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Li G, Yuan W, Liu G, Qiao L, Zhang Y, Wang Y, Wang W, Zhao M, Wang Y, Wang J. Effects of radial extracorporeal shockwave therapy on spasticity of upper-limb agonist/antagonist muscles in patients affected by stroke: a randomized, single-blind clinical trial. Age Ageing 2020; 49:246-252. [PMID: 31846499 DOI: 10.1093/ageing/afz159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the effects of radial extracorporeal shock wave therapy (rESWT) were assessed on agonist/antagonist muscles in stroke patients with elbow spasticity, the duration of effects and influence on function. METHODS patients were randomly assigned into groups: control (A, n = 25), rESWT on agonist muscles (B, n = 27) and rESWT on antagonist muscles (C, n = 30) groups. Conventional physical therapy was given to three groups for 3 weeks, six times a week, and besides, rESWT was given at 4-day intervals for five consecutive treatments, B received rESWT on agonist muscles and C received rESWT on antagonist muscles. The primary outcome was Modified Ashworth Scale (MAS) scores. Modified Tardieu Scale, Visual Analogue Scale (VAS), Fugl-Meyer Assessment and swelling scale (SS) scores were secondary outcomes. Indicators were assessed at baseline, after five treatments and after 4 weeks follow-up. RESULTS the rate of treatment was determined by changes in MAS, which was 16.0 (A), 70.4 (B) and 63.3% (C) after rESWT treatments, and was 24.0 (A), 74.1 (B) and 66.7% (C) after 4 weeks follow-up. Improvements were achieved for R1 (P < 0.01), R2 (P < 0.01) and VAS (P < 0.01) after five rESWT interventions. At 4 weeks, significant improvements were achieved for R1 (P < 0.01) and VAS (P < 0.01). CONCLUSIONS rESWT is an effective therapy for spasticity after stroke, with lasting effects on both agonist and antagonist muscles after 4 weeks. rESWT relieved pain but had no effect on active function or swelling of the upper limbs.
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Affiliation(s)
- Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Wenchao Yuan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Gongliang Liu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Wei Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Minglei Zhao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
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Qin W, Yang M, Li F, Chen C, Zhen L, Tian S. Influence of positional changes on spasticity of the upper extremity in poststroke hemiplegic patients. Neurosci Lett 2019; 712:134479. [DOI: 10.1016/j.neulet.2019.134479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 01/16/2023]
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Rice LA, Yarnot R, Mills S, Sonsoff J. A pilot investigation of anterior tilt use among power wheelchair users. Disabil Rehabil Assist Technol 2019; 16:152-159. [PMID: 31348680 DOI: 10.1080/17483107.2019.1644676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To examine the influence of use of the anterior tilt-in-space power seat function on performance of functional activities, physical health, and user satisfaction on among power wheelchair users. MATERIALS AND METHODS Ten full-time power wheelchair users with a seat elevator on their current chair participated in a mixed-methods, repeated measures study. At Visit 1 participants completed the Wheelchair Outcome Measure, Functional Mobility Assessment, Wheelchair Users Shoulder Pain Index, Fatigue Severity Scale, and the Spinal Cord Injury Secondary Conditions Scale. Physical assessments were performed to examine transfer quality (transfer assessment instrument), functional reach, activities of daily living (performance assessment of self-care skills), seated balance (function in sitting test), spasticity, respiratory function, and speech production. Approximately 3 days later (Visit 2), participants were trained on use and provided a power wheelchair with anterior tilt to trial for two weeks. After two weeks (Visit 3), the Visit 1 protocol was repeated and a semistructured interview conducted. RESULTS Participants lived with disabilities of cerebral palsy, spinal muscular atrophy and multiple sclerosis. With use of anterior tilt, significant improvements were seen among safety of meal preparation, p = 0.033, dz = 0.91 and functional reach in the vertical direction, p = 0.000, dz = 2.62. Subjectively, participants found anterior tilt helpful in performance of reaching tasks in but found the safety equipment restrictive. CONCLUSION Preliminary results indicate that use of the anterior tilt may help to improve performance of functional activities. Additional research is needed to examine the long-term influence of the technology.Implications for rehabilitationThe anterior tilt seat function changes the seat angle orientation in relation to the ground in the sagittal plane and angles the seat forward. As a result, the individual using the assistive technology is positioned in a semistanding position.Preliminary results of this study indicate that with use of anterior tilt, safety of meal preparation and functional reach in the vertical direction significantly improved. Subjectively, participants found anterior tilt helpful in performance of reaching tasks but found the safety equipment restrictive.Additional research is needed to examine the long-term influence of anterior tilt on functional activities, physical health and user satisfaction on among a large and diverse group of power wheelchair users.
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Affiliation(s)
- Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, College of Applied Health Sciences University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Sarah Mills
- Department of Human Development and Family Studies, College of Agricultural, Consumer and Environmental Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jacob Sonsoff
- Department of Kinesiology and Community Health, College of Applied Health Sciences University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Center on Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Zhang X, Tang X, Zhu X, Gao X, Chen X, Chen X. A Regression-Based Framework for Quantitative Assessment of Muscle Spasticity Using Combined EMG and Inertial Data From Wearable Sensors. Front Neurosci 2019; 13:398. [PMID: 31130834 PMCID: PMC6509177 DOI: 10.3389/fnins.2019.00398] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/08/2019] [Indexed: 01/27/2023] Open
Abstract
There have always been practical demands for objective and accurate assessment of muscle spasticity beyond its clinical routine. A novel regression-based framework for quantitative assessment of muscle spasticity is proposed in this paper using wearable surface electromyogram (EMG) and inertial sensors combined with a simple examination procedure. Sixteen subjects with elbow flexor or extensor (i.e., biceps brachii muscle or triceps brachii muscle) spasticity and eight healthy subjects were recruited for the study. The EMG and inertial data were recorded from each subject when a series of passive elbow stretches with different stretch velocities were conducted. In the proposed framework, both lambda model and kinematic model were constructed from the recorded data, and biomarkers were extracted respectively from the two models to describe the neurogenic component and biomechanical component of the muscle spasticity, respectively. Subsequently, three evaluation methods using supervised machine learning algorithms including single-/multi-variable linear regression and support vector regression (SVR) were applied to calibrate biomarkers from each single model or combination of two models into evaluation scores. Each of these evaluation scores can be regarded as a prediction of the modified Ashworth scale (MAS) grade for spasticity assessment with the same meaning and clinical interpretation. In order to validate performance of three proposed methods within the framework, a 24-fold leave-one-out cross validation was conducted for all subjects. Both methods with each individual model achieved satisfactory performance, with low mean square error (MSE, 0.14 and 0.47) between the resultant evaluation score and the MAS. By contrast, the method using SVR to fuse biomarkers from both models outperformed other two methods with the lowest MSE at 0.059. The experimental results demonstrated the usability and feasibility of the proposed framework, and it provides an objective, quantitative and convenient solution to spasticity assessment, suitable for clinical, community, and home-based rehabilitation.
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Affiliation(s)
- Xu Zhang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiao Tang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiaofei Zhu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiaoping Gao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiang Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xun Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
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Brandenburg JE, Fogarty MJ, Sieck GC. A Critical Evaluation of Current Concepts in Cerebral Palsy. Physiology (Bethesda) 2019; 34:216-229. [PMID: 30968751 PMCID: PMC7938766 DOI: 10.1152/physiol.00054.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/11/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022] Open
Abstract
Spastic cerebral palsy (CP), despite the name, is not consistently identifiable by specific brain lesions. CP animal models focus on risk factors for development of CP, yet few reproduce the diagnostic symptoms. Animal models of CP must advance beyond risk factors to etiologies, including both the brain and spinal cord.
