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Biomedical subjects

E Knutsson

Publications and source records attributed to E Knutsson.

At least 37 records · Page 2Linked to original sources

Changes in voluntary muscle strength, somatosensory transmission and skin temperature concomitant with pain relief during autotraction in patients with lumbar and sacral root lesions.

Earlier clinical observations of rapid changes of certain neurological dysfunctions after autotraction treatment of patients with lumbar and sacral root affections have been evaluated by objective registration methods. Isokinetic recordings of maximal voluntary strength showed that in 6 out of 8 patients, weakness of the foot dorsal flexor muscles could be more or less completely restored after one session of autotraction resulting in pain relief. In a group of patients with clinical signs of impaired sensibility, the low or abolished SEP responses to nerve stimulation on the affected side were restituted in 4 out of 5 cases during autotraction. The asymmetric leg skin temperatures in 10 patients with sciatic pain levelled off in the 6 cases obtaining pain relief by the traction. The results suggest a causal relationship between pain relief and restitution of certain neurological deficits.

Adult↗

The effect of voluntary diaphragmatic activation on back lifting.

The effect of increased intraabdominal pressure upon the activation of the erector spinae muscles during back lifting was studied in 10 healthy volunteers. The intraabdominal pressure was increased by voluntary prelifting coactivation of the diaphragm and the abdominal muscles. EMG was recorded with surface electrodes over the diaphragm and the erector spinae, abdominal and intercostal muscles. The EMG signals were rectified and averaged from 20 lifts of 10 kg with and without pressurization to give mean level of activity during 2 s before lifting and during successive angular positions of the trunk during lifting. In 7 of the 10 subjects the pre-lifting coactivation of diaphragm and abdominal muscles reduced erector spinae activity at lift-off and/or during the trunc erecting movement. An increased intraabdominal pressure thus often has an unloading effect on the erector spinae muscle during back lifting.

Abdomen↗

Three-dimensional electrogoniometric gait recording.

Gait recordings of twenty healthy subjects were made on a treadmill and on level ground by means of a light-weight computerised electrogoniometer. The angular excursions in three planes were recorded simultaneously with regard to hip, knee and ankle joints in both legs. Determinations of the mean values and dispersions were then made. In order to establish the reliability of the method tests and retests were performed. Also its validity was checked by comparing the goniometric recordings with concomitant measurements obtained by other methods. The reliability and validity of the method was found to be satisfactory. Apart from flexion of the hip and knee joints during stance phase (i.e. a difference of 2 and 2.4 degrees respectively), no difference was ascertained between walking on a treadmill and walking on level ground.

Adult↗

Reduction of pain inhibition on voluntary muscle activation by epidural analgesia.

The influence of postoperative pain on muscle function, and the possible effect of local anesthetics on the normal muscle function are discussed. The integrated EMG (IEMG) during maximum voluntary contraction of the quadriceps muscle was registered in ten patients the day after undergoing reconstruction of the anterior cruciate ligament. Recordings were taken before, 5, 12, and 20 min to 25 min after epidural injection of 20 ml of 0.25% lidocaine with adrenaline (2.5 micrograms/ml). As pain gradually subsided, IEMG increased a mean of 2,728% 20 min to 25 min after injection (range 425% to 10,068%), compared to initial recordings before anesthesia. This indicates that pain relief plays a significant role in the ability to normally activate the quadriceps muscle after open knee surgery. Neither the Hoffman (H-)reflex, nor maximum voluntary isokinetic muscle torque was appreciably affected by epidural injection of dilute local anesthetics, as tested on two healthy volunteers. Infiltrations of local anesthetics into the distal part of the quadriceps muscle did not affect maximum voluntary isokinetic knee extension torque. From the experiments performed we conclude that it is possible to selectively block pain by injections of local anesthetics into the epidural space, without interfering with normal muscle function. It might thus be possible to prevent some of the postoperative muscle atrophy by using a continuous epidural analgesia for two to three days following surgery, and starting an early active physical therapy program.

Adolescent↗

Isokinetic measurements of muscle strength in hysterical paresis.

The torque during isokinetic knee extensions and flexions was determined in repeated tests at 3 speeds of angular rotation in 25 patients with pareses considered to be hysterical after relevant examinations and follow-up. The torque records were combined with surface EMG from the quadriceps and the hamstring muscles in some patients. Besides the weakness, 3 signs were observed that are not usually seen in patients with pareses due to verified peripheral or central lesions. These signs were: Enlarged variability of torque in repeated tests of the same movement (larger than 20% of maximum torque in 22 patients). Higher torque in fast movements than in slow movements (8 patients). Force production in knee flexion less than that expected from the weight of leg and lever arm due to restraining activation of the quadriceps muscle (12 patients). The restraint was present although there was no spasticity. The signs reflect inconsistent and contradictory motor performance that is not compatible with a genuine paresis. Thus, they aid the identification of weakness of functional origin.

Adult↗

Gait apraxia in normal-pressure hydrocephalus: patterns of movement and muscle activation.

