Establishing a valid, reliable, and objective method for determining the number of functioning motor units in a muscle is important clinically, as it would provide a quantitative means of documenting changes in neuromuscular health over time. This thesis addressed the reliability of motor unit number estimates (MUNEs) derived using decomposition-based quantitative electromyography (DQEMG) from the extensor digitorum brevis (EDB) and abductor hallucis (AH) muscles. Additionally, the effect of the mean surface motor unit potential (SMUP) parameter averaging method (arithmetic/ensemble), the size-related parameter used to calculate MUNE (amplitude/area), and the type of SMUP marker editing (automatic/manual) was investigated in terms of MUNE values. Two separate analyses on a single data set collected from twenty healthy subjects on two occasions were conducted. MUNEs were calculated by dividing a size-related parameter (amplitude/area) of the compound muscle action potential (CMAP) by the same size-related parameter of a representative mean SMUP. First, paired t-tests investigated differences in MUNEs calculated using arithmetic and ensemble averaged SMUP parameters. Within- and between-day reliability of the two measurements was established using intra-class correlation coefficients (ICCs), coefficients of variation (CV), mean absolute differences (MAD), and Bland Altman limits of agreement (LOA). Second, MUNEs (using both parameters) derived from automated and manually edited SMUPs were compared. The effect of the size-related parameter and editing type was identified using a two-factor, repeated measures analysis of variance. Reliability was determined as described above. Arithmetic averaged SMUP parameters produced smaller MUNEs than those derived from ensemble averaging (p<0.001). SMUP area produced higher MUNEs than SMUP amplitude (p<0.05), except when using arithmetic averaged parameters in AH. Interaction effects between editing type and size parameter were present in both muscles (F>6.68, p<0.001). Between-day MUNEs had lower CVs and MADs, higher ICCs, and narrower LOAs than within-day MUNEs. MUNEs derived from arithmetic averaged SMUP parameters showed the highest reliability (ICCs>0.91). MUNEs calculated from automated SMUP marker placements were highly correlated (r>0.86) and displayed comparable reliabilities to those derived from manual marker placement (ICCs>0.90). To optimize the reproducibility of MUNEs calculated using DQEMG, while minimizing processing time, between-day automated estimates using arithmetic averaged SMUP amplitude is recommended. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2012-08-30 08:32:06.141

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In daily activities, hand use is dominated by individuated thumb and finger movements, and by grasping. This thesis focused on the level of ???independence??? of the digits and its relationship to hand grasps, from the level of the motor units to the level of synergistic grasping forces. Four major studies were conducted in healthy adult volunteers. First, spike-triggered averages of forces produced by single motor units in flexor pollicis longus (FPL) in a grasp posture showed small but significant loading of the index, but not other fingers. This reflected a neural rather than anatomical coupling, as intramuscular stimulation produced minimal effect in any finger. Also, FPL had a surprisingly large number of low-force motor units and this may account for the thumb???s exceptional dexterity and force stability compared with the fingers. Second, independent control of extensor digitorum (ED) was more limited than flexor digitorum profundus (FDP), as more ED motor units of a ???test??? finger were recruited inadvertently by extension than by flexion of adjacent digits. Third, ???force enslavement??? in maximal voluntary tasks was greater in digit extension than flexion. The distribution of force enslavement (and deficits) matched the pattern of daily use of the digits (alone and in combination), and reveals a neural control system which preferentially lifts fingers together from an object by extension but allows an individual digit to flex to contact an object so the finger pads can engage in exploration and grasping. Finally, during grasping, irrespective of whether a digit had been lifted from the object, coherence among forces generated by the digits was similar. In addition, the coherence between finger forces was independent of any contraction of the thumb, was stable over 2 months, and required no learning. The pattern of coherence between digital grasping forces may be closely related to the level of digit independence and daily use. Overall, the grasp synergy was remarkably invariant over the various tasks and over time. In summary, this thesis demonstrates novel aspects of the properties of FPL, the lack of complete independence of the digits, and robustness in the production of flexion forces in hand grasps.