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1.
Biomed Res Int ; 2021: 9912094, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485529

RESUMO

Background: Spasticity is a factor that impairs the independent functional ability of stroke patients, and noninvasive methods such as electrical stimulation or taping have been reported to have antispastic effects. The purpose of this study was to investigate the effects of transcutaneous electrical nerve stimulation (TENS) combined with taping on spasticity, muscle strength, and gait ability in stroke patients. Methods: From July to October 2020, 46 stroke patients with moderate spasticity in the plantar flexors participated and were randomly assigned to the TENS group (n = 23) and the TENS+taping group (n = 23). All subjects performed a total of 30 sessions of functional training for 30 min/session, 5 days/week, for 6 weeks. For therapeutic exercise, sit-to-standing, indoor walking, and stair walking were performed for 10 min each. In addition, all participants in both groups received TENS stimulation around the peroneal nerve for 30 min before performing functional training. In the TENS+taping group, taping was additionally applied to the feet, ankles, and shin area after TENS, and the taping was replaced once a day. The composite spasticity score and handheld dynamometer measurements were used to assess the intensity of spasticity and muscle strength, respectively. Gait ability was measured using a 10 m walk test. Results: The spasticity score and muscle strength were significantly improved in the TENS+taping group compared to those in the TENS group (p < 0.05). A significant improvement in gait speed was observed in the TENS+taping group relative to that in the TENS group (p < 0.05). Conclusions: Thus, TENS combined with taping may be useful in improving spasticity, muscle strength, and gait ability in stroke patients. Based on these results, an additional application of taping could be used to enhance the antispastic effect of TENS or other electrical stimulation treatments in the clinic. A long-term follow-up study is needed to determine whether the spasticity relieving effect persists after taping is removed.


Assuntos
Tornozelo/fisiopatologia , Terapia por Exercício/métodos , Espasticidade Muscular/terapia , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/patologia , Espasticidade Muscular/fisiopatologia , Resultado do Tratamento
2.
Phys Ther ; 101(8)2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34464449

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the relative importance of different approaches to measure upper extremity selective voluntary motor control (SVMC), spasticity, strength, and trunk control for explaining self-care independence in children affected by upper motor neuron lesions. METHODS: Thirty-one patients (mean [SD] age = 12.5 [3.2] years) with mild to moderate arm function impairments participated in this observational study. Self-care independence was evaluated with the Functional Independence Measure for children (WeeFIM). Upper extremity SVMC was quantified with the Selective Control of the Upper Extremity Scale (SCUES), a similarity index (SISCUES) calculated from simultaneously recorded surface electromyography muscle activity patterns, and an accuracy and involuntary movement score derived from an inertial-measurement-unit-based assessgame. The Trunk Control Measurement Scale was applied and upper extremity spasticity (Modified Ashworth Scale) and strength (dynamometry) were assessed. To determine the relative importance of these factors for self-care independence, 3 regression models were created: 1 included only upper extremity SVMC measures, 1 included upper extremity and trunk SVMC measures (overall SVMC model), and 1 included all measures (final self-care model). RESULTS: In the upper extremity SVMC model (total variance explained 52.5%), the assessgame (30.7%) and SCUES (16.5%) were more important than the SISCUES (4.5%). In the overall SVMC model (75.0%), trunk SVMC (39.0%) was followed by the assessgame (21.1%), SCUES (11.0%), and SISCUES (4.5%). In the final self-care model (82.1%), trunk control explained 43.2%, upper extremity SVMC explained 23.1%, spasticity explained 12.3%, and strength explained 2.3%. CONCLUSION: Although upper extremity SVMC explains a substantial portion of self-care independence, overall trunk control was even more important. Whether training trunk control and SVMC can translate to improved self-care independence should be the subject of future research. IMPACT: This study highlights the importance of trunk control and selective voluntary motor control for self-care independence in children with upper motor neuron lesions.