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Affiliation(s)
- Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine , Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine , Rochester, Minnesota
| | - Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine , Rochester, Minnesota
| | - Gary C Sieck
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine , Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine , Rochester, Minnesota
- Department of Anesthesiology, Mayo Clinic College of Medicine , Rochester, Minnesota
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Park JH, Kim Y, Lee KJ, Yoon YS, Kang SH, Kim H, Park HS. Artificial Neural Network Learns Clinical Assessment of Spasticity in Modified Ashworth Scale. Arch Phys Med Rehabil 2019; 100:1907-1915. [PMID: 31009599 DOI: 10.1016/j.apmr.2019.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To propose an artificial intelligence (AI)-based decision-making rule in modified Ashworth scale (MAS) that draws maximum agreement from multiple human raters and to analyze how various biomechanical parameters affect scores in MAS. DESIGN Prospective observational study. SETTING Two university hospitals. PARTICIPANTS Hemiplegic adults with elbow flexor spasticity due to acquired brain injury (N=34). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Twenty-eight rehabilitation doctors and occupational therapists examined MAS of elbow flexors in 34 subjects with hemiplegia due to acquired brain injury while the MAS score and biomechanical data (ie, joint motion and resistance) were collected. Nine biomechanical parameters that quantify spastic response described by the joint motion and resistance were calculated. An AI algorithm (or artificial neural network) was trained to predict the MAS score from the parameters. Afterwards, the contribution of each parameter for determining MAS scores was analyzed. RESULTS The trained AI agreed with the human raters for the majority (82.2%, Cohen's kappa=0.743) of data. The MAS scores chosen by the AI and human raters showed a strong correlation (correlation coefficient=0.825). Each biomechanical parameter contributed differently to the different MAS scores. Overall, angle of catch, maximum stretching speed, and maximum resistance were the most relevant parameters that affected the AI decision. CONCLUSIONS AI can successfully learn clinical assessment of spasticity with good agreement with multiple human raters. In addition, we could analyze which factors of spastic response are considered important by the human raters in assessing spasticity by observing how AI learns the expert decision. It should be noted that few data were collected for MAS3; the results and analysis related to MAS3 therefore have limited supporting evidence.
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Affiliation(s)
- Jeong-Ho Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Yushin Kim
- Division of Health Administration and Healthcare, Cheongju University, Cheongju, Korea
| | - Kwang-Jae Lee
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Yong-Soon Yoon
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Si Hyun Kang
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Heesang Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea.
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McNish RN, Chembrammel P, Speidel NC, Lin JJ, López-Ortiz C. Rehabilitation for Children With Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11470. [PMID: 31344678 PMCID: PMC6682270 DOI: 10.2196/11470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common developmental motor disorder in children. Individuals with CP demonstrate abnormal muscle tone and motor control. Within the population of children with CP, between 4% and 17% present dystonic symptoms that may manifest as large errors in movement tasks, high variability in movement trajectories, and undesired movements at rest. These symptoms of dystonia typically worsen with physical intervention exercises. OBJECTIVE The aim of this study is to establish the effect of haptic feedback in a virtual reality (VR) game intervention on movement outcomes of children with dystonic CP. METHODS The protocol describes a randomized controlled trial that uses a VR game-based intervention incorporating fully automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and 1 month following the completion of the 6-session game-based intervention. Children with dystonic CP, aged between 7 and 17 years, will be recruited for this study through posted fliers and laboratory websites along with a group of typically developing (TD) children in the same age range. We anticipate to recruit a total of 68 participants, 34 each with CP and TD. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. The primary outcome measure will be the smoothness index of the interaction force with the robot and of the accelerometry signals of sensors placed on the upper limb segments. Secondary outcomes include a battery of clinical tests and a quantitative measure of spasticity. Assessors administering clinical measures will be blinded. All sessions will be administered on-site by research personnel. RESULTS The trial has not started and is pending local institutional review board approval. CONCLUSIONS Movement outcomes will be examined for changes in muscle activation and clinical measures in children with dystonic CP and TD children. Paired t tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed. TRIAL REGISTRATION ClinicalTrials.gov NCT03744884; https://clinicaltrials.gov/ct2/show/NCT03744884 (Archived by WebCite at http://www.webcitation.org/74RSvmbZP). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/11470.
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Affiliation(s)
- Reika Nicole McNish
- Department of Kinesiology and Community Health, Neuroscience Program, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Chamapign, Urbana, IL, United States
| | - Pramod Chembrammel
- Health Care Engineering Systems Center, College of Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | | | - Julian Jwchun Lin
- Children's Hospital of Illinois, OSF Saint Francis Medical Center, OSF Illinois Neurological Institute, Peoria, IL, United States
| | - Citlali López-Ortiz
- Department of Kinesiology and Community Health, Department of Dance, Neuroscience Program, Illinois Informatics Institute, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Amatya B, Khan F, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019; 1:CD012732. [PMID: 30637728 PMCID: PMC6353175 DOI: 10.1002/14651858.cd012732.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a major cause of chronic, neurological disability, with a significant long-term disability burden, often requiring comprehensive rehabilitation. OBJECTIVES To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes, and to highlight current gaps in knowledge. METHODS We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework. MAIN RESULTS Overall, we included 15 reviews published in the Cochrane Library, comprising 164 randomised controlled trials (RCTs) and four controlled clinical trials, with a total of 10,396 participants. The included reviews evaluated a wide range of rehabilitation interventions, including: physical activity and exercise therapy, hyperbaric oxygen therapy (HBOT), whole-body vibration, occupational therapy, cognitive and psychological interventions, nutritional and dietary supplements, vocational rehabilitation, information provision, telerehabilitation, and interventions for the management of spasticity. We assessed all reviews to be of high to moderate methodological quality, based on R-AMSTAR criteria.Moderate-quality evidence suggested that physical therapeutic modalities (exercise and physical activities) improved functional outcomes (mobility, muscular strength), reduced impairment (fatigue), and improved participation (quality of life). Moderate-quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation, and interventions that provided information improved patient knowledge. Low-qualitty evidence suggested that neuropsychological interventions, symptom-management programmes (spasticity), whole body vibration, and telerehabilitation improved some patient outcomes. Evidence for other rehabilitation modalities was inconclusive, due to lack of robust studies. AUTHORS' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit, although the certainty of evidence varies across the different types of interventions evaluated by the reviews. Structured, multidisciplinary rehabilitation programmes and physical therapy (exercise or physical activities) can improve functional outcomes (mobility, muscle strength, aerobic capacity), and quality of life. Overall, the evidence for many rehabilitation interventions should be interpreted cautiously, as the majority of included reviews did not include data from current studies. More studies, with appropriate design, which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge.
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Affiliation(s)
- Bhasker Amatya
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Fary Khan
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Mary Galea
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
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Andringa A, van Wegen E, van de Port I, Kwakkel G, Meskers C. Measurement Properties of the NeuroFlexor Device for Quantifying Neural and Non-neural Components of Wrist Hyper-Resistance in Chronic Stroke. Front Neurol 2019; 10:730. [PMID: 31379705 PMCID: PMC6618514 DOI: 10.3389/fneur.2019.00730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/19/2019] [Indexed: 01/17/2023] Open
Abstract
Introduction: Differentiating between the components of wrist hyper-resistance post stroke, i.e., pathological neuromuscular activation ("spasticity") and non-neural biomechanical changes, is important for treatment decisions. This study aimed to assess the reliability and construct validity of an innovative measurement device that quantifies these neural and non-neural components by biomechanical modeling. Methods: Forty-six patients with chronic stroke and 30 healthy age-matched subjects were assessed with the NeuroFlexor, a motor-driven device that imposes isokinetic wrist extensions at two controlled velocities (5 and 236°/s). Test-retest reliability was evaluated using intraclass correlation coefficients (ICC) and smallest detectable changes (SDC), and construct validity by testing the difference between patients and healthy subjects and between subgroups of patients stratified by modified Ashworth scale (MAS), and the association with clinical scales. Results: Test-retest reliability was excellent for the neural (NC) and non-neural elastic (EC) components (ICC 0.93 and 0.95, respectively), and good for the viscous component (VC) (ICC 0.84), with SDCs of 10.3, 3.1, and 0.5 N, respectively. NC and EC were significantly higher in patients compared to healthy subjects (p < 0.001). Components gradually increased with MAS category. NC and EC were positively associated with the MAS (r s 0.60 and 0.52, respectively; p < 0.01), and NC with the Tardieu scale (r s 0.36, p < 0.05). NC and EC were negatively associated with the Fugl-Meyer Assessment of the upper extremity and action research arm test (r s ≤ -0.38, p < 0.05). Conclusions: The NeuroFlexor reliably quantifies neural and non-neural components of wrist hyper-resistance in chronic stroke, but is less suitable for clinical evaluation at individual level due to high SDC values. Although construct validity has been demonstrated, further investigation at component level is needed.
