Summary of Technological Foundation/Lit review

Background:
EMG
Biofeedback, the basis for EMG, has been proven to be an effective approach in rehabilitation
of muscular function and the reformation of neural connections (Glanz, M., Klawansky, S.,
Stason, W., Berkey, C., Shah, N., Phan, H., et al., 1995) resulting in effective application of
EMG
SEMG has become a staple diagnostic tool in modern day biomechanics as a
result of the signal acquisition technique advancements; from invasive needlebased electrodes to commonly used non-invasive surface electrodes. Throughout
the twentieth century, EMG has established prominence in neurology as a tool for
widen diagnostic capabilities, especially for those suspected of having
neuromuscular disorders. For instance Cifuentes et al (C. Cifuentes, A. Braidot, L.
Rodriguez, M. Frisoli, 2012) developed a wireless tool for assessment and therapy
in post-stroke upper-limb rehabilitation based on the ZigBee module, which
allows the creation of simpler and less expensive wireless personal area
networks, for wearable inertial measurement units and using SEMG. The vast
utility of SEMG in rehabilitation is demonstrated through its application to
measure kinematic and electrical activity of patients in continuous therapy
motion all over the body.
More engaging methods of therapy have also been tested. Converse et al (H.
Converse, 2013) developed an integrated, wireless physiotherapy system for the
forearm, which utilizes SEMG for its measurements. The system is composed of a
mixture of custom made electronics and off-the-shelf products. From the few test
trials undertaken, their system has shown exceptional capability in discriminating
different physiotherapy exercises, with an accuracy of 92%.
Such a method of therapy is a part of gamification; the concept of applying game
mechanics and techniques to engage and motivate people to achieve their goals.
Shown to increase participants levels of engagement, influence, loyalty and time
spent in activity (refXXX). Gamification has different applications from indusrty to
industry, but is also highly applicable in an education context.
^works by Converse not considered gamification, talk about gamification in intro

Neuroprosthetics are devices that replace the function of a damaged body part
by interfacing with the nervous system. Neurons in human brains and spinal cord
cannot regrow, except those in the hippocampus (memory center) and certain
parts of the olfactory system within the brain. When spinal cord is damaged
causing immobility, if the individuals leg muscles are still healthy then it is
possible to bypass the injured section of spinal cord with the use of
neuroprosthetics.
Famous research includes a neuroprostetic arm controlled by a monkey for selffeeding (Veleste, Perel, 2008 XXX) , and a rat controlling a robotic arm to push
a lever that releases food (Chapin, J. K. et al. Nature Neurosci. 2, 664670
(1999).XXX).

TENS - transcutaneous electrical nerve stimulation

TENS is the use of an electrical current applied to nerves with the aid of electrodes on the
skin, and has seen large-scale medical use in the treatment of muscular and joint pain
(refXXX). Pain signals sent to the spine and brain are reduced, and production of endorphins
is increased to further reduce pain.
By modulating the TENS unit output pulse width, frequency, and intensity, it is possible to
cause muscle contractions. Muscle contraction is instigated with low frequency signals (14Hz), high intensity, and a large pulse width (200s) (refXXX!).
The frequency of the TENS unit refers to the number of pulses delivered per second. The
intensity refers to the magnitude of current or voltage supplied by the TENS unit, and the
pulse width defines the duration of the positive component of each pulsed waveform in
microseconds.
TENS waveforms are either asymmetrical or symmetrical biphasic rectangular forms. A
biphasic waveform has current flow in both directions, therefore each electrode acts as both
an anode and a cathode over the course of the waveform. Figure (XXX) illustrates a typical
TENS waveform.

TENS waveforms typically have a zero net direct current, i.e. the total positive charge
produced equals the total negative charge produced. A non-zero net direct current can cause
chemical skin irritation, due to homogenously charged ion build up under the electrodes.
It is vitally important that all individuals be screened for any relevant contraindications (situations in
which a procedure should not be used) prior to the first application of TENS. There are however only
a handful to be aware of:

Electrodes should never be placed over the eyes, or over the neck. Placement over the neck

can cause a drop in blood pressure.

TENS has been shown to interfere with specific cardiac pacemakers. The individuals

cardiologist should be consulted before application of TENS.

Individuals with epilepsy should only have TENS applied after consultation with their

clinician.
Individuals should not wear TENS whilst driving or operating heavy machinery.

Physiology
Biomechanics describes and analyses the kinematics and kinetics of a body. All bodily
motion is enabled by the control of the central nervous system (CNS) and the skeletal
muscular system, which regulates a diverse range of forces.
Figure XX is a schematic of the fundamental hierarchy of the CNS. Outputs from the primary
motor cortex relay signals via the neurones of the brain stem and spinal cord, to the motor
units of target skeletal muscles. The motor units, consisting of -motoneurones, innervate the
spinal cord link to muscle fibres.Invalid source specified.

Figure 1 Invalid source specified.

SEMG refers to the non-invasive detection and analysis of bioelectric signals from the
actuation of skeletal muscles. These signals arise from the generation of motor unit action
potentials (MUAP), created by a sequence of chemical exchanges between the synaptic gaps

(motor end plates) of motoneurones. This action potential generates a which induce a
transverse depolarisation wave along the muscular fibres the summation of which,
constitutes the fundamental signals detected by the surface electrodes. Invalid source
specified.
This technology has been widely employed in the clinical environment as an
electrodiagnostic tool, whilst also bridging the gap between engineering and physiology. Not
only has it been used to broaden capabilities in researching neuromuscular functions, it has
been applied to biomechanics, being used in neuromuscular dysfunction rehabilitation
Invalid source specified. and gait analysis. It has seen use in more novel and

innovative applications, such as biofeedback mechanisms, and even myoelectric control of

robotic prostheses (neuroprosthetics) Invalid source specified..
The amplitudal range of the EMG signals prior to amplification typically lies within the range
of 1-10 mV Invalid source specified., with a frequency range of 0-500Hz, of which the
usable energy of the signal is limited to, as shown by frequency spectrum in Figure XX.

