Relationship between bulbocavernosus reflex,patellar reflex and rehabilitation during acute stage of cervical spinal injury

AIM:To investigate the relationship between bulbocavernous reflex(BTR),patellar reflex(PTR) and rehabilitation during acute stage of cervical spinal injury.METHODS:73 cases of a class frankel cervical spinal injury patients were examined with BTR and PTR and recorded the time of the two reflexes,then follow-up after 6 months to monitor recovery situation.RESULTS:There were 28 cases of positive BCR within the first 72h(38%),7 cases of improved conditions(25%);there were 13 cases of PTR positive(17%),13 casses of improved status(100%).CONCLUSION:BCR and PTR are the sign of improved status and better rehabilitation during the acute stage.     

Therapy for persistent vegetative state with SW cerebral reflex therapeutic instrument

Persistentvegetativestate(PVS)isonespecialkindofdistur-banceofconsciousness.Atpresent,thereisnoeffectivetherapeuticmethodforPVS,andmostpatientswiththisdiseasecan'trestoretonormalandlifequalityisverypoor.OurdepartmenthaveappliedSWcerebralreflextherapeuticinstrumenttotreat8patientswithPVSsince1977,andmadesomeeffects.Theresultswereshowedasfollow:1Subjectsandmethod1.1SubjectsAcohortof8patientswithPVS(agedfrom13to66,averaged43,6maleand2female)wasinvolved.Thecauseofonset:5casesfromcerebraltra…     

Can stapedius reflex testing objectively measure muscle function in Pompe patients?

We assessed the value of stapedius reflex testing as an objective measurement of striated muscle function in four patients with Pompe disease. Common tests of disease severity and efficacy of enzyme replacement therapy (ERT) yield highly variable results that depend on patient cooperation and day‐to‐day performance, whereas stapedius reflex thresholds improved in seven of eight ears after 2 years of ERT.     

Is the R3 component of the human blink reflex nociceptive in origin?

The R3 component of the blink reflex can reproducibly be evoked by noxious stimulation but can probably also be elicited by innocuous stimuli. This study was conducted to investigate the contribution of nociceptive A delta and C fibers to the generation of the electrically evoked R3 blink reflex. Electrical thresholds for detection, pain and all blink reflex components were determined and the modulatory effects of local anesthesia were investigated. The electrical R3 threshold of 4.6 +/- 0.5 mA (mean +/- SE) corresponded to 2.9 times the detection threshold and to 0.35 times the pain threshold. The R3 threshold was significantly below the pain threshold. Under local anesthesia of the supraorbital skin with a complete loss of warm and cold sensation, a loss of pinprick sensation, but a normal detection of tactile stimuli, the electrical pain threshold increased, all other thresholds remained unchanged. Under local anesthesia none of the reflex components were significantly reduced. Cutaneous A beta fibers and nociceptive A delta fibers, but not unmyelinated C fibers, contribute to the generation of the electrically evoked R3 component. According to the recruitment order in peripheral sensory nerves the electrical threshold of the R3 is mainly determined by activation of A beta fibers. Thus, it can not be assumed that the electrically evoked R3 is an adequate model to investigate nociceptive processing.     

The sympathetic skin response--a useful method for the diagnosis of reflex sympathetic dystrophy?

