Objective : To examine the agreement between clinical and electromyographic assessments during th... more Objective : To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement. Design : Serial clinical and electromyographic assessments were performed. Settings : Physical Medicine and Rehabilitation Department of a university hospital. Subjects : Thirty patients with acute complete idiopathic facial paralysis were included. Main measures : Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa ( κ) statistics were performed to measure the agreement between clinical and electromyographic assessments. Results : Agreement between assessments yielded an overall κ value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall κ value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles. Conclusions : Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.
American Journal of Physical Medicine & Rehabilitation, Jul 1, 1999
This preliminary study was designed to investigate the effects of botulinus toxin Type A and phen... more This preliminary study was designed to investigate the effects of botulinus toxin Type A and phenol treatments on electrophysiologic tests evaluating spinal afferent and efferent motor pathways involved in spasticity. The questions posed were whether different types of mechanisms act on reducing spasticity with these different treatment modalities and whether the tests are correlated with clinical recovery. Twenty patients with lower limb spasticity secondary to stroke were randomly assigned to receive 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. The amplitudes of the Achilles tendon response, M response, H reflex response, and maximum H:M ratio and Achilles tendon response to H response ratio were recorded from the soleus muscle at baseline and at Weeks 2, 4, and 12. The most obvious change was a reduction in the amplitude of the tendon response in the group that received botulinus toxin Type A, and it was a reduction in the M response amplitude in the group that received phenol. The decrease in the tendon response amplitude and tendon response to H ratio in the group that received botulinus toxin Type A and the decrease in the M response amplitude in the phenol group were found to be well correlated with clinical recovery as assessed by the Ashworth scale. The findings suggested that botulinus toxin Type A injection decreases spasticity primarily by affecting the fusimotor system and muscle spindle, and the involvement of the alpha-motor fibers within the tibial nerve is the most likely factor contributing to the reduction of spasticity after phenol blockade. The therapeutic effectiveness of these agents could be assessed and followed up by the changes in electrophysiologic responses matching their mechanisms of action. The findings should be supported by further electrophysiologic techniques.
American Journal of Physical Medicine & Rehabilitation, Nov 1, 1998
Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage ... more Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. This randomized, double-blind study is the first trial that was designed to find out whether botulinus toxin Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods offers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. A combination of subjective and objective measures were used to assess functional change at baseline and at Weeks 2, 4, 8, and 12. At follow-up, significant improvement (P < 0.05) in the Ashworth score for dorsiflexion was observed in both groups. The change in the Ashworth score for eversion was significant in the group that received botulinus toxin Type A (P < 0.05) but not in the group that received phenol (P > 0.05). When those variables were compared between the two groups, the change in the Ashworth score at Weeks 2 and 4 was significantly better in the group that received botulinus toxin Type A (P < 0.05) but there was not a significant difference between the two groups at Weeks 8 and 12 (P > 0.05). The decrease in clonus duration that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Type A was significantly better at Weeks 2 and 4 (P < 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial nerve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a significant difference between the two groups at Weeks 8 and 12. Future research should explore the long-term effect of these two treatment modalities.
Objectives: The aim of this study was to examine the localizing value of short segment conduction... more Objectives: The aim of this study was to examine the localizing value of short segment conduction studies (SSCSs) by comparing pre-surgical SSCS findings with intraoperative findings in patients with ulnar neuropathy of the elbow. Patients and Methods: Pre-surgical SSCSs were performed in 20 patients and compared with the intraoperative findings. Functional and electrophysiological recoveries were assessed at postoperative month 3. Overall, compressed nerve segments identified by SSCSs were compatible with the intraoperative findings in 90% of patients. Results: The success rate of surgery was higher in the patients with SSCS-determined single-level compression as compared to multi-level compression. SSCS abnormalities persistent in six patients with poor functional recovery. Conclusion: SSCSs are valuable for localizing compressed segments, thus they can be used as a guide for minimalist surgical techniques. These studies also appear valuable for predicting surgical outcome in patients with ulnar neuropathy of the elbow.
American Journal of Physical Medicine & Rehabilitation, May 1, 2000
Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on th... more Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on the electrophysiologic findings, 35 cases referred to our electromyography laboratory have been diagnosed as tourniquet paralysis within a 3-yr period. This preliminary report suggests that tourniquet paralysis should be considered during clinical and electrophysiologic evaluations after primary nerve repairs.
