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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
The Problem of Neurology Is
Montreal NeurologicalInstitute & Hospital
to Understand Human Himself
Wilder Penfield
Principles of Electrophysiologic StudyPrinciples of Electrophysiologic Study
Instruments & Instruments & IntroductionIntroduction
ElectrodeElectrodeAnodeAnodeCathodeCathodeAmplitudeAmplitudeFrequencyFrequencyCalibrationCalibrationFilterFilter
General DevicesGeneral Devices
ElectrodesElectrodes
StimulatorStimulator
Nerve Conduction StudyNerve Conduction Study
Compound Motor Action PotentialCompound Motor Action Potential
latency
duration
amplitude
amplitude
Nerve Conduction StudyNerve Conduction Study
Nerve Action PotentialsNerve Action Potentials
Sensory Action PotentialsSensory Action Potentials
Structures of Peripheral NerveStructures of Peripheral Nerve
Nerve ConductionNerve Conduction
Temporal DispersionTemporal Dispersion
F-WavesF-Waves
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
Median NerveMedian Nerve
Median NerveMedian Nerve
Nerve Conduction VelocityNerve Conduction Velocity
NCV=NCV=distance/distance/latencylatency
45-55 m/Sec45-55 m/Sec
Ulnar NerveUlnar Nerve
Ulnar NerveUlnar Nerve
Radial NerveRadial Nerve
Radial Nerve (SAP)Radial Nerve (SAP)
Peroneal NervePeroneal Nerve
Peroneal NervePeroneal Nerve
Tibial NerveTibial Nerve
Tibial NerveTibial Nerve
Sural Nerve (SAP)Sural Nerve (SAP)
H-reflexH-reflex
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).
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).
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
ContraindicationsContraindications
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.
Blink ReflexBlink Reflex
Blink ReflexBlink Reflex
Blink ReflexBlink Reflex
ApplicationsApplications
To evaluate brainstem dysfunctionTo evaluate brainstem dysfunction
ElectromyographyElectromyography
EMG-NeedlesEMG-Needles
Spontaneous DischargesSpontaneous Discharges
Normal Motor Unit PotentialsNormal Motor Unit Potentials
Motor Unit PotentialsMotor Unit Potentials
RecruitmentRecruitment
Acute Denervational ChangesAcute Denervational Changes
fibrillationpositive sharp waves
Positive Sharp WavesPositive Sharp Waves
Polyphasic WavesPolyphasic Waves
Giant WavesGiant Waves
Myopathic DischargesMyopathic Discharges
Short-duration small-amplitude polyphasic waves
Polyphasic WavesPolyphasic Waves
Positive Sharp Waves
Positive Sharp Waves
MyotomesMyotomes
Anterior TibialisAnterior Tibialis
GastrocnemiusGastrocnemius
Abductor Pollicis BrevisAbductor Pollicis Brevis
First Dorsal InterosseusFirst Dorsal Interosseus
Paraspinalis (lower lumbar)Paraspinalis (lower lumbar)
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
Motor Evoked PotentialsMotor Evoked Potentials
Brainstem Auditory Brainstem Auditory Evoked PotentialEvoked Potential
Somatosensory Evoked PotentialsSomatosensory Evoked Potentials