Development of an EMG-Based Muscle Health Model for Elbow Trauma Patients

Wearable robotic braces have the potential to improve rehabilitative therapies for patients suffering from musculoskeletal (MSK) conditions. Ideally, a quantitative assessment of health would be incorporated into rehabilitative devices to monitor patient recovery. The purpose of this work is to develop a model to distinguish between the healthy and injured arms of elbow trauma patients based on electromyography (EMG) data. Surface EMG recordings were collected from the healthy and injured limbs of 30 elbow trauma patients while performing 10 upper-limb motions. Forty-two features and five feature sets were extracted from the data. Feature selection was performed to improve the class separation and to reduce the computational complexity of the feature sets. The following classifiers were tested: linear discriminant analysis (LDA), support vector machine (SVM), and random forest (RF). The classifiers were used to distinguish between two levels of health: healthy and injured (50% baseline accuracy rate). Maximum fractal length (MFL), myopulse percentage rate (MYOP), power spectrum ratio (PSR) and spike shape analysis features were identified as the best features for classifying elbow muscle health. A majority vote of the LDA classification models provided a cross-validation accuracy of 82.1%. The work described in this paper indicates that it is possible to discern between healthy and injured limbs of patients with MSK elbow injuries. Further assessment and optimization could improve the consistency and accuracy of the classification models. This work is the first of its kind to identify EMG metrics for muscle health assessment by wearable rehabilitative devices.

[1]  D. Ring,et al.  Traumatic elbow instability. , 2010, The Journal of hand surgery.

[2]  J. D. Van Putten,et al.  EMG onset determination using a maximum likelihood method , 1999 .

[3]  Donald W. Bouldin,et al.  A Cluster Separation Measure , 1979, IEEE Transactions on Pattern Analysis and Machine Intelligence.

[4]  Daniela M. Witten,et al.  An Introduction to Statistical Learning: with Applications in R , 2013 .

[5]  Hong Liu,et al.  A Novel EMG Motion Pattern Classifier Based on Wavelet Transform and Nonlinearity Analysis Method , 2006, 2006 IEEE International Conference on Robotics and Biomimetics.

[6]  Angkoon Phinyomark,et al.  EMG feature evaluation for improving myoelectric pattern recognition robustness , 2013, Expert Syst. Appl..

[7]  Linking of the Patient Rated Elbow Evaluation (PREE) and the American Shoulder and Elbow Surgeons - Elbow questionnaire (pASES-e) to the International Classification of Functioning Disability and Health (ICF) and Hand Core Sets. , 2015, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[8]  A. Weiland The Elbow and its Disorders. 3rd ed. , 2001 .

[9]  A. Lovy,et al.  Stiff Elbow. , 2017, American journal of orthopedics.

[10]  Martin J. McKeown,et al.  A Hidden Markov, Multivariate Autoregressive (HMM-mAR) Network Framework for Analysis of Surface EMG (sEMG) Data , 2008, IEEE Transactions on Signal Processing.

[11]  C. D. Bryce,et al.  Anatomy and biomechanics of the elbow. , 2008, The Orthopedic clinics of North America.

[12]  Ana Luisa Trejos,et al.  A wearable mechatronic brace for arm rehabilitation , 2014, 5th IEEE RAS/EMBS International Conference on Biomedical Robotics and Biomechatronics.

[13]  D.J. Reinkensmeyer,et al.  Automating Arm Movement Training Following Severe Stroke: Functional Exercises With Quantitative Feedback in a Gravity-Reduced Environment , 2006, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[14]  Arto Visala,et al.  urrent state of digital signal processing in myoelectric interfaces and elated applications , 2015 .

[15]  Gary Kamen,et al.  Essentials of Electromyography , 2009 .

[16]  Ruth Urner,et al.  Generative Multiple-Instance Learning Models For Quantitative Electromyography , 2013, UAI.

[17]  Jamileh Yousefi,et al.  Characterizing EMG data using machine-learning tools , 2014, Comput. Biol. Medicine.

