropriate IED for a single bipolar, surface recording-i.e., the distance from the electrode to the target muscle boundary may heuristically serve as a lower bound when choosing an IED.

Differential behavior of distinct motoneuron pools that innervate the triceps surae

It has been shown that when humans lean in various directions, the central nervous system (CNS) recruits different motoneuron pools for task completion; common units that are active during different leaning directions, and unique units that are active in only one leaning direction. We used high-density surface electromyography (HD-sEMG) to examine if motor unit (MU) firing behavior was dependent on leaning direction, muscle (medial and lateral gastrocnemius; soleus), limits of stability, or whether a MU is considered common or unique. Fourteen healthy participants stood on a force platform and maintained their center of pressure in five different leaning directions. HD-sEMG recordings were decomposed into MU action potentials and the average firing rate (AFR), coefficient of variation (CoV_ISI), and firing intermittency were calculated on the MU spike trains. During the 30°-90° leaning directions both unique units and common units had higher firing rates (F = 31.31, P < 0.0001). However, the unique units achieved higher firing rates compared with the common units (mean estimate difference = 3.48 Hz, P < 0.0001). The CoV_ISI increased across directions for the unique units but not for the common units (F = 23.65, P < 0.0001). Finally, intermittent activation of MUs was dependent on the leaning direction (F = 11.15, P < 0.0001), with less intermittent activity occurring during diagonal and forward-leaning directions. These results provide evidence that the CNS can preferentially control separate motoneuron pools within the ankle plantarflexors during voluntary leaning tasks for the maintenance of standing balance.NEW & NOTEWORTHY In this study, we demonstrate that the different subpopulations of motor units within the three muscles comprising the ankle plantarflexors behave differently during multidirectional leaning. Our results suggest that the central nervous system has the capability to control distinct subpopulations of motor units to meet the force requirements necessary for leaning. This may allow for a precise, efficient, and flexible control strategy for the maintenance of standing balance.

Longing for a Longitudinal Proxy: Acutely Measured Surface EMG Amplitude is not a Validated Predictor of Muscle Hypertrophy

Surface electromyography amplitudes are commonly measured in acute sports and exercise science studies to make inferences about muscular strength, performance, and hypertrophic adaptations that may result from different exercises or exercise-related variables. Here, we discuss the presumptive logic and assumptions underlying these inferences, focusing on hypertrophic adaptations for simplicity's sake. We present counter-evidence for each of its premises and discuss evidence both for and against the logical conclusion. Given the limited evidence validating the amplitude of surface electromyograms as a predictor of longitudinal hypertrophic adaptations, coupled with its weak mechanistic foundation, we suggest that acute comparative studies that wish to assess stimulus potency be met with scrutiny.

Non-uniform excitation of the pectoralis major muscle during flat and inclined bench press exercises

Non-physiological sources may lead to equivocal interpretation on the degree of muscle excitation from electromyograms (EMGs) amplitude. This presumably explains the contradictory findings regarding the effect of the bench press inclination on the pectoralis major (PM) activation pattern. To contend with these issues, herein we used high-density surface EMG to investigate whether different PM regions are excited during the flat and 45° inclined bench press exercises. Single-differential EMGs were collected from 15 regions along the PM cranio-caudal axis, while 8 volunteers performed a set of the flat and 45° inclined bench press at 50% and 70% of 1 repetition maximum. The coefficient of variation, the range of motion, and the cycle duration were calculated from the barbell vertical position to assess the within-subject consistency across cycles. The number of channels detecting the largest EMGs amplitude (active channels), their interquartile range, and their barycentre coordinate were assessed to characterize the EMG amplitude distribution within PM. No significant differences in the range of motion (p > 0.11), cycle duration (p > 0.28), number of active channels (p > 0.05), and interquartile range of active channels (p > 0.39) were observed between the two bench press inclinations. Conversely, the barycentre shifted toward the PM clavicular region (p < 0.001) when the bench press changed from flat to 45°. Our results revealed that greatest EMG amplitudes were concentrated at the PM sternocostal and clavicular heads when exercising in the flat and 45° inclined bench press, respectively. Performing the bench press exercise, with different postures, seem to demand the excitation of different PM regions.

Changes in supramaximal M-wave amplitude at different regions of biceps brachii following eccentric exercise of the elbow flexors

PURPOSE

Previous evidence from surface electromyograms (EMGs) suggests that exercise-induced muscle damage (EIMD) may manifest unevenly within the muscle. Here we investigated whether these regional changes were indeed associated with EIMD or if they were attributed to spurious factors often affecting EMGs.

