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Thread: Dr. Young - Bio feedback question

  1. #1

    Dr. Young - Bio feedback question

    Dr. Young, it is possible that some nerves can be intact even if nothing registers on a needle emg.

    Recently, I had a needle emg. My hip flexors registered pretty strong. Up until a few months ago, I didn't have any use of hip flexors that I know of (possibly very trace.) They've gotten much stronger in the last month or two (probably due to Kao surgery/ decompression / untethering... and/or exercise.)

    Since I've been spending so much time working my lower body, I also feel a lot more sensation in my quads... they seem to burn after I do my exercises... like the muscles have been worked.

    But the emg showed nothing at all in my quads - it was baseline. And I have a flaccid injury.

    Is it possible that something is going on in my quads but just not registering? I know the mind can play tricks on us, but after 23 years, this is by far the most feeling I've ever had in my quads.

    Thanks, Jan

  2. #2
    Jan, EMG sometimes can show muscle activity that cannot be seen or felt. Have you tried stimulation of the quadriceps? Also, do you have spasticity in the quadriceps? That is often the best way to tell whether you have innervation of the quadriceps. By the way, because the quadriceps is such a big muscle, it is possible that EMG electrodes may miss some activity so that an EMG alone may not be definitive. Wise.

  3. #3
    Thank you, Dr. young, for your response.

    My injury is T12/L1 and flaccid. I have no spasticity at all and I am not able to get a noticeable contraction with a regular AC electrical stim unit. But I can get a decent contraction with a high-powered DC unit (and have built up a small amount of muscle tone.)

    I assume the DC unit bypasses the nerve and effects the muscle directly. More than likely, there is no innervation but I will continue to plug away and probably retest the EMG at a later date.

    Thanks, Jan

  4. #4
    Jan, I wouldn't be so quick to assume that there is no innervation of the quadriceps. Electrical stimulation through the skin usually cannot contract the quadriceps all that much. You may very well have some innervation of the quadriceps and the electrical stimulation may be activating both the muscle and the nerve. One of the ways of determining whether this is true is to stimulate the nerve going to the muscle. This can be done with needle electrodes but not something that I would recommend that you do on your own. Wise.

  5. #5
    Dr. Young,

    I just realized you're right. I have been stimulating the peroneal nerve by placing one electrode on the outside of each shin. The current runs up my legs and meets at the pelvic floor. With this pad placement, my feet move a couple of inches and my legs bend slightly at the knee and there is an strong visible contraction of the adductors - all from that one pad placement.

    So, I guess this means all those muscles have some innervation. WOOHOO!!
    Does that sound right?... Or could it just be the current stimulating the muscle, running through the soft tissue to the muscle?

    Thanks, Jan

  6. #6
    I think your conclusion that you have innervation of those muscles is correct. Wise.

  7. #7
    Senior Member defiler's Avatar
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    I wish I could see a "real" doctor. I too experience that with similar pad placement. The two pads right outside my shins using a bifricator. The 3rd pad right above my spinal injury. I get all kinds of movement. Hands, fingers, legs, toes. I'm uneducated on this subject. Although it doesn't relate to this thread, I can also control spasms. What does all of this indicate Wise? In case you forgot, I'm a c-3 vent dependant. Jan, I don't know about you but I think it's neat to see your limbs doing 'things'. Enough to make me intrigued

    "Failure is impossible"

  8. #8
    defiler,

    You should be able to get strong activation of muscles, as well as reflexes, by stimulating nerve and muscle below the injury site. It means that your spinal cord is still intact, as it should be, below the injury site.

    Regarding your ability to suppress spasms, a majority of the descending fibers in the spinal cord are inhibitory. You may have some those inhibitory axons remaining even though you may not be able to activate any voluntary movement. Ability to inhibit spasms would be one sign of such connections still present.

    Wise.

  9. #9
    Jan, I was going to ask you how long ago you had the kao operation. Wise.

  10. #10
    Wise,
    my Kao operation was 14 months ago. I did have some compression, stenosis of the cord at L1.

    Defiler,
    I agree, seeing some activity in your limbs is intriguing. Sometimes I worry about sending high-powered DC current through my muscles and nerves; but the thought of having NO muscle tone and possible calcification of muscle is more worrisome... so, I'm very careful. When I first started using this machine 7 years ago, I could barely see a twitch in my leg muscle. Also, stimming my butt relieves pain. Since yours is an upper motor-neuron injury, you can stimulate the nerve/muscle much easier than me and could probably even use an FES bike, with assistance.

    I also use the pad placement you mentioned with the bifurcated lead (for about two years now.) It is suppose to stimulate the injury site and is, I believe, still considered experimental. If you place one lead on each shin without using the bifurcated lead, you'll get an even stronger contraction. Good luck!

    Jan

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