Henneberg, K. “Principles of Electromyography.

”
The Biomedical Engineering Handbook: Second Edition.
Ed. Joseph D. Bronzino
Boca Raton: CRC Press LLC, 2000
 14
Principles of
Electromyography

14.1 The Structure and Function of Muscle

14.2 The Origin of Electromyograms
14.3 Electromyographic Recordings
Kaj-Åge Henneberg Concentric Electrode EMG • Single-Fiber EMG • Macro
University of Montreal EMG

Movement and position of limbs are controlled by electrical signals traveling back and forth between the
muscles and the peripheral and central nervous system. When pathologic conditions arise in the motor
system, whether in the spinal cord, the motor neurons, the muscle, or the neuromuscular junctions, the
characteristics of the electrical signals in the muscle change. Careful registration and study of electrical
signals in muscle (electromyograms) can thus be a valuable aid in discovering and diagnosing abnor-
malities not only in the muscles but also in the motor system as a whole. Electromyography (EMG) is
the registration and interpretation of these muscle action potentials. Until recently, electromyograms
were recorded primarily for exploratory or diagnostic purposes; however, with the advancement of
bioelectric technology, electromyograms also have become a fundamental tool in achieving artificial
control of limb movement, i.e., functional electrical stimulation (FES) and rehabilitation. This chapter
will focus on the diagnostic application of electromyograms, while FES will be discussed in Chapter 17.
Since the rise of modern clinical EMG, the technical procedures used in recording and analyzing
electromyograms have been dictated by the available technology. The concentric needle electrode intro-
duced by Adrian and Bronk in 1929 provided an easy-to-use electrode with high mechanical qualities
and stable, reproducible measurements. Replacement of galvanometers with high-gain amplifiers allowed
smaller electrodes with higher impedances to be used and potentials of smaller amplitudes to be recorded.
With these technical achievements, clinical EMG soon evolved into a highly specialized field where
electromyographists with many years of experience read and interpreted long paper EMG records based
on the visual appearance of the electromyograms. Slowly, a more quantitative approach emerged, where
features such as potential duration, peak-to-peak amplitude, and number of phases were measured on
the paper records and compared with a set of normal data gathered from healthy subjects of all ages. In
the last decade, the general-purpose rack-mounted equipment of the past have been replaced by ergo-
nomically designed EMG units with integrated computers. Electromyograms are digitized, processed,
stored on removable media, and displayed on computer monitors with screen layouts that change in
accordance with the type of recording and analysis chosen by the investigator.
With this in mind, this chapter provides an introduction to the basic concepts of clinical EMG, a
review of basic anatomy, the origin of the electromyogram, and some of the main recording procedures
and signal-analysis techniques in use.

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FIGURE 14.1 Schematic illustration of different types of muscles: (a) fusiform, (b) unipennate, and (c) bipennate.

14.1 The Structure and Function of Muscle

Muscles account for about 40% of the human mass, ranging from the small extraocular muscles that
turn the eyeball in its socket to the large limb muscles that produce locomotion and control posture.
The design of muscles varies depending on the range of motion and the force exerted (Fig. 14.1). In the
most simple arrangement (fusiform), parallel fibers extend the full length of the muscle and attach to
tendons at both ends. Muscles producing a large force have a more complicated structure in which many
short muscle fibers attach to a flat tendon that extends over a large fraction of the muscle. This arrange-
ment (unipennate) increases the cross-sectional area and thus the contractile force of the muscle. When
muscle fibers fan out from both sides of the tendon, the muscle structure is referred to as bipennate.
A lipid bilayer (sarcolemma) encloses the muscle fiber and separates the intracellular myoplasma from
the interstitial fluid. Between neighboring fibers runs a layer of connective tissue, the endomysium,
composed mainly of collagen and elastin. Bundles of fibers, fascicles, are held together by a thicker layer
of connective-tissue called the perimysium. The whole muscle is wrapped in a layer of connective tissue
called the epimysium. The connective tissue is continuous with the tendons attaching the muscle to the
skeleton.
In the myoplasma, thin and thick filaments interdigitate and form short, serially connected identical
units called sarcomeres. Numerous sarcomeres connect end to end, thereby forming longitudinal strands
of myofibrils that extend the entire length of the muscle fiber. The total shortening of a muscle during
contraction is the net effect of all sarcomeres shortening in series simultaneously. The individual sar-
comeres shorten by forming cross-bridges between the thick and thin filaments. The cross-bridges pull
the filaments toward each other, thereby increasing the amount of longitudinal overlap between the thick
and thin filaments. The dense matrix of myofibrils is held in place by a structural framework of inter-
mediate filaments composed of desmin, vimetin, and synemin [Squire, 1986].
At the site of the neuromuscular junction, each motor neuron forms collateral sprouts (Fig. 14.2) and
innervates several muscle fibers distributed almost evenly within an elliptical or circular region ranging
from 2 to 10 mm in diameter. The motor neuron and the muscle fibers it innervates constitute a functional
unit, the motor unit. The cross section of muscle occupied by a motor unit is called the motor unit
territory (MUT). A typical muscle fiber is only innervated at a single point, located within a cross-
sectional band referred to as the end-plate zone. While the width of the end-plate zone is only a few
millimeters, the zone itself may extend over a significant part of the muscle. The number of muscle fibers
per motor neuron (i.e., the innervation ratio) ranges from 3:1 in extrinsic eye muscles where fine-graded
contraction is required to 120:1 in some limb muscles with coarse movement [Kimura, 1981]. The fibers

