Mechanomyographic determination of post-activation potentiation in myopathies.

OBJECTIVE: There is a need to provide an index of muscle contractility in evaluating myopathies especially in the clinical setting. This study was conducted to investigate if the mechanomyogram post-activation potentiation (MMG-PAP) can be used as an index of muscle contractile force potentiation (force-PAP), if it differs between normal and myopathic muscles, and if it can reflect abnormalities in muscle fiber anatomy. METHODS: The correlation between MMG-PAP and force-PAP was evaluated in 12 normal subjects after maximum voluntary contraction (MVC) of the biceps brachii muscle. The same method was then applied to study MMG-PAP in 16 patients with myopathies, 16 disease and 25 normal controls. Mean fiber diameters and the proportions of type 1 and 2 fibers in biopsied biceps brachii muscle were determined and compared with MMG-PAP values. RESULTS: There was a significant positive correlation between force-PAP (197 +/- 148%) and MMG-PAP (135 +/- 68%) immediately after MVC (P < 0.05). The mean MMG-PAP in myopathies (66 +/- 53%) was significantly lower than those of the disease (128 +/- 34%; P < 0.005) and normal controls (120 +/- 56%; P < 0.005). Patients with non-dystrophic myopathies, including those with myositis, had significantly lower MMG-PAP values (38 +/- 20%; P < 0.005) than those with muscular dystrophy (148 +/- 23%). MMG-PAP did not clearly correlate with either type 2 fiber atrophy or type 2 fiber disproportion based on muscle biopsy analysis of myopathic patients. CONCLUSIONS: This study shows that MMG-PAP can be used as an index of muscle contractility and that it is significantly lower in non-dystrophic myopathies compared to normal subjects. MMG-PAP does not seem to reflect abnormal muscle fiber anatomy. SIGNIFICANCE: MMG-PAP may become a valuable non-invasive tool in augmenting routine clinical electrophysiologic studies especially in evaluating muscle contractility in myopathies.

Electromyographic and mechanomyographic estimation of motor unit activation strategy in voluntary force production.

Electromyographic and mechanomyographic estimation of motor unit activation strategy in voluntary force production. In order to determine whether electromyogram (EMG) and mechanomyogram (MMG) are suitable for the noninvasive estimation of the motor unit (MU) activation strategy, the EMG/force and MMG/force relationships were examined simultaneously during isometric ramp contractions in biceps brachii muscle. The highest mean power frequency (MPF) of the EMG, which reflects the full MU recruitment, was determined at 51% MVC. Two obvious inflection points were identified on the MMG-amplitude/force relationship that showed an initial slow increase followed by a rapid increase and a progressive decrease at higher force levels. Our results suggest that the MMG amplitude allows the estimation of the beginning of recruitment of MUs that innervate the first-twitch fibers in addition to identification of the full MU recruitment. The rate coding strategy was qualitatively reflected by the MMG-MPF/force relationship. We conclude that the MU activation strategy is estimated in more detail by the MMG than by the EMG.

Reliability of the mechanomyogram detected with an accelerometer during voluntary contractions.

The accelerometer is used for mechanomyogram (MMG) recordings of muscle contractions. Although the mechanical characteristics of other MMG transducers have been determined with reference to the accelerometer, mechanical aspects of the accelerometer itself, including the weight of the transducer, have not been verified. This study was designed to reinvestigate the mechanical variable of the MMG signal detected with an accelerometer, with reference to a laser distance sensor (LDS), and then to clarify the influence of the accelerometer weight on the MMG recording during muscle contractions. The study was performed during mechanical sinusoidal vibrations and during voluntary contractions of the quadriceps muscle. Maximum differences in the amplitude spectral density functions between the LDS signal and the double integral of the accelerometer signal were approximately 4 microm. The results verified that the MMG signal from the accelerometer accurately reflected the acceleration of body surface vibration. However, the MMG signal was gradually distorted when weight was added to the accelerometer: the addition of 4.0 g (total 6.0 g, including 2.0 g of accelerometer) substantially attenuated the MMG signal. The results suggest that the appropriate weight for the accelerometer should be less than 5.0 g for measurements of the quadriceps muscle and indicate that the transducer weight must be taken into account for accurate measurement of muscles of different sizes.

Mechanomyogram and force relationship during voluntary isometric ramp contractions of the biceps brachii muscle.

