Fatiguing Effects on the Multi-Scale Entropy of Surface Electromyography in Children with Cerebral Palsy

The objective of this study was to investigate the effects of muscle fatigue on the multi-scale entropy of surface electromyography (EMG) in children with cerebral palsy (CP) and typical development (TD). Sixteen CP children and eighteen TD children participated in experiments where they performed upper limb cyclic lifting tasks following a muscle fatiguing process, while the surface EMG signals were recorded from their upper trapezius muscles. Multi-scale entropy (MSE) analyses of the surface EMG were applied by calculating sample entropy (SampEn) on individual intrinsic mode functions (IMFs) adaptively generated by empirical mode decomposition (EMD) of the original signal. The declining degree of the resultant MSE curve was found to reflect muscle fatigue level for all subjects, with its slope (purposely calculated over the first four scales) increasing significantly as the fatigue level increased. Further, such a slope increase was less significant for CP children as compared with TD children. Our findings confirmed that the decrease of muscle fiber conduction velocity (MFCV) and the increase of motor unit synchronization may be two possible factors induced by muscle fatigue, and further indicated that there appear to be some neuromuscular changes (such as MFCV decrease, motor unit synchronization increase, motor unit firing rates reduction, selective loss of larger motor units) that occur as a result of cerebral palsy. These changes may account for experimentally observed difference in fatiguing effects between subject groups. Our study provides an investigative tool to assess muscle fatigue as well as to help reveal complex neuropathological changes underlying the motor impairments of CP children.