title: The influence of dynamic polyelectromyography in formulating a surgical plan in treatment of spastic elbow flexion deformity.
abstract: OBJECTIVE
  To determine the influence of motor-control analysis with dynamic electromyography on surgical planning in patients with spastic elbow flexion deformity.
  
  
  METHODS
  Prospective observational design.
  
  
  METHODS
  A Traumatic Brain Injury Model Systems-affiliated specialty referral center for the evaluation and treatment of mobility problems associated with neurologic injury and disease.
  
  
  METHODS
  Twenty-one patients with spastic elbow flexion deformity.
  
  
  METHODS
  Two surgeons each formulated a detailed surgical plan for each individual muscle-tendon unit. Patients then underwent motor-control analysis in which kinetic and polyelectromyographic data were collected by using a standard protocol. Each surgeon formulated another surgical plan after independently reviewing the laboratory study.
  
  
  METHODS
  The frequency of change and degree of agreement in the surgical plans after review of the laboratory data were used as measures of the effect of the laboratory studies.
  
  
  RESULTS
  Fifty-seven percent of the surgical plans were changed after the motor-control study. The frequency of change did not differ by clinical experience. There was a trend toward higher agreement between surgeons after the study than before.
  
  
  CONCLUSIONS
  Detailed electromyographic motor-control analysis alters surgical planning for patients with spastic elbow flexion deformity. Clinical assessment alone does not accurately identify the muscles responsible for the deformity or dysfunction. More clinical experience does not result in greater accuracy. Motor-control analysis produces higher agreement between surgeons in planning surgery.
authors.affiliation: Institute for Mobility Evaluation and Treatment, MossRehab Hospital, Albert Einstein Medical Center, Philadelphia, PA, USA. DrKeenan@AOL.com
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Keenan
authors.forename: David A
authors.initials: DA
authors.lastname: Fuller
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Mayer
authors.forename: Alberto
authors.initials: A
authors.lastname: Esquenazi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fidler-Sheppard
mesh_terms: D000328:Adult; D000368:Aged; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D014741:Video Recording