Final Project Report

BENG 3000 Bioinstrumentation

Performance Date 04/04/2023 and 04/11/2023

EMG and Grip Strength Analysis in Rock Climbing

— By —

Alisa Christensen, Mylie Christensen, Emily Hanson, and Kristine Peterson

Department of Biological Engineering,

BENG 3000 Bioinstrumentation Final Project

Introduction

Rock climbing is an efficient way to develop fine motor skills in the hands and fingers, as
well as strengthen muscles in the arms and legs [1]. To determine the effectiveness of rock
climbing in strengthening muscles, two tests will be conducted: grip strength and muscle
fatigue. Although there are many different types of climbing grips, this study will focus on
two; the crimp and the pinch as seen in Figure 1. Both grips will be tested during the
collection of dynamometer grip strength data, and only the crimp grip will be tested for the
Electromyography (EMG) muscle fatigue data. The data from both tests will then undergo
their respective testing; the dynamometer data will undergo ANOVA statistical analysis,
and the EMG data will undergo a fatigue analysis.

EMG measures electrical signals produced when muscles contract and is useful in many
clinical and biomedical applications. Muscle signals can be measured using invasive or
non-invasive electrodes and can be used to diagnose neuromuscular disorders. After
recording an EMG signal, the signal can be decomposed to show individual motor unit
action potential trains, which allows for mechanisms of muscle and nerve control to be
seen. Different methods such as wavelet analysis or fatigue analysis can also be used to
process the EMG signal to a more useful form [2].

In this experiment, fatigue will be

measured along the brachioradialis, a
muscle commonly employed during rock
climbing. This fatigue test will be
conducted by evaluating EMG data up
until the point of failure, which is defined
as the point at which a climber can no
longer hold themselves on the wall. To
collect this data, electrodes will be
placed along the participants prepped
right arm, and the EMG LabChart
software will record the muscle
response, or more accurately, LabChart
will record the electrical activity in
response to nerve stimulation of the
muscle [3]. While a higher maximal
handgrip has been shown to correlate
with climbing ability, handgrip
endurance is a crucial aspect of
successful climbing [4]. The
dynamometer testing and ANOVA test
to follow will provide further insight into
grip strength of climbers. This testing
will allow the hypothesis that rock
climbers have a higher grip strength to
Figure 1. Crimp and pinch climbing grips from various angles [5].
be either validated or refuted.

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BENG 3000 Bioinstrumentation Final Project

While rock climbing, the skeletal muscles in the arms and hands are employed in multiple
sustained intermittent isometric contractions, creating a unique series of physiological
responses, including disproportionate heart rate increases in comparison to oxygen intake
[1]. Due to these unique responses, heart rate is not a reliable measurement for analyzing
the sports effectiveness. The use of the EMG to measure a sustained contraction during
rock climbing will allow for analysis of the effects of climbing on small muscle groups in
the hands and arms without noise from other movements or physiological responses.

Materials and Methods

Supplies:
- PowerLab and connective cables
- MCT003/D Hand Dynamometer
- Disposable electrodes
- Nuprep Skin Prep Gel
- Hand Sanitizing Alcohol Wipes
- Rock climbing shoes
- Extension cord

Software:
- ADInstruments LabChart 8 Software with EMG settings and grip strength settings

Dynamometer/ANOVA analysis:

To begin the experiment, the LabChart grip settings were opened, and the dynamometer
was set up with the PowerLab. After ensuring equipment was working properly, ‘Start’
was clicked and a participant was asked to maintain a maximum grip strength using the
crimp grip on the dynamometer for 20 seconds. After 20 seconds, “Stop” was clicked and
a marker was placed at the beginning of the 20 seconds of data.

Next, 20 seconds of data were highlighted. The marker was removed without unselecting
the data and ‘Multiple Add to Data Pad’ was clicked. Next, ‘Current selection’ was selected
and ‘Add’ was clicked. ‘Data Pad View’ then ‘Add to Data Pad’ was also clicked to add
the mean of the data points. The data was then saved.

A new LabChart window was opened. “Start” was clicked and the participant was asked to
maintain a pinch grip on the dynamometer for 20 seconds. Following the 20 seconds,
“Stop” was clicked and data points were collected using the same method as above. The
data was then saved. This process of recording maximum crimp and pinch grips was
repeated for each volunteer. The crimp and pinch grips on the dynamometer are shown in
Figure 2.

