Experimental muscle pain increases mechanomyographic signal activity during sub-maximal isometric contractions

A single session of motor imagery paired with spinal stimulation improves manual dexterity and increases cortical excitability after spinal cord injury

OBJECTIVE

Non-invasive stimulation of the spinal cord at the cervical level (TSCS) can induce neural plasticity and improve upper limb function in people living with cervical spinal cord injury (SCI) when paired with task practice. The aim of this study was to investigate the effects of a session of motor imagery (MI) paired with TSCS on manual dexterity, corticospinal and spinal excitability in people living with cervical SCI.

METHODS

Eight participants (4 females, mean age 46yrs ± 17) completed three sessions of: 1) MI; 2) TSCS at C5-C6 level; 3) MI + TSCS, listening to the MI script while receiving TSCS. Manual dexterity was assessed with the Purdue Pegboard Test (PPT), corticospinal excitability was assessed with Transcranial Magnetic Stimulation (TMS) delivered at motor threshold and suprathreshold (120 % intensities, and spinal excitability delivered at motor threshold and suprathreshold (110 %, 120 %) intensities was assessed with single pulses of TSCS.

RESULTS

Manual dexterity increased from baseline after all three conditions (p = 0.016). Corticospinal excitability increased from baseline after MI (p = 0.002] and MI + TSCS (p = 0.031], but not TSCS (p = 0.343). Spinal excitability was not affected by any of the conditions (p = 0.425).

CONCLUSIONS

These findings demonstrate that a single session of MI and TSCS, either alone or in combination, can increase manual dexterity in people living with cervical SCI. The increase in dexterity was paralleled by increases in corticospinal excitability for the MI and MI + TSCS conditions.

SIGNIFICANCE

Our findings indicate that MI and TSCS improve manual dexterity and increase corticospinal excitability in people living with cervical SCI when employed in isolation or in combination.

Electromechanical efficiency index of skeletal muscle and its applicability: a systematic review

Introduction: The electromechanical efficiency of skeletal muscle represents the dissociation between electrical and mechanical events within a muscle. It has been widely studied, with varying methods for its measurement and calculation. For this reason, the purpose of this literature review was to integrate the available research to date and provide more insights about this measure. Methods: A systematic search of the literature was performed across three online databases: PubMed, ScienceDirect, and SPORTDiscus. This yielded 1284 reports, of which 10 met the inclusion criteria. Included studies have used different methods to measure the electromechanical efficiency (EME) index, including electromyography (EMG), mechanomyography and tensiomyography (TMG). Results: The EME index was used to assess muscle conditions such as muscle atrophy, pain syndromes, or to monitor rehabilitation in patients with knee problems, fatigue and the effects of exercise and rehabilitation. TMG has been shown to be one of the most reliable methods to obtain the EME index, but its use precludes obtaining the index during voluntary muscle contractions. Conclusion: Standardizing the EME index is crucial for its diverse applications in clinical, sport, and rehabilitation contexts. Future research should prioritize standardization of measurement protocols for establishing the most repeatable, and reliable approach that can be used for inter-individual comparisons or for assessing an individual for multiple times over a longer period. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440333 Identifier: CRD42023440333.

The acute effects of motor imagery and cervical transcutaneous electrical stimulation on manual dexterity and neural excitability

Transcutaneous electrical stimulation (TCES) of the spinal cord induces changes in spinal excitability. Motor imagery (MI) elicits plasticity in the motor cortex. It has been suggested that plasticity occurring in both cortical and spinal circuits might underlie the improvements in performance observed when training is combined with stimulation. We investigated the acute effects of cervical TCES and MI delivered in isolation or combined on corticospinal excitability, spinal excitability and manual performance. Participants (N = 17) completed three sessions during which they engaged in 20 min of: 1) MI, listening to an audio recording instructing to complete the purdue pegboard test (PPT) of manual performance; 2) TCES at the spinal level of C5-C6; 3) MI + TCES, listening to the MI script while receiving TCES. Before and after each condition, we measured corticospinal excitability via transcranial magnetic stimulation (TMS) at 100% and 120% motor threshold (MT), spinal excitability via single-pulse TCES and manual performance with the PPT. Manual performance was not improved by MI, TCES or MI + TCES. Corticospinal excitability assessed at 100% MT intensity increased in hand and forearm muscles after MI and MI + TCES, but not after just TCES. Conversely, corticospinal excitability assessed at 120% MT intensity was not affected by any of the conditions. The effects on spinal excitability depended on the recorded muscle: it increased after all conditions in biceps brachii (BB) and flexor carpi radialis (FCR); did not change after any conditions in the abductor pollicis brevis (APB); increased after TCES and MI + TCES, but not after just MI in the extensor carpi radialis (ECR). These findings suggest that MI and TCES increase the excitability of the central nervous system through different but complementary mechanisms, inducing changes in the excitability of spinal and cortical circuits. MI and TCES can be used in combination to modulate spinal/cortical excitability, an approach particularly relevant for people with limited residual dexterity who cannot engage in motor practice.

