Comparison of Transcutaneous Electrical Nerve Stimulation and Cryotherapy for Increasing Quadriceps Activation in Patients With Knee Pathologies

Clinical Scenario:Proper neuromuscular activation of the quadriceps muscle is essential for maintaining quadriceps (quad) strength and lower-extremity function. Quad activation (QA) failure is a common characteristic observed in patients with knee pathologies, defined as an inability to voluntarily activate the entire alpha-motor-neuron pool innervating the quad. One of the more popular techniques used to assess QA is the superimposed burst (SIB) technique, a force-based technique that uses a supramaximal, percutaneous electrical stimulation to activate all of the motor units in the quad during a maximal, voluntary isometric contraction. Central activation ratio (CAR) is the formula used to calculate QA level (CAR = voluntary force/SIB force) with the SIB technique. People who can voluntarily activate 95% or more (CAR = 0.95–1.0) of their motor units are defined as being fully activated. Therapeutic exercises aimed at improving quad strength in patients with knee pathologies are limited in their effectiveness due to a failure to fully activate the muscle. Within the past decade, several disinhibitory interventions have been introduced to treat QA failure in patients with knee pathologies. Transcutaneous electrical nerve stimulation (TENS) and cryotherapy are sensory-targeted modalities traditionally used to treat pain, but they have been shown to be 2 of the most successful treatments for increasing QA levels in patients with QA failure. Both modalities are hypothesized to positively affect voluntary QA by disinhibiting the motor-neuron pool of the quad. In essence, these modalities provide excitatory afferent stimuli to the spinal cord, which thereby overrides the inhibitory afferent signaling that arises from the involved joint. However, it remains unknown whether 1 is more effective than the other for restoring QA levels in patients with knee pathologies. By knowing the capabilities of each disinhibitory modality, clinicians can tailor treatments based on the rehabilitation goals of their patients.Focused Clinical Question:Is TENS or cryotherapy the more effective disinhibitory modality for treating QA failure (quantified via CAR) in patients with knee pathologies?

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EFFICACY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION AND THERAPEUTIC ULTRASOUND IN PATIENTS SUFFERING FROM CHRONIC CERVICAL PAIN

International Journal of Medical Science and Diagnosis Research ◽

10.32553/ijmsdr.v5i6.814 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Meenakshi Sharma ◽

Shyamal Koley

Keyword(s):

Nerve Stimulation ◽

Daily Living ◽

Transcutaneous Electrical Nerve Stimulation ◽

Therapeutic Ultrasound ◽

Cervical Pain ◽

Electrical Nerve Stimulation ◽

Therapeutic Exercises ◽

Group A ◽

Group B ◽

Hot Pack

The purpose of the present study was to search to search the efficacy of transcutaneous electrical nerve stimulation and therapeutic ultrasound in patients suffering from chronic cervical pain. To fulfill the purpose, A total of randomly selected 30 patients with chronic cervical pain aged 20-70 years were selected from the Physiotherapy Center of Guru Nanak Dev University, Amritsar for the present study. The patients were further randomly divided into two groups, in Group-A, patients were treated with Transcutaneous Electrical Nerve Stimulation (TENS), Therapeutic Ultrasound (TUS), followed by hot pack, massage, therapeutic exercises (shoulder circumduction, pectoral stretching), cervical stretching, cervical isometrics with the recommendation for daily living activities, whereas, in Group-B, the patient s were treated only with hot pack, massage, therapeutic exercises (shoulder circumduction, pectoral stretching), cervical stretching and cervical isometrics with the recommendation for daily living activities. The outcome measures were Visual Analogue Scale (VAS) for pain, Neck Pain Visual Disability Index (NDI) for disability. The results revealed statistically significant decrease (p<0.001) both in NDI and VAS in patients with cervical pain between pre- and post-intervention in the Group-A and B, but Group-A showed significantly superior effects both in NDI (82.88% decrement) and VAS (71.62% decrement) than Group-B. In conclusion, it might be stated that transcutaneous electrical nerve stimulation and therapeutic ultrasound were found more effective than conventional physiotherapeutic techniques in relieving pain intensity and disability in patients with chronic cervical pain. Keywords: Transcutaneous Electrical Nerve Stimulation, Therapeutic Ultrasound, Patients with Chronic Cervical Pain.

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Neurophysiology in amyotrophic lateral sclerosis and other motor degenerations

10.1093/med/9780199688395.003.0022 ◽

2016 ◽

Author(s):

Mamede de Carvalho ◽

Michael Swash

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Motor Neuron ◽

Motor Unit ◽

Chronic Conditions ◽

Motor Units ◽

Disease Course ◽

Motor Neuron Diseases ◽

Motor Neuron Pool ◽

Neuron Pool ◽

Lateral Sclerosis

Electromyography is critical for the diagnosis of motor neuron disease, as its findings exclude mimicking disorders, and confirm signs of widespread motor unit loss and reinnervation. In chronic conditions the slow disease course allows giant, stable motor unit potentials to appear. In contrast, in amyotrophic lateral sclerosis, the rapid degenerative process is characterized by signs of denervation and unstable motor unit potentials, where motor units become dysfunctional before having time to sustain very large reinnervated motor unit potentials. Fasciculation potentials are observed in both conditions. In amyotrophic lateral sclerosis fasciculation potentials are important supporting electrodiagnostic evidence, permitting earlier diagnosis. Many methods have been developed to quantify and monitor the lower motor neuron pool, but few have been used in clinical trials. Their role as tools to follow interventions or to interpret pathogenesis remains incompletely explored. Electromyography is a sensitive and reliable test in the diagnosis and assessment of motor neuron diseases.

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