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Aim There are ongoing discussions whether cesarean section is the safest mode of childbirth to prevent pelvic floor disorders. Pelvic floor electromyography (EMG) allows the analysis of external anal sphincter (EAS) function during voluntary contractions. The primary objective of this study was the evaluation of EMG amplitude of external anal sphincter in women who had vaginal delivery, compared to women who had cesarean section. The secondary objective was to evaluate the anal incontinence score changes before and after delivery between the groups, and to look for any relationship between the clinical and EMG findings. Methods Multichannel surface EMG was detected during maximal contractions in three sessions: (i) during pregnancy, (ii) 6 weeks after delivery and (iii) 1 year after delivery. Women were divided into two groups: cesarean section and vaginal delivery. Results External anal sphincter EMG amplitude decreases 6 weeks after vaginal deliveries from 10.1 to 8.6 μV with effect size of 0.4, but returns to baseline after 1 year. No differences were observed between groups in all other variables. Conclusion No differences were observed after 1 year in EMG activity between the two groups; however, a slight decrease of sphincter muscle amplitude was noted 6 weeks after vaginal delivery. The delivery mode does not have effect on the EAS amplitude 1 year after delivery. Incontinence score slightly increased in both groups after delivery, with no significant differences between the two groups. No association was observed between the increase of incontinence score and the decrease of EMG signal amplitude.

The purpose of the present study was to evaluate the Pearson correlations between hemodynamic parameters obtained with near infrared spectroscopy (NIRS), namely total hemoglobin (tHb) and tissue oxygen index (TOI %), as indicators of blood flow and oxygen extraction, and myoelectric parameters obtained with surface multichannel electromyography (sEMG), namely fractal dimension (FD) and conduction velocity (CV) slopes, as descriptors of central and peripheral fatigue, during sustained high level isometric contractions at 60% maximal voluntary contraction (MVC), in elderly subjects. Ten recreationally healthy elderly subjects (age 67.7 ± 4.6 years), 5 males and 5 females, performed one isometric contraction of the elbow flexors at 120° joint angle at 60% of MVC until exhaustion in two subsequent trials 1 week apart, one for the sEMG and the other one for NIRS recordings from the biceps brachii. A negative strong Pearson’s correlation between TOI % slope in the functional hyperemic phase (HP) of contraction and a positive correlation between the slope of TOI % recorded during the ischemic phase (IP) and the CV slope were found (r = − 0.76, P

Purpose In facioscapulohumeral muscular dystrophy (FSHD) fatigue is a major complaint. We aimed to investigate whether during isometric sustained elbow flexions, performance fatigability indexes differ in patients with FSHD with respect to healthy controls. Methods Seventeen patients with FSHD and seventeen healthy controls performed two isometric flexions of the dominant biceps brachii at 20% of their maximal voluntary contraction (MVC) for 2 min and then at 60% MVC until exhaustion. Muscle weakness was characterized as a percentage of predicted values. Maximal voluntary strength, endurance time and performance fatigability indices (mean frequency of the power spectrum (MNF), muscle fiber conduction velocity (CV) and fractal dimension (FD)), extracted from the surface electromyogram signal (sEMG) were compared between the two groups. Results In patients with FSHD, maximal voluntary strength was 68.7% of predicted value (p p r = 0.62) and lower levels of performance fatigability, characterized by reduced rate of changes in MNF (p r = 0.56), CV (p p r = 0.51) and increased endurance time (p r = 0.63), during the isometric contraction at 60% MVC. Conclusion A decreased reduction in the slopes of all the considered sEMG parameters during sustained isometric elbow flexions suggests that patients with FSHD experience lower levels of performance fatigability compared to healthy controls.

The relationship between fractal dimension of the surface electromyogram (sEMG) and the intensity of muscle contraction is still controversial in simulated and experimental conditions. To support the use of fractal analysis to investigate myoelectric fatigue, it is crucial to establish the interdependence between fractal dimension and muscle contraction intensity. We analyzed the behavior of fractal dimension, conduction velocity, mean frequency, and average rectified value in twenty-eight volunteers at nine levels of isometric force. sEMG was obtained using bidimensional arrays in the biceps brachii muscle. The values of fractal dimension and mean frequency increased with force unless a plateau was reached at 30% maximal voluntary contraction. Overall, our findings suggest that, above a certain level of force, the use of fractal dimension to evaluate the myoelectric manifestations of fatigue may be considered, regardless of muscle contraction intensity.

The central- and peripheral mechanisms by which heat strain limits physical performance are not fully elucidated. Nevertheless, pre-cooling is often used in an attempt to improve subsequent performance. This study compared the effects of pre-cooling vs. a pre-thermoneutral application on central- and peripheral fatigue during 60% of isometric maximum voluntary contraction (MVC) of the right quadriceps femoris muscle. Furthermore, the effects between a pre-cooling and a pre-thermoneutral application on isometric MVC of the right quadriceps femoris muscle and subjective ratings of perceived exertion (RPE) were investigated. In this randomized controlled trial, 18 healthy adults voluntarily participated. The participants received either a cold (experimental) application (+8 °C) or a thermoneutral (control) application (+32 °C) for 20 min on their right thigh (one cuff). After the application, central (fractal dimension – FD) and peripheral (muscle fiber conduction velocity – CV) fatigue was estimated using sEMG parameters during 60% of isometric MVC. Surface EMG signals were detected from the vastus medialis and lateralis using bidimensional arrays. Immediately after the submaximal contraction, isometric MVC and RPE were assessed. Participants receiving the cold application were able to maintain a 60% isometric MVC significantly longer when compared to the thermoneutral group (mean time: 78 vs. 46 s; p=0.04). The thermoneutral application had no significant impact on central fatigue (p>0.05) compared to the cold application (p=0.03). However, signs of peripheral fatigue were significantly higher in the cold group compared to the thermoneutral group (p=0.008). Pre-cooling had no effect on isometric MVC of the right quadriceps muscle and ratings of perceived exertion. Pre-cooling attenuated central fatigue and led to significantly longer submaximal contraction times compared to the pre-thermoneutral application. These findings support the use of pre-cooling procedures prior to submaximal exercises of the quadriceps muscle compared to pre-thermoneutral applications.

