Electromyography

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Electromyography
Intervention
EMG - SIMI.jpg
EMG from gait termination, bottom left is the raw EMG, right is the rectified pattern
ICD-9-CM 93.08
MeSH D004576

Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles.[1] EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle cells[2] when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, or recruitment order or to analyze the biomechanics of human or animal movement.

Medical uses[edit]

EMG signals are used in many clinical and biomedical applications. EMG is used as a diagnostics tool for identifying neuromuscular diseases, assessing low-back pain, kinesiology, and disorders of motor control. EMG signals are also used as a control signal for prosthetic devices such as prosthetic hands, arms, and lower limbs.

EMG then acceleromyograph may be used for neuromuscular monitoring in general anesthesia with neuromuscular-blocking drugs, in order to avoid postoperative residual curarization (PORC).[3][4][5][6]

Electromyography and nerve conduction studies (NCS) measure nerve and muscle function, and may be indicated when there is pain in the limbs, weakness from spinal nerve compression, or concern about some other neurologic injury or disorder.[7] Spinal nerve injury does not cause neck, mid back pain or low back pain, and for this reason, evidence has not shown EMG or NCS to be helpful in diagnosing causes of axial lumbar pain, thoracic pain, or cervical spine pain.[7]

Technique[edit]

Skin preparation[edit]

The first step before sensor placement is skin preparation. This includes shaving any excess hair and cleaning the skin with an alcohol pad; abrasion of the skin is also a common step. The goal of all of these steps is to allow for better adhesion of the electrode and the reduction of skin electrical resistance. After the skin preparation, an adhesive piece usually must be applied to the electrode before it can be placed on the skin. Commercial electrodes often have adhesives surrounding the conductive surface of the electrode.[1]184

The actual placement of the electrode can be difficult and depends on a number of factors, such as specific muscle selection and the size of that muscle. Proper EMG placement is very important for accurate representation of the muscle of interest, although EMG is more effective on superficial muscles as it is unable to bypass the action potentials of superficial muscles and detect deeper muscles. Also, the more body fat an individual has, the weaker the EMG signal. When placing the EMG sensor, the ideal location is at the belly of the muscle: the longitudinal midline. The belly of the muscle can also be thought of as in-between the motor point (middle) of the muscle and the tendonus insertion point.[8]

Surface EMG versus intramuscular[edit]

There are two kinds of EMG in widespread use: surface EMG and intramuscular (needle and fine-wire) EMG. To perform intramuscular EMG, a needle electrode or a needle containing two fine-wire electrodes is inserted through the skin into the muscle tissue. A trained professional[citation needed] (such as a neurologist, physiatrist, chiropractor, or physical therapist) observes the electrical activity while inserting the electrode. Certain places limit the performance of needle EMG by non-physicians. A recent case ruling in the state of New Jersey declared that it cannot be delegated to a physician's assistant.[9][10][11] The insertional activity provides valuable information about the state of the muscle and its innervating nerve. Normal muscles at rest make certain, normal electrical signals when the needle is inserted into them. Then the electrical activity when the muscle is at rest is studied. Abnormal spontaneous activity might indicate some nerve and/or muscle damage. Then the patient is asked to contract the muscle smoothly. The shape, size, and frequency of the resulting electrical signals are judged. Then the electrode is retracted a few millimetres, and again the activity is analyzed until at least 10–20 motor units have been collected. Each electrode track gives only a very local picture of the activity of the whole muscle. Because skeletal muscles differ in the inner structure, the electrode has to be placed at various locations to obtain an accurate study.

Intramuscular EMG may be considered too invasive or unnecessary in some cases. Instead, a surface electrode may be used to monitor the general picture of muscle activation, as opposed to the activity of only a few fibres as observed using an intramuscular EMG. This technique is used in a number of settings; for example, in the physiotherapy clinic, muscle activation is monitored using surface EMG and patients have an auditory or visual stimulus to help them know when they are activating the muscle (biofeedback).

Maximal voluntary contraction[edit]

The basic function of EMG is to see if a muscle is active or inactive. The most common way that can be determined is by performing a maximal voluntary contraction (MVC) of the muscle that is being tested. If the action of the muscle is completed, then the muscle is activated. Any signal that comes from the electrodes signifies that the muscle is active.[12]

Measuring the activation and force output of a muscle contraction is biomechanically assessed through the use of surface EMG electrodes. This methodology is a non-invasive practice to quantify the relationship between a specific movement and the activation of the underlying muscle group(s). The specific amount of force generated by a muscle is also a common use for EMG. Based on the different muscular efforts, the EMG signals will vary. However, muscle force indication only represents those muscle fibers that are close to the EMG signals.

