Punctual mechanical oscillation in modulation of muscular tonus in children with spasticity

Spasticity is a motor condition present in 75 to 88% of children with Cerebral Palsy (CP). One form of treatment is called punctual mechanical oscillation (PO). The current study aimed to study different protocols for the application of PO and the magnitude of their effects. In total, 7children with medical diagnosis of CP and ICD (International Classification of Diseases) were included. The first intervention protocol (Int1) consisted of the application of PO to the spastic muscle tendon and the second intervention protocol (Int2) to the muscle belly ofthe spastic antagonist muscle. For evaluation, the Modified Ashworth Scale (MAS) was used, while simultaneously capturing the mechanomyography (MMG) signals. Data were collected pre-intervention and 1 (Post1), 15 (Post15), 30 (Post30), 45 (Post45), and60 (Post60) minutes after the interventions. The MAS values (median ± interquartile range) post intervention were statistically lower when compared to the pre values in the 2 protocols studied; in Int1between Pre (2 ± 0) andPost15 (0 ± 1.75), Post30 (0 ± 1), Post45 (1 ± 1),and Post60 (1 ± 1), and in Int2only between Pre (2 ± 1) and Post1 (0 ± 1).The values found in the MMG in both its temporal and spectral domains did not follow a pattern (p>0.05). The comparison between the protocols did not demonstrate statistical differences in any characteristics (MAS, MMGMF, and MMGRMS). However, PO was shown to be a therapeutic resource that modulated spasticity for up to 60 minutes after its application, and PO could contribute as a tool to aid the treatment of spasticity.

Influence of subcutaneous fat on mechanomyographic signals at three levels of voluntary effort

Abstract Introduction This study aims to assess the influence of different skinfold thicknesses (ST) and their relation to the attenuation of the mechanomyographic (MMG) signal at different force levels (maximal voluntary contraction – MVC, 40% of MVC and 70% of MVC) of the rectus femoris muscle. Methods Fifteen volunteers were divided in two groups: ST lower than 10mm (G<10) (8 participants) and ST higher than 35mm (G>35) (7 participants). Student t tests were employed to investigate differences between G<10 and G>35 regarding MMG analysis parameters (acceleration root mean square – aRMS, zero crossing – ZC, and median frequency – MDF), for the X, Y and Z axes, as well as for the modulus of these three axes. Results We found that thicker layers of body fat act as attenuator filters for the MMG signal [MDFMVC: X (p = 0.005), Z (p = 0.003); MDF70%MVC: X (p = 0.034); ZCMVC: Z (p = 0.037), modulus (p = 0.005); ZC70%MVC: Z (p = 0.047)]. We found significant correlation between ST values and aRMS in three levels, in the Yaxis (p = 0.591), for the group G<10. For the modulus, the aRMS value showed correlation with ST values for group G>35 in 40%MVC (R2 = 0.610), and 70%MVC (R2 = 0.592). The MDF parameter showed correlation with ST values only in the Yaxis in 70%MVC (R2 = 0.700) for G>35. Conclusions We observed MMG signal attenuation in at least one of the parameters analyzed for each level of the rectus femoris muscle force, indicating that MMG signals are significantly attenuated with increasing thickness of the subcutaneous fat layer.

Correlation between spectral and temporal mechanomyography features during functional electrical stimulation

Abstract Introduction: Signal analysis involves time and/or frequency domains, and correlations are described in the literature for voluntary contractions. However, there are few studies about those correlations using mechanomyography (MMG) response during functional electrical stimulation (FES) elicited contractions in spinal cord injured subjects. This study aimed to determine the correlation between spectral and temporal MMG features during FES application to healthy (HV) and spinal cord injured volunteers (SCIV). Methods: Twenty volunteers participated in the research divided in two groups: HV (N=10) and SCIV (N=10). The protocol consisted of four FES profiles transcutaneously applied to quadriceps femoris muscle via femoral nerve. Each application produced a sustained knee extension greater than 65º up to 2 min without adjusting FES intensity. The investigation involved the correlation between MMG signal root mean square (RMS) and mean frequency (MF). Results: HV and SCIV indicated that MMGRMS and MMGMF variations were inversely related with -0.12 ≥ r ≥ -0.82. The dispersion between MMGMF and MMGRMS reached 0.50 ≤ r2 ≤ 0.64. Conclusion The increase in MMGRMS and the decrease in MMGMF may be explained by the motor units coherence during fatigue state or by motor neuron adaptation (habituation) along FES application (without modification on parameters).