This study aimed to investigate the variation in muscle activity and movement in the lumbar and lumbothoracic region during a singular mono-planar lifting task, and how this is altered in individuals experiencing low back pain (LBP). Muscle activity from the lumbar and lumbothoracic erector spinae of 14 control and 11 LBP participants was recorded using four 13 × 5 high-density surface electromyography (HDEMG) grids. Root mean squared HDEMG signals were used to create spatial maps of the distribution of muscle activity. Three-dimensional kinematic data were recorded focusing on the relationship between lumbar and thoracic movements. In the task, participants lifted a 5 kg box from knee height to sternal height, and then returned the box to the starting position. The center of muscle activity for LBP participants was found to be systematically more cranial throughout the task compared to the control participants (P < 0.05). Participants with LBP also had lower signal entropy (P < 0.05) and lower absolute root mean squared values (P < 0.05). However, there were no differences between groups in kinematic variables, with no difference in contributions between lumbar and thoracic motion segments (P > 0.05). These results indicate that participants with LBP utilize an altered motor control strategy to complete a singular lifting task which is not reflected in their movement strategy. While no differences were identified between groups in the motion between lumbar and thoracic motion segments, participants with LBP utilized a less homogenous, less diffuse and more cranially focussed contraction of their erector spinae to complete the lifting movement. These results may have relevance for the persistence of LBP symptoms and the development of new treatments focussing on muscle retraining in LBP.

Objective. The aim of this study was to determine the test-retest reliability of muscle fiber conduction velocity (CV) and fractal dimension (FD) obtained from multichannel surface electromyographic (sEMG) recordings. Approach. Forty healthy recreationally active subjects (20 men and 20 women) performed two elbow flexions on two trials with a 1 week interval. The first was a 20% maximal voluntary contraction (MVC) of 120 s, and the second at 60% MVC held until exhaustion. sEMG signals were detected from the biceps brachii, using bi-dimensional arrays. Main results. Initial values and slope of CV and FD were used for the reliability analysis. The intraclass correlation coefficient (ICC) values for the isometric contraction at 20% MVC were (−0.09) and 0.67 for CV and FD respectively; whereas the ICC values at 60% MVC were 0.78 and 0.82 for CV and FD respectively. The Bland Altman plots for the two isometric contractions showed a mean difference close to zero, with no evident outliers between the repeated measurements: at 20% MVC 0.001 53 for FD and −0.0277 for CV, and at 60% MVC 0.006 66 for FD and 0.009 07 for CV. Significance. Overall, our findings suggest that during isometric fatiguing contractions, CV and FD slopes are reliable variables, with potential application in clinical populations.

AIM To apply topographical mapping of the electromyography (EMG) amplitude recorded from the upper trapezius muscle to evaluate the distribution of activity and the location of peak activity during a shoulder elevation task in participants with and without myofascial pain and myofascial trigger points (MTrP) and compare this location with the site of the MTrP. MATERIALS AND METHODS Thirteen participants with myofascial pain and MTrP in the upper trapezius muscle and 12 asymptomatic individuals participated. High-density surface EMG was recorded from the upper trapezius muscle using a matrix of 64 surface electrodes aligned with an anatomic landmark system (ALS). Each participant performed a shoulder elevation task consisting of a series of 30 s ramped contractions to 15% or 60% of their maximal voluntary contraction (MVC) force. Topographical maps of the EMG average rectified value were computed and the peak EMG amplitude during the ramped contractions was identified and its location determined with respect to the ALS. The location of the MTrP was also determined relative to the ALS and Spearman correlation coefficients were used to examine the relationship between MTrP and peak EMG amplitude location. RESULTS The location of the peak EMG amplitude was significantly (P

An increased fatigability associated with anterior cruciate ligament (ACL) injury may persist several months after surgery. The purpose of this study was to investigate the behavior of muscle fiber conduction velocity (CV) as a descriptor of myoelectric fatigue, at different stages after rehabilitation, post-ACL reconstruction. Nineteen subjects acted as control group (CG), 10 patients had undergone surgery within 12 months (R12), and 23 patients were more than 24 months post-surgery (R24+). Surface electromyography (EMG) signals were detected from the quadriceps femoris using bidimensional arrays during isometric contractions at 20% and 60% maximal voluntary contraction (MVC). We observed a lower fatigability in the R24+ group during the 60% MVC contraction, with respect to the other groups. Lower fatigability of quadriceps muscle after ACL reconstruction in the long term may be linked to a recovery from a transitory altered motor unit recruitment strategy due to surgery, observed in the R12 group. Therefore, the findings of this study do not suggest an impaired fatigability of the quadriceps muscle during sustained isometric contractions in active patients in the long term.

