10 PP.pmd

Original Article / œ·¡œ›r˜œo Œ´
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2551; 18(3): 105-108
J Thai Rehabil Med 2008; 18(3): 105-108
„µ¦«¹„¬µ¨´„¬–³…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê ×¥Á…Ȥ
œ·—…´ªÊ Á—¸¥É ª
¦nŠ» š·¡¥r ͇š¦­·œ ¡..
„¨n¤» ŠµœÁª«µ­˜¦r¢œg ¢¼ 抡¥µµ¨Á¨·—­·œ „¦¤„µ¦Â¡š¥r „¦³š¦ªŠ­µ›µ¦–­»…
ABSTRACT
Characteristics of motor unit action
potentials (MUAPs) by monopolar
needles
Chokpraisin R.
Rehabilitation Medicine Division,
Lerdsin General Hospital, Department
of Health Service, Ministry of Public
Health
Objectives: To determine the electromyographic characteristics of MUAPs
by monopolar needles and to compare
them with normal data from foreign
studies.
Subjects: Forty-four healthy volunteers,
22 males and 22 females with mean
age of 39 years, working at Lerdsin
General Hospital
Methods: By using the monopolar
needles, amplitudes, durations and
phases of MUAPs of abductor digiti
minimi (ADM), deltoid, biceps brachii,
extensor digitorum communis (EDC)
and tibialis anterior (TA) muscles on
the right side were collected and
compared with normal data from other
studies.
Results: Most of the subjects were
non-regular exercisers and righthanded. When compared with the
foreign data, the amplitudes of MUAPs
in our subjects were significantly 2-3
times less in all muscles except of
Correspondence to: Dr. Rungtip
Chokpraisin, Rehabilitation Medicine
Division, Lerdsin General Hospital, Silom
road, Bangrak, Bangkok, 10500.
E–mail : [email protected]
biceps brachii muscles. Regarding
durations and phases, results were
nearly the same.
Conclusion: The characteristics of
MUAPs by monopolar needles in
healthy Thai population were the
same as those reported in foreign
studies except amplitudes which were
2-3 times smaller in all muscles.
Keywords: electromyography, motor
unit action potentials, monopolar
