To determine whether patients with lumbosacral (LS) radiculopathy and peripheral polyneuropathy (PPNP) exhibit sudomotor abnormalities and whether SUDOSCAN (Impeto Medical, Paris, France) can complement nerve conduction study (NCS) and electromyography (EMG).
Outpatients with lower extremity dysesthesia underwent electrophysiologic studies and SUDOSCAN. They were classified as normal (group A), LS radiculopathy (group B), or PPNP (group C). Pain severity was measured by the Michigan Neuropathy Screening Instrument (MNSI) and visual analogue scale (VAS). Demographic features, electrochemical skin conductance (ESC) values on hands and feet, and SUDOSCAN-risk scores were analyzed.
There were no statistical differences in MNSI and VAS among the three groups. Feet-ESC and hands-ESC values in group C were lower than group A and B. SUDOSCAN-risk score in group B and C was higher than group A. With a cut-off at 48 microSiemens of feet-ESC, PPNP was detected with 57.1% sensitivity and 94.2% specificity (area under the curve [AUC]=0.780; 95% confidence interval [CI], 0646–0.915). With a SUDOSCAN-risk score cut-off at 29%, NCS and EMG abnormalities related to LS radiculopathy and PPNP were detected with 64.1% sensitivity and 84.2% specificity (AUC=0.750; 95% CI, 0.674–0.886).
SUDOSCAN can discriminate outpatients with abnormal electrophysiological findings and sudomotor dysfunction. This technology may be a complementary tool to NCS and EMG in outpatients with lower extremity dysesthesia.
Citations
To investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI.
Fifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging.
Twenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs.
In our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients.
Citations
To investigate the predictive value of the sympathetic skin response (SSR) in diagnosing complex regional pain syndrome (CRPS) by comparing three diagnostic modalities-SSR, three-phasic bone scans (TPBS), and thermography.
Thirteen patients with severe limb pain were recruited. Among them, 6 were diagnosed with CRPS according to the proposed revised CRPS clinical diagnostic criteria described by the International Association for the Study of Pain. SSR was measured in either the hands or feet bilaterally and was considered abnormal when the latency was prolonged. A positive TPBS finding was defined as diffuse increased tracer uptake on the delayed image. Thermographic findings were considered positive if a temperature asymmetry greater than 1.00℃ was detected between the extremities.
Five of 6 CRPS patients showed prolonged latency on SSR (83% sensitivity). TPBS was positive in the 5 CRPS patients who underwent TPBS (100% sensitivity). Thermography was positive in 4 of 5 CRPS patients who underwent the procedure (80% sensitivity). The remaining 7 non-CRPS patients differed on examination. SSR latencies within normal limit were noted in 4 of 7 non-CRPS patients (57% specificity). Results were negative in 4 of 5 non-CRPS patients who underwent TPBS (80% specificity), and negative in 3 of 5 non-CRPS patients who underwent thermography (60% specificity).
SSR may be helpful in detecting CRPS.
Citations
Evaluation of the Sympathetic Skin Response in Men with Chronic Prostatitis: A Case-Control Study
Purpose of this study is to evaluate the temperature lowering effects of the local cold air application on the skin surface and the muscle of different depth, and to observe whether the rebound rise of the temperature occurs after the cold air application.
Subjects were prepared in a relaxed prone position. Cold air of CRAis(Kyung-won Century, Korea) was applied to the gluteal area of 20 healthy subjects for 5 minutes. The skin and intramuscular temperatures were measured by a thermogram(Infrared system, Sweden) and digital thermometers(Barnant company, USA). The temperatures were measured before and 30 seconds after the cold air application, and then every 5 minutes for the next 110 minutes. The few variables were considered that might affect the temperature changes. The thermometer-probes were inserted into the outer quadrant of the gluteal muscle below 5 cm from the iliac crest with the depth of 2 cm, 4 cm, and 6 cm respectively. ANOVA was used for the analysis of the data. The resting temperature of the skin surface was 32.6⁑1.2℃, and the lowest temperature was 12.9⁑3.3℃ after 5 minutes of cold air application. The resting intramuscular temperatures with 2 cm, 4 cm, and 6 cm depth were 36.5⁑0.2℃, 36.9⁑0.2℃, and 37.1⁑0.2℃ respectively (p＜0.05). The lowest temperature in 2 cm, 4 cm, and 6 cm depth was 35.1⁑0.7℃, 36.2⁑0.4℃, and 36.9⁑0.3℃ respectively(p＜0.05). The mean duration to reach the lowest temperature was 20, 25, and 45 minutes respectively. The temperatures in the skin and the muscle with the depth of 2 cm, 4 cm, and 6 cm after 2 hours on cold air application were 32.2⁑1.1℃, 36.2⁑0.5℃, 36.6⁑0.3℃, and 36.9⁑0.3℃(p＜0.05) respectively. The temperatures in the skin and the muscle were significantly lower after 2 hours than before the cold air application(p＜0.05).
