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Electrodermal screening (EDS) is based on three commonly held assumptions: acupuncture points (APs) have lower electrical resistance than non-APs; resistance at APs varies with health and disease; and effective acupuncture treatments are associated with normalization of resistance at APs. Although evidence confirming these assumptions is limited, EDS is frequently practiced worldwide. Researchers are also beginning to assess EDS' utility as an outcome measure in acupuncture trials. Fundamental in developing EDS as a research tool is the need for an accurate and reliable measurement. We developed an automated multichannel prototype system, the Octopus, and recorded electrical resistance and capacitance at eight skin sites in 33 healthy participants over 2 hours. The Octopus accurately measured against known resistors (within 2.5% of the mean value) and capacitors (within 10% of the mean value), and yielded repeatable readings at all eight skin sites: LR 1 (r=0.79), SP 1 (r=0.79), toe non-AP (r=0.77), LU 9 (r=0.97), PC 6 (r=0.96), wrist non-APs (r=0.97), SP 6 (r=0.96), and leg non-APs (r=0.97). Resistance at APs was significantly lower than the nearby non-APs in one out of three comparisons. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To summarise the acu-magnet therapy literature and determine if the evidence justifies further investigation of acu-magnet therapy for specific clinical indications. METHODS: Using various search strategies, a professional librarian searched six electronic databases (PubMed, AMED, ScienceDirect College Edition, China Academic Journals, Acubriefs, and the in-house Journal Article Index maintained by the Oregon College of Oriental Medicine Library). English and Chinese language human studies with all study designs and for all clinical indications were included. Excluded were experimental and animal studies, electroacupuncture and transcranial magnetic stimulation. Data were extracted on clinical indication, study design, number, age and gender of subjects, magnetic devices used, acu-magnet dosing regimens (acu-point site of magnet application and frequency and duration of treatment), control devices and control groups, outcomes, and adverse events. RESULTS: Three hundred and eight citations were retrieved and 50 studies met our inclusion criteria. We were able to obtain and translate (when necessary) 42 studies. The language of 31 studies was English and 11 studies were in Chinese. The 42 studies reported on 32 different clinical conditions in 6453 patients from 19862007. A variety of magnetic devices, dosing regimens and control devices were used. Thirty seven of 42 studies (88%) reported therapeutic benefit. The only adverse events reported were exacerbation of hot flushes and skin irritation from adhesives. CONCLUSIONS: Based on this literature review we believe further investigation of acu-magnet therapy is warranted particularly for the management of diabetes and insomnia. The overall poor quality of the controlled trials precludes any evidence based treatment recommendations at this time. [ABSTRACT FROM AUTHOR]

OBJECTIVES: (1) To characterize and calibrate an electrodermal screening device, Prognos. (2) To replicate a previous test-retest reliability study of this device with measurements of electrical skin resistance (ESR) at 24 Jing-well acupuncture points (APs). (3) To determine measurement precision in three successively more exacting trial protocols on the same set of subjects. SETTINGS: Oregon College of Oriental Medicine and Portland State University, Portland, OR. INSTRUMENTS: The Prognos device was electrically characterized by a team of research engineers at the Biomedical Signal Processing Laboratory of Portland State University. They determined that Prognos measures the average direct-current (DC) resistance between a metallic wrist strap and an electrode probe tip. The probe tip is connected to a linear spring set to trigger with an optically generated signal at a deflection of 2.62 mm, which corresponds to an average applied force of 2.68 +/- 0.04 N (mean +/- standard deviation [SD], n = 6). They also determined that the device quantifies resistance by applying a 1.1 microA current for an average of 223 +/- 3 ms (n = 7). When calibrated against a series of known resistors, Prognos measures accurately in the range of 150 kOmega to 14.3 MOmega with an error of less than 0.4%. SUBJECTS: Thirty-one (31) healthy volunteers, 17 females and 14 males, 23-63 years of age. RESULTS OF RELIABILITY TEST-RETEST: The mean reliability of a single measurement was; 0.758 for a standard measurement protocol of four sequential sweeps of 24 Jing-well (Ting) APs; 0.851 for four sequential sweeps after ink-marking the APs; and 0.961 for four rapid repeat measurements at each inked AP. Mean absolute values of ESR decreased between the standard and marked protocols, but not between the marked and rapid repeat protocols. CONCLUSIONS: Prognos performs accurately, against known resistors over the reported range of ESR. The reliability in the standard protocol (r = 0.758) is comparable to the reliability of 0.721 demonstrated under similar conditions by other investigators. Marking APs, and performing measurements in a rapid sequence, increases reliability of ESR measurements. Increased reliability in the second and third protocols is associated with decreased mean ESR values which may be related to increased accuracy of Prognos probe placement and/or inking the APs. [ABSTRACT FROM AUTHOR]

