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Jules G. Becher – One of the best experts on this subject based on the ideXlab platform.

  • Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by me
    BMC pediatrics, 2013
    Co-Authors: Jessica Warnink-kavelaars, Roland Jeroen Vermeulen, Jules G. Becher
    Abstract:

    Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle for each individual Muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimstimulation to determine its precision. University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands. prospective observational study. children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands. a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle has been developed for each individual Muscle injection location of the Adductor Brevis Muscle, Adductor longus Muscle, gracilis Muscle, semimembranosus Muscle, semitendinosus Muscle, biceps femoris Muscle, rectus femoris Muscle, gastrocnemius lateralis Muscle, gastrocnemius medialis Muscle and soleus Muscle. This protocol will be verified as by means of electrical stimstimulation.Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used. Botulinum toxin type-A injected in the intended Muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

  • Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by me
    BMC Pediatrics, 2013
    Co-Authors: Jessica Warnink-kavelaars, Roland Jeroen Vermeulen, Jules G. Becher
    Abstract:

    Background Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle for each individual Muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimstimulation to determine its precision. Methods Setting: University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands. Design: prospective observational study. Participants: children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands. Method: a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle has been developed for each individual Muscle injection location of the Adductor Brevis Muscle, Adductor longus Muscle, gracilis Muscle, semimembranosus Muscle, semitendinosus Muscle, biceps femoris Muscle, rectus femoris Muscle, gastrocnemius lateralis Muscle, gastrocnemius medialis Muscle and soleus Muscle. This protocol will be verified as by means of electrical stimstimulation. Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used. Discussion Botulinum toxin type-A injected in the intended Muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

Jessica Warnink-kavelaars – One of the best experts on this subject based on the ideXlab platform.

  • Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by me
    BMC pediatrics, 2013
    Co-Authors: Jessica Warnink-kavelaars, Roland Jeroen Vermeulen, Jules G. Becher
    Abstract:

    Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle for each individual Muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimulation to determine its precision. University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands. prospective observational study. children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands. a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle has been developed for each individual Muscle injection location of the Adductor Brevis Muscle, Adductor longus Muscle, gracilis Muscle, semimembranosus Muscle, semitendinosus Muscle, biceps femoris Muscle, rectus femoris Muscle, gastrocnemius lateralis Muscle, gastrocnemius medialis Muscle and soleus Muscle. This protocol will be verified as by means of electrical stimulation.Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used. Botulinum toxin type-A injected in the intended Muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

  • Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by me
    BMC Pediatrics, 2013
    Co-Authors: Jessica Warnink-kavelaars, Roland Jeroen Vermeulen, Jules G. Becher
    Abstract:

    Background Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle for each individual Muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimulation to determine its precision. Methods Setting: University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands. Design: prospective observational study. Participants: children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands. Method: a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle has been developed for each individual Muscle injection location of the Adductor Brevis Muscle, Adductor longus Muscle, gracilis Muscle, semimembranosus Muscle, semitendinosus Muscle, biceps femoris Muscle, rectus femoris Muscle, gastrocnemius lateralis Muscle, gastrocnemius medialis Muscle and soleus Muscle. This protocol will be verified as by means of electrical stimulation. Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used. Discussion Botulinum toxin type-A injected in the intended Muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

Roland Jeroen Vermeulen – One of the best experts on this subject based on the ideXlab platform.

  • Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by me
    BMC pediatrics, 2013
    Co-Authors: Jessica Warnink-kavelaars, Roland Jeroen Vermeulen, Jules G. Becher
    Abstract:

    Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle for each individual Muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimulation to determine its precision. University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands. prospective observational study. children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands. a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle has been developed for each individual Muscle injection location of the Adductor Brevis Muscle, Adductor longus Muscle, gracilis Muscle, semimembranosus Muscle, semitendinosus Muscle, biceps femoris Muscle, rectus femoris Muscle, gastrocnemius lateralis Muscle, gastrocnemius medialis Muscle and soleus Muscle. This protocol will be verified as by means of electrical stimulation.Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used. Botulinum toxin type-A injected in the intended Muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

  • Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by me
    BMC Pediatrics, 2013
    Co-Authors: Jessica Warnink-kavelaars, Roland Jeroen Vermeulen, Jules G. Becher
    Abstract:

    Background Intramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle for each individual Muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimulation to determine its precision. Methods Setting: University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands. Design: prospective observational study. Participants: children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands. Method: a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target Muscle has been developed for each individual Muscle injection location of the Adductor Brevis Muscle, Adductor longus Muscle, gracilis Muscle, semimembranosus Muscle, semitendinosus Muscle, biceps femoris Muscle, rectus femoris Muscle, gastrocnemius lateralis Muscle, gastrocnemius medialis Muscle and soleus Muscle. This protocol will be verified as by means of electrical stimulation. Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used. Discussion Botulinum toxin type-A injected in the intended Muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

Andrew T. Gray – One of the best experts on this subject based on the ideXlab platform.

