4/23/2016 Electromyography Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Electromyography 1/11 Electromyography Intervention EMG from gait termination, bottom left is the raw EMG, right is the rectified pattern ICD9CM 93.08 MeSH D004576 Electromyography From Wikipedia, the free encyclopedia Electromyography (EMG) is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles. [1] EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle cells [2] when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, or recruitment order, or to analyze the biomechanics of human or animal movement. Contents 1 Medical uses 2 Technique 2.1 Skin preparation and Risks 2.2 Surface and intramuscular EMG recording electrodes 2.3 Maximal voluntary contraction 2.4 Other measurements 2.5 EMG signal decomposition 2.6 EMG signal processing 2.7 Limitations 2.8 Electrical characteristics 3 Procedure outcomes 3.1 Normal results 3.2 Abnormal results 4 History 5 Research 6 See also 7 References 8 External links 9 Further reading Medical uses EMG testing has a variety of clinical and biomedical applications. EMG is used as a diagnostics tool for identifying neuromuscular diseases, or as a research tool for studying kinesiology, and disorders of motor control. EMG signals are sometimes used to guide botulinum toxin or phenol injections into muscles. EMG
Transcript
4/23/2016 Electromyography Wikipedia, the free encyclopedia
EMG from gait termination, bottom left is the rawEMG, right is the rectified pattern
ICD9CM 93.08
MeSH D004576
ElectromyographyFrom Wikipedia, the free encyclopedia
Electromyography (EMG) is an electrodiagnosticmedicine technique for evaluating and recording theelectrical activity produced by skeletal muscles.[1] EMGis performed using an instrument called anelectromyograph, to produce a record called anelectromyogram. An electromyograph detects theelectrical potential generated by muscle cells[2] whenthese cells are electrically or neurologically activated.The signals can be analyzed to detect medicalabnormalities, activation level, or recruitment order, or toanalyze the biomechanics of human or animal movement.
Contents
1 Medical uses2 Technique
2.1 Skin preparation and Risks2.2 Surface and intramuscular EMG
recording electrodes2.3 Maximal voluntary contraction2.4 Other measurements2.5 EMG signal decomposition2.6 EMG signal processing2.7 Limitations2.8 Electrical characteristics
3 Procedure outcomes3.1 Normal results3.2 Abnormal results
4 History5 Research6 See also7 References8 External links9 Further reading
Medical uses
EMG testing has a variety of clinical and biomedical applications. EMG is used as a diagnostics tool foridentifying neuromuscular diseases, or as a research tool for studying kinesiology, and disorders of motorcontrol. EMG signals are sometimes used to guide botulinum toxin or phenol injections into muscles. EMG
signals are also used as a control signal for prosthetic devices such as prosthetic hands, arms, and lowerlimbs.
EMG then acceleromyograph may be used for neuromuscular monitoring in general anesthesia withneuromuscularblocking drugs, in order to avoid postoperative residual curarization (PORC).[3][4][5][6]
Except in the case of some purely primary myopathic conditions EMG is usually performed with anotherelectrodiagnostic medicine test that measures the conducting function of nerves. This is called a nerveconduction studies (NCS). Needle EMG and NCSs are typically indicated when there is pain in the limbs,weakness from spinal nerve compression, or concern about some other neurologic injury or disorder.[7]Spinal nerve injury does not cause neck, mid back pain or low back pain, and for this reason, evidence hasnot shown EMG or NCS to be helpful in diagnosing causes of axial lumbar pain, thoracic pain, or cervicalspine pain.[7] Needle EMG may aid with the diagnosis of nerve compression or injury (such as carpal tunnelsyndrome), nerve root injury (such as sciatica), and with other problems of the muscles or nerves. Lesscommon medical conditions include amyotrophic lateral sclerosis, myasthenia gravis, and musculardystrophy.
Technique
Skin preparation and Risks
The first step before insertion of the needle electrode is skin preparation. This typically involves simplycleaning the skin with an alcohol pad.
