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1.
NeuroRehabilitation ; 45(4): 471-481, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31868686

RESUMO

BACKGROUND: The upper extremity spasticity following stroke limits individuals' activities of daily living. Focal muscle vibration (FMV) is a device producing vibration signals affecting the central nervous system. OBJECTIVE: This systematic review was conducted to investigate the effects of FMV on individuals with stroke, and to identify the effective training protocol in reducing upper extremities spasticity post-stroke. METHODS: We searched in SCOPUS, PEDro, PUBMED, REHABDATA, and Web of Science for randomized clinical trials (RCTs) and pseudo-RCTs published in English. The outcome measure included is the Modified Ashworth Scale (MAS). The methodological quality of the included trials was evaluated using the Cochrane Collaboration's instrument. Effect sizes were calculated. RESULTS: Eight articles published from 2012 to 2019 were included in this systematic review. A total of 268 post-stroke patients, 28.73% of which were females, were included in all studies. The methodological quality for included studies ranged from moderate to high. FMV showed some evidence in reducing hemiplegic upper extremity spasticity in patients with stroke. CONCLUSIONS: The FMV may be an efficient intervention in reducing upper extremity spasticity in the stroke population. The efficient treatment protocol and dosage remain unclear. Additional randomized controlled trials are strongly needed to study the effects of FMV on spasticity in individuals with stroke.


Assuntos
Hemiplegia/terapia , Espasticidade Muscular/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Vibração/uso terapêutico , Atividades Cotidianas , Feminino , Hemiplegia/reabilitação , Humanos , Espasticidade Muscular/reabilitação , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Extremidade Superior/fisiopatologia
2.
IEEE Int Conf Rehabil Robot ; 2019: 542-547, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374686

RESUMO

Vibration stimulation seems to be an affordable easy-to-use rehabilitation tool. Focal muscle vibration (FV) has potential to reduce spasticity and enhance muscle strength and performance. Combined with robotic assisted movement therapy, the rehabilitation can benefit from improvement of more than one aspect. For example, FV could firstly decrease abnormally increased muscle tone and joint rigidity by tackling volitional control for easier robotic movement exercise. Exactly this approach is evaluated within a clinical trial presented in this paper. FV were applied to relaxed spastic wrist flexor and extensor muscles for 15min. Subsequently, the wrist was engaged in a robotic-assisted game-playing. Results from two cases who completed the trial showed short-term decrease in wrist stiffness as assessed by clinical spasticity measurement Modified Ashworth Scale (MAS). Active range of motion (AROM) and engineering joint stiffness (JS) measurements were estimated using a robotic apparatus and the results complemented previous observations. The AROM increased and JS decreased for both cases when compared at the beginning and at the end of each interventional session. These results are a part of an ongoing clinical trial but show promise for reducing repercussions of spasticity in incomplete spinal cord injury.


Assuntos
Técnicas de Exercício e de Movimento , Espasticidade Muscular , Músculo Esquelético/fisiopatologia , Traumatismos da Medula Espinal , Vibração , Articulação do Punho/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Espasticidade Muscular/fisiopatologia , Espasticidade Muscular/reabilitação , Força Muscular , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação
3.
Artigo em Russo | MEDLINE | ID: mdl-31407681

RESUMO

AIM: To study the efficacy of the developed approach to the specialized Spa-rehabilitation of motor disorders in patients with cerebral palsy (spastic diplegia). MATERIAL AND METHODS: The study included 86 patients (45 (52,33%) women and 41 (47.67%) men), aged from 10 to 16-years, mean 13,02±2,13. All patients were divided into 2 groups depending on the method of treatment. RESULTS AND CONCLUSION: Administration of minimally invasive procedures during the course of rehabilitation can effectively restore the volume of movements in the limbs, stimulate motor development in children and form a new stereotype of walking. An analysis of the follow-up data one year after the treatment confirms the efficacy of the proposed approach to rehabilitation.


