Research Paper on Peripheral Nerve Injuries

2 Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Ciptomangunkusumo Hospital

3 Departemen Histology, Faculty of Medicine, University of Indonesia

4 Department of Physiology, Faculty of Medicine, University of Indonesia

5 Department of Parasitology, Faculty of Medicine, University of Indonesia

Abstract

Peripheral nerves are important in the body because they innervate muscles which aid in movements. Peripheral nerve injuries are more common than spinal injuries. Sciatic function index is a measure that is commonly used for walking analysis. Previous methods used one type of ink and the method made it difficult to interpret foot prints because they were mingled. In this study four different types of inks were used for easier interpretation of results. In this study the tools are modified from existing tools in literature. The measurements in this tool include the TS and PL which are components of the sciatic function index. When using this tool validity and reliability are a necessity to ensure that the data is trust worthy. The TOA is then used to confirm the SFI. The purpose of this study was to look into the relationship between the walking analysis parameters (SFI, TFI and PFI) and the Q1, Q2, Q3 and Q4 angles in sciatic nerve injury. The study was a laboratory based research that used an examination of 36 Sprague-Dawley rats which were put in a hall way covered with graph papers for a period of 70 days. The analysis of the data obtained from the experiment used t-test. It was discovered that there was a significant correlation between the walking parameters and the Q1 to Q 4 angles in the sciatic nerve injury.

Keywords: Walking Analysis Parameter, SFI, PFI, TFI, Q1-Q4

Introduction

Peripheral nerve injuries occur in 2-5% of all trauma patients and these injuries are more common than spinal injury (1). The most common injured peripheral nerve is the sciatic nerve. Injury to peripheral nerves causes disability in young people leading to economic effects in the community because they are the most productive age. In cases where patients recover from the injuries, they take long time to heal (5). The frequent of occurrence of the injury has been a matter of concern to many health practitioners and researchers making them to look for the relationship between the factors affecting walking parameters. Most of the examinations of the matters use animals to determine the relationship between the factors affecting the walking parameters. In determining the progress of the peripheral nerve injury in animals used for experiments Sciatic Functional Index (SFI), Tibial Functional Index (TFI) and Peroneal Functional Index (PFI), are used (6). There is a good correlation between TOA, SFI and the angles around the midpoint of TS and PR

In the study conducted by Margiana et al, 2015, it has been known that the angle parameters around the point which acts as the meeting point of the lines between the heel and the third fingertip and between finger one and finger five (Q1, Q2, Q3, and Q4) are strongly correlated with Sciatic Functional Index (SFI), Tibial Functional Index (TFI) and Peroneal Functional Index (PFI). In experimental animals with normal walking function, however, whether these parameters can be used in cases of injury is unknown. This study aimed to prove that Q1, Q2, Q3, and Q4 are correlated with SFI, TFI and PFI. It will fill the gap of information in the matter and help other future researches in dealing with other important aspects of the issue (4).

To examine the relationship between walking analysis parameters and Q1to Q4 angles in the experimental animal model of sciatic nerve injury one needs to determine the nerve function indexes. This is done by observing the movement of the particular animals used in the experiment (5). The movements in the limb include abduction, adduction, flexion and extension, which is the common between human beings and animals. These movements influence the body posture during walking. The Q1 to Q4 angles keep on changing depending on the movement of the limb. The changing angle while one is walking is assumed to have some contribution in the sciatic nerve injury (2, 30). The main reason behind the assumption is because the changing angle determines the speed of walking of an individual. The most common injuries in the nerve occurs when one is walking at a relatively high speed or running meaning the changing of the Q1 to Q4 angles is frequent or the angle is wider than the usual one.