There is increasing interest in the application of magnetic/electromagnetic fields for therapeutic purposes. Magnetotherapy provides non-invasive, safe and easy to apply methods to directly treat the site of injury, the source of pain and inflammation as well as other types of dysfunction. This review summarizes several decades of experience worldwide in studying biological and clinical effects initiated by various magnetic and electromagnetic fields. The physiological basis for tissue repair as well as physical principles of dosimetry and application of magnetic fields are discussed. An analysis of magnetic/electromagnetic stimulation is followed by a discussion of the advantage of magnetic field stimulation compared with electric current stimulation. Finally, the proposed mechanisms of action are discussed. [ABSTRACT FROM AUTHOR]

Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p<.005), Pittsburgh Sleep Quality Inventory (PSQI p<.0001), PSQI Sleep Efficiency (p<.007), and Quality of Life Inventory (p<.02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p<.001) which were lowered post-treatment (paired z-tests p<.001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.

Objectives: To provide an in-depth analysis of seven well-reported studies that examined electrodermal activity (EDA) at acupuncture points with regard to three commonly held tenets of acupuncture: (1) EDA at pathology-related acupuncture points is distinguishable from non-pathology-related acupuncture points; (2) EDA at acupuncture points can assist in diagnosing and monitoring therapeutic progress; and (3) EDA at acupuncture points is able to identify substances that are either therapeutically beneficial or toxic to an individual., Methods: Seven of 29 studies that scored>50% on their quality of reporting 54 essential technical and clinical details of EDA testing in human patients were identified from a previous literature review. Fourteen categories of data were extracted from these seven studies for further discussion., Results: Two studies compared EDA at pathology-related auricular acupuncture points to non-pathology-related sites. Two studies correlated EDA measurements at sites other than auricular acupuncture points with the presence of specific medical conditions. The final three studies assessed changes in EDA at acupuncture points on the fingers and toes when different substances were placed in the electrical circuit with the patient., Conclusions: This review highlights the heterogeneity of approaches to EDA assessments and the discrepancies between common clinical practice and the scientific evidence to support that practice. It also provides pilot data that suggest EDA testing at auricular acupuncture points may distinguish pathology-related acupuncture points from non-pathology-related points; decreased skin conductance correlates with tiredness or low energy; and EDA testing at the Jing-Well acupuncture points, on the tips of the fingers and toes, may assist in monitoring effectiveness of acupuncture treatment. The evidence does not support the use of VEGA testing for allergic status.

Objective: There are many commercially available instruments for measuring electrical conductance, but there is little information about their reliability. The aim of this study was to quantify measurement variability and assess reliability of the AcuGraph system-a commonly used electrodermal screening device., Methods: Four experiments were conducted to measure variability in electrical conductance readings obtained by the AcuGraph system. The first involved measuring known resistors. The second measured non-human organic matter. The third was a test-retest assessment of the Yuan-Source and Jing-Well points in 30 healthy volunteers who were measured by a single operator. The fourth was an interoperator reliability evaluation of seven acupuncturists at the Yuan-Source and Jing-Well acupoints on four individuals at two time points., Results: Against known resistors, the AcuGraph had an average coefficient of variability (CV) of 1.8% between operators and test-retests. On non-human organic material the AcuGraph had an average CV of 0.9% and 2.8%. When a single operator tested 30 participants, the average reliability for the Yuan-Source points was 0.86 and 0.76 for Jing-Well points with a CV of 23.2% and 25.9% respectively. The average CV for the seven acupuncturists was 24.5% on Yuan-Source points and 23.7% on Jing-Well points., Conclusions: The AcuGraph measures known resistors and organic matter accurately and reliably. Skin conductance at acupoints recorded by one operator was also reliable. There was less consistency in electrodermal recordings obtained by seven different operators. Operator training and technical improvements to the AcuGraph may improve consistency among operators.

