Discrimination of Speech Sound Contrasts Determined with Behavioral Tests and Event-Related Potentials in Cochlear Implant Recipients

Cortical potentials evoked with speech stimuli were investigated in ten experienced cochlear implant (CI, type Nucleus 24M) users using three different speech-coding strategies and two different speech contrasts, one vowel (/i/-/a/) and one consonant (/ba/-/da/) contrast. On average, results showed that, compared to subjects with normal hearing, P300 amplitudes were smaller; however, most latencies were within the normal range. Next, individual P300 measures in response to the two speech contrasts were compared to behavioral discrimination scores. Significant within-subject differences in P300 amplitudes and latencies were found for the three speech coding strategies. These differences were in agreement with the behavioral, strategy-dependent discrimination of the speech contrasts.

The addition of the MEP amplitude of finger extension muscles to clinical predictors of hand function after stroke: A prospective cohort study

BACKGROUND

Within the first 72 hours after stroke, active finger extension is a strong predictor of long-term dexterity. Transcranial magnetic stimulation may add prognostic value to clinical assessment, which is especially relevant for patients unable to follow instructions.

OBJECTIVE

The current prospective cohort study aims at determining whether amplitude of motor evoked potentials of the extensor digitorum communis (EDC) can improve clinical prediction after stroke when added to clinical tests.

METHODS

the amplitude of motor evoked potentials of the affected EDC muscle at rest was measured in 18 participants within 4 weeks after stroke, as were the ability to perform finger extension and the Fugl-Meyer Motor Assessment of the upper extremity (FMA_UE). These three determinants were related to the FMA_UE at 26 weeks after stroke (FMA_UE26), both directly, and via the proportional recovery prediction model. The relation between amplitude of the motor evoked potentials and FMA_UE26 was evaluated for EDC. For comparison, also the MEP amplitudes of biceps brachii and adductor digiti minimi muscles were recorded.

RESULTS

Patients' ability to voluntarily extend the fingers was strongly related to FMA_UE26, in our cohort there were no false negative results for this predictor. Our data revealed that the relation between amplitude of motor evoked potential of EDC and FMA_UE26 was significant, but moderate (rs = 0.58) without added clinical value. The other tested muscles did not correlate significantly to FMA_UE26.

CONCLUSIONS

Our study demonstrates no additional value of motor evoked potential amplitude of the affected EDC muscle to the clinical test of finger extension, the latter being more strongly related to FMA_UE26.

Modeling Trans-Spinal Direct Current Stimulation in the Presence of Spinal Implants

Trans-spinal direct current stimulation (tsDCS) is a technique considered for the treatment of corticospinal damage or dysfunction. TsDCS aims to induce functional modulation in the corticospinal circuitry via a direct current (DC) generated an electric field (EF). To ensure subject safety, subjects with metallic implants are generally excluded from receiving neural dc stimulation. However, spinal injuries often require spinal implants for stabilization. Our goal was to investigate implant imposed changes to EF and current density (CD) magnitude during tsDCS. We simulated the EF and CD, generated by tsDCS in the presence of spinal rods for two electrode configurations and four implant locations along the spinal cord. For each scenario, a no-implant condition was computed for comparison. We assessed changes in EF and CD at the implant location and the EF inside the spinal cord. Our results show that implant presence was able to influence peak CD, compared to the no-implant condition. Nonetheless, the highest calculated CD levels were a factor six lower than those thought to lead to hazardous tissue-damaging effects. Additionally, implant presence did not considerably affect the average EF inside the spinal cord. Our findings do therefore not indicate potentially unsafe CD levels, or significant alterations to stimulation intensity inside the spinal cord, caused by a spinal implant during tsDCS. Our results are relevant to the safety of transcutaneous spinal stimulation applied in the presence of metallic spinal implants.

Repeatability and reliability of muscle relaxation properties induced by motor cortical stimulation

Impaired muscle relaxation is a feature of many neuromuscular disorders. However, few tests are available to quantify muscle relaxation. Transcranial magnetic stimulation (TMS) of the motor cortex can induce muscle relaxation by abruptly inhibiting corticospinal drive. The aim of our study was to investigate whether repeatability and reliability of TMS-induced relaxation are greater than voluntary relaxation. Furthermore, effects of sex, cooling, and fatigue on muscle relaxation properties were studied. Muscle relaxation of deep finger flexors was assessed in 25 healthy subjects (14 men and 11 women, age 39.1 ± 12.7 and 45.3 ± 8.7 yr, respectively) with handgrip dynamometry. All outcome measures showed greater repeatability and reliability in TMS-induced relaxation compared with voluntary relaxation. The within-subject coefficient of variability of normalized peak relaxation rate was lower in TMS-induced relaxation than in voluntary relaxation (3.0% vs. 19.7% in men and 6.1% vs. 14.3% in women). The repeatability coefficient was lower (1.3 vs. 6.1 s^-1 in men and 2.3 vs. 3.1 s^-1 in women) and the intraclass correlation coefficient was higher (0.95 vs. 0.53 in men and 0.78 vs. 0.69 in women) for TMS-induced relaxation compared with voluntary relaxation. TMS enabled demonstration of slowing effects of sex, muscle cooling, and muscle fatigue on relaxation properties that voluntary relaxation could not. In conclusion, repeatability and reliability of TMS-induced muscle relaxation were greater compared with voluntary muscle relaxation. TMS-induced muscle relaxation has the potential to be used in clinical practice for diagnostic purposes and therapy effect monitoring in patients with impaired muscle relaxation. NEW & NOTEWORTHY Transcranial magnetic stimulation (TMS)-induced muscle relaxation demonstrates greater repeatability and reliability compared with voluntary relaxation, represented by the ability to demonstrate typical effects of sex, cooling, and fatigue on muscle relaxation properties that were not seen in voluntary relaxation. In clinical practice, TMS-induced muscle relaxation could be used for diagnostic purposes and therapy effect monitoring. Furthermore, fewer subjects will be needed for future studies when using TMS to demonstrate differences in muscle relaxation properties.

Modeling trans-spinal direct current stimulation for the modulation of the lumbar spinal motor pathways

OBJECTIVE

Trans-spinal direct current stimulation (tsDCS) is a potential new technique for the treatment of spinal cord injury (SCI). TsDCS aims to facilitate plastic changes in the neural pathways of the spinal cord with a positive effect on SCI recovery. To establish tsDCS as a possible treatment option for SCI, it is essential to gain a better understanding of its cause and effects. We seek to understand the acute effect of tsDCS, including the generated electric field (EF) and its polarization effect on the spinal circuits, to determine a cellular target. We further ask how these findings can be interpreted to explain published experimental results.

APPROACH

We use a realistic full body finite element volume conductor model to calculate the EF of a 2.5 mA direct current for three different electrode configurations. We apply the calculated electric field to realistic motoneuron models to investigate static changes in membrane resting potential. The results are combined with existing knowledge about the theoretical effect on a neuronal level and implemented into an existing lumbar spinal network model to simulate the resulting changes on a network level.