METHODS

Ten healthy male subjects performed 3 × 10 eccentric elbow flexions. Maximal voluntary contraction (MVC), muscle soreness and ultrasound images from biceps brachii distal and proximal regions were measured immediately before (baseline) and during each of the following 4 days after the exercise. Moreover, 64 monopolar surface EMGs were detected while 10 supramaximal pulses were applied to the musculocutaneous nerve. The innervation zone (IZ), the number of electrodes detecting largest M-waves and their centroid longitudinal coordinates were assessed to characterize the spatial distribution of the M-waves amplitude.

RESULTS

The MVC torque decreased (~ 25%; P < 0.001) while the perceived muscle soreness scale increased (~ 4 cm; 0 cm for no soreness and 10 cm for highest imaginable soreness; P < 0.005) across days. The echo intensity of the ultrasound images increased at 48 h (71%), 72 h (95%) and 96 h (112%) for both muscle regions (P < 0.005), while no differences between regions were observed (P = 0.136). The IZ location did not change (P = 0.283). The number of channels detecting the greatest M-waves significantly decreased (up to 10.7%; P < 0.027) and the centroid longitudinal coordinate shifted distally at 24, 48 and 72 h after EIMD (P < 0.041).

CONCLUSION

EIMD consistently changed supramaximal M-waves that were detected mainly proximally from the biceps brachii, suggesting that EIMD takes place locally within the biceps brachii.

Timing and Modulation of Activity in the Lower Limb Muscles During Indoor Rowing: What Are the Key Muscles to Target in FES-Rowing Protocols?

The transcutaneous stimulation of lower limb muscles during indoor rowing (FES Rowing) has led to a new sport and recreation and significantly increased health benefits in paraplegia. Stimulation is often delivered to quadriceps and hamstrings; this muscle selection seems based on intuition and not biomechanics and is likely suboptimal. Here, we sample surface EMGs from 20 elite rowers to assess which, when, and how muscles are activated during indoor rowing. From EMG amplitude we specifically quantified the onset of activation and silencing, the duration of activity and how similarly soleus, gastrocnemius medialis, tibialis anterior, rectus femoris, vastus lateralis and medialis, semitendinosus, and biceps femoris muscles were activated between limbs. Current results revealed that the eight muscles tested were recruited during rowing, at different instants and for different durations. Rectus and biceps femoris were respectively active for the longest and briefest periods. Tibialis anterior was the only muscle recruited within the recovery phase. No side differences in the timing of muscle activity were observed. Regression analysis further revealed similar, bilateral modulation of activity. The relevance of these results in determining which muscles to target during FES Rowing is discussed. Here, we suggest a new strategy based on the stimulation of vasti and soleus during drive and of tibialis anterior during recovery.

Contraction level, but not force direction or wrist position, affects the spatial distribution of motor unit recruitment in the biceps brachii muscle

PURPOSE

Different motor units (MUs) in the biceps brachii (BB) muscle have been shown to be preferentially recruited during either elbow flexion or supination. Whether these different units reside within different regions is an open issue. In this study, we tested wheter MUs recruited during submaximal isometric tasks of elbow flexion and supination for two contraction levels and with the wrist fixed at two different angles are spatially localized in different BB portions.

METHODS

The MUs' firing instants were extracted by decomposing high-density surface electromyograms (EMG), detected from the BB muscle of 12 subjects with a grid of electrodes (4 rows along the BB longitudinal axis, 16 columns medio-laterally). The firing instants were then used to trigger and average single-differential EMGs. The average rectified value was computed separately for each signal and the maximal value along each column in the grid was retained. The center of mass, defined as the weighted mean of the maximal, average rectified value across columns, was then consdiered to assess the medio-lateral changes in the MU surface representation between conditions.

RESULTS

Contraction level, but neither wrist position nor force direction (flexion vs. supination), affected the spatial distribution of BB MUs. In particular, higher forces were associated with the recruitment of BB MUs whose action potentials were represented more medially.

CONCLUSION

Although the action potentials of BB MUs were represented locally across the muscle medio-lateral region, dicrimination between elbow flexion or supination seems unlikely from the surface representation of MUs action potentials.

