Skin and not dorsal root stimulation reduces hypertonus in thoracic motor complete spinal cord injury: a single case report.

On demand and localized treatment for excessive muscle tone after spinal cord injury (SCI) is currently not available. Here, we examine the reduction in leg hypertonus in a person with mid-thoracic, motor complete SCI using a commercial transcutaneous electrical stimulator (TES) applied at 50 or 150 Hz to the lower back and the possible mechanisms producing this bilateral reduction in leg tone. Hypertonus of knee extensors without and during TES, with both cathode (T11-L2) and anode (L3-L5) placed over the spinal column (midline, MID) or 10 cm to the left of midline (lateral, LAT) to only active underlying skin and muscle afferents, was simultaneously measured in both legs with the pendulum test. Spinal reflexes mediated by proprioceptive (H-reflex) and cutaneomuscular reflex (CMR) afferents were examined in the right leg opposite to the applied LAT TES. Hypertonus disappeared in both legs but only during thoracolumbar TES, and even during LAT TES. The marked reduction in tone was reflected in the greater distance both lower legs first dropped to after being released from a fully extended position, increasing by 172.8% and 94.2% during MID and LAT TES, respectively, compared with without TES. Both MID and LAT (left) TES increased H-reflexes but decreased the first burst, and lengthened the onset of subsequent bursts, in the cutaneomuscular reflex of the right leg. Thoracolumbar TES is a promising method to decrease leg hypertonus in chronic, motor complete SCI without activating spinal cord structures and may work by facilitating proprioceptive inputs that activate excitatory interneurons with bilateral projections that in turn recruit recurrent inhibitory neurons.NEW & NOTEWORTHY We present proof of concept that surface stimulation of the lower back can reduce severe leg hypertonus in a participant with motor complete, thoracic spinal cord injury (SCI) but only during the applied stimulation. We propose that activation of skin and muscle afferents from thoracolumbar transcutaneous electrical stimulation (TES) may recruit excitatory spinal interneurons with bilateral projections that in turn recruit recurrent inhibitory networks to provide on demand suppression of ongoing involuntary motoneuron activity.

Myofascial urinary frequency syndrome is a novel syndrome of bothersome lower urinary tract symptoms associated with myofascial pelvic floor dysfunction.

This study describes a novel, distinct phenotype of urinary symptoms named "myofascial urinary frequency syndrome" (MUFS) present in one-third of individuals presenting with urinary frequency. In addition to a characteristic symptom constellation suggestive of myofascial dysfunction, MUFS subjects exhibit "persistency": a persistent feeling of needing to urinate regardless of urine volume. On examination, 97% of MUFS patients demonstrated pelvic floor hypertonicity with either global tenderness or myofascial trigger points, and 92% displayed evidence of impaired muscular relaxation, hallmarks of myofascial dysfunction. To confirm this symptom pattern was attributable to the pelvic floor musculature, we confirmed the presence of "persistency" in 68 patients with pelvic floor myofascial dysfunction established through comprehensive examination and electromyography and corroborated by improvement with pelvic floor myofascial release. These symptoms distinguish subjects with myofascial dysfunction from subjects with OAB, IC/BPS, and asymptomatic controls, confirming MUFS is a distinct LUTS symptom complex.

[Sacral neuromodulation for bladder voiding dysfunction: Experience at a French university center]. / Neuromodulation sacrée pour trouble de la vidange vésicale : expérience d'un centre universitaire français.