Shoulder complex control of motion is influenced by neuromuscular function and can be quantified through the analysis of helical axes (HAs) dispersion. Muscle fatigue is a variable able to influence neuromuscular control, altering muscle activation timing and proprioception. The aim of the study was to describe shoulder complex HAs dispersion after muscle fatigue during upper limb movements of young healthy subjects. Thirty healthy right-handed volunteers (age 23.2 ± 2.6 years) were asked to perform a test made up of 15 humerothoracic flexion and rotation movements using both upper limbs in two different recording sessions. After each session, muscles of the tested movement were fatigued in isometric condition at dominant side. After fatigue, subjects repeated the test. Kinematics was recorded by an optoelectronic system and HAs dispersion was computed using Mean Distance (MD) and Mean Angle (MA) for the entire Range of Motion (RoM) and in portions of RoM. After fatigue of shoulder flexion muscles, greater MD (p = 0.001) and MA (p = 0.019) were found on the dominant side. After fatigue of shoulder rotation muscles, greater MD and MA were found on the dominant (p = 0.002 for MD; p = 0.047 for MA) and non-dominant (p = 0.038 for MD; p = 0.019 for MA) sides. Independently of fatigue, greater MA was found in portions of RoM with higher external resistance torque in flexion and rotation tasks. Muscle fatigue increases shoulder complex HAs dispersion, probably due to alteration in neuromuscular control. This data should be considered when exercise involving upper arms are proposed to subjects undergoing fatigue.

Background: The purpose of this study was to investigate the acute effects of a single oral administration of an essential amino acids enriched mixture (EAA) on myoelectric descriptors of fatigue and maximal force production after a resistance exercise protocol (REP).Methods: Twenty adult males (age: 27 ± 6 years; body mass: 72.7 ± 7.50 kg; height: 1.76 ± 0.06 m) were enrolled in a double-blind crossover placebo-controlled study. Subjects were randomized to receive EAA mix (0.15 g/kg BM) or a placebo (PLA) in two successive trials 7 days apart. In both trials subjects completed a REP 2 h after the ingestion of the EAA mix or PLA. Before ingestion and after REP subjects performed isometric contractions of the dominant upper limb with the elbow joint at 120 degrees: (1) two maximal voluntary contractions (MVCs) for 2–3 s; (2) at 20% MVC for 90 s; (3) at 60% MVC until exhaustion. Mean values of MVC, conduction velocity initial values (CV), fractal dimension initial values (FD), their rates of change (CV slopes, FD slopes) and the Time to perform the Task (TtT) were obtained from a multichannel surface electromyography (sEMG) recording technique. Basal blood lactate (BL) and BL after REP were measured.Results: Following REP a significant decrease of MVC was observed in PLA (P < 0.05), while no statistical differences were found in EAA between pre-REP and post-REP. After REP, although a significant increase in BL was found in both groups (P < 0.0001) a higher BL Δ% was observed in PLA compared to EAA (P < 0.05). After REP, at 60% MVC a significant increase of CV rate of change (P < 0.05) was observed in PLA but not in EAA. At the same force level TtT was longer in EAA compared to PLA, with a significant TtT Δ% between groups (P < 0.001).Conclusion: Acute EAA enriched mix administration may prevent the loss of force-generating capacity during MVC following a REP. During isometric contraction at 60% MVC after REP the EAA mix may maintain CV rate of change values with a delay in the TtT failure.

The purpose of this study was to review the literature (1) to determine whether surface electromyography (sEMG) is a reliable tool for estimating muscle fiber conduction velocity (CV) and (2) to identify the experimental conditions that allow highly reliable CV estimation. A literature search was performed using PubMed and Web of Science databases using the terms "reproducibility", "reliability", "agreement", "surface electromyography" and "conduction velocity". Reporting quality was assessed using the "Guidelines for the Reporting of Reliability and Agreement Studies" checklist. Seventeen papers met the eligibility criteria. Test-retest, intrasession and intersession reliability were investigated in four, three and 12 studies, respectively. Although none of the studies satisfied all the relevant quality criteria, in fifteen studies, it was possible to locate an appropriate description for up to five items of the checklist. High reliability (intraclass correlation coefficient >0.69) was reported in eight studies and was, in general, associated with using the initial or mean CV value, using several electrodes (3 to 8), ensuring appropriate electrode positioning, and evaluating muscles with fibers that run parallel to the skin. Consequently, sEMG is suitable for use when investigating CV across multiple sessions in sport science, rehabilitation, physiological and clinical studies.

We read with interest the study by Bocardi et al.1 aimed to evaluate the impact of aging on female pelvic floor function (PFF). For this purpose, the authors assessed PFF in 70 healthy nulliparous ...

