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2.
Clin Interv Aging ; 15: 9-28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32021129

RESUMO

Purpose: This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT). Methods: PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done. Results: A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: ∆=34.45% of grade for fESWT and ∆=34.97% for rESWT that gives a slightly better effect of rESWT (∆=0.52%) for spasticity (p<0.05), and ∆=38.83% of angular degrees for fESWT and ∆=32.26% for rESWT that determines the more beneficial effect of fESWT (∆=6.57%) for range of motion (p<0.05), and ∆=18.32% for fESWT and ∆=22.27% for rESWT that gives a slightly better effect of rESWT (∆=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70±2.5 points for fESWT and 5.71±2.21 points for rESWT, thus an overall quality of evidence grade of moderate ("fair" for fESWT and "good" for rESWT). Three studies in fESWT and four in rESWT obtained Sackett's grading system's highest Level 1 of evidence. Conclusion: The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.


Assuntos
Espasticidade Muscular , Reabilitação do Acidente Vascular Cerebral/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Humanos , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Recuperação de Função Fisiológica , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 29(3): 104591, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899073

RESUMO

OBJECTIVE: The purpose of this meta-analysis was to assess the long-term effects of extracorporeal shock wave therapy (ESWT) on post-stroke spasticity. DATA SOURCES: An electronic search of EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) with hand search of relevant papers were performed on 20 June 2019. REVIEW METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the literature for randomized controlled trials of ESWT in stroke patients with spasticity. The primary outcome was the Modified Ashworth Scale (MAS) grade, and the second outcomes were the Visual Analogue Scale (VAS), range of motion (ROM) of joint, the Fugl-Meyer assessment (FMA) grade and adverse events. Two authors independently extracted data, assessed trial eligibility and risk of bias. Meta-analyses were performed using RevMan 5.3 software. RESULTS: We extracted data from 8 randomized controlled trials (301 participants). At long-term follow-up, ESWT significantly reduced MAS (Weighted Mean Difference (WMD) = -.36, 95% confidence interval (CI) = -.53 to -.19, I2 = 68%; P < .001) and VAS (WMD = -.94, 95% CI = -1.51 to -.37, I2 = 15%; P = .001), enhanced ROM (WMD = 5.97, 95% CI = 2.76 to 9.18, I2 = 0%; P < .001) and FMA (WMD = 1.26, 95% CI = .29 to 2.24, I2 = 96%; P = .01). CONCLUSIONS: ESWT showed long-term effects in relieving spasticity, while reducing pain, enhancing ROM and motor function in stroke patients.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Contração Muscular , Espasticidade Muscular/terapia , Músculo Esquelético/inervação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
4.
World Neurosurg ; 134: 507-509, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715419

RESUMO

BACKGROUND: Cauda equina syndrome (CES) is a neurosurgical emergency warranting urgent surgical decompression. Treatment delay may precipitate permanent adverse neurological sequelae. CES is a clinical diagnosis, corroborated by radiological findings. Atypical presentations should be acknowledged to avoid inappropriately rejected diagnoses. CASE DESCRIPTION: We report the case of a woman exhibiting bilateral lower limb weakness, perineal numbness, sphincter disturbance, and lower limb clonus. Classically, CES displays lower motor neuron signs in the lower limbs. The presence of clonus, an upper motor neuron sign, brought the diagnosis into doubt. The history included chronic fatigue, difficulty mobilizing, and intermittent blurred vision. A lumbosacral magnetic resonance imaging (MRI) scan demonstrated a large disc prolapse at L5/S1. The cord was not low-lying or tethered. Therefore, the possibility of second diagnoses, including of inflammatory or demyelinating nature, was raised. An urgent MRI scan of the brain and cervicothoracic cord identified no other lesions. On balance, the clinical presentation could overwhelmingly be attributed to the L5/S1 disc prolapse. Given the time-critical nature of cauda equina (CE) compression, an urgent laminectomy and discectomy was offered with continued postoperative investigation of the clonus. Intraoperatively, significant CE compression was found. The operation proceeded uneventfully and the patient recovered fully. In the immediate postoperative period, the clonus persisted yet subsequently resolved completely. CONCLUSIONS: We conclude that the clonus was attributable to CE compression and not a second pathology. The corresponding neuroanatomical correlate remains nondelineated. The presence of clonus does not preclude a diagnosis of CES. If the clinicoradiological information otherwise correlate, surgery should not be delayed while alternative diagnoses are sought. The literature is also reviewed.


