EMG Threshold Research Articles

P96 Surface electromyography thresholds as a measure for performance fatigability during incremental cycling in patients with neuromuscular disorders

P96 Surface electromyography thresholds as a measure for performance fatigability during incremental cycling in patients with neuromuscular disorders

ID: 214525 Utilizing intraoperative EMG and Post-Operative Paresthesia Thresholds to Quantify Post-Synaptic Excitability Following Burst SCS

Burst spinal cord stimulation (SCS) has demonstrated superior relief from overall pain and a reduction in back and leg pain compared to traditional tonic neurostimulation therapies. However, nearly 80% of patients have 2 or more non-contiguous pain areas. This can affect the ability to effectively program stimulation and the long-term efficacy of therapy. Multiple BurstDR region programming is a new option to treat multi-site pain by interleaving stimulation at multiple areas along the spinal cord. Prior intraoperative studies have shown that BurstDR stimulation provides broader myotomal coverage at a lower recruitment threshold. The overall goal of this study is to use changes in intraoperative EMG threshold and post-operative paresthesia thresholds to optimize burst stimulation programming.

Electromyographic signals and the starting threshold voltage of orbicularis oris muscle in healthy rhesus monkeys

Objective: To investigate the characteristics of electromyography (EMG) signals and the starting threshold voltages of the orbicularis oris muscles (OOM) in healthy rhesus monkeys under different muscle movement conditions. Methods: The EMG signals and the starting threshold voltages at different time points in 4 healthy rhesus monkeys were acquired and recorded with EMG device and evoked potentiometer. The voltage amplitude variation of EMG signals was analyzed, and the voltage amplitude range of EMG signals at the beginning of OOM contraction was established. The data were statistically analyzed by one-way ANOVA. Results: The EMG of OOM in healthy monkeys in the quiet, natural and continuous mouth-closed state was linear and relatively stable, and the absolute value fluctuated between 15 and 50 μV. The EMG waveform increased rapidly during the natural lip contraction movement, and its amplitude fluctuated greatly, with the highest absolute value of the peak value reaching hundreds of microvolts. The amplitude of EMG induced by continuous mouth closure was more than thousands of microvolts. There was no significant difference in EMG amplitudes of OOM in the healthy rhesus monkey under quiet and continuous lip closure at different time points (P>0.05). There was no significant difference in threshold voltages in the state of natural lip contraction of bilateral OOM at different time points (average range: 57.17-57.47 μV) in the healthy rhesus monkeys (P>0.05). There was no significant difference in threshold voltages of OOM induced by bilateral OOM at different time points(average range: 55.38-55.99 μV) in the healthy rhesus monkeys(P>0.05). There were significant differences in the absolute values of EMG amplitudes of OOM between the three lip movement modes: (30.67±8.72) μV in quiet and natural continuous lip closure (475.12±54.72) μV in natural lip contraction, and (921.22±312.79) μV in the induced persistent lip closure, with t values of -8.48, -9.35 and -5.01 respectively, all P<0.001. Conclusions: The EMG signals of OOM show different characteristics under different muscle movement conditions, which can be used as a basis for computer to judge and recognize the movement conditions of OOM. The upper limits of the EMG threshold voltage values of OOM under different motion states are 55-60 μV.

Robotic-assisted spine surgery allows for increased pedicle screw sizes while still improving safety as indicated by elevated triggered electromyographic thresholds

The present study used triggered electromyographic (EMG) testing as a tool to determine the safety of pedicle screw placement. In this Institutional Review Board exempt review, data from 151 consecutive patients (100 robotic; 51 non-robotic) who had undergone instrumented spinal fusion surgery of the thoracic, lumbar, or sacral regions were analyzed. The sizes of implanted pedicle screws and EMG threshold data were compared between screws that were placed immediately before and after adoption of the robotic technique. The robotic group had significantly larger screws inserted that were wider (7 ± 0.7 vs 6.5 ± 0.3 mm; p < 0.001) and longer (47.8 ± 6.4 vs 45.7 ± 4.3 mm; p < 0.001). The robotic group also had significantly higher stimulation thresholds (34.0 ± 11.9 vs 30.2 ± 9.8 mA; p = 0.002) of the inserted screws. The robotic group stayed in the hospital postoperatively for fewer days (2.3 ± 1.2 vs 2.9 ± 2 days; p = 0.04), but had longer surgery times (174 ± 37.8 vs 146 ± 41.5 min; p < 0.001). This study demonstrated that the use of navigated, robot-assisted surgery allowed for placement of larger pedicle screws without compromising safety, as determined by pedicle screw stimulation thresholds. Future studies should investigate whether these effects become even stronger in a later cohort after surgeons have more experience with the robotic technique. It should also be evaluated whether the larger screw sizes allowed by the robotic technology actually translate into improved long-term clinical outcomes.