Identification of muscle fasciculations from surface EMG: comparison with ultrasound-based detection

The clinical standard for the identification of muscle fasciculations is needle electromyography. However, both surface electromyograms (sEMG) and ultrasound imaging (US) have been recently proposed as alternative and more sensitive approaches. The aims of this study were to: (i) compare the sensitivity to muscle fasciculations of sEMG and US, (ii) assess the rate of agreement (RoA) between the two approaches, and (iii) investigate how much sensitivity and RoA are affected by the selectivity of sEMG detection. Surface EMGs were collected concurrently with US images using an array of 32 electrodes spanning the whole, posterior aspect of the leg. Muscle fasciculations were identified from US videos and from monopolar and single differential sEMGs computed between electrodes spaced by 1, 2, and 3 cm. Results from five healthy subjects showed that US detected as many fasciculations as single differential EMGs, but always less than monopolar sEMGs. However, monopolar sEMGs exhibited a very poor spatial selectivity, likely responsible for the small RoA with US measures. The RoA was maximal for single differential recordings with 3cm inter-electrode distance, however, it was always smaller than 75% (median=30%). Although preliminary, these results suggest that sEMG and US are sensitive to different events in the muscle volume and that their integration may increase the detection sensitivity to muscle fasciculations.

Postural Muscle Unit Plasticity in Stroke Survivors: Altered Distribution of Gastrocnemius' Action Potentials

Neuromuscular adaptations are well-reported in stroke survivors. The death of motor neurons and the reinnervation of residual muscle fibers by surviving motor neurons, for example, seem to explain the increased density of muscle units after stroke. It is, however, unknown whether reinnervation takes place locally or extensively within the muscle. Here we combine intramuscular and surface electromyograms (EMGs) to address this issue for medial gastrocnemius (MG); a key postural muscle. While seven stroke survivors stood upright, two intramuscular and 15 surface EMGs were recorded from the paretic and non-paretic gastrocnemius. Surface EMGs were triggered with the firing instants of motor units identified through the decomposition of both intramuscular and surface EMGs. The standard deviation of Gaussian curves fitting the root mean square amplitude distribution of surface potentials was considered to assess differences in the spatial distribution of motor unit action potentials and, thus, in the distribution of muscle units between limbs. The median number of motor units identified per subject in the paretic and non-paretic sides was, respectively, 2 (range: 1–3) and 3 (1–4). Action potentials in the paretic gastrocnemius were represented at a 33% wider skin region when compared to the non-paretic muscle (Mann-Whitney; P = 0.014). Side differences in the representation of motor unit were not associated with differences in subcutaneous thickness (skipped-Spearman r = −0.53; confidence interval for r: −1.00 to 0.63). Current results suggest stroke may lead to the enlargement of the gastrocnemius muscle units recruited during standing. The enlargement of muscle units, as assessed from the skin surface, may constitute a new marker of neuromuscular plasticity following stroke.

Does the activity of ankle plantar flexors differ between limbs while healthy, young subjects stand at ease?

Inferences on the active contribution of plantar flexors to the stabilisation of human standing posture have been drawn from surface electromyograms (EMGs). Surface EMGs were however often detected unilaterally, presuming the myoelectric activity from muscles in a single leg reflects the pattern of muscle activation in both legs. In this study we question whether surface EMGs detected from plantar flexor muscles in both legs provide equal estimates of the duration of activity. Arrays of surface electrodes were used to collect EMGs from gastrocnemius and soleus muscles while twelve, young male participants stood at ease for 60 s. Muscles in each leg were deemed active whenever the Root Mean Square amplitude of EMGs (40 ms epochs) detected by any channel in the arrays exceeded the noise level, defined from EMGs detected during rest. The Chi-Square statistics revealed significant differences in the relative number of active periods for both muscles in 10 out of 12 participants tested, ranging from 2% to 65% (χ² > 17.90; P < 0.01). Pearson correlation analysis indicated side differences in the duration of gastrocnemius though not soleus activity were associated with the centre of pressure mean, lateral position (R = 0.60; P = 0.035). These results suggest therefore that surface EMGs may provide different estimates of the timing of plantar flexors' activity if collected unilaterally during standing and that asymmetric activation may be not necessarily associated with weight distribution between limbs. Depending on the body side from which EMGs are collected, the active contribution of plantar flexors to standing stabilization may be either under- or over-valued.

Does the amplitude of biceps brachii M waves increase similarly in both limbs during staircase, electrically elicited contractions?

