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Cox's Bazar
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Cox's Bazar
'কক্সবাজার'
City
Cox's Bazar
Location of Cox's Bazar in Bangladesh
Coordinates: 21°35′0″N 92°01′0″E / 21.58333°N 92.01667°E / 21.58333; 92.01667
Country
Bangladesh
Division
Chittagong Division
District
Cox's Bazar District
Area
• City
6.85 km2 (2.64 sq mi)
Elevation
3 m (10 ft)
Population (2007 est.)Total population represents population in city and metro represents entire district.[1]
• City
51,918
• Density
7,579.27/km2 (19,630.2/sq mi)
• Metro
120,480
Time zone
BST (UTC+6)

Part of a series on
Tourism in Bangladesh

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Cox's Bazar sea beach · Kuakata
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St. Martin's Island · Nijhum Dwip
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Cox's Bazar (Bengali: কক্সবাজার, pronounced [kɔksbadʒaɾ]) is a city, fishing port, tourism centre and district headquarters in Bangladesh. The beach in Cox's Bazar is sandy and has a gentle slope; with a unbroken length of 120 km (75 mi), it is the longest natural sea beach in the world.[2][3][4] It is located 150 km (93 mi) south of the industrial port of Chittagong. Cox's Bazar is also known by the name Panowa, which Translates literally as "yellow flower." Another old name was "Palongkee".
The modern Cox's Bazar derives its name from Captain Hiram Cox, an officer of the British East India Company. Cox was appointed Superintendent of Palongkee outpost after Warren Hastings became Governor of Bengal. He embarked upon the task of rehabilitation and settlement of the Arakanese refugees in the area.[5] Captain Cox died in 1799 before he could finish his work. To commemorate his role in rehabilitation work, a market was established and named Cox's Bazar after him. Unlike many locations in the Indian Subcontinent where place names dating from the colonial period have been changed, Cox's name is still retained in the city he founded.
Today, Cox's Bazar is one of the most visited tourist destinations in Bangladesh, although not a major international tourist destination. In 2013, the Bangladesh Government formed the Tourist Police unit to protect local and foreign tourists better, as well as to look after the nature and wildlife in the tourist spots of Cox's Bazar.[6]
In 2017, the Kutupalong refugee camp for Rohingya people escaping from Myanmar opened near Cox's Bazar.[7]
Contents
[hide]
1 Town
1.1 History
2 Geography and climate
3 Important Educational Institutions
3.1 Economy and development
3.2 Tourist attractions near the town
4 See also
5 References
6 External links
Town[edit]
Cox's Bazar Town was constituted in 1869, eventually becoming a B-grade municipality in 1989. Located along the Bay of Bengal in South Eastern Bangladesh, Cox's Bazar Town is a health resort. But it is famous mostly for its long natural sandy beach. The municipality covers an area of 6.85 km2 (2.64 sq mi) with 27 mahallas and 9 wards and has a population of 51,918.[8] Cox's Bazar is connected by road and air with Chittagong.[9]
History[edit]
The greater Chittagong area, including Cox's Bazar, was under the rule of Arakan kings from the early 9th century until its conquest by the Mughals in 1666 AD.[10] When the Mughal Prince Shah Shuja was passing through the hilly terrain of the present-day Cox's Bazar on his way to Arakan, he was attracted to its scenic and captivating beauty. He commanded his forces to camp there. His retinue of one thousand palanquins stopped there for some time. A place named Dulahazara, meaning "one thousand palanquins," still exists in the area. After the Mughals, the place came under the control of the Tipras and the Arakanese, followed by the Portuguese and then the British.
The name Cox's Bazar originated from the name of a British East India Company officer, Captain Hiram Cox, who was appointed as the Superintendent of Palonki (today's Cox's Bazar) outpost. He succeeded Warren Hastings, who became the Governor of Bengal following the British East India Company Act in 1773. The Captain rehabilitated many refugees in the area, but died in 1799 before he could finish his work. To commemorate him, a market was established and named after him, called Cox's Bazar. Cox's Bazar then was first established in 1854 and became a municipality in 1869.[10]
After the Sepoy Mutiny (Indian Rebellion of 1857) in 1857, the British East India Company was highly criticised and questioned on humanitarian grounds, specially for its opium trade monopoly over the Indian Sub-Continent. However, after its dissolution on 1 January 1874, all of the company's assets including its Armed Forces were acquired by the British Crown. After this historic take over, Cox's Bazar was declared a district of the Bengal Province under the British Crown.
