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Phillips K, Pitt V, O'Connor D, Gruen RL. Interventions for managing skeletal muscle spasticity following traumatic brain injury. Hippokratia 2011. [DOI: 10.1002/14651858.cd008929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kate Phillips
- Monash University; School of Public Health and Preventive Medicine; The Alfred Centre 99 Commercial Road Melbourne Victoria Australia 3004
| | - Veronica Pitt
- National Trauma Research Institute, Alfred Hospital, Monash University; Level 4, 89 Commercial Road Melbourne Victoria Australia 3004
| | - Denise O'Connor
- Monash University; School of Public Health and Preventive Medicine; The Alfred Centre 99 Commercial Road Melbourne Victoria Australia 3004
| | - Russell L Gruen
- Alfred Hospital, Monash University; National Trauma Research Institute; Level 4, 89 Commercial Road Melbourne Victoria Australia 3004
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102
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Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke 2010; 41:2402-48. [PMID: 20813995 DOI: 10.1161/str.0b013e3181e7512b] [Citation(s) in RCA: 458] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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103
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Deltombe T, Gustin T. Selective Tibial Neurotomy in the Treatment of Spastic Equinovarus Foot in Hemiplegic Patients: A 2-Year Longitudinal Follow-Up of 30 Cases. Arch Phys Med Rehabil 2010; 91:1025-30. [DOI: 10.1016/j.apmr.2010.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/03/2010] [Accepted: 04/16/2010] [Indexed: 11/15/2022]
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104
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Cousins E, Ward A, Roffe C, Rimington L, Pandyan A. Does low-dose botulinum toxin help the recovery of arm function when given early after stroke? A phase II randomized controlled pilot study to estimate effect size. Clin Rehabil 2010; 24:501-13. [DOI: 10.1177/0269215509358945] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Spasticity after stroke may be associated with worse functional outcome. Our study aim is to establish whether a low dose of botulinum toxin, given early post stroke before clinically evident spasticity warrants treatment, will improve recovery of arm function. Design: A double-blind randomized placebo-controlled trial. Setting: An acute stroke unit. Subjects: Individuals recruited within three weeks of stroke onset with severe arm function deficits. Interventions: Injections of quarter and half standard dose botulinum toxin A to the upper limb, with a control of normal saline injections. Main measures: Arm function, active and passive movement, and spasticity at elbow and wrist were recorded at baseline, and at 4, 8, 12 and 20 weeks post intervention. A pre-planned subgroup analysis included only subjects with no arm function at baseline (Action Research Arm Test score = 0). Results: Thirty subjects were recruited, and 21 completed all assessments. Arm function scores improved in all three groups between baseline and week 20. There was no benefit for active treatment over control in the whole group analysis. In the subgroup analysis the active groups improved when compared with the control group and effect sizes for improvement in this subgroup were 0.6 and 0.5 for the quarter dose and half dose groups respectively. Conclusions: Individuals with no arm function within three weeks of stroke may benefit functionally from botulinum toxin. Using the effect size of 0.5, further studies would need a minimum of 101 participants in each group to confirm this finding.
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Affiliation(s)
- Elizabeth Cousins
- School of Health and Rehabilitation, Keele University and Institute for Science and Technology in Medicine
| | - Anthony Ward
- North Staffordshire Rehabilitation Centre, Stoke on Trent
| | - Christine Roffe
- Stroke Service, University Hospital of North Staffordshire, Institute for Life Course Studies, Keele University
| | - Lesley Rimington
- School of Health and Rehabilitation, Keele University and Institute for Life Course Studies, Keele University
| | - Anand Pandyan
- School of Health and Rehabilitation, Keele University and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK,
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105
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Chiu HC, Ada L, Butler J, Coulson S. Relative contribution of motor impairments to limitations in activity and restrictions in participation in adults with hemiplegic cerebral palsy. Clin Rehabil 2010; 24:454-62. [PMID: 20354058 DOI: 10.1177/0269215509353263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine which motor impairments make a significant relative contribution to upper limb activity limitations, and whether activity limitations are related to participation restrictions in people with hemiplegic cerebral palsy. DESIGN An observational study. SETTING Neurological Rehabilitation Research Group at Faculty of Health Sciences, The University of Sydney. SUBJECTS Twenty-three people with hemiplegic cerebral palsy participated. MAIN MEASURES Four motor impairments (strength, coordination, spasticity and contracture), upper limb activity and participation were measured. Multiple regression was used to determine the relative contribution of motor impairments to activity limitations. Linear regression was used to determine the correlation between activity and participation. RESULTS The four motor impairments accounted for 63% of the variance in upper limb activity with coordination independently accounting for 21% (P<0.01). Upper limb activity accounted for 13% of the variance in participation (P=0.10). CONCLUSIONS The findings imply that coordination of four motor impairments makes the largest independent relative contribution to activity limitations, whereas upper limb activity makes less contribution to participation in people with mild and moderate hemiplegic cerebral palsy.