OBJECTIVE: To report the experience of a university hospital center with sacral neuromodulation for patients with bladder voiding disorders. MATERIAL AND METHODS: All patients who underwent sacral neuromodulation between 1998 and 2022 for bladder voiding disorders were included. Medical records were analyzed retrospectively, and population, efficacy and follow-up data were collected. RESULTS: A total of 134 patients underwent test implantation and 122 patients were analyzed. 68 patients (56%) were implanted with a definitive neuromodulation device. Mean age was 43±16 years and BMI 25.5±5.4kg/m2. 74% were women. Bladder voiding disorder was due to sphincter hypertonia in 51% of cases, with associated bladder hypocontractility in 29%. The spontaneous micturition rate after implantation increased from 34% to 92%. Implantation results appeared to be better in patients with sphincter hypertonia, whether or not associated with bladder hypocontractility. The benefit was most often present with a frequency of 5Hz (54.4%). Side-effects were present in 52% of cases at 5 years, and in 85% of cases were pain in relation to the implanted devices. They resolved under medical treatment or after revision of the device (27% of cases at 5 years). CONCLUSION: SNM is effective in micturition recovery, but has side effects. Urodynamic mechanism and etiology may provide clues for modulating NMS box settings and determining predictive factors for NMS success. Data from other centers are needed to identify reliable predictive factors.

Effects of the Structured Water Dance Intervention (SWAN) on muscular hypertonia in adults with profound intellectual and multiple disabilities.

This study aimed to evaluate the effect of Structured Water Dance Intervention (SWAN) on muscular hypertonia in individuals with profound intellectual and multiple disability (PIMD). Muscular hypertonia has a multitude of negative consequences for people with PIMD because it can lead to contractures, pain, mobility impairment, pressure ulcers that limits functional behavior as well as gross and fine motor function. Thirty-six individuals with PIMD in four Swedish regions were randomized to two groups in a multicenter, crossover design. Two withdrew participation, thus 34 individuals completed the intervention. The intervention was administered for 40 min once a week during a 12-week period. Outcomes related to muscular hypertonia were examined using the Modified Ashworth Scale (MAS), and based on accompanying assistants' assessments. Hypertonia decreased from baseline to the end of the intervention period, as demonstrated by a decrease in MAS score. Hypertonia also decreased during the sessions, as shown by the assistants' ratings. In conclusion, this study demonstrates that SWAN holds potential to reduce muscular hypertonia in people with PIMD and points out the importance of customized physical treatment alternatives. The study provides useful information for the design of future non-invasive, non-pharmacological interventions to reduce muscular hypertonia in PIMD.

Acupuncture alleviates spinal hyperreflexia and motor dysfunction in post-ischemic stroke rats with spastic hypertonia via KCC2-mediated spinal GABAA activation.

The majority of patients simultaneously develop motor dysfunction and spastic hypertonia after ischemic strokes, which can be associated with an increasing trend in motor impairments, seriously impeding the rehabilitation process. Evidence suggests that some deficits in the KCC2 expression in the spinal cord along with maladaptive endogenous plasticity via GABAA receptors are often involved in the pathology of spastic hypertonia after a stroke. In this respect, acupuncture has been commonly used in clinical settings for post-stroke patients' rehabilitation. Nevertheless, the mechanism of the modulating activity of this alternative medicine in the spinal pathways to relieve spasticity and improve functional recovery after a stroke has still remained unclear. Utilizing laser speckle imaging, functional assessments (viz. neurologic function scale, muscular tension scale, foot balance test, and gait analysis), H-reflex recording, TTC, Western blotting, RT-qPCR, ELISA, and immunofluorescence molecular assay, the study results illustrated that acupuncture could significantly alleviate the spinal hyperreflexia, decrease muscle tone, and enhance locomotor function by elevating the GABA, KCC2, and GABAAγ2 expressions in the lumbar spine of a rat model of post-ischemic stroke with spastic hypertonia. Furthermore, the KCC2 antagonist DIOA abolished the benefits induced by this practice. Overall, the data revealed that acupuncture is a promising therapeutic approach for spastic hypertonia after a stroke, and the positive outcomes in this sense could be achieved via activating the KCC2-mediated spinal GABAA signaling pathway.

Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial.

