Innervation zone location of the biceps brachii, a comparison between genders and correlation with anthropometric measurements

Improving Botulinum Toxin Efficiency in Treating Post-Stroke Spasticity Using 3D Innervation Zone Imaging

Spasticity is a common post-stroke syndrome that imposes significant adverse impacts on patients and caregivers. This study aims to improve the efficiency of botulinum toxin (BoNT) in managing spasticity, by utilizing a three-dimensional innervation zone imaging (3DIZI) technique based on high-density surface electromyography (HD-sEMG) recordings. Stroke subjects were randomly assigned to two groups: the control group ([Formula: see text]) which received standard ultrasound-guided injections, and the experimental group ([Formula: see text]) which received 3DIZI-guided injections. The amount of BoNT given was consistent for all subjects. The Modified Ashworth Scale (MAS), compound muscle action potential (CMAP) and muscle activation volume (MAV) from bilateral biceps brachii muscles were obtained at the baseline, 3 weeks, and 3 months after injection. Intra-group and inter-group comparisons of MAS, CMAP amplitude and MAV were performed. An overall improvement in MAS of spastic elbow flexors was observed during the 3-week visit ([Formula: see text]), yet no statistically significant difference found with intra-group or inter-group analysis. Compared to the baseline, a significant reduction of CMAP amplitude and MAV were observed in the spastic biceps muscles of both groups at 3-week post-injection, and returned to approximate baseline value at 12-week post injection. A significantly higher reduction was found in CMAP amplitude ([Formula: see text]% versus [Formula: see text]%, [Formula: see text]) and MAV ([Formula: see text]% versus [Formula: see text]%, [Formula: see text]) in the experimental group compared to the control group. The study has demonstrated preliminary evidence that precisely directing BoNT to the innervation zones (IZs) localized by 3DIZI leads to a significantly higher treatment efficiency improvement in spasticity management. Results have also shown the feasibility of developing a personalized BoNT injection technique for the optimization of clinical treatment for post-stroke spasticity using proposed 3DIZI technique.

Motor unit innervation zone localization based on robust linear regression analysis

With the aim of developing a flexible and reliable procedure for superficial muscle innervation zone (IZ) localization, we proposed a method to estimate IZ location using surface electromyogram (EMG) based on robust linear regression. Regression lines were used to model the bidirectional propagation pattern of a single motor unit action potential (MUAP) and visualize the trajectory of the MUAP propagation. IZ localization was performed by identifying the origin of the bidirectional MUAP propagation. Robust linear regression and MUAP peak detection, combined with propagation phase reversal identification, may provide an efficient way to estimate IZ location. Our method offers high resolution in locating IZs based on simulation studies and experimental tests. Furthermore, our method is flexible and may also be applied using a relatively small number of EMG channels. A comparative study of the proposed method with the cross-correlation method for IZ localization was conducted. The results obtained with simulated MUAPs and measured spontaneous MUAPs in the biceps brachii muscle in six subjects (four males and two females, 57 ± 10 years old) with amyotrophic lateral sclerosis (ALS). Our method achieved estimation performance comparable to that obtained by using the cross-correlation method but with higher resolution. This study provides an accurate and practical method to estimate IZ location.

Innervation zones of fasciculating motor units: observations by a linear electrode array

This study examines the innervation zone (IZ) in the biceps brachii muscle in healthy subjects and those with amyotrophic lateral sclerosis (ALS) using a 20-channel linear electromyogram (EMG) electrode array. Raster plots of individual waveform potentials were studied to estimate the motor unit IZ. While this work mainly focused on fasciculation potentials (FPs), a limited number of motor unit potentials (MUPs) from voluntary activity of 12 healthy and seven ALS subjects were also examined. Abnormal propagation of MUPs and scattered IZs were observed in fasciculating units, compared with voluntarily activated MUPs in healthy and ALS subjects. These findings can be related to muscle fiber reinnervation following motor neuron degeneration in ALS and the different origin sites of FPs compared with voluntary MUPs.

Corticomotor excitability of arm muscles modulates according to static position and orientation of the upper limb

OBJECTIVE

We investigated how multi-joint changes in static upper limb posture impact the corticomotor excitability of the posterior deltoid (PD) and biceps brachii (BIC), and evaluated whether postural variations in excitability related directly to changes in target muscle length.

METHODS

The amplitude of individual motor evoked potentials (MEPs) was evaluated in each of thirteen different static postures. Four functional postures were investigated that varied in shoulder and elbow angle, while the forearm was positioned in each of three orientations. Posture-related changes in muscle lengths were assessed using a biomechanical arm model. Additionally, M-waves were evoked in the BIC in each of three forearm orientations to assess the impact of posture on recorded signal characteristics.

