Peripheral Nerve Injuries
Peripheral Nerve Injuries
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This is Chapter 17 from RC’s best-selling book:
Second Edition ~ Wiliams & Wilkins
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Chapter 17: PERIPHERAL NERVE INJURIES
Neurotherapy and Spondylotherapy
Neurotherapy refers to the inhibition of overly active nerve function or the activation of sluggish function. Spondylotherapy is the treatment by physical methods applied to the spinal region. A nerve fiber may be stimulated artificially (ie, mechanically, thermally, chemically, electrically) anywhere along its course.
Certain nerve fibers function specifically for certain sensory and motor acts and may be stimulated at either their central or peripheral ends: efferent nerves are stimulated centrally and afferent nerves peripherally. The ability of sensory nerve stimulation to produce a motor or glandular response is readily demonstrated in eliciting any tendon reflex where superficial percussion produces the characteristic jerk, the muscle-spasm reflex resulting from skin exposure to a cool wind or proprioceptive excitement from strain or sprain, or the salivary response from seeing a person eat a lemon.
Neuroinhibition. Abnormal reflexes appear to be inhibited more by pressure and cold than by any other methods. For example, a painful splinting erectormuscle spasm can be relaxed by placing the muscle in a position of functional rest and then applying mild continuous stretching or pressure. Cold is an excellent neuroinhibitor, especially with nerves which are located not too deep. Functional inhibition can be gained by stimulating a nerve whose chief function is inhibitory. Pressure may be applied digitally or with a pressor instrument at or near the paravertebral spaces. Steady pressure on the surface of the body, usually applied digitally, over the course of a nerve tends to be a restraining influence. There also appears to be a reflex influence upon vessels and glandular secretions. Certain skin areas (eg, suboccipital, paraspinal, parasacral, perianal, peripheral-meridian) are highly responsive to mild pressure from which reflexes of vasodilation and muscle relaxation can be initiated.
Neurostimulation. Deep and rapid short-duration percussion, applied either by hand or by a percussion-type vibrator, upon spinous processes at a rate 1-2/sec for about 20 sec with 30-sec rest intervals can be used to stimulate a spinal center. Prolonged stimulation such as 3 min or longer fatigues excitability and produces an inhibitory effect. When a medium-strength electric current passes through a portion of nerve, an impulse is created at the instant the current is initiated and broken, as evidenced by muscle contraction. Experience has shown that sinusoidal current is the best method to contract involuntary muscle without irritation, but pulsating ultrasound is also effective in stimulating spinal centers. Therapeutic heat in most any form increases nerve conductivity.
Effects of Spinal Center Stimulation:
C1-C2: initiates vagal responses of increased gastric secretion and peristalsis; increased nasal, buccal, and pulmonary mucosal secretions.
C3: initiates phrenic influence to increase depth of diaphragmatic excursions. Note that C3 inhibition is helpful in chronic cough, hiccups.
C4-C5: initiates lung reflex contraction (eg, used in expiratory dyspnea, emphysema) and pulmonary vascular vasoconstriction.
C6-C7: reflex center for increasing generalized vasoconstriction and myocardial tone.
T1-T3: initiates lung reflex dilation (eg, inspiratory dyspnea), dilates stomach body, and contracts pylorus; inhibits heart action (ie, antitachycardia reflex) and gastric hypermotility.
T4: initiates cardiac and aortic dilation and inhibits viscerospasms.
T5: initiates pyloric and duodenal dilation when applied to the right side.
T6: initiates gallbladder contraction when applied to the right side.
T7: initiates slight visceromotor renal dilation when applied bilaterally and stimulates hepatic function.
T8-T9: initiates gall duct dilation.
T10-T11: initiates slight visceromotor renal contraction, enhances pancreatic secretion, relaxes intestines and colon, and stimulates adrenals when applied bilaterally; initiates splenic contraction (and vascular rbc’s) when applied on the left.
T12: initiates prostate contraction and tone of the cecum and bladder sphincter.
L1-L3: initiates uterine body, round ligament, and bladder contraction; pelvic vasoconstriction; vesicular sphincter relaxation.
L4-L5: initiates sigmoidal and rectal contraction; increases tone of lower bowel.
Vagal Tone. Johnson states that the tone of the parasympathetics may be increased through several methods such as
(1) applying sinusoidal stimulation to the area of C7,
(2) moderate percussion of the C7 spinous process,
(3) extending the neck to raise the hyoid,
(4) mild percussion of the upper cervical area,
(5) pressure in an intercostal space, and
(6) rectal dilation.
It has been Johnson’s experience when sinusoidal current is used that stimulation should not exceed 30 sec, with current alternated 5 sec on and 5 sec off, at 6-8 cycles, otherwise the reflex becomes exhausted. Others have found that vagal inhibitory action can also be aroused through several methods such as
(1) pinching the sternocleidomastoideus between the thumb and the forefinger and working deeply under the muscle’s medial margin,
(2) bilateral submastoid pressure,
(3) concussion over the T2-T4 spinous processes, and
(4) paravertebral pressure near T4.
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