Should Physical Therapists Do Electromyography? Yes or No Yes, if they are adequately trained. No, mains a requirement for appropriate electrode under all other circumstances. The issue lies in location. The effects of variation in needle the concept of adequate training. insertion rate and superimposed motions are Electromyography is a highly subjective skill. added subtleties to the investigating technique The signals are subtle and interpretation de­ which have to be appreciated. pends on a great deal of experience, supported The systemic myopathies and neuropathies by a firm knowledge of three-dimensional present the most intricate challenge to the anatomy, neuromuscular physiology, and neu­ electromyographer. These require the utmost romuscular pathology. knowledge of physiology and pathology as well The field can be divided into four areas: as superior skill in the technical aspects of the nerve conduction measurement, myoelectric procedure. The test must be conducted as a analysis of nerve injury, systemic neuro­ continuous interplay between the suspected muscular pathology interpretation, and kinesio- pathology noted in the referral, the investiga­ logical definition. Each has its own knowledge tive technique employed, and the response if meaningful information is to be elicited. Few and skill requirements. Nerve conduction measurement is the easiest. without doctoral-level education (academic or One must know the anatomy of the superficial medical) can do justice to these patients and to nerves and the muscles they supply. The testing the referring physician because of the required technique is simple, the signal interpretation is breadth of background and the ability to sense self-evident, and the results are finite numbers. the most subtle differences and to correlate Kinesiological EMG is next on the scale of complex data. complexity. The basic requirement is knowl­ Physical therapists interested in this field edge of three-dimensional anatomy and muscle should seek quality preparation commensurate function. This awareness is needed both to with the level of electromyography they would accurately locate wire electrodes in specific like to do. Anything less is doing the patient, muscles and to understand all that may be themselves, and their profession a disservice. feeding into surface electrodes. Electrode appli­ Failure to exercise judgment in this area will cation has just a few technical requirements. rightfully stimulate strong reprisals from those Interpretation of the results requires signal who guard the quality of patient care. recognition skill, the ability to discriminate Short-term courses cannot adequately pre­ artifact from fact, and an appreciation that pare the physical therapist to do even the most absolute quantification is not yet possible. The simple EMG because there is no prior experi­ investigator clinician must have the maturity ence on which to build. These courses cannot and knowledge not to over-read the data. provide sufficient detail nor the clinical refer­ Myoelectric analysis of nerve and root injury ence to display their pertinence. At each level, presents two added requirements. The pathol­ protracted clinical practice under the guidance ogy must be understood so appropriate areas of experts is required after the theoretical are studied. Also, one must gain the skill knowledge has been learned. The higher the needed for interpreting the quality of the EMG level, the longer the apprenticeship necessary. wave form. The different stages in nerve recovery present characteristic, but subtle, changes which require considerable tutorial JACQUELIN PERRY, M.D. experience before any useful competency is Rancho Los Amigos Hospital reached. A firm background in anatomy re­ Downey, CA 90242 Volume 55 / Number 5, May 1975

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