Electromyography and clinical neurophysiology
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Electromyogr Clin Neurophysiol · Jan 2010
Phase relation changes between the firings of alpha and gamma-motoneurons and muscle spindle afferents in the sacral micturition centre during continence functions in brain-dead human and patients with spinal cord injury.
1. Single-nerve fibre action potentials (APs) were recorded with 2 pairs of wire electrodes from lower sacral nerve roots during surgery in patients with spinal cord injury and in a brain-dead human. Conduction velocity distribution histograms were constructed for afferent and efferent fibres, nerve fibre groups were identified and simultaneous impulse patterns of alpha and gamma-motoneurons and secondary muscle spindle afferents (SP2) were constructed. ⋯ It is conceivable that the mutual inhibitory action of detrusor and external bladder sphincter has the capacity to recover, if the functional neuronal organization of the sacral micturition center is improved in the direction of more stable phase relations between the firings of neurons and neuronal ensembles by natural coordinated afferent inputs from continence organs, supraspinal neurons, and functionally connected neuronal networks. For supraspinal control and improvement of neuronal organization some kinds of bulbo-spinal-bulbo pathways have to exist or to be reconstructed by regeneration. 7. It will be shown in a following article that the sacral micturition centre can be repaired after spinal cord injury by a functional reorganization and limited regeneration of the human spinal cord by administering coordination dynamics therapy.
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Electromyogr Clin Neurophysiol · Sep 2009
The classification and identification of human somatic and parasympathetic nerve fibres including urinary bladder afferents and efferents is preserved following spinal cord injury.
Single-fibre extracellular action potentials were recorded with 2 pairs of wire electrodes from lower human sacral nerve roots during surgery. The roots from which was recorded from were used for morphometry. Nerve fibre groups were identified by conduction velocity distribution histograms of single afferent and efferent fibres and partly by nerve fibre diameter distribution histograms. The values of group conduction velocity and group nerve fibre diameter measured in the paraplegics were very similar to those obtained from brain-dead humans and patients with no spinal cord injury. Thus the classification and identification of nerve fibre groups remained preserved following spinal cord injury. Upon retrograde bladder filling the urinary bladder stretch and tension receptor afferent activities were increased; on two occasions they even fired when the bladder was empty. Two reasons are brought forward for a too small storage volume of the urinary bladder in paraplegics: too high afferent activity of the bladder due to changed receptor field transduction mechanisms and too low compliance. ⋯ 1. Single nerve fibre action potentials (APs) of lower sacral nerve roots were recorded extracellularly with 2 pairs of wire electrodes during an operation for implanting an anterior root stimulator for bladder control in 9 humans with a spinal cord injury and a dyssynergia of the urinary bladder. Roots that were not saved and that were used to record from were later used for morphometry. 2. Nerve fibre groups were identified by conduction velocity distribution histograms of single afferent and efferent fibres and partly by nerve fibre diameter distribution histograms, and correlation analysis was performed. Group conduction velocity values were obtained additionally from compound action potentials (CAPs) evoked by electrical stimulation of nerve roots and the urinary bladder. 3. The group conduction velocities and group nerve fibre diameters had the following pair-values at 35.5 degrees C: Spindle afferents: SP1 (65 m/s / 13.1 microm), SP2 (51/12.1); touch afferents: T1 (47/11.1), T2 (39/10.1), T3 (27/9.1), T4 (19/8.1); urinary bladder afferents: S1 (41 m/s / -), ST (35/-); alpha-motoneurons: alpha 13 (-/14.4), alpha 12 (65 m/s /13.1 microm), alpha 11 (60?/12.1)[FF], alpha 2 (51/10.3)[FR], alpha 3 (41/8.2)[S]; gamma-motoneurons: gamma(beta) (27/7.1), gamma 1 (21/6.6), gamma 21 (16/5.8), gamma 22 (14/5.1); preganglionic parasympathetic motoneurons: (10 m/s / 3.7 microm). 4. The values of group conduction velocity and group nerve fibre diameter measured in the paraplegics were very similar to those obtained earlier from brain-dead humans and patients with no spinal cord injury. Also, the axon number and the axon density of myelinated fibres of lower sacral nerve roots remain unchanged following spinal cord injury. Thus the classification and identification of nerve fibre groups remained preservedfollowing spinal cord injury. A direct comparison can thus be made of natural impulse patterns of afferent and efferent nerve fibres between paraplegics (pathologic) and brain-dead humans (supraspinal destroyed CNS, in many respects physiologic). 5. When changing the root temperature from 32 degrees C to 35.5 degrees C, the group conduction velocities changed in the following way in one case: SP2: 40 m/s (32 degrees C) to 50 m/s (35.5%), S1: 31.3 to 40, ST: 25 to 33.8, M: 12.5 to 13.8; alpha 2: 40 to 50, alpha 3: 33 to 40. The group conduction velocities showed different temperature dependence apart from SP2 fibres and alpha 2-motoneurons. 6. Upon retrograde bladder filling the urinary bladder stretch (S1) and tension receptor afferent (ST) activity levels were undulating and increased. As compared to activity levels detected in a brain-dead human, S1 (designates afferents, not cord segment) and ST afferents fired even when the bladder was empty, with an activity level similar to those observed in a brain-dead human with the bladder half filled. Two reasons are brought forward for an too small storage volume of the urinary bladder in paraplegics: too high afferent activity of the bladder due to changed receptor field signal transduction mechanisms and too low compliance. 7. With the newly developed 'coordination dynamics therapy', applied early after spinal cord injury, such complications of bladder functioning can be avoided; the bladder can causally be cured in severe spinal cord injury.
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Electromyogr Clin Neurophysiol · May 2009
Randomized Controlled TrialEvaluation of effectiveness of local insulin injection in non-insulin-dependent diabetic patient with carpal tunnel syndrome.
Carpal tunnel syndrome (CTS) is the most common type of peripheral nerve entrapment and is a significant cause of morbidity. Carpal tunnel syndrome (CTS) has more incidences in diabetic patients. It has been suggested that insulin has an effect on nerve regeneration similar to that of nerve growth factor (NGF). Therefore, we aimed to evaluate the effectiveness of local insulin injection on the median nerve in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have mild-to-moderate carpal tunnel syndrome (CTS). ⋯ Local insulin injection is an effective and safe treatment for carpal tunnel syndrome in NIDDM patients as physiotherapy
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Electromyogr Clin Neurophysiol · Nov 2008
Influence of trunk muscle co-contraction on spinal curvature during sitting reclining against the backrest of a chair.
Today, many office workers frequently adopt a relaxed or slumped sitting posture for many hours, and often people tend to spend their leisure time reclining against the backrest of a chair while sitting for a long time, as when watching television. While sitting, the pelvis rotates backwardly, and lumbar lordosis is flattened. Simultaneously, the load on the intervertebral discs and spine increases. ⋯ The co-contraction of the trunk muscles resulted in significantly less lumbar curvature and more sacral angle than during slump sitting. The thoracic curvature showed no significant change during either sitting posture. The results of this study indicated that co-contraction of the trunk muscles during sitting reclining against the backrest of a chair could bring about the correct lumbar curvature, effectively stabilize the lumbopelvic region, and decrease focal stress on passive structures.
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Electromyogr Clin Neurophysiol · Jun 2008
Case ReportsNitrous oxide induced sub-acute combined degeneration of spinal cord: a case report.
We report a patient who developed signs and symptoms of a myelopathy after exposure to nitrous oxide. Magnetic Resonance Imaging of the cervical spinal cord disclosed hyperintensities of the dorsal columns on T2 weighted images suggesting sub-acute combined degeneration.