MAIN RESULTS

Across electrode configurations, the maximum EF inside the spinal cord ranged from 0.47 V m^-1 to 0.82 V m^-1. Axon terminal polarization was identified to be the dominant cellular target. Also, differences in electrode placement have a large influence on axon terminal polarization. Comparison between the simulated acute effects and the electrophysiological long-term changes observed in human tsDCS studies suggest an inverse relationship between the two.

SIGNIFICANCE

We provide methods and knowledge for better understanding the effects of tsDCS and serve as a basis for a more targeted and optimized application of tsDCS.

Generalization and transfer of contextual cues in motor learning

We continuously adapt our movements in daily life, forming new internal models whenever necessary and updating existing ones. Recent work has suggested that this flexibility is enabled via sensorimotor cues, serving to access the correct internal model whenever necessary and keeping new models apart from previous ones. While research to date has mainly focused on identifying the nature of such cue representations, here we investigated whether and how these cue representations generalize, interfere, and transfer within and across effector systems. Subjects were trained to make two-stage reaching movements: a premovement that served as a cue, followed by a targeted movement that was perturbed by one of two opposite curl force fields. The direction of the premovement was uniquely coupled to the direction of the ensuing force field, enabling simultaneous learning of the two respective internal models. After training, generalization of the two premovement cues' representations was tested at untrained premovement directions, within both the trained and untrained hand. We show that the individual premovement representations generalize in a Gaussian-like pattern around the trained premovement direction. When the force fields are of unequal strengths, the cue-dependent generalization skews toward the strongest field. Furthermore, generalization patterns transfer to the nontrained hand, in an extrinsic reference frame. We conclude that contextual cues do not serve as discrete switches between multiple internal models. Instead, their generalization suggests a weighted contribution of the associated internal models based on the angular separation from the trained cues to the net motor output.

Investigation of tDCS volume conduction effects in a highly realistic head model

OBJECTIVE

We investigate volume conduction effects in transcranial direct current stimulation (tDCS) and present a guideline for efficient and yet accurate volume conductor modeling in tDCS using our newly-developed finite element (FE) approach.

APPROACH

We developed a new, accurate and fast isoparametric FE approach for high-resolution geometry-adapted hexahedral meshes and tissue anisotropy. To attain a deeper insight into tDCS, we performed computer simulations, starting with a homogenized three-compartment head model and extending this step by step to a six-compartment anisotropic model.

MAIN RESULTS

We are able to demonstrate important tDCS effects. First, we find channeling effects of the skin, the skull spongiosa and the cerebrospinal fluid compartments. Second, current vectors tend to be oriented towards the closest higher conducting region. Third, anisotropic WM conductivity causes current flow in directions more parallel to the WM fiber tracts. Fourth, the highest cortical current magnitudes are not only found close to the stimulation sites. Fifth, the median brain current density decreases with increasing distance from the electrodes.

SIGNIFICANCE

Our results allow us to formulate a guideline for volume conductor modeling in tDCS. We recommend to accurately model the major tissues between the stimulating electrodes and the target areas, while for efficient yet accurate modeling, an exact representation of other tissues is less important. Because for the low-frequency regime in electrophysiology the quasi-static approach is justified, our results should also be valid for at least low-frequency (e.g., below 100 Hz) transcranial alternating current stimulation.

The influence of sulcus width on simulated electric fields induced by transcranial magnetic stimulation

Volume conduction models can help in acquiring knowledge about the distribution of the electric field induced by transcranial magnetic stimulation. One aspect of a detailed model is an accurate description of the cortical surface geometry. Since its estimation is difficult, it is important to know how accurate the geometry has to be represented. Previous studies only looked at the differences caused by neglecting the complete boundary between cerebrospinal fluid (CSF) and grey matter (Thielscher et al 2011 NeuroImage 54 234-43, Bijsterbosch et al 2012 Med. Biol. Eng. Comput. 50 671-81), or by resizing the whole brain (Wagner et al 2008 Exp. Brain Res. 186 539-50). However, due to the high conductive properties of the CSF, it can be expected that alterations in sulcus width can already have a significant effect on the distribution of the electric field. To answer this question, the sulcus width of a highly realistic head model, based on T1-, T2- and diffusion-weighted magnetic resonance images, was altered systematically. This study shows that alterations in the sulcus width do not cause large differences in the majority of the electric field values. However, considerable overestimation of sulcus width produces an overestimation of the calculated field strength, also at locations distant from the target location.

Unchanged muscle fiber conduction velocity relates to mild acidosis during exhaustive bicycling

Muscle fiber conduction velocity (MFCV) has often been shown to decrease during standardized fatiguing isometric contractions. However, several studies have indicated that the MFCV may remain constant during fatiguing dynamic exercise. It was investigated if these observations can be related to the absence of a large decrease in pH and if MFCV can be considered as a good indicator of acidosis, also during dynamic bicycle exercise. High-density surface electromyography (HDsEMG) was combined with read-outs of muscle energetics recorded by in vivo ³¹P magnetic resonance spectroscopy (MRS). Measurements were performed during serial exhausting bouts of bicycle exercise at three different workloads. The HDsEMG recordings revealed a small and incoherent variation of MFCV during all high-intensity exercise bouts. ³¹P MRS spectra revealed a moderate decrease in pH at the end of exercise (~0.3 units down to 6.8) and a rapid ancillary drop to pH 6.5 during recovery 30 s post-exercise. This additional degree of acidification caused a significant decrease in MFCV during cycling immediately after the rest period. From the data a significant correlation between MFCV and [H⁺] ([H⁺] = 10^−pH) was calculated (p < 0.001, Pearson’s R = −0.87). Our results confirmed the previous observations of MFCV remaining constant during fatiguing dynamic exercise. A constant MFCV is in line with a low degree of acidification, considering the presence of a correlation between pH and MFCV after further increasing acidification.

The 2nd Berlin BedRest Study: protocol and implementation

Long-term bed-rest is used to simulate the effect of spaceflight on the human body and test different kinds of countermeasures. The 2nd Berlin BedRest Study (BBR2-2) tested the efficacy of whole-body vibration in addition to high-load resisitance exercise in preventing bone loss during bed-rest. Here we present the protocol of the study and discuss its implementation. Twenty-four male subjects underwent 60-days of six-degree head down tilt bed-rest and were randomised to an inactive control group (CTR), a high-load resistive exercise group (RE) or a high-load resistive exercise with whole-body vibration group (RVE). Subsequent to events in the course of the study (e.g. subject withdrawal), 9 subjects participated in the CTR-group, 7 in the RVE-group and 8 (7 beyond bed-rest day-30) in the RE-group. Fluid intake, urine output and axiallary temperature increased during bed-rest (p < .0001), though similarly in all groups (p > or = .17). Body weight changes differed between groups (p < .0001) with decreases in the CTR-group, marginal decreases in the RE-group and the RVE-group displaying significant decreases in body-weight beyond bed-rest day-51 only. In light of events and experiences of the current study, recommendations on various aspects of bed-rest methodology are also discussed.

