, Volume 32, Issue 1, pp 90–103 | Cite as

Electromyography and Mechanomyography Signals During Swallowing in Healthy Adults and Head and Neck Cancer Survivors

  • Gabriela Constantinescu
  • William Hodgetts
  • Dylan Scott
  • Kristina Kuffel
  • Ben King
  • Chris Brodt
  • Jana RiegerEmail author
Original Article


Surface electromyography (sEMG) is used as an adjuvant to dysphagia therapy to demonstrate the activity of submental muscles during swallowing exercises. Mechanomyography (MMG) has been suggested as a potential superior alternative to sEMG; however, this advantage is not confirmed for signal acquired from submental muscles. This study compared the signal-to-noise ratio (SNR) obtained from sEMG and MMG sensors during swallowing tasks, in healthy participants and those with a history of head and neck cancer (HNC), a population with altered anatomy and a high incidence of dysphagia. Twenty-two healthy adults and 10 adults with a history of HNC participated in this study. sEMG and MMG signals were acquired during dry, thin liquid, effortful, and Mendelsohn maneuver swallows. SNR was compared between the two sensors using repeated measures ANOVAs and subsequent planned pairwise comparisons. Test–retest measures were collected on 20 % of participants. In healthy participants, MMG SNR was higher than that of sEMG for dry [t(21) = −3.02, p = 0.007] and thin liquid swallows [t(21) = −4.24, p < 0.001]. Although a significant difference for sensor was found in HNC participants F(1,9) = 5.54, p = 0.043, planned pairwise comparisons by task revealed no statistically significant difference between the two sensors. sEMG also showed much better test–retest reliability than MMG. Biofeedback provided as an adjuvant to dysphagia therapy in patients with HNC should employ sEMG technology, as this sensor type yielded better SNR and overall test–retest reliability. Poor MMG test–retest reliability was noted in both healthy and HNC participants and may have been related to differences in sensor application.


Deglutition Deglutition disorders Visual biofeedback Electromyography Mechanomyography Head and neck cancer 



This work was supported by Alberta Cancer Foundation Transformative Program Grant (26355); Alberta Innovate – Health Solutions (AIHS) Clinician Fellowship (#201400350); Natural Sciences and Engineering Research Council (NSERC) and industrial and government partners, through the Healthcare Support through Information Technology Enhancements (hSITE) Strategic Research Network (22143).

Compliance with Ethical Standards

Conflict of Interest

The authors Gabriela Constantinescu, Dylan Scott, Ben King, and Jana Rieger are inventors listed on a patent for the mobile swallowing therapy device. The patent application was made through TEC Edmonton Office, University of Alberta (file number: 2014015. No commercial interest has been shown at this stage).


  1. 1.
    Langerman A, MacCracken E, Kasza K, Haraf DJ, Vokes EE, Stenson KM. Aspiration in CRT patients with HNC. Arch Otolaryngol Head Neck Surg. 2007;133:1289–95.CrossRefPubMedGoogle Scholar
  2. 2.
    Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MW, Holsinger FC. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012;118:5793–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shaw SM, Martino R. The normal swallow: muscular and neurophysiological control. Otolaryngol Clin North Am. 2013;46:937–56.CrossRefPubMedGoogle Scholar
  4. 4.
    Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82:1661–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Lazarus C, Logemann JA, Song CW, Rademaker AW, Kahrilas PJ. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002;54:171–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Bryant M. Biofeedback in the treatment of a selected dysphagic patient. Dysphagia. 1991;6:140–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Crary MA, Carnaby Mann GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia. 2004;19:160–4.PubMedGoogle Scholar
  8. 8.
    Wheeler-Hegland K, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hear Res. 2008;51:1072–87.CrossRefPubMedGoogle Scholar
  9. 9.
    Azola AM, Greene LR, Taylor-Kamara I, Macrae P, Anderson C, Humbert IA. The relationship between submental surface electromyography and hyo-laryngeal kinematic measures of Mendelsohn maneuver duration. J Speech Lang Hear Res. 2015;58:1627–36.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Reaz MB, Hussain MS, Mohd-Yasin F. Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online. 2006;8:11–35.CrossRefGoogle Scholar
  11. 11.
    Stepp CE. Tutorial: surface electromyography for speech and swallowing systems: measurement, analysis, and interpretation. J Speech Lang Hear Res. 2012;55:1232–46.CrossRefPubMedGoogle Scholar
  12. 12.
    Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10:361–74.CrossRefPubMedGoogle Scholar
  13. 13.
    Vigreux B, Cnockaert JC, Pertuzon E. Factors influencing quantified surface EMGs. Eur J Appl Physiol. 1979;41:119–29.CrossRefGoogle Scholar
  14. 14.
    Brown CC. Reliability of electromyography detection systems for the pelvic floor muscles. School of Rehabilitation Therapy. Kingston: Queen’s University; 2007.Google Scholar
  15. 15.
    Islam MA, Sundaraj K, Ahmad RB, Sundaraj S, Ahamed NU, Ali MA. Cross-talk in mechanomyographic signals from the forearm muscles during sub-maximal to maximal isometric grip force. PLoS one. 2014;9:e96628.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Posatskiy AO.Design and evaluation of pressure-based sensors for mechanomyography: an investigation of chamber geometry and motion artefact.: Mechanical and Industrial Engineering, in collaboration with the Institute of Biomaterials and Biomedical Engineering: University of Toronto, 2011.Google Scholar
  17. 17.
    Silva S, Chau T. A Mathematical model for source separation of MMG signals recorded with a coupled microphone-accelerometer sensor pair. IEEE Trans Biomed Eng. 2005;52:1493–501.CrossRefPubMedGoogle Scholar
  18. 18.
    Posatskiy AO, Chau T. Design and evaluation of a novel microphone-based mechanomyography sensor with cylindrical and conical acoustic chambers. Med Eng Phys. 2012;34:1184–90.CrossRefPubMedGoogle Scholar
  19. 19.
    Mohamed Irfan MR, Sudharsan N, Santhanakrishnan S, Geethanjali B. A comparative study of EMG and MMG signals for practical applications. International conference on signal, image processing and applications with workshop of ICEEA 2011.Google Scholar
  20. 20.
    Lee J, Chau T, Steele CM. Effects of age and stimulus on submental mechanomyography signals during swallowing. Dysphagia. 2009;24:265–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Roy SH, De Luca G, Cheng MS, Johansson A, Gilmore LD, De Luca CJ. Electro-mechanical stability of surface EMG sensors. Med Bio Eng Comput. 2007;45:447–57.CrossRefGoogle Scholar
  22. 22.
    Lee J, Steele CM, Chau T. Swallow segmentation with artificial neural networks and multi-sensor fusion. Med Eng Phys. 2009;31:1049–55.CrossRefPubMedGoogle Scholar
  23. 23.
    Silva J, Chau T. Coupled microphone-accelerometer sensor pair for dynamic noise reduction in MMG signal recording. Electron Lett. 2003;39:1496.CrossRefGoogle Scholar
  24. 24.
    Posatskiy AO, Chau T. The effects of motion artifact on mechanomyography: a comparative study of microphones and accelerometers. J Electromyogr Kinesiol. 2012;22:320–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Seikaly H, Jha N, McGaw T, Coulter L, Liu R, Oldring D. Submandibular gland transfer: a new method of preventing radiation-induced xerostomia. Laryngoscope. 2001;111:347–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Beck TW, Housh TJ, Cramer JT, Weir JP, Johnson GO, Coburn JW, Malek MH, Mielke M. Mechanomyographic amplitude and frequency responses during dynamic muscle actions: a comprehensive review. Biomed Eng Online. 2005;4:67.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Jaskolska A, Brzenczek W, Kisiel-Sajewicz K, Kawczynski A, Marusiak J, Jaskolski A. The effect of skinfold on frequency of human muscle mechanomyogram. J Electromyogr Kinesiol. 2004;14:217–25.CrossRefPubMedGoogle Scholar