After dynamometer data collection, ANOVA statistical tests were performed for both the
crimp and pinch grips with all the volunteers, the rock-climbing volunteer group, and the
non-rock climber group. The six ANOVA tests were performed using an online
calculator at https://goodcalculators.com/one-way-anova-calculator/ [6].

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BENG 3000 Bioinstrumentation Final Project

Figure 2. Participant modelling the pinch (left) and crimp (right) grips used in dynamometer test.

EMG/Fatigue analysis

Set Up and Subject Preparation:

The subjects’ forearms were prepped

for surface electrodes by gently
abrading the skin surface by rubbing
abrasive gel to the desired areas of
the forearm. The gel was then
removed by an alcohol wipe and the
electrodes were placed across the
brachioradialis muscle in the
formation pictured in Figure 3.

To prepare the rock wall, two

identical crimp grip climbing holds
were screwed onto the wall
approximately a foot and a half apart
at the same height. This was done to
ensure the subject would have an
even grip between each arm.

Data collection:

The electrodes were connected to the Figure 3. Participant modelling the electrode placement along the
brachioradialis. In descending order, the placement is ground,
Power lab which was connected to a positive, negative.
computer running LabChart. EMG
data collection settings were loaded and once the subject was connected, data collection
was started. Each subject was still for 10 seconds to record a resting baseline. Once the
baseline was established, the subject would climb onto the wall and grab the two climbing
grips. Each subject held their body as close to the wall as possible with each foot on
climbing holds below as seen in Figure 4. Subjects remained still as possible and held onto
the wall until failure. Once the subject reached the point that they could no longer hold on,

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they came down from the wall and repeated a 10 second resting baseline before recording
was stopped. Data was saved after each subject, and a new file was created for each subject.
The process was done six times for the three climbers and three non-climber subjects.

Fatigue Analysis:

A fatigue analysis was conducted using

the LabChart software to graph the
voltage (mV) over the frequency (Hz).
This was done for different areas of
selected data. Sections that were 5
seconds in length were selected at the
beginning of the subject’s hold, at the
mid-point, and the end. The mid-point
was calculated as half of the time the
subject was on the wall. Data selection
times were recorded in a table to keep
track of each subject beginning, ending,
and mid-point.

Each spectrum generated was scaled on

the voltage axis from 0-100 V (106), and
the frequency axis from 0-200 Hz. Screen
shots of each spectrum were saved. A
general trendline was added manually to
each image and the approximate
maximum frequency was estimated as
where the peak of the trendline occurred.
These approximate values were plotted in Figure 4. Participant on rock wall during EMG testing.
a scatter plot to create the Muscle Fatigue
Index. The average values for each group were calculated and put into a scatter plot to
create a Combine Muscle Fatigue Index.

Project Process Flow Chart

The fundamental steps taken to create and complete this research project include
hypothesis, literature review, data collection, data analysis, and conclusions. Figure 5
below details the order of these steps.

Figure 5. Project process flow diagram.

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BENG 3000 Bioinstrumentation Final Project

Hypothesis:

During this step, the group theorized about the differences in grip strength between rock
climbers and non-rock climbers. This led to the original hypothesis that those who regularly
rock climb will have stronger grip strength due to fine muscle training and will take longer
to fatigue in general. To determine the best ways to test this hypothesis, a literature review
was conducted.

Literature Review:

To conduct the literature review, members of the group utilized the various search engines
provided through Utah State University. This led to a few journal articles that detailed
EMG rock wall testing. After reading about what muscles are used during rock climbing,
the set up described in the methods sections “EMG/Fatigue Analysis” was produced. Note
that there is an additional ‘review’ step between each step. This sub-step refers to the
constant reference to literature and data to ensure research is proceeding with accuracy.

Dynamometer Testing:

Prior to testing, the group gathered two additional participants so that the data would be in
triplicate. During the dynamometer testing, precautions were taken to help ensure accurate
results, including, not moving during testing, not using the thumb during crimp grip, and
not encouraging people during testing.

EMG Testing:

The EMG testing was able to be completed by acquiring a LabChart software license. Once
at the rock wall, the equipment was bought, set up, and maintained using proper techniques.
To limit the noise in the data, each participant was asked to stand still before beginning the
test, and directly after stepping off the wall. In addition, the subjects were instructed to stay
as still as possible while holding on to the wall.