Outpatient outcomes of patients with femoral nerve neurapraxia after prone lateral lumbar interbody fusion at L4-5.

Single-position prone lateral lumbar interbody fusion (LLIF) improves the efficiency of staged minimally invasive lumbar spine surgery. However, laterally approaching the lumbar spine, especially L4-5 with the patient in the prone position, could increase the risk of complications and presents unique challenges, including difficult ergonomics, psoas migration, and management of the nearby lumbar plexus. The authors sought to identify postoperative femoral neurapraxia after single-position prone LLIF at L4-5 to better understand how symptoms evolve over time. This retrospective analysis examined a prospectively maintained database of LLIF patients who were treated by two surgeons (J.S.U. and J.D.T.). Patients who underwent single-position prone LLIF at L4-5 and percutaneous pedicle screw fixation for lumbar stenosis or spondylolisthesis were included if they had at least 6 weeks of follow-up. Outpatient postoperative neurological symptoms were analyzed at 6-week, 3-month, and 6-month follow-up evaluations. Twenty-nine patients (16 women [55%]; overall mean ± SD age 62 ± 11 years) met the inclusion criteria. Five patients (17%) experienced complications, including 1 (3%) who had a femoral nerve injury with resultant motor weakness. The mean ± SD transpsoas retractor time was 14.6 ± 6.1 minutes, the directional anterior electromyography (EMG) threshold before retractor placement was 20.1 ± 10.2 mA, and the directional posterior EMG threshold was 10.4 ± 9.1 mA. All patients had 6-week clinical follow-up evaluations. Ten patients (34%) reported thigh pain or weakness at their 6-week follow-up appointment, compared with 3/27 (11%) at 3 months and 1/20 (5%) at 6 months. No association was found between directional EMG threshold and neurapraxia, but longer transpsoas retractor time at L4-5 was significantly associated with femoral neurapraxia at 6-week follow-up (p = 0.02). The only case of femoral nerve injury with motor weakness developed in a patient with a retractor time that was nearly twice as long as the mean time (27.0 vs 14.6 minutes); however, this patient fully recovered by the 3-month follow-up evaluation. To our knowledge, this is the largest study with the longest follow-up duration to date after single-position prone LLIF at L4-5 with percutaneous pedicle screw fixation. Although 34% of patients reported ipsilateral sensory symptoms in the thigh at the 6-week follow-up evaluation, only 1 patient sustained a nerve injury; this resulted in temporary weakness that resolved by the 3-month follow-up evaluation. Thus, longer transpsoas retractor time at L4-5 during prone LLIF is associated with increased ipsilateral thigh symptoms at 6-week follow-up that may resolve over time.

Surface Electromyography Thresholds as a Measure for Performance Fatigability During Incremental Cycling in Patients With Neuromuscular Disorders.

In healthy persons, there is an excellent relation between the timing of the (two) surface electromyography (sEMG) thresholds and the (two) ventilatory thresholds during exercise. The primary aim of this study was to determine the relative timing of both sEMG and ventilatory thresholds in patients with neuromuscular disorders compared with healthy subjects during a maximal ergospirometry cycling test. We hypothesized that in patients with neuromuscular disorders, the sEMG thresholds would occur relatively earlier in time than the ventilatory thresholds, compared to healthy subjects, because performance fatigability occurs more rapidly. In total, 24 healthy controls and 32 patients with a neuromuscular disorder performed a cardiopulmonary exercise test on a bicycle using a 10-min ramp protocol, during which we collected ergospirometry data: power at both ventilatory and sEMG thresholds, and sEMG data of lower leg muscles. In line with our hypothesis, normalized values for all thresholds were lower for patients than healthy subjects. These differences were significant for the first ventilatory (p = 0.008) and sEMG threshold (p < 0.001) but not for the second sEMG (p = 0.053) and ventilatory threshold (p = 0.238). Most parameters for test–retest reliability of all thresholds did not show any fixed bias, except for the second ventilatory threshold. The feasibility of the sEMG thresholds was lower than the ventilatory thresholds, particularly of the first sEMG threshold. As expected, the sEMG thresholds, particularly the first threshold, occurred relatively earlier in time than the ventilatory thresholds in patients compared with healthy subjects. A possible explanation could be (a combination of) a difference in fiber type composition, disuse, and limited muscle-specific force in patients with neuromuscular disorders. sEMG measurements during submaximal dynamic exercises are needed to generalize the measurements to daily life activities for future use in prescribing and evaluating rehabilitation interventions.