Advances and perspectives of mechanomyography

INTRODUCTION: The evaluation of muscular tissue condition can be accomplished with mechanomyography (MMG), a technique that registers intramuscular mechanical waves produced during a fiber's contraction and stretching that are sensed or interfaced on the skin surface. OBJECTIVE: Considering the scope of MMG measurements and recent advances involving the technique, the goal of this paper is to discuss mechanomyography updates and discuss its applications and potential future applications. METHODS: Forty-three MMG studies were published between the years of 1987 and 2013. RESULTS: MMG sensors are developed with different technologies such as condenser microphones, accelerometers, laser-based instruments, etc. Experimental protocols that are described in scientific publications typically investigated the condition of the vastus lateralis muscle and used sensors built with accelerometers, third and fourth order Butterworth filters, 5-100Hz frequency bandpass, signal analysis using Root Mean Square (RMS) (temporal), Median Frequency (MDF) and Mean Power Frequency (MPF) (spectral) features, with epochs of 1 s. CONCLUSION: Mechanomyographic responses obtained in isometric contractions differ from those observed during dynamic contractions in both passive and functional electrical stimulation evoked movements. In the near future, MMG features applied to biofeedback closed-loop systems will help people with disabilities, such as spinal cord injury or limb amputation because they may improve both neural and myoelectric prosthetic control. Muscular tissue assessment is a new application area enabled by MMG; it can be useful in evaluating the muscular tonus in anesthetic blockade or in pathologies such as myotonic dystrophy, chronic obstructive pulmonary disease, and disorders including dysphagia, myalgia and spastic hypertonia. New research becomes necessary to improve the efficiency of MMG systems and increase their application in rehabilitation, clinical and other health areas.

Avaliação da fadiga muscular pela mecanomiografia durante a aplicação de um protocolo de EENM / Muscle fatigue assessment by mechanomyography during application of NMES protocol

Contextualização: A estimulação elétrica neuromuscular (EENM) é uma técnica bastante utilizada na área da reabilitação em fisioterapia, porém a instalação da fadiga ocorre de maneira mais rápida se comparada à contração voluntária. Na prática clínica, torna-se necessário monitorar a fadiga muscular em protocolos de EENM, visando adequar os parâmetros da corrente elétrica e prolongar o tempo de estimulação. OBJETIVOS: O objetivo deste estudo foi utilizar a mecanomiografia como meio de avaliação da fadiga muscular periférica durante a aplicação de um protocolo de EENM. MÉTODOS: Um sistema de aquisição de sinais mecanomiográficos (MMG) e um protocolo experimental foram desenvolvidos. Durante os ensaios in vivo com 10 voluntários, foram realizados testes de contração voluntária máxima (CVM) para extensão do joelho. Realizou-se uma fase de potencialização com contrações dinâmicas produzidas por EENM a 10 por cento da CVM (100 Hz, 400 µm) no músculo quadríceps femoral, e o protocolo de EENM propriamente dito ocorreu a 30 por cento da CVM (50 Hz, 400 µm). Simultaneamente, foram adquiridos os sinais de MMG RMS (amplitude) e MMG MPF (frequência) do músculo reto femoral e de torque (amplitude) para a extensão do joelho. RESULTADOS: A linha de tendência da MMG RMS foi descendente, indicando que a MMG RMS relaciona-se à amplitude do torque. Porém, a MMG MPF não teve uma boa correlação com o torque para este protocolo de EENM. CONCLUSÕES: A MMG pode ser aplicada simultaneamente à EENM, pois não ocorre interferência elétrica, e pode ser utilizada na realização de movimentos funcionais na contração muscular gerada por EENM. Artigo registrado no Australian New Zealand Clinical Trials Registry (ANZCTR) sob o número ACTRN12609000866202.

Background: Neuromuscular electrical stimulation (NMES) is a widely used technique for rehabilitation in physical therapy, however it causes muscle fatigue more rapidly than does voluntary contraction. In clinical practice, it becomes necessary to monitor muscle fatigue during NMES protocols to adjust the parameters of electrical current stimulation and, thus, increase stimulation time. OBJECTIVES: The aim of this study is to use mechanomyography (MMG) as a means of evaluating peripheral muscle fatigue during the execution of an NMES protocol. METHODS: An MMG signal acquisition system and an experimental protocol were developed. During in vivo tests, 10 participants performed maximal voluntary contractions (MVCs) for knee extension. A maximization phase was conducted with dynamic contractions generated by NMES at 10 percent of MVC (100 Hz, 400 µs) on the quadriceps muscle, and the main NMES protocol occurred at 30 percent of MVC (50 Hz, 400 µs). Simultaneously, MMG RMS (amplitude) and MMG MPF (frequency) signals of the rectus femoris and the knee extension torque were acquired. RESULTS: The tendency line of the MMG RMS was descendant, indicating that MMG RMS correlates with torque amplitude. However, MMG MPF did not show a significant correlation with torque for the present NMES protocol. CONCLUSIONS: MMG is a technique that can be simultaneously applied to NMES because there is no electrical interference and it can be used during functional movements in the NMES-generated muscle contraction. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12609000866202.