Assuntos
Doença dos Neurônios Motores/fisiopatologia , Espasticidade Muscular/fisiopatologia , Autocuidado , Tronco/fisiopatologia , Extremidade Superior/fisiopatologia , Adolescente , Criança , Eletromiografia , Feminino , Humanos , Masculino
3.
World Neurosurg ; 153: e213-e219, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34182176

RESUMO

BACKGROUND: Contralateral C7 (CC7) nerve transfer has successfully restored hand function in patients with spastic hemiplegia from chronic central nervous system injuries. However, little is known about the morphology and anatomy of the donor C7 nerve root in patients undergoing this procedure. This study quantified intraoperative measurements of donor C7 nerve roots during CC7 transfer surgery for spastic hemiplegia in patients treated at a high-volume center to describe observed anatomical variations for successful direct anastomosis. METHODS: A database of images from 21 patients (2 females, 19 males) undergoing CC7 surgery was searched for photographic data that contained a standard ruler measuring donor C7 nerve root length after surgical sectioning and before transfer. Two independent observers analyzed these images and recorded C7 nerve root diameter, length, and branch lengths. RESULTS: Mean (SD) values of donor C7 nerve measurements were length, 53.5 (8.0) mm; diameter, 5.1 (0.9) mm; branch length following surgical sectioning, 18.3 (6.3) mm. Right-sided donor C7 nerve roots yielded significantly longer branches compared with left-sided donor C7 nerve roots (P = 0.01). Other patient factors such as age, sex, or laterality of brain injury did not influence intraoperative anatomy. CONCLUSIONS: We report detailed intraoperative measurements of the donor C7 root during CC7 nerve transfer for spastic hemiplegia. These findings describe existing variation in surgical C7 nerve root anatomy in patients undergoing this procedure and may serve as a general reference for the expected donor C7 length in successful direct anastomosis.


Assuntos
Hemiplegia/cirurgia , Transferência de Nervo/métodos , Raízes Nervosas Espinhais/anatomia & histologia , Nervos Espinhais/transplante , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Hemorragia Cerebral/complicações , Infarto Cerebral/complicações , Paralisia Cerebral/complicações , Vértebras Cervicais , Criança , Feminino , Hemiplegia/etiologia , Hemiplegia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Espasticidade Muscular/cirurgia , Tamanho do Órgão , Nervos Espinhais/anatomia & histologia , Adulto Jovem
4.
Medicine (Baltimore) ; 100(25): e26356, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160405

RESUMO

ABSTRACT: In dystonic and spastic movement disorders, abnormalities of motor control and somatosensory processing as well as cortical modulations associated with clinical improvement after botulinum toxin A (BoNT-A) treatment have been reported, but electrophysiological evidence remains controversial. In the present observational study, we aimed to uncover central correlates of post-stroke spasticity (PSS) and BoNT-A-related changes in the sensorimotor cortex by investigating the cortical components of somatosensory evoked potentials (SEPs). Thirty-one chronic stroke patients with PSS of the upper limb were treated with BoNT-A application into the affected muscles and physiotherapy. Clinical and electrophysiological evaluations were performed just before BoNT-A application (W0), then 4 weeks (W4) and 11 weeks (W11) later. PSS was evaluated with the modified Ashworth scale (MAS). Median nerve SEPs were examined in both upper limbs with subsequent statistical analysis of the peak-to-peak amplitudes of precentral P22/N30 and postcentral N20/P23 components. At baseline (W0), postcentral SEPs were significantly lower over the affected cortex. At follow up, cortical SEPs did not show any significant changes attributable to BoNT-A and/or physiotherapy, despite clear clinical improvement. Our results imply that conventional SEPs are of limited value in evaluating cortical changes after BoNT-A treatment and further studies are needed to elucidate its central actions.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Potenciais Somatossensoriais Evocados/efeitos dos fármacos , Terapia por Exercício/métodos , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/efeitos dos fármacos , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Córtex Somatossensorial/efeitos dos fármacos , Córtex Somatossensorial/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Extremidade Superior/inervação , Adulto Jovem
5.
J Neuroeng Rehabil ; 18(1): 81, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985543

RESUMO

BACKGROUND: Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. METHODS: Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the 'distance' between pathological and normal movement, (a) the bidirectional Kullback-Liebler divergence (BKLD) and (b) Hellinger's distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. RESULTS: Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. CONCLUSIONS: The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.