High-density surface EMG study on the time course of central nervous and peripheral neuromuscular changes during 8weeks of bed rest with or without resistive vibration exercise

The aim of the present study was to assess the time course and the origin of adaptations in neuromuscular function as a consequence of prolonged bed rest with or without countermeasure. Twenty healthy males volunteered to participate in the present study and were randomly assigned to either an inactive control group (Ctrl) or to a resistive vibration exercise (RVE) group. Prior to, and seven times during bed rest, we recorded high-density surface electromyogram (sEMG) signals from the vastus lateralis muscle during isometric knee extension exercise at a range of contraction intensities (5-100% of maximal voluntary isometric torque). The high-density sEMG signals were analyzed for amplitude (root mean square, RMS), frequency content (median frequency, F(med)) and muscle fiber conduction velocity (MFCV) in an attempt to describe bed rest-induced changes in neural activation properties at the levels of the motor control and muscle fibers. Without countermeasures, bed rest resulted in a significant progressive decline in maximal isometric knee extension strength, whereas RMS remained unaltered throughout the bed rest period. In line with observed muscle atrophy, both F(med) and MFCV declined during bed rest. RVE training during bed rest resulted in maintained maximal isometric knee extension strength, and a strong increase ( approximately 30%) in maximal EMG amplitude, from 10 days of bed rest on. Exclusion of other factors led to the conclusion that the RVE training increased motor unit firing rates as a consequence of an increased excitability of motor neurons. An increased firing rate might have been essential under training sessions, but it did not affect isometric voluntary torque capacity.

Characteristics of fast voluntary and electrically evoked isometric knee extensions during 56 days of bed rest with and without exercise countermeasure

The contractile characteristics of fast voluntary and electrically evoked unilateral isometric knee extensions were followed in 16 healthy men during 56 days of horizontal bed rest and assessed at bed rest days 4, 7, 10, 17, 24, 38 and 56. Subjects were randomized to either an inactive control group (Ctrl, n = 8) or a resistive vibration exercise countermeasure group (RVE, n = 8). No changes were observed in neural activation, indicated by the amplitude of the surface electromyogram, or the initial rate of voluntary torque development in either group during bed rest. In contrast, for Ctrl, the force oscillation amplitude at 10 Hz stimulation increased by 48% (P < 0.01), the time to reach peak torque at 300 Hz stimulation decreased by 7% (P < 0.01), and the half relaxation time at 150 Hz stimulation tended to be slightly reduced by 3% (P = 0.056) after 56 days of bed rest. No changes were observed for RVE. Torque production at 10 Hz stimulation relative to maximal (150 Hz) stimulation was increased after bed rest for both Ctrl (15%; P < 0.05) and RVE (41%; P < 0.05). In conclusion, bed rest without exercise countermeasure resulted in intrinsic speed properties of a faster knee extensor group, which may have partly contributed to the preserved ability to perform fast voluntary contractions. The changes in intrinsic contractile properties were prevented by resistive vibration exercise, and voluntary motor performance remained unaltered for RVE subjects as well.

Highly Demanding Resistive Vibration Exercise Program is Tolerated During 56 Days of Strict Bed-Rest

Several studies have tried to find countermeasures against musculoskeletal de-conditioning during bed-rest, but none of them yielded decisive results. We hypothesised that resistive vibration exercise (RVE) might be a suitable training modality. We have therefore carried out a bed-rest study to evaluate its feasibility and efficacy during 56 days of bed-rest. Twenty healthy male volunteers aged 24 to 43 years were recruited and, after medical check-ups, randomised to a non-exercising control (Ctrl) group or a group that performed RVE 11 times per week. Strict bed-rest was controlled by video surveillance. The diet was controlled. RVE was performed in supine position, with a static force component of about twice the body weight and a smaller dynamic force component. RVE comprised four different units (squats, heel raises, toe raises, kicks), each of which lasted 60 - 100 seconds. Pre and post exercise levels of lactate were measured once weekly. Body weight was measured daily on a bed scale. Pain questionnaires were obtained in regular intervals during and after the bed-rest. Vibration frequency was set to 19 Hz at the beginning and progressed to 25.9 Hz (SD 1.9) at the end of the study, suggesting that the dynamic force component increased by 90 %. The maximum sustainable exercise time for squat exercise increased from 86 s (SD 21) on day 11 of the BR to 176 s (SD 73) on day 53 (p = 0.006). On the same days, post-exercise lactate levels increased from 6.9 mmol/l (SD2.3) to 9.2 mmol/l (SD 3.5, p = 0.01). On average, body weight was unchanged in both groups during bed-rest, but single individuals in both groups depicted significant weight changes ranging from - 10 % to + 10 % (p < 0.001). Lower limb pain was more frequent during bed-rest in the RVE subjects than in Ctrl (p = 0.035). During early recovery, subjects of both groups suffered from muscle pain to a comparable extent, but foot pain was more common in Ctrl than in RVE (p = 0.013 for plantar pain, p = 0.074 for dorsal foot pain). Our results indicate that RVE is feasible twice daily during bed-rest in young healthy males, provided that one afternoon and one entire day per week are free. Exercise progression, mainly by progression of vibration frequency, yielded increases in maximum sustainable exercise time and blood lactate. In conclusion, RVE as performed in this study, appears to be safe.

Strength, size and activation of knee extensors followed during 8 weeks of horizontal bed rest and the influence of a countermeasure

Changes in the quadriceps femoris muscle with respect to anatomical cross sectional area (CSA), neural activation level and muscle strength were determined in 18 healthy men subjected to 8 weeks of horizontal bed rest (BR) with (n = 9) and without (n = 9) resistive vibration exercise (RVE). CSA of the knee extensor muscle group was measured with magnetic resonance imaging every 2 weeks during bed rest. In the control subjects (Ctrl), quadriceps femoris CSA decreased linearly over the 8 weeks of bed rest to -14.1 +/- 5.2% (P < 0.05). This reduction was significantly (P < 0.001) mitigated by the exercise paradigm (-3.5 +/- 4.2%; P < 0.05). Prior to and seven times during bed rest, maximal unilateral voluntary torque (MVT) values of the right leg were measured together with neural activation levels by means of a superimposed stimulation technique. For Ctrl, MVT decreased also linearly over time to -16.8 +/- 7.4% after 8 weeks of bed rest (P < 0.01), whereas the exercise paradigm fully maintained MVT during bed rest. In contrast to previous reports, the maximal voluntary activation remained unaltered for both groups throughout the study. For Ctrl, the absence of deterioration of the activation level might have been related to the repeated testing of muscle function during the bed rest. This notion was supported by the observation that for a subset of Ctrl subjects (n = 5) the MVT of the left leg, which was not tested during BR, was reduced by 20.5 +/- 10.1%, (P < 0.01) which was for those five subjects significantly (P < 0.05) more than the 11.1 +/- 9.2% (P < 0.01) reduction for the right, regularly tested leg.

