SECTION VIII • Electronics and Instrumentation

39  Basics of Electricity and Electronics

for Electrodiagnostic Studies

In the office, hospital, and home, we are surrounded by

equipment, appliances, and many other devices powered
by electricity. Although knowledge of electricity and elec­
tronics is not needed to watch television, talk on the tele­
phone, or use a toaster, these examples are just the tip of
the electrical and electronic iceberg in the world we live in
as electromyographers.
One might ask, is it really necessary to understand the
basics of electricity and electronics in order to perform
routine electrodiagnostic (EDX) studies? Although a
degree in electrical engineering certainly is not needed,
the answer clearly is yes. First, and most important, under­
standing the basics of electricity is essential to safely
perform EDX studies and prevent potential electrical
injuries to patients (see Chapter 40). Second, all of the
responses recorded during nerve conduction studies and
needle electromyography (EMG) are small electrical signals
that are amplified, filtered, and then displayed electroni­
cally. Knowledge of electricity and electronics allows for
a better understanding of what these potentials represent.
Finally, and equally as important, knowledge of electricity
and electronics is critical to understand and correct the
variety of technical problems that frequently arise during
EDX studies (see Chapter 8).
BASICS OF ELECTRICITY
All atoms have a nucleus composed of positively (+) charged
particles, protons, and particles with no charge, neutrons.
Orbiting around the nucleus are negatively (−) charged
particles, electrons. Most atoms have the same number of
protons and electrons; the electrons remain bound in their
orbit by their magnetic attraction to the protons (i.e., in
magnetism, opposites attract).
– Electron
–
+ N Neutron
N
Nucleus N +
Proton
+ +
– –
Electricity is formed when electrons are removed from
their orbit and flow to adjacent atoms. Materials that
allow electrons to move freely are known as conductors.
In contrast, materials that inhibit the flow of electrons
are known as insulators. Conductors typically are metals,
most often copper. Insulators most often are rubber,
plastic, or ceramic. To understand basic electrical cir­
cuits, one needs first to be acquainted with several im­
portant terms:
• Coulomb is the standard unit of electric charge,
approximately equal to 6.24 × 1018 electrons.
• Current, represented by the symbol I, is the actual
flow of electrons. The ampere is a measure of
current, designated by the letter A. An ampere is
defined as 1 coulomb passing a point in a conductor
in 1 second. Current can only flow when a complete
circuit exists.
• Voltage is the electromotive force required to make
electricity flow through a conductor. This electromo­
tive force results from a fundamental property of
magnetism that oppositely charged particles attract
each other. Any source with an excess of electrons
(negatively charged particle) will be drawn to a source
with a lack of electrons (positively charged particle).
Voltage is designated by the symbol E. Its unit of
measurement is volts, which is designated by the
letter V.

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 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies
• Resistance opposes the flow of electrons. Resistance
is designated by the symbol R. The unit of measure­
ment for resistance is Ohms, which is designated by
the Greek letter Ω. All materials, even conductors,
impede the flow of electrical current to some extent.
In general, resistance increases with the length of the
conductor and decreases as the cross-section of the
conductor increases.
Analogy between Electricity and Water
Because current and electrons cannot be seen, it may be
difficult to relate to electricity and its basic definitions.
One useful way of understanding electricity and its
properties is to make an analogy to the flow of water.
The analogy to water and plumbing often is easier to
grasp and can be extrapolated to the understanding of
electricity.
Water
pressure
A B
Water
pump
D C
Reservoir
Water can be measured as a specific volume (e.g., a liter
or gallon). Thus, a gallon of water is analogous to a coulomb
of electricity, an amount of charge. For water to flow, it must
have some force that is driving or pushing it. This force can
be gravity, in the case of water stored in a water tower, or a
pump that mechanically propels the water. In either case,
water is put under pressure. Pressure is measured as force
per unit area, typically as pounds per square inch (psi). Thus,
water pressure is analogous to voltage, the driving electro­
motive force. Water will flow if there is a pressure difference
between two points (i.e., from an area of high pressure to
low pressure). Likewise, electrons will flow if there is a dif­
ference in voltage between two points. Flow is the actual
movement of water, which is measured as volume passing
by a point in a specific time period (e.g., gallons per second).
Thus, flow of water is analogous to current, the movement
of electrons, which is measured in amperes (1 coulomb
passing a point in a conductor in 1 second). Lastly, resistance
to water flow is determined by the physical characteristics
of the pipes it is traveling through. Longer and especially
narrow-diameter pipes impede the flow of water. Thus, the
mechanical resistance of a water pipe is analogous to the
electrical resistance of a circuit.
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601
The flow of water is determined by Poiseuille’s law:
Change in water pressure between two points
Flow =
Water resistance
At point D in the figure above, the water pressure is essen­
tially zero. Water is taken up by the pump and pressurized,
resulting in a high pressure at point A. Water will now flow
because it is under high pressure at point A and low pressure
at point D. The water pressure at point B will still be high
because the diameter of the pipe is so large that it offers
little resistance to flow. However, the marked narrowing of
the pipe between points B and C increases the resistance to
flow. The higher the resistance, the less the flow. Con­
versely, the higher the water pressure difference, the more
the flow. At point C, the water pressure is now very low.
However, it must still be slightly higher than point D so that
water will flow from point C to D. If extra water were to
somehow get into the system and be a greater amount than
the water pump could pump, it could easily be diverted to
the reservoir (analogous to the ground, see later).
P
Resistance
+
E
R
-
Ground
Ohm’s Law
The most important basic principle of electricity is Ohm’s
law, which defines the relationship among current, voltage,
and resistance in a circuit. Ohm’s law is directly analogous
to Poiseuille’s law for water. For electrical circuits, Ohm’s
law states that:
Change in voltage between two points
Current =
Resistance
E
I=
R
The figure above depicts a simple circuit consisting of a
battery (E) (an electromotive source of electrons) con­
nected to one resistor (R). The amount of current (I) flow
is determined by Ohm’s law, I = E/R, where E is the voltage
from the battery, and R is the resistance. Also note the
presence of the ground connection. The ground is ideally a
true electrical zero. Most often true grounds are physically
connected to the earth (e.g., through a pipe).
602 SECTION VIII Electronics and Instrumentation