Objective: Fatigue experienced by people with multiple sclerosis (pwMS) is multidimensional, consisting of different components, such as perceived, physical and cognitive fatigue and performance fatigability. At present, there is no gold standard to assess performance fatigability in pwMS; therefore, we aimed to determine whether, during a fatiguing task, average rectified value (ARV), mean frequency of the power spectrum (MNF), muscle fiber conduction velocity (CV) and fractal dimension (FD) of surface electromyography (sEMG) may be used as indirect indices of performance fatigability. Moreover, we analyzed whether a three-week rehabilitation program impacts on performance fatigability in pwMS, and whether a relationship between sEMG parameters and trait levels of perceived fatigability, before and after rehabilitation, does exist. Approach: Twenty-one pwMS performed a 20% maximal voluntary contraction (MVC) of 1 min, and afterwards a 60% MVC held until exhaustion. sEMG signals were detected from the biceps brachii, vastus medialis and vastus lateralis. Performance fatigability was determined at entry to (t 0) and discharge from (t 1) rehabilitation. Perceived fatigability was measured at t 0 and t 2, one month after rehabilitation. Main results: ARV, MNF, CV and FD rates of change showed significant changes at t 0 and t 1 (p t 0 and t 2, were found. Significance: Our findings suggest that the sEMG parameters are useful for indirectly assessing performance fatigability in pwMS during sub-maximal fatiguing contractions, particularly in the biceps brachii.

A method to detect automatically the location of innervation zones (IZs) from 16-channel surface EMG (sEMG) recordings from the external anal sphincter (EAS) muscle is presented in order to guide episiotomy during child delivery. The new algorithm (2DCorr) is applied to individual motor unit action potential (MUAP) templates and is based on bidimensional cross correlation between the interpolated image of each MUAP template and two images obtained by flipping upside-down (around a horizontal axis) and left-right (around a vertical axis) the original one. The method was tested on 640 simulated MUAP templates of the sphincter muscle and compared with previously developed algorithms (Radon Transform, RT; Template Match, TM). Experimental signals were detected from the EAS of 150 subjects using an intra-anal probe with 16 equally spaced circumferential electrodes. The results of the three algorithms were compared with the actual IZ location (simulated signal) and with IZ location provided by visual analysis (VA) (experimental signals). For simulated signals, the inter quartile error range (IQR) between the estimated and the actual locations of the IZ was 0.20, 0.23, 0.42, and 2.32 interelectrode distances (IED) for the VA, 2DCorr, RT and TM methods respectively.

Although elbow extensors (EE) have a great role in cross-country skiing (XC) propulsion, previous studies on neuromuscular fatigue in long-distance XC have investigated only knee extensor (KE) muscles. In order to investigate the origin and effects of fatigue induced by long-distance XC race, 16 well-trained XC skiers were tested before and after a 56-km classical technique race. Maximal voluntary isometric contraction (MVC) and rate of force development (RFD) were measured for both KE and EE. Furthermore, electrically evoked double twitch during MVC and at rest were measured. MVC decreased more in KE (−13%) than in EE (−6%, P = 0.016), whereas the peak RFD decreased only in EE (−26%, P = 0.02) but not in KE. The two muscles showed similar decrease in voluntary activation (KE −5.0%, EE −4.8%, P = 0.61) and of double twitch amplitude (KE −5%, EE −6%, P = 0.44). A long-distance XC race differently affected the neuromuscular function of lower and upper limbs muscles. Specifically, although the strength loss was greater for lower limbs, the capacity to produce force in short time was more affected in the upper limbs. Nevertheless, both KE and EE showed central and peripheral fatigue, suggesting that the origins of the strength impairments were multifactorial for the two muscles.

Anatomical studies on the external anal sphincter (EAS) indicate that superficial muscle fibres are circular at low depth within the anal canal. A more complex geometry of the fibres is documented for increasing depth within the muscle and along the anal canal. Monopolar intra-anal EMG signals recorded using an array of electrodes placed in circular direction have no common mode components if the muscle fibres are circular, with constant depth within the muscle and parallel to the detection array. Thus, the presence of common mode signals may provide indications about the geometry of muscle fibres of EAS. Intra-anal EMG signals were recorded from EAS of 12 subjects using an anal probe carrying three circumferential arrays of 16 electrodes at three depths within the anal canal. Contribution of common mode components in single MUAPs was lower for MUs located superficially in the muscle (Pearson correlation coefficient: R=-0.75, p≪0.001) and at a lower depth within the anal canal (non-parametric one way Kruskal-Wallis ANOVA, Χ=17.3, p

Muscle fiber conduction velocity (CV) was estimated in 20 healthy subjects with a multichannel technique using a linear electrode array placed on the upper trapezius (UT) muscle during isometric voluntary contractions at 20% of the maximal voluntary effort. The array had 16 contacts spaced by 5mm and was centered in the middle of the line connecting C7 and the acromion. The effect of array displacement was investigated by shifting it either cranially or caudally by 1, 2 and 3cm. The effect of array misalignment was investigated by rotating it either clockwise or counterclockwise, by 10 degrees , 20 degrees and 30 degrees . The thickness of subcutaneous fat was measured by ultrasonic echography (range was 3-18mm). The average location of the innervation zone of the UT is in the middle of the line connecting C7 to the acromion, however, individual differences of up to 2cm were observed. The lateral side, near the acromion, should be preferred for electrode placement because of the thinner fat layer. The double differential (DD) montage should be preferred to the single differential (SD) electrode configuration. In this case, displacements of +/-1cm or misalignments of +/-10 degrees do not imply statistically significant bias in the estimate of CV. The same applies to amplitude and frequency variables estimated from the SD signals. CV estimates based on DD signals are lower because they are less affected by the thickness of the subcutaneous fat than estimates based on SD signals.