The actual placement of the needle electrode can be difficult and depends on a number of factors, such asspecific muscle selection and the size of that muscle. Proper needle EMG placement is very important foraccurate representation of the muscle of interest, although EMG is more effective on superficial muscles asit is unable to bypass the action potentials of superficial muscles and detect deeper muscles. Also, the morebody fat an individual has, the weaker the EMG signal. When placing the EMG sensor, the ideal location isat the belly of the muscle: the longitudinal midline. The belly of the muscle can also be thought of as inbetween the motor point (middle) of the muscle and the tendonus insertion point.[8]
Cardiac pacemakers and implanted cardiac defibrillators (ICDs) are used increasingly in clinical practice,and no evidence exists indicating that performing routine electrodiagnostic studies on patients with thesedevices pose a safety hazard. However, there are theoretical concerns that electrical impulses of nerveconduction studies (NCS) could be erroneously sensed by devices and result in unintended inhibition ortriggering of output or reprogramming of the device. In general, the closer the stimulation site is to thepacemaker and pacing leads, the greater the chance for inducing a voltage of sufficient amplitude to inhibitthe pacemaker. Despite such concerns, no immediate or delayed adverse effects have been reported withroutine NCS.[9]
No known contraindications exist from performing needle EMG or NCS on pregnant patients. In addition,no complications from these procedures have been reported in the literature. Evoked potential testing,likewise, has not been reported to cause any problems when it is performed during pregnancy.[9]
Patients with lymphedema or patients at risk for lymphedema are routinely cautioned to avoid percutaneousprocedures in the affected extremity, namely venipuncture, to prevent development or worsening oflymphedema or cellulitis. Despite the potential risk, the evidence for such complications subsequent tovenipuncture is limited. No published reports exist of cellulitis, infection, or other complications related toEMG performed in the setting of lymphedema or prior lymph node dissection. However, given theunknown risk of cellulitis in patients with lymphedema, reasonable caution should be exercised inperforming needle examinations in lymphedematous regions to avoid complications. In patients with grossedema and taut skin, skin puncture by needle electrodes may result in chronic weeping of serous fluid. Thepotential bacterial media of such serous fluid and the violation of skin integrity may increase the risk ofcellulitis. Prior to proceeding, the physician should weigh the potential risks of performing the study withthe need to obtain the information gained.[9]
Surface and intramuscular EMG recording electrodes
There are two kinds of EMG: surface EMG and intramuscular EMG. Surface EMG assesses musclefunction by recording muscle activity from the surface above the muscle on the skin. Surface electrodes areable to provide only a limited assessment of the muscle activity. Surface EMG can be recorded by a pair ofelectrodes or by a more complex array of multiple electrodes. More than one electrode is needed becauseEMG recordings display the potential difference (voltage difference) between two separate electrodes.Limitations of this approach are the fact that surface electrode recordings are restricted to superficialmuscles, are influenced by the depth of the subcutaneous tissue at the site of the recording which can behighly variable depending of the weight of a patient, and cannot reliably discriminate between thedischarges of adjacent muscles.
Intramuscular EMG can be performed using a variety of different types of recording electrodes. Thesimplest approach is a monopolar needle electrode. This can be a fine wire inserted into a muscle with asurface electrode as a reference; or two fine wires inserted into muscle referenced to each other. Mostcommonly fine wire recordings are for research or kinesiology studies. Diagnostic monopolar EMGelectrodes are typically stiff enough to penetrate skin and insulated, with only the tip exposed using asurface electrode for reference. Needles for injecting therapeutic botulinum toxin or phenol are typicallymonopolar electrodes that use a surface reference, in this case, however, the metal shaft of a hypodermicneedle, insulated so that only the tip is exposed, is used both to record signals and to inject. Slightly morecomplex in design is the concentric needle electrode. These needles have a fine wire, embedded in a layerof insulation that fills the barrel of a hypodermic needle, that has an exposed shaft, and the shaft serves asthe reference electrode. The exposed tip of the fine wire serves as the active electrode. As a result of thisconfiguration, signals tend to be smaller when recorded from a concentric electrode than when recordedfrom a monopolar electrode and they are more resistant to electrical artifacts from tissue and measurementstend to be somewhat more reliable. However, because the shaft is exposed throughout its length, superficialmuscle activity can contaminate the recording of deeper muscles. Single fiber EMG needle electrodes aredesigned to have very tiny recording areas, and allow for the discharges of individual muscle fibers to bediscriminated.