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Affiliation(s)
- Hsiu-Ching Chiu
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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106
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Agostinucci J, Lyons H. Soleus stretch reflex in subjects with cerebrovascular accident. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.3.46744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- James Agostinucci
- Physical Therapy Department, University of Rhode Island, Kingston, Rhode Island; and
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107
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Shaw L, Rodgers H. Botulinum toxin type A for upper limb spasticity after stroke. Expert Rev Neurother 2010; 9:1713-25. [PMID: 19951131 DOI: 10.1586/ern.09.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spasticity is involuntary overactivity of muscles that occurs following upper motor neuron damage to the brain or spinal cord. Upper limb spasticity is common after stroke and can cause deformity, pain and reduced function. Botulinum toxin type A is a neurotoxin produced by the bacterium Clostridium botulinum that blocks the release of acetylcholine from cholinergic neurons. When given by intramuscular injection it causes temporary local paresis and has become an important component of focal spasticity treatment. Randomized controlled trials have shown that botulinum toxin type A can decrease upper limb spasticity and improve the ease of performing basic upper limb functional activities, such as cleaning the hand or dressing a sleeve. This article will review the pharmacology of botulinum toxin type A and its clinical efficacy when used to treat upper limb spasticity after stroke.
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Affiliation(s)
- Lisa Shaw
- Institute for Ageing and Health (Stroke Research Group), Newcastle University, The Medical School, Newcastle upon Tyne, NE2 4HH, UK.
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108
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Ghotbi N, Ansari NN, Naghdi S, Hasson S, Jamshidpour B, Amiri S. Inter-rater reliability of the Modified Modified Ashworth Scale in assessing lower limb muscle spasticity. Brain Inj 2009; 23:815-9. [PMID: 19697170 DOI: 10.1080/02699050903200548] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PRIMARY OBJECTIVE To assess the inter-rater reliability of the Modified Modified Ashworth Scale (MMAS) in lower limb muscle spasticity. RESEARCH DESIGN Cross-sectional observational study. INTERVENTIONS Not applicable. METHODS AND PROCEDURES Twenty-two adults with neurological conditions (17 women, five men, age range 21-82 years; mean +/- SD, 44 +/- 18 years) participated. Hip adductor, knee extensor and ankle plantarflexor were assessed in a random order. MAIN OUTCOMES AND RESULTS Inter-rater agreement for two raters was very good for the hip adductor and the knee extensor (weighted kappa = 0.82, p < 0.0001) and good for the ankle plantarflexor (weighted kappa = 0.74, p < 0.0001). CONCLUSIONS The Modified Modified Ashworth Scale produced reliable measurements between raters in the assessment of lower limb muscle spasticity.
