Firing rate analysis using decompostion-enhanced spike triggered averaging in the quadriceps femoris

Motor unit potential recruitment reference values in common upper and lower extremity muscles

OBJECTIVE

To define reference values for motor unit (MU) recruitment during needle EMG of six commonly examined muscles at low to moderate contraction.

METHODS

Needle examination was performed for each muscle in a total of 111 subjects without neuromuscular disorders. Fastest firing rates and recruitment ratios (RRs) were calculated in at least 5 sites within each muscle. Upper limits of normal based on 97th percentile for fastest MU firing rates and RRs were calculated for each muscle. The means of fastest firing rates were compared among muscles using the Friedman and Wilcoxon signed rank tests.

RESULTS

The upper limits of normal were 12-15 Hz for fastest firing rates and were slightly higher in the deltoid and triceps than the other muscles.

CONCLUSION

Firing rates >15 Hz recorded at multiple sites within a single muscle exceed the 97th percentile of normal subjects and may suggest reduced MU recruitment. In some muscles, rates >12 Hz might support mildly reduced recruitment. Recruitment ratios varied depending on number of firing MUs, whereas the fastest firing MU rate did not.

SIGNIFICANCE

The determination of reference values for fastest MU firing rates can help to identify mild reduction in recruitment with more accuracy.

A method for the estimation of a motor unit innervation zone center position evaluated with a computational sEMG model

Motion predictions for limbs can be performed using commonly called Hill-based muscle models. For this type of models, a surface electromyogram (sEMG) of the muscle serves as an input signal for the activation of the muscle model. However, the Hill model needs additional information about the mechanical system state of the muscle (current length, velocity, etc.) for a reliable prediction of the muscle force generation and, hence, the prediction of the joint motion. One feature that contains potential information about the state of the muscle is the position of the center of the innervation zone. This feature can be further extracted from the sEMG. To find the center, a wavelet-based algorithm is proposed that localizes motor unit potentials in the individual channels of a single-column sEMG array and then identifies innervation point candidates. In the final step, these innervation point candidates are clustered in a density-based manner. The center of the largest cluster is the estimated center of the innervation zone. The algorithm has been tested in a simulation. For this purpose, an sEMG simulator was developed and implemented that can compute large motor units (1,000's of muscle fibers) quickly (within seconds on a standard PC).

Neuromuscular electrodiagnosis

The electrodiagnostic (EDX) study is an extension of the clinical examination, which means that the clinical features dictate the initial nerve conduction studies (NCS) performed. However, once the EDX study is started, it continues in an independent manner, meaning that the initial NCS findings dictate the subsequent studies performed. Because competent EDX study performance requires considerable knowledge (and special training), it is not possible to convey all of the basic and advanced concepts in a single chapter. Nonetheless, the most important concepts are easily conveyed by a discussion limited to EDX-pertinent anatomical, physiological, pathological, pathophysiological, and basic electrical concepts. The focus of this chapter will be on the standard NCS and needle EMG measurements made during EDX studies and their significance with regard to lesion localization and characterization. Because the most challenging portion of EDX study is motor unit action potential analysis, this topic is more extensively reviewed. The utility of the sensory NCS for identifying focal axon loss, the utility of the motor NCS for screening long nerve segments for focal demyelination and for determining lesion severity, and the utility of the needle EMG for confirming the NCS findings, better defining lesion localization, and identifying the temporal features (e.g., chronicity) and rate of progression of the lesion are also reviewed.

Normal and abnormal voluntary activity

An important component of needle EMG entails recording and interpreting the electrical signals generated from motor units during voluntary contraction. The recorded motor unit potentials (MUPs) reflect the number of motor units within a muscle and the distribution and density of muscle fibers within a motor unit within a portion of a muscle. Various MUP parameters are assessed to determine the integrity of the motor units, including recruitment, stability, phases and turns, duration, and amplitude. Each of these parameters is altered in a different way in various neuromuscular diseases. In neurogenic disorders, the earliest changes occur in the recruitment pattern of motor units followed by MUP morphologic changes (increased MUP phases and duration) as reinnervation occurs. MUP instability, indicating impaired neuromuscular transmission, also occurs in reinnervating neurogenic disorders as well as in neuromuscular junction disorders. In myopathies, a reduction in the size of the motor unit is manifested by MUPs of low amplitude and short duration. Interpreting the voluntary MUP changes along with spontaneous activity helps to determine the type, severity, and temporal course of neuromuscular diseases.

