Summary Of EMG & NCV Findings: Evaluation Of The Left .
2018 ASSH Symposium EDx TestingNerve Conduction Study[NCS]-nNeedle Electromyography[EMG]1/4/2018Objectives General Knowledge– Components to the Electrophysiological Report– Purpose of NCS and needle EMG– Test Procedures SynthesisDavid Hutchinson PT, DSc, MS, ECS– Understand typical findings– Pathology for common upper limb presentations Case ReviewsEDX ReportChief Complaint(s)Patient Complaints:patient is a 35-year-old RHD male who reports on 5/15/2013 was injured atwork after his left elbow got stuck in a machine pulling his arm away from his body. Since this time,he reports ongoing left shoulder and elbow discomfort as well as numbness and tingling into theEDX Reportdistal fingertips D4-5 D3 aggravated when he attempts to lift objects. He is now 3 months followingthis reported event. He underwent a prior EMG/NCV a few weeks after the accident whichdemonstrated normal findings.Medical HistoryMedical History: Past Medical History:None. Past Surgical History: None. Allergies: NKDA.Medications: Baclofen, hydrocodone, Zolpidem, Meloxicam, and Cymbalta. Family History: He hasno family history disease. Social History: He is a truck driver. He is married, with 2 children. Hedoes not drink. Non-smoker.EvaluationClinical Findings: Observation: no atypical pain posturing noted within the upper limbs withoutguarding of the limb. Pain: reports mild left shoulder discomfort at “2 out of 10”mainly within theshoulder joint itself. Reports mild medial elbow discomfort on the left at “7 out of 10.” Motor: goodstrength in bilateral C5-T1 myotomes; no visible wasting/atrophy within the arm and shoulder girdlemusculature. Sensation: reduced light touch sensibility into D4-5 on the left; otherwise, intact C5-T1dermatomes. No abnormalities within the MAC distribution and DUC distribution. Reflexes: 2 andsymmetric C5 (biceps), C6 (BR), and C7 (triceps) bilaterally. Special Tests: Cervical Spine: - Quadranttest Rt/L, - Spurling’s Rt/Lt, - Adson Rt/Lt; - Phalen’s Rt/L, Tinels: Ulnar Tinel’s Lt elbow, mild Ltsupraclavicular fossa.Reason forReasonReferralfor Referral: LUE NCV/EMG for Ulnar Tunnel Lt elbow vs Brachial Plexopathy.Nerve Conduction Velocity [NCV] FindingsSummary of FindingsSummary of EMG & NCV Findings: Evaluation of the Left Ulnar Motor nerve showed decreasedconduction velocity (AE-BE, 43 m/s), decreased conduction velocity (ME-BE, 37 m/s), and decreasedconduction velocity (AE FDI-BE FDI, 43 m/s). The Left Ulnar Anti Sensory nerve showed prolongeddistal peak latency (Palm, 2.6 ms, Wrist, 4.2 ms), reduced amplitude (Wrist, 4.3 µV, Palm 4.6 µV). Allremaining nerves (as indicated in the following tables) were within normal limits. All F Wavelatencies were within normal limits. Needle evaluation of the Left 1stDorInt muscle showedincreased motor unit duration, moderately increased polyphasic potentials, and 75% IP. Allremaining muscles (as indicated in the following table) showed no evidence of electrical instability.Electrophysiological Conclusion(s)Electrophysiological Conclusion(s): (Limited study as per reason for referral). Electrophysiologicalfindings revealElectromyographic [EMG] Findings Low moderate left ulnar motor and sensory changes across the elbow with features c/w focaldemyelinating process and axonotmetric changes. There is evidence of reinnervation withinthe FDI. No evidence of left-sided C5-T1 radiculopathic or plexopathic changes. Normal left median motor and sensory findings across the wrist. Clinical correlation is suggested.Thank you for the opportunity to participate in the evaluation of your patient.D. Hutchinson, PT, DCS, ECSCopyright DHutchinson1
