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Quantitation in EMG

Published online by Cambridge University Press:  18 September 2015

K. Ming Chan
Affiliation:
Department of Neurology, New England Medical Center, Boston, Massachusetts
William F. Brown*
Affiliation:
Department of Neurology, New England Medical Center, Boston, Massachusetts
*
Department of Neurology, New England Medical Center, #314, 750 Washington Street, Boston, Massachusetts U.S.A. 02111
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Abstract

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The neuromuscular system may be affected by disorders of the central nervous system as well as other disorders affecting motoneurons, axons, neuromuscular transmission, the sarcolemmal membrane, the contractile elements and other components of the muscle fibers themselves. One or a combination of these possibilities can present in patients in the critical care unit. This paper reviews various qualitative and quantitative methods for assessing the various components of the peripheral contributions to the electrical and force output as well as the central motor drive to motoneurons. These methods all have their own strengths and weaknesses but many are complementary and together, can provide important diagnostic and prognostic information to guide management.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

REFERENCES

1.Bolton, CF, Gilbert, JJ, Hahn, AF, et al. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 1984; 47: 12231231.CrossRefGoogle ScholarPubMed
2.Giostra, E, Magistris, MR, Pizzolato, G, et al. Neuromuscular disorder in intensive care unit patients treated with pancuronium bromide. Occurrence in a cluster group of seven patients and two sporadic cases, with electrophysiologic and histologic examination. Chest 1994; 106: 210220.CrossRefGoogle Scholar
3.Spitzer, AR, Giancarlo, T, Maher, L, et al. Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve 1992; 15: 682686.CrossRefGoogle ScholarPubMed
4.Wijdicks, EF, Litchy, WJ, Harrison, BA, et al. The clinical spectrum of critical illness polyneuropathy. Mayo Clin Proc 1994; 69: 955959.CrossRefGoogle ScholarPubMed
5.Witt, NJ, Zochodne, DW, Bolton, CF, et al. Peripheral nerve function in sepsis and multiple organ failure. Chest 1991; 99: 176184.CrossRefGoogle ScholarPubMed
6.Young, GB, Bolton, CF, Austin, TW, et al. The encephalopathy associated with septic illness. Clin Invest Med 1990; 13: 297304.Google ScholarPubMed
7.Zochodne, DW, Bolton, CF, Wells, GA. Critical illness polyneuropathy — a complication of sepsis and multiple organ failure. Brain 1987; 110: 819842.CrossRefGoogle ScholarPubMed
8.Zochodne, DW, Ramsay, DA, Saly, V, et al. Acute necrotizing myopathy of intensive care: electrophysiological studies. Muscle Nerve 1994; 17: 285292.CrossRefGoogle ScholarPubMed
9.Bolton, CF. Neuropathies in the critical care unit. Br J Hosp Med 1992; 47: 358360.Google Scholar
10.Maher, J, Rutledge, F, Remtulla, H, et al. Neuromuscular disorders associated with failure to wean from the ventilator. Intensive Care Med 1995; 21: 737743.CrossRefGoogle ScholarPubMed
11.Zochodne, DW, Bolton, CF. Neuromuscular disorders in critical illness. Baillieres Clin Neurol 1996; 5: 645671.Google ScholarPubMed
12.Medical Research Council. Aids to the Examination of the Peripheral Nervous System. England: Her Majesty’s Stationary Office, 1981.Google Scholar
13.Andres, PL, Thibodeau, LM, Finison, LJ, et al. Quantitative assessment of neuromuscular deficit in ALS. Neurol Clin 1987; 5: 125141.CrossRefGoogle ScholarPubMed
14.Dvir, Z. Grade 4 in manual muscle testing: the problem with submaximal strength assessment. Clin Rehabil 1997; 11: 3641.CrossRefGoogle ScholarPubMed
