RESUMO
INTRODUCTION: A denervated half of the orbicularis oris muscle is not reinnervated spontaneously by axon sprouting from the intact contralateral side. The borderline between the facial nerve territories seems to act as a barrier. The muscle-nerve-muscle technique was advocated as a technique to reneurotize a denervated half of the orbicularis oris muscle in cases of marginal mandibular paralysis. MATERIAL AND METHODS: This muscle-nerve-muscle neurotization was tried to induce reinnervation of a denervated angle of the mouth in four patients. Grafts were harvested from the sural nerve. Functional recovery was assessed by measurement of facial movements and by electrophysiological examination. RESULTS: In three of the four cases presented, this technique helped to improve function of the lower lip. The clinical relevance of the results is discussed.
Assuntos
Paralisia Facial/cirurgia , Lábio/inervação , Transferência de Nervo/métodos , Eletromiografia , Músculos Faciais/inervação , Nervo Facial/cirurgia , Humanos , Regeneração Nervosa , Nervo Sural/transplante , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the impact of an 8-wk neuromuscular stimulation program of thigh muscles on strength and cross-sectional area in patients with refractory heart failure listed for transplantation. DESIGN: Forty-two patients with a stable disease course were assigned randomly to a stimulation group (SG) or a control group (CG). The stimulation protocol consisted of biphasic symmetric impulses with a frequency of 50 Hz and an on/off regime of 2/6 sec. RESULTS: Primary outcome measures were isometric and isokinetic thigh muscle strength and muscle cross-sectional area. Our results showed an increase of muscle strength by mean 22.7 for knee extensor and by 35.4 for knee flexor muscles. The CG remained unchanged or decreased by -8.4 in extensor strength. Cross-sectional area increased in the SG by 15.5 and in the CG by 1.7. CONCLUSIONS: Activities of daily living as well as quality of life increased in the SG but not in the CG. Subscales of the SF-36 increased significantly in the SG, especially concerning physical functioning by +7.5 (1.3-30.0), emotional role by +33.3 (0-66.6), and social functioning by +18.8 (0-46.9), all P < 0.05. Neither a change nor a decrease was observed in the CG. Neuromuscular electrical stimulation of thigh muscles in patients with refractory heart failure is effective in increasing muscle strength and bulk and positively affects the perception of quality of life and activities of daily living.
Assuntos
Terapia por Estimulação Elétrica/métodos , Insuficiência Cardíaca/complicações , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Atrofia Muscular/etiologia , Atrofia Muscular/reabilitação , Coxa da Perna , Atividades Cotidianas , Doença Crônica , Emoções , Tolerância ao Exercício , Feminino , Transplante de Coração , Humanos , Contração Isométrica , Contração Isotônica , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Debilidade Muscular/psicologia , Atrofia Muscular/diagnóstico , Atrofia Muscular/fisiopatologia , Atrofia Muscular/psicologia , Qualidade de Vida , Método Simples-Cego , Comportamento Social , Resultado do Tratamento , Listas de EsperaRESUMO
A laboratory model for the study of possible reinnervation by muscle-nerve-muscle (MNM) neurotization is presented. Preliminary studies revealed that MNM neurotization occurs in synergistically closely-related facial muscles. However, for larger antagonistic somatic muscle (flexor and extensor), this phenomenon could not be reproduced. The potential clinical relevance of these findings is presented and discussed.
Assuntos
Músculo Esquelético/inervação , Transferência de Nervo , Nervo Fibular/cirurgia , Animais , Denervação Muscular , Junção Neuromuscular , CoelhosRESUMO
Spinal cord lesions at level C5 to C6 lead to loss of hand functions and lesions at C4 to additional deficits of arm functionality. The presented dual channel surface stimulator with dual channel electromyogram (EMG) measurement was developed to investigate control strategies for an EMG-controlled implantable stimulation system and serves in addition as a therapy device for patients with partial innervation but weak muscle force. Four different control strategies for stimulation amplitude are available. The amplitude can be preset manually or can follow the preprocessed EMG signals proportionally. The shoulder control program allows proportional control of both stimulation channels with one EMG channel while the second EMG channel serves as the channel selector. Finally, a special feedback training program triggers a stimulation burst when EMG activity is detected. During a 2 year patient study, 18 patients from 2 hospitals and 1 rehabilitation center performed the feedback training. Almost all patients obtained an improvement of functionality. Apart from muscle strengthening, the feedback effect led to an improvement of proprioception and supported relearning of motions. For the documentation of the training status, functional muscle test (British Medical Research Council) and measurements of power, angle, torque, muscle fatigue, and EMG were performed. Obviously, EMG triggered stimulation provides several advantages compared to conventional passive electrical stimulation.
