This paper is an introduction to a workshop on electrodes location and specific exercises. Selectivity of EMG electrodes depends on their interspacing, their conductive area and axis direction with respect to the direction of the underlying muscular fibres. Minimal cross talk area (MCA) helps to limit or avoid crosstalk from neighbouring muscles. We present examples of MCA and typical sEMG patterns during specific exercises.
Repetitive Transcranial Magnetic Stimulation (rTMS) ameliorates motor and neuropsychological deficits following stroke, but little is known about the underlying neuroplasticity. We investigated neuroplastic changes following 5 days of low-frequency rTMS on the intact motor cortex to promote motor recovery in a chronic patient with subcortical stroke. The feasibility of administering multiple treatments was also assessed 6 months later by applying the same protocol over the patient's parietal cortex to improve visuospatial disorders. Behavioral improvements and no adverse events were observed. Neuroimaging findings indicated that motor symptoms amelioration was associated with downregulation and cortical reorganization of hyperactive contralesional hemisphere.
Study of muscles started probably when someone tried to understand how he can move from A to B and executes movements at will. Knowledge was always dependent on the technology available to conduct investigation. Religious belief had a negative impact on muscle study when interfering with dissection of human corpse. During the Italian Renaissance (end of XIV th to beginning of XVI th century), study of muscles was first descriptive, based on dissection. Artists like Leonardo da Vinci (1452-1519) and Michael Angelo (1475-1564) exaggerated the bulk of muscles. Their first concern was the influence of the volume of the superficial muscle on the surface modelling represented in their paintings and sculptures. Leonardo da Vinci multiplied the number of bundles of some muscles. Most of his representations of tendon insertions are imprecise. Leonardo da Vinci applied mechanical principles to rib, elbow kinematics and kinetics of the foot. Vesalius (1514-1574) was a medical doctor and an anatomist. His anatomical plates are remarkable because they respect most of the relationships between muscles. Then Galileo (1564-1642), Borelli (1608-1679) and Newton (1642-1727) thought that physics and mechanical laws governed motility of animal and human body alike. Incidental discovery of electro stimulation effect on muscle in Galvani's laboratory and electric current concomitant of muscles contraction by Matteucci and Du Bois Reymond were major breakthroughs. Recording of this current was the starting point for ECG, EMG and EEG. ECG entered first in the clinic. EMG and EEG waited for cathode ray oscilloscope.The Voltaic Pile and faradic current opened the door of electrical stimulation to Duchenne de Boulogne (1806-1875).Matteucci's (1811-1868) publications inspired and stimulated Du Bois Reymond. Du Bois Reymond (1818-1889) repeated and completed his experiments on frogs. He designed a very sensitive galvanometer with which he recorded his own global EMG. EMG remained a curiosity of laboratory until Erlander (1874Erlander ( -1965 and his pupil Gasser (1888Gasser ( -1963 improved the cathode ray oscilloscope for electrophysiological recordings. A combination of orthopaedic surgeons, engineers and physiologists in Berkeley (1945) systematically recorded EMG during gait of normal man. EMG biofeedback and phonomyography have also raised interest by clinicians. Their EMG signals processing in the time domain (full wave rectification miscalled integrated EMG) was later completed in the early '80s by computation of the root mean square on personal computers. Despite all factors minimizing the reliability of analysis based on amplitude of the EMG signals, these methods still represent the clinician's routine tool today. Since 1999, researchers have proven the benefits of muscular intensity analysis, time frequency analysis, mapping of spatio temporal activity. We deplore that the corresponding software is not available for clinicians. Multivariate methods of statistics allow the comparison of EMG patterns under pathological c...
The aim of our work is to propose a systematic approach in the management of the upper limb rehabilitation in tetraplegic patients, focused on the preoperative rehabilitation aspects that must be tailored to the specific therapeutic path, in order to assure the best conditions both before the intervention or the conservative management, and optimize the results.Methods: Evaluation criteria, surgical and rehabilitation timing with reference to the recent literature are reported. Timing and objectives of upper limb rehabilitation in tetraplegic patients are discussed, focusing on obstacles in the management of patients that can be overcome with a multidisciplinary approach.Results and Discussion: The upper limb diagnostic-therapeutic path of tetraplegic patients is developed point by point, starting from the evaluation, the indications, therapeutic options, surgical timing and focusing on the role of pre-operative rehabilitation. At present, there is consensus regarding the need for physiotherapy aimed to maintain flexible joints if surgery is planned or learning compensatory mechanisms for candidates to a conservative management. The application timing of rehabilitation protocols in relation to the different surgical strategies is of great importance, as the choice to perform the classic tendon transfers or the most innovative nerve transfers influences the entire therapeutic path. Conclusion:The management of the tetraplegic patient requires a coordinated and multidisciplinary approach, which can be intended to implement residual functions, or prepare for surgery. Preoperative physiotherapy must take into account both the best personalized protocol and the timing dictated by the type of surgical choice.
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