Relation between muscle fiber conduction velocity and fiber size in neuromuscular disorders

To determine the relation between muscle fiber conduction velocity (MFCV) and muscle fiber diameter (MFD) in pathological conditions, we correlated invasively measured MFCV values with MFD data obtained from muscle needle biopsies in 96 patients with various neuromuscular disorders. MFCV was significantly correlated with MFD and independent of the underlying disorder. Pathological diameter changes were fiber-type dependent, with corresponding MFCVs. A linear equation expresses the relation well: MFCV (m/s) = 0.043·MFD (μm) + 0.83. We conclude that fiber diameter determines MFCV largely independent of the underlying neuromuscular disorders studied.

Improved evaluation of back muscle SEMG characteristics by modelling

Surface EMG (SEMG) as non-invasive method is a valuable tool in functional studies of movement co-ordination. The interpolation of the SEMG power (EMG mapping) gives information about intra- and inter-muscular co-ordination. It has been shown that SEMG maps of low back pain patients and healthy subjects differ. The only major drawback to SEMG is that volume conduction of muscle tissue, fat, and skin decreases the spatial and temporal resolution of signals. To improve the interpretation of SEMG signals, we have applied high pass filtering of cross covariance functions, which has proved to be useful in increasing the spatial resolution, to SEMG data of the back region. Experimental data demonstrate that SEMG signals from the back extensors show only rarely signs of action potential propagation. This behaviour, also described in the literature, can be explained by a model assuming short, deep muscle fibres, having bipolar end effects, with overlapping positions parallel to the fibre direction. This condition is fulfilled by the mm. multifidii et rotatores which are part of the m. erector spinae. Although the model is simplistic, the agreement between simulations and experiments is good.

The effects of bipolar electrode montage on conduction velocity estimation from the surface electromyogram

This study examines the influence of the bipolar electrode montage on conduction velocity (CV) estimation. Electrode montage refers to the combination of two parameters, the inter-electrode distance (IED), the distance between the two electrodes of a bipolar pair, and the inter-signal distance (ISD), the distance between two bipolar signals used to calculate CV. Data from the biceps brachii (BB) and tibialis anterior (TA) of healthy subjects are analysed. Two approaches are used for CV estimation. The first returns a single value per epoch. The second is based on finding velocity values from individual peaks in the signal and results in a peak velocity (PV) distribution being generated per epoch. It is concluded that CV estimation is significantly dependent on the choice of the (IED, ISD) electrode montage. The main results are that the electrode montage affects (1) the mean PV and CV estimates, (typically P < 0.001), (2) the degree of spatial variability, and (3) the width of the PV distributions. The combination of a small IED and large an ISD is recommended.

A thin, flexible multielectrode grid for high-density surface EMG

Although the value of high-density surface electromyography (sEMG) has already been proven in fundamental research and for specific diagnostic questions, there is as yet no broad clinical application. This is partly due to limitations of construction principles and application techniques of conventional electrode array systems. We developed a thin, highly flexible, two-dimensional multielectrode sEMG grid, which is manufactured by using flexprint techniques. The material used as electrode carrier (Polyimid, 50 microm thick) allows grids to be cut out in any required shape or size. One universal grid version can therefore be used for many applications, thereby reducing costs. The reusable electrode grid is attached to the skin by using specially prepared double-sided adhesive tape, which allows the selective application of conductive cream only directly below the detection surfaces. To explore the practical possibilities, this technique was applied in single motor unit analysis of the facial musculature. The high mechanical flexibility allowed the electrode grid to follow the skin surface even in areas with very uneven contours, resulting in good electrical connections in the whole recording area. The silverchloride surfaces of the electrodes and their low electrode-to-skin impedances guaranteed high baseline stability and a low signal noise level. The electrode-to-skin attachment proved to withstand saliva and great tensile forces due to mimic contractions. The inexpensive, universally adaptable and minimally obstructive sensor allows the principal advantages of high-density sEMG to be extended to all skeletal muscles accessible from the skin surface and may lay the foundation for more broad clinical application of this noninvasive, two-dimensional sEMG technique.

Pyridostigmine in postpolio syndrome: no decline in fatigue and limited functional improvement

OBJECTIVES

To investigate the effect of pyridostigmine on fatigue, physical performance, and muscle function in subjects with postpoliomyelitis syndrome.

METHODS

67 subjects with increased fatigue and new weakness in one quadriceps muscle showing neuromuscular transmission defects, were included in a randomised, double blind, placebo controlled trial of 60 mg pyridostigmine four times a day for 14 weeks. Primary outcome was fatigue (on the "energy" category of the Nottingham health profile). Secondary outcomes included two minute walking distance and quadriceps strength and jitter. Motor unit size of the quadriceps was studied as a potential effect modifier. The primary data analysis compared the changes from baseline in the outcomes in the last week of treatment between groups.

RESULTS

31 subjects treated with pyridostigmine and 31 subjects treated with placebo completed the trial. No significant effect of pyridostigmine was found on fatigue. The walking distance improved more in the pyridostigmine group than in the placebo group (by 7.2 m (6.0%); p<0.01). Subgroup analysis showed that a significant improvement in walking performance was only found in subjects with normal sized motor units. Quadriceps strength improved more in the pyridostigmine group than in the placebo group (by 6.7 Nm (7.2%); p = 0.15). No effect of pyridostigmine was found on jitter.

CONCLUSIONS

Pyridostigmine in the prescribed dose did not reduce fatigue in subjects with postpoliomyelitis syndrome. However, it may have a limited beneficial effect on physical performance, especially in subjects with neuromuscular transmission defects in normal sized motor units.

Selective spatial information from surface EMG after temporal filtering: the application to interference EMG using cross-covariance analysis

OBJECTIVE

An increased spatial resolution in multichannel surface EMG recordings would provide new possibilities for the investigation of intermuscular and intramuscular coordination. A known analytical solution for volume conduction allows the conclusion that a high pass filtered surface electromyography (SEMG) signal contains information from a smaller environment near the recording electrode and therefore provides a higher spatial resolution.

METHODS

The present paper concerns experiments on 9 subjects to measure, from the human biceps brachii muscle during static isometric contraction, using multichannel surface EMG. Cross-correlation functions between bipolar SEMG channels were calculated and high pass filtered.

RESULTS

The correlation peaks showed the signs of propagating action potentials. The spatial width in the direction perpendicular to the muscle fibres decreased with increasing cut-off frequency. There exists an optimal cut-off frequency, which provides the best spatial resolution. It correlates with the thickness of the subcutaneous fat layer which causes a minimum depth of the active muscle fibres measured.

CONCLUSIONS

High pass filtered cross-covariance functions of bipolar SEMG channels have an increased spatial resolution perpendicular to the muscle fibre direction and the frequency content of the signals can potentially give an indication of the depth of the active muscle fibres.