Electrodermal activity (EDA) at acupuncture points (acupoints) has been investigated for its utility as a diagnostic aid, a therapeutic monitoring tool, and a physiological outcome measure. The research methodologies reported in published trials, however, vary considerably and publications often lack sufficient details about electrical instrumentation, technical procedures, laboratory conditions, recorded measures, and control comparisons to permit a critical appraisal of the studies or to replicate promising findings. We developed a 10-category (54 subitems) Quality of Reporting scale based on technical issues associated with EDA measurements, publication requirements for reporting EDA in the psychophysiological literature, and recommendations from the CONSORT Statement for reporting clinical trials. Using our Quality of Reporting scale, we extracted data from 29 studies that evaluated EDA at acupoints in patients and generated weighted scores for each of the 10 categories of essential information. Only 9 of the 29 studies reviewed scored a mean of greater than 50% for reporting details of essential information. To rigorously build a program of research on EDA at acupoints we need to standardize research methodology and reporting protocols. We propose a checklist of recommended informational items to report in future clinical trials that record EDA at acupoints., (Copyright © 2011 Korean Pharmacopuncture Institute. Published by .. All rights reserved.)

The clinical practice of recording skin conductance (SC) at acupuncture points (acupoints), as a diagnostic and/or therapeutic monitoring aid may have scientific merit. However, influences of age, gender and time of day on these recordings are unknown and it is unclear whether SC at acupoints differs from SC levels in general (as reported in psychophysiology research). This paper summarizes SC data obtained with the AcuGraph 3 Digital Meridian Imaging System between June 2005 and March 31, 2010. An initial dataset of 117,725 SC examinations was scrubbed to include only the first SC examination on individual patients and exclude potentially faulty data. The final dataset consists of SC recordings at the 24 Source (Yuan) acupoints in 8637 patients, collected by 311 practitioners. Twelve left/right average conductance measures and an overall average of the 24 acupoints were assessed. Statistical analyses included two sample t tests, three way analyses of variance and linear regression. Results indicate that mean SC at acupoints, similar to SC in general, is higher in males, higher in afternoons and declines with age. Not previously reported, the rate of SC decline with age differs at different acupoints between males and females. These findings have substantial implications for acupuncture research and practice., (Copyright © 2011 Korean Pharmacopuncture Institute. Published by .. All rights reserved.)

Objectives: To assess the feasibility of conducting trials of static magnetic field (SMF) therapy for carpal tunnel syndrome (CTS), to collect preliminary data on the effectiveness of 2 SMF dosages, and to explore the influence of an SMF on median nerve conduction., Design: Randomized, double-blind, sham-controlled trial with a 6-week intervention and a 12-week follow-up., Setting: University hospital outpatient clinics., Participants: Women and men (N=60), ages 21 to 65 years, with an electrophysiologically confirmed CTS diagnosis recruited from the general population., Interventions: Participants wore nightly either neodymium magnets that delivered either 15 or 45 mTesla (mT) to the contents of the carpal canal or a nonmagnetic disk., Main Outcome Measures: Symptom Severity Scale (SSS) and Function Severity Scale (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ) and 4 median nerve parameters: sensory distal latency, sensory nerve action potential amplitude, motor distal latency and compound motor action potential amplitude., Results: Fifty-eight of 60 randomized participants completed the study. There were no significant between-group differences for change in the primary endpoint SSS or for FSS or median nerve conduction parameters. For the SSS and the FSS, each group showed a reduction at 6 weeks indicating improvement in symptoms., Conclusions: This study showed the feasibility and safety of testing SMF therapy for CTS. There were no between-group differences observed for the BCTQ or median nerve parameters after 6 weeks of SMF therapy. Significant within-group, symptomatic improvements of the same magnitude were experienced by participants in both active and sham magnet groups. Future studies are needed to optimize SMF dosimetry and resolve issues related to the use of sham controls in SMF trials., (Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Static magnetic field (SMF) therapy, applied via a permanent magnet attached to the skin, is used by people worldwide for self-care. Despite a lack of established SMF dosage and treatment regimens, multiple studies are conducted to evaluate SMF therapy effectiveness. Our objectives in conducting this review are to:(i) summarize SMF research conducted in humans; (ii) critically evaluate reporting quality of SMF dosages and treatment parameters and (iii) propose a set of criteria for reporting SMF treatment parameters in future clinical trials. We searched 27 electronic databases and reference lists. Only English language human studies were included. Excluded were studies of electromagnetic fields, transcranial magnetic stimulation, magnets placed on acupuncture points, animal studies, abstracts, posters and editorials. Data were extracted on clinical indication, study design and 10 essential SMF parameters. Three reviewers assessed quality of reporting and calculated a quality assessment score for each of the 10 treatment parameters. Fifty-six studies were reviewed, 42 conducted in patient populations and 14 in healthy volunteers. The SMF treatment parameters most often and most completely described were site of application, magnet support device and frequency and duration of application. Least often and least completely described were characteristics of the SMF: magnet dimensions, measured field strength and estimated distance of the magnet from the target tissue. Thirty-four (61%) of studies failed to provide enough detail about SMF dosage to permit protocol replication by other investigators. Our findings highlight the need to optimize SMF dosing parameters for individual clinical conditions before proceeding to a full-scale clinical trial.

