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  • 1. Reflex & Conduction Liu, An-Bang M.D., M.M.Sci. Department of Neurology, Tzu Chi Medical Center, Hualien, Taiwan Division of Neuromuscular Research and Neurogenetics, Tzu Chi Neuro-Medical Scientific Center, Hualien, Taiwan The Clinical Application of Neuroscience
  • 2. The Problem of Neurology Is Montreal Neurological Institute & Hospital to Understand Human Himself Wilder Penfield
  • 3.
    • Principles of Electrophysiologic Study
  • 4. Instruments & Introduction
    • Electrode
    • Anode
    • Cathode
    • Amplitude
    • Frequency
    • Calibration
    • Filter
  • 5. General Devices
  • 6. Electrodes
  • 7. Stimulator
  • 8.
    • Nerve Conduction Study
  • 9. Compound Motor Action Potential latency duration amplitude amplitude
  • 10. Nerve Conduction Study
  • 11. Nerve Action Potentials
  • 12. Sensory Action Potentials
  • 13. Structures of Peripheral Nerve
  • 14. Nerve Conduction
  • 15. Temporal Dispersion
  • 16. F-Waves
  • 17. Tested Nerves
    • Median nerve
      • CMAPs and SAPs
    • Ulnar nerve
      • CMAPs and SAPs
    • Tibial nerve
      • CMAPs, H-reflex
    • Peroneal nerve
      • CMAPs
    • Sural nerve
      • SAPs
  • 18. Median Nerve
  • 19. Median Nerve
  • 20. Nerve Conduction Velocity NCV=  distance/  latency 45-55 m/Sec
  • 21. Ulnar Nerve
  • 22. Ulnar Nerve
  • 23. Radial Nerve
  • 24. Radial Nerve (SAP)
  • 25. Peroneal Nerve
  • 26. Peroneal Nerve
  • 27. Tibial Nerve
  • 28. Tibial Nerve
  • 29. Sural Nerve (SAP)
  • 30. H-reflex
  • 31. H-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).
  • 32. H-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).
  • 33. Applications
    • To confirm the diagnosis of neuropathy
    • To evaluate the possible pathological changes of neuropathy
    • To detect and evaluate the site of conduction block of entrapment neuropathy
    • To insure the diagnosis of multi-focal conduction block motor neuropathy
  • 34.
    • Contraindications
  • 35. Facial 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.
  • 36. Blink Reflex
  • 37. Blink Reflex
  • 38. Blink Reflex
  • 39. Applications
    • To evaluate brainstem dysfunction
  • 40. Electromyography
  • 41. EMG-Needles
  • 42. Spontaneous Discharges
  • 43. Normal Motor Unit Potentials
  • 44. Motor Unit Potentials
  • 45. Recruitment
  • 46. Acute Denervational Changes fibrillation positive sharp waves
  • 47. Positive Sharp Waves
  • 48. Polyphasic Waves
  • 49. Giant Waves
  • 50. Myopathic Discharges Short-duration small-amplitude polyphasic waves
  • 51. Polyphasic Waves
  • 52. Positive Sharp Waves
  • 53. Positive Sharp Waves
  • 54. Myotomes
  • 55. Anterior Tibialis
  • 56. Gastrocnemius
  • 57. Abductor Pollicis Brevis
  • 58. First Dorsal Interosseus
  • 59. Paraspinalis (lower lumbar)
  • 60. Applications
    • To localize and stage the lesion of neuropathy or radiculopathy
    • To differentiate neuropathy from myopathy
    • To identify neuromuscular junction disorders
    • To confirm the diagnosis of motor neuron disease
  • 61. Motor Evoked Potentials
  • 62. Brainstem Auditory Evoked Potential
  • 63. Somatosensory Evoked Potentials