Conventional flow notation bottom as shown, the value of E, I, or R can readily be

determined by blocking the variable of interest (shaded in
the figure) and looking at the relationship between the
other two parameters.
+
E Kirchhoff’s Laws
- In addition to Ohm’s law, there are two other important
principles, known as Kirchhoff ’s laws, with which one must
be familiar in order to understand basic electricity.

Electron flow notation PA PB

PA = PB

+ PB
E
- PA PC

PD

PA = PB + PC + PD

One of the confusing aspects of electricity is figuring out PB

the direction that current actually flows. In the conventional
flow notation, electric charges move from the positive
(surplus) side of the battery to the negative (deficiency)
side. However, as electricity comes about by the flow of
electrons, which are negatively charged, the actual flow of
electrons occurs from the negative to the positive. In the
electron flow notation, electric charges moves from the
surplus of negative charges at the negative side of the battery
to the positive side of the battery which has a deficiency
of negative electrical charges. Both notations are correct
when used consistently. The conventional flow notation is
used by most electrical engineers and found in most electri­
cal engineering textbooks, and will be used in this chapter.
PC PA
PD
PB + PC + PD =PA
Kirchhoff ’s current law states that the algebraic sum of
all the currents meeting at any point in a circuit must be
zero. Put another way, the sum of incoming currents must
equal the sum of outgoing currents. This law represents the
conservation of charge. The number of electric charges that
flow toward a point must equal the number of electric
charges that flow away from that point.

E
VB
P R

E E E +
VA VC
-
P R P R P R
E=PxR P=E E=R
R P

One helpful aid in remembering the relationships in

VD
Ohm’s law is the Ohm’s triangle illustration (above). If a
triangle is constructed with E at the top and I and R at the VA = VB + VC + VD

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 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies 603

Kirchhoff ’s voltage law states that, in a closed circuit, the 48 V

algebraic sum of all the voltage (i.e., potential) drops is
equal to the electromotive source voltage of the circuit. The
figure above shows a battery with a voltage (VA) connected
in series to three resistors (B, C, D). The current running 12Ω
through the three resistors results in a voltage drop across
+
each resistor, VB, VC, and VD, respectively. Kirchhoff ’s 10Ω
100 V 40 V
voltage law requires that the sum of the voltage drops -
across all three resistors equals the voltage of the battery 3Ω
(i.e., VB + VC + VD = VA).

Simple Resistive Circuits

Resistors in Series
12 V
From Ohm’s and Kirchhoff ’s laws, one can predict the
R = 12Ω+ 10Ω + 3Ω = 25Ω
behavior of simple resistive circuits.
P = E = 100 V = 4 Amperes
R 25Ω

R1 The battery has a voltage of 100 V. The resistors have

a resistance of 12, 10, and 3 Ω, respectively. Thus, the
total resistance of the circuit is the sum of the resistors
(12 + 10 + 3)  = 25 Ω. With this information, the current can
P be easily calculated from Ohm’s law:
+
E E
R2 I=
- R

100 V
I= =4A
25 Ω
Ground
Knowing the current, the individual voltage drop across
R3
each resistor (48 V, 40 V, 12 V) can be calculated from
Ohm’s law (E = I × R).

