The polysynaptic spine-stem reflex in clinical neurology.

Data from 25 years of studies of the spinobulbospinal (SBS) reflex in normal conditions and in a variety of nervous system diseases with lesions of the afferent and efferent systems, subcortical brain formations, and musculature (contracture of the expressive muscles, myofascial pain syndrome) are presented. The instability of many characteristics of the reflex (latency, amplitude, duration of response, presence) is shown to characterize this reflex in normal conditions. These measures become more stable in central nervous system pathology, which is evidence for impairment of programs which construct and execute movements. Lesions of the peripheral neuromotor apparatus produced no significant changes in the characteristics of the SBS reflex.

[Myofascicular hypertonia as a generator of peripheral determinant structure]. / Miofastsikuliarnyi gipertonus--generator perifericheskoi determinantnoi struktury.

The reflex nature of the myofascicular hypertonus (MFH) is evidenced. This is a consequence of the changes in muscular contractile activity. Local, segmental and suprasegmental motor control structures participate in the MFH pathogenesis. MFH generates a perifheral determinant structure. It is capable of substantially changing the manifestations of spastic torticollis++ and syringomyelia. MFH is a major factor of the secondary contracture in the face muscles. It is important in muscular tonic manifestations in spondylogenic neurologic disorders. Postisometric relaxation (manual therapy) provides a means of pathogenetic treatment for MFH.

[Functional status of cervical segments of the spinal cord in patients with local muscle hypertonia]. / Funktsional'noe sostoianie sheinykh segmentov spinnogo mozga u bol'nykh s lokal'noi gipertoniei myshts.

The reflex response of shoulder girdle muscles to stimulation of the ulnar nerve was registered with the use of needle electrodes. The M- and F-responses of the hand muscles were registered simultaneously. The reflex response had a polysynaptic character, and was not constant in the form, amplitude, and latent period. In healthy subjects the polysynaptic response is registered more often in humerus adductors. In the presence of local painful hypertonicity of the muscles the reflex response was registered in all cases. The intensity of the pain syndrome was inversely proportional to the duration of the latent period. The method described can be used for objective assessment of the time course of the pain syndrome and for forecasting the formation of reflex syndromes of cervical osteochondrosis.

[Electromyography in spastic torticollis]. / Elektromiografiia pri spasticheskoi krivoshee.

The EMG characteristics of convulsive activity in the sternocleidomastoid muscle in spastic torticollis vary in different stages of the disease. At the onset of the disease, the bioelectric muscle activity which accomplishes an involuntary turn of the head is registered. Eventually, as the morbid areas of myopathosis are formed in the "active" muscles and muscles preventing an involuntary turn, the electrogenesis of the latter becomes dominating. It is assumed that at the basis of this phenomenon lies a lowering of the excitation threshold in the neuromotor apparatus in the respective group of muscles with an appearance of a peripheral subordinating factor.

[Dynamics of the clinico-electromyographic indices of secondary contracture of the mimetic muscles in neuritis of the facial nerve (role of myogelosis)]. / Dinamika kliniko-élektromiograficheskikh pokazatelei vtorichnoi kontraktury mimicheskikh myshts pri nevrite litsevogo nerva (o roli miogelozov).

Clinical and electromyographic examinations of the mimic muscles were carried out in 24 patients with facial neuritis. A method of kinesthetic palpation of the mimic muscles has been developed, which has enabled one to reveal pathological infiltrations (myogeloses) in 13 patients with secondary contractures. In 6 patients the emergence and development of the myogeloses before the appearance of distinct symptoms of the facial muscle contractures were followed. In the course of these examinations clinico-electromyographic comparisons were made that gave the authors an opportunity to specify the role of the myogeloses in the formation of principal symptoms of initial manifestations of the post-neuritic contractures.

[Manual therapy of secondary contractures of the facial musculature]. / Manual'naia terapiia vtorichnoi kontraktury mimicheskoi muskulatury.

The authors have developed a technique of manual therapy of mimic muscles contracture secondary to facial neuritis. The therapy is based on a combination of isometric work of the facial muscles against the external pressure created by the physician's hand pressed onto the patient's cheek in the oral cavity with passive extension of the contracture-altered muscles. The effect of post-isometric relaxation is expressed in complete elimination of facial muscle painfulness and of a feeling of tightening.

[Combined treatment of myodystonic pain syndromes by manual therapy and acupuncture]. / Lechenie miodistonicheskikh bolevykh sindromov sochetaniem manual'noi terapii i akupunktury.

Combination of manual therapy (++post-isometric relaxation) and acupuncture in the treatment of myodystonic syndromes is based from the standpoint of realization of the neurophysiological components of the pathogenesis of myofascicular hypertonus. The controlled afferent flow created by ++post-isometric relaxation and acupuncture exerts a varying effect on the structural and functional levels of the nervous system. The therapeutic effect of manual therapy is realized at the special segmental level, that of acupuncture with participation of the suprasegmental systems.

[Diagnostic significance of the spinal-brain stem polysynaptic reflex and the period of inhibition]. / Diagnosticheskoe znachenie spinal'no-stvolovogo polisinapticheskogo refleksa i perioda tormozheniia.

Electrical stimulation of the radial nerve associated with voluntary contraction of the shoulder girdle inhibited bioelectrical activity not only in the muscles of the hypothenar but also in the proximal muscles. In resting muscles, such stimulation elicited a reflex response with a large latent period. With weak voluntary tension stimulation elicited a reflex response while in the presence of considerable contraction the reflex response merged with bioelectrical activity, with a clearly demonstrable subsequent period of inhibition. The current viewpoint about the antidromal blockade of the segmental motoneurons is debated. It is suggested that the polysynaptic reflex and the inhibition period are connected with the same level of realization -- the oral portions of the brain stem.

