Intra and inter-raters reliability and agreement of stimulus electrodiagnostic tests with two different electrodes in sedated critically-ill patients.

Objective: The aim of the present study was to verify the intra- and inter-rater reliability and agreement of the stimulus electrodiagnostic test (SET) measurements obtained by pen and square electrodes in the vastus lateralis and tibialis anterior muscles. Design: An intra- and inter-rater reliability and agreement study was performed for the SET by two independent raters. Two different sizes of cathode electrodes (1 cm2 and 25 cm2) and two muscles were assessed (tibialis anterior and vastus lateralis). Results: Chronaxie did not change according to the different electrodes. A high intra-rater reliability (0.72 ≤ r ≤ 0.88) was detected independently of the electrode and muscle assessed. Moreover, moderate and almost perfect agreements (0.51 ≤ Kappa ≤ 1.00) were detected on intra-rater assessment. Similar correlations (0.74 ≤ r ≤ 0.79) were found for intra-rater reliability. However, dissimilar inter-rater agreement was detected: Kappa ≤ 0.40 for tibialis anterior and Kappa = 1.00 for vastus lateralis. Conclusion: The SET presented high reliability and moderate agreement in intra-rater evaluations. A fair agreement was found in the inter-rater assessment of the tibialis anterior. Evaluations performed with different electrode sizes did not influence the results. Therefore, the SET should be performed by a unique rater in test retest situations.

A correlation between clinical severity and functional state with nerve conduction studies findings in patients with carpal tunnel syndrome: a systematic review / Correlação entre gravidade clínica e estado funcional com achados eletroneuromiograficos, em pacientes com síndrome do túnel do carpo: uma revisão sistemática

Carpal Tunnel Syndrome is the most common compressive neuropathy in the general population, and it may lead to disabling symptoms and significant functional limitation. This systematic review covered Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS, and SCIELO databases, with no time or language delimitations. The PICO strategy defined the search strategy with keywords extracted from the Medical Subjects Headings, and the quality of the studies was evaluated by the Agency for Healthcare Research and Quality (AHRQ) scale. Overall, 857 studies were identified, of which only 10 fulfilled the inclusion criteria. Despite the good results shown, a noticeable heterogeneity was observed among the studies included, associated with methodological discrepancy and to limited sample size in a few of them. Four studies showed no correlation between electrophysiological findings and clinical symptoms and signs, whereas three could demonstrate such association and other three studies had equivocal results. Other studies are necessary, with better methodological standards and more homogeneous and precise evaluations, so as to improve the level of scientific evidence

A síndrome do Túnel do Carpo é a neuropatia compressiva mais frequente na população geral que pode levar a sintomas incapacitantes e significativa limitação funcional. Uma revisão sistemática foi realizada nas bases de dados Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS e SCIELO, sem delimitação de tempo ou idioma. Utilizou-se da estratégia PICO para a pesquisa, palavras-chave extraídas dos Descritores de Ciências da Saúde (Decs) e a qualidade dos estudos foi avaliada através da escala Agency for Healthcare Research and Quality (AHRQ). Identificaram-se 857 estudos dos quais, somente 10 obedeceram aos critérios de inclusão. Apesar dos bons resultados apresentados, verificou-se uma expressiva heterogeneidade existente entre os estudos incluídos, associado à discrepância metodológica, e um limitado tamanho amostral em alguns deles. São necessários estudos com melhor padrão metodológico, bem como avaliações mais homogêneas e precisas, a fim de melhorar o nível de evidência científica

Confiabilidad de los estudios de neuroconducción en el síndrome de túnel carpiano / Reliability of neuroconduction studies in carpal tunnel syndrome