When dealing with stochastic signals such as the EMG, one of the main concerns regarding a
clean signal acquisition is noise. These contaminants could be generated by a number of
sources:
-

Motion artefacts: low frequency baseline jumps resulting from the displacement of

electrode-skin interface and movement in the electrode cables.

Ambient noise: interferences caused by external sources of electromagnetic radiation.
Cross-talk: signal interference from neighbouring MUAPs. Invalid source specified.
Inherent instability of the signal: it is suggested that the quasi-random nature of the
firing rate of motor units should be considered as noise.

Figure XX shows a block diagram that describes the chain of processes involved from signal
acquisition to signal processing.

Signal Processing
Signal Acquisition
For the best desirable quality of the EMG signal, such that electrical noise contamination is
minimized, the signal-to-noise ratio needs to be maximized. The electrode design is critical in
determining the quality of the signal, as it influences all consequent aspects of signal
processing.
The following characteristics for acquisition are recommended by De Luca Invalid source
specified.:
-

Active differential amplification:

Active differential amplification is a necessity in order to eliminate most of the noise

induced by interference and common mode signals. The human body has good conductive
properties, and as such, will pick up electromagnetic radiation that is present in the
surrounding environment. A bipolar electrode configuration should therefore be used,
with reference electrode connected to an electrically unrelated area, as shown in Figure
XX.

The detection electrodes act as a differential pair. Differential amplification eliminates

noise signals that are common to both active terminals, and its tendency to do so is
determined by the common mode rejection ratio (CMRR).

The signals at the first and second electrode can be written as ( m1+ n and m2+ n
respectively, where m1 , m2 are the signals from each respective electrode, and n is
the noise. Hence, the ideal output of the differential amplifier can be written as:
m
( 1+n)( m2 +n ) =m 1+ m2

A CMRR of magnitude 32,000 or 90dB is generally sufficient to supress extraneous

electrical noise. CMRR is commonly expressed as a logarithmic ratio, with units in
decibels (dB), which can be calculated as such:
CMRR ( dB )=20 log10 CMRR ( linear )
-

High input impedance

As soon as the connection is established, current will flow through the electrodes. This
resistance against the current will cause a voltage drop at the contact surface.
The impedance at the skin-to-electrode interface is finite, dependent on several factors:
thickness of the skin layer, surface topology of the skin prior to attachment etc. The
impedance may be up to magnitudes of several M . Invalid source specified. To
prevent the attenuation and distortion of the detected signal, the input impedance of the
differential amplifier must be as large as possible (without causing functional
complications).
The input impedance for a SEMG amplifier should be at least 100 times greater than the
expected electrode-skin impedance, which can be at least 1 M . Invalid source
specified.
Signal Conditioning
Signal conditioning concerns the frequency response of the EMG signal. As described in
section XXX, the usable energy of the EMG signal is limited to a frequency range of 0 - 500
Hz, with most of the signal concentrated in the ranges of 20-150Hz. Therefore, filters are
required to isolate the contraction-induced electrical signals. The signal-to-noise ratio can be
increased by filtering, with a roll-off slope of 40dB/decade.Invalid source specified.

Low pass filters

Low pass filters are employed to set the upper bandwidth cut-off frequency, with a cut off
frequency near 500 Hz. Strict design characteristics should consider 400 Hz as the upper
bandwidth cut off, but 500 Hz provides a wider margin for safety when designing the
filter circuits.
-

High pass filters

Surface-detected signals often show variations caused by movement artefacts and

instability of the electrode-skin contact. These typically manifest with harmonics in the
frequency range of 0 to 20Hz. Consequently, high pass filters are designed with a cut off
frequency in the range of 15-20Hz. Movement artefacts caused by fluctuating electrode
impedances may be attenuated, but not fully eliminated.
-

AC interference

Interferences from AC powerline radiation, with a frequency of 50 or 60 Hz (dependent

on country), will be a key source of noise, especially since this lies close to the dominant
energy frequency of the EMG signal. Notch filters could be implemented to eliminate the
particular frequency. However, its implementation also leads to the removal of adjacent
frequency components and therefore affect the quality of the signal. Hence, the
implementation of notch filters is ill-advised, and alternatives to this should be
considered.
Signal Processing
Signal processing requires an analogue-to-digital converter (ADC) to feed the signal to a
processor. This is the final component of the hardware chain, which controls the sampling of
data and converting the continuous analogue quantities (the EMG signal) into discrete, digital
time representatives. The discrete data is then fed into a computer for processing.
-

Analogue-to-Digital Conversion

Microprocessors are typically used for the analogue-to-digital (A/D) conversion and data
transmission.
Loss of data in sampling, also known as aliasing, is a concern when dealing with signal
processing. This is caused when the discrete forms of two different analogue signals

cannot be distinguished from each other, creating an information hole, hence there is an
ambiguity in the results shown. [ref]
The Nyquist-Shannon sampling theorem [ref] states that, when digitising a band-limited
signal, it must be sampled at a rate at least twice the frequency of its highest harmonic
(band limit) in order to avoid loss of data and aliasing.
Leading from this, the upper band limit is around 500Hz, hence a sampling rate of
1000Hz is sufficient to prevent aliasing. The sensitivity of the results are dependent on the
resolution, sampling rate and accuracy of the ADC used.
Simply put, all EMG systems require the same characteristics: a front end amplifier, some
sort of filtering and conditioning before digitalisation for analysis.

Appendix