The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: A scoping review.

• Surface electromyography (sEMG) is used to explore promising neurorehabilitation strategies in spinal cord injury (SCI) by the assessment of spontaneous muscle activity and/or volitional effort – including patterns of multi-muscle activation. • There is a limited use of sEMG in clinical trials and day-to-day clinical routines. • The barriers to the use of sEMG in more clinical studies focused on SCI include normatization, cultural, educational, technical, and economic/administrative aspects. Surface electromyography (sEMG) is a common electrophysiological assessment used in clinical trials in individuals with spinal cord injury (SCI). This scoping review summarizes the most common sEMG techniques used to address clinically relevant neurorehabilitation questions. We focused on the role of sEMG assessments in the clinical practice and research studies on neurorehabilitation after SCI, and how sEMG reflects the changes observed with rehabilitation. Additionally, this review emphasizes the limitations and pitfalls of the sEMG assessments in the field of neurorehabilitation after SCI. A comprehensive search of Medline (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Emcare, Cumulative Index to Nursing & Allied Health Literature, and PubMed was conducted to find peer-reviewed journal articles that included individuals post-SCI that participated in neurorehabilitation interventions using sEMG assessments. This is a scoping review using a systematic search (hybrid review). Of 4522 references captured in the primary database searches, 100 references were selected and included in the scoping review. The main focus of the studies was on neurorehabilitation using sEMG biofeedback, brain stimulation, locomotor training, neuromuscular electrical stimulation (NMES), paired-pulse stimulation, pharmacology, posture and balance training, spinal cord stimulation, upper limb training, vibration, and photobiomodulation. Most studies employed sEMG amplitude to understand the effects of neurorehabilitation on muscle activation during volitional efforts or reduction of spontaneous muscle activity (e.g., spasms, spasticity, and hypertonia). Further studies are needed to understand the long-term reliability of sEMG amplitude, to circumvent normalization issues, and to provide a deeper physiological background to the different sEMG analyses. This scoping review reveals the potential of sEMG in exploring promising neurorehabilitation strategies following SCI and discusses the barriers limiting its widespread use in the clinic. [ABSTRACT FROM AUTHOR]