Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly / Efeitos da manipulação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos

ABSTRACT Introduction: Subjects with sensorial losses present balance deficits. Although such condition is often observed among elderly, there is discussion concerning the dependence on sensorial information for body sway control in the elderly without sensorial losses. Purpose: We investigated the effects of foot sensitivity manipulation on postural control during upright standing in young adults and independent elderly (n = 19/group). Methods: Plantar sensitivity was evaluated by esthesiometry, and speed of center of pressure shift data during upright posture were evaluated for each foot using a baropodometer while the subjects were standing with eyes open or closed. The young adult group was evaluated for center of pressure in normal conditions and after plantar sensitivity disturbance, by immersing their feet in water and ice. Results: Young adults did not show alterations in their center of pressure after sensorial perturbation and presented, even under sensorial perturbation, better postural control than elderly subjects. The elderly showed lower foot sensitivity and greater center of pressure oscillation than young adults. Conclusion: Elderly subjects seem to rely more on foot sensitivity for control of body sway than young adults. In the elderly, a clinical intervention to improve foot sensitivity may help in upright posture maintenance.

RESUMO Introdução: Pessoas com perdas sensoriais apresentam déficits de equilíbrio. Embora esse quadro seja comum em idosos, ainda se discute o quanto idosos sem doenças que afetam as vias sensoriais dependem dessa informação para controlar oscilações corporais durante o controle da postura. Objetivo: Investigar os efeitos da perturbação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos independentes (n = 19/grupo). Métodos: A sensibilidade plantar foi avaliada com estesiômetro e dados de velocidade e deslocamento do centro de pressão durante a postura de pé foram avaliados para cada pé com um baropodômetro, em condições de olhos abertos e fechados. O grupo de adultos jovens foi avaliado quanto ao centro de pressão nas condições normal e pós-perturbação da sensibilidade plantar, pela imersão dos pés em água e gelo. Resultados: Adultos não apresentaram alterações no centro de pressão em resposta à perturbação sensorial e tiveram, mesmo na condição de perturbação sensorial, melhor controle postural do que idosos. Idosos apresentaram menor sensibilidade plantar e maior oscilação do centro de pressão do que os adultos jovens. Conclusão: Idosos pareceram depender mais da sensibilidade plantar para manter o controle postural do que adultos jovens. Em idosos, intervenções clínicas que melhorem a sensibilidade plantar podem auxiliar na tarefa de manter a postura de pé.

Tibial and fibular nerves evaluation using intraoperative electromyography in rats

ABSTRACT PURPOSE: To evaluate a new model of intraoperative electromyographic (EMG) assessment of the tibial and fibular nerves, and its respectives motor units in rats. METHODS: Eight Wistar rats underwent intraoperative EMG on both hind limbs at two different moments: week 0 and week 12. Supramaximal electrical stimulation applied on sciatic nerve, and compound muscle action potential recorded on the gastrocnemius muscle (GM) and the extensor digitorum longus muscle (EDLM) through electrodes at specifics points. Motor function assessment was performaced through Walking Track Test. RESULTS: Exposing the muscles and nerves for examination did not alter tibial (p=0.918) or fibular (p=0.877) function between the evaluation moments. Electromyography of the GM, innervated by the tibial nerve, revealed similar amplitude (p=0.069) and latency (p=0.256) at week 0 and at 12 weeks, creating a standard of normality. Meanwhile, electromyography of the EDLM, innervated by the fibular nerve, showed significant differences between the amplitudes (p=0.003) and latencies (p=0.021) at the two different moments of observation. CONCLUSION: Intraoperative electromyography determined and quantified gastrocnemius muscle motor unit integrity, innervated by tibial nerve. Although this study was not useful to, objectively, assess extensor digitorum longus muscle motor unit, innervated by fibular nerve.

A Study of Somatic Nerve Functions in Diabetic and Normal Persons.

This hospital-based case-control study was undertaken among 50 diabetic cases and 50 non-diabetic controls of Burdwan to evaluate neurophysiological changes. Neurophysiological assessment was done with nerve conduction velocity, amplitude and latency of median nerve motor and sensory component of upper arms and tibial motor and sural sensory part of lower limbs. NCV and amplitude had negative correlation where latency had positive correlation with age and duration of diabetes. Independent t-test was done to compare NCV and amplitude among cases and controls and results showed diminished values in cases than controls (p< 0.001). This study reflected that early diagnosis and management of neuropathy by neurophysiological test may retard the progression of neuropathy in diabetic persons.