Resistors in Parallel
First, take the example of a simple circuit with a battery When resistors in a circuit are placed in parallel, a net
(E) connected to three resistors in series. From Kirchhoff ’s resistance can also be calculated using Ohm’s and Kirch­
current law, the current (I) must be the same going through hoff ’s laws.
each resistor (i.e., current flowing into any point equals the
current flowing out of that point). From Ohm’s law, a
voltage drop will be present across each resistor (E = I × R). P
Thus, the voltage drops for the three resistors must be I × R1,
I × R2, and I × R3, respectively. From Kirchhoff ’s voltage law,
the voltage from the battery (E) must equal the sum of all +
the voltage drops across the three resistors (VB + VC + VD). E P1 R1 P2 R2 P3 R3
With this information, applying simple algebra: -

E = VB + VC + VD (Kirchhoff ’s voltage law)

E = I × R1 + I × R2 + I × R3  (Ohm’s law)
E = I ×  (R1 + R2 + R3) (Algebra)
E = I × R (Ohm’s law)
R = R1 + R2 + R3 (Algebra, using substitution)
Thus, resistors in a series can be directly added together to
calculate a net resistance. Take an example of the same
circuit of a battery connected to a series of three resistors,
using real values.
Ground
Take an example of a simple circuit with a battery (E)
connected to three resistors in parallel. From Kirchhoff ’s
current law, the total current (I) must be the sum of the
individual currents going through each resistor:
I = I1 + I2 + I3

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604 SECTION VIII Electronics and Instrumentation

From Ohm’ law, the voltage across each resistor can be Direct Current and Alternating Current
calculated:
Direct current (DC) is current that always flows in the
V1 = I1 × R1 same direction. In DC, electrons flow uniformly from the
power source through a conductor to a load (i.e., an electri­
V2 = I2 × R2 cal device) and back to the power source. The most
common example of a DC power source is the battery.
V3 = I3 × R3 However, current also can be supplied as an alternating
current (AC). In an AC, electrons follow the path of a sine
From Kirchhoff ’s voltage law, the voltage from the battery wave, flowing first in one direction and then reversing. The
must equal the voltage drops along any closed circuit. Thus, current reverses polarity many times a second [measured
the same voltage (E) from the battery must be present as cycles per second (cps) or Hertz (Hz)]. The most
across each of the three resistors: common example of AC is the conventional 60 Hz electric­
ity in wall sockets in houses and offices.
E = V1 = V2 = V3
+
With this information, we can solve the equation for total
current:

I = I1 + I2 + I3
Peak
RMS
V V V
I= 1+ 2 + 3

Voltage
R1 R2 R3
Time

E E E
I= + +
R1 R2 R3

 1 1 1
I = E × + +
 R1 R2 R3  -

Now, we can solve for the total resistance: Because DC and voltage are constant, their measure­
E ments are straightforward. However, AC measurement is
R= more complicated, because voltage and current are con­
I
stantly changing values. There are several ways to measure
E AC, including measuring baseline to peak or peak to peak.
R=
 1 1 1 A mean would not be useful, because the mean of an AC
E × + +
 R1 R2 R3  current is actually zero. However, the most common
method of measuring AC is the root mean square (RMS)
1 value. The RMS is calculated by dividing the waveform into
R=
1 1 1 many small increments. The value of each increment is
+ +
R1 R2 R3 squared and a mean of all the squares determined. Finally,
the square root of the mean results in the RMS value. The
Thus, resistors in parallel reduce the total resistance, as RMS value is the most useful way of measuring AC because
opposed to resistors in series, which increase the total power in a circuit is defined as voltage multiplied by current:
resistance. For instance, three resistors in series, each
100 Ω, result in a total resistance of 300 Ω. However, Power ( watts ) = E × I
three resistors in parallel, each 100 Ω, result in a net E
= E × ( substituting E/R for Ι per Ohm’s law )
resistance of 33 Ω. The analogy to water is as follows. R
Imagine a bucket full of water. The weight of the water E2
creates a water pressure against the bottom of the bucket. =
R
If a hole is drilled through the bottom of the bucket,
water will start to flow, based on how large the hole is Thus, power is proportional to the square of the voltage.
(i.e., the resistance) and the water pressure in the bucket. Accordingly, for the same resistance, 1 volt RMS of AC
If another hole is drilled nearby (i.e., in parallel), there are delivers the same power as 1 volt DC. For the typical
now two ways for water to escape (under the same pres­ house or office AC, the RMS voltage is approximately
sure), and hence the amount of water leaving the bucket 0.707 multiplied by the voltage measured between base­
(i.e., the current) will increase. Thus, the two holes in line and the maximum value. Thus, in the United States,
parallel effectively decrease the resistance to water leaving 120 V RMS corresponds to approximately 170 V baseline
the bucket. to peak.