OBJECTIVE

Humans usually tend to control more finely muscle force production in dominant than non-dominant upper limbs. It is well established that motor unit recruitment is a key mechanism by which muscle force is controlled, and we hypothesized that a relatively smaller number of motor units may be recruited in muscles of dominant than non-dominant limbs for any given increase in synaptic input. Hence, we investigated peripheral properties of dominant and non-dominant biceps brachii through the analysis of M-wave responses to incremental electrical stimulation.

APPROACH

Current pulses at progressively greater intensities were applied in the proximal region of biceps brachii of 16 subjects while surface electromyograms were recorded with a grid of electrodes in the distal region. M-wave amplitude was averaged across channels and normalized with respect to the maximum amplitude value, separately for each stimulation intensity and limb. Amplitude-current intensity curves were interpolated to provide an equal number of stimulation levels between limbs. Differences between dominant and non-dominant arms were assessed through the average increase in M-wave amplitude for consecutive stimulation intensities (increments).

MAIN RESULTS

Wilcoxon's signed-rank test showed that increments in the M-wave amplitude were significantly smaller (p  =  0.017) in dominant than non-dominant biceps brachii.

SIGNIFICANCE

The results suggest that there was a more gradual recruitment of motor units in biceps brachii of dominant than non-dominant arms. This is in agreement with the hypothesis of a broader spectrum of motor unit recruitment thresholds in the dominant arm, which may contribute to a finer regulation of force production.

Motor unit activity, force steadiness, and perceived fatigability are correlated with mobility in older adults

The purpose of our study was to examine the associations between the performance of older adults on four tests of mobility and the physical capabilities of the lower leg muscles. The assessments included measures of muscle strength, muscle activation, and perceived fatigability. Muscle activation was quantified as the force fluctuations-a measure of force steadiness-and motor unit discharge characteristics of lower leg muscles during submaximal isometric contractions. Perceived fatigability was measured as the rating of perceived exertion achieved during a test of walking endurance. Twenty participants (73 ± 4 yr) completed one to four evaluation sessions that were separated by at least 3 wk. The protocol included a 400-m walk, a 10-m walk at maximal and preferred speeds, a chair-rise test, and the strength, force steadiness, and discharge characteristics of motor units detected by high-density electromyography of lower leg muscles. Multiple-regression analyses yielded statistically significant models that explained modest amounts of the variance in the four mobility tests. The variance explained by the regression models was 39% for 400-m walk time, 33% for maximal walk time, 42% for preferred walk time, and 27% for chair-rise time. The findings indicate that differences in mobility among healthy older adults were partially associated with the level of perceived fatigability (willingness of individuals to exert themselves) achieved during the test of walking endurance and the discharge characteristics of soleus, medial gastrocnemius, and tibialis anterior motor units during steady submaximal contractions with the plantar flexor and dorsiflexor muscles. NEW & NOTEWORTHY Differences among healthy older adults in walking endurance, walking speed, and ability to rise from a chair can be partially explained by the performance capabilities of lower leg muscles. Assessments comprised the willingness to exert effort (perceived fatigability) and the discharge times of action potentials by motor units in calf muscles during submaximal isometric contractions. These findings indicate that the nervous system contributes significantly to differences in mobility among healthy older adults.

Interpreting Signal Amplitudes in Surface Electromyography Studies in Sport and Rehabilitation Sciences

Surface electromyography (sEMG) is a popular research tool in sport and rehabilitation sciences. Common study designs include the comparison of sEMG amplitudes collected from different muscles as participants perform various exercises and techniques under different loads. Based on such comparisons, researchers attempt to draw conclusions concerning the neuro- and electrophysiological underpinning of force production and hypothesize about possible longitudinal adaptations, such as strength and hypertrophy. However, such conclusions are frequently unsubstantiated and unwarranted. Hence, the goal of this review is to discuss what can and cannot be inferred from comparative research designs as it pertains to both the acute and longitudinal outcomes. General methodological recommendations are made, gaps in the literature are identified, and lines for future research to help improve the applicability of sEMG are suggested.