2018 ASSH Symposium EDx Testing1/4/2018History and Clinical Evaluation History Clinical Evaluation and Neurologic Evaluation Motor (myotome vs peripheral nerve pattern)Sensory (dermatome vs peripheral nerve pattern)ReflexesKozin S, Kothari M. Evaluating the patient withperipheral nervous system complaints. opathiesMuscularDystrophyNeuromuscularJunction DisordersEDX TESTINGNCS/EMG: Focal Neuropathy Assess functionality of the myelinated motor and sensory somaticnerve fibers of the Peripheral Nervous System. Demyelination Conduction Block AxonopathyNatureLocationSeverityDuration Mild Moderate SevereCopyright DHutchinsonProximalDistalMixedGeneralizedLambert EatonPolyneuropathiesMyastheniaGravisMotor neuronconditionsBotulism Prognostic Aide Complements clinical assessment and other testfindings (e.g. MRI) Acute Subacute Chronic2
2018 ASSH Symposium EDx Testing1/4/2018Consider within your differential1.2.3.4.Pre-existing or co-existing etiologiesNon-neural factorsAtypical presentationsIntrinsic vs Extrinsic MediatorsUMNLMNParalysis: movement alterationsParalysis: weakness muscle(s)Atrophy: none or slight except if severechronic lesionAtrophy: evidencedTone: hypertonicity, spasticityTone: hypotonic, flaccidMSR’s: , ClonusMSR’s or absentSuperficial Reflexes diminished or modifiedSuperficial reflexes often unalteredAbdominal reflex absentBabinski sign positive; inc jaw jerkNCS Technique A supramaximal electricalstimulus is applied to the nerveat key sites (Palm, Wrist,Elbow, Axilla, etc.)Nerve Conduction Study[NCS] Technique A wave of depolarization (ionicdischarge) travels along thenerve activating the sensory &motor fibers supplied by thatnerveTypical Findings and Pathology The desired response isrecorded with specialelectrodes.– As shown, the bar electrode D2NCS MeasuresFocal Neuropathy: Value of NCSFindings Tabular Data are organized by nerve, site of stimulation, distance betweensegments, and normative valuesNerve Conduction StudiesAnti Sensory Summary TableSiteNR PeakNormO-P(ms)PeakAmp(ms)(µV)Left Median Anti Sensory (3rd Digit) 31.9 CPalm1.833.8Wrist3.5 3.627.0Elbow8.113.1NormO-PAmpNegDur(ms)Neg NormVel(m/s) 10 102.091.751.6930.4324.2912.59WristWristElbow3rd DigitPalmWrist3.51.74.614.07.025.5404155 38 48 Waveform parameters include: Latency (ms) – time from stimulus to waveonset or peak (x-axis) Conduction Velocity (m/sec) – the latencyfactored by distance between segments Amplitude (mV or microV) – strength of sensoryor motor response to the supramaximalstimulus (y-axis)Copyright DHutchinson3
2018 ASSH Symposium EDx Testing1/4/2018NCS Response: HealthyNervePathologyNerve Conduction StudiesS3Anti SensorySensory SummarySummary mO-PPeakAmpPeakAmp(ms)(µV)Left Median Anti Sensory (ms)(3rd Digit) (µV)33.9 CPalmMedian Anti1.9LeftSensory (3rd Digit) 57.033.9 CWrist3.3 3.638.0Palm1.957.0Elbow6.820.2Wrist3.3 3.638.0RightMedianAntiSensory(3rdDigit)34.2 CElbow6.820.2Palm2.043.8S3S2Right(3rd Digit)39.834.2 CWrist Median Anti3.5Sensory 3.6Palm2.043.8Elbow7.514.4Wrist3.5 3.639.8Left Ulnar Anti Sensory(5thDigit) 34.5 CElbow7.514.4Palm1.843.2WristUlnar Anti Sensory2.8 3.730.9Left(5thDigit) 34.5 CRight Ulnar Anti1.8Sensory (5th Digit) 34.3 CPalm43.2Palm1.948.6Wrist2.8 3.730.9Wrist3.2 3.734.8RightSensory (5th Digit) 34.3 CBE Ulnar Anti5.912.6Palm1.948.6AE7.618.1Wrist3.2 3.734.8BE Summary mpAmpNeg 1NmlDelta-PS1 [Palm]:DistVelDistVel(cm)(m/s)Site2Site1Site23rd Digit 102.1643.61Wrist 10 stPalm3rdDigitElbow PalmWristWristElbow Wrist 10 10S12.381.882.381.88 10 Vel(m/s)(m/s)3.314.042 381.47.0503.314.042 383.521.060 481.47.0503.5 S2 21.060 48[Wrist]:Nml Response3.514.040 381.53.54.0PalmWrist5th Digit7.014.020.51.54.02.84740517.020.514.0475150 istWrist5th Digit5th