Cox's Bazar Map from Series U542, US Army Map Service, 1955
After the end of British rule in 1947, Cox's Bazar became part of East Pakistan. Captain Advocate Fazlul Karim, the first chairman (after independence from the British) of Cox's Bazar Municipality, established the Tamarisk Forest along the beach. He wanted to attract tourists as well as to protect the beach from tsunami. He donated much of his father-in-law's and his own lands as sites for constructing a public library and a town hall. He was inspired to build Cox's Bazar as a tourist spot after seeing beaches of Bombay and Karachi, and was a resort pioneer in developing Cox's Bazar as a destination. He established a maternity hospital, the stadium and the drainage system by procuring grants from the Ford Foundation and Rockefeller Foundation through correspondence. T. H. Matthews, the principal of the Dacca Engineering College (1949~1954), was a friend who had helped him in these fundraising efforts. Engineer Chandi Charan Das was the government civil engineer who worked on all these projects. In 1959 the municipality was turned into a town committee.[10]
In 1961 the Geological Survey of Pakistan initiated investigation of radioactive minerals like monazite around the Cox's Bazar sea-beach area.[11]
Cox's Bazar Bus Terminal
In 1971, Cox's Bazar wharf was used as a naval port by the Pakistan Navy's gunboats. This and the nearby airstrip of the Pakistan Air Force were the scene of intense shelling by the Indian Navy during the Bangladesh Liberation War. During the war, Pakistani soldiers killed many people in the town, including eminent lawyer Jnanendralal Chowdhury. The killing of two freedom fighters named Farhad and Subhash at Badar Mokam is also recorded in history.[8]
After Bangladesh's independence, Cox's Bazar started to receive administrative attention. In 1972 the town committee of Cox's Bazar was turned into a municipality. In 1975, The Government of Bangladesh established a pilot plant at Kalatali.[11] Later, in 1984 Cox's Bazar subdivision was promoted to a district, and five years later (in 1989) the Cox's Bazar municipality was elevated to B-grade.[10] In 1994 (jobs) the Marine Fisheries and Technology Station (MFTS) was established at Cox's Bazar. MFTS is a research station of Bangladesh Fisheries Research Institute (BFRI) headquartered in Mymensingh. The station covers a land area of four hectares and contains five laboratories.[12] In April 2007 Bangladesh got connected to the submarine cable network as a member of the SEA-ME-WE-4 Consortium, as Cox's Bazar was selected as the landing station of the submarine cable.[13] In September 2012 the municipality was the site of the Cox's Bazar and Ramu riots, where local Muslims attacked the Buddhist community over an alleged Quran desecration posted to Facebook.[14]
Geography and climate[edit]
Panorama of Cox's Bazar in the early morning: clouds on a blue sky, still water and forest in the distance.
Cox's Bazar town with an area of 6.85 km2 (2.64 sq mi), is located at 21°35′0″N 92°01′0″E / 21.58333°N 92.01667°E / 21.58333; 92.01667 and bounded by Bakkhali River on the north and East, Bay of Bengal in the West, and Jhilwanj Union in the south.
The climate of Bangladesh is mostly determined by its location in the tropical monsoon region: high temperature, heavy rainfall, generally excessive humidity, and distinct seasonal variations.[15] The climate of Cox's bazar is mostly similar to the rest of the country. It is further characterised by the location in the coastal area. The annual average temperature in Cox's Bazar remains at about a maximum of 34.8 °C (94.6 °F) and a minimum of 16.1 °C (61.0 °F). The average amount of rainfall remains at 3,524 mm (138.7 in).
[hide]Climate data for Cox's Bazar
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
Record high °C (°F)
32.8
(91) 33.9
(93) 36.1
(97) 37.2
(99) 35.0
(95) 36.1
(97) 33.3
(91.9) 33.3
(91.9) 34.4
(93.9) 33.9
(93) 33.3
(91.9) 31.7
(89.1) 37.2
(99)
Average high °C (°F)
26.7
(80.1) 28.5
(83.3) 30.9
(87.6) 32.1
(89.8) 32.3
(90.1) 30.7
(87.3) 30.0
(86) 30.2
(86.4) 30.9
(87.6) 31.6
(88.9) 30.0
(86) 27.5
(81.5) 30.1
(86.2)
Average low °C (°F)
15.0
(59) 17.0
(62.6) 20.7
(69.3) 23.9
(75) 25.1
(77.2) 25.2
(77.4) 25.1
(77.2) 25.0
(77) 25.0
(77) 24.3
(75.7) 21.1
(70) 16.5
(61.7) 22.0
(71.6)
Record low °C (°F)
7.8
(46) 9.4
(48.9) 11.1
(52) 16.1
(61) 16.7
(62.1) 20.6
(69.1) 21.7
(71.1) 19.4
(66.9) 21.7
(71.1) 17.2
(63) 13.3
(55.9) 8.9
(48) 7.8
(46)
Average precipitation mm (inches)
4.1
(0.161) 17.0
(0.669) 34.7
(1.366) 121.8
(4.795) 286.8
(11.291) 801.9
(31.571) 924.6
(36.402) 667.1
(26.264) 330.1
(12.996) 213.6
(8.409) 109.4
(4.307) 13.0
(0.512) 3,524.1
(138.744)
Average precipitation days
1 2 3 6 13 19 22 21 14 7 4 1 113
Average relative humidity (%)
72 71 75 78 80 87 89 88 86 82 77 74 80
Source #1: Bangladesh Meteorological Department[16][17][18][19][20]
Source #2: Deutscher Wetterdienst (extremes)[21]
Important Educational Institutions[edit]
1962: Cox's Bazar Govt. College is the earliest Secondary and bachelor's degree offering college founded in Cox's Bazar.
1985: Cox's Bazar Law College is the first profession based college founded in this district.
1991: Cox's Bazar Govt. Women's College is the first Secondary and bachelor's degree offering college in this district solely for women.
2008: Cox's Bazar Medical College is the first medical college in this district and 200 bedded hospital

Other Colleges in this area: Cox's Bazar City College, Ramu Degree College, Ukhiya Degree College, Teknaf Degree College, Moheskhali degree college

High Schools: Cox's Bazar Govt. High School, Cox's Bazar Govt. Girls High School, Cox's Bazar Model High School, Kishalaya Model High School, Chokoria, Korak Bidda-pith, Chokoria, Chokoria Govt. High School, Palong Model High School, Shilkhali High School, Pekua.
