Effect of cryotherapy in controlling spasticity of calf muscles in patients with multiple sclerosis.

BACKGROUND: Spasticity is a common symptom of multiple sclerosis (MS), affecting 80% of patients. Many studies have aimed to detect methods to reduce spasticity under these conditions and found that spasticity can be efficiently reduced using cryotherapy. OBJECTIVE: To examine the impact of cryotherapy on spasticity among patients with MS. METHODS: Thirty-two participants were randomized into two groups. The study group was given airflow cryotherapy and a selected physical therapy program, whereas the control group was only given a selected physical therapy program. The treatment was administered three times each week for a total of twelve consecutive sessions. The outcome measures were the modified Ashworth scale and the H/M ratio. RESULTS: The study group showed significant decrease in calf muscle spasticity, indicated by a reduction in spasticity grade (p = 0.001) and a decrease in the H/M ratio of 33.81% (p = 0.001). The control group also showed significant reduction in calf muscle spasticity, as indicated by a reduction in spasticity grade (p = 0.001) and a reduction in the H/M ratio of 19.58% (p = 0.001). There was a significant decrease in the spasticity grade and H/M ratio of the study group posttreatment compared with those of the control group (p = 0.02 and p = 0.001). CONCLUSION: The combined effect of cryotherapy and a selected physical therapy program are more effective in controlling the spasticity of calf muscles in patients with MS than a selected physical therapy program alone.

Dry needling effects on motor impairments in a patient with traumatic brain injury: A case study.

BACKGROUND: Motor impairments are common consequences of traumatic brain injury (TBI). It affects the individuals' participation in activities of daily living (ADLs). Dry needling treatment (DNT) uses a specialized needle to alter cortical activity. This case study aims to examine the effects of DNT on spasticity, balance, gait, and self-independence in a single patient with TBI. CASE DESCRIPTION: A twenty-six-year-old male with a history of TBI, resulting in muscle weakness on the right side of the body, spasticity, distributed balance, and difficulties with independent gait participated in this study. The Berg balance scale (BBS), 6-min walk test (6MWT), Modified Ashworth Scale (MAS), and Functional Independence Measure (FIM) were used to evaluate balance, gait, spasticity, and functional performance, respectively. OUTCOME: After 36 DNT sessions extended over 12 weeks, the patient demonstrated improvements in spasticity, balance, gait, and functional capacity both immediately after the intervention and at the 4-week follow-up. CONCLUSION: This case study demonstrates that DNT is considered a novel intervention for treating spasticity and improving balance, gait, and functional capacity post-TBI. Further research is recommended to verify these findings.

Effects of training with a rehabilitation device (Rebless®) on upper limb function in patients with chronic stroke: A randomized controlled trial.

BACKGROUND: Upper limb dysfunction is one of the most common sequelae of stroke and robotic therapy is considered one of the promising methods for upper limb rehabilitation. OBJECTIVE: This study aimed to explore the clinical effectiveness of upper limb training using a rehabilitation robotic device (Rebless®) for patients with stroke. METHODS: In this prospective, unblinded, randomized controlled trial, patients were randomly assigned to receive robotic training (experimental group, n = 15) or conventional therapy (control group, n = 15). Both groups received upper limb training lasting for 30 minutes per session with a total of 10 training sessions within 4 weeks. Motor function, functional evaluation, and spasticity were clinically assessed before and after the training. Cortical activation was measured using functional near-infrared spectroscopy at the 1st and 10th training sessions. RESULTS: The experimental group demonstrated a significant improvement in the Fugl-Meyer assessment-upper extremity score and the modified Ashworth scale grade in elbow flexors. The cortical activity of the unaffected hemisphere significantly decreased after 10 training sessions in the experimental group compared with the control group. CONCLUSIONS: The experimental group showed significant improvement in the Fugl-Meyer assessment-upper extremity score and spasticity of elbow flexors and had significantly decreased cortical activity of the unaffected hemisphere. Training with Rebless® may help patients with chronic stroke in restoring upper limb function and recovering the contralateral predominance of activation in motor function.

Inhibitory kinesiotaping has no effect on post-stroke spasticity: Prospective, randomised, controlled study.

