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At least 433 records · Page 24Linked to original sources

The effects of neuromuscular stimulation on muscle tone at the knee in paraplegia.

Resting muscle tone of the leg was measured in terms of thigh muscle stiffness and knee resonant frequency in muscles of spinal cord injured subjects who had been involved in an electrical neuromuscular stimulation training programme of the thigh muscles over at least 2 months. The thigh circumference of these patients was 6.6% larger than before training commenced (P less than 0.001) and showed increased muscle stiffness and resonant frequency compared to a similar group of paralysed subjects who had not used any neuromuscular stimulation. Resonant frequency and stiffness after the long-term training were similar to those of non-injured controls and therefore the stimulation programme seemed to reverse the effects of paralysis on muscle tone. Short periods of rest (30 min) caused increased muscle stiffness in non-injured controls and paralysed muscles trained by neuromuscular stimulation. Additional 15 min periods of neuromuscular stimulation further increased muscle stiffness in the trained muscles but also in the muscles of paralysed subjects who had no long-term neuromuscular training. In contrast, 15 min sessions of passive movement of the knee decreased muscle stiffness in long-term trained paralysed muscles and untrained paralysed muscles. Knee resonant frequency was also significantly decreased in the trained paralysed muscles. Results show that muscle tone varies depending on the amount of previous movement or rest and that although neuromuscular stimulation of paralysed muscles increases muscle stiffness and knee resonant frequency, it is in fact restoring such properties of the muscle to a state approaching that of non-injured controls.

Adult↗

Design and assessment of an adaptive intermittent cervical traction modality with EMG biofeedback.

An intermittent cervical traction modality with closed-loop traction force control based on EMG biofeedback was developed and used for clinical study. This system consists of a EMG scanner, on-line self-adjusted traction force controller, audio/video alarm system, real time therapeutic status display, computer interface hardware, and control software. Twenty-four subjects with diagnosed cervical radiculopathy and muscle spasm symptom who were randomly divided into two groups served as subjects in this study. The control and experimental groups were treated with conventional open loop and new EMG biofeedback closed loop traction control protocols respectively. The results of this study indicate that the average reductions in paraspinal EMG signal during traction after 7 weeks treatment for experimental and control groups were 71 and 50 percent, respectively (p < 0.001). These results not only support the clinical use of intermittent, sitting traction to produce cervical paraspinal muscle relaxation, but also revealed that the average myoelectric activity of cervical paraspinal muscle during traction was reduced as traction force increased over the 7-week duration of traction treatment. Through EMG biofeedback traction force control, muscle injury, neck soreness, or pain after traction may be avoided.

Adult↗

Study of sensitivity to curare in certain neurological disorders using a regional technique.

A regional technique for the study of curare sensitivity has been applied to patients with Duchenne type muscular dystrophy, myotonic disorders, certain lower motor neurone disorders, to patients with weakness in the arm after hemiplegia, to patients with hyper-reflexia and hypertonia without weakness, and to Parkinsonism. In the dystrophy patients, sensitivity to curare differs from normal controls in that the neuromuscular block persists. The possibilities that this latent defect of neuromuscular transmission is the result of acetylcholine deficiency due to a prejunctional defect or the result of alterations in the property of the postjunctional membrane are discussed. In the myotonic and lower motor neurone disorders, curare sensitivity was similar to that of normal controls. After hemiplegia, the affected side shows resistance to curare when compared with the unaffected side. In states of hyper-reflexia and hypertonia, however, the sensitivity to curare is greater than in normal controls. In Parkinsonism, sensitivity is similar to that of the controls. The results in upper motor neurone lesions are discussed in relation to the dependence of neuromuscular transmission upon the motor neurone, which, in turn, is dependent upon descending impulses.

Action Potentials↗

Monosynaptic reflexes in the superficial forearm flexors in man and their clinical significance.

Indirect motor responses with the characteristics of the H wave were recorded from the flexor carpi radialis and the palmaris longus muscles in normal adults. A series of experiments has been performed, constituting circumstantial arguments for the monosynaptic nature of these reflex responses. The findings in pathological conditions, which corroborated this point of view, are documented briefly.

Adolescent↗

Pathophysiological mechanisms in cerebral palsy.

To investigate some of the pathophysiological mechanisms in cerebral palsy, surface electromyograms (EMG) were recorded from pairs of flexor/extensor muscles during both voluntary and passive flexion/extension of upper and lower limbs of 20 patients. Elbow, knee, or ankle joint angles were measured simultaneously, as well as the force required to flex/extend the limbs passively at frequencies of 0.1--1.0 Hz. In addition, single motor units were recorded from the first dorsal interosseous muscles of six of the patients. Almost all patients showed resistance to passive movements (hypertonia). This hypertonia did not necessarily impair voluntary flexion/extension movements if alternating EMG activity was maintained in at least one of the pairs of flexor/extensor muscles involved in the movement. In six severly involved patients, there was a complete breakdown in the reciprocal relationship between reciprocally acting pairs of flexor/extensor motoneurones, which resulted in synchronous activation (co-contractions) of flexor/extensor muscles during both voluntary and passive movements. In these patients the hyperactive segmental reflex added to the disabling effects of co-contractions during voluntary movements. Single motor units recorded from patients with dystonic movements were recruited with variable delays (2--10 s) and usually discharged intermittently at high frequencies (60--120/s). This abnormla motor unit discharge pattern may relate to pathology of the basal ganglia.

