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MUAPs were decomposed from multielectrode surface recordings during 30\u2010s maximum contraction of the abductor digiti minimi (ADM). Isometric strength, upper limb function, patient\u2010reported function, and standard electrophysiologic measures of the ADM (compound muscle action potential [CMAP], single motor unit potential [SMUP], motor unit number estimation [MUNE]) were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>dEMG MUAP amplitudes were higher in ambulatory versus control and non\u2010ambulatory groups and were higher in controls versus non\u2010ambulatory SMA. In contrast, dEMG firing rates were higher in ambulatory versus non\u2010ambulatory and control groups but similar between non\u2010ambulatory and control. dEMG parameters showed moderate to strong positive correlation with strength and function whereas CMAP and MUNE better correlated with function than strength. SMUP did not correlate with strength, function, or dEMG MUAP amplitude. dEMG parameters show overall good test\u2013retest reliability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>dEMG provided reliable, noninvasive measure of MUAP amplitude size and firing rate and revealed divergent patterns across disease severity in adults with SMA. Firing rate enhancement, as seen in milder SMA, may provide a therapeutic avenue for improving function in more severe SMA, where firing rates appear preserved. MUAP amplitude size and firing rate, quantified with dEMG, may be promising monitoring biomarker candidates for noninvasive assessment of SMA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51906","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T05:05:56Z","timestamp":1695359156000},"page":"2208-2222","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Differential impact on motor unit characteristics across severities of adult spinal muscular atrophy"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2151-0873","authenticated-orcid":false,"given":"Kristina Marie","family":"Kelly","sequence":"first","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation University of Missouri  Columbia MO USA"},{"name":"NextGen Precision Health University of Missouri  Columbia MO 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