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The Effect of Sternocleidomastoid Muscle Activation Pattern and Feedback Condition on the Vestibular Evoked Myogenic Potential." (2010)

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The Effect of Sternocleidomastoid Muscle Activation Pattern and Feedback Condition on the Vestibular Evoked Myogenic Potential. East Tennessee State University Digital Commons @ East Tennessee State University Electronic Theses and Dissertations Student Works 12-2010 The ffecE t of Sternocleidomastoid Muscle Activation Pattern and Feedback Condition on the Vestibular Evoked Myogenic Potential. Mary Jo Davenport East Tennessee State University Follow this and additional works at: https://dc.etsu.edu/etd Part of the Investigative Techniques Commons Recommended Citation Davenport, Mary Jo, "The Effect of Sternocleidomastoid Muscle Activation Pattern and Feedback Condition on the Vestibular Evoked Myogenic Potential." (2010). Electronic Theses and Dissertations. Paper 1776. https://dc.etsu.edu/etd/1776 This Dissertation - Open Access is brought to you for free and open access by the Student Works at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact [email protected]. The Effect of Sternocleidomastoid Muscle Activation Pattern and Feedback Condition on the Vestibular Evoked Myogenic Potential ___________________ A dissertation presented to the faculty of the Department of Anatomy and Cell Biology East Tennessee State University In partial fulfillment of the requirements for the degree Doctor of Philosophy in Biomedical Sciences ___________________ by Mary Jo Davenport December 2010 ___________________ Committee Chair, Owen Murnane, PhD Committee Co-Chair, Ronald Baisden, PhD Faith Akin, PhD Uta Schambra, PhD Mike Woodruff, PhD Keywords: Vestibular, Otolith, Saccular, Sound ABSTRACT The Effect of Sternocleidomastoid Muscle Activation Pattern and Feedback Condition on the Vestibular Evoked Myogenic Potential by Mary Jo Davenport The vestibular evoked myogenic potential (VEMP) has been shown to be clinically useful in providing diagnostic information regarding the function of the otolith receptors, inferior vestibular nerve, and vestibulospinal pathways. The VEMP is a biphasic response elicited by loud clicks or tone bursts and recorded from the tonically contracted sternocleidomastoid (SCM) muscle. Because the VEMP is an inhibitory response, it is important to investigate stimulus and parameter characteristics in order to determine the optimal test protocol and maximize clinical usefulness. The aims of this study were 1) to evaluate the effects of 4 different methods of SCM muscle activation and the effect of visual biofeedback on VEMP latency, amplitude, asymmetry ratio, mean rectified EMG level, and difficulty ratings, and 2) to determine the influence of SCM muscle activation pattern and visual biofeedback level on test- retest reliability. Forty-eight healthy volunteers between the ages of 18 and 50 underwent VEMP testing using each of the following muscle activation patterns: supine with the head raised (SE), supine with the head turned away from the test ear (SR), supine with the head raised and turned away from the test ear (SER), and sitting with the head turned away from the test ear (SitR). Testing subjects with the SER method yielded the most robust amplitude response and sternocleidomastoid EMG activity. No statistically significant differences were found in interaural asymmetry ratios among the 4 methods of SCM activation. Subjects rated 2 the SE and SER methods as more difficult than the SE and SitR methods at each of the 3 target levels. Test-retest reliability was high for P1/N1 amplitude and mean rectified EMG levels when subjects were provided visual biofeedback to monitor the level of tonic SCM muscle activity. The study demonstrates the importance of providing patients a means of monitoring and maintaining the amplitude of the rectified EMG at a constant target level during SCM muscle activation. Although no evidence to reject or strongly favor a specific method was found, monaural-ipsilateral recording with the SitR method was found to be advantageous for individuals with weakness or decreased endurance for sustained muscle contraction. 