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1.
Percept Mot Skills ; 128(3): 1107-1129, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33535899

RESUMO

This study aimed to investigate the short and long-term effects of Whole-Body Vibration (WBV) therapy on spasticity and motor performance in children with hemiparetic cerebral palsy. We recruited 26 patient participants from among children undergoing conventional physiotherapy in a private rehabilitation center. We randomly assigned 22 participants to equally sized treatment (n = 11) and control (n = 11) groups. We evaluated the participants at the beginning of the study with the Gross Motor Function Measure-88, LEGSys™ Spatio-Temporal Gait Analyzer, SportKAT550™ Portable Computerized Kinesthetic Balance Device and the Modified Ashworth Scale. While children in the treatment group were treated with Compex-Winplate™ to administer WBV in three 15-minute sessions per week for eight weeks, children in the control group received continued conventional physiotherapy during this period. We then re-evaluated all participants both immediately after the treatment and again 12 weeks after the treatment. Following WBV, both gross motor functions and gait and balance skills were significantly improved (p < 0.05), and spasticity in lower and upper extremity muscles was significantly inhibited (p < 0.05). These improvements were preserved even after 12 weeks. We conclude that WBV is an effective incremental approach to conventional physiotherapy in children with hemiparetic cerebral palsy for inhibiting spasticity and improving motor performance.


Assuntos
Paralisia Cerebral , Paralisia Cerebral/terapia , Criança , Marcha , Humanos , Espasticidade Muscular/terapia , Modalidades de Fisioterapia , Vibração/uso terapêutico
2.
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
4.
J Rehabil Med ; 52(10): jrm00110, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-32939558

RESUMO

OBJECTIVE: To investigate changes in hemiparetic gait parameters after treatment of elbow flexor spasticity with botulinum neurotoxin (BoNT) injection and adjunctive casting. DESIGN: Prospective case series. SUBJECTS: Ten participants with spasticity secondary to acquired brain injury (8 stroke, 2 traumatic brain injury). INTERVENTIONS: Participants received BoNT injections for their spastic elbow flexors under ultrasound guid-ance. Two weeks post-injection, an elbow stretching cast was applied for 1 week. OUTCOME MEASURES: Assessments using the Modified Ashworth Scale (MAS), Tardieu scale V1 angle of arrest at slow speed and V3 angle of catch at fast speed, 2-min walk test (2MWT), Edinburgh Gait Score scale (EGS) and video gait analysis for step-length symmetry were conducted pre-BoNT injection (t0) and at cast removal (t1). Goal attainment scale (GAS) was used to assess changes in spasticity and gait 3 months post-injection (t2). RESULTS: At t1, participants showed a mean increase of 16.7° (p < 0.01) on the Tardieu Scale V3 and a mean reduction of 0.5 points on the MAS (p < 0.05). There was also a mean reduction on EGS of 2.7 points (p < 0.05), and a mean increase on 2MWT of 3.1 m (p < 0.05). On the GAS, all participants report-ed impro-ved gait at t2 and 80% reported a decrease in spasticity. CONCLUSION: Combining BoNT injection with casting for treatment of elbow flexor spasticity without treat-ing the lower limb may improve hemiparetic gait parameters.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Cotovelo/patologia , Marcha/fisiologia , Espasticidade Muscular/terapia , Fármacos Neuromusculares/uso terapêutico , Paresia/tratamento farmacológico , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Estudos Prospectivos
5.
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
6.
Medicine (Baltimore) ; 99(27): e21042, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629729

RESUMO

BACKGROUND: This systematic review protocol will appraise the effectiveness and safety of electrical stimulation (ES) for limb spasticity (LS) in children with stroke. METHODS: Cochrane Library, EMBASE, PUBMED, PsycINFO, Scopus, OpenGrey, CINAHL, ACMD, CNKI, and WANGFANG will be systematically retrieved for randomized controlled trials (RCTs) testing the effectiveness of ES compared with other interventions on LS in children with stroke. Two independent authors will evaluate eligibility using predefined criteria and will perform data extraction and study quality appraisal of eligible trials. Primary outcomes include gait velocity, and limb spasticity status. Limb function, quality of life, pain intensity, and adverse events will be assessed as secondary outcomes. We will perform data analysis using RevMan 5.3 software. RESULTS: This systematic review will summarize the most recent evidence to assess the effectiveness and safety of ES for LS in children with stroke. CONCLUSIONS: The results of this study may help to determine whether ES is effective or not for LS in children with stroke. STUDY REGISTRATION: INPLASY202050115.