Method

This experimental study used 36 Sprague-Dawley rats as the experimental animals that had been approved by the FKUI Ethics Commission. Sprague Dawley rats is a special breed of rats breed and used for scientific purposes.The Sprague-Dawley rats used in the experiment were selected randomly from the available population. The selection was done from mature Sprague-Dawley rats which were determined by the weight of the sample rate picked. Usually, the weight of a mature female Sprague-Dawley rat is 250-300 g and a male one is 300 350 grams (11, 17, and 18). Using mature rats ensures that the comparison of the outcomes of the walking was easy and would not distort the results. During random selection, if a young Sprague-Dawley rat was picked it was released and another matured one looked for as a replacement. Sciatic nerve injury in the rats was simulated. The neuropathic pain felt was the same as the one that could have been felt if a human model had been used (9). Theoretically, the Sprague-Dawley rats are more sensitive to pain compare to other animals. The rats were divided as per the peripheral nerve injuries to ensure the right results were gathered. The Seddon 5 classification was done on the rats with end-to-end suture (1). To examine the sciatic functional index, Tibial functional index and peroneal functional index the Sprague-Dawley rats were placed in a hall way which was covered with graph papers which had been predetermined in size and length (16). The hall way used for this experiment also had methyl methacrylate. The rats were allowed to walk in a hallway and different color inks had firstly been given on each rat's paws. After the formation of foot prints, the measurementof all parameters were made. Covering the hall way with graph papers made it easier and clearer to examine the rats foot prints. During walking, the rats would step on these graph papers and the foot prints would be left on the paper. Each walking parameter was measured severally during a single walking cycle and a mean was obtained. The measurements were carried on several days and the results were analyzed. The length measurements that were conducted include the PL (the distance between tip of the third toe and the heel), TS (distance between the tips of the second and the forth finger) and IT (the distance between the thumb and the little toe) (19). These length measurements were carried out on both the right and the left feet of the rats hind limbs during straight walking. The intersection of two lines formed quadrants and the angles formed between TS and PL which we refer to them as Q1, Q2, Q3 and Q4 were measured and recorded. Each quadrant was measured on both the right and the left of the paw of the rats hind limbs. The midpoint of the foot prints need to be determined. The midpoint of the rats foot print was the intersection of TS and PL lines. The results of the length measurements were used to compute the SFI, PFI and TFI. Then the index values (SFI, PFI and TFI) and the mean values for the angles (Q1, Q2, Q3, and Q4) decided on were analyzed using the SPSS software using the normality test. Q1 refers to the angle between the line from the midpoint to the third toe and the line from midpoint to the thump tip. Q2 is the angle between the lines from the midpoint to the thumb and the line from midpoint to heel. Q3 is the angle between the line from the midpoint to the heel and the line from the midpoint to the little toe (1). Q4 is the angle between the line from the midpoint to the tip of the little to and the line from the midpoint to the tip of third finger. The data obtained would be tested with the t test to determine the existence of a correlation between walking parameters with Q1, Q2, Q3 and Q4 angle.

Result

The Spearman correlation (SPSS 23) analysis showed that there were correlations between SFI, TFI, PFI and Q1, Q2, Q3 and Q4. The correlation coefficient range (r) was categorized as medium correlation.

Table 1: Walking analysis parameters

Days SFI TFI PFI

Mean (SD)

CM Std Sham CM Std Sham CM Std Sham

Pre -9.65 (2.02) -8.62 (2.10) -10.23 (2.11) -9.95 (2.10) -7.97 (2.18) -11.17 (2.25) -8.79 (6.37) -18.79 (6.03) -15.93 (1.87)

3 -93.30 (0.00) -93.30 (0.00) -17.26 (5.75) -121.60 (0.00) -121.60 (0.00) -17.76 (6.12) -268.60 (0.00) -268.60 (0.00) -26.44 (11.91)

7 -59.53 (30.07) -93.30 (0.00) -21.32 (11.35) -72.78 (42.21) -121.60 (0.00) -21.51 (12.00) -107.78 (125.61) -268.60 (0.00) -20.48 (9.01)

14 -45.05 (26.15) -93.30 (0.00) -13.55 (5.26) -54.83 (35.52) -121.60 (0.00) -15.48 (6.20) -64.47 (101.87) -268.60 (0.00) -20.03 (9.00)

28 -20.96 (8.73) -57.36 (28.13) -11.95 (7.38) -22.01 (7.70) -70.05 (40.13) -12.86 (7.48) -18.82 (3.59) -114.13 (120.17) -13.08 (12.27)

42 -17.71 (8.43) -36.61 (8.31) -13.31 (7.35) -19.96 (9.03) -43.82 (11.95) -13.08 (9.12) -18.27 (7.17) -28.90 (7.141) -20.71 (8.55)

