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PubMed1999

Use of functional electrical stimulation in the lower extremities of incomplete spinal cord injured patients.

After a program of therapeutic electrical stimulation, 3 groups of incomplete spinal cord injured (SCI) patients were identified, those in whom an improvement of both voluntary and stimulated muscle force was observed, those with an increase in stimulation response only, and patients in whom no effect of electrical stimulation training could be recorded. As it is difficult to predict the outcome of the electrical stimulation rehabilitation process, a diagnostic procedure was developed to predict soon after accidents which incomplete SCI patients are candidates for permanent use of a functional electrical stimulation (FES) orthotic aid. The candidates for chronic use of FES are patients with weak ankle dorsiflexors and sufficiently strong knee extensors. These patients are equipped with a single channel peroneal stimulator augmenting dorsiflexion and knee and hip flexion in a total lower limb flexion response. By applying FES to the ankle plantar flexors, the swing phase of walking can be significantly shortened and faster walking obtained.

Ankle Joint↗
PubMed1999

Adaptive restriction rules provide functional and safe stimulation pattern for foot drop correction.

We report on our advances in sensory feedback data processing and control system design for functional electrical stimulation (FES) assisted correction of foot drop. We have applied 2 methods of signal purification on the bin integrated electroneurogram (i.e., optimized low pass filtering and wavelet denoising) before training adaptive logic networks (ALN). ALN generated stimulation control pulses, which correspond to the swing phase of the impaired leg when dorsal flexion of the foot is necessary to provide safe ground clearance. However, the obtained control signal contained sporadic stimulation spikes in the stance phase, which can collapse the subject, and infrequent broken stimulation pulses in the swing phase, which can result in unpredictable consequences. In this study, we have introduced adaptive restriction rules (ARR), which are initially used as previously reported and then dynamically adapted during the use of the system. Our results suggest that ARR provide a safer and more reliable stimulation pattern than fixed restriction rules.

Adult↗
PubMed2002

Implantable devices for pain control: spinal cord stimulation and intrathecal therapies.

Untreated chronic pain is costly to society and to the individual suffering from it. The treatment of chronic pain, a multidimensional disease, should rely on the expertise of varying health care providers and should focus not only on the neurobiological mechanisms of the process but also on the psychosocial aspects of the disease. Implantable devices are costly and invasive, and such efficacious therapies should be used only when more conservative and less costly therapies have failed to provide relief of pain and suffering. Spinal cord stimulation provides neuromodulation of neuropathic, but not nociceptive, pain signals and when used for appropriate indications in the right individuals provides approximately 60-80% long-term pain relief in 60-80% of patients trialled for efficacy. Intrathecal therapies with opioids such as morphine, fentanyl, sufentanil or meperidine--or non-opioids such as clonidine or bupivacaine--provide analgesia in patients with nociceptive or neuropathic pain syndromes. Baclofen, intrathecally, provides profound relief of muscle spasticity due to multiple sclerosis, spinal cord injuries, brain injuries or cerebral palsy.

Adrenergic alpha-Agonists↗
PubMed2001

Clinical characteristics and management of ALS.

Amyotrophic lateral sclerosis (ALS) is the most common form of degenerative motor neuron disease in adulthood. The clinical picture was accurately described by Charcot over 125 years ago and consists of generalized fasciculations, progressive atrophy and weakness of the skeletal muscles, spasticity and pyramidal tract signs, dysarthria, dysphagia, and dyspnea. Pseudobulbar affect is common. Disease-specific treatment options are still unsatisfactory. However, therapeutic nihilism is not justified as a large array of palliative measures is available to enhance the quality of life of patients and their families. Palliative care in ALS is a multidisciplinary effort requiring careful coordination. An open and frank disclosure of the diagnosis is of paramount importance. Nutritional deficiency due to pronounced dysphagia can be relieved by a percutaneous endoscopic gastrostomy. Respiratory insufficiency can be effectively treated by noninvasive home mechanical ventilation. The terminal phase of the disease should be discussed, at the latest, when symptoms of dyspnea appear in order to prevent unwarranted fears of "choking to death." Collaboration with hospice and completion of advance directives can be of invaluable help in the terminal phase.

Adult↗
PubMed1998

Multiple sclerosis: symptomatic therapies.

Although new disease-altering treatments offer hope for those with multiple sclerosis, they are not appropriate for most. Management of symptoms, however, can help everyone with the disease. Several new therapies, including tizanidine, intrathecal baclofen, botulinum toxin injections, gabapentin, ondansitron, thalamic stimulation, and lamotrigine, increase our treatment options. Better understanding of the sleep disorders that commonly occur in those with multiple sclerosis will help us treat another disabling symptom. This chapter reviews the medical and surgical management of multiple sclerosis symptoms, including these new options.

