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Comparison of Laryngeal Palpatory Scale (LPS), With Surface Electromyographic Measures in Patients with Muscle Tension Dysphonia. J Voice 2024; 38:245.e37-245.e48. [PMID: 34627703 DOI: 10.1016/j.jvoice.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/08/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to examine the laryngeal palpatory scale (LPS) to ascertain possible correlation with neck surface electromyography (sEMG). METHODS Two otolaryngologists and one certified speech-language pathologist assessed 21 participants (seven women and 14 men; with a mean age of 42.8 years; ranged: 21 to 70 years) with muscle tension dysphonia (MTD) diagnosed with the current version of the LPS rating system. Consequently, relationships between LPS and objective measures of sEMG were evaluated using Spearman's rank correlation coefficient (r). RESULTS The results show that there was a low to moderate between correlations, (statistically positive and significant in 10 correlations among the examined items/states). CONCLUSIONS In conclusion, low-moderate positive correlations between sEMG and LPS ratings were found with particular strength for LPS ratings of tightness and ratings made during dynamic tasks. Further investigations can provide useful evidence for researchers and clinicians to document treatment outcomes by using LPS and sEMG in patients with MTD and leading to the more standardized care and improved information about patient progress.
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A computational model of surface electromyography signal alterations after spinal cord injury. J Neural Eng 2023; 20:066020. [PMID: 37948762 DOI: 10.1088/1741-2552/ad0b8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
Objective. Spinal cord injury (SCI) can cause significant impairment and disability with an impact on the quality of life for individuals with SCI and their caregivers. Surface electromyography (sEMG) is a sensitive and non-invasive technique to measure muscle activity and has demonstrated great potential in capturing neuromuscular changes resulting from SCI. The mechanisms of the sEMG signal characteristic changes due to SCI are multi-faceted and difficult to studyin vivo. In this study, we utilized well-established computational models to characterize changes in sEMG signal after SCI and identify sEMG features that are sensitive and specific to different aspects of the SCI.Approach. Starting from existing models for motor neuron pool organization and motor unit action potential generation for healthy neuromuscular systems, we implemented scenarios to model damages to upper motor neurons, lower motor neurons, and the number of muscle fibers within each motor unit. After simulating sEMG signals from each scenario, we extracted time and frequency domain features and investigated the impact of SCI disruptions on sEMG features using the Kendall Rank Correlation analysis.Main results. The commonly used amplitude-based sEMG features (such as mean absolute values and root mean square) cannot differentiate between injury scenarios, but a broader set of features (including autoregression and cepstrum coefficients) provides greater specificity to the type of damage present.Significance. We introduce a novel approach to mechanistically relate sEMG features (often underused in SCI research) to different types of neuromuscular alterations that may occur after SCI. This work contributes to the further understanding and utilization of sEMG in clinical applications, which will ultimately improve patient outcomes after SCI.
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Evaluation of a spring-loaded upper-limb exoskeleton in cleaning activities. APPLIED ERGONOMICS 2023; 106:103877. [PMID: 36095895 DOI: 10.1016/j.apergo.2022.103877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
In the past few years, companies have started considering the adoption of upper-limb occupational exoskeletons as a solution to reduce the health and cost issues associated with work-related shoulder overuse injuries. Most of the previous research studies have evaluated the efficacy of these devices in laboratories by measuring the reduction in muscle exertion resulting from device use in stereotyped tasks and controlled conditions. However, to date, uncertainties exist about generalizing laboratory results to more realistic conditions of use. The current study aims to investigate the in-field efficacy (through electromyography and perceived exertion), usability, and acceptance of a commercial spring-loaded upper-limb exoskeleton in cleaning job activities. The operators were required to maintain prolonged overhead postures while holding and moving a pole equipped with tools for window and ceiling cleaning. Compared to the normal working condition, the exoskeleton significantly reduced the total shoulder muscle activity (∼17%), the activity of the anterior deltoid (∼26%), medial deltoid (∼28%), and upper trapezius (∼24%). With the exoskeleton, the operators perceived reduced global effort (∼17%) as well as a reduced local effort in the shoulder (∼18%), arm (∼22%), upper back (∼14%), and lower back (∼16%). The beneficial effect of the exoskeleton and its suitability in cleaning settings are corroborated by the acceptance and usability scores assigned by operators, which averaged ∼5.5 out of 7 points. To the authors' knowledge, this study is the first to present an experience of exoskeleton use in cleaning contexts. The outcomes of this research invite further studies to test occupational exoskeletons in various realistic applications to foster scientific-grounded ergonomic evaluations and encourage the informed adoption of the technology.
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Effect of epidural spinal cord stimulation after chronic spinal cord injury on volitional movement and cardiovascular function: study protocol for the phase II open label controlled E-STAND trial. BMJ Open 2022; 12:e059126. [PMID: 35851008 PMCID: PMC9297213 DOI: 10.1136/bmjopen-2021-059126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies have indicated that epidural spinal cord stimulation (eSCS) is a promising therapy to improve motor control and autonomic function for patients with chronic SCI. The aim of this study is to assess the effects of tonic eSCS after chronic SCI on quantitative outcomes of volitional movement and cardiovascular function. Our secondary objective is to optimise spinal cord stimulation parameters for volitional movement. METHODS AND ANALYSIS The Epidural Stimulation After Neurologic Damage (ESTAND) trial is a phase II single-site self-controlled trial of epidural stimulation with the goal of restoring volitional movement and autonomic function after motor complete SCI. Participants undergo epidural stimulator implantation and are followed up over 15 months while completing at-home, mobile application-based movement testing. The primary outcome measure integrates quantity of volitional movement and similarity to normal controls using the volitional response index (VRI) and the modified Brain Motor Control Assessment. The mobile application is a custom-designed platform to support participant response and a kinematic task to optimise the settings for each participant. The application optimises stimulation settings by evaluating the parameter space using movement data collected from the tablet application and accelerometers. A subgroup of participants with cardiovascular dysautonomia are included for optimisation of blood pressure stabilisation. Indirect effects of stimulation on cardiovascular function, pain, sexual function, bowel/bladder, QOL and psychiatric measures are analysed to assess generalisability of this targeted intervention. ETHICS AND DISSEMINATION This study has been approved after full review by the Minneapolis Medical Research Foundation Institutional Review Board and by the Minneapolis VA Health Care System. This project has received Food and Drug Administration investigational device exemption approval. Trial results will be disseminated through peer-reviewed publications, conference presentations and seminars. TRIAL REGISTRATION NUMBER NCT03026816.
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Exoskeletons for workers: A case series study in an enclosures production line. APPLIED ERGONOMICS 2022; 101:103679. [PMID: 35066399 DOI: 10.1016/j.apergo.2022.103679] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
This case-series study aims to investigate the effects of a passive shoulder support exoskeleton on experienced workers during their regular work shifts in an enclosures production site. Experimental activities included three sessions, two of which were conducted in-field (namely, at two workstations of the painting line, where panels were mounted and dismounted from the line; each session involved three participants), and one session was carried out in a realistic simulated environment (namely, the workstations were recreated in a laboratory; this session involved four participants). The effect of the exoskeleton was evaluated through electromyographic activity and perceived effort. After in-field sessions, device usability and user acceptance were also assessed. Data were reported individually for each participant. Results showed that the use of the exoskeleton reduced the total shoulder muscular activity compared to normal working conditions, in all subjects and experimental sessions. Similarly, the use of the exoskeleton resulted in reductions of the perceived effort in the shoulder, arm, and lower back. Overall, participants indicated high usability and acceptance of the device. This case series invites larger validation studies, also in diverse operational contexts.
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Validity and reliability of an electromyography-based similarity index to quantify lower extremity selective voluntary motor control in children with cerebral palsy. Clin Neurophysiol Pract 2022; 7:107-114. [PMID: 35372733 PMCID: PMC8967969 DOI: 10.1016/j.cnp.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 11/26/2022] Open
Abstract
The SISCALE is a new electromyography-based measure to quantify selective voluntary motor control. There is a need for precise, interval-scaled measures of selective voluntary motor control in children with cerebral palsy. Concurrent and discriminative validity of the new measure was affirmed and test–retest reliability was acceptable.
