1
|
Fridén J, Lieber RL. Wrist extensor pathomechanics: implications for tendon and nerve transfer. J Hand Surg Eur Vol 2024; 49:1047-1050. [PMID: 38190974 DOI: 10.1177/17531934231224737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Central and peripheral nervous system lesions may disrupt the intricate balance of the prime movers of the wrist. In spasticity, hyperactive wrist flexors create a flexion moment and, if untreated, can lead to flexion contractures. In patients with C6 spinal cord injury and tetraplegia, the posterior interosseus nerve is typically affected by a complex pattern of upper and/or lower motoneuron lesions causing radial deviation of the wrist due to loss of ulnar deviation actuators. In this report, we illustrate severe pathomechanics that may occur even with relatively modest changes in wrist balance. These results illustrate how thorough understanding of muscle-tendon-joint interaction aids in designing tendon and nerve reconstructive surgeries to normalize wrist positions and balance in neuromuscular conditions.
Collapse
Affiliation(s)
- Jan Fridén
- Department of Tetrahand Surgery and Hand Surgery (Nottwil Tetrahand), Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Richard L Lieber
- Departments of Physical Medicine and Rehabilitation, Physiology and Biomedical Engineering, Northwestern University, Chicago, IL, USA
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Hines V. A. Medical Center, Maywood, IL, USA
| |
Collapse
|
2
|
Bjelica B, Bartels MB, Hesebeck-Brinckmann J, Petri S. Non-motor symptoms in patients with amyotrophic lateral sclerosis: current state and future directions. J Neurol 2024; 271:3953-3977. [PMID: 38805053 PMCID: PMC11233299 DOI: 10.1007/s00415-024-12455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by the progressive degeneration of both upper and lower motor neurons. A defining histopathological feature in approximately 97% of all ALS cases is the accumulation of phosphorylated trans-activation response (TAR) DNA-binding protein 43 protein (pTDP-43) aggregates in the cytoplasm of neurons and glial cells within the central nervous system. Traditionally, it was believed that the accumulation of TDP-43 aggregates and subsequent neurodegeneration primarily occurs in motor neurons. However, contemporary evidence suggests that as the disease progresses, other systems and brain regions are also affected. Despite this, there has been a limited number of clinical studies assessing the non-motor symptoms in ALS patients. These studies often employ various outcome measures, resulting in a wide range of reported frequencies of non-motor symptoms in ALS patients. The importance of assessing the non-motor symptoms reflects in a fact that they have a significant impact on patients' quality of life, yet they frequently go underdiagnosed and unreported during clinical evaluations. This review aims to provide an up-to-date overview of the current knowledge concerning non-motor symptoms in ALS. Furthermore, we address their diagnosis and treatment in everyday clinical practice.
Collapse
Affiliation(s)
- Bogdan Bjelica
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Strasse, 30625, Hannover, Germany.
| | - Maj-Britt Bartels
- Precision Neurology of Neuromuscular and Motoneuron Diseases, University of Luebeck, Lübeck, Germany
| | - Jasper Hesebeck-Brinckmann
- Neurology Department, Division for Neurodegenerative Diseases, University Medicine Mannheim, Heidelberg University, Mannheim Center for Translational Medicine, Mannheim, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Strasse, 30625, Hannover, Germany
| |
Collapse
|
3
|
Lee Y, Park HS. Design Optimization of a Soft Robotic Rehabilitation Glove Based on Finger Workspace Analysis. Biomimetics (Basel) 2024; 9:172. [PMID: 38534857 DOI: 10.3390/biomimetics9030172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024] Open
Abstract
The finger workspace is crucial for performing various grasping tasks. Thus, various soft rehabilitation gloves have been developed to assist individuals with paralyzed hands in activities of daily living (ADLs) or rehabilitation training. However, most soft robotic glove designs are insufficient to assist with various hand postures because most of them use an underactuated mechanism for design simplicity. Therefore, this paper presents a methodology for optimizing the design of a high-degree-of-freedom soft robotic glove while not increasing the design complexity. We defined the required functional workspace of the index finger based on ten frequently used grasping postures in ADLs. The design optimization was achieved by simulating the proposed finger-robot model to obtain a comparable workspace to the functional workspace. In particular, the moment arm length for extension was optimized to facilitate the grasping of large objects (precision disk and power sphere), whereas a torque-amplifying routing design was implemented to aid the grasping of small objects (lateral pinch and thumb-two-finger pinch). The effectiveness of the optimized design was validated through testing with a stroke survivor and comparing the assistive workspace. The observed workspace demonstrated that the optimized glove design could assist with nine out of the ten targeted grasping posture functional workspaces. Furthermore, the assessment of the grasping speed and force highlighted the glove's usability for various rehabilitation activities. We also present and discuss a generalized methodology to optimize the design parameters of a soft robotic glove that uses an underactuated mechanism to assist the targeted workspace. Overall, the proposed design optimization methodology serves as a tool for developing advanced hand rehabilitation robots, as it offers insight regarding the importance of routing optimization in terms of the workspace.