Several methods for determining muscle activation are commonly used depending on the application. The use of mean EMG activation or the peak contraction value is a debated topic. Most studies commonly use the maximal voluntary contraction as a means of analyzing peak force and force generated by target muscles. According to the article, Peak and average rectified EMG measures: Which method of data reduction should be used for assessing core training exercises?,[13] concluded that the “average rectified EMG data (ARV) is significantly less variable when measuring the muscle activity of the core musculature compared to the peak EMG variable.” Therefore, these researchers would suggest that “ARV EMG data should be recorded alongside the peak EMG measure when assessing core exercises.” Providing the reader with both sets of data would result in enhanced validity of the study and potentially eradicate the contradictions within the research.[14][15]

Other measurements[edit]

EMG can also be used for indicating the amount of fatigue in a muscle. The following changes in the EMG signal can signify muscle fatigue: an increase in the mean absolute value of the signal, increase in the amplitude and duration of the muscle action potential and an overall shift to lower frequencies. Monitoring the changes of different frequency changes the most common way of using EMG to determine levels of fatigue. The lower conduction velocities enable the slower motor neurons to remain active.[16]

A motor unit is defined as one motor neuron and all of the muscle fibers it innervates. When a motor unit fires, the impulse (called an action potential) is carried down the motor neuron to the muscle. The area where the nerve contacts the muscle is called the neuromuscular junction, or the motor end plate. After the action potential is transmitted across the neuromuscular junction, an action potential is elicited in all of the innervated muscle fibers of that particular motor unit. The sum of all this electrical activity is known as a motor unit action potential (MUAP). This electrophysiologic activity from multiple motor units is the signal typically evaluated during an EMG. The composition of the motor unit, the number of muscle fibres per motor unit, the metabolic type of muscle fibres and many other factors affect the shape of the motor unit potentials in the myogram.

Nerve conduction testing is also often done at the same time as an EMG to diagnose neurological diseases.

Some patients can find the procedure somewhat painful, whereas others experience only a small amount of discomfort when the needle is inserted. The muscle or muscles being tested may be slightly sore for a day or two after the procedure.

EMG signal decomposition[edit]

EMG signals are essentially made up of superimposed motor unit action potentials (MUAPs) from several motor units. For a thorough analysis, the measured EMG signals can be decomposed into their constituent MUAPs. MUAPs from different motor units tend to have different characteristic shapes, while MUAPs recorded by the same electrode from the same motor unit are typically similar. Notably MUAP size and shape depend on where the electrode is located with respect to the fibers and so can appear to be different if the electrode moves position. EMG decomposition is non-trivial, although many methods have been proposed.

EMG signal processing[edit]

Rectification is the translation of the raw EMG signal to a single polarity frequency (usually positive). The purpose of rectifying a signal is to ensure the raw signal does not average zero, due to the raw EMG signal having positive and negative components. It facilitates the signals and process and calculates the mean, integration and the fast fourier transform (FFT). The two types of rectification of signals refer to what happens to the EMG wave when it is processed. These types include full length frequency and half length. Full length frequency adds the EMG signal below the baseline (usually negative polarity) to the signal above the baseline making a conditioned signal that is all positive. This is the preferred method of rectification because it conserves all signal energy for analysis, usually in the positive polarity. Half length rectification deletes the EMG signal below the baseline. In doing so, the average of the data is no longer zero therefore it can be used in statistical analyses. The only difference between the two types of rectification is that full-wave rectification takes the absolute value of the signal array of data points.[17][18]

Limitations[edit]

EMG use in clinical settings has practical applications such as helping to discover disease; however, surface EMG can have limited applications due to inherent problems associated with EMG. Adipose tissue (fat) can affect EMG recordings. Studies show that as adipose tissue increased the active muscle directly below the surface decreased. As adipose tissue increased, the amplitude of the surface EMG signal directly above the center of the active muscle decreased. EMG signal recordings are typically more accurate with individuals who have lower body fat, and more compliant skin, such as young people when compared to old. Muscle cross talk occurs when the EMG signal from one muscle interferes with that of another limiting reliability of the signal of the muscle being tested. Surface EMG is limited due to lack of deep muscles reliability. Deep muscles require intramuscular wires that are intrusive and painful in order to achieve an EMG signal. Surface EMG can only measure superficial muscles and even then it is hard to narrow down the signal to a single muscle.[19]

Electrical characteristics[edit]

The electrical source is the muscle membrane potential of about –90 mV.[20] Measured EMG potentials range between less than 50 μV and up to 20 to 30 mV, depending on the muscle under observation.

