Peter Konrad - EMG in Gait Analysis

Noraxon User Meeting 2011
EMG Processing & Analysis

Techniques for Gait
Peter Konrad PhD Sports Science
Lead Software & Application Designer
Noraxon USA, Inc.
Noraxon EMG Workshop 2011
Hosted by:
Dr. Chris Powers
Movement Performance Institute
Los Angeles, California
1. New Hardware Aspects
2. Electrode Recommendations
3. Artifact Management
4. Signal Processing Routines
5. Time Normalized Averaging
6. On/Off Pattern Determination
7. Gait Phase Detection
8. Analysis and Interpretation
Topics
1- Hardware
EMG Milestone Telemetry
From: Ines A. Kramers-de Quervain, Edgar Stussi, Alex Stacoff
Ganganalyse beim Gehen und Laufen
1980 1990
Cleaner Signals
Less noise interference
Easier handling
Direct Transmission Systems
Key Benefits:
Very fast/easy handling
No cable fixation
Natural movement
Very helpful for small subjects
Benefits of Latest EMG Technology
2008
Noraxon User Meeting 2011 Carlo Frigo, Paolo Crenna, Clinical Biomechanics 24 (2009) p. 239
Benefits of Latest EMG Technology
...even non specialists can easily use EMG
Excellent Artifact Stability
Stable baseline even under heavy impact conditions
Long Distance Transmission
Natural and unlimited movement
Subject on 100 Meter
sprint parcour
2 - Electrodes
Electrode Recommendation
Typical:
1 cm active area
2 cm distance
Parallel to fiber direction
Wet gel Silver/Silver Chloride
Recommendations given by international research societies
The International Society
of Electrophysiology and
Kinesiology (ISEK)
Electrode selection relates to the intended use
Single / Dual electrodes
Adhesive or Wet Gel
Re-usable (Beckmann style)
Centralized or decentralized snap
Commercial Fine Wire or
needle electrodes
Incontinence probes
Numerous styles/manufacturers
2
1
3
4
2
1
3
4
Free Selection of Electrode Type
Konrad 2005; ABC of EMG
Top Mounted Transmission Probes
Problems:
Probe inertia, restrictions, pressure artifacts
?
(C) BTS Italy- www.btsbioengineering.com
(C) Delsys www.delsys.com
(C) BTS - Italy
The connection cable allows for management of pressure areas, skin
prolongation, small or thin muscles
Skin prolongation at mm. er.spinae Small muscle areas, e.g. m. interossei
Thin muscle regions (e.g. SCM) Transmission probe is moved away from pressure area
Flexible Use via Mini Cable
Fine Wire - Electrodes
1) Insert Needle 2) Remove Needle 3) Connect wires to springs
Un-isolated
Ending (red)
Steel
cannula
Un-isolated Ending (red)
- electrode site
Hooked electrode
wires
Application Example Fine Wire
Use of Fine Wire
Copied from: Whittle, 2007,page 181
.access to deeper muscle layers
Application Example Fine Wire
Rect.Fem
Surface
Rect.Fem
Fine Wire
Switch
Sole
Data from Rudroff, 2008
Fine Wire vs Surface
Surface RF recording nicely matches with fine wire recording
Rect.Fem
Fine Wire
Switch
Sole
Rect.Fem
Surface
3 - Artifacts
Interfering 50/60 Hz power hum
Seldom appears with telemetry technology
Evaluation via Frequency Spectrum
50/60 Hz Power peaks in total power spectrum:
Only Posthoc Solution:
Notch filtering
EMG Baseline Zero Offset
EMG baseline is shifted
away from zero line:
Oftentimes seen in imported EMG
data from motion capture
systems!
Solution:
10 or 20Hz High Pass Filter
Baseline artifacts
Temporary zero shift
(typically motion artifacts)
Solution:
10 or 20Hz High Pass Filter
Fine Wire Raw
Fine Wire 20 Hz HP
Cable artifacts
Motion artifact spikes:
Solution:
better cable fixation!
4 - Signal Processing
Full Wave Rectification
Full wave rectification
All negative amplitude data are converted to positive data
EMG Signal Processing: Smoothing
Movag at 300 ms
RMS at 300 ms
Moving average (Movag)
Root Mean Square (RMS)
Creates the linear envelope or RMS EMG
How To Smooth?
