Related to Material relating to the rehabilitation of spinal and spinal cord injuries
Description:

'In a previous paper (Gutmann and Guttmann, 1942) it was shown that galvanic exercise of denervated muscles to a great extent counteracted the atrophyof the paralysed muscles and accelerated return to their initial volume after re-innervation...

The experiments which are described in this paper provide further evidences of the beneficial effect of galvanic exercise on denervated and re-innervated muscles. An attempt to find the optimum manner of application, time for starting, duration, and strength of treatment is also described.' (7)

 

'The experiments may be divided into two groups. (a) Treatment of denervated muscles without possibility of re-innervation. The peroneal nerve was cut and resected as far as possible on both sides, and the absence of re-innervation of the peripheral stump was confirmed at biopsy. A distinction was made between short-term denervation (37 days) and long-term denervation (67-150 days) and in the second group between early and late start of treatment also. (b) Treatment of muscles in which re-innervation was allowed: (1) after crushing the nerve; (2) after division and primary suture of the nerve; (3) after division and secondary suture by cross union...

Galvanic current only was used in all cases as this type of current is mostly used in man... The initial standard method of treatment was 20 minutes galvanic exercise daily at a current strength of 4-6 ma.' (7)

 

'muscles were excised... from the living animal at biopsy, put in a Petri dish with Ringer-soaked gauze and weighed after blotting twice with filter paper.' (8)

 

'In a previous paper it has been shown that after crushing the peroneal nerve with fine watchmaker's forceps, about 80 mm. from the M. peroneus longus, 20 minutes daily treatment with a current strength of about 5 ma. produced no significant difference in the time of onset of motor recovery (Gutmann and Guttmann, 1942).' (12)

 

'The results of all these experiments show clearly that the effect of galvanic exercise varies with its time and duration of application. The effect in preventing atrophy was found to be especially marked after daily application, with a current strength sufficient to elicit vigorous contractions of the muscles. The effect was greater the earlier the [(15-16)] treatment was started. Twenty minutes galvanic exercise gave very satisfactory results and has been used as the standard time of application, but 10 minutes daily exercise gave results only slightly inferior, while 30 minutes exercise showed little superiority to 20 minutes. No damage of denervated muscles was detected by the longer duration of daily treatment. These findings, which agree with those of Fischer (1939) and Hines,et al. (1943) do not support the view held by many physiologists and clinicians that galvanic exercise of paralysed muscles should not be used during the period of denervation, especially in the early stages. In fact no harmful effect of fatigue on denervated muscles of the rabbit was found and the results indicate that fatigue of denervated muscles by galvanic exercise in man may not be so harmful as formerly thought.' (15-16)

 

'After re-innervation of a muscle its "trophic state" will be restored spontaneously to a greater or less degree by voluntary impulses. Although there cannot be any doubt that in man active exerciseby voluntary impulses is the best treatment for a recovering muscle, it must be remembered that at the time of motor recovery muscle atrophy is still very marked and the power of voluntary or reflex movement is limited. Moreover, longer times of denervation and less successful re-innervation can be expected in most of the human cases. It is, therefore, advisable to continue electrical exercise until motor recovery is satisfactory, for as clinical experience has shown electrotherapy is most useful in augmenting active exercise in cases in which the patient co-operates poorly although re-innervation of the muscles is taking place (Guttmann L.,1942).' (16)

 

'The demonstration of the beneficial effect ofgalvanic exercise on denervated muscles has an important bearing on the problem of the cause of denervation atrophy which is still the subject of controversy. The theory of Langley and Kato (1915) that atrophy of denervated muscles is a fatigue phenomenon caused by ceaseless fibrillation was widely accepted until quite recently (Tower, 1937). The negative experimental results of Langley and Kato on electrotherapy and their statement that "the fact that the denervated muscles are in a state of continuous fibrillation makes it a priori an open question whether further activity caused by electrical stimulation will be beneficial" seems to have influenced many clinicians to condemn galvanic exercise...

Most of the negative results of electrotherapy have been due to inadequate technique. The effect of the condensor discharges used by Langley and Kato (1915) was very small and they stated "either then the daily induced contractions were insufficient in number to replace the normal contractions or the change in the muscles is not simply an inactivity atrophy." In fact, comparison of intensive within sufficient treatment, described here, indicates that the first explanation of Langley and Kato is the correct one (see also Fischer, 1943).' (16)

 

'The experiments described here reveal the great importance of activity as the leading factor in preventing muscular atrophy. Although the present experiments... do not prove that inactivity is the only cause of atrophy after denervation, they show clearly that the impulses which are responsible for the normal muscular activity and which are lost after denervation can be effectively replaced by galvanic exercise. Activity appears to be the important factor for the healthy "trophic state" of a muscle.' (17)

 

note: 'The authors are very indebted to Mr. J. Z. Young for his help and advice throughout the whole course of this work and for revision of the paper.' (17)