The aim of the present study was to examine the value of the sympathetic skin response (SSR) in the diagnosis of reflex sympathetic dystrophy (RSD). PATIENTS AND METHODS: SSR was recorded in 20 normal subjects and in 24 patients with predominantly chronic RSD. In 3 patients with RSD, additional recordings of the SSR were performed before and several times after administration of local anaesthetics via a plexus catheter on the diseased side. SSR was recorded with standard EMG apparatus. Disc electrodes were positioned on the middle of the volar and dorsal surfaces of the hands and feet. Electrical stimuli were applied to the middle of the forehead at irregular intervals longer than 60 s. RESULTS: In normal subjects inter- and intraindividually different monophasic, biphasic and triphasic potentials without difference in the waveform between sides were recorded. SSR abnormalities were found in 15 patients with RSD and correlated with the severity of the disease. In patients with slight dystrophy SSR was predominantly normal, while in most of those with intermediate dystrophy differences in the SSR waveform between sides were observed. In the presence of severe dystrophy SSR amplitude was predominantly decreased on the affected side. Following the administration of local anaesthetics via a plexus catheter, the differences in SSR waveform became smaller in patients with initial distinct side difference of the waveform. However, differences in SSR amplitudes or latencies between sides were not affected. CONCLUSIONS: Side differences in SSR waveform could be due to a mild, reversible unilateral sudomotor dysfunction, whereas differences in SSR amplitude or latency indicate more serious damage to sudomotor activity, possibly due to dysfunction of autonomic fibres. In patients with slight dystrophy sweat secretion is predominantly normal, while in severe dystrophy more serious damage to the sweat secretory system can be observed. SSR provides useful information on sudomotor dysfunction in patients with RSD. However, as there is no consensus on the clinical criteria for diagnosis of RSD, it is also not possible to determine the diagnostic value of SSR in the diagnosis of RSD.     

“Hypnopuncture”—A Dental-Emergency Treatment Concept for Patients with A Distinctive gag reflex

The present case report describes a newly developed dental treatment concept for patients with a distinctive gag reflex. “Hypnopuncture” is a combination therapy of hypnosis and acupuncture. Its simple, fast, and effective application autonomous of the cause makes it a valuable tool for dental-emergency treatment procedures. Physiologic and psychological aspects of gagging are influenced at the same time. The protocol is illustrated in the case of a 76-year-old patient with a severe gag reflex who was successfully treated by this combination approach. Necessary and effective therapeutic measures from both acupuncture and hypnosis are portrayed.     

Do physical therapy and occupational therapy reduce the impairment percentage in reflex sympathetic dystrophy?

Reflex sympathetic dystrophy (RSD) is a disorder that can potentially result in permanent impairment. Because there are no adequate comparative studies regarding the additional value of physical therapy (PT) or occupational therapy (OT) for reducing the severity of permanent impairment in RSD, we prospectively investigated their effectiveness. At two university hospitals, we randomly assigned 135 patients with RSD of one upper limb, existing for <1 yr, to PT, OT, or control therapy (CT). One year after inclusion, impairment percentages were calculated according to the general method of the American Medical Association's Guides to the Evaluation of Permanent Impairment. For statistical evaluation, the Wilcoxon's signed-rank test (two-sided; alpha = 0.05) was used. The mean whole body impairments were as follows: PT, 21.6% and 19.1%; OT, 22.8% and 22.1%; CT, 22.0% and 22.1% (intention-to-treat and per protocol analysis, respectively). There were no significant differences between the groups. We conclude that impairment percentages in RSD patients treated with PT or OT did not differ significantly from those treated with CT at 12 months after inclusion.     

Does spasticity result from hyperactive stretch reflexes? Preliminary findings from a stretch reflex characterization study

Purpose:?To characterize the stretch reflex response of the biceps brachii in stroke patients with elbow spasticity (prior to or within 15?min of treatment with botulinum toxin) and non-impaired volunteers with the aim of quantifying the stretch reflex excitability and observe the differences between the groups.

Methods:?A cross-sectional study. Stretch reflexes from the biceps brachii were elicited following a controlled elbow extension. The amplitude, latency, rise time and duration, calculated from surface EMG recordings from the biceps brachii, were used to characterize the stretch reflex response.

Results:?Seventeen non-impaired and 14 stroke patients participated. The amplitude was significantly lower in stroke patients than in non-impaired volunteers (p?<?0.05). The latency was significantly shorter in stroke patients than in non-impaired volunteers (p?<?0.05). There were no significant differences in rise time or duration (p?>?0.10).

Discussion:?Reduction in the amplitude in stroke patients was unexpected suggesting the stretch reflex is not necessarily hyper-excitable in people with clinically diagnosed spasticity. Latency differences suggest decreased presynaptic inhibition and/or increased motor neurone excitability can occur following a stroke. However, carry over effects from previous botulinum toxin treatment may have confounded amplitude measurements. Further work evaluating the excitability of the stretch reflex independent of Botulinum toxin and its contribution to resistance to passive stretching is being conducted.     