Economy and development[edit]
Cox's Bazar Lighthouse
Bangladesh
Location
Cox's Bazar
Bangladesh
Coordinates
21°25′53″N 91°58′42″E / 21.431389°N 91.978306°E / 21.431389; 91.978306
Year first constructed
n/a
Foundation
concrete base
Construction
metal skeletal tower[22]
Tower shape
square prism skeletal tower with balcony and lantern[22]
Markings / pattern
white tower, orange lantern[22]
Height
7 metres (23 ft)[23]
Focal height
54 metres (177 ft)[23]
Range
21 nautical miles (39 km; 24 mi)[23]
Characteristic
Fl W 15s.[23]
Admiralty number
F1056.4[23]
NGA number
26756 [23]
ARLHS number
BAN-001[22]
Managing agent
Bangladesh Department of Shipping[22]
[edit on Wikidata]
Submarine Cable Landing Station
As one of the most beautiful and famous tourist spots in Bangladesh, the major source of economy in Cox's Bazar is tourism. Millions of foreigners and Bangladeshi natives visit this city every year. As a result, a large number of hotels, guest houses and motels have been built in the city and coastal region. Many people are involved in hospitality and customer service orientated businesses. The number of high-end hotels in the city was about 2 or 3 about 5 years ago, but today there are dozens and counting. A few international hotel chains now operate in the city, but others are planning to build hotels here.
People are also involved in fishing and collecting seafood and sea products for their livelihood. Oysters, snails, pearls and their ornaments are very popular with tourists. Some people are involved in the transportation business for tourists. Cox's Bazar is one of the few major spots for aquaculture in Bangladesh.[24] Along with Khulna, it is considered a major source of revenue from foreign exchanges. Beside a mix of small-scale agriculture, marine and inland fishing and salt production are other industrial sources that play important roles in the national economy.
Tourist attractions near the town[edit]
Beach-side accessories for the tourists at Cox's Bazar
The beach is the main attraction of the town. There is several 3 star and 5 star hotels provide exclusive beachside area with accessories for the tourist. Visitors in other hotels visit the Laboni beach which is the area of the beach closest to the town. Other than the beach there are several places of interest near the town which can easily be visited from town centre.
Himchari National Park : Himchari is located just south of the Cox's Bazar town. It consists of lush tropical rain forest, grasslands and trees, and features a number of waterfalls, the biggest of which cascades down toward the sandy, sun-drenched beach. The National Park was established in 1980 by the Government of Bangladesh as a conservation area for research, education and recreation. Once it was the stomping grounds of herds of Asian elephant. It is still home to a limited number of these mammals.[25]
Aggmeda Khyang: a large Buddhist monastery, and a place revered by around 400,000 Buddhist people of Cox's Bazar; and the Chittagong Hill Tracts. The main sanctuary is posted on a series of round timber columns. It has a prayer chamber and an assembly hall along with a repository of large and small bronze Buddha images and a number of old manuscripts.
Ramu: about 10 km (6 mi) from Cox's Bazar,[26] is a village with a sizeable Buddhist population. The village is famous for its handicrafts and homemade cigars. There are monasteries, khyangs and pagodas containing images of Buddha in bronze, gold and other metals with precious stones. One of the most interesting of these temples is on the bank of the Baghkhali river. It houses not only relics and Burmese handicrafts but also a large bronze statue of Buddha measuring thirteen feet high which rests on a six feet high pedestal. Weavers ply their trade in open workshops and craftsmen make handmade cigars in their pagoda like houses.
Bangabandhu Sheikh Mujib Safari Park: Bangabandhu Sheikh MujibSafari Park is the first Safari Park in Bangladesh. The nature of the forest is tropical evergreen and rich with Garjan, Boilam, Telsur and Chapalish along with herbs, shrubs and creepers. Safari Park is a declared protected area where the animals are kept in fairly large area with natural environment and visitors can easily see the animal when ever they visit by bus, jeep or on foot. This park was established on the basis of South Asian model. This safari park is an extension of an animal sanctuary located along the Chittagong-Cox's Bazar road about 50 km (30 mi) from Cox's Bazar town. The sanctuary itself protects a large number of wild elephants which are native to the area. In the safari park there are domesticated elephants which are available for a ride. Other animal attractions include lions, Bengal tigers, Crocodiles, Bears, Chitals and lots of different types of birds and monkeys.which is wonder full project to attract the tourist.
Inani Beach Inani is a stony beach near Cox's Bazar.
See also[edit]
Cox's Bazar District
Cox's Bazar Sadar Upazila
Cox's Bazar Airport
List of lighthouses in Bangladesh
References[edit]
Jump up ^ "Area, Population and Literacy Rate by Paurashava −2001" (PDF). Bangladesh Bureau of Statistics. Archived from the original (PDF) on 17 December 2008.
Jump up ^ Ethirajan, Anbarasan (26 December 2012). "Bangladesh's Cox's Bazar: A paradise being lost?". BBC World. Retrieved 29 January 2015.