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Affiliation(s)
- Aukje Andringa
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Carel Meskers
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- *Correspondence: Carel Meskers
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Broderick P, Horgan F, Blake C, Ehrensberger M, Simpson D, Monaghan K. Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil 2018; 26:163-172. [PMID: 30580672 DOI: 10.1080/10749357.2018.1556504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous lower-limb mirror therapy research has focused on non-weight bearing interventions. OBJECTIVES The primary aim of this study was to investigate the effect and feasibility of a combination of mirror therapy and treadmill training on post-stroke lower-limb recovery compared to a placebo intervention. METHODS All patients (N = 30) walked on a treadmill for 30 min per day, 3 days per week, for 4 weeks. The mirror therapy and treadmill training group (n = 15) walked on the treadmill while viewing a reflection of their non-paretic limb in a mirror positioned in their mid-sagittal plane. The placebo group (n = 15) received no mirror visual feedback due to an altered mirror position. PRIMARY OUTCOME MEASURES Ten Metre Walk Test (10MWT) and Six Minute Walk Test (6MWT). SECONDARY OUTCOME MEASURES Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Feasibility was appraised by examining participant compliance and any adverse events. RESULTS No significant between group differences were demonstrated for the 10MWT, 6MWT or FMA-LE at post-training or 3-month follow-up assessment. A significant between group difference on the MAS was demonstrated in the reduction of ankle dorsiflexion muscle tone (p = 0.006) and ankle plantarflexion muscle tone (p = 0.01) in the mirror therapy group compared to the placebo group at post-training assessment but not at 3-month follow-up. CONCLUSION Our study reveals that in our group of patients with chronic stroke, mirror therapy combined with treadmill training facilitated significant reductions in ankle muscle tone (p < 0.05) compared to a placebo intervention.
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Affiliation(s)
- P Broderick
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - F Horgan
- b School of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - C Blake
- c School of Public Health , University College Dublin , Dublin , Ireland
| | - M Ehrensberger
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - D Simpson
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - K Monaghan
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
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Martens G, Deltombe T, Foidart-Dessalle M, Laureys S, Thibaut A. Clinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury. Clin Neurophysiol 2018; 130:207-213. [PMID: 30580243 DOI: 10.1016/j.clinph.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC. METHODS We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well. RESULTS 21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios. CONCLUSIONS In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture. SIGNIFICANCE Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly.
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Affiliation(s)
- G Martens
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
| | - T Deltombe
- Departments of Physical Medicine and Rehabilitation, CHU UCL (Université catholique de Louvain) Namur site Godinne, Belgium
| | - M Foidart-Dessalle
- Departments of Physical Medicine and Rehabilitation, University and University Hospital of Liege, Liege, Belgium
| | - S Laureys
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
| | - A Thibaut
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
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Wu YN, Park HS, Chen JJ, Ren Y, Roth EJ, Zhang LQ. Position as Well as Velocity Dependence of Spasticity-Four-Dimensional Characterizations of Catch Angle. Front Neurol 2018; 9:863. [PMID: 30416478 PMCID: PMC6212511 DOI: 10.3389/fneur.2018.00863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022] Open
Abstract
We investigated the muscle alterations related to spasticity in stroke quantitatively using a portable manual spasticity evaluator. Methods: Quantitative neuro-mechanical evaluations under controlled passive elbow stretches in stroke survivors and healthy controls were performed in a research laboratory of a rehabilitation hospital. Twelve stroke survivors and nine healthy controls participated in the study. Spasticity and catch angle were evaluated at 90°/s and 270°/s with the velocities controlled through real-time audiovisual feedback. The elbow range of motion (ROM), stiffness, and energy loss were determined at a slow velocity of 30°/s. Four-dimensional measures including joint position, torque, velocity and torque change rate were analyzed jointly to determine the catch angle. Results: The catch angle was dependent on the stretch velocity and occurred significantly later with increasing velocity (p < 0.001), indicating position dependence of spasticity. The higher resistance felt by the examiner at the higher velocity was also due to more extreme joint position (joint angle) since the spastic joint was moved significantly further to a stiffer elbow position with the higher velocity. Stroke survivors showed smaller ROM (p < 0.001), higher stiffness (p < 0.001), and larger energy loss (p = 0.005). Compared to the controls, stroke survivors showed increased reflex excitability with higher reflex-mediated torque (p < 0.001) and at higher velocities (p = 0.02). Conclusion: Velocity dependence of spasticity is partially due to joint angle position dependence with the joint moved further (to a stiffer position where higher resistance was felt) at a higher velocity. The “4-dimensional characterization” including the joint angle, velocity, torque, and torque change rate provides a systematic tool to characterize catch angle and spasticity quantitatively.
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Affiliation(s)
- Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jia-Jin Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yupeng Ren
- Rehabtek LLC, Glenview, IL, United States
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
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63
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Becker S, von Werder SCFA, Lassek AK, Disselhorst-Klug C. Time-frequency coherence of categorized sEMG data during dynamic contractions of biceps, triceps, and brachioradialis as an approach for spasticity detection. Med Biol Eng Comput 2018; 57:703-713. [PMID: 30353246 DOI: 10.1007/s11517-018-1911-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 11/05/2017] [Indexed: 10/28/2022]
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Park JH, Lee KJ, Yoon YS, Son EJ, Oh JS, Kang SH, Kim H, Park HS. Development of elbow spasticity model for objective training of spasticity assessment of patients post stroke. IEEE Int Conf Rehabil Robot 2018; 2017:146-151. [PMID: 28813809 DOI: 10.1109/icorr.2017.8009237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Reliable assessment is essential for the management of spasticity, one of the most frequent complication of various neurological diseases. For the spasticity assessment, several clinical tools have been developed and widely used in clinics. The most popular one is modified Ashworth scale (MAS). It has a simple protocol, but is subjective and qualitative. To improve its reliability, quantitative measurement and consistent training would be needed. This study presents an elbow spasticity simulator which mimics spastic response of adult post stroke survivors. First, spastic responses (i.e. resistance and joint motion) from patients with a stroke were measured during conventional MAS assessment. Each grade of MAS was quantified by using three parameters representing three characteristics of the spasticity. Based on the parameters, haptic models of MAS were developed for implementing repeatable and consistent haptic training of novice clinicians. Two experienced clinicians participated in preliminary evaluation of the models.
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65
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A novel sensor-based assessment of lower limb spasticity in children with cerebral palsy. J Neuroeng Rehabil 2018; 15:45. [PMID: 29866177 PMCID: PMC5987429 DOI: 10.1186/s12984-018-0388-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To provide effective interventions for spasticity, accurate and reliable spasticity assessment is essential. For the assessment, the Modified Tardieu Scale (MTS) has been widely used owing to its simplicity and convenience. However, it has poor or moderate accuracy and reliability. METHODS We proposed a novel inertial measurement unit (IMU)-based MTS assessment system to improve the accuracy and reliability of the MTS itself. The proposed system consists of a joint angle calculation algorithm, a function to detect abnormal muscle reaction (a catch and clonus), and a visual biofeedback mechanism. Through spastic knee and ankle joint assessment, the proposed IMU-based MTS assessment system was compared with the conventional MTS assessment system in 28 children with cerebral palsy by two raters. RESULTS The results showed that the proposed system has good accuracy (root mean square error < 3.2°) and test-retest and inter-rater reliabilities (ICC > 0.8), while the conventional MTS system has poor or moderate reliability. Moreover, we found that the deteriorated reliability of the conventional MTS system comes from its goniometric measurement as well as from irregular passive stretch velocity. CONCLUSIONS The proposed system, which is clinically relevant, can significantly improve the accuracy and reliability of the MTS in lower limbs for children with cerebral palsy.