Motor unit discharge characteristics and walking performance of individuals with multiple sclerosis

Walking performance of persons with multiple sclerosis (MS) is strongly influenced by the activation signals received by lower leg muscles. We examined the associations between force steadiness and motor unit discharge characteristics of lower leg muscles during submaximal isometric contractions with tests of walking performance and disability status in individuals who self-reported walking difficulties due to MS. We expected that worse walking performance would be associated with weaker plantar flexor muscles, worse force steadiness, and slower motor unit discharge times. Twenty-three individuals with relapsing-remitting MS (56 ± 7 yr) participated in the study. Participants completed one to three evaluation sessions that involved two walking tests (25-ft walk and 6-min walk), a manual dexterity test (grooved pegboard), health-related questionnaires, and measurement of strength, force steadiness, and motor unit discharge characteristics of lower leg muscles. Multiple regression analyses were used to construct models to explain the variance in measures of walking performance. There were statistically significant differences (effect sizes: 0.21-0.60) between the three muscles in mean interspike interval (ISI) and ISI distributions during steady submaximal contractions with the plantar flexor and dorsiflexor muscles. The regression models explained 40% of the variance in 6-min walk distance and 47% of the variance in 25-ft walk time with two or three variables that included mean ISI for one of the plantar flexor muscles, dorsiflexor strength, and force steadiness. Walking speed and endurance in persons with relapsing-remitting MS were reduced in individuals with longer ISIs, weaker dorsiflexors, and worse plantar flexor force steadiness. NEW & NOTEWORTHY The walking endurance and gait speed of persons with relapsing-remitting multiple sclerosis (MS) were worse in individuals who had weaker dorsiflexor muscles and greater force fluctuations and longer times between action potentials discharged by motor units in plantar flexor muscles during steady isometric contractions. These findings indicate that the control of motor unit activity in lower leg muscles of individuals with MS is associated with their walking ability.

Changes in tibialis anterior architecture affect the amplitude of surface electromyograms

Background

Variations in the amplitude of surface electromyograms (EMGs) are typically considered to advance inferences on the timing and degree of muscle activation in different circumstances. Surface EMGs are however affected by factors other than the muscle neural drive. In this study, we use electrical stimulation to investigate whether architectural changes in tibialis anterior (TA), a key muscle for balance and gait, affect the amplitude of surface EMGs.

Methods

Current pulses (500 μs; 2 pps) were applied to the fibular nerve of ten participants, with the ankle at neutral, full dorsi and full plantar flexion positions. Ultrasound images were collected to quantify changes in TA architecture with changes in foot position. The peak-to-peak amplitude of differential M waves, detected with a grid of surface electrodes (16 × 4 electrodes; 10 mm inter-electrode distance), was considered to assess the effect of changes in TA architecture on the surface recordings.

Results

On average, both TA pennation angle and width increased by respectively 7 deg. and 9 mm when the foot moved from plantar to dorsiflexion (P < 0.02). M-wave amplitudes changed significantly with ankle position. M waves elicited in dorsiflexion and neutral positions were ~25% greater than those obtained during plantar flexion, regardless of where they were detected in the grid (P < 0.001). This figure increased to ~50% when considering bipolar M waves.

Conclusions

Findings reported here indicate the changes in EMG amplitude observed during dynamic contractions, especially when changes in TA architecture are expected (e.g., during gait), may not be exclusively conceived as variations in TA activation.

Is the firing rate of motor units in different vastus medialis regions modulated similarly during isometric contractions?

INTRODUCTION

Previous evidence suggests the fibers of different motor units reside within distinct vastus medialis (VM) regions. It remains unknown whether the activity of these motor units may be modulated differently. Herein we assess the discharge rate of motor units detected proximodistally from the VM to address this issue.

METHODS

Surface electromyograms (EMGs) were recorded proximally and distally from the VM while 10 healthy subjects performed isometric contractions. Single motor units were decomposed from surface EMGs. The smoothed discharge rates of motor units identified from the same and from different VM regions were then cross-correlated.

RESULTS

During low-level contractions, the discharge rate varied more similarly for distal (cross-correlation peak; interquartile interval: 0.27-0.40) and proximal (0.28-0.52) than for proximodistal pairs of VM motor units (0.20-0.33; P = 0.006).

DISCUSSION

The discharge rates of motor units from different proximodistal VM regions show less similarity in their variations than those of pairs of units either distally or proximally. Muscle Nerve 57: 279-286, 2018.