Adolescent↗

Effects of muscle length on an increased stretch reflex in children with cerebral palsy.

No inhibitory influence of length on the increased stretch reflex was found in the internal gastrocnemius muscle of 19 cerebral palsied children. A facilitory influence of length was found in at least five patients in which quantitative data were obtained. These results were compared with previous data on a facilitory influence in the hamstrings and inhibitory influence in quadriceps muscles.

Cerebral Palsy↗

Presynaptic inhibition of monosynaptic reflexes in the lower limbs of subjects with upper motoneuron disease.

Presynaptic inhibition of muscle spindle Ia afferents by group I afferents from the same and other muscles has been studied in the lower limbs of subjects with upper motoneuron lesions. The experiments utilised conditioning of soleus test monosynaptic reflexes during controlled voluntary contraction. The protocol was designed to isolate presynaptic inhibition from postsynaptic components. The relation between estimate of inhibition and test reflex amplitude was examined. The subjects showed less inhibition than controls at all levels of voluntary torque investigated (less than or equal 15 Nm). Two thirds had weak inhibition which did not show the decrease during muscle contraction characteristic of controls. The degree of difference from the normal situation correlated with severity of the clinical sign (weakness of voluntary ankle flexion).

Adult↗

Observations on the innervation of the sternomastoid muscle.

Nine out of fifteen cases having division of the spinal component of the accessory nerve and the upper cervical motor roots as treatment for spasmodic torticollis had residual movements in the sternomastoid of sufficient magnitude to make further surgery necessary before the muscle was effectively paralysed. These observations imply a more complex innervation for the muscle than is to be found in most anatomical texts.

Accessory Nerve↗

Morvan's fibrillary chorea: a paraneoplastic manifestation of thymoma.

Morvan's fibrillary chorea is a rare disease characterised by symptoms which include neuromyotonia, cramping, weakness, pruritus, hyperhidrosis, insomnia, and delirium. The first case of Morvan's fibrillary chorea to be associated with clinical manifestations of myasthenia gravis with thymoma, psoriasis, and atopic dermatitis is reported. Muscle histopathology disclosed chronic denervation and myopathic changes and in vitro electrophysiology demonstrated both presynaptic and postsynaptic defects in neuromuscular transmission. Serum antibodies to acetylcholine receptors, titin, N-type calcium channels, and voltage gated potassium channels were detected. Plasmapheresis, thymectomy, and long term immunosuppression induced a dramatic resolution of symptoms. The association of thymoma with other autoimmune disorders and autoantibodies, and prolonged and sustained remission with chronic immunosuppression, place Morvan's fibrillary chorea on the range of neurological diseases arising as a paraneoplastic complication of cortical thymomas.

Biopsy↗

Is symptomatology useful in distinguishing between carpal tunnel syndrome and cervical spondylosis?

Hand paraesthesia is a common symptom found in patients either with carpal tunnel syndrome or cervical spondylosis. To differentiate between the two conditions, it is important to identify additional diagnostic symptoms. Ninety-two patients with operated carpal tunnel syndrome and 138 patients with spinal surgery for cervical spondylosis were reviewed. After exclusion of cases co-morbid with both cervical spondylosis and carpal tunnel syndrome or other neurological disorders, 44 patients with carpal tunnel syndrome and 41 patients with cervical spondylosis were compared. There were significant differences in the symptomatology between the two groups. In carpal tunnel syndrome, 84% had nocturnal paraesthesia, 82% hand paraesthesia were aggravated by hand activity, and hand pain occurred in 64%. The incidences were only 10%, 7% and 10%, respectively in cervical spondylosis. Neck pain was present in 76% of cervical spondylosis but only in 14% of carpal tunnel syndrome, and lower limb symptoms were present in 44% of cervical spondylosis and only 9% in carpal tunnel syndrome.

Carpal Tunnel Syndrome↗

Motor unit behavior during clonus.

Medial gastrocnemius surface electromyographic activity and intramuscular electromyographic activity were recorded from six individuals with chronic cervical spinal cord injury to document the recruitment order of motor units during clonus. Four subjects induced clonus that lasted up to 30 s while two subjects induced clonus that they actively stopped after 1 min. Mean clonus frequency in different subjects ranged from 4.7 to 7.0 Hz. Most of the 166 motor units recorded during clonus (98%) fired once during each contraction but at slightly different times during each cycle. Other motor units fired during some clonus cycles (1%) or in bursts (1%). When 59 pairs of units were monitored over consecutive clonus cycles (n = 5-89 cycles), only 8 pairs of units altered their recruitment order in some cycles. Recruitment reversals only occurred in units that fired close together in the clonus cycle. These data demonstrate that orderly motor unit recruitment occurs during involuntary contractions of muscles paralyzed chronically by cervical spinal cord injury, providing further support for the importance of spinal mechanisms in the control of human motor unit behavior.