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 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies
One natural question to ask is: why alternating current?
Current constantly flowing back and forth in opposite
directions many times a second seems confusing and coun­
terintuitive. However, alternating current arises from all
the common ways that electricity is generated. Whether
the source is a windmill, hydroelectric, nuclear, coal, or
natural gas, all ultimately result in a rotational mechanical
movement (e.g., wind and hydro directly turning an axis;
nuclear, coal, and natural gas heating water to steam which
then turns a turbine). Electricity is then created by attach­
ing a coil (a conductor shaped as a loop) to the mechanical
rotation with the coil placed in a strong magnetic field. As
the conductor rotates in the magnetic field, electricity is
generated and flows to an attached load. The angle and
direction of the coil in the magnetic field determines the
amount and direction of the electricity. When the coil is
perpendicular to the magnetic field and moving with the
positive side of the coil up, the maximal current is gener­
ated (i.e., the top of the sine wave). However, when the
coil is perpendicular to the magnetic field and moving with
the negative side of the coil up, the maximal current is
generated in the other direction (i.e., the bottom of the
sine wave). When the coil is parallel to the magnetic field,
no current is generated (the zero crossings of the sine
wave). It is this rotation of a coil within a magnetic field
that creates an alternating current with its characteristic
sinusoidal waveform.
Magnetic field
N S
Rotating coil
Negative Positive
lead lead
CAPACITANCE, INDUCTANCE,
AND REACTANCE
Beyond simple resistive circuits, one needs to move next
to the basics of capacitance, inductance, and reactance.
Although these concepts are more complicated, they have
direct relevance to EDX studies regarding (1) low- and
high-frequency filters, and (2) stray leakage currents that
potentially pose a risk of electrical injury to patients under­
going EDX studies (see Chapter 40).
Although capacitance and inductance are present in DC
circuits, they are more germane to AC circuits. The concept
of reactance is only applicable to AC circuits. As noted in
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605
the following, capacitance and inductance share many fun­
damental properties but also have significant and important
differences.
Capacitance
Capacitance, represented by the symbol C, is a property
of a circuit that allows it to store an electrical charge. The
farad is a measure of capacitance, designated by the letter
F. A capacitor is an electronic component made from a pair
of conductive plates separated by a thin layer of insulating
material (the insulating material is known as a dielectric).
When a voltage is applied across the plates of a capacitor,
electrons are forced onto one plate and pulled away from
the other. The plate with an excess of electrons is nega­
tively charged, whereas the opposite plate with a deficiency
of electrons is positively charged. The amount of charge
stored in a capacitor is proportional to the voltage across it
as described by:
Q = C×V
where Q is the charge in coulombs, C is capacitance in
Farads, and V is voltage in volts.
Because of the dielectric material between the plates, no
actual current (i.e., flow of electrons) moves across the
plate; however, there is an “apparent flow,” also known as
a capacitive current.
+
E C
-
Take the above example of a battery connected to a single
capacitor with a simple open and closed switch.
e- e- e-
e-
P
+
E
C
-
When the switch is moved to the closed position, elec­
trons flow from the power source to the conductive plate
606 SECTION VIII Electronics and Instrumentation

of the capacitor. This flow of electrons will create an actual 100.0%

98.1%
current in the conductor. When the electrons arrive at the 94.9%
negative plate, they do not actually cross the plate. 86.4%

e- 63.2%
e- e- e-
e-
e- P

e- e- e-
+ First time Second time Third time Fourth time Fifth time
E C constant constant constant constant constant
-
e- Thus, one time constant (RC) defines the time it takes
for the voltage across a capacitor to reach 63.2% of its
e- e- maximum value. During the second time constant, voltage
will rise to 63.2% of the remaining 36.8%, or a total of
However, the buildup of electrons at the negative plate 86.4%. It takes about five time constants for voltage across
results in the electrons at the opposite plate being repelled the capacitor to reach its maximum value.
(in magnetism: opposites attract, but likes repel). Thus, Once fully charged, what happens if the power source is
there will be an “apparent current” across the capacitor. then turned off? The opposite occurs. The capacitor will
This will continue until the voltage across the capacitor discharge, with the excess electrons now flowing away (i.e.,
equals the voltage from the power source. in the opposite direction than during charging) from the
negative plate of the capacitor. Again, an apparent capaci­
tive current will occur on the other side of the circuit and
continues until the capacitor is fully discharged. The dis­
charge of a capacitor follows a similar exponential fall,
e- e- e- described by the equation:
+ e- e-
E C Voltage (at the capacitor ) = e− t /RC
-
100.0%
First time Second time Third time Fourth time Fifth time
constant constant constant constant constant

At that time, no further apparent current will flow. The

36.8%
capacitor will be fully charged, and an electric field will
exist between the two plates.
13.6%
The rate of accumulation of charge (and the resulting
5.1%
voltage) at a capacitor occurs exponentially, based on the 1.9%
0%
equation:
Thus, after one time constant, the voltage across the
Voltage = 1 − e− t/RC
capacitor will have dropped to 36.8% of its original value.
Again, it takes approximately five time constants for a
where t is time
capacitor to completely discharge.
e (natural logarithm base) is 2.718281828459045235
In a DC circuit, when the circuit initially is turned on,
R is resistance of the circuit in Ohms
current flows. However, after five time constants, the
C = capacitance in Farads
capacitor is fully charged and no further current occurs. At
this point, the capacitor effectively acts as an open circuit.
Note that, in the above equation, the time required for
Understanding these properties of a capacitor in a simple
voltage to rise to its maximum value in a circuit is depend­
DC circuit allows one to extrapolate to what occurs in an
ent on the product of resistance (R) multiplied by capaci­
AC circuit.
tance (C). This product (RC) is known as the time constant
Take the example of an AC circuit where the frequency
of a capacitive circuit.
of the current is much faster than the frequency 1/RC.
When t = RC When current is first applied to a capacitive circuit, it flows
readily because of the apparent or capacitive current. If the
AC then reverses before the capacitor is fully charged, a
Voltage (at the capacitor ) = 1 − e−1 capacitive or apparent current will flow in the opposite
= 0.632 = 63.2% direction. Thus, in essence, a capacitor is effectively a short