DigitPalm2.83.21.014.014.07.050 .32.71.7 151.441.721.471.84 15NROnsetNormO-P Amp(ms)Onset (ms)(mV)Motor Summary TableLeft Median Motor (Abd Poll Brev) 35 CPalm1.69.9Site NROnsetNormO-P8.9AmpWrist3.2 4.2(ms)Onset (AbdPollPollBrev)Brev)35 C35.5 CLeftPalm1.614.3Palm1.69.9Wrist3.8 4.210.1Wrist3.2 4.28.9Elbow7.79.8Elbow7.08.4Left Ulnar Motor (Abd Dig Minimi) 34.9 CRightBrev) 35.5 C8.2Wrist Median Motor2.6 (Abd Poll 3.8Palm1.614.3Right Ulnar Motor (Abd Dig Minimi) 35.4 CWrist3.8 4.210.1Wrist2.9 3.88.3Elbow7.79.8BE5.77.7AE Ulnar Motor 7.5Left(Abd Dig Minimi) 34.9 C 6.725.0011.4643.0316.751.441.721.84Norm O-PAmpSite1Site2Delta-0(ms)7.016.010.0Dist(cm) 5WristSite1WristElbowAbd Poll BrevPalm tWristWristElbowElbowAbd PollPoll 8.00.00.019.80.0 3Wrist 5 5 3 3 33.2Abd Dig MinimiWristWristWristElbowBE8.0545959 48 38 50 50Vel(m/s)Norm Vel(m/s)Vel(m/s)Norm Vel(m/s) 4851 48 485161 48 5056 506156 50 508.0AEBE1.810.0WristAbd Dig Minimi2.68.0 3 3 3WristBEAEAbd Dig MinimiWristBE2.92.81.88.017.010.0Pathologic FindingsNRPeak(ms)NormO-PPeak Amp(ms)(µV)Right Median Anti Sensory (3rd Digit)Palm2.228.9Wrist 3.623.64.1Elbow9.117.5NormO-PAmp32 C 10 10S3S1S2 S3S1DemyelinationS3S2S3Conduction BlockS2S1S1NRS1S1 S2Axonopathy – non-localizingNRS3Conduction Block Changes – ImmediateDemyelinating and Axonal Changes – time dependentPathologic Findings Demyelination [localized to wrist]– slowed Latency and ConductionVelocitySiteS2 388.00.08.019.817.0 3S1 S2 38 483.82.22.93.92.82.6Abd Poll BrevPalmAbd Dig MinimiWristS344 38701.3 S3 [Elbow]:7.054 ResponseNml2.716.059 503.214.044 381.710.059 50PalmWrist5thBE Digit 5 5 5 5Norm 5O-PAmpWrist2.6 3.88.2Right Ulnar Motor (Abd Dig Minimi) 35.4 CWrist2.9 3.88.3BE5.77.7AE7.56.7WristBEWristAES1Healthy NerveResponseNormDelta-P(ms)(ms)3rd 912.092.7529.1023.8722.71WristWristElbow3rd DigitPalmWrist4.11.95.014.07.024.0343748 38 48 Axonopathy [non-localizing] - generalized amplitude reduction t/o nervebut we do not know where the problem originates based on limited datafurnished– further testing needed– This leads to the next part of our discussion. Conduction Block –[localized to wrist] reduced or absent amplitude at orSiteNR )PeakAmpO-PDurAreaP (ms) (cm) (m/s)Velproximal to O-PNormNegNegRight Lat Ante BrachCutanPeakAnti SensoryForearm)Dur35.3 C Area(ms)Amp(Lat O-P(ms)(µV)Amp(ms)(µV·ms)Lat Biceps2.99.51.699.33RightLat AnteBrachCutanAntiSensory(Lat Forearm) 35.3 CLeft MedianAntiSensory(3rdDigit)32.8 CLat2.99.51.699.33PalmBiceps1.942.8 101.5028.19LeftDigit) 10.532.8 C 10WristMedian Anti Sensory3.2 (3rd 3.61.0916.60Palm1.942.8 101.5028.19Elbow6.61.0017.128.8Wrist3.2 3.6 101.0916.6010.5Elbow6.68.81.0017.12Site1Site2Lat BicepsLat ForearmLatBicepsWristLat3rd ForearmDigitWristWristElbowWristElbowDeltaP 44 382.9Palm1.33rd 019.044565456 38 48 48 Axonopathy with Slowing at wrist [localized to wrist] - reducedamplitudes all sites with latency slowing across wristSite NR PeakNormO-PNorm(ms)PeakAmpO-P(ms)(µV)AmpRight Median Anti Sensory (3rd Digit) 31.7 CPalm1.9 106.6Wrist 3.6 106.55.6NegDur(ms)Neg NormVel(m/s)1.916.414.4620.62WristWrist3rd DigitPalm6.54.614.07.02215 38Healthy Nerve-MuscleAxonopathyElectromyography TechniqueNormal vs Pathologic Findings Nerve study findings CausationIntrinsic (e.g. virus) vs extrinsic (e.g. pressure source)Copyright DHutchinson4