Objective To quantify selective voluntary motor control (SVMC) objectively and more precisely, we combined the “Selective Control Assessment of the Lower Extremity” (SCALE) with surface electromyography. The resulting Similarity Index (SI) measures the similarity of muscle activation patterns. This study evaluated the preliminary validity and reliability of this novel SISCALE measure in children with cerebral palsy (CP). Methods We investigated concurrent validity by correlating the SISCALE of 24 children with CP (median age 10.6 years) with comparator assessments. For discriminative validity, the patients’ SISCALE scores were compared to 31 neurologically intact age-matched peers. Test-retest reliability was quantified using intraclass correlation coefficients (ICC) and minimal detectable change (MDC) values. Results The SISCALE correlated strongly with the SCALE (ρ = 0.90, p < .001) and the Gross Motor Function Classification System (ρ = −0.74, p < .001). SISCALE scores were significantly lower in children with CP compared to healthy peers. Test-retest reliability appeared good (for the more and less affected leg, ICC ≥ 0.84, and MDC ≤ 0.17). Conclusions Validity and reliability of the SISCALE leg and total scores lay within clinically acceptable ranges. Further clinimetric analyses should include responsiveness. Significance A neurophysiology-based assessment could contribute to a more refined assessment of SVMC impairments.
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Effect of Test Interface on Respiratory Muscle Activity and Pulmonary Function During Respiratory Testing in Healthy Adults. Cardiopulm Phys Ther J 2022; 33:87-95. [PMID: 36148286 PMCID: PMC9488548 DOI: 10.1097/cpt.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose The mouthpiece is the standard interface for spirometry tests. Although the use of a mouthpiece can be challenging for patients with orofacial weakness, maintaining a proper seal with a facemask can be an issue for healthy individuals during forceful efforts. We compared respiratory muscle activity and tests using a mouthpiece and facemask in healthy adults to investigate whether they can be used interchangeably. Methods In this observational study, subjects (n=12) completed forced vital capacity, maximal respiratory pressure, and peak cough flow with a mouthpiece and facemask. Root mean square values of the genioglossus, diaphragm, scalene, and sternocleidomastoid were compared between conditions. Results When switching from a mouthpiece to a facemask, significantly higher values were seen for peak cough flow (average bias= -54.36 L/min, p<0.05) and the difference seen with MEP and MIP were clinically significant (average bias: MEP=27.33, MIP=-5.2). Additionally, submental activity was significantly greater when MIP was conducted with a mouthpiece. No significant differences were seen in respiratory muscle activity during resting breathing or spirometry. Conclusion There are clinically significant differences with cough and MEP tests and neck muscles are activated differently based on interface. Considering the small sample size, our findings suggest a facemask may be used to complete some PFTs.
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Acute intermittent hypoxia and respiratory muscle recruitment in people with amyotrophic lateral sclerosis: A preliminary study. Exp Neurol 2022; 347:113890. [PMID: 34624328 PMCID: PMC9488543 DOI: 10.1016/j.expneurol.2021.113890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 01/03/2023]
Abstract
Respiratory failure is the main cause of death in amyotrophic lateral sclerosis (ALS). Since no effective treatments to preserve independent breathing are available, there is a critical need for new therapies to preserve or restore breathing ability. Since acute intermittent hypoxia (AIH) elicits spinal respiratory motor plasticity in rodent ALS models, and may restore breathing ability in people with ALS, we performed a proof-of-principle study to investigate this possibility in ALS patients. Quiet breathing, sniff nasal inspiratory pressure (SNIP) and maximal inspiratory pressure (MIP) were tested in 13 persons with ALS and 10 age-matched controls, before and 60 min post-AIH (15, 1 min episodes of 10% O2, 2 min normoxic intervals) or sham AIH (continuous normoxia). The root mean square (RMS) of the right and left diaphragm, 2nd parasternal, scalene and sternocleidomastoid muscles were monitored. A vector analysis was used to calculate summated vector magnitude (Mag) and similarity index (SI) of collective EMG activity during quiet breathing, SNIP and MIP maneuvers. AIH facilitated tidal volume and minute ventilation (treatment main effects: p < 0.05), and Mag (ie. collective respiratory muscle activity; p < 0.001) during quiet breathing in ALS and control subjects, but there was no effect on SI during quiet breathing. SNIP SI decreased in both groups post-AIH (p < 0.005), whereas Mag was unchanged (p = 0.09). No differences were observed in SNIP or MIP post AIH in either group. Discomfort was not reported during AIH by any subject, nor were adverse events observed. Thus, AIH may be a safe way to increase collective inspiratory muscle activity during quiet breathing in ALS patients, although a single AIH presentation was not sufficient to significantly increase peak inspiratory pressure generation. These preliminary results provide evidence that AIH may improve breathing function in people with ALS, and that future studies of prolonged, repetitive AIH protocols are warranted.
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Comparison of kinematic similarity index during gait between adults with and without nonspecific chronic neck pain. Gait Posture 2022; 91:99-104. [PMID: 34673448 DOI: 10.1016/j.gaitpost.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with nonspecific chronic neck pain (NP) walk with a stiffer spine. However, there is a lack of understanding on kinematic similarities on the limbs during gait between individuals with and without NP. RESEARCH QUESTION Are there differences in gait parameters and the kinematic similarity index (SI) between individuals with and without NP? METHODS Eighteen individuals with NP and 17 controls participated in this study. A three-dimensional motion capture system and two force plates were utilized to measure kinematic changes of the upper and lower limbs during gait. The gait parameters included cadence, speed, stride length, and step width. The SI calculations were compared based on the response vectors from the NP group and the prototype response vectors from the control participants. The SI values at 5% intervals of the entire gait cycle were compared between groups. RESULTS Although the gait parameters were not significantly different between groups, the SI values of the control group were significantly higher than the NP group during gait (0.98 ± 0.02 vs. 0.95 ± 0.03), especially at the midstance (10-30 %) and swing (80-90 %) phases. Also, the standard deviation of the SI decreased in the control group when compared to the NP group (0.02 ± 0.01 vs. 0.04 ± 0.02). SIGNIFICANCE The SI was a useful measure to differentiate similarities between groups in the gait cycle at specific phases. These results indicated that the NP group demonstrated a greater variation of walking patterns during the midstance and swing phases and displayed altered compensatory gait. Clinicians need to consider the similarities of the kinematic changes for the NP group to aid in detection of limb motion differences and the resulting gait dysfunction.
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Validity and Reliability of Surface Electromyography Features in Lower Extremity Muscle Contraction in Healthy and Spinal Cord-Injured Participants. Top Spinal Cord Inj Rehabil 2021; 27:14-27. [PMID: 34866885 DOI: 10.46292/sci20-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Spinal cord injury (SCI) has a significant impact on motor control and active force generation. Quantifying muscle activation following SCI may help indicate the degree of motor impairment and predict the efficacy of rehabilitative interventions. In healthy persons, muscle activation is typically quantified by electromyographic (EMG) signal amplitude measures. However, in SCI, these measures may not reflect voluntary effort, and therefore other nonamplitude-based features should be considered. Objectives: The purpose of this study was to assess the correlation of time-domain EMG features with the exerted joint torque (validity) and their test-retest repeatability (reliability), which may contribute to characterizing muscle activation following SCI. Methods: Surface EMG (SEMG) and torque were measured while nine uninjured participants and four participants with SCI performed isometric contractions of tibialis anterior (TA) and soleus (SOL). Data collection was repeated at a subsequent session for comparison across days. Validity and test-retest reliability of features were assessed by Spearman and intraclass correlation (ICC) of linear regression coefficients. Results: In healthy participants, SEMG features correlated well with torque (TA: ρ > 0.92; SOL: ρ > 0.94) and showed high reliability (ICCmean = 0.90; range, 0.72-0.99). In an SCI case series, SEMG features also correlated well with torque (TA: ρ > 0.86; SOL: ρ > 0.86), and time-domain features appeared no less repeatable than amplitude-based measures. Conclusion: Time-domain SEMG features are valid and reliable measures of lower extremity muscle activity in healthy participants and may be valid measures of sublesional muscle activity following SCI. These features could be used to gauge motor impairment and progression of rehabilitative interventions or in controlling assistive technologies.
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Gait Asymmetry Comparison between Subjects with and without Nonspecific Chronic Low Back Pain. Symmetry (Basel) 2021. [DOI: 10.3390/sym13112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individuals with chronic low back pain (LBP) report impaired somatosensory function and balance. However, there is a lack of investigation on limb motion similarities between subjects with and without LBP during gait. The aim of this study was to compare gait parameters as well as combined limb motions using the kinematic similarity index (KSI) between subjects with and without LBP. Twenty-two subjects with LBP and 19 age- and body mass index-matched control subjects participated in this study. The combined limb motions in the gait cycle of subjects with LBP were compared with those of a prototype derived from healthy subjects. The calculations resulted in response vectors that were analyzed in comparison to control-derived prototype response vectors for the normalized index at 5% increments in the gait cycle. The results of our study indicated that the KSI of the control group demonstrated higher similarities in the swing (t = 4.23, p = 0.001) and stance (t = 6.26, p = 0.001) phases compared to the LBP group. The index for the whole gait cycle was significantly different between the groups (t = 6.52, p = 0.001), especially in the midstance and swing phases. The LBP group could have adjusted the gait patterns during these specific phases. The KSI is useful for clinical outcome measures to differentiate kinematic changes and to demonstrate quantified similarities in the gait cycle between subjects with and without LBP. It is warranted to validate the KSI for the analysis of physiological gait asymmetry using a larger sample in future studies.