The change of skin surface temperature was more rapid than that of the muscle and the deeper the muscle was the lesser the temperature change. In conclusion, the effect of cold air application for 5 minutes lasts up to 2 hours and the rebound rise of the temperature due to reactive vasodilatation seems not to occur in the gluteal muscle.
Objective: The purposes of these study were to evaluate the changes of temperature and sympathetic skin response (SSR) before and after sympathectomy in patients with palmar hyperhidrosis and to quantify long standing effect of sympathectomy.
Method: The SSR and skin temperature were measured before, one day and 30 days after thoracoscopic sympathectomy. SSR was recorded from palm and sole bilaterally. Temperature was recorded on 9 sites of each hand and 11 site of each sole. Patient's satisfaction with operation was assessed by 10-point scale.
Results: One day after sympathectomy, the amplitude of SSR was significantly decreased and latency of SSR was delayed in all cases on bilateral palm and sole. However, after sympathectomy 30 days, the amplitude of SSR was normalized in all cases on bilateral sole. All patients who had undergone sympathectomy showed significant clinical improvement. The temperature increased dramatically over 3oC on postoperation 1 day and maintained 1.72oC higher in post-operation 30 days than pre-operation on both hands. There was no significant difference of temperature among pre-operation and post-operation 1 day and post-operation 30 days on sole.
Conclusion: Our study proved effect of thoracoscopic sympathectomy to the patients with palmar hyperhidrosis objectively and quantified the decrement of sympathetic tone. Further study is needed for long term follow up over 2 months or more. (J Korean Acad Rehab Med 2002; 26: 543-549)
Objective: The sympathetic skin response (SSR) was measured in patients with chronic renal failure (CRF) for diagnosis of uremic polyneuropathy and its correlations with nerve conduction study (NCS) and clinical autonomic symptoms were investigated.
Method: The SSR was measured in 15 patients with CRF on regular hemodialysis, aged 26 to 67 years. With median nerve stimulation at the wrist using the extremity without arteriovenous fistula, the SSR was recorded from both palm and sole simultaneously. The responses were interpreted as normal (presence) or abnormal (absence). Routine nerve conduction study was also performed in the same extremities and clinical autonomic symptoms were investigated.
Results: Nine of fifteen patients (60.0%) had symptoms suggestive of autonomic dysfunction: the most frequent findings were orthostatic dizziness and sweating problem. The SSR was absent in four of fifteen patients (26.7%). There is no significant relationship between SSR and autonomic symptoms (P＞0.05). The nerve conduction study was abnormal in eight of fifteen patients (53.3%), and the SSR was absent in two of seven patients with normal NCS. There is no significant relationship between NCS and SSR (P＞0.05).
Conclusion: Although the proportion of abnormal SSR was small, it may be a valuable method in the assessment of uremic polyneuropathy in conjunction with routine nerve conduction study in CRF patients.
Digital infrared thermal imaging(DITI) has been proposed as a diagnostic aid in patient with many disease entities, such as the cardiovascular, the neurologic, the musculoskeletal diseases and so on. Supporters of thermography state that normal patients have the normal thermograms and abnormal patients have the abnormal thermograms. The purpose of this study was to determine how much a cigarette will affect skin temperature change in the course of normal day's smoking.
Twenty one healthy smokers(mean age, 27.4⁑5.1 years old) and fourteen nonsmokers(mean age, 24.4⁑1.6 years old) took parts in the study. All were male. The cigarette consumption averaged 14.0 per day. Smokers maintained their smoking habit in the ambient temperature before on initial measurement and smoked a cigarette in the controlled laboratory room. Measurements were taken for 5 minutes, 1 hour and 2 hours afterward. The skin temperature of the face, the both palms and the both soles was measured using DorexⰒ digital infrared thermal imaging system.
