Electrodiagnóstico y Electroestimulación de Músculos Denervados
Electrodiagnóstico y Electroestimulación de Músculos Denervados
Electrodiagnóstico y Electroestimulación de Músculos Denervados
Palabras Clave
Electroterapia; Estimulacin muscular elctrica; Msculo
denervado.
Keywords
Electrotherapy; Electrical muscle stimulation (EMS); muscle
denervation.
Resumen
Los principales parmetros del electrodiagnstico por estimulacin son los
siguientes: curva I/t, cronaxia, valoracin cualitativa de la respuesta
muscular, test de Fishgold, cociente de acomodacin y el test de
excitabilidad fardica.La estimulacin elctrica de msculos denervados
genera grandes controversias. El protocolo propuesto tiene por objetivo
prevenir la fibrosis muscular durante el perodo de reinervacin. Consiste en
estimular elctricamente el msculo denervado (total o parcialmente) con
un impulso unidireccional rectangular de 30-300 milisegundos de duracin.
El tratamiento consta de cinco impulsos por da, con una separacin entre
ellos de cuatro segundos (0,2 Hz).
Abstract
The main parameters of electro-diagnostic stimulation are the following:
strength-duration curve, cronaxia, quality valuation of muscular response,
Fishgold test, accommodation quotient and the excitability faradic. The
electrical stimulation of the denervated muscles has generated large scale
controversies. The proposed protocol has as an objective the prevention of
muscular fibrosis during the period of reinnervation of a denervated muscle.
This consists in electrical stimulation of the denervated muscle (total or
partial) with a rectangular monophasic waveform with a pulse duration of
30-300 miliseconds. The treatment consists of five impulses each day, with
a separation of four seconds between them (0.2 Hz).
Artculo
LESIONES DE LOS NERVIOS PERIFRICOS
El nervio perifrico presenta una envuelta denominada epineurio que
encapsula los diferentes fascculos. Cada fascculo est delimitado por
su perineurio y contiene axones separados entre s por el tejido conectivo
del endoneurio (Fig. 1).
Bibliografa
1.Alberts B, Bray D, et al. Biologie molculaire de la cellule. Paris:
Flammarion; 1990.
2.Brodart R,. , Gobelet C. Donnes actualles en lectromyostimulation
fonctionelle. Genve: Ed. Medicompex; 1988; 4/1;2-1-4/1.4-5.
3.But M, Verd E, Labrador RO, Vilches JJ, Fors J, Navarro X. Influence of
physical parameters of nerve chambers on pheripheral nerve regeneration
and reinnervation. Exp Neurol 1996;137:26-33.
Medline
4.Cameron MH. Physical agents in rehabilitation. Phyladelphia: WB Saunders
Company; 1999.
5.Cummings JP. Electrical stimulation of denervated muscle. Electrotherapy
in rehabilitation. Philadelphia: FA Davis; 1992.
6.Crpon F, Castel-Kremer E. lectrostimulation des muscles dnervs.
Profession Kin Plus, n. 64, 4-7, Juin-Jullet 1997.
7.Davis HL. Is electrostimulation beneficial to denervated muscle? A review
of resultats from basic research. Physiotherapy (Canad) 1983;35:306-10.
8.Duchenne de Boulogne GB. Physiologie des mouvements dmontre
l'aide de l'exprimentation lectrique et de l'observation clnique et
applicable l'tude des paralysies et des dformations. Paris: JB Baillre et
Fils, 1867.
9.Girlanda R,. , Dattola R., et al. Effect of electrotherapy on denervated
muscle in rabbits. Exp Neurol 1982;77:483-91.
Medline
10.Kline DG. Nerve surgery as it is now and as it may be. Neurosurgery
2000;46:1285-93.
Medline
11.Lundborg G. Nerve injury and repair. New York: Churchill Livingstone;
1988.
12.Nix WA. Effects of intermittent high frequency electrical stimulation on
denervated EDL muscle of rabbit. Muscle Nerve 1990;13:580-5.
Medline
13.Plaja J. Gua prctica de electroterapia. Carin-electromedicarin.
Barcelona; 1999.
14.Rodrguez FJ, Verd E, Ceballos D, Navarro X. Nerve guides seeded with
autologous schwann cells improve nerve regeneration. Exp Neurol
2000;161:571-84
Medline
15.Rodrguez FJ, Gmez N, Labrador RO, But M, Ceballos D, Cuadras J,
Verd E, Navarro X. Peripheral nerve regeneration thought bioresorbable
and durable nerve guides. Restor Neurol Neurosci 1999;14:65-79.
Medline
16.Rodrguez FJ, Gmez N, Perego G, Navarro X. Highly permeable
polylactide-caprolactone nerve guides enhance peri-pheral nerve
regeneration through long gaps. Biomaterials 1999;20:1489-500.
Medline
17.Seddon HJ. Peripheral nerve injuries. Medical Research Council. Special
Report Series n. 282, 1954.
18.Schimrigk K, et al. The effect of electrical stimulation on the
experimentally denervated rat muscle. Scand J Rehabil Med 1977;9:55-60
Medline
19.Sengler J, Grosse D. lectrostimulation du muscle dnerv. Ann
Kinsithr 1993, t. 20, n. 3. p. 129-40.
20.Spielholz NI. Electrical stimulation of denervated muscle. En: Nelson RM,
Currier DP, eds. Clinical electrotherapy, 2.a ed. Norwaclk, CT: Appleton &
Lange; 1991.
21.Stockert BW. Peripheral neuropaties. En: Umphred Da, ed. Neurological
rehabilitation, 3.a ed. St Louis: CV Mosby; 1995.
22.Sunderland S. Nerve injuries and their repair. Edimburg: Churchill
Livingstone; 1991.
23.Valencic V, Vodovnik L, et al. Improved motor response due to chronic
electrical stimulation of denervated tibialis anterior muscle in humans.
Muscle Nerve 1986;9:612-7.
Medline
24.Verd E, Rodrguez FJ, Gudio-Cabrera G, Nieto-Sampedro M, Navarro X. J
Expansion of adult Schwann cells from mouse predegenerated peripheral
nerves. Neurosci Meth 2000;99: 111-7.