Changes in muscle fiber conduction velocity indicate recruitment of distinct motor unit populations

To obtain more insight into the changes in mean muscle fiber conduction velocity (MFCV) during sustained isometric exercise at relatively low contraction levels, we performed an in-depth study of the human tibialis anterior muscle by using multichannel surface electromyogram. The results show an increase in MFCV after an initial decrease of MFCV at 30 or 40% maximum voluntary contraction in all of the five subjects studied. With a peak velocity analysis, we calculated the distribution of conduction velocities of action potentials in the bipolar electromyogram signal. It shows two populations of peak velocities occurring simultaneously halfway through the exercise. The MFCV pattern implies the recruitment of two different populations of motor units. Because of the lowering of MFCV of the first activated population of motor units, the newly recruited second population of motor units becomes visible. It is most likely that the MFCV pattern can be ascribed to the fatiguing of already recruited predominantly type I motor units, followed by the recruitment of fresh, predominantly type II, motor units.

A surface EMG electrode for the simultaneous observation of multiple facial muscles

With previous surface electromyography (sEMG) electrodes it has been difficult to combine small outer dimensions and secure skin attachment. We resolved this problem by developing a new skin attachment technique that yields firm electrode fixation without requiring an acrylic housing. Consequently, we could reduce the outer electrode dimensions to 4-mm diameter and only 1.5-mm thickness. In a bipolar montage, this electrode allows an inter-electrode distance of 8 mm. This improves measurement selectivity and, because of the small dimensions, makes possible the non-invasive observation of multiple facial muscles with a minimum of obstruction. Our new technique was tested on a group of 11 professional trumpeters. They were instructed to perform a series of muscle-specific facial poses and to play exercises on their instruments while EMG signals were recorded simultaneously from seven different perioral muscles. Although the skin attachment was subjected to high stress during trumpet playing, more than 98% of electrode placements yielded a secure mechanical and electrical connection. Muscle selectivity of the signals recorded during the facial poses was similar to that obtained in a previous investigation using intra-muscular fine-wire electrodes. Crosstalk in the perioral area was estimated to be lower than 25%. The availability of an unobstructive sEMG electrode for simultaneously observing multiple facial muscles opens up a wide range of applications (e.g. in speech research, psychophysiology and orthodontics).

An additional phase in PCr use during sustained isometric exercise at 30% MVC in the tibialis anterior muscle

The occurrence of an abrupt acceleration in phosphocreatine hydrolysis in the tibial anterior muscle during the last part of a sustained isometric exercise at 30% maximal voluntary contraction until fatigue is demonstrated in seven out of eight healthy subjects by applying in vivo 31P NMR spectroscopy at 1.5 T field strength. This additional third phase in PCr hydrolysis, is preceded by a common biphasic pattern (first fast then slow) in PCr use. The NMR spectra, as localized by a surface coil and improved by proton irradiation, were collected at a time resolution of 16 s. Mean rates of PCr hydrolysis during exercise were -0.44 +/- 0.19% s(-1), -0.07 +/- 0.04% s(-1), and -0.29 +/- 0.10% s(-1) for the three successive phases. The increased rate of PCr hydrolysis, and also the loss of fine force control evident in the force records are consistent with increased involvement of large, fast-fatiguable units later in the contraction.

Repeated ischaemic isometric exercise increases muscle fibre conduction velocity in humans: involvement of Na(+)-K(+)-ATPase

This study was performed to test two hypotheses: (1) ischaemic preconditioning (development of tolerance to ischaemia) influences muscle fibre conduction velocity (MFCV) during repeated ischaemic isometric exercise and (2) the increase in MFCV to supranormal levels during recovery from ischaemic exercise is caused by activation of Na(+)-K(+)-ATPase. For this purpose, MFCV was measured with surface electromyography (sEMG) during repeated ischaemic isometric exercise of the brachioradial muscle (2 min at 30 % of maximal voluntary contraction). The involvement of ischaemic preconditioning was tested by changing the duration of ischaemia and by intra-arterial infusion of adenosine (brachial artery, 50 microg min(-1) dl(-1)). The role of Na(+)-K(+)-ATPase was explored using ouabain (0.2 microg min(-1) dl(-1)). During the exercise, MFCV decreased from 4.4 +/- 0.2 m s(-1) to 3.7 +/- 0.2 m s(-1) (P < 0.01, n = 13). Similar reductions in MFCV were observed during repeated exercise, irrespective of the reperfusion time (10 min vs. 18 min) or duration of the ischaemia (2 vs. 10 min). However, initial MFCV gradually increased for each subsequent contraction when contractions were repeated at 10 min intervals (4.4 +/- 0.2 m s(-1) vs. 4.9 +/- 0.2 m s(-1) for the first and fourth contraction respectively; P < 0.01; n = 13). This increase was not observed when contractions were performed at 18 min intervals, nor when additional ischaemia was applied. Intra-arterial adenosine did not affect MFCV. Intra-arterial ouabain did not affect the reduction in MFCV during exercise but completely prevented the increase in MFCV during recovery: from 4.7 +/- 0.2 m s(-1) to 5.2 +/- 0.2 m s(-1) vs. 4.5 +/- 0.1 m s(-1) to 4.5 +/- 0.1 m s(-1) in the absence and presence of ouabain respectively (P < 0.05 for ouabain effect; n = 6). In conclusion, ischaemic preconditioning is not involved in changes in MFCV during repeated ischaemic isometric exercise. The increase in MFCV during recovery from repeated ischaemic isometric exercise is caused by rapid activation of Na(+)-K(+)-ATPase.

Three-layer volume conductor model and software package for applications in surface electromyography

On comparing multichannel surface electromyographic measurements of the m. biceps brachii with simulations performed with a previously developed two-layer volume conduction model, we found substantial discrepancies. To incorporate an apparent distorting effect of the skin tissue, the model was extended to three layers. This new model describes the potential resulting from an eccentric bioelectric source in a finite, cylindrical, and anisotropic volume conductor consisting of three layers, representing muscle, subcutaneous fat, and skin tissue. This contribution presents the governing mathematical equations of the three-layer volume conductor model as well as our approach to their solution. A comparison of various models shows that the three-layer model best describes measured potential distributions. Furthermore, we present the "ANVOLCON" (analytical volume conductor) software package. This package has been developed to facilitate the use of the model for scientific and educational purposes and is freely available from http://www.mbfys.kun.nl/knf

Influence of motoneuron firing synchronization on SEMG characteristics in dependence of electrode position

The frequency content of the surface electromyography (SEMG) signal, expressed as median frequency (MF), is often assumed to reflect the decline of muscle fiber conduction velocity in fatigue. MF also decreases when motor unit firings synchronize, and we hypothesized that this effect can explain the electrode-dependent pattern in our previous recordings from the trapezius muscle. An existing motoneuron (MN) model describes the afterhyperpolarization following a spike as an exponential function on which membrane noise is superimposed. Splitting the noise into a common and an individual component extended the model to a MN pool with a tunable level of firing synchrony. An analytical volume conduction model was used to generate motor unit action potentials to simulate SEMG. A realistic level of synchrony decreased the MF of the simulated bipolar SEMG by approximately 30% midway between endplate position and tendon but not above the endplate. This is in accordance with experimental data from the biceps brachii muscle. It was concluded that the pattern of decrease of MF during sustained contractions indeed reflects MN synchronization.