A estimulação elétrica nervosa do nervo tibial posterior no tratamento de pacientes com incontinência urinária: uma revisão de literatura / Electrical nerve stimulation posterior tibial nerve in the treatment of patients with urinary incontinence: a review of literature

A incontinência urinária é um problema de saúde pública e tem alta prevalência entre as mulheres. Os sintomas decorrentes dessa afecção afetam a qualidade de vida dos pacientes em suas implicações sociais, físicas e sexuais, justificando assim a importância desse estudo, que se trata de um levantamento bibliográfico sobre a estimulação elétrica do nervo tibial no tratamento dos sintomas miccionais. O objetivo da pesquisa foi analisar as evidências científicas da terapia, seu mecanismo e benefícios no tratamento da incontinência urinária, incluindo a melhoria da qualidade de vida e dos sintomas. Após a análise de 12 estudos, foram observados dados que incluem o número de participantes, a intervenção, a técnica realizada, os métodos de avaliação e a eficácia da técnica comparada ou não a estudos com placebo. A estimulação elétrica do nervo tibial posterior é uma terapia relativamente recente no tratamento da incontinência, já utilizada em ambiente clínico por fisioterapeutas. Conclui-se por meio da analise dos estudos que a terapia é eficaz e pode melhorar os sintomas e trazer benefícios para a qualidade de vida dos pacientes...

Urinary incontinence is a public health problem and has a high prevalence among women. Symptoms resulting from this condition affect the quality of life of patients in their social, physical and sexual implications, thus justifying the importance of this study that is a literature on electrical stimulation of the tibial nerve in the treatment of LUTS. The objective of the research was to analyze the scientific evidence of the therapy, its mechanism and benefits in the treatment of urinary incontinence, including improved quality of life and symptoms. After analyzing 12 studies were observed data that include the number of participants,the intervention, the technique used, the assessment methods and the effectiveness of the technique or not compared to studies with placebo. Electrical stimulation of the posterior tibial nerve is a relatively new therapy in the treatment of incontinence, already used in the clinical setting by physiotherapists. We conclude by analyzing the studies that the therapy is effective and can improve symptoms and bring benefits to the quality of life of patients...

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft / Reinervação muscular em um ou dois estágios?: estudo experimental em ratos com enxerto de nervo término-lateral

PURPOSE: To compare muscle reinnervation in one and two surgical stages using end-to-side neurorrhaphy (ESN) without donor nerve injury. METHODS: The experiment was performed on four groups of 20 rats. Group 1 (G1), one stage, received the graft which was sutured to the tibial nerve, with ESN, and its free stump was sutured end-to-end to the distal stump of the sectioned peroneal nerve (PN), all in the same operation. In Group 2 (G2), two stages, the nerve graft was sutured to the tibial nerve, with ESN. Two months later the PN was sectioned and its distal stump connected to the distal stump of the graft as in G1. Normal control group (Gn) received the graft only sutured to the tibial nerve, with ESN. Denervated control group (Gd), as well received the graft and had the PN sectioned and its two stumps buried in adjacent musculature, with the aim of denervating the cranial tibial muscle (CTM), the target of this study. The parameters used to evaluate CTM reinnervation were muscle mass, muscle fiber's minimum diameter and area. RESULTS: The mean CTM mass, the average of the muscular fibers areas and the average of the muscular fiber minimum diameters was higher (all p<0.0001) in G2 than in G1. Comparing the four groups, these parameters had their maximum expression in Gn and the minimum in Gd, as expected. CONCLUSION: The two stages showed better muscle reinnervation than one stage.