[18]  Sijiang Du,et al.  Temporal vs. spectral approach to feature extraction from prehensile EMG signals , 2004, Proceedings of the 2004 IEEE International Conference on Information Reuse and Integration, 2004. IRI 2004..

[19]  Ana Luisa Trejos,et al.  Postoperative healing patterns in elbow using electromyography: Towards the development of a wearable mechatronic elbow brace , 2017, 2017 International Conference on Rehabilitation Robotics (ICORR).

[20]  B. Freriks,et al.  Development of recommendations for SEMG sensors and sensor placement procedures. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[21]  C.J. De Luca,et al.  A Combined sEMG and Accelerometer System for Monitoring Functional Activity in Stroke , 2009, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[22]  G. Bettelli,et al.  Elbow rehabilitation in traumatic pathology , 2014, MUSCULOSKELETAL SURGERY.

[23]  Grant D. Huang,et al.  Robot-assisted therapy for long-term upper-limb impairment after stroke. , 2010, The New England journal of medicine.

[24]  A. Burden How should we normalize electromyograms obtained from healthy participants? What we have learned from over 25 years of research. , 2010, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[25]  Juvenal Rodriguez-Resendiz,et al.  A Study of Movement Classification of the Lower Limb Based on up to 4-EMG Channels , 2019, Electronics.

[26]  Radzi Bin Ambar,et al.  Multi-sensor arm rehabilitation monitoring device , 2012, 2012 International Conference on Biomedical Engineering (ICoBE).

[27]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[28]  Abdulhamit Subasi,et al.  Muscle Fatigue Detection in EMG Using Time–Frequency Methods, ICA and Neural Networks , 2009, Journal of Medical Systems.

[29]  Shyamal Patel,et al.  Tracking motor recovery in stroke survivors undergoing rehabilitation using wearable technology , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[30]  Maciej Krawczyk,et al.  Timing of electromyographic activity and ranges of motion during simple motor tasks of upper extremities , 2017 .

[31]  Ganesh R. Naik,et al.  Principal Component Analysis Applied to Surface Electromyography: A Comprehensive Review , 2016, IEEE Access.

[32]  Experimental Anatomy,et al.  Electromyography in sports and occupational settings : an update of its limits and possibilities , 2007 .

[33]  Xu Zhang,et al.  Wavelet transform theory and its application in EMG signal processing , 2010, 2010 Seventh International Conference on Fuzzy Systems and Knowledge Discovery.

[34]  T. Hortobágyi,et al.  Teager–Kaiser energy operator signal conditioning improves EMG onset detection , 2010, European Journal of Applied Physiology.

[35]  Mamun Bin Ibne Reaz,et al.  Surface Electromyography Signal Processing and Classification Techniques , 2013, Sensors.

[36]  M. Knaflitz,et al.  A statistical method for the measurement of muscle activation intervals from surface myoelectric signal during gait , 1998, IEEE Transactions on Biomedical Engineering.

[37]  Abdulhamit Subasi,et al.  Classification of EMG signals using PSO optimized SVM for diagnosis of neuromuscular disorders , 2013, Comput. Biol. Medicine.

[38]  Egon L. van den Broek,et al.  Computing Emotion Awareness Through Facial Electromyography , 2006, ECCV Workshop on HCI.

[39]  Agnes Roby-Brami,et al.  Upper-Limb Robotic Exoskeletons for Neurorehabilitation: A Review on Control Strategies , 2016, IEEE Reviews in Biomedical Engineering.

[40]  B. Gabbe,et al.  Outcome instruments for the assessment of the upper extremity following trauma: a review. , 2005, Injury.

[41]  Pornchai Phukpattaranont,et al.  A Novel Feature Extraction for Robust EMG Pattern Recognition , 2009, ArXiv.

[42]  Bruce C. Wheeler,et al.  EMG feature evaluation for movement control of upper extremity prostheses , 1995 .