Assuntos
Atividade Motora/fisiologia , Espasticidade Muscular/fisiopatologia , Exame Neurológico/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Fenômenos Biomecânicos , Articulação do Cotovelo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Espasticidade Muscular/etiologia , Paresia/etiologia , Reflexo de Estiramento/fisiologia , Extremidade Superior
6.
Toxins (Basel) ; 13(4)2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33805988

RESUMO

There is extensive literature supporting the efficacy of botulinum toxin (BoNT-A) for the treatment of post-stroke spasticity, however, there remain gaps in the routine management of patients with post-stroke spasticity. A panel of 21 Italian experts was selected to participate in this web-based survey Delphi process to provide guidance that can support clinicians in the decision-making process. There was a broad consensus among physicians that BoNT-A intervention should be administered as soon as the spasticity interferes with the patients' clinical condition. Patients monitoring is needed over time, a follow-up of 4-6 weeks is considered necessary. Furthermore, physicians agreed that treatment should be offered irrespective of the duration of the spasticity. The Delphi consensus also stressed the importance of patient-centered goals in order to satisfy the clinical needs of the patient regardless of time of onset or duration of spasticity. The findings arising from this Delphi process provide insights into the unmet needs in managing post-stroke spasticity from the clinician's perspective and provides guidance for physicians for the utilization of BoNT-A for the treatment of post-stroke spasticity in daily practice.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/tratamento farmacológico , Inibidores da Liberação da Acetilcolina/efeitos adversos , Toxinas Botulínicas Tipo A/efeitos adversos , Tomada de Decisão Clínica , Consenso , Técnica Delfos , Humanos , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Assistência Centrada no Paciente , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
7.
Toxins (Basel) ; 13(4)2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33807196

RESUMO

Ultrasound (US)-guided botulinum neurotoxin (BoNT) injections are becoming a mainstay in the treatment of muscle spasticity in upper motor neuron syndromes. As a result, there has been a commensurate increase in US-guided BoNT injection for spasticity training courses. However, many of these courses do not emphasize the importance of ergonomics. This paper aims to highlight the importance of ultrasound ergonomics and presents ergonomic recommendations to optimize US-guided BoNT injection techniques in spasticity management. Expert consensus opinion of 11 physicians (4 different continents; representing 8 countries, with an average of 12.6 years of practice using US guidance for BoNT chemodenervation (range 3 to 22 years)). A search using PubMed, College of Physicians and Surgeons of British Columbia database, EMbase was conducted and found no publications relating the importance of ergonomics in US-guided chemodenervation. Therefore, recommendations and consensus discussions were generated from the distribution of a 20-question survey to a panel of 11 ultrasound experts. All 11 surveyed physicians considered ergonomics to be important in reducing physician injury. There was complete agreement that physician positioning was important; 91% agreement that patient positioning was important; and 82% that ultrasound machine positioning was important. Factors that did not reach our 80% threshold for consensus were further discussed. Four categories were identified as being important when implementing ultrasound ergonomics for BoNT chemodenervation for spasticity; workstation, physician, patient and visual ergonomics. Optimizing ergonomics is paramount when performing US-guided BoNT chemodenervation for spasticity management. This includes proper preparation of the workspace and allowing for sufficient pre-injection time to optimally position both the patient and the physician. Lack of awareness of ergonomics for US-guided BoNT chemodenervation for spasticity may lead to suboptimal patient outcomes, increase work-related injuries, and patient discomfort. We propose key elements for optimal positioning of physicians and patients, as well as the optimal setup of the workspace and provide clinical pearls in visual identification of spastic muscles for chemodenervation.