Myofascial Trigger Points therapy decreases myotonometric tone and stiffness of trapezius muscle, benefits headaches and muscle pain in migraine

BACKGROUND

Migraine is a primary headache disorder. Studies have shown that 93% of people with migraine have an increased number of active Ischemic Compression Myofascial Trigger Points (IC-MTrPs) therapy.

OBJECTIVE

To examine the effects of the IC-MTrPs therapy on: (1) mechanical properties of the upper trapezius muscle (UTM), (2) shoulder girdle and neck (SGN) muscles pain and (3) headaches characteristics in episodic migraine patients without aura.

METHODS

Thirty-one adult, female, migraine patients without aura underwent seven IC-MTrPs therapy sessions and were tested during maximally five measurement sessions (pre- and post-1'st, post-4'th, post-7'th therapy and 1-month follow-up). Myotonometric measurements of the UTM's tone, stiffness and elasticity, subjective SGN muscles pain, as well as headache's level, frequency and duration were analyzed.

RESULTS

Myotonometric tone and stiffness of the UTM significantly decreased in post-1'st, post-4'th therapy and in 1-month follow-up measurements versus pre-1'st therapy testing session. The scores for the SGN muscles' pain significantly decreased: (i) in post-4'th and post-7'th therapy versus post-1'st therapy session, and (ii) in post-7'th versus post-4'th therapy measurements. Headache's level, frequency and duration significantly decreased in post-7'th therapy versus pre-1'st therapy measurement session.

CONCLUSION

IC-MTrPs therapy resulted in a decrease of upper trapezius muscle tone and stiffness, with simultaneous alleviation of shoulder girdle and neck muscle pain and the headaches characteristics in episodic migraine patients without aura.

Phonomyography on Perioperative Neuromuscular Monitoring: An Overview

Complications related to neuromuscular blockade (NMB) could occur during anesthesia induction, maintenance, and emergency. It is recommended that neuromuscular monitoring techniques be utilized perioperatively to avoid adverse outcomes. However, current neuromuscular monitoring methods possess different shortcomings. They are cumbersome to use, susceptible to disturbances, and have limited alternative monitoring sites. Phonomyography (PMG) monitoring based on the acoustic signals yielded by skeletal muscle contraction is emerging as an interesting and innovative method. This technique is characterized by its convenience, stable signal quality, and multimuscle recording ability and shows great potential in the application field. This review summarizes the progression of PMG on perioperative neuromuscular monitoring chronologically and presents the merits, demerits, and challenges of PMG-based equipment, aiming at underscoring the potential of PMG-based apparatuses for neuromuscular monitoring.

Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review

OBJECTIVES

Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing.

METHODS

A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator.

RESULTS

Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated.

CONCLUSIONS

Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.

Altered muscle activation in agility dogs performing warm-up exercises: an acoustic myography study

Agility is physically demanding and dogs encounter a considerable risk of injury during training and competition. Pre-performance warm-up is used routinely among human athletes to prepare the tissues for these physical demands, but in canine sports evidence for effects of warm-up is lacking. The aim of this study was to investigate the effects of warm-up in dogs on two major muscles involved in locomotion. It was hypothesised that, after warm-up, the muscles would be used more efficiently (more fibre resting time/total time), recruit fewer fibres (reduced spatial summation) and/or activated with a lower firing frequency (reduced temporal summation). The following factors ‘sex, age, weight, height, training level and agility experience’ were evaluated for their potential impact on muscle function parameters. Fourteen large (≥46 cm at the withers) agility dogs of different breeds and training levels performed a 5 min warm-up program three times, with a 2 min break between the programs for recording purposes. Acoustic myography sensors were attached on the skin over the muscles m. triceps brachii (TB) and m. gluteus superficialis (GS). Recordings of muscle activity were made, while the dogs trotted before warm-up and after each 5 min warm-up program. The dogs used TB more efficiently after 5 min (P<0.05), 10 min (P<0.05) and 15 min (P<0.001) of exercise compared to pre-warm-up values. No changes were found in the activity of GS. For well-trained dogs, TB recruited fewer muscle fibres after 10 and 15 min of warm-up compared to dogs that trained less than 1 h weekly (P<0.03). For dogs with more than 2 years of experience, GS had a lower firing frequency before and after 10 min warm-up compared to dogs with less experience. The results indicate that warm-up alters muscle activation by an increased muscular efficiency. Training level and experience have an influence on muscle function parameters.

