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Ex vivo performance
ICCs revealed high levels of agreement between the custom-fabricated and industry standard electrodes across all waveforms (sine [ICC = 0.993], square [ICC = 0.995], triangle [ICC = 0.958]; p < .001). Bland-Altman plots also revealed a high degree of signal agreement between electrodes. Bland Altman plots and Pearson correlations are summarized in Figure 3 with strong positive correlations between the custom-fabricated and industry standard electrodes. Pearson correlations revealed high levels of temporal synchrony between the custom-fabricated and industry standard electrode across all waveforms (sine [r = 0.987], square [r = 0.990], triangle [r = 0.931]).

Figure 3: Ex vivo testing results. Raw data from custom and industry standard electrodes for a repeated (A) sine wave, (D) square wave, and (G) triangle wave at 0.1 V and 5 Hz. (B,E,H) Correlation between voltage measurements for the custom and MicroProbe electrodes for 8,000 samples of the respective waveforms. (C,F,I) Bland Altman plot assessing the percent difference between the custom and MicroProbe electrode across average values of the respective waveforms. Please click here to view a larger version of this figure.
A representative impedance spectrum for a custom-fabricated epimysial electrode is shown in Figure 4. Although impedance measurements were collected from 10 Hz to 31 kHz, results are reported at 1 kHz, which is a relevant frequency for EMG acquisition. The industry standard (reference electrode) had an impedance of 2 kΩ. For comparison, the mean impedance of 10 custom-fabricated epimysial electrodes was 3.61 ± 7.95 kΩ and 1.63 ± 1.59 kΩ at 1 kHz for contact surfaces 1 and 2, respectively.

Figure 4: Impedance. Bode magnitude plot depicting the impedance value in Ohms (Ω) at ~ 1 kHz for a representative custom-fabricated epimysial electrode. Channels 1 and 2 pertain to contact surfaces 1 and 2 respectively. Please click here to view a larger version of this figure.
In vivo performance (Supplemental Video S1)
The custom-fabricated electrode effectively captured the physiological fluctuations in VL EMG activity induced during various treadmill walking conditions. Notably, the mean peak EMG activity was found to be significantly lower during downhill walking (0.008 ± 0.005 mV) than uphill (0.031 ± 0.180 mV, p = 0.005), in agreement with previous findings10. Furthermore, a paired t-test revealed that the peak EMG amplitude values at 14 days (0.01 ± 0.007 mV) did not exhibit a significant difference from those at 56 days (0.012 ± 0.007 mV, p > 0.05), supporting the long-term reliability of the device (Figure 5). Significantly different EMG magnitude values under the same recording conditions may be indicative of electrode damage or failure.

Figure 5: In vivo electrode reliability. Tukey boxplot of peak EMG amplitude (mV) of the vastus lateralis during level treadmill walking (16 m/min) at 14 days (T14) and 56 days (T56) following instrumentation. Abbreviations: EMG = electromyography; ns = not significant. Please click here to view a larger version of this figure.
Biocompatibility
H&E revealed no evidence of inflammation in the control muscle (Figure 6, left panel) relative to the instrumented muscle (Figure 6, right panel). This included no clear evidence of immune cell infiltration, internal myonuclear accumulation, fibrogenesis, and/or sarcolemma fragmentation between cross-sections extracted from the control or instrumented muscle.

Figure 6: Biocompatibility. Histological comparison of control (left) and instrumented (right) vastus lateralis muscles stained with hematoxylin and eosin (40x). Scale bars = 100 µm. Please click here to view a larger version of this figure.
Supplemental File 1: Catch_tray.gcode. 3D printing template of the catch tray, designed as part of the folding jig to catch the folded foils from the folding jig. Please click here to download this File.
Supplemental File 2: Cutting_jig.gcode. 3D printing template of the cutting jig, which contains evenly spaced slots as a guide to consistently perforate the silicone base. The cutting jig is configured for the placement of twenty foils to form ten bipolar epimysial electrodes. However, we currently use the cutting jig to produce a batch of six bipolar electrodes as we suggest leaving a space between electrodes. Please click here to download this File.
Supplemental File 3: Folding_jig.gcode. 3D printing template of the folding jig, which allows for easier folding of the platinum-iridium foils to form the desired U-shape. Folding of the foils can also be performed manually if needed. Please click here to download this File.
Supplemental Video S1: In vivo testing. EMG signaling of the VL during decline walking (-16°) on a motorized treadmill at 16m/min using the custom-fabricated epimysial EMG electrode. Please click here to download this File.