BACKGROUND: Persons with stroke commonly have impairments associated with a reduction in functionality. Motor impairments are the most prevalent, causing an impact on activities of daily life. OBJECTIVE: The aim of this study was to evaluate the effect of a session of dry needling (DN) applied to the upper extremity muscles on the sensorimotor function, hypertonia, and quality of life of persons with chronic stroke. METHODS: A randomized, sham-controlled clinical trial was performed. Participants were randomly assigned into an intervention group that received a single session DN in the biceps brachii, brachialis, flexor digitorum superficialis and profundus, extensor digitorum, adductor pollicis and triceps brachii muscles, or into a control group that received the same treatment but with a sham DN intervention. Treatment outcomes included the Fugl-Meyer Assessment Scale for the upper extremity, the Modified Modified Ashworth Scale, and the EuroQol-5D questionnaire. Measurements were carried out before, immediately after, and 14 days after intervention. RESULTS: Twenty-three persons participated in the study. Significant differences between groups were observed after the intervention in the total wrist-hand motor score (p = 0.023) and sensorimotor score (p = 0.022), for hypertonia in the elbow extensors both after treatment (p = 0.002) and at follow-up (p = 0.018), and in quality of life at follow-up (p = 0.030). CONCLUSIONS: A single session of DN improved total wrist-hand motor function and total sensorimotor function in persons with chronic stroke immediately after treatment, as well as quality of life 2 weeks after treatment. TRIAL REGISTRATION NUMBER: NCT03546517 (ClinicalTrials.gov).

Managing Paratonia in Persons With Dementia: Short-term Effects of Supporting Cushions and Harmonic Techniques.

OBJECTIVES: Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored. DESIGN: This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants. SETTING AND PARTICIPANTS: The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium. METHODS: Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items. RESULTS: After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P < .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT. CONCLUSIONS/IMPLICATIONS: This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.

Transvaginal Trigger Point Injections Improve Pain Scores in Women with Pelvic Floor Hypertonicity and Pelvic Pain Conditions.

OBJECTIVES: Chronic pelvic pain in women often requires multimodal treatment regimens. We describe our method of transvaginal trigger point injections (TPIs) and report outcomes using change in pain scores. METHODS: This was a retrospective review of women treated with in-office pelvic floor muscle injections from January 2012 to August 2015. Lidocaine 1% and 2%, bupivacaine 0.5%, or ropivacaine 0.5% with or without the addition of triamcinolone 40 mg was used for the injections. Pain was reported on a 0- to 10-point numerical rating scale before and after injection. Differences in pretreatment and posttreatment pain scores were analyzed after the first injection and after subsequent injections. Repeated-measures analysis was used to determine if any variable affected treatment response. RESULTS: One hundred one women with a mean age of 44 years had a total of 257 separate visits for pelvic floor muscle injections. Triamcinolone was used at 90.2% (230/255) of the TPI visits. After the initial TPI visit, there was significant decrease in total levator numerical rating scale score (maximum score, 20; mean, -6.21 ± 4.7; P < 0.0001), and 77% (70/91) of patients had improved. These significant improvements were noted at all visits 1 through 4 and whether bilateral or unilateral injections were done. Only the total amount of local anesthestic used had a significant effect on the change in total levator pain scores (P = 0.002). Minor adverse effects including leg numbness, dizziness, nausea, bleeding, and headache occurred at 10% of visits. CONCLUSIONS: Pelvic floor muscle injections decrease pain levels in women with pelvic floor dysfunction.

Relevancia del síndrome piramidal en la esclerosis lateral amiotrófica / Relevance of the pyramidal syndrome in amyotrophic lateral sclerosis

Introducción: Los signos piramidales (hiperreflexia, espasticidad, signo de Babinski) son fundamentales para el diagnóstico de esclerosis lateral amiotrófica (ELA). Sin embargo, no siempre están presentes al comienzo, pueden variar con el tiempo y es controvertido su papel en la evolución. El objetivo del estudio es describir qué signos piramidales están presentes inicialmente y cómo evolucionan en una cohorte de pacientes con ELA, así como su papel pronóstico. Métodos: Análisis retrospectivo de pacientes recogidos de manera prospectiva, diagnosticados de ELA en nuestro centro, desde 1990 hasta 2015. Resultados: Del total de 130 pacientes con ELA, 34 (26,1%) no presentaron inicialmente ningún signo piramidal, mientras que 15 (11,5%) presentaban un síndrome piramidal completo. De aquellos pacientes sin piramidalismo inicial, la mediana de aparición de los primeros signos fue de 4,5 meses. El signo de Babinski estaba presente en 64 (49,2%), la hiperreflexia en 90 (69,2%) y en 22 (16,9%) pacientes existía espasticidad. Los signos piramidales tendían a mantenerse inalterados en el tiempo, aunque existe un porcentaje de pacientes en el que aparecen tardíamente o desaparecen con el tiempo. No se encontró asociación entre supervivencia y la presencia o modificación de signos piramidales, aunque la disminución de la espasticidad se asociaba a mayor deterioro clínico (escala ALSFR) (p < 0,001). Conclusión: Una cuarta parte de pacientes con ELA no presentaron inicialmente ningún signo piramidal y, en algunos casos, estos desaparecen con el tiempo. Esto resalta la necesidad de la inclusión de herramientas para la valoración de la vía piramidal (AU)

