Reliability of the biceps brachii M-wave

BACKGROUND: The peak-to-peak (P-P) amplitude of the maximum M-wave and the area of the negative phase of the curve are important measures that serve as methodological controls in H-reflex studies, motor unit number estimation (MUNE) procedures, and normalization factors for voluntary electromyographic (EMG) activity. These methodologies assume, with little evidence, that M-wave variability is minimal. This study therefore examined the intraclass reliability of these measures for the biceps brachii. METHODS: Twenty-two healthy adults (4 males and 18 females) participated in 5 separate days of electrical stimulation of the musculocutaneous nerve supplying the biceps brachii muscle. A total of 10 stimulations were recorded on each of the 5 test sessions: a total of fifty trials were used for analysis. A two-factor repeated measures analysis of variance (ANOVA) evaluated the stability of the group means across test sessions. The consistency of scores within individuals was determined by calculating the intraclass correlation coefficient (ICC). The variance ratio (VR) was then used to assess the reproducibility of the shape of the maximum M-wave within individual subjects. RESULTS: The P-P amplitude means ranged from 12.62 ± 4.33 mV to 13.45 ± 4.07 mV across test sessions. The group means were highly stable. ICC analysis also revealed that the scores were very consistent (ICC = 0.98). The group means for the area of the negative phase of the maximum M-wave were also stable (117 to 126 mV·ms). The ICC analysis also indicated a high degree of consistency (ICC = 0.96). The VR for the sample was 0.244 ± 0.169, which suggests that the biceps brachii maximum M-wave shape was in general very reproducible for each subject. CONCLUSION: The results support the use of P-P amplitude of the maximum M-wave as a methodological control in H-reflex studies, and as a normalization factor for voluntary EMG. The area of the negative phase of the maximum M-wave is both stable and consistent, and the shape of the entire waveform is highly reproducible and may be used for MUNE procedures.