Herta Flor1 and Frank Andrasik2

Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany and 2Institute for Human and Machine Cognition, University of West Florida, Pensacola, FL, USA Despite the many advances in the pathophysiology and treatment of pain, chronic pain still remains elusive to treat. Once the pain problem has exceeded the acute and subacute stage, peripheral factors seem to loose their importance and central changes become much more...

Therapeutic exercise

The most common system for lower extremity FES exercise is the bicycle ergometer (Glenn and Phelps, 1985). The most common commercially available ergometer is the ERGYS Clinical Rehabilitation System (Therapeutic Technologies, Inc., Tampa, FL). This computer controlled ergometer uses six channels and surface electrodes to sequentially stimulate quadriceps, hamstrings and glutei bilaterally. Some systems also include the capacity for simultaneous voluntary arm crank exercise by paraplegics,...

Use of the EMG as an outcome measure

The ability to predict a patient's eventual prognosis is an important part of the overall treatment plan. Unfortunately the current literature dealing with electrodiagnostic prognostication is meager. There are only a few areas that electrophysiologic testing provides important outcome data. One of these areas is the evaluation of traumatic peripheral nerve injury. Traumatic nerve injuries can result in different grades of injuries as outlined by Seddon neuropraxic, axonotmesis, and...

Vibration exposure injuries and prevention

While propelling a wheelchair, users encounter obstacles such as bumps, curb descents, and uneven driving surfaces. These obstacles cause vibrations on the wheelchair and in turn, the wheelchair user, which through extended exposure can cause low back pain, disc degeneration and other harmful effects to the body (Seidel et al., 1986). Typically, seating systems are prescribed by clinicians based on the ability of the cushion to reduce pressure and provide proper positioning (Cooper et al.,...

References

Abbruzzese, G. and Berardelli, A. (2003). Sensorimotor integration in movement disorders (Review). Mov Disord, 18, 231-240. Angel, R.W. (1983). Muscular contractions elicited by passive shortening. In Advances in Neurology (ed. Desmedt, J.E.), Vol. 39, Raven Press, New York, pp. 555-563. Ashby, P. (1989). Spasticity. Discussion I. In The Current Status of Research and Treatment (eds. Emre, M. and Benecke, R.), Partheno, Carnforth, pp. 68-69. Barbeau, H. and Rossignol, S. (1987). Recovery of...

John C Rosenbek and Neila J Donovan

Department of Communicative Disorders, VA RR& D Brain Rehabilitation Research Center, University of Florida, Gainesville, FL, USA Dysphagia is defined as difficulty moving food and liquid from the mouth into the stomach. Traditionally this condition is divided into oropharyngeal and esophageal dysphagia to identify the locus of involvement. Oropharyngeal dysphagia is the focus of this chapter. It results when the structures or functions of the face, mouth, palate, pharynx, rostral esophagus,...

A1 A2 A3 A4 A5

A normal motor response when stimulating the affected nerve distal to the lesion, but either a reduced or absent response is elicited when stimulating proximal to the lesion. (Fig. 4.1) Neuropraxic lesions, (conduction block), may take up to 6 months to resolve, although typically block reverses over 2 weeks to 3 months. The presence of Wallerian degeneration can be especially observed during EMG. In this situation of axon loss, one can see fibrillation potentials of the involved muscles. These...

Leeanne Carey

School of Occupational Therapy Faculty of Health Sciences, LaTrobe University, Bundoora, Victoria, Australia Evidence of behavioral recovery of somatic sensations following peripheral and central nervous system lesions challenges therapists to not only understand the nature and extent of the change, but the conditions under which the recovery can be maximized and the mechanisms underlying. This challenge requires input from basic sciences and rehabilitation fields. Integration of these fields...

Triple Flexion Is A Spinal Reflex

Spinal reflex pathways, results in positive symptoms including spasticity, hyperactive muscle stretch reflexes, abnormal cutaneous and autonomic reflexes, and co-contraction of agonist and antagonist muscles (dystonia). Immediately after an acute brain or spinal cord injury muscles generally become weak and hypotonic (O'Brien et al., 1996). This is referred to as spinal shock and is accompanied by loss of muscle stretch reflexes and impaired F-wave responses on nerve conduction testing...

Basic principles in EMG

The primary goals of the EMG study are to localize the lesion, characterize the underlying nerve pathophysiology, quantitate the severity of the lesion, and assess the temporal course of the disorder (Preston et al., 1998). Localizing a lesion within the peripheral nervous system is best determined with the use of an EMG study. The EMG study can be tailored in such a fashion as to specifically localize the lesion to the nerve roots, plexus, trunks, or individual peripheral nerves. The clinician...

Dietz

Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland This chapter deals with the neuronal mechanisms underlying impaired gait as a paradigm of movement disorder with the aim of first, a better understanding the underlying pathophysiology and second, the selection of an adequate treatment and rehabilitation. For the patient usually one of the first symptoms of a lesion within the central motor system represents the movement disorder, which is most characteristic during...

Info

CONV conventional physical therapy LEMS lower extremity motor score. CONV conventional physical therapy LEMS lower extremity motor score. observers has been reported, and that revealed no benefit of BWSTT over conventional care in incomplete subjects. The SCI Locomotor Trial SCILT randomized 145 subjects with incomplete SCI who could not walk on admission to six regional SCI facilities. Subjects received 12 weeks of BWSTT complemented by over ground training when feasible or an equal amount of...

Interventions for retraining gait

Strategies for retraining gait start with interventions to improve control of the head and trunk when necessary, then proceed to sitting and standing balance Chapter 8 of Volume II . Practice paradigms ought to include a clear schedule and form of reinforcement Chapter 7 of Volume II . Rehabilitation approaches for walking are listed in Table 3.1. Locomotor interventions are limited only by the imagination of the rehabilitation team. An eclectic problem-solving approach is taken by most...

David A Gelber

Springfield Clinic Neuroscience Institute, Springfield, IL, USA Spasticity is commonly defined as excessive motor activity characterized by a velocity-dependent increase in tonic stretch reflexes. It is often associated with exaggerated tendon jerks, and is often accompanied by abnormal cutaneous and autonomic reflexes, muscle weakness, lack of dexterity, fatigability, and co-contraction of agonist and antagonist muscles Young, 1987 Young, 2002 Sanger et al., 2003 . It is a common complication...

HI Krebs1 N Hogan2 WK Durfee3 and HM Herr4

1 Department of Mechanical Engineering, Massachusetts Institute of Technology and Adjunct Assistant Research Professor of Neuroscience, The Winifred Masterson Burke Medical Research Institute, Weill Medical College of Cornell University, New York, USA 2Departments of Mechanical Engineering, and Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, USA 3Department of Mechanical Engineering, University of Minnesota, Minnesota, USA and 4 The Media Lab and The Harvard MIT...