needles, normal data
J Thai Rehabil Med 2008; 18(3): 105-108
š‡´—¥n°
ª´˜™»ž¦³­Š‡r: Á¡º°É «¹„¬µ¨´„¬–³®œnª¥
‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ° (motor unit
action potentials, MUAPs) š¸Éŗo‹µ„
„¨oµ¤Áœº°Ê …°Š°µ­µ­¤´‡¦š¸žÉ „˜·Ã—¥ÄoÁ…Ȥ
œ·—…´ªÊ Á—¸¥É ª ¨³Áž¦¸¥Áš¸¥„´‡nµž„˜·
…°Š˜nµŠž¦³Áš«
¦¼žÂ„µ¦ª·‹¥´ : „µ¦ª·‹¥´ Á·Š¡¦¦–œµ
­™µœš¸É š¶„µ¦ª· ‹´ ¥ : „¨n» ¤ ŠµœÁª«µ­˜¦r¢œg ¢¼ 抡¥µµ¨Á¨·—­·œ
„¨n»¤ž¦³µ„¦: °µ­µ­¤´‡¦‹¶œªœ 44
¦µ¥ Áž}œµ¥ 22 ¦µ¥ ¨³®·Š 22 ¦µ¥
Ž¹ŠÉ Áž}œÁ‹oµ®œoµš¸ÃÉ ¦Š¡¥µµ¨Á¨·—­·œ¤¸°µ¥»
ÁŒ¨¸É ¥ 39 že ­» … £µ¡Â…È Š ¦ŠÂ¨³Å¤n ¤¸
懚µŠ¦³ž¦³­µš
ª· ›¸ „ µ¦«¹ „ ¬µ: čo°·Á¨È„Ú¦—œ·—Á…Ȥ
…´Ê ª Á—¸É ¥ ª «¹ „ ¬µ®œn ª ¥‡¨ºÉ œ Å¢¢j µ ‹µ„
„¨o µ ¤ÁœºÊ ° ‹µ„„¨o µ ¤ÁœºÊ ° Ž¸ „ …ªµ…°Š
¦nµŠ„µ¥‹¶œªœ 5 ¤´— ŗo„n „¨oµ¤ÁœºÊ°
abductor digiti minimi, deltoid, biceps
brachii, extensor digitorum communis
¨³ tibialis anterior ×¥ª´—°¤¡¨·‹—¼
- 105 -
‡ªµ¤„ªo µ Šn ª Š‡¨ºÉ œ ¨³‹¶œªœÁ¢­
®µ‡n µ ÁŒ¨¸É ¥ ¨³‡n µ Á¸É ¥ ŠÁœ ‹µ„œ´Ê œ
Áž¦¸¥Áš¸¥„´‡nµž„˜·š¦¸É µ¥Šµœ‹µ„˜nµŠ
ž¦³Áš«
Ÿ¨„µ¦«¹ „ ¬µ: °µ­µ­¤´ ‡ ¦­n ª œÄ®n
™œ´—…ªµ š¶Šµœ®œ´„ ˜n°°„„¶¨´Š„µ¥
Ťn­¤É¶Á­¤° ¡ªnµ¨´„¬–³…°Š®œnª¥
‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ°‹µ„„¨oµ¤ÁœºÊ°
š´ÊŠ 5 ¤´— ¤¸…œµ—°¤¡¨·‹¼—Á¨È„„ªnµš¸É
¦µ¥Šµœ‹µ„˜nµŠž¦³Áš« 2-3 Ášnµ ¥„Áªoœ
‹µ„„¨oµ¤ÁœºÊ° biceps brachii Ášnµœ´Êœ
­n ª œ‡ªµ¤„ªo µ Šn ª Š‡¨ºÉ œ ¨³‹¶œªœ
Á¢­œ´œÊ ¤¸‡µn Ą¨oÁ‡¸¥Š„´œ
­¦»ž: Á¤ºÉ°Äo°·Á¨È„Ú¦—œ·—Á…Ȥ…´ÊªÁ—¸É¥ª
´œš¹„®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê ¡ªnµ
°¤¡¨·‹—¼ …°Š‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê …°Š
°µ­µ­¤´‡¦‡œÅš¥ž„˜·¤…¸ œµ—Á¨È„„ªnµ…°Š
˜nµŠž¦³Áš« ­nªœ‡ªµ¤„ªoµŠnªŠ‡¨ºœÉ ¨³
‹¶œªœÁ¢­œ´œÊ ¤¸‡µn Ą¨oÁ‡¸¥Š„´…°Š˜nµŠž¦³Áš«
‡¶­¶‡´  : ‡¨ºÉ œ Å¢¢j µ ‹µ„„¨o µ ¤ÁœºÊ ° ,
®œnª¥‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ°, °·Á¨È„Ú¦—œ·—Á…Ȥ…´ªÊ Á—¸¥É ª, ‡nµž„˜·
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2551; 18(3): 105-108
šœ¶
Å¢¢jµª·œ‹· Œ´¥ ®¦º° electrodiagnosis
Áž}œ„µ¦ž¦³¥»„˜rž¦³­µš­¦¸¦ª·š¥µ¤µÄo