Assuntos
Paralisia Cerebral , Espasticidade Muscular , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/reabilitação , Criança , Feminino , Humanos , Masculino , Espasticidade Muscular/reabilitação , Amplitude de Movimento Articular , Caminhada
4.
Trials ; 20(1): 419, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291976

RESUMO

BACKGROUND: Stroke is characterized by high morbidity, high mortality, and high disability. Spasticity, one of the most common complications after stroke, may reduce the potential success of rehabilitation and has a detrimental effect on stroke patients' daily function and quality of life. Moreover, the long-term management of spasticity is a financial burden to patients and increases societal costs. The current treatments, mainly including physical therapy, oral drugs, drug injection therapy, and surgical interventions, have been used to reduce spasticity. However, every conventional approach has its limitations. Acupuncture at the "Wang's Jiaji" acupoints, based on the experience of the famous old doctor of traditional Chinese medicine (TCM) Le Ting Wang in treating post-stroke limb spasm, has been widely practiced in our department. This intervention has effectively avoided the controversy around acupuncture at local acupoints on the limbs, and is easy to apply without side effects. Our previous studies had found that acupuncture at the "Wang's Jiaji-points" can reduce the occurrence and severity of spasticity occurring after stroke in the early stage (the first 21 days). In this study, we chose patients in the convalescent stage, 1-6 months after stroke, so as to study the efficacy and the specific intervention time of "Wang's jiaji" in the convalescent stage after stroke. METHODS: This is a randomized, controlled, and single-blind study. Patients in the convalescent stage within 1-6 months of ischemic stroke will be selected as subjects. A total of 100 subjects will be randomly assigned to two groups. The acupuncture group will be given acupuncture treatment five times a week; the medicine group will be given 10mg baclofen three times a day. These two groups will continue to receive current usual care for the prevention and treatment of cerebrovascular diseases, but drugs that affect muscle tone will not be allowed. The treatment will last for 2 weeks. The primary outcome measurement is the simplified Fugl-Meyer Assessment. The secondary outcome measurements are the Modified Ashworth Scale, Modified Barthel Scale, and the H-reflex, F response, and H/M ratios of electromyography. All outcome measurements are assessed at baseline, 2 weeks, 4 weeks, and 12 weeks after first treatment except the electromyography, which is assessed at baseline and 2 weeks after first acupuncture. DISCUSSION: This trial aims to evaluate the effects and the specific intervention time of "Wang's Jiaji" acupoints on spasticity after stroke. TRIAL REGISTRATION: ISRCTN registry, ISRCTN31511176 . Registered on 29 August 2017. Version number of protocol 2016-2-1161 Version date of protocol: 2016-1.


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura , Isquemia Encefálica/reabilitação , Convalescença , Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Terapia por Acupuntura/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pequim , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
5.
Int J Neurosci ; 129(11): 1066-1075, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220973

RESUMO

Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury. Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment. Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance. Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.


Assuntos
Terapia por Exercício/instrumentação , Espasticidade Muscular/reabilitação , Músculo Esquelético , Reabilitação Neurológica , Paralisia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Idoso , Ciclismo , Desenho de Equipamento , Terapia por Exercício/métodos , Feminino , Reflexo H/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Reabilitação Neurológica/instrumentação , Reabilitação Neurológica/métodos , Paralisia/etiologia , Estimulação Física , Estudo de Prova de Conceito , Traumatismos da Medula Espinal/complicações
6.
Eur J Phys Rehabil Med ; 55(5): 551-557, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31199103

RESUMO

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke. AIM: The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke. DESIGN: A randomized controlled pilot study. SETTING: A hospital center. POPULATION: Participants with stroke within six months. METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week). RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037). CONCLUSIONS: Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke. CLINICAL REHABILITATION IMPACT: Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.


Assuntos
Fita Atlética , Mãos/fisiopatologia , Hemiplegia/reabilitação , Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral , Adulto , Idoso , Avaliação da Deficiência , Feminino , Hemiplegia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Projetos Piloto , Recuperação de Função Fisiológica
7.
Fisioter. Pesqui. (Online) ; 26(2): 185-189, abr.-jun. 2019. tab
Artigo em Português | LILACS | ID: biblio-1012133

RESUMO

RESUMO A espasticidade causada pelo acidente vascular encefálico (AVE) é uma das principais causas de incapacidade funcional no membro superior. O objetivo do estudo foi verificar o efeito da crioterapia associada à cinesioterapia e da estimulação elétrica na capacidade de preensão palmar do membro espástico de pacientes com AVE na fase crônica. Participaram do estudo 40 pacientes com idade média de 60,5 (±9,45) anos e hemiparesia espástica, divididos aleatoriamente em grupo A (GA): submetidos à crioterapia nos músculos flexores de punho e cinesioterapia nos músculos flexores e extensores de punho; e grupo B (GB): submetidos à estimulação elétrica nos músculos extensores de punho. A capacidade de preensão palmar foi avaliada por meio de um dinamômetro de bulbo antes, depois de 16 atendimentos e um mês após o término do tratamento. Os resultados demonstraram que houve aumento da capacidade de preensão palmar no GA (p=0,0244) e GB (p=0,0144) após o tratamento, com manutenção um mês após seu término (p=0,6002 e 0,3066 respectivamente), sem diferença estatística entre estes. Os achados apontam que ambos os recursos terapêuticos foram eficazes para o aumento da capacidade de preensão palmar dos participantes do estudo.