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FIGURE 14.2 Innervation of muscle fibers. (a) Two normal motor units with intermingled muscle fibers.
(b) Reinnervation of muscle fibers. The second and fourth muscle fibers have lost their motor neuron (2) and
subsequently have become reinnervated by newly formed sprouts from the motor neuron (1) innervating adjacent
muscle fibers. Not drawn to scale.

of one motor unit are intermingled with fibers of other motor units; thus several motor units reside
within a given cross section. The fibers of the same motor unit are thought to be randomly or evenly
distributed within the motor unit territory; however, reinnervation of denervated fibers often results in
the formation of fiber clusters (see Fig. 14.2).

14.2 The Origin of Electromyograms

Unlike the myocardium, skeletal muscles do not contain pacemaker cells from which excitations arise
and spread. Electrical excitation of skeletal muscle is initiated and regulated by the central and peripheral
nervous systems. Motor neurons carry nerve impulses from the anterior horn cells of the spinal cord to
the nerve endings, where the axonal action potential triggers the release of the neurotransmitter acetyl-
choline (Ach) into the narrow clefts separating the sarcolemma from the axon terminals. As Ach binds
to the sarcolemma, Ach-sensitive sodium channels open, and miniature end-plate potentials arise in the
sarcolemma. If sufficient Ach is released, the summation of miniature end-plate potentials, i.e., the end-
plate potential, reaches the excitation threshold, and sarcolemma action potentials propagate in opposite
directions toward the tendons. As excitation propagates down the fiber, it spreads into a highly branched
transverse network of tubules (T system) which interpenetrate the myofibrils. The effective radial con-
duction velocity (~4 cm/s) is about two orders of magnitude slower than the longitudinal conduction
velocity (2 to 5 m/s). This is due to the fact that the main portion of the total membrane capacitance is
located in the T system and that the lumen of the T system constitutes a higher electrical resistance than
the myoplasma.
The slower tubular conduction velocity implies an increasingly delayed onset of tubular action poten-
tials toward the center of the fiber relative to that of the sarcolemmal action potential (Fig. 14.3a).
However, compared with the time course of the subsequent contraction, the spread of excitation along
and within the muscle fiber is essentially instantaneous, thereby ensuring simultaneous release of calcium
from the sarcoplasmic reticulum throughout the entire volume of the muscle. If calcium release were
restricted to a small longitudinal section of the muscle fiber, only sarcomeres in this region would contract,
and sarcomeres in the rest of the fiber would stretch accordingly. Similarly, experiments in detubulated
muscle fibers, i.e., fibers in which the continuation between the sarcolemmal and the tubular membrane
has been disrupted, have demonstrated that only a thin layer of superficial myofibrils contracts when
tubular action potentials fail to trigger calcium release deep in the muscle fiber.
It is well known that the shape of the skeletal muscle action potential differs from that of nerve action
potentials with regard to the repolarization phase. In skeletal muscle, the falling phase of the action

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FIGURE 14.3 Simulated sarcolemmal and tubular action potentials of frog sartorius muscle fiber. (a) Temporal
membrane action potentials calculated in a transverse plane 5 mm from the end-plate zone of a fiber with radius
a = 50 µm. Curve 1: Sarcolemmal action potential; curves 2 to 4: action potentials in tubular membrane patches at
r = a (2), r = a/2 (3), and r = a/20 (4). (b) Sarcolemmal action potentials for fibers with radius 70 (1), 50 (2), and
30 (3) µm. The time axes have been expanded and truncated.

