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[Electoneuromyography in the study of diseases of the neuromuscular system].

Results of electroneuromyographic examinations of 207 patients with hereditary neuromuscular diseases are presented. Patients with neural amyotrophies showed a sharp slowdown of the speed of impulse transmission along the median and the tibial nerves, a lowering of the induced potentials of the muscle and the nerve, and an increase of the M-response. In patients with spinal amyotrophies a slight lowering of the speed of the impulse transmission along the tibial nerves with the transmission speed along the median nerves being normal, a diminution of the amplitude and a shortening of the duration of the M-response, and an increase of the amplitude of the nerve action potentials were revealed. Patients with myodystrophies exhibited a slowdown of the speed of impulse transmission along the afferent fibres, and increase of the motosensor coefficient, a moderate lowering of the maximal with a tendency to a heightening of the minimal amplitude of the M-response and the nerve action potential.

Animals↗

Generalised Listeria monocytogenes infection in a dog.

A 6-year-old Doberman bitch was presented for an acute onset of circling, hemiparesis and depression. Clinical examination revealed conjunctivitis, abdominal pain, anaemia, decreased facial sensation, decreased jaw, tongue and pharyngeal tone, decreased conscious proprioception, decreased flexor withdrawal reflexes, and abnormal hemiwalking and hemistanding. Pancytopaenia was evident on haematological evaluation. Bone marrow cytology revealed a bacterial infection. Cerebrospinal fluid analysis was normal. Despite antibiotic treatment, the dog died. On autopsy, widespread multifocal inflammatory lesions were found to be present in the lungs, liver, spleen, meninges, lymph nodes, adrenal glands and kidneys. Listeria monocytogenes was isolated in pure culture from these organs and tissues. Histopathological examination showed numerous gram-positive intracellular rod-shaped bacteria seen in all the above-mentioned organs.

Animals↗

Posture in otoneurology. Volume I.

In this study, posture is studied in the context of neuro-otological problems. In the several chapters, postural elements, postural influence upon balance aspects as well as postural components of the balance function in normal and pathological conditions are emphasized. Two main applications are put forward: rehabilitation by postural treatment techniques (REHAB) and examination techniques for the vestibulospinal aspects (posturography--PG). I. Balance function Balance is provided by automatic reflexes for stabilization of the visual field (vestibulo-ocular reflex--VOR) and for a correct posture, erect standing (vestibulo-spinal reflex--VSR) and head position (vestibulo-collic reflex--VCR). The fundamental characteristics of these reflexes are described, especially of those related to posture. The reflexes are elaborated on the basis of sensory inputs that inform about changed relations to space and environment, provided by visual, vestibular and proprioceptive systems. The sensory signals are further processed by the centers to adequate reflexes and to some extent to a conscious awareness. II. Dysfunction and adaptation Dysfunction in the balance mechanisms leads to erroneous reflexes, but most importantly to frightening sensations of vertigo. The peripheral disturbances produce a sensory mismatch which is the primum movens of vertigo. Built-in adaptive mechanisms cope with this disturbance and restore global balance function. The mechanisms involved have been studied as vestibular compensation and habituation, VOR-reflex plasticity and sensory "substitutive" compensation. The mechanisms are set into action by the dysfunctional situation and constitute an error-controlled process. Emphasis is laid upon the items related to rehabilitation treatment and posturography. A survey of clinical entities of vestibular peripheral dysfunction is included. III. Examination techniques The logical approach to the patient with vertigo consists in an analysis of the complaints pattern, correlation of it with the dysfunctional state revealed by clinical observation, and functional tests of balance. Correct interpretation of the test results is a pre-requisite. Postural aspects of these examination techniques, especially posturography, are put into evidence in this review. The strategy used in the department is sketched. IV. Contribution of the examination techniques: functional evaluation results The several data obtained by each examination technique are discussed within the scope of the experiences in the department. Data from the literature and from personal experience, especially interpreted in the context of rehabilitation and posturography, are analysed. V. Reh

Adaptation, Physiological↗

Electrical study of jaw and orbicularis oculi reflexes after trigeminal nerve surgery.