An 8-channel skin impedance measurement system for acupuncture research has been developed. The underlying model of the skin used is a parallel R & C network. Pulses are used to measure the R and C values. The measurement circuit is time multiplexed across the 8 channels at the rate of 2 measurements per second, leading to a complete set of measurements every 4 seconds. In static tests, the system has been operational for over 2 days of continuous measurements. In preliminary human tests, measurements over 2 hours have been collected per subject.

Skin impedance at acupuncture points (APs) has been used as a diagnostic/therapeutic aid for more than 50 years. Currently, researchers are evaluating the electrophysiologic properties of APs as a possible means of understanding acupuncture's mechanism. To comprehensively assess the diagnostic, therapeutic and mechanistic implications of acupuncture point skin impedance, a device capable of reliably recording impedances from 100 kOmega to 50 MOmega at multiple APs over extended time periods is needed. This article describes design considerations, development and testing of a single channel skin impedance system (hardware, control software and customized electrodes). The system was tested for accuracy against known resistors and capacitors. Two electrodes (the AMI and the ORI) were compared for reliability of recording over 30 min. Two APs (LU 9 and PC 6) and a nearby non-AP site were measured simultaneously in four individuals for 60 min. Our measurement system performed accurately (within 5%) against known resistors (580 kOmega-10 MOmega) and capacitors (10 nF-150 nF). Both the AMI electrode and the modified ORI electrode recorded skin impedance reliably on the volar surface of the forearm (r = 0.87 and r = 0.79, respectively). In four of four volunteers tested, skin impedance at LU 9 was less than at the nearby non-AP site. In three of four volunteers skin impedance was less at PC 6 than at the nearby non-AP site. We conclude that our system is a suitable device upon which we can develop a fully automated multi-channel device capable of recording skin impedance at multiple APs simultaneously over 24 h.

The widespread use of static magnetic field (SMF) therapy as a self-care physical intervention has led to the conduct of numerous randomized controlled trials (RCTs). A recent systematic review of SMF trials for pain reduction concluded that the evidence does not support the use of permanent magnets for pain relief. We argue that this conclusion is unwarranted if the SMF dosage was inadequate or inappropriate for the clinical condition treated. The purpose of this communication is to (1) provide a rationale and an explanation for each of 10 essential SMF dosing parameters that should be considered when conducting trials of SMF therapy, and (2) advocate for the conduct of Phase I studies to optimize SMF dosimetry for each condition prior to implementing a large-scale RCT. A previous critical review of SMF dosimetry in 56 clinical studies found that reporting SMF dosages in a majority of those studies was of such poor quality that the magnetic field exposure at the target tissue could not be characterized. Without knowing what magnetic field actually reached the target, it is impossible to judge dosage adequacy. In order to quantify SMF exposure at the site of pathology (target tissue/s), that site must be clearly named; the distance of the permanent magnet surface from the target must be delineated; the physical parameters of the applied permanent magnet must be described; and the dosing regimen must be precisely reported. If the SMF dosimetry is inadequate, any inferences drawn from reported negative findings are questionable.