[43]  R. Goitz,et al.  Elbow arthroscopy: surgical techniques and rehabilitation. , 2006, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[44]  Huosheng Hu,et al.  Support Vector Machine-Based Classification Scheme for Myoelectric Control Applied to Upper Limb , 2008, IEEE Transactions on Biomedical Engineering.

[45]  Raneem Haddara Elbow Patients’ Data Collection and Analysis: An Examination of Electromyography Healing Patterns , 2016 .

[46]  Alicja Rutkowska-Kucharska,et al.  Two stage EMG onset detection method , 2012 .

[47]  Guido Bugmann,et al.  A note on the probability distribution function of the surface electromyogram signal☆ , 2013, Brain Research Bulletin.

[48]  D. Dumitru,et al.  Physiologic basis of potentials recorded in electromyography , 2000, Muscle & nerve.

[49]  S. Steinmann,et al.  Immediate Active Range of Motion after Modified 2-Incision Repair in Acute Distal Biceps Tendon Rupture , 2009, The American journal of sports medicine.

[50]  Marko Robnik-Sikonja,et al.  Overcoming the Myopia of Inductive Learning Algorithms with RELIEFF , 2004, Applied Intelligence.

[51]  Roberto Merletti,et al.  Basic Physiology and Biophysics of EMG Signal Generation , 2004 .

[52]  Mustafa Yilmaz,et al.  Comparison of AR parametric methods with subspace-based methods for EMG signal classification using stand-alone and merged neural network models , 2016 .

[53]  Shyamal Patel,et al.  A Novel Approach to Monitor Rehabilitation Outcomes in Stroke Survivors Using Wearable Technology , 2010, Proceedings of the IEEE.

[54]  Firas AlOmari,et al.  Analysis of Extracted Forearm sEMG Signal Using LDA, QDA, K-NN Classification Algorithms , 2014 .

[55]  Ranjan Gupta,et al.  Anatomy and Biomechanics of the Elbow Joint , 2003, Techniques in hand & upper extremity surgery.

[56]  S. Backus,et al.  Electromyographic activity in stiff and normal elbows during elbow flexion and extension. , 2003, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[57]  Dario Farina,et al.  A fast and reliable technique for muscle activity detection from surface EMG signals , 2003, IEEE Transactions on Biomedical Engineering.

[58]  Adrian D. C. Chan,et al.  Myoelectric Control Development Toolbox , 2007 .

[59]  Blair A. Lock,et al.  Determining the Optimal Window Length for Pattern Recognition-Based Myoelectric Control: Balancing the Competing Effects of Classification Error and Controller Delay , 2011, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[60]  Sylvia A Dávila,et al.  Managing the stiff elbow: operative, nonoperative, and postoperative techniques. , 2006, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[61]  Robert L Sainburg,et al.  Handedness: dominant arm advantages in control of limb dynamics. , 2002, Journal of neurophysiology.

[62]  F. Blyth,et al.  Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the Global Burden of Disease 2010 Study and the next steps forward , 2014, Annals of the rheumatic diseases.

[63]  Silvestro Micera,et al.  Evaluation of a New Exoskeleton for Upper Limb Post-stroke Neuro-rehabilitation: Preliminary Results , 2014 .

[64]  Position Stand American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. , 2009, Medicine and science in sports and exercise.

[65]  Hyeon-Min Shim,et al.  Multi-channel electromyography pattern classification using deep belief networks for enhanced user experience , 2015, Journal of Central South University.

[66]  R. Merletti,et al.  Spatial Aliasing and EMG Amplitude in Time and Space: Simulated Action Potential Maps , 2014 .

[67]  Y. Benjamini,et al.  Controlling the false discovery rate: a practical and powerful approach to multiple testing , 1995 .

[68]  S. Leonhardt,et al.  A survey on robotic devices for upper limb rehabilitation , 2014, Journal of NeuroEngineering and Rehabilitation.

[69]  Robert Riener,et al.  ARMin III --arm therapy exoskeleton with an ergonomic shoulder actuation , 2009 .

[70]  A. Chan,et al.  Surface Electromyographic Signals Using Dry Electrodes , 2010, IEEE Transactions on Instrumentation and Measurement.