RESUMEN Objetivo Determinar la confiabilidad entre dos observadores y el cambio mínimo detectable de los estudios de neuroconducción para diagnosticar el síndrome de túnel carpiano. Métodos Se estudiaron 69 pacientes remitidos para estudio electrofisiológico por sospecha de síndrome de túnel carpiano. A los pacientes, se les realizaron dos exámenes, dos días diferentes, por dos evaluadores. Se evaluaron las latencias sensitivas y motoras de los nervios mediano y cubital; todos fueron clasificados como negativos, incipientes, leves, moderados, severos o extremos. Se calculó la variación relativa entre ensayos, el coeficiente de correlación intraclase, el índice de kappa, el límite de acuerdo y el cambio mínimo detectable. Resultados La variación relativa entre ensayos de la latencia motora del nervio mediano fue de -6,8 % a 15,9 % con coeficiente de correlación intraclase de 0,98 para la diferencia con la latencia del nervio cubital. El cambio mínimo detectable fue de 0,4ms. La variación relativa entre ensayos de la latencia sensitiva del nervio mediano fue -5,0 % a 11 % con coeficiente de correlación intraclase de 0,95 para la diferencia con el nervio cubital. El cambio mínimo detectable fue de 0,2ms. La clasificación ele trofisiológica coincidió en 93 % de los casos, índice de kappa de 0,89. Conclusiones Las latencias sensitivas y motoras del nervio mediano así como la diferencia de estas con el nervio cubital son medidas confiables. El cambio mínimo detectable obtenido en nuestro estudio le sirve al clínico para establecer si los cambios de las latencias en estudios consecutivos o después del tratamiento son significativos.(AU)

ABSTRACT Objective To determine the reliability of neuroconduction studies by comparing two observers and detecting minimum changes when diagnosing carpal tunnel syndrome. Methods Sixty-nine patients referred for electrophysiological study due to suspected carpal tunnel syndrome were studied. The patients underwent two examinations, performed by two evaluators, on two different days. Sensory and motor latencies of the median and ulnar nerves were evaluated; all were classified as negative, incipient, mild, moderate, severe or extreme. Relative interval variation, intraclass correlation coefficient, kappa index, limit of agreement and minimum detectable change were estimated. Results The relative variation of motor nerve latency of the median nerve was -6.8% to 15.9%, with intraclass correlation coefficient of 0.98 for the difference of median-ulnar nerve latency. The minimum detected change was 0.4ms, while the relative interval variation of sensory latency of the median nerve was -5.0% to 11%, with intraclass correlation coefficient of 0.95 for difference with the ulnar nerve. The minimum detectable change was 0.2ms. Electrophysiological classification agreed in 93% of the cases, with a kappa index of 0.89. Conclusions Sensory and motor latencies of the median nerve, as well as the difference between them and the ulnar nerve, are reliable measures. The minimum detectable change obtained in our study helps clinicians to establish whether changes in latencies in consecutive or post-treatment studies are significant.(AU)

Combined nerve conduction index in diabetic polyneuropathy.

UNLABELLED: Diabetic polyneuropathy can be confirmed by nerve conduction studies. The data can be analyzed in the form of a combined index instead of individual parameters. METHODS: The combined index included five parameters of nerve conduction studies commonly used for evaluation of polyneuropathies. We evaluated sensitivity in 100 diabetic patients with suspected polyneuropathy, and specificity in 200 non-diabetic patients with suspected lumbosacral radiculopathy. All results were expressed in number of standard deviations (SD). RESULTS: The sensitivity of the combined index was 81 or 74%, and specificity was 97 or 98%, using respectively -2.0 or -2.5 SD as cutoff. The range of sensitivity of the other parameters was 57-65% or 48-56%, and specificity range was 96-98% or 98-100%, using the same criteria. DISCUSSION: The combined index had higher sensitivity and equivalent specificity compared to isolated parameters.

Combined nerve conduction index in diabetic polyneuropathy / Índice combinado de condução nervosa na polineuropatia diabética

Diabetic polyneuropathy can be confirmed by nerve conduction studies. The data can be analyzed in the form of a combined index instead of individual parameters. METHODS: The combined index included five parameters of nerve conduction studies commonly used for evaluation of polyneuropathies. We evaluated sensitivity in 100 diabetic patients with suspected polyneuropathy, and specificity in 200 non-diabetic patients with suspected lumbosacral radiculopathy. All results were expressed in number of standard deviations (SD). RESULTS: The sensitivity of the combined index was 81 or 74%, and specificity was 97 or 98%, using respectively -2.0 or -2.5 SD as cutoff. The range of sensitivity of the other parameters was 57-65% or 48-56%, and specificity range was 96-98% or 98-100%, using the same criteria. DISCUSSION: The combined index had higher sensitivity and equivalent specificity compared to isolated parameters.