Introduction: Pyramidal signs (hyperreflexia, spasticity, Babinski sign) are essential for the diagnosis of amyotrophic lateral sclerosis (ALS). However, these signs are not always present at onset and may vary over time, besides which their role in disease evolution is controversial. Our goal was to describe which pyramidal signs were present and how they evolved in a cohort of patients with ALS, as well as their role in prognosis. Methods: Retrospective analysis of prospectively collected patients diagnosed with ALS in our centre from 1990 to 2015. Results: Of a total of 130 patients with ALS, 34 (26.1%) patients showed no pyramidal signs at the first visit while 15 (11.5%) had a complete pyramidal syndrome. Of those patients without initial pyramidal signs, mean time of appearance of the first signs was 4.5 months. Babinski sign was positive in 64 (49.2%) patients, hyperreflexia in 90 (69.2%) and 22 (16.9%) patients had spasticity. Pyramidal signs tended to remain unchanged over time, although they seem to appear at later stages or even disappear with time in some patients. We found no association between survival and the presence of changes to pyramidal signs, although decreased spasticity was associated with greater clinical deterioration (ALSFR scale) (P < .001). Conclusion: A quarter of patients with ALS initially showed no pyramidal signs and in some cases they even disappear over time. These data support the need for tools that assess the pyramidal tract (AU)

The effect of a single massage based on the tensegrity principle on postural stability in young women.

OBJECTIVE: The aim of this study was to investigate the effects of normalized muscle tension via tensegrity-based massage on postural stability in a sample of female young adults. METHODS: Nineteen females aged 21.8 ± 1.9 years were recruited presenting abnormal tension at muscles adhering to any of the following structural sites: superior iliac spine, lateral sacropelvic surface, linea aspera at 1/2 of femur length, and superior nuchal line of the occiput. Balance and postural control were assessed during bipedal stance using a force platform in multiple conditions: hard surface or soft foam surface with the head in either a neutral posture or tilted backward. Baseline and 3-min and 15-min post-treatment measures were collected while barefoot and eyes closed. Main outcomes measures included center of pressure variability, range, radius, and velocity in the anteroposterior (AP) mediolateral (ML) dimensions. RESULTS: In the solid surface with neutral head posture condition only AP COP measures decreased significantly (p< 0.05). In the soft surface condition, significant differences were observed in the AP and ML dimensions among most measures (p< 0.05). CONCLUSIONS: A single application of tensegrity-based massage positively influenced postural control in young adult females, particularly in the AP direction.

Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study.

OBJECTIVE: We investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04± 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care. METHODS: Pain Visual-Analogue-Scale (range 1-5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89± 1.36) compared to standard-care (3.85± 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (~3). FINDINGS: Children who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naïve children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001). CONCLUSIONS: Clown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present. TRIAL REGISTRATION: clinicaltrials.gov ID # NCT01377883.