Pain-Related Suppression of Beta Oscillations Facilitates Voluntary Movement

Increased beta oscillations over sensorimotor cortex are antikinetic. Motor- and pain-related processes separately suppress beta oscillations over sensorimotor cortex leading to the prediction that ongoing pain should facilitate movement. In the current study, we used a paradigm in which voluntary movements were executed during an ongoing pain-eliciting stimulus to test the hypothesis that a pain-related suppression of beta oscillations would facilitate the initiation of a subsequent voluntary movement. Using kinematic measures, electromyography, and high-density electroencephalography, we demonstrate that ongoing pain leads to shorter reaction times without affecting the kinematics or accuracy of movement. Reaction time was positively correlated with beta power prior to movement in contralateral premotor areas. Our findings corroborate the view that beta-band oscillations are antikinetic and provide new evidence that pain primes the motor system for action. Our observations provide the first evidence that a pain-related suppression of beta oscillations over contralateral premotor areas leads to shorter reaction times for voluntary movement.

Mechanomyographic parameter extraction methods: an appraisal for clinical applications

The research conducted in the last three decades has collectively demonstrated that the skeletal muscle performance can be alternatively assessed by mechanomyographic signal (MMG) parameters. Indices of muscle performance, not limited to force, power, work, endurance and the related physiological processes underlying muscle activities during contraction have been evaluated in the light of the signal features. As a non-stationary signal that reflects several distinctive patterns of muscle actions, the illustrations obtained from the literature support the reliability of MMG in the analysis of muscles under voluntary and stimulus evoked contractions. An appraisal of the standard practice including the measurement theories of the methods used to extract parameters of the signal is vital to the application of the signal during experimental and clinical practices, especially in areas where electromyograms are contraindicated or have limited application. As we highlight the underpinning technical guidelines and domains where each method is well-suited, the limitations of the methods are also presented to position the state of the art in MMG parameters extraction, thus providing the theoretical framework for improvement on the current practices to widen the opportunity for new insights and discoveries. Since the signal modality has not been widely deployed due partly to the limited information extractable from the signals when compared with other classical techniques used to assess muscle performance, this survey is particularly relevant to the projected future of MMG applications in the realm of musculoskeletal assessments and in the real time detection of muscle activity.

Mechanomyography and muscle function assessment: a review of current state and prospects

Previous studies have explored to saturation the efficacy of the conventional signal (such as electromyogram) for muscle function assessment and found its clinical impact limited. Increasing demand for reliable muscle function assessment modalities continues to prompt further investigation into other complementary alternatives. Application of mechanomyographic signal to quantify muscle performance has been proposed due to its inherent mechanical nature and ability to assess muscle function non-invasively while preserving muscular neurophysiologic information. Mechanomyogram is gaining accelerated applications in evaluating the properties of muscle under voluntary and evoked muscle contraction with prospects in clinical practices. As a complementary modality and the mechanical counterpart to electromyogram; mechanomyogram has gained significant acceptance in analysis of isometric and dynamic muscle actions. Substantial studies have also documented the effectiveness of mechanomyographic signal to assess muscle performance but none involved comprehensive appraisal of the state of the art applications with highlights on the future prospect and potential integration into the clinical practices. Motivated by the dearth of such critical review, we assessed the literature to investigate its principle of acquisition, current applications, challenges and future directions. Based on our findings, the importance of rigorous scientific and clinical validation of the signal is highlighted. It is also evident that as a robust complement to electromyogram, mechanomyographic signal may possess unprecedented potentials and further investigation will be enlightening.

Does stress within a muscle change in response to an acute noxious stimulus?

BACKGROUND

Altered muscle activation during pain is thought to redistribute stress within muscles and ultimately decrease the load on painful structures. However, change in muscle stress during pain has not been directly tested. The aim of the present study is to determine whether stress within muscle tissue is reduced during local acute experimental pain.

METHODS AND RESULTS

Ten participants attended 2 experimental sessions that each involved isometric knee extension tasks in 2 series of control trials and 1 series of test trials at ∼10%MVC. Shear elastic modulus was measured from vastus lateralis using a shear wave elastographic technique (Supersonic Shear Imaging). Prior to the test contractions, a bolus of hypertonic (Pain) or isotonic saline (No-pain) was injected into vastus lateralis. Pain intensity was 5.2±1.0 during the painful contractions. The intra-session repeatability of the shear elastic modulus determined between control trials was good (ICC: 0.95 and 0.99; SEM: 5.1 and 9.3 kPa for No-pain and Pain, respectively). Muscle shear elastic modulus did not change systematically during Pain or No-pain contractions (all main effects and interaction P>0.14). Examination of data for individual participants showed that stress either increased or decreased. If the absolute change in modulus is considered between the control and the test trials, the change during Pain (16.2±9.5 kPa) was double that observed with No pain (7.9±5.9 kPa; P = 0.046).

CONCLUSION

This is the first study to directly determine the change in stress within a muscle (change in shear elastic modulus) during pain. We conclude that experimental pain induced by hypertonic saline does not induce a systematic reduction in muscle stress during a single-joint isometric task. Therefore, the changes in muscle activity reported previously during similar tasks are unlikely to systematically reduce load in the painful region. Whether the individual-specific increase and decrease are physiologically relevant or purposeful requires further investigation.