pH heterogeneity in tibial anterior muscle during isometric activity studied by (31)P-NMR spectroscopy

The occurrence of pH heterogeneity in human tibial anterior muscle during sustained isometric exercise is demonstrated by applying (31)P-nuclear magnetic resonance (NMR) spectroscopy in a study of seven healthy subjects. Exercise was performed at 30 and 60% of maximal voluntary contraction (MVC) until fatigue. The NMR spectra, as localized by a surface coil and improved by proton irradiation, were obtained at a high time resolution (16 s). They revealed the simultaneous presence of two pH pools during most experiments. Maximum difference in the two pH levels during exercise was 0.40 +/- 0.07 (30% MVC, n = 7) and 0.41 +/- 0.03 (60% MVC, n = 3). Complementary two-dimensional (31)P spectroscopic imaging experiments in one subject supported the supposition that the distinct pH pools reflect the metabolic status of the main muscle fiber types. The relative size of the P(i) peak in the spectrum attributed to the type II fiber pool increases with decreasing pH levels. This phenomenon is discussed in the context of the size principle stating that the smaller (type I) motor units are recruited first.

Impaired motor cortical inhibition in Parkinson's disease: motor unit responses to transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS)-induced corticospinal volleys can be investigated in detail by analysing the firing pattern modulation of active motor units (MUs) at close to threshold stimulation strengths. In amyotropic lateral sclerosis (ALS) these volleys are dispersed and prolonged, attributed to altered motor cortical excitability. Impaired intracortical inhibition, as found in ALS, is not unique to this disease, but is also a well-established finding in Parkinson's disease (PD). The present study explored whether reduced inhibition in the motor cortex in PD is accompanied by similar changes in motor unit firing modulation by TMS as are found in ALS. TMS was applied to the contralateral motor cortex during a low-force voluntary elbow flexion while 126-channel surface electromyography (SEMG) was recorded from the brachial biceps muscle. A recently developed method for SEMG decomposition was used to extract the firing pattern of up to five simultaneously active MUs. Sixteen MUs in 7 PD patients and 17 MUs in 5 healthy control subjects were analysed and peristimulus time histograms (PSTHs) and interspike interval change functions (IICFs) were calculated. The IICF provides an estimate of the modulation of the postsynaptic membrane potential at the spinal motoneuron, evoked by the stimulus. In PD the duration of the PSTH peak was significantly increased and the synchrony was decreased. The excitatory phase at 20-50 ms of the IICF was broader in PD, reflecting a longer duration of the TMS-evoked excitatory postsynaptic potential. It is proposed that these results are due to prolonged corticospinal volleys resulting from impaired intracortical inhibition.

Spatiotemporal surface EMG characteristics from rat triceps brachii muscle during treadmill locomotion indicate selective recruitment of functionally distinct muscle regions

Multichannel surface EMG recordings of a multiheaded skeletal muscle during cyclic locomotion combined with cineradiography were analysed in a chronic experiment. The resulting detailed two-dimensional activation pattern from the long and lateral triceps brachii heads of the rat during treadmill locomotion were combined with gait characteristics and fibre typing of the muscle. Shortly before ground contact of the forelimb, maximum muscle activity was found in the proximal part of the long head of the muscle. During the stance phase maximum activity was observed in the proximal part of the lateral head. The frequency dependent behaviour of cross-covariance functions over both muscle heads confirmed this selective shift in activation. In the lateral triceps brachii head of the investigated rats, exclusively type II fibres were found. In the long head the frequency of type I fibres was the highest in the deep muscle layers, proximally more than distally, whereas type II fibres were dominant in more superficial muscle layers. A combination of physiological and histological findings supports an anticipating mechanism whereby fine-tuning of the vertical foot down manoeuvre is mainly achieved by the (type I fibre dominated) proximal deep compartment of the biarticular long triceps brachii head and force generation is predominantly executed by the monoarticular lateral triceps brachii head.

Overlap of attention and movement-related activity in lateralized event-related brain potentials

OBJECTIVE

In tasks that involve lateralized visuospatial attention and a lateralized motor response, the associated brain electrical potentials, i.e. the attention-related N2pc and the lateralized readiness potential, typically overlap at central scalp sites. The manifestation of the N2pc at central electrode sites is commonly attributed to electric volume conduction effects, assuming the N2pc to be generated in occipito-temporal brain areas. We evaluated this explanation in a simulation study.

METHODS

Using a forward modeling approach with a realistically shaped volume conduction model, we calculated the range of amplitude ratios between occipital and central electrode sites when a single source is assumed in area V4 or in area TO, at the temporo-occipital convexity.

RESULTS

A comparison of the simulated amplitude ratios with reported data indicates that volume conduction effects from the investigated source origins in the occipito-temporal region are insufficient to explain the experimental data.

CONCLUSIONS

We conclude that the anterior spread of the N2pc from its occipito-temporal maximum to central electrode sites is probably due to simultaneous attention-related activity in posterior and central brain areas.

Propagation disturbance of motor unit action potentials during transient paresis in generalized myotonia: a high-density surface EMG study

Patients with autosomal recessive generalized myotonia, or Becker's disease, often suffer from a peculiar transient paresis. As yet, the relationship between this transient paresis and the defect in the gene encoding for a voltage gated Cl- channel protein in the muscle membrane of these patients is unclear. In order to gain a better understanding of the electrophysiological properties of the muscle fibre membrane in these generalized myotonia patients, we have studied transient paresis with a novel high-density surface EMG (sEMG) technique. We conclude that the transient paresis is explained by a deteriorating muscle membrane function, ending in conduction block and paresis. Multi-channel sEMG during the period of force decline in transient paresis shows a decrease in peak-peak amplitude of the motor unit action potentials from endplate towards tendon. This disturbance increases with time and place, indicating a deteriorating membrane function, and ends in a complete blocking of propagation within seconds. Spatiotemporally, this leads to a V-shaped sEMG pattern. In a more general sense, this contribution shows how spatiotemporal information, available through non-invasive high-density sEMG, may provide novel insights into electrophysiological aspects of membrane dysfunction.

The conductivity of the human skull: results of in vivo and in vitro measurements

The conductivity of the human skull was measured both in vitro and in vivo. The in vitro measurement was performed on a sample of fresh skull placed within a saline environment. For the in vivo measurement a small current was passed through the head by means of two electrodes placed on the scalp. The potential distribution thus generated on the scalp was measured in two subjects for two locations of the current injecting electrodes. Both methods revealed a skull conductivity of about 0.015 [symbol: see text]/m. For the conductivities of the brain, the skull and the scalp a ratio of 1:1/15:1 was found. This is consistent with some of the reports on conductivities found in the literature, but differs considerably from the ratio 1:1/80:1 commonly used in neural source localization. An explanation is provided for this discrepancy, indicating that the correct ratio is 1:1/15:1.

