Velocity recovery function of the compound muscle action potential assessed with doublet and triplet stimulation

Normative values of muscle fiber conduction velocity depend on the conditions in which conduction velocity is measured due to the velocity recovery function (VRF) of muscle fibers. In this study the VRF of the compound muscle action potential (CMAP) was assessed following doublet and triplet stimulation in order to investigate the effect of repetitive muscle activation on muscle fiber conduction velocity. The VRF from doublet and triplet activation showed a peak of 4.6%-15.0% and 6.4%-25.9%, respectively, which is not significantly different. The VRF of the CMAP with doublet stimulation had a plateau between 25-75 ms, similar to that reported for single muscle fibers, and changed as a consequence of previous activation. The VRFs with doublet and triplet stimulation were different for interstimulus intervals in the range of 12-250 ms, where the triplet resulted in a plateau of supernormal conduction velocity. The VRF of the triplet could be explained by linear summation of the effects from doublet stimulations only for small distances between the two conditioning stimuli. These results provide new information on the adaptation of membrane properties of muscle fibers to repetitive activation. Changes in CMAP properties due to repeated activation may influence the accuracy of techniques based on CMAP recordings, such as collision methods.