According to conventional wisdom within the acupuncture community, acupuncture points and meridians are special conduits for electrical signals. This view gained popularity after anecdotal reports and clinical studies asserted that these anatomical structures are characterized by lower electrical impedance compared to adjacent controls. To ascertain whether evidence exists to support or refute this claim, we conducted a systematic review of studies directly evaluating the electrical characteristics of acupuncture structures and appropriate controls. We searched seven electronic databases until August 2007, hand-searched references, and consulted technical experts. We limited the review to primary data human studies published in English. A quality scoring system was created and employed for this review. A total of 16 articles representing 18 studies met inclusion criteria: 9 examining acupuncture points and 9 examining meridians. Five out of 9 point studies showed positive association between acupuncture points and lower electrical resistance and impedance, while 7 out of 9 meridian studies showed positive association between acupuncture meridians and lower electrical impedance and higher capacitance. The studies were generally poor in quality and limited by small sample size and multiple confounders. Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. However, the preliminary findings are suggestive and offer future directions for research based on in-depth interpretation of the data., ((c) 2008 Wiley-Liss, Inc.)

Objectives: To test whether electrical skin impedance at each of three acupuncture points (APs) is significantly lower than at nearby sites on the meridian (MP) and off the meridian (NP)., Design: Two instruments - Prognos (MedPrevent GmbH, Waldershof, Germany), a constant-current (DC) device, and PT Probe (designed for this study), a 100-Hz sinusoidal-current (AC) device-were used to record electrical impedance at three APs (right Gallbladder 14, right Pericardium 8, and left Triple Energizer 1), and two control sites for each AP. Each AP, MP, and NP was measured four times in random order with each device., Setting: The study was conducted over a period of 4 days at the Oregon College of Oriental Medicine (OCOM)., Subjects: Twenty (20) healthy adults (14 women and 6 men), all recruited from the OCOM student body and faculty, participated in the study., Results: The Prognos measurements had an intraclass correlation (ICC) = 0.84 and coefficient of variation (CV) = 0.43. The PT Probe had ICC = 0.81 and CV = 0.31. Impedance values at APs were not significantly less than at MPs or NPs. Impedance values at MPs were also not significantly less than NPs, although their individual p values were <0.05 in 4 of 6 cases. There was a significant trend of increasing impedance with repeated measurements with both the Prognos (p =0.003) and the PT Probe (p= 0.003)., Conclusions: Within the reliability limits of our study methods, none of the three APs tested has lower skin impedance than at either of the nearby control points. These results are not consistent with previous studies that detected lower skin impedance at APs than nearby sites. Further study is necessary to determine whether MPs have lower skin impedance than nearby NPs. Our study suggests caution is warranted when developing, using, and interpreting results from electrodermal screening devices. Further studies are needed to clarify the clinically important and controversial hypothesis that APs are sites of lower impedance.

Ventilator assistance is offered to patients with Duchenne muscular dystrophy as an option to extend life. This paper discusses the effect of respiratory difficulties and the subsequent quality of life for 17 patients and 14 family members living in the community. Areas covered included decision-making, health, education, vocational and recreational status, community resources and life satisfaction. Activity levels before and after ventilator use were assessed. Despite restrictions in daily life both before and after ventilator use, quality of life was fairly good. Restrictions in daily life were caused by a combination of progression of the disease and the ventilator, and family members were more burdened by the ventilator than were patients. It is concluded that patients and their families should make the decision about accepting or rejecting assisted ventilation.

