Abstract
BACKGROUND: The nociceptive withdrawal reflex (NWR) is a polysynaptic spinal reflex that induces complex muscle synergies to withdraw a limb from a potential noxious stimulus. Several studies indicate that assessment of the NWR is a valuable objective tool in relation to investigation of various pain conditions. However, existing methodologies for NWR assessment evaluate standard surface electromyography (sEMG) measured over just one muscle and do not consider the possible interference of crosstalk originating from adjacent active muscles. The present study had two aims: firstly, to investigate to which extent the presence of crosstalk may affect NWR detection using a standardized scoring criterion (interval peak z-score) that has been validated without taking crosstalk into consideration. Secondly, to investigate whether estimation of muscle fiber conduction velocity can help identifying the propagating and non-propagating nature of genuine reflexes and crosstalk respectively, thus allowing a more valid assessment of the NWR. RESULTS: Evaluation of interval peak z-score did apparently allow reflex detection with high sensitivity and specificity (0.96), but only if the influence of crosstalk was ignored. Distinction between genuine reflexes and crosstalk revealed that evaluation of interval peak z-score incorporating a z-score threshold of 12 was associated with poor reflex detection specificity (0.26-0.62) due to the presence of crosstalk. Two different standardized methods for estimation of muscle fiber conduction velocity were employed to demonstrate that significantly different muscle fiber conduction velocities may be estimated during genuine reflexes and crosstalk, respectively. This discriminative feature was used to develop and evaluate a novel methodology for reflex detection from sEMG that is robust with respect to crosstalk. Application of this conduction velocity analysis (CVA) entailed reflex detection with excellent sensitivity (1.00 and 1.00) and specificity (1.00 and 0.96) for the tibialis anterior and soleus muscles. CONCLUSION: This study investigated the negative effect of electrical crosstalk during reflex detection and revealed that the use of a previously validated scoring criterion may result in poor specificity due to crosstalk. The excellent performance of the developed methodology in the presence of crosstalk shows that assessment of muscle fiber conduction velocity allows reliable detection of EMG crosstalk during reflex detection.