šµŠ‡¨·œ„· Á¡º°É ˜¦ª‹„µ¦š¶Šµœ nª¥ª·œ‹· Œ´¥
Ä®o „ µ¦¡¥µ„¦–r à ¦‡Â¨³¡¥µ›· ­ £µ¡
š¸ÉÁ„·—„´¦³ž¦³­µšÂ¨³/®¦º°„¨oµ¤Áœº°Ê (1) ×¥š´ªÉ Ş „µ¦˜¦ª‹„µ¦š¶Šµœ…°Š
¦³ž¦³­µš­nªœž¨µ¥¦ª¤š´ŠÊ „¨oµ¤Áœº°Ê
(lower motor neuron) ž¦³„°—oª¥„µ¦
˜¦ª‹„µ¦´„œ¶ž¦³­µšÃ—¥„µ¦„¦³˜o»œ
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2551; 18(3)
Á­oœž¦³­µš—oª¥Å¢¢jµ (nerve conduction study) ¨³„µ¦Äo°Á· ¨È„Ú¦—¦´‡¨ºœÉ
Å¢¢j µ ‹µ„„¨o µ ¤ÁœºÊ ° (electromyography) Ž¹ÉŠÄo°·Á¨È„Ú¦—œ·—Á…Ȥ´œš¹„
‡¨ºœÉ Å¢¢jµ—´Š„¨nµª ¨³Á…Ȥš¸œÉ ¥· ¤ÄošµŠ
‡¨·œ„· œ·¥¤¤¸ 2 œ·— ‡º° 1) œ·—¤µ˜¦“µœ
coaxial concentric Ž¹ÉŠ¤¸…´Êª¦´ (active
electrode) ‡¨ºœÉ Å¢¢jµ°¥n˜¼ ¦Š„¨µŠ ­nªœ
ž¨µ¥…°Š˜´ªÁ…Ȥš¶®œoµš¸ÉÁž}œ…´Êª°oµŠ°·Š
(reference electrode) ¨³ 2) œ·—
monopolar ®¦º°Á…Ȥœ·—…´ªÊ Á—¸¥É ª Ž¹ŠÉ Áž}œ
Á…È ¤ ˜´ œ š¶‹µ„­Â˜œÁ¨­ Á‡¨º ° —o ª ¥
Áš¢¨°œ ­nªœž¨µ¥Áž¨º°¥š¶®œoµš¸ÁÉ ž}œ
…´Êª¦´ ­nªœ…´Êª°oµŠ°·ŠÁž}œ°·Á¨È„Ú¦—œ·—
Ÿnœ˜·—š¸ŸÉ ª· ®œ´Š Ĝž¦³Áš«Åš¥œ´œÊ ¡š¥r
Áª«µ­˜¦r¢gœ¢¼œ·¥¤ÄoÁ…Ȥœ·—…´ÊªÁ—¸É¥ª
Ž¹ŠÉ ¤¸…°o —¸‡°º ¦µ‡µÅ¤n¡Š ¨³Ÿo™¼ „¼ ˜¦ª‹
¦o­¼ „¹ Á‹Èœo°¥„ªnµ(2,3)
š¸ÉŸnµœ¤µ ¥´ŠÅ¤n¤¸¦µ¥Šµœ„µ¦«¹„¬µ
¨´„¬–³…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê
®¦º ° motor unit action potentials
(MUAPs) …°Š‡œž„˜·Äœž¦³Áš«Åš¥
š¶Ä®o‡¨·œ„· Å¢¢jµª·œ‹· Œ´¥˜nµŠ Ç ˜o°Š°µ«´¥
‡nµž„˜·šÅ¸É —o‹µ„˜nµŠž¦³Áš« —´Šœ´œÊ Á¡º°É
Ä®o ¤¸ ‡n µ ž„˜· … °Š®œn ª ¥‡¨ºÉ œ Å¢¢j µ ‹µ„
„¨oµ¤ÁœºÊ° Ÿo¼ª·‹´¥‹¹Š«¹„¬µ¨´„¬–³®œnª¥
‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ°…°Š°µ­µ­¤´‡¦
ž„˜·ŽŠ¹É …o°¤¼¨š¸ÅÉ —o°µ‹Áž}œ˜´ªÂšœ‡nµž„˜·
…°Š‡œÅš¥Â¨³­µ¤µ¦™ÄoÁž}œÁ„–”rªn ¥
ª·œ‹· Œ´¥Ã¦‡Â¨³¡¥µ›·­£µ¡…°Š¦³ž¦³­µš
¨³„¨oµ¤Áœº°Ê Ä®oŗo™„¼ ˜o°Š¥·ŠÉ …¹œÊ
ª·›„¸ µ¦«¹„¬µ
„¨n¤» ž¦³µ„¦
°µ­µ­¤´‡¦Ž¹ŠÉ Áž}œÁ‹oµ®œoµš¸ÃÉ ¦Š¡¥µµ¨Á¨·—­·œš¸¥É œ· ¥°¤Á…oµ¦nª¤„µ¦ª·‹¥´ ‹¶œªœ
44 ¦µ¥ Áž}œµ¥ 22 ¦µ¥ ®·Š 22 ¦µ¥
Á„–”r„µ¦‡´—Á…oµ
- Ťn¤Ã¸ ¦‡ž¦³‹¶˜´ªšµŠ¦³ž¦³­µš
- „¶¨´Š„¨oµ¤Áœº°Ê °¥nļ œÁ„–”rž„˜·
Á„–”r„µ¦‡´—°°„
- ¤¸ž¦³ª´˜Å· —o¦´ „µ¦µ—Á‹È¦·Áª–
…œ…µ…ªµ
J Thai Rehabil Med 2008; 18(3)
- ¤¸£µª³Á¨º°—°°„Ťn®¥»—®¨´Š¤¸
µ—Ÿ¨
Á„–”r¥»˜·„µ¦«¹„¬µ
