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1.
Medicine (Baltimore) ; 100(14): e25252, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832085

RESUMO

RATIONALE: Wrist-hand extension function rehabilitation is a vital and difficult part of hand function recovery in spastic stroke patients. Although botulinum toxin type A (BoNTA) injection plus post injection therapy was applied to the wrist-hand rehabilitation in previous reports, conclusion was inconsistent in promoting function. For this phenomenon, proper selection of patients for BoNTA injection and correct choice of post-injection intervention could be the crucial factors for the function recovery. PATIENT CONCERNS: We reported a 46-year-old male suffered a spastic hemiplegia with wrist- hand extension deficit. DIAGNOSES: Computed tomography showed cerebral hemorrhage in the left basal ganglia region. INTERVENTIONS: Four hundred units of BoNTA were injected into the spasticity flexors, and four-week post injection surface electromyography (sEMG) biofeedback therapy was applied to the patient. OUTCOMES: The patient exhibited post-intervention improvement in wrist-hand extensors performance (strength, range of motion, sEMG signals), the flexors spasticity, and upper extremity function. LESSONS: The present case showed that 4-week of BoNTA injection plus sEMG biofeedback exercise improved the performance and function of wrist-hand extensors in the patient for short- and long-term. Proper selection of patients for BoNTA injection and correct choice of post injection exercise could play a vital role in the hand rehabilitation for patient with spastic hemiplegia.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Mãos , Espasticidade Muscular/tratamento farmacológico , Punho , Eletromiografia/métodos , Hemiplegia/complicações , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação
2.
BMJ Case Rep ; 14(3)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731393

RESUMO

Establishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as 'COVID-19 toes'', previously described predominantly in children. Additionally, this patient presented with possible COVID-associated muscle spasticity of the lower limbs, as well as a prolonged and atypical timeline of COVID-19 infection. The rare occurrence of 'COVID-19 toes'' in this adult patient suggests that her medical history could have predisposed her to this symptom. This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2.


Assuntos
/complicações , Doenças do Pé/etiologia , Espasticidade Muscular/etiologia , Analgésicos/uso terapêutico , Vesícula/tratamento farmacológico , Vesícula/etiologia , Vesícula/patologia , Feminino , Doenças do Pé/tratamento farmacológico , Doenças do Pé/patologia , Gabapentina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/patologia , Dedos do Pé/patologia
3.
J Rehabil Med ; 53(3): jrm00169, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33616193

RESUMO

BACKGROUND: Post-stroke spasticity is a major factor disturbing rehabilitation and functional recovery in stroke survivors. Clinical predictors of post-stroke spasticity have often been discussed, but brain image predictors for spasticity have been insufficiently researched. The aim of this study was to use magnetic resonance imaging data to identify early brain imaging predictors for potential development of spasticity after stroke. METHODS: Consecutive patients admitted to a stroke unit were screened prospectively over 22 months. Patients with first-ever supratentorial ischaemic stroke were included in the study. Standardized clinical assessments for post-stroke spasticity were prospectively performed within 7 days and at 3 months. Brain imaging data (3 Tesla magnetic resonance imaging (3T MRI)) were collected at the baseline and evaluated. RESULTS: Brain imaging data from 103 stroke patients were collected in the hyperacute phase (< 7 days after stroke onset). A total of 23 patients developed post-stroke spasticity. The volumes of brain lesions involving motor network areas were significantly larger in patients with post-stroke spasticity compared with those without post-stroke spasticity (p < 0.01). Supratentorial lesion of < 0.5 cm3 were not associated with risk of post-stroke spasticity, except when the internal capsule and striatum was affected. CONCLUSION: Lesions involving motor network areas are considered to be a precondition of post-stroke spasticity. There is, however, a low risk of developing post-stroke spasticity with < 0.5 cm3 volumes of supratentorial brain lesions involving motor network areas. Larger volume brain lesions involving motor network areas, e.g. > 3 cm3, were significantly more common in patients with post-stroke spasticity. Pure cortical lesions has no risk of post-stroke spasticity in stroke survivors.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Espasticidade Muscular/etiologia , Neuroimagem/métodos , Acidente Vascular Cerebral/complicações , Idoso , Feminino , Humanos , Masculino
4.
Medicine (Baltimore) ; 100(7): e24859, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607860