Jump up ^ Panday, V.C., ed. (2004). Environment, Security and Tourism Development in South Asia: Tourism development in South Asia. Environment, Security and Tourism Development in South Asia. 3. New Delhi: Gyan Publishing House. pp. 100–101. ISBN 978-81-8205-139-3.
Jump up ^ The Europa World Year Book 2003. Taylor & Francis. 2003. p. 679. ISBN 978-1-85743-227-5.
Jump up ^ Nandita Haksar (2009). Rogue Agent: How India's Military Intelligence Betrayed the Burmese Resistance. Penguin Books India. pp. 55–56. ISBN 978-0-14-306489-3.
Jump up ^ Mahmud, Tarek (31 August 2013). "Seashores to get tourist police". Dhaka Tribune. Retrieved 18 June 2015.
Jump up ^ [1]
^ Jump up to: a b Alam, Badiul (2012). "Cox's Bazar Sadar Upazila". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
Jump up ^ "Cox's Bazar, Bangladesh". Encyclopædia Britannica. 12 January 2015. Retrieved 14 January 2008.
^ Jump up to: a b c d Siddiqi, Mohammad Mahibbullah (2012). "Cox's Bazar District". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
^ Jump up to: a b Chowdhury, Sifatul Quader (2012). "Beach Sand Heavy Mineral". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
Jump up ^ Kabir, SM Humayun (2012). "Bangladesh Fisheries Research Institute". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
Jump up ^ "Much needed Submarine Cable – Bangladesh". Bangladesh Development Gateway. 2 March 2006. Archived from the original on 20 April 2006. Retrieved 14 January 2008.
Jump up ^ "Muslim protesters torch Buddhist temples, homes in Bangladesh | Reporters Club". Reportersnepal.com. 30 September 2012. Retrieved 25 October 2012.
Jump up ^ Ahmed, Rafique (2012). "Climate". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
Jump up ^ "Monthly Maximum Temperature". Bangladesh Meteorological Department. Retrieved 31 January 2016.
Jump up ^ "Monthly Minimum Temperature". Bangladesh Meteorological Department. Retrieved 31 January 2016.
Jump up ^ "Normal Monthly Rainfall". Bangladesh Meteorological Department. Retrieved 31 January 2016.
Jump up ^ "Normal Monthly Rainy Day". Bangladesh Meteorological Department. Retrieved 31 January 2016.
Jump up ^ "Normal Monthly Humidity". Bangladesh Meteorological Department. Retrieved 31 January 2016.
Jump up ^ "Klimatafel von Koks Bazar (Cox's Bazar) / Bangladesch" (PDF). Baseline climate means (1961–1990) from stations all over the world (in German). Deutscher Wetterdienst. Retrieved 31 January 2016.
^ Jump up to: a b c d e "Bangladesh". The Lighthouse Directory. University of North Carolina at Chapel Hill. Retrieved 30 September 2016.
^ Jump up to: a b c d e f List of Lights, Pub. 112: Western Pacific and Indian Oceans Including the Persian Gulf and Red Sea (PDF). List of Lights. United States National Geospatial-Intelligence Agency. 2016.
Jump up ^ Reeves, Peter. "The Development of Export-Oriented Shrimp Aquaculture in Bangladesh: a preliminary assessment of moves to more intensive production in southeastern Bangladesh". University of Edinburgh (Abstract). Archived from the original on 1 September 2005. Retrieved 1 February 2008.
Jump up ^ "Himchari National Park – A Birdwatcher's Paradise". Bangladesh.com. Retrieved 1 February 2015.
Jump up ^ Hossain, Mofazzal (2012). "Cox's Bazar". In Islam, Sirajul; Jamal, Ahmed A. Banglapedia: National Encyclopedia of Bangladesh (Second ed.). Asiatic Society of Bangladesh.
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Has Been
From Wikipedia, the free encyclopedia
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For the grammatical construction "has been (to)", see have been. For the word "has-been", see its Wiktionary entry.
Has Been
Studio album by William Shatner
Released
October 5, 2004
Genre
Indie rock, spoken word
Length
39:49
Label
Shout! Factory
Producer
Ben Folds
William Shatner chronology
Captain of the Starship
(1978)Captain of the Starship1978 Has Been
(2004) Exodus: An Oratorio in Three Parts
(2008)Exodus: An Oratorio in Three Parts2008
Singles from Has Been
"Common People"
Released: 2004[1]
Professional ratings
Review scores
Source
Rating
AllMusic [2]
The Guardian neutral[3]
Pitchfork Media 7.5/10[4]
Has Been (2004) is William Shatner's second musical album after 1968's The Transformed Man.
The album was produced and arranged by Ben Folds and most of the songs are co-written by Folds and Shatner, with Folds creating arrangements for Shatner's prose-poems, and features guest appearances from Joe Jackson (on a cover of Pulp's "Common People"), Folds and Aimee Mann (backup vocals on "That's Me Trying"), Lemon Jelly (on "Together"), Henry Rollins, and Adrian Belew (on "I Can't Get Behind That"), and Brad Paisley (on "Real", which he wrote specifically for Shatner).
Henry Rollins also talks about his experience while recording the song "I Can't Get Behind That" with Shatner on his spoken-word album Talk Is Cheap Vol IV and in his live spoken-word video, Shock and Awe.
