P. Åke Öberg

Evaluation of a Laser Doppler Flowmeter for Measurement of Tissue Blood Flow

An instrument for measurement of tissue blood flow based on the laser Doppler principle was evaluated using a fluid model. A unique and linear relationship between flowmeter response and flux of red cells was demonstrated with red cell velocities and volume fractions within the normal physiological range of the microcirculatory network of the skin. Different degrees of oxygenation proved to influence the Doppler signal only to a minor extent. The study also shows that the Doppler signal is formed essentially by heterodyne mixing of light beams backscattered in static structures and moving red cells.

A New Instrument for Continuous Measurement of Tissue Blood Flow by Light Beating Spectroscopy

A new instrument for measurement of regional tissue blood flow based on the laser Doppler principle is reported. The theoretical background of light beating spectroscopy is discussed and a detection technique which makes possible the suppression of the adverse effects of laser-mode interference and wide-band beam amplitude noise is described. Instead of using a single square-law photodetector a differential detector technique is introduced that reduces common-mode noise to a negligible level, without influencing the blood flow related signal. The new instrument has proved to be highly stable and sensitive. Continuous recordings of tissue blood flow can be performed in the laboratory as well as at the bedside.

changes of trapezius muscle blood flow and electromyography in chronic neck pain due to trapezius myalgia

Chronic neck pain may increase the transmitter activity of neuropeptides in the upper cervical medulla causing impairment of the blood flow in the local muscle because of a lack of vasodilatatory substances excreted axonally. We have been using a new single-fibre technique for clinical determination of the microcirculation (LDF) in the trapezius muscles in relation to electromyography (EMG). This study pertains to the 76 patients (46 women and 30 men) who received a final diagnosis of chronic trapezius myalgia out of a total series of 300 cases with chronic neck pain which had been remitted to the National Insurance Administration Hospital in Tranås, Sweden, because their complaints interfered with their working ability. The purpose was to derive more objective medical information upon which to base rehabilitation. Sixty percent had continuous pain and 40% had pain after physical effort, or at work. Twenty healthy women volunteered to participate as a normal control group. The right and left trapezius muscles of all individuals were examined simultaneously with laser-Doppler flowmetry (LDF) and surface EMG during a fatiguing series of stepwise-increased contractions, each of 1 min duration with 1 min rest in between. The most painful side was compared with the opposite side in all patients and, in the female patients, also with the right shoulder of the healthy control women. The patients showed consistently low local blood flow in the painful side. The difference was statistically significant at low contraction intensities. Muscle tension was somewhat elevated, as evidenced by a slight increase of the rms-EMG that was statistically significant at high contraction intensities. The mean power frequency (MPF) of the EMG showed no change. The lowered local blood flow was not explained by a changed intramuscular pressure which is low in the trapezius during ordinary activities that do not normally impair the local blood flow (Larsson, S-E., Cai, H. and (Oberg, P.A., Microcirculation in the upper trapezius muscle during varying levels of static contraction, fatigue and recovery in healthy women. A study using percutaneous laser-Doppler flowmetry and surface electromyograpy, Eur. J. Appl. Physiol., 66 (1993) 483-488). We conclude that an impaired regulation of the microcirculation in the local muscle is of central importance in chronic trapezius myalgia, causing nociceptive pain which can be differentiated objectively from neuralgic neck-shoulder pain by the atraumatic technique described.

Effects of psychophysiological stress on trapezius muscles blood flow and electromyography during static load.

Mental stress was induced by the Stroop colour word task (CW task) and the effects on the micro-circulation and electromyography (EMG) in the upper portion of the trapezius muscle were studied during a series of fatiguing, standardized static contractions. A lowered blood flow of the skin recorded continuously by laser-Doppler flowmetry (LDF) was used as a stress indicator in addition to an elevated heart rate. Muscle blood flow was recorded continuously by LDF using a single optical fibre placed inside the muscle, and related to surface EMG. A group of 20 healthy women of different ages was examined. Recordings were made during a 50-min period in the following sequence: a 10-min series of alternating 1-min periods of rest and stepwise increased contraction induced by keeping the arms straight and elevated at 30, 60, 90 and 135° with a 1-kg load carried in each hand; a 10-min recovery period without load; a repeated contraction series with simultaneous performance of the CW task; a second 10-min recovery period, and a second contraction series without CW task. Signal processing was done on line by computer. The LDF and root mean square (rms)-EMG values were calculated, as well as the EMG mean power frequency (MPF) for fatigue. The CW-task added to the contraction series caused an increase in the heart rate accompanied by a decrease in the blood flow to the skin and a 30% increase in the blood flow in the exercising muscle. Both returned to normal during the subsequent recovery period and showed normal levels during the final contraction series without CW. The rms-EMG showed a 20% increase that persisted during the final contraction series performed without CW. There was no influence on MPF. This CW has previously been shown to evoke an increased secretion of adrenaline from the adrenal medullae to the blood. The increased blood flow in the exercising muscle would therefore appear to have been caused by β-adrenoceptor vasodilatation, and the fall in the blood flow in the skin by α-adrenoceptor vasoconstriction. The findings may have implications for work situations characterized by repetitive static loads to the shoulder muscles and psychological stress.

Optical properties of blood in motion

An in vitro model is developed for application in studies of the optical and physical characteristics of flowing blood in rigid and flexible tubes (artificial vessels). The results indicate that both transmission and reflection of light are dependent on blood volume changes and orientation as well as the deformability of the red blood cells. Light transmission and reflection in human blood shows a parabolic behavior at hematocrit levels greater than 40%, when plotted against blood flow. At both low and high flow rates, the light transmission increases when compared to an intermediate flow where the transmission shows a minimum. The optical wavelength used also affects the light transmission and reflection in moving blood. The results of studies of blood in flow-through models are important for the understanding of the optical mechanisms behind the signal generation in photometrical measurement techniques.