In all sessions, the skin temperature was higher on the face and lower on the sole. There were no significant differences of skin temperature on both sides of body in all subjects(p＞0.05). The skin temperature of all measured parts was significantly lower in the smoking group before and 5 minutes after smoking(p＜0.01). There were no significant differences of skin temperature between smoker and nonsmoker after 1 hour of smoking(p＞0.01).
Dysfunction of the autonomic nervous system is reported to occur at an incidence of 20% to 40% in diabetes. The clinical symptoms include orthostatic hypotension, vomiting, diarrhea, bladder dysfunction, male impotence, sweating, etc. Two simple noninvasive tests, sympathetic skin response (SSR) and R-R interval variation (RRIV), were used to assess autonomic functions. We performed SSR and RRIV on the diabetic patients and controls. The patients were classified into 4 groups (group I: without peripheral neuropathy or dysautonomia, group II: with dysautonomia only, group III: with peripheral neuropathy only, group IV: with both peripheral neuropathy and dysautonomia). We also tried to correlate their clinical dysautonomic symptoms and the results of nerve conduction studies (NCS) and of SSR and RRIV.
The subjects of this study were 82 diabetic patients, 20 to 73 years old with the mean age of 53, and 12 controls.
Latency, amplitude, and loss of SSR all showed a significant difference in relation to the dysautonomic symptoms. The loss of SSR in the foot showed a remarkable difference in group I.
In groups III and IV, three RRIVs (Valsalva ratio, E:I ratio, 30 : 15 ratio) showed a significant decrease compared with the control group, and in group II, only the 30:15 ratio showed a statistically significant decrease.
In conclusion, the changes in SSR and RRIV were significantly associated with the dysautonomia. Among these, loss of SSR in the foot and decrease in the 30 : 15 ratio were useful parameters for early detection of diabetic autonomic neuropathy without peripheral neuropathy.
Objective: This study was designed to assess the influences of skin temperature and age on latency and amplitude of the sympathetic skin response (SSR).
Method: We examined the sympathetic skin responses in 77 normal subjects aged 25 to 73 years. With stimulation of both median nerve and both tibial nerve at the wrist and ankle, the SSRs were recorded from both palms and soles simulaneously. To determine the effects of skin temperature change on SSR, we examined the SSRs in 12 healthy subjects before and after heating. The heat was applied on right forearm by infra-red lamp.
Results: The mean latency and the mean amplitude of SSR with stimulation of the right median nerve at the wrist were 1.47 sec and 6.08 mV at the right palm, 1.50 sec and 6.07 mV at the left palm, 1.95 sec and 3.38 mV at right sole, and 1.95 sec and 3.09 mV at left sole. There was no side-to-side difference in the latency and the amplitude. Regardless of the site of stimulation, latency was longer at the sole than at the palm, and amplitude was greater at the palm than at the sole (p＜0.05). The latency of the SSR was positively correlated with the age of subjects (p＜0.05), and the amplitude was negatively correlated with the age of subjects (p＜0.05). At higher skin temperature, the latency of SSR was shortened and the amplitude was reduced significantly (p＜0.05).
Conclusion: The amplitude of the SSR decreases with aging and the latency increases with aging. As the skin temperature rises, the latency and amplitude show tendency to decrease. We suggest that the skin temperature and age are important factors to be considered carefully in assessing the SSR parameters.
The purpose of this study is to measure the skin epidural distance(SED) of L3∼4 interspace and to correlate SED with the individual constitutional data of patients such as body-weight, height, abdominal circumference and body mass index(BMI; kg/m2). In this study we examined 120 patients (45 men and 75 women) who had no pathological abnormality in L3∼4 interspace such as herniated disc, spondylolisthesis and spinal stenosis in MRI study, although majority of patients had pathology below this level. The SED was measured under fluoroscopic guide with loss of resistance technique, and we also measured individual constitutional data of patients.
Pearson's correlation analysis of the data showed that there were no correlations of statistical significance between SED and the height, abdominal circumference of the patient (p＞0.01). But there were statistically significant correlations between SED and body-weight as well as BMI (p＜0.0001). Linear regression analysis of these data showed significant correlations between SED and body weight(male r2=0.49, p＜0.0001, y=0.37x18.1; female r2=0.31, p＜0.0001, y=0.18x30.8), BMI(male r2=0.52, p＜0.0001, y=0.89x23.1; female r2=0.35, p＜0.0001, y=0.41x31.6).