Purpose The purpose of the present study was to evaluate inter-arm and inter-gender differences in fractal dimension (FD) and conduction velocity (CV) obtained from multichannel surface electromyographic (sEMG) recordings during sustained fatiguing contractions of the biceps brachii. Methods A total of 20 recreationally active males (24±6 years) and 18 recreationally active females (22±9 years) performed two isometric contractions at 120 degrees elbow joint angle: (1) at 20% maximal voluntary contraction (MVC) for 90 s, and (2) at 60% MVC until exhaustion the time to perform the task has been measured. Signals from sEMG were detected from the biceps brachii using bidimensional arrays of 64 electrodes and initial values and rate of change of CV and FD of the sEMG signal were calculated. Results No difference between left and right sides and no statistically significant interaction effect of sides with gender were found for all parameters measured. A significant inter-gender difference was found for MVC (p0.05). During the sustained 60% MVC no statistical correlation was found between MVC and CV or FD initial estimates nor between MVC and CV or FD slopes both in males and females whereas. A significant positive correlation between CV and FD slopes was found in both genders (males: r = 0,61; females: r = 0,55). Conclusions Fatigue determines changes in FD and CV values in biceps brachii during sustained contractions at 60% MVC. In particular males show greater increase in the rate of change of CV and FD than females whereas no difference in percentage change of these sEMG descriptors of fatigue was found. A significant correlation between FD and CV slopes found in both genders highlights that central and peripheral myoelectric components of fatigue may interact during submaximal isometric contractions.

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.

Purpose The purpose of the study was the non-invasive investigation of the innervation zone (IZ) location of the gracilis muscle of both thighs by means of surface electromyography (EMG). Materials and methods Multichannel EMG signals were detected by means of a flexible array of 16 equally spaced silver bar electrodes. Tests were performed on both gracilis muscles on 15 subjects. Motor unit (MU) action potentials were visually identified and extracted. The locations of the IZs of the recognized MUs were statistically analyzed to find significant differences between the subjects and between the right and left muscle of each subject. Results and conclusions A statistically significant difference was found between the gracilis IZ position in the two sides, with more proximal IZs on the left side. This difference suggests a possible role of surface EMG in preoperative evaluation of patients prepared for the dynamic graciloplasty procedure. This test would provide an objective criterion for the choice of the gracilis muscle to be transposed with the highest probability of success.

Background and Purpose: This study aims to verify if amplitude and spectral characteristics of surface EMG signal are modified due to recording in a wet environment. Methods: Isometric contractions of the biceps brachii muscle of ten subjects were performed in several different set-up combinations, both in dry (D) and in water from hydrotherapy pools (PW), with (PWM) or without moving the pool water and with (T) or without water-resistant adhesive taping. Results: In PW condition the amplitude of the recorded signal is reduced to 5–10% of the corresponding signal recorded in D condition. In PWM the power spectrum is drastically reduced and altered by the water movement that introduces an increase of spectral power in the frequency range 0–20 Hz. The use of T modality allows to record signals with both amplitude and spectral frequencies comparable with those obtained in the D conditions. Discussion and Conclusion: This work demonstrates the need for water resistant taping when EMG signals are recorded in water. Signals recorded without such a protective film are strongly affected in their amplitude and frequency characteristics by the conductivity and the movement of water.

New recording techniques for detecting surface electromyographic (EMG) signals based on concentric-ring electrodes are proposed in this paper. A theoretical study of the two-dimensional (2-D) spatial transfer function of these recording systems is developed both in case of rings with a physical dimension and in case of line rings. Design criteria for the proposed systems are presented in relation to spatial selectivity. It is shown that, given the radii of the rings, the weights of the spatial filter can be selected in order to improve the rejection of low spatial frequencies, thus increasing spatial selectivity. The theoretical transfer functions of concentric systems are obtained and compared with those of other detection systems. Signals detected with the ring electrodes and with traditional one-dimensional and 2-D systems are compared. The concentric-ring systems show higher spatial selectivity with respect to the traditional detection systems and reduce the problem of electrode location since they are invariant to rotations. The results shown are very promising for the noninvasive detection of single motor unit (MU) activities and decomposition of the surface EMG signal into the constituent MU action potential trains.

Background. Myalgia frequently affects the upper trapezius muscle, and patients typically complain of dull pain and stiffness. Evidence suggests a correlation between repetitive movements, awkward posture, and the development of neck-shoulder muscle pain. However the mechanisms underlying these associations remain unclear. Purpose. To investigate the effect of experimentally induced upper trapezius muscle pain on the distribution of upper trapezius muscle activity during a repetitive task. It was hypothesized that pain would change the distribution of muscle activity resulting in activation of upper trapezius muscle regions which would not normally be active during the task. Methods. Ten healthy male (age: 26.2 ± 3.1 years) volunteers participated. Subjects lifted a 1 kg box between shelves positioned at hip and shoulder height with a cycle time of 3 s for 50 cycles. The task was repeated: 1. baseline, 2. following injection of 0.4 ml isotonic saline (0.9%) into the right upper trapezius muscle, 3. following injection of 0.4 ml hypertonic saline (5.8%) into the right upper trapezius muscle and 4. 15 mins after the last injection. Pain intensity ratings were obtained immediately following the injection and every 30 s until pain was no longer reported. Surface electromyography (EMG) was recorded from the upper trapezius muscle using a grid of 64 electrodes and 4 uniaxial accelerometers were mounted on the box to obtain the start and end points of the cyclic movement. The EMG root mean square (RMS) was computed for each location of the electrode grid to form a map of the EMG amplitude distribution.The following EMG variables were extracted from the RMS maps: mean RMS, entropy, and y- (cranial-caudal) and x-axis (medio-lateral) coordinates of the centroid of the RMS map. The EMG variables were then averaged across the 50 cycles for each epoch of the cycle. Results. Peak pain intensity was greater following the injection of hypertonic (4.7 ± 1.9/10) compared to isotonic saline (0.8 ± 1.1, P 0.05). Conclusions. The results indicate that nociceptive stimulation of the upper trapezius during a repetitive task changes the distribution of upper trapezius muscle activity and its amplitude. Implications. The described alterations of muscle activity may have an important role in the perpetuation of pain during repetitive activity.