Trigeminal nerve ophthalmic and motor division function was assessed clinically and electrically in 32 patients who had undergone various surgical procedures for trigeminal neuralgia. Using known electrophysiological techniques, the orbicularis oculi and jaw reflexes were tested in all subjects. Abnormalities of the orbicularis oculi reflex were anticipated on the basis of ophthalmic division anaesthesia. However, jaw reflex abnormalities appeared in operated cases with no clinical or electromyographic evidence of masseter denervation. These results were unexpected, and imply that the proprioceptive fibres of the jaw reflex are mediated by a sensory and not a motor root as previously believed.

Adult↗

Phase-dependent and task-dependent modulation of stretch reflexes during rhythmical hand tasks in humans.

Phase-dependent and task-dependent modulation of reflexes has been extensively demonstrated in leg muscles during locomotory activity. In contrast, the modulation of reflex responses of hand muscles during rhythmic movement is poorly documented. The objective of this study was to determine whether comparable reflex modulation occurs in muscles controlling finger motions during rhythmic, fine-motor tasks akin to handwriting. Twelve healthy subjects performed two rhythmic tasks while reflexes were evoked by mechanical perturbations applied at various phases of each task. Electromyograms (EMGs) were recorded from four hand muscles, and reflexes were averaged during each task relative to the movement phase. Stretch reflexes in all four muscles were found to be modulated in amplitude with respect to the phase of the rhythmic tasks, and also to vary distinctly with the tasks being conducted. The extent and pattern of reflex modulation differed between muscles in the same task, and between tasks for the same muscle. Muscles with a primary role in each task showed a higher correlation between reflex response and background EMG than other muscles. The results suggest that the modulation patterns observed may reflect optimal strategies of central-peripheral interactions in controlling the performance of fine-motor tasks. As with comparable studies on locomotion, the phase-dependency of the stretch reflexes implies a dynamically fluctuating role of proprioceptive feedback in the control of the hand muscles. The clear task-dependency is also consistent with a dynamic interaction of sensory feedback and central programming, presumably adapted to facilitate the successful performance of the different fine-motor tasks.

Adult↗

Postural stability, neck proprioception and tension neck.

We examined whether tension neck (TN) may due to inadequate proprioceptive and vestibular activation of the cervico-collic reflex (CCR). CCR and vestibulospinal responses (VSRs) were recorded from 106 forest workers by stimulating the neck, lumbar or calf proprioceptors by vibration. The VSRs were recorded with posturography. TN occurred in 27 out of 106 subjects. The subjects with TN (48.5 years) were older than those without TN (43.1). The mean body sway during quiet stance was the same in both groups during the neck stimulation. In subjects with tension neck stimulation of neck or lumbar proprioceptors caused excessive, unpredictable body excursion in the lateral and anteroposterior direction that continued after stimulation. Results from stimulation of lower limb proprioceptors did not significantly differ between the 2 groups. In logistic regression analysis a model to predict TN consisting of perstimulatory postural stability (odds ratio 1.4) and poststimulatory postural stability (odds ratio 1.8) turned out to be statistically significant. The anatomical findings of CCR in the medulla oblongata suggest that neck muscle afferents control the posture and muscle activity of the neck. The erroneus facilitation of proprioception in TN subjects indicate that TN may be raised by inadequate facilitation of CCR.

Adult↗

Eye movements evoked by proprioceptive stimulation along the body axis in humans.