Insight into motor adaptation to pain from between-leg compensation

PURPOSE

Although it appears obvious that we change movement behaviors to unload the painful region, non-systematic motor adaptations observed in simple experimental tasks with pain question this theory. We investigated the effect of unilateral pain on performance of a bilateral plantarflexion task. This experimental task clearly allowed for stress on painful tissue to be reduced by modification of load sharing between legs.

METHODS

Fourteen participants performed a bilateral plantarflexion at 10, 30, 50 and 70 % of their MVC during 5 conditions (Baseline, Saline-1, Washout-1, Saline-2, Washout-2). For Saline-1 and -2, either isotonic saline (Iso) or hypertonic saline (Pain) was injected into the left soleus.

RESULTS

The force produced by the painful leg was less during Pain than Baseline (range -52.6 % at 10 % of MVC to -20.1 % at 70 % of MVC; P < 0.003). This was compensated by more force produced by the non-painful leg (range 18.4 % at 70 % of MVC to 70.2 % at 10 % of MVC; P < 0.001). The reduction in plantarflexion force was not accompanied by a significant decrease in soleus electromyographic activity at 10 and 30 % of MVC. Further, no significant linear relationship was found between changes in soleus electromyographic activity and change in plantarflexion force for the painful leg (with the exception of a weak relationship at 10 % of MVC, i.e., R (2) = 0.31).

CONCLUSION

These results show that when the nervous system is presented with an obvious solution to decrease stress on irritated tissue, this option is selected. However, this was not strongly related to a decrease in soleus (painful muscle) activity level.

Design and evaluation of a novel microphone-based mechanomyography sensor with cylindrical and conical acoustic chambers

Mechanomyography has recently been proposed as a control modality for alternative access technologies for individuals with disabilities. However, MMG recordings are highly susceptible to contamination from limb movements. Pressure-based transducers are touted to be the most robust to external movement although there is some debate about their optimal chamber geometry, in terms of low frequency gain and spectral flatness. To investigate the question of preferred geometry, transducers with cylindrical and conical chambers of varying dimensions were designed, manufactured and tested. Using a computer-controlled electrodynamic shaker, the frequency response of each chamber geometry was empirically derived. Of the cylindrical chambers, the highest gain and the flattest frequency response was exhibited by a chamber 10 mm in diameter and 5-7 mm in height. However, conical chambers offered an average rise in gain of 6.79 ± 1.06 dB/Hz over that achievable with cylindrical geometries. The highest gain and flattest response was achieved with a transducer consisting of a low-frequency MEMS microphone, a 4 μm aluminized mylar membrane and a rigid conical chamber 7 mm in diameter and 5mm in height. This design is recommended for MMG applications where limb movement is prevalent.

Interactive effects of acute experimental pain in trapezius and sored wrist extensor on the electromyography of the forearm muscles during computer work

We investigated the interactive effects of shoulder pain and wrist extensor muscle soreness on surface electromyography (EMG) during computer mouse work. On day one, subjects (N = 12) performed computer work with/without acute muscle pain induced in the trapezius muscle. Subsequently, eccentric exercise was performed to induce delayed onset muscle soreness (DOMS) in wrist extensor muscles. In presence of DOMS on day two, computer work recordings with/without pain were repeated. EMG signals were recorded from the descending part of trapezius bilaterally, flexor carpi ulnaris and extensor carpi radialis brevis. Experimental muscle pain in trapezius led to a decrease in the muscular activity of the wrist extensor (P < 0.02) and decreased the relative rest time in the wrist flexor even in presence of DOMS (P < 0.01). The present result suggests that shoulder pain plays a role in the coordination of wrist flexors and extensors during computer work.

Biofeedback effectiveness to reduce upper limb muscle activity during computer work is muscle specific and time pressure dependent

Continuous electromyographic (EMG) activity level is considered a risk factor in developing muscle disorders. EMG biofeedback is known to be useful in reducing EMG activity in working muscles during computer work. The purpose was to test the following hypotheses: (1) unilateral biofeedback from trapezius (TRA) can reduce bilateral TRA activity but not extensor digitorum communis (EDC) activity; (2) biofeedback from EDC can reduce activity in EDC but not in TRA; (3) biofeedback is more effective in no time constraint than in the time constraint working condition. Eleven healthy women performed computer work during two different working conditions (time constraint/no time constraint) while receiving biofeedback. Biofeedback was given from right TRA or EDC through two modes (visual/auditory) by the use of EMG or mechanomyography as biofeedback source. During control sessions (no biofeedback), EMG activity was (mean ± SD): 2.4 ± 1.1, 2.5 ± 2.1, and 9.1 ± 3.1%max-EMGrms for right and left TRA and EDC, respectively. During biofeedback from TRA, activity was reduced in right TRA (1.7 ± 1.6%max-EMGrms) and left TRA (1.2 ± 2.0%max-EMGrms) compared to control. During biofeedback from EDC, activity in EDC was reduced (8.3 ± 3.3%max-EMGrms) compared with control. During time constraint, activity was reduced in right TRA (1.9 ± 1.3%max-EMGrms), left TRA (1.5 ± 1.5%max-EMGrms), and EDC (8.4 ± 3.2%max-EMGrms), during biofeedback compared to control.