Objective : To examine the agreement between clinical and electromyographic assessments during th... more Objective : To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement. Design : Serial clinical and electromyographic assessments were performed. Settings : Physical Medicine and Rehabilitation Department of a university hospital. Subjects : Thirty patients with acute complete idiopathic facial paralysis were included. Main measures : Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa ( κ) statistics were performed to measure the agreement between clinical and electromyographic assessments. Results : Agreement between assessments yielded an overall κ value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall κ value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles. Conclusions : Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.
American Journal of Physical Medicine & Rehabilitation, Jul 1, 1999
This preliminary study was designed to investigate the effects of botulinus toxin Type A and phen... more This preliminary study was designed to investigate the effects of botulinus toxin Type A and phenol treatments on electrophysiologic tests evaluating spinal afferent and efferent motor pathways involved in spasticity. The questions posed were whether different types of mechanisms act on reducing spasticity with these different treatment modalities and whether the tests are correlated with clinical recovery. Twenty patients with lower limb spasticity secondary to stroke were randomly assigned to receive 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. The amplitudes of the Achilles tendon response, M response, H reflex response, and maximum H:M ratio and Achilles tendon response to H response ratio were recorded from the soleus muscle at baseline and at Weeks 2, 4, and 12. The most obvious change was a reduction in the amplitude of the tendon response in the group that received botulinus toxin Type A, and it was a reduction in the M response amplitude in the group that received phenol. The decrease in the tendon response amplitude and tendon response to H ratio in the group that received botulinus toxin Type A and the decrease in the M response amplitude in the phenol group were found to be well correlated with clinical recovery as assessed by the Ashworth scale. The findings suggested that botulinus toxin Type A injection decreases spasticity primarily by affecting the fusimotor system and muscle spindle, and the involvement of the alpha-motor fibers within the tibial nerve is the most likely factor contributing to the reduction of spasticity after phenol blockade. The therapeutic effectiveness of these agents could be assessed and followed up by the changes in electrophysiologic responses matching their mechanisms of action. The findings should be supported by further electrophysiologic techniques.
American Journal of Physical Medicine & Rehabilitation, Nov 1, 1998
Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage ... more Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. This randomized, double-blind study is the first trial that was designed to find out whether botulinus toxin Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods offers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. A combination of subjective and objective measures were used to assess functional change at baseline and at Weeks 2, 4, 8, and 12. At follow-up, significant improvement (P < 0.05) in the Ashworth score for dorsiflexion was observed in both groups. The change in the Ashworth score for eversion was significant in the group that received botulinus toxin Type A (P < 0.05) but not in the group that received phenol (P > 0.05). When those variables were compared between the two groups, the change in the Ashworth score at Weeks 2 and 4 was significantly better in the group that received botulinus toxin Type A (P < 0.05) but there was not a significant difference between the two groups at Weeks 8 and 12 (P > 0.05). The decrease in clonus duration that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Type A was significantly better at Weeks 2 and 4 (P < 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial nerve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a significant difference between the two groups at Weeks 8 and 12. Future research should explore the long-term effect of these two treatment modalities.
Objectives: The aim of this study was to examine the localizing value of short segment conduction... more Objectives: The aim of this study was to examine the localizing value of short segment conduction studies (SSCSs) by comparing pre-surgical SSCS findings with intraoperative findings in patients with ulnar neuropathy of the elbow. Patients and Methods: Pre-surgical SSCSs were performed in 20 patients and compared with the intraoperative findings. Functional and electrophysiological recoveries were assessed at postoperative month 3. Overall, compressed nerve segments identified by SSCSs were compatible with the intraoperative findings in 90% of patients. Results: The success rate of surgery was higher in the patients with SSCS-determined single-level compression as compared to multi-level compression. SSCS abnormalities persistent in six patients with poor functional recovery. Conclusion: SSCSs are valuable for localizing compressed segments, thus they can be used as a guide for minimalist surgical techniques. These studies also appear valuable for predicting surgical outcome in patients with ulnar neuropathy of the elbow.
American Journal of Physical Medicine & Rehabilitation, May 1, 2000
Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on th... more Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on the electrophysiologic findings, 35 cases referred to our electromyography laboratory have been diagnosed as tourniquet paralysis within a 3-yr period. This preliminary report suggests that tourniquet paralysis should be considered during clinical and electrophysiologic evaluations after primary nerve repairs.
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