To perform intramuscular EMG, typically either a monopolar or concentric needle electrode is insertedthrough the skin into the muscle tissue. The needle is then moved to multiple spots within a relaxed muscleto evaluate both insertional activity and resting activity in the muscle. Normal muscles exhibit a brief burstof muscle fiber activation when stimulated by needle movement, but this rarely lasts more than 100ms. Thetwo most common pathologic types of resting activity in muscle are fasciculation and fibrillation potentials.A fasciculation potential is an involuntary activation of a motor unit within the muscle, sometimes visible
4/23/2016 Electromyography Wikipedia, the free encyclopedia
with the naked eye as a muscle twitch or by surface electrodes. Fibrillations, however, are only detected byneedle EMG, and represent the isolated activation of individual muscle fibers, usually as the result of nerveor muscle disease. Often, fibrillations are triggered by needle movement (insertional activity) and persist forseveral seconds or more after the movement ceases.
After assessing resting and insertional activity, the electromyographer assess the activity of muscle duringvoluntary contraction. The shape, size, and frequency of the resulting electrical signals are judged. Then theelectrode is retracted a few millimetres, and again the activity is analyzed. This is repeated, sometimes untildata on10–20 motor units have been collected in order to draw conclusions about motor unit function. Eachelectrode track gives only a very local picture of the activity of the whole muscle. Because skeletal musclesdiffer in the inner structure, the electrode has to be placed at various locations to obtain an accurate study.
Single fiber electromyography assessed the delay between the contractions of individual muscle fiberswithin a motor unit and is a sensitive test for dysfunction of the neuromuscular junction caused by drugs,poisons, or diseases such as myasthenia gravis. The technique is complicated and typically only performedby individuals with special advanced training. Surface EMG is used in a number of settings; for example, inthe physiotherapy clinic, muscle activation is monitored using surface EMG and patients have an auditoryor visual stimulus to help them know when they are activating the muscle (biofeedback). A review of theliterature on surface EMG published in 2008 concluded that surface EMG may be useful to detect thepresence of neuromuscular disease (level C rating, class III data), but there are insufficient data to supportits utility for distinguishing between neuropathic and myopathic conditions or for the diagnosis of specificneuromuscular diseases. sEMG may be useful for additional study of fatigue associated with postpoliomyelitis syndrome and electromechanical function in myotonic dystrophy (level C rating, class IIIdata).[9]
Certain US states limit the performance of needle EMG by nonphysicians. New Jersey declared that itcannot be delegated to a physician's assistant.[10][11] Michigan has passed legislation saying needle EMG isthe practice of medicine.[12] Special training in diagnosing medical diseases with EMG is required only inresidency and fellowship programs in neurology, clinical neurophysiology, neuromuscular medicine, andphysical medicine and rehabilitation. There are certain subspecialists in otolaryngology who have hadselective training in performing EMG of the laryngeal muscles, and subspecialists in urology, obstetrics andgynecology who have had selective training in performing EMG of muscles controlling bowel and bladderfunction.
Maximal voluntary contraction
One basic function of EMG is to see how well a muscle can be activated. The most common way that canbe determined is by performing a maximal voluntary contraction (MVC) of the muscle that is being tested.[13]
Muscle force, which is measured mechanically, typically correlates highly with measures of EMGactivation of muscle. Most commonly this is assessed with surface electrodes, but it should be recognizedthat these typically only record from muscle fibers in close approximation to the surface.