Assuntos
Inibidores da Liberação da Acetilcolina/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Ergonomia , Espasticidade Muscular/tratamento farmacológico , Músculo Esquelético/inervação , Bloqueio Nervoso , Posicionamento do Paciente , Postura , Ultrassonografia de Intervenção , Inibidores da Liberação da Acetilcolina/efeitos adversos , Toxinas Botulínicas/efeitos adversos , Consenso , Pesquisas sobre Serviços de Saúde , Humanos , Injeções Intramusculares , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/diagnóstico por imagem , Saúde do Trabalhador , Traumatismos Ocupacionais/etiologia , Traumatismos Ocupacionais/prevenção & controle , Resultado do Tratamento
8.
Clin Neurophysiol ; 132(6): 1226-1233, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33867256

RESUMO

OBJECTIVE: To determine inter-rater reliability, minimal detectable change and responsiveness of Tonic Stretch Reflex Threshold (TSRT) as a quantitative measure of elbow flexor spasticity. METHODS: Elbow flexor spasticity was assessed in 55 patients with sub-acute stroke by determining TSRT, the angle of spasticity onset at rest (velocity = 0°/s). Elbow flexor muscles were stretched 20 times at different velocities. Dynamic stretch-reflex thresholds, the elbow angles corresponding to the onset of elbow flexor EMG at each velocity, were used for TSRT calculation. Spasticity was also measured with the Modified Ashworth Scale (MAS). In a sub-group of 44 subjects, TSRT and MAS were measured before and after two weeks of an upper-limb intervention. RESULTS: The intraclass correlation coefficient was 0.65 and the 95% minimal detectable change was 32.4°. In the treated sub-group, TSRT, but not MAS significantly changed. TSRT effect size and standardized response mean were 0.40 and 0.35, respectively. Detection of clinically meaningful improvements in upper-limb motor impairment by TSRT change scores ranged from poor to excellent. CONCLUSIONS: Evaluation of stroke-related elbow flexor spasticity by TSRT has good inter-rater reliability. Test responsiveness is low, but better than that of the MAS. SIGNIFICANCE: TSRT may be used to complement current scales of spasticity quantification.


Assuntos
Cotovelo/fisiopatologia , Espasticidade Muscular/diagnóstico , Reflexo de Estiramento/fisiologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/fisiopatologia
9.
Toxins (Basel) ; 13(4)2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33923397

RESUMO

The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal cord, and muscle spindle. Disorders of muscle tone can arise from dysfunction in these pathways and manifest as hypertonia or hypotonia. The loss of supraspinal control mechanisms gives rise to hypertonia, resulting in spasticity or rigidity. On the other hand, dystonia and paratonia also manifest as abnormalities of muscle tone, but arise more due to the network dysfunction between the basal ganglia and the thalamo-cerebello-cortical connections. In this review, we have discussed the normal homeostatic mechanisms maintaining tone and the pathophysiology of spasticity and rigidity with its anatomical correlates. Thereafter, we have also highlighted the phenomenon of network dysfunction, cortical disinhibition, and neuroplastic alterations giving rise to dystonia and paratonia.


Assuntos
Encéfalo/fisiopatologia , Distonia/fisiopatologia , Contração Muscular , Hipertonia Muscular/fisiopatologia , Tono Muscular , Músculo Esquelético/inervação , Medula Espinal/fisiopatologia , Animais , Distonia/diagnóstico , Humanos , Hipertonia Muscular/diagnóstico , Rigidez Muscular/diagnóstico , Rigidez Muscular/fisiopatologia , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Vias Neurais/fisiopatologia
10.
Medicine (Baltimore) ; 100(12): e25061, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761664