Fatigue Analysis and Statistical Testing:

To conduct the fatigue analysis, the EMG data was plotted over frequency instead of time
to create a power spectrum and the data was used to create a Muscle Fatigue Index. The
statistical testing included a one-way ANOVA test to determine p-values among the
dynamometer data.

Conclusions:

To make accurate conclusions from the results, any possible sources of error were
identified and discussed. The results were also analyzed to validate or refute the original
hypothesis.

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BENG 3000 Bioinstrumentation Final Project

Results and Discussion

Dynamometer Data – ANOVA

Data from dynamometer grip force testing for rock climber volunteers is shown in Table
1. Table 1 shows grip force data of rock climber volunteers for both the crimp and pinch
grip along with the average grip force for both of those grips.

Table 1. Dynamometer grip force data for rock climber volunteers.

Rock climbers
Volunteer 1 2 3
Grip Crimp Pinch Crimp Pinch Crimp Pinch
Grip force (N) 156.75 82.54 191.47 81.37 99.11 57.02
152.62 85.44 180.18 73.71 91.12 60.82
149.43 80.57 157.79 70.84 100.70 59.43
146.22 72.79 151.20 75.95 105.37 58.88
144.66 69.42 140.93 75.92 98.84 57.22
125.47 66.36 133.25 75.16 91.55 55.22
122.44 61.34 132.38 74.16 84.52 49.77
142.51 59.18 122.39 69.82 88.21 47.14
139.71 60.35 118.55 69.65 83.61 41.59
139.71 59.29 110.85 66.70 80.75 45.70
138.27 54.12 114.50 63.05 75.23 43.97
129.65 59.22 107.92 60.40 65.94 44.79
129.19 57.40 100.12 48.77 62.14 37.13
128.70 53.93 99.13 50.59 66.81 26.94
122.78 50.84 106.23 50.89 64.75 40.27
117.73 52.92 104.02 48.30 67.31 49.33
111.55 51.09 100.08 44.56 73.60 46.31
106.46 50.52 93.18 43.36 77.03 49.45
101.35 50.29 86.68 42.90 81.54 45.72
105.16 51.78 85.16 44.07 73.84 44.29
106.31 50.11 83.02 44.27 75.23 45.26
Mean grip force (N) 130.40 61.28 120.74 61.34 81.57 48.03

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BENG 3000 Bioinstrumentation Final Project

Table 2 shows dynamometer grip force data for the non-rock climber volunteers and
includes grip strength over time and the average grip strength for both the crimp and the
pinch grips.

Table 2. Dynamometer grip force data for non-rock climber volunteers.

Non-rock climbers
Volunteer 4 5 6
Grip Crimp Pinch Crimp Pinch Crimp Pinch
Grip force (N) 186.28 72.39 200.10 63.28 87.37 50.99
185.02 66.65 232.04 63.32 100.23 49.06
176.44 61.58 228.05 63.55 105.34 54.27
171.46 57.59 215.29 59.83 109.65 46.43
167.09 51.26 227.94 59.47 107.24 51.53
166.76 57.29 216.77 59.65 99.07 49.68
165.00 55.44 207.04 58.20 105.70 47.23
139.54 53.87 200.54 56.07 106.25 48.81
153.25 52.44 204.00 55.65 102.23 45.39
145.97 53.66 191.58 54.15 103.68 43.75
153.44 52.09 195.74 51.90 97.37 49.87
154.31 55.54 192.62 51.27 94.13 43.17
156.55 52.00 188.44 50.26 108.66 42.43
135.27 53.78 181.58 46.14 102.50 41.70
150.29 47.36 178.70 46.71 96.33 43.84
138.38 49.35 169.33 47.85 99.40 43.34
135.20 48.50 179.73 45.21 97.93 40.65
145.12 47.26 174.51 44.42 96.37 41.73
155.16 48.90 168.68 44.29 90.88 40.42
138.76 55.97 172.02 43.56 85.79 41.04
127.64 54.03 121.01 40.24 82.98 41.13
Mean grip force (N) 155.44 54.63 197.44 52.97 99.46 45.76

Using the data from Tables 1 and 2, box and whisker plots of the dynamometer data were
created. Figure 6 shows the box and whisker plot for all volunteers using the crimp grip.
Figure 7 shows the box and whisker plot of all the volunteer data for the pinch grip. Figure
6 shows that non-climbers have a higher crimp grip force than rock climbers. From Figure
7 we can see that climbers seem to have a slightly higher pinch grip force than non-
climbers. From Figures 6 and 7 we can see the rock climber volunteers did not necessarily
have a higher grip force than the non-rock climbers. This indicates that grip strength may
not be as important during rock climbing. Stamina, or how long the climber can hold onto
the wall, is likely more important when rock climbing.

