Somatosensory evoked potentials after decompressive craniectomy for traumatic brain injury.

Somatosensory evoked potentials (SSEPs) are used for neuroprognosis after severe traumatic brain injury (TBI). However decompressive craniectomy (DC), involving removal of a portion of the skull to alleviate elevated intracranial pressure, is associated with an increase in SSEP amplitude. Accordingly, SSEPs are not available for neuroprognosis over the hemisphere with DC. We aim to determine the degree to which SSEP amplitudes are increased in the absence of cranial bone. This will serve as a precursor for translation to clinically prognostic ranges. Intra-operative SSEPs were performed before and after bone flap replacement in 22 patients with severe TBI. SSEP measurements were also performed in a comparison non-traumatic group undergoing craniotomy for tumor resection. N20/P25 amplitudes and central conduction time were measured with the bone flap in (BI) and out (BO). Linear regressions, adjusting for skull thickness and study arm, were performed to evaluate the contribution of bone presence to SSEP amplitudes. Latencies were not different between BO or BI trials in either group. Mean N20/P25 amplitudes recorded with BO were statistically different (p = 0.0001) from BI in both cohorts, showing an approximate doubling in BO amplitudes. For contralateral-ipsilateral montages r2 was 0.28 and for frontal pole montages r2 was 0.62. Cortical SSEP amplitudes are influenced by the presence of cortical bone as is particularly evident in frontal pole montages. Larger, longitudinal trials to assess feasibility of neuroprognosis over the hemisphere with DC in severe TBI patients are warranted.

Development of an integrated optical coherence tomography-gas nozzle system for surgical laser ablation applications: preliminary findings of in situ spinal cord deformation due to gas flow effects.

Gas assisted laser machining of materials is a common practice in the manufacturing industry. Advantages in using gas assistance include reducing the likelihood of flare-ups in flammable materials and clearing away ablated material in the cutting path. Current surgical procedures and research do not take advantage of this and in the case for resecting osseous tissue, gas assisted ablation can help minimize charring and clear away debris from the surgical site. In the context of neurosurgery, the objective is to cut through osseous tissue without damaging the underlying neural structures. Different inert gas flow rates used in laser machining could cause deformations in compliant materials. Complications may arise during surgical procedures if the dura and spinal cord are damaged by these deformations. We present preliminary spinal deformation findings for various gas flow rates by using optical coherence tomography to measure the depression depth at the site of gas delivery.

A comparison of ballistic-movement and ballistic-intent training on muscle strength and activation.

PURPOSE: Studies have both supported and refuted the concept that it is the intent to perform ballistic contractions that determines velocity-specific gains in resistance training. The purpose of this investigation was to determine whether ballistic intent is as effective as ballistic movement in improving muscle activation, force, movement time, and reaction time. METHODS: Subjects completed 8 wk of punch training. A dynamic (DYN) group trained with elastic resistance bands, and the isometric (ISO) group trained with an unyielding strap. A control (CTRL) group was also tested. Pretesting and posttesting measures included isometric force; electromyography (EMG) of triceps, biceps, pectoralis major, and latissimus dorsi; movement and reaction time of both arms; and a quick-hands test of coordination. RESULTS: Triceps iEMG increased by 63% in the ISO group (P = .03). Pectoralis major iEMG increased by 65% in the DYN group (P = .007). Movement time decreased 17.6% in the DYN training group (P = .001). Isometric force did not improve in either training group or in the CTRL group. CONCLUSIONS: Because of its specificity of movement, dynamic training might be a more appropriate method to improve punching speed for martial artists and boxers. The intent to contract explosively over a short duration does not appear to be beneficial in increasing force production or speed of movement in punching.