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Mizuno S, Takeda K, Maeshima S, Shigeru S. Effect of oral baclofen on spasticity poststroke: responders versus non-responders. Top Stroke Rehabil 2018; 25:438-444. [PMID: 29768106 DOI: 10.1080/10749357.2018.1474422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective To assess quantitatively the efficacy of oral baclofen for spasticity poststroke. Methods The participants were 29 persons poststroke with increased resistance to passive ankle dorsiflexion and ankle clonus on clinical assessment. Baclofen was administered at 20 mg/day for 1 week. The ankle joint was passively dorsiflexed at either 5°/s (slow stretch) or 90°/s (fast stretch) by a custom-built device. The ankle joint angle and resistive torque were measured during the ramp-and-hold stretch, with gastrocnemius electromyogram. The main outcome measures were the numbers of ankle clonus during hold, and the torques at 10° of ankle dorsiflexion in slow stretch (T-slow) and fast stretch (T-fast). Moreover, the velocity-dependent torque (ΔT = T-fast - T-slow) was compared between before and after oral baclofen. Results The numbers of ankle clonus, T-slow, T-fast, and ΔT for all participants did not exhibit significant differences between before and after baclofen administration. However, reduction in the number of ankle clonus of five or more was accompanied with a reduction in ΔT (4.0 ± 1.8 Nm) in three participants (the responders). Conclusion Although the responder rate was low, some participants responded to oral baclofen. Thus, a short-term trial of oral baclofen, and quantitative and electrophysiological assessments of muscle tone and ankle clonus are recommended.
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Affiliation(s)
- Shiho Mizuno
- a Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Tsu , Japan
| | - Kotaro Takeda
- b Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | - Shinichiro Maeshima
- a Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Tsu , Japan
| | - Sonoda Shigeru
- a Department of Rehabilitation Medicine II, School of Medicine , Fujita Health University , Tsu , Japan
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Quantitative assessment for flexed-elbow deformity during gait following botulinum toxin A treatment. Gait Posture 2018; 62:409-414. [PMID: 29649706 DOI: 10.1016/j.gaitpost.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/25/2018] [Accepted: 04/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of botulinum toxin A (BoNTA) injection on flexed-elbow deformity is usually evaluated using the Modified Ashworth Scale (MAS), but only with the muscle tone at rest. Some patients show the flexed-elbow deformity during gait despite low muscle tone at rest. OBJECTIVE This study aimed to evaluate the effect of BoNTA injection on flexed-elbow deformity during gait using a three-dimensional motion analysis system. METHODS Twenty stroke patients with spastic flexed-elbow deformity during gait received BoNTA injections into the upper limb muscles. The MAS score of the elbow flexors, passive elbow range of motion, comfortable overground gait velocity, and elbow flexion angle during treadmill gait were evaluated just before and 2, 6, and 12 weeks after the injection. Twenty-five healthy subjects were also recruited to provide a normal reference of the elbow flexion angle. RESULTS The MAS scores at 2, 6 and 12 weeks after the injection were significantly lower than that before the injection. Some patients showed no spasticity at rest but an obviously flexed elbow during gait. The elbow flexion angles during gait at 2 and 6 weeks after the injection were significantly lower than that before the injection. CONCLUSIONS BoNTA injections to the upper limb muscles reduced muscle tone at rest and flexed-elbow deformity during gait. However, the elbow flexion angle during gait returned to its pre-injection level sooner than the muscle tone at rest. We strongly recommend evaluating muscle tone during motion and at rest, preferably using three-dimensional motion analysis since it can objectively detect small changes.
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68
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Thibaut A, Wannez S, Deltombe T, Martens G, Laureys S, Chatelle C. Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture. NeuroRehabilitation 2018; 42:199-205. [PMID: 29562552 DOI: 10.3233/nre-172229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. OBJECTIVES In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with disorders of consciousness (DOC). METHODS 109 patients with subacute and chronic disorders of consciousness (Vegetative state/Unresponsive wakefulness syndrome - VS/UWS; minimally conscious state - MCS and patients who emerged from MCS - EMCS) were included in the study (39 female; mean age: 40±13.5y; 60 with traumatic etiology; 35 VS/UWS, 68 MCS, 6 EMCS; time since insult: 38±42months). The number of PT sessions (i.e., 20 to 30 minutes of conventional stretching of the four limbs) was collected based on patients' medical record and varied between 0 to 6 times per week (low PT = 0-3 and high PT = 4-6 sessions per week). Spasticity was measured with the Modified Ashworth Scale (MAS) on every segment for both upper (UL) and lower limbs (LL). The presence of muscle contracture was assessed in every joint. We tested the relationship between spasticity and muscle contracture with the frequency of PT as well as other potential confounders such as time since injury or anti-spastic medication intake. RESULTS We identified a negative correlation between the frequency of PT and MAS scores as well as the presence of muscle contracture. We also identified that patients who received less than four sessions per week were more likely to be spastic and suffer from muscle contracture than patients receiving 4 sessions or more. When separating subacute (3 to 12 months post-insult) and chronic (>12months post-insult) patients, these negative correlations were only observed in chronic patients. A logit regression model showed that frequency of PT influenced spasticity, whereas neither time since insult nor medication had a significant impact on the presence of spasticity. On the other hand, PT, time since injury and medication seemed to be associated with the presence of muscle contracture. CONCLUSION Our results suggest that, in subacute and chronic patients with DOC, PT could have an impact on patients' spasticity and muscles contractures. Beside PT, other factors such as time since onset and medication seem to influence the development of muscle contractures. These findings support the need for frequent PT sessions and regular re-evaluation of the overall spastic treatment for patients with DOC.
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Affiliation(s)
- A Thibaut
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium.,Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - S Wannez
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - T Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Mont-Godinne, (Université Catholique de Louvain), Yvoir, Belgium
| | - G Martens
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - S Laureys
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - C Chatelle
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, MA, USA
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69
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Improving the test-retest and inter-rater reliability for stretch reflex measurements using an isokinetic device in stroke patients with mild to moderate elbow spasticity. J Electromyogr Kinesiol 2018; 39:120-127. [PMID: 29486423 DOI: 10.1016/j.jelekin.2018.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/05/2018] [Accepted: 01/29/2018] [Indexed: 11/22/2022] Open
Abstract
The conventional tools to measure spasticity exhibited insufficient test-retest or inter-rater reliability. Therefore, the spasticity measurement using an isokinetic device has been proposed to improve these reliabilities of the angle of catch (AoC) measurements; however, this proposal has not been investigated in a standardized manner. In this study, the comparison of the AoC measurement was performed using two modes (isokinetic and manual motion) to investigate whether the standardized isokinetic motion could increase the reliabilities. Motion consistency was calculated using a newly developed index. To analyze the effect of the motion standardization, AoC were estimated using EMG data for both modes, and to compare the measurement reliability, AoC for isokinetic mode was estimated using both EMG and torque data. Although the test-retest reliability for manual motion was excellent, the use of isokinetic motion improved it to the level of extremely excellent. Intraclass correlation coefficient (ICC) for the inter-rater reliability of manual motion was 0.788, which was near the lower limit of the excellent. Isokinetic motion improved it to the ICC of 0.890 and 0.931 based on the EMG and torque, respectively. These improvements in reliabilities reduced the measurement errors, sample size, and need for the same rater in clinical trials.