RESUMO

INTRODUCTION: C7 nerve transfer alone can improve upper limb motor function and partial spasticity. Selective posterior rhizotomy (SPR) of the cervical nerve alone can comprehensively improve spasticity but without neuromotor regeneration. We propose a novel possible improvement of contralateral C7 (CC7) nerve transfer through the posterior vertebral approach, which was combined with SPR of the affected cervical nerve. PATIENT CONCERNS: A 33-year-old male patient presented with cerebral hemorrhage of the left basal ganglia, paralysis of the right limbs, and hypesthesia 8 months earlier. The dysfunction of the affected hand was already present at admission. The patient reported a previous history of hypertension for several years and oral antihypertensive drugs, and blood pressure was controlled within a normal range. DIAGNOSIS: Central upper limb spastic paralysis. The muscle strength of the right lower limb was grade IV. The Fugl-Meyer score of the right upper limb was 7 points, and the modified Ashworth score was 10. INTERVENTIONS: The patient underwent CC7 transfer and SPR. OUTCOMES: The patient successfully underwent CC7 transfer and SPR without complications. On the day after surgery, the left upper limb motions were normal. The Fugl-Meyer score was 9, and the modified Ashworth score of the right upper limb was 2. CONCLUSIONS: CC7 nerve transfer through the posterior vertebral approach combined with SPR of the affected cervical nerve can possibly improve the surgical outcomes of selected patients with upper limb motor dysfunction and partial spasticity. This method has not been reported in the literature before, and additional studies are necessary.


Assuntos
Transferência de Nervo/métodos , Paralisia/cirurgia , Rizotomia/métodos , Extremidade Superior/inervação , Adulto , Hemorragia Cerebral/complicações , Vértebras Cervicais , Terapia Combinada , Humanos , Masculino , Espasticidade Muscular/fisiopatologia , Espasticidade Muscular/cirurgia , Força Muscular , Paralisia/fisiopatologia , Resultado do Tratamento
11.
PLoS One ; 16(2): e0246288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571238

RESUMO

INTRODUCTION: This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. METHODS: 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. RESULTS: 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). CONCLUSIONS: The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013190.


Assuntos
Braço/fisiologia , Espasticidade Muscular/reabilitação , Humanos , Espasticidade Muscular/fisiopatologia , Psicometria , Reprodutibilidade dos Testes , Resultado do Tratamento
12.
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
13.
Dev Med Child Neurol ; 63(6): 748-754, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33411352

RESUMO

AIM: To determine the features cited by motor phenotyping experts when identifying dystonia in people with cerebral palsy (CP). METHOD: Dystonia identification in CP, particularly when comorbid with spasticity, can be difficult. The dystonia diagnostic criterion standard remains subjective visual identification by expert consensus. For this qualitative study, we conducted an inductive thematic analysis of consensus-building discussions between three pediatric movement disorder physicians as they identified the presence or absence of dystonia in gait videos of 40 participants with spastic CP and periventricular leukomalacia. RESULTS: Unanimous consensus about the presence or absence of dystonia was achieved for 34 out of 40 videos. Two main themes were present during consensus-building discussions as videos were evaluated for dystonia: (1) unilateral leg or foot adduction that was variable over time, and (2) difficulty in identifying dystonia. Codes contributing to the first theme were more likely to be cited by a discussant when they felt dystonia was present (as opposed to absent) in a video (χ2 test, p=0.004). DISCUSSION: These results describe the gait features cited by experts during consensus-building discussion as they identify dystonia in ambulatory people with CP. Qualitative thematic analysis of these discussions could help codify the subjective process of dystonia diagnosis.


Assuntos
Paralisia Cerebral/fisiopatologia , Distonia/diagnóstico , Marcha/fisiologia , Leucomalácia Periventricular/fisiopatologia , Espasticidade Muscular/fisiopatologia , Adolescente , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Distonia/etiologia , Distonia/fisiopatologia , Feminino , Humanos , Leucomalácia Periventricular/complicações , Masculino , Espasticidade Muscular/complicações , Adulto Jovem
14.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495167

RESUMO

A 5-year-old male child of consanguineous parentage, without any adverse perinatal history, presented with progressive cognitive regression predominantly in the language and attention domains, for 2 years. He had simultaneous pyramidal and extrapyramidal involvement, frequent generalised tonic-clonic seizures and recurrent respiratory tract infections. Examination was significant for vertical supranuclear gaze palsy, coarse facial features and splenomegaly. Given the clinical features, in the background of consanguinity and mother's history of spontaneous pregnancy losses, inborn errors of metabolism were suspected. Following relevant investigations including tailored genetic study, Niemann-Pick disease type C (NPC) was diagnosed. Interestingly, MRI brain showed bilateral T2/fluid-attenuated inversion recovery claustrum hyperintensities, which are more commonly associated with autoimmune encephalitis and febrile infection-related epilepsy syndrome and not reported previously in NPC. Additionally, language regression as a presenting manifestation in NPC as opposed to classical dysarthria makes this case truly unique.