OBJECTIVE: Motor neuron pool activity is high in spasticity. The effect of inhibitory kinesiotaping (KT) on spasticity is unclear. The aim of this study is to investigate the effect of inhibitory KT on spasticity after stroke. METHODS: Fifty stroke patients with ankle plantarflexor spasticity were randomised to intervention (27) and control (23) groups. Inhibitory KT was applied to the triceps surae muscle in the intervention group and sham KT to the Achilles tendon in the control group. Inhibitory and sham KT were applied for 72 h with a combined conventional rehabilitation programme. Spasticity was assessed at baseline and 72 h after KT using three instruments: Modified Ashworth Scale (MAS), Homosynaptic Post-Activation Depression (HPAD) reflecting the level of motor neuron pool activity, and joint torque as a measure of resistance to passive ankle dorsiflexion. RESULTS: The baseline MAS score, HPAD levels and dorsiflexion torque of the two groups were not significantly different. The change in MAS score was -3.7 ± 17.5 (p = 0.180) in the intervention group and 3.6 ± 33.3 (p = 0.655) in the control group. The change in dorsiflexion torque was -0.3 ± 16.1 kg m (p = 0.539) in the intervention group and 8.0 ± 24.1 kg m (p = 0.167) in the control group. The change in mean HPAD was 8.7 ± 34.7 (p = 0.911) in the intervention group and 10.1 ± 41.6 (p = 0.609) in the control group. CONCLUSIONS: The present study showed that inhibitory KT has no antispastic effect in stroke patients.

Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study.

BACKGROUND: The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. METHODS: From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. RESULTS: There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). CONCLUSION: Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.

Characterizing clinical patterns of physical therapy activities for post-stroke spasticity in stroke rehabilitation: looking into the "Black Box".

Physical therapy is considered to be an adjunctive therapy for the management of post-stroke spasticity. The insight of this study is to observe the current clinical practices of rehabilitation for post-stroke spasticity. For this purpose, an observational cross-sectional study was conducted. Data was collected by a standardized therapy documentation form for spasticity management. Fifty physiotherapists filled out that form. Almost all of them used subjective measures (modified Ashworth scale) for spasticity assessment and functional independence measure for level of independence. Readings were taken in the first, second, and third blocks of six-hour duration. Results showed that 42 (83.5%) physiotherapists measured spasticity at the initial session, while 47(94.6%) reported various multiple rehabilitation treatment preferences for spasticity management. Disparities exist in therapeutic management for post-stroke spasticity throughout rehabilitation which are mainly based on physiotherapists' clinical expertise. However, a better understanding of current trends in physical therapy clinical practices will assist in tailoring strategies to upgrade management for post-stroke spasticity.

Neck muscle spasticity in patients with disorder of consciousness: a pilot study.

BACKGROUND: Disorder of consciousness (DOC) is a state of prolonged altered consciousness due to severe acquired brain injury (ABI). DOC can be differentiated into coma, unresponsive wakefulness syndrome (UWS), or minimally conscious state (MCS) depending on the behavioral features observed and their relationship to the level of consciousness. Spasticity is one of the most frequently reported medical comorbidities in DOC patients. Since there is a critical lack of spasticity-focused studies and, in turn, of target treatment, we designed this pilot prospective study to evaluate cervical spine muscle spasticity and its effect on rehabilitation outcome in a large cohort of patients followed from the post-acute phase to 6 months after severe ABI. AIM: To evaluate neck muscle spasticity and investigate its impact on neurological and functional outcome in a large cohort of adult patients with DOC followed from post-acute to 6 months after severe ABI. DESIGN: Single-center prospective pilot study. SETTING: Highly specialized inpatient neurorehabilitation clinic. POPULATION: Patients with severe ABI admitted within 3 months after the acute event to our Neurorehabilitation Unit between May 21st, 2019 and April 23rd, 2020 for treatment of DOC as a part of their rehabilitation program. METHODS: In this single-center prospective pilot study demographic data, etiology of ABI (traumatic versus non-traumatic), DOC evaluated with the revised Coma Recovery Scale (CRS-R), and neurological and functional outcome assessed respectively with the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) were considered. During cervical examination, we assessed spasticity with the Modified Ashworth Scale (MAS), deviation of head alignment with a goniometer, and pain with the Nociception Coma Scale-Revised (NCS-R). RESULTS: Of the 48 patients, 41.7% were diagnosed with UWS and 58.3% were in a minimally conscious state (MCS). We found spasticity of neck muscles in 91.7% of patients, with no difference in severity (assessed with MAS) between UWV and MCS. The NCS-R score at cervical spine examination was lower in UWS than MCS. Spasticity was severer in patients with traumatic brain injury (TBI) compared to non-traumatic. At multiple linear regression analysis, younger age, hemisyndrome, and tetraparesis were independent predictors of severity of neck muscle spasticity in MCS. More severe spasticity was a predictor of worse neurological and functional outcome at discharge in UWS patients, independently of the other confounding variables at admission (e.g., age, severity of brain injury, functional assessment, and pain). CONCLUSIONS: Spasticity of neck muscles frequently develops in patients with DOC and is more severe in those after TBI. UWV and MCS have different spasticity profiles as regards risk factors and neurological and functional outcome. Severity of neck muscle spasticity in UWV patients may represent an early indicator of worse neurological and functional outcome after inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Our findings could prompt clinicians to redefine the rehabilitation aims regarding spasticity and to estimate the functional outcome in patients undergoing intensive rehabilitation after severe ABI.