Several analytical methods for determining muscle activation are commonly used depending on theapplication. The use of mean EMG activation or the peak contraction value is a debated topic. Most studiescommonly use the maximal voluntary contraction as a means of analyzing peak force and force generated
by target muscles. According to the article, Peak and average rectified EMG measures: Which method ofdata reduction should be used for assessing core training exercises?,[14] concluded that the “averagerectified EMG data (ARV) is significantly less variable when measuring the muscle activity of the coremusculature compared to the peak EMG variable.” Therefore, these researchers would suggest that “ARVEMG data should be recorded alongside the peak EMG measure when assessing core exercises.” Providingthe reader with both sets of data would result in enhanced validity of the study and potentially eradicate thecontradictions within the research.[15][16]
Other measurements
EMG can also be used for indicating the amount of fatigue in a muscle. The following changes in the EMGsignal can signify muscle fatigue: an increase in the mean absolute value of the signal, increase in theamplitude and duration of the muscle action potential and an overall shift to lower frequencies. Monitoringthe changes of different frequency changes the most common way of using EMG to determine levels offatigue. The lower conduction velocities enable the slower motor neurons to remain active.[17]
A motor unit is defined as one motor neuron and all of the muscle fibers it innervates. When a motor unitfires, the impulse (called an action potential) is carried down the motor neuron to the muscle. The areawhere the nerve contacts the muscle is called the neuromuscular junction, or the motor end plate. After theaction potential is transmitted across the neuromuscular junction, an action potential is elicited in all of theinnervated muscle fibers of that particular motor unit. The sum of all this electrical activity is known as amotor unit action potential (MUAP). This electrophysiologic activity from multiple motor units is the signaltypically evaluated during an EMG. The composition of the motor unit, the number of muscle fibres permotor unit, the metabolic type of muscle fibres and many other factors affect the shape of the motor unitpotentials in the myogram.
Nerve conduction testing is also often done at the same time as an EMG to diagnose neurological diseases.
Some patients can find the procedure somewhat painful, whereas others experience only a small amount ofdiscomfort when the needle is inserted. The muscle or muscles being tested may be slightly sore for a dayor two after the procedure.
EMG signal decomposition
EMG signals are essentially made up of superimposed motor unit action potentials (MUAPs) from severalmotor units. For a thorough analysis, the measured EMG signals can be decomposed into their constituentMUAPs. MUAPs from different motor units tend to have different characteristic shapes, while MUAPsrecorded by the same electrode from the same motor unit are typically similar. Notably MUAP size andshape depend on where the electrode is located with respect to the fibers and so can appear to be different ifthe electrode moves position. EMG decomposition is nontrivial, although many methods have beenproposed.
EMG signal processing
Rectification is the translation of the raw EMG signal to a single polarity frequency (usually positive). Thepurpose of rectifying a signal is to ensure the raw signal does not average zero, due to the raw EMG signalhaving positive and negative components. It facilitates the signals and process and calculates the mean,
integration and the fast fourier transform (FFT). The two types of rectification of signals refer to whathappens to the EMG wave when it is processed. These types include full length frequency and half length.Full length frequency adds the EMG signal below the baseline (usually negative polarity) to the signalabove the baseline making a conditioned signal that is all positive. This is the preferred method ofrectification because it conserves all signal energy for analysis, usually in the positive polarity. Half lengthrectification deletes the EMG signal below the baseline. In doing so, the average of the data is no longerzero therefore it can be used in statistical analyses. The only difference between the two types ofrectification is that fullwave rectification takes the absolute value of the signal array of data points.[18][19]
Limitations
Needle EMG use in clinical settings has practical applications such as helping to discover disease. NeedleEMG has limitations, however, in that it does involve voluntary activation of muscle, and as such is lessinformative in patients unwilling or unable to cooperate, children and infants, and in individuals withparalysis., Surface EMG can have limited applications due to inherent problems associated with surfaceEMG. Adipose tissue (fat) can affect EMG recordings. Studies show that as adipose tissue increased theactive muscle directly below the surface decreased. As adipose tissue increased, the amplitude of thesurface EMG signal directly above the center of the active muscle decreased. EMG signal recordings aretypically more accurate with individuals who have lower body fat, and more compliant skin, such as youngpeople when compared to old. Muscle cross talk occurs when the EMG signal from one muscle interfereswith that of another limiting reliability of the signal of the muscle being tested. Surface EMG is limited dueto lack of deep muscles reliability. Deep muscles require intramuscular wires that are intrusive and painfulin order to achieve an EMG signal. Surface EMG can only measure superficial muscles and even then it ishard to narrow down the signal to a single muscle.[20]
Electrical characteristics
The electrical source is the muscle membrane potential of about –90 mV.[21] Measured EMG potentialsrange between less than 50 μV and up to 20 to 30 mV, depending on the muscle under observation.