Assuntos
Claustrum/diagnóstico por imagem , Doença de Niemann-Pick Tipo C/diagnóstico , Atenção , Pré-Escolar , Disfunção Cognitiva/fisiopatologia , Consanguinidade , Distonia/fisiopatologia , Eletroencefalografia , Humanos , Idioma , Imageamento por Ressonância Magnética , Masculino , Espasticidade Muscular/fisiopatologia , Doença de Niemann-Pick Tipo C/diagnóstico por imagem , Doença de Niemann-Pick Tipo C/fisiopatologia , Paralisia Pseudobulbar/fisiopatologia , Infecções Respiratórias/fisiopatologia , Convulsões/fisiopatologia , Esplenomegalia/fisiopatologia
15.
Gait Posture ; 85: 14-19, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33487525

RESUMO

BACKGROUND: Cerebral palsy (CP) is the most common motor and movement disability in childhood. The mechano-morphological alterations of the spastic muscle itself as well as the functional limitations in CP are well documented. However, the relationship between muscle tendon properties and functional tests in CP remains unknown. RESEARCH QUESTION: The aim of this study was to explore the relationship between spastic muscle mechano-morphological properties and functional performance in children with CP. METHODS: This study included retrospective data from 22 children with spastic cerebral palsy with a mean age of 12.8 years (19 GMFCS I/3 GMFC II, 15 male/7 female, 8 unilateral involved/14 bilateral). Mechano-morphological properties of gastrocnemius (GM) and Achilles tendon (AT) were correlated with a variety of functional measures, maximal isometric strength, the Muscle Power Sprint test (MPST), 6-minute walk test (6MWT) and 3D-gait analysis using the Pearson Coefficient. RESULTS: Muscle-tendon properties were normalized to remove anthropometric dimensions because of strong associations with anthropometric data. Higher isometric muscle strength was related to longer normalized GM fascicle lengths (r = 0.67, p < 0.01). The distance reached in the 6MWT positively correlated with normalized GM fascicle lengths (r = 0.61, p < 0.01). Higher AT stiffness was associated with faster performance in the MPST (r = 0.77, p < 0.01). Finally, there was an association between ankle power and both longer normalized AT length and shorter muscle belly (r = 0.60 and r = 0.54, p < 0.01). SIGNIFICANCE: The findings of this study give more insight into the function specific adaptations of a spastic muscle-tendon unit. While walking, assessed through the 6MWT, was related to normalized gastrocnemius fascicle length, sprint performance was associated with an increased AT stiffness. These results provide a better understanding of the relationship between functional tasks and spastic muscle-tendon properties, which offers potential for improved and targeted interventions in CP.


Assuntos
Paralisia Cerebral/fisiopatologia , Músculo Esquelético/fisiopatologia , Tendões/fisiopatologia , Tendão do Calcâneo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Antropometria , Paralisia Cerebral/patologia , Criança , Feminino , Análise da Marcha , Humanos , Masculino , Espasticidade Muscular/patologia , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/patologia , Estudos Retrospectivos , Análise e Desempenho de Tarefas , Teste de Caminhada , Caminhada/fisiologia
16.
Brain Dev ; 43(4): 590-595, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33402283