Assuntos
Síndrome da Cauda Equina/complicações , Espasticidade Muscular/etiologia , Síndrome da Cauda Equina/diagnóstico , Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Extremidade Inferior , Região Lombossacral , Pessoa de Meia-Idade
5.
Arch Phys Med Rehabil ; 101(2): 242-248, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31469982

RESUMO

OBJECTIVE: To assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. DESIGN: A multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. SETTING: Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. PARTICIPANTS: People with hemiparesis with chronic post stroke lower limb spasticity (N=40). INTERVENTIONS: Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. MAIN OUTCOME MEASURES: The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. RESULTS: Forty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (-0.7, P=.049 in the soleus muscles; -0.8, P=.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P=.005) in the sway area occurred in the treatment group (-3.11±6.92) in comparison with the placebo group (+0.27±3.57). CONCLUSION: Treating spasticity by injecting botulinum toxin into people's lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/uso terapêutico , Equilíbrio Postural/efeitos dos fármacos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Injeções Intramusculares , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Paresia/etiologia , Estudos Prospectivos
6.
J Pediatr Orthop B ; 29(1): 1-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31305364

RESUMO

Many surgical options have been proposed to improve the ambulatory status of children with spastic cerebral palsy (CP), but none have focused on addressing both spasticity and lower extremity tendon contractures. The purpose of this study is to evaluate the results of selective dorsal rhizotomy (SDR) followed by minimally invasive tendon lengthening allowing immediate return to ambulation. Two hundred fifty-five spastic CP patients (who received SDR procedure at an average age of 6.9±2.6 years and tendon lengthening procedure at an average age of 7.2±2.5 years) were retrospectively reviewed. Patients were grouped by the gross motor function classification system (GMFCS) 1-3 and 4-5. Kaplan-Meier analysis and Cox proportional hazard model using a requirement for additional tendon lengthening as an end point were conducted. Tendon lengthening followed SDR at an average of 4.3±10.7 months. On an average of 4.9±1.2 years after tendon lengthening, GMFCS was improved in 28 and maintained in 213 patients, respectively. There was no difference of variables and joint angles between the two GMFCS groups. A repeat tendon lengthening was required in 19 patients. The Kaplan-Meier analysis showed 81% success rate. Cox proportional hazard model identified age at tendon lengthening [hazards ratio (HR), 0.53; 95% confidence interval (CI), 0.37-0.76] and duration between SDR and tendon lengthening of more than 6 months (HR, 2.96; 95% CI, 1.05-8.33) associated with need for a repeat tendon lengthening procedure. Our novel approach of SDR/tendon lengthening results in improved joint angles as well as stable or improved GMFCS. Longer follow-up is necessary to determine if this approach could prolong ambulatory ability and reduced need for more invasive orthopedic surgeries.


Assuntos
Paralisia Cerebral/complicações , Procedimentos Cirúrgicos Minimamente Invasivos , Atividade Motora/fisiologia , Espasticidade Muscular/cirurgia , Recuperação de Função Fisiológica/fisiologia , Rizotomia/métodos , Tenotomia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Reoperação , Estudos Retrospectivos
9.
Artigo em Russo | MEDLINE | ID: mdl-31626223

RESUMO

Diagnosis, treatment and rehabilitation of patients with spasticity remain a challenge, in which standard methodological approaches have not yet been developed. One of the most promising solutions to this problem is the use of the Modified Tardieu scale (MTS). The article describes the method of working with MTS tested in the examination, treatment and rehabilitation of patients with acute cerebrovascular accident (n=112) and patients with multiple sclerosis (n=17). The original version of MTS has been translated into Russian. The use of MTS assessment system allows the diagnosis of the main elements of the clinical picture of the damage to the central nervous system, such as paresis, spasticity, violation of proprioception, as well as the qualitative and quantitative assessment of the dynamics of rehabilitation and treatment of spasticity with botulinum neurotoxin (BoNT).


