Attention 6-year M.D. Program, 2nd year Students!
|Pathophysiology of Locomotor Organs namely (Clinical Neurophysiology)||ECTS credits: 2|
|Stage of study:||5th 6th semesters|
|Type and length of course:||
|Practicals:||22 hours with patients (a group of students is subdivided into subgroups, “C” category practices)|
Main pathological phenomena diagnosed in muscles and nerves as well as in the supraspinal and spinal cord centers with the clinical neurophysiological methods are presented for students during seminars and clinical examinations with patients. They are explained during practical examinations which are performed by students on healthy volunteers and on patients (with their previous consent) for comparison. All examinations are superintended by Assistants and the Course Coordinator. In fact, this is introducing to the Evidence Based Medicine “Clinical Neurophysiology” diagnostics in cases of the neuromusclular disorders.
|Coordinator of the elective course:||Professor dr Juliusz Huber and three assistants (All teachers were trained and certified as the specialized neurophysiologists by The Polish Association of the Clinical Neurophysiology|
Chair of Department of Pathophysiology of Locomotor Organs
Wiktor Dega Orthopaedic and Rehabilitation Clinical Hospitalenter "D", second floor, "EMG" Department, telephone: (61) 8-310-230
|Teachers:||Coordinator||Professor Juliusz Huber (neurophysiologist) firstname.lastname@example.org|
Aleksandra Kulczyk, MD, PhD
Agnieszka Wincek PhD
Upon completing the course the student should be competent at:
-recognize the origin of neurogenic and myogenic pathologies in muscle motor units with EMG recordings,
-find out the pathological changes in sensory and motor fibers of nerves supplying areas of the human body with the methods of clinical neurophysiology (electroneurographical-ENG examinations of SCV, M, F, H and A waves as well as the “blink reflex” method),
-recognize the changes in afferent and efferent transmission at spinal or supraspinal levels with SEPs (somatosensory evoked potentials examinations performed with electrical pulses) and MEPs (motor evoked potentials induced with the magnetic field) in clinical neurophysiological diagnostics,
-recognize the neuromuscular transmission disorders with the method of clinical neurophysiology (“decrement” examinations of high-frequency electrical stimulation of nerves),
Have knowledge of
-general rules of practical using and proper applying the clinical neurophysiological methods to the diagnostic of sensory and motor innervations of human body areas in cases of neurogenic disorders
Be familiar with
-aspects of applying the clinical neurophysiological methods of examination to the diagnostic of sensory and motor innervation of human body in cases of different pathologies basing on the rules of differential diagnostics (EBM)
1. Motor units based on the clinical electromyography (EMG) approach (classification, neurophysiological properties, activity of motoneurones and the muscle fibres in normal and pathological states)
2. Motor units under the neurogenic and myogenic states – differences in spontaneous discharges and during the muscle voluntary contraction
3. Peripheral motor and sensory transmission in electroneurographic studies (ENG; M, F, H and A waves as well as SCV potentials) in normal subjects and in mononeuropathies and polyneuropathies in patients with different movement disorders
4. Supraspinal and spinal cord afferent and efferent transmission neurophysiological examinations with SEPs and MEPs
5. Diagnostic methods of clinical neurophysiology. Their applications in neurology, neuroorthopaedy, neurosurgery and neurorehabilitation: electromyography (EMG) global (surface) and elementary (needle), EMG analysis and the interference pattern, spontaneous activity recorded from muscles, neurogenic and myogenic changes in motor units, electroneurography (ENG; nerve conduction studies), MEPs and SEPs at different levels of the efferent and afferent transmission, sensory perception curves (intensity of current versus stimulus duration curves; IC-SD method) in cases of axonotmesis and neurotmesis and regeneration processes comparing with von Frey's filament method
6. Reference values in neurophysiological examinations, interpretation of results, correlations with other clinical examinations with the special reference to the high-sensitivity neuroimaging examinations
7. Examples of neurophysiological examinations (as above) among healthy volunteers
8. Neurophysiological studies of neuromuscular transmission and neuromuscular disorders (Myasthenia gravis, Lambert-Eaton syndrome)
9. Application of neurophysiological methods in degeneration and regeneration nerve studies in patients after brachial plexus injury and carpal tunnel syndrome as well as the facial nerve injuries
10. Examples of complex neurophysiological studies in peripheral mono- and some of polyneuropathies: carpal tunnel syndrome, facial nerve palsy, blink-reflex studies
Kimura J.: Electrodiagnosis in diseases of nerve and muscle, Principles and Practise, Oxford University Press, 2001.
Preston D.C., Shapiro B.E.: Electromyography and neuromuscular disorders, ELSEVIER, Butterworth Heinemann, 2005.
Lenman J.A.R., Ritchie A.E., Clinical Electromyography, Churchill Livingstone, 1987.
|Form of final assessment:||
Ten points of multiple choice questions test (only one answer is correct). The final test will cover all material in the course. Obligatory the student must practically shows his/her skills with performing the neurophysiological clinical examination with the patient treated because of movement disorders of different origin. Evidence Based Medicine approach is cordially invited with performing examination of the patient.