OBJETIVO: Comparar a reinervação muscular com enxerto de nervo em um e dois tempos operatórios, utilizando a neurorrafia término-lateral (NTL) sem lesão do nervo doador. MÉTODOS: Vinte ratos foram distribuídos em quatro grupos. O grupo 1 (G1), um estágio, recebeu o enxerto que foi suturado ao nervo tibial (NT), por meio de NTL, e seu coto livre foi suturado por NTL ao coto distal do nervo peroneal (NP), seccionado a um centímetro do NT, na mesma cirurgia. O grupo 2 (G2), dois estágios, recebeu o enxerto de nervo na primeira cirurgia, como já descrito. Dois meses depois, na segunda cirurgia, o NP foi seccionado e seu coto distal ligado ao coto distal do enxerto como em G1. O grupo controle de normalidade (Gn) recebeu o enxerto da mesma forma, apenas. E o grupo controle de denervação (Gd), além de receber o enxerto, teve o NP seccionado e seus cotos sepultados na musculatura adjacente, com a finalidade de denervar o músculo tibial cranial (MTC), alvo deste estudo. Os parâmetros utilizados para avaliar a reinervação do MTC foram massa muscular, diâmetro mínimo da fibra muscular e área. RESULTADOS: O grupo G2 apresentou superioridade (p<0,0001) em relação ao G1 na massa do MTC, no diâmetro mínimo e na área das fibras musculares. Na comparação entre os quatro grupos, estes mesmos parâmetros tiveram sua expressão máxima em Gn e mínima em Gd, como era esperado. CONCLUSÃO: A reinervação muscular em dois estágios apresenta melhor resultado quando comparada à técnica em um tempo.

Valores de referencia de los estudios de Neuroconducción de miembros inferiores en adultos jóvenes / Young adults' lower limb neuroconduction study reference values

Objetivo Establecer valores de referencia de los estudios de neuroconducción de los nervios peroneo, tibial y sural en un grupo de adultos jóvenes. Materiales y Métodos Se realizaron neuroconducciones en 155 sujetos asintomáticos, de los nervios tibial, peroneo y sural, usando técnicas convencionales actuales y previo consentimiento informado. Se obtuvieron valores de referencia presentados con promedios, desviaciones estándar, percentiles y su correlación con parámetros como edad, peso y estatura a través de un análisis bivariado de correlación lineal utilizando la prueba de Spearman. Resultados Para el nervio peroneo el promedio de la latencia distal fue de 3,6ms (DE 0,4), la amplitud fue de 6,1mV (DE 2,0) y la velocidad de conducción 54,8m/s (DE 4,2). Para el nervio tibial el promedio de la latencia distal fue de 3,5ms (DE 0,4), la amplitud fue de 16,7mV (DE 4,7) y la velocidad de conducción 53m/s (DE 3,8). Para el nervio sural el promedio de la latencia al pico fue de 3,4ms (DE 0,3), la amplitud fue de 21,3mV (DE 5,0). El límite superior de la variación normal de la latencia lado a lado para el nervio peroneo y tibial fue de 0,8ms (promedio + 2DE) y para el nervio sural fue de 0,4ms (promedio + 2DE). Se encontró relación estadísticamente significativa con variables como peso, estatura y edad. Conclusiones Los valores obtenidos pueden ser utilizados en los laboratorios de electrofisiología de nuestro país como referencia en la evaluación de pacientes con patologías musculoesqueléticas y con diferentes tipos de polineuropatía.

Objective Establishing reference values for neuroconduction studies regarding the peroneal, tibial and sural nerves in a group of young adults. Materials and Methods Neuroconduction was tested (also known as nerve conduction velocity (NCV) tests) on 155 asymptomatic subjects' tibial, peroneal and sural nerves using current conventional techniques, after informed written consent had been obtained. Reference values were obtained and presented as averages, standard deviations and percentiles, along with their correlation with parameters such as age, weight and height, via bivariate analysis of linear correlation using Spearman's rank correlation test. Results Peroneal nerve average distal latency was 3.6ms (0.4 SD), amplitude 6.1mV (2.0 SD) and conduction velocity 54.8m/s (4.2 SD). Average tibial nerve distal latency was 3.5ms (0.4 SD), amplitude 16.7mV (4.7 SD) and conduction velocity 53m/s (3.8 SD). Average sural nerve peak latency was 3.4ms (0.3 SD) and amplitude 21.3V (5.0 SD). Peroneal and tibial nerve upper limit of normal side to side variation was 0.8ms (average+2DE) and 0.4ms (average + 2 SD) for the sural nerve. A statistically significant relationship was found with variables such as weight, height and age. Conclusions The values so obtained could be used in Colombia's electrophysiology laboratories as reference in evaluating patients' suffering musculoskeletal pathologies and different types of polyneuropathy.

