The two volumes under review are in the form of compact
disks, which combines video pictures and verbal text.
Clinical electromyography is mostly learned from watching
and performing studies, as in an apprenticeship. Reading
should supplement knowledge, but there is no substitute
for observation and participation. The subject is thus
ideally suited for computer-aided learning.
The CDs are played through PC based computers. There
are minimal computing
requirements, which differ for the two volumes; the
most demanding requirements are a PC computer with a
133- MHz processor (233 MHz for lap-top computers),
Windows 95 or 98, a 6X CD-ROM, and 50 megabytes of free
space on the hard drive to run the program. Although
I have minimal experience with PC computers and windows
operating systems, I was able easily to sort through
the opening and execution of the programs. Operations
of the program are straightforward with a table of contents
on the opening screen of each CD-ROM, and the various
chapters are opened by marking them with the cursor
and clicking with mouse. Each chapter in turn may have
several sections that can be opened similarly. Only
one sunsection of a chapter failed to open, and one
error message occurred; restarting the program solved
the problem.
Electronic Myoanatomic Atlas for Clinical Electromyography
consists of one CD that includes a book of text and
a pictorial atlas of
muscles commonly used in clinical electromyography.
The book covers general
techniques of electromyography as well as descriptors
of muscles and how to
study them. It has many valuable tips and pointers about
how to be a better
electromyographer. The book can be printed. The main
body of the CD is an atlas of upper and lower extremity
muscles as well as cranial and paraspinal muscles.
The introduction acknowledges that the selection of
muscles is not exhaustive,
but there are 23 muscles of the upper limb, and 7 cranial
and paraspinal muscles. In general, the selection of
muscles is appropriate. The only muscle I found lacking
was the tibialis posterior.
For each muscle, there is a textual description if
its innervation (nerve and
roots), origin, and insertion; the optimum positioning
and method of activating
the muscle; and a description of where to insert the
electrode with appropriate
cautions. There is a still image of the muscle, with
arrows pointing to landmarks, etc., and two live action
videos, at different magnifications. I found reviewing
the different muscles very informative. Electromyographers
are creatures of habit (initial training), and viewing
the CDs amounted to a 'busman's holiday' seeing how
other electromyographers position and activate muscles.
Two areas were found wanting. One was that the resolution
of the video pictures was marginal and it was difficult
to contours of muscles. The second was that it would
have been helpful to include a diagrammatic picture
of the muscle beside or after the live video to better
visualize the muscle in question from surrounding muscles.
Nevertheless, I felt that this was an ideal way for
the electromyographers to learn and review muscles and
for experienced electromyographers to see another way
to position the limb, activate the muscle, and insert
the electrode.
Electronic Atlas of Electromyographic Wave Forms,
consisting
of four CDs, constitutes a unique tutorial in electromyography.
Dr. Nandedkar is an electrical engineer who has focused
his career on the analysis of EMG waveforms.
Dr. Barkhaus is a clinical electromyographer with extensive
experience with
quantitative EMG and electrode recording characteristics.
They bring an
extraordinary amount of experience to these CDs. They
are very good and clear teachers.
The first CD contains a section on instrumentation,
including a recording
characteristics of electrodes, a section on cables,
the principles of amplifiers
and filters, and discussions on how to make manual measurements
of motor unit action potentials. With this as a background,
the CD contains normal electromyographic tracings from
different muscles, showing characteristic differences
with respect to discharge frequency, amplitude, and
waveform configuration.
The second CD focuses on spontaneous activity
and it includes insertion activity, endplate activity,
fasciculation potentials, complex discharges, fibrillation
and positive waves and iterative discharges. It also
includes a section on the practical use of changing
filter settings to clarify signals. The first two CDs
include assessment quizzes for recognizing spontaneous
activity and motor unit waveforms.
The third CD focuses on motor unit potentials.
It starts with a tutorial
discussing the generation of the motor unit potential
and its relationship
to muscle architecture. It focuses on motor units seen
in various disease
states including defects of neuromuscular transmission.
It discusses specific
recording techniques, including the use of a delay line
and triggering circuit
as well as multi-motor unit analysis. The authors also
introduce the concepts
of neuromuscular jitter and blocking as recorded by
a 'poor persons'
single-fiber EMG (raising the filter to 500 Hz). The
second half the disk
includes examples of motor units found in various disease
states. The fourth
CD starts with a tutorial on the analysis of interference
pattern. This
includes basic information about recruitment and firing
rates at low levels
of contraction and ends with analysis of full interference
pattern, including
analysis of turns and amplitude and precision decomposition.
The second half
of the disk consists of examples of normal, neuropathic
and myopathic
interference patterns.
All in all, I found the method of live presentation
very effective. An apt
analogy is given in the introduction: if a picture is
worth a thousand words,
a video is worth a million. Drs. Nandedkar and Barkhaus
are pioneering a new
medium for teaching electromyography. It is like having
a private tutorial
with an experienced engineer and clinician, with a complete
spectrum of patients.
This series of CDs will obviously appeal to residents
and fellows as they start
their training, but it is also a refresher course for
experienced electromyogaphers.
I highly recommend this for all teaching programs,
for any trainee, and for
anyone who wishes to improve their skills. It will be
especially valuable for
those who are taking certifying examinations.
Mark B. Bromberg, MD, PhD
The above review was reproduced with permission
from 'Muscle and Nerve' and the reviewer, Mark B. Bromberg,
MD, PhD
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