In 2007, a ballet called Common People, set to Has Been, was created by Margo Sappington (of Oh! Calcutta! fame) and performed by the Milwaukee Ballet.[5] Shatner attended the première and had the event filmed. This footage became William Shatner's Gonzo Ballet, a feature film with a well received[by whom?] world première at the Nashville Film Festival on 17 April 2009. The documentary also features interviews with William Shatner, Ben Folds, and Henry Rollins.
Contents
[hide]
1 Track listing
2 Charts
2.1 Album
2.2 Song
3 See also
4 References
5 External links
Track listing[edit]
"Common People" (Nick Banks, Jarvis Cocker, Candida Doyle, Steve Mackey, Russell Senior) – 4:40
"It Hasn't Happened Yet" (Folds, Shatner) – 3:49
"You'll Have Time" (Folds, Shatner) – 5:18
"That's Me Trying" (Folds, Nick Hornby) with Aimee Mann on vocals – 3:48
"What Have You Done" (Shatner) – 1:46
"Together" (Lemon Jelly, Elizabeth Shatner, William Shatner) – 5:39
"Familiar Love" (Folds, Shatner) – 4:00
"Ideal Woman" (Folds, Shatner) – 2:23
"Has Been" (Folds, Shatner) – 2:18
"I Can't Get Behind That" (Folds, Henry Rollins, Shatner) with Adrian Belew on guitar – 3:00
"Real" (Brad Paisley) – 3:08
Charts[edit]
Album[edit]
Chart (2004)
Position
Billboard Top Heatseekers 22[6]
Song[edit]
Song
Chart (2004)
Position
"Common People" Triple J Hottest 100, 2004 21
See also[edit]
William Shatner's musical career
References[edit]
Jump up ^ "William Shatner - Common People". Discogs. Retrieved 1 August 2017.
Jump up ^ Has Been at AllMusic
Jump up ^ Wyse, Pascal (1 October 2004). "William Shatner, Has Been". The Guardian. London.
Jump up ^ "William Shatner - Has Been". Pitchfork.
Jump up ^ "The William Shatner Ballet". Milwaukee Ballet. Archived from the original on 2015-04-04.
Jump up ^ Has Been Billboard chart history, Billboard.com. Retrieved November 18, 2011.
External links[edit]
Has Been at Metacritic
[hide]
v
t
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Has Been
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Retrieved from "https://en.wikipedia.org/w/index.php?title=Has_Been&oldid=816873544"
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Nerve conduction velocity
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Nerve conduction velocity is an important aspect of nerve conduction studies. It is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, including age, sex, and various medical conditions. Studies allow for better diagnoses of various neuropathies, especially demyelinating conditions as these conditions result in reduced or non-existent conduction velocities.
Saltatory Conduction
Contents
[hide]
1 Normal conduction velocities
2 Testing methods
2.1 Nerve conduction studies
2.1.1 Micromachined 3D electrode arrays
3 Causes of conduction velocity deviations
3.1 Anthropometric and other individualized factors
3.1.1 Age
3.1.2 Sex
3.1.3 Temperature
3.1.4 Height
3.1.5 Hand factors
3.2 Medical conditions
3.2.1 Amyotrophic lateral sclerosis (ALS)
3.2.2 Carpal tunnel syndrome
3.2.3 Guillain–Barré syndrome
3.2.4 Lambert-Eaton myasthenic syndrome
3.2.5 Peripheral diabetic neuropathy
4 See also
5 References
6 External links
Normal conduction velocities[edit]
Ultimately, conduction velocities are specific to each individual and depend largely on an axon's diameter and the degree to which that axon is myelinated, but the majority of 'normal' individuals fall within defined ranges.[1]
Nerve impulses are extremely slow compared to the speed of electricity, where electric current can flow on the order of 50–99% of the speed of light; however, it is very fast compared to the speed of blood flow, with some myelinated neurons conducting at speeds up to 120 m/s (432 km/h or 275 mph).
Motor fiber types
Type
Erlanger-Gasser
Classification
Diameter
Myelin
Conduction velocity
Associated muscle fibers
α
Aα 13–20 µm Yes 80–120 m/s Extrafusal muscle fibers
γ
Aγ 5–8 µm Yes 4–24 m/s [2][3] Intrafusal muscle fibers
Different sensory receptors are innervated by different types of nerve fibers. Proprioceptors are innervated by type Ia, Ib and II sensory fibers, mechanoreceptors by type II and III sensory fibers, and nociceptors and thermoreceptors by type III and IV sensory fibers.
Sensory fiber types
Type
Erlanger-Gasser
Classification
Diameter
Myelin
Conduction velocity
Associated sensory receptors
Ia
Aα 13–20 µm Yes 80–120 m/s[4] Responsible for proprioception
Ib
Aα 13–20 µm Yes 80–120 m/s Golgi tendon organ
II
Aβ 6–12 µm Yes 33–75 m/s Secondary receptors of muscle spindle
All cutaneous mechanoreceptors
III
Aδ 1–5 µm Thin 3–30 m/s Free nerve endings of touch and pressure
Nociceptors of neospinothalamic tract
Cold thermoreceptors
IV
C 0.2–1.5 µm No 0.5–2.0 m/s Nociceptors of paleospinothalamic tract
Warmth receptors
Autonomic efferent fibre types
Type
Erlanger-Gasser
Classification
Diameter
Myelin
Conduction velocity
preganglionic fibers
B 1–5 µm Yes 3–15 m/s
postganglionic fibers
C 0.2–1.5 µm No 0.5–2.0 m/s
Peripheral Nerves
Nerve
Conduction velocity[5][6]
Median Sensory
45–70 m/s
Median Motor
49–64 m/s
Ulnar Sensory
48–74 m/s
Ulnar Motor
49+ m/s
Peroneal Motor
44+ m/s
Tibial Motor
41+ m/s
Sural Sensory
46–64 m/s
Normal impulses in peripheral nerves of the legs travel at 40–45 m/s, and 50–65 m/s in peripheral nerves of the arms.[7] Largely generalized, normal conduction velocities for any given nerve will be in the range of 50–60 m/s.[8]
Testing methods[edit]
Nerve conduction studies[edit]
Nerve Conduction Velocity is just one of many measurements commonly made during a nerve conduction study (NCS). The purpose of these studies is to determine whether nerve damage is present and how severe that damage may be.
