Electrical Impedance Myography in the Assessment of Disuse Atrophy

doi:10.1016/j.apmr.2009.04.007

Archives of Physical Medicine and Rehabilitation

Volume 90, Issue 10, October 2009, Pages 1806-1810

Presented to the American Academy of Neurology, May 3, 2007, Boston, MA.

https://doi.org/10.1016/j.apmr.2009.04.007 Get rights and content

Abstract

Tarulli AW, Duggal N, Esper GJ, Garmirian LP, Fogerson PM, Lin CH, Rutkove SB. Electrical impedance myography in the assessment of disuse atrophy.

Objective

To quantify disuse atrophy using electrical impedance myography (EIM), a noninvasive technique that we have used successfully to study neurogenic and myopathic atrophy.

Design

We performed EIM of the tibialis anterior of subjects with disuse atrophy secondary to cast immobilization and in their contralateral normal leg. Subjects were studied shortly after cast removal and again several weeks to months after the cast was removed and normal mobility was restored.

Setting

Outpatient neurology and orthopedic practices at a tertiary care medical center.

Participants

Otherwise healthy subjects (N=10) with unilateral leg fracture.

Interventions

Not applicable.

Main Outcome Measures

Resistance, reactance, and phase measured at 50kHz.

Results

The main EIM outcome parameter, phase at 50kHz, was lower in the immobilized leg in 9 of 10 cases. Additionally, when normal mobility was restored, the phase of the casted leg increased relative to its initial measurement in all 10 cases, while it increased inconsistently in the contralateral leg.

Conclusions

EIM may be a powerful tool for the assessment of disuse atrophy.

Section snippets

Subjects

Ten otherwise healthy subjects (6 men, 4 women), ranging in age from 20 to 52 years, with distal leg and foot fractures requiring cast immobilization were recruited consecutively from the orthopedic surgery department at Beth Israel Deaconess Medical Center. All subjects were treated nonoperatively in below-knee casts that consisted of the serial application of a 4-inch stockinette,^a followed by 4 to 6 rolls of Webril undercast padding,^b and then 4 rolls of 10cm × 3.6m Delta Lite fiberglass

Results

Table 1 lists patient characteristics including the durations of immobilization (I₁) and time between serial EIM measurements (I₂).

Discussion

Disuse atrophy is an important phenomenon with health consequences that are potentially of great magnitude. A noninvasive method to quantify disuse atrophy could be helpful in monitoring rehabilitation efforts in patients with orthopedic injuries,¹⁵ assessing sarcopenia of aging,16, 17, 18 and planning adaptive countermeasures for microgravity environments.6, 7 Unfortunately, the methods used thus far are not ideal for the clinical study of disuse atrophy, as they are invasive, inconsistent, or

Conclusions

EIM may be a powerful tool for the assessment of disuse atrophy. Further study to verify these results in a larger population of patients with disuse atrophy from a variety of conditions is indicated.