Assuntos
Esclerose Múltipla , Espasticidade Muscular , Acidente Vascular Cerebral , Humanos , Esclerose Múltipla/complicações , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Paresia , Federação Russa , Acidente Vascular Cerebral/complicações
10.
Eur J Phys Rehabil Med ; 55(6): 761-771, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31615195

RESUMO

INTRODUCTION: Recently, clinical trials have been performed to evaluate the efficacy of extracorporeal shockwave therapy (ESWT) in patients with cerebral palsy (CP). However, various studies adopted different clinical scales, making it insufficient to draw a definite conclusion about the efficacy of ESWT in reducing spasticity after cerebral palsy. The purpose of this meta-analysis was to assess the effects of ESWT on reducing spasticity after applying ESWT in patients with CP. EVIDENCE ACQUISITION: In accordance with the PRISMA statement, authors searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials and Scopus from their inception dates through December 11th 2018. We included randomised controlled trials in any language that using ESWT for the purpose of ameliorating spasticity in patients with CP. We assessed spasticity measured by modified Ashworth Scale (MAS), range of motion (ROM) and baropodometric values as outcomes. EVIDENCE SYNTHESIS: Two authors independently extracted and verified data. Meta-analysis was completed where possible, otherwise data were synthesised narratively. From a total of 206 articles, 16 manuscripts were selected and 5 of them were ultimately included in this meta-analysis. MAS grade as primary outcome was significantly improved after ESWT compared to that in the control group (mean difference [MD]: -0.62; 95% CI: -1.52 to -0.18). ROM after ESWT was also significantly improved compared to that in the control groups (MD: 18.01; 95% CI: 6.11 to 29.91). Baropodometric measures showed significantly increases in foot contact area during gait (SMD: 29.00; 95% CI: 11.08 to 46.92), but not significantly in peak pressure under the heel (MD: 15.12; 95% CI: -1.85 to 32.10) immediately after ESWT. CONCLUSIONS: No serious side effects were observed in any patient after ESWT. ESWT may be a valid alternative to existing treatment options targeting spasticity diminishment and ROM improvement in CP patients to maintain healthy lifestyles and normalize spastic gait pattern. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow-up studies are needed to verify our results.


Assuntos
Paralisia Cerebral/terapia , Tratamento por Ondas de Choque Extracorpóreas , Espasticidade Muscular/terapia , Paralisia Cerebral/complicações , Humanos , Espasticidade Muscular/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Medicine (Baltimore) ; 98(39): e17124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574812

RESUMO

INTRODUCTION: Spasticity is the most common complication after stroke, which is the main obstacle in the recovery of motor function. Spasticity seriously affects the quality of life and brings a heavy burden to families and society. Acupuncture is an effective method for stroke. However, whether acupuncture is effective for poststroke spasticity is still unknown. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of acupuncture for poststroke spasticity. METHODS AND ANALYSIS: We will search the following databases from inception to July 2019: China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang Data, the Chinese Science and Technology Periodical Database (VIP), PubMed, Embase, The Cochrane Library, and Web of Science. All relevant randomized controlled trials (RCTs) utilizing acupuncture for poststroke spasticity will be included. The primary outcome is the modified Ashworth scale. Secondary outcomes include composite spasticity scale, clinic spasticity index, electromyographic activity, Hoffmann reflex activity, or other spasticity-related outcomes. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be conducted using Review Manager V5.3 software. ETHICS AND DISSEMINATION: The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines. PROSPERO REGISTRATION NUMBER: CRD42019129779.