56 -14.89 (6.66) -28.69 (11.22) -16.22 (9.83) -17.31 (6.34) -33.11 (12.42) -17.23 (12.17) -14.58 (7.18) -26.90 (8.18) -18.81 (6.30)

70 -11.67 (1.87) -35.50 (15.09) -10.65 (4.24) -12.41 (2.97) -41.94 (19.38) -11.36 (4.20) -15.01 (2.63) -33.23 (11.51) -11.73 (7.49)

Table 2:Q1-Q4 and TOA angles parameters

Days Q1 Q2 Q3 Q4 TOA

Mean (SD)

CM (0) Std (0) Shm (0) CM (0) Std (0) Shm (0) CM (0) Std (0) Shm (0) CM (0) Std (0) Shm (0) CM(0) Std(0) Sham(0)

Pre 79.83 (4.79) 76.33 (8.03) 81.80 (7.50) 100.17 (4.79) 103.67 (8.03) 98.20 (7.50) 79.83 (4.79) 76.33 (8.03) 81.80 (7.50) 100.17 (4.79) 103.67 (8.03) 98.20 (7.50) 29.64 (1.98) 30.77 (1.39) 30.12 (0.52)

3 0.00 (0.00) 0.00 (0.00) 80.53 (4.45) 0.00 (0.00) 0.00 (0.00) 99.47 (4.45) 0.00 (0.00) 0.00 (0.00) 80.53 (4.45) 0.00 (0.00) 0.00 (0.00) 99.47 (4.45) 0.00 (0.00) 0.00 (0.00) 24.19 (4.23)

7 79.42 (6.71) 0.00 (0.00) 83.72 (6.91) 100.58 (6.71) 0.00 (0.00) 96.28 (6.91) 79.42 (6.71) 0.00 (0.00) 83.72 (6.91) 100.58 (6.71) 0.00 (0.00) 96.28 (6.91) 21.33 (4.23) 0.00 (0.00) 26.73 (2.31)

14 79.75 (6.40) 0.00 (0.00) 84.00 (7.90) 100.25 (6.40) 0.00 (0.00) 96.00 (7.90) 79.75 (6.40) 0.00 (0.00) 84.00 (7.90) 100.25 (6.40) 0.00 (0.00) 96.00 (7.90) 21.55 (5.01) 0.00 (0.00) 27.98 (2.24)

28 80.86 (2.96) 82.93 (8.31) 80.00 (7.07) 99.14 (2.96) 97.08 (8.31) 100.00 (7.07) 80.86 (2.96) 82.93 (8.31) 80.00 (7.07) 99.14 (2.96) 97.08 (8.31) 100.00 (7.07) 26.81 (3.49) 18.73 (3.82) 29.03 (2.38)

42 82.85 (4.27) 80.60 (6.66) 83.50 (5.32) 97.15 (4.27) 99.20 (6.69) 96.50 (5.32) 82.85 (4.27) 80.60 (6.66) 83.50 (5.32) 97.15 (4.27) 99.20 (6.69) 96.50 (5.32) 27.40 (2.40) 19.52 (6.07) 28.38 (2.02)

56 78.47 (7.50) 78.70 (5.83) 83.92 (3.25) 101.53 (7.50) 100.80 (5.53) 96.08 (3.25) 78.47 (7.50) 78.70 (5.83) 83.92 (3.25) 101.53 (7.50) 100.80 (5.53) 96.08 (3.25) 27.83 (2.41) 21.08 (6.51) 27.95 (0.91)

70 80.86 (1.83) 77.10 (4.13) 81.40 (3.44) 99.69 (2.93) 102.90 (4.13) 98.60 (3.44) 80.86 (1.83) 77.10 (4.13) 81.40 (3.44) 99.69 (2.93) 102.90 (4.13) 98.60 (3.44) 26.82 (3.26) 18.94 (4.85) 28.00 (0.78)

Table one show the mean standard deviations of the SFI, PFI, and TFI while table two shows the mean standard deviations of Q1, Q2, Q3 and Q4 against time. The table shows the variations of walking in the different days from day one to seventy. The measurements were done after several days which are identical in t...