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BENG 3000 Bioinstrumentation Final Project

Figure 6. Box and whisker plot for crimp dynamometer grip force data. Volunteers 1-3 are rock
climbers. Volunteers 4-6 are the non-rock climbers.

Figure 77. Box and whisker plot for pinch dynamometer grip force data. Volunteers 1-3 are rock climbers. Volunteers
4-6 are the non-rock climbers.

Data from Tables 1 and 2 was also used to perform one-way ANOVA tests. For the crimp
grip with all the volunteers, a p-value of 0 was found. This small p-value indicates that at
least one of the volunteers means is not equal for the crimp grip. The ANOVA test for
crimp grip with just the rock climbers resulted in a p-value of 0. A p-value of 0 indicates
that for the crimp grip not all the means for the rock climbers were the same. For the crimp

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grip and the non-climber volunteers, a p-value of 0 was found. This indicates that within
the non-climbers, not all the means were the same for the crimp grip.

For the pinch grip and all the volunteers, the ANOVA test resulted in a p-value of 0. Based
on this p-value, at least one of the volunteers mean grip strength for the pinch grip was
different. For the ANOVA test for the pinch grip with the rock climber group, a p-value of
0.0003 was found. This small p-value indicates that within the rock climber group, at least
one of the volunteers had a different mean for the pinch grip. The ANOVA test for the non-
rock climbers and the pinch grip resulted in a p-value of 0. Based on this p-value, at least
one volunteer in the non-rock climber group had a different mean.

Based on the ANOVA tests run on the crimp and pinch grips, there were many differences
in the mean grip strength values of the volunteers. This indicates that most of the volunteers
had a different grip strength from each other for both the crimp and pinch grips.

EMG Data – Fatigue Analysis

The total time subjects where on the climbing wall holding the crimp grip position is
recorded in Table 3. The calculated midpoint for each subject was calculated and is also
included in Table 3. These time points were used to select raw EMG data for the use in
Power Spectrums seen in Figures 8 and 9.

The time on the wall varied from subject to subject. It is seen that the climber group held
on for longer periods than the non-climber test group with an average time held of 151.67
seconds, while the average non-climber time held was 64.33 seconds. The longest time
held was 240 seconds by subject number 2 in the climber group and the shortest time held
was 35 seconds by subject 6 in the non-climber group.

Table 3. Time of data collection for each subject, the calculated amount of time
held and the calculated midpoint.
Test Subject Start (s) End (s) Time Held (s) Midpoint (s)
1 20 195 175 87.5
2 25 240 215 107.5
3 20 85 65 32.5
Climber Average - - 151.67 -
4 22 115 93 46.5
5 30 95 65 32.5
6 20 55 35 17.5
Non-Climber Average - - 64.33 -

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Muscle Fatigue Index - Data

Figure 8. Power spectrum of the climber subjects at the beginning, midpoint, and end of the data collection period.
Figure 8 shows the data after a power vs. frequency analysis of five second intervals for
the climber subject group. The red trendline on the spectrum emphasizes the power shift
of the subjects as the data collection progressed. The general trend is a shift to lower
frequency as the subjects hold on to the wall. This shift indicates that the test subjects were
starting to experience muscle fatigue. These plots were used to estimate the approximate
maximum frequency of each subject at each time point and this data is seen in Table 4.

Figure 9. Power spectrum of the non-climber subjects at the beginning, midpoint, and end of the data collection
period.

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BENG 3000 Bioinstrumentation Final Project

The power vs. frequency analysis of five second intervals for the non-climber group of test
subjects is seen in Figure 9. The trendlines indicate that there was only a slight shift in the
power spectrum as the subjects held onto the wall. This lack of shift when compared to the
climber subject group indicates the non-climbers do not experience muscle fatigue during
the time they are holding onto the wall. The plots were also used to estimate the
approximate maximum frequency that is recorded in Table 4.