Channel Curves Mean, uV
50
100
150
200
250
0
300
69 54 28
Processing, RMS 100, uV MEAN 100 LP 6HZ
0.5 1.0 1.5 2.0 2.5 0.0 3.0 sec
Moving average 100ms
Root Mean Square 100 ms
Butterworth LP 6Hz
Deduction of signal energy based on selected algorithm:
Amplitude Normalization
Amplitude normalization to max. EMG (MVC)
M
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%

M
V
C
MVC
100%
Test Trials
Static
Test
Rescaling of uV
to % of reference value
MVC Test Sequences
Compile a set of best candidates for MVC
Rect. Abd.
Obliquus
Rect.Fem.
3 5
1
10
2
3 4 2
MVC-Test
Sequence
MVC - Hit-Quotes
Numbers indicate how many out of 10 subjects hit their MVC for a given exercise
Automatic MVC Detection
Highest MVC Window (500ms)
within the overall sequence of
MVC contractions/exercises
Normalization Data from Perry
Perry 2007, page 33
Data for normal walking -
already at 80% MVC?
Inappropriate MVC tests
create unrealistic data in
gait trials
Jnhagen, S.; Ericson, M.O.; Nemeth, G.; Eriksson, E.: Amplitude and timing of
electromyographic activity during sprinting. Scand. J. Med Sciences Sports 1996, page
19
Supra- Maximal EMG
Inappropriate MVC tests create supra-
maximal EMG data
Supra- Maximal EMG
Possible Causes:
Subjects are not familar with MVC contraction
Inappropriate arrangement of MVC exercise
Static vs Dynamic condition
Better synchronization of motor units in
dynamic conditions => more electrical signal superposition
MVC-Test-Positions
MVC-Test-Recommendations
Subjects need some MVC training
Full body support
Always ask for full body tension
Use heavy exercise machines with solid constructions,
fixation belts, muscle isolation (single joint tests)
Normalization with patient populations may add more
error than benefit => change to other analysis designs
Provide external motivation
ISEK Recommendation MVC
Without training, the MVC could be as much as 20-30 % less than that
obtained after appropriate training and lead to incorrect conclusions or
interpretation of data
Estimates of MVC may be performed in different conditions that should
be described (e.g. with/without biofeedback, position of the subject,
condition of the joint proximal to the one of interest, etc.)
(C) 1999 by International Society of Electrophysiology and Kinesiology
To Mean Normalization
Winter, D. A.: The Biomechanics and Motor Control of Human Gait: Normal, Elderly, and Pathological. Waterloo -
Ontario: University of Waterloo Press, 1987
Normalization to the internal mean shows lowest variability in group curves:
Drawback: loss of
any amplitude
magnitude
information
Impact on Analysis
Curve shape of (averaged) EMG is not altered by normalization
EMG shapesdescribe the behavior of innervations in
motion cycles and do not need MVC
Concentrate on direct comparison designs within muscles
(no MVC needed, data are expressed in % difference)
Observe the muscle over the course of treatment and test
modules by using qualitative criteria
Sometimes the MVC can add more error than benefit
Alternatives:
4 - Time Normalized
Averaging
Stride Variability
M. Tibialis Anterior:
Smoothed rectified EMG
Activation patterns in gait
Individual EMG pattern
in gait has high
variability
Averaging of Motion Cycles
Time normalized cycle
0%
Repetitive Movement Cycles in ms =>
100%
A sequence of repetition cycles is averaged in a time normalized window
Mean curve
+/- 1 SD range
Time Normalization
Movement Cycle 100% 0%
Repetition 1
Repetition 2
Data of each stride are expressed in a vector of 100 data points:
Averaged EMG Curves
Standardized time format allows easy record comparisons
EMG Normative Data by Winter
Gastrocnemius Medialis
0
50
100
150
200
250
300
350
400
450
500
Zeitnormalisierter Zyklus
M
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G
Tibialis Anterior
0
100
200
300
400
500
600
700
M
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Glutaeus Maximus
0
10
20
30
40
50
60
70
80
90
100
M
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Semitendinosus
0
50
100
150
200
250
300
M
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Rectus Femoris
0
20
40
60
80
100
120
140
M
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Vastus Lateralis
0
50
100
150
200
250
300
M
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Vastus Medialis
0
50
100
150
200
250
300
M
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Glutaeus Medius
0
20
40
60
80
100
120
140
M
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Soleus
0
50
100
150
200
250
300
350
400
450
500
M
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G
Noraxon User Meeting 2011 Copied from: Smidt, G.L. (ed.), Gait in Rehabilitation 1990
EMG Normative Data by Eberhart
MVC Normalized Gait Data
Ericson et al. 1986:
Quantified electromyography of lower limb
muscles during level walking. Scand. J.