[The nature of an early component of the trigemino-facial (perioral) reflex]. / Priroda rannego komponenta trigeminofastsial'nogo (perioral'nogo) refleksa.

A study was made of an early reflex response of the perioral muscle. The marginal branch of the facial nerve was irritated with electric stimuli in the mode of supramaximal stimulation for the M-response, and the leading of the responses was performed with needle electrodes. After the M-response with the latency of 7.5--15 ms one could record discharges not exceeding, when normal, the amplitude of the M-response, depending, like the M-response, on the position of the stimulating electrode above the branch of the facial nerve. In patients with derangement of the central motoneuron of the facial nerve and in those with the akinetic -rigid syndrome, the amplitude of the discharges did not surpass the M-response. The conclusion is made that these discharges, known in the literature as an early component of trigemino-facial++ (perioral) reflex, present an antidromal response of motoneurons of the facial nerve nucleus.

[Role of the muscle factor in the pathogenesis of painful forms of syringomyelia]. / Rol' myshechnogo faktora v patogeneze algicheskikh form siringomielii.

On the basis of examining the disease histories of patients with syringomyelia it was found that in 68.7% of the cases the disease began from algic manifestations. Under observation there were 48 patients with syringomyelia who complained of pains in the neck and the upper extremities. A connection between the algic syndrome and the pathology of the vertebral column cervical division was noted. It was local myopathosis which was found to be the principle factor causing the algic manifestations. It was discovered even in patients who had no cervical osteochondrosis. When the deep was discovered even in patients who had no cervical osteochondrosis. When the deep sensitivity was affected the myopathoses could not be determined. The myopathoses were characterized electromyographically by the presence of constant bioelectrical activity registered by needle electrodes. In the spectrum of motor unit activity shortened and prolonged potentials were revealed simultaneously. The regional circulatory changes in the upper extremities were found to be connected to a considerable extent with the intensity of the algic manifestations in local myopathoses. Segmental message is an effective means for eliminating the local myopathoses.

[Humeroscapular periarthrosis in patients with post-stroke hemiplegia]. / Plechelopatochnyi periartroz u bol'nykh s postinsul'tnoi gemiplegiei.

Neuro-orthopedic and electrophysiological studies in 122 patients with post-insult hemiplegia underlie the authors' conclusion of shoulder pains peripheral origin. According to the authors' data these patients have humeroscapular periarthrosis formed as a result of cerebral and peripheral damages, including neck osteochondrosis. Fixing shoulder adductors are shown to become originally "numb" because of constant tonic impulsation damages. The mechanisms of this state are supposed to be connected with trophic changes and demand further study.

[Alternating-discrete tonometry in evaluating the efficacy of post-isometric relaxation of local muscle hypertonia]. / Peremenno-diskretnaia tonometriia v otsenke éffektivnosti postizometricheskoi relaksatsii lokal'nykh myshechnykh gipertonusov.

A technique of tonometry of the local muscular hypertonus has been developed. Its essence lies in the registration of muscle deformation in response to the external exertion varying from 0 to 5 kg. The detected changes in the tonus are expressed in a graphic form. A session of postisometric relaxation is followed by an increase in the muscle tonus for a brief interval, succeeded by its stable decrease over 24-48 hours. The results obtained are discussed in terms of changing proprioceptive afferentation.

[Evoked potentials in patients with myofascial pain syndrome in the late residual period of natal cervical trauma].

Evoked potentials (EP), including short-latency brainstem auditory and somatosensory EP, have been studied in 80 patients with myofascial pain syndrome. Brainstem dysfunction, predominantly on the ponto-mesencephalic level, and conduction delay in the somatosensory pathway on the supraspinal level have been found in patients with natal trauma of cervical spine, being most significant in patients with severe myofascial pain syndrome. EP findings showed impairments of afferent structures of nervous system and inefficiency of antinociceptive system of supraspinal level in this group of patients that could cause the development of persistent brain syndrome.

[Arterial and venous blood flow disturbances in children with vertebral basilar insufficiency].

Two hundred and sixty-two patients aged from 1 month to 18 years with vertebral basilar insufficiency syndrome have been studied. This pathology is caused by the natal trauma of cervical spine and related structures, connective tissue dysplasias, anomalies of the spine, the cranial vertebral transition and spinal vessels. Basic clinical, X-ray and dopplerographic indices of vertebral basilar insufficiency (VBI) in children of different age groups have been specified. Statistically significant correlation between VBI, spinal arterial blood flow asymmetry and disturbance of the deep venous drainage were revealed. Reactivity coefficients for the functional loading in children of school age were calculated and their correlations with the autoregulation system and vessel reactivity were shown. These peculiarities of hemodynamics in children of different age should be taken into account in the choice of therapeutic and rehabilitative measures.

[Spinal-bulbo-spinal polysynaptic reflex in clinical neurology]. / Spinal'no-stvolovoi polisinapticheskii refleks v klinicheskoi nevrologii.

The data of 25-year study on "bulbar" spinal reflex (BSR) in health and different neurological diseases with afferent and efferent system damages, subcortical brain lesions and muscle lesions (mimic muscle contracture, myofascial pain syndrome are presented). The instability of the majority of the reflex characteristics (latency, amplitude, response duration, display) was shown to be its key feature in normal conditions. In a case of central nervous system pathology, stabilization of these parameters takes place that evidence for defect in the movement programming and performance. In damaging peripheral sections of neuromotor system, any substantial BSR characteristics changes were not detected.