Proprioceptive input arising from torsional body movements elicits small reflexive eye movements. The functional relevance of these eye movements is still unknown so far. We evaluated their slow components as a function of stimulus frequency and velocity. The horizontal eye movements of seven adult subjects were recorded using an infrared device, while horizontal rotations were applied at three segmental levels of the body [i.e., between head and shoulders (neck stimulus), shoulders and pelvis (trunk stimulus), and pelvis and feet (leg stimulus)]. The following results were obtained: (1) Sinusoidal leg stimulation evoked an eye response with the slow component in the direction of the movement of the feet, while the response to trunk and neck stimulation was oriented in the opposite direction (i.e., in that of the head). (2) In contrast, the gain behavior of all three responses was similar, with very low gain at mid- to high frequencies (tested up to 0.4 Hz) but increasing gain at low frequencies (down to 0.0125 Hz). We show that this gain behavior is mainly due to a gain nonlinearity for low angular velocities. (3) The responses were compatible with linear summation when an interaction series was tested in which the leg stimulus was combined with a vestibular stimulus. (4) There was good correspondence of the median gain curves when eye responses were compared with psychophysical responses (perceived body rotation in space; additionally recorded in the interaction series). However, correlation of gain values on a single-trial basis was poor. (5) During transient neck stimulation (smoothed position ramp), the neck response noticeably consisted of two components -- an initial head-directed eye shift (phasic component) followed by a shift in the opposite direction (compensatory tonic component). Both leg and neck responses can be described by one simple, dynamic model. In the model the proprioceptive input is fed into the gaze network via two pathways which differ in their dynamics and directional sign. The model simulates either leg or neck responses by selecting an appropriate weight for the gain of one of the pathways (phasic component). The interaction results can also be simulated when a vestibular path is added. This model has similarities to one we recently proposed for human self-motion perception and postural control. A major difference, though, is that the proprioceptive input to the gaze-stabilizing network is weak (restricted to low velocities), unlike that used for perception and postural control. We hold that the former undergoes involution during ontogenesis, as subjects depend on the functionally more appropriate vestibulo-ocular reflex. Yet, the weak proprioceptive eye responses that remain may have some functional relevance. Their tonic component tends to stabilize the eyes by slowly shifting them toward the primary head position relative to the body support. This applies solely to the earth-horizontal plane in which the vestibular signal has no static sensitivity.

Adult↗

[Function of proprioceptors of the cervical spine in the cervico-ocular reflex].

Disease of the cervical spine may cause vestibular vertigo. The anatomical basis for this type of cervical vertigo are the proprioceptive stretch receptors of the upper cervical joints. These are connected to the vestibular nuclei, and, thus, to ocular reactions (nystagmus). Quantitative data about this cervico-ocular reflex are still scarce since the reflex is strongly suppressed in healthy persons. However, suppression ceases in bilateral complete vestibular deficiency. We measured the cervico-ocular reflex in 6 patients with complete bilateral labyrinthine deficiency. One patient showed a complete absence of the reflex, which might be explained by degeneration of the vestibular nuclei. 5 patients showed a strong cervico-ocular reflex with a gain (relation of eye amplitude to head amplitude) of 0.35-1.0. This gain was present with stimulus frequencies of 0.15-0.65 Hz. Data on the proprioceptive sensory organ of the cervical column could be the basis for evaluation of the widely-discussed importance of diseases of the cervical spine in vertigo.

Adult↗

A neural-network model enabling sensorimotor learning: application to the control of arm movements and some implications for speech-motor control and stuttering.

Low-level motor control is defined as adapting an organism to the unique physical properties of its own limbs. The two-jointed arm serves to exemplify that effective low-level motor control demands a neurally medicated inversion of the dynamics, as well as of the kinematics, of a limb system. Reflex-like processing--that is, feedforword of either actual or predicted proprioceptive signals--is thereby assumed to be the principle of the dynamics control. As regards speech-motor control, the overall tool transformation is assumed to transform the force pattern of the articulatory muscles into speech sounds. Like the arm model, the vocal-tract transformation thus defined is also divided into two parts, namely the transformation relating the muscle forces to the mechanospatial states of the vocal tract (which is analogous to the forward dynamics including natural interarticulatory couplings), and the transformation relating the mechanospatial states to the speech sounds. Low-level speech-motor control, then, needs to invert both transformations, each of which can be learned by means of the self-imitation algorithm. Erroneous learning can fail to decouple interarticulatory coupling and therefore lead to abnormal feedback loops through the reflex-like operating neural network, which in turn can cause stuttering if audiophonatoric coupling is involved in learning.

Algorithms↗

Functional roles of the proprioceptive system in the control of goal-directed movement.

