Electromiyographic evaluation of the reflexes and the sympathetic skin response and determining the relationship with the functional capacity

Purpose: To evaluate the relationship among sympathetic skin responses (SSR) , electrodiagnostic reflex activities ( F wave, H reflex), and functional capacity in post stroke patients.Methods: Forty hemiplegia/ hemiparalysis patients ( mean age 57,8 ± 10,9 years, 22men 18 women) patients and forty healthy volunteers ( mean age 55,7 ±8,5 years, 18 men, 22 women) included in this study. Seventeen of the patients were in acute period, twenty-three of them were in chronic period.The measurement of SSR was obtained from median and ulnar stimulation from upper and lower extremities bilaterally. The records of F wave were measured by the stimulation of right/left median, ulnar and tibial nerves. H reflex records were done from tibial nerves.To assesment parameters of the functional capacity included Functional Independence Measure (FIM), Rivermead Mobility index (RMİ), Brunnstrom stages and Modify Ashworth Scala (MAS) scores. The results were correlated with electrophysiologic data. Student T test, Mann Whitney U test, chi-square test and pearson correlation analyses were used for statistical analyses.Results: There were no differences in age and gender between patients and volunteers. There were no statistically significant differences in SSR latancy and amplitudes of patients between hemiplegia and non-hemiplegia extremities (p> 0.05). SSR latancy values of hemiplegia group both in upper and lower extremities were higher than the latancy values of control group (p<0.05). Amplitude values of paretic arms were significantly lower when compared to controls right upper extremities (p<0.05). There was a significant correlation between SSR amplitude values and FIM scores. The amplitudes of patients with RMI (0-7) scores and Brunnstrom 1-3 grades were significantly lower than the patients RMI (8-15) scores and Brunnstrom 4-6 grades (p<0.05).There was a statistically significant differences in F latancy, persistance of ulnar nerve and persistance of tibial nerve between patients and control groups (p<0.05). Furthermore, in patient group, the persistance and amplitude of F wave showed statistically significant differences between Brunnstrom grades 1?3 and grades 4?6 (p<0.05). Also, we found a statistical correllation between ulnar nerve F amplitudes and total scores of FIM and RMI. Also a significant correlation was observed between tibial nerve persistance and total FIM, RMI and MAS scores.Finally there was a statistical correlation between Hmaks/Mmaks amplitüde ratios of H reflex and score of MAS. There was not statistical correlation between Hmaks/Mmaks amplitüde ratios of H reflex and scores of FIM and RMI.Conclusion: Accordingly to these results; it was thought that the values of SSR amplitudes and the values of F wave persistance and amplitude were helpful to evaluate functional capacity. The values of SSR amplitudes in acute period showed a statistical significant decrease and achieved to normal ranges in collaboration with increasing functionla capacity values. In this respect the values of SSR amplitudes may be useful to evalute the function of autonomic nervous system.