Safety of dry needling in stroke patients: a scoping review.

INTRODUCTION: Spasticity is a common problem in stroke patients. Treatments of spasticity often have side effects or are insufficiently effective. Dry needling (DN) has been proposed as a potential additional option to consider in the multimodal treatment of post-stroke spasticity, although questions about its safety remain. The goal of this study is to assess the safety of DN in stroke patients. EVIDENCE ACQUISITION: A systematic search in Medline, Embase, The Cochrane Library, Web of Science, CIHNAL and PEDro was conducted in June 2023. Two reviewers independently screened abstracts according to the eligibility criteria. EVIDENCE SYNTHESIS: Twenty-five articles were included in this review. Only six studies reported adverse events, all of which were considered minor. None of the included studies reported any serious adverse events. In four of the included studies anticoagulants were regarded as contra-indicative for DN. Anticoagulants were not mentioned in the other included studies. CONCLUSIONS: There is a paucity of literature concerning the safety of DN in stroke patients. This review is the first to investigate the safety of DN in stroke patients and based on the results there is insufficient evidence regarding the safety of DN in stroke patients. CLINICAL REHABILITATION IMPACT: Although DN could be a promising treatment in post-stroke spasticity, further research is indicated to investigate its mechanism of action and its effect on outcome. However, before conducting large clinical trials to assess outcome parameters, the safety of DN in stroke patients must be further investigated.

Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

BACKGROUND: The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. OBJECTIVE: To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. METHODS: Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. RESULTS: A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. CONCLUSION: The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool.

The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spasticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patient-centred goal-setting; an algorithm for setting SMART (specific, measurable, attainable, realistic, and timed) treatment goals; goal-related target muscles and botulinum toxin type A dose determinants; goal attainment follow-up, scoring, and interpretation; and the multimodal approach to spasticity management. The Tool can enhance clinical practice by providing guided assistance with goal-setting and target muscle selection for botulinum toxin type A treatment. It also provides support with the follow-up evaluation of goal attainment and calculation of treatment success. The Tool is designed to be used by clinicians with varying levels of expertise in the field of neurological rehabilitation and post-stroke spasticity management, from those who are new to the field to those with many years of experience. A case study is presented in the Results Section of the article to illustrate the utility of the Tool in setting SMART treatment goals in the management of patients with post-stroke spasticity.

Effect of TCM rehabilitation program on activities of daily living in patients with post-stroke limb spasticity: An observational study.

BACKGROUND: Stroke is a neurological disease with many common complications that reduce the activities of daily living and the quality of life of patients. Traditional Chinese medicine (TCM) rehabilitation techniques, scalp acupuncture, and TCM can relieve spasticity symptoms and recovery from physical obstacles is significant. METHODS: Three hundred twenty-one patients with post-stroke limb spasticity were randomly divided into trial and control groups, with 159 and 162 patients in the trial and control groups, respectively. The control group received basic treatment combined with modern rehabilitation techniques, whereas the trial group received basic treatment combined with TCM, Tuina, and scalp acupuncture with kinesiotherapy. The treatment course in both groups was 4 weeks. The Modified Ashworth Scale, magnetic resonance imaging, and Stroke Specific Quality of Life Scale were used to evaluate limb spasticity, activities of daily living, and quality of life, respectively. PASW 18.0 was used for statistical analysis. RESULTS: With a longer treatment period, the improvement in limb spasticity was greater in the trial group than in the control group (P < .05). Similarly, improvements in activities of daily living and quality of life were better in the trial group than in the control group (P < .05). CONCLUSION: The TCM rehabilitation program using Tongjing Tiaoxing combined with scalp acupuncture and kinesiotherapy can effectively treat spasticity symptoms in stroke patients and improve their activities of daily living and quality of life.