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 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies
circuit for high frequencies. Conversely, if the frequency of
the current is much slower than the frequency 1/RC, the
capacitor can fully charge before the current reverses.
Thus, a capacitor can act like an open circuit for low fre­
quencies. These properties can be used to an advantage in
designing low and high filters (see following sections).
In an AC circuit, also note that a capacitor constantly
charges and discharges. When charge accumulates between
the two plates of the capacitor, an electric field develops
between the plates. Thus, in an AC circuit, there is a con­
stantly expanding and collapsing electrical field around a
capacitor. Other conductors near this changing electrical
field may develop capacitive currents. This is of importance
in understanding the concept of stray capacitance and the
risks of leakage currents (see following sections).
Inductance
The property of an electrical circuit that causes it to oppose
any change in current is known as inductance. Inductance
is designated by the symbol L and is measured in henries
(H). Inductance is somewhat similar to mechanical inertia,
which must be overcome to get a mechanical object moving
or stopping. Whereas resistance opposes all current flow,
inductance only opposes a change in current. If current
increases, inductance tries to hold it down; conversely, if
current decreases, inductance tries to hold it up.
- -
Current flow
Magnetic field
Inductance occurs as a result of magnetic fields induced
by a current. Whenever current flows, a magnetic field
develops around the conductor, known as an electromag-
netic field. Moving a conductor through a magnetic field will
induce a voltage in a conductor. Likewise, having a station­
ary conductor in a magnetic field that is either expanding or
collapsing will also induce a voltage in the conductor. Thus,
when current first begins to flow in a conductor, an expand­
ing magnetic field develops. This expanding (i.e., changing)
magnetic field induces a voltage in the conductor that
opposes the flow of current, known as a counter electromo-
tive force. This counter electromotive force results in a time
delay for current to reach a steady value. Once a steady
value is reached, the magnetic field around a conductor is
static, and no further opposing voltage develops.
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607
Similar to the calculation for capacitance, the resulting
current in a circuit with an inductor occurs exponentially
and is described by the following equation:
L
−t
Current = 1 − e R
where t is time
e (natural logarithm base) is 2.718281828459045235
L is inductance in Henries
R is resistance of the circuit in Ohms
Note that, in the above equation, the time required for
current to rise to its maximum value in a circuit is dependent
on the value of inductance divided by resistance. This value
(L/R) is known as the time constant of an inductive circuit.
When t = L /R
Current = 1 − e−1
= 0.632 = 63.2%
Thus, one time constant (L/R) defines the time it takes
for the current to reach 63.2% of its maximum value.
During the second time constant, current will rise to
63.2% of the remaining 36.8%, or a total of 86.4%. It
takes about five time constants for current to reach its
maximum value.
At steady state, what happens if the power source is then
turned off? The opposite occurs. The electromagnetic field
collapses and induces a counter electromotive force in
the conductor, opposing the flow of current. The current
flow follows a similar exponential fall, described by the
equation:
- −t
L
Current = e R
Thus, after one time constant, the current will have
dropped to 36.8% of its original value. Again, it takes
approximately five time constants for current to completely
dissipate. Once the current has reached a steady state (in
this case zero), there will be no changing magnetic field,
and no further opposing voltage will be induced.
In a DC circuit, when the circuit is turned on, current
flows but is initially impeded by inductance. However,
after five time constants, the current reaches steady state
and no further inductive voltage occurs. At this point, an
inductor effectively acts as a short circuit. From under­
standing these properties of inductance in a simple DC
circuit, one can extrapolate what happens in an AC circuit.
Take an AC circuit where the frequency of the current is
much slower than the frequency 1/(L/R). When current is
first applied to the circuit, it is impeded due to induct­
ance. However, after five time constants, the current has
reached steady state and no further inductance occurs.
Thus, for low frequencies, inductors allow current to flow
and reach their maximum. However, in AC circuits with
frequencies higher than 1/(L/R), the AC reverses before
the current can reach its steady state. In this case, the
608 SECTION VIII Electronics and Instrumentation

inductor effectively attenuates high-frequency currents • Impedance = Resistance, in circuits with no inductance

