Abstract
Surface electromyography (sEMG) can be used to assess the integrity of the neuromuscular system and its impairment in neurological disorders. Here we will consider several issues related to the current clinical applications, difficulties and limited usage of sEMG for the assessment and rehabilitation of children with cerebral palsy. The uniqueness of this methodology is that it can determine hyperactivity or inactivity of selected muscles, which cannot be assessed by other methods. In addition, it can assist for intervention or muscle/tendon surgery acts, and it can evaluate integrated functioning of the nervous system based on multi-muscle sEMG recordings and assess motor pool activation. The latter aspect is especially important for understanding impairments of the mechanisms of neural controllers rather than malfunction of individual muscles. Although sEMG study is an important tool in both clinical research and neurorehabilitation, the results of a survey on the clinical relevance of sEMG in a typical department of pediatric rehabilitation highlighted its limited clinical usage. We believe that this is due to limited knowledge of the sEMG and its neuromuscular underpinnings by many physiotherapists, as a result of lack of emphasis on this important methodology in the courses taught in physical therapy schools. The lack of reference databases or benchmarking software for sEMG analysis may also contribute to the limited clinical usage. Despite the existence of educational and technical barriers to a widespread use of, sEMG does provide important tools for planning and assessment of rehabilitation treatments for children with cerebral palsy.
Highlights
Cerebral palsy (CP) is the most common form of motor disability in childhood
Since the discovery of Surface electromyography (sEMG) in 1912, myoelectric activity measurements provided many examples of normal and pathological skeletal muscle function, improved our knowledge about the neural control of movement and contributed to the development of clinical applications [43]. sEMG registers the electrical potential at the surface of the skin associated with the summation of multiple action potentials of individual muscle fibers during their contraction and provides a direct measure of muscle contraction/relaxation activity controlled by the nervous system
We aimed at examining these barriers by gathering information from the clinicians involved in pediatric rehabilitation to generate opinion on the current use of sEMG and its clinical utility
Summary
Cerebral palsy (CP) is the most common form of motor disability in childhood. It describes a group of permanent disorders of movement and posture, caused by disturbances in the fetal or infant brain [1]. The clinical manifestations of CP vary greatly in the type of movement disorder and the degree of functional disability It is often characterized by impaired coordination, muscle weakness, spasticity, hyperreflexia, hypertonia, clonus, spasms and co-contraction [2, 3]. Some performance indicators, factors and processing methods, such as the determination of the onset/offset of sEMG bursts or amplitude normalization [43], require attention and agreement between the users, and in particular, the interpretation of sEMG signals with respect to muscular coordination requires some caution [51]. For this reason, to support the interpretation of sEMG signals, different signal processing methodologies were developed [52]
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