Técnica para redução do tônus e alongamento muscular passivo: efeitos na amplitude de movimento de crianças com paralisia cerebral espástica / Technique to reduce tonus and passive muscle stretching: effects on range of motion in children with spastic cerebral palsy

INTRODUÇÃO: A paralisia cerebral (PC) é resultante de lesão no encéfalo em fase de maturação, acarretando em disfunções motoras. A espasticidade, forma mais comum de acometimento, gera prejuízos funcionais intensificados pela diminuição da mobilidade. OBJETIVO: Analisar os efeitos do alongamento passivo lento do músculo tríceps sural e de técnica para diminuir o tônus do conceito Bobath na amplitude de movimento (ADM) de dorsiflexão do tornozelo de crianças com PC espástica. MÉTODOS: Participaram 18 crianças atendidas no Hospital Estadual Mario Covas de Santo André e na Santa Casa de Diadema. O grau da hipertonia do músculo tríceps sural foi determinado pela Escala de Aswhorth Modificada e a ADM de dorsiflexão foi medida pela goniometria. Esses dois procedimentos foram realizados antes e após as seguintes situações: 1) aplicação de um protocolo de alongamento muscular passivo; 2) protocolo com uma técnica para diminuir o tônus do conceito Bobath; e 3) emprego associado dos dois protocolos. RESULTADOS: O grau de hipertonia não se modificou após o protocolo 1, porém os protocolos 2 e 3 diminuíram a espasticidade de maneira semelhante, conforme a Escala de Ashworth Modificada. Já o ângulo de dorsiflexão aumentou após aplicação dos três protocolos: 1 (p=0,176); 2 (p=0,008); e 3, com o aumento mais significativo (p=0,003). CONCLUSÃO: A técnica para redução do tônus mostrou efeito positivo na redução da espasticidade, segundo a Escala de Ashworth Modificada, e no aumento da ADM de crianças espásticas. A execução subsequente do alongamento muscular aumentou sua efetividade.

INTRODUCTION: Cerebral palsy (CP) is consequent of brain injury in the maturation phase, causing motor dysfunctions. The decreased mobility is intensified by spasticity, most common form of attack, generating functional impairment. OBJECTIVE: To analyze the effects of slow passive stretching of triceps sure muscle and technique for decreasing the tonus of Bobath concept on the range of motion (ROM) of ankle dorsiflexion in children with spastic CP. METHODS: 18 children seen at Hospital Estadual Mario Covas, in Santo André, and Santa Casa, in Diadema, participated in this study. The hypertonia rate of triceps sure muscle was determined by Modified Ashworth Scale and the ROM dorsiflexion by goniometer. Both procedures were realized before and after the following situations: 1) application of a passive muscle stretching protocol; 2) protocol with technique for decreasing the tonus of Bobath concept; and 3) use associated to two protocols. RESULTS: The hypertonia rate did not modify after protocol 1; however, protocols 2 and 3 decreased the spasticity similarly, according to Modified Ashworth Scale. The dorsiflexion angle increased after all protocols: protocol 1 (p=0.176); protocol 2 (p=0.008); and protocol 3, with the most significant increase of ROM (p=0.003). CONCLUSION: The technique to reduce tonus shows positive effects on decreasing in hypertonia rate and increase of ROM in spastic children. The subsequent execution of muscle stretching increased its effectiveness.

Acupuncture Reduces Excitability of Spinal Motor Neurons in Patients with Spastic Muscle Overactivity and Chronic Disorder of Consciousness Following Traumatic Brain Injury.

BACKGROUND AND OBJECTIVE: Spastic hypertonia usually occurs in patients with chronic disorders of consciousness (DOC) following severe traumatic brain injury (TBI). Spinal motor neuron excitability has been reported to increase in patients with brain damage. The aim of this study was to evaluate the immediate effects of acupuncture on spinal motor neuron excitability in patients with DOC following TBI by using evoked electromyography. SETTING AND PARTICIPANTS: Eleven male patients (mean age, 33 ± 14 years) with refractory muscle spasticity of the upper extremity accompanying chronic DOC following TBI and admitted to Chubu Medical Center for Prolonged Traumatic Brain Dysfunction were included. DESIGN: A crossover study design was used. Changes in variables in the acupuncture session were compared with those in the control session in the same patients. INTERVENTION: Acupuncture treatment was performed at GV 26, Ex-HN 3, bilateral LI 4, and ST 36 for 10 minutes. OUTCOME MEASURES: F-wave was recorded from the abductor pollicis brevis muscle. The main outcome measure was F/M amplitude ratio (F-wave amplitude/M-wave amplitude), calculated as an index for spinal motor neuron excitability. F-waves were recorded before treatment (baseline), 10 minutes after needle insertion (phase 1), and 10 minutes after needle removal (phase 2). The same procedure was followed in the control session without acupuncture on a separate day. RESULTS: F/M ratio was significantly reduced from baseline to phase 1 (p < 0.001) and phase 2 (p < 0.001) in the acupuncture session, whereas no significant changes were observed in the control session. Changes in F/M ratio from baseline to phase 1 and phase 2 were greater in the acupuncture session than the control session (p = 0.001 and <0.001, respectively). CONCLUSION: The excitability of the spinal motor neurons in patients with DOC following TBI was reduced after acupuncture treatment, suggesting that it is beneficial for reducing spastic muscle hypertonia in these patients.