from flowing. or capacitance
Thus, as a capacitor stores energy as charge in an electri­ • Impedance = Resistance, in circuits where inductive
cal field, an inductor stores energy in the form of a magnetic reactance equals capacitive reactance
field. Just like capacitance, inductance is dependent on the • Inductive and capacitive reactances directly oppose
frequency. If the frequency is low, the current has more each other.
time to reach its maximal value, before the polarity of the
sine wave reverses. Conversely, if the frequency is very
high, the current has less time to reach its maximal value. WAVEFORMS, FREQUENCY
Thus, inductance attenuates high frequencies much more
than low frequencies; this is exactly the opposite of capaci­
ANALYSIS, AND FILTERING
tance. Taken to the limit, an inductor is essentially a short During nerve conduction studies and needle EMG, every
circuit at low frequencies and an open circuit at high displayed waveform represents a small bioelectrical poten­
frequencies. tial (i.e., voltage) that is recorded, amplified, and then fil­
In an AC circuit, current will be constantly flowing and tered. The last process, filtering, improves the quality of
then reversing, resulting in an expanding and collapsing the recorded potential by preventing a wandering baseline
magnetic field around any conductor. This can induce volt­ and eliminating much unwanted electrical noise. To under­
ages in other conductors near this changing magnetic field, stand the process of filtering, one must first appreciate the
which is important to understanding the concept of stray frequency spectrum of any recorded waveform.
inductance and the risks of leakage currents (see following The Fourier analysis is a mathematical construct that
sections). states that any waveform can be derived by adding a series
of sine waves. The sine waves may vary by amplitude, fre­
Reactance and Impedance quency, or phase. One of the most illustrative examples is
that of a square wave, which also can be constructed by
In a purely resistive circuit, either DC or AC, opposition to adding a series of sine waves.
current flow is termed resistance. However, in an AC circuit,
current can also be opposed by inductance, capacitance, or
both. Opposition to current flow from capacitance is the
capacitive reactance, termed XC. The larger the capacitor,
the smaller the capacitive reactance. Opposition to current
flow from inductance is the inductive reactance, termed
XL. The larger the inductor, the larger the inductive reac­ Take the above example of a square wave with a frequency
tance. Similar to resistance, reactance is measured in Ohms of 3 Hz.
(Ω). Thus, total reactance in an AC circuit depends on both
inductive and capacitive reactances. Clearly, from the earlier
discussion, inductive and capacitive reactances depend on
frequency. In the case of inductance, reactance is much
higher for high frequencies. Conversely, in the case of capac­
3 Hz
itance, reactance is much lower for high frequencies.
Capacitive and inductive reactance can be calculated by
the following equations: The square wave can first be approximated by a 3 Hz
1 sine wave.
XC =
2π fC
where f is frequency, and C is capacitance.
XL = 2π fL

where f is frequency, and L is inductance. 3 Hz

Lastly, impedance, designated by the letter Z, is also +

measured in Ohms (Ω). Impedance incorporates the total
9 Hz
opposition to current flow in an AC circuit, including resist-
ance, capacitive reactance, and inductive reactance. Imped­
ance is calculated using the following equation:
Impedance ( Z ) = R 2 + ( XL − XC )2

Thus, from the above equation, one can appreciate several

facts about impedance: =

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 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies
If a smaller-amplitude 9 Hz sine wave is added to the 3 Hz
sine wave, the following waveform results. This is now
starting to look somewhat like a square wave.
3 Hz
9 Hz
15 Hz
= muscle action potential (CMAP) compared to that of a
If now an even smaller-amplitude 15 Hz sine wave is added
to the two earlier sine waves, the resultant waveform is
generated. If one continues this analysis, the actual Fourier
analysis for a square wave with a frequency (x) can be
derived from the following equation:
= sin( x ) + 1/ 3 sin( 3 x ) + 1/ 5 sin( 5 x ) + 1/ 7 sin(7 x ) + 1/ 9
sin(9 x ) + 1/11sin(11x ) + …
The above waveform represents the Fourier reconstruction
of ten separate sine waves. Thus, as more waveforms
with higher frequencies and smaller amplitudes are added,
the reconstructed waveform continues to more closely
approximate that of a true square wave. Thus, a 3 Hz
square wave contains the following frequencies: 3, 9, 15,
21, and 27 Hz, in addition to other higher frequencies.
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609
Relative signal intensity
SNAP Frequency spectrum
CMAP Frequency spectrum
0 500 1000 1500 2000 2500 3000
Frequency (Hertz)
A similar analysis can be performed for all waveforms
recorded during routine EDX studies. The figure above
shows the relative frequency components of a compound
sensory nerve action potential (SNAP) (from Gitter and
Stolov, 1995). Note that the SNAP has higher-frequency
components compared to the CMAP.
Ideally, one would like an EMG machine to display the
amplified bioelectric signal of interest exactly. However, if
a signal is contaminated with electrical noise, it can be dif­
ficult to properly record and interpret it. In general, very
low frequencies will contaminate the signal of interest by
causing the baseline to wander and very high frequencies
can easily obscure many small waveforms (e.g., SNAPs,
fibrillation potentials). Thus, it is desirable to filter out
unwanted low and high frequencies while retaining the
frequency spectrum of the actual waveform as much as
possible.
Low-Frequency (High-Pass) Filters
A B
C
Input Signal
R Output
source
Ground
Low-frequency filters remove undesirable low frequencies
while allowing high frequencies to pass. Analog low-
frequency filters can be constructed with a capacitor fol­
lowed by a resistor. In the illustration above and those that
follow, the Signal Source will be modeled to generate either
610 SECTION VIII Electronics and Instrumentation

a low frequency, high frequency, or square wave input to A B

the circuit. The input to the circuit is measured from point
A (to a reference or ground), and the output of the circuit C
is measured from point B (to a reference or ground).
Signal
R
source