Assuntos
Terapia por Estimulação Elétrica/métodos , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Criança , Terapia por Estimulação Elétrica/efeitos adversos , Humanos , Espasticidade Muscular/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento , Velocidade de Caminhada/fisiologia
7.
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
8.
Rev. neurol. (Ed. impr.) ; 70(12): 453-460, 16 jun., 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195435

RESUMO

INTRODUCCIÓN: La espasticidad es un signo clínico frecuente en personas con enfermedades neurológicas que afecta a la movilidad y causa graves complicaciones: dolor, limitación articular, contracturas y úlceras por presión, que conllevan una afectación significativa de la funcionalidad del individuo y de su calidad de vida. OBJETIVO: Revisar la integración, la descripción y la interpretación crítica de la evidencia científica más reciente sobre la variabilidad clínica de la espasticidad y los síntomas asociados, los distintos mecanismos fisiopatológicos y su relevancia en el abordaje diagnóstico y terapéutico. DESARROLLO: Se realizó una búsqueda de las publicaciones científicas sobre los distintos aspectos de la espasticidad agrupados en dos categorías magistrales: patologías cerebral y medular; y se revisaron aspectos epidemiológicos, clínicos y fisiopatológicos, el diagnóstico clínico e instrumental, y el abordaje fisioterapéutico, farmacológico y quirúrgico de la espasticidad en cada grupo de patologías. CONCLUSIÓN: La espasticidad se relaciona con lesiones estructurales y cambios neuroplásticos maladaptativos que determinan una importante variabilidad en su expresión clínica. Aunque su diagnóstico presenta importantes limitaciones, el uso de herramientas de diagnóstico clínico y neurofisiológico encaminadas al abordaje diferencial en las patologías neurológicas de origen cerebral y medular podría optimizar la eficacia de las terapias de la espasticidad


INTRODUCTION: Spasticity is a frequent clinical sign in people with neurological diseases that affects mobility and causes serious complications: pain, joint limitation, muscular contractions and bed sores, which have a significant effect on the individual's functionality and quality of life. AIM: To review the integration, description and critical interpretation of the most recent scientific evidence on the clinical variability of spasticity and associated symptoms, the different pathophysiological mechanisms and their relevance in the diagnostic and therapeutic approach. DEVELOPMENT: A search was conducted in the scientific publications on the different aspects of spasticity grouped into two main categories: cerebral and spinal cord pathologies. The epidemiological, clinical and pathophysiological aspects, clinical and instrumental diagnoses, and the physiotherapeutic, pharmacological and surgical approach to spasticity in each group of pathologies were all reviewed. CONCLUSION: Spasticity is related to structural lesions and maladaptive neuroplastic changes that determine an important variability in its clinical expression. Although its diagnosis presents important limitations, the use of clinical and neurophysiological diagnostic tools aimed at achieving different approaches in cases of neurological pathologies originating in the brain and in the spinal cord could optimise the effectiveness of spasticity therapies


Assuntos
Humanos , Espasticidade Muscular/fisiopatologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/fisiopatologia , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/terapia , Doenças do Sistema Nervoso/fisiopatologia , Espasticidade Muscular/epidemiologia , Modalidades de Fisioterapia , Aparelhos Ortopédicos
10.
Zhongguo Zhen Jiu ; 40(5): 473-8, 2020 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-32394652

RESUMO

OBJECTIVE: To compare the clinical therapeutic effect on post-stroke spastic paralysis of the upper extremity between the combination of kinematic-acupuncture therapy and rehabilitation training and the combined treatment of the conventional acupuncture with rehabilitation training. METHODS: A total of 60 patients of post-stroke spastic paralysis of the upper extremity at the non-acute stage were randomized into an observation group (30 cases) and a control group (30 cases, 1 case dropped off). On the base of the routine western medication and rehabilitation treatment, the kinematic-acupuncture therapy was added in the observation group and the conventional acupuncture was used in the control group. Baihui (GV 20), Dazhui (GV 14), Jiaji (EX-B 2) from T1 to T8, Tianzong (SI 11), Jianzhen (SI 9), Jianyu (LI 15) and Quyuan (SI 13) were selected in both groups. The treatment was given once daily and the treatment for 14 days was as one course. The one course of treatment was required in this research. Separately, before treatment and in 7 and 14 days of treatment, the score of simplified Fugl-Meyer scale of the upper extremity (FMA-UE), the grade of the modified Ashworth scale (MAS) and the score of the modified Barthel index scale (MBI) were compared between the two groups. RESULTS: Compared before treatment, in 7 and 14 days of treatment, FMA-UE score was increased obviously in either group (P<0.01). In 14 days of treatment, FMA-UE score in the observation group was higher than that in the control group (P<0.05). In 7 and 14 days of treatment, MAS grades of shoulder joint, elbow joint, wrist joint and metacarpophalangeal joint were all improved markedly in the two groups (P<0.05). Compared with the grades in 7 days of treatment, MAS grades of elbow joint and metacarpophalangeal joint were improved markedly in 14 days of treatment in the two groups (P<0.05). Compared with the control group, MAS grades of elbow joint and metacarpophalangeal joint were improved more markedly in the observation group in 14 days of treatment (P<0.05). Compared with the score before treatment, MBI score was increased in 7 and 14 days of treatment respectively in the observation group (P<0.05, P<0.01). In 14 days of treatment, MBI score was increased in the control group (P<0.01). CONCLUSION: For the patients with post-stroke spastic paralysis of the upper extremity at the non-acute stage, the combined treatment with kinematic-acupuncture therapy and rehabilitation training obviously improves the motor function of the upper extremity and the muscle tone of elbow joint and metacarpophalangeal joint. The therapeutic effect of this combination is better than that of the combined treatment of the conventional acupuncture with rehabilitation training. Additionally, this combined therapy improves the ability of daily life activity.