A polineuropatia diabética pode ser confirmada por estudos de condução nervosa. Os dados podem ser analisados por um índice combinado ao invés de parâmetros isolados. MÉTODOS: O índice combinado incluiu cinco parâmetros usados rotineiramente na avaliação de polineuropatias. Avaliamos a sensibilidade em 100 pacientes diabéticos com suspeita de polineuropatia e a especificidade em 200 pacientes não diabéticos com suspeita de radiculopatia lombossacral. Todos os resultados foram expressos em número de desvios-padrão (DP). RESULTADOS: A sensibilidade do índice combinado foi 81 ou 74%, e a especificidade foi 97 ou 98%, usando respectivamente -2,0 ou -2,5 DP como ponto de corte. A sensibilidade dos parâmetros isolados oscilou entre 57-65% ou 48-56%, e a especificidade foi 96-98% ou 98-100%, usando os mesmos critérios. DISCUSSÃO: O índice combinado apresentou melhor sensibilidade e especificidade equivalente aos parâmetros isolados.

Estimation of stray coupling capacitances in biopotential measurements.

Biopotential measurements are very sensitive to electromagnetic interference (EMI) from power-lines. Interference conditions are mainly imposed by electric-field coupling, whose effects can be described by coupling capacitances. The main of them are the patient-to-ground and the patient-to-power-line capacitances, usually denoted as C(B) and C(P), respectively. A technique to estimate these elements and experimental data obtained in different environmental conditions are presented. It was found that C(B) ranges from hundreds of pF to nF, and C(P) from hundredths of pF to few pF. The presented technique also lets it know the small amplifier-to-ground and amplifier-to-power-line capacitances. The knowledge of all these capacitances allows estimating the EMI conditions that biopotential amplifiers can be subject to, thus, resulting useful data for specifying their design requirements and constraints in real working conditions.

A method for better positioning bipolar electrodes for lower limb EMG recordings during dynamic contractions.

To obtain a high quality EMG acquisition, the signal must be recorded as far away as possible from muscle innervations and tendon zones, which are known to shift during dynamic contractions. This study describes a methodology, using commercial bipolar electrodes, to identify better electrode positions for superficial EMG of lower limb muscles during dynamic contractions. Eight female volunteers participated in this study. Myoelectric signals of the vastus lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles were acquired during maximum isometric contractions using bipolar electrodes. The electrode positions of each muscle were selected assessing SENIAM and then, other positions were located along the length of muscle up and down the SENIAM site. The raw signal (density), the linear envelopes, the RMS value, the motor point site, the position of the IZ and its shift during dynamic contractions were taken into account to select and compare electrode positions. For vastus lateralis and peroneus longus, the best sites were 66% and 25% of muscle length, respectively (similar to SENIAM location). The position of the tibialis anterior electrodes presented the best signal at 47.5% of its length (different from SENIAM location). The position of the gastrocnemius medialis electrodes was at 38% of its length and SENIAM does not specify a precise location for signal acquisition. The proposed method should be considered as another methodological step in every EMG study to guarantee the quality of the signal and subsequent human movement interpretations.

Tactile threshold detection in leprosy patients with an electronic algometer.

OBJECTIVE: To propose an electronic method for sensitivity evaluation in leprosy and to compare it to the Semmes-Weinstein monofilaments. METHODS: Thirty patients attending the Dermatology outpatient clinic of HCFMRP-USP were consecutively evaluated by both the electronic aesthesiometer and Semmes-Weinstein monofilaments on hand and foot test points. The intraclass correlation coefficient (ICC) was calculated to determine the variability of the electronic measures and the Kappa coefficient was calculated to determine the agreement between methods according to their categories (altered and non-altered tactile sensitivity). RESULTS: The ICC was approximately 1, demonstrating repeatability. The Kappa coefficient showed more than 75 and 63% agreement on the hand and foot points, respectively. The mean agreement between the 2 methods for the 7 points of the right and left hand was 77.14 and 75.71%, respectively. The mean agreement for all 10 points was 74.33 and 63.66% on the right and left foot, respectively. In cases of disagreement the detection of altered tactile sensitivity by the electronic esthesiometer on the right and left foot was 90.91 and 84.25%, respectively, with no detection by the monofilaments. CONCLUSION: The results suggest that the electronic esthesiometer is a reliable and easy application, capable of evaluating alterations of tactile sensitivity in leprosy patients.

A multiarray mapping method to minimize morbidity from thermocoagulation as treatment of refractory trigeminal neuralgia.