A B
C
Ground

Signal Input
R
source
Output

Ground Of course, most waveforms have a combination of low

and high frequencies. If a square wave is put through a
Input low-frequency filter, the high frequencies will pass, but the
lower frequencies will be filtered out.
Output
High-Frequency (Low-Pass) Filters

A B

Recall from earlier discussions that for an AC with a high R

frequency, the capacitor effectively acts like a short circuit,
allowing the current to pass. If the AC changes direction Signal
C
before the capacitor has charged, the apparent or capacitive source
current will continue unaltered.

Ground
A B
C
High-frequency filters remove undesirable high frequencies
while allowing low frequencies to pass. Analog high-
Signal frequency filters can be constructed with a resistor fol­
R
source lowed by a capacitor.

A B

Ground R

Input Signal
C
source
Output

Ground
Conversely, for an AC with a very low frequency, the
capacitor effectively acts like an open circuit. In this case, Input
there will be ample time for the capacitor to fully charge
before any change in current direction occurs. Once the Output
capacitor is fully charged, no current, real or apparent, will
flow. At this point, the capacitor will act as an effective In the case of an AC with a high frequency, the capacitor
open circuit, not allowing the waveform to pass from point effectively acts like a short circuit and shunts the signal to
A to the output at point B. ground.

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 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies 611

A B Putting low- and high-frequency filters in tandem allows

for a passband, whereby frequencies above and below
R the cutoff values are filtered out. However, no passband
removes frequencies above or below a cutoff value with
Signal perfect precision. There is a normal roll-off of the frequen­
C
source cies that pass through. In general, cutoff frequency values
for both high and low filters are defined as the point where
the power of the signal is reduced by 50% [i.e., approxi­
mately 0.707 of its voltage. Remember that power is pro­
Ground portional to the square of the voltage and that (0.707)2 = 0.50.]

Input
Output
Conversely, for a very low-frequency AC, the capacitor
effectively acts like an open circuit. In this case, there will be
ample time for the capacitor to fully charge before any
change in current direction occurs. Once the capacitor is
fully charged, no current, real or apparent, will flow. At this
point, the capacitor will act as an effective open circuit,
allowing the waveform to be present at the output at point B.
A B
R passband). Although filters remove unwanted electri­
Signal
source
Ground
Input
Output
Of course, most waveforms have a combination of low
and high frequencies. If a square wave is put through a
high-frequency filter, the low frequencies will pass, but the
higher frequencies will be filtered out.
Low cut-off
1.0
Signal strength
PRACTICAL IMPLICATIONS FOR
ELECTRODIAGNOSTIC STUDIES
Congratulations. You have almost reached the end of this
chapter, but you still may be asking whether basic knowl­
edge of electricity and electronics really is needed to
perform EDX studies. The answer clearly is yes, because
there are many practical implications for performing EDX
studies based on the principles learned in this chapter. Most
important among them are the following:
• Filters. Understanding that all waveforms, including
those recorded during EDX studies, have their own
unique frequency spectrum allows for the use of
electronic filters to remove unwanted low- and
high-frequency noise while permitting the principal
frequencies of the waveform to pass unaffected (i.e.,
cal noise, they also impact the waveform of interest
C
and can alter certain characteristics of the waveform
(especially amplitude for high-frequency filters and
duration for low-frequency filters).
• Tissue acting as a filter: nerve conduction studies.
Skin and subcutaneous tissue act as a high-frequency
filter. Accordingly, if surface electrodes are not opti­
mally placed directly over a nerve or muscle, much of
the waveform’s higher frequencies will be filtered out.
Amplitude is predominantly a high-frequency response.
SNAPs contain more high frequencies than CMAPs.
Thus, if the surface electrodes are not optimally placed,
amplitudes on nerve conduction studies will be
reduced, more so for SNAPs than for CMAPs. If a
patient has limb edema, then even if the surface
electrodes are optimally placed, the increased tissue and
edema between the nerve or muscle and the recording
electrode will result in an artificially low amplitude.
• Tissue acting as a filter: needle EMG. During the
needle EMG examination, tissue between the motor
High cut-off
unit action potentials and the needle electrode also
acts as a high-frequency filter. Again, as amplitude is

0.707 predominantly a high-frequency response, MUAP

amplitude can be markedly influenced by the distance
Passband between the needle and the motor unit. During
needle EMG, the proper location to analyze an
0.0 MUAP is reached when the major spike (i.e., the
Frequency highest frequency component of the MUAP) is very