  • Sonographic Imaging of the Obturator Nerve for Regional Block
    Regional anesthesia and pain medicine, 2007
    Co-Authors: Julie Soong, Ingeborg Schafhalter-zoppoth, Andrew T. Gray
    Abstract:

    Today, there is a growing appreciation of the importance of the obturator nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the obturator nerve for potential utility in guiding these nerve blocks. We scanned left and right inguinal regions of 20 volunteers lateral and distal to the pubic tubercle (PT) and assessed visibility, size and shape, and depth from the skin of common obturator nerves and their associated divisions. In addition to the volunteer study, we retrospectively reviewed a clinical series of obturator nerve blocks performed with ultrasound guidance and nerve stimulation. The obturator nerve can be sonographically visualized by scanning along the known course of the nerve; the anterior division characteristically converges toward the posterior division along the lateral border of the Adductor Brevis Muscle to form the common obturator nerve more proximally. In the set of 20 volunteers, 25% (10/40) of common, 85% (34/40) of anterior, and 87.5% (35/40) of posterior obturator nerves were sonographically identified. The common obturator nerve was visualized 1.3 +/- 1.5 cm distal and 2.3 +/- 1.2 cm lateral to the PT. Divisions were visualized 2.1 +/- 2.0 cm distal and 2.1 +/- 1.2 cm lateral to the PT. The nerves (common, anterior, and posterior) averaged 2.7 +/- 1.2 mm, 1.4 +/- 0.6 mm, and 1.7 +/- 0.6 mm in anterior-posterior dimension and 9.0 +/- 4.3 mm, 9.6 +/- 3.9 mm, and 10.9 +/- 4.1 mm in medial-lateral dimension and were 25.9 +/- 7.6 mm, 15.5 +/- 3.9 mm, and 29.3 +/- 7.9 mm below the skin surface. The common obturator nerve and its anterior and posterior divisions are all relatively flat nerves with average anterior-posterior/medial-lateral dimension ratios of 0.32, 0.18, and 0.18, respectively. In the clinical series, nerve identification was confirmed with nerve stimulation (n = 6 block procedures, mean threshold stimulating current for evoked Adductor contraction = 0.70 +/- 0.14 mA). The obturator nerve and its divisions are the flattest peripheral nerves yet described with ultrasound imaging. Knowledge of the obturator nerve’s ultrasound appearance facilitates localization of this nerve for regional block and may increase success of such procedures.

Julie Soong – One of the best experts on this subject based on the ideXlab platform.

  • Sonographic Imaging of the Obturator Nerve for Regional Block
    Regional anesthesia and pain medicine, 2007
    Co-Authors: Julie Soong, Ingeborg Schafhalter-zoppoth, Andrew T. Gray
    Abstract:

    Today, there is a growing appreciation of the importance of the obturator nerve in clinical anesthesia. The aim of this study is to describe the ultrasound appearance of the obturator nerve for potential utility in guiding these nerve blocks. We scanned left and right inguinal regions of 20 volunteers lateral and distal to the pubic tubercle (PT) and assessed visibility, size and shape, and depth from the skin of common obturator nerves and their associated divisions. In addition to the volunteer study, we retrospectively reviewed a clinical series of obturator nerve blocks performed with ultrasound guidance and nerve stimulation. The obturator nerve can be sonographically visualized by scanning along the known course of the nerve; the anterior division characteristically converges toward the posterior division along the lateral border of the Adductor Brevis Muscle to form the common obturator nerve more proximally. In the set of 20 volunteers, 25% (10/40) of common, 85% (34/40) of anterior, and 87.5% (35/40) of posterior obturator nerves were sonographically identified. The common obturator nerve was visualized 1.3 +/- 1.5 cm distal and 2.3 +/- 1.2 cm lateral to the PT. Divisions were visualized 2.1 +/- 2.0 cm distal and 2.1 +/- 1.2 cm lateral to the PT. The nerves (common, anterior, and posterior) averaged 2.7 +/- 1.2 mm, 1.4 +/- 0.6 mm, and 1.7 +/- 0.6 mm in anterior-posterior dimension and 9.0 +/- 4.3 mm, 9.6 +/- 3.9 mm, and 10.9 +/- 4.1 mm in medial-lateral dimension and were 25.9 +/- 7.6 mm, 15.5 +/- 3.9 mm, and 29.3 +/- 7.9 mm below the skin surface. The common obturator nerve and its anterior and posterior divisions are all relatively flat nerves with average anterior-posterior/medial-lateral dimension ratios of 0.32, 0.18, and 0.18, respectively. In the clinical series, nerve identification was confirmed with nerve stimulation (n = 6 block procedures, mean threshold stimulating current for evoked Adductor contraction = 0.70 +/- 0.14 mA). The obturator nerve and its divisions are the flattest peripheral nerves yet described with ultrasound imaging. Knowledge of the obturator nerve’s ultrasound appearance facilitates localization of this nerve for regional block and may increase success of such procedures.