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Diagnonistic Test

Myelography (Myelogram)

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Definition:

A myelogram is an x-ray test in which dye is injected directly into your spinal canal to help show places where the vertebrae in your back may be pinching the spinal cord.It is utilized to diagnose disorders of the spinal canal and cord, such as nerve compression causing pain and weakness.It is sometimes used to help diagnose back or leg pain problems, especially if surgery is being planned.

The test is usually performed on an outpatient basis at a hospital or other medical facility by a neuroradiologist. Neuroradiology is a sub-specialty of radiology that conducts studies of the central nervous system.
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A myelogram requires introduction of radiographic contrast media (dye) into the sac (dura) surrounding the spinal cord and nerves. The patient lies on their stomach during the test. After the skin area has been numbed, the dye is injected into the spinal sac followed by x-rays, CT, or MRI scans. After the images are processed, a neuroradiologist interprets the results and sends a report to the referring physician.

Following the myelogram, the patient is taken to a recovery area where they rest lying down with their head elevated for several hours. Once at home, quiet non-strenuous activities are recommended for 24 hours to allow the puncture site to heal. Plenty of fluids (e.g. water, juice) should be consumed to clear the dye from the body.

Important Considerations :-
Certain medical conditions, drugs, or allergies should be discussed with the referring physician prior to the myelogram. Some of these topics are listed below.

1. Metallic components such as a pacemaker, aneurysm clip, or other metal implants prohibit the patient from an MRI scan.
2. Allergies to an IVP (intravenous pyelography) or other contrast dye should be reported. Adverse reactions include hives, swelling, and difficulty breathing. Fore knowledge of an allergy can often be controlled by pre-medicating.
3. Epilepsy or seizure disorder, and if medication is taken to control episodes.
4. Angina or kidney disorders.
5. Diabetic patients who control their disease with medication need to discuss this with their physician. Certain drugs may need to be discontinued for 48 hours prior to the test.
6. Blood thinners may need to be discontinued prior to the test.
7. Difficulty lying flat on the stomach or inability to remain still.

How do you prepare for the test?
Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office, or to x-ray dyes. You should also tell your doctor if you might be pregnant.

1. The patient will need someone to drive them home following the test. This should be prearranged in advance of the scheduled test day.
2. Leave valuables at home.
3. Bring prior relevant x-rays, CT or MRI scan for the neuroradiologist’s review.
4. Do not eat anything after midnight the night before the myelogram. Some patients experience side effects such as nausea and vomiting. Clear liquids are acceptable.
5. Take scheduled medication with clear liquid, unless the referring physician has instructed otherwise (e.g. diabetics).
What happens when the test is performed?
Patients usually wear a hospital gown. Typically, you lie on your side with your knees curled up against your chest. In some cases, the doctor asks you to sit on the bed or a table instead, leaning forward against some pillows.

The doctor feels your back to locate your lower vertebrae and feels the bones in the back of your pelvis. An area on your lower back is cleaned with soap. Medicine is injected through a small needle to numb the skin and the tissue underneath the skin in the area. This causes some very brief stinging.

A different needle is then placed in the same area and moved forward until fluid can be injected through it into the spinal canal. This fluid is a type of dye that shows up on x-rays; this allows your doctors to get a clear picture of the fluid space around your spinal cord and to see places where the space is narrowed by bones around it. Because the needle must be placed through a small opening between two bones, the doctor must sometimes move the needle in and out several times to locate the opening. Because of the numbing medicine used in this area, most patients experience only a feeling of pressure from this movement. Occasionally some patients do get a sharp feeling in the back or (rarely) in the leg. Let your doctor know if you feel any pain.

Once the dye has been injected, the needle is removed and several x-ray pictures are taken of your back. Sometimes a CT (computed tomography) scan picture is taken instead.

The process usually involves lying face down on a table, and your feet are secured tightly with straps to the table itself. The Radiologist will perform the spinal tap, introducing the contrast medium. The table is then slowly rotated in a circular motion, first down at the head end for approximately 4-6 minutes, then rotated up at the head end for the same duration. Several more minutes lying flat and the process is complete. This movement insures the contrast has sufficiently worked its way through the spinal cord.