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Properties of the surface electromyogram following traumatic spinal cord injury: a scoping review. J Neuroeng Rehabil 2021; 18:105. [PMID: 34187509 PMCID: PMC8244234 DOI: 10.1186/s12984-021-00888-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) disrupts spinal and supraspinal pathways, and this process is reflected in changes in surface electromyography (sEMG). sEMG is an informative complement to current clinical testing and can capture the residual motor command in great detail-including in muscles below the level of injury with seemingly absent motor activities. In this comprehensive review, we sought to describe how the sEMG properties are changed after SCI. We conducted a systematic literature search followed by a narrative review focusing on sEMG analysis techniques and signal properties post-SCI. We found that early reports were mostly focused on the qualitative analysis of sEMG patterns and evolved to semi-quantitative scores and a more detailed amplitude-based quantification. Nonetheless, recent studies are still constrained to an amplitude-based analysis of the sEMG, and there are opportunities to more broadly characterize the time- and frequency-domain properties of the signal as well as to take fuller advantage of high-density EMG techniques. We recommend the incorporation of a broader range of signal properties into the neurophysiological assessment post-SCI and the development of a greater understanding of the relation between these sEMG properties and underlying physiology. Enhanced sEMG analysis could contribute to a more complete description of the effects of SCI on upper and lower motor neuron function and their interactions, and also assist in understanding the mechanisms of change following neuromodulation or exercise therapy.
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Motor Control Changes after Innovative Aquatic Proprioceptive Training in Athletes with Anterior Cruciate Ligament Reconstruction: Voluntary Response Index Analysis. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.112185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The main aim of this study was to determine and compare the effects of innovative aquatic proprioceptive training plus conventional rehabilitation with conventional rehabilitation alone on voluntary response index (VRI) components in athletes with anterior cruciate ligament reconstruction (ACLR). Methods: Forty male athletes with ACLR (18 - 35 years of age) voluntarily participated in this study. They were randomly allocated into two groups. The conventional therapy group (n = 20) underwent conventional rehabilitation for ten weeks, three sessions a week. The aquatic proprioceptive training plus conventional rehabilitation (n = 20) group received the same conventional rehabilitation plus 30 sessions of innovative hydrotherapy exercises. Voluntary response index analysis was carried out to determine changes in motor control and muscle activation patterns based on electromyographic (EMG) outcome measures. Results: There was a significant difference in the magnitude (MAG) and similarity index (SI) between the two groups at all phases of the functional task (sit-stand-sit) (P < 0.05). Also, both groups showed a significant change in MAG and SI at all phases of the functional task (sit-stand-sit) after the intervention (P < 0.05). Effect size in both groups for MAG and SI at all phases of the functional task (sit-stand-sit) ranged from 2.5 to 4.61 and from 0.29 to 1.7, respectively. Conclusions: The incorporation of innovative aquatic proprioceptive training into conventional accelerated rehabilitation protocol leads to changes in motor control due to changes in the muscle activation pattern after the intervention.
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Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions. Sci Prog 2021; 104:368504211008058. [PMID: 33871293 PMCID: PMC10454990 DOI: 10.1177/00368504211008058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = -0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients' median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.
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Quantifying muscle coactivation in individuals with incomplete spinal cord injury using wavelets. Clin Biomech (Bristol, Avon) 2020; 73:101-107. [PMID: 31958701 DOI: 10.1016/j.clinbiomech.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/11/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury often have decreased gait function and coactivation of antagonistic muscle pairs. Common ways of quantifying coactivation using electromyographic signals do not consider frequency information in the signal. As electromyographic signals from different motor unit types have different frequency components and muscle fiber type can change in individuals with spinal cord injury, it may be beneficial to consider frequency components. The aims were to demonstrate the utility of using a method which considers temporal and frequency components of the electromyographical signal to quantify coactivation in lower extremity muscles in individuals with incomplete spinal cord injury through 1) comparison with able-bodied individuals and 2) comparison before and after body weight supported treadmill training. METHODS Frequency decomposition techniques were applied to electromyographical signals to consider the temporal and frequency components of the electromyographical signals to quantify coactivation over a range of frequencies. RESULTS Our main findings show that correlation coefficients between total EMG intensities of rectus femoris-biceps femoris and medial gastrocnemius-tibialis anterior were significantly different between able-bodied individuals and those with incomplete spinal cord injury (p = 0006, p = 0.01). The correlation spectra of medial gastrocnemius-tibialis anterior of the spinal cord injury group were substantially different than those the able-bodied group, while the EMG normalcy score was significantly different (p = 0.002). We also found that there was a change in coactivation of ankle muscles after body weight supported treadmill training. INTERPRETATION Our findings indicate that there may be frequency specific differences in muscle coactivation between able-bodied individuals and those with incomplete spinal cord injury. Changes in coactivation were also observed before and after body weight supported treadmill training. These differences may reflect the changes in recruitment patterns of different motor unit types.
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Muscle Activation Patterns During Movement Attempts in Children With Acquired Spinal Cord Injury: Neurophysiological Assessment of Residual Motor Function Below the Level of Lesion. Front Neurol 2019; 10:1295. [PMID: 31920919 PMCID: PMC6933608 DOI: 10.3389/fneur.2019.01295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction: Characterization of residual neuromotor capacity after spinal cord injury (SCI) is challenging. The current gold standard for measurement of sensorimotor function after SCI, the International Society for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam, seeks to determine isolated intentional muscle activation, however many individuals with SCI exhibit intentional movements and muscle activation patterns which are not confined to specific joint or muscle. Further, isolated muscle activation is a feature of the neuromuscular system that emerges during development, and thus may not be an appropriate measurement standard for children younger than 6. Methods: We utilized neurophysiological assessment methodology, long studied in adult SCI populations, to evaluate residual neuromotor capacity in 24 children with SCI, as well as 19 typically developing (TD) children. Surface electromyography (EMG) signals were recorded from 11 muscles bilaterally, representing spinal motor output from all regions (i.e., cervical, thoracic, and lumbosacral), during standardized movement attempts. EMG records were subjectively analyzed based on spatiotemporal muscle activation characteristics, while the voluntary response index (VRI) was utilized for objective analysis of unilateral leg movement tasks. Results: Evidence of intentional leg muscle activation below the level of lesion was found in 11/24 children with SCI, and was classified based on activation pattern. Trace activation, bilateral (generalized) activation, and unilateral or isolated activation occurred in 32, 49, and 8% of movement tasks, respectively. Similarly, VRI analyses objectively identified significant differences between TD and SCI children in both magnitude (p < 0.01) and similarity index (p < 0.05) for all unilateral leg movement tasks. Activation of the erector spinae muscles, recorded at the T10–T12 vertebral level, was observed in all children with SCI, regardless of injury level or severity. Conclusions: Residual descending influence on spinal motor circuits may be present after SCI in children. Assessment of multi-muscle activation patterns during intentional movement attempts can provide objective evidence of the presence and extent of such residual muscle activation, and may provide an indicator of motor recovery potential following injury. The presence of residual intentional muscle activation has important implications for rehabilitation following pediatric-onset SCI.
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A First-in-Human, Phase I Study of Neural Stem Cell Transplantation for Chronic Spinal Cord Injury. Cell Stem Cell 2019; 22:941-950.e6. [PMID: 29859175 DOI: 10.1016/j.stem.2018.05.014] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 12/14/2022]
Abstract
We tested the feasibility and safety of human-spinal-cord-derived neural stem cell (NSI-566) transplantation for the treatment of chronic spinal cord injury (SCI). In this clinical trial, four subjects with T2-T12 SCI received treatment consisting of removal of spinal instrumentation, laminectomy, and durotomy, followed by six midline bilateral stereotactic injections of NSI-566 cells. All subjects tolerated the procedure well and there have been no serious adverse events to date (18-27 months post-grafting). In two subjects, one to two levels of neurological improvement were detected using ISNCSCI motor and sensory scores. Our results support the safety of NSI-566 transplantation into the SCI site and early signs of potential efficacy in three of the subjects warrant further exploration of NSI-566 cells in dose escalation studies. Despite these encouraging secondary data, we emphasize that this safety trial lacks statistical power or a control group needed to evaluate functional changes resulting from cell grafting.