Method: 15 healthy adults were recruited as subjects. We applied two hot packs to the lumbar region for two consecutive days. On the first day, the body part was on the top of hot pack and on the second day, the hot pack was placed over the body part. We measured peak skin temperature, skin temperature elevation, time required to peak skin temperature, skin temperature after 20 minutes and visual analogue scale(VAS) of subjective feeling of heat (hot).
Results: In the peak skin temperature, the means were 44.4⁑0.70oC and 42.7⁑ 0.99oC in the supine and prone position, respectively. In the skin temperature elevation, the means were 11.2⁑1.1oC and 9.5⁑1.6oC, respectively. In the time required to peak skin temperature elevation, the means were 6'49"⁑15" and 10'33"⁑ 15", respectively. In the skin temperature after 20 minutes, the means were 42.4⁑ 0.7oC and 41.6⁑0.8oC, respectively. In the VAS of subjective feeling of heat (hot), the means were 8.66⁑1.11 and 5.72⁑1.48, respectively.
Conclusion: The patient's position is one of the important factors in determining temperature elevation. Therefore, it should be considered during application of the hot pack.
Objective: The purpose of this study is to evaluate the effect of visible light therapy for the management of somatic pain.
Method: Subjects consisted of 42 patients with pain and were divided into two groups; control (n=22) and experimental (n=20) groups. Control group received conventional physical therapy only, while experimental group received additional light therapy with blue light (light intensity 4080 lux, wave length 581 nm, distance from lamp 5 cm). Intensity of pain was assessed by visual analogue scale (VAS) and McGill pain questionnaire. Sympathetic skin response was measured to assess the status of autonomic nervous system. VAS and McGill pain questionnaire were administered before treatment and at 1 day, 2 days, 3 days, 1 week, and 2 weeks after treatment. Sympathetic skin response were performed before and 2 weeks after treatment.
Results: 1) In both experimental and control groups, VAS became significantly lower at two weeks after treatment compared to pretreatment scale (p＜0.05). 2) McGill pain questionnaire showed significantly lower scores two weeks after treatment compared to pretreatment score, only in experimental group (p＜0.05). 3) Experimental group showed significantly lower McGill pain questionnaire score than control group at two weeks after treatment (p＜0.05). 4) Latency and amplitude of sympathetic skin response showed no significant difference between experimental and control groups.
Conclusion: Visible light therapy can be used as an effective therapeutic modality for the management of symptomatic pain in combination with conventional physical therapy. (J Korean Acad Rehab Med 2002; 26: 81-85)
Objective: Most spinal cord injured patients suffered form various autonomic dysfunction. The purpose of this study is evaluation of sympathetic skin response (SSR) and R-R interval variability (RRIV) as a method of autonomic function test in spinal cord injured patients.
Method: Thirty-six spinal cord injured patients were enrolled in this study. SSR was recorded in the palm and sole by electrical stimulation of right median nerve and RRIV during rest, deep breathing and Valsalva maneuver for 1 minute.
Results: The higher level of spinal cord injury, the higher rate of the abnormal sympathetic skin response in the palm and sole and more reduced values of Valsalva ratio (p＜0.05). The parameters of sympathetic skin response and R-R interval variability were not correlated with injury severity of spinal cord and their autonomic symptoms.
Conclusion: Evaluation of SSR and RRIV could be helpful methods to evaluate autonomic function in the spinal cord injured patients.
The sympathetic skin response(SSR) is a simple test to assess sympathetic nerve function through sudomotor activity after electric stimulation. However the electrophysiologic characteristics of sympathetic skin response have not been fully documented regardless of the impending necessities. To understand the characteristics of central conduction of SSR by taking SSRs in various central nervous system diseases, 336 SSRs were measured in 14 stroke patients, 6 spinal cord injury patients and 2 traumatic brain injury patients and analysed by classifying into no response(NR), slight and normal groups.
In stroke patients, normal SSRs were obtained more in hemiplegic side than non-hemiplegic side after both limb stimulations. And normal SSR were obtained more in left hemiplegic patients than right hemiplegic patients even though number of subject was limited. The patterns of SSR in traumatic brain injured and spinal cord injured patients were not so closely correlated with severity of clinical symptoms and abnormal somatosensory evoked potentials.