2018 ASSH Symposium EDx Testing1/4/2018EMG Changes Correlate to Axonal Timeline3-4 WeeksEMG: TYPICAL TABLE OFFINDINGSMuscle Membrane Instability3-4 Months Collateral Sprouts9-12 Months Maturation1 inch/month Axonal RegrowthEMG Assessment: Abnormal FindingsEMG ApproachNORMAL STATE So far we discussedRest– EMG to define Severity and Duration of axonal pathology– NCS Localizing: demyelination and conduction block Non-localizing: axonopathy How do we determine the lesion site when there areaxonal loss changes?Voluntary Contraction– By performing needle EMG into muscles distal to the lesion and thenproximal. Then assure non-affected nerves follow a normal pattern– Remember muscles innervated downstream [distal] from site ofnerve injury show abnormalities Lets look at an exampleEMG LocalizationParticularly useful for AIN and PIN palsiesPronator Teres Entrapment:AINBrachial Plexopathy vsCervical Radiculopathy1. Map potential abnormalitiesat/distal to compression site? Assess PQ, FPL, FDP(median)Pathology and Localization of the Problem2. Define normal muscles? PT, FCRCheck Ulnar FDI, radialEIPC8 mulifidusCheck rostral/caudal areasSource: NetterCopyright DHutchinson5
2018 ASSH Symposium EDx Testing1/4/2018NCS TechniquePre and post-ganglionic lesions A supramaximal electricalstimulus is applied to the nerveat key sites Recall: Wallerian degeneration,the axon dies back towardslesion– Lesion proximal to cell body preserved stimulated response– Lesion distal to cell body abnormal response A wave of depolarization (ionicdischarge) travels along thenerve activating the sensory &motor fibers supplied by thatnerve The desired response is recordedwith special electrodes– As shown, deltoid recording Avulsion: proximal to sensorycell body (Preserved SNAP),distal to the motor cell body(Abnormal MAP)Location Rupture: distal both sensory andPreservationmotor cell bodies (AbnormalSNAP and cProximal to DRGDistal to DRGSNAPsMAPsSNAPs & MAPsAxillaPreganglionic AxonopathyPeripheral Nerve: BasicsPartial AxonopathyMotorNerveSensoryNerveComplete AxonopathyMotorNerveMotor StudyRobust signals (mV)Assess Responses t/o the armMotorNerveNRNRNRSensory StudySensoryNerveSmall signals (microV)Assess Distal responsesPostganglionic AxonopathyPartial AxonopathySensoryNerveNCS Delineation of Pre vs PostganglionicLesionKey: recording sites delineate which fibers are assessedC5 Root vs Upper Plexus1. Motor Study: Axillary Nn,Musculocutaneous,Suprascapular2. Sensory Study: LACMotorNerveSensoryNerveComplete AxonopathyC6 Root vs Upper Plexus1. Motor Study: as above2. Sensory Study: LAC, Median D1C7 Root vs Mid Plexus1. Motor Study: Radial2. Sensory Study: Radial, Median D33. Median H-reflex off FCRMotorNerveSensoryNerveCopyright DHutchinsonC8, T1 Root vs Lower Plexus1. Motor Study: Median APB, Ulnar2. Sensory: Ulnar D5, MAC6
2018 ASSH Symposium EDx Testing1/4/2018EMG TABLE OF FINDINGSElectromyography TechniqueNormal vs Pathologic FindingsLook over the table and lets review key findings1. Significant EMG change seen in all muscles at rest but less in the neck2. No evidence of volitional motor unit activity in the C5-T1 ventral motor fibersfrom hand to root3. Severe postganglionic preganglionic changes C5-C7 and pre/postganglionic changes C8-T1Brachial Plexopathies NCS testing– We perform motor and sensory testing C5-T1 to Evaluate sensory and motor amplitude changes for pre and post ganglionic changes Evaluate focal changes along nerve (demyelination and conduction block) Needle evaluation: sensitive measure for detectingaxononopathy and further evaluates extent of pathology– Recall: Axonopathic changes occur within muscle supplied by a nerve just distalto the site of the lesion– Needle Sampling Approach Sample distal and proximal along nerve to delineate normal vs abnormal findings Sample other nerves in distal and proximalNCS: Considerations Temperature: cool hand decreased latency, increasedamplitude Age: 5 and 65-70 decreased latency, decreasedamplitude Anomalies: Martin Gruber, Riche Cannei’, Pre vs postfixed plexus Time from reported onset Height – adjust with certain parts of test Concurrent Issues – consider multiple overlapping issues(CTS vs C6-7 radiculopathy/plexopathy, CTS withunderlying poly)Publications on Testing Methodology Carpal Tunnel Syndrome1, 6-9– Median sensory and motor NCSs are valid and reproducible clinicallaboratory studies.