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Abstract
Introduction
Protocol
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Neuroscience

神经肌肉功能的应用经皮神经电刺激评估

Published: September 13, 2015
doi:
10.3791/52974
, , ,
1INSERM U1093, Faculty of Sport Sciences,Univ. Bourgogne Franche–Comté, 2Neural Control of Movement Laboratory, School of Medicine, Faculty of Science, Medicine and Health,University of Wollongong

Summary

We present a protocol to assess changes in neuromuscular function. Percutaneous electrical nerve stimulation is a non-invasive method that evokes muscular responses. Electrophysiological and mechanical properties of these responses permit the evaluation of neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels).

Abstract

Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels). The present protocol describes how this method can be used to stimulate the posterior tibial nerve that activates plantar flexor muscles. Percutaneous electrical nerve stimulation consists of inducing an electrical stimulus to a motor nerve to evoke a muscular response. Direct (M-wave) and/or indirect (H-reflex) electrophysiological responses can be recorded at rest using surface electromyography. Mechanical (twitch torque) responses can be quantified with a force/torque ergometer. M-wave and twitch torque reflect neuromuscular transmission and excitation-contraction coupling, whereas H-reflex provides an index of spinal excitability. EMG activity and mechanical (superimposed twitch) responses can also be recorded during maximal voluntary contractions to evaluate voluntary activation level. Percutaneous nerve stimulation provides an assessment of neuromuscular function in humans, and is highly beneficial especially for studies evaluating neuromuscular plasticity following acute (fatigue) or chronic (training/detraining) exercise.

Introduction

经皮神经电刺激被广泛用于评估神经肌肉功能1。其基本原理是感应电刺激到周围运动神经唤起肌肉收缩。机械（扭矩测量）和电生理（肌电活动）响应，同时记录。扭矩，记录在考虑联合，用测力计进行评估。采用表面电极记录的肌电（EMG）信号已被证明代表肌肉2的活性。这种非侵入性方法是不痛，更容易比肌内录音实现。两个单极和双极电极都可以使用。单极电极结构已被证明是变化的肌肉活动3，其可以为小肌肉是有用的更敏感。然而，双极性电极已被证明是更有效地改善了信号 – 噪音r加信息4和是最常用的作为记录和量化运动单位活性的方法。下面描述的方法将集中于双极记录。 EMG活动是神经肌肉系统的有效性和完整性的指标。使用经皮神经电刺激的提供进一步深入了解神经肌肉功能，在肌肉，脊柱，或超脊髓水平（图1），即改变。

图1
图1：神经肌肉测量概述 STIM：神经刺激。肌电图检查：肌电图。 VAL：自愿激活水平。 RMS：均方根。 m最大：最大M-波幅。

静止时，复合肌肉动作电位，也称为M-波，是刺激假象后观察到的短潜伏期反应，并表示可激发的肌肉质量的直接ACTIV通货膨胀运动轴突导致肌肉（图2，3号）的。 M-波振幅增大与强度，直到达到其最大价值的平台。这种反应，称为M max时，表示表面肌电电极 5下记录，所有马达单元和/或肌纤维动作电位的同步求和。的峰-峰幅值或波区域的进化用于识别神经肌肉传导6的改动。变化中，与M-波， 即峰值抽搐转矩/力，相关联的机械响应可能是由于肌肉兴奋和/或内的肌纤维7的改变。 m最大振幅和峰抽搐扭矩幅值（铂/ M比）的协会提供的肌肉8机电效率， 即对于给定的电动机命令机械响应的索引。

52974 / 52974fig2.jpg“/>
图2：电机和神经刺激激活反身途径的混合（电机/感觉）神经（STIM）的电刺激诱 ​​导两个运动轴突和Ia传入射击的去极化。 1a的去极化传入朝脊髓激活的α-运动神经元，这反过来又唤起一个H-反射反应（途径1 + 2 + 3）。根据不同的刺激强度，运动轴突去极化唤起了直接的肌肉反应：M波（途径3）。以最大的M-波强度，一个逆向电流也产生（3'）和碰撞与反射凌空（2）。这个碰撞部分或完全取消H反射响应。

该H-反射是用来评估变化IA-α运动神经元突触9的电生理学反应。此参数可以在休息或在自主收缩进行评估。 H反射表示牵张反射的变体（ 图2，γMBER 1-3）。该H-反射激活马达单元由IA传入神经 ​​通路10,11 monosynaptically招募，并且可以进行外周和中枢的影响12。唤起H反射的方法是已知的具有高的被检体内的可靠性在休息13,14和期间等长收缩15，以评估脊髓兴奋性。

