title: Stimulus point distribution in deep or superficial peroneal nerve for treatment of ankle spasticity.
abstract: OBJECTIVE
  To develop effective electrical stimulation treatment to reduce spasticity, we examined the optimal stimulus point of the common peroneal nerve.
  
  
  METHODS
  The locations of selective stimulus points for the deep peroneal nerve or superficial peroneal nerve fiber were examined in 25 healthy subjects in both legs (50 legs) using the ratio of the tibialis anterior (TA) to the peroneus longus (PL) M-wave amplitude (TA/PL ratio). In addition, we measured reciprocal Ia inhibition in ten healthy subjects. The amount of inhibition was determined from short-latency suppression of the soleus (Sol) H-reflex by conditioning stimuli to the deep or superficial peroneal nerve. The paired t-test was used for statistical analysis.
  
  
  RESULTS
  The mean TA/PL ratio during deep peroneal nerve stimulation was significantly different from superficial peroneal nerve stimulation (p < 0.001). The mean stimulus point for the deep peroneal nerve was located 7 ± 5 mm distal and 3 ± 6 mm anterior from the distal edges of the head of fibula and was markedly different from the stimulus point for the superficial peroneal nerve (20 ± 7 mm distal and 12 ± 8 mm posterior). During deep peroneal nerve stimulation, the mean conditioned H-reflex was depressed to 83.8 ± 10.7% of the unconditioned value of the H-reflex. In contrast, during superficial peroneal nerve stimulation, the mean conditioned H-reflex increased to 105.3 ± 5.2%. These values were significantly different (p < 0.001).
  
  
  CONCLUSIONS
  In the present study, we revealed a stimulus area of the deep peroneal nerve. Also, we observed the inhibitory effects of stimulation upon the deep peroneal nerve at individual stimulus point. Our results appear to indicate that localized stimulation of the deep peroneal nerve is more useful for the reduction of ankle spasticity.
authors.affiliation: Department of Rehabilitation, Nanakuri Sanatorium, Fujita Health University, Tsu, Mie, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kubota
authors.forename: Shigeo
authors.initials: S
authors.lastname: Tanabe
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugawara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Muraoka
authors.forename: Norihide
authors.initials: N
authors.lastname: Itoh
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Kanada
mesh_terms: D000328:Adult; D000842:Ankle / Q000294:innervation*; D001703:Biophysics; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography; D005260:Female; D006181:H-Reflex / Q000502:physiology*; D006801:Humans; D008297:Male; D010543:Peroneal Nerve / Q000502:physiology*; D013997:Time Factors; D055815:Young Adult