Recent progress in the diagnostic use of surface EMG for neurological diseases

The different techniques to measure and analyze surface EMG are summarized with an emphasis on the clinician's point of view. The application of surface EMG in neurological disease is hampered by many inherent problems, especially the difficulties in extracting features of single motor units. However, the evolution of surface EMG from single bipolar recordings via a linear array of multiple electrodes to densely packed, multi-channel electrode arrays could in principle solve this problem. The added value of using multiple channels (up to 128) with an interelectrode distance of a few millimetres to obtain more spatial information is emphasized. At least for some muscles it is now possible to extract information from the surface EMG, conventionally thought to belong to the domain of needle EMG (for example the "electrical size" of motor units). The use of analysis techniques such as the estimation of muscle fiber conduction velocity has already proven to be of diagnostic value in several myopathies characterized by a disturbed membrane function and in metabolic myopathies with abnormal fatigue profiles. Future research should be directed at the development of analysis techniques enabling the extraction of more relevant motor unit variables from surface EMG signals.

Surface EMG models: properties and applications

After a general introduction on the kind of models and the use of models in the natural sciences, the main body of this paper reviews potential properties of structure based surface EMG (sEMG) models. The specific peculiarities of the categories (i) source description, (ii) motor unit structure, (iii) volume conduction, (iv) recording configurations and (v) recruitment and firing behaviour are discussed. For a specific goal, not all aspects conceivable have to be part of a model description. Therefore, finally an attempt is made to integrate the 'question level' and the 'model property level' in a matrix providing direction to the development and application of sEMG models with different characteristics and varying complexity. From this overview it appears that the least complex are models describing how the morphological muscle features are reflected in multi-channel EMG measurements. The most challenging questions in terms of model complexity are related to supporting the diagnosis of neuromuscular disorders.

Magnetic stimulation-induced modulations of motor unit firings extracted from multi-channel surface EMG

The noninvasive assessment of motor unit (MU) firing patterns on the basis of topographical information from 128-channel high-density surface electromyography (SEMG) is reported. First, multi-channel MU action potential (MUAP) templates are obtained by clustering detected firing events according to the surface topography of the MUAP. Second, a template-matching algorithm is used to find all firings of a MU, including the superimpositions of MUAPs. From a single recording, the firing pattern of up to five MUs could be derived. The modulation of MU firing by transcranial magnetic stimulation was analyzed in peri-stimulus time histograms. The results are similar to previous results of transcranial magnetic stimulation (TMS) obtained by needle electromyographic (EMG) recordings. The method can be used to investigate MU firing patterns in patients with central motor disorders. An additional advantage of the technique, apart from its noninvasiveness, is the structural and functional information that it provides on the MUs, which is not obtained by needle EMG.

Possible mechanisms of muscle cramp from temporal and spatial surface EMG characteristics

In this study, the initiation and development of muscle cramp are investigated. For this, we used a 64-channel surface electromyogram (EMG) to study the triceps surae muscle during both cramp and maximal voluntary contraction (MVC) in four cramp-prone subjects and during cramp only in another four cramp-prone subjects. The results show that cramp presents itself as a contraction of a slowly moving fraction of muscle fibers, indicating that either the spatial arrangement of the motoneurons and muscle fibers is highly related or that cramp spreads at a level close to the muscle. Spectral analyses of the EMG and peak-triggered average potentials show the presence of extremely short potentials during cramp compared with during MVC. These results can also be interpreted in two ways. Either the motoneurons fire with enlarged synchronization during MVC compared with cramp, or smaller units than motor units are active, indicating that cramp is initiated close to or even at the muscle fiber level. Further research is needed to draw final conclusions.

Surface EMG mapping of the human trapezius muscle: the topography of monopolar and bipolar surface EMG amplitude and spectrum parameters at varied forces and in fatigue

OBJECTIVES

To investigate the factors affecting the topography of trapezius muscle EMG, multichannel recordings were made at different forces of isometric shoulder elevation and during fatiguing exercise.

METHODS

Twenty-eight channels of monopolar EMG were recorded from an array of 4 x 7 electrodes placed on the upper trapezius muscle. From the monopolar EMG and the bipolar derivations the root mean square (RMS(monopolar), RMS(bipolar)) and power spectrum median frequency (MF(monopolar), MF(bipolar)) were calculated.

RESULTS

The maximum RMS(monopolar) was located above the middle part of the trapezius muscle, where a minimum was found for RMS(bipolar). The cranial-caudal RMS distribution shifted upwards when the force was increased from 50 to 100% MVC and during fatigue. MF(bipolar) showed a peak above the endplate region, where the MF(monopolar) was low. During fatigue the normalized MF slope was independent of the cranial-caudal electrode position, but MF(monopolar) decreased most strongly at positions above the endplate region, where MF(bipolar) decreased less.

CONCLUSIONS

While the changes in MF reflected metabolic properties and volume conduction phenomena in the muscle, changes in RMS reflected a compensation for the fatigue processes within the muscle. The RMS changes in fatigue can be explained by the direction of the fibres involved in shoulder elevation.

Electrophysiological manifestations of open- and closed-class words in patients with Broca's aphasia with agrammatic comprehension. An event-related brain potential study

This paper presents electrophysiological data on the on-line processing of open- and closed-class words in patients with Broca's aphasia with agrammatic comprehension. Event-related brain potentials were recorded from the scalp when Broca patients and non-aphasic control subjects were visually presented with a story in which the words appeared one at a time on the screen. Separate waveforms were computed for open- and closed-class words. The non-aphasic control subjects showed clear differences between the processing of open- and closed-class words in an early (210-375 ms) and a late (400-700 ms) time-window. The early electrophysiological differences reflect the first manifestation of the availability of word-category information from the mental lexicon. The late differences presumably relate to post-lexical semantic and syntactic processing. In contrast to the control subjects, the Broca patients showed no early vocabulary class effect and only a limited late effect. The results suggest that an important factor in the agrammatic comprehension deficit of Broca's aphasics is a delayed and/or incomplete availability of word-class information.

CMAP amplitude cartography of muscles innervated by the median, ulnar, peroneal, and tibial nerves

The spatial and temporal distribution of compound muscle action potential (CMAP) amplitudes was mapped using 1 x 1-cm grids over thenar, hypothenar, dorsal foot, and foot sole muscles (seven maps each). The high-amplitude zone (HAZ, area where amplitudes were over 80% of the maximum amplitude) denoted susceptibility to changes in recording site. Thenar maps had one peak (spatially and temporally) with a HAZ of 3.5 +/- 2.3 cm2. Hypothenar maps had two peaks (spatially and temporally) with a HAZ of 7.7 +/- 3.6 cm2. Dorsal foot maps had one temporal peak, which could be split up spatially; the HAZ was smallest, at 1.7 +/- 1.7 cm2. Foot sole muscles had one peak (spatially and temporally), with the largest HAZ at 18.4 +/- 6.1 cm2. Wave-form differences were ascribed to differences in muscle anatomy, architecture, and variability. These explain differences in amplitude reproducibility between nerves and the differing effect that increasing electrode size has on reproducibility.

