Update on the diagnostic clinical neurophysiology for rheumatology

The current concepts on the clinical neurophysiology examinations for the differential diagnosis of rheumatic diseases are presented. The review aims to provide experience and practical guidelines, especially regarding electromyography. More needle than surface electromyography examinations at muscle rest or during its maximal contraction may reveal the characteristic effects of the myogenic injury caused by particular rheumatic diseases. The diagnosis of myopathic disorders, often found in rheumatic diseases is difficult because of the frequent vasculitis coexistence in the patients evoking subsequent changes in nerve fibres leading to degenerative neurogenic changes that may overlap the diagnostic picture of the primary myogenic changes caused by rheumatic diseases. In these cases, the neurophysiological studies of efferent and afferent neural transmission often reveal peripheral neuropathies just at the subclinical level

Neurophysiological Evaluation of the Functional State of Muscular and Nervous Systems in High-Maneuvering Jet Fighters

The present study aimed to assess the function of muscular and nervous systems in high-maneuvering jet fighters with the chosen method of clinical neurophysiology, which methodologically has not yet been presented in detail. Fifteen pilots with the experience of more than 1700 flying hours at 7G overloading on average and fifteen healthy subjects for the comparison of health status declared to participate in this study. The dermatomal perception from C4 to S1 was examined using von Frey’s filaments tactile method. Surface electromyography (sEMG) recordings examined the activity of proximal and distal muscles in the upper and lower extremities, the transmission of motor nerve impulses peripherally was diagnosed by electroneurography (ENG), the efferent transmission from C5–C7 and L4–L5 spinal centers to muscles was entirely verified with recordings of motor-evoked potentials induced oververtebrally with the magnetic field (MEP). The pilots estimated more lumbosacral than cervical pain at about 2 on the 10-point visual analog scale (VAS). Sensory perception studies did not reveal abnormal symptoms in the C2–S1 dermatomes innervation. Clinical neurophysiology studies indicated, in general, the lack of pathology during sEMG tests in comparison to healthy subjects or even better muscle motor unit contractile properties in pilots, both in the upper and lower extremities. In pilots, the parameters of ENG and MEP examinations show a statistically significant sensitivity for detecting the slight changes and their consequences in the transmission of neural impulses within L4–L5 ventral root fibers. The research results enable specifying the algorithm of future preventing rehabilitative treatment in high-maneuvering jet fighters with an average flight experience of 2000 h and working conditions at 7G on average. This study, for the first time, describes the application of a set of diagnostic neurophysiological methods with the particular importance of MEPs in the clinical evaluation of the jet fighters’ health status

Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention

Perspectives of Motor Functional Upper Extremity Recovery with the Use of Immersive Virtual Reality in Stroke Patients

Stroke is one of the leading causes of disability, including loss of hand manipulative skills. It constitutes a major limitation in independence and the ability to perform everyday tasks. Among the numerous accessible physiotherapeutic methods, it is becoming more common to apply Virtual Reality "VR”. The aim of this study was to establish whether immersive VR was worth considering as a form of physical therapy and the advisability of applying it in restoring post-stroke hand function impairment. A proprietary application Virtual Mirror Hand 1.0 was used in the research and its effectiveness in therapy was compared to classical mirror therapy. A total of 20 survivors after ischaemic stroke with comparable functional status were divided into a study group (n = 10) and control group (n = 10). Diagnostic tools included 36-Item Short Form Survey “SF-36” and the Fugl-Meyer Assessment Upper Extremity “FMA-UE”. Collected metrics showed a normal distribution and the differences in mean values were tested by the student’s t-test. In both, the study and control groups’ changes were recorded. A statistically significant outcome for FMA-UE and SF-36 measured by the student’s t-test for dependent or independent samples (p > 0.05) were obtained in both groups. Importantly, proven by conducted studies, an advantage of VR proprietary application was subjective sensations amelioration in pain and sensory impressions. Applying Virtual Mirror Hand 1.0 treatment to patients after a stroke appears to be a good solution and definitely provides the opportunity to consider VR applications as an integral part of the neurorehabilitation process. These results give a basis to plan further larger-scale observation attempts. Moreover, the development of the Virtual Mirror Hand 1.0 as an innovative application in physiotherapy may become equivalent to classical mirror therapy in improving the quality and effectiveness of the treatment used for post-stroke patients

Efektywność masażu klasycznego u chorych z zesztywniającym zapaleniem stawów kręgosłupa