Assuntos
Terapia por Acupuntura , Espasticidade Muscular/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Fenômenos Biomecânicos , Humanos , Resultado do Tratamento , Extremidade Superior
11.
Rev Med Suisse ; 16(692): 904-906, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374534

RESUMO

Spasticity is a common sign of central nervous system lesions and its management is difficult because it is usually associated with other symptoms of upper motoneuron syndrome (paresis, spastic dystonia, contractures, …). We propose an interprofessional evaluation, which demonstrates that a standardized evaluation, a common approach and a gait analysis improve the therapeutic decision.


Assuntos
Sistema Nervoso Central/lesões , Sistema Nervoso Central/fisiopatologia , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/terapia , Análise da Marcha , Humanos , Espasticidade Muscular/fisiopatologia
12.
BMC Health Serv Res ; 20(1): 478, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460773

RESUMO

BACKGROUND: Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial. METHODS: Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods. DISCUSSION: The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.


Assuntos
Toxinas Botulínicas Tipo A , Análise Custo-Benefício/métodos , Espasticidade Muscular/terapia , Modalidades de Fisioterapia/economia , Extremidade Superior/fisiopatologia , Austrália , Toxinas Botulínicas Tipo A/economia , Humanos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/terapia
13.
J Stroke Cerebrovasc Dis ; 29(6): 104814, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32327366

RESUMO

BACKGROUND: Spasticity is one of the main complications in poststroke survivors leading to difficulties in walking and standing resulting in high levels of disability. OBJECTIVE: The aim of the study was to investigate the effects of deep dry needling on lower limb dysfunction in poststroke spastic patients. METHODS: A randomized clinical trial conducted in poststroke survivors who were assigned to one of 2 groups: Deep dry needling (intervention group) and sham dry needling (control group). The primary outcome measures were Modified Modified Ashworth Scale (MMAS) and functional tests (timed up and go test, 10-meter walk test). Secondary outcome measures were active ankle dorsiflexion range of motion (AROM), passive ankle dorsiflexion range of motion (PROM), single leg stance test, and Barthel index. All measurements were assessed at baseline (T0), immediately after the third session 1 week later (T1), and 1 month after the end of the intervention (T2). RESULTS: We recruited 24 patients (71% male; mean age 57 ± 10 years; 26.4 ± 1.8 kg•m-2; time since event: 25.2 ± 12.5 months). There were significant improvements in MMAS, timed up and go test, 10-meter walk test, Barthel scale, and PROM (P < .05) in the intervention group compared to controls across the time-points. There were no significant improvements in AROM assessments (P > .05). CONCLUSIONS: Deep dry needling decreases muscle spasticity and improves lower limb function and gait speed in poststroke survivors.


Assuntos
Agulhamento Seco , Atividade Motora , Contração Muscular , Espasticidade Muscular/terapia , Músculo Esquelético/inervação , Acidente Vascular Cerebral/complicações , Velocidade de Caminhada , Adulto , Idoso , Avaliação da Deficiência , Método Duplo-Cego , Agulhamento Seco/efeitos adversos , Feminino , Humanos , Irã (Geográfico) , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
14.
J Clin Neurosci ; 75: 225-228, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32178992