The aim of the present study was to examine the non-stationary mechanomyogram (MMG) during voluntary isometric ramp contractions of the biceps brachii muscles using the short-time Fourier transform, and to obtain more detailed information on the motor unit (MU) activation strategy underlying in the continuous MMG/force relationship. The subjects were asked to exert ramp contractions from 5% to 80% of the maximal voluntary contraction (MVC) at a constant rate of 10% MVC/s. The root mean squared (RMS) amplitude of the MMG began to increase slowly at low levels of force, then there was a slight reduction between 12% and 20% MVC. After that, a progressive increase was followed by a decrease beyond 60% MVC. As to the mean power frequency (MPF), a relatively rapid increase up to 30% MVC was followed by a period of slow increment between 30% and 50% MVC. Then temporary reduction at around 50% MVC and a further rapid increase above 60% MVC was observed. The interaction between amplitude and MPF of the MMG in relation to the MU activation strategy is discussed for five force regions defined on the basis of their inflection points in the RMS-amplitude/force and MPF/force relationships. It was found that the MMG during ramp contractions enables deeper insights into the MU activation strategy than those determined during traditional separate contractions. In addition, this contraction protocol is useful not only to ensure higher force resolution in the MMG/force relationship, but also to markedly shorten the time taken for data acquisition and to reduce the risk of fatigue.

Mechanical behaviour of condenser microphone in mechanomyography.

Condenser microphones (MIC) have been widely used in mechanomyography, together with accelerometers and piezoelectric contact sensors. The aim of the present investigation was to clarify the mechanical variable (acceleration, velocity or displacement) indicated by the signal from a MIC transducer using a mechanical sinusoidal vibration system. In addition, the mechanomyogram (MMG) was recorded simultaneously with a MIC transducer and accelerometer (ACC) during voluntary contractions to confirm the mechanical variable reflected by the actual MMG and to examine the influence of motion artifact on the MMG. To measure the displacement-frequency response, mechanical sinusoidal vibrations of 3 to 300 Hz were applied to the MIC transducer with different sizes of air chambers (5, 10, 15 and 20 mm in diameter and 15, 20 or 25 mm long). The MIC transducer showed a linear relationship between the output amplitude and the vibration displacement, however, its frequency response declined with decreasing diameter and decreasing length of the air chamber. In fact, the cut-off frequency (-3dB) of the MIC transducer with the 5-mm-diameter chamber was 10, 8 and 4 Hz for the length 15, 20 and 25 mm, respectively. The air chamber with at least a diameter of 10 mm and a length of 15 mm is recommended for the MIC transducer. The sensitivity of this MIC transducer arrangement was 92 mV microm(-1) when excited at 100 Hz. During voluntary contraction, the amplitude spectral density function of the MMG from the MIC transducer resembled that of the double integral of the ACC transducer signal. The angle of the MIC transducer was delayed by 180 degrees in relation to the ACC transducer signal. The sensitivity of the MIC transducer was reduced to one-third because of the peculiar volume change of air chamber when the MMG was detected on the surface of the skin. In addition, the MIC transducer was contaminated by a smaller motion artifact than that from the ACC transducer. The maximal peak amplitude of the MIC and ACC transducer signal with the motion artifact was 7.7 and 12.3 times as much as the RMS amplitude of each signal without the motion artifact, respectively. These findings suggest that the MIC transducer acts as a displacement meter in the MMG. The MIC transducer seems to be a possible candidate for recording the MMG during dynamic muscle contractions as well as during sustained contractions.

Mechanomyographic investigation of muscle contractile properties in preadolescent boys.

The aim of the present study was to elucidate the muscle contractile properties of preadolescent boys using the mechanomyogram (MMG) and electromyogram (EMG). In 8 preadolescent boys and 10 male young adults, the EMG and MMG were recorded from quadriceps muscles during isometric knee extension contractions at levels of 10 to 80% MVC. The relationship of EMG and MMG to absolute force was approximated by a regression line (r > 0.8). The regression line of the EMG in preadolescent was located above that of the adults, whereas the MMG in both subject groups was fitted by virtually the same regression line. Thus, the MMG seems to be indicative of absolute force in preadolescents as well as young adults. Both groups showed a non-linear increase in the EMG and MMG with relative force (%MVC). The EMG and %MVC relationship was not significantly different between the two groups, whereas the MMG in preadolescents was smaller than that of adults over the range of force studied. The MMG increment with %MVC was more remarkable above 30 or 40% MVC in both groups; however, the rate of the increment in preadolescents was smaller than that in adults. The MMG and %MVC relationship suggests that the muscle contractile properties in preadolescent boys are characterized by immaturity of the fast twitch fibers.