RESUMO

BACKGROUND: The purpose of this paper is to evaluate the effectiveness and safety of electroacupuncture in the treatment of spasticity after stroke. METHODS: We will electronically search PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan-Fang Database from the date of creation to November 2020. In addition, we will manually retrieve other resources including the reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to electroacupuncture in the treatment of spasticity after stroke will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The modified Ashworth scale was the primary outcomes. Simplified Fugl-Meyer assessment scale (FMA), Stroke specific quality of life scale (SS-QOL) and adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis. If it is not appropriate for a meta- analysis, then a descriptive analysis will be conducted. Data synthesis will use the risk ratio and the standardized or weighted average difference of continuous data to represent the results. RESULTS: This study will provide a high-quality synthesis to assess the effectiveness and safety of electroacupuncture in the treatment of spasticity after stroke. CONCLUSION: This systematic review will provide evidence to judge whether electroacupuncture is an effective and safety intervention for patients with spasticity after stroke. ETHICS AND DISSEMINATION: The protocol of the systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION: CRD42021220300.


Assuntos
Eletroacupuntura/métodos , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , China/epidemiologia , Gerenciamento de Dados , Eletroacupuntura/efeitos adversos , Feminino , Humanos , Masculino , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Acidente Vascular Cerebral/psicologia , Resultado do Tratamento
5.
Am J Phys Med Rehabil ; 100(3): 266-270, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595939

RESUMO

OBJECTIVE: The aim of this study was to explore the time course of onset and peak effects of phenol neurolysis. DESIGN: This is a retrospective chart review. Eleven patients with elbow flexor spasticity after brain injury were enrolled. The resting angle of the elbow joint was measured before and after the injection and up to 6 wks of follow-up. RESULTS: Phenol injection was performed to 13 musculocutaneous nerves under ultrasound and electrical stimulation guidance. The resting elbow angles were 84.4° ± 25.8° (before injection), 116.6° ± 20.9° (immediately after injection), 121.2° ± 21.4° (2 hrs after injection), 127.2° ± 19.7° (24 hrs after injection), 145.4° ± 11.8° (7 days after injection), 145.5° ± 10.4° (14 days after injection), and 150.3° ± 12.2° (6 wks after injection; N = 7). The mean resting angle was statistically different among the time points from preinjection to 14 days after (F2.625, 31.505 = 36.805, P < 0.01). Post hoc tests revealed that significant improvements existed immediately after and 7 days after the injection (P < 0.01 for both). The effects seemed to reach its peak in 7 days. The effect sizes immediately and 7 days after the injection were 1.37 and 3.04, respectively. The immediate effect accounted for approximately 60% of the maximal effect. CONCLUSIONS: Phenol neurolysis has an immediate effect on spasticity reduction and reaches its peak effect around 1 wk after injection.


Assuntos
Articulação do Cotovelo/fisiopatologia , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/fisiopatologia , Nervo Musculocutâneo/efeitos dos fármacos , Bloqueio Nervoso/métodos , Fenóis/administração & dosagem , Adulto , Lesões Encefálicas/complicações , Estudos de Coortes , Feminino , Humanos , Injeções Subcutâneas , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Tempo
7.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431538

RESUMO

Stiff-Person syndrome (SPS) is a rare autoimmune neurological disorder characterised by episodic painful muscle rigidity and violent spasms. A significant trigger for the painful spasms experienced by patients is pain itself, making optimal pain management and avoidance a necessity. While first-line and second-line therapies for spasm prevention and termination are known, there is a paucity of evidence to guide pain management. We report the case of a 26-year-old woman with SPS referred for excruciating muscle cramping and rigidity with pain lasting beyond the episodes themselves. We report the novel use of ketamine and intravenous magnesium sulfate which may provide analgesia, spasm avoidance and early termination of exacerbations in SPS.