- …°™°œ˜´ª…–³š¶„µ¦«¹„¬µ
Á‡¦º°É Š¤º°Â¨³°»ž„¦–r
- Á‡¦º°É Š˜¦ª‹„¨oµ¤Áœº°Ê ¨³Á­oœž¦³­µš
—oª¥Å¢¢jµ ¥¸®É °o Medelec ¦nœ»
Synergy T5EP
- °· Á ¨È „ Ú¦—Á…È ¤ œ· — …´Ê ª Á—¸É ¥ ª
­¶®¦´˜¦ª‹‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ°
¥¸®É °o TECA ¡ºœÊ Ÿ·ª¦´­´µ–Å¢¢jµ
500 ˜µ¦µŠÅ¤Ã‡¦¤·¨¨·Á¤˜¦ ‡ªµ¤¥µª
27 ¨³ 35 ¤·¨¨·Á¤˜¦
…´œÊ ˜°œ„µ¦ª·‹¥´
- ´œš¹„…o°¤¼¨ž¦³ª´˜· …o°¤¼¨š´ÉªÅž…°Š
°µ­µ­¤´‡¦ ŗo„n°µ¥» Á¡« °µ¸¡
„µ¦°°„„¶¨´Š ¤º°™œ´—
- čoަ„¦¤ Multi MUP ´œš¹„®œnª¥
‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ° ×¥˜´ÊŠ‡nµ
band pass filter Áž}œ 20 Hz – 10
KHz(4)
- ž{„Á…Ȥš¸„É ¨oµ¤Áœº°Ê 5 ¤´—‡º° abductor
digiti minimi (ADM), deltoid, biceps
brachii, extensor digitorum communis (EDC) ¨³„¨oµ¤Áœº°Ê tibialis
anterior (TA) ¦·Áª–—oµœ…ªµ…°Š
°µ­µ­¤´ ‡ ¦ ×¥°µ«´ ¥ ˜¶Â®œn Š š¸É
°oµŠ°·ŠÄœ®œ´Š­º°‡n¼¤º° Anatomical
Guide for The Electromyographer(5)
¨³˜·—…´Êª°·Á¨È„Ú¦—°oµŠ°·Š®nµŠ‹µ„
Á…Ȥ 1 ÁŽœ˜·Á¤˜¦
- Ä®o°µ­µ­¤´‡¦°°„¦ŠÁ„¦ÈŠ„¨oµ¤ÁœºÊ°
Áµ Ç (minimal voluntary contraction) ¨oª´œš¹„ MUAPs‹¶œªœ 2-6
˜´ª˜n°„¨oµ¤ÁœºÊ° 1 ¤´— ¨oª¦ª¦ª¤
…o°¤¼¨¡µ¦µ¤·Á˜°¦r˜µn Š Ç …°Š MUAP
(6,7,8)
(—¼¦¼žš¸É 1) ŗo„n °¤¡¨·‹¼—
(amplitude) Ž¹ŠÉ ª´—‹µ„‹»—­¼Š­»—™¹Š‹»—
˜É¶ ­» — …°Š‡¨ºÉ œ ¤¸ ® œn ª ¥Áž} œ ŤÇ¦
ꨚr®¦º°¤·¨¨·Ãª¨šr, ‡ªµ¤„ªoµŠnªŠ
‡¨ºœÉ (duration) Ž¹ŠÉ ª´—‹µ„‹»—Á¦·¤É ˜oœ
™¹ Š ‹» — ­·Ê œ ­» — …°Š‡¨ºÉ œ ¤¸ ® œn ª ¥Áž} œ
¤·¨¨·ªœ· µš¸ ‹¶œªœÁ¢­ (phases) ¨³
¦o°¥¨³…°Š‹¶œªœ®œnª¥‡¨ºÉœÅ¢¢jµ
‹µ„„¨oµ¤ÁœºÊ°œ·—ᨸÁ¢­·„ (polyphasic potentials) Ž¹ŠÉ ¤¸‹¶œªœÁ¢­
¤µ„„ªnµ 4 Á¢­…¹œÊ Ş
„µ¦ª·Á‡¦µ³®r…°o ¤¼¨šµŠ­™·˜·
- ®µ‡nµÁŒ¨¸¥É (mean) ¨³‡nµÁ¸¥É ŠÁœ
(standard deviation) …°Š¡µ¦µ¤·Á˜°¦r—Š´ „¨nµª
- Áž¦¸ ¥ Áš¸ ¥ ‡n µ ¡µ¦µ¤· Á ˜°¦r … °Š
„¨oµ¤ÁœºÊ°¤´—˜nµŠ Ç š¸Éŗo‹µ„°µ­µ
­¤´ ‡ ¦Åš¥„´  š¸É ¦ µ¥Šµœ‹µ„˜n µ Š
ž¦³Áš«(3,10-13)
Ÿ¨„µ¦«¹„¬µ
°µ­µ­¤´‡¦¤¸°µ¥»ÁŒ¨¸¥É 39 že (21-56
že) ­nªœÄ®nš¶Šµœ®œ´„˜n°°„„¶¨´ŠÅ¤n
­¤É¶Á­¤° ¤¸­ªn œœo°¥š¸™É œ´—Žoµ¥ ‡nµÁŒ¨¸¥É
¡µ¦µ¤·Á˜°¦r…°Š®œnª¥‡¨ºÉœÅ¢¢jµ„¨oµ¤ÁœºÊ°…°Š„¨oµ¤ÁœºÊ°Â˜n¨³¤´—…–³°°„¦Š