Efeitos de dois parâmetros antropométricos no comportamento do sinal mecanomiográfico em testes de força muscular / Effects of two anthropometric parameters in the behavior of the mechanomyographic signal on muscle force tests

Apesar da mecanomiografia (MMG) ser uma técnica com crescente destaque em investigações relativas ao fenômeno da contração muscular, poucos trabalhos se dedicaram a entender os possíveis efeitos de variáveis antropométricas no sinal de MMG. Portanto, o objetivo do estudo foi avaliar os efeitos da dobra cutânea e do perímetro do braço no comportamento do sinal de MMG nos domínios do tempo e da freqüência em diferentes níveis de contração isométrica. Participaram do estudo 21 indivíduos do sexo masculino (24,9 ± 7,8 anos) e 21 do feminino (20,7 ± 2,5 anos), todos destros. O protocolo experimental constou de um teste de contração voluntária máxima (CVM) que permitiu determinar cinco cargas percentuais administradas durante os testes de força (20 por cento, 40 por cento, 60 por cento, 80 por cento e 100 por cento da CVM). Um acelerômetro biaxial foi colocado sobre o ventre muscular do bíceps braquial direito. O sinal de MMG foi analisado nos domínios do tempo, mediante o comportamento da amplitude do sinal, por meio do cálculo da raiz média quadrática (valor RMS), e da freqüência, através da freqüência mediana (FM) calculada a partir do seu espectro de potência. Estes parâmetros foram extraídos a partir dos sinais gerados na direção X, perpendicular às fibras musculares. Foram também medidos os parâmetros antropométricos dobra cutânea biciptal (BD_DC_B) e perímetros de braço relaxado (BD_PR) e contraído (BD_PC) no terço médio do braço direito. Ambos os grupos apresentaram um comportamento decrescente da FM com o nível de contração. O valor RMS apresentou comportamento crescente com a carga para ambos os grupos. Houve diferenças estatisticamente significativas (p < 0,05) entre as variáveis antropométricas quando comparados os grupos. Sugere-se que o valor RMS, ao contrário da FM, que poderá sofrer atenuações por parte dos tecidos presentes na interface entre o músculo e o transdutor, seja mais consistente na discriminação da força muscular.

In spite of being a useful method on muscle contraction analysis, few studies have been dedicated to understand how some anthropometrical parameters can interfere in the mechanomyographic (MMG) signal properties. Therefore, the aim of this study was to evaluate the effects of skinfold thickness and arm circumference in the MMG signal behavior in the temporal and frequency domains at different levels of isometric contraction. Twenty-one males (24.9 ± 7.8 years) and 21 females (20.7 ± 2.5 years), all right-handed, participated in this study. Prior to the MMG signals collection, a maximum voluntary contraction test (MVC) was performed to further determine the five levels (20 percent, 40 percent, 60 percent, 80 percent and 100 percent of CVM) used during the tests. The two groups performed isometric contractions in the five different levels while MMG signal was collected from the right biceps brachii muscle by a biaxial accelerometer. The root mean square value (RMS), and the median frequency (MF) calculated from the MMG power spectrum were extracted from the MMG signals in X direction, which meant perpendicular to the muscle fibres direction. The bicipital skinfold thickness (BD_DC_B), and the circumference of the right arm, with and without contraction of elbow muscles flexors, have also been measured. The MF presented a decreasing behaviour with the increasing level of contraction; the RMS value followed an increasing pattern, though. There were significant statistical differences (p < 0.05) for the anthropometric variables between groups. It is suggested that the RMS value, differently from the MF, which can be disrupted by the tissues between the muscle and the transducer, should be better correlated with muscle force level.

The comparison among Mechanical, Electromyographic and Accelerographic responses during recovery from vecuronium induced neuromuscular blockade / 대한마취과학회지

As the use of muscle relaxants routinize in the clinical general anesthesia, the proper estimation of neuromuscular blockade and recovery is needed for the more safe anesthetic management. Three recording methods of measurement in recovery are available; measurement of the evoked mechanical responses (mechanography), measurement of the evoked electrical responses (electromyography), and measurement of the acceleration of the muscle responses, The purpose of this study was to evaluate the correlations among mechanomyographic, electromyographic and accelerographic responses during recovery from vecuronium induced neuromuscular blockade. 15 ASA class 1 adult patients were studied. Measurements were as follows: 1) Recovery time of T(1)/Tc, of 25%, 50%, 75%, 90% and 100% in each device. 2) Recovery index in each device 3) The values of T(1)>Tc, in EMG and ACC corresponding ta that of MMG. 4) The values of TOF ratio in EMG and ACC corresponding to that of MMG. The results were as follows: 1) Recovery time of T(1).