Assuntos
Espasticidade Muscular/tratamento farmacológico , Manejo da Dor/métodos , Dor Intratável/tratamento farmacológico , Rigidez Muscular Espasmódica/complicações , Adulto , Analgesia Controlada pelo Paciente/métodos , Analgésicos/administração & dosagem , Anticonvulsivantes/administração & dosagem , Feminino , Humanos , Sulfato de Magnésio/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Medição da Dor , Dor Intratável/diagnóstico , Dor Intratável/etiologia , Dor Intratável/reabilitação , Índice de Gravidade de Doença , Rigidez Muscular Espasmódica/diagnóstico
8.
Turk J Med Sci ; 51(2): 385-392, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33350298

RESUMO

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Paralisia Cerebral/reabilitação , Espasticidade Muscular/tratamento farmacológico , Paralisia Cerebral/fisiopatologia , Criança , Controle de Doenças Transmissíveis , Técnica Delfos , Humanos , Controle de Infecções , Injeções Intramusculares/métodos , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Guias de Prática Clínica como Assunto
9.
J Comp Eff Res ; 9(18): 1293-1300, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33325276

RESUMO

Aim: This study aims to investigate reliability of quantitative ultrasound measurement of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles in stroke. Materials & methods: Patients with a history of stroke were recruited. FDP and FDS muscles on both upper extremities were investigated with ultrasound. Two independent assessors acquired images and analyzed them using a program and Heckmatt scale. Results: Forty-eight patients were included. The inter-rater intraclass correlation coefficient for echo intensities was calculated as 0.91 while intrarater intraclass correlation coefficient as 0.80. For Heckmatt scale, the inter-rater reliability for FDS was Kw = 0.74 (p < 0.0005) and for FDP it was Kw = 0.73 (p < 0.0005). Mean echo intensity values showed significant strong correlations with Heckmatt scores (r = 0.663 and r = 0.633 with both p values <0.001). Conclusion: Quantitative ultrasound imaging of FDS and FDP is a reliable method to demonstrate echo intensity changes of muscles in stroke.


Assuntos
Articulação da Mão/diagnóstico por imagem , Mãos/diagnóstico por imagem , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Acidente Vascular Cerebral/complicações , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Mãos/fisiologia , Articulação da Mão/fisiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/diagnóstico por imagem , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento , Dedo em Gatilho , Ultrassonografia/normas , Adulto Jovem
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3856-3859, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018842

RESUMO

We aimed to characterize the therapeutic effects of Anti-Gravity Treadmill (AlterG) Training on neuromuscular abnormalities associated with spasticity in children with cerebral palsy (CP). Eighteen subjects were divided into two groups; AlterG and control. All subjects received up to 40 minutes of training 3 times a week for 8 weeks. The control group received conventional occupational therapy. The advanced parallel-cascade system identification technique was used to characterize the neuromuscular abnormalities associated with spasticity and separated its intrinsic and reflex components. Reflex stiffness gain (GR) and intrinsic stiffness gain (K) were used to track the therapeutic effects of training on neural and muscular abnormalities. Both K and GR were strongly positioned dependent; they varied linearly with the ankle angle at dorsiflexion. Their position dependence was quantified by fitting a linear model to K and GR over dorsiflexion positions. The evaluations were performed at four-time points; i.e. the baseline (before starting the training), 1 and 2 months after starting the training, and 1 month after the completion of the training to assess the persistent effects. We determined the changes in K and GR intercept and slope parameters over these 3 months to evaluate the therapeutic effects of training on neuromuscular abnormalities. The results revealed that all K and GR parameters decreased substantially following using AlterG training and these changes were greater than those observed in the control. The results also showed that these therapeutic effects were persistent to a high extent, particularly in the AlterG group. Our findings suggested that AlterG training could be considered as a robust therapeutic intervention to reduce neuromuscular abnormalities and manage spasticity.


Assuntos
Paralisia Cerebral , Articulação do Tornozelo , Paralisia Cerebral/complicações , Criança , Teste de Esforço , Gravitação , Humanos , Espasticidade Muscular/etiologia
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3860-3863, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018843