Table 4. Approximate max frequency of all participants.

Approximate Maximum Frequency (Hz)
Test Subject Beginning Midpoint End
1 36 22 16
2 40 36 31
3 38 32 21
Climbers (Average) 38 30 22.67
4 44 36 29
5 36 40 38
6 40 38 34
Non-Climbers (Average) 40 38 33.67

The values in Table 4 were approximated from the curves found from the power spectrum
analysis in Figures 8 and 9. The trend shown by the data suggests that the maximum
frequency of the climber test group drops lower than the non-climber test group.

Both groups start with similar beginning maximum frequencies around 38-40 Hz. The
climber subject group drops to an average of 22.67 Hz by the end of data collection while
the non-climber subject group only drops to an average of 33 Hz by the end of data
collection. These values were visualized by creating the muscle fatigue index found in
Figures 10 and 11.

Figure 10.8 Muscle fatigue index of all participants beginning, middle, and end measurements.

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BENG 3000 Bioinstrumentation Final Project

Figure 11. Combined muscle fatigue index of all participants beginning, middle, and end measurements.

Figures 10 and 11 are a visualization of the fatigue experienced by the subjects in the form
of a Muscle Fatigue Index. These plots indicate the approximate maximum frequencies are
decreasing for all subjects with the greater decrease occurring in the climber group. This
data indicates the more experienced climbers experienced more muscle fatigue than the
non-climber subjects. While this trend could seem to oppose the hypothesis, it does support
the hypothesis when central drive is considered. The more experienced climbers will have
more central drive than the non-climber group since they already know what climbing
fatigue will feel like for them. This data indicates that climbers are more likely to hold on
longer and create a deeper level of fatigue in their muscles at the neuromuscular or the
peripheral level [8]. On the other hand, non-climbers do not hold on to the wall long enough
to experience this type of fatigue.

Conclusion

In this project, we used a dynamometer to measure the grip strengths of climbers vs. non-
climbers for two different types of rock-climbing grips: the pinch and the crimp.
Additionally, we recorded the muscle activation of each participant using an EMG while
they held their body weight on the wall using a crimp grip with both hands. The subjects
held this crimp grip for as long as they could stay on the wall, and EMG signals were
recorded for this duration of time for each subject.

The p-values from the ANOVA test of the dynamometer data approached zero, which
indicated the volunteers had different mean grip strengths. Our dynamometer data showed
that climbers overall had a higher pinch grip strength, whereas non-climbers had a higher
crimp grip strength. This is not consistent with our expected outcome. We expected that
climbers would have better grip strength for both types of grips. This irregularity could
possibly be due to our small sample size. Repeating this experiment with a larger sample
size may be useful in the future to see if different results are recorded. Our data could also
have been skewed by inconsistent verbal encouragement from group members while
recording the dynamometer data.

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For the EMG research performed on the rock-climbing wall, we found that the climbers
stayed on the wall for significantly longer than non-climbers. In general, climbers stayed
on the wall for 2-3 minutes, whereas non-climbers stayed on the wall for 1-2 minutes.
However, the EMG data analysis showed the climbers’ muscles fatigued, whereas the non-
climbers' muscles did not fatigue. This was evidenced by the shift from larger to smaller
frequencies from the beginning to end of the climber EMG data sets.

Based on these observations, we concluded that climbers were able to stay on the wall even
after their muscles fatigued, whereas non-climbers fell off the wall before muscle fatigue
was reached. Fatigue can be mental (perceptual) or physical. Muscle fatigue can originate
at different levels of the motor pathway and is usually divided into central and peripheral
components. Peripheral fatigue is produced by changes at or distal to the neuromuscular
junction [8].

From our data, we saw that climbers were able to get deeper into the peripheral zone of
muscle fatigue while still being able to stay on the wall. This was likely because climbers
regularly practice holding onto the wall past initial muscle fatigue. Therefore, climbers
were more physically and mentally capable of overcoming a loss of central drive, which
allowed them to sustain a grip force strong enough to stay on the wall past the point of
muscle fatigue.

Possible sources of error during the EMG data collection include movement of the subjects
while climbing on the wall. Attempts to minimize the movement of subjects while on the
wall were made, however it is likely this noise played a role in producing error.
Additionally, noise in the data was accounted for during the period when climbers were
getting on and off the wall by excluding data recorded during wall mounting and
dismounting.