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70
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Zhu H, Poon W, Liu Y, Leung GKK, Wong Y, Feng Y, Ng SCP, Tsang KS, Sun DTF, Yeung DK, Shen C, Niu F, Xu Z, Tan P, Tang S, Gao H, Cha Y, So KF, Fleischaker R, Sun D, Chen J, Lai J, Cheng W, Young W. Phase I-II Clinical Trial Assessing Safety and Efficacy of Umbilical Cord Blood Mononuclear Cell Transplant Therapy of Chronic Complete Spinal Cord Injury. Cell Transplant 2018; 25:1925-1943. [PMID: 27075659 DOI: 10.3727/096368916x691411] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Umbilical cord blood-derived mononuclear cell (UCB-MNC) transplants improve recovery in animal spinal cord injury (SCI) models. We transplanted UCB-MNCs into 28 patients with chronic complete SCI in Hong Kong (HK) and Kunming (KM). Stemcyte Inc. donated UCB-MNCs isolated from human leukocyte antigen (HLA ≥4:6)-matched UCB units. In HK, four patients received four 4-μl injections (1.6 million cells) into dorsal entry zones above and below the injury site, and another four received 8-μl injections (3.2 million cells). The eight patients were an average of 13 years after C5-T10 SCI. Magnetic resonance diffusion tensor imaging of five patients showed white matter gaps at the injury site before treatment. Two patients had fiber bundles growing across the injury site by 12 months, and the rest had narrower white matter gaps. Motor, walking index of SCI (WISCI), and spinal cord independence measure (SCIM) scores did not change. In KM, five groups of four patients received four 4-μl (1.6 million cells), 8-μl (3.2 million cells), 16-μl injections (6.4 million cells), 6.4 million cells plus 30 mg/kg methylprednisolone (MP), or 6.4 million cells plus MP and a 6-week course of oral lithium carbonate (750 mg/day). KM patients averaged 7 years after C3-T11 SCI and received 3-6 months of intensive locomotor training. Before surgery, only two patients walked 10 m with assistance and did not need assistance for bladder or bowel management before surgery. The rest could not walk or do their bladder and bowel management without assistance. At about a year (41-87 weeks), WISCI and SCIM scores improved: 15/20 patients walked 10 m ( p = 0.001) and 12/20 did not need assistance for bladder management ( p = 0.001) or bowel management ( p = 0.002). Five patients converted from complete to incomplete (two sensory, three motor; p = 0.038) SCI. We conclude that UCB-MNC transplants and locomotor training improved WISCI and SCIM scores. We propose further clinical trials.
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Affiliation(s)
- Hui Zhu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Waisang Poon
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - Yansheng Liu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | | | - Yatwa Wong
- Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Yaping Feng
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China
| | - Stephanie C P Ng
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - Kam Sze Tsang
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - David T F Sun
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - David K Yeung
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - Caihong Shen
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Fang Niu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Zhexi Xu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Pengju Tan
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Shaofeng Tang
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China
| | - Hongkun Gao
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Yun Cha
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China
| | - Kwok-Fai So
- Department of Ophthalmology and State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, SAR, P.R. China.,GHM Institute of CNS Regeneration, and Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, P.R. China.,China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | | | - Dongming Sun
- W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - John Chen
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | - Jan Lai
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | - Wendy Cheng
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | - Wise Young
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China.,W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, USA
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Abstract
Spasticity is a serious problem that adversely affects the daily life of patients, and creates difficulties for caregivers. The symptom that causes the most disability in multiple sclerosis patients is spasticity. The methods used in the measurement and evaluation of spasticity have some incomplete aspects and errors. In this article, we examined and compared the old and new methods used in the quantitative evaluation of spasticity, and tried to define the ideal method.
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Affiliation(s)
- Belgin Petek Balci
- Department of Neurology, Faculty of Medicine, University of Health Sciences; Haseki Research and Education Hospital Neurology Clinic, İstanbul, Turkey
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72
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Gholami S, Ansari NN, Naghdi S, Tabatabaei A, Jannat D, Senobari M, Dadgoo M. Biomechanical investigation of the modified Tardieu Scale in assessing knee extensor spasticity poststroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23. [PMID: 29148611 DOI: 10.1002/pri.1698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/15/2017] [Accepted: 10/10/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The modified Tardieu Scale (MTS) is a clinical tool for the measurement of muscle spasticity. The present study aimed to investigate the relationship between the MTS and the slope of the work-velocity curve as a biomechanical measure in assessing knee extensor muscle spasticity in patients with stroke. METHODS Thirty patients with stroke (22 female, 8 male; mean age 55.4 ± 12.0 years) participated in this study. The knee extensor spasticity was assessed with the MTS. An isokinetic dynamometer was used to move the knee passively from full extension to 90° flexion at speeds of 60°/s, 120°/s, 180°/s, and 240°/s to collect torque-angle data. The slope of the work-velocity curve was calculated using linear regression [J/(°/s)]. RESULTS The mean of R2-R1 component of MTS was 19.73 (SD 29.85). The mean work significantly decreased as the speed increased (p < .001). The mean (SD) slope for the work-velocity curve was -0.83 (SD 0.73, range -2.6-0.3). There was no significant relationship between the R2 -R1 and the slope of work-velocity curve (r = 0.09, p = .62). CONCLUSIONS The lack of significant relationship between the MTS and the slope of work-velocity curve may question the usefulness of the MTS as a valid measure of muscle spasticity after stroke.
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Affiliation(s)
- Samaneh Gholami
- School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Tabatabaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Jannat
- Industrial Engineering, Tarbiat Modares University, Tehran, Iran
| | - Maryam Senobari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Dadgoo
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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73
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Intrathecal Baclofen Therapy for the Control of Spasticity. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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74
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Klochkova OA, Kurenkov AL, Mamontova NA. [Treatment of spasticity after traumatic brain injury in children: the role of botulinum toxin therapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:114-121. [PMID: 29171499 DOI: 10.17116/jnevro2017117101114-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traumatic brain injury (TBI) is one of the main reasons of death and disability in children and adolescents in Russia and abroad. Spasticity is a frequent outcome of the TBI that influences on the rehabilitation prognosis, degree of movement disorders and quality of life after trauma. Early spasticity correction and complex rehabilitation lead to the optimal recovery and prevent secondary complications. This review presents the current data about the prognostic role of the spasticity in children after TBI, methods of its correction and their scientific evidence. Limitations and challenges of per-oral antispastic agents are described especially for the patients with local spasticity. Attention is focused on the methods of treatment of local hypertonus, in particular botulinum toxin A (BTA) injections proved to be effective in adults with acquired brain injury. The article summarizes the results of international investigations, systematic reviews and consensus statements about the efficacy and safety of botulinum toxin treatment in children after the TBI. The authors describe an algorithm of the optimal patient selection and goal setting for BTA injections in children with acquired brain injury.
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Affiliation(s)
- O A Klochkova
- National Medical Research Center of Children's Health of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A L Kurenkov
- National Medical Research Center of Children's Health of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - N A Mamontova
- Moscow Scientific Research Institute of Emergency Children's Surgery and Traumatology, Moscow, Russia
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75
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Amatya B, Khan F, Ng L, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2017. [DOI: 10.1002/14651858.cd012732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bhasker Amatya
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
| | - Fary Khan
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
| | - Louisa Ng
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
| | - Mary Galea
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
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76
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Eby S, Zhao H, Song P, Vareberg BJ, Kinnick R, Greenleaf JF, An KN, Chen S, Brown AW. Quantitative Evaluation of Passive Muscle Stiffness in Chronic Stroke. Am J Phys Med Rehabil 2017; 95:899-910. [PMID: 27149584 DOI: 10.1097/phm.0000000000000516] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the potential for shear wave elastography (SWE) to measure passive biceps brachii individual muscle stiffness as a musculoskeletal manifestation of chronic stroke. DESIGN This was a cross-sectional study. Nine subjects with stroke were evaluated using the Fugl-Meyer and Modified Ashworth scales. Electromyography, joint torque, and SWE of the biceps brachii were obtained during passive elbow extension in subjects with stroke and four controls. Torque values at the time points corresponding to each SWE measurement during all trials were selected for direct comparison with the respective SWE stiffness using regression analysis. Intraclass correlation coefficients (ICC(1,1)) were used to evaluate the reliability of expressing alterations in material properties. RESULTS Torque and passive stiffness increased with elbow extension-minimally for the controls and most pronounced in the contralateral limb of those with stroke. In the stroke group, several patterns of shear moduli and torque responses to passive elbow extension were identified, with a subset of several subjects displaying a very strong torque response coupled with minimal stiffness responses (y = 2.712x + 6.676; R = 0.181; P = 0.0310). Values of ICC(1,1) indicate consistent muscle stiffness throughout testing for the dominant side of controls, but largely inconsistent stiffness for other study conditions. CONCLUSIONS SWE shows promise for enhancing evaluation of skeletal muscle after stroke. The wide variability between subjects with stroke highlights the need for precise, individualized measures.