  28. 28.
    Valouchova P, Lewit K. Surface electromyography of abdominal and back muscles in patients with active scars. J Bodyw Mov Ther. 2009;13:262–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Crary MA, Baldwin BO. Surface electromyographic characteristics of swallowing in dysphagia secondary to brainstem stroke. Dysphagia. 1997;12:180–7.CrossRefPubMedGoogle Scholar
  30. 30.
    De-Ary-Pires B, Ary-Pires R, Pires-Neto MA. The human digastric muscle: patterns and variations with clinical and surgical correlations. Ann Anat. 2003;185:471–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Basmajian JV, De Luca CJ. Muscles alive: their functions revealed by electromyography. 2nd ed. Baltimore: Williams & Wilkins; 1985.Google Scholar
  32. 32.
    Petitjean M, Maton B, Cnockaert J-C. Evaluation of human dynamic contraction by phonomyography. Am Physiol Soc. 1992;73:2567–73.Google Scholar
  33. 33.
    Ibitoye MO, Hamzaid NA, Zuniga JM, Hasnan N, Wahab AK. Mechanomyographic parameter extraction methods: an appraisal for clinical applications. Sensors. 2014;14:22940–70.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Al-Mulla MR, Sepulveda F, Colley M. A review of non-invasive techniques to detect and predict localised muscle fatigue. Sensors. 2011;11:3545–94.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Nonaka H, Mita K, Akataki K, Watakabe M, Itoh Y. Sex differences in mechanomyographic responses to voluntary isometric contractions. Med Sci Sports Exerc. 2006;38:1311–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Lazarus C. Dysphagia Secondary to the Effects of Chemotherapy and Radiotherapy. In: Shaker R, Belafsky PC, Postma GN, Easterling C, editors. Principles of deglutition: a multidisciplinary text for swallowing and its disorders. New York: Springer; 2013. p. 431–43.CrossRefGoogle Scholar
  37. 37.
    McCabe D, Ashford J, Wheeler-Hegland K, Frymark T, Mullen R, Musson N, Hammond CS, Schooling T. Evidence-based systematic review: oropharyngeal dysphagia behavioral treatments. Part IV—Impact of dysphagia treatment on individuals’ postcancer treatments. J Rehabil Res Dev. 2009;46:205.CrossRefPubMedGoogle Scholar
  38. 38.
    Russell JA, Connor NP. Effects of age and radiation treatment on function of extrinsic tongue muscles. Radiother Oncol. 2014;9:1–15.CrossRefGoogle Scholar
  39. 39.
    Zaheer F, Roy SH, De Luca CJ. Preferred sensor sites for surface EMG signal decomposition. Physiol Meas. 2012;33:195–206.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Holobar A, Zazula D. Correlation-based decomposition of surface electromyopgrams at low contraction forces. Med Biol Eng Comput. 2004;42:487–95.CrossRefPubMedGoogle Scholar
  41. 41.
    Evetovich TK, Housh TJ, Stout JR, Johnson GO, Smith DR, Ebersole KT. Mechanomyographic responses to concentric isokinetic muscle contractions. Eur J Appl Physiol. 1997;75:166–9.CrossRefGoogle Scholar
  42. 42.
    Cramer JT, Housh TJ, Johnson GO, Ebersole KT, Perry SR, Bull AJ. Mechanomyographic and electromyographic responses of the superficial muscles of the quadriceps femoris during maximal, concentric isokinetic muscle actions. Isokinet Exerc Sci. 2000;8:109–17.Google Scholar
  43. 43.
    Smith DB, Housh TJ, Stout JR, Johnson GO, Evetovich TK, Ebersole KT. Mechanomyographic responses to maximal eccentric isokinetic muscle actions. Am Physiol Soc. 1997;82:1003–7.Google Scholar
  44. 44.
    Herda TJ, Ryan ED, Beck TW, Costa PB, DeFreitas JM, Stout JR, Cramer JT. Reliability of mechanomyographic amplitude and mean power frequency during isometric step and ramp muscle actions. J Neurosci Method. 2008;171:104–9.CrossRefGoogle Scholar
  45. 45.
    Woodward R, Shefelbine S, Vaidyanathan R. Pervasive motion tracking and muscle activity monitor. Computer-based medical systems (CBMS), 2014 IEEE 27th international symposium on, 2014, pp 421–426.Google Scholar
  46. 46.
    Vaiman M, Eviatar E, Segal S. Evaluation of normal deglutition with the help of rectified surface electromyography records. Dysphagia. 2004;19:125–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Gabriela Constantinescu
    • 1
    • 2
  • William Hodgetts
    • 1
    • 2
  • Dylan Scott
    • 1
  • Kristina Kuffel
    • 1
  • Ben King
    • 1
    • 3
  • Chris Brodt
    • 3
  • Jana Rieger
    • 1
    • 2
    Email author
  1. 1.Department of Communication Sciences and Disorders, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Institute for Reconstructive Sciences in Medicine (iRSM)Misericordia Community HospitalEdmontonCanada
  3. 3.Department of Industrial DesignUniversity of AlbertaEdmontonCanada

Personalised recommendations