在一个自主收缩，自愿神经驱动器的大小可以用肌电信号的幅度进行评估，使用均方根通常量化（RMS）。 RMS 肌电图是常用期间自主收缩力（图1）量化电机系统的激励的水平的手段。由于区域内和跨学科的变异16，RMS 肌电必须使用过程中肌肉特异性最大自主收缩（RMS EMGmax）录制的肌电图进行归一化。此外，由于改变肌电信号可能bë由于使用外围参数在周边电，正常化的改变如M波是必需的，以评估肌电信号的只有中央部分。这可以通过将RMS 肌电由最大振幅或M波的RMS M最大来完成。使用RMS M最大正常化（ 即 RMS 肌电图 / RMS M最大 ）是首选的方法，因为它考虑到了M-波持续时间17的可能变化。

马达命令也可以通过计算自愿激活电平（VAL）来评价。该方法通过在一个最大随意收缩叠加在m最大强度的电刺激使用抽搐插值技术18。额外的扭矩诱发刺激神经 ​​相比，由相同的神经刺激，在轻松增效肌肉19产生的控制抽搐。为了评估最大VAL，原来抽搐interpo由默顿18描述LATION技术涉及到一个单一的刺激插在一个自主收缩。近来，采用成对的刺激已经变得越来越流行，因为相比于单一刺激反应20诱发扭矩增量更大，更容易检测出来，变化较少。 VAL子提供对中枢神经系统，以最大程度地激活工作肌肉21的容量的指标。目前，VAL评价使用抽搐插技术是评估肌肉激活22的水平的最有价值的方法。此外，使用一个测力计评估峰值扭矩是适用于研究和临床设置23使用的最适当的研究强度测试参数。

神经电刺激可以以各种肌肉群（如肘屈肌，腕屈肌，膝伸肌，跖屈肌）的使用。然而，神经访问使技术很难在某些肌肉群。跖屈肌肉，尤其小腿三头（比目鱼肌和gastrocnemii）肌肉，经常研究在文献24。的确，这些肌肉都参与运动，证明他们的特别的兴趣。刺激位置和记录电极间的距离允许小腿三头肌的不同引起波的识别。胫后神经的腘窝浅部和大量纱锭使得相对于其他的肌肉24更容易来记录反射响应。由于这些原因，在目前提出的反射方法侧重于小腿三头肌肉群（比目鱼肌和腓肠肌）。因此，该协议的目的是描述的经皮神经刺激技术研究的小腿三头肌神经肌肉功能。

Protocol

实验过程概述获得机构伦理委员会批准，并符合赫尔辛基宣言。数据来自一个代表性的参与者谁知道的程序，并给他的书面知情同意书收集。 1.仪器准备清洁皮肤在由剃须电极的位置，并用酒精，得到低阻抗（<5千欧）的污垢。 放置两个氯化银表面电极（10毫米直径的记录）在股骨内踝的比目鱼肌的内侧condylis之间的线路的2/3;对肌肉的内侧腓肠肌的最突出的?…

Representative Results

增加刺激强度导致H和M-波之间的反应振幅不同的进化。休息时，H反射达到最大值是由肌电信号完全不存在之前，而X波逐渐增加，直到达到高原最大强度（参见图4为 M-波的图示，图6的演变的M-波和H反射与强度）。为比目鱼肌，刺激发病和M-波之间的延迟为大约10毫秒（图4A）和一般在25和40毫秒为H-波。然而，将延迟的肌肉群和被检者的肢体长度或?…

Discussion

经皮神经刺激使的神经肌肉系统不仅要了解神经运动功能的健康人的基本控制，而且还能够通过疲劳或训练17来分析急性或慢性改编许多特征的量化。这是非常有益的特别是对疲劳的协议，其中，测量必须尽快进行锻炼结束后，以避免快速恢复42的影响。

虽然许多研究都集中在小腿三头肌24，经皮神经刺激可以在其它下肢施加（例如胫前43,44?…

Disclosures

The authors have nothing to disclose.

Acknowledgements

The authors have no acknowledgements.

Materials

Biodex dynamometer Biodex Medical System Inc., New York, USA www.biodex.com
MP150 Data Acquisition System Biopac Systems Inc., Goleta, USA
Acknowledge 4.1.0 software Biopac Systems Inc., Goleta, USA www.biopac.com
DS7A constant current high voltage stimulator Digitimer, Hertfordshire, UK www.digitimer.com
Silver chloride surface electrodes Control Graphique Medical, Brie-Comte-Robert, France
Computer
1 Cable for connecting the Biodex to the MP150
1 Cable for connecting the Digitimer to the MP150
1 Cable for connecting the MP150 to the computer
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Neuromuscular FunctionPercutaneous Electrical Nerve StimulationPosterior Tibial NervePlantar Flexor MusclesM-waveH-reflexTwitch TorqueSurface ElectromyographyForce/torque ErgometerVoluntary Activation LevelNeuromuscular PlasticityExercise
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Rozand, V., Grosprêtre, S., Stapley, P. J., Lepers, R. Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation. J. Vis. Exp. (103), e52974, doi:10.3791/52974 (2015).
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