Rehab. Med. 18, page 160
5 - On/Off Pattern
Determination
Onset Determination
Multiple SD of baseline
% of local peak or MVC
Fixed amplitude value
SD
peak
fixed
Classical Concept: Multiple SD of Baseline
Onset
Time
Off set
Time
Based on e.g. multiple SD of baseline noise
LeVeau, B.; Andersson, G. Output Forms: Data Analysis and applications. In : Selected topics in Surface
Electromyography for use in the occupational Setting: Expert Perspectives, page 70
Pitfalls of Onset determination
M. vastus medialis
M. vastus lateralis
M. rectus femoris
M. biceps f.- c. brev.
M. gracilis
M. sartorius
M. biceps f.- c. long.
M. semimembranosus
M. semintendi nosus
M.vastus intermedius
Knee joint angle
(Degree flexion)
60
40
20
Gait cycle % 50 100 0 12 31 62 75 87
IC LR MST TST PSW ISW MSW TSW
EMG On/Off Patterns
Redrawn from Perry
Comparison Fine Wire vs Surface
Surface and fine wire activation pattern are nearly identical for rectus femoris:
Rose, S.A.; Ounpuu, S.; DeLuca, P.A: Strategies for the assessment of Pediatric gait in the
Clinical setting. Phys Ther Vol 71, No. 12 1991
EMG On/Off Patterns
On/Off patterns help to
visualize the center
activity of muscles in
the gait cycle
EMG On/Off Patterns - Conclusions
Data reduction to On/Off suggests true On/Off behavior of
muscles which in the real world is not the case
No objective algorithms/methods are found yet that gives
standardized and reliable results in clinical conditions
(1) Shiavi, R. Electromyograhpic Patterns in Normal Adult Locomotion, page 99. In Smidt, L.S. 1990
Citation: .... . this report and subsequent publications
cogently argue that the best method is the ensemble average
of the time normalized linear envelope. (Shiavi (1) )
5 - Gait Phase
Detection
Gait Analysis Gait Phases
Heel
strike
Toe
off
2.Heel
strike
E
v
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t
s
P
h
a
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e
s
StancePhase SwingPhase
Initial
Contact
Loading
Response
Pre
Swing
Initial/Mid/Terminal
Swing
GaitCycle%: 12 62 100
Double
Support
SingleSupport
Double
Support
Stance Phase SwingPhase
Stance Phase Stance Phase SwingPhase
Mid/Terminal
Stance
50
Contralateral Leg
Gait Phase Detection
Foot
switches
3D Force
Plate
Pressure
Soles
Pressure
Plates
Instrumented
treadmills
Optical
Systems
Force
Soles
Kinematic
Calculation
Accelero-
meter
Technologies to detect gait events:
Noraxon User Meeting 2011 Perry, 2007, page 129
Foot and Pressure Switches
Switch-based signal inconsistencies:
Winter: Shifted Normative Curves
Vastus Medialis
0
50
100
150
200
250
300
Time Normalized Cycle
M
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Data published by Winter cannot
be reproduced with modern gait
phase detection technology.
Winter Data
Reproduced data
Time Shift
Mobile Sensor Based Gait Analysis
Inclinometer
Goniometer
Accelerometer
Foot Switch
EMG
3D - Accelerometer
Heel
strikes
Very helpful for fast running and jumping activities
Difficult to detect Toe Off
Foot Switch Based Gait Analysis
Foot Switch
or Sole
Multi-mode
or multi-stair
signal:
each sensor
switches with
its own voltage
increment
Difficult to mount and fragile
Many artifacts
Integrated Insole Pressure Distribution
Telemetric Insole System Medilogic: 3D Visualization of Foot Pressure:
Flexible thin insoles Color-coded foot
pressure data
Full Contact Area detection
EMG or biomech. sensor
recording up to 16 ch.
