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PubMed2005

Relationship of physical examination findings and self-reported symptom severity and physical function in patients with degenerative lumbar conditions.

BACKGROUND AND PURPOSE: Limited data are available to assist clinicians in clinical decision making. The purpose of this study was to examine the relationships of symptom provocation during physical examination (PE) procedures and self-report of symptom severity and function in patients with degenerative lumbar conditions. SUBJECTS: Twenty-four men and 50 women with chronic low back pain (CLBP) (>6 months duration) were recruited from a university hospital (median age=64.2 years, mean=66.8, SD=12.4, range=55.7-97.8). METHODS: Demographic information, medical history, PE findings, and data from 2 self-report measures of symptom severity and function (Lumbar Spinal Stenosis [LSS] questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were collected. RESULTS: Patients had moderate symptoms of degenerative lumbar conditions (mean LSS symptom score=2.67, SD=0.71) and reported some difficulties with low back function (mean LSS function score=1.99, SD=0.61). The most frequent physical examination findings were a positive quadrant test (70%), followed by lower-extremity muscle weakness (64%), abnormal reflexes (62%), and active lumbar extension (61%). Patients who were symptomatic during the quadrant test, patients who had pain with lateral flexion, and patients who had lower-extremity weakness had higher self-reported LSS symptom severity (t=-3.06, P=.003; t=-2.96, P=.004; and t=-3.2, P=.002, respectively). Pain with lumbar extension was moderately correlated with LSS symptom severity (Spearman rho=.31, P=.007). No lumbar PE procedure was associated with decreased condition-specific function. The quadrant test was the strongest predictor of symptom severity (beta=.54, r(2)=.21, P=.0009). DISCUSSION AND CONCLUSION: The association between PE findings and self-reported symptom severity in this sample is consistent with the pathoanatomy of degenerative spinal conditions and indicates that movement that narrows the foraminal space contributes to symptom severity. The quadrant test distinguished those subjects with clinically meaningful low back symptom severity but was not predictive of impaired function. This study illustrates the potential benefit of identifying clinical PE measures that are reflective of condition severity and back-specific function in patients with similar clinical syndromes.

Activities of Daily Living↗
PubMed1984

Fetal cardiac responding: a correlate of birth weight and neonatal behavior.

Certain intrapartum fetal heart-rate (FHR) patterns are associated with low Apgar scores and other neonatal risks. Intrapartum FHR has been the subject of extensive clinical investigation, but only occasional reference is made to the possible behavioral correlates of this phenomenon. The current investigation found that neonates classified as FHR decelerators had lower birth weights and shorter gestational ages than FHR accelerators. Decelerators exhibited higher baseline heart rate and experienced more frequent uterine contractions than accelerators. Neurobehavioral assessment of these neonates indicated that decelerators had more abnormal reflex ratings and were less behaviorally organized than heart-rate accelerators. The results indicate that FHR responses are associated with prenatal growth, maturity, and possibly stress tolerance, and that intrapartum FHR responses be related to nonoptimal neonatal behavior.

Behavior↗
PubMed1975

An investigation of the correlation between abnormal patterns of ocular microtremor and an abnormal pupil reflex in neurological patients.

Twenty-two patients and 7 normal subjects at the Burdenko Institute of Neurosurgery, Moscow, have taken part in an investigation in which the direct light reflex to a brief flash, and the high-frequency microtremor of the eyes, have been recorded. The direct pupil reflex recordings obtained with a flash of 20 msec duration and 100 lux intensity at the plane of the pupil were registered from the right eye of each patient. Ocular microtremor recordings were obtained simultaneously from both eyes of 20 of the patients. A set of criteria of abnormality of ocular microtremor, as judged by visual examination of the records, is proposed by the authors. Abnormality of the pupil reflex is assessed in terms of the amplitude, latent period, and time course of the contraction and relaxation phases of the reflex. A strong correlation has been found between the occurrence of an abnormal ocular tremor record and an abnormal pupil reflex. On the basis of this correlation, the authors propose that ocular tremor recordings may be used in diagnosis as sensitive indicators of brain-stem dysfunction.