RESUMEN La espasticidad causada por el accidente cerebrovascular (ACV) es una de las principales causas de incapacidad funcional en el miembro superior. El objetivo del estudio fue verificar el efecto de la crioterapia asociada a la cinesioterapia y de la estimulación eléctrica en la capacidad de prensión palmar del miembro espástico de pacientes con ACV en fase crónica. Participaron del estudio 40 pacientes con edad media de 60,5 (±9,45) años y hemiparesia espástica, divididos aleatoriamente en grupo A (GA) -sometidos a la crioterapia en los músculos flexores del puño y cinesioterapia en los músculos flexores y extensores del puño - y grupo B (GB) - sometidos a la estimulación eléctrica en los músculos extensores del puño. Se evaluó la capacidad de prensión palmar por medio de un dinamómetro neumático antes del tratamiento, después de 16 atendimientos y un mes después del término del tratamiento. Los resultados demostraron un aumento de la capacidad de prensión palmar en el GA (p=0,0244) y en el GB (p=0,0144) después del tratamiento, con mantenimiento un mes después de su término (p=0,6002 y 0,3066 respectivamente), sin diferencia estadística entre éstos. Los hallazgos apuntan que ambos recursos terapéuticos fueron eficaces para aumentar la capacidad de prensión palmar de los participantes del estudio.


ABSTRACT Spasticity caused by stroke is a cause of functional disability of the upper extremity. The aim of this study was to check the effect of cryotherapy associated with kinesiotherapy and electrical stimulation on the palmar grip strength of the spastic limb of stroke patients in the chronic phase. Forty patients whose mean age was 60.5 (±9.45) years old and who had spastic hemiparesis participated in the study, having been randomly sorted into group A (GA): submitted to cryotherapy on the wrist flexors and kinesiotherapy on the wrist flexors and wrist extensors, and Group B (GB): submitted to electrical stimulation on the wrist extensors. Palmar grip strength was evaluated by a bulb dynamometer before, after 16 sessions and one month after the end of treatment. The results showed that there was an increase in palmar grip strength in GA (p=0.0244) and GB (p=0.0144) after treatment, with maintenance one month after its completion (p=0.6002 and 0.3066, respectively), and no statistical difference was observed between them. The findings indicate that both therapeutic resources were effective in increasing the study participants' palmar grip strength.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Crioterapia , Estimulação Elétrica , Terapia por Exercício , Espasticidade Muscular/reabilitação , Paresia/reabilitação , Articulação do Punho , Modalidades de Fisioterapia , Acidente Vascular Cerebral/terapia
8.
Arch Phys Med Rehabil ; 100(10): 1945-1963, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078616

RESUMO

OBJECTIVE: To assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury. DATA SOURCES: Ovid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers. STUDY SELECTION: Randomized controlled trials (RCTs) published in English were included if they met the following criteria. POPULATION: Pediatric patients with motor disorders following brain injury. INTERVENTION: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). OUTCOMES: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS). DATA EXTRACTION: Predefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used. DATA SYNTHESIS: A grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables. CONCLUSION: Pediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.


Assuntos
Lesões Encefálicas/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Espasticidade Muscular/reabilitação , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Lesões Encefálicas/fisiopatologia , Criança , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Espasticidade Muscular/fisiopatologia , Pediatria , Equilíbrio Postural/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Extremidade Superior/fisiopatologia
9.
Tokai J Exp Clin Med ; 44(1): 20-24, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-30963525

RESUMO

A 64-year-old man had spasticity of digits 3 and 4 of the right hand for 22 years following a stroke. Activities of daily living (ADL) were impaired due to the disuse of the right arm. The flexor digitorum superficialis and flexor digitorum profundus muscles of digits 3 and 4 of the patient's right forearm were identified using ultrasound guidance, and botulinum toxin type A was selectively injected into those sites. Furthermore, following the injections, occupational therapy was performed for the right arm and fingers, and spasticity was assessed after 2 weeks and at 1, 2, 3, 4, and 5 months. The patient showed improvement in all the evaluations (the Modified Ashworth Scale, Disability Assessment Scale, functional independence measure, active range of motion angle, and movement of holding a cup), and function was maintained throughout the evaluation period. Performing botulinum toxin type A injection under ultrasound guidance to selectively identify the flexor digitorum superficialis and flexor digitorum profundus muscles involved in finger spasticity helped restore finger functioning and improve ADL.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Dedos/diagnóstico por imagem , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/reabilitação , Músculo Esquelético/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Ultrassonografia , Atividades Cotidianas , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Toxins (Basel) ; 11(4)2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30965599

