Klaps S, Langer D, Gosselink R, Dacha S, Louvaris Z, Jacobs N, Janssens W, Janssens L
REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium.
Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.
Respir Med. 2025 Jul;243:108127. doi: 10.1016/j.rmed.2025.108127. Epub 2025 Apr 25.
Concurrent dysfunctions in postural control and diaphragm are observed in patients with chronic obstructive pulmonary disease (COPD). Measuring diaphragm activation traditionally involves transesophageal diaphragm electromyography (EMG), which is costly and relatively invasive. Extra-diaphragmatic inspiratory muscle surface electromyography may serve as a useful physiological marker for EMG. This study compared EMG amplitude with surface EMG amplitude of other inspiratory muscles, including sternocleidomastoid (sEMG), scalene (sEMG), and parasternal intercostal muscles (sEMG) during postural control tasks in nine patients with COPD (5 males; age: 65 ± 6 years; forced expiratory volume in the first second: 60 ± 27 % predicted). Simultaneous recordings of EMG, sEMG, sEMG, and sEMG amplitudes were obtained during six postural control tasks involving upright standing with ballistic arm movements under different conditions of support surface (stable/foam), arm movement frequency (single/repetitive), and breathing modes (normal/breath-hold at end-expiration). EMG amplitudes were normalized to each muscle's maximum voluntary contraction. A linear mixed model with Bonferroni-Holm post-hoc tests and Bland-Altman analyses were performed. There was a significant EMG-by-task interaction (p = 0.0223). The amplitude of EMG was significantly lower than sEMG across all tasks (p < 0.0001 to 0.0007), while no significant differences were observed between EMG and sEMG or EMG and sEMG after Bonferroni-Holm correction (p = 0.019-0.858). Bland-Altman analyses indicated reasonable agreement between EMG and both sEMG and sEMG (mean biases: 1.8 % and -3.7 %), while sEMG had a significantly higher overall bias of -20.7 %. These findings suggest that both sEMG and sEMG can serve as useful physiological markers for EMG in postural control assessments in patients with COPD. NEW & NOTEWORTHY. This study highlights the potential of extra-diaphragmatic inspiratory muscle surface electromyography as a physiological marker for transesophageal diaphragm electromyography during postural control tasks in patients with COPD, thereby reducing the need for costly and invasive measurements.
在慢性阻塞性肺疾病（COPD）患者中观察到姿势控制和膈肌功能同时出现障碍。传统上，测量膈肌激活需要进行经食管膈肌肌电图（EMG）检查，这种方法成本高且具有一定的侵入性。膈外吸气肌表面肌电图可作为EMG的一种有用的生理标志物。本研究比较了9例COPD患者（5例男性；年龄：65±6岁；第一秒用力呼气量：预测值的60±27%）在姿势控制任务期间，膈肌肌电图（EMG）幅度与其他吸气肌的表面肌电图（sEMG）幅度，包括胸锁乳突肌（sEMG）、斜角肌（sEMG）和胸骨旁肋间肌（sEMG）。在六种姿势控制任务中同时记录EMG、sEMG、sEMG和sEMG的幅度，这些任务包括在不同支撑表面条件（稳定/泡沫）、手臂运动频率（单次/重复）和呼吸模式（正常/呼气末屏气）下进行的直立站立并伴有弹道式手臂运动。将EMG幅度标准化为每块肌肉的最大自主收缩。进行了带有Bonferroni-Holm事后检验和Bland-Altman分析的线性混合模型分析。存在显著的任务与EMG交互作用（p = 0.0223）。在所有任务中，EMG幅度均显著低于sEMG（p < 0.0001至0.0007），而在Bonferroni-Holm校正后，EMG与sEMG或EMG与sEMG之间未观察到显著差异（p = 0.019 - 0.858）。Bland-Altman分析表明EMG与sEMG和sEMG之间具有合理的一致性（平均偏差分别为1.8%和 -3.7%），而sEMG的总体偏差显著更高，为 -20.7%。这些发现表明，在COPD患者的姿势控制评估中，sEMG和sEMG均可作为EMG的有用生理标志物。新发现与值得注意之处。本研究强调了膈外吸气肌表面肌电图在COPD患者姿势控制任务期间作为经食管膈肌肌电图生理标志物的潜力，从而减少了对昂贵且有创测量的需求。