Brain Diseases↗
PubMed1991

[A follow-up study of pupillary dynamics in patients with ocular hypertension and primary open angle glaucoma].

The authors previously reported light reflex abnormalities and adrenergic supersensitivity to topical epinephrine (DPE; dipivalyl epinephrine) of the pupils in patients with ocular hypertension (OH) and those with primary open angle glaucoma (POAG). In this investigation, we attempted to reconfirm pupillary light reflex abnormalities we reported previously, and to investigate the relationship between the normotensive effect of 0.1% DPE and the pupillary light reflex abnormalities in OHs and POAGs. A total of 11 OHs and 11 POAGs under good oculotensive control with neither mydriatics nor miotics were examined. They were measured by an open-loop photically stimulated infrared videopupilogram, and were neurologically diagnosed by comparing the simulated patterns of the light reflex made by topical autonomic agents. When we considered the progress of the stage of POAG, both OHs and POAGs showed satisfactory reproducibility of pupillary light reflex abnormalities. Other cases in which light reflexes altered, showed worsening of the visual field deficit, which was prominent when OHs developed into POAG. OHs with significant reduction of intraocular pressure (IOP) after topical administration of 0.1% DPE showed various kinds of abnormal pupillary light reflexes. On the contrary, cases with little reduction of IOP after 0.1% DPE instillation showed normal pupillary light reflexes in OHs and afferent pupillary defect on POAGs.

Adult↗
PubMed1994

Abnormal cardiovascular reflexes in patients with achalasia.

Using 3 non-invasive tests, abnormalities of cardiovascular reflex function were found in 7 of 15 patients with achalasia. Abnormalities of heart rate responses to the Valsalva maneuver, deep breathing, and standing were noted in patients with autonomic neuropathy defect. The findings are consistent with the hypothesis that an abnormality of vagal function may contribute to the pathogenesis of achalasia.

Adult↗
PubMed1976

Abnormal postural reflex activity and voice usage deviations in cerebral palsy.

A relationship is considered between abnormal postural reflex activity and its effect on vocal processes in infants and very young children having cerebral palsy. Neurodevelopmental treatment concepts are interpreted as they may apply to evaluation and intiial management of hypertonic children who exhibit voice usage deviations. Interdisciplinary team function in the areas of physical therapy, occupational therapy, and speech pathology is suggested.

Cerebral Palsy↗
PubMed1983

External ophthalmoplegia, alpha and spindle coma in imipramine overdose: case report and review of the literature.

A 13-year-old boy with imipramine overdose developed seizures, respiratory arrest, and coma. Abnormalities of oculovestibular reflexes, electroencephalograms, and brainstem auditory evoked potentials were monitored in relation to measurements of drug levels. An alpha-coma electroencephalographic pattern evolved into one evidencing spindle coma and eventually into a normal pattern. Prolonged brainstem auditory evoked potentials also normalized as coma and oculocephalic reflex abnormalities resolved. In spite of the history that suggested hypoxic damage, the absence of reflex eye movements in a comatose patient and the presence of alpha- and spindle-coma electroencephalographic patterns, even with prolonged brainstem auditory evoked potentials, are not reliable prognostic indicators in tricyclic drug overdose.

Adolescent↗
PubMed1991

Twenty-four hour blood pressure and heart rate profiles of diabetic patients with abnormal cardiovascular reflexes.