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Affiliation(s)
- Nastaran Ghotbi
- Faculty of Rehabilitation, Tehran University of Medical Sciences, Iran
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109
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Gracies JM, Singer BJ, Dunne JW. The role of botulinum toxin injections in the management of muscle overactivity of the lower limb. Disabil Rehabil 2009; 29:1789-805. [DOI: 10.1080/09638280701568437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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110
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Affiliation(s)
- Valerie M Pomeroy
- Rehabilitation for Older People, Rehabilitation and Ageing, Geriatric Medicine, St George's University of London, UK
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111
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Nakhostin Ansari N, Naghdi S, Hasson S, Rastgoo M. Efficacy of therapeutic ultrasound and infrared in the management of muscle spasticity. Brain Inj 2009; 23:632-8. [PMID: 19557566 DOI: 10.1080/02699050902973939] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PRIMARY OBJECTIVE This study was designed to compare the short-term effects of infrared (IR) and therapeutic ultrasound (US) on clinical and electrophysiological measures of spasticity and range of motion (ROM) in hemiplegic patients with plantar flexor muscle spasticity. RESEARCH DESIGN A cross-sectional, single centre trial. INTERVENTIONS Ultrasound and Infrared were used. METHODS AND PROCEDURES Twenty-one patients (13 males and eight females) aged 27-78 years (mean +/- SD: 60.4 +/- 13.2) were randomly assigned into either the US or IR treatment groups. The IR and US were delivered for 20 and 10 minutes, respectively. The H-reflex, Ashworth scale (AS) and ROM were collected before, immediately after and 15 minutes after the end of the treatment. MAIN OUTCOMES AND RESULTS Both groups were statistically similar on all variables at the beginning of the study. Results indicated that the dependent variables were not significantly different between groups at the end of study. The use of IR and US was not associated with significant reductions of H-reflex and Ashworth scores. A significant main effect for time on active and passive ROM was obtained. CONCLUSIONS It was concluded neither IR nor US reduced electrophysiological or clinical measures of spasticity in this sample of patients.
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112
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Burridge JH, Turk R, Notley SV, Pickering RM, Simpson DM. The relationship between upper limb activity and impairment in post-stroke hemiplegia. Disabil Rehabil 2009; 31:109-17. [PMID: 18608395 DOI: 10.1080/09638280701824699] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the relationship between upper limb impairments and activity limitation. METHOD A cross sectional, single assessment observational study in which people with hemiplegia as a result of a stroke underwent a testing procedure in an instrumented wrist rig in which the following measures of impairment were recorded: Spasticity; motor control (ability to track a moving target); muscle activation patterns during tracking; stiffness; range of active movement and isometric muscle strength. Participants also performed clinical tests of upper limb activity (Action Research Arm Test) and hyper-tonicity (Modified Ashworth Scale). RESULTS Seventeen people with hemiplegia whose mean age was 57 (SD 13.4) took part. Their mean upper limb activity, measured by the Action Research Arm Test, was 19.3 (SD 11.2). Statistically significant positive relationships between level of activity and the negative features of the upper motor neuron syndrome such as motor control r = 0.710 (p = 0.003), active range of movement r = 0.540 (p = 0.025) and strength into flexion r = 0.515 (p = 0.034) and extension r = 0.575 (p = 0.016) were identified, but not with the positive features, such as spasticity or the secondary features such as stiffness. CONCLUSIONS The negative features of the upper motor neuron syndrome appear more likely to affect upper limb activity than the positive or secondary features, but findings need confirming in different study populations, preferably with larger samples.
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113
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Hughes AM, Freeman CT, Burridge JH, Chappell PH, Lewin PL, Rogers E. Feasibility of iterative learning control mediated by functional electrical stimulation for reaching after stroke. Neurorehabil Neural Repair 2009; 23:559-68. [PMID: 19190087 DOI: 10.1177/1545968308328718] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and functional electrical stimulation (FES) to reduce upper limb impairments, but current systems may not encourage maximal voluntary contribution from the participant because assistance is not responsive to performance. OBJECTIVE This study aimed to investigate whether iterative learning control (ILC) mediated by FES is a feasible intervention in upper limb stroke rehabilitation. METHODS Five hemiparetic participants with reduced upper limb function who were at least 6 months poststroke were recruited from the community. No participants withdrew. INTERVENTION Participants undertook supported tracking tasks using 27 different trajectories augmented by responsive FES to their triceps brachii muscle, with their hand movement constrained in a 2-dimensional plane by a robot. Eighteen 1-hour treatment sessions were used with 2 participants receiving an additional 7 treatment sessions. OUTCOME MEASURES The primary functional outcome measure was the Action Research Arm Test (ARAT). Impairment measures included the upper limb Fugl-Meyer Assessment (FMA), tests of motor control (tracking accuracy), and isometric force. RESULTS Compliance was excellent and there were no adverse events. Statistically significant improvements were measured (P <or= .05) in FMA motor score, unassisted tracking for 3 out of 4 trajectories, and in isometric force over 5 out of 6 directions. Changes in ARAT were not statistically significant. CONCLUSION This study has demonstrated the feasibility of using ILC mediated by FES for upper limb stroke rehabilitation.
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Affiliation(s)
- A M Hughes
- School of Health Sciences, University of Southampton, Southampton, United Kingdom.
