Objective: Create standardized procedures or movement neurophysiology studies (MNS).

Background: Movement neurophysiology studies (MNS) with surface electromyography (EMG), accelerometers, and other tools have established clinical utility for phenotyping abnormal movements, including distinguishing tremor from myoclonus and other hyperkinetic movements, and evaluating for functional vs structural (“organic”) movement disorders prior to invasive treatments. However, MNS availability is limited, partly due to lack of standardization. The goal of this project is to develop and validate standardized MNS procedures.

Method: MNS involve recording from a montage array of wired or wireless surface EMG electrodes and accelerometers placed on multiple body segments, with simultaneous video recording. The patient is guided through a series of tasks including rest, static postures, gross movements, fine movements, cognitive distraction, and tactile stimulation. Muscle activity and motion data are interpreted using raw data visualization, frequency domain analysis, and other signal processing techniques. Standardized MNS montages and task protocols are being drafted with input from an international group of experts with active MNS clinical services, beginning with a survey of current clinical practice patterns.

Results: Current MNS practice patterns in the MDS Pan-American Section are presented, including hardware/software, personnel, referral pathways, volumes, wait times, and billing. Standardized MNS procedures in draft include montages based on abnormal movement location and number of EMG electrodes, and modular task protocols based on abnormal movement location, referral question, and initial MNS findings. For bilateral distal upper limb tremor, priority muscles include bilateral wrist and/or finger flexors and extensors (e.g. extensor digitorum communis, flexor carpi ulnaris), with additional upper limb muscles included as feasible. Protocols include sitting at rest, forward outstretched posture, finger to nose, spiral/circle drawing, mass loading, finger tapping, ballistic movements, and distraction. These standardized montages and protocols are being refined in pilot testing.

Conclusion: Standardized procedures will enable consistent MNS performance across institutions to enable clinical reliability, education, implementation, and research insight.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-neurophysiology-studies-clinical-practice-patterns-and-standardization/