Single-fibre laser Doppler flowmetry

A laser Doppler flowmeter with one optical fibre guiding light to and from the tissue under study has been developed. The outer diameter of the probe equals the optical fibre diameter (0·5 mm). The small size makes it useful for studying the deep tissue perfusion in organs. Differential-channel operation was compared with the single-channel operation and the benefit of this technique was evaluated theoretically as well as in a fluid model resembling tissue perfusion. The signal-to-noise improvement ratio was calculated and found to be related to the number of coherence areas detected and to the broadband noise of the laser. In vivo experiments in the gastrocnemius muscle of the pig were performed to compare the results from the single-fibre technique with those of the electromagnetic flowmeter. Linear regression analysis of femoral blood flow data obtained with the electromagnetic flowmeter and local muscle blood flow measured with the single-fibre technique showed a correlation coefficient of 0·88 (n=36, p<0·001).

Presentation and evaluation of a new optical sensor for respiratory rate monitoring

A new optical sensor for respiratory rate monitoring was simultaneously compared with an acoustic sensor and a transthoracic impedance plethysmograph during normoventilation in the respiratory rate range of 9–17 breaths per minute. The response characteristics of the optical sensor were then measured during simulation of central apnoea and tachypnoea. Visual observation was chosen as the reference method for monitoring the respiratory rate. The measurements were performed in ten healthy volunteers and the respiratory signals recorded on an analogue tape and strip-chart recorder and analysed off-line. The response characteristics of the fibre optic sensor corresponded well with those of the acoustic sensor and impedance plethysmograph. All three methods responded rapidly to an apnoeic event.

Movement-induced potentials in surface electrodes

Movement-induced potentials of streaming potential type were studied in various electrode configurations. The geometric design of the electrode was important for the reduction of noise generated by the movements of gel. Potential and impedance variations were measured for electrode movements in electrolytes. The impedance variations were small and the streaming potentials were electrolyte-concentration dependent and in the order of 10μV. The same type of study was carried out for electrodes applied to the skin. The conclusion from this experiment is that skin deformation potentials dominate the disturbance pattern in this type of recordings.

Microcirculation in the upper trapezius muscle during varying levels of static contraction, fatigue and recovery in healthy women —a study using percutaneous laser-Doppler flowmetry and surface electromyography

SummaryMicrocirculation in the upper portion of the trapezius muscle was measured percutaneously by continuous laser-Doppler flowmetry (LDF) during two 10-min series of alternating 1-min periods of static contraction and rest determined electromyographically (EMG). Stepwise increased contraction was induced by keeping the arms straight and elevated at 30, 60, 90 and 135°, which was repeated with a 1-kg load carried in each hand. Thereafter, fatigue and recovery were recorded while the subject kept her arms straight and elevated at 45° carrying the 1-kg hand load as long as possible, followed by rest with arms hanging and no load. A group of 16 healthy women of different ages was studied. Signal processing was done on line using a 386 SX computer. The LDF- and root-mean-square (rms) EMG signals were normalized. Spectrum analyses of EMG mean power frequency (MPF) and median spectrum frequency were performed. The rms-EMG increased significantly with an increase in the calculated shoulder torque (r=0.75). Accumulated local fatigue was indicated by a decrease in MPF with increased shoulder angle and added load (r = −0.54). Blood flow increased with increased shoulder angle (r=0.82, with hand loadr=0.62) and with increased shoulder torque (r=0.72), and also showed a significant increase with increased EMG activity (r=0.74). The LDF showed a negative correlation to MPF (r= −0.67), with increased values when MPF was lowered. During the endurance test, a moderate increase of LDF occurred which reached its maximum during the 1st min of recovery. Then, a slow return to the base level was recorded. The ability to increase the flow in the microcirculation with increasing muscle load was not diminished with age.

Continuous percutaneous measurement by laser-Doppler flowmetry of skeletal muscle microcirculation at varying levels of contraction force determined electromyographically

SummaryLaser-Doppler flowmetry (LDF) and electromyography (EMG) were used simultaneously for measuring skeletal muscle blood perfusion in relation to static load and fatigue. Percutaneous single-fibre LDF and bipolar surface EMG of the trapezius muscle were performed continuously during a 10-min series of alternating periods of static contractions and rest, each of 1-min duration. The muscle was exposed to static load expressed as shoulder torque, by keeping the arms straight and elevated at 30, 60, 90 and 135°. On-line computer processing of the LDF and EMG signals made possible the interpretation of the relationship between the perfusion and the activity of the muscle. The LDF and root mean square (rms)-EMG were normalized by using the average value of the serial examinations of each individual as a reference value. Spectrum analyses of EMG showed the lowest variability for median frequency (MDF) in the frequency range 10–1000 Hz and mean power frequency (MPF) at 2–1000 Hz. The LDF power spectrum density during low (muscle rest) and high (high-force muscle contraction) perfusion indicated that disturbances were small when measurements were performed during sustained static contraction with as little movement as possible. Vasomotion, i.e. rhythmic variations in the blood flow, were present and showed a frequency of 5–6 cycles · min−1. Application of a tourniquet to the upper arm caused an arrest of the microcirculation in the distally situated brachioradial muscle which was followed by a postischaemic hyperaemia upon removal of the torniquet. In ten healthy men, regression analyses showed positive correlation between rms-EMG and shoulder torque (r=0.77), negative correlation between MPF and arm elevation angle (r= −0.89) indicating accumulated fatigue, and almost positive correlations between LDF and rms-EMG (r=0.65), and between LDF and shoulder angle (r=0.67) when the right trapezius muscle was examined.