Typical repetition rate of muscle motor unit firing is about 7–20 Hz, depending on the size of the muscle(eye muscles versus seat (gluteal) muscles), previous axonal damage and other factors. Damage to motorunits can be expected at ranges between 450 and 780 mV.
Procedure outcomes
Normal results
Muscle tissue at rest is normally electrically inactive. After the electrical activity caused by the irritation ofneedle insertion subsides, the electromyograph should detect no abnormal spontaneous activity (i.e., amuscle at rest should be electrically silent, with the exception of the area of the neuromuscular junction,which is, under normal circumstances, very spontaneously active). When the muscle is voluntarilycontracted, action potentials begin to appear. As the strength of the muscle contraction is increased, moreand more muscle fibers produce action potentials. When the muscle is fully contracted, there should appeara disorderly group of action potentials of varying rates and amplitudes (a complete recruitment andinterference pattern).
EMG findings vary with the type of disorder, the duration of the problem, the age of the patient, the degreeto which the patient can be cooperative, the type of needle electrode used to study the patient, and samplingerror in terms of the number of areas studied within a single muscle and the number of muscles studiedoverall. Interpreting EMG findings is usually best done by an individual informed by a focused history andphysical examination of the patient, and in conjunction with the results of other relevant diagnostic studiesperformed including most importantly, nerve conduction studies, but also, where appropriate, imagingstudies such as MRI and ultrasound, muscle and nerve biopsy, muscle enzymes, and serologic studies.
Abnormal results may be caused by the following medical conditions (please note this is not an exhaustivelist of conditions that can result in abnormal EMG studies):
The first documented experiments dealing with EMG started with Francesco Redi’s works in 1666. Redidiscovered a highly specialized muscle of the electric ray fish (Electric Eel) generated electricity. By 1773,Walsh had been able to demonstrate that the eel fish’s muscle tissue could generate a spark of electricity. In1792, a publication entitled De Viribus Electricitatis in Motu Musculari Commentarius appeared, written byLuigi Galvani, in which the author demonstrated that electricity could initiate muscle contraction. Sixdecades later, in 1849, Emil du BoisReymond discovered that it was also possible to record electricalactivity during a voluntary muscle contraction. The first actual recording of this activity was made byMarey in 1890, who also introduced the term electromyography. In 1922, Gasser and Erlanger used anoscilloscope to show the electrical signals from muscles. Because of the stochastic nature of the myoelectricsignal, only rough information could be obtained from its observation. The capability of detectingelectromyographic signals improved steadily from the 1930s through the 1950s, and researchers began touse improved electrodes more widely for the study of muscles. The AANEM was formed in 1953 as one ofseveral currently active medical societies with a special interest in advancing the science and clinical use ofthe technique. Clinical use of surface EMG (sEMG) for the treatment of more specific disorders began inthe 1960s. Hardyck and his researchers were the first (1966) practitioners to use sEMG. In the early 1980s,Cram and Steger introduced a clinical method for scanning a variety of muscles using an EMG sensingdevice.[22]
It is not until the middle of the 1980s that integration techniques in electrodes had sufficiently advanced toallow batch production of the required small and lightweight instrumentation and amplifiers. At present, anumber of suitable amplifiers are commercially available. In the early 1980s, cables that produced signalsin the desired microvolt range became available. Recent research has resulted in a better understanding ofthe properties of surface EMG recording. Surface electromyography is increasingly used for recording fromsuperficial muscles in clinical or kinesiological protocols, where intramuscular electrodes are used forinvestigating deep muscles or localized muscle activity.