Assuntos
Terapia por Acupuntura/métodos , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Humanos , Metanálise como Assunto , Espasticidade Muscular/etiologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(39): e17261, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574840

RESUMO

BACKGROUND: This study aims to systematically explore the effectiveness of neuromuscular electrical stimulation (NMES) combined with rehabilitation training (RT) for the treatment of post-stroke limb spasticity (PSLS). METHODS: We will search Cochrane Library, MEDILINE, EMBASE, CINAHL, AMED, PsycINFO, WOS, Scopus, OpenGrey, and 4 Chinese databases from inception to the present without language restrictions. We will only consider randomized controlled trial on assessing the effectiveness and safety of NMES combined with RT for the treatment of PSLS. All included randomized controlled trials will be assessed using Cochrane risk of bias tool. Two researchers will independently perform study selection, risk of bias assessment, and data extraction, respectively. Any disagreements will be solved by a third researcher through discussion. RESULTS: Primary outcome is limb spasticity status. Secondary outcomes comprise of limb function, quality of life, and adverse events. CONCLUSION: This study will summarize the latest evidence of NMES combined with RT for the treatment of patients with PSLS. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138900.


Assuntos
Terapia por Estimulação Elétrica/métodos , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Humanos , Extremidade Inferior/fisiopatologia , Espasticidade Muscular/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Acidente Vascular Cerebral/fisiopatologia , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Extremidade Superior/fisiopatologia
13.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31649137

RESUMO

Niemann-Pick disease type C is a rare progressive genetic disorder that leads to the abnormal accumulation of lipids within various tissues of the body, including brain tissue and liver. There is a rapid progression of the disease, resulting in severe disability in only a few years after the first symptoms, and survival is not much longer. Spasticity, dystonia, and chronic pain are common findings that severely impact quality of life in these patients. Analgesic management with traditional pain medications is not always effective, and the risk for secondary effects in medically complex patients is high. Liver function is also a limiting factor in these patients. This is a case report of a boy with advanced Niemann-Pick disease type C with developmental regression, cataplexia, and seizures. His severe spasticity made positioning and care difficult, and intense pain required multiple hospitalizations. He had unsuccessfully trialed multiple drugs. An intrathecal baclofen pump was placed without surgical complications and resulted in positive clinical effects. Baclofen pumps have classically been used for spasticity management in adults and children with nonprogressive diseases such as cerebral palsy or spinal cord injury with relatively long life expectancies. In adults, they have been used in patients with multiple sclerosis; however, use in pediatric neurodegenerative diseases has scarcely been reported. The use of intrathecal baclofen in palliative settings might provide an additional resource to provide comfort and quality of life for children with neurodegenerative diseases not only at end-of-life stages but also earlier on.


Assuntos
Baclofeno/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Doença de Niemann-Pick Tipo C/tratamento farmacológico , Cuidados Paliativos , Criança , Evolução Fatal , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Masculino , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Doença de Niemann-Pick Tipo C/complicações
14.
J Rehabil Med ; 51(10): 813-816, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31529136

RESUMO

OBJECTIVE: To compare walking speed in patients with spastic hemiparesis who received abobotulinumtoxinA either in the lower limb or simultaneously in both the lower and upper limbs. DESIGN: Post hoc analysis from a phase 3 study of abobotulinumtoxinA (Dysport®, NCT01251367). PATIENTS: Adult patients with spastic hemiparesis causing gait dysfunction. METHODS: Comfortable barefoot walking speed over 10 m was evaluated in patients receiving lower limb vs lower and upper limb injections over ≤4 treatment cycles; 1,000 U or 1,500 U in lower limb for cycle 1/2; optional upper limb injections from cycle 3 (500 U: upper limb, 1,000 U: lower limb). RESULTS: Mean (standard deviation; SD) lower limb cycle 3/4 doses were lower in the lower plus upper limb group vs lower limb only (1,000 U (SD 50), 1,000 U (SD 50) vs 1,380 U (SD 210), 1,360 U (SD 220). Baseline comfortable barefoot walking speed was similar between groups. Changes at cycle 3 week 4, in m/s, were: lower and upper limb: +0.063 (SD 0.131); lower limb only: +0.078 (SD 0.114), and cycle 4 week 4: lower and upper limb: +0.086 (SD 0.166); lower limb only: +0.086 (SD 0.123). CONCLUSION: Simultaneous lower and upper limb abobotulinumtoxinA treatment does not hamper improvement in walking speed compared with lower limb treatment alone. Thus, physicians may split the 1,500 U abobotulinumtoxinA dose as needed to best treat patients with spastic paresis.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Lesões Encefálicas/complicações , Espasticidade Muscular , Paresia , Acidente Vascular Cerebral/complicações , Caminhada/fisiologia , Adulto , Humanos , Extremidade Inferior/fisiologia , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Paresia/tratamento farmacológico , Paresia/fisiopatologia , Extremidade Superior/fisiologia
15.
Arq Neuropsiquiatr ; 77(8): 568-573, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31508683