Effects of extracorporeal shock wave therapy combined with isokinetic strength training on spastic calf triceps in patients after a stroke: a double-blinded randomised controlled trial.

OBJECTIVES: To evaluate the antitetanic effects of extracorporeal shock wave therapy (ESWT) combined with isokinetic strength training (IST) on calf triceps spasm in patients after a stroke. METHODS: Forty-five patients with hemiplegia after a stroke and lower extremity spasms were randomly assigned into three groups: a control group (n = 15), an ESWT group (n = 15) and an ESWT+IST group (n = 15). All patients agreed to conventional rehabilitation therapy, while the ESWT and ESWT+IST groups received ESWT of 2.0-3.0 bar once a week for four weeks. In addition, the ESWT+IST group underwent four weeks of ankle IST. All groups were assessed using the modified Ashworth scale (MAS) and surface electromyography before and after four weeks of treatment. The ankle passive movement of all groups was measured using the BIODEX isokinetic system at angular velocities of 60°/s, 120°/s, 180°/s and 240°/s. RESULTS: After four weeks of treatment, compared with the control group, the ESWT+IST groups showed a significant reduction in MASscores (P = 0.030). The ESWT+IST group had significantly lower MAS scores than the baseline (P = 0.002), while the ESWT group did not show a significant difference (P = 0.072). The average electromyography (AEMG) analysis demonstrated a significant difference among the groups after four weeks (P = 0.001), with the ESWT+IST group having lower AEMG values compared with the control group (P < 0.001) and the ESWT group (P = 0.042). Peak resistive torque significantly decreased in both the ESWT and ESWT+IST groups at all velocities (60°/s: P = 0.030, 120°/s: P = 0.039, 180°/s: P = 0.030 and 240°/s: P = 0.042). CONCLUSIONS: Extracorporeal shock wave therapy combined with IST can significantly improve calf triceps spasm in patients after a stroke.

[Spasticity-correcting surgery can have long-lasting effects]. / Spasticitetskorrigerande kirurgi kan ge långvariga förbättringar.

Spasticity is a common secondary complication after injuries to the central nervous system (CNS). Spasticity may severely impair arm and hand function, and consequently, affect an individual's function, resulting in disabilities or limiting activities and participation. Today, there is conflicting evidence regarding the effectiveness of available spasticity treatments. The population of adults with spasticity problems due to a CNS injury is heterogenic. A multidisciplinary approach is essential in customizing treatment to individual needs. The planning of treatment should consider the remaining upper limb functions and the patient's potential to improveme. Spasticity-correcting surgery is an option that seems underutilized. This article describes a structured and standardized program for the preoperative assessment, the surgical technique and the postoperative rehabilitation of patients undergoing upper limb spasticity-correcting surgery.

Influence Of Rehacom System Programme On Hand Function In Spastic Hemiplegic Children.

Objectives: To assess the impact of cognitive therapy with the rehacom visual-motor module on the hand function in hemiplegic cerebral palsy children. METHODS: The randomised case-control study was conducted at Kafrelsheikh University, Egypt, from September 2021 to February 2022, and comprised children aged 6-8 years with spastic hemiplegic cerebral palsy. They were randomised into control group A and intervention group B. Subjects in group A received designed physical therapy and hand function training, while those in group B additionally received visual-motor coordination training with the help of rehacom system. The groups were evaluated for both visual-motor coordination and fine motor skills at baseline and after 6-month training. SPSS version 26 was used to analyse the raw data of the current study. RESULTS: Of the 40 subjects, 20(50%) were in each of the two groups. There were 13(65%) boys and 7(35%) girls with mean age 66±4.01 monthsin group A, and 9(45%) boys and 11(55%) girls with mean age 67±4.06 monthsin group B (p>0.05). Both groups showed improvement related to grasping, visual-motor integration and fine motor quotient post-intervention, but improvement in group B was significantly higher on each count(p<0.05). CONCLUSIONS: The addition of visual-motor integration programme by rehacom system wasfound to be more effective than the effect of routine physiotherapy training alone.

