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Dr. Young - Bio feedback question

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


            • #7
              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[img]/forum/images/smilies/smile.gif[/img]

              "Failure is impossible"
              "Failure is impossible"


              • #8

                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.



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


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

                    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!



                    • #11
                      Thanks for the response Wise. Jan, indeed no muscle tone & calcification would be worrisome. Too much current can cause that? If so, heheh no comment [img]/forum/images/smilies/eek.gif[/img]. Very cool it helps out as far as pain relief. Simple&effective is good. Fes bike.. Haha, my insurance covers NADA & well, can't happen, yet[img]/forum/images/smilies/frown.gif[/img]. I'd love to though. Experimental ehh?? Interesting. How can you hook it up without a bifurcator? You'd have 4 leads total. 1 on each shin, 1 on your injury & the other,,, on your forehead? hehe. You need a closed circuit to have any conductivity. Like a wire etcetc. How do you do that? I'd love to try that method out as I'm always looking to come as close to electrocution as possible haha. Let me know.

                      "Failure is impossible"
                      "Failure is impossible"


                      • #12
                        Sorry, my response was probably not very clear.

                        No, I don't think too much current would cause no muscle tone & calcification - but at my injury level with no spasticity (not yours), I would be concerned about those things if I didn't use electrical simulation.

                        To place electrodes above and below the injury site, sending the current through the injury site is, I guess, considered experimental. There are some who believe this placement will allow nerves to remylinate (sp?) or maybe even regenerate, but it hasn't been proven. I have a hard time believing there is potential for regeneration using this pad placement, but I'm hoping it will keep my injury site "fresh" until a viable treatment comes along. This is not based on any scientific fact - just my own intuition.

                        You can try to place one lead on each shin (two total) without placing one above the injury site. This placement works well to work the leg muscles and pelvic floor.

                        And please, no electrocutions! Do this at your own risk.... admittedly, I am a self-proclaimed guinea pig.


                        • #13
                          WOW!! There is innervation!

                          I just got back from aquatic PT and my therapist was able to feel contractions in my quads! Once before, she thought she might have felt something, but we couldn't duplicate. Today during an exercise, she felt them several times.
                          She said there are four muscles in the quads and the ones that contracted are the latterous (something like that) and the TFC. She said the TFC is mostly ligament but I would probably have to move the muscle part in order for the ligament to move as much as it did.

                          I'm pumped!!

                          It's amazing to me that someone could have a flaccid injury and be severely atrophied for 15 years and then slowly build a small amount of tone over many more years....and then get something Back! STUFFS COMING BACK!

                          OK, I guess I need to try and isolate those muscles and stim, stim stim.... and work, work, work. Maybe I'll even try the AC current. Yowwwza!


                          • #14
                            Oops, I meant to say TFL, not TFC.

                            I was so excited, I had to ask her three times.
                            ....doesn't take much to knock my socks off.
                            I guess it's all relative.


                            • #15
                              Congrats!! That is awesome. Have you tried sticking 2wires in an ac outlet with a switch? On & off. Get a true 120v pulse hehehe. Seriously that'd knock my socks off too. I'm just waiting to make my finger twitch. I can feel tingling but no movement though sometimes random. Soon enough. Feels like I've been sleeping on my hand & sensation is ssllowwlyy coming back. YOU GO GIRL[img]/forum/images/smilies/smile.gif[/img].

                              "Failure is impossible"
                              "Failure is impossible"