Neuromodulación central y periférica en incontinencia fecal: presentación de 2 casos y revisión de la literatura / Central and peripheral neuromodulation for fecal incontinence: report of 2 cases and review of the literature

Fecal incontinence is a condition that creates a huge impact on quality of life, it affects up to 45 percent of patients of the elderly. Treatment is initially conservative with dietary changes, drugs and perineal biofeedback. Surgery is reserved for those who do not respond to medical treatment. The most frequently performed procedure is anal sphincteroplasty, useful in patients with proven lesions of the external anal sphincter. Other alternatives include the implantation of an artificial anal sphincter and dynamic graciloplasty, which are very expensive techniques with high rate of complications. If there is no other alternative, a permanent ostomy can be done. In recent years, less invasive techniques have been developed for the treatment of fecal incontinence. Among these, central neuromodulation or sacral root stimulation (SRS) and peripheral neuromodulation or posterior tibial nerve stimulation (PTNS) have shown promising results. The aim of this paper is to present 2 cases of patients with fecal incontinence refractory to conventional treatment (medical and surgical) that are successfully treated with central and peripheral neuromodulation respectively. We present 2 cases and a review of the literature available to date.

La incontinencia fecal (IF) es una patología que genera un enorme impacto en la calidad de vida, afectando hasta el 45 por ciento de los pacientes de la tercera edad. El tratamiento es inicialmente conservador mediante cambios dietéticos, fármacos y rehabilitación perineal. La cirugía se reserva para quienes no responden a tratamiento medico. El procedimiento efectuado con más frecuencia es la esfinteroplastía anal, de utilidad en pacientes con lesión demostrada del esfínter anal externo. En casos de IF grave, otras alternativas son la instalación de un esfínter anal artificial y/o la graciloplastía dinámica, procedimientos de alto costo y con un alto porcentaje de complicaciones. En caso de no existir otra alternativa se puede realizar una ostomía definitiva. Durante los últimos años se han desarrollado técnicas mínimamente invasivas para el tratamiento de la incontinencia fecal. Entre éstas, la neuromodulación central o de las raíces sacras (NMS) y últimamente la neuromodulación periférica o estimulación del nervio tibial posterior (ENTP) han mostrado resultados promisorios. Los objetivos de este trabajo son presentar 2 casos clínicos de pacientes con incontinencia fecal refractaria al tratamiento convencional (medico y quirúrgico) que son tratados exitosamente con neuromodulación central y periférica, respectivamente, y realizar una revisión de la literatura disponible a la fecha.

Viability of nerve grafts preserved in different storage medium: ultrastructural features

We investigated the ultrastructural organization of transplanted autologous grafts after storage in two different solutions. Male Wistar rats were divided into groups to obtain normal tibial nerves, freshly transplanted nerves, and nerves stored in Wisconsin/Belzer or Collins solution for 24 or 72 hours at 4 °C and transplanted (W1, W3, C1, C3). After storage or transplantation, the specimens were processed for ultrastructural analysis. All grafts showed alterations in collagen fiber organization in the endoneurial space compared to normal nerves. These fibers were more loosely organized among nerve fibers, a finding that was significantly more marked in group C3 compared to groups W1 and W3. Important alterations were also observed in the myelin sheath structure of grafts stored in the two media. These changes were characterized by separation of the lipid lamellae, clearly visible in larger diameter nerve fibers. These findings were more marked and frequent in the C1 and C3 groups compared to the W1 and W3 groups. Ultrastructural analysis showed better preservation of Schwann cells and other elements that support axonal regeneration for grafts stored in Wisconsin/Belzer solution. These results support ongoing studies for the formulation of storage solutions that permit the creation of nerve banks for heterologous transplantation.

Topographic distribution of the tibial somatosensory evoked potential using coherence

