Electrophysiological comparison study between effectiveness of the treatment modalities (Baclofen and Tizanidine drug) on spasticity management

Background: Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. patients and methods: This study was conducted in Ibn Al-Quf hospital for spinal cord injuries from the period December 2011 to June 2012. All of the participants gave written consent to participate in the study. The patients were divided into 2 groups: Group (I): Baclofen with physiotherapy treatment group; and Group (II): Tizanidine with physiotherapy treatment groups .H-reflex measurements were performed. parameters were studied: H-reflex latency, M wave latency, H-reflex conduction velocity, H-reflex duration, H-reflex amplitude. Results: All the patients had symptoms of spasticity at any time during the day with a Modified Ashworth Scale (MAS) before performing the H-reflex study. highly significant improvement in the H/M ratio when comparing positive controls to the two groups while the H/M ratio in the negative controls shows no significant difference with group I and group II. A significant correlation was noticed between the height of control subjects & H-reflex latency (P= 0.002), significant positive correlation was also found (P=0.028) between the height & M wave latency in the control subjects, The results revealed that the type of treatment did not affect the H-reflex and F wave parameters except for the H/M ratio. conclusion: H-reflex can provide information regarding neural function after spinal cord injury and the H/M ratio can be used as a good indicator for both spasticity assessment and response to treatment. Tizanidine hydrochloride is useful in the management of spasticity caused by SCI and can be used as a routine drug treatment although liver function tests should be periodically monitored.

Effects of adding neural mobilization to traditional physical therapy on pain, functional disability, and H-reflex in patients after lumbar laminectomy: A randomized controlled trial

Objective: To investigate whether adding neural mobilization to a standard postoperative physical therapy program could improve the outcomes of patients after lumbar laminectomy. Design: A single blinded randomized controlled trial. Setting: Outpatient setting. Participants: Sixty participants of both sexes who had undergone lumbar laminectomy. Interventions: Participants were allocated randomly to two groups; study and control groups. All patients received a standard postoperative physical therapy program. Those in the study group received additional neural mobilization in the form of straight leg raising and dorsiflexion with two-ended slider. Treatment was administered three times/week for six successive weeks. Outcome measures: Visual analog scale (VAS), Oswestry disability index (ODI), and H-reflex latency were measured pre and post-treatment. Results: The mean age of participants was 44.23 ± 4.64 and 45.3 ± 5.3 in study and control groups respectively ( P > 0.05). There were statistically significant differences in VAS, ODI, and H-reflex latency in favor of the study group ( P < 0.05). The mean ± SD for VAS, ODI, and H-reflex latency pre vs post treatment was 6.13 ± 1.22 vs 1.40 ± 0.77, 64.46 ± 4.05 vs 16.86 ± 2.55, and 32.07 ± 2.76 vs 27.46 ±1.79 in study group and 5.86 ± 1.07 vs 2.46 ± 0.73, 63.93 ± 3.91 vs 23.40 ± 2.93, and 31.76 ± 2.69 vs 29.4 ± 1.94 in control group, respectively. Conclusions: Neural mobilization combined with traditional physical therapy program achieved better improvement in pain, functional disability and H-reflex in patients who underwent decompressive laminectomy than traditional physical therapy program only.

Sacral Reflex Characteristics of Patients with Multiple System Atrophy

Objectives. To observe and analyze the parameters of the sacral reflex and pudendal nerve somatosensory evoked potential (SSEP) in patients with multiple system atrophy (MSA) with respect to factors such as age, disease course, and subtype and provide evidence for the clinical diagnosis of MSA. Materials and Methods. A total of 51 MSA patients and 30 healthy controls were selected from the First Affiliated Hospital of Wenzhou Medical University from May 2013 to November 2015. Electrophysiological sacral reflex detection and SSEP detection were performed using the Keypoint EMG/EP system. The extraction rate, latency, and amplitude of the sacral reflex and SSEP in the MSA group and control group were compared. Results. The sacral reflex latency and amplitude in patients with MSA were statistically different from those of the healthy controls. The latency of sacral reflex increases with the prolongation of the disease course, and the amplitude and initiation rate decrease with the prolongation of the disease course. There was no significant difference in sacral reflex latency and amplitude between MSA patients of different ages and subtypes. There was no significant difference in the latency or amplitude of SSEP between the MSA group and healthy control group. Conclusions. The latency of sacral reflex increases with the prolongation of the disease course, and the amplitude and extraction rate decrease with the prolongation of the disease course. There was no significant difference in the parameters of sacral reflex between young MSA patients and elderly patients. And there was no statistically significant difference between MSA-P subtypes and MSA-C subtypes. This trial is registered with ISRCTNCR2009041.