Action Potentials↗

Distinct patterns of motor unit behavior during muscle spasms in spinal cord injured subjects.

Surface electromyograms (EMG) and force were recorded during repeated involuntary spasms of paralyzed triceps surae muscles of four men with chronic cervical spinal cord injury. The firing rates of 78 medial gastrocnemius (MG) motor units also were recorded intramuscularly with tungsten microelectrodes. Spasms typically involved a relatively rapid rise, then a more gradual fall in triceps surae EMG and torque. Motor unit firing rates either increased and then decreased with the spasm intensity (54%) or were relatively constant (26%), firing mainly at 2-10 Hz. The remaining units (20%) produced trains that included one or several doublets. Mean peak spasm firing rates were 18 +/- 9 Hz (mean +/- SD) for rate modulated units and 11 +/- 10 Hz for units with little or no rate modulation. Some motor units fired at rates comparable with those recorded previously during maximum voluntary contractions performed by intact subjects. Others fired at rates below the minimum usually seen when normal units are first recruited (< 6 Hz). Doublets (interspike interval < 10 ms) often repeated every 123-333 ms, or were interspersed in trains firing at low steady rates (< 11 Hz). This study shows that rate coding for many motor units appears to be similar whether descending motor input is intact or whether it has been reduced severely by spinal cord injury. In contrast, rate modulation in other units appears to depend mainly on voluntary motor commands.

Adult↗

Reflexes from the superficial peroneal nerve during walking in stroke subjects.

The function of ipsilateral cutaneous reflexes was studied with short trains of stimuli presented pseudorandomly to the superficial peroneal nerve (SP; innervates the top of the foot) during treadmill walking in neurologically intact (NI) subjects and subjects who had had a stroke. Ankle and knee joint angles together with electromyograms (EMG) of tibialis anterior (TA), soleus (SOL), medial gastrocnemius (MG), vastus lateralis (VL), and biceps femoris (BF) muscles were recorded. Net reflex EMG and kinematic responses to stimulation were quantified in each of the 16 parts of the step cycle and responses compared between the stroke and NI subjects. Stimulation strongly suppressed extensor muscles throughout stance in the stroke subjects. TA muscle showed a significant suppression during swing phase that was correlated with reduced ankle dorsiflexion in both stroke and NI subjects. BF reflexes were facilitatory during parts of swing and VL reflexes were suppressive throughout stance in the stroke subjects. There was a significant correlation between BF facilitation and knee flexion during swing, which was stronger in NI subjects. We conclude that only part of the stumble correction to foot dorsum electrical stimulation observed in NI subjects is maintained after stroke, and that new, suppressive responses are seen.

Adult↗

Neurophysiological assessment of electrode placement in the spinal cord.

The use of neurophysiological techniques in addition to radiographic methods to determine the location of electrodes to be introduced into the epidural space for spinal cord stimulation is beneficial. Information on the distribution of paresthesias and muscle twitches provides an indication of the level and lateral location in relation to the midline of the spinal cord. For electrodes placed posteriorly, the threshold currents necessary for sensation are lower than those for muscle responses. Somatosensory evoked potentials resulting from epidural stimulation demonstrate effective depolarization of ascending structures. Evoked potentials recorded from the electrodes in response to peripheral nerve or spinal cord stimulation at a distant segment illustrate the possibility of activation of underlying generators of the spinal cord.

Brain Injuries↗

Effects of splinting on wrist contracture after stroke: a randomized controlled trial.

BACKGROUND AND PURPOSE: Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke. METHODS: Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque). RESULTS: Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4 degrees (95% CI, -5.4 degrees to 8.2 degrees), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3 degrees (95% CI, -4.9 degrees to 2.4 degrees) compared with the control condition. CONCLUSIONS: Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.

Aged↗

Rehabilitation of walking with electromyographic biofeedback in foot-drop after stroke.

BACKGROUND AND PURPOSE: Alterations of gait cycle and foot-drop on the paretic limb are characteristic of stroke patients. Electromyographic biofeedback treatment has been used in rehabilitation of walking, but results are controversial. We performed gait analysis to evaluate the efficacy of electromyographic biofeedback compared with physical therapy. METHODS: Sixteen patients with ischemic stroke were enrolled in the study. The experimental group (4 men, 4 women) received electromyographic biofeedback treatment together with physical therapy. The control group (5 men, 3 women) was treated with physical therapy only. Clinical and functional evaluations before and after treatment were performed using Canadian Neurological, Adams, Ashworth, Basmajian, and Barthel Index scales. Computerized gait analysis was performed in all patients. RESULTS: Electromyographic biofeedback patients showed significantly increased scores on the Adams scale (P < .05) and Basmajian scale (P < .01). Gait analysis in this group showed a recovery of foot-drop in the swing phase (P < .02) after training. CONCLUSIONS: Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia.

Adult↗