BACKGROUND: Conventional percutaneous thermocoagulation of postgasserian fibers has shown high success rates, with significant residual morbidity. METHODS: This communication summarizes conclusions of multiple publications on our computerized mapping method and technique, and presents new data on short- and long-term results on trigeminal pain, including an actuarial analysis, complications. RESULTS: In TTN, 97.4% of 75 procedures produced initial pain relief without medication. In all, 84.7% of appropriate verbal responses were achieved by proper location of the needle at the chosen target, requiring an average of 1.45 tracts per procedure. Needle tip was located between 1 and 15 mm below the sellar floor in 97.0% of procedures and in an angle of 40 degrees to 80 degrees regarding the clivus profile projection in 99.1%. A 93% reduction of corneal analgesia and a 100% suppression of major dysesthesias and cranial nerve palsies were found. CONCLUSION: We have shown a significant reduction of morbidity from percutaneous thermocoagulation of postgasserian fibers with similar short- and long-term results as those shown in 11 recently selected series. Strict adherence to all details of our new method and technique is essential. Future multiinstitutional studies are needed to confirm and enrich this small series.

Electrical and mechanical effects of hyoscine butylbromide on the human stomach: a non-invasive approach.

Due to the importance of motility in a number of gastrointestinal disorders, efforts have been made to evaluate both gastric motility counterparts: electrical activity and mechanical activity. The present work aimed to propose a new approach, associating AC biosusceptometry (ACB) and electrogastrography (EGG), to noninvasively monitoring mechanical and electrical gastric activity, respectively. Fourteen volunteers ingested a test meal and their gastric activity was evaluated by EGG and ACB at a baseline and after 20 mg of i.v. hyoscine butylbromide. ACB and EGG showed a similar signal pattern and high temporal correlation. Hyoscine butylbromide decreased the mechanical motility index (MI) by 50.9%, while for electrical MI the reduction was 36.5%. Delayed times to onset (mean+/-SD: 50+/-15 versus 40+/-20 s; P<0.01) and the inhibitory effect (16+/-4 versus 14+/-5 min; P<0.01) were calculated for ACB and EGG, respectively. ACB and EGG emerged due to their interesting nature, noninvasiveness and low cost to evaluate gastric motility. Our approach associating ACB and EGG allowed monitoring and quantification of the effects of an anticholinergic drug in gastric electrical activity and contractile activity in humans.

Analysis of TMJ vibration sounds before and after use of two types of occlusal splints.

Temporomandibular joint (TMJ) sounds are important and common physical signs of temporomandibular disorders (TMD). The aim of this study was to evaluate the influence of the effect of the use of occlusal bite splints (stabilizing and repositioning) on the sounds produced in the TMJ, by means of the electrovibratography (EVG). Thirty-one patients with TMD from the Dental School of Ribeirão Preto, University of São Paulo, Brazil were selected for this study. Group 1 (n=23) wore stabilizing bite splints and Group 2 (n=8) used anterior repositioning splints. Before and after treatment with occlusal splints both groups were analyzed using the SonoPAK Q/S recording system (BioResearch System, Inc.). The treatments with stabilizing bite splints were satisfactory, since they reduced the total amount of the sound energies (p<0.05), but the use of anterior repositioning splints for no more than 4 weeks produced significantly better results (p<0.01). The total amount of vibration energy involved in the vibrating movements of the TMJ showed significant improvement using anterior repositioning splints.

Analysis of TMJ vibration sounds before and after use of two types of occlusal splints

Temporomandibular joint (TMJ) sounds are important and common physical signs of temporomandibular disorders (TMD). The aim of this study was to evaluate the influence of the effect of the use of occlusal bite splints (stabilizing and repositioning) on the sounds produced in the TMJ, by means of the electrovibratography (EVG). Thirty-one patients with TMD from the Dental School of Ribeirão Preto, University of São Paulo, Brazil were selected for this study. Group 1 (n=23) wore stabilizing bite splints and Group 2 (n=8) used anterior repositioning splints. Before and after treatment with occlusal splints both groups were analyzed using the SonoPAK Q/S recording system (BioResearch System, Inc.). The treatments with stabilizing bite splints were satisfactory, since they reduced the total amount of the sound energies (p<0.05), but the use of anterior repositioning splints for no more than 4 weeks produced significantly better results (p<0.01). The total amount of vibration energy involved in the vibrating movements of the TMJ showed significant improvement using anterior repositioning splints.