High-density surface electromyography provides reliable estimates of motor unit behavior

OBJECTIVE

To assess the intra- and inter-session reliability of estimates of motor unit behavior and muscle fiber properties derived from high-density surface electromyography (HDEMG).

METHODS

Ten healthy subjects performed submaximal isometric knee extensions during three recording sessions (separate days) at 10%, 30%, 50% and 70% of their maximum voluntary effort. The discharge timings of motor units of the vastus lateralis and medialis muscles were automatically identified from HDEMG by a decomposition algorithm. We characterized the number of detected motor units, their discharge rates, the coefficient of variation of their inter-spike intervals (CoVisi), the action potential conduction velocity and peak-to-peak amplitude. Reliability was assessed for each motor unit characteristics by intra-class correlation coefficient (ICC). Additionally, a pulse-to-noise ratio (PNR) was calculated, to verify the accuracy of the decomposition.

RESULTS

Good to excellent reliability within and between sessions was found for all motor unit characteristics at all force levels (ICCs>0.8), with the exception of CoVisi that presented poor reliability (ICC<0.6). PNR was high and similar for both muscles with values ranging between 45.1 and 47.6dB (accuracy>95%).

CONCLUSION

Motor unit features can be assessed non-invasively and reliably within and across sessions over a wide range of force levels.

SIGNIFICANCE

These results suggest that it is possible to characterize motor units in longitudinal intervention studies.

Effects of electrical stimulation parameters on fatigue in skeletal muscle

STUDY DESIGN

Experimental laboratory study.

OBJECTIVES

The primary purpose was to investigate the independent effects of current amplitude, pulse duration, and current frequency on muscle fatigue during neuromuscular electrical stimulation (NMES). A second purpose was to determine if the ratio of the evoked torque to the activated area could explain muscle fatigue.

BACKGROUND

Parameters of NMES have been shown to differently affect the evoked torque and the activated area. The efficacy of NMES is limited by the rapid onset of muscle fatigue.

METHODS AND MEASURES

Seven healthy participants underwent 4 NMES protocols that were randomly applied to the knee extensor muscle group. The NMES protocols were as follows: standard protocol (Std), defined as 100-Hz, 450-micros pulses and amplitude set to evoke 75% of maximal voluntary isometric torque (MVIT); short pulse duration protocol (SP), defined as 100-Hz, 150-micros pulses and amplitude set to evoke 75% of MVIT; low-frequency protocol (LF), defined as 25-Hz, 450-micros pulses and amplitude set to evoke 75% of MVIT; and low-amplitude protocol (LA), defined as 100-Hz, 450-micros pulses and amplitude set to evoke 45% of MVIT. The peak torque was measured at the start and at the end of the 4 protocols, and percent fatigue was calculated. The outcomes of the 4 NMES protocols on the initial peak torque and activated cross-sectional area were recalculated from a companion study to measure torque per active area.

RESULTS

Decreasing frequency from 100 to 25 Hz decreased fatigue from 76% to 39%. Decreasing the amplitude and pulse duration resulted in no change of muscle fatigue. Torque per active area accounted for 57% of the variability in percent fatigue between Std and LF protocols.

CONCLUSIONS

Altering the amplitude of the current and pulse duration does not appear to influence the percent fatigue in NMES. Lowering the stimulation frequency results in less fatigue, by possibly reducing the evoked torque relative to the activated muscle area.

Age-associated changes in motor unit physiology: observations from the Baltimore Longitudinal Study of Aging

OBJECTIVE

To examine motor unit characteristics (size and firing rate) associated with aging.

