Guidance for resumption of routine electrodiagnostic testing during the COVID-19 pandemic.

As the world accommodates to the coronavirus disease 2019 (COVID-19) pandemic, routine in-person medical services are resuming. The resumption of non urgent electrodiagnostic (EDX) testing faces unique challenges due to the long duration of the procedure and direct close contact with patients, including studies with risk of exposure to oropharyngeal secretions. We provide consensus guidance for resumption of EDX testing, addressing scheduling, patient arrival and registration, use of personal protective equipment, COVID-19 screening and testing, the performance of EDX testing in outpatient and inpatient settings, cleaning and maintenance of the EDX equipment and laboratory, balancing trainee safety and training requirements, and patient care issues. These are broad recommendations that need to be adapted to local COVID-19 risks, institutional guidelines and policies, and changing federal, state, and local regulations, and to changes in the pandemic over time.

Guiding Treatment for Foot Pain.

In the electrodiagnostic (EDX) approach of the patient who presents with foot pain, numbness, and/or tingling, it is important to consider a broad differential diagnosis of both neuropathic and nonneuropathic conditions, including focal and systemic causes. This article assists the electromyographer in the selection and utilization of the most appropriate EDX studies for evaluation. The EDX findings and impression can then help guide potential treatment options for the patient with foot pain and other symptoms. Moreover, this discussion demonstrates the added value that EDX evaluation of the foot provides to the comprehensive assessment of foot pain.

Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations.

INTRODUCTION: To address the need for greater standardization within the field of electrodiagnostic medicine, the Normative Data Task Force (NDTF) was formed to identify nerve conduction studies (NCS) in the literature, evaluate them using consensus-based methodological criteria derived by the NDTF, and identify those suitable as a resource for NCS metrics. METHODS: A comprehensive literature search was conducted of published peer-reviewed scientific articles for 11 routinely performed sensory and motor NCS from 1990 to 2012. RESULTS: Over 7,500 articles were found. After review using consensus-based methodological criteria, only 1 study each met all quality criteria for 10 nerves. CONCLUSION: The NDTF selected only those studies that met all quality criteria and were considered suitable as a clinical resource for NCS metrics. The literature is, however, limited and these findings should be confirmed by larger, multicenter collaborative efforts. Muscle Nerve 54: 371-377, 2016.

Establishing high-quality reference values for nerve conduction studies: A report from the normative data task force of the American Association Of Neuromuscular & Electrodiagnostic Medicine.

INTRODUCTION: There are not uniform standards for nerve conduction testing across the United States. The objective of this study is to present a set of methodologically sound criteria to evaluate the literature for the purpose of identifying high-quality normative nerve conduction studies (NCS) suitable for widespread use. METHODS: The Normative Data Task Force (NDTF) was formed to review published studies on methodological issues related to NCS. A set of criteria was then developed to evaluate the literature. These criteria and their rationale are described. RESULTS: We identified 7 key issues that reflect high quality in NCS. For each issue, specific review criteria were developed. CONCLUSION: Rigorous criteria enable identification of high-quality studies dealing with nerve conduction reference values. This represents the first step toward the overarching goal of recommending NCS techniques and reference values for electrodiagnostic medicine. Muscle Nerve 54: 366-370, 2016.

Amputee Subject Testing Protocol, Results, and Analysis of a Powered Transtibial Prosthetic Device.

A powered ankle-foot prothesis and its control system were previously designed and built. To evaluate this prosthesis, amputee subject testing was performed. The testing results are analyzed and compared between the powered prosthesis, passive prosthesis, and able-bodied gait. Qualitative comparison showed the prosthesis achieved the design objectives. During stance phase, active ankle moment was generated in the powered prosthesis before push-off to help the amputee walk more naturally. During swing phase, the powered prosthesis was able to move to natural position to achieve foot clearance. However, the prosthesis is slightly under powered compared with the able-bodied ankle.

Impact of contact isolation on FIM score change, FIM efficiency score, and length of stay in patients in acute inpatient rehabilitation facility.

OBJECTIVES: To explore the impact of contact isolation on the change in functional independence measure (FIM) score, FIM efficiency score, and length of stay. DESIGN: Retrospective matched case control study. SETTING: Tertiary care hospital (academic medical center). PARTICIPANTS: Persons admitted to an acute inpatient rehabilitation facility at a tertiary care hospital from July 2009 through December 2010. METHODS: Retrospective chart review by obtaining patient data regarding contact isolation status, patient demographics, and rehabilitation diagnosis. Two hundred charts were reviewed, which resulted in identification of 20 patients in contact isolation. These patients subsequently were matched to patients not in contact isolation based on age, rehabilitation diagnosis, and type of insurance. Admission and discharge FIM scores were obtained for these 40 study subjects (20 cases and 20 matched controls). MAIN OUTCOME MEASUREMENTS: The primary study outcome measurements were change in FIM score (discharge FIM score minus admission FIM score), FIM efficiency score (change in FIM score divided by length of stay), and length of stay. RESULTS: Compared with patients not in contact isolation, patients in contact isolation showed no statistically significant difference in FIM score change, a lower FIM efficiency score (P = .010), and a 39% longer length of stay (P = .017) when adjusting for confounders. CONCLUSIONS: This study identifies contact isolation as a likely variable that is associated with increased length of stay and decreased FIM efficiency score in patients in an acute inpatient rehabilitation facility. Further study is needed to identify the role or mechanisms by which contact isolation is involved in these adverse effects so that interventions may be developed to counteract them.

Evidence-based guideline: treatment of painful diabetic neuropathy--report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine & Rehabilitation.

The objective of this report was to develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). The basic question that was asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" A systematic review of literature from 1960 to August 2008 was performed, and studies were classified according to the American Academy of Neurology classification of evidence scheme for a therapeutic article. Recommendations were linked to the strength of the evidence. The results indicate that pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence, or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness. Few studies have sufficient information on their effects on function and QOL.

Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

OBJECTIVE: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). METHODS: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; and non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" RESULTS AND RECOMMENDATIONS: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulphate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.

Electrodiagnostic findings and surgical outcome in isolated first branch lateral plantar neuropathy: a case series with literature review.

Two patients with recalcitrant unilateral heel pain and plantar fasciitis were referred for electrodiagnostic evaluation. They both reported constant, sharp, unilateral medial heel pain, with nocturnal symptoms, as well as exacerbation by weight-bearing activities. Examination of both patients demonstrated focal medial heel tenderness and a Tinel sign over the tarsal tunnel on the affected side. Neither patient had weakness or sensory deficits in the affected foot. In both patients, findings on nerve conduction studies were normal in the affected foot, including the first branch of the lateral plantar nerve (FBLPN), as well as the medial and lateral plantar motor and sensory (ie, mixed nerve) responses. Needle electromyographic (EMG) abnormalities were found only in the abductor digiti quinti pedis (ADQP), an intrinsic foot muscle that is exclusively innervated by the FBLPN, but there were no EMG abnormalities noted in the medial or lateral plantar-innervated muscles studied, nor the contralateral ADQP. Both patients then underwent surgical decompression of the FBLPN. Postoperative follow-up (patient 1 at 10 months, patient 2 at 21 months) revealed excellent outcomes, as defined by symptom resolution, in both patients. Electrodiagnostic evaluation was useful in diagnosing isolated first branch lateral plantar neuropathy.