RESUMO

Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment (n = 12; experimental group) or BoNT-A alone (n = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Terapia por Exercício , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/reabilitação , Fármacos Neuromusculares/uso terapêutico , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/tratamento farmacológico , Idoso , Doença Crônica , Feminino , Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Projetos Piloto , Método Simples-Cego , Acidente Vascular Cerebral/fisiopatologia , Caminhada
11.
BMC Neurol ; 19(1): 69, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023258

RESUMO

BACKGROUND: Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation that has been used to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. METHODS: This was a randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or control group. All patients received 1 session per day for 10 days of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were assessed before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was adopted to compare the treatment effects between groups. RESULTS: The iTBS group had greater improvement in the MAS and FMA than the control group (η2 = 0.151-0.233; p < 0.05), as well as in the ARAT and BBT (η2 = 0.161-0.460; p < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in MAL changes. CONCLUSIONS: The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke have a relatively low potential for fine motor function recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function. Further larger-scale study is warranted to confirm the findings and its long-term effect. TRIAL REGISTRATION: This trial was registered under ClinicalTrials.gov ID No. NCT01947413 on September 20, 2013.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/reabilitação , Projetos Piloto , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento , Extremidade Superior/fisiopatologia
12.
Eur J Phys Rehabil Med ; 55(5): 558-569, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30868835

RESUMO

INTRODUCTION: Results of several recent studies suggest that tendon/muscle vibration treatment may improve motor performance and reduce spasticity in individuals with stroke. We performed a systematic review and meta-analysis to assess the efficacy of tendon/muscle vibration treatment for upper limb functional movements in persons with subacute and chronic stroke. EVIDENCE ACQUISITION: We searched MEDLINE (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials (Wiley) from inception to September 2017. We included randomized controlled trials comparing upper limb tendon/muscle vibration to sham treatment/rest or conventional interventions in persons with subacute and chronic stroke. Our primary outcome was upper limb functional movement at the end of the treatment period. EVIDENCE SYNTHESIS: We included eight trials, enrolling a total of 211 participants. We found insufficient evidence to support a benefit for upper limb functional movement (standard mean difference -0.32, 95% confidence interval (CI) -0.74 to 0.10, I2 25%, 6 trials, 135 participants). Movement time for reaching tasks significantly decreased after using tendon/muscle vibration (standard mean difference -1.20, 95% CI -2.05 to -0.35, I2 65%, 2 trials, 74 participants). We also found that tendon/muscle vibration was not associated with a significant reduction in spasticity (4 trials). CONCLUSIONS: Besides shorter movement time for reaching tasks, we did not identify evidence to support clinical improvement in upper limb functional movements after tendon/muscle vibration treatment in persons with subacute and chronic stroke. A small number of trials were identified; therefore, there is a need for larger, higher quality studies and to consider the clinical relevance of performance-based outcome measures that focus on time to complete a functional movement such as a reach.


Assuntos
Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral , Tendões/fisiopatologia , Extremidade Superior/fisiopatologia , Vibração , Atividades Cotidianas , Doença Crônica , Avaliação da Deficiência , Humanos , Espasticidade Muscular/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Neurol Sci ; 40(6): 1199-1207, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852696

RESUMO

OBJECTIVE: Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients. METHODS: Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. RESULTS: The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). CONCLUSION: One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.