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Epidural Spinal Cord Stimulation Facilitates Immediate Restoration of Dormant Motor and Autonomic Supraspinal Pathways after Chronic Neurologically Complete Spinal Cord Injury. J Neurotrauma 2019; 36:2325-2336. [PMID: 30667299 PMCID: PMC6648195 DOI: 10.1089/neu.2018.6006] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Epidural Spinal Cord Stimulation (eSCS) in combination with extensive rehabilitation has been reported to restore volitional movement in a select group of subjects after motor-complete spinal cord injury (SCI). Numerous questions about the generalizability of these findings to patients with longer term SCI have arisen, especially regarding the possibility of restoring autonomic function. To better understand the effect of eSCS on volitional movement and autonomic function, two female participants five and 10 years after injury at ages 48 and 52, respectively, with minimal spinal cord preservation on magnetic resonance imaging were implanted with an eSCS system at the vertebral T12 level. We demonstrated that eSCS can restore volitional movement immediately in two female participants in their fifth and sixth decade of life with motor and sensory-complete SCI, five and 10 years after sustaining severe radiographic injuries, and without prescribed or significant pre-habilitation. Both patients experienced significant improvements in surface electromyography power during a volitional control task with eSCS on. Cardiovascular function was also restored with eSCS in one participant with cardiovascular dysautonomia using specific eSCS settings during tilt challenge while not affecting function in a participant with normal cardiovascular function. Orgasm was achieved for the first time since injury in one participant with and immediately after eSCS. Bowel-bladder synergy improved in both participants while restoring volitional urination in one with eSCS. While numerous questions remain, the ability to restore some supraspinal control over motor function below the level of injury, cardiovascular function, sexual function, and bowel and bladder function should promote intense efforts to investigate and develop optimization strategies to maximize recovery in all participants with chronic SCI.
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Quantitative Evaluation of Post-stroke Spasticity Using Neurophysiological and Radiological Tools: A Pilot Study. Ann Rehabil Med 2018; 42:384-395. [PMID: 29961736 PMCID: PMC6058583 DOI: 10.5535/arm.2018.42.3.384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients. Methods Eight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides. Results MAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2–R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis. Conclusion The BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.
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A comparison of lower limb muscle activation pattern using voluntary response index between pronated and normal foot structures during forward jump landing. J Bodyw Mov Ther 2018; 22:379-384. [PMID: 29861238 DOI: 10.1016/j.jbmt.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/01/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pronated of the foot is one of the important factors contributing to musculoskeletal problems affecting the lower extremities. It is known that in a pronated foot, excessive mechanical load is applied to the lower limb structures which may result in altered biomechanics and muscle activation patterns. The aim of this study was to determine changes in the muscle activation pattern of the lower extremities in individuals with pronated, compared to normal, feet, using the voluntary response index (VRI). METHODS In this cross sectional study, 15 asymptomatic pronated foot individuals (mean age 23.27 ± 3.28 years) and 15 normal subjects (mean age 23.40 ± 3.11 years) were recruited by simple non-random sampling. Electrical activities of gluteus medius (GM), vastus lateralis (VL), vastus medialis (VM), biceps femoris, semitendinosus (ST), and medial gastrocnemius (MG) muscles were recorded during a forward jump landing task. Voluntary response index (VRI) variables, included similarity index (SI) and magnitude (Mag) were also evaluated. RESULTS Muscle activity of VM (p < 0.001) and ST (p = 0.010) were significantly higher but VL (p = 0.039) and MG (p = 0.001) were significantly lower in pronated foot, compared to normal subjects. Similarity index was found to be different (p < 0.001) between pronated foot and healthy individuals. No significant difference was found in terms of Mag between the two groups (p = 0.576). CONCLUSION The altered pattern of lower limb muscle activation identified in the pronated foot during landing may be attributed to the different activation involving VL, VM, MG and ST muscles. Adaptations to the biomechanical effects, due to the pronated foot causing altered activation of VL, VM, MG, and ST muscles, results in an altered pattern of muscle activation. This change in activation pattern may harm the effectiveness of movement control processes; and might also predispose individuals with pronated feet, to injuries. It seems that an altered motor strategy with the aim of minimizing biomechanical changes, predisposes individuals to injuries. However, further large scale studies are needed to support the findings of the present study.
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Lower limb muscular activity during walking at different speeds: Over-ground versus treadmill walking: A voluntary response evaluation. J Bodyw Mov Ther 2017; 21:605-611. [PMID: 28750972 DOI: 10.1016/j.jbmt.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/15/2016] [Accepted: 09/05/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the overall lower limb muscular activity pattern during treadmill walking compared to over-ground walking. METHODOLOGY The study was conducted on 25 healthy young females. Surface electromyography was recorded from gastrocnemius, hamstrings, vasti and gluteus medius muscles during walking over-ground and treadmill at 3 different speeds (comfortable, slow and fast). The pattern of muscle activity was compared between two walking conditions at different speeds by the voluntary response index method. Voluntary response index is composed of two numeric values: magnitude which represents the strength of overall muscular activity, and similarity index which represents the resemblance of overall muscle activity. RESULTS The main effect of walking conditions and speed as well as their interaction effect (P < 0.001) on magnitude of muscle activity were significant but not for similarity index. CONCLUSIONS The pattern of muscular activity during walking on treadmill and over-ground was similar but walking on treadmill induced higher muscular activity in the lower limb musculature.
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Reliability of SEMG measurements for trunk muscles during lifting variable loads in healthy subjects. J Bodyw Mov Ther 2017; 21:711-718. [DOI: 10.1016/j.jbmt.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
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Validity and Reliability of Surface Electromyography in the Assessment of Primary Muscle Tension Dysphonia. J Voice 2017; 31:386.e9-386.e17. [PMID: 27742497 DOI: 10.1016/j.jvoice.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aims to evaluate the reliability and the discriminative validity of surface electromyography (sEMG) in the assessment of patients with primary muscle tension dysphonia (MTD). STUDY DESIGN The study design is cross-sectional. METHODS Fifteen patients with primary MTD (mean age: 34.07 ± 10.99 years) and 15 healthy volunteers (mean age: 34.53 ± 10.63 years) were included. All participants underwent evaluation of sEMG to record the electrical activity of the thyrohyoid and cricothyroid muscles. The outcome measures were the root mean square (RMS), activity peak, duration, and time to the peak activity, which were obtained during /a/ and /i/ prolongation for test-retest reliability. RESULTS The test-retest reliability was good to excellent for the RMS and peak activity measures (intraclass correlation coefficient [agreement] [ICCagreement] = 0.49-0.98). The reliability for the activity duration was poor to excellent (ICCagreement = 0.19-0.9). Poor test-retest reliability was found for the time to peak measure (ICCagreement = 0.15-0.37). The standard error of measurement for all sEMG measures was between 0.41 and 2.05. The smallest detectable change (SDC) was calculated between 1.13 and 5.66. The highest SDC values were obtained for the peak and the lowest SDCs were documented for the duration (5.66 and 1.13, respectively). All sEMG measures were not able to discriminate between the MTD patients and healthy subjects (P > 0.05). CONCLUSIONS The sEMG is a reliable tool to measure the RMS, the peak activity, and the activity duration in primary MTD. However, it is not able to discriminate the patients with primary MTD from healthy subjects.
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Abstract
BACKGROUND The goal of stroke rehabilitation has shifted from mere survival of a victim to how well a survivor can be effectively reintegrated back into the community. OBJECTIVES The present study determined the level of satisfaction with community reintegration (CR) and related factors among Nigerian community-dwelling stroke survivors (CDSS). METHODS This was a cross-sectional survey of 71 volunteering CDSS (35 males, 36 females) from selected South-Eastern Nigerian communities. Reintegration to Normal Living Index was used to assess participants' CR. Data was analysed using Spearman rank-order correlation, Kruskal-Wallis and Mann-Whitney U tests at p≤0.05. RESULTS Participants generally had deficits in CR which was either mild/moderate (52.1%) or severe (47.9%). Scores in the CR domains of distance mobility, performance of daily activities, recreational activities and family roles were particularly low (median scores ≤ 4). CR was significantly correlated with and influenced by age (r=-0.35; p=0.00) and presence/absence of diabetes mellitus (u=3.56.50; p=0.01), pre- (k=6.13; p=0.05) and post-stroke employment (k=18.26; p=0.00) status, type of assistive mobility device being used (AMD) (k=25.39; p=0.00) and support from the community (k=7.15; p=0.03) respectively. CONCLUSION CR was generally poor for this CDSS sample. Survivors who are older, having diabetes as co-morbidity, using AMD (particularly wheel-chair) and without employment pre- and/or post-stroke may require keener attention. Rehabilitation focus may be targeted at enhancing mobility functions, vocational and social skills.