Os ruídos da articulação temporomandibular (ATM) são sinais físicos importantes e comuns da disfunção temporomandibular (DTM). O objetivo do presente estudo foi avaliar o efeito do uso da placa oclusal (estabilizadora e reposicionadora) nos sons produzidos na ATM, por meio da eletrovibratografia (EVG). Um total de 31 pacientes da Faculdade de Odontologia de Ribeirão Preto - USP foram selecionados para este estudo. O grupo 1 (n=23) foi selecionado para usar a placa estabilizadora e o grupo 2 (n=8) para usar a placa reposicionadora. Antes e depois do uso das placas os grupos foram analisados usando o SonoPAK Q/S (BioResearch System). Os tratamentos com placas estabilizadoras foram satisfatórios quando analisados estatisticamente uma vez que reduziram a quantidade total de energia dos sons (p<0,05). O tratamento com placa reposicionadora, por 4 semanas no máximo, produziu melhores resultados estatísticos (p<0,01). A quantidade total de energia de vibração nos movimentos vibratórios da ATM mostrou significante melhora usando a placa reposicionadora.

Effect of occlusion on joint sounds in asymptomatic individuals.

Occlusion is a predisposing factor for Temporomandibular Dysfunctions (TMD) of the joint, whose first sign and/or symptom is usually joint sound. To verify the effect of occlusion on joint sounds, temporomandibular joints (TMJ) were analyzed in 78 asymptomatic individuals with various dental conditions. Electrosonography was used to determine the intensity of the vibration in the temporomandibular joint (TMJ) on opening and closing the mouth. Transducers (piezoelectric accelerometer) were placed on the right and left joints. Results were tabled and analyzed using the Kruskal-Wallis test (a=0.05). It was concluded that TMJ vibration in partly edentulous individuals from Kennedy classes I, II and III is statistically higher than in dentate and fully edentulous subjects.

Two-electrode biopotential measurements: power line interference analysis.

In this paper, an analysis of power line interference in two-electrode biopotential measurement amplifiers is presented. A model of the amplifier that includes its input stage and takes into account the effects of the common mode input impedance Z(C) is proposed. This approach is valid for high Z(C) values, and also for some recently proposed low-Z(C) strategies. It is shown that power line interference rejection becomes minimal for extreme Z(C) values (null or infinite), depending on the electrode-skin impedance's unbalance deltaZ(E). For low deltaZ(E) values, minimal interference is achieved by a low Z(C) strategy (Z(C) = 0), while for high deltaZ(E) values a very high Z(C) is required. A critical deltaZ(E) is defined to select the best choice, as a function of the amplifier's Common Mode Rejection Ratio (CMRR) and stray coupling capacitances. Conclusions are verified experimentally using a biopotential amplifier specially designed for this test.

Caries detection methods: can they aid decision making for invasive sealant treatment?

The decision to place sealants is a difficult one, and it has been suggested that in a low risk population it may be efficient to wait until caries is detected in the fissure. An invasive sealant technique with fissure preparation may then be indicated. The diagnostic method used in the indication of such a procedure should accurately detect both dentine caries and sound fissures: high sensitivity for dentine caries (at D3 threshold) with high specificity for enamel caries (at D1 threshold). The aims of this study were to assess the diagnostic performance of selected diagnostic methods at normal cut-offs for traditional dentine caries detection and at reduced cut-offs in relation to the desired performance mentioned above, and to assess whether fissure opening allows for accurate visual detection of dentinal caries. Data were obtained from 230 occlusal sites of 101 extracted human molar teeth. Diagnostic methods used on the entire sample were: visual inspection, electrical conductance measurements and laser fluorescence measurements. The sample was then divided into two groups. Group 1 was subjected to visual inspection after application of a dye. Group 2 was subjected to visual inspection after fissure opening only, and after subsequent dye application. Validation was performed by histological investigation. The results with cut-offs normally used in dentine caries detection were roughly in accordance with the literature, except for laser fluorescence. The sensitivity of visual inspection for dentinal caries (D3) was 17% before and 70% after fissure opening. Using reduced cut-offs, a 100% sensitivity (D3) was achieved with 2 methods, but this also resulted in 63 or 87% false positive diagnoses of sound surfaces. Visual inspection and electrical methods both showed a moderate to high sensitivity (D3) with a higher than 50% specificity (D1). It was concluded that visual inspection and electrical methods at reduced cut-offs may aid the indication of invasive sealant treatment. The visual detection of dentinal caries is substantially increased, but not perfect after fissure opening.

