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Twitch Responses (twitch + response)
Selected AbstractsMyofascial Trigger Points, Neck Mobility, and Forward Head Posture in Episodic Tension-Type HeadacheHEADACHE, Issue 5 2007César Fernández-de-las-Peñas PT Objective.,To assess the differences in the presence of trigger points (TrPs) in head and neck muscles, forward head posture (FHP) and neck mobility between episodic tension-type headache (ETTH) subjects and healthy controls. In addition, we assess the relationship between these muscle TrPs, FHP, neck mobility, and several clinical variables concerning the intensity and the temporal profile of headache. Background.,TTH is a headache in which musculoskeletal disorders of the craniocervical region might play an important role in its pathogenesis. Design.,A blinded, controlled pilot study. Methods.,Fifteen ETTH subjects and 15 matched controls without headache were studied. TrPs in both upper trapezius, both sternocleidomastoids, and both temporalis muscles were identified according to Simons and Gerwin diagnostic criteria (tenderness in a hypersensible spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation). Side-view pictures of each subject were taken in both sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. A cervical goniometer was employed to measure neck mobility. All measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results.,The mean number of TrPs for each ETTH subject was 3.7 (SD: 1.3), of which 1.9 (SD: 0.9) were active, and 1.8 (SD: 0.9) were latent. Control subjects only had latent TrPs (mean: 1.5; SD: 1). TrP occurrence between the 2 groups was significantly different for active TrPs (P < .001), but not for latent TrPs (P > .05). Differences in the distribution of TrPs were significant for the right upper trapezius muscles (P= .04), the left sternocleidomastoid (P= .03), and both temporalis muscles (P < .001). Within the ETTH group, headache intensity, frequency, and duration outcomes did not differ depending on TrP activity, whether the TrP was active or latent. The craniovertebral angle was smaller, ie, there was a greater FHP, in ETTH patients than in healthy controls for both sitting and standing positions (P < .05). ETTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions, though differences were only significant for certain muscles. Finally, ETTH patients also showed lesser neck mobility than healthy controls in the total range of motion as well as in half-cycles (except for cervical extension), although neck mobility did not seem to influence headache parameters. Conclusions.,Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache. ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters. [source] NERVE STIMULATION IN THYROID SURGERY: IS IT REALLY USEFUL?ANZ JOURNAL OF SURGERY, Issue 5 2007Thorbjorn J Loch-Wilkinson Background: Monitoring of the recurrent laryngeal nerve (RLN) has been claimed in some studies to reduce rates of nerve injury during thyroid surgery compared with anatomical dissection and visual identification of the RLN alone, whereas other studies have found no benefit. Continuous monitoring with endotracheal electrodes is expensive whereas discontinuous monitoring by laryngeal palpation with nerve stimulation is a simple and inexpensive technique. This study aimed to assess the value of nerve stimulation with laryngeal palpation as a means of identifying and assessing the function of the RLN and external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. Methods: This was a prospective case series comprising 50 consecutive patients undergoing total thyroidectomy providing 100 RLN and 100 EBSLN for examination. All patients underwent preoperative and postoperative vocal cord and voice assessment by an independent ear, nose and throat surgeon, laryngeal examination at extubation and all were asked to complete a postoperative dysphagia score sheet. Dysphagia scores in the study group were compared with a control group (n = 20) undergoing total thyroidectomy without nerve stimulation. Results: One hundred of 100 (100%) RLN were located without the use of the nerve stimulator. A negative twitch response occurred in seven (7%) RLN stimulated (two bilateral, three unilateral). Postoperative testing, however, only showed one true unilateral RLN palsy postoperatively (1%), which recovered in 7 weeks giving six false-positive and one true-positive results. Eighty-six of 100 (86%) EBSLN were located without the nerve stimulator. Thirteen of 100 (13%) EBSLN could not be identified and 1 of 100 (1%) was located with the use of the nerve stimulator. Fourteen per cent of EBSLN showed no cricothyroid twitch on EBSLN stimulation. Postoperative vocal function in these patients was normal. There were no instances of equipment malfunction. Dysphagia scores did not differ significantly between the study and control groups. Conclusion: Use of a nerve stimulator did not aid in anatomical dissection of the RLN and was useful in identifying only one EBSLN. Discontinuous nerve monitoring by stimulation during total thyroidectomy confers no obvious benefit for the experienced surgeon in nerve identification, functional testing or injury prevention. [source] The effect of strength training on the force of twitches evoked by corticospinal stimulation in humansACTA PHYSIOLOGICA, Issue 2 2009T. J. Carroll Abstract Aim:, Although there is considerable evidence that strength training causes adaptations in the central nervous system, many details remain unclear. Here we studied neuromuscular responses to strength training of the wrist by recording electromyographic and twitch responses to transcranial magnetic stimulation (TMS) and cervicomedullary stimulation of the corticospinal tract. Methods:, Seventeen participants performed 4 weeks (12 sessions) of strength training for the radial deviator (RD) muscles of the wrist (n = 8) or control training without external load (n = 9). TMS recruitment curves were constructed from stimuli at five to eight intensities ranging between 15% below resting motor threshold and maximal stimulator output, both at rest and during isometric wrist extension (EXT) and RD at 10% and 50% of maximal voluntary contraction (MVC). Responses to weak TMS and cervicomedullary stimulation (set to produce a response of 10% maximal M wave amplitude during 10% MVC EXT contraction) were also compared at contraction strengths ranging from 10% to 75% MVC. Results:, Isometric strength increased following strength training (10.7% for the RD MVC, 8.8% for the EXT MVC), but not control training. Strength training also significantly increased the amplitude of TMS- and cervicomedullary-evoked twitches during low-force contractions. Increases in the force-generating capacity of the wrist extensor muscles are unlikely to account for this finding because training did not affect the amplitude of twitches elicited by supra-maximal nerve stimulation. Conclusion:, The data suggest that strength training induces adaptations that increase the net gain of corticospinal-motor neuronal projections to the trained muscles. [source] Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007B. C. H. Tsui Background:, Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. Methods:, After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1,10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2,8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Results:, Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4,7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. Conclusion:, This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization. [source] Functional Electrical Stimulation-Induced Surface Muscle Stiffness Captured by Computer-Controlled TonometryARTIFICIAL ORGANS, Issue 3 2002Dietmar Rafolt Abstract: A new tonometric test system to assess surface stiffness over relaxed and activated calf muscles was developed. The mechanical arrangement consists of a skin indentor driven by a torque motor (galvo-drive) that is rigidly connected to an ankle dynamometer. The indentation depth is measured by a displacement transducer. Software routines for cyclic indentation (recording of stiffness curves), static indentation (sensing of twitch responses), and vibration (skin resonance) were implemented. A visual interface is used to capture surface stiffness during target contractions and during controlled relaxation. For functional electrical stimulation (FES) applications, the software includes a pulse train synthesizer to generate arbitrary stimulation test patterns. The system's performance was tested in FES and voluntary contraction procedures. [source] | ||||||||||