Electromyographic and Systemic Physiological Thresholds in Single-Joint Elbow Flexion Movements.

Reported relationships between electromyographic (EMG) thresholds and systemic thresholds based on lactate, ventilation, or heart rate are contradictory. This might be related to the complexity of the investigated whole-body movements involving many muscles with different activation patterns. Therefore, the aim of the study was to investigate these relationships during an incremental single-joint exercise. Eighteen male subjects (29.7 [4.4]y) performed single-arm elbow flexions on a biceps curl machine with loads increasing every minute until exhaustion. EMG signals of the main elbow flexors (short and long head of the biceps brachii, flexor carpi radialis, and brachioradialis) as well as gas exchange variables, blood lactate concentration, and heart rate were measured, and 2 turn points based on a 3-phase model of metabolism were determined for each variable. The first and second turn points for EMG were determined at 32.0% to 33.1% and 64.4% to 66.5% of maximal achieved performance (maximum weight), respectively. Systemic turn points were determined at 33.3% to 34.4% and 65.9% to 66.7% of maximum weight and were not significantly different from EMG turn points. Furthermore, systemic and EMG turn points showed a strong or very strong relationship at the first (ρ = .54-.93, P < .05) and second turn point (ρ = .76-.93, P < .01). A close relationship between EMG and systemic turn points could be confirmed for the applied movement of a small muscle group. The determination of local single muscle thresholds using EMG provides additional muscle-specific information about performance-limiting properties of muscles involved in endurance-type incremental exercise.

Electromyographic assessment of condylar screw placement during occipitocervical fusion.

This is a retrospective study of a series of occipitocervical fusion procedures with condylar screw fixation in which the authors investigated the utility of electromyography (EMG, free-running and triggered) as a reliable tool in assessing the positioning of condylar screws. This series consisted of 197 patients between 15 and 60 years of age who presented with craniocervical instability, and who were treated between October 2014 and December 2017. Intraoperative free-running EMG was observed at the placement of condylar screws, as well as at realigning of the spine. After placement the condylar screws were stimulated electrically, and the thresholds were recorded. CT scans were obtained intraoperatively soon after screw stimulation, and the results were analyzed by the surgeon in real time. Free-running EMG results and triggered EMG thresholds were tabulated, and the minimum acceptable threshold was established. Intraoperative free-running EMG and triggered EMG were able to correlate alerts with condylar screw placement accurately. A triggered EMG threshold of 2.7 mA was found to be a minimum acceptable threshold. A combination criterion of free-running EMG and triggered EMG alerts was found to enable accurate assessment of condylar screw positioning and placement. Intraoperative free-running EMG and triggered EMG were both found to be invaluable utilities in assessing the placement and positioning of condylar screws. Stimulation thresholds below 2.7 mA correlated with a superior or anterior condylar breach. Thresholds in the 2.7-mA to 9.0-mA range were generally acceptable but warranted additional inspection by the surgeon. Threshold values above 9.0 mA corresponded with solid condylar screw placement.