Twenty-four hour ambulatory blood pressure and heart rate profiles of 24 patients with diabetes were monitored in order to assess the effect of autonomic neuropathy on 24-h haemodynamic profiles. Eighteen patients had abnormal cardiovascular reflexes. Mean arterial pressure rose at night in six of the patients with autonomic neuropathy and fell by less than or equal to 5 mmHg in seven. In the remaining five patients with autonomic neuropathy and in the six diabetic patients with normal cardiovascular reflexes, the fall in nocturnal mean arterial pressure was comparable to that of 11 non-diabetic patients with essential hypertension. Median 24-h mean arterial pressure was similar in all four groups of diabetic patients. Prevalence of autonomic symptoms was not related to the change in blood pressure in those with autonomic neuropathy. Twenty-seven months after monitoring, three fatal and five severe non-fatal cardiovascular or renal events had occurred in four of the six patients with a rise in nocturnal blood pressure, compared with one non-fatal event in those with a small fall and no severe events in those with a pronounced fall (p = 0.02). Blood pressure rises at night in certain diabetic patients with abnormal cardiovascular reflexes and the nocturnal rise appears to be associated with a poor prognosis.

Adult↗
PubMed1990

The effect of sulindac on the abnormal cough reflex associated with dry cough.

In order to determine the possible role of prostaglandins in the abnormal cough reflex in patients with dry cough, the effects of a cyclooxygenase inhibitor on cough symptoms were examined. This was measured by a cough symptom score and by the cough reflex sensitivity to inhaled capsaicin in a double blind, randomized, cross-over study comparing the effects of placebo with sulindac, 200 mg daily for 1 week. We studied six hypertensive patients with angiotensin converting enzyme inhibitor-associated cough and six patients with an idiopathic, dry, unproductive cough, all of whom had an increase in the sensitivity of the cough reflex. There was no change in blood pressure control in the hypertensive patients during sulindac therapy. The patients with the angiotensin converting enzyme-associated cough had a significant reduction in the cough symptom score and also a significant increase in the dose of capsaicin causing two or more coughs (threshold sensitivity) and that causing five or more coughs (near maximum response) during sulindac therapy as compared to placebo. In those patients with idiopathic, dry, unproductive cough, sulindac did not alter the symptom of cough or the cough reflex response to capsaicin. These results suggest that prostaglandins may be involved in cough associated with angiotensin converting enzyme inhibitor therapy, but are less likely to be important in the pathogenesis of more common dry coughs of unknown cause.

Aged↗
PubMed1997

Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes, and abnormal muscle responses.

In patients with hemifacial spasm, it has been said that the spasm is due to cross compression of the facial nerve by a blood vessel and that microvascular decompression (MVD) of the facial nerve is an effective treatment. The F waves, which result from backfiring of antidromically activated motor neurons of the facial motor nucleus, are indices of the excitability of the facial motor nucleus and are enhanced in patients with hemifacial spasm. Measuring blink reflexes and abnormal muscle responses (lateral spread), a characteristic sign of hemifacial spasm, has been used to investigate the mechanism of hemifacial spasm pathophysiologically. Thus the authors measured F waves of the facial muscle, blink reflexes, and abnormal muscle responses before and after MVD in patients suffering from hemifacial spasm to investigate the excitability of the facial motor nucleus and the course of the cure of hemifacial spasm after MVD. The authors obtained facial nerve-evoked electromyograms in 20 patients with hemifacial spasm before and after the MVD procedure. On the spasm side, the F waves and blink reflexes were enhanced preoperatively compared to those on the normal side and abnormal muscle responses were recorded in all patients. In 12 patients whose hemifacial spasm had not disappeared completely for 5.1 +/- 1.7 (mean +/- standard error) months following the MVD procedure, F waves were still enhanced significantly and abnormal muscle responses were still recordable, albeit at lower amplitude. Within 1 month after the hemifacial spasm had disappeared completely. F waves were still significantly enhanced in 17 patients and abnormal muscle responses were recorded in seven of 15 patients. Subsequently, the enhanced F waves and abnormal muscle responses disappeared completely. The authors' study supports the hypothesis that the cause of hemifacial spasm is hyperexcitability of the facial motor nucleus and suggests that additional surgery should not be performed for at least 2 years after MVD, because that period is necessary for the disappearance of the hyperexcitability of the facial motor nucleus.

Adult↗
PubMed2004

Hyperekplexia and stiff-man syndrome: abnormal brainstem reflexes suggest a physiological relationship.