Positive sharp wave and fibrillation potential modeling

A finite muscle fiber simulation program which calculates the extracellular potential for any given intracellular action potential (IAP) was used to model a fibrillation potential and a positive sharp wave. This computer model employs the core conductor model assumptions for an active muscle fiber and allows two distinct types of end effects: a cut or a crush. A "cut end" is defined as a membrane segment with the termination of both active and passive ion channels. The "crush end" is simulated as a focal membrane segment which blocks action potential propagation, and is connected to a region of normal membrane on either side of it so that a normal transmembrane potential is maintained beyond the crush zone. A prototypical positive sharp wave of appropriate amplitude and duration could only be detected extracellularly by using an IAP of the configuration found in denervated rat muscle recorded from a muscle fiber terminating in a crush segment of membrane.

Intracellular contribution to extracellularly recorded waveforms: the 'membrane rent' hypothesis

OBJECTIVE

This investigation uses simulation studies to account for single muscle fiber waveforms with complex configurations as arising from the simultaneous recording of a partial intracellular discharge and its associated extracellular manifestation by way of an electrode-induced 'rent' or tear in the sarcolemma.

METHODS

Published material on intracellular action potentials from healthy and 7 day denervated rat skeletal muscle was used as the basis for calculations. A single muscle fiber computer simulation capable of formulating a cut or crush termination effect used the modeled action potentials to generate extracellular waveforms at different locations along the muscle fiber. These extracellular waveforms were then summated with a varied fraction of the intracellular action potential to yield a combined potential. These simulated waveforms were then compared to previously recorded single muscle fiber discharges in order to establish if a combined waveform could reproduce the clinically recorded potentials' configuration.

RESULTS

It was not possible to simulate any of the previously detected innervated single muscle fiber discharges by combining the action potential's intracellular and extracellular configurations. However, 12 of the 14 clinically observed complex waveforms documented in denervated tissue could be simulated with morphologies similar to the clinical potentials.

CONCLUSIONS

Presumed single muscle fiber discharges with complex configurations may result from the needle electrode simultaneously recording the action potential's intracellular and extracellular waveforms secondary to a 'rent' in the sarcolemma. This explanation may in part account for some of the complex appearing potentials detected in denervated tissue, but this 'rent' hypothesis is likely not the explanation for potentials observed in innervated muscle tissue. The apparent success of the 'rent' hypothesis in denervated tissue may be a result of the denervated action potential's unique morphology rather than an actual tear in the sarcolemma. Further investigations are necessary to determine if it is possible for a needle electromyographic electrode to actually record in part the intracellular action potential without disrupting the fiber.

EEG findings in patients with vascular parkinsonism

OBJECTIVES

To investigate whether the conventional and quantitative EEGs of patients with vascular parkinsonism (VP) differ from those of idiopathic Parkinson's disease (PD) patients.

MATERIAL AND METHODS

The EEGs of 13 patients with vascular parkinsonism and 14 patients with idiopathic Parkinson's disease were scored on a simple scale regarding aspects of conventional EEG variables. Alpha band power asymmetry and EEG slowing (increased delta and theta power) were calculated by the neurometrics method of quantitative EEG data evaluation.

RESULTS

Analysis of both conventional and quantitative EEG data shows that VP patients had significantly less EEG slowing than PD patients.

CONCLUSION

This study shows that the EEG in a group of patients with vascular parkinsonism differ from a patient group with idiopathic Parkinson's disease. Our results indicate that VP patients are not PD patients with subcortical vascular lesions, because then they would have had at least as much EEG slowing as PD patients.

Normal needle electromyographic insertional activity morphology: a clinical and simulation study

Needle electromyographic insertional activity waveform morphology, and mechanisms of generation, have received little attention. This study analyzes the individual component waveforms that contribute to the burst of electrical activity known as insertional activity. One hundred monopolar needle insertions were slowly performed and high speed recorded to allow better separation of the contributing individual component waveforms. Analysis of the many waveforms recorded demonstrates several classes of potentials. All of these could be reconstructed by the summation of two basic or elementary waveform patterns: a biphasic initially negative spike with or without a "prepotential" similar to an end-plate spike, and the biphasic initially positive spike with a slowly declining negative phase, similar to a positive sharp wave, though shorter in duration. The relationship between these elementary waveforms and their hypothesized generator sources is discussed.

Motor unit size estimation of enlarged motor units with surface electromyography

Surface EMG is hardly used to estimate motor unit (MU) characteristics, while its non-invasiveness is less stressful for patients and allows multi-electrode recordings to investigate different sites of the muscle and MU. The present study compares motor unit potentials (MUPs) obtained with surface EMG and macro EMG during voluntary contraction of the biceps brachii muscle of patients with enlarged MUs caused by prior poliomyelitis. Averaged surface MUPs were obtained by means of needle EMG (SMUP1) and surface EMG (SMUP2) triggering. The MUPs area and peak amplitudes correlated well when comparing the macro MUP and SMUP1 of the same MUs. When MU populations of different patients were compared, the SMUP1s and SMUP2s were equally sensitive to pathology as macro MUPs. In this, the late non-propagating positive wave (only present in unipolar recordings) is more robust than the triphasic propagating wave. Therefore, surface EMG can be used for detecting enlarged MUs.

Endplate spike morphology: a clinical and simulation study

OBJECTIVE

To describe the various morphologic appearances of endplate spikes, define the theoretical volume conduction basis of these waveforms' morphologies, and simulate "atypical" endplate spike waveforms documented by other investigators.

DESIGN

Endplate spikes were recorded from the biceps brachii in healthy individuals using a monopolar needle electrode. The morphologies of these waveforms were compared with those obtained from a computer simulation. Previously documented endplate waveforms were simulated using two fundamental types of biphasic initially negative and positive waveform morphologies.

SETTING

University clinic outpatient electrodiagnostic medicine facility.

SUBJECTS

Five subjects without history or physical evidence of neuromuscular disease.

MAIN OUTCOME MEASURES

Endplate potential morphologies were assessed with respect to overall waveform shape and number of phases. Computer-generated waveforms for individual endplate spike waveforms were qualitatively compared with those recorded from the subjects.

RESULTS

Three fundamental waveforms were documented to arise from the endplate regions of all subjects and were successfully simulated: (1) biphasic initially negative potential from the endplate itself and up to 0.2mm from the endplate, (2) triphasic initially positive potential from within 0.2mm of the endplate up to 0.5mm from the musculotendinous junction, and (3) biphasic initially positive potential from the last 0.4mm of the fiber or from impulse blocking. Two biphasic endplate spike waveforms could be summated to generate all other endplate waveforms described in previously documented literature.

CONCLUSION

The combination of clinical and simulation studies suggests that endplate spike potentials can have quite varied morphologies. Triphasic initially positive and biphasic initially positive endplate spikes may be mistaken for fibrillation potentials and positive sharp waves, respectively. The triphasic waveforms most likely arise from an action potential propagating past the recording electrode adjacent to the endplate, while the biphasic initially positive potential is simulated to arise from the needle electrode blocking action potential propagation.