Modulation of Muscle Tone and Sympathovagal Balance in Cervical Dystonia Using Percutaneous Stimulation of the Auricular Vagus Nerve.

Primary cervical dystonia is characterized by abnormal, involuntary, and sustained contractions of cervical muscles. Current ways of treatment focus on alleviating symptomatic muscle activity. Besides pharmacological treatment, in severe cases patients may receive neuromodulative intervention such as deep brain stimulation. However, these (highly invasive) methods have some major drawbacks. For the first time, percutaneous auricular vagus nerve stimulation (pVNS) was applied in a single case of primary cervical dystonia. Auricular vagus nerve stimulation was already shown to modulate the (autonomous) sympathovagal balance of the body and proved to be an effective treatment in acute and chronic pain, epilepsy, as well as major depression. pVNS effects on cervical dystonia may be hypothesized to rely upon: (i) the alteration of sensory input to the brain, which affects structures involved in the genesis of motoric and nonmotoric dystonic symptoms; and (ii) the alteration of the sympathovagal balance with a sustained impact on involuntary movement control, pain, quality of sleep, and general well-being. The presented data provide experimental evidence that pVNS may be a new alternative and minimally invasive treatment in primary cervical dystonia. One female patient (age 50 years) suffering from therapy refractory cervical dystonia was treated with pVNS over 20 months. Significant improvement in muscle pain, dystonic symptoms, and autonomic regulation as well as a subjective improvement in motility, sleep, and mood were achieved. A subjective improvement in pain recorded by visual analog scale ratings (0-10) was observed from 5.42 to 3.92 (medians). Muscle tone of the mainly affected left and right trapezius muscle in supine position was favorably reduced by about 96%. Significant reduction of muscle tone was also achieved in sitting and standing positions of the patient. Habituation to stimulation leading to reduced stimulation efficiency was observed and counteracted by varying stimulation patterns. Experimental evidence is provided for significantly varied sympathovagal modulation in response to pVNS during sleep, assessed via heart rate variability (HRV). Time domain measures like the root mean square of successive normal to normal heart beat intervals, representing parasympathetic (vagal) activity, increased from 37.8 to 67.6 ms (medians). Spectral domain measures of HRV also show a shift to a more pronounced parasympathetic activity.

[Cohort study of hyperbaric oxygention (HBO) in controlling hypermyotonia caused by spinal cord injury].