It is very important to not lift anything for at least 24 hours following this procedure, and to lie flat for at least the same amount of time. There is a high chance that excessive movement or any lifting will release the ‘plug’ at the site of the spinal tap, and CSF will then drain from your brain and cause very severe headaches. This can be corrected by returning to the medical facility and having them perform a ‘blood patch’, a small amount of blood from your arm, injected into the exact spinal tap location, to stop the leaking of CSF.
What are the benefits vs. risks?
Benefits:-

* Myelography is relatively safe and painless.
* When a contrast material is injected into the space surrounding the spinal cord, it allows the radiologist to view outlines of the different areas of the spine that usually are not visible or distinguishable on x-rays.
* No radiation remains in a patient’s body after an x-ray examination.
* X-rays usually have no side effects in the diagnostic range*Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.

# Minimizing Radiation Exposure:State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures that those parts of a patient’s body not being imaged receive minimal radiation exposure.

Risks:-

* There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
* The effective radiation dose from this procedure is about 4 mSv, which is about the same as the average person receives from background radiation in 16 months. See the Safety page for more information about radiation dose.
* Although it is uncommon, headache due to the needle puncture following myelography is one risk. The headache, when it occurs, usually begins when the patient begins to sit upright or stand. One of the common features of this type of headache is that it is improved when the patient lays flat. When present, the headache usually begins within 2-3 days after the procedure. Rest while laying on one’s back and increased fluid intake readily relieve mild headaches, but more severe headaches may call for medication. In rare circumstances some patients continue to experience spinal headaches, which may necessitate a special procedure to stop leakage of cerebrospinal fluid from the puncture site.
* Adverse reactions to injection of contrast material during a myelogram are infrequent and usually mild in nature, including itching, rash, sneezing, nausea, or anxiety. The development of hives or wheezing may require treatment with medication. More severe reactions involving the heart or lungs are rare.
* Other rare complications of myelography include nerve injury from the spinal needle and bleeding around the nerve roots as they enter or exit the spinal cord. In addition, the membrane covering the spinal cord may become inflamed or infected. Seizures are a very uncommon complication of myelography.
* There is a very small risk that contrast material will block the spinal canal, which can make surgery necessary.
* Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

If symptoms persist 48 hours, contact the referring physician and/or medical facility.

Must you do anything special after the test is over?
Nothing. Usually a Band-Aid is the only dressing necessary for your back.

How long is it before the result of the test is known?
It takes about an hour to have your x-rays or CT scan developed and some time for the films to be reviewed by a radiologist. Usually your doctor can get the results within a day.

Limitations:–

* The most significant limitation of myelography is that it only sees inside the spinal canal and the very proximal nerve roots. Abnormalities outside these areas may be better imaged with MRI.
* Myelography usually is avoided during pregnancy because of the potential risk to the baby.
* The findings may not be accurate if the patient moves during the exam.
* It may be difficult to inject contrast material in patients with structural defects of the spine or some forms of spinal injury.
* Myelography cannot be done if the injection site is infected.

Resources:
https://www.health.harvard.edu/diagnostic-tests/myelography.htm
http://www.spineuniverse.com/displayarticle.php/article249.html
http://en.wikipedia.org/wiki/Myelography
http://www.radiologyinfo.org/en/info.cfm?pg=myelography

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Computed Tomography (CT Scan) for Back Problems

The prototype CT scanner
Image via Wikipedia

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Definition:
Computed tomography (CT) scan, also called computerized axial tomography (CAT) scan, is used to create cross-sectional images of structures in the body. In this procedure, x-rays are taken from many different angles and processed through a computer to produce a three-dimensional (3-D) image called a tomogram.

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CT scans are pictures taken by a specialized x-ray machine. The machine circles your body and scans an area from every angle within that circle. The machine measures how much the x-ray beams change as they pass through your body. It then relays that information to a computer, which generates a collection of black-and-white pictures, each showing a slightly different “slice” or cross-section of your internal organs. Because these “slices” are spaced only about a quarter-inch apart, they give a very good representation of your internal organs and other structures. Doctors use CT scans to evaluate all major parts of the body, including the abdomen, back, chest, and head.

A CT scan is not a very common test to have done for back problems. It does a better job showing the abdominal internal organs than showing details of the bones in the spine. But some back pain is caused by problems in these internal organs, such as the pancreas or the kidney. The CT scan is an excellent way to examine these organs. Also, the CT scan can be combined with a test called a “myelogram” (discussed separately) to give a clear view of the spinal cord and places where the vertebral bones might be pinching it.

Why It Is Done
A CT scan of the spine is done to:

*Look at the bones of the spine (vertebrae).