Which patients with chronic reflex sympathetic dystrophy are most likely to benefit from physical therapy?

BACKGROUND: Chronic reflex sympathetic dystrophy (RSD) is a painful and disabling disorder for which no treatment with proven effects exists. Physical therapy (PT) has been demonstrated to be effective for recently diagnosed RSD, but its value in chronic RSD has not yet been studied. OBJECTIVE: To find predictors for successful use of PT in RSD with regard to (1) function, strength, and mobility and (2) patient satisfaction. SUBJECTS: Fifty-four patients with chronic RSD, age range 21 to 65 years. METHODS: All patients were treated in accordance with a standardized PT protocol for at least 6 months. The effects of treatment (functional status, strength, range of motion) and patient satisfaction measures (grade for result, would repeat, global effect) were evaluated at 12 months. Subgroup analyses were performed to find predictors for success of PT. RESULTS: The subgroup analyses revealed that patients with better baseline function (especially of the hands) obtained better results and greater satisfaction. Greater satisfaction was also associated with less baseline pain and higher baseline range of motion and strength (of leg) values. In general, PT did not show large improvements on effect measures, and the patients' mean grade for the result was 3.8 (on a 10-point scale). CONCLUSIONS: In overall terms, PT did not influence functional parameters or give satisfaction to patients with chronic RSD in this study. A randomized trial is required to prove or exclude the actual value of PT for these patients.     

Does spasticity result from hyperactive stretch reflexes? Preliminary findings from a stretch reflex characterization study

PURPOSE: To characterize the stretch reflex response of the biceps brachii in stroke patients with elbow spasticity (prior to or within 15 min of treatment with botulinum toxin) and non-impaired volunteers with the aim of quantifying the stretch reflex excitability and observe the differences between the groups. METHODS: A cross-sectional study. Stretch reflexes from the biceps brachii were elicited following a controlled elbow extension. The amplitude, latency, rise time and duration, calculated from surface EMG recordings from the biceps brachii, were used to characterize the stretch reflex response. RESULTS: Seventeen non-impaired and 14 stroke patients participated. The amplitude was significantly lower in stroke patients than in non-impaired volunteers (p<0.05). The latency was significantly shorter in stroke patients than in non-impaired volunteers (p<0.05). There were no significant differences in rise time or duration (p>0.10). DISCUSSION: Reduction in the amplitude in stroke patients was unexpected suggesting the stretch reflex is not necessarily hyper-excitable in people with clinically diagnosed spasticity. Latency differences suggest decreased presynaptic inhibition and/or increased motor neurone excitability can occur following a stroke. However, carry over effects from previous botulinum toxin treatment may have confounded amplitude measurements. Further work evaluating the excitability of the stretch reflex independent of Botulinum toxin and its contribution to resistance to passive stretching is being conducted.     

Does wearing a functional knee brace affect hamstring reflex time in subjects with anterior cruciate ligament deficiency during muscle fatigue?

OBJECTIVE: To evaluate the effects of wearing a functional knee brace and muscle fatigue on hamstring reflex time in subjects with anterior cruciate ligament (ACL) deficiency. DESIGN: Repeated-measures clinical trial. SETTING: Outpatient physical therapy department. PARTICIPANTS: Sixteen subjects with ACL deficiency. INTERVENTION: Subjects tested with and without a functional knee brace before and after an exercise protocol designed to fatigue the knee muscles. MAIN OUTCOME MEASURE: Latency of hamstring reflex muscle activity after sudden perturbation of the knee. RESULTS: Wearing a knee brace shortened the hamstring reflex latency regardless of fatigue (F(1,15)=20.62, P<.001). Muscle fatigue lengthened the hamstring reflex time regardless of the bracing condition (F(1,15)=7.57, P<.015). CONCLUSION: Wearing a functional knee brace facilitated hamstring muscle reflex, but muscle fatigue lengthened the hamstring reflex latency. Subjects with ACL deficiency should not rely on the knee brace to facilitate hamstring reflex for joint protection during prolonged sporting activities when muscles are fatigued.