Fatigue↗
PubMedDate not supplied

[Principals of surgical treatment of paresis due to damage to the central nervous system (author's transl)].

In pareses due to cerebral affections there is a sensomotoric disturbance of coordination and function which usually leads to typical contractions. The aim of treatment consists primarily in the creation or restitution of the greatest possible degree of dynamic equilibrium in unequally affected musculature. In addition to detonization of the spastically hypertonic muscles this also includes the elimination of deformities which disturb function. Only by detailed analysis of neuro-orthopedic findings can adequate conditions be created for the comprehensive therapeutic measures to be taken. For optimal surgical results not only accurate and detailed indication are required, but also specifically oriented preoperative and postoperative physiotherapy and ergotherapy.

Cerebral Palsy↗
PubMed1981

[A method of measuring centrally determined disturbances of muscle tone (author's transl)].

A technique is described (myotonography) for recording the centrally determined disturbances of muscle tone, whereby the mechanical and electro-myographic changes in the affected muscle groups are accessible to objective and quantitative study. The efficacity and reliability of the method are given and the clinically distinguishable forms of central disturbances of tonus are shown in typical tracings. These are of particular value for assessing the progress of an illness and the results of treatment. In addition it facilitates the interpretation of the patho-physiological processes. The apparatus is so constructed that in the same way as in a clinical examination, a passive extension and flexion of the elbow joint is reproduced over a range of about 100 degrees. In this way it is possible to record the stretch resistance of the extremities as well as the superficial electromyogram of the flexors and extensors.

Adolescent↗
PubMed1994

[Syringomyelia as a rare cause of respiratory insufficiency requiring ventilation].

For 17 years a now 45-year-old man had suffered from progressively more severe flaccid paresis of the arms and thoracic muscles, spastic paralysis of the legs and kyphoscoliosis. Artificial ventilation was required when he contracted pneumonia. Although it was being treated with antibiotics, frequent bronchoalveolar lavage had to be done because of repeated atelectases. After 6 weeks clonuses developed in the legs, predominantly on the right, stretch synergisms and opisthotonos. The pupils were small with sluggish reaction to light, and there was a positive "doll's head" phenomenon. The level of consciousness alternated between somnolence and sleepiness. Magnetic resonance imaging demonstrated cavities in cervical and thoracic spinal cord, supporting the diagnosis of an abnormal cerebrospinal circulation due to gliosis in syringomyelia. To secure cerebrospinal fluid drainage, the cerebellar tonsils were resected, together with a duraplasty and partial resection of the atlas. Following this he became fully conscious and the spastic state improved. During the following 8 weeks it became possible gradually to wean him from the artificial ventilation and achieve satisfactory mobilization so that he could be discharged to domiciliary care.

Combined Modality Therapy↗
PubMed1993

Development of muscle power in preterm infants: individual trajectories after term age.

In a longitudinal study individual trajectories were traced for the developing relationship between active and passive muscle power in preterm (n = 37) and fullterm (n = 20) infants from term to 24 weeks (corrected) age. Such trajectories should enable the identification of those infants at highest risk for later neurological dysfunctions. This contention is supported by the findings of this study: those preterm infants who showed marked discrepancies between the two sorts of muscle power or rigidity in both beyond 12 weeks corrected age were most likely to manifest neurological problems at 52 weeks of age.

Female↗
PubMed1994

Influence of stabilization occlusal splint on craniocervical relationships. Part II: Electromyographic analysis.

The aim of this study was to determine the effect of stabilization occlusal splints on electromyographic (EMG) activity of sternocleidomastoid and trapezius muscles in subjects with spasm in the mentioned muscles. A full-arch maxillary stabilization occlusal splint was made for each of the 15 subjects. In the sternocleidomastoid muscle, tonic and saliva swallowing EMG activity decreased significantly with the splint, whereas maximal clenching activity did not change. In the trapezius muscle, no significant changes were observed with the occlusal splint. The different pattern in both muscles during tonic and swallowing EMG activity with the splint is attributed to differences in the synaptic inputs to the respective motoneuron pools, suggesting that a differential modulation of the motor neuron pools may exist of both muscles, of peripheral and/or central origin.

Adult↗
PubMed1998

Botulinum toxin injections for voiding dysfunction following SCI.

Botulinum toxin (BT) injections have been used successfully to treat spastic muscle conditions, including detrusor-sphincter dyssynergia (DSD) seen in spinal cord injury (SCI) patients. In our urology clinic, we used BT to treat three SCI patients who had voiding dysfunction, using a transperineal needle with electromyographic (EMG) monitoring. Two of the patients reported excellent results following the treatment. One patient, with whom the staff had difficulty doing intermittent catheterization (IC), improved significantly. The other patient had improved voiding with an external catheter and minimal urinary residual. The third patient had no improvement of leg spasms with his voiding dysfunction and required a sphincterotomy. Although patients may need repeat injections, BT is minimally invasive and easy to administer with no side effects. Overall, BT injection is an excellent method of managing voiding in SCI patients, especially those on continuous external catheters and with IC management who refuse or are not good candidates for surgery.