Nerve conduction studies are performed as follows:[8]
Two electrodes are attached to the subject's skin over the nerve being tested.
Electrical impulses are sent through one electrode to stimulate the nerve.
The second electrode records the impulse sent through the nerve as a result of stimulation.
The time difference between stimulation from the first electrode and pick-up by the downstream electrode is known as the latency. Nerve conduction latencies are typically on the order of milliseconds.
Although conduction velocity itself is not directly measured, calculating conduction velocities from NCS measurements is trivial. The distance between the stimulating and receiving electrodes is divided by the impulse latency, resulting in conduction velocity.
Many times, Needle EMG is also performed on subjects at the same time as other NCS procedures because they aid in detecting whether muscles are functioning properly in response to stimuli sent via their connecting nerves.[8] EMG is the most important component of electrodiagnosis of motor neuron diseases as it often leads to the identification of motor neuron involvement before clinical evidence can be seen.[9]
Micromachined 3D electrode arrays[edit]
Typically, the electrodes used in an EMG are stuck to the skin over a thin layer of gel/paste.[8] This allows for better conduction between electrode and skin. However, as these electrodes do not pierce the skin, there are impedances that result in erroneous readings, high noise levels, and low spatial resolution in readings.[10]
To address these problems, new devices are being developed, such as 3-dimensional electrode arrays. These are MEMS devices that consist of arrays of metal micro-towers capable of penetrating the outer layers of skin, thus reducing impedance.[10]
Compared with traditional wet electrodes, multi-electrode arrays offer the following:[10]
Electrodes are about 1/10 the size of standard wet surface electrodes
Arrays of electrodes can be created and scaled to cover areas of almost any size
Reduced impedance
Improved signal power
Higher amplitude signals
Allow better real-time nerve impulse tracking
Causes of conduction velocity deviations[edit]
Anthropometric and other individualized factors[edit]
Baseline nerve conduction measurements are different for everyone, as they are dependent upon the individual's age, sex, local temperatures, and other anthropometric factors such as hand size and height.[5][11] It is important to understand the effect of these various factors on the normal values for nerve conduction measurements to aid in identifying abnormal nerve conduction study results. The ability to predict normal values in the context of an individual's anthropometric characteristics increases the sensitivities and specificities of electrodiagnostic procedures.[5]
Age[edit]
Normal 'adult' values for conduction velocities are typically reached by age 4. Conduction velocities in newborns and toddlers tend to be about half the adult values.[1]
Nerve conduction studies performed on healthy adults revealed that age is negatively associated with the sensory amplitude measures of the Median, Ulnar, and Sural nerves. Negative associations were also found between age and the conduction velocities and latencies in the Median sensory, Median motor, and Ulnar sensory nerves. However, conduction velocity of the Sural nerve is not associated with age. In general, conduction velocities in the upper extremities decrease by about 1 m/s for every 10 years of age.[5]
Sex[edit]
Sural nerve conduction amplitude is significantly smaller in females than males, and the latency of impulses is longer in females, thus a slower conduction velocity.[5]
Other nerves have not been shown to exhibit any gender biases.
Temperature[edit]
In general, the conduction velocities of most motor and sensory nerves are positively and linearly associated with body temperature (low temperatures slow nerve conduction velocity and higher temperatures increase conduction velocity).[1]
Conduction velocities in the Sural nerve seem to exhibit an especially strong correlation with the local temperature of the nerve.[5]
Height[edit]
Conduction velocities in both the Median sensory and Ulnar sensory nerves are negatively related to an individual's height, which likely accounts for the fact that, among most of the adult population, conduction velocities between the wrist and digits of an individual's hand decrease by 0.5 m/s for each inch increase in height.[5] As a direct consequence, impulse latencies within the Median, Ulnar, and Sural nerves increases with height.[5]
The correlation between height and the amplitude of impulses in the sensory nerves is negative.[5]
Hand factors[edit]
Circumference of the index finger appears to be negatively associated with conduction amplitudes in the Median and Ulnar nerves. In addition, people with larger wrist ratios (anterior-posterior diameter : medial-lateral diameter) have lower Median nerve latencies and faster conduction velocities.[5]
Medical conditions[edit]
Amyotrophic lateral sclerosis (ALS)[edit]
Amyotrophic Lateral Sclerosis (ALS) aka 'Lou Gehrig's disease' is a progressive and inevitably fatal neurodegenerative disease affecting the motor neurons.[9] Because ALS shares many symptoms with other neurodegenerative diseases, it can be difficult to diagnose properly. The best method of establishing a confident diagnosis is via electrodiagnostic evaluation. To be specific, motor nerve conduction studies of the Median, Ulnar, and peroneal muscles should be performed, as well as sensory nerve conduction studies of the Ulnar and Sural nerves.[9]
In patients with ALS, it has been shown that distal motor latencies and slowing of conduction velocity worsened as the severity of their muscle weakness increased. Both symptoms are consistent with the axonal degeneration occurring in ALS patients.[9]
Carpal tunnel syndrome[edit]
Carpal tunnel syndrome (CTS) is a form of nerve compression syndrome caused by the compression of the median nerve at the wrist. Typical symptoms include numbness, tingling, burning pains, or weakness in the hand.[12][13] CTS is another condition for which electrodiagnostic testing is valuable.[12][14] However, before subjecting a patient to nerve conduction studies, both Tinel's test and Phalen's test should be performed. If both results are negative, it is very unlikely that the patient has CTS, and further testing is unnecessary.[13]
Carpal tunnel syndrome presents in each individual to different extents. Measurements of nerve conduction velocity are critical to determining the degree of severity.[14][15] These levels of severity are categorized as:[12][13]
Mild CTS: Prolonged sensory latencies, very slight decrease in conduction velocity. No suspected axonal degeneration.