The sympathetic skin response seems to be exclusively under the control of central nervous system of which the subcortex would be regarded as the sudomotor reflex center.
Congenital insensitivity to pain with anhidrosis (CIPA: a hereditary sensory and autonomic neuropathy, HSAN IV) is a rare disease characterized by the self-mutilation, bone fracture, multiple scars, osteomyelitis, joint deformities and anhidrosis. The pathophysiologic mechanism remains unknown.
This is the report of a twelve years old boy who had been diagnosed as the CIPA at his age of five. Loss of unmyelinated and small myelinated nerve fibers have been noted in an abdominal skin biopsy. On follow up studies, no significant changes were noted in the clinical manifestations and in the findings of laboratory, radiologic and electrophysiologic studies when compared to the initial studies except for the minimally progressed neuropathic ankle joints. Long term follow up study including the sequential electrophysiologic examination and biopsy of nerve and muscle might be necessary to establish the natural course of the disease. Prevention of the injury should be emphasized for the good prognosis.
Objectives: This study was designed to measure sympathetic skin responses (SSRs) following magnetic stimulation of the cervicothoracic spine and to evaluate its clinical usefulness.
Methods: Fifteen healthy volunteers who had no dysautonomic symptoms or signs and a patient with C6 spinal cord transection participated in this study. To evoke SSR, we stimulated the C7 spinous process (SP) and T2 SP with 90 mm circular coil (Magstim 200). We recorded the sensory nerve action potential (SNAP) from the right middle finger to ascertain whether the C7 dorsal root was depolarized by the C7 SP stimulation. The same stimulation intensity by which SNAP had been obtained was used to evoke the SSR by the C7 and T2 SP stimulation. The recording of SSR was done in both palms. SNAP was recorded by the magnetic stimulation on the C7 SP in all subjects.
Results: By the C7 SP stimulation, the latency of SSR was 1.35 sec in the right palm, 1.33 sec in the left palm and by the T2 SP stimulation, the latency was 1.24 sec, 1.23 sec in order. The right-left difference was not found by each SP stimulation, but the latency of SSR by the T2 SP stimulation was faster than that by the C7 SP stimulation (p＜0.01). The latency difference of C7 and T2 SP stimulation was 0.11 sec in the right palm, 0.10 sec in the left palm. In a case of C6 cord transection, SSR was evoked neither by the right median electric stimulation, nor by the C7 SP magnetic stimulation. However, SSR was successfully evoked by the T2 SP stimulation.
Conclusion: We believe that the latency difference of C7 and T2 spinous process stimulation reflects the central conduction time of SSR.
Objective: The purpose of this study was to determine the difference of temperature effects on the nerve conduction variables and to obtain correction factors for temperature in demyelinated and normal peripheral nerves.
Method: The compound muscle action potentials (CMAPs) were recorded with wrist stimulation during cooling and warming in 10 control subjects and 13 subjects with demyelinating neuropathies. The temperature of cooling and warming were 18oC and 40oC, respectively. The time of cooling and warming were 60 minutes and composed of successive 4 sessions of 15 minutes. The skin temperature of thenar area, latency, amplitude, duration, and area of CMAPs were measured before and after each session of 15 minutes of cooling or warming.
Results: The time constants of parameters of CMAPs were of higher tendency in cooling than in warming. The time constants of latency of CMAP were higher in subjects with demyelinating neuropathy than in controls (p＜0.05): 33.3⁑4.0 minutes versus 27.2⁑2.2 minutes in cooling; 30.0⁑7.8 minutes versus 19.6⁑3.3 minutes in warming. The temperature correction factor of latency of CMAPs was 0.23⁑0.03 msec/oC in control and 0.33⁑0.06 msec/oC in subjects with demyelinating neuropathies (p＜0.05).
Conclusion: When studying a subject with demyelinating neuropathies, we should warm the extremity for more sufficient time than in normal subject, or may applicate a differenct temperature correction factors.
Objective: To evaluate the autonomic nervous system function in chronic renal failure patients compared to normal control and to assess the effect of dialysis method and underlying diseases such as diabetes mellitus and hypertension, on autonomic nervous system function in chronic renal failure patients.