CONCLUSION

biofeedback reduced muscle activity in TRA by ∼ 30-50% and in EDC by ∼ 10% when given from the homologous or bilateral muscle but not from the remote muscle, and was significant in the time constraint condition; while feedback source and presentation mode showed only minor differences in the effect on reducing homologous muscle activity. This implies that biofeedback should be given from the most affected muscle in the occupational setting for targeting relief and prevention of muscle pain most effectively.

The effect of accelerometer location on the classification of single-site forearm mechanomyograms

Background

Recently, pattern recognition methods have been deployed in the classification of multiple activation states from mechanomyogram (MMG) signals for the purpose of controlling switching interfaces. Given the propagative properties of MMG signals, it has been suggested that MMG classification should be robust to changes in sensor placement. Nonetheless, this purported robustness remains speculative to date. This study sought to quantify the change in classification accuracy, if any, when a classifier trained with MMG signals from the muscle belly, is subsequently tested with MMG signals from a nearby location.

Methods

An arrangement of 5 accelerometers was attached to the flexor carpi radialis muscle of 12 able-bodied participants; a reference accelerometer was located over the muscle belly, two peripheral accelerometers were positioned along the muscle's transverse axis and two more were aligned to the muscle's longitudinal axis. Participants performed three classes of muscle activity: wrist flexion, wrist extension and semi-pronation. A collection of time, frequency and time-frequency features were considered and reduced by genetic feature selection. The classifier, trained using features from the reference accelerometer, was tested with signals from the longitudinally and transversally displaced accelerometers.

Results

Classification degradation due to accelerometer displacement was significant for all participants, and showed no consistent trend with the direction of displacement. Further, the displaced accelerometer signals showed task-dependent de-correlations with respect to the reference accelerometer.

Conclusions

These results indicate that MMG signal features vary with spatial location and that accelerometer displacements of only 1-2 cm cause sufficient feature drift to significantly diminish classification accuracy. This finding emphasizes the importance of consistent sensor placement between MMG classifier training and deployment for accurate control of switching interfaces.

On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region

BACKGROUND

Occupations characterized by a static low load and by repetitive actions show a high prevalence of work-related musculoskeletal disorders (WMSD) in the neck-shoulder region. Moreover, muscle fatigue and discomfort are reported to play a relevant initiating role in WMSD.

AIMS

To investigate relationships between altered sensory information, i.e. localized muscle fatigue, discomfort and pain and their associations to changes in motor control patterns.

MATERIALS & METHODS

In total 101 subjects participated. Questionnaires, subjective assessments of perceived exertion and pain intensity as well as surface electromyography (SEMG), mechanomyography (MMG), force and kinematics recordings were performed.

RESULTS

Multi-channel SEMG and MMG revealed that the degree of heterogeneity of the trapezius muscle activation increased with fatigue. Further, the spatial organization of trapezius muscle activity changed in a dynamic manner during sustained contraction with acute experimental pain. A graduation of the motor changes in relation to the pain stage (acute, subchronic and chronic) and work experience were also found. The duration of the work task was shorter in presence of acute and chronic pain. Acute pain resulted in decreased activity of the painful muscle while in subchronic and chronic pain, a more static muscle activation was found. Posture and movement changed in the presence of neck-shoulder pain. Larger and smaller sizes of arm and trunk movement variability were respectively found in acute pain and subchronic/chronic pain. The size and structure of kinematics variability decreased also in the region of discomfort. Motor variability was higher in workers with high experience. Moreover, the pattern of activation of the upper trapezius muscle changed when receiving SEMG/MMG biofeedback during computer work.

DISCUSSION

SEMG and MMG changes underlie functional mechanisms for the maintenance of force during fatiguing contraction and acute pain that may lead to the widespread pain seen in WMSD. A lack of harmonious muscle recruitment/derecruitment may play a role in pain transition. Motor behavior changed in shoulder pain conditions underlining that motor variability may play a role in the WMSD development as corroborated by the changes in kinematics variability seen with discomfort. This prognostic hypothesis was further, supported by the increased motor variability among workers with high experience.

CONCLUSION

Quantitative assessments of the functional motor adaptations can be a way to benchmark the pain status and help to indentify signs indicating WMSD development. Motor variability is an important characteristic in ergonomic situations. Future studies will investigate the potential benefit of inducing motor variability in occupational settings.

The design and testing of a novel mechanomyogram-driven switch controlled by small eyebrow movements

Background

Individuals with severe physical disabilities and minimal motor behaviour may be unable to use conventional mechanical switches for access. These persons may benefit from access technologies that harness the volitional activity of muscles. In this study, we describe the design and demonstrate the performance of a binary switch controlled by mechanomyogram (MMG) signals recorded from the frontalis muscle during eyebrow movements.