RESUMO

INTRODUCTION: Aminoacyl-tRNA synthetase-interacting multifunctional protein 1 (AIMP1) is a non-catalytic component of the multi-tRNA synthetase complex that catalyzes the ligation of amino acids to their correct tRNAs. Bi-allelic truncating variants in the AIMP1 gene have been associated with hypomyelinating leukodystrophy-3 (HLD3; MIM 260600), which is characterized by hypomyelination, microcephaly, seizures and decreased life expectancy. Although peripheral nerve involvement has been assumed for HLD3, no compelling evidence is available to date. CASE REPORT: The case was a first-born Filipino male. He showed profound developmental delay, failure to thrive, and spasticity in his limbs. At three months of age he developed refractory epilepsy. Serial magnetic resonance imaging (MRIs) showed profound myelination delay and progressive cerebral atrophy. He showed abnormal nerve conduction studies. Genetic testing revealed a homozygous pathogenic variant in the AIMP1 gene (NM_004757.3: c.115C > T: p.Gln39*). The parents were heterozygous for the same variant. CONCLUSION: Here, we report a patient with a homozygous nonsense AIMP1 variant showing peripheral neuropathy as well as HLD3. Our case suggests that AIMP1 plays a pivotal role in the peripheral nerve as well as the central nervous system.


Assuntos
Códon sem Sentido , Citocinas/genética , Deficiências do Desenvolvimento/genética , Leucoencefalopatias/genética , Espasticidade Muscular/genética , Proteínas de Neoplasias/genética , Nervos Periféricos/fisiopatologia , Proteínas de Ligação a RNA/genética , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Deficiências do Desenvolvimento/diagnóstico por imagem , Deficiências do Desenvolvimento/fisiopatologia , Humanos , Lactente , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Espasticidade Muscular/diagnóstico por imagem , Espasticidade Muscular/fisiopatologia , Condução Nervosa/fisiologia , Substância Branca/diagnóstico por imagem , Substância Branca/fisiopatologia
17.
Dev Med Child Neurol ; 63(6): 743-747, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33483965

RESUMO

AIM: To assess the efficacy of intermittent serial casting in conjunction with occupational therapy and botulinum neurotoxin A (BoNT-A) in children with cerebral palsy (CP) presenting spastic wrist flexion deformity. METHOD: This was a controlled, prospective study in which 34 children (19 females, 15 males; mean [SD] 11y [4y 6mo]) were randomly allocated to casting or control groups in a ratio of 2:1. Both groups were subjected to BoNT-A treatment and occupational therapy. The casting group additionally received a series of progressive casts intermittently for three consecutive weekends. Outcome measures consisted of passive range of motion (PROM) as assessed by goniometer, muscle tone by Modified Ashworth scale (MAS), and spasticity by Tardieu Scale. Assessments were done at baseline, week 4, and week 12. RESULTS: Baseline characteristics of casting and control groups were comparable. PROM, MAS, and Tardieu angle of catch (XV3) of the casting and control groups significantly improved after treatment (p<0.001 for all). Nevertheless the mean change from baseline MAS at week 12, mean changes from baseline PROM, Tardieu XV3, and the spasticity grade (Y) at week 4 and week 12 of the casting group showed statistical superiority over those of the control group (p<0.05 for all). INTERPRETATION: Children with CP presenting spastic wrist flexion deformity might gain additional benefits from supplementary intermittent serial casting as well as BoNT-A injections and occupational therapy. Serial casting could be considered as a complementary treatment to BoNT-A and occupational therapy in children with clinically significant PROM limitations.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Moldes Cirúrgicos , Paralisia Cerebral/terapia , Espasticidade Muscular/terapia , Fármacos Neuromusculares/uso terapêutico , Punho/fisiopatologia , Adolescente , Paralisia Cerebral/tratamento farmacológico , Paralisia Cerebral/fisiopatologia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Masculino , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/fisiopatologia , Terapia Ocupacional , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
18.
J Rehabil Med ; 53(1): jrm00137, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33284354