RESUMO

Spasticity is a common ailment following stroke, which can cause pain, contracture, abnormal limb posture and functional limitation. Early management of post-stroke spasticity is vital to reduce these complications, and improve function and help patients become independent. We propose a therapeutic program based on applying a series of vibrations to the ankle joints at specific ankle position as well as over the range of motion using a rehabilitation robotic system to reduce the neural and muscular abnormalities associated with spasticity. We provided a 30-minute perturbation training, 3 times a week for 10 sessions for 8 stroke survivor subjects. Ankle stiffness was calculated using the hysteresis curves. Other kinematic and kinetic parameters were also used to evaluate the mechanical abnormalities. We evaluated participants before starting the therapeutic program, immediately after first session of training and after 10 sessions of training.Our results showed that all subjects had substantial improvements in stiffness, max voluntary contraction, energy loss, passive range of motion, and voluntary movement after both short- and long-term therapeutic program. Surprisingly, for most of these measures the maximum improvement obtained at short-term training. Interestingly, these improvements became persistent over the long-term training. These findings suggest that vibration therapy can be considered as an effective rehabilitation intervention to reduce neuromuscular abnormalities associated with the spasticity in stroke.


Assuntos
Procedimentos Cirúrgicos Robóticos , Acidente Vascular Cerebral , Tornozelo , Articulação do Tornozelo , Humanos , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Sobreviventes
12.
J Stroke Cerebrovasc Dis ; 29(10): 105160, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912522

RESUMO

BACKGROUND AND PURPOSE: Botulinum toxin (BoNT) is a commonly used agent in the treatment of stroke-related spasticity. Sleep disorders can often be seen as a comorbidity or complication in stroke patients. Based on the data that spasticity is associated with sleep disorders, in this study, we aimed to evaluate whether sleep quality has changed in patients with stroke treated with BoNT. METHODS: Thirty five (17 female / 18 male) stroke patients with gastrocnemius and / or soleus spasticity were included in this observational cross-sectional study. In clinical evaluation before and three months after BoNT injection; for spasticity evaluation modified Ashworth scale (MAS), pain assessment visual analog scale (VAS), functional evaluation; passive joint range of motion (ROM) measurement, functional independence measurement (FIM), lower limb Brunstrom staging, life quality assessment short form-36 (SF-36) quality of life scale, and sleep quality assessment Pittsburgh sleep quality index (PSQI) scales were used. RESULTS: After the BoNT injection, there was a statistically significant decrease in MAS and VAS scores, a significant increase in passive ROM measurements, FIM, lower limb Brunstrom staging, and SF-36 physical function sub parameter. There was also a significant decrease in PSQI scores. Before and after treatment, there was no correlation found between PSQI values with pain and spasticity. However, there was a weak negative correlation between post-treatment PSQI values, passive ROM, SF-36 physical function and SF-36 physical role sub parameters (respectively: r: -0.335 p: 0.049, r: -0.364, 0.032, r: -0.404, p: 0.016). Conlusion: The results of our study suggest that BoNT, which is frequently used in the treatment of spasticity in stroke patients, has positive effects on sleep quality.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Músculo Esquelético/efeitos dos fármacos , Transtornos do Sono-Vigília/prevenção & controle , Sono , Acidente Vascular Cerebral/fisiopatologia , Inibidores da Liberação da Acetilcolina/efeitos adversos , Adulto , Idoso , Toxinas Botulínicas/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Qualidade de Vida , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
13.
Praxis (Bern 1994) ; 109(10): 794-800, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32752967

RESUMO

Treatment and Management of Spasticity Abstract. In the care of neurological patients with a lesion of the first motor neuron, for example after stroke or multiple sclerosis, spasticity is a common problem with considerable impairment of quality of life. The treatment is based in the first place on therapeutic and nursing interventions. In addition, a systemic antispastic medication or, depending on the distribution of the spasticity, local injections with botulinum neurotoxin can be applied. If this is insufficient, surgical procedures may be considered.


Assuntos
Toxinas Botulínicas Tipo A , Espasticidade Muscular , Acidente Vascular Cerebral , Humanos , Esclerose Múltipla/complicações , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Qualidade de Vida , Acidente Vascular Cerebral/complicações
14.
Medicine (Baltimore) ; 99(27): e20974, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629711