– Confirm a clinical diagnosis of CTS with a high degree of sensitivity( 85%) and specificity ( 95%).Case Reviews Cubital Tunnel Syndrome2, 6-9– Guidelines for testing proposed. Optimal elbow position (70-90 deg) andstimulus site recommendations– Sensitivity and specificity studies needed– Operator rigor and experience critical. Radial Sensory, Ulnar Tunnel, Anterior and PosteriorInterosseous Neuropathies6-9– Guidelines for testing proposed– Sensitivity and specificity studies needed– Operator rigor and experience criticalCopyright DHutchinson7
2018 ASSH Symposium EDx Testing1/4/2018Publications on TestingMethodology Brachial Plexopathies5Normal Values: Sensory NCSN e rv e– Overview of testing methodologies and sensitivities for detection Cervical Radiculopathies2– Minimal needle sampling 5-6 muscles Para spinals for localization MononeuropathiesR c dgS it eD is t ( c m )P e a k La t(msec)Digit 2 o rD3WristElbo w14n/a 3.6D4wrist14 3.6D1wrist/fo rearm14 3.6D5WristBEAE14 3.74th webDUCLat FrmA rm14 3.2 (peak)M dl Frm5cm up fro mCubital Crease14D1Lat Fo rearmEP LDo rso lat radiusO-P A mpN o rm a l C VO t he rM edian 38 481. W - P transcarpal lat 1.7 ms @ 7-cm distance2. W - P no 50% reductio n3. Side - side ampl no 50% difference fo r all test sites4. 3.0 ms if using o nsetM ed-Ulnar1. No 0.5 mseco nd differenceM ed-Radial– Testing techniques published with normal values and recommendationsfor standardization. Sensitivity and specificity studies lacking6-91. No 0.5 mseco nd differenceUlnar 38 48 50 401. M d SDL to Uln SDL no 0.5.2. W - P transcarpal lat 1.7 ms @ 7-cm distance3. W to P no 50% reductio n.4. 3.0 ms if using o nset4. Side to side amp no 50% difference.1. A mp no 50% reductio n side to side5micro V (p to p) 451. A SNA P amp 50% is significant.1.0micro V 451. A SNA P amp 50% is significant.14 381. A mpl are greater with reco rding using nn o ver EP Lvs Thumb.12 40DUCLA CM ACSup RadialNormal Values: Motor NCSN e rv eR e c o rdingS it eD is tO ns e t La t(msec)A mp (mV)Wrist8cm 4.0 to 4.5 ms5.00N o rm a l C VO t he rM edianAPBElbo wA xillaErbs2nd web spacewrist8cmA DM (A DQ)wrist8.00n/aM DL: ipsi o r co ntral ulnar no 1.0 msecNml: Wrist to palm 2.2 msec 48 (so me use 50) 55 60A cro ss upper and lo wer trunks 1.2 o r 1.3 msec fo r nmllatencylumb to intero sseo us co mparisio n. Diff 0.5 ismeaningfulReferences1.2.Ulnar 3.63.00BEAE1. M DL to A DM no 1.0msec than M DL to A P B2. M DL to A DM no 2.0msec than M DL to FDI3. definitive abnl 4 ms5050A xillaErb's 55 60FDIWrist 4.5A cro ss upper and lo wer trunks 1.2 o r 1.3 msec fo r nmllatencyno 1.5 ms co mpared to A DM valueA xillaryDelto idErb’ s 4.9Supraspinatus(needle)Infraspinatus (tab)Erb's 3.7EIPFrmAEA xillaErb's3.1. Greater 20% ampl reductio n with B E and A E issignificant.2. Change in mo rpho lo gy may be significant.3. A 10m/sec reductio n co mpared to fo rearm segmentis abno rmal. So me use 15 m/sec side to side o rco mpared to fo rearm4.5. 