RESULTS

BIC-MEP amplitudes were altered by shoulder and elbow posture, and demonstrated robust changes according to forearm orientation. Observed changes in BIC-MEP amplitudes exceeded those of the M-waves. PD-MEP amplitudes changed predominantly with shoulder posture, but were not completely independent of influence from forearm orientation.

CONCLUSIONS

Results provide evidence that overall corticomotor excitability can be modulated according to multi-joint upper limb posture.

SIGNIFICANCE

The ability to alter motor pathway excitability using static limb posture suggests the importance of posture selection during rehabilitation aimed at retraining individual muscle recruitment and/or overall coordination patterns.

Investigation of innervation zone shift with continuous dynamic muscle contraction

Innervation zone (IZ) has been identified as the origin of action potential propagation in isometric contraction. However, IZ shifts with changes in muscle length during muscle activity. The IZ shift has been estimated using raw EMG signals. This study aimed to investigate the movement of IZ location during continuous dynamic muscle contraction, using a computer program. Subjects flexed their elbow joint as repetitive dynamic muscle contractions. EMG signals were recorded from the biceps brachii muscle using an eight-channel surface electrode array. Approximately 100 peaks from EMG signals were detected for each channel and summed to estimate the IZ location. For each subject, the estimated IZ locations were subtracted from the IZ location during isometric contractions with the elbow flexed at 90°. The results showed that the IZ moved significantly with elbow joint movement from 45° to 135°. However, IZ movement was biased with only a 3.9 mm IZ shift on average when the elbow angle was acute but a 16 mm IZ shift on average when it was obtuse. The movement of IZ location during continuous dynamic muscle contraction can be investigated using this signal processing procedure without subjective judgment.

Reliability of surface EMG matrix in locating the innervation zone of upper trapezius muscle

The identification of the motor unit (MU) innervation zone (IZ) using surface electromyographic (sEMG) signals detected on the skin with a linear array or a matrix of electrodes has been recently proposed in the literature. However, an analysis of the reliability of this procedure and, therefore, of the suitability of the sEMG signals for this purpose has not been reported. The purpose of this work is to describe the intra and inter-rater reliability and the suitability of surface EMG in locating the innervation zone of the upper trapezius muscle. Two operators were trained on electrode matrix positioning and sEMG signal analysis. Ten healthy subjects, instructed to perform a series of isometric contractions of the upper trapezius muscle participated in the study. The two operators collected sEMG signals and then independently estimated the IZ location through visual analysis. Results showed an almost perfect agreement for intra-rater and inter-rater reliability. The constancy of IZ location could be affected by the factors reflecting the population of active MUs and their IZs, including: the contraction intensity, the acquisition period analyzed, the contraction repetition. In almost all cases the IZ location shift due to these factors did not exceed 4mm. Results generalization to other muscles should be made with caution.

A review of non-invasive techniques to detect and predict localised muscle fatigue

Muscle fatigue is an established area of research and various types of muscle fatigue have been investigated in order to fully understand the condition. This paper gives an overview of the various non-invasive techniques available for use in automated fatigue detection, such as mechanomyography, electromyography, near-infrared spectroscopy and ultrasound for both isometric and non-isometric contractions. Various signal analysis methods are compared by illustrating their applicability in real-time settings. This paper will be of interest to researchers who wish to select the most appropriate methodology for research on muscle fatigue detection or prediction, or for the development of devices that can be used in, e.g., sports scenarios to improve performance or prevent injury. To date, research on localised muscle fatigue focuses mainly on the clinical side. There is very little research carried out on the implementation of detecting/predicting fatigue using an autonomous system, although recent research on automating the process of localised muscle fatigue detection/prediction shows promising results.

Repeatability of surface EMG-based single parameter muscle fatigue assessment strategies in static and cyclic contractions

The repeatability of a spectral surface electromyography-based fatigue assessment strategy was evaluated. Variability of two fatigue-trend tracking parameters was used as an indicator for repeatability. The parameters were the natural logarithm of the slope of linear mean frequency decline lnMF(S) and the percent drop in mean frequency MF(D). The coefficient of variation CoV was used as the metric for repeatability, representing the ratio of the standard deviation to the mean of repeated measures from the same individual. Five weekly fatigue tests on the right biceps brachii were conducted on 11 participants with a fatiguing regime comprising of alternating static and cyclic segments, collecting seven channels of differential EMG. The resulting 95% confidence intervals of the CoV were: 15.38-24.87% (Static lnMF(S)), 12.21-23.36% (Cyclic lnMF(S)), 13.18-21.85% (Static MF(D)), and 12.37-24.39% (Cyclic MF(D)). There was no statistically significant difference in repeatability between any combination of parameter and types of motion.