HIPPOTHERAPY IN CEREBRAL PALSY - SURVEY RESEARCH.

OBJECTIVE: The aim: To assess the effects of a one-year hippotherapy programme on the physical and mental functioning of children with cerebral palsy. PATIENTS AND METHODS: Materials and methods: The study included 15 children with cerebral palsy whose mean age was 9 years. The children participated in hippotherapy ses¬sions at the Rehabilitation Centre in Rusinowice (one-year observation). The clinical presentation was dominated by manifestations of motor and postural abnormalities caused by central nervous system damage. A survey questionnaire was used in the study to collect information about problems associated with everyday life and functioning. RESULTS: Results: The results obtained in this study showed that spastic CP was the most common form of the disorder, affecting 8 out of 15 children (53%). It was followed by mixed CP (40%, 6 children). Among the respondents, 67% (10 people) were already familiar with hippotherapy whereas 33% did not know this method. CONCLUSION: Conclusions: There was a strong correlation between being familiar with effects of hippotherapy and the level of education of the parent/guardian. This result had a moderate influence on the frequency of hippotherapy sessions. Systematic hippotherapy sessions helped improve physical fitness and everyday functioning in children with cerebral palsy.

Clinical Features to Predict the Use of a sEMG Wearable Device (REMO®) for Hand Motor Training of Stroke Patients: A Cross-Sectional Cohort Study.

After stroke, upper limb motor impairment is one of the most common consequences that compromises the level of the autonomy of patients. In a neurorehabilitation setting, the implementation of wearable sensors provides new possibilities for enhancing hand motor recovery. In our study, we tested an innovative wearable (REMO®) that detected the residual surface-electromyography of forearm muscles to control a rehabilitative PC interface. The aim of this study was to define the clinical features of stroke survivors able to perform ten, five, or no hand movements for rehabilitation training. 117 stroke patients were tested: 65% of patients were able to control ten movements, 19% of patients could control nine to one movement, and 16% could control no movements. Results indicated that mild upper limb motor impairment (Fugl-Meyer Upper Extremity ≥ 18 points) predicted the control of ten movements and no flexor carpi muscle spasticity predicted the control of five movements. Finally, severe impairment of upper limb motor function (Fugl-Meyer Upper Extremity > 10 points) combined with no pain and no restrictions of upper limb joints predicted the control of at least one movement. In conclusion, the residual motor function, pain and joints restriction, and spasticity at the upper limb are the most important clinical features to use for a wearable REMO® for hand rehabilitation training.

Clinical Onset of Action of Incobotulinum Toxin A Preparation.

BACKGROUND: Many studies in vitro compared the onset of action, maximum efficacy, and duration of botulinum toxin type A (BoNT/A) preparations. OBJECTIVE: In this study, we analyzed the onset of action of BoNT/A preparation free of complexing proteins in patients with upper limb spasticity post stroke up to 30 days after treatment. METHODS: 75 patients affected by Biceps Brachii spasticity were enrolled. Outcome measures were instrumental muscle tone modification (myometric measurement), improvement of Modified Ashworth Scale (MAS), improvement of elbow's passive extension, and improvement of compound muscle action potential (cMAP) evaluated by electroneurography. We analyzed data at t0 (pre-injection), t1 (1 day after), t2 (7 days after), t3 (14 days after), and t4 (30 days after). RESULTS: All measurements decreased at t2, t3, and t4 with initial improvement at t2 and maximum improvement at t4; no statistical difference at t1 was found. CONCLUSION: This study demonstrated the onset of Incobotulinumtoxin A efficacy started after 7 days; this rapid action and efficacy of BoNT/A preparation could improve an intensive rehabilitation program after some days post-injection. Early clinical onset of action could be by the absence of complexing proteins in the preparation.

Prevalence and factors influencing the occurrence of spasticity in stroke patients: a retrospective study.