Synchronized DV
Video up to 50 HZ
Vertical force for
left/right side
Pressure prints for left and
right side
Based on the ankle velocity computed in the reference frame of the sacrums anterior axis
At ground contact foots velocity will become negative relative to the sacrum
Similarly, at toe-off the foots velocity will be positive relative to the sacrum.
Gait Events via Kinematic Calculation
Left ankle
velocity
Left vertical
force
Right ankle
velocity
Right vertical
force
Virtual Foot
switchevent
Optical Foot Switch/Contact System
LED Light beams, appr. 0.5 cm above ground
Distance between beams: 1 cm
Max floor width: 8 meters
Max floor length: 100 meter
Technical Specifications:
Contact Free Virtual Foot Switch
Can be used on treadmill and for floor walking
Long Pressure Plates
Foot Rotation RT Left and Right Overlap
1 calibrated sensor per square cm
Up to 9 meter long
Technical Specifications:
True pressure distribution
Pressure Plate Instrumented Treadmill
Synchronized DV
Video up to 50 HZ
Foot print detection with
3D presentation of data
Synchronized
EMG recordings
Resulting vertical
force left/right
3D Force Plate Treadmill
3D Instrumented Dual Belt Treadmill Bertec
EMG
Accelerometer
Inclinometer
3D Forces
3D Moments
Gait Analysis Report
Left-Right
Comparison
Event
signal
Gait Phases
6 Analysis & Interpretation
Strategies
Key Strategy For Interpretation -1
Try to create reasonable comparisons:
Pre - test versus Post -
test
Focus on changes in EMG parameters
after treatment, intervention, surgery etc
Activity 1 versus
Activity 2
Observe muscle activation in different
test/treatment conditions
Left side versus Right
side
Identify differences between healthy and
injured side
Patient/Subject versus
Norm curve
Identification of abnormal patterns
Muscle A versus
Muscle B
Coordinative aspects in muscle groups,
co-activation, reciprocal firing, symmetry
Test portion 1 versus
Portion 2
Time domain changes of parameter
e.g. fatigue studies
Key Strategy For Interpretation -2
....continued
Gait
Research
aims to improve our understanding of gait
Whittle, 2007,page 177
Operational Background
Clinical Gait
Assessment
has the aim of helping individual patients directly
The background defines economical and technical frame
Whittle, 2007,page 177 modified text
Clinical Gait Assessment
(Whittle)
Gait Assessment
Full clinical history
Physical exam
Hypothesis Formulation
Expected cause of
observed abnormality
Hypothesis Testing
Appropriate selection
of analysis tools
Derive Tools for Analytical Questions
Observat ion of a
probl em or phenomenom
Formul ation of hypot hesis
or expect ation
Need for di agnosi s
or i mproved underst anding
Transl ati on to
analysi s questions
Selecti on of the right
sensor / method
Adjustment and f ine
tuning of analysis questi ons
Analysis Based Questions for EMG
Type of questioning Type of answer Type of scaling
1) Is the muscle active? Yes/No and On/Off Nominal
2) Is the muscle more or less active? Ranking between tests in qualitative terms Ordinal
3) When is the muscle on/off? Onset/Offset calculations, firing orders Metric
4) How much is the muscle active? Expressed in e.g. % MVC Metric
5) Does the muscle fatigue? Slope calculation of EMG parameters Metric
EMG answers these questions:
Clinical Analysis Questions
Is there amplitude symmetry
between synergist (VMO/VLO)?
Does the muscle go off when
not needed?
Is the timing of firing
appropriate/symmetric?
Is there increased
co-activation?
Clinical Analysis Questions 2
Does the muscle show a
constant firing over the course
of repetitions?
Is the muscle fire phase
specific?
Is muscle activation
absent or inhibited?