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With age, the elderly showed a significant decrease in Xc as a result of muscle atrophy (including the reduction of the mass and number of muscle tissue cells) and disturbances in the proper functioning of cells [7,28]. Similar observations were made for disuse atrophy in younger patients with limb fractures [29]. Although we did not find significant age-related, but only sex-related Xc differences in younger children, this component of impedance was the strongest positive predictor of the muscle functional quality.
The condition of skeletal muscles is a key marker of the nutritional status and function of an organism. It is necessary to monitor muscle quality in basic pediatric preventive health care, especially due to the increase in negative health behaviors during a pandemic. The aims of this study were to assess body composition and muscle strength as well as to analyze the relationship between muscle functional quality and impedance parameters in 6- and 7-y-old children.
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A 1-y age difference between the children differentiated not only basic somatic parameters, body composition, and handgrip strength, but also the electrical properties of the tissues. The relative difference in muscle mass between younger and older children was twice that of the muscle strength. A significant regression model of the muscle quality index was obtained, in which reactance and impedance phase angle were strong positive predictors. Adjusted fat mass negatively correlated with the muscle quality.
Reactance and phase angle are good indicators of the quality of appendicular skeletal muscle in healthy children and can be potentially used in pediatric preventive health care and screening.
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EIM takes just a few seconds to complete once the electrodes are placed and bioimpedance devices provide at least three EIM components: angle phase, reactance and resistance (Narayanaswami et al., 2012). Through these three components, many studies have evidenced that EIM can discriminate healthy from diseased muscle tissues, and even to assess the disease status, the progression or the effects of therapies (Rutkove et al. 2002; Tarulli et al. 2009; Nescolarde et al., 2013; Nescolarde et al., 2015; Sanchez and Rutkove, 2017). This method is also used to assess relationships between composition and functional qualities of healthy skeletal muscle such as strength or gait speed (Ikenaga et al., 2017; Taniguchi et al., 2017; Yamada et al., 2017).
In spite of the growing use of the electrical impedance myography (EIM) measures for clinical assessment and follow-up of diseased muscle tissue, reliability studies are scarce. We evaluate the reliability of the (EIM) technique using four adhesive electrodes over the muscle of interest.
Intra- and inter-rater reliability was studied within the same session and between sessions. Thirty-one healthy and volunteer subjects aged between 20 and 26 years were recruited. Phase angle, reactance and resistance were assessed for each EIM measurement. Intraclass correlation coefficient (ICC) was used to determine the relative reliability. Absolute reliability was expressed as the standard error of measurement and the minimum detectable change.
Relative reliability within the same session and between sessions for the EIM technique was excellent (ICCs > 0.9) concerning both intra- and inter-rater reliability, except for the component reactance. The absolute reliability was very high for the three EIM components.
EIM measures using four adhesive electrodes over the area of interest is a reliable technique to assess muscle tissue status. This study confirms that these measurement results barely vary depending on the examiner and the moment. The present study also confirms phase angle as the least affected EIM component by examiner and evaluation moment.
Standards for quantification of EMG and neurography
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This document is an update and extension of ICCN Standards published in 1999. It is the consensus of experts on the current status of EMG and Neurography methods. A panel of authors from different countries with different approach to routines in neurophysiological methods was chosen based on their particular interest and previous publications. Each member of the panel submitted a section on their particular area of interest and these submissions were circulated among the panel members for edits and comments. This process continued until a consensus was reached.
The document covers EMG topics such as conventional EMG, Macro EMG, applications of surface EMG and electrical impedance myography. Single Fiber EMG is not included, since it is the topic in a separate IFCN document. A neurography section covers topics such as motor and sensory neurography, F wave recordings, H-reflex, short segment recordings, CMAP scan and motor unit number methods. Other sections cover repetitive nerve stimulation and Pediatric electrodiagnostic testing.
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Exploring the relationship between electrical impedance myography and quantitative ultrasound parameters in Duchenne muscular dystrophy
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Anisotropy also becomes reduced in myopathic conditions and shows substantial reduction in DMD in particular (Rutkove et al., 2016). Thus, EIM reflects alterations in both muscle composition and microstructure (Tarulli et al., 2009; Sanchez and Rutkove, 2017b). In addition to differences in the biophysical underpinnings of both techniques, a number of other factors undoubtedly contributed to our results and the fact that the correlation coefficients were no higher than about 0.70 in the DMD patients.
Quantitative ultrasound (QUS), including grayscale level analysis (GLA) and quantitative backscatter analysis (QBA), and electrical impedance myography (EIM) have been proposed as biomarkers in Duchenne muscular dystrophy (DMD). However, the relationship between these methods has not been assessed.
QUS values (including GLA and QBA) and several EIM measures were recorded from six muscles in 36 DMD and 29 healthy boys between ages 5 and 13 years at baseline, 6-months, and 12-months.
In the DMD boys, a moderate correlation was noted between QUS and EIM parameters, with the strongest correlations being identified for averaged muscle values. Of the individual muscles, biceps brachii and deltoid showed the strongest correlations. For example, in biceps, the QBA/EIM correlation coefficient (Spearman rho) was ≥0.70 (p < 0.01). Importantly, changes in QUS values over 12 months also correlated moderately with changes in EIM parameters and EIM/QBA rho values mostly varied between −0.53 and −0.70 (p ≤ 0.02). No significant correlations were identified in the healthy boys.
A moderate correlation of QUS with EIM in DMD boys suggests that the two technologies provide related data but are sensitive to different pathological features of muscle.
The use of both technologies jointly in assessing DMD progression and response to therapy should be considered.
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An informative biomarker is any biological characteristic that can be objectively measured and predicts a future clinical outcome. Spinal muscular atrophy (SMA) biomarkers can be broadly divided into those that involve the survival motor neuron 1 (SMN1) gene and those that do not. SMN2 gene copy number is a good prognostic biomarker that has a meaningful clinical application and is useful in the design of SMA clinical trials. SMN mRNA and protein levels and non-SMN molecular biomarkers can be measured in biological samples; however, their utility as biomarkers in clinical trials is less clear. Electrophysiological biomarkers, such as compound muscle action potential and motor unit number estimation, report the functional integrity of the motor neuron, correlate with motor function, and have the potential to be predictive biomarkers in SMA clinical trials. Electrical impedance myography and ultrasound report indirectly on the health of the motor unit and have potential as informative SMA biomarkers.
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Electrical impedance myography (EIM) refers to the specific application of electrical bioimpedance techniques for the assessment of neuromuscular disorders. In EIM, a weak, high-frequency electrical current is applied to a muscle or muscle group of interest and the resulting voltages measured. Among its advantages, the technique can be used noninvasively across a variety of disorders and requires limited subject cooperation and evaluator training to obtain accurate and repeatable data. Studies in both animals and human subjects support its potential utility as a primary diagnostic tool, as well as a biomarker for clinical trial or individual patient use. This review begins by providing an overview of the current state and technological advances in electrical impedance myography and its specific application to the study of muscle. We then provide a summary of the clinical and preclinical applications of EIM for neuromuscular conditions, and conclude with an evaluation of ongoing research efforts and future developments.

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: Supported by the National Institutes of Health, National Institute of Neurological Disorders and Stroke (grant nos. F32 NS055583-01A1, R01 NS042037).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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Original articleElectrical Impedance Myography in the Assessment of Disuse Atrophy

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Subjects

Results

Discussion

Conclusions

Clin Nutr

Clin Neurophysiol

Muscular atrophy following immobilisation: a review

Sports Med

Longitudinal study of skeletal muscle adaptations during immobilization and rehabilitation

Muscle Nerve

Weakness in patients with hemiparesis

Am J Occup Ther

Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans

N Engl J Med

Microgravity and skeletal muscle

J Appl Physiol

Space travel directly induces skeletal muscle atrophy

FASEB J

Localized bioimpedance analysis in the evaluation of neuromuscular disease

Muscle Nerve

Electrical impedance myography in the detection of radiculopathy

Muscle Nerve

Original article
Electrical Impedance Myography in the Assessment of Disuse Atrophy