3 ACKNOWLEDGMENTS I would like to first and foremost express my sincerest gratitude to my advisor and mentor, Dr. Owen Murnane, for his invaluable guidance and support throughout my graduate career. I would also like to thank Dr. Faith Akin for her continual guidance and insights from project beginning to end. This dissertation would not have been possible without the two of them. I consider myself fortunate to have had the opportunity to work with such highly gifted, knowledgeable, and respected members of the field. I would also like to acknowledge my co- Chair, Dr. Ron Baisden, for his continual mentoring and guidance not only in how to become a good researcher but how to master the art of teaching. Heartfelt gratitude and special thoughts go to Dr. Mike Woodruff and to the late Dr. Barney Miller for their unwavering support and guidance throughout this lengthy process. A very special thank you goes to Dr. Uta Schambra for coming on board at the last minute and working so diligently to familiarize herself with the project and provide helpful insights toward its improvement. I am forever grateful to Dr. Kip Kelly for his intellectual insights and his patience and kindness in coming to my rescue when technical issues threatened to take me down. A tremendous appreciation is given to my colleagues in the College of Clinical and Rehabilitative Sciences at ETSU. Their friendship and encouragement has given me the confidence to complete my research and move forward in my professional and personal endeavors. I offer my thanks and blessings to all of those wonderful friends and colleagues who supported me in any respect throughout this process. 4 Finally, words alone cannot express the love and thanks I give to my late husband, Rod, and to my children, Jolene, Tim, Sean, Scott, Cherub, Aaron, and Stephanie for their encouragement, support, and assistance. And last of all but far from the least, to the joys of my life, Liam and Logan - don’t ever give up on a dream, no matter how long it might take. 5 CONTENTS ABSTRACT………..………….….……………………………………………………………………………………………………..….2 LIST OF TABLES….……………………………………………………………………………………………………………………...9 LIST OF FIGURES.……………………………………………………………..……………………………………………………...10 ABBREVIATIONS……………….…………………….…………….………..……………………………………………………….12 Chapter 1. INTRODUCTION..…………………………………….…………………….……………………………………..…..13 2. LITERATURE REVIEW……………………………………………………………….…………………………..…..17 Basic Anatomy and Physiology of the Vestibular System…………………………………..17 Assessment of Vestibular Function……………………………………………………………………20 Historical Framework of the VEMP……………………………………………..…………………….22 Neurophysiological Bases of VEMP……………………………………………….………………….24 Anatomical Pathway……………………………………………………………………….………………..29 Measurement Techniques……………………………………………………………….……………….35 Activation of the SCM Muscle……………………………………………….………………37 Response Laterality……………………………………………………………….………………40 EMG Monitoring Techniques………………………………………………….……………..43 Normal Response Characteristics……………………………………………………….…………….44 Nonpathological Factors………………………………………………………………….……………….47 Stimulus………………………………………………………………………………………………..47 EMG Level……………………………………………………………………………….…………….49 Gender Effects………………………………………………………………………………………49 Aging Effects………………………………………………………………………………………...49 6 Clinical Applications………………………………………………………………………………………….54 3. METHODS…………………………………………………………………………………………………………………61 Participants………………………………………………………………………………………………………61 Stimulus and Recording Parameters…………………………………………………………………62 Experiment 1…………………………………………………………………………………………………….65 Experiment 2…………………………………………………………………………………………………….66 Data Analysis…………………………………………………………………………………………………….69 4. RESULTS……………………………………………………………………………………………………………………70 Experiment 1: Effect of SCM Activation Method on SCM EMG Level, VEMP Amplitude, Latency, and Perceived Difficulty Rating…………………….70 Mean Rectified EMG Measures……………………………………………………………..75 P1/N1 Amplitude Measures………………………………………………………………….82 Self-Perceived Level of Difficulty…………………………………………………………..87 P1 and N1 Latency Measures………………………………………………………………..89 Experiment 1: Test-Retest Reliability………………………………………………………………..97 P1/N1 Amplitudes…………………………………………………………………………………98 P1 and N1 latencies……………………………………………………………….……………101 Mean Rectified EMG Values………………………………………………………………..106 Self-Perceived Difficulty Ratings………………………………………………………….109 Experiment 2: Effect of SCM Activation Method on VEMP Asymmetry Ratio………………………………………………………………………………….…………113 5. DISCUSSION…………..………………………………………………………………………………………………116 Effect of Visual Biofeedback on EMG Levels…………………………………………………...117 Effect of SCM Muscle Activation Method and Feedback Condition on Amplitude Measures………………………………………………………………………………….121 7 Effect of SCM Muscle Activation Method and Feedback Condition on Perceived Difficulty Ratings……………………………………………………………………….125 Effect of SCM Muscle Activation Method and Feedback Condition on Asymmetry Measures………………………………………………………………………….…….129 Effect of SCM Muscle Activation Method and Feedback Condition on Latency Measures……………………………………………………………………………….……..134 P1 Latency…………………………………………………………………………………………..134 N1 Latency……………………………………………..…………………………………………..135 Overall Summary of the Influence of SCM Muscle Activation Method and Target EMG Level on the VEMP Response………………………………….138 Test-Retest Reliability………………………………………………………………………….………….139 Test-Retest Reliability of Amplitude Measures……………………………………140 Test-Retest Reliability of Latency Measures………………………………………..143
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