potential is interrupted by a long, slowly decaying potential known as the afterpotential. This late potential
is caused by two opposing forces, the repolarization force due to the efflux of potassium through the
sarcolemma and a depolarization force due to an influx of current from the interstitial space into the
tubular lumen. The latter current is drawn in through the tubular openings by the repolarizing tubular
membrane. Large muscle fibers have a higher tubular-sarcolemma area ratio; hence the inward surge of
tubular current increases with fiber size. Figure 14.3b illustrates this by comparing sarcolemmal action
potentials for fibers of increasing diameter. The small fiber has only a small amount of tubular membrane;
hence the sarcolemmal potassium current has sufficient strength to rapidly repolarize the membrane.
For the large fiber, inward tubular current actually depolarizes the sarcolemma slightly during repolar-
ization of the tubular membrane system, thereby producing a small hump on the afterpotential. Since
the hump on the afterpotential is influenced primarily by fiber size, this feature is more typical for large
frog fibers than for smaller human fibers. Experiments have demonstrated that the sarcolemma action
potential of detubulated fibers hyperpolarizes in a manner similar to that of a nerve action potential.
In Fig. 14.4a, the time course of the sarcolemmal current density is compared with that of the current
passing through the tubular mouth during the time course of the sarcolemmal action potential. The
positive (outward) peak of the tubular current overlaps in time with the small capacitive sarcolemmal

FIGURE 14.4 Simulated currents and extracellular potentials of frog sartorius muscle fiber (radius a = 50 µm).
(a) The net fiber current density is the summation of the current density through the sarcolemma and that passing
the tubular mouth. (b) Extracellular action potentials calculated at increasing radial distances (in units of fiber radius)
using a bidomain volume conductor model and the net current source in panel a. The time axes have been expanded
and truncated.

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FIGURE 14.5 Schematic cross-sectional view of overlapping single-fiber action potential distributions in a normal
(a) and reinnervated (b) motor unit. Muscle fibers are represented by filled black circles. Concentric rings represent
axisymmetric isopotential lines of the individual single-fiber potentials at 2 (gray) and 5 radii from the fiber center,
respectively. Compare with radial decline of extracellular potentials in Fig. 14.4. See text for discussion of simplifying
assumptions.

displacement current (initial positive peak) and the negative peak (inward sarcolemmal sodium current).
As a result, the net current has a much larger positive peak than that of the sarcolemma alone, and the
negative peak of the net current is only about half that of the sarcolemmal current. The outward
sarcolemmal potassium current (late positive phase) is almost completely opposed by an antisymmetric
inward tubular current, i.e., the current drawn into the tubular lumen by the repolarizing T system. The
combined effect of the sarcolemmal and tubular interaction is a net current with an almost biphasic
waveform and with similar amplitudes of the positive and negative peaks.
As the net current source propagates toward the tendon, an extracellular potential field arises and
follows the action potential complex. At a given field point, this phenomenon is observed as a temporal
potential waveform (Fig. 14.4b); however, a more complete picture of the phenomenon is obtained by
considering the spatial distribution of potentials in the cross section of the motor unit. Figure 14.5 shows
schematically how the concentric isopotential lines of individual fibers overlap with those of other fibers
in the same motor unit. In a typical healthy motor unit (Fig. 14.5a), the mean interfiber distance is on
the order of a few hundred microns. Taking into account the steep radial decline of the potential
amplitudes illustrated in Fig. 14.4b, it is evident that single-fiber action potential (SFAP) overlapping
occurs between low-magnitude isopotential lines. Figure 14.5b illustrates how spatial overlapping between
SFAPs might look like in a motor unit with extensive fiber grouping. In this case, higher-level isopotential
lines overlap within the clusters, while regions with no fibers would appear as electrically silent.
Several factors ignored in Fig. 14.5 need further discussion. All fibers are assumed to be of the same
size and with identical, perfectly axisymmetric potential distributions. The net single-fiber current source
is an increasing function of fiber size; thus the magnitude of the potential distribution will vary with
varying fiber size. Fibers can to a good approximation be considered as constant current sources; hence
if the resistivity of the muscle tissue increases, e.g., due to increased fiber packing density, the potential
difference between an observation point and a reference point also will increase. It follows that local
variations in fiber packing density in the region of an active fiber will destroy the axisymmetric appearance
of its potential distribution. Muscle fibers are not perfect cylinders, and angular variation in the shape
of the sarcolemma must be expected to create angular variations in the potential distribution. However,
due to the relatively high conductivity of the volume conductor, it is plausible that such variations become
increasingly insignificant as the distance to the fiber is increased.