A correlation exists between external anal sphincter (EAS) damage during birth and the subsequent development of fecal incontinence. This study evaluated the effect of delivery-related trauma on EAS innervation by means of intra-anal EMG performed with a rectal probe with 16 silver electrodes equally spaced along the circumference, before and after delivery. Pre-partum EMG measurements were performed on 511 women, by nine clinical partners from five European countries at the 28th to 34th gestational weeks and the 6th to 8th post-delivery weeks; 331 women returned, after delivery, for the second test. The innervation zones (IZ) of EAS single motor units were identified by means of an EMG decomposition algorithm. The subjects were divided into four groups according to the delivery mode (Caesarean, vaginal with no evident damage, spontaneous lacerations and episiotomies). The number of IZs before and after delivery was compared. In the 82 women who underwent right mediolateral episiotomy, a statistically significant reduction of IZs was observed, after delivery, in the right ventral quadrant of the EAS (side of the episiotomy). Women who had Caesarean section, spontaneous lacerations or lack of evident damage did not present any significant change in the innervation pattern. Right episiotomy reduces the number of IZs on the right-ventral side of the EAS. The fast and reliable test proposed indicates the sphincter innervation pattern before delivery and helps obstetricians to evaluate the risks and to choose the preferred side of the episiotomy, if deemed necessary at the time of delivery.

Locating the innervation zones (IZs) of the external anal sphincter (EAS) is helpful to obstetricians to identify areas particularly vulnerable to episiotomy in pregnant women. The aim was to investigate the motor unit (MU) properties of the EAS during voluntary contractions.Electromyographic signals were detected, from 478 pregnant women, by means of an intra-anal cylindrical probe carrying a circumferential array of 16 electrodes. The signals were decomposed into the constituent MU action potential trains and 5,947 templates were extracted and analyzed in order to identify the IZ position.MUs innervated at one end are concentrated in the dorsal portion of the sphincter, while MUs innervated in the middle are distributed symmetrically in the left and right portions of the EAS. The angular propagation velocity was estimated for each MU resulting in 260 ± 45 rad/s, corresponding to 1.8 m/s on the probe surface and to about 4 m/s at a radial depth of 10 mm from the probe surface.A novel method for identification and classification of MUs of the EAS is proposed and applied to a large-scale study. It is possible to distinguish MUs of the EAS in a minimally invasive way and identify their IZs. This information should be used to plan episiotomies and minimize risks of EAS denervation.

Background Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius. Methods We screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject’s trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants. Results No significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 ± 5.8 mm. Conclusions According to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.

This article is the second part of a larger review work that has been structured in three parts. The three parts concern a) advances in surface EMG detection and processing techniques, b) recent progress in surface EMG clinical research applications, and c) myoelectric control in neurorehabilitation. This second part concerns state of the art applications of surface EMG techniques to a) the external anal sphincter in relation to episiotomy and incontinence; b) the assessment of postural control mechanisms; c) exercise physiology, electrical stimulation and muscle cramps; and d) ergonomics and work-related neuromuscular disorders. The material is presented with an effort to fill gaps left by previous reviews and identify areas open for future research.

The study presents analytical, simulation, and experimental analyses of amplitude cancellation of motor-unit action potentials (APs) in the interference electromyogram (EMG) and its relation to the size of the spike-triggered average (STA) EMG. The amount of cancellation of motor-unit APs decreases monotonically as a function of the ratio between the root mean square (RMS) of the motor-unit AP and the RMS of the interference EMG signal. The theoretical derivation of this association indicates a method to measure cancellation in individual motor units by STA of the interference and squared EMGs. The theoretical relation was examined in both simulated EMG signals generated by populations of 200 motor units and experimental recordings of 492 and 184 motor-unit APs in the vastus medialis and abductor digiti minimi muscles, respectively. Although the theoretical relation predicted ( R2 = 0.95; P < 0.001) the amount of cancellation in the simulated EMGs, the presence of motor-unit synchronization decreased the strength of the association for small APs. The decrease in size of the STA obtained from the squared EMG relative to that extracted from the interference EMG was predicted by the experimental measure of cancellation ( R2 = 0.65; P < 0.001, for vastus medialis; R2 = 0.26; P < 0.05, for abductor digiti minimi). The results indicate that cancellation of APs in the interference EMG can be analytically predicted and experimentally measured with STA from the discharge times of the motor units into the surface EMG.