Methods

Muscle contractions, detected in real-time with a continuous wavelet transform algorithm, were used to control a binary switch for computer access. The automatic selection of scale-specific thresholds reduced the effect of artefact, such as eye blinks and head movement, on the performance of the switch. Switch performance was estimated by cued response-tests performed by eleven participants (one with severe physical disabilities).

Results

The average sensitivity and specificity of the switch was 99.7 ± 0.4% and 99.9 ± 0.1%, respectively. The algorithm performance was robust against typical participant movement.

Conclusions

The results suggest that the frontalis muscle is a suitable site for controlling the MMG-driven switch. The high accuracies combined with the minimal requisite effort and training show that MMG is a promising binary control signal. Further investigation of the potential benefits of MMG-control for the target population is warranted.

Recognition of forearm muscle activity by continuous classification of multi-site mechanomyogram signals

Recent studies on identifying multiple activation states from mechanomyogram (MMG) signals for the purpose of controlling switching interfaces have employed pattern recognition methods where MMG signal features from multiple muscle sites are extracted and classified. The purpose of this study is to determine if MMG signal features retain enough discriminatory information to allow reliable continuous classification, and to determine if there is a decline in classification accuracy over short time periods. MMG signals were recorded from two accelerometers attached to the flexor carpi radialis and extensor carpi radialis muscles of 12 able-bodied participants as participants performed three classes of forearm muscle activity. The data were collected over five recording sessions, with a ten-minute interval between each session. The data were spliced into 256 ms epochs, and a comprehensive set of signal features was extracted. A pattern classifier, trained with continuously acquired signal features from the first recording session, was tested with signals recorded from the other sessions. The average classification accuracy over the five sessions was 89 ± 2%. There was no obvious declining trend in classification accuracy with time. These results show that MMG signals recorded at the forearm retain enough discriminatory information to allow continuous recognition of hand motion across multiple (>90) repetitions, and the MMG-classifier does not show short-term degradation. These results indicate the potential of MMG as a multifunction control signal for muscle-machine interfaces.

Uncovering patterns of forearm muscle activity using multi-channel mechanomyography

A coordinated activation of distal forearm muscles allows the hand and fingers to be shaped during movement and grasp. However, little is known about how the muscle activation patterns are reflected in multi-channel mechanomyogram (MMG) signals. The purpose of this study is to determine if multi-site MMG signals exhibit distinctive patterns of forearm muscle activity. MMG signals were recorded from forearm muscle sites of nine able-bodied participants during hand movement. By using 14 features selected by a genetic algorithm and classified by a linear discriminant analysis classifier (LDA), we show that MMG patterns are specific and consistent enough to identify 7+/-1 hand movements with an accuracy of 90+/-4%. MMG-based movement recognition required a minimum of three recording sites. Further, by classifying five classes of contraction patterns with 98+/-3% accuracy from MMG signals recorded from the residual limb of an amputee participant, we demonstrate that MMG shows pattern-specificity even in the absence of typical musculature. Multi-site monitoring of the RMS of MMG signals is suggested as a method of estimating the relative contributions of muscles to motor tasks. The patterns in MMG facilitate our understanding of the mechanical activity of muscles during movement.

Stationarity distributions of mechanomyogram signals from isometric contractions of extrinsic hand muscles during functional grasping

This study investigates the stationarity of steady state mechanomyogram signals for the purpose of determining appropriate features for signal classification. Mechanomyography is the superficial recording of low frequency vibrations detected over contracting muscles. Steady state mechanomyogram signals, recorded at the belly of the extensor digitorum, flexor digitorum superficialis and flexor pollicis longus muscles during functional grasps were tested for weak stationarity. Twenty percent of the contractions were found to be non-stationary, indicating that time frequency methods may be appropriate for automatic pattern recognition of functional grasp from the mechanomyogram. The distribution of the stationary test statistic was dependent on the type of muscle contractions, suggesting that the test statistic itself might be a discriminating feature for mechanomyogram pattern recognition in applications such as multifunction prosthetic control. Since the major known source of non-stationarity was decreasing variance, it is suggested that shifts in the distribution of the test statistic may indicate the time course of relative muscle contributions to functional grasp.

Vision-based segmentation of continuous mechanomyographic grasping sequences

In detecting motor related activity from mechanomyographic (MMG) recordings, the acquisition of long, continuous streams of MMG signals is typically preferred over the painstaking collection of individual, isolated contractions. However, a major challenge with continuous collection is the subsequent separation of the MMG data stream into segments representing individual contractions. This paper proposes a method for segmenting continuously recorded MMG data streams using computer vision while providing a highly reduced set of key images for rapid human expert verification. Transverse plane video recordings of functional grasp sequences were synchronized with the acquisition of MMG signals from the forearm. An automatic, vision-based algorithm exploiting skin color detection, motion estimation, and template matching provided segmentation cues for MMG signals arising from multiple grips. The automatic segmentation method tolerated extraneous hand movements, differentiated among multiple grips and estimated grip transition times. Our implementation segmented two grips with an average accuracy of 97.8 -/+ 4%, and up to seven grips with an accuracy of 73 -/+ 20%. The automatically extracted contraction initiation and termination times were within 173 -/+ 133 ms of the times obtained via manual segmentation. It is suggested that the proposed method would be particularly conducive to the assembly of large collections of signals for training MMG-driven prostheses.