[71]  Erik Scheme,et al.  Electromyogram pattern recognition for control of powered upper-limb prostheses: state of the art and challenges for clinical use. , 2011, Journal of rehabilitation research and development.

[72]  David A. Gabriel,et al.  Analysis of surface EMG spike shape across different levels of isometric force , 2007, Journal of Neuroscience Methods.

[73]  E. Rogers,et al.  Shoulder and elbow muscle activity during fully supported trajectory tracking in neurologically intact older people. , 2009, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[74]  Sunil Kumar Agrawal,et al.  Design of a Cable-Driven Arm Exoskeleton (CAREX) for Neural Rehabilitation , 2012, IEEE Transactions on Robotics.

[75]  Huosheng Hu,et al.  Myoelectric control systems - A survey , 2007, Biomed. Signal Process. Control..

[76]  S Micera,et al.  A hybrid approach to EMG pattern analysis for classification of arm movements using statistical and fuzzy techniques. , 1999, Medical engineering & physics.

[77]  Chi-Woong Mun,et al.  Comparison of k-nearest neighbor, quadratic discriminant and linear discriminant analysis in classification of electromyogram signals based on the wrist-motion directions , 2011 .

[78]  M. Bergamasco,et al.  Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke , 2012, Journal of NeuroEngineering and Rehabilitation.

[79]  Gbd Disease and Injury Incidence and Prevalence Collab Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017 .

[80]  Chris B Del Mar,et al.  Resting injured limbs delays recovery: a systematic review. , 2004, The Journal of family practice.

[81]  Todd A. Kuiken,et al.  Improving Myoelectric Pattern Recognition Robustness to Electrode Shift by Changing Interelectrode Distance and Electrode Configuration , 2012, IEEE Transactions on Biomedical Engineering.

[82]  D. Gabriel,et al.  Differences in EMG spike shape between individuals with and without non-specific arm pain , 2009, Journal of Neuroscience Methods.

[83]  J. Macdermid,et al.  A Survey of Practice Patterns for Rehabilitation Post Elbow Fracture , 2012, The open orthopaedics journal.

[84]  François Hug,et al.  Can muscle coordination be precisely studied by surface electromyography? , 2011, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[85]  Elizabeth A. OBrien Adherence to Therapeutic Splint Wear in Adults With Acute Upper Limb Injuries: A Systematic Review , 2010 .

[86]  Nancy Byl,et al.  Robotic unilateral and bilateral upper-limb movement training for stroke survivors afflicted by chronic hemiparesis , 2013, 2013 IEEE 13th International Conference on Rehabilitation Robotics (ICORR).

[87]  Roberto Merletti,et al.  Advances in surface EMG: recent progress in detection and processing techniques. , 2010, Critical reviews in biomedical engineering.

[88]  Jiping He,et al.  RUPERT: An exoskeleton robot for assisting rehabilitation of arm functions , 2008, 2008 Virtual Rehabilitation.

[89]  R.N. Scott,et al.  A new strategy for multifunction myoelectric control , 1993, IEEE Transactions on Biomedical Engineering.

[90]  Hyung-Soon Park,et al.  Developing a Multi-Joint Upper Limb Exoskeleton Robot for Diagnosis, Therapy, and Outcome Evaluation in Neurorehabilitation , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[91]  Jean-Yves Hogrel,et al.  Clinical applications of surface electromyography in neuromuscular disorders , 2005, Neurophysiologie Clinique/Clinical Neurophysiology.

[92]  A. Youderian,et al.  Surgical Management of Acute Distal Biceps Tendon Ruptures. , 2017, The Journal of bone and joint surgery. American volume.

[93]  Pornchai Phukpattaranont,et al.  Fractal analysis features for weak and single-channel upper-limb EMG signals , 2012, Expert Syst. Appl..

[94]  D. A. Schwartz Static progressive orthoses for the upper extremity: a comprehensive literature review , 2012, Hand.

[95]  V. Dietz,et al.  Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial , 2014, The Lancet Neurology.