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114
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Cheeran B, Cohen L, Dobkin B, Ford G, Greenwood R, Howard D, Husain M, Macleod M, Nudo R, Rothwell J, Rudd A, Teo J, Ward N, Wolf S. The future of restorative neurosciences in stroke: driving the translational research pipeline from basic science to rehabilitation of people after stroke. Neurorehabil Neural Repair 2009; 23:97-107. [PMID: 19189939 PMCID: PMC3230220 DOI: 10.1177/1545968308326636] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Major advances during the past 50 years highlight the immense potential for restoration of function after neural injury, even in the damaged adult human brain. Yet, the translation of these advances into clinically useful treatments is painstakingly slow. OBJECTIVE Here, we consider why the traditional model of a "translational research pipeline" that transforms basic science into novel clinical practice has failed to improve rehabilitation practice for people after stroke. RESULTS We find that (1) most treatments trialed in vitro and in animal models have not yet resulted in obviously useful functional gains in patients; (2) most clinical trials of restorative treatments after stroke have been limited to small-scale studies; (3) patient recruitment for larger clinical trials is difficult; (4) the determinants of patient outcomes and what patients want remain complex and ill-defined, so that basic scientists have no clear view of the clinical importance of the problems that they are addressing; (5) research in academic neuroscience centers is poorly integrated with practice in front-line hospitals and the community, where the majority of patients are treated; and (6) partnership with both industry stakeholders and patient pressure groups is poorly developed, at least in the United Kingdom where research in the translational restorative neurosciences in stroke depends on public sector research funds and private charities. CONCLUSIONS We argue that interaction between patients, front-line clinicians, and clinical and basic scientists is essential so that they can explore their different priorities, skills, and concerns. These interactions can be facilitated by funding research consortia that include basic and clinical scientists, clinicians and patient/carer representatives with funds targeted at those impairments that are major determinants of patient and carer outcomes. Consortia would be instrumental in developing a lexicon of common methods, standardized outcome measures, data sharing and long-term goals. Interactions of this sort would create a research-friendly, rather than only target-led, culture in front-line stroke rehabilitation services.
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115
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Freivogel S, Mehrholz J, Husak-Sotomayor T, Schmalohr D. Gait training with the newly developed 'LokoHelp'-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury. A feasibility study. Brain Inj 2008; 22:625-32. [PMID: 18568717 DOI: 10.1080/02699050801941771] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PRIMARY OBJECTIVE To evaluate the feasibility of using a newly developed electromechanical gait device (LokoHelp) for locomotion training in neurological patients with impaired walking ability with respect to training effects and patients' and therapists' efforts and discomfort. METHODS AND PROCEDURES design: Case series. setting: A neurological rehabilitation centre for children, adolescents and young adults. subjects: Six patients with impaired walking function: two after stroke, two after spinal cord injury and two after brain injury. INTERVENTION Twenty additional training sessions on a treadmill fitted with a newly developed electromechanical gait device and body weight support (BWS), performed over a study-period of 6 weeks. MAIN OUTCOMES AND RESULTS Patients' progress was assessed with the following instruments: the Functional Ambulation Category FAC (walking ability), the 10-metre walk test (gait velocity), the Motricity Index (lower limb strength), the Berg Balance Scale (postural capacity), the modified Ashworth Scale (spasticity) and the Rivermead Mobility Index (activity). After each therapy session, therapists completed a form, thereby indicating whether manual assistance was necessary and, if so, how much physical effort was expended and how much discomfort was experienced during the therapy session. The therapists also indicated on the form information about the patient's effort and discomfort. No severe adverse events were observed during the locomotion training with the LokoHelp device. Patients improved with regard to Functional Ambulation Category (FAC) (from mean 0.7, SD = 1.6, to mean 2.5, SD = 2.1, p = 0.048), Motricity Index (from mean 94 points, SD = 50, to mean 111, SD = 52, p = 0.086), Berg Balance Scale (BBS) (from mean 20 points, SD = 23 to mean 25, SD = 23, p = 0.168) and Rivermead Mobility Index (RMI) (from mean 5 points, SD = 4, to mean 7, SD = 5, p = 0.033). Therapists required a low level of effort to carry out the training and seldom experienced discomfort. Patients described their effort during training as being low-to-exhausting. They rarely experienced discomfort, which was mostly related to difficulties with the BWS-System. Training intensity had to be adjusted in one patient who complained of knee pain. CONCLUSIONS Locomotion training with the newly developed 'LokoHelp'-system is feasible in severely affected patients after brain injury, stroke and spinal cord injury. In addition, our results indicate that the described alternative method of gait training may decrease the exertion needed by therapists to carry out the training.