A Prospective Multicenter Case Series Utilizing Intraoperative Neuromonitoring With Evoked Compound Action Potentials to Confirm Spinal Cord Stimulation Lead Placement

ObjectivesThe use of intraoperative neuromonitoring (IONM) has been adapted to address issues of safety and proper lead positioning in spinal cord stimulation. This multicenter case series seeks to incorporate the use of evoked compound action potential (ECAP) and late response (LR) recording and compare it with the results obtained with IONM, specifically electromyography (EMG), for the confirmation of lead placement. This study aimed to establish a correlation between ECAPs, LR, and EMG and publish human recordings of ECAPs and LR during their use with IONM. Materials and MethodsStandard neuromonitoring protocols were followed at two institutions, with two separate physicians and with seven patients, as part of a larger ongoing study registered with ClinicalTrials.gov (NCT02924129). Stimulation and recording were performed, top and bottom, on each percutaneous lead. Stimulation amplitude was increased considering ECAP, LR, and EMG thresholds. ResultsECAPs, LRs, and EMG signals were observed in all patients. The onset of LR signals on implanted electrodes and EMG signal on subdermal electrodes was well correlated (rs = 0.94, p < 0.001), with a median LR:EMG value of 1.06 (N = 21). LR:EMG for the top (mean = 0.97, N = 8) vs bottom (mean = 1.15, N = 13) of the lead was compared using a paired Wilcoxon signed rank test and an independent samples Mann-Whitney test, revealing a marginally significant and a statistically significant difference (p = 0.078 and p = 0.015, respectively). Mean LR:ECAP was >2 in all locations and approximately 3.5 overall. LR:ECAP between the top and bottom of the lead was significantly different (Wilcoxon test, p < 0.01, N = 12). ConclusionsLR correlated with EMG; leads with bilateral (not necessarily symmetric) EMG activity showed LR:ECAP > 1.5. An LR:ECAP of <1, with LR/EMG generated before the ECAP, indicated that the lead is too lateral. The use of ECAP and LR has the potential of maintaining objective lead placement, without the need for needle placement with IONM.

Do the triggered EMG thresholds for pedicle screws vary depending on the time elapsed after screw placement?

Do the triggered EMG thresholds for pedicle screws vary depending on the time elapsed after screw placement?

Features of electromyography threshold of the respiratory muscles during incremental exercise test

In this study, we aimed to examine the electromyography threshold (EMGT) of the respiratory muscle and accessory respiratory muscles. Sixteen healthy men underwent an incremental exercise test at 15 W/minute to the end point. Expired gases and electromyograms of the respiratory and lower limb muscles were measured. The breakpoints for the EMG and expired gas data were analyzed using a segmented regression model. EMGT of the sternocleidomastoid and diaphragm was significantly more delayed than the ventilation threshold (VT) (287.94 s, 288.15 s vs. 185.5 s, p = 0.028 and 0.044, respectively). The EMGT of respiratory muscles and VT were not related, though EMGT of rectus femoris and vastus lateralis correlated with VT (r = 0.854, p < 0.001; r = 0.657, p = 0.011, respectively). EMGT of respiratory muscles may be influenced by multiple factors, such as central command and afferent input of mechanical stimulation from muscles, in addition to VT-induced changes in metabolic dynamics.

Selective Facial Muscle Activation with Acute and Chronic Multichannel Cuff Electrode Implantation in a Feline Model.

Facial paralysis is a debilitating condition with substantial functional and psychological consequences. This feline-model study evaluates whether facial muscles can be selectively activated in acute and chronic implantation of 16-channel multichannel cuff electrodes (MCE). Two cats underwent acute terminal MCE implantation experiments, 2 underwent chronic MCE implantation in uninjured facial nerves (FN) and tested for 6 months, and 2 underwent chronic MCE implantation experiments after FN transection injury and tested for 3 months. The MCE were wrapped around the main trunk of the skeletonized FN, and data collection consisted of EMG thresholds, amplitudes, and selectivity of muscle activation. In acute experimentation, activation of specific channels (ie, channels 1-3 and 6-8) resulted in selective activation of orbicularis oculi, whereas activation of other channels (ie, channels 4, 5, or 8) led to selective activation of levator auris longus with higher EMG amplitudes. MCE implantation yielded stable and selective facial muscle activation EMG thresholds and amplitudes up to a 5-month period. Modest selective muscle activation was furthermore obtained after a complete transection-reapproximating nerve injury after a 3-month recovery period and implantation reoperation. Chronic implantation of MCE did not lead to fibrosis on histology. Field steering was achieved to activate distinct facial muscles by sending simultaneous subthreshold currents to multiple channels, thus theoretically protecting against nerve damage from chronic electrical stimulation. Our proof-of-concept results show the ability of an MCE, supplemented with field steering, to provide a degree of selective facial muscle stimulation in a feline model, even following nerve regeneration after FN injury. N/A.