There are many applications for the use of EMG. EMG is used clinically for the diagnosis of neurologicaland neuromuscular problems. It is used diagnostically by gait laboratories and by clinicians trained in theuse of biofeedback or ergonomic assessment. EMG is also used in many types of research laboratories,including those involved in biomechanics, motor control, neuromuscular physiology, movement disorders,postural control, and physical therapy.
Research
EMG can be used to sense isometric muscular activity where no movement is produced. This enablesdefinition of a class of subtle motionless gestures to control interfaces without being noticed and withoutdisrupting the surrounding environment. These signals can be used to control a prosthesis or as a controlsignal for an electronic device such as a mobile phone or PDA.
EMG signals have been targeted as control for flight systems. The Human Senses Group at the NASAAmes Research Center at Moffett Field, CA seeks to advance manmachine interfaces by directlyconnecting a person to a computer. In this project, an EMG signal is used to substitute for mechanicaljoysticks and keyboards. EMG has also been used in research towards a "wearable cockpit," which employsEMGbased gestures to manipulate switches and control sticks necessary for flight in conjunction with agogglebased display.
Unvoiced speech recognition recognizes speech by observing the EMG activity of muscles associated withspeech. It is targeted for use in noisy environments, and may be helpful for people without vocal cords andpeople with aphasia.
EMG has also been used as a control signal for computers and other devices. An interface device based onEMG could be used to control moving objects, such as mobile robots or an electric wheelchair.[23] This maybe helpful for individuals that cannot operate a joystickcontrolled wheelchair. Surface EMG recordingsmay also be a suitable control signal for some interactive video games.[24]
A joint project involving Microsoft, the University of Washington in Seattle, and the University of Torontoin Canada has explored using muscle signals from hand gestures as an interface device.[25] A patent basedon this research was submitted on June 26, 2008.[26]
References1. Kamen, Gary. Electromyographic Kinesiology. In Robertson, DGE et al. Research Methods in Biomechanics.Champaign, IL: Human Kinetics Publ., 2004.
2. Electromyography (https://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?mode=&term=Electromyography) at the USNational Library of Medicine Medical Subject Headings (MeSH)
3. Harvey AM, Masland RL: Actions of durarizing preparations in the human. Journal of Pharmacology AndExperimental Therapeutics, Vol. 73, Issue 3, 304311, 1941
4. Botelho SY: Comparison of simultaneously recorded electrical and mechanical activity in myasthenia gravispatients and in partially curarized normal humans. Am J Med. 1955 Nov;19(5):6936. PMID 13268466
5. Christie TH, ChurchillDavidson HC: The St. Thomas's Hospital nerve stimulator in the diagnosis of prolongedapnoea. Lancet. 1958 Apr 12;1(7024):776. PMID 13526270
6. Engbaek J, Ostergaard D, VibyMogensen J: Double burst stimulation (DBS): a new pattern of nerve stimulationto identify residual neuromuscular block. Br J Anaesth. 1989 Mar;62(3):2748. PMID 2522790
Association of Electromyography Technologists of Canada (AETC) (http://www.aetc.ca)MedlinePlus entry on EMG (http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm) describesEMGNeuromuscular.edu (http://neuromuscular.wustl.edu/mtime/mgdx.html)American Association of Neuromuscular & Electrodiagnostic Medicine (http://www.aanem.org)EmedicineHealth page on EMG(http://www.emedicinehealth.com/electromyography_emg/article_em.htm)
7. North American Spine Society (February 2013), "Five Things Physicians and Patients Should Question",Choosing Wisely: an initiative of the ABIM Foundation (North American Spine Society), retrieved 25 March2013, which cites
Sandoval, AE (Nov 2010). "Electrodiagnostics for low back pain.". Physical medicine and rehabilitationclinics of North America 21 (4): 767–76. doi:10.1016/j.pmr.2010.06.007. PMID 20977959.North American Spine Society (2011). "Diagnosis and treatment of degenerative lumbar spinal stenosis".Burr Ridge, Illinois: Agency for Healthcare Research and Quality: 104.