Two physiological factors are assumed in this paper to mainly determine the myoelectric manifestations of fatigue: (1) the decrease of the conduction velocity (CV) of motor unit action potentials (MUAP) (peripheral fatigue), and (2) the increase of MU synchronization by the central nervous system (central fatigue). To describe separately the peripheral and central components of the myoelectric manifestations of fatigue, we investigated the following indexes: (1) mean spectral frequency – MNF, (2) median spectral frequency – MDF, (3) root mean square – RMS, (4) average rectified value – ARV, (5) estimation of muscle fiber conduction velocity – ECV, (6) percentage of determinism – %DET, (7) spectral indexes defined as the ratio between signal spectral moments – FI k , (8) MNF estimated by autoregressive analysis – MNF AR , (9) MNF estimated by Choi–Williams time-frequency representation – MNF CWD , (10) MNF estimated by continuous wavelet transform – MNF CWT , (11) signal entropy – S, (12) fractal dimension – FD. The indexes were tested with a set of synthetic EMG signals, with different CV distribution and level of MU synchronization. The indexes were calculated on epochs of 0.5s. It was observed that ECV is uncorrelated with the level of simulated synchronization (promising index of peripheral fatigue). On the other hand FD was the index least affected by CV changes and most related to the level of synchronism (promising index of central fatigue). A representative application to some experimental signals from vastus lateralis muscle during an isometric endurance test supported the results of the simulations. The vector (ECV, FD) is suggested to provide selective indications of peripheral and central fatigue. The description of EMG fatigue by a bi-dimensional vector opens new perspectives in the assessment of muscle properties, with potential application in both clinical and sport sciences.

Purpose Over the past decade, linear and non-linear surface electromyography descriptors for central and peripheral components of fatigue have been developed. In the current study, we tested fractal dimension (FD) and conduction velocity (CV) as myoelectric descriptors of central and peripheral fatigue, respectively. To this aim, we analyzed FD and CV slopes during sustained fatiguing contractions of the quadriceps femoris in healthy humans. Methods A total of 29 recreationally active women (mean age±standard deviation: 24±4 years) and two female elite athletes (one power athlete, age 24 and one endurance athlete, age 30 years) performed two knee extensions: (1) at 20% maximal voluntary contraction (MVC) for 30 s, and (2) at 60% MVC held until exhaustion. Surface EMG signals were detected from the vastus lateralis and vastus medialis using bidimensional arrays. Results Central and peripheral fatigue were described as decreases in FD and CV, respectively. A positive correlation between FD and CV (R=0.51, p

The purpose of the study was the non invasive investigation of the innervation zone (IZ) location of the gracilis muscle of both thighs by means of surface electromyography (EMG). Multichannel EMG signals were detected by means of a flexible array of 16 equally spaced silver bar electrodes. Tests were performed on both gracilis muscles on 15 subjects. The locations of the innervation zones of the active MUs were automatically identified by means of an algorithm based on the Radon transform. A statistically significant difference was found between the gracilis IZ position in the two sides, with more proximal IZs on the left side. This difference suggests a possible role of sEMG in preoperative evaluation of patients prepared for the dynamic graciloplasty procedure. This test would provide an objective criterion for the choice of the gracilis muscle to be transposed with the highest probability of success

Purpose The purpose of the study was to demonstrate that anatomical features of individual motor units of the puborectalis muscle can be detected with non-invasive electromyography (EMG) and to evaluate differences in electrophysiological properties of the puborectalis muscles in a small group of healthy and pathologic subjects. Methods Multichannel EMG was recorded by means of a flexible probe applied on the gloved index finger and carrying an array of eight equally spaced (1.15 mm) electrodes. A multichannel EMG amplifier provided seven outputs corresponding to the pairs of adjacent electrodes. Tests were performed in three different positions (dorsal, left and right) over the puborectalis muscle on 20 subjects (nine healthy, seven constipated and four incontinent patients). Motor unit action potentials (MUAPs) generated at the innervation zone of a MU and propagating along the muscle fibers generated repetitive characteristic patterns on the seven output channels allowing identification of anatomical features of the motor units. Results MUAPs were observed travelling in either one or both directions with the array in dorsal position, and mainly in ventral-to-dorsal direction in either lateral position. MUAP amplitude was lower in constipated and incontinent patients with respect to healthy subjects. The conduction velocity estimated on the identified MUAPs was lower for constipated patients with respect to healthy subjects suggesting different mechanical properties of the active motor units. Conclusions This technique allows the extraction of relevant information about the anatomical features (innervation zone position and overlapping of motor unit branches) of the puborectalis muscle and its electrophysiological properties and maybe can be applied as an novel methodology for assessing the anorectal function in patients.

The aim of the study was to investigate amplitude and frequency content of single motor unit (MU) electromyographic (EMG) and mechanomyographic (MMG) responses. Multi-channel surface EMG and MMG signals were detected from the dominant biceps brachii muscle of 10 volunteers during isometric voluntary contractions at 20%, 50%, and 80% of the maximal voluntary contraction (MVC) force. Each contraction was performed three times in the experimental session which was repeated in three non-consecutive days. Single MU action potentials were identified from the surface EMG signals and their times of occurrence used to trigger the averaging of the MMG signal. At each contraction level, the MUs with action potentials of highest amplitude were identified. Single MU EMG and MMG amplitude and mean frequency were estimated with normalized standard error of the mean within subjects (due to repetition of the measure in different trials and experimental sessions) smaller than 15% and 7%, respectively, in all conditions. The amplitude of the action potentials of the detected MUs increased with increasing force (mean +/- SD, 244 +/- 116 microV at 20% MVC, and 1426 +/- 638 microV at 80% MVC; P < 0.001) while MU MMG amplitude increased from 20% to 50% MVC (40.5 +/- 20.9 and 150 +/- 88.4 mm/s(2), respectively; P

