Electromyography
(EMG) :- Instrumentation,
Assessment and Evaluation
EMG Measures
Movement involves electrical
activity in the muscles
Electrodes detect electrical
activity
Electromyography (EMG) =
Recording of muscle electrical
activity
Common use is to determine
when a muscle begins and ends
activation
EMG is fractionated as an index
of movement preparation
EMG Studies
An extension of the Physical Examination
Quantitates muscle injury
Provides Useful Data Regarding Injury
Site
Type
Severity
Duration
Prognosis
EMG
EMG: assess physiology of muscle
Neurologic consultation is best obtained
when testing is ordered
If EMG normal or non-contributory,
justification for neurologic consultation is
greater than before testing
When to order NCSs and
EMG
Mononeuropathy Diffuse neuropathies
Mononeuropathy Cranial
Multiplex neuropathies
Radiculopathy Neuromuscular
Plexopathy (Brachial Junction Disorders
or Lumbosacral) Myopathy
Anterior Horn Cell
Disorders
When Not to order NCSs and
EMG
Central Nervous System Disorders (Stroke,
TIA, Encephalopathy, spinal cord injury)
Multiple Sclerosis
Total body fatigue, fibromyalgia
Joint pain
Unexplained weakness (without a neurologic
consultation)
Failed back, S/P multiple neck and low back
surgeries
In place of a neurologic consultation
TYPES ELECTROMYOGRAPHY-
EMG
Raw EMG
Full wave
Rectify
Linear
Envelope
Integrate over
contraction
Research Applications of
Surface EMG
Indicator for muscle
activation/deactivation
Relationship of force/EMG signal
Use of EMG signal as a fatigue index
Types of EMG
Electrode Categories
Inserted
Fine-wire (Intra-muscular)
Needle
Surface
Fine-wire Electrodes
Advantages
Extremely sensitive
Record single muscle activity
Access to deep musculature
Little cross-talk concern
Disadvantages
Requires medical personnel, certification
Repositioning nearly impossible
Detection area may not be representative of entire
muscle
Surface Electrodes
Advantages
Quick, easy to apply
No medical supervision, required certification
Minimal discomfort
Disadvantages
Generally used only for superficial muscles
Cross-talk concerns
No standard electrode placement
May affect movement patterns of subject
Limitations with recording dynamic muscle activity
Needle Electromyography:
Techniques
Needle electrode is inserted into the muscle
Needle is disposable, single use
Multiple muscles are accessible for examination
Combination of muscles tested
Dependent upon clinical question
Level of discomfort is mild
Needle Electromyography:
Data
InsertionalActivity
Spontaneous Activity
Motor Unit Configuration
Motor Unit Recruitment
Interference Pattern
Needle Electromyography:
Data
Motor Unit Configuration
Single motor unit: A motor axon and all its muscle
fibers
Motor Unit Configuration: Amplitude, Duration, Morphology
Muscle is volitionally activated at different force levels
Needle recording properties enable assessment of single MUs
Motor Unit Recruitment
Pattern of motor unit activation with increasing volitional
activation
Interference Patterns
Motor unit pattern with full voluntary activation
Needle EMG findings suggestive of
denervation include:
fibrillations,
positive sharp waves, and
giant motor unit potentials (MUP).
EMG
Motor Unit Changes
Single Fiber EMG
Myasthenia Gravis
What to Expect From an
EMG Report
A clinically and physiologically relevant
interpretation/diagnosis
An outline of the localization, severity,
and acuity of the process
Notation of other diagnoses that are
detected/excluded
Explanation of any technical problems
Neuropathic disease has the following
defining EMG characteristics:
An action potential amplitude that is
twice normal due to the increased
number of fibres per motor unit because
of reinnervation of denervated fibres
An increase in duration of the action
potential
A decrease in the number of motor units
in the muscle (as found using motor unit
number estimation techniques)
Myopathic disease has these defining
EMG characteristics:
A decrease in duration of the action
potential
A reduction in the area to amplitude
ratio of the action potential
A decrease in the number of motor units
in the muscle (in extremely severe
cases only)
Electrode Comparison Studies
Giroux & Lamontagne - Electromyogr. Clin.