DESIGN

Cross-sectional, observational.

SETTING

Community.

PARTICIPANTS

Baltimore Longitudinal Study of Aging participants (N=102), aged 22.2 to 94.1 years, were studied.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Surface-represented motor unit size and firing rate were collected from the vastus medialis during knee extension at 10%, 20%, 30%, and 50% of each subject's maximum isometric voluntary contraction (MVC).

RESULTS

MVC declined with older age (P<.0001). Adjusting for differences in MVC, both firing rate and motor unit size per newton force generated began to increase in the 6th decade of life. Motor unit size increased per newton force to a greater extent than firing rate. Those over the age of 75 years also activated significantly larger motor units per unit force (P=.04). Relative to force generated, the average firing rate began increasing at 57.8+/-3.4 years and between 50.2 and 56.4 years (+/-4y) for motor unit size.

CONCLUSIONS

The size of motor units and firing rates used to achieve a given force changes with age, particularly after middle age. Whether these changes precede, follow, or occur concurrent to age-related modifications in muscle structure and contractile properties or sarcopenia is not known.

Needle electromyography

Physiologic assessment of diseases of the motor unit from the anterior horn cells to the muscles relies on a combination of needle electromyography (EMG) and nerve conduction studies (NCS). Both require a unique combination of knowledge of peripheral nervous system anatomy, physiology, pathophysiology, diseases, techniques, and electricity is necessary. Successful, high-quality, reproducible EMG depends on the skills of a clinician in patient interaction during the physical insertion and movement of the needle while recording the electrical signals. These must be combined with the skill of analyzing electric signals recorded from muscle by auditory pattern recognition and semiquantitation.1052 This monograph reviews the techniques of needle EMG and waveform analysis and describes the types of EMG waveforms recorded during needle EMG.

Electromyographic patterns suggest changes in motor unit physiology associated with early osteoarthritis of the knee

OBJECTIVE

To assess characteristics of active motor units (MUs) during volitional vastus medialis (VM) activation in adults with symptomatic knee osteoarthritis (OA) across the spectrum of radiographic severity and age-comparable healthy control volunteers.

METHODS

We evaluated 39 participants (age 65+/-3 years) in whom weight-bearing knee X-rays were assigned a Kellgren & Lawrence (KL) grade (18 with KL grade=0; four each with KL grades=1, 2 and 4; nine with grade 3). Electromyography (EMG) signals were simultaneously acquired using surface [surface EMG (S-EMG)] and intramuscular needle electrodes, and analyzed by decomposition-enhanced spike-triggered averaging to obtain estimates of size [surface-represented MU action potentials (S-MUAP) area], number [MU recruitment index (MURI)] and firing rates [MU firing rates (mFR)] of active MUs at 10%, 20%, 30% and 50% effort relative to maximum voluntary force [maximal voluntary isometric contraction (MVIC)] during isometric knee extension.

RESULTS

Knee extensor MVIC was lower in OA participants, especially at higher KL grades (P=0.05). Taking the observed force differences into account, OA was also associated with activation of larger MUs (S-MUAP area/MVICx%effort; P<0.0001). In contrast, the estimated number of active units (MURI/MVICx%effort) changed differently as effort increased from 10% to 50% and was higher with advanced OA (KL=3, 4) than controls (P=0.0002).

CONCLUSION

VM activation changes at the level of the MU with symptomatic knee OA, and this change is influenced by radiographic severity. Poor muscle quality may explain the pattern observed with higher KL grades, but alternative factors (e.g., nerve or joint injury, physical inactivity or muscle composition changes) should be examined in early OA.

