Improving the repeatability of Motor Unit Number Index (MUNIX) by introducing additional epochs at low contraction levels

Objective: To evaluate the repeatability of (Motor Unit Number Index) MUNIX under repeatability conditions, specify the origin of variations and provide strategies for quality control. Methods: MUNIX calculations were performed on the bicep brachii muscles of eight healthy subjects. Negative effect of suboptimal electrode positions on MUNIX accuracy was eliminated by employing the high-density surface electromyography technique. MUNIX procedures that utilized a variety of surface interferential pattern (SIP) epoch recruitment strategies (including the original MUNIX procedure, two proposed improvement strategies and their combinations) were described. For each MUNIX procedure, ten thousands of different SIP pools were constructed by randomly recruiting necessary SIP epochs from a large SIP epoch pool (3 datasets, 9 independent electromyography recordings at different contraction levels per dataset and 10 SIP epochs per recording) and implemented for MUNIX calculation. The repeatability of each MUNIX procedure was assessed by summarizing the resulting MUNIX distribution and compared to investigate the effect of SIP epoch selection strategy on repeatability performance. Results: SIP epochs selected at lower contraction levels have a stronger influence on the repeatability of MUNIX than those selected at higher contraction levels. MUNIX under repeatability conditions follows a normal distribution and the standard deviation can be significantly reduced by introducing more epochs near the MUNIX definition line. Conclusions: The MUNIX technique shows an inherent variation attributable to SIP epochs at low contraction levels. It is recommended that more epochs should be sampled at these low contraction levels to improve the repeatability. (C) 2017 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.