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 A very important factor not considered in Fig. 14.5 concerns the degree of longitudinal alignment of
SFAPs in the motor unit. As illustrated in Fig. 14.2, SFAPs are usually dispersed along the motor unit
axis, and their potential distributions do not sum up in a simple manner. SFAPs can be misaligned for
several reasons. The end plates are not aligned; hence some SFAPs originate ahead of others. Variations
in fiber size and packing density cause variations in conduction velocity; thus the dispersion of SFAPs
may actually increase with increasing distance from the end-plate zone. Neuropathologic conditions can
affect the alignment of SFAPs. Complete or partial failure of collateral nerve sprouts to conduct nerve
action potentials can abolish or delay the onset of action potentials, and immature sprouts formed during
reinnervation may cause significant variability (jitter) in the onset of muscle action potentials. Denervated
muscle fibers shrink; hence a newly reinnervated muscle fiber is likely to have a slower conduction velocity.
An increased dispersion of SFAPs creates a very complex and irregular spatial potential distribution. The
superimposed temporal potential waveform in a fixed observation point, i.e., the motor unit potential
(MUP), is therefore comprised of several peaks rather than a simple bi- or triphasic waveform. MUPs
with five or more peaks are classified as polyphasic. A satellite potential is an SFAP that is so misaligned
from the main potential complex that its waveform is completely separated from the MUP.

14.3 Electromyographic Recordings

A considerable amount of information regarding the bioelectrical state of a muscle is hidden in the time-
varying spatial distribution of potentials in the muscle. Unfortunately, it is not clinically feasible to obtain
high-resolution three-dimensional samples of the spatial potential distribution, since this would require
the insertion of hundreds of electrodes into the muscles. In order to minimize the discomfort of the
patient, routine EMG procedures usually employ only a single electrode that is inserted into different
regions of the muscle. As the SFAPs of an active motor unit pass by the electrode, only their summation,
i.e., the MUP, will be registered by the electrode. The electrode is effectively integrating out the spatial
information hidden in the passing potential complex, leaving only a time-variant potential waveform to
be recorded and interpreted. It goes without saying that such a constraint on the recording procedure
puts the electromyographist at a considerable disadvantage. To partially circumvent this setback, technical
innovations and new procedures have continued to refine EMG examinations to such a level that some
of the spatial information originally obscured by the electrode can be extracted intuitively from the
temporal waveforms by an experienced electromyographist. With a detailed understanding of the bio-
electric principles involved, e.g., the bioelectric sources, the volume conductor, and the recording prop-
erties of the electrode, the electromyographist can quickly recognize and explain the waveform
characteristics associated with various neuromuscular abnormalities.
To increase the amount of diagnostic information, several sets of EMG investigations may be performed
using electrodes with different recording characteristics. Figure 14.6 illustrates three of the most popular
EMG needle electrodes. The concentric and monopolar electrodes have an intermediate pickup range
and are used in conventional recordings. The single-fiber electrode is a more recent innovation. It has a
very small pickup range and is used to obtain recordings from only one or two muscle fibers. The macro
electrode, which is the cannula of either the concentric or single-fiber electrode in combination with a
remote reference electrode, picks up potentials throughout the motor unit territory. This section will
review these EMG electrodes, the waveforms they produce, and the signal analysis performed in each case.

Concentric Electrode EMG

Adrian and Bronk developed the concentric electrode (see Fig. 14.6) in order to obtain a pickup range
that is smaller than that of wire electrodes. The modern version of the concentric electrode consists of
a platinum or stainless steel wire located inside the lumen of a stainless steel cannula with an outer
diameter of about 0.5 mm. The tip is beveled at 15 to 20 degrees, thereby exposing the central wire as
an oblique elliptical surface of about 150 × 580 µm. The central wire is insulated from the cannula with
araldite or epoxy.