This article explored functional roles of the proprioceptive system during the control of goal-directed movements. Proprioceptive information contributes to the control of movement through both reflex and central connections. Spinal and transcortical reflex loops establish a servomechanism which provides automatic corrections of unexpected changes in muscle length and allows compensation for undesirable irregularities in the mechanical properties of muscles by modulating limb stiffness at the subconscious level. Central connections provide the control system with information about peripheral states which is used in voluntary components of movement control. Before the initiation of movement, proprioceptive information about initial limb orientation becomes a basis for the programming of motor commands. During a movement, proprioceptive input about velocities and angular displacements of a limb is used to regulate movement by triggering planned sequences of muscle activation and modulating motor commands. After movement, feedback produced by responses is compared with previously stored information, verifying the quality of the movement. Considering potential roles of the reflex and central connections, the proprioceptive system seems to constitute an important aspect of motor control mechanisms, providing the control system with efficiency and flexibility in the regulation of goal-directed movements.

Biomechanical Phenomena↗

The cervico-ocular reflex is increased in whiplash injury patients.

Whiplash-associated disorders (WAD) are a major problem in the Western world, which put a formidable financial burden on modern society and which evoke an emerging debate on the true nature of their origin. To date there is no generally accepted test that allows us to diagnose WAD objectively. Because whiplash injury causes dysfunction of proprioception in the neck, we investigated the characteristics of the cervico-ocular reflex (COR) of presumptive WAD patients. These patients and age-matched healthy controls were rotated at different stimulus peak velocities in the dark while their head was fixed in space. The gain values of the COR were significantly increased in the patient population at a wide range of stimulus peak velocities with maximum difference at the lower frequencies (p = 0.037, ANOVA). Hence, although larger numbers of patients should be measured, the COR gain appears to be a parameter that may permit an objective diagnosis of WAD.

Adult↗

Afferent limb of the human jaw reflex: electrophysiologic and anatomic study.

Jaw reflexes were recorded before and after neurosurgery of the trigeminal sensory root or the gasserian ganglion in 11 patients with idiopathic trigeminal neuralgia and in 2 patients with orbital malignancies. The reflex was also studied in three patients with unilateral midbrain lesions verified by postmortem findings. Jaw reflex abnormalities appeared in all cases, although there were no clinical or EMG signs of masseter dysfunction. Proprioceptive afferent fibers of the jaw reflex therefore seem to be mediated by the sensory and not the motor root. The afferent limb of the jaw reflex seems to run centrally through the midbrain, probably through the mesencephalic nucleus of the trigeminal nerve.

Adult↗

Nociceptive considerations in treating with counterstrain.

The proprioceptive mechanistic model of somatic dysfunction proposed by Korr is accepted as the neurophysiologic basis of counterstrain by the developer of that manipulative technique. We suggest that the physician should also take into account the physical damage, if any, that the original trauma produced. We propose that with tissue injury, nociceptive reflexes could produce patterns of motion restriction opposite that predicted by a solely proprioceptive model. A nociceptive component is suggested as an explanation for the origin and maintenance of somatic dysfunction and its response to the counterstrain technique. In actuality, both proprioceptive and nociceptive responses may occur in dysfunctional states. Other physiologic responses also may be involved. These views are consistent with clinical experience.

Humans↗

Electrophysiological study of the peripheral nervous system in children. Changes in proximal and distal conduction velocities from birth to age 5 years.

Hoffman's reflex was evoked in the soleus muscle of 105 normal children from birth to age 5 years. This technique made it possible to determine conduction time and to estimate conduction velocity over the reflex arc. For 59 children, proprioceptive and motor distal nerve conduction velocities were calculated for the tibial nerve trunk. These measurements enabled the common changes for these three velocities to be described in terms of an exponential curve. Proximal conduction velocity has similar values to those of proprioceptive distal nerve fibres: it is always higher than motor nerve conduction velocity, but the difference gradually diminishes, remaining constant after the eighteenth month. Conduction time diminishes between birth and one year of age, whereas height increases. Then conduction time increases slowly, reaching at about age 5 years, when average height is 1050 mm, the value it had just after birth. For the child born at term, maturation of the nervous system is thus especially rapid during the first year of life.

Age Factors↗

Mechanoreceptors in human cruciate ligaments. A histological study.

