Evaluating the use of electromyography in UK and european gait laboratories for the assessment of cerebral palsy and neurological conditions

Shepherd, Hannah; Reeves, Jo; Stewart, Caroline

Abstract

Introduction
Electromyography (EMG) can estimate the magnitude and timing of muscle activation during walking in those with neurological gait disorders. Despite the potential of EMG use in assessment and clinical decision-making, some report declining use of EMG within gait laboratories, with data only recorded when specifically requested or in special circumstances (Shortland, 2013, p. 71-72). Technical and educational barriers to EMG usage in clinics in Italy were recently reported (Cappellini et al., 2020).

Research question
What are the current EMG practices across CMAS and ESMAC gait laboratories and what is the associated knowledge, beliefs and barriers to using EMG?

Methods
Semi-structured interviews were conducted online with 10 participants from three ESMAC/GAMMA gait laboratories and five CMAS accredited gait laboratories (including two labs not routinely using EMG). Participants held various professions: three physiotherapists, five clinical scientists, one lab manager and one biomedical engineer. Interviews were transcribed and analysed using reflexive thematic analysis.

Results
EMG training was often completed in-house informally by colleagues. Preliminary findings show EMG was considered useful for assessing muscle activation timings, spasticity and co-contraction in patients with neurological gait disorders. Challenges of using EMG included: justifying the effort, distinguishing true deviations from the norm, capacity to collect good quality data and feasibility with a given patient.
In the labs not currently using EMG the biggest barrier was justifying the time required to collect and process EMG data considering a lack of evidence that EMG supports decision-making: “What difference does it really make?” In labs using EMG, it was a confirmatory tool and its decision-making contribution varied from “definitely” to “that’s a big question actually”. The CMAS requirement to have normative data from one’s own lab was another barrier to implementing EMG. However, one lab in Germany used EMG “almost all the time” and compared to normative data from textbooks and manufacturers.
Feasibility related to patient readiness such as “limited attention span” and other practicalities such as affixing sensors: “when kids are too small, we just don't have enough space for everything on the skin”. Conversely, this wasn’t considered a barrier in the lab not using EMG: “you're sticking another interesting measurement device thing on me, that, that's cool”.

Discussion
The challenge of interpreting EMG signals and time requirements were consistent between the UK and Germany reflecting previous reports from Italy (Cappellini et al. 2020). In contrast to previous findings, cost was not considered important, unlike patient readiness. The need for one’s own age-matched normative database is essential in the UK, while currently not required in Germany. For EMG to be more widely and routinely used, the perceived effort of staff and patients would need to be justified by a clear link to the treatment planning and decision-making through further published evidence and training.

Citation

Shepherd, H., Reeves, J., & Stewart, C. (in press). Evaluating the use of electromyography in UK and european gait laboratories for the assessment of cerebral palsy and neurological conditions. Gait & Posture, 106(S1), S170. https://doi.org/10.1016/j.gaitpost.2023.07.205

• Journal Article Type: Conference Paper
• Conference Name: ESMAC 2023
• Acceptance Date: Sep 13, 2023
• Online Publication Date: Sep 13, 2023
• Deposit Date: Oct 4, 2023
• Journal: Gait & Posture
• Print ISSN: 0966-6362
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 106
• Issue: S1
• Pages: S170
• DOI: https://doi.org/10.1016/j.gaitpost.2023.07.205