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612 SECTION VIII Electronics and Instrumentation
short, less than 500 µs. This ensures that the needle is
very close to the motor unit. Likewise, this property
of tissue acting as a filter also explains why duration is
a much better determinate of motor unit size than is
amplitude. Duration is predominantly a low-frequency
function. Thus, tissue, which acts as a high-frequency
(low-pass) filter, allows the low-frequency compo­
nents from distant muscle fibers of the same motor
unit to be recorded.
• Inductive electrical noise from the environment.
How does a nearby radio or coffee maker result in
electrical interference during EDX studies? Every
power cord contains a 60 Hz AC signal. Around that
power cord is a continuously expanding and collapsing
magnetic field. If a conductor (e.g., a recording
electrode) is near that magnetic field, an inductive
voltage can be generated on that lead, which then
can be amplified, often saturating the amplifier and
obscuring the signal of interest.
The photo above is a real example of this problem from
one of our laboratories. Note the ophthalmoscope hanging
on the wall adjacent to the EMG table and the power cord
next to it. Even in the off position, AC is present in the
power cord, resulting in an unseen expanding and collapsing
magnetic field. When recording electrodes were placed
near the magnetic field, an induced current was generated
in the leads. Sensory responses could not be recorded
without excessive electrical noise unless the power cord
plug was physically pulled out of the socket.
• The stimulator cable and the recording electrodes
should not cross or be near each other. When the
stimulator is discharged, a brief current flows through
the stimulator, creating an expanding and then
collapsing magnetic field around the stimulator cable.
If the recording electrodes or their leads are near that
field (especially if the cables are crossed and touch­
ing), an inductive voltage can easily be generated in
the recording leads, resulting in a large stimulus
artifact.
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• Importance of eliminating electrode impedance
mismatch. Despite one’s best efforts, there will
always be some electrical noise in every EMG
laboratory, usually 60 Hz AC from nearby electrical
equipment. However, if the impedances (which
include resistance, capacitive reactance, and inductive
reactance) of the active and reference electrodes are
identical, then any current resulting from electrical
noise contaminating the recording electrodes will
create the same extraneous voltage on each lead (from
Ohm’s law: Voltage = CurrentNoise × Impedance).
Because all signals are amplified by way of a differen­
tial amplifier, the extraneous voltage will be canceled
out. Several important techniques help ensure that
the recording electrodes have the same impedance,
among them, the use of a coaxial cable, good skin
preparation, and an ample amount of conductive paste
between each electrode and the skin.
• Importance of the ground electrode. One might
assume at first glance that there is no difference
between the reference and the ground lead, both
being at electrical zero. However, all voltages are
relative potentials, determined by the difference
between two points in a circuit. Thus, one can
measure a potential of 10 V between a point on a
circuit that is 10 V higher than the ground (which is
at electrical zero). However, 10 V also can be meas­
ured in a circuit between a point that is 20 V above
ground and another point that is 10 V above ground.
Thus, in most electronic applications, there is usually
a potential difference (i.e., a voltage) between the
neutral or reference electrode, and the ground
electrode.
Active
+
E R
-
Reference
Ground RREFERENCE
Voltage Reference = P x RREFERENCE
Whenever a waveform is recorded, current flows from
the active to the reference lead. Even though the reference
electrode is a conductor, there is a small amount of resist­
ance in all materials, including conductors. Thus, a small
voltage will be present on the reference lead, as determined
by Ohm’s law (E = I × RReference). Accordingly, the ground
potential is actually at a lower potential than the reference
electrode. If a stray current develops on the patient, the
ground allows a safe pathway to dissipate the current,
thereby protecting the patient from possible electrical
injury (see Chapter 40). In addition, because the ground is
 Chapter 39 • Basics of Electricity and Electronics for Electrodiagnostic Studies 613

at a lower potential than the reference electrode, any stray
current will be preferentially shunted to the ground elec­
trode rather than the reference electrode (electricity
follows the path of least resistance). Thus, the electrical
noise will not contaminate the reference electrode and
obscure the potential of interest.
10 uV / D 2 ms / D 10 uV / D
Ground in place Ground removed
This is easily demonstrated in the EMG laboratory. In the
example above, a routine radial sensory response is recorded
from a normal individual, first with the ground electrode
attached and then with the ground electrode disconnected.
Note that with the ground electrode disconnected, there is
a large superimposed 60 Hz electrical signal, making the
sensory response barely visible.
• Leakage currents: stray capacitance and
inductance. Although EMG machines are designed to
minimize leakage currents, there will always be some
leakage current on the machine chassis from stray
2 ms / D
capacitance and inductance. This is because any
circuitry with ACs containing capacitors will have
expanding and collapsing electrical fields. Likewise,
any circuitry with ACs will have expanding and
collapsing magnetic fields. If any part of the machine
chassis is metal (i.e., a conductor) and near enough to
electrical or magnetic fields from internal circuitry,
stray capacitive or inductive currents potentially can
be produced. These small leakage currents pose a
potential electrical risk to certain vulnerable patient
groups (see Chapter 40). With preventative mainte­
nance of the machinery and by closely following
specific protocols these possible hazards can be
eliminated (see Chapter 40).

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