clinical
TRANSCRIPT
![Page 1: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/1.jpg)
Reflex & ConductionReflex & Conduction
Liu, An-Bang M.D., M.M.Sci.Liu, An-Bang M.D., M.M.Sci.Department of Neurology, Tzu Chi Medical Center, Hualien, TaiwanDepartment of Neurology, Tzu Chi Medical Center, Hualien, Taiwan
Division of Neuromuscular Research and Neurogenetics,Division of Neuromuscular Research and Neurogenetics,Tzu Chi Neuro-Medical Scientific Center, Hualien, TaiwanTzu Chi Neuro-Medical Scientific Center, Hualien, Taiwan
The Clinical Application of NeuroscienceThe Clinical Application of Neuroscience
![Page 2: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/2.jpg)
The Problem of Neurology Is
Montreal NeurologicalInstitute & Hospital
to Understand Human Himself
Wilder Penfield
![Page 3: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/3.jpg)
Principles of Electrophysiologic StudyPrinciples of Electrophysiologic Study
![Page 4: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/4.jpg)
Instruments & Instruments & IntroductionIntroduction
ElectrodeElectrodeAnodeAnodeCathodeCathodeAmplitudeAmplitudeFrequencyFrequencyCalibrationCalibrationFilterFilter
![Page 5: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/5.jpg)
General DevicesGeneral Devices
![Page 6: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/6.jpg)
ElectrodesElectrodes
![Page 7: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/7.jpg)
StimulatorStimulator
![Page 8: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/8.jpg)
Nerve Conduction StudyNerve Conduction Study
![Page 9: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/9.jpg)
Compound Motor Action PotentialCompound Motor Action Potential
latency
duration
amplitude
amplitude
![Page 10: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/10.jpg)
Nerve Conduction StudyNerve Conduction Study
![Page 11: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/11.jpg)
Nerve Action PotentialsNerve Action Potentials
![Page 12: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/12.jpg)
Sensory Action PotentialsSensory Action Potentials
![Page 13: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/13.jpg)
Structures of Peripheral NerveStructures of Peripheral Nerve
![Page 14: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/14.jpg)
Nerve ConductionNerve Conduction
![Page 15: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/15.jpg)
Temporal DispersionTemporal Dispersion
![Page 16: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/16.jpg)
F-WavesF-Waves
![Page 17: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/17.jpg)
Tested NervesTested Nerves
Median nerveMedian nerve CMAPs and SAPsCMAPs and SAPs
Ulnar nerveUlnar nerve CMAPs and SAPsCMAPs and SAPs
Tibial nerveTibial nerve CMAPs, H-reflexCMAPs, H-reflex
Peroneal nervePeroneal nerve CMAPsCMAPs
Sural nerveSural nerve SAPsSAPs
![Page 18: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/18.jpg)
Median NerveMedian Nerve
![Page 19: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/19.jpg)
Median NerveMedian Nerve
![Page 20: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/20.jpg)
Nerve Conduction VelocityNerve Conduction Velocity
NCV=NCV=distance/distance/latencylatency
45-55 m/Sec45-55 m/Sec
![Page 21: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/21.jpg)
Ulnar NerveUlnar Nerve
![Page 22: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/22.jpg)
Ulnar NerveUlnar Nerve
![Page 23: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/23.jpg)
Radial NerveRadial Nerve
![Page 24: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/24.jpg)
Radial Nerve (SAP)Radial Nerve (SAP)
![Page 25: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/25.jpg)
Peroneal NervePeroneal Nerve
![Page 26: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/26.jpg)
Peroneal NervePeroneal Nerve
![Page 27: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/27.jpg)
Tibial NerveTibial Nerve
![Page 28: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/28.jpg)
Tibial NerveTibial Nerve
![Page 29: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/29.jpg)
Sural Nerve (SAP)Sural Nerve (SAP)
![Page 30: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/30.jpg)
H-reflexH-reflex
![Page 31: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/31.jpg)
H-ReflexH-Reflex
The H-reflex can normally be seen in many muscles but is easily obtained in the soleus muscle (with posterior tibial nerve stimulation at the popliteal fossa), the flexor carpi radialis muscle (with median nerve stimulation at the elbow), and the quadriceps (with femoral nerve stimulation).