Typical repetition rate of muscle motor unit firing is about 7–20 Hz, depending on the size of the muscle (eye muscles versus seat (gluteal) muscles), previous axonal damage and other factors. Damage to motor units can be expected at ranges between 450 and 780 mV.[citation needed]

Procedure outcomes[edit]

Normal results[edit]

Muscle tissue at rest is normally electrically inactive. After the electrical activity caused by the irritation of needle insertion subsides, the electromyograph should detect no abnormal spontaneous activity (i.e., a muscle at rest should be electrically silent, with the exception of the area of the neuromuscular junction, which is, under normal circumstances, very spontaneously active). When the muscle is voluntarily contracted, action potentials begin to appear. As the strength of the muscle contraction is increased, more and more muscle fibers produce action potentials. When the muscle is fully contracted, there should appear a disorderly group of action potentials of varying rates and amplitudes (a complete recruitment and interference pattern).

Abnormal results[edit]

EMG is used to diagnose diseases that generally may be classified into one of the following categories: neuropathies, neuromuscular junction diseases, and myopathies.

Neuropathic disease has the following defining EMG characteristics:

Myopathic disease has these defining EMG characteristics:

  • A decrease in duration of the action potential
  • A reduction in the area to amplitude ratio of the action potential
  • A decrease in the number of motor units in the muscle (in extremely severe cases only)

Because of the individuality of each patient and disease, some of these characteristics may not appear in every case.

Abnormal results may be caused by the following medical conditions (please note this is nowhere near an exhaustive list of conditions that can result in abnormal EMG studies):

History[edit]

The first documented experiments dealing with EMG started with Francesco Redi’s works in 1666. Redi discovered a highly specialized muscle of the electric ray fish (Electric Eel) generated electricity. By 1773, Walsh had been able to demonstrate that the eel fish’s muscle tissue could generate a spark of electricity. In 1792, a publication entitled De Viribus Electricitatis in Motu Musculari Commentarius appeared, written by Luigi Galvani, in which the author demonstrated that electricity could initiate muscle contraction. Six decades later, in 1849, Emil du Bois-Reymond discovered that it was also possible to record electrical activity during a voluntary muscle contraction. The first actual recording of this activity was made by Marey in 1890, who also introduced the term electromyography. In 1922, Gasser and Erlanger used an oscilloscope to show the electrical signals from muscles. Because of the stochastic nature of the myoelectric signal, only rough information could be obtained from its observation. The capability of detecting electromyographic signals improved steadily from the 1930s through the 1950s, and researchers began to use improved electrodes more widely for the study of muscles. Clinical use of surface EMG (sEMG) for the treatment of more specific disorders began in the 1960s. Hardyck and his researchers were the first (1966) practitioners to use sEMG. In the early 1980s, Cram and Steger introduced a clinical method for scanning a variety of muscles using an EMG sensing device.[21]

It is not until the middle of the 1980s that integration techniques in electrodes had sufficiently advanced to allow batch production of the required small and lightweight instrumentation and amplifiers. At present, a number of suitable amplifiers are commercially available. In the early 1980s, cables that produced signals in the desired microvolt range became available. Recent research has resulted in a better understanding of the properties of surface EMG recording. Surface electromyography is increasingly used for recording from superficial muscles in clinical or kinesiological protocols, where intramuscular electrodes are used for investigating deep muscles or localized muscle activity.

There are many applications for the use of EMG. EMG is used clinically for the diagnosis of neurological and neuromuscular problems. It is used diagnostically by gait laboratories and by clinicians trained in the use of biofeedback or ergonomic assessment. EMG is also used in many types of research laboratories, including those involved in biomechanics, motor control, neuromuscular physiology, movement disorders, postural control, and physical therapy.

Research[edit]

EMG can be used to sense isometric muscular activity where no movement is produced. This enables definition of a class of subtle motionless gestures to control interfaces without being noticed and without disrupting the surrounding environment. These signals can be used to control a prosthesis or as a control signal for an electronic device such as a mobile phone or PDA.

EMG signals have been targeted as control for flight systems. The Human Senses Group at the NASA Ames Research Center at Moffett Field, CA seeks to advance man-machine interfaces by directly connecting a person to a computer. In this project, an EMG signal is used to substitute for mechanical joysticks and keyboards. EMG has also been used in research towards a "wearable cockpit," which employs EMG-based gestures to manipulate switches and control sticks necessary for flight in conjunction with a goggle-based display.

Unvoiced speech recognition recognizes speech by observing the EMG activity of muscles associated with speech. It is targeted for use in noisy environments, and may be helpful for people without vocal cords and people with aphasia.