Á„¦ÈŠÁµ Ç —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 1-5
¦¼žš¸É 1 ­—Š Motor unit action potential (MUAP)
¦¼ž£µ¡—´—ž¨Š¤µ‹µ„®œ´Š­º° Electrodiagnosis Medicine …°Š Dumitru(6)
- 106 -
„µ¦«¹„¬µœ¸Ê
Nelson(9)
‡nµÁŒ¨¸É¥ +/- ‡nµÁ¸É¥ŠÁœ
…œµ—
‡ªµ¤„ªoµŠnªŠ‡¨ºÉœ
‹Îµœªœ
(¤·¨¨·Ãª¨šr)
(¤·¨¨·ª·œµš¸)
Á¢­
0.61±0.42
11.07±2.43
3.46±0.79
1.76±0.90
7.80±0.24
3.11±0.09
¦o°¥¨³
polyphasic
potentials
8.06
Ťn¤¸…o°¤¼¨
˜µ¦µŠš¸É 1 ­—Š¡µ¦µ¤·Á˜°¦r…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê abductor digiti minimi (ADM)
„µ¦«¹„¬µœ¸Ê
Chu-Andrews(3)
Nelson(9)
…œµ—
(¤·¨¨·Ãª¨šr)
0.42±0.28
0.9 ±0.5
1.5±0.6
‡nµÁŒ¨¸É¥ +/-‡nµÁ¸É¥ŠÁœ
‡ªµ¤„ªoµŠnªŠ‡¨ºÉœ
(¤·¨¨·ª·œµš¸)
13.81±4.07
12.7±1.9
6.2±2.2
‹Îµœªœ
Á¢­
3.35±0.90
3.4 ±1.4
2.9±0.8
¦o°¥¨³
polyphasic
potentials
7.40
19.0
Ťn¤¸…o°¤¼¨
˜µ¦µŠš¸É 2 ­—Š¡µ¦µ¤·Á˜°¦r…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê deltoid
„µ¦«¹„¬µœ¸Ê
Chu-Andrews(3)
Howard(10)
…œµ—
(¤·¨¨·Ãª¨šr)
0.49±0.35
0.7±0.4
0.8±0.2
‡nµÁŒ¨¸É¥ +/-‡nµÁ¸É¥ŠÁœ
‡ªµ¤„ªoµŠnªŠ‡¨ºÉœ
(¤·¨¨·ª·œµš¸)
14.39±4.21
14.9±3.9
9.5±1.4
‹Îµœªœ
Á¢­
3.60±0.91
3.3 ±1.0
Ťn¤¸…o°¤¼¨
¦o°¥¨³
polyphasic
potentials
8.30
14.2
Ťn¤¸…o°¤¼¨
˜µ¦µŠš¸É 3 ­—Š¡µ¦µ¤·Á˜°¦r…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê biceps brachii
„µ¦«¹„¬µœ¸Ê
Chu-Andrews(3)
Pease (11)
…œµ—
(¤·¨¨·Ãª¨šr)
0.47±0.24
1.0± 0.6
1.0±0.4
‡nµÁŒ¨¸É¥ +/-‡nµÁ¸É¥ŠÁœ
‡ªµ¤„ªoµŠnªŠ‡¨ºÉœ
(¤·¨¨·ª·œµš¸)
12.50±3.18
14.5 ±4.9
10.8±2.0
‹Îµœªœ
Á¢­
3.74±0.96
3.6±1.1
Ťn¤¸…o°¤¼¨
¦o°¥¨³
polyphasic
potentials
9.20
19.2
Ťn¤¸…o°¤¼¨
˜µ¦µŠš¸É 4 ­—Š¡µ¦µ¤·Á˜°¦r…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê extensor digitorum communis
„µ¦«¹„¬µœ¸Ê
Chu-Andrews(3)
Howard (10)
Chan(12)
…œµ—
(¤·¨¨·Ãª¨šr)
0.63±0.45
1.2±0.7
1.1±0.3
0.83±0.44
‡nµÁŒ¨¸É¥ +/-‡nµÁ¸É¥ŠÁœ
‡ªµ¤„ªoµŠnªŠ‡¨ºÉœ
(¤·¨¨·ª·œµš¸)
14.01±3.44
16.2±5.2
11.2±1.7
14.7±4.02
‹Îµœªœ
Á¢­
3.65±1.15
3.6±1.1
Ťn¤¸…o°¤¼¨
3.8±1.45
˜µ¦µŠš¸É 5 ­—Š¡µ¦µ¤·Á˜°¦r…°Š®œnª¥‡¨ºœÉ Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê tibialis anterior