![Page 32: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/32.jpg)
H-ReflexH-Reflex
The H-reflex can normally be seen in many muscles but is easily obtained in the soleus muscle (with posterior tibial nerve stimulation at the popliteal fossa), the flexor carpi radialis muscle (with median nerve stimulation at the elbow), and the quadriceps (with femoral nerve stimulation).
![Page 33: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/33.jpg)
ApplicationsApplications
To confirm the diagnosis of neuropathyTo confirm the diagnosis of neuropathyTo evaluate the possible pathological To evaluate the possible pathological
changes of neuropathychanges of neuropathyTo detect and evaluate the site of To detect and evaluate the site of
conduction block of entrapment neuropathyconduction block of entrapment neuropathyTo insure the diagnosis of multi-focal To insure the diagnosis of multi-focal
conduction block motor neuropathyconduction block motor neuropathy
![Page 34: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/34.jpg)
ContraindicationsContraindications
![Page 35: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/35.jpg)
Facial NerveFacial Nerve
Recording sites: Place the active recording over the orbicularis oris at the corner of the mouth, over the orbicularis oculi on the outer canthus of the eye, over the frontalis in the forehead, or over the nasalis muscle on the nasolabial fold. Place the reference electrode on the nose. Either a needle or surface electrode may be used for recording.
![Page 36: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/36.jpg)
Blink ReflexBlink Reflex
![Page 37: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/37.jpg)
Blink ReflexBlink Reflex
![Page 38: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/38.jpg)
Blink ReflexBlink Reflex
![Page 39: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/39.jpg)
ApplicationsApplications
To evaluate brainstem dysfunctionTo evaluate brainstem dysfunction
![Page 40: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/40.jpg)
ElectromyographyElectromyography
![Page 41: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/41.jpg)
EMG-NeedlesEMG-Needles
![Page 42: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/42.jpg)
Spontaneous DischargesSpontaneous Discharges
![Page 43: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/43.jpg)
Normal Motor Unit PotentialsNormal Motor Unit Potentials
![Page 44: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/44.jpg)
Motor Unit PotentialsMotor Unit Potentials
![Page 45: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/45.jpg)
RecruitmentRecruitment
![Page 46: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/46.jpg)
Acute Denervational ChangesAcute Denervational Changes
fibrillationpositive sharp waves
![Page 47: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/47.jpg)
Positive Sharp WavesPositive Sharp Waves
![Page 48: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/48.jpg)
Polyphasic WavesPolyphasic Waves
![Page 49: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/49.jpg)
Giant WavesGiant Waves
![Page 50: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/50.jpg)
Myopathic DischargesMyopathic Discharges
Short-duration small-amplitude polyphasic waves
![Page 51: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/51.jpg)
Polyphasic WavesPolyphasic Waves
![Page 52: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/52.jpg)
Positive Sharp Waves
![Page 53: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/53.jpg)
Positive Sharp Waves
![Page 54: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/54.jpg)
MyotomesMyotomes
![Page 55: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/55.jpg)
Anterior TibialisAnterior Tibialis
![Page 56: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/56.jpg)
GastrocnemiusGastrocnemius
![Page 57: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/57.jpg)
Abductor Pollicis BrevisAbductor Pollicis Brevis
![Page 58: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/58.jpg)
First Dorsal InterosseusFirst Dorsal Interosseus
![Page 59: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/59.jpg)
Paraspinalis (lower lumbar)Paraspinalis (lower lumbar)
![Page 60: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/60.jpg)
ApplicationsApplications
To localize and stage the lesion of neuropatTo localize and stage the lesion of neuropathy or radiculopathyhy or radiculopathy
To differentiate neuropathy from myopathyTo differentiate neuropathy from myopathyTo identify neuromuscular junction disordeTo identify neuromuscular junction disorde
rsrsTo confirm the diagnosis of motor neuron diTo confirm the diagnosis of motor neuron di
seasesease
![Page 61: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/61.jpg)
Motor Evoked PotentialsMotor Evoked Potentials
![Page 62: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/62.jpg)
Brainstem Auditory Brainstem Auditory Evoked PotentialEvoked Potential
![Page 63: Clinical](https://reader035.vdocuments.us/reader035/viewer/2022062705/556ebcc1d8b42aa32b8b4f0a/html5/thumbnails/63.jpg)
Somatosensory Evoked PotentialsSomatosensory Evoked Potentials