Moderate CTS: Abnormal sensory conduction velocities and reduced motor conduction velocities. No suspected axonal degeneration.
Severe CTS: Absence of sensory responses and prolonged motor latencies (reduced motor conduction velocities).
Extreme CTS: Absence of both sensory and motor responses.
One common electrodiagnostic measurement includes the difference between sensory nerve conduction velocities in the pinkie finger and index finger. In most instances of CTS, symptoms will not present until this difference is greater than 8 m/s.[12][13]
Guillain–Barré syndrome[edit]
Guillain–Barré syndrome (GBS) is a peripheral neuropathy involving the degeneration of myelin sheathing and/or nerves that innervate the head, body, and limbs.[7] This degeneration is due to an autoimmune response typically initiated by various infections.
Two primary classifications exist: demyelinating (Schwann cell damage) and axonal (direct nerve fiber damage).[7][16] Each of these then branches into additional sub-classifications depending on the exact manifestation. In all cases, however, the condition results in weakness or paralysis of limbs, the potentially fatal paralysis of respiratory muscles, or a combination of these effects.[7]
The disease can progress very rapidly once symptoms present (severe damage can occur within as little as a day).[7] Because electrodiagnosis is one of the fastest and most direct methods of determining the presence of the illness and its proper classification, nerve conduction studies are extremely important.[16] Without proper electrodiagnostic assessment, GBS is commonly misdiagnosed as Polio, West Nile virus, Tick paralysis, various Toxic neuropathies, CIDP, Transverse myelitis, or Hysterical paralysis.[7] Two sets of nerve conduction studies should allow for proper diagnosis of Guillain–Barré syndrome. It is recommended that these be performed within the first 2 weeks of symptom presentation and again sometime between 3 and 8 weeks.[16]
Electrodiagnostic findings that may implicate GBS include:[6][7][16]
Complete conduction blocks
Abnormal or absent F waves
Attenuated compound muscle action potential amplitudes
Prolonged motor neuron latencies
Severely slowed conduction velocities (sometimes below 20 m/s)
Lambert-Eaton myasthenic syndrome[edit]
Lambert–Eaton myasthenic syndrome (LEMS) is an autoimmune disease in which auto-antibodies are directed against voltage-gated calcium channels at presynaptic nerve terminals. Here, the antibodies inhibit the release of neurotransmitters, resulting in muscle weakness and autonomic dysfunctions.[17]
Nerve conduction studies performed on the Ulnar motor and sensory, Median motor and sensory, Tibial motor, and Peroneal motor nerves in patients with LEMS have shown that the conduction velocity across these nerves is actually normal. However, the amplitudes of the compound motor action potentials may be reduced by up to 55%, and the duration of these action potentials decreased by up to 47%.[17]
Peripheral diabetic neuropathy[edit]
At least half the population with diabetes mellitus is also affected with diabetic neuropathy, causing numbness and weakness in the peripheral limbs.[18] Studies have shown that the Rho/Rho-kinase signaling pathway is more active in individuals with diabetes and that this signaling activity occurs mainly in the nodes of Ranvier and Schmidt-Lanterman incisures.[18] Therefore, over-activity of the Rho/Rho-kinase signaling pathway may inhibit nerve conduction.
Motor nerve conduction velocity studies revealed that conductance in diabetic rats was about 30% lower than that of the non-diabetic control group. In addition, activity along the Schmidt-Lanterman incisures was non-continuous and non-linear in the diabetic group, but linear and continuous in the control. These deficiencies were eliminated after the administration of Fasudil to the diabetic group, implying that it may be a potential treatment.[18]
See also[edit]
Nerve conduction study
Electrodiagnosis
Electromyography
References[edit]
^ Jump up to: a b c "Nerve conduction velocity". National Institutes of Health. 31 October 2013. Retrieved 13 November 2013.
Jump up ^ Andrew BL, Part NJ (1972) Properties of fast and slow motor units in hind limb and tail muscles of the rat. Q J Exp Physiol Cogn Med Sci 57:213-225.
