American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Jun 1990
Comparative StudyNeedle electrode insertion into tibialis posterior. A new approach.
The tibialis posterior can be a valuable muscle in the electrodiagnostic evaluation of the sacral plexus, lumbosacral roots, lower extremity neuropathies and tibial nerve lesions. It may be under utilized, however, because it is generally considered to be inaccessible to needle examination. ⋯ In six cadaver legs, the safe access to this muscle via the anterior approach was 16.8 +/- 5 mm by contrast to 9.5 +/- 2 mm by the posterior approach. We conclude that the anterior approach to needle electromyography of the tibialis posterior muscle is easier, safer and deserves more widespread practice.
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Stokes (J Occup Med; 1983;25:683-684) proposed that feigned weak hand grip can be distinguished from sincere efforts by examining force measurements for the different handle positions of the Jamar hand dynamometer. Sincere efforts yield a curvilinear relationship between grip force and handle position; feigned efforts yield a horizontal, linear relationship. The purpose of the present set of three experiments was to investigate the degree of control normal subjects have over submaximal effort and their ability to feign weakened grip. ⋯ In Experiment 2 we found a linear relationship between the degree of submaximal effort and grip force for efforts of 30, 50, 70, and 90% of maximal effort. In Experiment 3 we found that subjects, with proper instruction as to the amount of effort to exert, can produce feigned submaximal efforts similar to the sincere, maximal efforts of injured people. Simple maximal grip force measurements are insensitive to the different motor strategies used in maximal and submaximal efforts and may provide little evidence for the detection of feigning.
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Am J Phys Med Rehabil · Feb 1990
Randomized Controlled Trial Clinical TrialCan trials of physical treatments be blinded? The example of transcutaneous electrical nerve stimulation for chronic pain.
Therapeutic trials often attempt to "blind" patient and investigator to the true nature of treatments received, reducing the influences of conscious or subconscious prejudices. In drug trials, this is accomplished with placebo tablets, but blinding in trials of physical treatments is more problematic. This issue arose in a clinical trial of transcutaneous electrical nerve stimulation (TENS) for patients with chronic low back pain. ⋯ Clinicians guessed treatments correctly 61% of the time (as opposed to 50% expected by chance), again suggesting partial success in blinding. These efforts at blinding may partly explain the negative trial results for TENS efficacy. We conclude that complete blinding is difficult to achieve because of sensory difference in treatment and unintended communication between patient and examiner.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am J Phys Med Rehabil · Dec 1989
Management alternatives for post-polio respiratory insufficiency. Assisted ventilation by nasal or oral-nasal interface.
Post-poliomyelitis patients may develop insidious respiratory failure. Chronic alveolar hypoventilation symptoms are often misdiagnosed and the condition is frequently treated inappropriately by oxygen therapy. Physicians are often at a loss to offer assisted ventilation by noninvasive methods and tracheostomy and long-term tracheostomy intermittent positive pressure ventilation is often refused. ⋯ Six have been on nocturnal SONI IPPV for an average of 35 (5-66) months. All patients' hypoventilation symptoms were relieved. In conclusion, NIPPV and SONI IPPV can improve the nocturnal ventilation of post-poliomyelitis patients with chronic alveolar hypoventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am J Phys Med Rehabil · Apr 1989
Case ReportsTibial nerve somatosensory evoked potentials in spinal cord hemisection.
Somatosensory evoked potentials (SEPs) have been studied in many disease states since they were first described by Dawson in 1947. However, there have been very few reports of SEP findings in patients with spinal cord hemisection. On the basis of clinical correlation, Giblin first postulated that the activity giving rise to the initial cortical components of the SEP travels through the dorsal column-lemniscal system. ⋯ This paper examines the results of tibial nerve SEPS performed on four patients with spinal cord hemisection (Brown-Séquard syndrome). In all four cases presented, the impairment of cortical SEP components was consistently associated with stimulation of the leg ipsilateral to the side of cord injury. We conclude that the most likely mechanism of transmission is through the ipsilateral dorsal columnlemniscal system.