Method: We checked palm and sole skin temperature with digital thermometer, sympathetic skin responses and heart rate variability in chronic renal failure patients (77 persons) and normal control group (77 persons).
Results: The amplitude of sympathetic skin response (SSR) and heart rate variability (RRIV) of patients group showed statistically significant difference compared to control group (p＜0.05). The diabetic patient group with chronic renal failure showed prolonged latency of SSR in sole but significant differences were shown in amplitude and RRIV (p＜0.05). The hypertensive group with chronic renal failure showed prolonged latency of SSR in both palm and sole (p＜0.05) but the amplitude and RRIV of those didn,t show statistical difference (p＞0.05). CRF without diabetes mellitus and hypertension showed significant difference on amplitude of SSR and RRIV (p＜0.05) but autonomic nervous system function tests showed no difference (p＞0.05) between hemodialysis and peritoneal dialysis groups.
Conclusion: SSR test and RRIV could be valuable measure to evaluate autonomic nervous system functions in the patients with chronic renal failure.
The radiation exposure has multiple complication of various organs. Especially, the Food and Drug Administration has recently issued a bulletin warning of the risks of acute skin injury occurring during fluoroscopically guided procedures. Physicians need information about typical radiation doses during fluoroscopically guided various procedures and estimates of entrance skin dose must be monitored using thermoluminescent dosimetry, film badge dosimetry, pocket dosimetry and on-line computer system. Current National Council on Radiation Protection and Measurements recommended are that yearly total body dose should not exceed 50 mSv (5 rem) and that life time dose measured in millisieverts should not exceed one's age in years multiplied by 10.
Types of skin injury are erythema, alopecia, dry desquamation, invasive fibrosis, dermal atropy, telangiectasia, moist desquamation, skin necrosis and secondary ulcer. Also, long-term exposure caused skin cancer.
We experienced personally pigmentation on the finger nail and the hand after repeated fluoroscopically guided procedures. Thus, we report this case for giving warning to the physiatrist by the complications due to frequent exposure during procedures.
Although electrodiagnostic sympathetic skin response(SSR) has been widely assessed the detail procedure, such as filter setting and stimulus intensity, has not been standardized yet. This study was performed to establish optimal settings for SSR recording. In 18 healthy subjects, SSRs were recorded in the left hand while stimulating the right median nerve. The data were analyzed for frequency and amplitude domains and statistically evaluated using the methods of analysis of variance(ANOVA) and regression analysis.
The peak frequency of SSR signal was 18.59⁑8.26 Hz, and the frequency of major signals ranged from 0.5 to 2 Hz. The amplitude of SSR was linearly regressed on the intensity of electical stimulus according to the equation: y=2.60x+277.89(p＜0.05). The latency of SSR was linearly decreased with the intensity of electrical stimulus with the relationship: y=1445.461.60x (p＜0.05).
On the bases of these results, we conclude that a proper filter setting for SSR measurement would be 1∼100 Hz, and at stimulus intensity below 128 mV, the higher the stimulus intensity, the amplitude was bigger and the latency was shorter.
The role of skin temperature is very important in clinical neurophysiology but has often been neglected. In nerve conduction studies, lower normal temperature affects slower conduction velocities and increased nerve (sensory or mixed) action potential amplitudes. To determine the normal skin temperature in various parts of upper and lower extremities within close approximation of the nerve passages, the temperature was measured using PhysitempⰒ Model BAT-12 (Accuracy 0.1oC, Clifton, New Jersey, U.S.A.). Fifty-three neurophysiologically healthy adults (Age range, 22∼77 years old) were tested : upper extremity, 20 (male, 7 ; female, 13) ; lower extremity, 33 (male, 11 ; female, 22). The total points of skin temperature measurement were 21 : upper extremity, 10 ; lower extremity, 11. The skin temperature for the upper and lower extremities was 34.6⁑0.9oC (range, 32.6∼36.7oC) and 33.4⁑1.1oC (range, 28.1∼35.7oC), respectively. Although it is frequently time consuming, monitoring normal skin temperature will result in greater electrodiagnostic accuracy.
Objective: To investigate the conduction velocity of sympathetic skin response(SSR) in normal adults.