H-reflex latency changes after combined application of traction and neural mobilization in cervical radiculopathy

Background Cervical radiculopathy is a pathology of the cervical nerve root and mostly caused by a cervical disk herniation leading to chronic pain and disability. Objectives This study was conducted to show the effect of the combined application of intermittent cervical traction with median nerve mobilization on flexor carpi radialis (FCR) muscle H-reflex latency of median nerve in patients with unilateral cervical radiculopathy due to disk lesion in a pre-post design. Methods Fifteen patients (10 females and 5 males) with a mean age of 38.07 ± 5.85 years received simultaneous application of intermittent cervical traction and median nerve mobilization. Six sessions were given every other day for 2 weeks. Also, patients perormed chin in exercises and upper back extension with scapular retraction. FCR H-reflex latency was measured pre- and post-treatment. Results Statistical analysis showed that there was a significant reduction of H-reflex latency at post-treatment in comparison to pretreatment (t = 5.447, p value = 0.0001*). Conclusion Simultaneous application of intermittent cervical traction and median nerve mobilization are effective in improving FCR H-reflex latency in patients with unilateral cervical radiculopathy.

The influences of stimulation mode and stimulus frequency on acoustic reflex latency (ARL) among young adults

Introduction Acoustic reflex (AR) is a valuable clinical test for hearing diagnosis. Parameters of AR such as its amplitude and threshold have been commonly reported in research. Acoustic reflex latency (ARL) has not been widely studied and more research is warranted to determine its basic properties and clinical usefulness. The present study aimed to determine the influences of stimulation mode and stimulus frequency on ARL. Methods In this study, 52 healthy young adults were enrolled (mean age = 23.2 ± 0.8 years, 61.8% were males). They underwent the standard AR testing and ARL values were computed. Both ipsilateral and contralateral recordings were made at 500, 1000, 2000 and 4000 Hz frequencies. Results The ARL values obtained are consistent with the findings from the previous studies. Two-way analysis of variance (ANOVA) revealed that the ARL values were not statistically influenced by either stimulation mode (p = 0.061) or stimulus frequency (p = 0.598). Conclusion Among young adults, ARL does not appear to be influenced by stimulation mode and stimulus frequency. Further large scale research is warranted to support the present study’s findings. The preliminary normative data for ARL obtained in this study can serve as the reference for future research involving this particular population.

Neuromusculoskeletal simulation reveals abnormal rectus femoris-gluteus medius reflex coupling in post-stroke gait

ABSTRACTPost-stroke gait is often accompanied by muscle impairments that result in adaptations such as hip circumduction to compensate for lack of knee flexion. Our previous work robotically enhanced knee flexion in individuals post-stroke with Stiff-Knee Gait (SKG), however, this resulted in greater circumduction, suggesting the existence of abnormal coordination in SKG. The purpose of this work is to investigate two possible mechanisms of the abnormal coordination: 1) an involuntary coupling between stretched quadriceps and abductors, and 2) a coupling between volitionally activated knee flexors and abductors. We used previously collected kinematic, kinetic and EMG measures from nine participants with chronic stroke and five healthy controls during walking with and without the applied knee flexion torque perturbations in the pre-swing phase of gait in the neuromusculoskeletal simulation. The measured muscle activity was supplemented by simulated muscle activations to estimate the muscle states of the quadriceps, hamstrings and hip abductors. We used linear mixed models to investigate two hypotheses: H1) association between quadriceps and abductor activation during an involuntary period (reflex latency) following the perturbation and H2) association between hamstrings and abductor activation after the perturbation was removed. We observed significantly higher rectus femoris (RF) activation in stroke participants compared to healthy controls within the reflex latency period following the perturbation based on both measured (H1, p < 0.001) and simulated (H1, p = 0.022) activity. Simulated RF and gluteus medius (GMed) activations were correlated only in those with SKG, which was significantly higher compared to healthy controls (H1, p = 0.030). There was no evidence of voluntary synergistic coupling between any combination of hamstrings and hip abductors (H2, p > 0.05) when the perturbation was removed. The RF-GMed coupling suggests an underlying abnormal reflex coordination pattern in post-stroke SKG. These results challenge earlier assumptions that hip circumduction in stroke is simply a kinematic adaptation due to reduced toe clearance. Instead, abnormal coordination may underlie circumduction, illustrating the deleterious role of abnormal coordination in post-stroke gait.