The Spatial Distribution of Ankle Muscles Activity Discriminates Aged from Young Subjects during Standing

During standing, age-related differences in the activation of ankle muscles have been reported from surface electromyograms (EMGs) sampled locally. Given though activity seems to distribute unevenly within ankle muscles, the local sampling of surface EMGs may provide a biased view on how often and how much elderly and young individuals activate these muscles during standing. This study aimed therefore at sampling EMGs from multiple regions of individual ankle muscles to evaluate whether the distribution of muscle activity differs between aged and young subjects during standing. Thirteen young and eleven aged, healthy subjects were tested. Surface EMGs were sampled at multiple skin locations from tibialis anterior, soleus and medial and lateral gastrocnemius muscles while subjects stood at ease. The root mean square amplitude of EMGs was considered to estimate the duration, the degree of activity and the size of the region where muscle activity was detected. Our main findings revealed the medial gastrocnemius was active for longer periods in aged (interquartile interval; 74.1-98.2%) than young (44.9-81.9%) individuals (P = 0.02). Similarly, while tibialis anterior was rarely active in young (0.7-4.4%), in elderly subjects (2.6-82.5%) it was often recruited (P = 0.01). Moreover, EMGs with relatively higher amplitude were detected over a significantly wider proximo-distal region of medial gastrocnemius in aged (29.4-45.6%) than young (20.1-31.3%) subjects (P = 0.04). These results indicate the duration and the size of active muscle volume, as quantified from the spatial distribution of surface EMGs, may discriminate aged from young individuals during standing; elderlies seem to rely more heavily on the active loading of ankle muscles to control their standing posture than young individuals. Most importantly, current results suggest different conclusions on the active control of standing posture may be drawn depending on the skin location from where EMGs are collected, in particular for the medial gastrocnemius.

Physiological arousal accompanying postural responses to external perturbations after stroke

OBJECTIVE

The purpose of this study was to examine simultaneously the level of physiological arousal and the postural response to external perturbations in people post-stroke compared to age-matched controls to build a more comprehensive understanding of the effect of stroke on postural control and balance self-efficacy.

METHODS

Participants stood with each foot on separate force platforms. Ten applications of loads of 2% body weight at the hips perturbed the participant anteriorly under two conditions: investigator-triggered or self-triggered (total 20). Electrodermal activity (EDA; measurement of physiological arousal), electromyography (EMG) of the ankle plantarflexor muscles and anterior-posterior center of pressure measurements were taken pre-perturbation (anticipatory) and post-perturbation (response) and compared between the initial (first two) and final (last two) perturbations.

RESULTS

Participants post-stroke demonstrated significantly higher levels of anticipatory EDA and anticipatory paretic plantarflexor EMG during both self- and investigator-triggered conditions compared to controls. Anticipatory EDA levels were higher in the final perturbations in participants post-stroke in both conditions, but not in controls. Habituation of the EDA responses post-perturbation was exhibited in the self-triggered perturbations in controls, but not in participants post-stroke.

CONCLUSIONS

Physiological arousal and postural control strategies of controls revealed habituation in response to self-triggered perturbations, whereas this was not seen in participants post-stroke.

SIGNIFICANCE

Understanding the physiological arousal response to challenges to standing balance post-stroke furthers our understanding of postural control mechanisms post-stroke.

Optimization of surface electrodes location for H-reflex recordings in soleus muscle

The Hoffmann reflex (H reflex) is extensively used to investigate the spinal motor neuron excitability in healthy and pathological subjects. Obtaining a representative and robust amplitude estimation of the H reflex is of marked relevance in clinical as well as in research applications. As for the motor responses, this issue is strictly related to the electrode positioning, especially for large, pinnate muscles such as the triceps surae. In this study we investigated the effect of electrode position on soleus H-reflex amplitude. A grid of 96 electrodes was used to identify maximal H reflexes (Hmax) across the whole soleus region available for surface recording. The spatial distribution of Hmax amplitude detected in monopolar and single-differential derivations was used to determine where greatest reflex responses were detected from soleus. For both derivations and for all participants, largest Hmax were detected consistently over the central soleus region, in correspondence of the muscle superficial aponeurosis. Indeed, the amplitude of Hmax provided by conventional electrodes (1cm² area, 2cm apart) located centrally was significantly greater (median: 35% for monopolar and 79% for single-differential derivations) than that obtained medially, where surface electromyograms are typically recorded from soleus. Computer simulations, used to assist in the interpretation of results, suggest the soleus pinnate architecture was the key determinant of the medio-lateral variability observed for the experimental Hmax. The presented results provide a clear indication for electrode positioning, of crucial relevance in applied studies aimed at eliciting H reflexes.

Filtered Virtual Reference: A New Method for the Reduction of Power Line Interference With Minimal Distortion of Monopolar Surface EMG

GOAL

This study tests and validates a new method to remove power line interference from monopolar EMGs detected by multichannel systems: the filtered virtual reference (FVR). FVR is an adaptation of the virtual reference (VR) method, which consists in referencing signals detected by each electrode in a grid to their spatial average. Signals may however be distorted with the VR approach, in particular when the skin region where the detection system is positioned does not cover the entire muscle.

