Electromyography Monitoring for Complete and Incomplete Transections of the Spinal Cord in Humans Who Received a Cell Therapy Combined with LASERPONCTURE ® or LASERPONCTURE ® Only : Methodology , Analysis , and Results

The most difficult thing to achieve in the case of a spinal cord injury (SCI) and/or spinal trauma is to objectively assess the progress and voluntary motor recovery. The exercise becomes even more hazardous when one sets as a preliminary rule that each SCI or spinal trauma is unique and original both in its bone and spinal anatomical location, and in its consequences on the whole body. Starting from here, we assume that there is no standard approach but an observation process to be adapted for each special case. For example, two SCI individuals suffering from a complete transection of the spinal cord at anatomical level T5 will show totally different clinical pictures. They may be affected, or not, by spasticity – even flaccidity for some cases with a loss of mass muscle – or neurological pain. Each case is different and should have its own approach. Before any examination can take place, a preliminary face-to-face interview to understand the injury and its manifestations is fundamental. Every single thing should be investigated during this interview whether it concerns the motor or sensory level, as well as the bowels and bladder functions, and sexual function. The information collected should be as thorough as possible. A psychological check-up should not be discarded either as it provides the SCI individual's input regarding his/her body image and relations s/he has with others. Electromyography monitoring is a pioneering work published in the peer-review journal Cell Transplantation and presented in various scientific meetings. Avicenna (980-1037), a Persian philosopher and physician commonly known as Ibn Sīnā, was credited with the following quotation “the sick person cannot only be encompassed through his disease”.


Introduction
The most difficult thing to achieve in the case of a spinal cord injury (SCI) and/or spinal trauma is to objectively assess the progress and voluntary motor recovery.The exercise becomes even more hazardous when one sets as a preliminary rule that each SCI or spinal trauma is unique and original both in its bone and spinal anatomical location, and in its consequences on the whole body.Starting from here, we assume that there is no standard approach but an observation process to be adapted for each special case.For example, two SCI individuals suffering from a complete transection of the spinal cord at anatomical level T5 will show totally different clinical pictures.They may be affected, or not, by spasticity -even flaccidity for some cases with a loss of mass muscle -or neurological pain.Each case is different and should have its own approach.Before any examination can take place, a preliminary face-to-face interview to understand the injury and its manifestations is fundamental.Every single thing should be investigated during this interview whether it concerns the motor or sensory level, as well as the bowels and bladder functions, and sexual function.The information collected should be as thorough as possible.A psychological check-up should not be discarded either as it provides the SCI individual's input regarding his/her body image and relations s/he has with others.Electromyography monitoring is a pioneering work published in the peer-review journal Cell Transplantation and presented in various scientific meetings.Avicenna (980-1037), a Persian philosopher and physician commonly known as Ibn Sīnā, was credited with the following quotation "the sick person cannot only be encompassed through his disease".

Aim
The aim of this chapter is to highlight that a voluntary muscle activity below the SCI can be measured by electromyography monitoring.

Methods and material
Exclusion criteria:  depression  hyper spasticity Inclusion criteria:  complete or incomplete transection of the spinal cord treated by Laserponcture ® only or Laserponcture ® combined with a stem cell therapy  cases with flaccidity post injury Guidance and instructions for the patients were to voluntary contract the tested muscles (quadriceps, abdominal muscles, etc.) on demand.The sessions were also recorded on video.The cases studied were selected according to the severity of the injury on MRI.For each recording, a zeroing was performed to erase the parameters of the previous test with the aim of monitoring a change in the spasticity appearing during the examination.

Commentary
During the recordings, the following observations can be made: a. a low curve when the individual is at rest predicts an increased response to the voluntary act during the next test

Different types of activity recordings
Examples of graphs and their interpretation   ... 187

Front face Squares: quadriceps
Triangles: abdominal muscles (upper, middle, and lower abdominal muscles) Rounds: gastrocnemius Other muscles can also be tested.

Case study
6.1 Quadriplegia with a complete SCI transection and Laserponcture ® only No MRI available for this case.

Conclusion
This chapter underlines that it is important to track voluntary muscle activity below a SCI in order to possibly determine recoveries to come.Electromyography monitoring suggests that there is muscle activity even though it may not be visible.Despite a complete transection of the spinal cord, it also suggests that back-up networks develop to carry the brain orders through the body.It also shows that the information can be transmitted through other means, such as wavelengths, when there is a complete anatomical transection of the spinal axis, that is a tissue discontinuity preventing neurotransmitters to travel through synapses.The information sent by the brain goes from an electrochemical state (neurotransmitters) to an electromagnetic state (wavelengths).It also suggests that the brain deals with two languages of different nature, the electrochemical transmitter and the electromagnetic signal, which can relay each other.

Fig. 3 .
Fig. 3. Example of a muscle activity interference caused by spasticity.

Fig. 6 .
Fig. 6.Voluntary muscle contraction against resistance (gastrocnemius muscles; the operator's hand has no direct contact on the patient skin).
Laserponcture ® combined with a therapy based on multiple autologous stem cells The American Spinal Injury Association Classification of Spinal Cord Injury defines a complete or incomplete SCI in its ASIA Impairment Scale as the following: -A = Complete: no motor or sensory function is preserved in the sacral segments S4-S5; -B = Incomplete: sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5; -C = Incomplete: motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3; -D = Incomplete: motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more; -E = Normal: motor and sensory functions are normal.