Textbook of Medical Physiology

Guyton, Arthur C.

doi:10.1097/00000441-196701000-00031

Cited by 988 publications

(1,572 citation statements)

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“…2,3 If these electrical pulses are applied to motor nerves they can elicit Action Potentials (AP) that propagate along the axons towards the target muscle. Once these AP reach the muscle they cause muscle contraction.…”

Section: Technical Backgroundmentioning

confidence: 99%

Functional electrical stimulation for grasping and walking: indications and limitations

et al. 2001

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This review describes the state of art in the ®eld of Functional Electrical Stimulation (FES) and its impact on improving grasping and walking functions in acute and chronic Spinal Cord Injured (SCI) patients. It is argued that during the early rehabilitation period the FES systems with surface stimulation electrodes should be used to assist training of hand and leg movements in SCI patients. Our clinical trials have shown that a number of acute SCI patients with impaired walking and grasping functions could improve these functions due to training with an adjustable FES system to the point that they ®nally did not need the FES system to carry out these tasks. Other acute SCI patients, who did not recover the desired function, were enabled to perform either walking or grasping with the FES assistance. We believe that the subjects who can perform grasping or walking with the help of FES, and still use the neuroprosthesis 6 months after being subjected to the FES training, should consider the FES system as a prosthetic device in Activities of Daily Living (ADL). Despite the signi®cant technical progress achieved in the last 10 to 15 years in the FES ®eld, there is a general consensus that these systems are not su ciently advanced and that they need further development. The limited acceptance of the FES technology can be in part explained by the fact that it is not completely mature and that the patients still require daily assistance to use the FES systems. Nevertheless the present FES treatments combined with conventional occupational and physical therapy still remain the most promising approach in rehabilitating SCI patients. In this review, advantages and limitations of di erent FES systems that are used to restore grasping and walking functions are discussed. Spinal Cord (2001) 39, 403 ± 412

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Section: Technical Backgroundmentioning

confidence: 99%

Functional electrical stimulation for grasping and walking: indications and limitations

et al. 2001

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“…Ingestion of diet containing highly unsaturated fatty acids usually depresses the blood cholesterol concentration to a slight moderate amount [Tables 8–11]. [14]…”

Section: Discussionmentioning

confidence: 99%

Clinical trial on different dose patterns of Shodhanartha Abhyantara Snehana

Patil¹,

Thakar

Baghel

2013

AYU

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Internal oleation (Snehana) is a major preparatory procedures performed before Bio-Purification (Shodhana). Oleation leads and decides the total outcome of the Bio-purification therapy; hence, standard guidelines are needed for performing the internal oleation in an effective manner and also for avoiding the inadequate and excess oleation. It is obligatory to start and increase the dose of lipids (Sneha) in appropriate and judicious way considering the bio-fire (Agni) and nature of bowel habit (Koshtha) of the subject. The outcome of Bio-Purification depends upon proper mobilization of Dosha from the periphery (Shakha) to gastrointestinal tract (Koshtha); which is achieved with the help of oleation therapy (Snehana Karma) and sudation therapy (Svedana Karma). This clinical study was carried out on 29 subjects to standardize the dose and duration of internal oleation and to develop the oleation grade for the assessment of internal oleation therapy. The selected subjects were randomly divided into two groups, in which group A was given fixed increase dose of ghee and in group B non-fixed increase dose was given. Results of this study show that the total percentage of oleation was 33.57% in group A and it was 45.28% in group B. Subjects of Group B (non-fixed dose schedule) have shown better oleation in all the aspects, i.e. duration, oleation grade, and purification grade.

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“…19 We argue, however, that these complex (supposedly) spinal cord reflexes and automatisms, [20][21][22] which are elicited in some 'brain-dead' patients, are very similar to some stereotyped movements mediated by the brain stem, such as the rotational movement of the head (controlled by the interstitial nucleus) and the raising and flexing movements (controlled by the prestitial and precommissuralis nuclei, respectively) of the head and body. 23 These stereotyped movements are feasible only when the above nuclei of the mesencephalon and lower diencephalon are functioning. Therefore, the similarity of these movements to the abovementioned stereotyped ones could raise the suspicion that the involved nuclei of the brain stem might be viable in patients, otherwise diagnosed as 'brain-dead'.…”

Section: Definition-criteria Inconsistenciesmentioning

confidence: 99%

“…16 Most neurologists claim that these movements originate in the spinal cord, and are therefore, not inconsistent with the diagnosis of 'brain death'. Nevertheless, in patients with complete high cervical cord transection all skeletal muscle reflexes integrated in the spinal cord are completely blocked in the early phase of the spinal shock; thus, these patients are generally flaccid for 1-4 days after the lesion of the spinal cord, 24 while according to Guyton and Hall 25 , skeletal muscle reflexes do not develop in humans until 2 weeks to several months after spinal cord transection. In addition, Shewmon 26 has recently pointed out that the patients with complete cessation of function of the brain (including that of the brain stem)F'brain-dead' patientsFshould be physiologically equivalent to patients with complete high cervical cord transection; therefore, one might expect that 'brain-dead' patients should also be generally flaccid for 1-4 days, as it happens in patients with complete spinal cord transection.…”

Section: Definition-criteria Inconsistenciesmentioning

confidence: 99%

‘Brain death’: should it be reconsidered?

Karakatsanis

2007

Spinal Cord

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Objective: To evaluate whether current clinical criteria and confirmatory tests for the diagnosis of 'brain death' satisfy the requirements for the irreversible cessation of all functions of the entire brain including the brainstem. Data sources: Medical, philosophical and legal literature on the subject of 'brain death'. Data extraction/synthesis: We present four arguments to support the view that patients who meet the current operational criteria of 'brain death' do not necessarily have the irreversible loss of all brain (or brainstem) functions. First, many clinically 'brain-dead' patients maintain residual vegetative functions that are mediated or coordinated by the brain or the brainstem. Second, it is impossible to test for any cerebral function by clinical bedside exam, because the tracts of passage to and from the cerebrum through the brainstem are destroyed or nonfunctional. Furthermore, since there are limitations of clinical assessment of internal awareness in patients who otherwise lack the motor function to show their awareness, the diagnosis of 'brain death' is based on an unproved hypothesis. Third, many patients maintain several stereotyped movements (the so-called complex spinal cord responses and automatisms) which may originate in the brainstem. Fourth, not one of the current confirmatory tests has the necessary positive predictive value for the reliable pronouncement of human death. Conclusion: According to the above arguments, the assumption that all functions of the entire brain (or those of the brainstem) in 'brain-dead' patients have ceased, is invalidated. Reconsideration of the current concept of 'brain death' is perhaps inevitable.

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Textbook of Medical Physiology

Cited by 988 publications

References 0 publications

Functional electrical stimulation for grasping and walking: indications and limitations

Functional electrical stimulation for grasping and walking: indications and limitations

Clinical trial on different dose patterns of Shodhanartha Abhyantara Snehana

‘Brain death’: should it be reconsidered?

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