Precise localization of motor branching and motor points: a cadeveric study.

In order to facilitate precise localization of motor nerves and motor points, and to increase effectiveness and minimize complications of neurolytic blocks. Locations of motor branching points and motor points of 31 cadavers were measured as relative to medial femoral condyle and mid posterior calf line. Needle insertion points 1.5 centimeters and 0.5 centimeters proximal to the level of medial femoral condyle yielded the best chance (66.25%-76.19%) of finding motor branches to medial gastrocnemius muscles and lateral gastrocnemius respectively. The points with greatest chance of success (67.69%-86.41%) for soleus, tibialis posterior and flexor hallucis longus motor branches blocks were found to be at 2.5, 6, and 11 centimeters distal to the level of medial femoral condyle respectively. However; even if these points are used as guidelline when performing motor branch block prodedure, the risk of sensory nerve fiber injury are still as high as 20.98% upto 50.0%. To avoid such complication, the authors have proposed a set of landmarks that would make it possible to access all of the motor branches of any single calf muscle with only three or less needle insertions, and still maintaining about 1% risk of sensory fiber injury.

Precision of a needle localization technic in the lumbosacral multifidus muscles for segmental specific needle electromyographic study: a cadaveric study.

The authors studied 14 cadavers to evaluate the claimed precision of needle placement into segment specific multifidus fascicles when using the "paraspinal mapping" electromyographic technic. Injection of acrylic dye was made according to landmarks proposed by Haig. The dissection showed 86.6 per cent of the injected dye in the correct fascicles. Only 1.4 per cent of the dye was lost. Spinous process level misidentification was the cause of the other 11.8 per cent incorrect injection. The authors expected that in living humans, in which the spinous processes are move identificable than embalmed cadavers, the precisions may be as high as 98.5 per cent. This remains to be studied in a further "in vivo" study.

Improved function of hemiplegic upper extremity after cognitive sensory motor training therapy in chronic stroke patients: preliminary report of a case series.

BACKGROUND: Recovery of upper extremity functions after a severe stroke and traumatic brain injuries (TBI) have generally been less than satisfactory. The "cognitive sensory motor training therapy" is a relatively new method claimed to improve motor control using a specific type of repetitive sensory and motor re-learning protocol. There has been no previous study demonstrating the effectiveness of this method. OBJECTIVE: To investigate the value of the cognitive sensory motor training therapy to improve upper extremity motor function in chronic stroke and TBI patients. MATERIAL AND METHOD: Seven patients with persistent impaired upper extremity functions for over 6 months after a stroke or TBI were trained with the cognitive sensory motor training therapy program. Hand and arm functions were measured with Action Research Arm (ARA) test before the beginning of the study and once a month thereafter. Data were analyzed retrospectively. RESULTS: There was improvement of ARA scores in all of the trained patients. On average there was an increase of the ARA score of 7.7 points during the average training time of 2.5 months. CONCLUSION: The cognitive sensory motor training therapy may be an effective method for motor rehabilitation of chronic stroke or traumatic brain injured patients. Further prospective randomized control trials are justified and required.