Similar response of agonist and antagonist muscles after eccentric exercise revealed by electromyography and mechanomyography

The purpose of this study was to investigate the influence of eccentric contractions (ECC) on the biceps (BB) and triceps brachii (TB) muscles during maximal voluntary contraction (MVC) of elbow flexors using electrical (EMG) and mechanomyographical activities (MMG). Each of 18 male students performed 25 submaximal contractions (50% MVC) of the elbow flexors. Root mean square amplitude (RMS) and median frequency (MDF) were calculated for the EMG and MMG signals recorded during MVC. All measurements were taken before, immediately after, 24, 48, 72, and 120 h post-ECC from the BB and TB muscles. MVC was reduced by 34% immediately after exercise and did not return to the resting value within 120 h (P0.05). The EMG MDF decreased significantly (P< or =0.05) in both muscles after ECC. The MMG RMS at 24h, 48, 72 and 120 h post-ECC was significantly lower compared to that recorded immediately after ECC in both muscles (P< or =0.05). The present research showed that (i) there were similar changes in electrical and mechanical activities during MVC after submaximal ECC in agonist and antagonist muscles suggesting a common drive controlling the agonist and antagonist motoneuron pool, (ii) the ECC induced different changes in EMG than in MMG immediately after ECC and during 120 h of recovery that suggested an increased tremor and contractile impairments, i.e., reduced rate of calcium release from the sarcoplasmic reticulum (acute effect), and changes in motor control mechanisms of agonist and antagonist muscles, and increased muscle stiffness (chronic effect).

Mechanomyography and electromyography during and after fatiguing shoulder eccentric contractions in males and females

The aim of this study was to investigate changes in mechanomyographic (MMG) and the surface electromyographic (EMG) signals during and after fatiguing shoulder eccentric contractions in a group consisting of 12 males and 12 females. Exerted force, MMG, EMG, pain and rate of perceived exertion were assessed before, during and after repeated high-intensity eccentric exercises. Bouts of eccentric contractions caused a decrease in the exerted force for males (P<0.05) and an increase in the rate of perceived exertion and pain for both genders (P<0.05). During eccentric exercise, the root mean square (RMS) values of the MMG signal increased (P<0.05). The mean power frequency (MPF) values of the EMG signal decreased at the end of each eccentric bout for both genders (P<0.05); the decrease was higher for females compared with males (P<0.05). Immediately after eccentric exercise in static abduction of the upper limbs, the MMG RMS and MPF values increased (P<0.05). The present study showed that (1) neuromuscular changes associated with pain and changes in muscle stiffness and (2) changes in motor units strategy during fatigue development in shoulder muscle are reflected in the MMG and EMG signals.

Heterogeneous mechanomyographic absolute activation of paraspinal muscles assessed by a two-dimensional array during short and sustained contractions

Spatial dependency of paraspinal muscle activity was assessed using a new two-dimensional MMG recording system. MMG signals were detected over the left and right paraspinal muscles of 10 volunteers using a grid of 12 accelerometers. During two separate trials subjects maintained a 20 degrees flexed position and held loads that ranged from 0 to 15 kg (in 2.5 kg increments) for 20s; and 7.5 kg for 6 min. Maps of absolute and normalised (with respect to initial values) average rectified value, mean power frequency, variance and skewness of the power spectral density were obtained from the two-dimensional MMG recordings. For both the short duration and sustained contractions, the MMG absolute average rectified value, mean power frequency, variance and skewness depended on accelerometer location (P<0.05), while, with the exception of the skewness (P<0.05), normalised values did not. These results demonstrate both inhomogeneous MMG absolute activity and homogeneous MMG normalised activity in paraspinal muscles for short duration and sustained contractions. Moreover, the effect of accelerometer location on spectral variables confirmed the limited validity of general relationships between MMG spectral changes and motor unit recruitment strategies. This study underlines the importance of using multiple recording sites when assessing back muscle activity.