Structure of Clinical EMG Analysis Items
Amplitude
characteristics
Activity
elevated
Activity
diminished
Asymmetries
between sides
Left side
greater than
Right side
Right side
greater than
left side
Timing
characteristics
Delayed
Premature
Out of
phase
Time domain
changes
Amplitude
increase
Inconsistency
in amplitude
Inconsistency
in timing
Amplitude
decrease
Coordination
between muscles
Increased
Co-activation
Missing
Co-activation
Dysfunctional
Timing
Faulty motor programs and skills
Pain sensations or expectations
Tissue damage
Neurophysiological /CNS/peripheral disabilities
Biomechanical problems related to joint & muscles structures
Metabolic problems
Psychological aspects like stress
Dysfunctional EMG: Why ?
The EMG signal itself never tells you the case of dysfunction, possible
reasons for a dysfunctional EMG response or behavior are:
Clinical Decision Making
Clinical Decision Making
Observation Expectation Analysis
Is EMG Needed At All?
Example: A hip extension does not necessarily mean that the main hip
extensor (glut max) has the most activation.
The Neuromuscular Level
A complex system of agonist, antagonists, synergists and muscle
layers allows several ways of solving motion tasks
The neural plasticity in CNS & ascending and descending
pathways allows re-education of muscle innervations
Muscle Dysfunction is oftentimes not the cause but
the reaction and compensation of underlying problems
Muscle dysfunction may reflect functional adjustments
The Neuromuscular Level
Many gait abormalities are a compensation for some problems experienced
by the patient and, although abnormal, they are nonetheless useful
(page 47)
One of the interesting things about gait is the way in which the same
movement may be achieved in a number of different ways and this
particularly applies to the use of muscles, so that two people may walk
with the same normal gait pattern but using different combinations of
muscles (page 62)
Whittle, 2009
Visual Inspection of Raw Data
Stroke: Comparison of right (unaffected) vs left (affected) side
Vastus med
Vastus Lat
Glut. Max
Adduktor
Vastus med
Vastus Lat
Glut. Max
Adduktor
R
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u
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Objective Analysis of Muscle Function
Clinical diagnosis before EMG-gait analysis:
Spastic dysfunction of abductors and knee flexors
Red: Patient
Grey: Norm
EMG-Gait analysis reveals:
Prolonged excessive innervation of quadriceps
muscles in stand phase
Normal ROM on knee joint
Somewhat normal innervation pattern for
hamstrings, increase co-activation in stance
Reduced stance phase
8 time normalized strides at free speed
Suggested Terminology for EMG Patterns
by Perry
Adapted from: J. Perry 2003
Addressing time dependent changes
with the EMG activation
M
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Premature
[%]
Prolonged Continuous Delayed
Curtailed Absent Out of phase
Adapted from: J. Perry 2003
Addressing amplitude intensity
M
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[%]
Excessive Inadequate Absent
Hyper-active Hypo-active Inhibited
Suggested Terminology for EMG Patterns
by Perry
Perry, 2008. Page 251 wih modified/adjusted text
Clinical EMG Findings
Continuous Activity Tib.Ant.
Premature activity of soleus
at stance phase
Inadequate activation level of
Tib.Post. in terminal stance
Prolonged activity of Tib.Ant.
at Swing
Premature, inadequate
innervation of soleus in stance
Inadequate/absent innervation
of Gastroc. and Tib.Post
Lower EMG on the paretic limb
Prolonged muscle burst duration
Tonic rather than phasic activity at gait transitions
Periods of peak muscle activity that do not coincide with requirements
of a normal gait pattern
Variability of the EMG increases at very slowwalking speed
In: Smidt, 1990. Page
Hemiplegic EMG Findings
Giuliani
Typical observations/expectations:
Davis, R.B. Reflections on the Clinical Gait Analysis, pag 254
J. Electomyogr. Kinesiol. Vol 7, No 4, 1997
Literature Data
Davis
From EMG Findings to Treatment
Identification of key muscles (Guilty Muscles
(1)
)
Uptraining of atrophic, weak, inhibited muscles
Downtraining of overused, hyperactive muscles
Stabilization Training of segmental and joint stabilizer muscles
Training of body awareness
Re-education of faulty motion patterns/programs
Therapeutic consequences based on EMG investigation:
Adjustment of gait aids, insoles, orthosis
Adjustment of medical drug use and dosage
Decision base of surgeries
Cited Books
Thank You For Your Attention!
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Noraxon User Meeting 2011

EMG Processing & Analysis

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