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Surface electromyography as a measure of trunk muscle activity in patients with spinal cord injury: a meta-analytic review. J Spinal Cord Med 2016; 39:15-23. [PMID: 26496045 PMCID: PMC4725787 DOI: 10.1179/2045772315y.0000000059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Surface electromyography (SEMG) may be a sensitive marker for distinguishing the activity of trunk muscles, which are critical to functional mobility recovery in patients with spinal cord injury (SCI). OBJECTIVES This manuscript presents a systematic review and meta-analysis of the published literature on the effect of SEMG as a measure of trunk muscle activity in patients with SCI. METHODS A comprehensive search of the research literature included Pubmed, Medline, CNKI, WANFANG DATA, Web of Science, Elsevier, Wiley-Blackwell, Karger, OVID, and a review of reference lists within found articles. Case-control, cohort, and cross-sectional studies were included in the review. RESULTS Eleven studies were included in this meta-analysis. Trunk muscle activities for the sitting condition were greater in patients with SCI than normal subjects. SEMG activity of trunk muscles for the sitting condition and posterior transfer was greater in patients with high level (HL)-SCI compared to those with low level (LL)-SCI. In addition, across studies, the level of trunk muscle activity for various difficulty settings was different for a given SCI group. CONCLUSION This systematic review evaluated the value of trunk muscles for patients with SCI. We recommend use of SEMG as an assessment tool for improving the comparability and interpretability of trunk muscle activity of SCI therapeutic strategies.
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Reliability of surface EMG as an assessment tool for trunk activity and potential to determine neurorecovery in SCI. Spinal Cord 2014; 53:368-74. [PMID: 25448189 DOI: 10.1038/sc.2014.171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/27/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Reliability and validity study. OBJECTIVE This study investigates the responsiveness and reliability of the brain motor control assessment (BMCA) as a standardized neurophysiological assessment tool to: (i) characterize trunk neural activity in neurologically-intact controls; (ii) measure and quantify neurorecovery of trunk after spinal cord injury (SCI). SETTING Kessler Foundation Research Center, West Orange, NJ. METHODS A standardized BMCA protocol was performed to measure surface electromyography (sEMG) recordings for seven bilateral trunk muscles on 15 able-bodied controls during six maneuvers (inhalation, exhalation, neck flexion, jendrassik, unilateral grip). Additionally, sEMG recordings were analyzed for one chronic SCI individual before electrical stimulation (ES), after ES of the lower extremities while supine, and after active stand training using body-weight support with bilateral ES. sEMG recordings were collected on bilateral erector spinae, internal and external obliques, upper and middle trapezius, biceps and triceps. For each maneuver a voluntary response index was calculated: incorporating the magnitude of sEMG signal and a similarity index (SI), which quantifies the distribution of activity across all muscles. RESULTS Among all maneuvers, the SI presented reproducible assessment of trunk-motor function within (ICC: 0.860-0.997) and among (P⩾0.22) able-bodied individuals. In addition, potential changes were measured in a chronic SCI individual after undergoing two intensive ES protocols. CONCLUSION The BMCA provides reproducible characterization of trunk activity in able-bodied individuals, lending credence for its use in neurophysiological assessment of motor control. Additionally, the BMCA as an assessment tool to measure neurorecovery in an individual with chronic SCI after intense ES interventions was demonstrated.
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The Voluntary Response Index in Electromyographic Study During Landing Test of the Patients With ACL Deficiency: A New Study Protocol. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14119. [PMID: 25031855 PMCID: PMC4082515 DOI: 10.5812/ircmj.14119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/03/2014] [Accepted: 03/10/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Daily Increased rate of anterior cruciate ligament (ACL) injuries in athletes calls for more investigation in these patients to differentiate copers from noncoper ACL-deficient (ACLD) knees as soon as possible. OBJECTIVES The current study aims to introduce a new electromyographic protocol, named voluntary response index (VRI), that might help to categorize and differentiate patients with ACLD knee from others in the early stage. MATERIALS AND METHODS Thirty-four patients with ACLD knee were allocated into two equal groups, namely, coper and noncoper groups, based upon their ability to return to sport during the preceding six months. The patients with ACLD knee were asked to perform a jump on a force platform from a 75-cm distance. RESULTS The results were compared with 17 matched healthy participants. The electromyographic disposable electrodes were attached to the seven muscles of the lower extremity of the participants before performing the test. The outcome measures were the magnitude and similarity index of the VRI, time to stop, vertical ground reaction force, the displacement of the center of pressure's (COP) path line length, and the participants' Tegner, IKDC (International Knee Documentation Committee) as well as KOOS (Knee injury and Osteoarthritis Outcome Score) questionnaires scores. Using the appropriate statistical analysis, the electromyographic and force plate data were compared among the three groups. All efforts went into determining whether an association exists between the findings of each group and the participants' functional questionnaires scores. CONCLUSIONS The results of this study would be helpful in objectively differentiating the patients with ACLD knee into coper and noncoper groups to receive appropriate treatments before their return to the competitions.
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Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Transl Stroke Res 2013; 2:463-73. [PMID: 22408690 DOI: 10.1007/s12975-011-0114-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pulmonary complications associated with persistent respiratory muscle weakness, paralysis, and spasticity are among the most important problems faced by patients with spinal cord injury when lack of muscle strength and disorganization of reciprocal respiratory muscle control lead to breathing insufficiency. This review describes the mechanisms of the respiratory motor control and its change in individuals with spinal cord injury, methods by which respiratory function is measured, and rehabilitative treatment used to restore respiratory function in those who have experienced such injury.
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Locomotor step training with body weight support improves respiratory motor function in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 2013; 189:491-7. [PMID: 23999001 PMCID: PMC3833892 DOI: 10.1016/j.resp.2013.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/19/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
This prospective case-controlled clinical study was undertaken to investigate to what extent the manually assisted treadmill stepping locomotor training with body weight support (LT) can change respiratory function in individuals with chronic spinal cord injury (SCI). Pulmonary function outcomes (forced vital capacity /FVC/, forced expiratory volume one second /FEV1/, maximum inspiratory pressure /PImax/, maximum expiratory pressure /PEmax/) and surface electromyographic (sEMG) measures of respiratory muscles activity during respiratory tasks were obtained from eight individuals with chronic C3-T12 SCI before and after 62±10 (mean±SD) sessions of the LT. FVC, FEV1, PImax, PEmax, amount of overall sEMG activity and rate of motor unit recruitment were significantly increased after LT (p<0.05). These results suggest that these improvements induced by the LT are likely the result of neuroplastic changes in spinal neural circuitry responsible for the activation of respiratory muscles preserved after injury.
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Quality of residual neuromuscular control and functional deficits in patients with spinal cord injury. Front Neurol 2013; 4:174. [PMID: 24223568 PMCID: PMC3819596 DOI: 10.3389/fneur.2013.00174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/22/2013] [Indexed: 12/02/2022] Open
Abstract
Study Design: Prospective cohort study. Objective: This study examined the relationship between motor control and clinical function outcomes after spinal cord injury (SCI). Setting: University of Louisville, Louisville, KY, USA. Materials: Eleven persons with SCI and 5 non-injured subjects were included in this study. Methods: The ASIA Impairment Scale (AIS) was used to categorize injury level and severity. Multi-muscle, surface EMG (sEMG) recording, was carried out using a protocol of reflex and volitional motor tasks and was analyzed using a vector-based tool that calculates index values that relate a distribution of multi-muscle activation pattern of each SCI subject to the prototype obtained from non-injured subject group and presents overall magnitude as a separate value. Functional Independence Measure motor sub-scale, Spinal Cord Injury Independence Measure (SCIM-III), and Walking Index for Spinal Cord Injury (WISCI) scale scores were compared to neurophysiological parameters. Results: AIS category and injury level correlated significantly with the WISCI and SCIM mobility sub-scales. sEMG-derived parameters were significantly correlated with SCIM and WISCI scores but only for examinations carried out 48 or more days post-injury. Conclusion: These results supported the hypothesis that clinically relevant function after SCI is related to the degree to which functional organization within the central nervous system is disrupted. Further, due likely to the constraints placed on the expression of functional ability by early post-injury immobilization and hospitalization, neurophysiological assessment of motor function may provide better sensitivity and reliability than can be obtained using the clinical function scales examined here within the early period after injury.