We obtained human cruciate ligaments at the time of total knee replacement and from autopsy and amputation specimens, and examined histological sections of the ligaments for the presence of mechanoreceptors using the Bodian, Bielschowsky, and Ranvier gold-chloride stains for axons and nerve-endings. The cruciate ligaments obtained at the time of total knee replacement were too distorted by disease processes to be of use. The autopsy and amputation specimens, however, contained fusiform mechanoreceptor structures measuring 200 by seventy-five micrometers, with a single axon exiting from the capsule of the receptor. One to three receptors were found at the surface of each ligament beneath the synovial membrane, and were absent from the joint capsules and menisci. Morphologically the receptors resembled Golgi tendon organs, and it seems likely that they provide proprioceptive information and contribute to reflexes inhibiting injurious movements of the knee. This is the first histological demonstration of mechanoreceptors in human cruciate ligaments.

Aged↗

Nitrergic proprioceptive afferents originating from quadriceps femoris muscle are related to monosynaptic Ia-motoneuron stretch reflex circuit in the dog.

1. The aim of the present study was to examine the occurrence of the neuronal nitric oxide synthase immunoreactivity in the stretch reflex circuit pertaining to the quadriceps femoris muscle in the dog. 2. Immunohistochemical processing for neuronal nitric oxide synthase and histochemical staining for nicotinamide adenine dinucleotide phosphate diaphorase were used to demonstrate the presence of neuronal nitric oxide synthase in the proprioceptive afferents issuing in the quadriceps femoris muscle. The retrograde tracer Fluorogold injected into the quadriceps femoris muscle was used to detect the proprioceptive afferents and their entry into the L5 and L6 dorsal root ganglia. 3. A noticeable number of medium-sized intensely nitric oxide synthase immunolabelled somata (1000-2000 microm(2) square area) was found in control animals in the dorsolateral part of L5 and L6 dorsal root ganglia along with large-caliber intraganglionic nitric oxide synthase immunolabelled fibers, presumed to be Ia axons. Before entering the dorsal funiculus the large-caliber nitric oxide synthase immunolabelled fibers of the L5 and L6 dorsal roots formed a massive medial bundle, which upon entering the dorsal root entry zone reached the dorsolateral part of the dorsal funiculus and were distributed here in a funnel-shaped fashion. The largest nitric oxide synthase immunolabelled fibers, 8.0-9.2 microm in diameter, remained close to the dorsal horn, while medium-sized fibers were seen dispersed across the medial portion of the dorsal funiculus. Single, considerably tapered nitric oxide synthase immunolabelled fibers, 2.2-4.6 microm in diameter, were seen to proceed in ventrolateral direction until they reached the mediobasal portion of the dorsal horn and the medial part of lamina VII. In lamina IX, only short fragments of nitric oxide synthase immunoreactive fibers and their terminal ramifications could be seen. Nitric oxide synthase immunolabelled terminals varying greatly in size were identified in control material at the base of the dorsal horn, in the vicinity of motoneurons ventrally and ventrolaterally in L5 and L6 segments and in Clarke's column of L3 and L4 segments. Injections of the retrograde tracer Fluorogold into the quadriceps femoris muscle and cut femoral nerve, combined with nitric oxide synthase immunohistochemistry of the L5 and L6 dorsal root ganglia, confirmed the existence of a number of medium-sized nitric oxide synthase immunoreactive and Fluorogold-fluorescent somata presumed to be proprioceptive Ia neurons (1000-2000 microm(2) square area) in the dorsolateral part of both dorsal root ganglia. L5 and L6 dorsal rhizotomy caused a marked depletion of nitric oxide synthase immunoreactivity in the medial bundle of the L5 and L6 dorsal roots and in the dorsal funiculus of L5 and L6 segments. 4. The analysis of control material and the degeneration of the large- and medium-caliber nitric oxide synthase immunoreactive Ia fibers in the dorsal funiculus of L5 and L6 segments confirmed the presence of nitric oxide synthase in the afferent limb of the monosynaptic Ia-motoneuron stretch reflex circuit related to the quadriceps femoris muscle.

Animals↗