RESUMO

Atlantoaxial rotatory fixation (AARF) in an adult without any trauma is an extremely rare condition. Here we report a case of surgical treatment for existing atlantoaxial rotatory fixation in an adult with spastic torticollis. A 50-year-old man had become aware of torticollis without any cause of injury 6 weeks before he visited our hospital, where he presented with a one-week history of severe neck pain. Based on the local and imaging findings, we diagnosed him as having existing AARF of Fielding classification type I. The AARF was not reduced by 3 weeks of Glisson traction. Thus, we performed C1-C2 posterior fusion surgery 3 months after his initial visit. Although CT findings just after surgery showed that the C1-2 facet subluxation was reduced, the complaint of torticollis was not improved, with scoliosis at the middle to lower cervical level because of left sternocleidomastoid hypertonia. Administration of diazepam was initiated 2 weeks after surgery and botulinum toxin injections to the left sternocleidomastoid were added 2 months after surgery under the neurological diagnosis of spastic torticollis. As a result, the complaint of his torticollis was significantly improved 3 months after surgery. There were no relapses of the torticollis and complete fusion of the C1-C2 laminae was observed at the 2-year final follow-up. Surgical treatment for AARF in an adult should be considered if the diagnosis of AARF is delayed. In addition, appropriate treatment for spastic torticollis applied after surgery resulted in a favorable outcome of this case.


Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Espasticidade Muscular/diagnóstico por imagem , Espasticidade Muscular/terapia , Fusão Vertebral/métodos , Torcicolo/diagnóstico por imagem , Torcicolo/terapia , Articulação Atlantoaxial/cirurgia , Toxinas Botulínicas Tipo A/administração & dosagem , Diazepam/administração & dosagem , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/complicações , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Cervicalgia/terapia , Torcicolo/complicações
15.
Clin Interv Aging ; 15: 9-28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32021129

RESUMO

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


Assuntos
Espasticidade Muscular , Reabilitação do Acidente Vascular Cerebral/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Humanos , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Recuperação de Função Fisiológica , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(6): e18932, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028402

RESUMO

BACKGROUND: Spasticity is one of the manifestations of motor dysfunction in upper motor neuron syndrome, which is characterized by increased muscle tone. Spasticity seriously affects the motor function and activity of daily life of patients. Some studies have shown that extracorporeal shock wave therapy (ESWT) can relieve spasticity in recent years. However, the effectiveness and safety of ESWT on spasticity after motor neuron injury have not been confirmed. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. METHODS: We will search China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wan Fang Data, China Biology Medicine (CBM), PubMed, Embase, The Cochrane Library, and Web of Science systematically from their inception dates through October 2019 to obtain randomized controlled trials (RCTs) using ESWT to relieve spasticity in patients after upper motor neuron injury. The primary outcome will be the Modified Ashworth Scale (MAS). Secondary outcomes will include Composite Spasticity Scale (CSS), Spasm Frequency Scale, Modified Tardieu Scale (MTS), electrophysiological study (ratio of maximum H reflex to maximum M response, root mean square value, integrated electromyogram, co-contraction ratio, etc.), or other spasticity-related outcomes. In addition, adverse events will also be assessed as safety measurement. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager software (RevMan, version 5.3.5) and R (version 3.6.1) software. RESULTS: We will synthesize current studies to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. CONCLUSION: Our study will provide evidence of ESWT on spasticity after upper motor neuron injury. ETHICS AND DISSEMINATION: The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines. PROSPERO REGISTRATION NUMBER: CRD42019131059.


Assuntos
Braço/inervação , Tratamento por Ondas de Choque Extracorpóreas , Espasticidade Muscular/terapia , Humanos , Projetos de Pesquisa
17.
Chin J Integr Med ; 26(1): 14-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31898768

RESUMO

OBJECTIVE: To compare the immediate effects of electroacupuncture (EA) and body acupuncture (BA) on gastrocnemius muscle tone in children with spastic cerebral palsy (CP). METHODS: Children with spastic CP, age from 24 to 60 months, who all received rehabilitation treatment in the Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University from April 2016 to May 2017 were enrolled in this trial and assigned to EA group and BA group through a random number table. Both EA and BA therapies were performed on acupoints of Zusanli (ST 36), Shangjuxu (ST 37), Sanyinjiao (SP 6), and Xuanzhong (GB 39) for 30 min once. The root mean square (RMS), integrated electromyogram (iEMG) of the gastrocnemius of surface electromyography (sEMG), and Modified Tardieu Scale (MTS) of the two groups were evaluated before and after treatment. All adverse events were accurately recorded. RESULTS: Thirty-six children with spastic CP completed the study (18 cases and 32 legs in the EA group; 18 cases and 31 legs in the BA group). There was no significant difference in RMS, iEMG and MTS between the two groups before treatment (P>0.05). After treatment, compared with before treatment, RMS and iEMG significantly reduced and MTS (R2-R1) significantly increased in both EA and BA groups (P<0.05), and EA was more effective than BA in RMS and MTS (P<0.05). However, the iEMG between the two groups were not statistically significant after treatment (P>0.05). There was no serious adverse event during this clinical trial. CONCLUSION: Both EA and BA could significantly relieve the gastrocnemius muscle tone in spastic CP, and EA was more effective than BA. (Registration No. ChiCTRONC-15007633).


