The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: A scoping review

Gustavo Balbinot; Matheus Joner Wiest; Guijin Li; Maureen Pakosh; Julio Cesar Furlan; Sukhvinder Kalsi-Ryan; José Zariffa

doi:10.1016/j.clinph.2022.02.028

The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: A scoping review

Clin Neurophysiol. 2022 Jun:138:61-73. doi: 10.1016/j.clinph.2022.02.028. Epub 2022 Mar 19.

Authors

Gustavo Balbinot¹, Matheus Joner Wiest², Guijin Li³, Maureen Pakosh⁴, Julio Cesar Furlan⁵, Sukhvinder Kalsi-Ryan⁶, José Zariffa⁷

Affiliations

¹ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada. Electronic address: gustavo.balbinot@uhn.ca.
² KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
³ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
⁴ Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Canada.
⁵ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Canada; Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network, Canada; Institute of Medical Sciences, University of Toronto, Canada.
⁶ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada; Department of Physical Therapy, University of Toronto, Canada.
⁷ KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Institute of Biomedical Engineering, University of Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada; Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Canada.

PMID: 35364465
DOI: 10.1016/j.clinph.2022.02.028

Abstract

Objective: Surface electromyography (sEMG) is a common electrophysiological assessment used in clinical trials in individuals with spinal cord injury (SCI). This scoping review summarizes the most common sEMG techniques used to address clinically relevant neurorehabilitation questions. We focused on the role of sEMG assessments in the clinical practice and research studies on neurorehabilitation after SCI, and how sEMG reflects the changes observed with rehabilitation. Additionally, this review emphasizes the limitations and pitfalls of the sEMG assessments in the field of neurorehabilitation after SCI.

Methods: A comprehensive search of Medline (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, Emcare, Cumulative Index to Nursing & Allied Health Literature, and PubMed was conducted to find peer-reviewed journal articles that included individuals post-SCI that participated in neurorehabilitation interventions using sEMG assessments. This is a scoping review using a systematic search (hybrid review).

Results: Of 4522 references captured in the primary database searches, 100 references were selected and included in the scoping review. The main focus of the studies was on neurorehabilitation using sEMG biofeedback, brain stimulation, locomotor training, neuromuscular electrical stimulation (NMES), paired-pulse stimulation, pharmacology, posture and balance training, spinal cord stimulation, upper limb training, vibration, and photobiomodulation.

Conclusions: Most studies employed sEMG amplitude to understand the effects of neurorehabilitation on muscle activation during volitional efforts or reduction of spontaneous muscle activity (e.g., spasms, spasticity, and hypertonia). Further studies are needed to understand the long-term reliability of sEMG amplitude, to circumvent normalization issues, and to provide a deeper physiological background to the different sEMG analyses.

Significance: This scoping review reveals the potential of sEMG in exploring promising neurorehabilitation strategies following SCI and discusses the barriers limiting its widespread use in the clinic.

Keywords: Barriers; Clinical trials; Neurorehabilitation; Spinal cord injuries; Surface electromyography.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Electromyography / methods
Humans
Neurological Rehabilitation*
Reproducibility of Results
Spinal Cord Injuries* / rehabilitation
Systematic Reviews as Topic