RESUMO

BACKGROUND: Stroke is emerging as a significant health issue that threatens human health worldwide and as a common sequela of stroke spastic paralysis after stroke (SPAS) has received wide attention. Currently, several systematic reviews have suggested that the commonly used acupuncture therapy (electroacupuncture, fire acupuncture, warm acupuncture, and filiform needle acupuncture) has achieved significant efficacy in the treatment of SPAS. In this study, network meta-analysis will be used to analyze the results of different clinical trials and evaluate the differences in the efficacy of different acupuncture treatments for SPAS. METHODS: Only randomized controlled trials will be included and all patients were diagnosed as spastic paralysis after stroke. A computer-based retrieval will be conducted at CNKI, WanFang databases, VIP, Sinoed, Pubmed, Embase, Web of Science, and the Cochrane library. The search period limit is from the time the date of database establishment to April 17, 2020. To avoid omissions, we will manually retrieve relevant references and conference papers. The risk of bias in the final included studies will be evaluated based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by Revman5.3, WinBUGS 1.4.3, and Stata14.2. RESULTS: This study quantified the effectiveness of each intervention for different outcome indicators. The primary outcomes include the Fugl-Meyer Assessment score, the modified Ashworth scale for the assessment of spasticity, and Barthel Index. The secondary outcomes include clinical effectiveness and adverse reactions. CONCLUSION: It will provide evidence-based medical evidence for clinicians to choose more effective acupuncture therapy for SPAS.


Assuntos
Terapia por Acupuntura/métodos , Paralisia/terapia , Acidente Vascular Cerebral/complicações , Humanos , Metanálise como Assunto , Espasticidade Muscular/etiologia , Paralisia/etiologia , Revisões Sistemáticas como Assunto
15.
NeuroRehabilitation ; 46(4): 519-528, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508341

RESUMO

BACKGROUND: Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity. OBJECTIVE: To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy. METHODS: Eighteen chronic stroke patients were randomly assigned to receive BTT (n = 7) or FTT (n = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment. RESULTS: Between-group comparison showed a significant change on the 10 MWT (P = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P = 0.001) and sway area (P = 0.002) eyes open and length of CoP (P = 0.021) and sway area (P = 0.008) eyes closed] after treatment. CONCLUSIONS: Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Terapia por Exercício/métodos , Marcha , Fármacos Neuromusculares/uso terapêutico , Equilíbrio Postural , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/administração & dosagem , Método Simples-Cego , Acidente Vascular Cerebral/complicações
16.
Arch Phys Med Rehabil ; 101(9): 1485-1496, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32497599

RESUMO

OBJECTIVE: To compare the efficacy and safety of MT10107 (Coretox) with those of onabotulinum toxin A (Botox) in patients with poststroke upper limb spasticity DESIGN: Prospective, randomized, double-blind, active drug-controlled, multicenter, phase III clinical trial. SETTING: Seven university hospitals in the Republic of Korea. PARTICIPANTS: Patients (N=220) with poststroke upper limb spasticity. INTERVENTIONS: All participants received a single injection of either MT10107 (Coretox group) or onabotulinum toxin A (Botox group). MAIN OUTCOME MEASURES: The primary outcome was change in wrist flexor spasticity from baseline to week 4, which was assessed using the modified Ashworth scale (MAS). The secondary outcomes were MAS scores for wrist, elbow, and finger flexors; percentage of treatment responders (response rate); Disability Assessment Scale (DAS) score, and global assessment of treatment. Safety was evaluated based on adverse events, vital signs, physical examination findings, and laboratory test results. The efficacy and safety were evaluated at 4, 8, and 12 weeks postintervention. RESULTS: The primary outcome was found to be -1.32±0.69 and -1.40±0.69 for the Coretox and Botox groups, respectively. MT10107 showed a non-inferior efficacy compared with onabotulinum toxin A, as the 95% confidence interval for between-group differences was -0.10 to 0.27 and the upper limit was less than the non-inferiority margin of 0.45. Regarding the secondary outcomes, MAS scores for all muscles and DAS scores showed a significant improvement at all time points in both groups, with no significant between-group difference. No significant between-group differences were observed regarding response rate, global assessment of treatment, and safety measures. CONCLUSIONS: MT10107 showed no significant difference in efficacy and safety compared with onabotulinum toxin A in poststroke upper limb spasticity treatment.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/uso terapêutico , Acidente Vascular Cerebral/complicações , Idoso , Toxinas Botulínicas Tipo A/efeitos adversos , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/efeitos adversos , Estudos Prospectivos , República da Coreia , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior
17.
Arch Phys Med Rehabil ; 101(9): 1570-1579, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32497601