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Affiliation(s)
- Sarah Eby
- From the Mayo Medical School, Mayo Graduate School, and the Medical Scientist Training Program, College of Medicine (SE); Biomechanics Laboratory, Division of Orthopedic Research (SE, K-NA); Physiology and Biomedical Engineering, College of Medicine (HZ, PS, RK, JFG, SC); and Department of Physical Medicine and Rehabilitation (BJV, AWB), Mayo Clinic, Rochester, Minnesota
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KAPS (kinematic assessment of passive stretch): a tool to assess elbow flexor and extensor spasticity after stroke using a robotic exoskeleton. J Neuroeng Rehabil 2017. [PMID: 28629415 PMCID: PMC5477344 DOI: 10.1186/s12984-017-0272-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Spasticity is a common sequela of stroke. Traditional assessment methods include relatively coarse scales that may not capture all characteristics of elevated muscle tone. Thus, the aim of this study was to develop a tool to quantitatively assess post-stroke spasticity in the upper extremity. Methods Ninety-six healthy individuals and 46 individuals with stroke participated in this study. The kinematic assessment of passive stretch (KAPS) protocol consisted of passive elbow stretch in flexion and extension across an 80° range in 5 movement durations. Seven parameters were identified and assessed to characterize spasticity (peak velocity, final angle, creep (or release), between-arm peak velocity difference, between-arm final angle, between-arm creep, and between-arm catch angle). Results The fastest movement duration (600 ms) was most effective at identifying impairment in each parameter associated with spasticity. A decrease in peak velocity during passive stretch between the affected and unaffected limb was most effective at identifying individuals as impaired. Spasticity was also associated with a decreased passive range (final angle) and a classic ‘catch and release’ as seen through between-arm catch and creep metrics. Conclusions The KAPS protocol and robotic technology can provide a sensitive and quantitative assessment of post-stroke elbow spasticity not currently attainable through traditional measures.
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Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Sarı A, Durmus B. Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries. Spinal Cord 2017; 55:944-949. [PMID: 28485384 DOI: 10.1038/sc.2017.48] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Psychometrics study. OBJECTIVES To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). SETTING Inpatient rehabilitation clinics at two state hospitals. METHODS The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores. RESULTS Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53). CONCLUSION MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.
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Affiliation(s)
- P Akpinar
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - A Atici
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - F U Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - I Aktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - D G Kulcu
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - A Sarı
- Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - B Durmus
- Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
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Spasticity Management: The Current State of Transcranial Neuromodulation. PM R 2017; 9:1020-1029. [DOI: 10.1016/j.pmrj.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
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Banky M, Ryan HK, Clark R, Olver J, Williams G. Do clinical tests of spasticity accurately reflect muscle function during walking: A systematic review. Brain Inj 2017; 31:440-455. [DOI: 10.1080/02699052.2016.1271455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Megan Banky
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Hannah K. Ryan
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
| | - John Olver
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia
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Naghdi S, Ansari NN, Ghorbani-Rad S, Senobari M, Sahraian MA. Intra-rater reliability of the Modified Tardieu Scale in patients with multiple sclerosis. Neurol Sci 2017; 38:93-99. [PMID: 27620726 DOI: 10.1007/s10072-016-2714-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 09/08/2016] [Indexed: 02/05/2023]
Abstract
The reliability of the Modified Tardieu Scale (MTS) has not been examined in patients with multiple sclerosis (MS). This study aimed to assess intra-rater reliability of the MTS in the assessment of lower limb spasticity in patients with MS. Data from 30 patients with MS (18 women, mean age = 41.5) were used to assess intra-rater reliability. An inexperienced physiotherapist in the scale randomly examined the hip adductors, knee extensors, and ankle plantar flexors on each subject twice with at least a 7-day interval. Kappa statistics (κ) were calculated for MTS quality of muscle reactions. Intraclass correlation coefficients (ICCagreement) and smallest detectable change (SDC) were calculated for R2, R1, and R2-R1. Qualitative rating of spasticity demonstrated moderate or good agreement, with an overall moderate κ of 0.72. Intra-rater reliability for all angle components of MTS was poor to good (ICCagreement range 0.45-0.83). The SDC for all the MTS components across the muscle groups was unacceptably large (range 14.6-55.6). Results did not establish good intra-rater reliability for the MTS when assessing lower limb muscle spasticity in patients with MS by a physiotherapist with no previous experience in the scale and with limited training.
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Affiliation(s)
- Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran.
| | - Sedighe Ghorbani-Rad
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran
| | - Maryam Senobari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Ave, Pitch-e-shemiran, 11489, Tehran, Iran
| | - Mohammad Ali Sahraian
- Sina MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Choolun P, Kuys S, Bisset L. Tracking changes in glenohumeral joint position in acute post-stroke hemiparetic patients: an observational study. Disabil Rehabil 2016; 40:259-266. [DOI: 10.1080/09638288.2016.1250167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Praline Choolun
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Suzanne Kuys
- Faculty of Health Sciences, School of Physiotherapy, Australian Catholic University, Brisbane Campus, Banyo, Queensland, Australia
| | - Leanne Bisset
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia
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de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W. Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised trial. J Physiother 2016; 62:203-8. [PMID: 27637770 DOI: 10.1016/j.jphys.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022] Open
Abstract
QUESTION Does 4 weeks of active functional electrical stimulation (FES) cycling in addition to usual care improve mobility and strength more than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma? DESIGN Multi centre, randomised, controlled trial. PARTICIPANTS Forty patients from three Sydney hospitals with recently acquired brain injury and a mean composite strength score in the affected lower limb of 7 (SD 5) out of 20 points. INTERVENTION Participants in the experimental group received an incremental, progressive, FES cycling program five times a week over a 4-week period. All participants received usual care. OUTCOME MEASURES Outcome measures were taken at baseline and at 4 weeks. Primary outcomes were mobility and strength of the knee extensors of the affected lower limb. Mobility was measured with three mobility items of the Functional Independence Measure and strength was measured with a hand-held dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb and spasticity of the affected plantar flexors. RESULTS All but one participant completed the study. The mean between-group differences for mobility and strength of the knee extensors of the affected lower limb were -0.3/21 points (95% CI -3.2 to 2.7) and 7.5 Nm (95% CI -5.1 to 20.2), where positive values favoured the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference of 3.0/20 points (95% CI 1.3 to 4.8). CONCLUSION Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear. TRIAL REGISTRATION ACTRN12612001163897. [de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W (2016) Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised controlled trial.Journal of Physiotherapy62: 203-208].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- School of Physiotherapy, Australian Catholic University
| | | | - Whitney Harris
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
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Choi S, Kim J. Improving modified tardieu scale assessment using inertial measurement unit with visual biofeedback. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:4703-4706. [PMID: 28269321 DOI: 10.1109/embc.2016.7591777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Reliable spasticity assessment is important to provide appropriate intervention for spasticity. Modified Tardieu scale (MTS) assessment is simple and convenient enough to be used in clinical environment, but has poor or moderate reliability due to irregular passive stretch velocity and goniometric measurement. We proposed a novel inertial measurement unit (IMU)-based MTS assessment with gyroscope-based visual biofeedback to improve the reliability of MTS by providing regular passive stretch velocity. With five children with cerebral palsy and two raters, the IMU-based MTS assessment was compared with conventional MTS assessment. The results showed that the proposed one has good test-retest and inter-rater reliabilities (ICC > .08) while the conventional MTS has poor or moderate reliability. Moreover, it was shown that the proposed visual biofeedback is effective enough to provide regular passive stretch velocity.