Assuntos
Terapia por Acupuntura , Paralisia Cerebral/terapia , Eletroacupuntura , Espasticidade Muscular/terapia , Músculo Esquelético/fisiopatologia , Paralisia Cerebral/fisiopatologia , Pré-Escolar , Feminino , Humanos , Masculino , Espasticidade Muscular/fisiopatologia , Projetos Piloto , Método Simples-Cego
18.
J Stroke Cerebrovasc Dis ; 29(3): 104591, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899073

RESUMO

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


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Contração Muscular , Espasticidade Muscular/terapia , Músculo Esquelético/inervação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Espasticidade Muscular/diagnóstico , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
19.
J Rehabil Med ; 52(1): jrm00005, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31922205

RESUMO

OBJECTIVE: To determine current evidence for casting as an adjunct therapy following botulinum toxin injection for adult limb spasticity. DESIGN: The databases MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials were searched for English language studies from 1990 to August 2018. Full-text studies using a casting protocol following botulinum toxin injection for adult participants for limb spasticity were included. Studies were graded according to Sackett's levels of evidence, and outcome measures were categorized using domains of the International Classification of Disability, Functioning and Health. The review was prepared and reported according to PRISMA guidelines. RESULTS: Five studies, involving a total of 98 participants, met the inclusion criteria (2 randomized controlled trials, 1 pre-post study, 1 case series and 1 case report). Casting protocols varied widely between studies; all were on casting of the lower limbs. There is level 1b evidence that casting following botulinum toxin injection improves spasticity outcomes compared with stretching and taping, and that casting after either botulinum toxin or saline injections is better than physical therapy alone. CONCLUSION: The evidence suggests that adjunct casting of the lower limbs may improve outcomes following botulinum toxin injection. Casting protocols vary widely in the literature and priority needs to be given to future studies that determine which protocol yields the best results.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Terapia Combinada/métodos , Extremidades/irrigação sanguínea , Espasticidade Muscular/terapia , Modalidades de Fisioterapia/instrumentação , Adulto , Humanos , Masculino , Contenções
20.
J Biol Regul Homeost Agents ; 34(5 Suppl. 3): 1-9. Technology in Medicine, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33386031

RESUMO

Focal muscular vibration (FMV) is a non-invasive technique that showed positive effects on spasticity of the upper limb in stroke subjects but different protocols have been proposed so the studies are not comparable and, to date, it is not clear which muscles should be treated, agonist, or antagonist muscles to obtain the better result on spasticity. The objective of this study is to evaluate the effects on spasticity of FMV on the upper limb flexor spastic muscles compared to the effects of FMV on the upper limb extensor muscles in subacute stroke patients. We treated 28 subacute stroke patients (mean age 64.28±13.79) randomized into two groups: Group A and Group B. Group A was treated by applying FMV to the flexor muscles of the upper limb, while Group B was treated by applying FMV to the extensor muscles of the upper limb. The effects on spasticity were assessed by Modified Ashworth Scale (primary outcome) and the upper limb motor function by instrumental robotic outcomes; moreover, muscle strength and pain were evaluated using Motricity Index and Numerical Rating Scale, respectively (secondary outcomes). Patients were subjected to FMV for three consecutive days and were evaluated three times: before treatment (T0), after a week (T1) and after a month (T2) from the end of treatment. Within group, analysis showed statistically significant changes over time of the MAS at the three joints (shoulder, elbow and wrist) in both groups, but post-hoc analysis showed that, only in Group A, MAS was significantly lower at T2, when compared with T0 at the shoulder and elbow. NRS, significantly changed over time only in the Group B. Motricity Index, did not change over time neither in the Group A, nor in the Group B. No statistically significant differences were detected in the between group analysis. Regarding the instrumental robotic outcomes, we detected a statistically significant reduction of the time required to complete the task (Duration) in both group a T2. In conclusion, this study highlighted how the same treatment protocol can determine an improvement in muscle tone and in the Duration to perform a task, regardless of the muscles treated, while the pain improves if we treat the agonist muscles.


Assuntos
Espasticidade Muscular , Acidente Vascular Cerebral , Idoso , Humanos , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Extremidade Superior , Vibração/uso terapêutico
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