15.Andres, PL, Hedlund, W, Finison, L, et al. Quantitative motor assessment in amyotrophic lateral sclerosis. Neurology 1986; 36: 937941.CrossRefGoogle ScholarPubMed
16.McGuire, D, Garrison, L, Armon, C, et al. Relationship of the Tufts Quantitative Neuromuscular Exam (TQNE) and the Sickness Impact Profile (SIP) in measuring progression of ALS. SSNJV/CNTF ALS Study Group. Neurology 1996; 46: 14421444.CrossRefGoogle ScholarPubMed
17.Pradas, J, Finison, L, Andres, PL, et al. The natural history of amyotrophic lateral sclerosis and the use of natural history controls in therapeutic trials. Neurology 1993; 43: 751755.CrossRefGoogle ScholarPubMed
18.Allen, GM, Gandevia, SC, Mckenzie, DK. Reliability of measurements of muscle strength and voluntary activation using twitch interpolation. Muscle Nerve 1995; 18: 593600.CrossRefGoogle ScholarPubMed
19.Dowling, JJ, Konert, E, Ljucovic, P, et al. Are humans able to voluntary elicit maximum muscle force? Neurosci Lett 1994; 179: 2528.CrossRefGoogle ScholarPubMed
20.Hales, JP, Gandevia, SC. Assessment of maximal voluntary contraction with twitch interpolation: an instrument to measure twitch responses. J Neurosci Meth 1988; 25: 97102.CrossRefGoogle ScholarPubMed
21.Mckenzie, DK, Bigland-Ritchie, B, Gorman, R, et al. Central and peripheral fatigue of human diaphragm and limb muscles assessed by twitch interpolation. J Physiol 1992; 4545: 643656.CrossRefGoogle Scholar
22.Gandevia, SC, Allen, GM, Butler, JE, et al. Supraspinal factors in human muscle fatigue: evidence for suboptimal output from the motor cortex. J Physiol 1996; 490: 529530.CrossRefGoogle ScholarPubMed
23.Taylor, JL, Butler, JE, Allen, GM, et al. Changes in motor cortical excitability during human muscle fatigue. J Physiol 1996; 490: 519528.CrossRefGoogle ScholarPubMed
24.Goslow, GE, Cameron, WE, Stuart, DG. The fast twitch motor units of cat ankle flexors. 2. Speed-force relations and recruitment order. Brain Res 1977; 134: 4757.CrossRefGoogle ScholarPubMed
25.Henneman, E. Relation between size of neurons and their susceptibility to discharge. Nature 1957; 13451347.Google ScholarPubMed
26.Henneman, E, Somjen, G, Carpenter, DO. Functional significance of cell size in spinal motoneurons. J Physiol 1965; 560580.Google ScholarPubMed
27.Milner-Brown, HS, Stein, RB, Yemm, R. The contractile properties of human motor units during voluntary isometric contractions. J Physiol 1973; 228: 285306.CrossRefGoogle ScholarPubMed
28.Milner-Brown, HS, Stein, RB, Yemm, R. Changes in firing rate of human motor units during linearly changing voluntary contractions. J Physiol 1973; 230: 371390.CrossRefGoogle ScholarPubMed
29.Olson, CB, Carpenter, DO, Henneman, E. Orderly recruitment of muscle action potentials. Arch Neurol 1968; 19: 591597.CrossRefGoogle ScholarPubMed
30.Thomas, CK, Ross, BH, Calancie, B. Human motor-unit recruitment during isometric contractions and repeated dynamic movements. J Neurophysiol 1987; 57: 311324.CrossRefGoogle ScholarPubMed
31.Macefield, G, Hagbarth, KE, Gorman, R, et al. Decline in spindle support to alpha motoneurones during sustained voluntary contractions. J Physiol 1991; 440: 497512.CrossRefGoogle ScholarPubMed
32.Macefield, VG, Gandevia, SC, Bigland-Ritchie, B, et al. The firing rates of human motoneurones voluntarily activated in the absence of muscle afferent feedback. J Physiol 1993; 471: 429443.CrossRefGoogle ScholarPubMed
33.Marsden, CD, Meadows, JC, Merton, PA. Muscular wisdom. In: Desmedt, , ed. Prog Clin Neurophysiol: Motor Control. Basel: Karger, 1983; 169211.Google Scholar
