Evaluating the use of electromyography in UK and European gait laboratories for the assessment of cerebral palsy and other neurological and musculoskeletal conditions

Background

Electromyography (EMG) can estimate the magnitude and timing of muscle activation during walking in those with gait disorders. Despite the potential of EMG use in assessment and clinical decision-making, there are reports of declining use of EMG within gait laboratories. Technical and educational barriers to EMG usage in clinics in Italy were recently suggested.

Research question

What is the current EMG practice and associated knowledge and barriers to EMG usage in UK and European clinical gait labs?

Methods

Semi-structured interviews were conducted online with 16 participants recruited from 13 gait laboratories across the UK and wider Europe, 11 participants used EMG routinely in clinical service and five did not. Participants held various professions including physiotherapists, clinical scientists, a lab manager, biomechanist, orthopaedic surgeon and a biomedical engineer. Interviews were transcribed and analysed using reflexive thematic analysis.

Results

EMG training was often completed in-house informally by colleagues. Findings show EMG was currently used for assessing muscle activation timings, spasticity, co-contraction in patients and often used as a confirmatory tool. Challenges of using EMG included: justifying the effort, distinguishing true deviations from the norm, capacity to collect good quality data and feasibility with a given patient.

Significance

The challenge of interpreting EMG signals, patient readiness and time requirements were consistent between the gait labs reflecting previous reports from Italy. There were also large variations in types of EMG training and education in agreement with previous findings. In contrast to previous findings, cost was not considered important within this study.

Conclusion

For EMG to be more widely and routinely used, the perceived effort of staff and patients would need to be justified by a clear link to the treatment planning and decision-making through further published evidence and training.