QSEMG Assessments for Physical, Occupational & Speech Therapists

With some patients it’s fairly easy to figure out what is going on; with others, not so much. One big advantage of QSEMG is the ability to look inside at muscle functions in both real time and for later review, either in a snapshot or a session playback. QSEMG is the method Dr. Bolek developed at the Cleveland Clinic to assess and create treatment protocols using surface electromyography. QSEMG is based on the constellation of muscle groups firing during a given movement—such as reaching, standing, sitting, head control, etc.  It  can be used to supplement the treatment being performed by the physical or occupational therapists.

SEMG has not been used effectively in the past because it typically targeted one or two muscles (agonist, antagonist) and not the muscle unit, as is well documented by physiotherapists such as Simons and Travell. During his time at the clinic, physical and occupational therapists would often make referrals just to see what was going on during muscle recruitment. Some of the patients would later be seen in treatment sessions only for an assessment. There is no better tool then trained hands to determine muscle functioning, but SEMG and especially QSEMG can be a big help. It is like having ten hands all at one time (if you are targeting ten muscles).

More often than not, what appeared to be the cause of the pathology was actually a symptom of some other dysfunctional muscle unit. If one can get an accurate diagnosis early on, the resulting treatment goes much faster and the patient is happier and more invested in the treatment.

Examples of the information obtained during the assessment are:

  1. Does the firing rate of the targeted muscle groups vary over time?
  2. Does one myotatic unit tend to lead the way or follow during a movement?
  3. Which muscles fatigue early?
  4. Is the pathology evident in both open and closed chain work?
  5. Are there fasciculations?
  6. Are there co-contractions? Associative reactions?
  7. Are muscle substitutions evident? When do they begin?
  8. What is the pattern of concentric, eccentric recruitment?
  9. Is the patient able to relax the muscle after recruitment?
  10. What changes in muscle amplitude (recruitment level) and frequency (rate of firing) occur during the session?
  11. At one point in the treatment session is true physiological fatigue evident?
  12. Based on QSEMG findings, is the current treatment plan working?

Assessment details include:

  • A typical assessment lasts for two to three one-hour sessions.
  • Often, patients needs to be seen more than once to get an accurate picture of muscle functioning.
  • Every assessment is tailored to the needs of the therapist.
  • There is no “cook book” used or set template.
  • A comprehensive report is prepared, one for the patient and one for the therapist.

What is the cause of shoulder circumduction in a post stroke hemiparetic patient when reaching? QSEMG can help determine the “chicken/egg” dilemma. Is the circumduction playing the role of compensating for a poorly aligned pelvis or is the base of support set off balance because of the shoulder circumduction? QSEMG can help determine the root cause of the poorly executed movement, saving time and allowing for more productive treatment sessions.