Physiological characteristics of motor units in the brachioradialis muscle across fatiguing low-level isometric contractions

The purpose of this study was to determine (i) if decomposition-based quantitative electromyography (DQEMG) could detect changes in motor unit potential (MUP) morphology and motor unit (MU) firing pattern statistics associated with muscle fatigue, (ii) if any detected changes are correlated with surface electromyographic (SEMG) signs of fatigue, and (iii) if significant fatigue-dependent changes are repeatable within individuals. Mean MU firing rates and the morphology of MUPs detected using needle and surface electrodes during constant-torque isometric contractions held until exhaustion were investigated in the brachioradialis (BR) muscle in 10 healthy volunteers (mean age=28.6 yr, SD+/-3.9). Time dependant changes were investigated using an analysis of variance with normalized time as a main effect. Partial correlation coefficients were computed using a repeated measures analysis of covariance to determine if changes in MU firing rates, needle-detected MUPs and surface-detected MUPs (SMUPs) were related to changes in SEMG signal amplitude and frequency parameters. Intraclass correlation coefficients (ICCs) were used to determine the within-subject repeatability of changes in MU firing rates, and MUP and SMUP parameters. Significant decreases in mean MU firing rates were found along with significant increases in various duration and area related parameters in both MUPs and SMUPs across the fatiguing contraction. The SEMG signal demonstrated the expected changes with fatigue: an increase in amplitude and a decrease in frequency content. SEMG amplitude was significantly positively correlated with SMUP peak-to-peak voltage (r=0.85, p<0.05), and SMUP area (r=0.86, p<0.05). Mean power frequency was significantly negatively correlated with SMUP negative peak duration (r=-0.74, p<0.05). The significant time-dependent changes were reliably observed (ICCs were 0.94 for MUP peak to peak amplitude, 0.97 for MUP area and 0.95 for MUP area to amplitude ratio, 0.95 for SMUP peak-to-peak voltage, 0.83 for SMUP area, 0.99 for SMUP negative peak amplitude and 0.88 for SMUP negative peak area). The decreases in mean MU firing rates measured along with the increases in amplitude, duration and area parameters of MUPs and SMUPs and their partial correlation with SEMG amplitude during submaximal fatiguing contractions of the BR, suggest that recruitment is a main cause of increased SEMG amplitude parameters with fatigue. We conclude that DQEMG can be effectively and reliably used to detect changes in physiological characteristics of MUs that accompany fatigue.

Effects of neuromuscular electrical stimulation parameters on specific tension

This study examined the effects of altering surface neuromuscular electrical stimulation (SNMES) parameters on the specific tension of the quadriceps femoris muscle. Seven able-bodied subjects had magnetic resonance images taken of both thighs prior to and immediately after four SNMES protocols to determine the activated muscle cross-sectional area (CSA). The four protocols were: (1) research (RES, 100 Hz, 450 micros, and amplitude set to evoke 75% of maximal voluntary isometric torque, MVIT); (2) pulse duration (PD, 100 Hz, 150 micros, same current as in RES); (3) frequency (FREQ, 25 Hz, 450 micros, and same current as in RES); (4) amplitude (AMP, 100 Hz, 450 mus, and current set to evoke the average of the initial torques of PD and FREQ, 45 +/- 9% of MVIT). Reducing the amplitude of the current from 75 to 45% of MVIT did not alter specific tension, 25 +/- 8 N/cm2, suggesting that the amplitude probably affects torque and the area of activated muscle proportionally. Shortening the pulse duration from 450 to 150 micros caused specific tension to drop from 25 +/- 6 to 20 +/- 6 N/cm2 (P < 0.05), indicating that pulse duration increased torque and the activated CSA disproportionally. Alternatively, reducing the frequency from 100 to 25 Hz decreased specific tension from 25 +/- 6 to 17 +/- 4 N/cm2 (P < 0.05), suggesting that the frequency increased torque without affecting the activated CSA. Clinicians who administer SNMES should be aware of the magnitude of adaptations to a given amplitude, pulse duration, and frequency.