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FIGURE 14.6 Needle electrodes for subcutaneous EMG recordings. For the single-fiber and concentric electrodes,
the cannula of the hypodermic needle acts as reference electrode. The monopolar electrode is used with a remote
reference electrode.

The concentric electrode is connected to a differential amplifier; thus common-mode signals are
effectively rejected, and a relatively stable baseline is achieved. The cannula cannot be regarded as an
indifferent reference electrode because it is located within the potential distribution and thus will pick
up potentials from active fibers. Simulation studies [Henneberg and Plonsey, 1993] have shown that the
cannula shields the central wire from picking up potentials from fibers located behind the tip. The
sensitivity of the concentric electrode is therefore largest in the hemisphere facing the oblique elliptical
surface. Due to the asymmetric sensitivity function, the waveshape of the recorded potentials will vary
if the electrode is rotated about its axis. This problem is not observed with the axisymmetric monopolar
electrode; however, this electrode has a more unstable baseline due to the remote location of the reference
electrode. Both the concentric and monopolar electrodes (see Fig. 14.6) are used in conventional EMG.
Because of the differences in recording characteristics, however, concentric and monopolar recordings
cannot be compared easily. A particular EMG laboratory therefore tends to use the one and not the other.
During the concentric needle examination, the investigator searches for abnormal insertional activity,
spontaneous activity in relaxed muscles, and motor unit potentials with abnormal appearance. The
waveshape of motor unit potentials is assessed on the basis of the quantitative waveform features defined
in Fig. 14.7:
• Amplitude is determined by the presence of active fibers within the immediate vicinity of the
electrode tip. Low-pass filtering by the volume conductor attenuates the high-frequency spikes of
remote SFAPs; hence the MUP amplitude does not increase for a larger motor unit. However,
MUP amplitude will increase if the tip of the electrode is located near a cluster of reinnervated
fibers. Large MUP amplitudes are frequently observed in neurogenic diseases.
• Rise time is an increasing function of the distance between the electrode and the closest active
muscle fiber. A short rise time in combination with a small MUP amplitude might therefore
indicate that the amplitude is reduced due to fiber atrophy rather than to a large distance between
the electrode and the closest fiber.
• Number of phases indicates the complexity of the MUP and the degree of misalignment between
SFAPs. In neurogenic diseases, polyphasic MUPs arise due to slow conduction velocity in immature
nerve sprouts or slow conduction velocity in reinnervated but still atrophied muscle fibers. Vari-
ation in muscle fiber size also causes polyphasic MUPs in myopathic diseases. To prevent noisy
baseline fluctuations from affecting the count of MUP phases, a valid baseline crossing must exceed
a minimum absolute amplitude criterion.

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FIGURE 14.7 Definition of quantitative waveform features of MUPs recorded with a concentric EMG electrode.
MUP area is defined as the rectified area under the curve in the interval between the onset and end. The number of
MUP phases is defined as the number of baseline crossings () plus one. MUP turns are marked by a . MUP rise
time is the time interval between the 10% and 90% deflection () of the main negative-going slope. As by convention,
negative voltage is displayed upward.

• Duration is the time interval between the first and last occurrence of the waveform exceeding a
predefined amplitude threshold, e.g., 5 µV. The MUP onset and end are the summation of low-
frequency components of SFAPs scattered over the entire pickup range of the electrode. As a result,
the MUP duration provides information about the number of active fibers within the pickup
range. However, since the motor unit territory can be larger than the pickup range of the electrode,
MUP duration does not provide information about the total size of a large motor unit. MUP
duration will increase if a motor unit has an increased number of fibers due to reinnervation.
MUP duration is affected to a lesser degree by SFAP misalignment.
• Area indicates the number of fibers adjacent to the electrode; however, unlike MUP amplitude,
MUP area depends on MUP duration and is therefore influenced by fibers in a larger region
compared with that of MUP amplitude.
• Turns is a measure of the complexity of the MUP, much like the number of phases; however, since
a valid turn does not require a baseline crossing like a valid phase, the number of turns is more
sensitive to changes in the MUP waveshape. In order to distinguish valid turns from signal noise,
successive turns must be offset by a minimum amplitude difference.

Based on the complimentary information contained in the MUP features defined above, it is possible
to infer about the number and density of fibers in a motor unit as well as the synchronicity of the SFAPs.
However, the concentric electrode is not sufficiently selective to study individual fibers, nor is it sufficiently
sensitive to measure the total size of a motor unit. The following two techniques were designed with
these objectives in mind.