20% side tosideSuprascapularPractice parameters for electrodiagnostic studies in carpal tunnel syndrome:summary statement. American Association of Electrodiagnostic Medicine.Mm Nn 2002;25: 918-922.Practice parameter for needle electromyographic evaluation of patients withsuspected cervical radiculopathy: summary statement. American Academyof Physical Medicine and Rehabilitation. Mm Nn 1999;22[8]: S209-S211.AAEM Quality Assurance Committee: Campbell WW, et.al. Literaturereview of the usefulness of nerve conduction studies and electromyographyin the evaluation of patients with ulnar neuropathy at the elbow. Mm Nn1999;22:S408-S411.Consensus criteria for the diagnosis of partial conduction block. Mm Nn.1999;22[8]:S225-S229.Ferrante MA. Electrodiagnostic assessment of the brachial plexus. NeurolClin 2012(30):551–5806-9A cro ss upper and lo wer trunks 1.2 o r 1.3 msec fo r nmllatency 4.3Radial4.5cm 2.5 50 55 60References6.Dumitru D, Amato A, Zwarts M. Electrodiagnostic Medicine 2nd Ed.Hanley and Belfus, Philadelphia 20027. Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle,Principles and Practice. 3rd Ed. Oxford, NY, Philadelphia 2001.8. Oh, Shin. Clinical Electromyography: Nerve Conduction Studies. 2 ndEd. Williams and Wilkins, Baltimore. 19939. Daube J. ed. Clinical Neurophysiology. F.A. Davis Company,Philadelphia 1996.10. Kozin S, Kothari M. Evaluating the patient with peripheral nervoussystem complaints. JAOA 105(2);2005:71-83Copyright DHutchinson8
¾ Normal left median m otor and sensory findings across the wrist. ¾ Clinical correlation is suggested. Thank you for the opportunity to participate in the evaluation of your patient. D. Hutchinson, PT, DCS, ECS Summary of Findings Electrophysiological Conclusion(s)
EKG-EMG-PA and SHIELD-EKG-EMG-PRO. The first one is considered open-hardware and its schematics might be used as a reference if you wish to make the cable yourself. The SHIELD-EKG-EMG-PRO works with different set of attachment cups that makes it easier to measure EMG signals at hard-to-
Sanei S, Chambers J. Introduction to EEG: EEG Signal Processing. John Wiley and Sons Ltd., 2007. EMG: . Introduction Slide I-18 64-Channel EEG Hand Muscles EMG EMG Electromyography (EMG) is a technique for evaluating and recording the activation signal of muscles. The electrical potential generated by
EMG Analysis and EMG Graphing Software User Tutorial Installing the Software 1 Installing the Software Overview All of the Motion Lab Systems applications are written for the Microsoft Windows series of operating systems and should run on Windows98, Windows XP, Windows NT, Windows 2000, Windows XP and Windows Vista. Although unsupported, all
Noraxon U.S.A., Inc. DTS EMG Sensor P-5428/5468 Rev A (Dec 2013) DTS EMG Sensor User Manual Model 542 Model 546 (Research) (Clinical)
more years rowing experience participated in the study. Processing of collected kinematics and EMG data were done in Matlab program package. Key - Words: rowing, biomechanics, EMG, computer vision, signal processing 1 Introduction One of the most important things in vari
500 µv/ division (Nicolet Viking Quest, Nicolet Biomedical, Madison, WI), to test for recruitment of the deep lumbar multifidus was then performed by the physician. While the reliability and va-lidity of EMG to determine muscle ac-tivity remains controversial41,42, the use of needle EMG for attempted assess-
Kinematic variables comprise of joint angular position, velocities and acceleration. The data are then processed by MATLAB to obtain the desired result of kinetic variables (moment experienced by subject). 2.2 EMG Techniques EMG sensors are also placed only on major muscles of lower limb, which include Quadriceps, Hamstrings, Tibialis Anterior
IELTS Academic Writing Task 2 Activity – teacher’s notes Description An activity to introduce Academic Writing task 2, involving task analysis, idea generation, essay planning and language activation. Students are then asked to write an essay and to analyse two sample scripts. Time required: 130 minutes (90–100 minutes for procedure 1-12. Follow up text analysis another 30–40 mins .
