My general principle has been to not necessarily rely on EMG switches since I think it is pretty much difficult or impossible to identify where an appropriate site would be in the absence of any movement. And in any case, even if one identifies an EMG site my thinking is that given the lower motor neuron involvement and progression, this particular site would also be time-limited. Even if it only works for one, two or three months, (of course that is something)... I expect that EMG is likely to stop working.

That being said: My more recent recommendations were unfortunately ultimately unsuccessful since I could not get a P 300 EEG system working.  So I suppose that an EMG system might be potentially more viable with the knowledge that may only be short-term.

Not that I see a high volume of these patients, but I wanted to confirm that my current thinking around EMG is correct.  I am aware of a couple of other more recent developments (Pison technologies) around EMG being adjusted for people with ALS but am not aware of them being successful with any end-stage PALS.

While I am mainly thinking out loud here, I am happy to hear any feedback.