OBJECTIVE: To evaluate the clinical effects of hyperbaric oxygention (HBO) in treating hypermyotonia caused by spinal cord injury (SCI). METHODS: From March 2009 to April 2011, 80 patients with hypermyotonia caused by SCI were divided into treatment group and control group, with 40 cases in each group. There were 49 males and 31 females with an average age of (34.12 +/- 6.61) years (ranged, 17 to 60) in the study. Course of disease was from 14 to 30 d with an average of (20.16 +/- 5.08) d. The patients of the treatment group were treated with HBO, rehabilitation exercise and baclofen medication. With pressure of HBO was 2ATA, the treatment project including mask oxygen-inspiration for 20 minutes and resting 5 min, repeating 3 circulations as once, once every day and 10 times as a course of treatment, a total of 6 courses. In the control group, the patients were only treated with rehabilitation exercise and baclofen medication. Course of treatment was same with treatment group. The muscular tensions of patients were evaluated according to method of Modified Ashworth scale (MAS) at 3 courses and 6 courses after treatment. RESULTS: After 3 courses of treatment,5 cases were effective in treatment group and 4 cases were effective in control group. There was no significant difference between two groups. After 6 courses of treatment, 24 cases were effective and 5 cases were obvious effective in treatment group; 14 cases were effective and 2 cases were obvious effective in control group. Clinical effect of treatment group was better than that of control group after 6 courses of treatment. CONCLUSION: HBO was effective to controlling hypermyotonia caused by SCI, it can be used widely as a routine adjuvant therapy in clinic, but adequate course of treatment is necessary.

Effect of spinal cord injury and of intrathecal baclofen on brainstem reflexes.

Reorganization of neural circuits within the central nervous system following injury appears to be a means of compensatory mechanism for loss of function. Reorganization following spinal cord injury is known to evoke changes at the cortical and spinal cord levels. Recent studies, however, provide evidence of enhanced brainstem reflexes and alterations in excitatory and inhibitory interneuronal brainstem circuits, suggesting that reorganization following spinal cord injury occurs also at the brainstem level. Reversal of these changes by continuous intrathecal baclofen infusion to normal levels or beyond indicates strong GABAergic involvement. Rapid changes in the blink reflex and its prepulse inhibition following intrathecal baclofen bolus application that parallel clinical changes in muscle hypertonia suggest a muscle tone regulating effect of baclofen at the brainstem level. Enhanced brainstem reflexes in spinal cord injury patients may be the consequence of decreased GABA-mediated inhibition and/or strengthening of facilitatory connections due to either direct or indirect plastic changes occurring at the brainstem level. Modulation of brainstem reflexes by baclofen may foster the understanding of pathophysiological mechanisms underlying diseases with increased brainstem activity. Rehabilitation after central nervous system injury will always be a challenge, but understanding the mechanisms of reorganization of undamaged neural pathways may help to develop better strategies for enhancing neuronal plasticity and for implementing neuronal reorganization into carefully planned therapy.

Cohort study of hyperbaric oxygention (HBO) in controlling hypermyotonia caused by spinal cord injury / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of hyperbaric oxygention (HBO) in treating hypermyotonia caused by spinal cord injury (SCI).</p><p><b>METHODS</b>From March 2009 to April 2011, 80 patients with hypermyotonia caused by SCI were divided into treatment group and control group, with 40 cases in each group. There were 49 males and 31 females with an average age of (34.12 +/- 6.61) years (ranged, 17 to 60) in the study. Course of disease was from 14 to 30 d with an average of (20.16 +/- 5.08) d. The patients of the treatment group were treated with HBO, rehabilitation exercise and baclofen medication. With pressure of HBO was 2ATA, the treatment project including mask oxygen-inspiration for 20 minutes and resting 5 min, repeating 3 circulations as once, once every day and 10 times as a course of treatment, a total of 6 courses. In the control group, the patients were only treated with rehabilitation exercise and baclofen medication. Course of treatment was same with treatment group. The muscular tensions of patients were evaluated according to method of Modified Ashworth scale (MAS) at 3 courses and 6 courses after treatment.</p><p><b>RESULTS</b>After 3 courses of treatment,5 cases were effective in treatment group and 4 cases were effective in control group. There was no significant difference between two groups. After 6 courses of treatment, 24 cases were effective and 5 cases were obvious effective in treatment group; 14 cases were effective and 2 cases were obvious effective in control group. Clinical effect of treatment group was better than that of control group after 6 courses of treatment.</p><p><b>CONCLUSION</b>HBO was effective to controlling hypermyotonia caused by SCI, it can be used widely as a routine adjuvant therapy in clinic, but adequate course of treatment is necessary.</p>

Respiratory retraining therapy in long-term treatment of paradoxical vocal fold dysfunction.

