A randomized controlled trial of intensive neurophysiology education in chronic low back pain

Objectives: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. Methods: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal drawing-in task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. Results: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. Discussion: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

The relationship between the auditory brain-stem response and its reconstructed waveforms following discrete wavelet transformation

Objective: To examine the relationship between the auditory brain-stem response (ABR) and its reconstructed waveforms following discrete wavelet transformation (DWT), and to comment on the resulting implications for ABR DWT time-frequency analysis. Methods: ABR waveforms were recorded from 120 normal hearing subjects at 90, 70, 50, 30, 10 and 0 dBnHL, decomposed using a 6 level discrete wavelet transformation (DWT), and reconstructed at individual wavelet scales (frequency ranges) A6, D6, D5 and D4. These waveforms were then compared for general correlations, and for patterns of change due to stimulus level, and subject age, gender and test ear. Results: The reconstructed ABR DWT waveforms showed 3 primary components: a large-amplitude waveform in the low-frequency A6 scale (0-266.6 Hz) with its single peak corresponding in latency with ABR waves III and V; a mid-amplitude waveform in the mid-frequency D6 scale (266.6-533.3 Hz) with its first 5 waves corresponding in latency to ABR waves 1, 111, V, VI and VII; and a small-amplitude, multiple-peaked waveform in the high-frequency D5 scale (533.3-1066.6 Hz) with its first 7 waves corresponding in latency to ABR waves 1, 11, 111, IV, V, VI and VII. Comparisons between ABR waves 1, 111 and V and their corresponding reconstructed ABR DWT waves showed strong correlations and similar, reliable, and statistically robust changes due to stimulus level and subject age, gender and test ear groupings. Limiting these findings, however, was the unexplained absence of a small number (2%, or 117/6720) of reconstructed ABR DWT waves, despite their corresponding ABR waves being present. Conclusions: Reconstructed ABR DWT waveforms can be used as valid time-frequency representations of the normal ABR, but with some limitations. In particular, the unexplained absence of a small number of reconstructed ABR DWT waves in some subjects, probably resulting from 'shift invariance' inherent to the DWT process, needs to be addressed. Significance: This is the first report of the relationship between the ABR and its reconstructed ABR DWT waveforms in a large normative sample. (C) 2004 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Alcoholic neurobiology: Changes in dependence and recovery

This article presents the proceedings of a symposium held at the meeting of the International Society for Biomedical Research on Alcoholism (ISBRA) in Mannheim, Germany, in October, 2004. Chronic alcoholism follows a fluctuating course, which provides a naturalistic experiment in vulnerability, resilience, and recovery of human neural systems in response to presence, absence, and history of the neurotoxic effects of alcoholism. Alcohol dependence is a progressive chronic disease that is associated with changes in neuroanatomy, neurophysiology, neural gene expression, psychology, and behavior. Specifically, alcohol dependence is characterized by a neuropsychological profile of mild to moderate impairment in executive functions, visuospatial abilities, and postural stability, together with relative sparing of declarative memory, language skills, and primary motor and perceptual abilities. Recovery from alcoholism is associated with a partial reversal of CNS deficits that occur in alcoholism. The reversal of deficits during recovery from alcoholism indicates that brain structure is capable of repair and restructuring in response to insult in adulthood. Indirect support of this repair model derives from studies of selective neuropsychological processes, structural and functional neuroimaging studies, and preclinical studies on degeneration and regeneration during the development of alcohol dependence and recovery from dependence. Genetics and brain regional specificity contribute to unique changes in neuropsychology and neuroanatomy in alcoholism and recovery. This symposium includes state-of-the-art presentations on changes that occur during active alcoholism as well as those that may occur during recovery-abstinence from alcohol dependence. Included are human neuroimaging and neuropsychological assessments, changes in human brain gene expression, allelic combinations of genes associated with alcohol dependence and preclinical studies investigating mechanisms of alcohol induced neurotoxicity, and neuroprogenetor cell expansion during recovery from alcohol dependence.

Motor unit synchronization between medial and lateral vasti muscles

Objective: Accurate neuromuscular control of the patellofemoral joint is important in knee joint mechanics. Strategies to coordinate the vasti muscles, such as motor unit synchronization, may simplify control of patellar tracking. This study investigated motor unit synchronization between vastus medialis (VM) and lateralis (VL). Methods: Electromyographic (EMG) recordings of single motor unit action potentials (MUAPs) were made from VM and single- and multi-unit recordings were made from VL. Synchronization was quantified from peaks in the cross-correlogram generated from single MUAP pairs in VL and VM. The proportion of motor units in VM with synchronized firing in VL was also quantified from peaks in averages of multiunit VL EMG triggered from the VM MUAP. Results: A high degree of synchronization of motor unit firing between VM and VL was identified. Results were similar for cross-correlation (similar to 45% of cases) and triggered averages (similar to 41% of cases). Conclusions: The data suggest that synchronization between VM and VL is higher than expected. Agreement between traditional cross-correlation and triggered averaging methods suggest that this new technique may provide a more clinically viable method to quantify synchronization. Significance: High synchronization between VM and VL may provide a solution to simplify control of the mechanically unstable patellofemoral joint. (c) 2005 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