*Find problems of the spine, such as tumors, fractures, deformities, infection, or narrowing of the spinal canal (spinal stenosis).

*Find a herniated disc of the spine.

*Check to see if osteoporosis has caused compression fractures.

*Check on problems of the spine that have been present since birth (congenital).

*Look at problems seen during a standard X-ray test.

*Check how well spinal surgery or therapy is working for a spine problem.

How do you prepare for the test?
If you are having an abdominal CT scan, you might have to fast 2–4 hours before your test. You also may have to drink a large quantity of oral contrast, a fluid that will show up on the CT scan and help define the lining of some internal organs. Tell your doctor if you’re allergic to x-ray contrast dyes, may be pregnant, or have diabetes and take insulin. Insulin can cause hypoglycemia after missing a meal.

What happens when the test is performed?
The test is done in the radiology department of a hospital or in a diagnostic clinic. You wear a hospital gown and lie on your back on a table that can slide back and forth through the donut-shaped CT machine.

During the test, you will lie on a table that is attached to the CT scanner, which is a large doughnut-shaped machine. The CT scanner sends X-rays through the body. Each rotation of the scanner takes a second and provides a picture of a thin slice of the organ or area being studied. One part of the scanning machine can tilt to follow the curve of your spine. All of the pictures are saved as a group on a computer. They also can be printed.

In some cases, a dye (contrast material) may be put in a vein (IV) in your arm or into the spinal canal (intrathecally). The dye make structures and organs easier to see on the CT pictures. The dye may be used to check blood flow and to look for tumors, areas of inflammation, or nerve damage.

The technologist moves the table with a remote control to enable the CT machine to scan your body from all of the desired angles. You will be asked to hold your breath for a few seconds each time a new level is scanned. The technologist usually works the controls from an adjoining room, watching through a window and sometimes speaking to you through a microphone. A CT scan takes about 30–45 minutes. Although it’s not painful, you might find it uncomfortable if you don’t like to lie still for extended periods.

How It Feels
You will not have pain during the scan. The table you lie on may feel hard and the room may be cool. It may be hard to lie still during the test.

Some people feel nervous inside the CT scanner.

If a medicine to help you relax (sedative) or a dye (contrast material) is used, an IV is usually put in your hand or arm. You may feel a quick sting or pinch when the IV is started. The dye may make you feel warm and flushed and give you a metallic taste in your mouth. Some people feel sick to their stomach or get a headache. Tell the technologist or your doctor how you are feeling.

Risk Factors:

The chance of a CT scan causing a problem is small. The contrast dye used in the test can damage your kidneys, especially if they are already impaired by disease.However, some newer dyes are less likely to cause kidney injuries. If kidney damage does occur, this is usually temporary, although in some rare cases it becomes permanent. If you are allergic to the dye used in the procedure, you may get a rash or your blood pressure may drop enough to make you feel faint until you get treatment. As with x-rays, there is a small exposure to radiation. The amount of radiation from a CT scan is greater than that from regular x-rays, but it’s still too small to be likely to cause harm unless you’re pregnant.
If you have diabetes or take metformin (Glucophage), the dye may cause problems. Your doctor will tell you when to stop taking metformin and when to start taking it again after the test so you will not have problems.You may have nausea or vomiting after the test.

There is a small chance of an infection at the needle site on your spine or bleeding into the space around the spinal cord.Intrathecal injections may cause a headache. On rare occasions, seizures may occur after an injection of intrathecal contrast material.

There is a slight chance of developing cancer from having tests that use radiation. The chance is higher in children or people who have many radiation tests. If you are concerned about this risk, talk to your doctor about the amount of radiation this test may give you or your child and confirm the test is needed.

Must you do anything special after the test is over?
Nothing.

Results
A computed tomography (CT) scan uses X-rays to make detailed pictures of the spine and vertebrae in the neck (cervical spine), upper back (thoracic spine), or lower back (lumbosacral spine).

The radiologist may discuss the CT scan with you right after the test. However, complete results usually are ready for your doctor in 1 to 2 days.

If you face any problem After the test is over
Call 911 or other emergency services immediately if you have a seizure.

Call your doctor immediately if you:

*Have pain, weakness, or numbness in your legs.
*Have a severe headache.
*Have a headache that lasts more than 24 hours.
*Feel extremely irritable.
*Have problems urinating or having a bowel movement.
*Develop a fever.

What Affects the Test
The following may stop you from having the test or may change the test results:

*Pregnancy. CT scans are not usually done during pregnancy.

*Barium and bismuth used for another test. These substances show up on a CT scan. If a CT scan of the lower back is needed, it should be done before any tests that use barium, such as a barium enema.

*Metal objects in the body. These items, such as surgical clips or metal in joint replacements, may prevent a clear view of the body area.

*You are not able to lie still during the test.

What To Think About
*Sometimes your CT test results may be different than those from other types of X-ray tests, magnetic resonance imaging (MRI), or ultrasound scans because the CT scan provides a different view.

*CT results are often compared to positron emission tomography (PET) results to help find cancer. Some new scanners do both scans at the same time.

*MRI may give more information than a CT scan about the spinal discs and spinal cord. For more information, see the medical test Magnetic Resonance Imaging (MRI).

*When a CT scan of the spine is done with a myelogram, it is called a CT myelogram. An MRI of the spine is often done in place of a CT myelogram. For more information, see the medical test Myelogram.

Resources:
https://www.health.harvard.edu/diagnostic-tests/ct-scan-for-back-problems.htm
http://www.neurologychannel.com/diagnostictests/CTscan.shtml
http://health.yahoo.com/nervous-diagnosis/computed-tomography-ct-scan-of-the-spine/healthwise–tu6220.html

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Magnetic Resonance Imaging (MRI)

fMRI - Functional magnetic resonance imaging s...
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Definition:
MRI is a noninvasive technique for visualizing many different body tissues. Unlike x-rays, MRI does not use any radiation. Instead, it uses radio waves, a large magnet, and a computer to create images.As with a CT scan, which does use x-rays, each MRI picture shows a different “slice,” or cross-section, of the area being viewed. Because these slices usually are spaced about a quarter-inch apart, your doctor can get a detailed representation of a particular area.

Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the magnetic field temporarily aligns all the water molecules in your body. Radio waves cause these aligned particles to produce very faint signals, which are used to create cross-sectional MRI images — like slices in a loaf of bread.

The MRI machine can combine these slices to produce 3-D images that may be viewed from many different angles.

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You may click to see more MRI pictures

MRI of the brain and spinal cord:
MRI is the most sensitive imaging test of the brain and spinal cord. It’s often performed to help diagnose:

*Tumors
*Developmental abnormalities
*Aneurysms
*Stroke
*Pituitary gland diseases
*Multiple sclerosis
*Dementia progression
*Spinal cord injuries

Functional MRI of the brain (fMRI) can be used to identify important language and movement control areas in the brain in people who are being considered for brain surgery.

MRI of the heart and blood vessels:
An MRI that focuses on the heart or blood vessels can assess:

*The size and thickness of walls in the heart’s chambers
*The extent of damage caused by heart attack or heart disease
*The buildup of plaques and blockages in the blood vessels
*Structural problems in the aorta, such as aneurysms or dissections
*MRI of other internal organs

An MRI may be used to check for tumors or other abnormalities of the:

*Lungs
*Liver
*Kidneys
*Spleen
*Pancreas
*Uterus
*Ovaries
*Prostate
*Testicles

MRI of bones and joints
MRI may be used to help evaluate:

*Joint disorders, such as arthritis
*Joint abnormalities caused by traumatic or repetitive injuries
*Disk abnormalities in the spine
*Bone infections

MRI of the breasts
MRI may be used in addition to mammography to detect breast cancer, particularly in women who have dense breast tissue or who may be at high risk of the disease.


Risks Factors:
For most individuals, there are no known harmful effects from exposure to the magnetic field or radio waves used in making MRI images. Allergic reactions to the dye are very rare.

Preparation for the test:-
Before an MRI exam, eat normally and continue to take your usual medications, unless otherwise instructed. You will be asked to change into a gown and to remove:

*Jewelry
*Hairpins
*Eyeglasses
*Watches
*Wigs
*Dentures
*Hearing aids
*Underwire bras

The presence of metal in your body may be a safety hazard or affect a portion of the MRI image. Tell the technologist if you have any metal or electronic devices in your body, such as:

*Metallic joint prostheses
*Artificial heart valves
*An implantable heart defibrillator
*A pacemaker
*Metal clips to prevent aneurysms from leaking
*Cochlear implants
*A bullet, shrapnel or any other type of metal fragment

Also tell the technologist if you think you’re pregnant, because the effects of magnetic fields on fetuses aren’t well understood. Your doctor may recommend choosing an alternative exam or postponing the MRI.

It’s also important to discuss any kidney or liver problems with your physician and the technologist, because problems with these organs may impose limitations on the use of injected contrast agents during your scan

If you know you have an implant, or are concerned, discuss the issue with your doctor, as other options may exist. (Some pacemakers, for example, can be reprogrammed prior to an MRI so that they are not disrupted.)

An IV is inserted into a vein if the particular scan you’re having requires a dye to make areas of inflammation or abnormality easier to detect. This dye is called gadolinium, and is different from the contrast dye used for x-rays or CT scans. Before undergoing the scan, remove metal objects such as belt buckles or watches, which could dislodge in the presence of the magnet and hurt you.

What happens when the test is performed?

During the test:
The MRI machine looks like a tunnel that has both ends open. You lie down on a movable table that slides into the opening of the tunnel. A technologist monitors you from another room. You can talk with him or her by microphone.

The MRI machine creates a strong magnetic field around you, and radio waves are directed at your body. The procedure is painless. You don’t feel the magnetic field or radio waves, and there are no moving parts around you.

During the MRI scan, the internal part of the magnet produces repetitive tapping, thumping sounds and other noises. Earplugs or music may be provided to help block the noise. If you are worried about feeling claustrophobic inside the MRI machine, talk to your doctor beforehand. He or she may make arrangements for you to receive a sedative before the scan.

An MRI typically lasts about an hour. You must hold very still because movement can blur the resulting images. In some cases, contrast agents are injected into your veins to enhance the appearance of certain tissues or blood vessels in the images.

During a functional MRI, you may be asked to perform a number of small tasks — such as tapping your thumb against your fingers, rubbing a block of sandpaper or answering simple questions. This helps pinpoint the portions of your brain that control these actions.

After the test:
If you haven’t been sedated, you may resume your usual activities immediately after the scan. Nursing mothers shouldn’t breast-feed for 36 to 48 hours after an MRI if a contrast material was used. Very rarely, the contrast material can cause hives and itching.

A radiologist — a doctor specially trained to interpret MRIs — will analyze the images from your scan and report the findings to your doctor. Your doctor will then discuss any important findings and next steps with you.

It can be difficult if you are uneasy in tight spaces or have trouble lying flat for that amount of time. If you think you might have trouble getting through the procedure, talk to your doctor beforehand and discuss whether an anti-anxiety medicine might help. After the test is done, you can go about your normal activities.

How long is it before the result of the test is known?
MRI images are often recorded on film; if so, it will take at least an hour for the MRI department to develop the images and additional time for a doctor to examine and interpret them. If the images are stored in and displayed by a computer, there is no time required to develop the images, although the doctor’s interpretation still takes time. You can probably get preliminary results within a day or two, but the complete results might take four to seven days.

Resources:
http://www.mayoclinic.com/health/mri/MY00227
https://www.health.harvard.edu/diagnostic-tests/magnetic-resonance-imaging-of-the-brain.htm
http://www.draimaging.com/mri.htm

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Lumbar Puncture (or Spinal Tap)

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Definition:
A lumbar puncture, also known as a spinal tap, uses a needle to remove a sample of fluid from the space surrounding the spinal cord. This fluid is known as cerebrospinal fluid (CSF). The test is used to diagnose meningitis infections and some neurological conditions.

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It is a procedure to collect cerebrospinal fluid to check for the presence of disease or injury. A spinal needle is inserted, usually between the 3rd and 4th lumbar vertebrae in the lower spine. Once the needle is properly positioned in the subarachnoid space (the space between the spinal cord and its covering, the meninges), pressures can be measured and fluid can be collected for testing.

Cerebral spinal fluid (CSF) is a clear fluid that circulates in the space surrounding the spinal cord and brain. CSF protects the brain and spinal cord from injury by acting like a liquid cushion. CSF is usually obtained through a lumbar puncture (spinal tap).

Preparation for the Test:

You will need to sign a consent form, which is generally required when the procedure is done outside of an emergency situation. Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office.
Doctors routinely do a physical examination and in some cases order a brain scan before recommending a lumbar puncture, to make sure you do not have a medical condition that could put you at risk for movement of the brain during the procedure, a very rare but serious complication.

What happens when the test is performed?
Most patients wear a hospital gown. Typically, you lie on your side with your knees curled up against your chest. In some cases, the doctor asks you to sit on the bed or a table instead, leaning forward against some pillows.

The doctor feels your back to locate your lower vertebrae and feels the bones in the back of your pelvis. An area on your lower back is cleaned with soap. Medicine is injected through a small needle to numb the skin and the tissue underneath the skin in the area from which the sample is to be removed. This causes some very brief stinging.

A different needle is then placed in the same area and moved forward until fluid can be obtained through it from the spinal canal. Because the needle must be placed through a small opening between two bones, the doctor must sometimes move the needle in and out several times to locate the opening. Because of the numbing medicine used in this area, most patients experience only a sense of pressure from this movement. Occasionally some patients do get a sharp feeling in the back or (rarely) in the leg. Let your doctor know if you feel any pain.

Sometimes the doctor measures the pressure of the fluid before taking a sample. The pressure is measured with a tube that looks like a large thermometer held against the needle. The fluid sample collected is usually less than three tablespoons. You will not feel any discomfort when it is removed. After this, the needle is taken out. Usually a Band-Aid is the only dressing necessary.

The whole lumbar puncture, including set-up time, takes 30–45 minutes. The needle is in place for close to one minute.

Risk Factors:
The most common risk of a lumbar puncture is that it can cause a temporary headache. Lying down for a few hours after the test can make a headache less likely to occur. Other problems are rare and include infection or bleeding. Because the volume of fluid is small, a lumbar puncture almost never causes movement of the brain or spinal cord, a serious complication.

What Must you do special after the test is over?
You may be told to lie flat for a while after the test, sometimes for a few hours.

Time for the result of the test is known?
Depending on the tests being done on the fluid sample, results take anywhere from a few hours to a few days.
For more knowledge you may click to see:-…………………...(1).…….(2).…….(3)
Resources:
http://www.health.harvard.edu/diagnostic-tests/lumbar-puncture.htm
http://www.clarian.org/ADAM/doc/CancerCenter/10/000303.htm

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9587.htm

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Mind Power Moves Paralysed Limbs

Scientists have shown it is possible to harness brain signals and redirect them to make paralysed limbs move.

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The technology bypasses injuries that stop nerve signals travelling from the brain to the muscles, offering hope for people with spinal damage.

So far the US team from the University of Washington have only tested their “brain-machine interfaces” in monkeys.

The hope is to develop implantable circuits for humans without the need for robotic limbs, Nature reports.

Wired up
Spinal cord injuries impair the nerve pathways between the brain and the limbs but spare both the limb muscles and the part of the brain that controls movement – the motor cortex.

“Similar techniques could be applied to stimulate the lower limb muscles during walking” Says Lead researcher Dr Chet Moritz

Recent studies have shown that quadriplegic patients – people who have paralysis in all four limbs – can consciously control the activity of nerve cells or neurons in the motor cortex that command hand movements, even after several years of paralysis.

Using a gadget called a brain-machine interface, Dr Chet Moritz and colleagues re-routed motor cortex control signals from the brains of temporarily paralysed monkeys directly to their arm muscles.

The gadget, which is the size of a mobile phone, interprets the brain signals and converts them into electrical impulses that can then stimulate muscle to contract.

By wiring up artificial pathways for the signals to pass down, muscles that lacked natural stimulation after paralysis with a local anaesthetic regained a flow of electrical signals from the brain.

Life-changing
The monkeys were then able to tense the muscles in the paralysed arm, a first step towards producing more complicated goal-directed movements, such as grasping a cup or pushing buttons, say the researchers.

Lead researcher Dr Chet Moritz said: “This could be scaled to include more muscles or stimulate sites in the spinal cord that could activate muscles in a coordinated action.”

“Similar techniques could be applied to stimulate the lower limb muscles during walking.”

The scientists found the monkeys could learn to use virtually any motor cortex nerve cell to control muscle stimulation – it did not have to be one that would normally controlled arm movement. And their control over the muscles improved with practice.

The researchers say they need to do trials in humans, meaning a treatment could be decades away.

Dr Mark Bacon, head of research at the UK charity Spinal Research, said: “This is clearly a step in the right direction and proves the principle that artificially transducing the will to move generated in the brain with relevant motor activity can be achieved.

“However, these results have been produced in experimental models where there is no injury per se.”

He said injury-induced changes to the nerve circuits might hinder the technology’s application in real life.

Also, brain-machine interfaces communicate in only one direction – in this case from the brain to the muscle.

“Sensory feedback, so important for fine control of movements and dexterity, is still some way away,” he said.

Sources: BBC NEWS:15 October 2008

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