Intraneural microstimulation of motor axons in the study of human single motor units

Single motor unit activity has been studied in depth since the first intramuscular electrodes were developed more than 70 years ago. Many techniques have been combined or used in isolation since then. Intraneural motor axon microstimulation allows the detailed study of single motor units in awake human subjects in a manner most analogous to that used in reduced animal preparations. A microelectrode, inserted percutaneously into a peripheral nerve, stimulates the axon of a single alpha-motoneuron at a site remote from the contracting muscle, allowing detailed analyses of the contractile properties of a single motor unit in an otherwise quiescent muscle, that is, without interference of simultaneously active motor units or the presence of an electrode within the muscle. The methods and results obtained using this technique are described and compared to those of other studies of single motor units in human subjects. Differences have been found between human and animal motor units and between motor units of various muscles. Studying human and animal motor units using an analogous technique provides insight into the interpretation of human data when results differ from animal data, and when human motor units cannot be examined in the same way, or at a similar level of detail, as animal motor units.

Motor unit number estimation by decomposition-enhanced spike-triggered averaging: Control data, test-retest reliability, and contractile level effects

Decomposition-enhanced spike-triggered averaging (DE-STA) has been developed as a method for obtaining a motor unit number estimate (MUNE). We describe the method and report control data for the first dorsal interosseous/adductor pollicis and thenar muscles and reliability in the thenar muscles. Seventeen subjects (ages 20-50 years) took part in the study. The maximum M potential was elicited with supramaximal stimulation of the ulnar or median nerve at the wrist. Surface and intramuscularly detected electromyographic signals were then collected simultaneously during mild to moderate contractions. Decomposition algorithms were used to detect and sort the individual motor unit potential (MUP) occurrences of several concurrently active motor units in the needle-detected signals. The MUP occurrences were used as triggering sources to estimate their corresponding surface-detected MUPs (S-MUPs) using STA. The mean S-MUP size was calculated and divided into the maximum M-potential size to derive a MUNE. The MUNE values were consistent with those previously reported with other methods, and thenar MUNEs for the two trials were similar (249 +/- 78 and 246 +/- 90), with high test-retest reliability (r = 0.94, P < 0.05). DE-STA thus appears to be a valid and reliable method to obtain MUNEs.

Relationships between surface-detected EMG signals and motor unit activation

INTRODUCTION

Surface-detected electromyographic (S-EMG) signals are used in exercise science to assess the extent of muscle activation, muscle fatigue, and neural activity during muscle contraction. However, the relationship has not been studied between S-EMG signal amplitude and motor unit activation at different muscle force levels.

METHODS

S-EMG signals were measured from 76 healthy subjects during target force levels of 5, 10, 20, 30, and 50% of maximal voluntary contraction (MVC) of the knee extensors over 20-30 s. Mean absolute S-EMG amplitude, surface-detected motor unit action potential amplitude (S-MUAP), motor unit mean firing rate (mFR), and motor unit mean voltage, which is the product of S-MUAP amplitude and mFR, were assessed in the vastus medialis by using EMG signal-decomposition and spike-triggered averaging techniques.

RESULTS

Motor unit mean voltage increased to the same degree as mean absolute S-EMG amplitude with increasing force, implying that motor unit size and firing rate explain the increase in mean absolute S-EMG amplitude with increasing force generation. In addition, mean absolute S-EMG amplitude increased linearly during the course of each 20-30 s contraction, with the slope being greater at higher force levels. A small change was observed in the shape of needle-detected motor unit action potentials during the contraction, but this change was not sufficient to explain the large change in mean absolute S-EMG amplitude during the contraction.

CONCLUSION

Mean absolute S-EMG amplitude at different force levels and its changes during the course of a submaximal contraction are dependent on the number of motor units active, their size, and firing rates.

EMG signal decomposition: how can it be accomplished and used?

Electromyographic (EMG) signals are composed of the superposition of the activity of individual motor units. Techniques exist for the decomposition of an EMG signal into its constituent components. Following is a review and explanation of the techniques that have been used to decompose EMG signals. Before describing the decomposition techniques, the fundamental composition of EMG signals is explained and after, potential sources of information from and various uses of decomposed EMG signals are described.

