Voluntary Contraction Direction Dependence of Motor Unit Number Index in Patients with Amyotrophic Lateral Sclerosis

We investigated the voluntary contraction direction dependence of motor unit number index (MUNIX) for multifunctional muscles in patients with amyotrophic lateral sclerosis (ALS). The MUNIX technique was applied in nine first dorsal interosseous muscles of eight ALS subjects, using surface electromyography (EMG) signals from index finger abduction and flexion, respectively. In seven examined muscles, the MUNIX derived from the index finger abduction mode was smaller than that from the flexion mode. For the remaining two muscles, one had the same MUNIX; the other showed an abduction mode MUNIX much higher than the flexion mode MNUIX. Across all muscles, the median MUNIX was 96 for the index finger abduction mode and 161 for the flexion mode. The findings reveal the dependence of multifunctional muscle MUNIX on voluntary contraction directions in ALS patients. Based on this analysis, we further explored the concept of "multidimensional MUNIX" for an appropriate performance or interpretation of MUNIX in multifunctional muscles of ALS patients. An effort towards such a development was presented using both abduction and flexion mode surface EMG for MUNIX calculation.