Triggered Electromyography is a Useful Intraoperative Adjunct to Predict Postoperative Neurological Deficit Following Lumbar Pedicle Screw Instrumentation

Study Design:Systematic review and meta-analysis.Objectives:Malposition of pedicle screws during instrumentation in the lumbar spine is associated with complications secondary to spinal cord or nerve root injury. Intraoperative triggered electromyographic monitoring (t-EMG) may be used during instrumentation for early detection of malposition. The association between lumbar pedicle screws stimulated at low EMG thresholds and postoperative neurological deficits, however, remains unknown. The purpose of this study is to assess whether a low threshold t-EMG response to lumbar pedicle screw stimulation can serve as a predictive tool for postoperative neurological deficit.Methods:The present study is a meta-analysis of the literature from PubMed, Web of Science, and Embase identifying prospective/retrospective studies with outcomes of patients who underwent lumbar spinal fusion with t-EMG testing.Results:The total study cohort consisted of 2,236 patients and the total postoperative neurological deficit rate was 3.04%. 10.78% of the patients incurred at least 1 pedicle screw that was stimulated below the respective EMG alarm threshold intraoperatively. The incidence of postoperative neurological deficits in patients with a lumbar pedicle screw stimulated below EMG alarm threshold during placement was 13.28%, while only 1.80% in the patients without. The pooled DOR was 10.14. Sensitivity was 49% while specificity was 88%.Conclusions:Electrically activated lumbar pedicle screws resulting in low t-EMG alarm thresholds are highly specific but weakly sensitive for new postoperative neurological deficits. Patients with new postoperative neurological deficits after lumbar spine surgery were 10 times more likely to have had a lumbar pedicle screw stimulated at a low EMG threshold.

A Novel sEMG Triggered FES-Hybrid Robotic Lower Limb Rehabilitation System for Stroke Patients

Stroke is a leading cause of acquired disability among adults. Current rehabilitation programs result in only partial recovery of motor ability for the patients, which has resulted in an ongoing search for methods to improve the rehabilitation approaches. Therefore, this study presents a novel method for early onset of active rehabilitation by combining an end effector robot with surface electromyography (sEMG) triggered functional electrical stimulation (FES) of rectus femoris and tibialis anterior muscles. This rehabilitation system was demonstrated in 10 able-bodied experimental participants. Defining a successful exercise repetition as a fully completed exercise, from start point to end point followed by a return to start point, when FES onset is triggered by the EMG threshold, the results showed that 97% of the exercise repetitions were successful for a leg press exercise and 100% for a dorsiflexion exercise. Furthermore, an FES stimulation current amplitude of 20–53 mA was required for the leg press exercise and 10–30 mA for the dorsiflexion exercise. The resulting generated force was in the range of 43.0-141.2 [N] for the leg press exercise and 5.4-17.6 [N] for dorsiflexion.

Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

BackgroundTo investigate in the conventional techniques of the pedicle screws using triggered screw electromyography (t-EMG), considering different threshold cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during surgery of the adolescent with idiopathic scoliosis (AIS).MethodsSixteen patients (4 males, 12 females, average age 16.6 years) were included, with an average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG considering different threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for predicting screw positions ARNI was investigated.ResultsThe EMG exam accuracy, in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was associated with a 12% increase in the odds of the screw position ARNI. In the axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a threshold cutoff of 25 mA. The PPV was always slightly higher for predicting screws ARNI in the sagittal plane than in the axial plane. In contrast, there was a moderate to high NPV (78–93%) for every cutoff analyzed.ConclusionsEMG had a moderate to high accuracy for positive predicting value screws ARNI with increase threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for minimizing false-negative screws ARNI in the different threshold cutoffs of the EMG in adolescent with idiopathic scoliosis (AIS).

VO2 Steady State at and Just Above Maximum Lactate Steady State Intensity.