Background/Aims: This work focuses on recording, processing and interpretation of multichannel surface EMG detected from the external anal sphincter muscle. The aim is to describe the information that can be extracted from signals recorded with such a technique. Methods: The recording of many signals from different locations on a muscle allows the extraction of additional information on muscle physiology and anatomy with respect to that obtained by classic bipolar recordings. Multichannel EMG methods have been recently developed for the assessment of the external anal sphincter. An anal probe was used in this study to record signals at different depths within the anal canal during contractions at different effort levels. The plug is 150 mm in length and 14 mm in diameter, holding a circumferential array of 16 equally spaced silver bar electrodes, located at a distance of 20 mm from the probe tip and aligned with the probe axis. Results: Information about localization of the innervation zone, fiber length, EMG amplitude, muscle fiber conduction velocity and single motor unit analysis can be obtained from the signals recorded with the circumferential array by means of innovative signal processing techniques. Conclusions: The type of information extracted from multichannel surface EMG signals cannot be obtained with other currently available techniques. The technological innovation described in this work is promising for a further insight into the investigation of pelvic floor pathologies and rehabilitation treatments.

Objectives: Recent studies demonstrated that there is a significant correlation between anal sphincter damage during vaginal birth, with or without episiotomy, and subsequent development of anal incontinence in women. Mediolateral episiotomy is usually performed on the right side. Knowledge of the location of the innervation zones (IZs) could avoid to perform episiotomy in innervation regions: this could presumably reduce the incidence of sphincter damage and anal incontinence. The aim of the TASI-2 project was to evaluate the effect of delivery related trauma on the external anal sphincter (EAS) muscle with surface electromyography (EMG). Materials: Five hundred primiparae women participated to the study. Nine clinical partners from five European Countries (Germany, Italy, Latvia, Slovenia, Ukraine) were involved in this multicenter study coordinated by the Lab for Eng. of the Neuromuscular System (LISiN). EMG measurements were performed with a rectal probe including 16 silver electrodes spaced along the circumference. The measurements were performed at the 28th-34th gestational week and 6-8 weeks after delivery. 328 women concluded the experimental protocol. Methods: The subjects were asked to perform a maximal voluntary contraction (MVC) of the EAS for 10s. The innervation zones of single motor units were identified by means of a recently developed surface EMG decomposition algorithm. The know the site and the extension of episiotomy, gynaecologists involved in the study were asked to draw a picture of the episiotomy in a standard form. Results: All episiotomies were performed on right side, except three on the left and three in the midline. In women who underwent mediolateral right episiotomy (82 up to date), a statistically significant reduction of the number of IZs was observed, after delivery, in the right ventral quadrant, corresponding to the side of episiotomy, while women who had Caesarean section did not present any significant change in the innervation pattern. Conclusions: The results of the present study showed that pregnant women could have a fast and reliable clinical test which would provide indications about their sphincter innervation pattern. This information could help the obstetricians to choose which side would be preferable for performing episiotomy if this intervention will be deemed necessary at the time of delivery.

Many previous studies were focused on the influence of anatomical, physical, and detection-system parameters on recorded surface EMG signals. Most of them were conducted by simulations. Previous EMG models have been limited by simplifications which did not allow simulation of several aspects of the EMG generation and detection systems. We recently proposed a model for fast and accurate simulation of the surface EMG. It characterizes the volume conductor as a non-homogeneous and anisotropic medium, and allows simulation of EMG signals generated by finite-length fibers without approximation of the current-density source. The influence of thickness of the subcutaneous tissue layers, fiber inclination, fiber depth, electrode size and shape, spatial filter transfer function, interelectrode distance, length of the fibers on surface, single-fiber action-potential amplitude, frequency content, and estimated conduction velocity are investigated in this paper. Implications of the results on electrode positioning procedures, spatial filter design, and EMG signal interpretation are discussed.

The probability of sphincter damage and the prevalence of anal incontinence have been estimated in the literature in relation to episiotomy rates. Injury to the pudendal nerve from prior obstetric trauma is described as the principal risk factor in women (Wheeler et al. 2007). The current knowledge of the external anal sphincter (EAS) is limited to global strength indexes (manometry), to structural data (ultrasonography, MRI, and anatomical studies on cadavers) and to local electrophysiological properties. This work focuses on detection and interpretation of multichannel surface electromyography (sEMG) of the EAS. We investigated the relationship between sEMG parameters, manometric measurements and anatomical parameters measured with endoanal 3D ultrasound. The study was conducted on 32 female patients (Age:48.7±12yrs). A novel anal probe was used to record multichannel sEMG signals at different depths during maximal voluntary contractions. The probe holds three circumferential arrays of 16 equally spaced silver bar electrodes. Manometric measurements were performed on a subset of 29 patients. Endoanal 3D ultrasound images were detected on a subset of 18 patients. Information about innervation zone position, sEMG amplitude, and motor unit discharge rate was obtained with innovative signal processing techniques. Knowledge of innervation zone location could be valuable in performing episiotomy with minimal risk of EAS denervation. Negative correlation was observed between sEMG amplitude and the thickness of anal mucosa and internal sphincter with Pearson's linear correlation coefficient r=-0.48 (p