BACKGROUND: To describe the prevalence and clinical characteristics of stroke patients without spasticity, and simultaneously analyse the factors related to post-stroke non-spasticity. METHODS: In this retrospective study, information on patients hospitalized in the department of rehabilitation, Daping Hospital, over the past eight years was collected. Demographic information and clinical characteristics were statistically analysed. RESULTS: A total of 819 stroke patients with an average age of 61.66±13.72 years old were analysed, including 561 males (68.5%), and 258 females (31.5%). In this study, 201 (24.5%) patients developed spasticity, and 618 (75.5%) patients had no spasticity. Patients without spasticity were older than those with spasticity. Patients with ischemic stroke and mild functional impairment were also less likely to have spasticity. Post-stroke spasticity may be related to age [odd ratio (OR): 0.982; 95% CI:0.965 to 0.999; P = 0.042), hemorrhagic stroke (OR: 1.643; 95% CI: 1.029 to 2.626; P = 0.038), National Institute of Health Stroke Scale (NIHSS) Scores (OR: 1.132; 95% CI: 1.063 to 1.204; P = 0.000]. CONCLUSION: Most stroke patients do not have spasticity, especially the elderly, patients with ischemic stroke, and those with mild functional impairment, suggesting that not all upper motor nerve injuries lead to increased muscle tension. For young individuals, patients with hemorrhagic stroke, and those with moderate to severe functional impairment, close follow-up is necessary to identify the occurrence of spasticity early on and then formulate corresponding rehabilitation strategies for prompt intervention.

Effect of whole-body vibration training on the recovery of lower limb function in people with stroke: a systematic review and meta-analysis.

PURPOSE: The purpose of this meta-analysis was to systematically evaluate the effects of whole-body vibration training (WBVT) on the recovery of lower limb function in people with stroke. METHODS: The literature search was made in the electronic databases PubMed, Web of Science, Scopus and Embase electronic databases. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. The search was conducted on September 01, 2022. The data analysis software was RevMan 5.3. RESULTS: A total of 13 RCTs were included, including 687 patients. The results showed that compared with the control group, the overall difference in balance function was statistically significant [MD = 4.23, 95% CI 2.21 ∼ 6.26, p < 0.0001]. There was no significant difference in the evaluation indexes of lower limb motor function, including the TUG, 10MWT, 6MWT, and FMA - LE. The overall difference in lower limb muscle spasticity was statistically significant [MD = -0.53, 95% CI -0.81 ∼ 0.26, p = 0.0001]. CONCLUSIONS: Compared with the control group, using WBVT treatment has a more obvious effect on the recovery of lower limb function and muscle spasticity, and there is no obvious advantage in motor function recovery.IMPLICATIONS FOR REHABILITATIONThis Systematic Review and meta-analysis of evidence suggest that whole-body vibration training is effective in the rehabilitation of lower limb function in patients with stroke.Whole body vibration training may be a better choice for improving balance and spasm in people with stroke.Currently it is not known which whole-body vibration training model with vibration intensity, stimulus type and duration is most effective and to design more targeted interventions.

Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial.

Background/aim: Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually or combined. Materials and methods: This randomized trial was conducted between December 1st, 2018, and May 15th, 2019, at Gazi University, Department of Physiotherapy and Rehabilitation. Randomly assigned into groups were 27 independently ambulant patients with unilateral/bilateral SCP, where PFEs were applied to the DF, PF, or DPF muscles. Muscle tone, balance, and functional mobility were assessed. The MVC was evaluated by surface electromyography. PFEs were performed 4 times a week, for 6 weeks. Results: The spasticity of the PF muscles decreased in all of the groups. PFE of the DF muscles led to an increase in ankle joint range of motion (ROM) and improved functional mobility (p < 0.05). PFE of the PF muscles resulted in improvements in balance and functional mobility (p < 0.05). PFE of the DPF muscles brought about improvements in balance but not in functional mobility (p < 0.05). No significant difference in the MVC was observed in any of the groups (p > 0.05). Conclusion: Gains are obtained according to the function of a muscle group. By training the DF muscles, it is possible to improve function and ROM. Furthermore, training the PF muscles led to improvements in balance and functional mobility, indicating that it is possible to bring about positive changes in spastic muscles. This study showed that muscle groups must be exercised according to the intended goal.