Adult↗
PubMed1982

Toxicity of fenvalerate to bobwhite quail (Colinus virginianus) including brain and liver residues associated with mortality.

The toxicity of the synthetic pyrethroid fenvalerate to bobwhite quail (Colinus virginianus) was examined. The acute oral LD50 to adult (19-wk-old) male and female birds was in excess of 4000 mg/kg. The LD50 to immature (5-wk-old) birds was 1785 mg/kg. Dietary toxicity testing with 2-wk-old chicks indicated an 8-d LC50 in excess of 15,000 ppm. Observed signs of intoxication included hyperactivity, irregular locomotion, ataxia, spastic muscle contraction, and, preceding death, sternal recumbency with muscle flaccidity. Significant weight loss (adult birds) or reduction in rate of weight gain (immature birds and chicks) was note generally at all dose levels in the acute testing, but only at the highest level in the dietary test. Brain residue levels associated with mortality increased with the dose (means of 0.10-1.26 ppm), whereas liver residues remained constant (overall mean of 0.74 ppm).

Animals↗
PubMed1977

The effect of lesions of the sensorimotor cortex and the capsular pathways on servo responses from the human long thumb flexor.

Lesions of the sensorimotor cortex, or of the capsular pathways beneath it, caused (with one exception out of 14 cases) diminution "r loss of the servo responses in the thumb, which are based on the long-latency stretch reflex. When not absent the long-latency stretch reflex tended to be late in onset. When absent it was often replaced by a large early reflex response at spinal latency. In general the results are consistent with the transcortical theory of the long-latency stretch reflex for the thumb, but, in detail, they indicate that the theory will require elaboration.

Adult↗
PubMed1975

The tonic ambulatory foot response. A clinical and electromyographic study.

Three cases with "pyramidal" symptoms in which standing and/or walking evoked a tonic flexion of the toes and sole of the affected foot, have been studied from the clinical and electrophysiological standpoint. The phenomenon, for which the definition of tonic ambulatory foot respone (TAFR) is proposed, appeared to be triggered by cutaneous stimuli travelling along fibres lying in the range of nociceptive afferents, and to depend on a background of complex sensorimotor patterns of standing posture and/or stepping movements against resistance. The relationship of TAFR to other flexor foot responses described in the literature is discussed.

Cerebrovascular Disorders↗
PubMed2006

Probabilistic diffusion tractography: a potential tool to assess the rate of disease progression in amyotrophic lateral sclerosis.

The goal of probabilistic tractography is to obtain a connectivity index along a white matter pathway that reflects fibre organization and is sensitive to pathological abnormalities contributing to disability. Here, we present the development of voxel-based connectivity measures along the tractography-derived corticospinal tract (CST). We investigated whether these connectivity measures are different in patients with amyotrophic lateral sclerosis (ALS) and correlate with the rate of disease progression. We also investigated whether fractional anisotropy (FA), which reflects directional coherence of fibre tracts, is reduced in the CST of ALS patients and relates to disease progression rate. Thirteen patients with probable or definite ALS and 19 healthy subjects were studied. The probabilistic tractography algorithm segmented the bilateral CST, along which FA and connectivity values were obtained. To take into account the asymmetric distribution of connectivity values, two summary statistic measures that focused on voxels with higher connectivity values were selected and then used in the analysis, together with the mean connectivity and the mean FA. To complete the analysis, the same summary measures for FA were included. Differences in all these indices between patients with moderate or rapid disease progression rate and controls were investigated using linear regression, adjusted for age and white matter fraction. The association between FA or connectivity in the CST and the disease progression rate was assessed using linear regression. Patients with a rapid disease progression rate had significantly lower summary connectivity measures than controls in the left CST, but there was only a borderline statistical difference in mean connectivity. Patients with rapid progression had a significantly lower mean FA, and any other FA measure, in both CSTs than controls. When only patients were considered, strong associations between the rate of disease progression and all the connectivity measures in the left CST were found (P-values between P < 0.001 and P = 0.002, partial correlation coefficients between -0.90 and -0.82). However, there was no evidence of an association between disease progression rate and any of the FA measures in the bilateral CST. Our findings suggest that FA and connectivity provide complementary information, since FA is sensitive to the detection of all the group differences, whereas the summary connectivity measures correlate with disease progression rate. The development of such connectivity measures raises their potential as markers of disease progression in ALS, and provides guidance for their use in other neurological diseases.

Adult↗