We made gait recordings in 11 patients with normal-pressure hydrocephalus. Sagittal rotations in hip, knee, and ankle joints were determined with intermittent light photography or with polarized light goniometry. In eight patients, gait muscle activation was determined with integrated surface EMG from six leg muscles on one side. We assessed the patterns of movement and muscle activity by averaging data from 20 gait cycles. Reduced speed and range of movements, short steps, small foot-floor clearance, and low swing-to-stance ratio were typical. The activation of the calf muscles was regularly premature and low. In severe disorders, there was continuous activity in the antigravity muscles acting on hip and knee joints. Gait records verified improvement after CSF drainage or shunting.

Aged↗

Peripheral neuropathy in patients with benign monoclonal gammopathy--a pilot study.

It is well known that peripheral neuropathy occurs in patients with myeloma or macroglobulinaemia, but its pathogenesis is still obscure. In recent years, neuropathy has also been reported in association with benign monoclonal or oligoclonal gammopathy. Modern histo-immunological methods have revealed evidence of antibody production to peripheral nerve tissue, probably the myelin sheath. The present study included 21 unselected, consecutive patients with benign monoclonal gammopathy observed in the Division of Haematology. Clinical and laboratory investigations included electrophysiological examination and analyses of the M components. Of the 21 patients 11 had noticed slight neuropathic symptoms in their extremities; in 5 both clinical and electrophysiological findings were compatible with neuropathy; 6 showed positive clinical signs of neuropathy; 4 had either positive electromyographic or electroneurographic findings. In summary, 15 of 21 patients had some signs of peripheral neuropathy. In spite of the screening design of the study, this strikingly high frequency is comparable with other recent reports. Haematological studies did not reveal any significant differences between the patient groups with positive or negative neurological findings. The findings indicate that even benign gammopathies may be associated with peripheral neuropathy.

Adult↗

Antiparetic and antispastic effects induced by tizanidine in patients with spastic paresis.

The effects of tizanidine were studied in patients with spastic paresis. The study consisted of 4 parts: I, double-blind cross-over trial at maximal dosage 10 mg/day in 13 patients; II, open trial at maximal dosage 32 mg/day in 10 patients; III, long-term medication at dosage 32 mg/day for 6-15 months in 4 patients; IV, single dose (12 mg) administration in 3 patients. The effects were evaluated from clinical examinations, subjective assessments, EMG, gait analysis and quantitative determinations of passive resistance and voluntary strength in isokinetic extensions and flexions of the knee and plantar and dorsal flexions of the ankle at different speeds of motion. At 3-10 mg/day, no effects were observed except for increased prime mover EMG activity in voluntary knee flexions. At 12-32 mg/day, passive resistance decreased significantly in 3 of the movements tested. The maximal voluntary strength increased significantly in 3 movements, frequently associated with enlarged activation of prime mover muscles, less frequently with reduced antagonist co-activation. Functional disability was subjectively reduced and verified by improved gait capacity in 4 patients. Sustained effects on motor performance during long-term medication were verified by withdrawal in 3 patients. Single dose administration resulted in reduced passive resistance and increased voluntary strength, associated with an increased activation of the prime mover muscles. The results indicate that tizanidine exerts its effects in part by reducing spastic restraint, in part by enhancing the capacity to activate paretic muscles.

Adult↗

The traction reaction in infancy-clinical and electromyographic study of normal infants.

The traction reaction was studied in 23 normal infants on 45 occasions at ages ranging from 2 weeks to 12 months. The distribution of the developmental phases of the reaction to some extent differed from that expected from age according to the description of Vojta (1976). EMG recordings from 15 trunk and leg muscles were obtained on 37 occasions from 20 of the infants. Six types of EMG activation pattern during traction were observed in different overlapping age periods from 1 month to 12 months. From these patterns, four well separated stages of motor development were distinguished. They were as follows: 1) No EMG activity related to traction. 2) Trunk flexor activation with weak or irregular activation in leg muscles. 3) Reciprocal activation in trunk flexor and extensor muscles combined with strong co-activation of the leg muscles, and 4) Trunk muscles activated as in stage 3, but the coactivation in leg muscles abolished and gradually followed by functionally adequate activation in some of the leg muscles.

Electromyography↗

Benign monoclonal gammopathy and peripheral neuropathy.

Peripheral neuropathy has been described in malignant plasma cell dyscrasias such as multiple myeloma and Waldenstöm's macroglobulinaemia. Since it is not known whether the neuropathy is related to the plasma cell disorder or is a paramalignant phenomenon, 21 consecutive out-patients with benign monoclonal gammopathy (BMG) were analysed for peripheral neuropathies. Eleven patients had noticed slight motor and/or sensory extremity symptoms. Clinical examination, electromyographic and electroneurographic studies of the upper and lower extremities were performed. In five patients all results indicated a neuropathy, six other patients had clinical signs of neuropathy and four additional patients had positive electromyographic and/or electroneurographic results compatible with neuropathy. There were no significant differences in haematological parameters between the group where all results indicated a neuropathy and the totally negative group or between the two groups with and without clinical neuropathy. Thus, the benign form of plasma cell dyscrasias seems also to be associated with mild clinical or subclinical peripheral neuropathy.

Adult↗