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A Brain Motor Control Assessment (BMCA) protocol for upper limb function. PLoS One 2013; 8:e79483. [PMID: 24223953 PMCID: PMC3817096 DOI: 10.1371/journal.pone.0079483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/22/2013] [Indexed: 11/19/2022] Open
Abstract
The Brain Motor Control Assessment (BMCA) protocol is a surface electromyography (sEMG)-based measure of motor output from central nervous system during a variety of reflex and voluntary motor tasks performed under strictly controlled conditions. The aim of this study was to evaluate the BMCA protocol for upper limb with the addition of shoulder voluntary tasks. The voluntary response index (VRI) was calculated from quantitative analysis of sEMG data during defined voluntary movement in neurologically intact people for comparison with that of patients after neurological injuries. The BMCA protocol included one bilateral and 4 unilateral voluntary tasks at different joints of both arms. The VRI, measured from 19 neurologically intact participants, comprises the total muscle activity recorded for the voluntary motor task (magnitude). The calculated similarity index (SI) for each phase of each task show the similarity of “the distribution of activity across the recorded muscles” for that task in this group off participants. Results: The VRI magnitude values from right and left sides for different tasks showed no significant difference (ANOVA: FSide: 0.09, P = 0.77). Therefore these values were pooled before calculating SI. SI values were higher for tasks against gravity: elbow flexion (0.99±0.03), wrist flexion with palm up (0.98±0.03) and wrist extension with palm down (0.97±0.07). On the other hand, the SI values were the lowest for bilateral shoulder abduction (0.84±0.08) and shoulder adduction (0.84±0.08). Conclusion: To validate this index for clinical use, serial studies on patients with neurological impairments should be performed. Tasks involving movement against gravity may be more suitable in future BMCAs.
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Evaluation of respiratory muscle activation using respiratory motor control assessment (RMCA) in individuals with chronic spinal cord injury. J Vis Exp 2013:50178. [PMID: 23912611 PMCID: PMC3740445 DOI: 10.3791/50178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination is disrupted by spinal cord injury (SCI), control of respiratory muscles innervated below the injury level is compromised leading to respiratory muscle dysfunction and pulmonary complications. These conditions are among the leading causes of death in patients with SCI. Standard pulmonary function tests that assess respiratory motor function include spirometrical and maximum airway pressure outcomes: Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Maximal Inspiratory Pressure (PImax) and Maximal Expiratory Pressure (PEmax). These values provide indirect measurements of respiratory muscle performance(6). In clinical practice and research, a surface electromyography (sEMG) recorded from respiratory muscles can be used to assess respiratory motor function and help to diagnose neuromuscular pathology. However, variability in the sEMG amplitude inhibits efforts to develop objective and direct measures of respiratory motor function. Based on a multi-muscle sEMG approach to characterize motor control of limb muscles, known as the voluntary response index (VRI), we developed an analytical tool to characterize respiratory motor control directly from sEMG data recorded from multiple respiratory muscles during the voluntary respiratory tasks. We have termed this the Respiratory Motor Control Assessment (RMCA). This vector analysis method quantifies the amount and distribution of activity across muscles and presents it in the form of an index that relates the degree to which sEMG output within a test-subject resembles that from a group of healthy (non-injured) controls. The resulting index value has been shown to have high face validity, sensitivity and specificity. We showed previously that the RMCA outcomes significantly correlate with levels of SCI and pulmonary function measures. We are presenting here the method to quantitatively compare post-spinal cord injury respiratory multi-muscle activation patterns to those of healthy individuals.
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Quantitative and sensitive assessment of neurophysiological status after human spinal cord injury. J Neurosurg Spine 2013; 17:77-86. [PMID: 22985373 DOI: 10.3171/2012.6.aospine12117] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This study was designed to develop an objective and sensitive spinal cord injury (SCI) characterization protocol based on surface electromyography (EMG) activity. METHODS Twenty-four patients at both acute and chronic time points post-SCI, as well as 4 noninjured volunteers, were assessed using neurophysiological and clinical measures of volitional motor function. The EMG amplitude was recorded from 15 representative muscles bilaterally during standardized maneuvers as a neurophysiological assessment of voluntary motor function. International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) examinations were performed as a clinical assessment of lesion severity. RESULTS Sixty-six functional neurophysiological assessments were performed in 24 patients with SCI and in 4 neurologically intact individuals. The collected EMG data were organized by quantitative parameters and statistically analyzed. The correlation between root mean square (RMS) of the EMG signals and ISNCSCI motor score was confirmed by Kendall correlation analysis. The Kendall correlation value between overall muscles/levels, motor scores, and the RMS of the EMG data is 0.85, with the 95% CI falling into the range of 0.76-0.95. Significant correlations were also observed for the soleus (0.51 [0.28-0.74]), tibialis anterior (TA) (0.53 [0.33-0.73]), tricep (0.52, [0.34-0.70]), and extensor carpi radialis (ECR) (0.80 [0.42-1.00]) muscles. Comparisons of RMS EMG values in groups defined by ISNCSCI motor score further confirmed these results. At the bicep and ECR, patients with motor scores of 5 had nearly significantly higher RMS EMG values than patients with motor scores of 0 (p = 0.059 and 0.052, respectively). At the soleus and TA, the RMS of the EMG value was significantly higher (p < 0.01) for patients with American Spinal Injury Association Impairment Scale motor scores of 5 than for those with ISNCSCI motor scores of 0. Those with C-7 ISNCSCI motor scores of 5 had significantly higher RMS EMG values at the tricep than those with motor scores of 4 (p = 0.008) and 0 (p = 0.02). Results also show that surface EMG signals recorded from trunk muscles allowed the examiner to pick up subclinical changes, even though no ISNCSCI scores were given. CONCLUSIONS Surface EMG signal is suitable for objective neurological SCI characterization protocol design. The quantifiable features of surface EMG may increase SCI characterization resolution by adding subclinical details to the clinical picture of lesion severity and distribution.
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Profiling motor control in spinal cord injury: moving towards individualized therapy and evidence-based care progression. J Spinal Cord Med 2012; 35:305-9. [PMID: 23031167 PMCID: PMC3459559 DOI: 10.1179/2045772312y.0000000040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This article, based on the keynote address at the 5th National Spinal Cord Injury Conference in Toronto, addresses methods to neurophysiologically characterize patients after spinal cord injury and proposes how those methods could be used to individualize therapeutic interventions and monitor their efficacy over the course of neurorehabilitation.
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Quantitative testing in spinal cord injury: overview of reliability and predictive validity. J Neurosurg Spine 2012; 17:141-50. [DOI: 10.3171/2012.5.aospine1296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The objective of this study was to identify commonly used physiological outcome measures and summarize evidence on the reliability and predictive validity of quantitative measures used in monitoring persons with spinal cord injury (SCI).
Methods
A systematic search of PubMed through January 5, 2012, was conducted to identify publications using common outcome measures in persons with SCI and for studies that were specifically designed to evaluate the reliability and predictive validity of selected quantitative measures. Quantitative measures were defined as tests that quantify sensory and motor function, such as amount of force or torque, as well as thresholds, amplitudes, and latencies of evoked potentials that might be useful in studies and monitoring of patients with SCI. Reliability studies reporting interclass correlation coefficients (ICCs) or weighted κ coefficients were considered for inclusion. Studies explicitly evaluating correlation between measures and specific functional outcomes were considered for predictive validity.
Results
From a total of 121 potentially relevant citations, 6 studies of reliability and 4 studies of predictive validity for quantitative tests met the inclusion criteria. In persons with incomplete SCI, ICCs for both interrater and intrarater reliability of electrical perceptual threshold (EPT) were ≥ 0.7 above the sensory level of SCI but were less reliable below the sensory level. Interclass correlation coefficients for interrater and intrarater reliability of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) components ranged from 0.84 to 0.98. For electromyography, the ICC was consistently high for within-day tests. The overall quality of reliability of the majority of studies was poor, due to the potential for selection bias and small sample sizes. No classic validation studies were found for the selected measures, and evidence regarding the predictive validity of the measures was limited. Somatosensory evoked potentials (SSEPs) may be correlated with ambulatory capacity, as well as the Barthel Index and motor index scores, but this correlation was limited for evaluation of bladder function recovery in 3 studies that assessed the correlation between baseline or initial SSEPs and a specific clinical outcome at a later follow-up time. All studies used convenience samples and the overall sample quality was low.
Conclusions
Evidence on the reliability and validity of the quantitative measures selected for this review is limited, and the overall quality of existing studies is poor. There is some evidence for the reliability of the EPT, dermatomal SSEPs, and the GRASSP to suggest that they may be useful in longitudinal studies of patients with SCI. There is a need for high quality studies of reliability, responsiveness, and validity for quantitative measures to monitor the level and degree of SCI.