Assuntos
Braço , Terapia por Estimulação Elétrica/métodos , Eletromiografia , Paralisia/reabilitação , Plexo Braquial/lesões , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Retroalimentação , Hemiplegia/reabilitação , Humanos , Movimento/fisiologia , Contração Muscular/fisiologia , Fadiga Muscular/fisiologia , Debilidade Muscular/terapia , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Paralisia/etiologia , Propriocepção/fisiologia , Ombro/fisiologia , Doenças da Medula Espinal/complicações , TorqueRESUMO
We compared two methods of reconstruction of the abductor mechanism in 15 patients after prosthetic replacement of the upper femur, to assess abductor strength and function. Six patients in group I had direct fixation of the gluteus medius tendon and a segment of the original bone to the prosthesis. Nine patients in group 2 had the abductor tendon fixed to the iliotibial band. We assessed clinical function, isometric muscle strength and muscle cross-sectional area for each patient. The patients in group 1 had better clinical and functional results (p = 0.059), with average peak torques for hip abduction of 92% of that in the non-operated leg in group 1, and of 57% in group 2. Group 1 had a mean muscle cross-sectional area of 69% and a mean value of strength per cross-sectional area of 134% when compared with the control side. The respective values for group 2 were 52% and 91%. Direct fixation of the abductor muscles to the prostheses gave improved function and higher isometric abductor muscle force.
Assuntos
Artroplastia de Quadril , Fêmur/cirurgia , Prótese de Quadril , Músculo Esquelético/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Parafusos Ósseos , Criança , Feminino , Seguimentos , Humanos , Ílio , Contração Isométrica/fisiologia , Ligamentos/cirurgia , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular/fisiologia , Estresse Mecânico , Tendões/cirurgia , Tíbia , Tomografia Computadorizada por Raios X , Torque , Resultado do TratamentoRESUMO
Many aspects of the pathogenesis of urinary incontinence are poorly understood. Most studies show good results for physical therapy for instance for pelvic floor exercises and biofeedback. Unfortunately most of these studies lack an objective diagnostic and neurophysiological assessment. This could be one reason for the strongly divergent therapeutical success rates reported (30 to 90%). We recommend the use of objective parameters, for instance the PAD test with standardized bladder volume and a neurophysiological and short urodynamic assessment as well as subjective parameters [satisfaction with the outcome of treatment measured with the VAS (visual analog scale), documentation of the changes in ADL (activities of daily living)] in future therapeutical studies. A more precise assessment of the pathological cause of the impairment will help to develop optimal therapeutic procedures. Because of poor documentation in the past the analysis of therapeutic failures and the decision if mono-or complex physiotherapy is more appropriate has not been possible. This aspect will become even more important as the cost-effectiveness of treatments becomes a more important issue.
Assuntos
Incontinência Urinária/fisiopatologia , Urodinâmica/fisiologia , Feminino , Humanos , Diafragma da Pelve/fisiopatologia , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Incontinência Urinária/terapia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/terapiaRESUMO
In order to determine donor-site morbidity after elevation of the gracilis flap, 53 patients from four different departments were examined. The patients filled out a questionnaire about their complaints. 36 patients underwent dynamometric measurements. The adduction strength of the hip-joint was decreased by 11% after elevation of the gracilis muscle. This decrease in strength was not noticed by the patients. 53% of the patients complained about hypesthesia or dysesthesia corresponding to the cutaneous territory of the obturator nerve. The contour of the thigh was adversely affected after elevation of a musculocutaneous flap. The gracilis flap has a low but definite donor-site morbidity, especially concerning the esthetic aspect.
Assuntos
Músculos/transplante , Complicações Pós-Operatórias/etiologia , Retalhos Cirúrgicos , Adulto , Cicatriz , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular , Parestesia/etiologia , Complicações Pós-Operatórias/fisiopatologia , Coxa da Perna/cirurgiaRESUMO
We examined 22 patients suffering from reflex sympathetic dystrophy with psychoanalytic interviews. In all 22 patients we found a common psychological structure corresponding to Balint's basic fault (Balint, 1970). For people with this structure the accident that preceded the reflex sympathetic dystrophy and the following pain, immobilisation and need to help are promoting the patient's regression in a specific way ending in the developing of reflex sympathetic dystrophy. The dispair of the patients about their reflex sympathetic dystrophy expresses unsolved fears of early childhood.