BACKGROUND AND OBJECTIVES: Hyperekplexia and the stiff-man syndrome (SMS) are both conditions with exaggerated startle suggesting abnormal brainstem function. Investigation of brainstem reflexes may provide insight into disturbed reflex excitation and inhibition underlying these movement disorders. PATIENTS AND METHODS: Using four-channel EMG, we examined four trigeminal brainstem reflexes (monosynaptic masseter, masseter inhibitory, glabella, and orbicularis oculi blink reflexes) and their spread into pericranial muscles in five patients with familial hyperekplexia (FH), two with acquired hyperekplexia (AH), 10 with SMS, and 15 healthy control subjects. RESULTS: Both FH/AH and SMS patients had abnormal propagation of brainstem reflexes into pericranial muscles. All patients with hyperekplexia showed an abnormal short-latency (15-20 ms) reflex in the trapezius muscle with a characteristic clinical appearance ("head retraction jerk") evoked by tactile or electrical stimulation of the trigeminal nerve, but normal monosynaptic masseter reflexes. Inhibitory brainstem reflexes were attenuated in some FH/AH patients. Four of 10 patients with SMS had similar short-latency reflexes in the neck muscles and frequently showed widespread enhancement of other excitatory reflexes, reflex spasms, and attenuation of inhibitory brainstem reflexes. CONCLUSION: Reflex excitation is exaggerated and inhibition is attenuated in both stiff-man syndrome and familial or acquired hyperekplexia, indicating a physiological relationship. Reflex transmission in the brainstem appears biased towards excitation which may imply dysfunction of inhibitory glycinergic or GABAergic interneurons, or both.

Adolescent↗
PubMed1991

Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation.

Cardiorespiratory reflexes were studied during slow breathing and a Valsalva maneuver in 232 Type 1 (insulin-dependent) diabetic subjects. At 1 to 7 years follow-up, death occurred in 23.4% of 175 patients with abnormal reflexes and in 3.5% of 57 patients with normal reflexes. The mortality rates of diabetic subjects with abnormal reflexes were 17% at 2.5 years, 33% at 5 years and 40% at 7 years, significantly higher than for patients with normal reflexes (4.6%, 4.6% and 13.8%). Among patients with abnormal reflexes, patients with a functioning pancreas transplantation had better survival rates than patients with a failed transplantation, and in long-term follow-up better than patients without transplantation. A functioning transplantation prevented the progressive decline of cardiorespiratory reflex function that occurred over time in control patients.

Adult↗
PubMed1983

Abnormal unloading reflex in a patient with infarction of the medial lemniscus.

The unloading reflex was measured in the intrinsic muscles of the hand. By removing various fractions of the load on the muscles, we determined the size of the electromyographic response as a function of the change in the external force. This technique was applied to both hands of a patient with a pontine lesion who had impaired position sense in the left hand. The response to fractional unloading was significantly smaller in the left hand, an asymmetry not found in control subjects. The results suggest (1) that the unloading reflex is mediated, at least in part, by suprasegmental pathways, and (2) that the fractional unloading technique can reveal abnormalities not found by conventional methods.

Adult↗
PubMed1984

ABR in patients with congenital/early acquired sensorineural hearing loss, abnormal stapedius reflex thresholds and speech retardation.

The auditory brain stem response (ABR) was recorded in 14 young subjects with mild to moderately severe congenital/early acquired sensorineural hearing loss and abnormal stapedius reflex thresholds. The speech problems of these patients as evaluated by experienced examiners were considered to be more pronounced than could be explained from the hearing loss as measured by the pure tone audiometry. Psychological testing yielded intelligence scores within normal limits or above average for age in 11. They all gave abnormal ABR, indicating dysfunction of the auditory brain stem pathways or, in a few cases, of the cochlear part of the auditory nerve. Presumably, the electrophysiologically demonstrable pathological changes were caused by perinatal complications or early life infectious disease. ABR may prove valuable in the evaluation of children with speech retardation.