Over recent decades the association between metabolic and gas exchange parameters during exercise has become evident. Different "thresholds" (such as lactate thresholds, critical power, EMG thresholds) and intensity domains appear to be linked to an upper limit of oxygen uptake steady state (V̇O2SS). The aim of this study was to investigate whether MLSS is associated with the upper limit for a V̇O2SS. Forty-five subjects underwent one incremental test and 4-6 30-minute MLSS tests on a cycle ergometer. A three-component model was used to describe V̇O2 response at PMLSS and just above PMLSS+1. To evaluate the results, breath-by-breath V̇O2 and lactate (LA) values were analyzed using the intraclass correlation coefficient (ICC), increasing (k-) values and the Wilcoxon test. According to the calculated k-values of LA and VO2 at PMLSS and PMLSS+1, no significant increase of VO2 occurred during both intensities (PMLSS and PMLSS+1) from minute 10 to minute 30, confirming the existence of a V̇O2SS. Additionally, the ICC of 0.94 confirmed high accordance of the VO2 kinetics at both intensities (PMLSS and PMLSS+1). This study shows that power output at MLSS workload does not represent an accurate cut for an upper limit of V̇O2SS.

Isometric-based test improves EMG-threshold determination in boys vs. men.

Children have been hypothesized to utilize higher-threshold (type-II) motor units (MUs) to a lesser extent than adults. Two recent studies, using a cycling-based EMG-threshold (EMGTh) protocol, supported the hypothesis, showing children's EMGTh intensities to be higher than adults'. Conclusions, however, were hampered by children's low EMGTh detection rates. Insufficiently high contractile forces at exhaustion were postulated as the reason for non-detection, predominantly in children. An intermittent isometric contraction test (IICT) protocol facilitates higher contractile forces prior to exhaustion and was shown effective in EMGTh testing of adults. Determine whether an IICT protocol would enhance EMGTh detection in children, and consequently increase the magnitude of the previously observed child-adult EMGTh differences. 18 boys and 21 men completed one-repetition-maximum (1RM) isometric knee-extension test. The IICT protocol followed, commencing at 25%1RM and comprising five isometric contractions per load, incremented by ~ 3%1RM to exhaustion. Vastus lateralis surface EMG was recorded and EMGTh, expressed as %1RM, was defined as the onset of the EMG-response's steeper segment. EMGTh was detected in 88.9% of boys and 95.2% of men, and occurred at higher relative intensities in boys (56.4 ± 9.2%1RM) than in men (46.0 ± 6.8%1RM). This 10.4% difference was 57% greater than the corresponding, previously reported cycling-based age-related difference. With the boys' detection rate nearly on par with the men's, the IICT protocol appears to overcome much of the intensity limitation of cycling-based protocols and provide a more sensitive EMGTh detection tool, thus extending the previously observed boys‒men difference. This difference adds supports to the notion of children's more limited type-II MU recruitment capacity.

Stimulating and dissecting instrument for transoral endoscopic thyroidectomy: proof of concept investigation.

Intraoperative neuromonitoring (IONM) is a useful adjunct for recurrent laryngeal nerve (RLN) mapping and identification in transoral endoscopic thyroidectomy vestibular approach (TOETVA). This experimental study aimed to investigate the feasibility, safety, thresholds required of an endoscopic forceps that combine the function of surgical dissection and nerve stimulation. Prospective experimental research. TOETVA was performed in 12 piglets, i.e., 24 RLNs and 24 vagal nerves (VN). RLNs electromyography (EMG) was recorded via endotracheal surface electrodes. Baseline EMG of VN and RLN were recorded and compared by (a) percutaneously placed monopolar stimulator probe (Group I), (b) adapted Maryland endoscopic dissector applied on nerves at its tip-end (Group II) and (c) endoscopic dissector tip-lateral applied (Group III). EMG profiles, amplitude, latency, waveform, thresholds and supra-maximal stimulation (5mA) were analyzed. Application of the endoscopic device was feasible in all TOETVA and did not result in any morbidity. 24 RLNs and VNs were detected, stimulated and monitored. With increase of stimulation current, the amplitude of EMG increased, showing a dose-response curve. Mean VN stimulation thresholds were: Group I 0.28mA, Group II 0.56mA, Group III 0.58mA (P1 = 0.00, P2 = 0.00, P3 = 0.11). Minimal current to evoked a maximal VN response was: Group I 0.65mA, Group II 1.07mA and Group III 1.14mA (P1 = 0.00, P2 = 0.00, P3 = 0.48). Minimal current to evoke a RLN maximal response was Group I 0.6mA, Group II 0.95mA and Group III 1.05mA (P1 = 0.00, P2 = 0.00, P3 = 0.31). Latency values were similar to each group. Repetitive (> 10min) supra-maximal (> 5mA) electrical stimulation was safe. The application of endoscopic stimulating dissector is simple, effective and safe way to monitor both VN and RLN function during a TOETVA animal model. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for RLN monitoring. Endoscopic instrument required higher current to evoke EMG response compared to hand probe stimulation. Tip-end required less current to evoke EMG response compared to tip-lateral mode of stimulation.