Assuntos
Excitabilidade Cortical , Espasticidade Muscular/fisiopatologia , Espasticidade Muscular/reabilitação , Modalidades de Fisioterapia , Medula Espinal/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Estimulação Magnética Transcraniana , Idoso , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Resultado do Tratamento , Extremidade Superior/fisiopatologia
14.
Medicine (Baltimore) ; 98(8): e13918, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813122

RESUMO

RATIONALE: Spasticity is a common issue in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of Fu's subcutaneous needling in combination with constraint-induced movement therapy in chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS: The patient suffered an infarction in the right posterior limb of the internal capsule 1 year ago, which resulted in hemiparesis in his left (nondominant) hand and arm. The only limitation for constraint-induced movement therapy was insufficient finger extension. The patient was unable to voluntarily extend his interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. However, his muscle tension did not change after the BTX type A injection. DIAGNOSES: A 35-year-old male experienced arm paresis after an infarction in the right posterior limb of the internal capsule 1 year before the intervention. INTERVENTIONS: The BTX type A injection did not work, so the patient received Fu's subcutaneous needling as an alternative therapy before 5 h of constraint-induced movement therapy for 12 weekdays. OUTCOMES: All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, and Motor Activity Log) substantially improved over the 1-year period. Moreover, during the observation period, the patient's muscle tone and arm function did not worsen. LESSONS: As a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combined therapy, the arm functions include volitional movements, and coordination or speed of movements in the paretic arm have been improved. However, we cannot rule out the possibility of an influence of the passage of time or the Hawthorne effect. The costs of the treatment of stroke may be reduced, if this combined therapy proved useful in future controlled studies.


Assuntos
Terapia por Acupuntura/métodos , Técnicas de Exercício e de Movimento/métodos , Espasticidade Muscular/reabilitação , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia por Acupuntura/economia , Adulto , Braço/fisiopatologia , Doença Crônica , Terapia Combinada , Técnicas de Exercício e de Movimento/economia , Seguimentos , Humanos , Masculino , Espasticidade Muscular/etiologia , Agulhas , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
15.
NeuroRehabilitation ; 44(1): 157-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30714982

RESUMO

BACKGROUND: Spasticity is a frequent symptom after traumatic brain injury. OBJECTIVE: To assess the effects of different interventions used for muscle spasticity after TBI. METHODS: To summarize a rehabilitation perspective "Cochrane Review" conducted by Synnot et al.RESULTS:Nine studies were involved for the Cochrane review. Poor report on the results of the studies that tested the effectiveness of interventions in spasticity are responsible for the low quality of the evidence. Most of the studies reported results in terms of decreasing spasticity and limiting effects in terms of how the decrease spasticity and no reports on the beneficial effects in terms of improving activities and participation. CONCLUSIONS: High quality adequately powered trials in patients with TBI should be encouraged.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Espasticidade Muscular/reabilitação , Reabilitação Neurológica/métodos , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Ensaios Clínicos como Assunto/métodos , Humanos , Espasticidade Muscular/complicações , Espasticidade Muscular/diagnóstico
16.
Ann Phys Rehabil Med ; 62(4): 225-233, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30290282

RESUMO

Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients' expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders.


Assuntos
Doenças do Sistema Nervoso Central/complicações , Espasticidade Muscular/cirurgia , Procedimentos Ortopédicos , Anormalidades Múltiplas/cirurgia , Toxinas Botulínicas Tipo A/uso terapêutico , Lesões Encefálicas Traumáticas/complicações , Paralisia Cerebral/complicações , Tomada de Decisão Clínica , Medicina Baseada em Evidências , Humanos , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Procedimentos Ortopédicos/métodos , Ossificação Heterotópica/complicações , Planejamento de Assistência ao Paciente , Poliomielite/complicações , Cuidados Pós-Operatórios , Quadriplegia/complicações , Acidente Vascular Cerebral/complicações , Transferência Tendinosa , Tenotomia
17.
Am J Phys Med Rehabil ; 98(1): 51-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30138128

RESUMO

OBJECTIVE: The aim of the study was to evaluate the immediate effects of cryotherapy (using an ice pack) on ankle joint position sense and the degree of spasticity after chronic hemiparetic stroke. DESIGN: We used a sham-controlled crossover design. Sixteen chronic hemiparetic patients were randomly assigned to two groups: (1) those who received cryotherapy followed by a control intervention 15 days later (cryotherapy group) and (2) those who received the control intervention followed by cryotherapy 15 days later (control intervention group). Ankle joint position sense was measured on the paretic side using a Biodex Multi-joint System 3 dynamometer before and after 20 mins of either application on the calf muscles. Lower absolute error scores were calculated for data analyses and were used to determine joint position sense. The degree of spasticity of the plantar flexor muscles was scored according to the Modified Ashworth Scale. RESULTS: Sixteen patients completed the crossover experiment; however, data analysis was successfully conducted in 15 participants. Cryotherapy reduced the degree of spasticity of the plantar flexor muscles without altering ankle joint position sense. CONCLUSIONS: Cryotherapy (using an ice pack) may reduce plantar flexor spasticity without influencing proprioception.