Adolescent↗
PubMed2002

Blink reflex in the prediction of outcome of idiopathic peripheral partial facioparesis: follow-up study.

AIM: To determine the value of the blink reflex as a predictor of outcome of idiopathic peripheral partial facial paresis. METHOD: The study included 30 patients suffering from acute idiopathic peripheral facioparesis and 30 age- and sex-matched healthy controls. Patients with symptomatic disease were excluded on the basis of neuroradiologic and laboratory findings. We stimulated the supraorbital foramen and recorded the evoked response from both orbiculares oculi muscles. We measured the ipsilateral early phasic component (R1) and bilateral late tonic component (ipsilateral R2 and contralateral R2) immediately, and a week and 6 months after the first test. RESULTS: In the acute phase of idiopathic peripheral partial facioparesis, the blink reflex showed slightly prolonged latencies and greatly reduced amplitudes of both R1 and R2 and the normal latencies and amplitudes of R2. All subjects showed clinical symptoms and typical electromyographic (EMG) changes, whereas 24 had blink reflex abnormalities. One week after the onset, all patients were still symptomatic and showed EMG changes, but blink reflex abnormalities remained in only 11 patients. Six months after the onset, 21 patients became asymptomatic and showed no EMG changes, 7 had no clinical symptoms but showed chronic neurogenic EMG changes, whereas 2 showed both clinical symptoms and EMG changes. Blink reflex abnormalities were observed in 6 patients. The amplitudes of R1 immediately and one week after the onset were the best predictors of residual motor deficit. CONCLUSION: Blink reflex is a useful tool for follow-up and recovery prognosis in patients with partial idiopathic facioparesis, especially in the early recovery phase.

Adult↗
PubMed1986

Orthostatic tolerance of normal Indians and those with suspected abnormal cardiovascular reflex status.

There were 143 healthy Indian males subjected to 70 degrees headup tilt (HUT) for 20 min on 166 occasions to evaluate their cardiovascular response. They responded with a significant rise in heart rate, diastolic pressure, and mean arterial pressure. Pulse pressure fell significantly. Heart rate and diastolic pressure during the tilt were significantly (p less than 0.05) and positively correlated to the height of the subjects. None of the subjects had syncope, which has been reported in normal individuals elsewhere. Of the 57 subjects with suspected abnormality of the cardiovascular reflex status, who were also investigated by the tilt test, 13 (22.8%) developed various degrees of orthostatic intolerance. Of these 13 subjects, 10 had had syncope in the past. In view of these observations, it is concluded that 70 degrees head-up tilt is an important clinicophysiological investigation in the assessment of subjects with a suspected abnormality of their cardiovascular reflex status.

Adult↗
PubMed1992

Oesophageal reflex responses: abnormalities of the enteric nervous system in patients with oesophageal symptoms.

An intraluminal balloon was used to study the peristaltic reflex, which is mediated by the intrinsic nerves of the oesophagus. Serial balloon distension was performed in nine asymptomatic volunteers and 133 patients with oesophageal symptoms. Eight of the volunteers had a normal response with proximal stimulation and distal inhibition of motility. Only 42 patients (31.6 per cent) had a normal response. The commonest abnormal response (39.1 per cent) was some form of failure of the distal inhibitory reflex. Other patterns of abnormality were an unresponsive oesophagus (15.8 per cent) with no motility change during balloon inflation, or spasm (13.5 per cent) proximal to the balloon. These alterations of secondary peristaltic activity suggest that there are abnormalities of the intrinsic (enteric) nerves of the oesophagus. Different abnormalities were found in patients with similar symptoms. Awareness of this difference might allow a more rational approach to treatment. This hypothesis was tested in a small pilot study treating functional dysphagia with cisapride. Three of nine patients had marked symptomatic improvement within 4 weeks and all three had an unresponsive oesophagus. The remaining six patients, who had failure of distal inhibition or a normal response, did not improve.

Adult↗