Jump up ^ Russell NJ (1980). "Axonal conduction velocity changes following muscle tenotomy or deafferentation during development in the rat". J Physiol. 298: 347–360.
Jump up ^ Siegel, Allan; Sapru, Hreday (2005). Essential Neuroscience. p. 257. ISBN 978-0781750776.
^ Jump up to: a b c d e f g h i j Stetson, PhD, Diana S.; James W. Albers; Barbara A. Silverstein; Robert A. Wolfe (October 1992). "Effects of Age, Sex, and Anthropometric Factors on Nerve Conduction Measures". Muscle & Nerve. 15: 1095–1104. doi:10.1002/mus.880151007.
^ Jump up to: a b Sedano, Maria J.; Canga, Ana; Pablos, Carmen; Polo, Jose M.; Berciano, Jose (31 January 2013). "Muscle MRI in severe Guillain–Barré syndrome with motor nerve inexcitability". Journal of Neurology. 260 (6): 1624–1630. doi:10.1007/s00415-013-6845-y.
^ Jump up to: a b c d e f g Parry, Gareth J. (2007). Guillain–Barré Syndrome. New York, NY: Demos Medical Publishing. pp. 1–9. ISBN 978-1-932603-56-9.
^ Jump up to: a b c d "Nerve Conduction Study (NCS)". Johns Hopkins Medicine. Retrieved 17 November 2013.
^ Jump up to: a b c d Joyce, Nanette C.; Carter, Gregory T. (May 2013). "Electrodiagnosis in Persons With Amyotrophic Lateral Sclerosis". PM&R. 5 (5, Supplement): S89–S95. doi:10.1016/j.pmrj.2013.03.020.
^ Jump up to: a b c Rajaraman, Swaminathan; Bragg, Julian A.; Ross, James D.; Allen, Mark G. (30 June 2011). "Micromachined three-dimensional electrode arrays for transcutaneous nerve tracking". Journal of Micromechanics and Microengineering. 21 (8). doi:10.1088/0960-1317/21/8/085014.
Jump up ^ Thanakiatpinyo, MD, Thanitta; Gulapar Srisawasdi (2013). "Effect of Hand Size on the Stimulation Intensities Required for Median and Ulnar Sensory Nerve Conduction Studies". Archives of Physical Medicine and Rehabilitation. 94: 925–929. doi:10.1016/j.apmr.2012.11.029.
^ Jump up to: a b c d Werner, Robert A.; Andary, Michael (October 2011). "Electrodiagnostic evaluation of carpal tunnel syndrome". Muscle & Nerve. 44 (4): 597–607. doi:10.1002/mus.22208.
^ Jump up to: a b c d Ntani, Georgia; Palmer, Keith T.; Linaker, Cathy; Harris, E Clare; Van der Star, Richard; Cooper, Cyrus; Coggon, David (15 August 2013). "Symptoms, signs and nerve conduction velocities in patients with suspected carpal tunnel syndrome". BMC Musculoskeletal Disorders. 14 (1): 1–10. doi:10.1186/1471-2474-14-242.
^ Jump up to: a b Inukai, Tomoo; Uchida, Kenzo; Kubota, Chikara; Takamura, Takaharu; Nakajima, Hideaki; Baba, Hisatoshi (24 October 2013). "Second lumbrical-interossei nerve test predicts clinical severity and surgical outcome of carpal tunnel syndrome". Journal of Clinical Neuroscience. 20 (9): 1224–1227. doi:10.1016/j.pmrj.2013.04.007.
Jump up ^ Robinson, Lawrence, R.; Strakowski, Jeffrey; Kennedy, David J. (May 2013). "Is the Combined Sensory (Robinson) Index Routinely Indicated for All Cases of Suspected Carpal Tunnel Syndrome Undergoing Electrodiagnostic Evaluation?". PM&R. 5 (5): 433–437. doi:10.1016/j.pmrj.2013.04.007.
^ Jump up to: a b c d Shahrizaila, Nortina; Goh, Khean Jin; Abdullah, Suhailah; Kuppusamy, Rishikesan; Yuki, Nobuhiro (8 February 2013). "Two sets of nerve conduction studies may suffice in reaching a reliable electrodiagnosis in Guillain–Barré syndrome". Clinical Neurophysiology. 124 (7): 1456–1459. doi:10.1016/j.clinph.2012.12.047.
^ Jump up to: a b Crone, Clarissa; Christiansen, Ingelise; Vissing, John (3 May 2013). "Myopathic EMG findings and type II muscle fiber atrophy in patients with Lambert-Eaton myasthenic syndrome". Clinical Neurophysiology. 124 (9): 1889–1892. doi:10.1016/j.clinph.2013.02.115.
^ Jump up to: a b c Kanazawa, Yasushi; Junko Takahashi-Fujigasaki; Sho Ishizawa; Naoko Takabayashi; Kumiko Ishibashi; Keiichiro Matoba; Daiji Kawanami; Tamotsu Yokota; Naoko Tajima; Kazunori Utsunomiya (September 2013). "The Rho-kinase inhibitor fasudil restores normal motor nerve conduction velocity in diabetic rats by assuring the proper localization of adhesion-related molecules in myelinating Schwann cells". Experimental Neurology. 247: 438–446. doi:10.1016/j.expneurol.2013.01.012.
External links[edit]
Virtual NCS training and other educational tools
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