Single-Fiber EMG
The positive lead of the single-fiber electrode (see Fig. 14.6) is the end cap of a 25-µm wire exposed
through a side port on the cannula of a steel needle. Due to the small size of the positive lead, bioelectric
sources, which are located more than about 300 µm from the side port, will appear as common-mode
signals and be suppressed by the differential amplifier. To further enhance the selectivity, the recorded
signal is high-pass filtered at 500 Hz to remove low-frequency background activity from distant fibers.
Due to its very small pickup range, the single-fiber electrode rarely records potentials from more than
one or two fibers from the same motor unit. Because of the close proximity of the fibers, potentials are
of large amplitudes and with small rise times. When two potentials from the same motor unit are picked
up, the slight variation in their interpotential interval (IPI) can be measured (Fig. 14.8). The mean IPI

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FIGURE 14.8 Measurement of interpotential interval (IPI) between single-fiber potentials recorded simultaneously
from two fibers of the same motor unit.

(jitter) is normally 5 to 50 µs but increases when neuromuscular transmission is disturbed. When the
single-fiber electrode records potentials from an increased number of fibers, it usually indicates that the
side port is close to either a cluster of fibers (reinnervation) or that the positive lead is close to fibers in
the process of splitting.

Macro EMG
For this electrode, the cannula of a single-fiber or concentric electrode is used as the positive lead, while
the reference electrode can be either a remote subcutaneous or remote surface electrode. Due to the large
lead surface, this electrode picks up both near- and far-field activity. However, the signal has very small
amplitude, and the macro electrode must therefore be coupled to an electronic averager. To ensure that
only one and the same MUP is being averaged, the averager is triggered by a SFAP picked up from that
motor unit by the side port wire of the single-fiber electrode or by the central wire of the concentric
electrode. Since other MUPs are not time-locked to the triggering SFAP, they will appear as random
background activity and become suppressed in the averaging procedure. Quantitative features of the
macro MUP include the peak-to-peak amplitude, the rectified area under the curve, and the number of
phases.

Defining Terms
Concentric electrode EMG: Registration and interpretation of motor unit potentials recorded with a
concentric needle electrode.
Electromyograms (EMGs): Bioelectric potentials recorded in muscles.
Jitter: Mean variation in interpotential interval between single-fiber action potentials of the same motor
unit.
Macro EMG: The registration of motor unit potentials from the entire motor unit using the cannula
of the single-fiber or concentric electrode.
Motor unit: The functional unit of an anterior horn cell, its axon, the neuromuscular junctions, and
the muscle fibers innervated by the motor neuron.
Motor unit potential (MUP): Spatial and temporal summation of all single-fiber potentials innervated
by the same motor neuron. Also referred to as the motor unit action potential (MUAP).
Motor unit territory (MUT): Cross-sectional region of muscle containing all fibers innervated by a
single motor neuron.
Satellite potential: An isolated single-fiber action potential that is time-locked with the main MUP.
Single-fiber action potential (SFAP): Extracellular potential generated by the extracellular current flow
associated with the action potential of a single muscle fiber.
Single-fiber EMG (SFEMG): Recording and analysis of single-fiber potentials with the single-fiber
electrode.

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References
Henneberg K, Plonsey R. 1993. Boundary element analysis of the directional sensitivity of the concentric
EMG electrode. IEEE Trans Biomed Eng 40:621.
Kimura J. 1981. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. Philadelphia,
FA Davis.
Squire J. 1986. Muscle: Design, Diversity and Disease. Menlo Park, Calif, Benjamin/Cummings.

Further Information
Barry DT. 1991. AAEM minimonograph no. 36: Basic concepts of electricity and electronics in clinical
electromyography. Muscle Nerve. 14:937.
Buchthal F. 1973. Electromyography. In Handbook of Electroencephalography and Clinical Neurophys-
iology, vol 16. Amsterdam, Elsevier Scientific.
Daube JR. 1991. AAEM minimonograph no. 11: Needle examination in clinical electromyography. Muscle
Nerve 14:685.
Dumitru D, DeLisa JA. 1991. AAEM minimonograph no. 10: Volume conduction. Muscle Nerve 14:605.
Stålberg E. 1986. Single fiber EMG, macro EMG, and scanning EMG: New ways of looking at the motor
unit. CRC Crit Rev Clin Neurobiol. 2:125.

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