W pracy przedstawiono przypadek 64-letniego pacjenta aktywnego zawodowo z rozpoznanym w 1979 roku zesztywniającym zapaleniem stawów kręgosłupa, aktualnie poddanego leczeniu biologicznemu. Celem badania była ocena efektywnośćmasażu klasycznego u chorego z zesztywniającym zapaleniem stawów. U pacjenta zastosowano fizjoterapię w postaci serii 6 masaży wykonywanych w czasie 3 tygodni z 3-dniową przerwą pomiędzy zabiegami.Do oceny postępów terapii wykorzystano wizualną skalę analogową (VAS), kwestionariusz wskaźników bólu według Laitinena, pomiar ruchomości kręgosłupa goniometrem, skale BASDAI i BASFI.Przeprowadzona terapia doprowadziła do poprawy ruchomości poszczególnych odcinków kręgosłupa. Po terapii badany lepiej radził sobie z codziennymi czynnościami zgodnie z wynikami skal BASDAI i BASFI

The Use of the ICF Classification Sheet to Assess Cognitive-Behavioral Disorders and Verbal Communication in Patients after Ischemic and Hemorrhagic Stroke during Rehabilitation

Background: In patients after experiencing stroke, the cognitive-behavioral deficits and disorders of verbal communication limit the effectiveness of rehabilitation. The key is to diagnose them at an early stage of rehabilitation and to implement appropriate psychological and speech therapy. Objective: Identify differences in the frequency and effectiveness of cognitive-behavioral disorder therapy depending on the clinical type of stroke, assessed before and after rehabilitation treatment, and their presentation using the ICF (International Classification of Functioning, Disability, and Health) classification. Materials and Methods: The study was prospective and included the analysis of cognitive-behavioral and verbal communication disorders. The study consisted of 47 patients after intracerebral hemorrhage (ICH) and 47 patients after an ischemic stroke (IS) before the implementation of rehabilitation and after completing a 4-week rehabilitation. Results: In the group after ICH, psychological therapy significantly reduced the disturbances of consciousness and orientation (p < 0.001) and improved the speed of performing tasks in tests (p < 0.001). In patients after IS and ICH, memory and attention function improved significantly (p < 0.001). Moreover, in patients after ICH, language function deficits decreased significantly (p = 0.018). Mood disturbances were maintained in 17% of patients after ICH and 40% of patients after IS (p = 0.007). Speech therapy reduced speech articulation disorders and aphasia in 85% of patients after ICH (p = 0.001) and in 68% of patients after IS (p = 0.033). Conclusions: The frequency and type of cognitive-behavioral and verbal communication disorders vary depending on the history of ICH or IS. The ICF classification may be useful in assessing and analyzing cognitive-behavioral and verbal communication disorders, which may lead to the implementation of appropriate psychological and speech therapy at an early stage of rehabilitation and increase the effectiveness of the therapy

Electroneurographic Evaluation of Neural Impulse Transmission in Patients after Ischemic Stroke Following Functional Electrical Stimulation of Antagonistic Muscles at Wrist and Ankle in Two-Month Follow-Up

The available data from electroneurography (ENG) studies on the transmission of neural impulses in the motor fibers of upper and lower extremity nerves following neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy in post-stroke patients during sixty-day observation do not provide convincing results. This study aims to compare the effectiveness of an NMFES of antagonistic muscle groups at the wrist and ankle and kinesiotherapy based mainly on proprioceptive neuromuscular facilitation (PNF). An ENG was performed once in a group of 60 healthy volunteers and three times in 120 patients after stroke (T0, up to 7 days after the incident; T1, after 21 days of treatment; and T2, after 60 days of treatment); 60 subjects received personalized NMFES and PNF treatment (NMFES+K), while the other 60 received only PNF (K). An ENG studied peripheral (M-wave recordings), C8 and L5 ventral root (F-wave recordings) neural impulse transmission in the peroneal and the ulnar nerves on the hemiparetic side. Both groups statistically differed in their amplitudes of M-wave recording parameters after peroneal nerve stimulation performed at T0 and T2 compared with the control group. After 60 days of treatment, only the patients from the NMFES+K group showed significant improvement in M-wave recordings. The application of the proposed NMFES electrostimulation algorithm combined with PNF improved the peripheral neural transmission in peroneal but not ulnar motor nerve fibers in patients after ischemic stroke. Combined kinesiotherapy and safe, personalized, controlled electrotherapy after stroke give better results than kinesiotherapy alone

Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

The aim of this study was to determine the sustained influence of personalized neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy (mainly, proprioceptive neuromuscular facilitation (PNF)) on the activity of muscle motor units acting antagonistically at the wrist and the ankle in a large population of post-stroke patients. Clinical evaluations of spasticity (Ashworth scale), manual muscle testing (Lovett scale), and surface electromyography recordings at rest (rEMG) and during attempts of maximal muscle contraction (mcEMG) were performed three times in 120 post-stroke patients (T0: up to 7 days after the incidence; T1: after 21 days of treatment; T2: after 60 days of treatment). Patients (N = 120) were divided into two subgroups—60 patients received personalized NMFES and PNF treatment (NMFES+K), and the other 60 received only PNF (K). The NMFES+K therapy resulted in a decrease in spasticity and an increase in muscle strength of mainly flexor muscles, in comparison with the K group. A positive correlation between the increase of rEMG amplitudes and high Ashworth scale scores and a positive correlation between low amplitudes of mcEMG and low Lovett scale scores were found in the wrist flexors and calf muscles on the paretic side. Negative correlations were found between the rEMG and mcEMG amplitudes in the recordings. The five-grade alternate activity score of the antagonists’ actions improved in the NMFES+K group. These improvements in the results of controlled NMFES treatment combined with PNF in patients having experienced an ischemic stroke, in comparison to the use of kinesiotherapy alone, might justify the application of conjoined rehabilitation procedures based on neurophysiological approaches. Considering the results of clinical and neurophysiological studies, we suppose that NMFES of the antagonistic muscle groups acting at the wrist and the ankle may evoke its positive effects in post-stroke patients by the modulation of the activity more in the spinal motor centers, including the level of Ia inhibitory neurons, than only at the muscular level

Aktualizacja diagnostyki neurofizjologii klinicznej dla potrzeb reumatologii

Omówiono aktualne koncepcje dotyczące badań neurofizjologii klinicznej w diagnostyce różnicowej chorób reumatycznych. Celem przeglądu jest przedstawienie własnych doświadczeń i praktycznych wskazówek, zwłaszcza w odniesieniu do elektromiografii. Elektromiografia igłowa wykonana w spoczynku mięśnia lub podczas jego maksymalnego skurczu może ujawnić charakterystyczne objawy uszkodzenia miogennego, wywołanego przez poszczególne choroby reumatyczne, w większym stopniu niż elektromiografia powierzchniowa. Rozpoznanie zaburzeń pochodzenia miopatycznego, często występujących w chorobach reumatycznych, jest trudne ze względu na współwystępowanie u pacjentów zapalenia naczyń wywołującego wtórne zmiany we włóknach nerwowych prowadzące do zwyrodnieniowych zmian neurogennych, co może się nakładać na obraz diagnostyczny pierwotnych zmian o charakterze miogennym wywołanych przez choroby reumatyczne. W tych przypadkach, badania neurofizjologiczne eferentnego i aferentnego przewodnictwa nerwowego często ujawniają neuropatie obwodowe już na poziomie subklinicznym

Fizjoterapia w radikulopatii szyjnej

W pracy przedstawiono przypadek 46-letniej kobiety ze zdiagnozowaną radikulopatią szyjną C4–C6 skierowanej na 4-tygodniowy turnus rehabilitacyjny. Celem badania była ocena skuteczności fizjoterapii u pacjenta ze zdiagnozowaną radikulopatia szyjną. U pacjentki zastosowano fizjoterapię w postaci: mobilizacji drobnych stawów odcinka C, ćwiczeń izometrycznych mięśni szyi, TENS, masażu podwodnego oraz ultradźwięków.Do oceny postępów terapii wykorzystano: skale VAS, pomiar ruchomości odcinka szyjnego taśmą centymetrową i pomiar zakres ruchu stawu ramiennego goniometrem, test dwupunktowy, badanie zaburzenia czucia temperatury ciepłą i zimną wodą, dynamometr, ISOMETER, kwestionariusz NDI.Przeprowadzona terapia wpłynęła pozytywnie na: poziom bólu, zakres zgięcia i wyrostu szyi, siłę ścisku ręki oraz mięśni szyi i grup mięśniowych unerwionych przez segment C5 i C6. W rezultacie poprawiła się jakość życia codziennego pacjenta. Forum Reumatol. 2019, tom 5, nr 4: 203–20