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85
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Concordance of Actigraphy With Polysomnography in Traumatic Brain Injury Neurorehabilitation Admissions. J Head Trauma Rehabil 2016; 31:117-25. [DOI: 10.1097/htr.0000000000000215] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mizuno S, Sonoda S, Takeda K, Maeshima S. Measurement of Resistive Plantar Flexion Torque of the Ankle during Passive Stretch in Healthy Subjects and Patients with Poststroke Hemiplegia. J Stroke Cerebrovasc Dis 2016; 25:946-53. [PMID: 26851973 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Quantification of increased muscle tone for patients with spasticity has been performed to date using various devices to replace the manual scales, such as the modified Ashworth scale or the Tardieu scale. We developed a device that could measure resistive plantar flexion (PF) torque of the ankle during passive dorsiflexion (DF) as an indicator of muscle tone of ankle plantar flexors. METHODS The primary objective was to explore the test-retest intrarater reliability of a custom-built device. Participants were 11 healthy subjects (7 men, 4 women; mean age 47.0 years) and 22 patients with poststroke hemiplegia (11 hemorrhagic, 11 ischemic; 14 men, 8 women; mean age 57.2 years). The device was affixed to the ankle. Subjects were seated with knees either flexed or extended. The ankle was passively dorsiflexed from 20° of PF to more than 10° of DF at 5°/second (slow stretch) or 90°/second (fast stretch). Angle and torque were measured twice during the stretches. The intraclass correlation coefficients (ICCs) of torque at 10° of DF (T10) in the 4 conditions-slow and fast stretches with knee flexed or extended-were calculated. RESULTS The T10 ICCs of the 4 conditions were .95-.99 in both groups. The healthy subjects showed significantly higher T10 of knee extension than of knee flexion during slow and fast stretches. The patients showed increased velocity-dependent torque during fast stretches. CONCLUSIONS Excellent reliability was observed. The device is suitable for measuring resistive PF torque during passive stretch in a flexed knee condition.
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Affiliation(s)
- Shiho Mizuno
- School of Medicine, Department of Rehabilitation Medicine II, Fujita Health University, Mie, Japan.
| | - Shigeru Sonoda
- School of Medicine, Department of Rehabilitation Medicine II, Fujita Health University, Mie, Japan
| | - Kotaro Takeda
- Fujita Memorial Nanakuri Institute, Fujita Health University, Mie, Japan
| | - Shinichiro Maeshima
- School of Medicine, Department of Rehabilitation Medicine II, Fujita Health University, Mie, Japan
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87
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Prokopenko SV, Mozheyko EY, Alekseevich GV. Methods of assessment of movement functions in the upper limb. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [DOI: 10.17116/jnevro201611671101-107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seth N, Johnson D, Taylor GW, Allen OB, Abdullah HA. Robotic pilot study for analysing spasticity: clinical data versus healthy controls. J Neuroeng Rehabil 2015; 12:109. [PMID: 26625718 PMCID: PMC4667530 DOI: 10.1186/s12984-015-0103-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spasticity is a motor disorder that causes significant disability and impairs function. There are no definitive parameters that assess spasticity and there is no universally accepted definition. Spasticity evaluation is important in determining stages of recovery. It can determine treatment effectiveness as well as how treatment should proceed. This paper presents a novel cross sectional robotic pilot study for the primary purpose of assessment. The system collects force and position data to quantify spasticity through similar motions of the Modified Ashworth Scale (MAS) assessment in the Sagittal plane. Validity of the system is determined based on its ability to measure velocity dependent resistance. METHODS Forty individuals with Acquired Brain Injury (ABI) and 45 healthy individuals participated in a robotic pilot study. A linear regression model was applied to determine the effect an ABI has on force data obtained through the robotic system in an effort to validate it. Parameters from the model were compared for both groups. Two techniques were performed in an attempt to classify between healthy and patients. Dynamic Time Warping (DTW) with k-nearest neighbour (KNN) classification is compared to a time-series algorithm using position and force data in a linear discriminant analysis (LDA). RESULTS The system is capable of detecting a velocity dependent resistance (p<0.05). Differences were found between healthy individuals and those with MAS 0 who are considered to be healthy. DTW with KNN is shown to improve classification between healthy and patients by approximately 20 % compared to that of an LDA. CONCLUSIONS Quantitative methods of spasticity evaluation demonstrate that differences can be observed between healthy individuals and those with MAS of 0 who are often clinically considered to be healthy. Exploiting the time-series nature of the collected data demonstrates that position and force together are an accurate predictor of patient health.
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Affiliation(s)
- Nitin Seth
- University of Guelph, 50 Stone Road East, N1G 2W1, Guelph, ON, Canada.
| | - Denise Johnson
- Hamilton Health Sciences, Regional Rehabilitation Centre, 300 Wellington Rd North, L8L 0A4, Hamilton, ON, Canada.
| | - Graham W Taylor
- University of Guelph, 50 Stone Road East, N1G 2W1, Guelph, ON, Canada.
| | - O Brian Allen
- University of Guelph, 50 Stone Road East, N1G 2W1, Guelph, ON, Canada.
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Krewer C, Luther M, Koenig E, Müller F. Tilt Table Therapies for Patients with Severe Disorders of Consciousness: A Randomized, Controlled Trial. PLoS One 2015; 10:e0143180. [PMID: 26623651 PMCID: PMC4666666 DOI: 10.1371/journal.pone.0143180] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/30/2015] [Indexed: 01/28/2023] Open
Abstract
One major aim of the neurological rehabilitation of patients with severe disorders of consciousness (DOC) is to enhance patients' arousal and ability to communicate. Mobilization into a standing position by means of a tilt table has been shown to improve their arousal and awareness. However, due to the frequent occurrence of syncopes on a tilt table, it is easier to accomplish verticalization using a tilt table with an integrated stepping device. The objective of this randomized controlled clinical trial was to evaluate the effectiveness of a tilt table therapy with or without an integrated stepping device on the level of consciousness. A total of 50 participants in vegetative or minimally conscious states 4 weeks to 6 month after injury were treated with verticalization during this randomized controlled trial. Interventions involved ten 1-hour sessions of the specific treatment over a 3-week period. Blinded assessors made measurements before and after the intervention period, as well as after a 3-week follow-up period. The coma recovery scale-revised (CRS-R) showed an improvement by a median of 2 points for the group receiving tilt table with integrated stepping (Erigo). The rate of recovery of the group receiving the conventional tilt table therapy significantly increased by 5 points during treatment and by an additional 2 points during the 3-week follow-up period. Changes in spasticity did not significantly differ between the two intervention groups. Compared to the conventional tilt table, the tilt table with integrated stepping device failed to have any additional benefit for DOC patients. Verticalization itself seems to be beneficial though and should be administered to patients in DOC in early rehabilitation. Trial Registration: Current Controlled Trials Ltd (www.controlled-trials.com), identifier number ISRCTN72853718.
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Affiliation(s)
- Carmen Krewer
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
- * E-mail:
| | - Marianne Luther
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
| | - Eberhard Koenig
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
| | - Friedemann Müller
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
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Sekiguchi Y, Muraki T, Tanaka N, Izumi SI. Relationship between activation of ankle muscles and quasi-joint stiffness in early and middle stances during gait in patients with hemiparesis. Gait Posture 2015. [PMID: 26215641 DOI: 10.1016/j.gaitpost.2015.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is unclear whether muscle contraction is necessary to increase quasi-joint stiffness (QJS) of the ankle joint during gait in patients with hemiparesis. The purpose of the present study was to investigate the relationship between QJS and muscle activation at the ankle joint in the stance phase during gait in patients with hemiparesis. Spatiotemporal and kinetic gait parameters and activation of the medial head of the gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) muscles were measured using a 3-dimensional motion analysis system and surface electromyography, in 21 patients with hemiparesis due to stroke and 10 healthy individuals. In the early stance, the QJS on the paretic side (PS) of patients was greater than that on the non-PS (p<0.05) and not significantly correlated with activation of the three muscles. In the middle stance, the QJS on the PS was lower than that on the non-PS (p<0.05) and that on the right side of controls (p<0.001), which was positively correlated with activation of the MG (r=0.51, p<0.05) and SOL (r=0.49, p<0.05). In the patients with hemiparesis, plantarflexor activation may not contribute to QJS in the early stance. On the other hand, QJS in the middle stance may be attributed to activation of the MG and SOL. Our findings suggest that activation of the MG and SOL in the middle stance on the PS may require to be enhanced to increase QJS during gait in patients with hemiparesis.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Naofumi Tanaka
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
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Tanino G, Tomita Y, Mizuno S, Maeda H, Miyasaka H, Orand A, Takeda K, Sonoda S. Development of an ankle torque measurement device for measuring ankle torque during walking. J Phys Ther Sci 2015; 27:1477-80. [PMID: 26157244 PMCID: PMC4483422 DOI: 10.1589/jpts.27.1477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To develop a device for measuring the torque of an ankle joint during walking
in order to quantify the characteristics of spasticity of the ankle and to verify the
functionality of the device by testing it on the gait of an able-bodied individual and an
equinovarus patient. [Subjects and Methods] An adjustable posterior strut (APS) ankle-foot
orthosis (AFO) was used in which two torque sensors were mounted on the aluminum strut for
measuring the anterior-posterior (AP) and medial-lateral (ML) directions. Two switches
were also mounted at the heel and toe in order to detect the gait phase. An able-bodied
individual and a left hemiplegic patient with equinovarus participated. They wore the
device and walked on a treadmill to investigate the device’s functionality. [Results]
Linear relationships between the torques and the corresponding output of the torque
sensors were observed. Upon the analyses of gait of an able-body subject and a hemiplegic
patient, we observed toque matrices in both AP and ML directions during the gait of the
both subjects. [Conclusion] We developed a device capable of measuring the torque in the
AP and ML directions of ankle joints during gait.