Method: The latency of SSR was measured in 41 normal healthy subjects by the simultaneous recordings from three sites of the hand. And we also measured the distance and conduction time between the recording sites of the hand. The conduction velocity of SSR was calculated by dividing the distance by conduction time.
Results: The SSR was obtainable in all subjects from three sites of the hand. The mean latencies of SSR recorded from wrist, midpalm and index finger were 1.29, 1.40 and 1.54 seconds respectively. And the mean latency showed a significant increase from wrist to index finger(p＜0.05). The conduction velocity of the SSR from wrist to index was 0.57 m/sec, and segmental conduction velocities from wrist to palm and palm to index were 0.62 and 0.66 m/sec respectively. The conduction velocity of SSR in the distal segment was slightly faster than in the proximal segment with no statistical significance.
Conclusion: The conduction velocity of SSR by the simultaneous recordings at two or more sites of the hand can be easily obtained and offers a useful parameter along with the amplitude and latency of SSR.
We studied a group of spinal cord injured patients, using two different mattresses, to analyze statistically the pressure measured over sacral area and skin changes developed on the dorsal skin surface of patients for specific duration of time.
Local pressure measured at sacral area and skin change score were lower on a Bazooka system than common hospital mattress. And the weight, BMI(Body Mass Index) and % IBW(Ideal Body Weight) of patients significantly correlated with the skin changes developed on the dorsal skin surface after lying on common hospital mattress for 2 hours. But skin changes developed after lying on a Bazooka system for 8 hours didn't correlate with these variables. Therefore a Bazooka system may be effective in the prevention of pressure ulcers for spinal cord injured patients.
Objective: The purpose of this study is to investigate the incidence and types of skin lesions occurring in the patients with a spinal cord injury(SCI), traumatic brain injury(TBI), cerebrovascular accident(CVA), and an amputation.
Method: Five hundred and eighty-nine charts from 1991 to 1997 were retrospectively reviewed. During the hospitalization, the skin lesions were examined by the dermatologists upon consultations. The patients were divided by their diagnosis of the SCI, TBI, CVA, and amputation. The incidence of the skin lesions were analysed.
Results: The number of patients was as follows; SCI 228, TBI 181, CVA 143, and amputation 37. The skin lesions occurred in 72 cases(12.9%) of which 30 cases(13.2%) occured in SCI, 21 cases(11.6%) in TBI, 15 cases(9.8%) in CVA and 7 cases(18.9%) in amputation. These include dermatophytosis 23 cases(23.9%), seborrheic dermatitis 21 cases(21.8%), pilosebaceous disorder 17 cases(17.7%) such as folliculitis, acne, and acneiform eruption, eczema 11 cases(11.4%), drug eruption 9 cases(9.4%), candidiasis 6 cases(6.3%), and others 9 cases(9.4%) such as steatocytoma multiplex, epidermal cyst, intertrigo, alopecia areata, and etc. The incidence of ANS related skin lesion such as seborrheic dermatitis and pilosebaceous disorder in SCI was significantly higher than in TBI and stoke, which the defect is in the brain(p＜0.05). However, the incidence in other lesions such as dermatophytosis, eczema, and candidiasis was not significantly different between these two groups(p＞0.05). The number of cases of ANS related skin lesions was 21(52.5%) and 3(42.9%) in SCI patients whose level of injury was from C1 to T6(in 40) and at or below T7(in 7) respectively. In contrast, the number of cases of other skin lesions such as dermatophytosis, eczema, and candidiasis was 15(37.5%) of C1 to T6 level and 4(57.1%) of at or below T7 level in the same SCI patients groups.
Conclusion: This study illustrates that the incidence of skin lesion in rehabilitation unit is 72 cases of 589 patients(12.9%). The incidence of ANS related skin lesion is higher in the patients with spinal cord injury than brain lesion. And the level of injury is higher in SCI, the more skin lesions occur.
Duchenne muscular dystrophy(DMD) is an X-linked recessive disease, caused by the mutation of dystrophin gene at Xp21. The dystrophin produced by this gene is therefore absent on the membrane of muscular fiber in the patients with DMD. Recently, it is known that the dystrophin has also been located on the myoepithelial layer of sweat gland in the mice.
We studied the sympathetic skin response(SSR) in a group of DMD patients and a control group to evaluate the function of sympathetic nerve and sweat gland in DMD patients.