The objective of the present study was to determine the adequate cortical regions based on the signal-to-noise ratio (SNR) for somatosensory evoked potential (SEP) recording. This investigation was carried out using magnitude-squared coherence (MSC), a frequency domain objective response detection technique. Electroencephalographic signals were collected (International 10-20 System) from 38 volunteers, without history of neurological pathology, during somatosensory stimulation. Stimuli were applied to the right posterior tibial nerve at the rate of 5 Hz and intensity slightly above the motor threshold. Response detection was based on rejecting the null hypothesis of response absence (significance level α= 0.05 and M = 500 epochs). The best detection rates (maximum percentage of volunteers for whom the response was detected for the frequencies between 4.8 and 72 Hz) were obtained for the parietal and central leads mid-sagittal and ipsilateral to the stimulated leg: C4 (87 percent), P4 (82 percent), Cz (89 percent), and Pz (89 percent). The P37-N45 time-components of the SEP can also be observed in these leads. The other leads, including the central and parietal contralateral and the frontal and fronto-polar leads, presented low detection capacity. If only contralateral leads were considered, the centro-parietal region (C3 and P3) was among the best regions for response detection, presenting a correspondent well-defined N37; however, this was not observed in some volunteers. The results of the present study showed that the central and parietal regions, especially sagittal and ipsilateral to the stimuli, presented the best SNR in the gamma range. Furthermore, these findings suggest that the MSC can be a useful tool for monitoring purposes.

Use of magnitude-squared coherence to identify the maximum driving response band of the somatosensory evoked potential

The present study proposes to apply magnitude-squared coherence (MSC) to the somatosensory evoked potential for identifying the maximum driving response band. EEG signals, leads [Fpz'-Cz'] and [C3'-C4'], were collected from two groups of normal volunteers, stimulated at the rate of 4.91 (G1: 26 volunteers) and 5.13 Hz (G2: 18 volunteers). About 1400 stimuli were applied to the right tibial nerve at the motor threshold level. After applying the anti-aliasing filter, the signals were digitized and then further low-pass filtered (200 Hz, 6th order Butterworth and zero-phase). Based on the rejection of the null hypothesis of response absence (MSC(f) > 0.0060 with 500 epochs and the level of significance set at a = 0.05), the beta and gamma bands, 15-66 Hz, were identified as the maximum driving response band. Taking both leads together ("logical-OR detector", with a false-alarm rate of a = 0.05, and hence a = 0.0253 for each derivation), the detection exceeded 70 percent for all multiples of the stimulation frequency within this range. Similar performance was achieved for MSC of both leads but at 15, 25, 35, and 40 Hz. Moreover, the response was detected in [C3'-C4'] at 35.9 Hz and in [Fpz'-Cz'] at 46.2 Hz for all members of G2. Using the "logical-OR detector" procedure, the response was detected at the 7th multiple of the stimulation frequency for the series as a whole (considering both groups). Based on these findings, the MSC technique may be used for monitoring purposes.

Low-frequency oscillations in human tibial somatosensory evoked potentials

Oscilações da atividade elétrica cerebral têm sido associadas a funções sensoriais, de percepção e de cognição. O presente estudo objetiva investigar as oscilações de baixa freqüência, em particular da banda gama (30-110 Hz), durante estimulação do nervo tibial. Vinte e um voluntários foram estimulados com pulsos de corrente de 0,2 ms, freqüência de 5 Hz e intensidade mínima para produzir o movimento involuntário dos músculos intrínsecos do pé. Sinais EEG espontâneo e durante estimulação foram registrados na área somato-sensitiva primária. A análise tempo-freqüência indicou o efeito do artefato ao estímulo na banda de freqüência do potencial evocado somato-sensitivo (PESS) até aproximadamente 5 ms pós-estímulo. As oscilações até 100 Hz apresentaram maior contribuição relativa de potência ao PESS (aproximadamente 99%) e se mostraram significativamente diferentes (p<0,01) das freqüências da média coerente do EEG espontâneo. Além disso, a banda 30-58 Hz foi identificada como a de maior contribuição à morfologia do PESS do nervo tibial (p<0,0001).

The diagnostic value of SEP in LDH and its forensic significance / 法医学杂志

OBJECTIVE@#To evaluate the diagnostic value of somatosensory evoked potential(SEP) in lumbosacral disc herniation(LDH).@*METHODS@#Posterior tibial nerve somatosensory evoked potential(PTNSEP) and dermatomal somatosensory evoked potential (DSEP) were recorded from 60 patients with radiculopathy caused by LDH and 30 healthy subjects.@*RESULTS@#DSEP was abnormal in 56 cases (93.3%) and PTNSEP was abnormal in 26 cases (43.3%). The significant difference was observed (P<0.001). The abnormality of DSEP from L4 dermatome was detected mainly in patients with L3-4 LDH, the abnormality of DSEP from L5 dermatome was detected mainly in patients with L4-5 LDH, the abnormality of DSEP from L5S1 dermatome was detected mainly in patients with S1 LDH. DSEP can reflect the compressed extent of nerve root.@*CONCLUSIONS@#There was a good correlation of DSEP with lumbosacral nerve root injury,which supplement the information that can not be provided by imaging examingation. DSEP is a sensitive electrophysic method that not only is used to evaluate single nerve root function, but also is helpful in the location of the lesion.