Estimulación magnética transcraneana en el hombre / Transcranial magnetic stimulation in man

La estimulación magnética constituye una herramienta de estudio de las vías motoras centrales de carácter no invasivo e indoloro. La ausencia de efectos colaterales y molestias para el paciente han permitido su rápido desarrollo y aceptación. Es posible la estimulación de la corteza motora mediante la estimulación transcraneana (EMT), así como de las raíces motoras a nivel de su pasaje por los agujeros de conjugación mediante la estimulación espinal. Esto permite conocer el tiempo de conducción motora central (TCMC), el parámetro más utilizado, aunque la morfología y la amplitud de las respuestas permite ampliar el espectro diagnóstico. Además del potencial evocado motor (PEM), obtenido como un efecto excitatorio de la EMT, también existe un efecto inhibitorio, conocido como período de silencio (PS). En la esclerosis múltiple es característico el aumento del TCMC debido al retardo en zonas de desmielinización. Pueden observarse también respuestas polifásicas, reducción en la amplitud, aumento en la duración de las respuestas y aun ausencia de éstas. En la mielopatía cervicoartrósica el aumento del TCMC es considerablemente menor que en la anterior, siendo más frecuentes los efectos sobre la amplitud. El estudio de diferentes grupos musculares permite un diagóstico topográfico del nivel de compresión. En el accidente muscular encefálico, la presencia o ausencia de respuestas en los primeros días de instalación permite un pronóstico de recuperación funcional. En la esclerosis lateral amiotrófica se encuentra una marcada reducción de la amplitud y frecuentemente ausencia de respuestas, con escaso o ningún efecto sobre el TCMC(AU)

Estimulación magnética transcraneana en el hombre / Transcranial magnetic stimulation in man

La estimulación magnética constituye una herramienta de estudio de las vías motoras centrales de carácter no invasivo e indoloro. La ausencia de efectos colaterales y molestias para el paciente han permitido su rápido desarrollo y aceptación. Es posible la estimulación de la corteza motora mediante la estimulación transcraneana (EMT), así como de las raíces motoras a nivel de su pasaje por los agujeros de conjugación mediante la estimulación espinal. Esto permite conocer el tiempo de conducción motora central (TCMC), el parámetro más utilizado, aunque la morfología y la amplitud de las respuestas permite ampliar el espectro diagnóstico. Además del potencial evocado motor (PEM), obtenido como un efecto excitatorio de la EMT, también existe un efecto inhibitorio, conocido como período de silencio (PS). En la esclerosis múltiple es característico el aumento del TCMC debido al retardo en zonas de desmielinización. Pueden observarse también respuestas polifásicas, reducción en la amplitud, aumento en la duración de las respuestas y aun ausencia de éstas. En la mielopatía cervicoartrósica el aumento del TCMC es considerablemente menor que en la anterior, siendo más frecuentes los efectos sobre la amplitud. El estudio de diferentes grupos musculares permite un diagóstico topográfico del nivel de compresión. En el accidente muscular encefálico, la presencia o ausencia de respuestas en los primeros días de instalación permite un pronóstico de recuperación funcional. En la esclerosis lateral amiotrófica se encuentra una marcada reducción de la amplitud y frecuentemente ausencia de respuestas, con escaso o ningún efecto sobre el TCMC

Estudo sobre a reprodutividade das provas eletrodiagnósticas da reobase, cronaxia e curvas I/T em indivíduos sadios / Study about the reproductive of electrodiagnosis test of rheobase, cronaxie and curves I/T in individual healthy

Neste estudo foi realizada uma comparaçäo entre os dados obtidos por 2 examinadores para as provas da reobase, cronaxia e curva I-D aplicadas em 5 indivíduos, a fim de estudar as prováveis variaçöes que podem influenciar no critério de contraçäo mínima e suas possíveis causas. Apesar da ocorrência de variaçäo inter e intra-examinadores, existe uma margem de erro que deve ser levada em consideraçäo no exame eletrodiagnóstico clínico, uma vez que pequenas variaçöes podem näo refletir alteraçäo do estado patológico de um indivíduo, mas sim, uma faixa de erro possível no processo de investigaçäo

Scientific support for electrodiagnosis

The use of acupuncture, homoeopathy and electrodermal instruments is increasing among physicians. Federal and state regulatory agencies have recently stepped up their investigations into the use of electrodiagnostic devices. A review of the history of medicine, the advent of electrodiagnosis and how it relates to acupuncture and homoeopathy, past and present research, scientific support and future possibilities is presented. Scientific concepts of holism and nonlinear physics provide a new medical paradigm, quantum morphodynamics