METHODS

Simulated and experimental EMGs were used to compare the performance of FVR and VR in terms of interference reduction and distortion of monopolar signals referred to a remote reference.

RESULTS

Simulated data revealed the monopolar EMG signals processed with FVR were significantly less distorted than those filtered by VR. These results were similarly observed for experimental signals. Moreover, FVR method outperformed VR in removing power line interference when it was distributed unevenly across the signals of the grid.

CONCLUSION

Key results demonstrated that FVR improves the VR method as it reduces interference while preserving the information content of monopolar signals.

SIGNIFICANCE

Although the actual distribution of motor unit action potential is represented in monopolar EMGs, collecting high quality monopolar signals is challenging. This study presents a possible solution to this issue; FVR provides undistorted monopolar signals with negligible interference and is insensitive to muscle architecture. It is therefore relevant for EMG applications benefiting from a clean monopolar detection (e.g., decomposition, control of prosthetic devices, motor unit number estimation).

Young, Healthy Subjects Can Reduce the Activity of Calf Muscles When Provided with EMG Biofeedback in Upright Stance

Recent evidence suggests the minimization of muscular effort rather than of the size of bodily sway may be the primary, nervous system goal when regulating the human, standing posture. Different programs have been proposed for balance training; none however has been focused on the activation of postural muscles during standing. In this study we investigated the possibility of minimizing the activation of the calf muscles during standing through biofeedback. By providing subjects with an audio signal that varied in amplitude and frequency with the amplitude of surface electromyograms (EMG) recorded from different regions of the gastrocnemius and soleus muscles, we expected them to be able to minimize the level of muscle activation during standing without increasing the excursion of the center of pressure (CoP). CoP data and surface EMG from gastrocnemii, soleus and tibialis anterior muscles were obtained from 10 healthy participants while standing at ease and while standing with EMG biofeedback. Four sensitivities were used to test subjects' responsiveness to the EMG biofeedback. Compared with standing at ease, the two most sensitive feedback conditions induced a decrease in plantar flexor activity (~15%; P < 0.05) and an increase in tibialis anterior EMG (~10%; P < 0.05). Furthermore, CoP mean position significantly shifted backward (~30 mm). In contrast, the use of less sensitive EMG biofeedback resulted in a significant decrease in EMG activity of ankle plantar flexors with a marginal increase in TA activity compared with standing at ease. These changes were not accompanied by greater CoP displacements or significant changes in mean CoP position. Key results revealed subjects were able to keep standing stability while reducing the activity of gastrocnemius and soleus without loading their tibialis anterior muscle when standing with EMG biofeedback. These results may therefore posit the basis for the development of training protocols aimed at assisting subjects in more efficiently controlling leg muscle activity during standing.

Between-day reliability of triceps surae responses to standing perturbations in people post-stroke and healthy controls: A high-density surface EMG investigation

The reliability of triceps surae electromyographic responses to standing perturbations in people after stroke and healthy controls is unknown. High-Density surface Electromyography (HDsEMG) is a technique that records electromyographic signals from different locations over a muscle, overcoming limitations of traditional surface EMG such as between-day differences in electrode placement. In this study, HDsEMG was used to measure responses from soleus (SOL, 18 channels) and medial and lateral gastrocnemius (MG and LG, 16 channels each) in 10 people after stroke and 10 controls. Timing and amplitude of the response were estimated for each channel of the grids. Intraclass Correlation Coefficient (ICC) and normalized Standard Error of Measurement (SEM%) were calculated for each channel individually (single-channel configuration) and on the median of each grid (all-channels configuration). Both timing (single-channel: ICC=0.75-0.96, SEM%=5.0-9.1; all-channels: ICC=0.85-0.97; SEM%=3.5-6.2%) and amplitude (single-channel: ICC=0.60-0.91, SEM%=25.1-46.6; ICC=0.73-0.95, SEM%=19.3-42.1) showed good-to-excellent reliability. HDsEMG provides reliable estimates of EMG responses to perturbations both in individuals after stroke and in healthy controls; reliability was marginally better for the all-channels compared to the single-channel configuration.