Two-dimensional spatial distribution of surface mechanomyographical response to single motor unit activity

In order to better understand the mechanisms of generation of mechanomyography (MMG) signals, the two-dimensional distribution of surface MMG produced by the activity of single motor units was analyzed by a novel two-dimensional recording method. Motor unit action potentials were identified from intramuscular electromyographic (EMG) signals and used to trigger the averaging of MMG signals detected over the tibialis anterior muscle of 11 volunteers with a grid of 5x3 accelerometers (20-mm inter-accelerometer distance). The intramuscular wires were inserted between the first and second accelerometer in the middle column of the grid, proximal to the innervation zone. The subjects performed three contractions with visual feedback of the intramuscular EMG signals. In each contraction, a new motor unit was recruited at the minimum stable discharge rate (mean+/-S.D., N = 11 subjects, 7.3+/-2.3 pulse/s), resulting in torque of 2.4+/-2.8% of the maximal voluntary contraction (MVC), 4.6+/-2.7% MVC, and 6.3+/-3.1% MVC (all different, P < 0.01). For 23 out of 33 detected motor units, it was possible to extract the motor unit surface acceleration map (MUAM). A negative MUAM peak (-2.7+/-2.2 mm/s2) was detected laterally and a positive MUAM peak (4.1+/-2.4 mm/s2) medially (P < 0.001). The time-to-peak was shorter in the medial part of the muscle (2.9+/-0.4 ms) than in the other locations (3.4+/-0.5 ms, P < 0.001). The double integrated signals (muscle displacement) indicated negative deflection in the lateral part and inflation close to the tibia bone. The maps of acceleration showed spatial dependency in single motor unit MMG activities. The technique provides a new insight into motor unit contractile properties.

Spatial and force dependency of mechanomyographic signal features

The aim was to investigate with a novel technique the spatial inhomogeneity in surface mechanomyographic (MMG) response to muscle contraction at varying force levels. MMG signals were detected over the dominant tibialis anterior muscle of 10 volunteers using a 5 x 3 grid of accelerometers. The subjects performed 3 s long isometric contractions at forces ranging from 0% to 100% of the maximal force (10% increment) in a randomised order. From the two-dimensional MMG recordings, maps of absolute and normalized temporal and spectral MMG descriptors were obtained. The centroid and entropy of these maps were computed to describe the spatial centre of activity and degree of homogeneity, respectively. MMG absolute amplitude did not depend on location over the muscle while normalized amplitude did and the centroid shifted with increasing force. Amplitude increased with force and its entropy decreased. Absolute and normalized spectral variables depended on location over the muscle and their centroid shifted with increasing force. In addition, the dependency of absolute and normalized spectral variables on force was affected by location. These results highlight limitations when using single-channel MMG features for the assessment of motor unit control strategies, due to a substantial effect of position on the relation between force and MMG characteristics.

Experimental muscle pain changes the spatial distribution of upper trapezius muscle activity during sustained contraction

OBJECTIVE

To investigate the effect of local excitation of nociceptive muscle afferents on the spatial distribution of muscle activity.

METHODS

Surface electromyographic (EMG) signals were recorded from the upper trapezius muscle of 10 healthy volunteers with a 5 x 13 electrode grid during 90-s isometric contractions before, during, 15 and 30 min after intramuscular injection of hypertonic (painful) or isotonic (non-painful) saline. From the multi-channel EMG recordings, two-dimensional maps of root mean square and mean power frequency were obtained. The centre of gravity of the root mean square map was used to quantify global changes in the spatial distribution of muscle activity.

RESULTS

During sustained contractions, average root mean square increased, average mean frequency decreased and the centre of gravity moved cranially. During experimental muscle pain, compared to before injection, the average root mean square decreased and there was a caudal shift of the centre of gravity. Fifteen minutes after the painful injection the centre of gravity returned to its original position.

CONCLUSIONS

Short-term dynamic reorganization of the spatial distribution of muscle activity occurred in response to nociceptive afferent input.

SIGNIFICANCE

The study furnishes an extension of the pain adaptation model indicating heterogeneous inhibition of muscle activity.

Effects of electromyographic and mechanomyographic biofeedback on upper trapezius muscle activity during standardized computer work

The purpose of this laboratory study was to investigate the effects of surface electromyography (EMG)- and mechanomyography (MMG)-based audio and visual biofeedback during computer work. Standardized computer work was performed for 3 min with/without time constraint and biofeedback in a randomized order. Biofeedback was given on the basis of an individual preset threshold value for the right trapezius EMG and MMG signal and a time factor (repetition of events above the threshold). The duration of muscle activity above the preset threshold, the right trapezius EMG and MMG root mean square (RMS) values as well as the work performance in terms of number of completed graph/mouse clicks/errors, the rating of perceived exertion (RPE) and the usefulness of the biofeedback were assessed. The duration of muscle activity above the threshold was significantly lower with MMG compared with EMG as source of biofeedback (p < 0.05). Biofeedback led to a significant decrease in the right trapezius EMG RMS, lower RPE and decreased number of errors and mouse clicks, but also decreased number of completed graphs (p < 0.05). Audio and visual biofeedbacks were as effective. MMG-based biofeedback is a potential reliable alternative to EMG in ergonomics. A lowering of the trapezius muscle activity may contribute to diminish the risk of work related musculoskeletal disorders development.