- 107 -
¦o°¥¨³
polyphasic
potentials
10.20
18.6
Ťn¤¸…o°¤¼¨
Ťn¤¸…o°¤¼¨
šª·‹µ¦–r
‹µ„„µ¦ª·Á‡¦µ³®r‡nµÁŒ¨¸É¥…°Š¡µ¦µ¤·Á˜°¦r˜nµŠ Ç …°Š®œnª¥‡¨ºÉœÅ¢¢jµ‹µ„
„¨oµ¤Áœº°Ê š´ŠÊ 5 ¤´— …°Š‡œÅš¥ž„˜·¡ªnµ
‡nµÂ°¤¡¨·‹¼—ÁŒ¨¸É¥°¥n¼¦³®ªnµŠ 0.4-0.6
¤·¨¨·Ãª¨šr ‡nµ‡ªµ¤„ªoµŠnªŠ‡¨ºÉœÁŒ¨¸É¥
¤µ„„ªnµ 10 ¤·¨¨·ªœ· µš¸ ˜nœ°o ¥„ªnµ 15
¤·¨¨·ª·œµš¸ ‹¶œªœÁ¢­ž¦³¤µ– 3 Á¢­
¨³¡®œnª¥‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ°
œ·—ᨸÁ¢­·„œo°¥„ªnµ¦o°¥¨³ 10
Á¤ºÉ°Áž¦¸¥Áš¸¥¡µ¦µ¤·Á˜°¦r¦³®ªnµŠ
„¨oµ¤Áœº°Ê ­nªœ˜oœÂ¨³„¨oµ¤Áœº°Ê ­nªœž¨µ¥
¦¥µŠ‡r ¡ªnµ MUAPs …°Š„¨oµ¤Áœº°Ê Ĝ
ÁšoµŽ¹ŠÉ ¤¸Â°¤¡¨·‹—¼ …œµ—Á¨È„„ªnµ„¨oµ¤Áœº°Ê
®œo µ …o Š ˜n „ ¨o µ ¤ÁœºÊ ° £µ¥Äœ¤º ° Ž¹É Š ¤¸
…œµ—Á¨È„„¨´¤¸‡µn °¤¡¨·‹—¼ ÁŒ¨¸¥É ­¼Š„ªnµ
…°Š„¨oµ¤Áœº°Ê ˜oœÂ…œŽ¹ŠÉ ¤¸…œµ—Ä®n Ž¹ŠÉ
˜nµŠ‹µ„‡nµš¸ÅÉ —o‹µ„„µ¦«¹„¬µ…°Š˜nµŠž¦³Áš«
š¸¤É „´ ¡ªnµ„¨oµ¤Áœº°Ê ¤´—Á¨È„Äœ¦¥µŠ‡r­ªn œ
ž¨µ¥¤´„¤¸‡µn °¤¡¨·‹—¼ Á¨È„ªnµ„¨oµ¤Áœº°Ê
¤´—Ä®nĜ¦¥µŠ‡r­ªn œ˜oœ š´ŠÊ œ¸ÁÊ ž}œÁ¡¦µ³
°¤¡¨·‹¼—…°Š MUAPs …¹Êœ„´‹¶œªœ
‡ªµ¤®œµÂœnœ…°ŠÄ¥„¨oµ¤Áœº°Ê ˜n°®œnª¥
ž¦³­µš­´ŠÉ „µ¦ (motor unit) ¨³ ‹¶œªœ
motor end plate …°ŠÄ¥„¨oµ¤Áœº°Ê š¸°É ¥nļ œ
¦³¥³š¸ÁÉ …Ȥ°·Á¨È‡Ãš¦—­µ¤µ¦™¦´«´„¥rÅ¢¢jµ
ŗo(13,14) ¨³Á¤ºÉ°Áž¦¸¥Áš¸¥„´‡nµž„˜·
…°Š˜nµŠž¦³Áš«¡ªnµ °¤¡¨·‹¼—…°Š
MUAPs š¸ÅÉ —o‹µ„„µ¦«¹„¬µœ¸¤Ê …¸ œµ—Á¨È„
„ªnµ…°Š˜nµŠž¦³Áš« ®¦º° MUAPs š¸É
¦µ¥Šµœ‹µ„˜nµŠž¦³Áš«¤¸Â°¤¡¨·‹—¼ Ä®n
„ªnµÁšnµ˜´ª š´ŠÊ œ¸Ê °µ‹¤¸­µÁ®˜»‹µ„¦¼ž¦nµŠÂ¨³
…œµ—„¨oµ¤Áœº°Ê …°Š‡œšµŠŽ¸„脘³ª´œ˜„¤¸…œµ—Ä®n„ªnµ‡œÅš¥ ­nªœž{‹‹´¥
š¸É ¤¸ Ÿ ¨˜n ° ‡ªµ¤„ªo µ Šn ª Š‡¨ºÉ œ ŗo  „n
°´˜¦µ‡ªµ¤Á¦Èª„µ¦´„œ¶„¦³Â­ž¦³­µš
­´ÉŠ„µ¦…°ŠÁ­oœž¦³­µš(13,15) ×¥š´ÉªÅž
‡ªµ¤„ªoµŠnªŠ‡¨ºÉœ…°Š MUAPs ž„˜·
‹µ„¦µ¥Šµœ…°Š˜nµŠµ˜·¤‡¸ µn ÁŒ¨¸¥É ¦³®ªnµŠ
7-16 ¤· ¨ ¨· ª· œ µš¸ ¨³Â‡š¸É ­» — ‡º °
MUAPs …°Š„¨oµ¤Áœº°Ê ADM(9) Ž¹ŠÉ Ÿ¨‹µ„
„µ¦«¹ „ ¬µ‡¦´Ê Š œ¸Ê „È ­ °—‡¨o ° Š„´  …°Š
˜nµŠž¦³Áš«
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2551; 18(3)
°œ¹É Š ‡ªµ¤Â˜„˜n µ Šš¸É Á „· — ‹µ„„µ¦
«¹ „ ¬µÂ˜n ¨ ³Â®n Š œ´Ê œ °µ‹œ¶¤µÁž¦¸ ¥ 
Áš¸¥„´œÅ¤nŗo Á¡¦µ³¤¸„µ¦ÄoÁ‡¦ºÉ°Š¥¸É®o°