On the dual structure of the auditory brainstem response in dogs

Objective: To use the over-complete discrete wavelet transform (OCDWT) to further examine the dual structure of auditory brainstem response (ABR) in the dog. Methods: ABR waveforms recorded from 20 adult dogs at supra-threshold (90 and 70 dBnHL) and threshold (0-15 dBSL) levels were decomposed using a six level OCDWT and reconstructed at individual scales (frequency ranges) A6 (0-391 Hz), D6 (391-781 Hz), and D5 (781-1563 Hz). Results: At supra-threshold stimulus levels, the A6 scale (0-391 Hz) showed a large amplitude waveform with its prominent wave corresponding in latency with ABR waves II/III; the D6 scale (391-781 Hz) showed a small amplitude waveform with its first four waves corresponding in latency to ABR waves I, II/III, V, and VI; and the D5 scale (781-1563 Hz) showed a large amplitude, multiple peaked waveform with its first six waves corresponding in latency to ABR waves I, II, III, IV, V, and VI. At threshold stimulus levels (0-15 dBSL), the A6 scale (0-391 Hz) continued to show a relatively large amplitude waveform, but both the D6 and D5 scales (391781 and 781-1563 Hz, respectively) now showed relatively small amplitude waveforms. Conclusions: A dual structure exists within the ABR of the dog, but its relative structure changes with stimulus level. Significance: The ABR in the dog differs from that in the human both in the relative contributions made by its different frequency components, and the way these components change with stimulus level. (c) 2006 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

The stimulus-response curve and motor unit variability in normal subjects and subjects with amyotrophic lateral sclerosis

The behavior and stability of motor units (MUs) in response to electrical stimulation of different intensities can be assessed with the stimulus-response curve, which is a graphical representation of the size of the compound muscle action potential (CMAP) in relation to stimulus intensity. To examine MU characteristics across the whole stimulus range, the variability of CMAP responses to electrical stimulation, and the differences that occur between normal and disease states, the curve was studied in 11 normal subjects and 16 subjects with amyotrophic lateral sclerosis (ALS). In normal subjects, the curve showed a gradual increase in CMAP size with increasing stimulus intensity, although one or two discrete steps were sometimes observed in the upper half of the curve, indicating the activation of large MUs at higher intensities. In ALS subjects, large discrete steps, due to loss of MUs and collateral sprouting, were frequently present. Variability of the CMAP responses was greater than baseline variability, indicating variability of MU responses, and at certain levels this variability was up to 100 mu Vms. The stimulus-response curve shows differences between normal and ALS subjects and provides information on MU activation and variability throughout the curve.

An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain

Objective: The purpose of this study was to investigate whether an endurance-strength training program is effective in reducing myoelectric manifestations of sternocleidomastoid (SCM) and anterior scalene (AS) muscle fatigue which have been found to be greater in people with chronic neck pain. Methods: Fifty-eight female patients with chronic non-severe neck pain were randomized into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or a referent exercise intervention involving low load retraining of the cranio-cervical flexor muscles. The primary outcomes were a change in maximum voluntary contraction (MVC) force and change of the initial value and rate of change of the mean frequency, average rectified value and conduction velocity detected from the SCM and AS muscles during sub-maximal isometric cervical flexion contractions at 50, 25 and 10% MVC. Results: At the 7th week follow-up assessment, the endurance-strength training group revealed a significant increase in MVC force and a reduction in the estimates of the initial value and rate of change of the mean frequency for both the SCM and AS muscles (P < 0.05). Both exercise groups reported a reduced average intensity of neck pain and reduced neck disability index score (P < 0.05). Conclusions: An endurance-strength exercise regime for the cervical flexor muscles is effective in reducing myoelectric manifestations of superficial cervical flexor muscle fatigue as well as increasing cervical flexion strength in a group of patients with chronic non-severe neck pain. Significance: Provision of load to challenge the neck flexor muscles is required to reduce the fatigability of the SCM and AS muscles in people with neck pain. Improvements in cervical muscle strength and reduced fatigability may be responsible for the reported efficacy with this type of exercise program. (c) 2006 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All fights reserved.

Seizure detection algorithm for neonates based on wave-sequence analysis

Objective: The description and evaluation of the performance of a new real-time seizure detection algorithm in the newborn infant. Methods: The algorithm includes parallel fragmentation of EEG signal into waves; wave-feature extraction and averaging; elementary, preliminary and final detection. The algorithm detects EEG waves with heightened regularity, using wave intervals, amplitudes and shapes. The performance of the algorithm was assessed with the use of event-based and liberal and conservative time-based approaches and compared with the performance of Gotman's and Liu's algorithms. Results: The algorithm was assessed on multi-channel EEG records of 55 neonates including 17 with seizures. The algorithm showed sensitivities ranging 83-95% with positive predictive values (PPV) 48-77%. There were 2.0 false positive detections per hour. In comparison, Gotman's algorithm (with 30 s gap-closing procedure) displayed sensitivities of 45-88% and PPV 29-56%; with 7.4 false positives per hour and Liu's algorithm displayed sensitivities of 96-99%, and PPV 10-25%; with 15.7 false positives per hour. Conclusions: The wave-sequence analysis based algorithm displayed higher sensitivity, higher PPV and a substantially lower level of false positives than two previously published algorithms. Significance: The proposed algorithm provides a basis for major improvements in neonatal seizure detection and monitoring. Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurophysiology.