F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
545
findings between treated and untreated muscles, as shown in Fig. 225. Larger muscle
fibres and definitely lesser degree of fibrous tissue formation between the muscle fibres
were found in the exercised muscles. Although the galvanic exercise did not affect the
time of onset of recovery, following nerve suture, the strength and degree of motor
recovery was higher in the treated muscles (Gutmann & Guttmann, 1942, 1944). These
results, which are in accordance with those of Fisher (1939) and Hines
et al.
(1942, 1943),
have been confirmed by Jackson (1945) in patients with ulnar nerve lesions and combined
median and ulnar nerve lesions due to war injuries. Moreover, she also confirmed our
findings, that daily electrical exercise of denervated muscles gave better results than if this
treatment was given only three times a week. Of particular interest is Jackson's confirma
tion (1945), that immobilization of the affected limb appeared to increase the rate of
wasting when galvanic exercise was not given.
Technique
Daily electrical exercise is started as early as possible, following lower motor neuron
lesion in paraplegics and tetraplegics (about 5 days after injury), and is applied in gradually
increasing number of contractions, starting with 50-100 per session of 15 min. In due
course, as many as 600-800 and more contractions are applied to paralysed muscle
groups during one session of about 30-45 min. This treatment is given at least once a
day, if possible twice daily. Care is taken to elicit powerful muscle contractions, separated
by rest periods of a few seconds. In the early stages of lower motor neurone lesions, the
denervated muscles still react to direct faradic stimulation, and this type of current may
be used; it has, however, to be substituted by galvanic or sinusoidal current in later
stages, as soon as R.D. has developed. In root and anterior horn lesions, not associated
with sensory disturbances, galvanism strong enough to elicit powerful contractions is
painful and poorly tolerated, especially if only small sized electrodes are used. In such
cases, sinusoidal and other forms of current should be used. lonization effects which may
be caused by unidirectional current by balanced-pulse galvanism, as recommended by
Wickham (1948). The ionizing effect of a square-wave stimulus of relatively high ampli
tude is avoided by a following stimulus of opposite polarity with subliminal amplitude
but of prolonged duration. The skin has to be thoroughly moistened with warm water.
Since the skin resistance decreases during electrical exercise, the same vigorous contrac
tion can be obtained by progressively weaker current strength. Hard water should be
avoided as it may deposit insoluble calcium in the tissues underneath the cathode, and
common salt may be mixed with the water. R.H.S.Holbourn and I suggested as an even
better solution for preventing skin burns: 25 g of Na2HPC>4 and 12 g of NH2PO4 in
i litre of water being diluted with 5 to 10 times its volume before use.
The electrodes should not be restricted to one position but should be repeatedly
altered, to avoid local damage by burning the underlying tissues; thus the current is
directed to various parts of the muscle. As mentioned before, if depolarized impulses
are used the danger of burning is greatly diminished. However, the danger of burning the
skin can altogether be avoided, if the active electrode is moved and stroking stimulation
along the whole length of the muscle is applied. This technique is particularly important