RESUMO

OBJECTIVE: To evaluate the psychometric properties of the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and Patient-Reported Impact of Spasticity Measure (PRISM) using Rasch analysis to optimize their validity and efficiency. DESIGN: Rasch analysis of the SCI-SET and PRISM represents a secondary analysis of data collected as part of a collaborative research project of the SCI Model Systems Centers. The overall survey was organized into 4 sections: (1) participant demographics and injury characteristics, (2) participant experiences of spasticity, (3) SCI-SET, and (4) PRISM. Participants were recruited from the community via multiple avenues. Data were collected and managed via an online survey tool using a secure web-based data management application. SETTING: Participating Spinal Cord Injury Model Systems Centers. PARTICIPANTS: Most participants (N=1239) had lived with their injury for more than 2 years and used a wheelchair as their primary mode of mobility. The majority of the sample (58%) sustained cervical injuries. INTERVENTIONS: None. MAIN OUTCOME MEASURES: SCI-SET and PRISM. RESULTS: The SCI-SET demonstrated strong measurement properties with acceptably high reliability and point-measure correlations and no evidence of multidimensionality. However, respondents underused some rating scale categories. Analyses of the PRISM demonstrated 3 distinct subscales relating to the physical, psychological, and social influences of spasticity; respondents underused some rating scale categories. Combining underused rating scale categories for both spasticity instruments resulted in increased reliability and reduced respondent burden compared with the original versions. Both the Modified SCI-SET (person separation reliability=0.93) and Modified PRISM (person separation reliability=0.85, 0.89, 0.83 for physical, psychological, and social subscores, respectively) display strong measurement properties. CONCLUSIONS: Measurement properties of the SCI-SET and PRISM improved from use of Rasch model methods. The SCI-SET required minor revisions, whereas the PRISM required definition of subscores. Both modified spasticity measures demonstrated adequate psychometric properties, and correlations among the modified measures were high, providing evidence of convergent validity. We recommend use of the Modified SCI-SET and Modified PRISM measures in future studies.


Assuntos
Avaliação da Deficiência , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/psicologia , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Autorrelato , Fatores Socioeconômicos , Índices de Gravidade do Trauma , Cadeiras de Rodas
18.
Artigo em Inglês | MEDLINE | ID: mdl-32526916

RESUMO

Stroke patients often have muscles spasticity, difficulty with posture control, and tend to fall. This study investigated the use of kinesiology tape for patients with spasticity of ankle muscles after stroke. This study had a randomized, repeated measures design, and evaluated the immediate effect of kinesiology tape on the center of pressure (COP) excursion when applied to the calf and tibialis anterior muscles in stroke survivors. We determined that the taping attachment direction affects the COP movement. Twenty subjects were randomly assigned to the tibialis anterior taping condition, calf taping condition, or nontaping condition. Condition excursion was assessed. The measured variables included the paretic side area, nonparetic side area, forward area, and backward area of COP. All evaluations were conducted immediately after taping. COP excursion for chronic stroke survivors improved after tibialis anterior and calf taping (p < 0.05). Calf taping conditions increased significantly in the forward area (p < 0.05), and tibialis anterior taping conditions increased significantly in the backward area (p < 0.05). Kinesiology tape immediately increased the forward and backward COP excursion for patients with stroke.


Assuntos
Articulação do Tornozelo , Fita Atlética , Acidente Vascular Cerebral , Idoso , Tornozelo , Articulação do Tornozelo/fisiopatologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações
19.
J Neuroeng Rehabil ; 17(1): 54, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321536

RESUMO

BACKGROUNDS: Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree. METHODS: An experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital "Dr. Juan Bruno Zayas Alfonso" in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher's Exact Tests were used as comparison criteria. RESULTS: Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.


Assuntos
Exoesqueleto Energizado , Hemiplegia/reabilitação , Dor de Ombro/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Terapia por Exercício/instrumentação , Terapia por Exercício/métodos , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Projetos Piloto , Reprodutibilidade dos Testes , Robótica/instrumentação , Robótica/métodos , Dor de Ombro/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
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