RESUMO

Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. OBJECTIVE We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. METHODS Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. RESULTS Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. CONCLUSION Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.


Assuntos
Inibidores da Liberação da Acetilcolina/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Posicionamento do Paciente/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior , Idoso , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
16.
NeuroRehabilitation ; 45(2): 213-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498134

RESUMO

BACKGROUND: With increased practice of real-time ultrasound imaging in the physical therapy profession, it is essential to evaluate the utility of its use post stroke. OBJECTIVE: Evaluate relationship of spastic brachialis muscle architectural parameters with clinical measures of upper extremity function and spasticity. METHODS: Eleven post stroke individuals with spasticity of the upper limb had their brachialis muscle pennation angle and fascicle length measured in the affected and unaffected upper arm, at rest. Involved side upper extremity Fugl-Meyer, Modified Ashworth Scale, and grip strength were collected and compared to muscle architectural parameters of affected and unaffected brachialis muscles. RESULTS: Affected side brachialis pennation angle was significantly greater than the unaffected side, and affected fascile length was significantly shorter than the unaffected side. Function levels were found to be significantly higher in those with greater fascile lengths and lower pennation angles. Higher Fugl-Meyer scores of the affected upper extremity were inversely correlated with lower Modified Ashworth Scale scores. CONCLUSIONS: An objective method of quantifying spasticity can assist in determining if functional gains made post stroke are due to compensations in movement, or due to physiological changes. Ultrasound imaging may be used as an alternative to the Modified Ashworth score to quantify muscular parameters in spastic muscles post stroke.


Assuntos
Movimento , Espasticidade Muscular/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia , Extremidade Superior/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologia , Projetos Piloto , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia
17.
NeuroRehabilitation ; 45(1): 67-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403954

RESUMO

BACKGROUND: There are limited evidence of instrumented measures of gait and balance to determine the functional effects of botulinum toxin injections (BoNT-A) in spasticity after stroke. OBJECTIVE: To evaluate the functional changes in gait and balance following upper limb and lower limb BoNT-A in persons with stroke. METHODS: A pre-post prospective study of 35 stroke patients with upper and/or lower limb spasticity after focal treatment with BoNT-A. Assessments were at baseline (T0), 6-weeks (T1) and 12-weeks (T2), using validated subjective and objective physical activity measures. RESULTS: After BoNT-A injections, significant improvements in most measures of impairments, activity and participation domains were found at T1 (p < 0.05, effect sizes (r) = 0.5-0.9). There was a significant increase in low intensity physical activity (at T1) and sedentary time reductions at both follow-up periods. Instrumented gait/balance measures showed a significant increase in cadence and turn velocity, but no changes in sway measures were found using posturography. Improvements in most outcome measures were maintained at 12-weeks. CONCLUSION: BONT-A improved scores in most clinical measures but only in some of the objective gait/balance and physical activity measures. Further robust studies should utilize a larger sample size to better determine the benefits of BoNT-A for stroke-related spasticity.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Marcha , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Acidente Vascular Cerebral/complicações , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Exercício Físico , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/administração & dosagem , Extremidade Superior/fisiopatologia
18.
NeuroRehabilitation ; 45(1): 45-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403956