Inervación del músculo semitendinoso, biometría de sus ramos y localización de sus puntos motores / Inervation of the semitendinous muscle, biometry of the branches and location of its motor points

La inervación motora de la musculatura esquelética es conocida, sin embargo, los padrones de distribución de esos ramos y los puntos motores son descritos de forma general. Con el propósito de aportar antecedentes anatómicos y biométricos sobre la inervación de la musculatura de los miembros, estudiamos las características de los ramos que inervan al músculo semitendinoso, considerando su origen respecto a la tuberosidad isquiática (TI), su longitud, la división de los ramos principales, como también la localización de los puntos motores respecto de la TI. La investigación se realizó en 28 miembros inferiores de 14 cadáveres formolizados, de individuos brasileños, adultos, de ambos sexos, de edades entre 25 y 65 años, pertenecientes a la disciplina de Anatomía Humana de la Universidade Federal de Santa Catarina, Brasil. Inicialmente registramos la distancia entre la parte inferior de la TI y una línea transversal que se extendió entre las partes más sobresalientes de los cóndilos femorales (LBE). En cada una de las muestras se realizó cuidadosa disección, observando los ramos musculares y registrando las mediciones respectivas. En la totalidad de los casos, los ramos dirigidos al músculo en cuestión procedieron de la porción tibial del nervio isquiático. El número más frecuente de ramos encontrados fue de 2, presentándose 9 casos en el lado derecho y 11 en el izquierdo; con 3 ramos observamos 2 casos en el lado derecho y 1 en el izquierdo; con un ramo hubo 3 casos en el lado derecho y 2 en el izquierdo. La distancia promedio para el origen de R1 fue de 30,5 + 10,4 mm y para R2 fue de 112,5 + 44,3 mm en el lado derecho, y, de 22,8 + 12,7 mm para R1 y de 106,2 + 38,2 mm para R2 en el izquierdo. La longitud promedio de R1 en el lado derecho fue de 9,2 + 5,3 mm y de R2 fue de 53,5 + 31,6 mm; en el lado izquierdo R1 tuvo una longitud de 12,2 + 6,6 mm y R2 de 49,3 + 25,6 mm. La mayoría de los ramos musculares principales se subdividieron antes de ingresar en el vientre muscular en 2,3,4 y hasta 5 ramos secundarios. Se presentan también las distancias entre la TI y los puntos motores, como también la correlación entre la distancia TI-LBE y el origen de los ramos así como con los puntos motores. Los datos aportados podrán ser usados como referencia en los procedimientos clínico-quirúrgicos y de electroestimulación.

Regeneraçäo de nervo periférico após anastomose término-lateral, com manutençäo do epineuro, em ratos / Regeneration of peripheral nerve after termino-lateral anastomosis with epineurium maintenance in rats

A reinervaçäo dos nervos periféricos pode ser realizada através de anastomoses término-terminais ou término-laterais, e este fenômeno tem sido amplamente estud ado. As anastomoses nervosas término-laterais tem sido utilizadas com pouca freqüência em relaçäo as anastomoses término-terminais e contestada por alguns autores quanto a possibilidade de reinervaçäo, quando a integridade do epineuro é mantida. Devido a estas divergências, estudou-se o efeito do epineuro na reinervaçäo em anastomoses término-laterais, em ratos. Foram utilizados 20 ratos Wistar, adultos, distribuídos em dois grupos (A e B). No grupo A, 10 animais foram submetidos à secçäo do nervo fibular no membro pélvico direito e fixaçäo desde à musculatura; no membro pélvico esquerdo foi realizada a secçäo do nervo fibular e anastomasado término-lateral com o nervo tibial. No grupo B, os procedimentos foram idênticos aos realizados no grupo A, sendo somente invertido os membros pélvicos. No nonagésimo dia do ato operatório, foi realizada uma biópsia em cada nervo fibular para análise histológica à microscópia óptica, onde a reinervaçäo foi objeto de estudo. A reinervaçäo ocorreu mostrando que a integridade do epineuro näo impediu a regeneraçäo axonal.

