Table 2.
Survey items that reached consensus.
| Survey items | Agreed | (%) |
|---|---|---|
| 1. sEMG is more frequently employed in technical/methodological research than clinical research. | 29/35 | (83) |
| 2. sEMG provides information on neuromuscular function that is not provided by other assessment techniques/tools in neurorehabilitation. | 32/35 | (91) |
| 3. Practical utility of sEMG in clinical neurorehabilitation. sEMG information on neuromuscular activation may: | ||
| Enhance the assessment and characterization of neuromuscular impairments in patients | 32/34 | (94) |
| Influence the intervention plan design | 28/33 | (85) |
| Allow to better track the changes in muscle activity from baseline when neurorehabilitation interventions are administered | 32/34 | (94) |
| Allow to evaluate the effects of non-invasive interventions designed to impact muscle activity (such as therapeutic exercise, orthotics, medication, physical agents, manual therapy techniques) | 32/25 | (91) |
| Allow to evaluate the effects of invasive interventions designed to impact muscle activity (such as surgery and neuromuscular blocks) | 30/34 | (88) |
| Be employed as biofeedback training if the clinician identifies abnormal patterns of muscle activity that may be modified through motor learning | 30/34 | (88) |
| 4. Role of sEMG in patient's assessment—sEMG may be useful to: | ||
| Outline the sequential timing of muscular actions during given movements (i.e., gait, motor tasks) | 35/35 | (100) |
| Evaluate the appropriateness of the activation among muscles participating to a specific movement (muscle/balance/imbalance/synergy/function) | 34/35 | (97) |
| Characterize the stretch reflex | 28/35 | (80) |
| Characterize muscular hyperactivity (e.g., spasticity, spastic co-contraction, spastic dystonia) | 26/33 | (79) |
| 5. Utility of sEMG in the definition of an intervention plan - sEMG may be useful when there is need to investigate or quantify: Abnormalities in the sequential timing of muscular actions during given movements (i.e., gait, motor tasks) | ||
| Muscle imbalance/dyssynergia | 26/33 | (79) |
| Muscular hyperactivity (e.g., spasticity, spastic co-contraction, spastic dystonia) | 25/32 | (78) |
| 6. If a therapeutic intervention is administered, sEMG information may prove useful to track changes from baseline in: | ||
| Sequential timing of muscular actions during given movements (i.e., gait, motor tasks) | 31/35 | (89) |
| Involuntary muscle activation (e.g., dystonia, ataxia) | 24/32 | (75) |
| 7. sEMG assessment can be performed as a stand-alone technique or to complement/optimize other methods used by neurorehabilitation professionals to quantify muscle and physical function. It seems useful adding sEMG to: | ||
| Gait/motion analysis (with or without motion capture) | 35/35 | (100) |
| Hyperactivity/Spasticity/muscle tone assessment | 29/34 | (85) |
| Accelerometry | 25/31 | (81) |
| Stretch reflex | 26/34 | (76) |
| 8. sEMG, when used as biofeedback, may help to: | ||
| Learn how to change the coordination pattern of an agonist with respect to antagonists and synergists (muscle selectivity) | 30/33 | (91) |
| Learn how to decrease the activity of overly tense and/or involuntarily hyperactive muscles | 29/33 | (88) |
| Learn how to increase the activity of weak and/or hypoactive muscles | 29/32 | (91) |
| 9.* Professional figure who is most frequently involved in sEMG recordings: | ||
| Biomedical engineer with a focus on instrumentation, e-health, and rehabilitation | Ranked 1st | |
| Physiotherapist | Ranked 2nd | |
| Kinesiologist/human motion scientist | Ranked 3rd | |
| 10. Professional figures involved in sEMG signal acquisition, processing, and quality control: | ||
| Biomedical engineer with a focus on instrumentation, E-health, and Rehabilitation | 31/34 | (91) |
| Kinesiologist/human motion scientist | 27/34 | (79) |
| 11. Professional figures involved in sEMG interpretation: | ||
| Kinesiologist/human motion scientist | 27/33 | (82) |
| Clinical neurophysiologist | 26/32 | (81) |
| Physical Medicine and Rehabilitation physician, also known as physiatrist | 25/32 | (78) |
| Biomedical engineer with a focus on instrumentation, e-health, and rehabilitation | 25/33 | (76) |
| Physiotherapist | 24/32 | (75) |
| 12. Greater qualification of neurorehabilitation professionals on sEMG would contribute to improve the quality of neurorehabilitation care delivery | 28/35 | (80) |
| 13. Years of practice/experience with sEMG techniques needed to qualify for providing education and training on the use of sEMG to clinical neurorehabilitation professionals: | ||
| <1 year: very inadequate | 29/32 | (91) |
| >5 years: very adequate | 25/29 | (86) |
| 14. In addition to basic know-how on sEMG recording (i.e., correct placement of electrodes, adequate skin preparation, etc.), further technical skills are needed: | ||
| Ability to recognize and filter out artifacts at the skin-electrode interface | 32/35 | (91) |
| Ability to choose the processing technique that is most appropriate for a given application | 30/35 | (86) |
| 15. EMG-derived variables considered of utmost importance for clinical applications in neurorehabilitation: | ||
| Timing of muscle activations and their variability | 34/34 | (100) |
| Amplitude estimators (i.e., average rectified value, root mean square) | 28/35 | (80) |
| Signal quality/reliability indicators (e.g., artifact reporting) | 26/34 | (77) |
| Envelope time course | 25/33 | (76) |
| 16. In addition to knowledge on physiological and non-physiological factors that influence sEMG, neurorehabilitation professionals need further competencies to interpret sEMG: | ||
| Knowledge about sEMG patterns of recruitment in the main central and peripheral neuromuscular disorders | 33/34 | (97) |
| Knowledge about the use of sEMG to assess muscular hyperactivity | 31/33 | (94) |
| Knowledge about sEMG patterns of recruitment of healthy individuals | 31/34 | (91) |
| Knowledge about the pathologies that affect muscle fiber conduction velocity | 23/30 | (77) |
| 17.* Work environment most likely to favor the usage of sEMG: | ||
| Privately operated clinic (with public or insurance-based reimbursement) | Ranked 1st | |
| Publicly operated clinic (with either public or insurance-based reimbursement) | Ranked 2nd | |
| Privately operated clinic (out-of-pocket) | Ranked 3rd | |
| 18. Potential barriers to the employment of sEMG in clinical neurorehabilitation: | ||
| sEMG data analysis/interpretation difficult to perform without specific education/training | 32/33 | (97) |
| Inadequate education for professionals in neurorehabilitation | 30/34 | (88) |
| Lack of widely accepted evidence that the use of sEMG improves treatment effectiveness | 26/34 | (77) |
| Inadequate education and training on sEMG in graduation courses | 27/34 | (79) |
| Time-consuming | 26/34 | (77) |
*
Questions were presented as ranking items, with ranking reported in the table only for the first three items.