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Neurophysiological characterization of the New Anatomy and motor control that results from neurological injury or disease. Clin Neurol Neurosurg 2012; 114:447-54. [DOI: 10.1016/j.clineuro.2012.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 12/14/2022]
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CERVICAL ELECTROMYOGRAPHIC ACTIVITIES DURING NECK MOVEMENTS AT DIFFERENT SPEEDS IN HEALTHY SUBJECTS: VOLUNTARY RESPONSE INDEX ANALYSIS. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2012. [DOI: 10.4015/s1016237207000458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The assessment of cervical muscle control patterns is important for the diagnosis of cervical dysfunction. Voluntary response index (VRI), including the similarity index (SI) and the magnitude (MAG), provides quantitative analysis of the surface electromyography (sEMG) pattern and total muscle voluntary activities respectively. This study was to investigate the effect of movement directions and speeds of the VRI response of cervical muscles in healthy subjects. The sEMG of bilateral sternocleidomastoid, semispinalis capitis, and splenius capitis were measured in thirteen asymptomatic young subjects. The subjects performed voluntary neck movements in flexion, extension, left and right side bending at fast, medium, and slow speeds. The results showed that SI ranged from 1–0.8 and MAG was generally less than 40 μV. The SI was significantly smallest and the MAG was largest at fast speed. The MAG was also significantly different among directions but the effect of direction on SI was only significant at fast speed. In conclusion, the movement speed and direction could affect the magnitude and control pattern of cervical muscles, such that both the speed and direction of the examined tasks should be carefully monitored during the assessment of cervical muscle activation.
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The effects of scapular taping on electromyographic muscle activity and proprioception feedback in healthy shoulders. J Orthop Res 2011; 29:53-7. [PMID: 20607815 DOI: 10.1002/jor.21146] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated the effects of scapular tape on the electromyographic (EMG) activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), anterior deltoid (AD), and shoulder proprioception in 12 healthy shoulders. Participants were blindfolded and required to complete a target end/mid range position with the hand. They performed six trials under two experimental conditions; no tape and therapeutic tape. EMG activity was measured by surface electrodes, and proprioception was measured by the FASTRAK electromagnetic motion tracking system. Two-way repeated measures ANOVA showed that UT and AD activities decreased 2.65% (p = 0.001), and SA muscular activities increased 1.9% (p = 0.015) in the taping condition. The proprioceptive feedback magnitude was significantly lower in the taping condition than in the no taping condition (11.9°, p < 0.005). Additionally, correlation coefficients were higher than 0.5 between muscle activity and proprioceptive feedback with the taping condition; UT and magnitude in the mid range task (R = 0.516); LT and magnitude in the end range task (R = -0.524); and SA and magnitude in the mid range task (R = -0.576). The results suggest that scapular tape affects the muscle activity of UT, AD, and SA, and that the effects are related to proprioception feedback. These results implicate that the mechanisms by which scapular taping induces effects can be explained by neuromuscular control and proprioceptive feedback factors.
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Abstract
Study Design Prospective cohort study Objective This study was designed to neurophysiologically characterize motor control recovery after spinal cord injury (SCI). Setting University of Louisville, Louisville, Kentucky, USA. Material Eleven acute SCI admissions and five non-injured subjects were recruited for this study. Methods The American Spinal Injury Association Impairment Scale (AIS) was used to categorize injury level and severity at onset. Multi-muscle surface EMG (sEMG) recording protocol of reflex and volitional motor tasks was initially performed between the day of injury and 11 days post onset (6.4 ± 3.6, mean ± SD days). Follow-up recordings were performed for up to 17 months after injury. Initial AIS distribution was: 4 AIS-A; 2 AIS-C; 5 AIS-D. Multi-muscle activation patterns were quantified from the sEMG amplitudes of selected muscles using a vector-based calculation that produces values for Magnitude and Similarity of SCI test-subject patterns to those produced by non-injured subjects. Results In SCI subjects, overall sEMG amplitudes were lower after SCI. Prime mover muscle voluntary recruitment was slower and multi-muscle patterns were disrupted by SCI. Recovery occurred in 9 of the 11 showing an increase in sEMG amplitudes, more rapid prime mover muscle recruitment rates and the progressive normalization of the multi-muscle activation patterns. The rate of increase was highly individualized, differing over time by limb and proximal or distal joint within each subject and across the SCI group. Conclusions Recovery of voluntary motor function can be quantitatively tracked using neurophysiological methods in the domains of time and multi-muscle motor unit activation. Sponsorship NIH NINDS funded project #NS049954-01
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Evaluation of respiratory muscle activation in individuals with chronic spinal cord injury. Respir Physiol Neurobiol 2010; 173:171-8. [DOI: 10.1016/j.resp.2010.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 07/27/2010] [Accepted: 07/30/2010] [Indexed: 11/24/2022]
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Alteration in shoulder kinematics and associated muscle activity in people with idiopathic scoliosis. Spine (Phila Pa 1976) 2010; 35:1151-7. [PMID: 20421854 DOI: 10.1097/brs.0b013e3181cd5923] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional control-matched study in adolescents with idiopathic scoliosis (IS). OBJECTIVE To evaluate whether subjects with IS had shoulder dysfunction and associated impairment in shoulder kinematics and muscular activation. SUMMARY OF BACKGROUND DATA Evidence indicates that shoulder kinematics are related to shoulder pain and dysfunction. Despite the degree of morbidity associated with altered shoulder kinematics likely to occur in subjects with IS, no report has been published to address this hypothesis. METHODS In this investigation, shoulder kinematics (scapular tipping, scapular upward rotation, and scapulohumeral rhythm) and associated muscular activities [upper trapezius (UT), lower trapezius (LT), serrantus anterior (SA), and middle deltoid (MD)] were evaluated with a 3-dimensional electromagnetic tracking device and electromyography during arm elevations in 13 female subjects with IS and 13 age-gender-dominant hand-matched controls. Additionally, self-reported Flexilevel Scale of Shoulder Function (FLEX-SF) was evaluated between the 2 groups. RESULTS Subjects with IS demonstrated lower FLEX-SF scores than the controls (P = 0.01). For the convex side, more anterior tilt of the scapula in resting position was identified (P = 0.006). For the concave side, more scapular upward rotation in resting position was identified (P = 0.01). For the EMG amplitude, higher LT contraction activity on the convex side and lower LT and SA contraction activity on the concave side were established (P = 0.007 and less than 0.01, respectively). A moderate positive association was found between scapular posterior tipping during movement and FLEX-SF functional score (R = 0.51). A moderate negative association was found between LT muscular activity and FLEX-SF functional score (R = -0.54). CONCLUSION Given the progressive nature of IS and kinematic linkage among the thoracic spine, scapula, and arm, inadequate posterior tipping movement and high LT muscular activity on the convex side of IS are important to consider in rehabilitation programs for subjects with IS.
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Position accuracy and electromyographic responses during head reposition in young adults with chronic neck pain. J Electromyogr Kinesiol 2009; 20:1014-20. [PMID: 20005126 DOI: 10.1016/j.jelekin.2009.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 10/30/2009] [Accepted: 11/05/2009] [Indexed: 11/20/2022] Open
Abstract
The head reposition test is traditionally used to examine the proprioceptive sensitivity of the neck. The aim of this study was to investigate the position accuracy and corresponding cervical electromyographic (EMG) responses of the neck pain subjects during sagittal head-to-neutral tasks. Twelve young subjects with chronic neck pain and twelve young healthy subjects were recruited. The position accuracy was measured by the constant error, variable error, and root mean square error of joint angles during head-to-neutral tasks in flexion and extension directions. Surface EMG of neck flexors and extensors were analyzed by the voluntary response index, including the similarity index (SI) and electromyographic magnitude (MAG) of muscle groups. The normalized average integration of EMG activity (NAIEMG) of individual muscle was also calculated. The results showed: (1) significantly larger constant error and root mean square error but similar variable error in patients compared with controls, (2) smaller SI but similar MAG in patients compared with controls, (3) greater synergistic/antagonistic NAIEMG in patients than controls. The findings suggested that young adults with chronic neck pain exhibit proprioceptive dysfunction and altered EMG pattern during voluntary sagittal neck motions. This study provides guidelines which could lead to the development of therapeutic exercise programs.
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Abstract
STUDY DESIGN Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. OBJECTIVES Assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies. METHODS a framework for the appraisal of evidence of metric properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. RESULTS Imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain and psychosocial tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. CONCLUSION Significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial.