Although the dynamometer data showed no clear positive correlation between climbing
experience level and raw grip force, the EMG data showed that people who climb regularly
were more capable of staying on the wall once muscle fatigue was reached. Therefore, we
conclude that climbing performance is more directly related to a climber’s stamina and
experience level than to their raw grip force strength.

Through this project, the team gained an in-depth understanding of the process behind
muscle activation and fatigue. By applying the use of dynamometer and EMG, the team
gained a deeper understanding of both the instruments used in this research. The team also
learned how to select appropriate statistical testing of the data collected. The fatigue
analysis and ANOVA testing allowed the team to see the relevant applications of the data
and to use software such as LabChart in a way more commonly used by industry
professionals. Learning to select a hypothesis, method of testing, and method of analysis
allowed for problem solving and research skills to be tested and built, creating more
effective and efficient biological engineers.

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Team Member Contributions

Alisa Christensen
Alisa participated in the data collection for both the dynamometer and the EMG testing.
She also helped determine the electrode location to be used during EMG testing.
Additionally, Alisa attended the progress meeting and aided in the statistical analysis
conducted on the dynamometer data using a T-test. Alisa also wrote the conclusion portion
of this document and the presentation.

Mylie Christensen
Mylie aided in the communication of the original project idea to Professor Zhou and the
project proposal. Mylie also helped determine methods of testing and participated in both
dynamometer and EMG data collection. During the literature review, Mylie helped
determine the placement of the electrodes during the MEG testing. Additionally, she
conducted the dynamometer ANOVA testing, and wrote both the dynamometer methods
section and results section. She also helped in the writing and editing of the project progress
summary and attended the progress meeting.

Emily Hanson
Emily participated in both the formulation of the rock-climbing comparison idea, and the
emailing of TA’s and the professor to make sure the idea was feasible. Emily also
participated in the data collection of the dynamometer data and EMG data. She repeatedly
communicated with the TAs to ensure the project could continue as planned. During the
EMG data collection, Emily took photos to document the process. Additionally, Emily
wrote the project proposal, project summary, introduction, project flow diagram, and team
member contributions. She also attended the progress meeting.

Kristine Peterson
Kristine participated in the brainstorming of the original ideas and came up with the rock-
climbing comparison idea. She also helped communicate with TAs throughout the project
to ensure proper progress. Additionally, Kristine called ADInstruments to acquire a
LabChart software license for her laptop, allowing the project to be conducted at the USU
rock wall. She then participated in the data collection for both the dynamometer and the
EMG and attended the progress meeting. Kristine also helped determine the location of the
electrodes during the EMG recording. She also conducted the fatigue analysis on the raw
EMG data, wrote the EMG portion of the methods sections, and contributed to the fatigue
results section.

Acknowledgements

Thank you to the volunteers who participated in this experiment. Thank you to Emily
Brothersen and Claudine Mock for direction during statistical analysis of the data and
support during EMG testing. Thank you to Anhong Zhou for his enthusiastic guidance
throughout this project.

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References

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Methods for Strength and Endurance Training in Rock Climbing. Medicina
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2. Reaz MBI, Hussain MS, Mohd-Yasin F. Techniques of EMG signal analysis:

detection, processing, classification, and applications. Biological Procedures
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3. Electromyography (EMG). Johns Hopkins Medicine. 2021.

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4. Van Galen GP, Müller MLTM, Meulenbroek RGJ, Van Gemmert AWA. Forearm
EMG response activity during motor performance in individuals prone to
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5. Types of Climbing Holds and How to Hold Them. Gubbies. 2018.

https://www.gubbies.com/blog/climbing-holds.

6. ANOVA Calculator: One-Way Analysis of Variance Calculator. Good

Calculators. https://goodcalculators.com/one-way-anova-calculator/ [Accessed
April 22, 2023].

7. Brenner B., Eisenberg E. The mechanism of muscle contraction. Biochemical,

mechanical, and structural approaches to elucidate cross-bridge action in muscle.
Basic Res Cardiol. 1987. 2:3-16.

8. Gruet M., Temesi J., Rupp T., Levy P., Millet GY, Verges S. Stimulation of the
motor cortex and corticospinal tract to assess human muscle fatigue.
Neuroscience. 2013. 231:384–99.

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