OBJECTIVES: Paradoxical vocal fold dysfunction (PVFD) is a disorder in the larynx featuring involuntary adduction of the vocal folds during the inspiratory phase of breathing. The symptoms include acute episodes of dyspnea and bouts of coughing. To date, there is no universally acknowledged treatment for PVFD, though respiratory retraining therapy is the treatment of choice. AIMS: The purpose of this work was to evaluate the results of long-term respiratory retraining therapy in cases of PVFD. PATIENTS AND METHODS: We treated 20 patients with PVFD for 2 years: 10 subjects were submitted to a cycle of respiratory retraining therapy every 12 months (receiving a total of 3 cycles) while 10 were given a cycle every 3 months (for a total of 9 cycles) no matter what their clinical conditions were. RESULTS: The results show that long-term respiratory retraining is particularly efficacious if the cycles of treatment are repeated, no matter what clinical conditions are present. In fact, when only one cycle of retraining treatment is given a year, there is initial improvement followed by progressive worsening. CONCLUSIONS: Long-term respiratory rehabilitation is effective, especially if the treatment is given at least once every 3 months.

Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.

OBJECTIVES: To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES. DESIGN: Within-subject comparison. SETTING: University hospital. PARTICIPANTS: Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg. INTERVENTIONS: Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session. MAIN OUTCOME MEASURES: Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity). RESULTS: Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling. CONCLUSIONS: The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia.

Efectos de un programa combinado de ejercicio físico y Halliwick sobre la hipertonía en personas adultas con lesión cerebral. Estudio piloto / Effects of a combined program of physical exercise and Halliwick method on hypertonia in adults with brain injury. A pilot study

ObjetivoDeterminar los efectos de un programa combinado de ejercicio físico y el Método Halliwick sobre la hipertonía del músculo sóleo de personas adultas con lesión cerebral.Material y métodosSe estudiaron 7 sujetos con lesión cerebral. Recibieron un total de 24 sesiones (12 de fisioterapia acuática más 12 de fisioterapia en seco). Es un estudio con un solo grupo, con un diseño pretest y postest. Se valoró la temperatura superficial de la piel, la movilidad articular pasiva máxima, la resistencia al movimiento pasivo del tobillo (Escala Modificada de Ashworth) y el registro electromiográfico durante el estiramiento del músculo sóleo. Para el análisis estadístico se empleó una prueba t para muestras relacionadas.ResultadosIncremento en la movilidad articular pasiva de dorsiflexión del tobillo (p=0,05). Disminución en la temperatura superficial de la piel tras la sesión de hidroterapia (p=0,001). No se hallaron cambios estadísticamente significativos en la Escala Modificada de Ashworth ni en la actividad eléctrica del músculo sóleo al estiramiento (p≥0,05).ConclusiónEl programa combinado de fisioterapia acuática y de fisioterapia en seco en personas adultas con lesión cerebral con una intervención de 3 meses mejora la movilidad articular. Se requieren futuros estudios aleatorios con muestras más amplias para determinar la efectividad clínica de esta terapia(AU)

AimTo determine the effects of a combine program of physical exercise and the Halliwick Method on hypertonia of the soleus muscle in adults with brain injury.Subjects and methodsSeven subjects with brain injury were studied and a total of 24 sessions were applied (12 aquatic physiotherapy and 12 regular physical therapy activity program). The study was performed in a single group, using a pre- and post- test design. Skin surface temperature, maximum passive joint range of movement, resistance to passive movement of the ankle (Modified Ashworth Scale) and electromyographic recording during the stretching of the soleus muscle were evaluated. The statistical analysis used was a T test for related samples.ResultsIncreased passive joint range of movement of ankle dorsiflexion (p=0.05). The skin surface temperature decreased after the hydrotherapy session (p=0.001). No statistically significant changes were found in the Modified Ashworth Scale or the electrical activity of the soleus muscle during the stretching (p ≥0.05).ConclusionThe combined program of aquatic physical therapy and a dry-land physical therapy program in adults with brain injury with a 3-month intervention improves joint range of movement. Future, prospective randomized studies with larger samples are required to determine the clinical effectiveness of this therapy(AU)