NeuroRehabilitation

Throughout history, medical theories that have undergirded medical thinking and practice at any given time have been tied to the then current knowledge of human physiology. This knowledge has, in turn, always been predicated on the latest technology available to researchers. As modern investigational tools come on stream, it is possible to regress back in phylogenetic time to understand better the progression of an emerging medical model that will replace much of the current model and which will serve us in the near future.

Physical parameters that are used to characterize different types of electromagnetic devices used in neurotherapy can include power, frequency, carrier frequency, current, magnetic field intensity, and whether an application is primarily electric or primarily magnetic. Currents can range from tens of microamperes to hundreds of milliamperes, magnetic fields from tens of microtesla to more than one tesla, and frequencies from a few Hz to more than 50 GHz. A division into three device categories is proposed, based on the current applied and the specificity of the therapeutic signal. Two research areas have great potential for new neuroelectromagnetic strategies. Studies of endogenous neural oscillatory states suggest using external fields to reinforce or inhibit such states. Also, various independent groups have reported that weak magnetic fields, in particular ion cyclotron resonance fields, are capable of sharply altering behavior in rats.

Induction of local tissue regeneration in the human would best be accomplished if the patient's own cells at the desired site could be caused to dedifferentiate into the required embryonic stem cells. A system involving the electrical iontophoretic introduction of free silver ions into human wounds for their antibiotic effect has been in clinical use since 1975. In addition to a major antibiotic effect, the technique was found to produce the regeneration of all local tissues, apparently by stimulating dedifferentiation of mature human cells. More recently the use of a newly developed silvered nylon fabric has been found to have similar results without the need for electrical parameters. The results of a preliminary laboratory and clinical study of this material are presented.

Fibromyalgia is characterized by diffuse pain, the origin of which remains obscure. This study explored a phenomenon labeled Diffuse Muscle Coactivation (DMC) as a possible source of pain in fibromyalgia. DMC is defined as an increase from resting levels (tonus) in the electrical activity of any muscle during a movement which does not involve that muscle and is not part of the agonist-antagonist unit. When compared to controls this activity in persons with fibromyalgia was 1.75 times more prevalent and demonstrated significantly higher peak amplitudes. Possible neurological mechanisms are discussed.

This study examined the electrical characteristics (Root Mean Square – RMS and median frequency) of Diffuse Muscular Coactivation (DMC) associated with the tender points of fibromyalgia. DMC is defined as an increase from resting levels (tonus) in the electrical activity of any muscle during a movement which does not involve that muscle and is not part of the agonist – antagonist unit. The results show an increase in RMS in fibromyalgia sufferers as compared to controls. Coactivation was stronger proximal to the neck and decreased in intensity as the area recorded moved distally. Median frequency changed over time but not significantly between groups. Possible neurological mechanisms are discussed.

The capability of reflex points on the external ear to alter neuromuscular and neuropathic disorders has been attributed to the descending pain inhibitory pathways of the central nervous system. The inverted fetus perspective of the somatotopic arrangement of auricular acupuncture points was first described in the 1950's by Dr. Paul Nogier of France, and has received scientific support from double blind studies examining auricular diagnosis of musculoskeletal and of coronary disorders. Acupuncture points on the ear and on the body have lower levels of electrical skin resistance than surrounding tissue. These electrodermal differences are apparently related to autonomic control of blood vessels rather than increased sweat gland activity. The heightened tenderness of reactive acupuncture points may be explained by the accumulation of noxious, subdermal substances. Electrical stimulation of specific points on the external ear leads to site specific neural responses in different regions of the brain. Behavioral analgesia produced by auricular acupuncture can be blocked by the opiate antagonist naloxone, indicating the role of endorphinergic systems in understanding the underlying mechanisms of auriculotherapy. The anatomical structures and electrical application of the auricle are described as they relate to the localization of master points, musculoskeletal points, internal organ points, and neuroendocrine points.

Back pain and the whiplash syndrome are very common diseases involving tremendous costs and extensive medical effort. A quick and effective reduction of symptoms, especially pain, is required. In two prospective randomized studies, patients with either lumbar radiculopathy in the segments L5/S1 or the whiplash syndrome were investigated. Inclusion criteria were as follows: either clinically verified painful lumbar radiculopathy in the segments L5/S1 and a Laségue's sign of 30 degrees (or more), or typical signs of the whiplash syndrome such as painful restriction of rotation and flexion/extension. Exclusion criteria were prolapsed intervertebral discs, systemic neurological diseases, epilepsy, and pregnancy. A total of 100 patients with lumbar radiculopathy and 92 with the whiplash syndrome were selected and entered in the study following a 1:1 ratio. Both groups (magnetic field treatment and controls) received standard medication consisting of diclofenac and tizanidine, while the magnetic field was only applied in group 1, twice a day, for a period of two weeks. In patients suffering from radiculopathy, the average time until pain relief and painless walking was 8.2 ± 0.5 days in the magnetic field group, and 11.7 ± 0.5 days in controls p < 0.04). In patients with the whiplash syndrome, pain was measured on a ten-point scale. Pain in the head was on average 4.6 before and 2.1 after treatment in those receiving magnetic field treatment, and 4.2/3.5 in controls. Neck pain was on average 6.3/1.9 as opposed to 5.3/4.6, and pain in the shoulder/arm was 2.4/0.8 as opposed to 2.8/2.2 (p < 0.03 for all regions). Hence, magnetic fields appear to have a considerable and statistically significant potential for reducing pain in cases of lumbar radiculopathy and the whiplash syndrome.

Five clinical case studies (1 normal, 3 brain injured and 1 subject who had a left frontal hematoma) are presented which addressed the effectiveness of EEG biofeedback for auditory memory impairment. A normative QEEG activation database of 59 right-handed subjects was developed, which delineated the QEEG variables which were positively related to auditory memory performance (paragraphs). Persons who had experienced a brain injury underwent the same procedure employed in the development of the database. The person's values on the effective parameters of memory functioning were determined. EEG biofeedback interventions were determined by the individual's deviation from the normative reference group in terms of the relevant QEEG parameters of effective auditory memory (paragraph recall). Improvements ranged from 39% subjects who had a follow up assessment that occurred from one month to one year following termination of treatment.

The purpose of this study was to examine the Functional Ambulation Performance Score (FAP; a quantitative gait measure) in persons with Parkinson's Disease (PD) using the auditory stimulation of a metronome (ASM). Participants (n = 16; 5F/11M; range 60–84 yrs.) had a primary diagnosis of PD and were all independent ambulators. Footfall data were collected while participants walked multiple times on an electronic walkway under the following conditions: 1) PRETEST: establishing baseline cadence, 2) ASM: metronome set to baseline cadence, 3) 10ASM: metronome set to 10% FAP scores increased between PRETEST and POSTTEST. PRE/POSTTEST comparisons also indicated decreases in cycle time and double support and increases in step length and step-extremity ratio (step length/leg length). The results confirm prior findings that auditory stimulation can be used to positively influence the gait of persons with PD and suggest beneficial effects of ASM as an adjunct to dopaminergic therapy to treat gait dysfunctions in PD.