Neurophysiol., 1990
Purpose: to compare EMG surface
electrodes and intramuscular wire
electrodes for isometric and dynamic
contractions
Results
No significant difference in either isometric or
dynamic conditions
However: dynamic activity was not very
“dynamic”
Electrode Placement
Away from motor point
MUAP traveling in opposite directions
Simultaneous (+) & (-) AP’s
Resultant increased frequency components
More jagged signal
Middleof muscle belly is generally
accepted
EMG Electrode Placement
Electrode Placement
Away from tendon
Fewer, thinner muscle fibers
Closer to other muscle origins, insertions
More susceptible to cross-talk
Away from outer edge of muscle
Closer to other musculature
Orientation parallel to muscle fibers
More accurate conduction velocity
Increased probability of detecting same
signal
Surface Electrode Placement
EMG - Force Relationship:
Isometric vs. Isotonic
Contractions
Rectification
Translates the raw EMG signal to a
single polarity (usually positive)
Facilitates signal processing
Calculation of mean
Integration
Fast Fourier Transform (FFT)
Rectification - Types
Full-wave Adds the EMG
signal below the
baseline (usually
negative polarity) to
the signal above the
baseline
Conditioned signal is
all positive polarity
Preferred method
Conserves all signal
energy for analysis
Rectification - Types
Full-wave Deletes the EMG
Half-wave signal below the
baseline
Rectification - Types
Raw EMG
Full-wave
Rectified EMG
Half-wave
Rectified EMG
Delete
Integration
A method of quantifying the EMG signal
Assigns the signal a numerical value
Permits manipulation
Calculation
⚫ Example: Normalization
Statistical analysis
A form of linear envelope procedure
Measures the area under a curve
Integration
Area Under a Curve
Units = mV - msec
Integration - Procedure
EMG signal is Full-wave rectified
(Usually) lowpass
filtered
5 - 8 (10) Hz
Segment selected
Integral read (mV-
msec [or secs])
Reference Electrode Placement
(Ground)
As far away as possible from recording
electrodes
Electrically neutral tissue
Bony prominence
Good electrical contact
Largersize
Good adhesive properties
General Concerns
Signal-to-noise ratio
Ratio
of energy of EMG signal divided by
energy of noise signal
Distortion of the signal
EMG signal should be altered as minimally
as possible for accurate representation
Characteristics of EMG Signal
Amplitude range: 0–
10 mV (+5 to -5) prior
to amplification
Useable energy:
Range of 0 - 500 Hz
Dominant energy: 50
– 150 Hz
Characteristics of Electrical
Noise
Inherent noise in electronics equipment
Ambient noise
Motion artifact
Inherent instability of signal
EMG Noise
A form of artifact
Interference with signal recording
Obscures a “clean” signal
Electromagnetic sources from the
environment may overlay or cancel the
signal being recorded from a muscle
Especially problematic when the interfering
frequency is the same as being recorded from
muscle
⚫ Example: 60 Hz from power lines vs. 20 - 125 Hz
slow twitch motor units
Inherent Noise in Electronics
Equipment
Generated by all electronics equipment
Frequency range: 0 – several thousand
Hz
Cannot be eliminated
Reduced by using high quality
components
Ambient Noise
Electromagnetic radiation sources
Radio transmission
Electrical wires
Fluorescent lights
Essentiallyimpossible to avoid
Dominant frequency: 60 Hz
Amplitude: 1 – 3x EMG signal
Sources of Noise
(Interference)
Driver amplifier Swinging cables
Electrodes Especially if un- or
poorly-shielded
Cable movement
artifact “Swing frequency”
will probably be
under 10 Hz
Slow twitch mu’s:
(20) 70 - 120 Hz
Motion Artifact
Two main sources
Electrode/skininterface
Electrode cable
Reducibleby proper circuitry and set-up
Frequency range: 0 – 20 Hz
Inherent Instability of Signal
Amplitude is somewhat random in
nature
Frequency range of 0 – 20 Hz is
especially unstable
Therefore, removal of this range is
recommended
Factors Affecting the EMG
Signal
Factors – direct affect on signal
Extrinsic – electrode structure and placement
