Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients.

PURPOSE: The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients. METHODS: This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery. RESULTS: Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training. CONCLUSION: Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

Study of interpolation method in diagnosis of carpal tunnel syndrome and comparison with midpalm antideromic sensory method.

Carpal tunnel syndrome (CTS) is the most common focal compression neuropathy. There are a significant number of different methods available to evaluate a patient for median nerve compromise at the carpal tunnel. One of them is interpolation method created by Dr E.B. Bodofski. In our study Sensitivity of interpolation method was 85.5%, Specificity was 85%, Positive predictive value was 94.6% and Negative predictive value was 65.4%. These results are lower than Dr Bodofski results. Also in our study sensitivity of midpalm antidromic sensory method was 95.1%, Specificity was 95%, Positive predictive value was 98.3% and Negative predictive value was 86.4%, these results are higher than results of interpolation method. These show interpolation method is a good method (with high sensitivity & specificity) for diagnosis of mild CTS, but it's sensitivity & specificity are lower than antideromic sensory stimulation method at wrist & midpalm.

Comparing distal and proximal techniques of saphenous nerve conduction study in healthy subjects.

For comparing distal and proximal techniques. To obtain saphenous nerve sensory response, 102 healthy subjects with mean age 43.1 years and mean Body Mass Index (BMI) 25.3 were studied. Both techniques performed by using surface electrodes. In distal technique recording site was anterior to medial malleolus and stimulator 14 cm proximal to it. In proximal technique stimulation performed on the medial aspect of the knee and response recorded from the leg, 14 cm distal to the cathode. In 204 studied nerves, response obtained in 145 nerves (71%) by distal technique, in 125 nerves (61%) by proximal technique and in 94 nerves (46%) by both techniques. In 176 nerves (86%) response obtained at least by one of two techniques. In men, response obtaining rate by proximal technique (90.5%) was higher than distal one (57%) (P < 0.0001) but in women this rate was 81% by distal technique and 41% by proximal technique (P < 0.0001). Distal technique was more successful than proximal in subjects with higher age (P < 0.05) and higher BMI (P < 0.001). In conclusion, for saphenous nerve conduction study in men, it is better to perform proximal technique primarily but in women distal technique is preferred. Performing the second technique when the first one is failed is suggested.

Prevalence and severity of carpal tunnel syndrome (CTS) during pregnancy.

Carpal Tunnel Syndrome (CTS) is the entrapment of Median nerve at wrist. Pregnancy can affect prevalence and severity of CTS. In this study frequency and severity of CTS in pregnancy was evaluated. In this study 100 pregnant women were evaluated by Hand symptoms, CTS provocation tests (Tinel and Phalen) and for definite diagnosis of CTS standard EDX studies were used. For this purpose sensory and motor distal latency of Median were measured and compared with ulnar nerve. 17% of pregnant women had CTS with 23.5% bilateral involvement and 17.5% severe CTS. Prevalence of hand symptom and clinical sign of CTS (phalen and tinel sign) were 36% and 26% respectively. Results indicated that prevalence of CTS in pregnant women was significant. Although hand signs and symptoms are useful, EDX study is more reliable.

Palmar cutaneous branch of the median nerve conduction study.

The study of the palmar cutaneous branch of median nerve (PCBMN) was down in the Shohada hospital from september 1st 2002 to june 1st 2004. One hundred fifty healthy adult, 65 men and 85 women, with mean age of 36 year were studied by antidromic stimulation of median nerve 10 cm from the surface recording over the midthenar eminence. The nerve maybe injured by direct trauma or during surgery at the wrist. The latency was 2.07+/-0.22 (range 1.50 to 2.80) and the Amplitude of SNAP was 14.36+/-0.86 (range 12 to 16.2). the study is useful in evaluating lesions of the PCBMN

Studying nerve conduction velocity and latency of accessory nerve motor potential in normal persons.

In order to standardize Nerve Conduction Velocity(NCV), proximal and distal latency and amplitude of motor conduction in intact accessory nerves, a cross-sectional, descriptive-analytic study was done on 60 healthy persons with strict attention to number of cases, distance between stimulation sites, temperature and age. The average results were as follows: Distal latency 2.54 milliseconds (msec.) (2.25-2.83), Proximal latency 3.64 msec. (3.34-3.94), Amplitude 13.76 millivolts (mv.) (8.56-18.96) and NCV 67.98 m/s (56.95-79.01). The average latencies in women were significantly less than men, on both sides which can be due to higher superficial skin temperature in women.