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Affiliation(s)
- Susanna Freivogel
- Neurological Rehabilitation Hospital, Hegau Jugendwerk, Gailingen, Germany.
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116
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Sorinola IO, White CM, Rushton DN, Newham DJ. Electromyographic Response to Manual Passive Stretch of the Hemiplegic Wrist: Accuracy, Reliability, and Correlation With Clinical Spasticity Assessment and Function. Neurorehabil Neural Repair 2008; 23:287-94. [PMID: 19050174 DOI: 10.1177/1545968308321778] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The management of spasticity is important in neurorehabilitation and needs to be assessed accurately. The commonly used clinical tools have been criticized for lack of validity and sensitivity. Objective. To investigate the reliability of electromyographic (EMG) response to manual stretches of the hemiplegic wrist and its correlation with clinical assessments of spasticity and physical function. Methods. EMG activity was measured in 10 stroke patients and control participants (53.7 ± 10 and 32 ± 9.1 years respectively, mean ± SEM) during 3 cycles of 10 seconds passive manual movements of the wrist at 60 to 360° • s-1. Isometric maximal voluntary contractions (MVC) strength, range of movement (ROM) of the wrist flexors and extensors, spasticity (Modified Ashworth Scale [MAS]) and hand function (Block and Box Test [BBT]) were also assessed. Results. EMG activity of the stroke patients increased with velocity from 4% to 40% MVC ( P < .001) but there was none in the controls. It was unaffected by repetition and good to moderate reliability occurred at all speeds (ICC, 0.71-0.81). EMG correlated negatively with MVC strength ( r = -.9), active wrist flexion ROM ( r = -.8), and hand function scores ( r = —.7), but not with clinical measures of spasticity except at the lowest velocity ( r = .72). Conclusions. Consistent and accurate stretch velocities and EMG responses can be achieved with manual wrist stretches for the assessment of the neural component of spasticity. These objective tests did not correlate well with the standard clinical assessment of spasticity. They showed significant negative relationships with function, indicating that increased reflex excitability contributes to hand disability after stroke.
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Affiliation(s)
- Isaac O. Sorinola
- Division of Applied Biomedical Research, School of Biomedical and Health Sciences, King's College, London
| | - Claire M. White
- Division of Applied Biomedical Research, School of Biomedical and Health Sciences, King's College, London
| | - David N. Rushton
- Academic Department of Rehabilitation, King's College Hospital, London
| | - Dianne J. Newham
- Division of Applied Biomedical Research, School of Biomedical and Health Sciences, King's College, London
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117
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Mehrholz J, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke. Cochrane Database Syst Rev 2008:CD006876. [PMID: 18843735 DOI: 10.1002/14651858.cd006876.pub2] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation and might help to improve arm function after stroke. OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living and arm function and motor strength of patients after stroke, and the acceptability and safety of the therapy. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), MEDLINE (1950 to October 2007), EMBASE (1980 to October 2007), CINAHL (1982 to October 2007), AMED (1985 to October 2007), SPORTDiscus (1949 to October 2007), PEDro (searched October 2007), COMPENDEX (1972 to October 2007) and INSPEC (1969 to October 2007). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts and researchers in our field, and manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation interventions or no treatment for patients after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and relative risk differences (RD) for dichotomous variables. MAIN RESULTS We included 11 trials (328 participants) in this review. Electromechanical and robot-assisted arm training did not improve activities of daily living (SMD = 0.29; 95% confidence interval (CI) -0.47 to 1.06; P = 0.45; I(2 )= 85%). Arm motor function and arm motor strength improved (SMD = 0.68, 95% CI 0.24 to 1.11; P = 0.002; I(2 )= 56% and SMD = 01.03, 95% CI 0.29 to 1.78; P = 0.007; I(2 )= 79% respectively). Electromechanical and robot-assisted arm training did not increase the risk of patients to drop out (RD) (fixed-effect model) = 0.01; 95% CI -0.05 to 0.06; P = 0.77; I(2 )= 0.0%) and adverse events were rare. AUTHORS' CONCLUSIONS Patients who receive electromechanical and robot-assisted arm training after stroke are not more likely to improve their activities of daily living, but arm motor function and strength of the paretic arm may improve. However, the results must be interpreted with caution because there were variations between the trials in the duration, amount of training and type of treatment, and in the patient characteristics.
