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Thread: Motor neuron replacement therapies

  1. #1

    Question Motor neuron replacement therapies

    Is there a simple way to determine whether a patient will need motor neuron replacement therapy?

  2. #2
    The simplest ways I know whether an individual has motor neuron loss would be a lack of spasticity and the inability of muscles to respond to Functional Electrical Stimulation (FES).

  3. #3
    Quote Originally Posted by Chaz19 View Post
    Is there a simple way to determine whether a patient will need motor neuron replacement therapy?
    The consequence of motoneuronal loss is flaccid paralysis. Flaccid paralysis means paralysis with loss of muscle tone. Spastic paralysis refers to loss of motor control with an increase of muscle tone and reflexes.

    Please note that while motoneuronal loss causes flaccid paralysis, the converse is not necessarily true. Flaccid paralysis does not necessarily mean loss of motoneurons. It may also occur as a result of damage to the spinal roots.

    Usually flaccid paralysis occurs with injuries to the lumbosacral spinal cord, which is located from T11 to L1. Damage to the cauda equina which consists of spinal roots from L1 to S5, also can cause flaccid paralysis.

    It is possible to tell the neuronal damage by doing testing for F-response in the arms and testing for the H-reflex from the legs. The F-response is response that comes from stimulating a peripheral nerve in the arm to activate motoneurons in the cervical segments antidromically (activating the motor nerve backwards) and the motoneurons then fire reflexly orthodromically to cause an F-wave.

    The H-reflex is a test of the monosynaptic reflex where stimulation of the peripheral nerve will activate the sensory nerves to excite the motoneuron to respond. If you have loss of H-reflex in the segment that innervate the stimulated nerve, this would mean damage to your neuronal circuit or the peripheral nerve or spinal roots that supply that reflex circuit.

    Damage to the motoneurons also cause more severe muscle atrophy than spastic paralysis. When doing EMG of the muscles (during the first months after spinal cord injury), the muscles will show hyperexcitable responses that are consistent with denervation. However, in chronic spinal cord injury where the muscles have already undergone atrophy, these responses are no longer present.

    Wise.
    Last edited by Wise Young; 07-03-2011 at 02:46 PM.

  4. #4
    Senior Member 0xSquidy's Avatar
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    Quote Originally Posted by Wise Young View Post
    Usually flaccid paralysis occurs with injuries to the lumbosacral spinal cord, which is located from T11 to L1.
    But, according to my medical report, my injury is T11 (left side) L1 (right side, but i don't have any hip muscles, just sensation) complete. My legs are skinny but not extremely (as i've seen in lower injuries than mine) and I do have spasms sometimes (depending in what i'm doing but in almost all muscles in my legs at different times)... Can this tell me anything about my motoneurons?
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  5. #5
    I thought I read at some point that cervical injuries may need motor neuron replacement therapy. Are there some quads that have lost spasticity in their arms/hands?

  6. #6
    Senior Member lynnifer's Avatar
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    Quote Originally Posted by Wise Young View Post
    However, in chronic spinal cord injury where the muscles have already undergone atrophy, these responses are no longer present.
    So when I'm hooked up to an EKG and two of the electrodes are attached to my legs, they're almost flat-lined ... and that's normal. 'My' normal.

    With all of the technology available, one would wonder why we can't see this via some nuclear medicine test yet?
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    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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