EMG has also been used as a control signal for computers and other devices. An interface device based on EMG could be used to control moving objects, such as mobile robots or an electric wheelchair.[22] This may be helpful for individuals that cannot operate a joystick-controlled wheelchair. Surface EMG recordings may also be a suitable control signal for some interactive video games.[23]

A joint project involving Microsoft, the University of Washington in Seattle, and the University of Toronto in Canada has explored using muscle signals from hand gestures as an interface device.[24] A patent based on this research was submitted on June 26, 2008.[25]

See also[edit]

References[edit]

  1. ^ a b Kamen, Gary. Electromyographic Kinesiology. In Robertson, DGE et al. Research Methods in Biomechanics. Champaign, IL: Human Kinetics Publ., 2004.
  2. ^ Electromyography at the US National Library of Medicine Medical Subject Headings (MeSH)
  3. ^ Harvey AM, Masland RL: Actions of durarizing preparations in the human. Journal of Pharmacology And Experimental Therapeutics, Vol. 73, Issue 3, 304-311, 1941
  4. ^ Botelho SY: Comparison of simultaneously recorded electrical and mechanical activity in myasthenia gravis patients and in partially curarized normal humans. Am J Med. 1955 Nov;19(5):693-6. PMID 13268466
  5. ^ Christie TH, Churchill-Davidson HC: The St. Thomas's Hospital nerve stimulator in the diagnosis of prolonged apnoea. Lancet. 1958 Apr 12;1(7024):776. PMID 13526270
  6. ^ Engbaek J, Ostergaard D, Viby-Mogensen J: Double burst stimulation (DBS): a new pattern of nerve stimulation to identify residual neuromuscular block. Br J Anaesth. 1989 Mar;62(3):274-8. PMID 2522790
  7. ^ a b North American Spine Society (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (North American Spine Society), retrieved 25 March 2013 , which cites
  8. ^ https://www.delsys.com/Attachments_pdf/TN101%20-%20EMG%20Sensor%20Placement-web.pdf
  9. ^ Arthur C. Rothman, MD, v. Selective Insurance Company of America, Supreme Court of New Jersey, Jan. 19
  10. ^ Texas Court of Appeals, Third District, at Austin, Cause No. 03-10-673-CV. April 5, 2012
  11. ^ Section 333.17018 Michigan Compiled Laws http://legislature.mi.gov/doc.aspx?mcl-333-17018
  12. ^ Behm, D.G., Whittle, J., Button, D., & Power, K. (2002). Intermuscle differences in activation. Muscle and Nerve. 25(2); 236-243.
  13. ^ Hibbs, A.E., Thompson, K.G., French, D.N., Hodgson, D., Spears, I.R. Peak and average rectified EMG measures: Which method of data reduction should be used for assessing core training exercises? Journal of Electromyography and Kinesiology. 21(1), 102 – 111. 2011.
  14. ^ Buchanan, T. S., Lloyd, D. G., Manal, K., & Besier, T. F. (2004). Neuromusculoskeletal modeling: estimation of muscle forces and joint moments and movements from measurements of neural command. Journal of applied biomechanics, 20(4), 367.
  15. ^ Halperin, I., Aboodarda, S. J., Button, D. C., Andersen, L. L., & Behm, D. G. (2014). ROLLER MASSAGER IMPROVES RANGE OF MOTION OF PLANTAR FLEXOR MUSCLES WITHOUT SUBSEQUENT DECREASES IN FORCE PARAMETERS. International journal of sports physical therapy, 9(1), 92.
  16. ^ Cifrek, M., Medved, V., Tonković, S., & Ostojić, S. (2009). Surface EMG based muscle fatigue evaluation in biomechanics. Clinical Biomechanics, 24(4), 327-340.
  17. ^ Weir, JP; Wagner, LL; Housh, TJ (1992). "Linearity and reliability of the IEMG v. torque relationship for the forearm flexors and leg extensors". American Journal of Physical Medicine and Rehabilitation 71 (5): 283–287. 
  18. ^ Vrendenbregt, J; Rau, G; Housh (1973). "Surface eletromyography in relation to force, muscle length and endurance.". New developments in electromyography and clinical neurophysiology: 607–622. 
  19. ^ Kuiken, TA; Lowery, Stoykob (April 2003). "The Effect of Subcutaneous Fat on myoelectric signal amplitude and cross talk". Prosthetics and Orthodontics International 27 (1): 48–54. 
  20. ^ Nigg B.M., & Herzog W., 1999. Biomechanics of the Musculo-Skeletal system. Wiley. Page:349.
  21. ^ Cram, JR.; Steger, JC. (Jun 1983). "EMG scanning in the diagnosis of chronic pain.". Biofeedback Self Regul 8 (2): 229–41. PMID 6227339. 
  22. ^ Andreasen, DS.; Gabbert DG,: EMG Switch Navigation of Power Wheelchairs, RESNA 2006. [1]
  23. ^ Park, DG.; Kim, HC. Muscleman: Wireless input device for a fighting action game based on the EMG signal and acceleration of the human forearm. [2]
  24. ^ Hsu, Jeremy (2009-10-29). "The Future of Video Game Input: Muscle Sensors". Live Science. Retrieved 2010-01-16. 
  25. ^ "Recognizing Gestures from Forearm EMG Signals". United States Patent and Trademark Office. 2008-06-26. Retrieved 2010-01-16. 

External links[edit]