The management of scoliosis in Duchenne muscular dystrophy is not standardized. Some centers offer no treatment, some provide customized body jackets or wheelchair inserts, and others recommend early surgical spinal fusion. Spinal orthoses are frequently prescribed at significant cost and inconvenience to the patient, with little evidence as to effectiveness in preventing scoliosis. This paper reports the preliminary findings of 22 patients involved in a study assessing the usefulness of a modified Jewett hyperextension brace. Seven brace wearers and 15 controls were entered into the study. The preliminary results indicate a mean curvature of 23.6 degrees (+/- 12.8 degrees) in the experimental group and 35.7 degrees (+/- 24.8 degrees) in the controls. Over an observation period ranging from two to seven years, the wearers have shown an average curve progression of 8.8 degrees/yr while the control group progressed at 11.2 degrees/yr. This difference is not considered statistically significant. We conclude that wearing the brace minimally slows scoliosis progression, but does not ultimately prevent a significant curve.

Twelve children with cerebral palsy ages 18 months to eight years received custom-molded DESEMO seats. All had markedly abnormal motor function manifested in spastic, athetoid, or mixed patterns of movement. None sat independently or were expected to gain such function. Three had minimal head control, and the remaining nine had fair head control. All were inadequately positioned in commercially available seats. The custom-molded DESEMO seat was clinically evaluated with regard to its ability to produce overall relaxation, assist head control, enhance feeding, improve upper extremity function, and prevent deformities. Also assessed were parents' acceptance of the device, cost, cosmesis, convenience, and its capacity to accommodate growth. Seven children utilized the seat as an insert for a motorized wheelchair. The secure positioning provided by this device permitted operation of a standard hand operated joystick control. Two seats were used as floor sitters, allowing the children to participate in peer group activities. Feeding improved dramatically with two children, as evidenced by weight gain and decreased feeding time. Three children with kyphotic spinal deformities showed no improvement or progression of their curves despite the seating device. The positioning device assisted head control for 10 children but failed to enhance head control in the remaining two. The overall cost of the device, including orthotist and physical therapist time, is $640.00 (1985). The average growth potential of the seat is six to nine months.

The ventilator management protocol followed over the last 12 years in 23 patients with Duchenne muscular dystrophy (DMD) and six polio survivors with chronic respiratory failure (CRF) secondary to the late effects of poliomyelitis or postpolio syndrome (PPS) is reviewed. After the onset of respiratory failure, patients with DMD continued to show a classic course of progressive, generalized muscle weakness and a steadily declining vital capacity from an average of 482mL to 336mL. The DMD group required an average increase of 0.95 hours in their daily use of assisted ventilation per year. Their overall average length of survival was increased from 19 years 9 months to 25 years 9 months. Members of the postpolio group, to date, have shown no significant decrease in muscle strength nor have they needed more than nocturnal ventilation. Recommended evaluation and pulmonary follow-up for patients with CRF secondary to neuromuscular disease is outlined. Most of these patients can be managed for a number of years with body ventilators before a tracheotomy is necessary.

The question of extending the lives of patients with progressive neuromuscular disease by means of ventilator support is controversial. It has been documented that ventilators can prolong the lives of patients with Duchenne muscular dystrophy by between two and 25 years, but few studies have assessed the effects of their use on individual or family functioning, or the quality of survival. A sample of patients with progressive disease and families living in the community was surveyed to assess these effects. Most of the sample were satisfied with their decision to extend life with the ventilator, but they found the experience significantly stressful in the home. Both patients and families believed their health-care team could have met their needs more comprehensively. Recommendations are made for health-care professionals working with patients with late-stage neuromuscular disease who need to use ventilators.

A survey was conducted to acquire information on the current pattern of respiratory device usage for patients with progressive neuromuscular diseases. Questionnaires were sent to 240 directors of Muscular Dystrophy Association (MDA) clinics. Of the 132 respondents, 32 (24%) physicians provide no respiratory support systems, 44 (33%) prescribe such systems routinely, and 56 (42%) provide the devices under specialized circumstances. A wide variety of negative and positive pressure ventilators are employed for patients having diseases such as amyotropic lateral sclerosis, Duchenne muscular dystrophy, spinal muscular atrophy. In the MDA clinics responding, 495 patients were found to be receiving some form of assisted ventilation. Of that number, 214 (43%) have permanent tracheostomies. We conclude that ventilators are being supplied to individuals with progressive neuromuscular disorders throughout the USA. However, there appear to be no standardized patient selection process or established protocol for respirator use in such cases.