The central conduction time in posterior tibial and pudendal nerve somatosensory evoked potentials

The somatosensory evoked potentials (SEPs), following stimulation of both the posterior tibial nerve (PTSEP) and pudendal nerve (PNSEP), comprise of the lumbar negative, subcortical and cortical potential. These can be used to assess the long somatosensory pathway, including peripheral, intraspinal and intracranial conduction along the entire length. This study aimed to compare the central conduction time between the PTSEP and the PNSEP, and to investigate the relationship between the intraspinal and intracranial conduction time in the SEP pathway. The SEPs following stimulation of the posterior tibial nerve at the ankle and the pudendal nerve at the shaft of the penis were analyzed in 20 normal male subjects. The central conduction of the PNSEP was found to be slower than that of the PTSEP (p <0.05). This difference is due to a delay in conduction rather than that of intracranial conduction.

Estudio normativo de velocidad de conducción en nervios cubitales, medianos y tibiales posteriores en adultos / Normative study of conduction velocity in cubital median and posterior tibial nerves in adults

Muchas alteraciones que involucran lesión de nervios periféricos pueden ser detectadas usando la técnica de la velocidad de conducción nerviosa periférica; técnica no invasiva y muy fácil de realizar, útil para valorar la integridad funcional de los nervios. El presente estudio se realizó para obtener valores normales de la velocidad de conducción en una población adulta hondureña, para ser usada como referencia en nuestro medio. Registramos la velocidad de conducción en 189 jóvenes en edades comprendidas entre 18 a 28 años. Se excluyeron del estudio, sujetos que tenian antecedentes de lesiones que afectan sistema nervioso periférico, registramos la velocidad de conducción y latencias en los nervios mediano, cubital y tibial posterior derechos e izquierdos, obteniéndose valores promedio de 65.58 +- 3.95 m/s para fibras más rápidas y 58.05 +- 4.24 m/s para la mayoría de las fibras en nervios de extremidades superiores y de 58.30 +- 3.71 m/s y 53.29 +- 3.33 m/s para fibras rápidas y mayoría de fibras en nervios de extremidades inferiores. concluimos que los presentes datos pueden ser usados como referencia para registros clínicos y de experimentación

A study of peripheral nerve function in neonates and infants.

Motor and sensory nerve conduction velocity, H-reflex and F-response have been studied in the age group showing maximum changes i.e. neonates and infants. The nerve conduction velocity in upper and lower limbs was 25 M/S and 23.75 M/S respectively in neonate age group; 34.4 M/S and 32.4 M/S respectively in infant group. A significant relationship of age with nerve conduction parameters (velocity, terminal latency) has been observed in infants group but not so in neonate group. H-reflex (late response) was elicited in both Abductor Pollicis Brevis and Soleus. It was present in small muscles of hand (i.e. APB) in all the neonates and 55% of the infants only. This could be attributed to immaturity of nervous system. However, in the lower limb, H-reflex could be elicited in 100% of infants and neonates. In the present study, the relationship of age and height with different nerve conduction parameters as well as H-reflex (latency) has been highlighted.

Nerve conduction studies and its importance in diagnosis of acute poliomyelitis.

Motor nerve conduction velocities was performed on 50 subjects in the pediatric age group. Thirty two patients with acute poliomyelitis and 18 controls. The MNCV was studied in the median nerve in the upper limb and the posterior tibial in the lower limb. The motor nerve conduction velocity in polio patients matched well with the controls, as well as within the accepted standards for normal. The MNCV of the median nerve ranged from 41.8 +/- 2.76 m/sec in under 1 year to 44 +/- 2.1 m/sec in 3-8 years, in polio patients, while the range in controls varied from 37 to 53 m/sec. Similarly, for the posterior tibial nerve, in polio patients the value of MNCV varied from 38.7 +/- 4.9 m/sec to 42.5 +/- 3.1 m/sec. In the controls, also the MNCV ranged from 38.5 +/- 6.3 m/sec to 48.4 +/- 3.42 m/sec. Thus, no delay on the motor nerve conduction velocity was seen. Poliomyelitis is a major problem in developing countries like Pakistan and India, where serological diagnosis is a luxury. The determination of motor nerve conduction velocity provides a quick and easy method of distinguishing poliomyelitis from other motor nerve disorders esp. Guillain Barre syndrome.