Intrinsic – physiological, anatomical,
biochemical
Intermediate Factors – physical &
physiological phenomena influenced by
one or more causative factors
Deterministic Factors – influenced by
intermediate factors
Factors Affecting the EMG
Signal
Maximizing Quality of EMG
Signal
Signal-to-noise ratio
Highest amount of information from EMG signal as
possible
Minimum amount of noise contamination
As minimal distortion of EMG signal as
possible
No unnecessary filtering
No distortion of signal peaks
No notch filters recommended
Ex: 60 Hz
Solutions for Signal Interruption
Related to Electrode and
Amplifier Design
Differential amplification
Reduces electromagnetic radiation noise
Dual electrodes
Electrode stability
Time for chemical reaction to stabilize
Important factors: electrode movement,
perspiration, humidity changes
Improved quality of electrodes
Less need for skin abrasion, hair removal
Differential Amplification
Ambient
(electromagnetic)
noise is constant
System subtracts
two signals
Resultant difference
is amplified
Double differential
technique
Electrode Configuration
Length of electrodes
of included fibers vs. increased noise
Distance between electrodes
Increased amplitude vs. misaligning electrodes,
Multiple motor unit action potentials (MUAP)
Muscle fibers of motor units are distributed evenly,
thus large muscle coverage is not necessary
(De Luca).
Usually 1 cm to 2 cm distance is maintained.
Cross-Talk
Electrodes over an adjacent muscle
pick-up a signal via skin conduction
M1 M2
Cross-Talk
Visuallyinspect a tracing (monitor or
printout) of a signal
Ifthey have the same shape there is
probably cross-talk
Muscle 1
Muscle 2
Cross-Talk Fixes
Check skin prep
Check skin resistance
Reposition electrodes
Check reference (ground) electrode
Move between electrode sets
Use a narrower OC distance between
electrodes, if available
Sampling Rate
Number of data points (cycles) collected
per unit of time - usually seconds
Example: 1000 cps = 1000 Hertz (Hz)
Anadequate sampling rate ensures that
what’s being recorded is truly
representative of the signal
Selecting the Sampling Rate
The “Two Times Rule”
Analyzethe signal (or movement) and
determine the highest possible
operating frequency
Example: motor unit frequency range =
(10) 70 - 250 Hz
Double the top rate
Sampling rate: 250 Hz x 2 = 500 Hz ~
1000Hz
Sampling at 1000 Hz
For
data plotted on a graph sampled at
1000 Hz, each tic on the X-axis is
1msec
1000 msec
1 second
Phase Transition
Visual assessment of phasic activity
1st 2nd 3rd
EMG “Pearls”
Electrodiagnostic studies are a
supplement to, and not a replacement,
for the history and physical examination
Electrodiagnostic results are often time-
dependent
Electrodiagnostic studies are not
“standardized” investigations and may
be modified by the practitioner to
answer the diagnostic question
References
Basmajian JV, De Luca CJ. Muscles Alive: their
functions revealed by electromyography (fifth ed.).
Williams & Wilkins, Baltimore, Maryland, 1985
Cram JR, Kasman GS. Introduction to surface
electromyography. Aspen Publishers, Inc.
Gaithersburg, Maryland, 1998
De Luca CJ: Surface electromyography: detection
and recording. DelSys, Inc., 2002
De Luca CJ: The use of surface electromyography in
biomechanics. J App Biomech 13: 135-163, 1997
MyoResearch: software for the EMG professional.
Scottsdale, Arizona, Noraxon USA, 1996-1999
Koh, T.J., Grabiner, M.D. (1993). Evaluation and methods
to minimize cross talk in surface electromyography.
Journal of Biomechnics, 26(supplement 1), 151-157.
Karst, G.M., & Willett, G.M. (1995). Onset timing of
electromyographic activity in vastus medialis oblique and
vastus lateralis muscles in subjects with and without
patellofemoral pain syndrome. Physical Therapy, 75,
813-823
Hodges, P.W., & Bui, B.H. (1996). A comparison of
computer-based methods for the determination of onset
of muscle contractions using electromyography.
Electroencephalography and Clinical Neurophysiology,
101,511-519.