Significant prolongation of latency of SSR in the palm and sole was noted in the group of DMD patients compared to the control group. However, there was no significant difference in the amplitude of SSR between two groups. In the patient group, the rise in latency of SSR was closely correlated with the duration of symptoms and weakly associated with the stage of the illness.
Therefore the latency of SSR may be a useful index in assessing the function of sympathetic nerve and sweat gland in DMD patients. These results could be a consequence of a lack of dystrophin at myoepithelium of sweat gland in DMD patients.
Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findings, which is very subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algo meter and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response(SSR), and to evaluate the electrophysiologic characteristics of MFTrP.
21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTR with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrod iagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed, SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism.
Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not. Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result.
In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP, although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.
Objective: The purposes of this study were to measure the effect of Stellate ganglion block(SGB) objectively and quantitatively by the use of sympathetic skin response(SSR), and to evaluate the cumulative effects and complications of repetitive SGB and to find out optimal numbers of injection per one cycle in the patients with reflex sympathetic dystrophy(RSD).
Method: Six patients with RSD were evaluated with a SSR test before and after the injection of 1% lidocaine 4 ml by SGB method.
Results: There was a significant prolongation of latencies in SSR of the lesion side of sixty mixed cases by the SGB methods and SSR tests. There were no significant changes in the latency and amplitude of SSR from the lesion side between pre- and post injection states. There was a significant decrease of amplitude in the sound side after the injection. The differences of the amplitudes between pre- and post injections were significantly higher in the lesion side than the sound side. The degree of pain of the patients with RSD was evaluated by visual analogue scale(VAS), which scored on pre and post injection state decreased from 10 to 6.5 by 5 times injections, but did not decrease by more injections.
Conclusion: We concluded that SGB is more effective in the RSD lesion side than the sound side and the SSR is a useful test for evaluating the effect of SGB.
Objective: To observe the change of sympathetic skin response (SSR) before and after sympathectomy in patients with idiopathic palmar hyperhidrosis and to find the usefulness of SSR for assessment of the effects of sympathectomy
Method: The SSR was measured in 20 patients with palmar hyperhidrosis and 20 normal control group. Ten days after thoracoscopic sympathectomy, SSR was also measured. A 50∼150 V stimulus was applied over the median nerve and SSR was recorded on bilateral palms and soles with Viking IV (Nicolet Biomedical Ins., U.S.A.). Patient's satisfaction with operation was assessed by questionnaire.
Results: Absent or unstable SSR recordings rate was increased and amplitudes of SSR were significantly decreased in patients with palmar hyperhidrosis compared with control group. After sympathectomy, SSR was absent in all cases on bilateral palms and these results were correlated with clinical improvment. All patients who had undergone surgery showed significant clinical improvement for palmar hyperhidrosis and about 75% of the cases were found to have compensatory sweating from other site of the body.
Conclusion: Abnormal sympathetic nerve system responses were observed in patients with palmar hyperhidrosis. SSR recordings and clinical manifestations were influenced by sysmpathectomy.
The purposes of this study are to investigate the effect of the cold air application in the skin and intraarticular temperature changes and to observe the rebound temperature changes after cooling.
We recorded the changes of the skin surface and intraarticular temperatures of knees during and after the cold air application. The intraarticular temperature was measured by a temperature probe inserted into the knee joint cavity and the skin temperature by the infrared system. Eighteen healthy subjects were examined. The knee was cooled by a 5-minutes application of CRAis (Kyung-won Century, Korea) machine and the intraarticular and skin temperatures of knees were measured at every 0.5-minute during and after the cold therpy, then at every minute for 5 minutes, and every 5-minute for the next 110 minutes. We also evaluated the variables that might affect the skin and intraarticular temperature changes.
Results showed that the mean skin temperature dropped from 31.8℃ to 10.5℃ immediately after the cold air application for 5-minutes. The mean intraarticular temperature dropped from 33.9℃ to 30.0℃ after the cold air application for 5-minutes. Two hours after the initiation of treatment with cold air, the mean intraarticular temperatures did not recover to the baseline values(p＜0.01). No significant correlations were found between the body mass index with the intraarticular and surface temperatures of knees. A highly significant correlation was noted between the baseline skin surface and intraarticular temperatures(p＜0.01).
In conclusion, the reduction of the joint temperature by the cold air application using CRAis machine can be a useful treatment method for the synovitis of knees.
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