Relationship between mechanomyogram and force during voluntary contractions reinvestigated using spectral decomposition.

A mechanomyogram (MMG) is considered to represent the pressure waves resulting from the lateral expansion of contracting muscle fibers. However, the actual MMG recording appears not only to reflect lateral changes of active fibers, but also to include the effect of their longitudinal shortening, because the fiber orientation, particularly in pennate muscles, is not parallel with the MMG transducer attached at the skin surface. In the present investigation, a spectral decomposition method was developed to eliminate the interference due to fiber longitudinal movement from the MMG recording. The MMG was recorded over the belly of the rectus femoris muscle, which is a pennate muscle. Vibration over the tibial tuberosity (VTT) was used as a measure of the integrated longitudinal movement of the muscle fibers. The lateral and longitudinal components included in the MMG were separated by a spectral decomposition method that is based on the coherence function of the MMG and VTT. The MMG/force relationship was compared between the original and decomposed MMG. One-third of the 12 subjects demonstrated a curvilinear relationship between the original MMG and force throughout the range of force. In the other two-thirds, the MMG saturated or reduced beyond 70% of the maximum voluntary contraction (MVC). After decomposition, the MMG increased progressively with force up to 70% MVC, beyond which it decreased in all subjects. The spectral decomposition method described here is considered to be a useful tool with which to examine in more detail the MMG/force relationship of different pennate muscles.

Repeatability study of mechanomyography in submaximal isometric contractions using coefficient of variation and intraclass correlation coefficient.

The within-day and between-day repeatability of the mechanomyogram (MMG) was assessed using the coefficient of variation (CV) and the intraclass correlation coefficient (ICC) and was compared with that of the electromyogram (EMG). The MMG and EMG were recorded simultaneously during isometric elbow flexion trials at different submaximal levels of 10% to 90% MVC. The testing session consisting of 9 submaximal trials was repeated 8 times on the same day for estimation of the within-day variation. In order to examine the between-day variation, the same testing session was also performed 8 times over 3 weeks with a 2-day rest interval between each session. The CVs within-day and between-day in both the MMG and EMG did not demonstrate any significant differences relating to the magnitude of force exerted. The CVs combined over all the force levels were approximately 10% within the same day and 25% between days for both the MMG and EMG. These corresponded to the within-day ICC of approximately 0.95 and the between-day ICC of 0.80. The repeatability of the MMG during submaximal isometric contractions of biceps brachii muscles is considered to be similar to that of the more established EMG.

Strain on the gastrocnemii and hamstrings affecting standing balance on an inclined plane in spastic cerebral palsy. A study using a geometric model.

The purpose of this study was to use an non-invasive method to determine whether strain on the gastrocnemii and hamstrings influences postural balance in spastic cerebral palsy (CP). Changes in alignment during standing posture with subjects positioned on a platform that was gradually inclined were measured in 10 normal children and 11 children with CP. The changes in postural alignment were plotted and geometric models used to determine the lines where the gastrocnemii and hamstrings were maximally stretched. In this way the relationship between postural alignment and the amount of strain on the gastrocnemii and hamstrings was investigated. On the inclined platform, which caused ankle joints to become dorsiflexed as the inclination angle increased, the gastrocnemii began to be strained and the hip joints began to be flexed (trunk bent forward) at the same time. In the children with CP, the gastrocnemii were more strained by smaller degrees of inclination. Furthermore, there was one child with CP whose hamstrings were also strained on the inclined platform. We confirmed that postural balance was affected by strain on the gastrocnemii and hamstrings.

Technical aspects of mechnomyography recording with piezoelectric contact sensor.

The piezoelectric contact sensor has been widely utilised in mechanomyography (MMG). The authors aim to clarify the mechanical variables (i.e. acceleration, velocity or displacement) reflected by the MMG signal detected with a piezoelectric contact sensor (PEC), and compare the results with those obtained simultaneously by an accelerometer (ACC). To measure the acceleration-frequency response, a mechanical sinusoidal excitation of 5 to 300 Hz at a constant magnitude of 0.01 G was applied to the two transducers. The acceleration-frequency response of the ACC transducer was confirmed to be almost flat. The PEC without any restriction of the transducer housing (including the combined seismic mass) demonstrated a similar response to the ACC transducer. The PEC transducer output with restricted housing decreased with increasing sinusoidal frequency and an attenuation slope of -40 dB/decade and phase angle of -180 degrees. The voluntary MMG signal during isometric knee extension was recorded simultaneously with the two transducers. The amplitude spectral density distribution of the MMG from the PEC transducer was narrow and the mean frequency was approximately one-half that obtained from the ACC transducer. The amplitude spectral density distribution with the PEC transducer resembled that of the double integral over time of the ACC transducer signal. The phase angle of the PEC transducer signal was different from that of the ACC transducer signal by approximately -180 degrees. These results suggest that the PEC transducer acts as a displacement meter of muscle vibration. In addition, differences in the MMG frequency components relating to the transducer type must be taken into consideration when investigating the mechanical activity of muscle.