RESUMO

OBJECTIVE: Spasticity assessment is often used to guide treatment decision-making. Assessment tool limitations may influence the conflicting evidence surrounding the relationship between spasticity and walking. This study investigated whether testing speeds and joint angles during a Modified Tardieu assessment matched lower-limb angular velocity and range of motion during walking. DESIGN: Observational study. SUBJECTS: Thirty-five adults with a neurological condition and 34 assessors. METHODS: The Modified Tardieu Scale was completed. Joint angles and peak testing speed during V3 (fast) trials were compared with these variables during walking in healthy people, at 0.400.59, 0.600.79 and 1.401.60 m/s. The proportion of trials in which the testing speed, start angle, and angle of muscle reaction matched the relevant joint angles and angular velocity during walking were analysed. RESULTS: The Modified Tardieu Scale was completed faster than the angular velocities seen during walking in 88.7% (0.400.59 m/s), 78.9% (0.600.79 m/s) and 56.2% (1.401.60 m/s) of trials. When compared with the normative dataset, 4.2%, 9.5% and 13.7% of the trials met all criteria for each respective walking speed. CONCLUSION: When applied according to the standardized procedure and compared with joint angular velocity during walking, clinicians performed the Modified Tardieu Scale too quickly.


Assuntos
Espasticidade Muscular/diagnóstico , Determinação de Necessidades de Cuidados de Saúde/normas , Amplitude de Movimento Articular/fisiologia , Caminhada/fisiologia , Adulto , Feminino , Humanos , Masculino , Espasticidade Muscular/fisiopatologia , Adulto Jovem
19.
Thyroid ; 31(4): 678-691, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32924834

RESUMO

Background: In humans, resistance to thyroid hormone (RTH) caused by mutations in the thyroid hormone receptor alpha (THRA) gene, RTHα, manifests as tissue-specific hypothyroidism and circulating thyroid hormone levels exhibit hypothyroid-like clinical features. Before the identification of patients with RTHα, several Thrα1 knock-in mouse models were generated to clarify the function of TRα1. However, the phenotypes of these mice were not consistent with the clinical presentation of RTHα in humans. For the present study, we generated an RTHα mouse model that carries the Thra1E403X mutation found in human RTHα patients. Here, we report the gross phenotypes of this mouse RTHα model. Methods: Traditional homologous recombination gene targeting techniques were used to introduce a mutation (Thra1E403X) in the mouse Thra gene. The phenotypes of the resulting mice were studied and compared with clinical features observed for RTHα with THRAE403X. Results: Thrα1E403X/E403X homozygous mice exhibited severe neurological phenotypes, such as spasticity and motor ataxia, which were similar to those observed in endemic cretinism. Thrα1E403X/+ heterozygous mice reproduced most clinical manifestations of patient with RTHα, such as a normal survival rate and male fertility, as well as delayed postnatal growth and development, neurological and motor coordination deficits, and anemia. The mice had typical thyroid function with a modest increase in serum triiodothyronine (T3) levels, a low thyroxine (T4)/T3 ratio, and low reverse T3 (rT3) levels. Conclusions: The Thrα1E403X/+ mice faithfully recapitulate the clinical features of human RTHα and thus can provide a useful tool to dissect the role of TRα1 in development and to determine the pathological mechanisms of RTHα.


Assuntos
Mutação , Glândula Tireoide/metabolismo , Receptores alfa dos Hormônios Tireóideos/genética , Síndrome da Resistência aos Hormônios Tireóideos/genética , Hormônios Tireóideos/sangue , Animais , Ataxia/genética , Ataxia/metabolismo , Ataxia/fisiopatologia , Desenvolvimento Ósseo , Encéfalo/crescimento & desenvolvimento , Modelos Animais de Doenças , Fertilidade , Predisposição Genética para Doença , Heterozigoto , Homozigoto , Camundongos Endogâmicos C57BL , Camundongos Mutantes , Atividade Motora , Espasticidade Muscular/genética , Espasticidade Muscular/metabolismo , Espasticidade Muscular/fisiopatologia , Força Muscular , Fenótipo , Glândula Tireoide/fisiopatologia , Receptores alfa dos Hormônios Tireóideos/metabolismo , Síndrome da Resistência aos Hormônios Tireóideos/sangue , Síndrome da Resistência aos Hormônios Tireóideos/fisiopatologia
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