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Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness. J Electromyogr Kinesiol 2009; 20:206-11. [PMID: 19524454 DOI: 10.1016/j.jelekin.2009.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 03/04/2009] [Accepted: 04/20/2009] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present study was to determine (1) if joint position sense (JPS) in subjects with shoulder stiffness (SS) differs from that in controls; (2) if, when JPS is reduced in SS, it is related to scapular muscular activities in the mid/end ranges of motion; and (3) if a person's function is associated with his or her level of JPS. Eighteen subjects with unilateral SS and 18 controls were included. Each subject performed abduction by self-selecting an end/mid range position. The electromagnetic motion-capturing system collected kinematic data while surface electromyography collected muscle activities (upper trapezius, lower trapezius, and serratus anterior muscles). Subjects were asked to move the upper limb to the target position (end/mid range) accurately without visual guidance. Reduced JPS was observed in subjects with SS (2.7 degrees in mid range, p<0.05). The JPS was enhanced by an increased scapula muscular activation level in the end range of motion (R=-0.61 for SS and -0.41 for controls) and by coordination among muscles' activation in the mid-range of motion (R=-0.87 for SS and R=-0.53 for controls). Impaired JPS was also related to self-reported functional status (R=-0.56) in subjects with SS. Shoulder JPS in subjects with chronic SS is impaired in comparison with controls. In the mid-range motion, the coordination of scapula muscular activation is related to shoulder JPS. Impaired JPS is also function-related in subjects with SS. These findings suggest that the coordination among scapula muscles' activation were important to consider in the rehabilitation of patients with chronic SS.
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A time-frequency based electromyographic analysis technique for use in cerebral palsy. Gait Posture 2007; 26:420-7. [PMID: 17161603 DOI: 10.1016/j.gaitpost.2006.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 10/25/2006] [Accepted: 10/29/2006] [Indexed: 02/02/2023]
Abstract
Surface electromyography (sEMG) is part of an instrumented gait assessment, however, the interpretation of the data in a clinically meaningful manner is often limited to the extraction of individual sEMG characteristics. The purpose of this study was to develop an assessment methodology using sEMG time and frequency characteristics extracted using wavelet analyses to provide clinically relevant information in children with cerebral palsy (CP). A retrospective study was conducted with 37 children (16 children with typical development (TD) and 21 children with spastic CP). sEMG signals were examined from selected musculature of the lower extremities during level ground walking. Wavelet analysis techniques, along with functional principal component analyses, were employed to calculate a sEMG index. The data indicated a grouping in the EMG index based on the level of motor impairment and the clinical diagnosis of spastic hemiplegia or diplegia. Further analyses of the index exhibited moderate to high (r=-0.43 to -0.74 and r=0.62-0.65) correlations with the existing gait kinetics, kinematics, and clinical measures of motor impairment, and was sensitive to walking ability according to the Gross Motor Functional Classification Scale (GMFCS). Overall, this methodology may have the potential to provide additional insight into the outcome of a clinical intervention that was not available previously, and may find use as a predictive tool that can be utilized for clinical decision making.
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Altered patterns of muscle activation during performance of four functional tasks in patients with shoulder disorders: Interpretation from voluntary response index. J Electromyogr Kinesiol 2006; 16:458-68. [PMID: 16324850 DOI: 10.1016/j.jelekin.2005.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 08/19/2005] [Accepted: 09/19/2005] [Indexed: 11/23/2022] Open
Abstract
Altered motor control of the shoulder muscles during performance of a specific motor task in patients with shoulder disorders (SDs) has been an interesting subject to researchers. This study compared shoulder muscle activation patterns by surface electromyography (sEMG), including the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA) muscles, during four functional tasks in 25 patients with SDs and controls. A voluntary response index (VRI) was calculated, including magnitude and similarity index (SI), to quantify sEMG patterns during four functional tasks. Responsiveness and clinically meaningful levels of discrimination between patients and control for EMG magnitude and SI were determined. An altered pattern of motor control during four functional tasks was evident in the patients, in which greater EMG amplitude and abnormal EMG patterns were found. For SI among four functional tasks, normal subjects ranged from 0.80 to 1.00 while patients ranged from 0.70 to 0.99. High probabilities (97%) of discrimination between patients and normal subjects were found by SI method during an overhead height task (patients: 0.85-0.96, normal subjects: 0.95-1.00). Our results also suggest that an individual can be estimated to be abnormal when lower SI values are observed during the four functional tasks.
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Assessment of wavelet analysis of gait in children with typical development and cerebral palsy. J Biomech 2005; 38:1351-7. [PMID: 15863120 DOI: 10.1016/j.jbiomech.2004.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 07/04/2004] [Indexed: 10/26/2022]
Abstract
The objective of this study was to examine the use of the continuous wavelet transform (CWT) on surface electromyographic (sEMG) signals acquired from the lower extremity muscles during gait in children with typical development (TD) and cerebral palsy (CP). This was done to explore the possibility of developing a quantitative assessment scale of motor function based on time-frequency information. An initial study was conducted on retrospective gait data from three children, matched in gender and in anthropometric variables but with differing levels of walking ability. EMG data were extracted from five lower extremity muscles to assess the degrees of differentiation. The data were processed using the CWT to derive an average scalogram, from which the instantaneous mean frequency (IMNF) was calculated. Principal component analysis was used to assess the differences between the curves. Preliminary results indicated that for select lower extremity muscles, there was a significant deviation in the IMNF curves in the child with CP as compared to the child with TD. Furthermore, as motor impairment increased, total percent explained variance to the TD curves decreased. This suggests that it might be possible to derive a physiologically based quantitative index for assessing motor function and for assessing clinical treatments in CP using the wavelet analysis.
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Neurophysiological assessment of lower-limb voluntary control in incomplete spinal cord injury. Spinal Cord 2005; 43:283-90. [PMID: 15672098 DOI: 10.1038/sj.sc.3101679] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional retrospective study of a neurophysiological method of voluntary motor control characterization. OBJECTIVES This study was undertaken to validate the surface electromyography (sEMG)-based voluntary response index (VRI) as an objective, quantitative, laboratory measure of spinal cord injury severity in terms of voluntary motor control disruption. SETTING VA Medical Centers in Houston and Dallas Texas, USA. METHODS A total of 67 subjects with incomplete spinal cord injury (iSCI), American Spinal Injury Association Impairment Scale (AIS)-C (n = 32) and -D (n = 35) were studied. sEMG recorded during a standardized protocol including eight lower-limb voluntary motor tasks was analyzed using the VRI method that relates multi-muscle activation patterns of SCI persons to those of healthy-subject prototypes (n = 15). The VRI is composed of a measure of the amount of the sEMG activity (magnitude) and the distribution of activity across muscle groups compared to that of healthy subjects for each motor task (similarity index, SI). These resulting VRI components, normalized magnitude and SI, were compared to AIS clinical findings in this study. Receiver operating characteristic analysis was performed to determine the SI values best separating AIS-C and AIS-D subjects. RESULTS Magnitude and SI for AIS-C subjects had mean values of 0.27 +/- 0.32 and 0.65 +/- 0.21, respectively. Both parameters were significantly larger in the AIS-D subjects (0.78 +/- 0.43 and 0.93 +/- 0.06), respectively (P < 0.01). An SI value of 0.85 was found to separate AIS-C and AIS-D groups with a sensitivity of 0.89 and a specificity of 0.81. Further, the VRI of each leg strongly correlated with the respective AIS motor score (0.80, r < 0.01). CONCLUSIONS In the domains of voluntary motor control, the sEMG-based VRI demonstrated adequate face validity and sensitivity to injury severity as currently measured by the AIS. SPONSORSHIP Veterans Affairs Medical Center.
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Analysis of sEMG during voluntary movement--Part II: Voluntary response index sensitivity. IEEE Trans Neural Syst Rehabil Eng 2005; 12:416-21. [PMID: 15614997 DOI: 10.1109/tnsre.2004.838445] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper, a method for analyzing surface electromyographic (sEMG) data recorded from the lower-limb muscles of incomplete spinal-cord injured (iSCI) subjects is evaluated. sEMG was recorded bilaterally from quadriceps, adductor, hamstring, tibialis anterior, and triceps surae muscles during voluntary ankle dorsiflexion performed in the supine position as part of a comprehensive motor control assessment protocol. Analysis of the sEMG centered on two features, the magnitude of activation and the degree of similarity [similarity index (SI)] of the sEMG distribution to that of healthy subjects performing the same maneuver (n = 10). The analysis calculations resulted in response vectors (RV) that were compared to healthy-subject-derived prototype response vectors resulting in a voluntary response index (VRI). Incomplete SCI subjects (n = 9) were used to test the sensitivity of this analysis method. They were given supported-weight treadmill ambulation training, which is expected to improve or at least not cause a deterioration of voluntary motor control. The VRI provided evidence that the quantitative sEMG analysis method used was able to differentiate between healthy subjects and those with iSCI, characterize individual differences among iSCI subjects, and track motor control changes occurring over time.
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