RESUMO

BACKGROUND: Reduction in grip-strength due to spasticity is a common cause of impairment after stroke. OBJECTIVE: To find an objective measure of post-stroke spasticity affecting grip-strength through quantification of interaction between antagonist and agonist muscles using complexity analysis of surface electromyogrm (sEMG) signals during isometric grip in healthy and post-stroke participants. METHODS: The interaction between sEMG signals from antagonist and agonist muscles is quantified through Multiscale-Multivariate-Sample-Entropy (MMSE). This is used to quantify dissimilarity between hands of 12 healthy and 8 post-stroke participants during isometric grip. The clinical relevance of MMSE is explored by examining its correlation with spasticity score i.e. Modified-Ashworth-Scale (MAS). Further, potential of sEMG-based approach to quantify muscle-specific dissimilarity in sEMG activation across hands is investigated in terms of Cepstral-coefficients and power content of sEMG during grip tasks. RESULTS: Mean MMSE scores of sEMG signals were significantly different (p < 0.05) between paretic and non-paretic hands of Post-stroke participants. High negative correlation was observed between spasticity and complexity scores of paretic hand for post-stroke participants. CONCLUSIONS: A negative correlation between MAS and MMSE shows higher spasticity can lead to reduced complexity in sEMG. Thus, MMSE based complexity analysis can be used as an indicator of spasticity, affecting grip function.


Assuntos
Eletromiografia/métodos , Força da Mão , Hemiplegia/diagnóstico , Espasticidade Muscular/diagnóstico , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Análise de Sistemas
19.
Ann Phys Rehabil Med ; 62(6): 409-417, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31454560

RESUMO

BACKGROUND: The pronator teres and pronator quadratus muscles are frequently injected with neuromuscular blocking agents to improve supination in children with spastic cerebral palsy and limited active elbow supination. However, determining by simple clinical examination whether these muscles are overactive during active movement is difficult. OBJECTIVE: This study aimed to develop a semi-automatic method to detect pronator muscle overactivity by using surface electromyography (EMG) during active supination movements in children with cerebral palsy. METHODS: In total, 25 children with unilateral spastic cerebral palsy (10 males; mean [SD] age 10.6 [3.0] years) and 12 typically developing children (7 males; mean age 11.0 [3.0] years) performed pronation-supination movements at 0.50Hz. Kinematic parameters and surface EMG signals were recorded for both pronator muscles. Three experts visually assessed muscle overactivity in the EMG signals of the children with cerebral palsy, in comparison with the reference group. The reliability and discrimination ability of the visual assessments were analysed. Overactivity detection thresholds for the semi-automatic method were adjusted by using the visual assessment by the EMG experts. The positive and negative predictive values of the semi-automatic detection method were calculated. RESULTS: Intra-rater reliability of visual assessment by EMG experts was excellent and inter-rater reliability was moderate. For the 25 children with unilateral spastic cerebral palsy, EMG experts could discriminate different profiles of pronator overactivity during active supination: no pronator overactivity, one overactive pronator, or overactivity of both pronators. The positive and negative predictive values were 96% and 91%, respectively, for this semi-automatic detection method. CONCLUSIONS: Detection of pronator overactivity by using surface EMG provides an important complement to the clinical examination. This method can be used clinically, with the condition that clinicians be aware of surface EMG limitations. We believe use of this method can increase the accuracy of treatment for muscle overactivity, resulting in improved motor function and no worsening of paresis.


Assuntos
Paralisia Cerebral/fisiopatologia , Eletromiografia/estatística & dados numéricos , Espasticidade Muscular/diagnóstico , Adolescente , Fenômenos Biomecânicos , Estudos de Casos e Controles , Paralisia Cerebral/complicações , Criança , Cotovelo/fisiopatologia , Eletromiografia/métodos , Feminino , Humanos , Masculino , Espasticidade Muscular/etiologia , Valor Preditivo dos Testes , Pronação/fisiologia , Reprodutibilidade dos Testes , Supinação/fisiologia
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