Assuntos
Crioterapia/métodos , Espasticidade Muscular/reabilitação , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Articulação do Tornozelo/fisiopatologia , Doença Crônica , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Propriocepção , Método Simples-Cego , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
18.
Arch Phys Med Rehabil ; 100(4): 751-768, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30452892

RESUMO

OBJECTIVES: (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. DATA SOURCES: PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. STUDY SELECTION: Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. DATA EXTRACTION: Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. DATA SYNTHESIS: Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD -0.64; 95% confidence interval [95% CI], -0.98 to -0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD -0.83; 95% CI, -1.51 to -0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. CONCLUSION: There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).


Assuntos
Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Resultado do Tratamento
19.
Phys Occup Ther Pediatr ; 39(2): 124-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30204515

RESUMO

AIMS: To create a standardized home exercise therapy program that could be implemented by international sites to provide a consistent level of therapeutic intervention for pediatric patients participating in an ongoing Phase-III, randomized, controlled trial of repeat abobotulinumtoxinA injections for pediatric upper limb spasticity (NCT02106351). METHODS: Physical therapists, occupational therapists, and medical doctors worked collaboratively to design an exercise therapy program to be implemented in the home setting. In this article, we describe the development process and the finalized program that is currently being used in the Phase-III trial. RESULTS: The final program is presented as a "toolbox" for therapists, and includes a standardized step-wise process for choosing the most appropriate exercises and functional activities to achieve the agreed treatment goals of each abobotulinumtoxinA injection. The core toolbox includes: a clear protocol for clinicians, information sheets, signature of commitment forms, exercise score charts, and the library of exercises and functional activities that therapists choose from to aid the patient in achieving their treatment goals. CONCLUSIONS: Implementation of this home therapy program provides a standardized background of good practice against which to test the efficacy of abobotulinumtoxinA. Preliminary data show that the program is readily accepted by patients and their families.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/reabilitação , Terapia por Exercício/métodos , Espasticidade Muscular/reabilitação , Fármacos Neuromusculares/uso terapêutico , Paralisia Cerebral/complicações , Paralisia Cerebral/tratamento farmacológico , Criança , Humanos , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Extremidade Superior/fisiopatologia
20.
Disabil Rehabil ; 41(8): 904-911, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29262734

RESUMO

PURPOSE: Multiple sclerosis is a chronic neurological disease with the highest prevalence in Canada. Replacing sedentary behavior with light activities may be a feasible approach to manage multiple sclerosis symptoms. This study explored the perspectives of adults with multiple sclerosis about sedentary behavior, physical activity and ways to change behavior. METHODS: Fifteen adults with multiple sclerosis (age 43 ± 13 years; mean ± standard deviation), recruited through the multiple sclerosis Clinic at the University of Alberta, Edmonton, Canada, participated in semi-structured interviews. Interview audios were transcribed verbatim and coded. NVivo software was used to facilitate the inductive process of thematic analysis. RESULTS: Balancing competing priorities between sitting and moving was the primary theme. Participants were aware of the benefits of physical activity to their overall health, and in the management of fatigue and muscle stiffness. Due to fatigue, they often chose sitting to get their energy back. Further, some barriers included perceived fear of losing balance or embarrassment while walking. Activity monitoring, accountability, educational and individualized programs were suggested strategies to motivate more movement. CONCLUSIONS: Adults with multiple sclerosis were open to the idea of replacing sitting with light activities. Motivational and educational programs are required to help them to change sedentary behavior to moving more. IMPLICATIONS FOR REHABILITATION One of the most challenging and common difficulties of multiple sclerosis is walking impairment that worsens because of multiple sclerosis progression, and is a common goal in the rehabilitation of people with multiple sclerosis. The deterioration in walking abilities is related to lower levels of physical activity and more sedentary behavior, such that adults with multiple sclerosis spend 8 to 10.5 h per day sitting. Replacing prolonged sedentary behavior with light physical activities, and incorporating education, encouragement, and self-monitoring strategies are feasible approaches to manage the symptoms of multiple sclerosis.


Assuntos
Exercício Físico , Motivação , Esclerose Múltipla , Participação do Paciente , Caminhada , Adulto , Canadá/epidemiologia , Feminino , Humanos , Masculino , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Esclerose Múltipla/reabilitação , Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Determinação de Necessidades de Cuidados de Saúde , Participação do Paciente/métodos , Participação do Paciente/psicologia , Comportamento Sedentário , Caminhada/fisiologia , Caminhada/psicologia
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