The effect of lymph drainage on the myoelectric manifestation of vastus lateralis fatigue: Preliminary results

Variations in surface electromyograms (EMGs) collected from the vastus lateralis muscle during isometric fatiguing contractions were investigated pre-post lymphatic drainage (intervention group, N=3) and pre-post rest (control group, N=3). The slope of conduction velocity and of EMG amplitude and spectral descriptors was computed from the start to the failure time; the instant after which subjects could not endure contractions. When compared to subjects in the control group, those in the intervention group endured longer. Similarly, muscle fatigue affected to a lesser extent EMGs following lymphatic drainage than following rest. These preliminary results suggest the lymphatic drainage may potentially delay muscle fatigue.

High Density EMG investigation of H-reflex distribution over the soleus muscle

The spatial distribution of H-reflexes over soleus muscle was investigated through High-Density EMG in five healthy subjects. The posterior tibial nerve was stimulated with a staircase current envelope with 1mA steps. The regions where the incremental responses (incremental H-reflexes) occurred were identified for each stimulation step with a validated segmentation algorithm. The average centroid of the segmented areas was located over the Achilles tendon, 5 cm below the myo-tendinous junction of the medial gastrocnemius. The average dimension of these regions corresponded to 28% of the surface covered by the grid of electrodes. The amplitude of H-reflexes recorded in the segmented areas was higher than the average amplitude computed over the entire detection system as well as the H-reflex recorded by the electrode positioned according to SENIAM guidelines. These preliminary results suggest that: i) H-reflex detected from a specific soleus region unlikely reflects the whole muscle volume and ii) H-reflexes with greatest amplitude can be recorded over the Achilles tendon.

Spatial variation of compound muscle action potentials across human gastrocnemius medialis

The massed action potential (M wave) elicited through nerve stimulation underpins a wide range of physiological and mechanical understanding of skeletal muscle structure and function. Although systematic approaches have evaluated the effect of different factors on M waves, the effect of the location and distribution of activated fibers within the muscle remains unknown. By detecting M waves from the medial gastrocnemius (MG) of 12 participants with a grid of 128 electrodes, we investigated whether different populations of muscle units have different spatial organization within MG. If populations of muscle units occupy discrete MG regions, current pulses of progressively greater intensities applied to the MG nerve branch would be expected to lead to local changes in M-wave amplitudes. Electrical pulses were therefore delivered at 2 pps, with the current pulse amplitude increased every 10 stimuli to elicit different degrees of muscle activation. The localization of MG response to increases in current intensity was determined from the spatial distribution of M-wave amplitude. Key results revealed that increases in M-wave amplitude were detected somewhat locally, by 10-50% of the 128 electrodes. Most importantly, the electrodes detecting greatest increases in M-wave amplitude were localized at different regions in the grid, with a tendency for greater stimulation intensities to elicit M waves in the more distal MG region. The presented results indicate that M waves recorded locally may not provide a representative MG response, with major implications for the estimation of, e.g., the maximal stimulation levels, the number of motor units, and the onset and normalization in H-reflex studies.

Ultraviolet spectrophotometric evaluation of corn oil oxidative stability during microwave heating and oven test

The effect of microwave heating on the oxidative stability of corn oil was determined by absorptivity in the UV spectrum and by peroxide and acid values. Oil samples with antioxidants BHA/BHT (1:1; 200 mg kg(-)(1)), with and without citric acid, were heated in a microwave oven (800 W, 2450 MHz) for 0-36 min. Absorptivity at 232 and 270 nm increased during microwave exposure. Control values of absorptivity at 232 nm increased from 3.568 to 12.874 after 36 min of heating. Peroxide value showed a significant difference in the initial stage of heating (0-6 min), but after this time, the peroxide value decreased due to the instability of hydroperoxides at high temperatures. Control 232 nm absorptivities after 6 days in the oven test were similar to those after 32-36 min of microwave heating. Effective antioxidants in the oven test did not show any protection during microwave heating. UV spectrophotometry is a suitable tool for microwave oxidation monitoring.

[Morphometric determination of changes in mastocyte population in cutaneous wound granulation tissue in hypothyroid and parotidectomized rats]

The authors have done a morphometric study by determination of mastocyte population of cutaneous wound's granulation tissue of parotidectomized rats and rats which were submitted to daily administration of 25 mg of 6-propyl-2-thiouracil (hypothyroid). The animals were sacrificed after four, eight and 12 post-operative days. The results analysis permitted to observe a statistically significant diminution of mastocyte population in the hypothyroid and parotidectomized animals granulation tissue in the fourth and 12th postsurgical days.