Geometrical analysis of hip and knee joint mobility in cerebral palsied children.

The present investigation attempted to define a geometrical hexagon model for representing the sagittal range of motion (ROM) of hip and knee joint. The effect of both monoarticular and biarticular muscles on joint mobility in children with spastic cerebral palsy (SCP) were analyzed by this geometrical method. Photographic analysis was used to measure hip and knee joint angle at six different boundary positions. The ROM in normal children indicated age dependent reduction of maximal hip flexion and shortening of hamstring and rectus femoris muscles. A number of SCP children showed greater reduction of both hip flexion and extension and shortening of hamstring and rectus femoris muscles, whereas the ROM of knee joint was similar to that in normal children. The deteriorated hip joint mobility seems to be associated with shortening of muscle due to their intrinsic spasticity. The impaired ROM was more noticeable in SCP non-ambulator child than in independent ambulator. Thus, more extended range and frequent opportunity of joint motion may play an important role in improving the joint mobility in this patient group. Copyright 1998 Elsevier Science B.V.

Physical characteristics of a new synthetic fiber mattress in relation to pressure sores.

The purpose of the present investigation was to develop a mattress which was made of the new synthetic fibers called 'Shin-Gosen', and to determine its physical characteristics associated with pressure sores such as pressure distribution, temperature and humidity. The Shin-Gosen mattress consisted of three layers of elastic fibers made of polyester multifilaments, which were mediated by four layers of wave-like fabrics made of nylon monofilaments. The physical characteristics of the mattress were compared with (a) the conventional cotton hospital mattress and (b) the SORELESS MAT made of vacuole gel which effectively eliminated compression forces. The Shin-Gosen mattress was found to provide pressure relief effects similar to that of the SORELESS MAT the desired thermal insulation as well as that of the cotton mattress and a higher level of moisture vapor permeability. These excellent features will not only contribute to preventing pressure sores, but will also enable comfortable resting and sleeping.

Acoustic and electrical activities during voluntary isometric contraction of biceps brachii muscles in patients with spastic cerebral palsy.

This study was designed to compare electromyogram (EMG) and acoustic myogram (AMG) recordings of biceps brachii muscles in patients with spastic cerebral palsy (CP). The maximal voluntary contraction (MVC) in the CP group was approximately one half of that of the normal group even after being normalized by the muscle cross-sectional area (CSA) (18.6 - 5.9 kNm/m2 in CP, 37.3 +/- 2.9 kNm/m2 in normal). Both CP and normal groups demonstrated a progressive increase in the root mean squared values per unit muscle CSA in the EMG (RMSEMG/CSA) as well as in the AMG (RMSAMG/CSA) with increasing force up to 50% MVC. The increasing magnitude of the RMSEMG/CSA with force was not significantly different between two subject groups. However, all the levels of force resulted in significantly smaller RMSAMG/CSA in the CP group compared to the normal group. The ratios of RMSAMG to RMSEMG in the CP group (0.75 +/- 0.03 m/s2/mV) were significantly smaller than those in the normal group (1.37 +/- 0.07 m/s2/mV) at force levels above 30% MVC. These results suggest that motor disabilities in CP patients are caused not only by primary neural impairment but also by secondary deterioration in muscular contractile properties, probably resulting from muscle fiber atrophy. This appears to be more selective in fast twitch fibers.

A developmental index of muscle strength and assessment of quadriceps function in children with spina bifida.

This study was designed to develop a new index of muscle strength for children that was independent of body weight thus accommodated their developmental changes and to assess the quadriceps strength influencing ambulatory status in children with spina bifida. Maximum voluntary strength in isometric knee extension was measured from 60 children with spina bifida and 92 normal children. The measured strength was described in terms of torque. A muscle strength index (MSI) was defined as a unitless measure independent of the subject's body weight (i) by normalizing the residual of the maximum torque from the developmental regression line for normal children by body weight and, furthermore, (ii) by dividing the normalized residuals by their standard deviation among normal children. Children with spina bifida demonstrated a tendency to increase in maximum quadriceps torque with body weight; however, spina bifida children with a body weight above 30 kg showed a progressive decrease in MSI below a normal limit of muscle weakness. The MSI was closely related to both neurologic level and ambulatory ability compared with the maximum torque. These findings suggest MSI provides useful and detailed information for assessing and predicting ambulatory ability in children with spina bifida.