˜nµŠ„´œ Ž¹ÉŠ°µ‹˜´ÊŠ‡nµ‡ªµ¤™¸É„µ¦„¦°Š
­´µ– (band pass filter) ˜nµŠ„´œ Ánœ
Chu-Andrews(3)1986 ŗočoÁ‡¦ºÉ°Š…°Š
TECA Corporation ¨³ª·Á‡¦µ³®r×¥
Swedish Electrophysiologic Software
œ°„‹µ„œ¸Ê Áš‡œ·‡„µ¦ª·Á‡¦µ³®r‡¨ºœÉ Å¢¢jµ
‹µ„„¨oµ¤ÁœºÊ°¤´„˜nµŠ„´œ Ánœ µŠ‡œ—¼
—oª¥­µ¥˜µŽ¹ÉŠ…¹Êœ„´‡ªµ¤¶œµ…°ŠŸo¼
˜¦ª‹ ¨³„µ¦ª·Á‡¦µ³®r—ªo ¥Ãž¦Â„¦¤š¸É
Á‡¦ºÉ°Š˜´ÊŠÅªo „µ¦«¹„¬µ‡¦´ÊŠœ¸Êŗo¡¥µ¥µ¤
¨—‡ªµ¤¨¶Á°¸¥Šš¸°É µ‹Á„·—‹µ„„µ¦ª·Á‡¦µ³®r
—oª¥­µ¥˜µ —oª¥„µ¦Äoަ„¦¤ MultiMUP š¸ÁÉ ‡¦º°É Š´œš¹„Ä®o ˜n×¥š´ªÉ ިoª
Ä®o Å —o ° ¥n µ Šœo ° ¥ 20 ˜´ ª Á¨º ° „˜´ ª š¸É œn µ
ÁºÉ°™º°Åªo ¨³¨˜´ªš¸ÉŤnœnµÁºÉ°™º°°°„
°¸„š´ÊŠž¦´Á‡¦ºÉ°Š®¤µ¥š¸Éª´—¦³¥³˜nµŠ Ç
„n°œœ¶‡nµ¡µ¦µ¤·Á˜°¦ršÁ¸É ‡¦º°É Š‡¶œª–Ūo¤µ
ÁŒ¨¸É ¥ Ž¹É Š „µ¦«¹ „ ¬µ‡¦´Ê Š œ¸Ê ¤¸ …o ° —o ° ¥‡º °
´œš¹„‹¶œªœ MUAPs ‹µ„„¨oµ¤Áœº°Ê ˜n
¨³¤´—œo°¥Á„·œÅž ‹¹Š°µ‹­nŠŸ¨š¶Ä®o‡nµ
š¸É Å —o ° µ‹Å¤n Á ž} œ ˜´ ª šœ…°Š MUAPs
š¸É  šo ‹ ¦· Š ®¦º ° š¶Ä®o ‡n µ ž„˜· š¸É Å —o ‡ ¦´Ê Š œ¸Ê ¤¸
‡ªµ¤œnµÁºÉ°™º°¨—¨Š —´Šœ´Êœ ™oµ¤¸„µ¦
«¹„¬µ‡¦´ÊŠ˜n°Åž ‡ª¦¤¸„µ¦´œš¹„‹¶œªœ
MUAPs Ä®o ¤ µ„Á¡¸ ¥ Š¡° ¨³œ¶¤µ
Áž¦¸¥Áš¸¥„´„µ¦«¹„¬µ‡¦´ŠÊ œ¸Ê
­¦»ž „µ¦«¹„¬µ¨´„¬–³®œnª¥‡¨ºÉœ
Å¢¢jµ‹µ„„¨oµ¤Áœº°Ê …°Š°µ­µ­¤´‡¦‡œÅš¥
ž„˜·Ã—¥Äo°·Á¨È„Ú¦—œ·—Á…Ȥ…´ÊªÁ—¸É¥ª
¡ªnµÂ°¤¡¨·‹—¼ ¤¸…œµ—˜É¶„ªnµ 1 ¤·¨¨·Ãª¨šr ‡ªµ¤„ªoµŠnªŠ‡¨ºÉœœo°¥„ªnµ 15
¤·¨¨·ªœ· µš¸ ¤¸‹¶œªœ 3-4 Á¢­ ¨³®œnª¥
‡¨ºÉœÅ¢¢jµ‹µ„„¨oµ¤ÁœºÊ°œ·—⨸Á¢­·„
¡œo°¥„ªnµ¦o°¥¨³ 10 Ž¹ÉŠ¡µ¦µ¤·Á˜°¦r
—´Š„¨nµª­nªœÄ®n‡¨oµ¥‡¨¹Š„´¦µ¥Šµœ…°Š
˜nµŠž¦³Áš«¥„ÁªoœÂ°¤¡¨·‹—¼ Ž¹ŠÉ …°Š‡œÅš¥
¤¸…œµ—Á¨È„„ªnµ
J Thai Rehabil Med 2008; 18(3)
Á°„­µ¦°oµŠ°·Š
1. Á¢g°~ Š¢jµ ‡»–µ—¦. „µ¦˜¦ª‹Å¢¢jµª·œ‹· Œ´¥.
Ĝ: Á­„ °´„¬¦µœ»Á‡¦µ³®r. ˜¶¦µÁª«µ­˜¦r¢gœ ¢¼. „¦»ŠÁš¡²: 抡·¤¡rÁš‡œ·‡ 19; 2539:
®œoµ 57-73
2. Dumitru D. Instrumentation. In: Dumitru
D, editor. Electrodiagnosis medicine.
Philadelphia: Hanley & Belfus, Inc; 1995.
p. 69-72.
3. Chu J . Principles of Electrodiagnostic
Consultation. In: Chu J, Johnson R,
editors. Electrodiagnosis: an anatomical
and clinical approach. Philadelphia: J.B.
Lippincott Company; 1986. p. 222.