[96]  Pornchai Phukpattaranont,et al.  Feature reduction and selection for EMG signal classification , 2012, Expert Syst. Appl..

[97]  I. Stasinopoulos,et al.  Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy , 2009, British Journal of Sports Medicine.

[98]  Roberto Merletti,et al.  Technology and instrumentation for detection and conditioning of the surface electromyographic signal: state of the art. , 2009, Clinical biomechanics.

[99]  S M Pincus,et al.  Approximate entropy as a measure of system complexity. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[100]  R. Rotini,et al.  Mobilization brace in post-traumatic elbow stiffness , 2010, Musculoskeletal surgery.

[101]  Nurhazimah Nazmi,et al.  A Review of Classification Techniques of EMG Signals during Isotonic and Isometric Contractions , 2016, Sensors.

[102]  Ping Zhou,et al.  Sample entropy analysis of surface EMG for improved muscle activity onset detection against spurious background spikes. , 2012, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[103]  J. Richman,et al.  Sample entropy. , 2004, Methods in enzymology.

[104]  Kevin B. Englehart,et al.  A robust, real-time control scheme for multifunction myoelectric control , 2003, IEEE Transactions on Biomedical Engineering.

[105]  Radford M. Neal Pattern Recognition and Machine Learning , 2007, Technometrics.

[106]  Carlos Robles-Algarín,et al.  Implementation of a Portable Electromyographic Prototype for the Detection of Muscle Fatigue , 2019, Electronics.

[107]  Takeshi Sakurada,et al.  A BMI-based occupational therapy assist suit: asynchronous control by SSVEP , 2013, Front. Neurosci..

[108]  Valerie Hill,et al.  Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial , 2013, Clinical rehabilitation.

[109]  K. Englehart,et al.  Resolving the Limb Position Effect in Myoelectric Pattern Recognition , 2011, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[110]  Mohammad Hassan Moradi,et al.  Evaluation of the forearm EMG signal features for the control of a prosthetic hand. , 2003, Physiological measurement.

[111]  M. Dimatteo,et al.  The challenge of patient adherence , 2005, Therapeutics and clinical risk management.

[112]  K. Englehart,et al.  Determination of optimum threshold values for EMG time domain features; a multi-dataset investigation. , 2016, Journal of neural engineering.

[113]  Gang Wang,et al.  Classification of surface EMG signals using optimal wavelet packet method based on Davies-Bouldin criterion , 2006, Medical and Biological Engineering and Computing.

[114]  S. Chinchalkar,et al.  Rehabilitation of elbow trauma. , 2004, Hand clinics.

[115]  L. Pignolo,et al.  Upper limb rehabilitation after stroke: ARAMIS a “robo-mechatronic” innovative approach and prototype , 2012, 2012 4th IEEE RAS & EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob).

[116]  Lauri Bishop,et al.  Three upper limb robotic devices for stroke rehabilitation: a review and clinical perspective. , 2013, NeuroRehabilitation.

[117]  H. Nazeran,et al.  Reducing power line interference in digitised electromyogram recordings by spectrum interpolation , 2004, Medical and Biological Engineering and Computing.

[118]  P H Chappell,et al.  Shoulder and elbow muscle activity during fully supported trajectory tracking in people who have had a stroke. , 2010, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[119]  Chusak Limsakul,et al.  Feature Extraction and Reduction of Wavelet Transform Coefficients for EMG Pattern Classification , 2012 .

[120]  G. Bain,et al.  Brachialis muscle anatomy. A study in cadavers. , 2007, The Journal of bone and joint surgery. American volume.

[121]  R Willms,et al.  Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population , 2011, Spinal Cord.

[122]  G. Morel,et al.  Constraining Upper Limb Synergies of Hemiparetic Patients Using a Robotic Exoskeleton in the Perspective of Neuro-Rehabilitation , 2012, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[123]  H. Gutiérrez-Espinoza,et al.  Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single‐blind randomized clinical study , 2017, Journal of hand therapy : official journal of the American Society of Hand Therapists.