Assessment of obesity of children with spina bifida.

Percentage body fat of 35 children with spina bifida and 129 age-matched normal children was measured by underwater weighing and skinfold thickness to assess obesity. Percentage body fat of patients below five years was similar to that of controls; however, 58 per cent of patients above six years had an increased percentage of body fat. The neurological level and ambulatory ability were associated with percentage body fat. A significant correlation between percentage body fat and hydrocephalus suggests that the metabolic and nutritional maladaptation is caused not only by these patients' physical inactivity but also by the condition itself. Appropriate nutritional and mobility programmes should be started early to prevent the development of obesity.

An investigation of the accuracy in measuring the body center of pressure in a standing posture with a force plate.

It has been reported that accuracy in the measured point of force application depends on the position and magnitude of load. The aim of this study is to investigate the error in measuring the body center of pressure in a standing posture with a force plate and to improve the accuracy by proposing a correction algorithm. The measurement of the point of force application with a calibrated load demonstrated its co-ordinates, which were scaled down towards the zero co-ordinate and moved parallel relative to the true co-ordinates. This trend was exaggerated with any decrease in magnitude of the load. The root mean square (r.m.s.) and maximum of errors at light load of 10 kg were 10 and 18 mm in the X axis, and 6 and 12 mm in the Y axis, respectively. The error seems to result from such causes as (i) non-linearity of the load cell, (ii) deformation of the top plate due to load application and (iii) differences in characteristics among individual load cells, including amplifiers. A mathematical representation of the measured point of force application accounting for these causes of error has been made and an algorithm for estimating the true point at any magnitude of load with only one correction equation is proposed. Actual correction of the measured point demonstrated an expected improvement in the r.m.s. error to less than 1 mm at any magnitude of load greater than 10 kg and the validity of this algorithm was confirmed.

Assessment of daily physical activity levels of severely disabled persons using heart rate series.

Daily physical activity levels of severely disabled persons were assessed by means of a statistical analysis of their heart rate during a 24-h period. A non-Gaussian probability density function of the heart rate was calculated and separated into two levels of heart rate distributions, i.e. a relatively lower heart rate for basic daily activity and a relatively higher heart rate relating to vigorous activity. Disabled persons with low ambulatory ability showed daily activity levels similar to normal subjects in the length of time and the level of the heart rate. Their daily activity satisfied their needs for maintaining good health. However, more prolonged vigorous activity in daily living was necessary to improve cardiovascular fitness. For severely disabled persons without ambulatory ability, almost all of the heart rates during daily activity were categorized into the lower heart rate distribution. Their low level of physical activity may lead to a serious decrease in cardiovascular function with its attendant risk of cardiopulmonary disease.

Non-stationary analysis of electromyographic activity prior to a ballistic voluntary contraction.

The electromyogram (EMG) in a ballistic voluntary action of muscle after a slight sustained contraction shows a short period of decrease or disappearance of the activity prior to the onset of phasic discharge. The EMG of elbow extensor (triceps brachii) prior to phasic discharge was analyzed as a non-stationary stochastic process. The distribution of the EMG amplitude began to change from 100 ms before the phasic discharge. The statistical test showed that the EMG activity became non-Gaussian from 30 to 50 ms before the phasic discharge. The standard deviation of the EMG showed a decreasing tendency from 80 to 100 ms prior to the phasic discharge. The statistical evidence for the EMG depression was also confirmed in fourth and sixth order coefficients of the orthogonal expansion of the probability density function. These results suggested that the EMG process profoundly changed its statistical characteristics just before the phasic discharge.

Statistical approach for the estimation of daily physical activity levels using the probability density function of heart rate.

An investigation was undertaken into the statistical properties of heart rate during daily physical activity. The probability density function of the heart rate was estimated using the Gram-Charlier series. In addition, the probability density was separated into two Gaussian distributions: relatively low and relatively high heart rates. The former appeared to correspond to the metabolic rate associated with basic daily living and the latter appeared to be associated with more active physical activity of the type necessary to sustain or elevate the level of physical fitness. The higher heart rate distribution of five subjects occupied 8.72 +/- 2.15% of a period of waking. The validity of the statistical approach was confirmed with fractional estimation error of 1.22 +/- 0.62%.