Enhanced spinal cord microstimulation using conducting polymer-coated carbon microfibers

Intraspinal microstimulation (ISMS) may help to restore motor functions after spinal cord injury. ISMS caudal to the lesion activates motoneurons and evokes selective movements with graded force in rats and other mammals. We investigated the safety and effectiveness of conducting polymer (CP)-coated carbon microfibers (CMFs) for ISMS. 7-µm-diameter CMFs coated with poly(3,4-ethylenedioxythiophene) doped with poly[(4-styrenesulfonic acid)-co-(maleic acid)] (PEDOT:PSS-co-MA) were used to apply current-controlled biphasic electric pulses at the cervical spinal cord (C7) of anesthetized rats. Electrode performance and motoneuron activation, as readout by voltage transients, cyclic voltammetry, electrochemical impedance spectroscopy, electromyography (EMG) and foreleg kinematics, were investigated as a function of microfiber length (50 µm vs. 250 µm) and presence of polymer coating. The microfibers were very effective in activating specific spinal motoneurons, with the lowest stimulus thresholds varying between −28 µA and −46 µA in the cathodic phase. EMG and kinematic thresholds decreased when the microfiber tip approached the targeted motor nucleus (triceps brachii, t.b.) from the dorsal spinal cord surface. ISMS with polymer-coated CMFs produced higher electrical activity in the t.b. fascicles compared to bare CMFs. PEDOT:PSS-co-MA coating of 250-µm CMFs avoided the generation of unsafe overvoltages for biphasic pulses up to −80/+40 µA in vivo, although the positive effect of the conducting polymer was lost after the application of a few thousands of electric pulses. Thus, CP-coated CMFs may provide an effective and minimally invasive electrode for ISMS; however, polymer optimization is still required to improve its electrical stability and safety for long-term use.Statement of significanceIntraspinal microstimulation may restore motor functions after spinal cord injury. In the present study we demonstrate that carbon microfibers (CMFs) coated with the conducting polymer PEDOT:PSS-co-MA can be advantageously used for this purpose. These microfibers allow for both effective and temporarily safe electrical activation of spinal motor circuits with high spatial resolution. The presence of the polymer enhances the effectiveness of the electrical stimuli to recruit spinal motoneurons. Thus, conducting polymer-coated CMFs have potential for the development of advanced neuroprosthetic devices, although further improvements are needed regarding their electrochemical and mechanical stability.

Evaluation of the Electromyography Test for the Analysis of the Aerobic-Anaerobic Transition in Elite Cyclists during Incremental Exercise

(1) Background: The aim of this study was to investigate the validity and reliability of surface electromyography (EMG) for automatic detection of the aerobic and anaerobic thresholds during an incremental continuous cycling test using 1 min exercise periods in elite cyclists. (2) Methods: Sixteen well-trained cyclists completed an incremental exercise test (25 W/1 min) to exhaustion. Surface bipolar EMG signals were recorded from the vastus lateralis, vastus medialis, biceps femoris, and gluteus maximus, and the root mean square (RMS) were assessed. The multi-segment linear regression method was used to calculate the first and second EMG thresholds (EMGT1 and EMGT2). During the test, gas exchange data were collected to determine the first and second ventilatory thresholds (VT1 and VT2). (3) Results: Two breakpoints (thresholds) were identified in the RMS EMG vs. time curve for all muscles in 75% of participants. The two breakpoints, EMGT1 and EMGT2, were detected at around 70%–80% and 90%–95% of VO2MAX, respectively. No significant differences were found between the means of VT1 and EMGT1 for the vastii and biceps femoris muscles (p &gt; 0.05). There were no significant differences between means of EMGT2 and VT2 (p &gt; 0.05). (4) Conclusions: It is concluded that the multi-segment linear regression algorithm is a valid non-invasive method for analyzing the aerobic-anaerobic transition during incremental tests with 1 min stage durations.