34.Ballantyne, JP, Hansen, . A new method for the estimation of the number of motor units in a muscle. J Neurol Neurosurg Psychiatry 1974; 37: 907915.CrossRefGoogle ScholarPubMed
35.Brown, WF. A method for estimating the number of motor units in thenar muscles and the changes in motor unit count with aging. J Neurol Neurosurg Psychiatry 1972; 35: 845852.CrossRefGoogle Scholar
36.Daube, JR. Estimating the number of motor units in a muscle. J Clin Neurophysiol 1995; 12: 585594.CrossRefGoogle ScholarPubMed
37.Doherty, T, Simmons, Z, O’Connell, B, et al. Methods for estimating the numbers of motor units in human muscles. J Clin Neurophysiol 1995; 12: 565584.CrossRefGoogle ScholarPubMed
38.Galea, V, de Bruin, H, Cavasin, R, et al. The numbers and relative sizes of motor units estimated by computer. Muscle Nerve 1991; 14: 11231130.CrossRefGoogle ScholarPubMed
39.Slawnych, M, Laszlo, C, Hershler, C. Motor unit estimates obtained using the new “MUESA” method. Muscle Nerve 1996; 19: 626636.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
40.Stashuk, DW, Doherty, TJ, Kassam, A, et al. Motor unit number estimates based on the automated analysis of F responses. Muscle Nerve 1994; 17: 881890.CrossRefGoogle ScholarPubMed
41.Stein, RB, Yang, JF. Methods for estimating the number of motor units in human muscles. Ann Neurol 1990; 28: 487495.CrossRefGoogle ScholarPubMed
42.McComas, AJ. Electrophysiological estimation of the number of motor units within a human muscle. J Neurol Neurosurg Psychiatry 1971; 34: 121131.CrossRefGoogle ScholarPubMed
43.Chan, KM, Andres, LP, Brown, WF. Longitudinal study of the contractile and electrical properties of single human motor units. Muscle Nerve 1996; 19: 1189.Google Scholar
44.Stein, RB, French, AS, Mannard, A, et al. New methods for analysing motor function in man and animals. Brain Res 1972; 40: 187192.CrossRefGoogle ScholarPubMed
45.Stephens, JA, Usherwood, TP. The mechanical properties of human motor units with special reference to their fatiguability and recruitment threshold. Brain Res 1977; 125: 9197.CrossRefGoogle ScholarPubMed
46.Taylor, A, Stephens, JA. Study of human motor unit contractions by controlled intramuscular microstimulation. Brain Res 1976; 117: 331335.CrossRefGoogle ScholarPubMed
47.Thomas, CK, Johansson, RS, Westling, G, et al. Twitch properties of human thenar motor units measured in response to intraneural axon stimulation. J Neurophysiol 1990; 64: 13391346.CrossRefGoogle ScholarPubMed
48.Doherty, TJ, WF, . Age related changes in human thenar motor unit twitch contractile properties. J Appl Physiol 1997; 82: 93101.CrossRefGoogle Scholar
49.Campbell, MJ, McComas, , Petito, F. Physiological changes in ageing muscles. J Neurol Neurosurg Psychiatry 1973; 36: 174182.CrossRefGoogle ScholarPubMed
50.Dengler, R, Konstanzer, A, Kuther, G, et al. Amyotrophic lateral sclerosis: macro-EMG and twitch forces of single motor units. Muscle Nerve 1990; 13: 545550.CrossRefGoogle ScholarPubMed
51.Felice, KJ. A longitudinal study comparing thenar motor unit number estimates to other quantitative tests in patients with amyotrophic lateral sclerosis. Muscle Nerve 1997; 20: 179185.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
52.Brown, WF, Jaatoul, N. Amyotrophic lateral sclerosis-electrophysiologic study (number of motor units and rate of decay of motor units). Arch Neurol 1974; 30: 242248.CrossRefGoogle Scholar
53.Stalberg, E, Fawcett, PRW. Macro EMG in healthy subjects of different ages. J Neurol Neurosurg Psychiatry 1982; 45: 870878.CrossRefGoogle ScholarPubMed
54.Dengler, R, Stein, RB, Thomas, CK. Axonal conduction velocity and force of single human motor units. Muscle Nerve 1988; 11: 136145.CrossRefGoogle ScholarPubMed