4. Chu J, Chan RC. Changes in motor unit
action potential parameters in monopolar
recordings related to filter settings of the
EMG Amplifier. Arch Phys Med Rehabil
1985; 66: 601-4.
5. Delagi EF. Anatomical guide for the
electromyographer. Illinois: Charles C
Thomas publisher; 1994.
6. Dumitru D. Volume conduction. In:
Dumitru D, editor. Electrodiagnosis
medicine. Philadelphia: Hanley &
Belfus, Inc; 1995. p. 53, 226.
7. Preston DC, Shapiro BE. Needle
electromyography: fundamentals,
normal and abnormal patterns. Neurol
Clin 2002; 20: 1-22.
8. Chu J. Principles of Electrodiagnostic
Consultation In: Chu J, Johnson R,
editors. Electrodiagnosis: an anatomical
and clinical approach. Philadelphia: J.B.
Lippincott Company; 1986. p. 220-35.
9. Nelson RM, Shedlock M, Kaczmarek C,
Gahrs J, MacLaughlin H. Comparison
of motor unit action potentials using
monopolar vs. concentric needle
electrodes in the middle deltoid and
abductor digiti minimi muscles.
Electromyogr Clin Neurophysiol 2003;
43: 459-64.
- 108 -
10. Howard JE, Mcgill KC, Dorfman LJ.
Properties of motor unit action potentials
recorded with concentric and
monopolar needle electrodes: ADEMG
analysis. Muscle and Nerve 1988; 11:
1051-5.
11. Pease WS, Bowyer BL. Motor unit
analysis: comparison between concentric and monopolar electrodes. Am J
Phys Med Rehabil 1988; 67: 2-6.
12. Chan RC, Hsu TC. Quantitative comparison of motor unit potential parameter
between monopolar and concentric
needles. Muscle and Nerve 1991; 14:
1028-32.
13. Dumitru D. Pitfalls. In: Dumitru D, editor.
Electrodiagnosis medicine. Philadelphia: Hanley & Belfus, Inc; 1995. p. 437.
14. Dumitru D. Needle EMG. In: Dumitru D,
editor. Electrodiagnosis medicine.
Philadelphia: Hanley & Belfus, Inc; 1995.
p. 211.
15. Nandedkar SD, Sanders DB. Recording
characteristics of monopolar EMG
electrodes. Muscle and Nerve 1991; 14:
108-12.