Motor unit physiology: some unresolved issues

The purpose of this review was to examine three issues that limit our understanding of motor unit physiology: (1) the range and distribution of the innervation ratios in a muscle; (2) the association between discharge rate and force; and (3) the variation in motor unit activity across contractions that differ in speed and type. We suggest that if more data were available on these issues, the understanding of neuromuscular function would be enhanced substantially, especially with regard to plasticity in the motor neuron pool, adequacy of the neural drive to muscle, and flexibility of activation patterns across various types of contractions. Current data are limited and these limitations influence our ability to interpret adaptations in muscle function in health and disease.

Fatigue effects on motor unit activity during submaximal contractions

OBJECTIVE

To examine motor unit changes during the development of fatigue in healthy subjects.

DESIGN

Automated decomposition-enhanced spike-triggered averaging was used to characterize motor unit size and firing rate in the dominant vastus medialis during maintained contractions at 10% and 30% of maxima voluntary contraction (MVC).

SETTING

Academic outpatient neuromuscular clinic.

PARTICIPANTS

Healthy laboratory personnel.

MAIN OUTCOME MEASURES

Surface electromyogram, surface-detected motor unit action potential amplitude (S-MUAP), mean firing rate, force (MVC), motor unit index.

RESULTS

Surface electromyogram values and S-MUAP amplitudes increased during both 10% and 30% MVC fatiguing contractions, while mean firing rates decreased. A motor unit index, indicating the degree of motor unit pool activation, increased similarly to S-MUAP size, implying that new and larger units were recruited to maintain the contraction. Repeated contractions led to earlier motor unit changes and fatigue.

CONCLUSION

During submaximal fatiguing contractions, additional motor units are activated to maintain strength. These changes begin early, within the first minute, particularly after a previous fatiguing effort.

Analysis of motor unit firing patterns in patients with central or peripheral lesions using singular-value decomposition

We applied the singular value decomposition (SVD) method to study single motor unit firing patterns. Two projects were carried out: (1) a computer simulation study to confirm the meanings of two SVD parameters, the eigenvalue corresponding to the positive-slope eigenvector (PEV) and that corresponding to the negative-slope eigenvector (NEV); and (2) a clinical study for which electromyographic (EMG) recordings were made from first dorsal interosseous muscle in patients with stroke, myopathies, or neuropathies and in healthy control subjects. Results of computer simulation reveal that the NEV reflects the amount of instantaneous firing variability, whereas the PEV/NEV (P/N) ratio exhibits the relative effect of a trend in the firing pattern. In human studies, the P/N ratio of stroke patients was significantly higher than that of the controls, whereas their NEV was comparable. By contrast, in the myopathy and neuropathy groups, the NEV increased significantly, whereas the P/N ratio did not. These results suggest that the SVD method decomposes the motor unit (MU) firing variation into two components and that the mechanism for increased firing variability is different for supraspinal and spinal-infraspinal lesions.

The relationship of motor unit size, firing rate and force

OBJECTIVE

Using a clinical electromyographic (EMG) protocol, motor units were sampled from the quadriceps femoris during isometric contractions at fixed force levels to examine how average motor unit size and firing rate relate to force generation.

METHODS

Mean firing rates (mFRs) and sizes (mean surface-detected motor unit action potential (mS-MUAP) area) of samples of active motor units were assessed at various force levels in 79 subjects.

RESULTS

MS-MUAP size increased linearly with increased force generation, while mFR remained relatively constant up to 30% of a maximal force and increased appreciably only at higher force levels. A relationship was found between muscle force and mS-MUAP area (r2 = 0.67), mFR (r2 = 0.38), and the product of mS-MUAP area and mFR (mS-MUAP x mFR) (r2 = 0.70).

CONCLUSIONS

The results support the hypothesis that motor units are recruited in an orderly manner during forceful contractions, and that in large muscles only at higher levels of contraction ( > 30% MVC) do mFRs increase appreciably. MS-MUAP and mFR can be assessed using clinical EMG techniques and they may provide a physiological basis for analyzing the role of motor units during muscle force generation.