8. https://www.delsys.com/Attachments_pdf/TN101%20%20EMG%20Sensor%20Placementweb.pdf9. http://www.aanem.org/getmedia/2034191e583b4c55b725fc38ea8262e2/risksinEDX.pdf.aspx.10. Arthur C. Rothman, MD, v. Selective Insurance Company of America, Supreme Court of New Jersey, Jan. 1911. Texas Court of Appeals, Third District, at Austin, Cause No. 0310673CV. April 5, 201212. Section 333.17018 Michigan Compiled Laws http://legislature.mi.gov/doc.aspx?mcl3331701813. Behm, D.G., Whittle, J., Button, D., & Power, K. (2002). Intermuscle differences in activation. Muscle and
Nerve. 25(2); 236243.14. Hibbs, A.E., Thompson, K.G., French, D.N., Hodgson, D., Spears, I.R. Peak and average rectified EMG
measures: Which method of data reduction should be used for assessing core training exercises? Journal ofElectromyography and Kinesiology. 21(1), 102 – 111. 2011.
15. Buchanan, T. S., Lloyd, D. G., Manal, K., & Besier, T. F. (2004). Neuromusculoskeletal modeling: estimation ofmuscle forces and joint moments and movements from measurements of neural command. Journal of appliedbiomechanics, 20(4), 367.
16. Halperin, I., Aboodarda, S. J., Button, D. C., Andersen, L. L., & Behm, D. G. (2014). ROLLER MASSAGERIMPROVES RANGE OF MOTION OF PLANTAR FLEXOR MUSCLES WITHOUT SUBSEQUENTDECREASES IN FORCE PARAMETERS. International journal of sports physical therapy, 9(1), 92.
17. Cifrek, M., Medved, V., Tonković, S., & Ostojić, S. (2009). Surface EMG based muscle fatigue evaluation inbiomechanics. Clinical Biomechanics, 24(4), 327340.
18. Weir, JP; Wagner, LL; Housh, TJ (1992). "Linearity and reliability of the IEMG v. torque relationship for theforearm flexors and leg extensors". American Journal of Physical Medicine and Rehabilitation 71 (5): 283–287.
19. Vrendenbregt, J; Rau, G; Housh (1973). "Surface eletromyography in relation to force, muscle length andendurance.". New developments in electromyography and clinical neurophysiology: 607–622.
20. Kuiken, TA; Lowery, Stoykob (April 2003). "The Effect of Subcutaneous Fat on myoelectric signal amplitudeand cross talk". Prosthetics and Orthodontics International 27 (1): 48–54.
21. Nigg B.M., & Herzog W., 1999. Biomechanics of the MusculoSkeletal system. Wiley. Page:349.22. Cram, JR.; Steger, JC. (Jun 1983). "EMG scanning in the diagnosis of chronic pain.". Biofeedback Self Regul 8
(2): 229–41. PMID 6227339.23. Andreasen, DS.; Gabbert DG,: EMG Switch Navigation of Power Wheelchairs, RESNA 2006. [1]
(http://www.tinkertron.com/Papers.html)24. Park, DG.; Kim, HC. Muscleman: Wireless input device for a fighting action game based on the EMG signal and
acceleration of the human forearm. [2] (http://melab.snu.ac.kr/Research/melab/doc/HCI/muscleman_paper.pdf)25. Hsu, Jeremy (20091029). "The Future of Video Game Input: Muscle Sensors". Live Science. Retrieved
20100116.26. "Recognizing Gestures from Forearm EMG Signals". United States Patent and Trademark Office. 20080626.
Risks in Electrodiagnostic Medicine (http://www.aanem.org/getmedia/2034191e583b4c55b725fc38ea8262e2/risksinEDX.pdf.aspx)Interactively design an EMG signal processing RMS envelope measurement application with theASN Filter Designer (ASNAN024) (http://www.advsolned.com/downloads/ASNAN024.pdf)
Further reading
Piper, H.: Elektrophysiologie menschlicher Muskeln, von H. Piper. Berlin, J.Springer, 1912
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