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Affiliation(s)
- Genichi Tanino
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan ; Nanakuri Sanatorium, Fujita Health University, Japan
| | - Yutaka Tomita
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan
| | - Shiho Mizuno
- Nanakuri Sanatorium, Fujita Health University, Japan ; Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Japan
| | - Hirofumi Maeda
- Nanakuri Sanatorium, Fujita Health University, Japan ; Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Japan
| | - Hiroyuki Miyasaka
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan ; Nanakuri Sanatorium, Fujita Health University, Japan
| | - Abbas Orand
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan
| | - Kotaro Takeda
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan
| | - Shigeru Sonoda
- Fujita Memorial Nanakuri Institute, Fujita Health University, Japan ; Nanakuri Sanatorium, Fujita Health University, Japan ; Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Japan
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93
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Williams G, Banky M, Olver J. Severity and distribution of spasticity does not limit mobility or influence compensatory strategies following traumatic brain injury. Brain Inj 2015; 29:1232-1238. [DOI: 10.3109/02699052.2015.1035328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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94
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Ishikawa S, Okamoto S, Isogai K, Akiyama Y, Yanagihara N, Yamada Y. Assessment of robotic patient simulators for training in manual physical therapy examination techniques. PLoS One 2015; 10:e0126392. [PMID: 25923719 PMCID: PMC4414623 DOI: 10.1371/journal.pone.0126392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/01/2015] [Indexed: 12/01/2022] Open
Abstract
Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard.
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Affiliation(s)
- Shun Ishikawa
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, Japan
| | - Shogo Okamoto
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, Japan
| | - Kaoru Isogai
- Department of Physical Therapy, Faculty of Health and Medical Science, Tokoha University, Hamamatsu, Japan
| | - Yasuhiro Akiyama
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, Japan
| | - Naomi Yanagihara
- Department of Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoji Yamada
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University, Nagoya, Japan
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95
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Thibaut A, Deltombe T, Wannez S, Gosseries O, Ziegler E, Dieni C, Deroy M, Laureys S. Impact of soft splints on upper limb spasticity in chronic patients with disorders of consciousness: A randomized, single-blind, controlled trial. Brain Inj 2015; 29:830-6. [DOI: 10.3109/02699052.2015.1005132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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96
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Boeskov B, Carver LT, von Essen-Leise A, Henriksen M. Kinesthetic taping improves walking function in patients with stroke: a pilot cohort study. Top Stroke Rehabil 2015; 21:495-501. [PMID: 25467397 DOI: 10.1310/tsr2106-495] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal walking speed and clinical indices of spasticity in patients with stroke. METHODS Thirty-two patients (9 women) receiving rehabilitation after stroke (average, 50 days since stroke) who had impaired walking ability were recruited. Primary outcome was maximal walking speed measured by the 10-meter walk test. Secondary outcomes were number of steps taken during the test and clinical signs of spasticity measured by the Tardieu Scale. Tests were conducted before and immediately after application of kinesthetic tape to the anterior thigh and knee of the paretic lower limb. RESULTS After application of the tape, the maximal walking speed increased, on average, by 0.08 m/s (95% CI, 0.04 to 0.12; P < .0001). The number of steps taken during the test was significantly decreased by 1.4 steps (95% CI, -2.3 to -0.5; P < .0031). The Tardieu scores were not significantly changed by the tape intervention, although a trend was observed indicating a lesser degree of spasticity. CONCLUSION The results of this study indicate that kinesthetic taping of the anterior thigh and knee provides an immediate improvement in walking function in patients with stroke. Such a positive effect on motor function could be a valuable adjunct in physical therapy and rehabilitation of patients with stroke.
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Affiliation(s)
- Birgitte Boeskov
- Clinical Motor Function Laboratory, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Line Tornehøj Carver
- Clinical Motor Function Laboratory, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Anders von Essen-Leise
- Clinical Motor Function Laboratory, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Marius Henriksen
- Clinical Motor Function Laboratory, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
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97
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Lee JY, Kim SN, Lee IS, Jung H, Lee KS, Koh SE. Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis. J Phys Ther Sci 2014; 26:1641-7. [PMID: 25364134 PMCID: PMC4210419 DOI: 10.1589/jpts.26.1641] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/10/2014] [Indexed: 02/02/2023] Open
Abstract
[Purpose] The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words "muscle hypertonia OR spasticity" were used for spasticity, and the key words "shock wave OR ESWT" were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], -0.792; 95% confidence interval [CI], -1.001 to -0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, -0.735; 95% CI, -0.951 to -0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.
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Affiliation(s)
- Jin-Youn Lee
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Soo-Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Heeyoune Jung
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Kyeong-Soo Lee
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
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98
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Krewer C, Hartl S, Müller F, Koenig E. Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study. Arch Phys Med Rehabil 2014; 95:1039-47. [PMID: 24561057 DOI: 10.1016/j.apmr.2014.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 01/20/2014] [Accepted: 02/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate short-term and long-term effects of repetitive peripheral magnetic stimulation (rpMS) on spasticity and motor function. DESIGN Monocentric, randomized, double-blind, sham-controlled trial. SETTING Neurologic rehabilitation hospital. PARTICIPANTS Patients (N=66) with severe hemiparesis and mild to moderate spasticity resulting from a stroke or a traumatic brain injury. The average time ± SD since injury for the intervention groups was 26 ± 71 weeks or 37 ± 82 weeks. INTERVENTIONS rpMS for 20 minutes or sham stimulation with subsequent occupational therapy for 20 minutes, 2 times a day, over a 2-week period. MAIN OUTCOME MEASURES Modified Tardieu Scale and Fugl-Meyer Assessment (arm score), assessed before therapy, at the end of the 2-week treatment period, and 2 weeks after study treatment. Additionally, the Tardieu Scale was assessed after the first and before the third therapy session to determine any short-term effects. RESULTS Spasticity (Tardieu >0) was present in 83% of wrist flexors, 62% of elbow flexors, 44% of elbow extensors, and 10% of wrist extensors. Compared with the sham stimulation group, the rpMS group showed short-term effects on spasticity for wrist flexors (P=.048), and long-term effects for elbow extensors (P<.045). Arm motor function (rpMS group: median 5 [4-27]; sham group: median 4 [4-9]) did not significantly change over the study period in either group, whereas rpMS had a positive effect on sensory function. CONCLUSIONS Therapy with rpMS increases sensory function in patients with severe limb paresis. The magnetic stimulation, however, has limited effect on spasticity and no effect on motor function.
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Affiliation(s)
- Carmen Krewer
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany.
| | - Sandra Hartl
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
| | - Friedemann Müller
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
| | - Eberhard Koenig
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
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99
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Balakatounis K. Commentary. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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100
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Park ES, Rha DW, Lee WC, Sim EG. The effect of obturator nerve block on hip lateralization in low functioning children with spastic cerebral palsy. Yonsei Med J 2014; 55:191-6. [PMID: 24339306 PMCID: PMC3874912 DOI: 10.3349/ymj.2014.55.1.191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP. MATERIALS AND METHODS The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation. RESULTS The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs. CONCLUSION ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.
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Affiliation(s)
- Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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