55.Dorfman, LJ. The distribution of conduction velocities (DCV) in peripheral nerves: a review. Muscle Nerve 1984; 7: 211.CrossRefGoogle ScholarPubMed
56.Lee, RG, Ashby, P, White, DG. Analysis of motor conduction velocity in the human median nerve by computer simulation of compound muscle action potentials. Clin Neurophysiol 1975; 39: 225237.CrossRefGoogle ScholarPubMed
57.Thomas, PK, Sears, TA, Gilliatt, RW. The range of conduction velocity in normal motor nerve fibres to the small muscles of the hand and foot. J Neurol Neurosurg Psychiatry 1959; 22: 175181.CrossRefGoogle Scholar
58.Stalberg, EV, Trontelj, JV. SFEMG findings in different disorders. In: Stalberg, EV, Trontelj, JV, eds. Single Fibre Electromyography. Old Woking: The Mirvalle Press Ltd, 1979: 99148.Google Scholar
59., E. Use of single fiber EMG and macro EMG in study of reinnervation. Muscle Nerve 1990; 13: 804813.CrossRefGoogle Scholar
60.Stalberg, E. Electrical microstimulation with single fiber electromyography: a useful method to study the physiology of the motor unit. J Clin Neurophysiol 1992; 9: 105119.CrossRefGoogle Scholar
61.Abbruzzese, G, Dall’Agata, D, Morena, M, et al. Electrical stimulation of the motor tracts in cervical spondylosis. J Neurol Neurosurg Psychiatry 1988; 51: 796802.CrossRefGoogle ScholarPubMed
62.Merton, PA. Scope of a technique for electrical stimulation of human brain, spinal cord, and muscle. Lancet 1982: 597600.CrossRefGoogle ScholarPubMed
63.Mills, KR. Electrical stimulation over the human vertebral column: which neural elements are excited? Electroencephalogr Clin Neurophysiol 1986; 63: 582589.CrossRefGoogle ScholarPubMed
64.Plassman, BL, Gandevia, SC. High voltage stimulation over the human spinal cord: sources of latency variation. J Neurol Neurosurg Psychiatry 1989; 52: 213217.CrossRefGoogle ScholarPubMed
65.Bolton, CF. Assessment of respiratory function in the intensive care unit. Can J Neurol Sci 1994; 21: S28-S34.CrossRefGoogle ScholarPubMed
66.Sonoo, M, Stalberg, E. The ability of MUP parameters to discriminate between normal and neurogenic MUPs in concentric EMG: analysis of the MUP ‘thickness’ and the proposal of ‘size index’. Electroencephalogr Clin Neurophysiol 1993; 89: 291303.CrossRefGoogle ScholarPubMed
67.Brown, WF. Needle electromyographic abnormalities in neurogenic and muscle diseases. In: Brown, WF, ed.The Physiological and Technical Basis of Electromyography. Boston: Butterworth, 1984: 317338.CrossRefGoogle Scholar
68.Daube, JR. Needle examination in clinical electromyography. Muscle Nerve 1991; 14: 685700.Google ScholarPubMed
69.Howard, JE, McGill, KC, Dorfman, LJ. Age effects on properties of motor unit action potentials: ADEMG analysis. Ann Neurol 1988; 24: 207213.CrossRefGoogle ScholarPubMed
70.Nandedkar, SD, Barkhaus, PE, Sanders, DB, et al. Analysis of amplitude and area of concentric needle EMG motor unit action potentials. Electroencephalogr Clin Neurophysiol 1988: 69: 561567.CrossRefGoogle ScholarPubMed
71.Frontera, WR, Meredith, CN, O’Reilly, KP, et al. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol 1988; 64: 10381044.CrossRefGoogle ScholarPubMed
72.Moon, KL Jr, Genant, HK, Helms, CA, et al. Musculoskeletal applications of nuclear magnetic resonance. Radiology 1983; 147: 161171.CrossRefGoogle ScholarPubMed
73.Brooke, MH, Kaiser, KK. Three “myosin adenosine triphosphate” systems: the nature of their pH lability and sulfhydryl dependence. J Histochem Cytochem 1970; 18: 670672.CrossRefGoogle Scholar
74.Peter, JB, Barnard, , Edgerton, VR, et al. Metabolic profiles of three fiber types of skeletal muscle in guinea pigs and rabbits. Biochemistry 1972; 11: 26272633.CrossRefGoogle ScholarPubMed