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Affiliation(s)
- Jan Mehrholz
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany.
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118
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Wagner LM, Capezuti E, Brush BL, Clevenger C, Boltz M, Renz S. Contractures in Frail Nursing Home Residents. Geriatr Nurs 2008; 29:259-66. [DOI: 10.1016/j.gerinurse.2007.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 09/12/2007] [Accepted: 09/15/2007] [Indexed: 10/21/2022]
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119
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Schindler-Ivens S, Desimone D, Grubich S, Kelley C, Sanghvi N, Brown DA. Lower extremity passive range of motion in community-ambulating stroke survivors. J Neurol Phys Ther 2008; 32:21-31. [PMID: 18463552 PMCID: PMC3963266 DOI: 10.1097/npt.0b013e31816594ea] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length. METHODS Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANGmax), torque required to achieve ANGmax (Tmax), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs. RESULTS Contrary to our expectations, between-group differences in ANGmax were observed only during hip extension in which ANGmax was greater bilaterally in people post-stroke compared to control subjects (P CONCLUSION This study demonstrates that community-ambulating stroke survivors with residual neuromuscular impairments do not have decreased lower extremity PROM caused by increased muscle stiffness or decreased muscle length. In fact, the population of stroke survivors examined here appears to have more hip extension PROM than age-matched able-bodied individuals. The clinical implications of these data are important and suggest that lower extremity PROM may not interfere with mobility in community-ambulating stroke survivors. Hence, physical therapists may choose to recommend activities other than stretching exercises for stroke survivors who are or will become independent community ambulators.
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Affiliation(s)
- Sheila Schindler-Ivens
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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120
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Yelnik AP, Bonan IV, Simon O, Gellez-Leman MC. Riabilitazione dopo un ictus cerebrale. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tsao CC, Mirbagheri MM. Upper limb impairments associated with spasticity in neurological disorders. J Neuroeng Rehabil 2007; 4:45. [PMID: 18047660 PMCID: PMC2213654 DOI: 10.1186/1743-0003-4-45] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 11/29/2007] [Indexed: 11/18/2022] Open
Abstract
Background While upper-extremity movement in individuals with neurological disorders such as stroke and spinal cord injury (SCI) has been studied for many years, the effects of spasticity on arm movement have been poorly quantified. The present study is designed to characterize the nature of impaired arm movements associated with spasticity in these two clinical populations. By comparing impaired voluntary movements between these two groups, we will gain a greater understanding of the effects of the type of spasticity on these movements and, potentially a better understanding of the underlying impairment mechanisms. Methods We characterized the kinematics and kinetics of rapid arm movement in SCI and neurologically intact subjects and in both the paretic and non-paretic limbs in stroke subjects. The kinematics of rapid elbow extension over the entire range of motion were quantified by measuring movement trajectory and its derivatives; i.e. movement velocity and acceleration. The kinetics were quantified by measuring maximum isometric voluntary contractions of elbow flexors and extensors. The movement smoothness was estimated using two different computational techniques. Results Most kinematic and kinetic and movement smoothness parameters changed significantly in paretic as compared to normal arms in stroke subjects (p < 0.003). Surprisingly, there were no significant differences in these parameters between SCI and stroke subjects, except for the movement smoothness (p ≤ 0.02). Extension was significantly less smooth in the paretic compared to the non-paretic arm in the stroke group (p < 0.003), whereas it was within the normal range in the SCI group. There was also no significant difference in these parameters between the non-paretic arm in stroke subjects and the normal arm in healthy subjects. Conclusion The findings suggest that although the cause and location of injury are different in spastic stroke and SCI subjects, the impairments in arm voluntary movement were similar in the two spastic groups. Our results also suggest that the non-paretic arm in stroke subjects was not distinguishable from the normal, and might therefore be used as an appropriate control for studying movement of the paretic arm.
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Affiliation(s)
- Cheng-Chi Tsao
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA.
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