Collapse
Affiliation(s)
- Yechan Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| |
Collapse
|
4
|
Hunter H, Qin E, Wallingford A, Hyon A, Patel A. Neurorehabilitation for Adults with Brain and Spine Tumors. Semin Neurol 2024; 44:64-73. [PMID: 38049116 DOI: 10.1055/s-0043-1777407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Central nervous system (CNS) malignancies (i.e. brain and spine tumors) and their treatments can result in a multitude of neurologic deficits. Patients with CNS malignancies experience physical, cognitive, and psychosocial sequelae that can impact their mobility and quality of life. Neurorehabilitation can play a critical role in maintaining independence, preventing disability, and optimizing safety with activities of daily living. This review provides an overview of the neurorehabilitation approaches for patients with CNS malignancies, neurologic impairments frequently treated, and rehabilitation interventions in various health care settings. In addition, we will highlight rehabilitative outcomes between patients with nononcologic neurologic conditions compared to brain and spine tumors. Finally, we address medical challenges that may impact rehabilitation care in these medically complex cancer patients.
Collapse
Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - April Hyon
- Department of Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amar Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
5
|
Zhu T, Liu K, Ni BY, Li L, Jin HP, Wu W. Effects of extracorporeal shock wave therapy combined with isokinetic strength training on spastic calf triceps in patients after a stroke: a double-blinded randomised controlled trial. Neurol Res 2023; 45:1019-1025. [PMID: 37668321 DOI: 10.1080/01616412.2023.2255413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To evaluate the antitetanic effects of extracorporeal shock wave therapy (ESWT) combined with isokinetic strength training (IST) on calf triceps spasm in patients after a stroke. METHODS Forty-five patients with hemiplegia after a stroke and lower extremity spasms were randomly assigned into three groups: a control group (n = 15), an ESWT group (n = 15) and an ESWT+IST group (n = 15). All patients agreed to conventional rehabilitation therapy, while the ESWT and ESWT+IST groups received ESWT of 2.0-3.0 bar once a week for four weeks. In addition, the ESWT+IST group underwent four weeks of ankle IST. All groups were assessed using the modified Ashworth scale (MAS) and surface electromyography before and after four weeks of treatment. The ankle passive movement of all groups was measured using the BIODEX isokinetic system at angular velocities of 60°/s, 120°/s, 180°/s and 240°/s. RESULTS After four weeks of treatment, compared with the control group, the ESWT+IST groups showed a significant reduction in MASscores (P = 0.030). The ESWT+IST group had significantly lower MAS scores than the baseline (P = 0.002), while the ESWT group did not show a significant difference (P = 0.072). The average electromyography (AEMG) analysis demonstrated a significant difference among the groups after four weeks (P = 0.001), with the ESWT+IST group having lower AEMG values compared with the control group (P < 0.001) and the ESWT group (P = 0.042). Peak resistive torque significantly decreased in both the ESWT and ESWT+IST groups at all velocities (60°/s: P = 0.030, 120°/s: P = 0.039, 180°/s: P = 0.030 and 240°/s: P = 0.042). CONCLUSIONS Extracorporeal shock wave therapy combined with IST can significantly improve calf triceps spasm in patients after a stroke.
Collapse
Affiliation(s)
- Ting Zhu
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Liu
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo-Ye Ni
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Li
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hua-Ping Jin
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wu
- Department of Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
6
|
Hassan AB, Salihu AT, Masta MA, Gunn H, Marsden J, Abdullahi A, Ahmad RY, Danazumi MS. Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis. Spinal Cord 2023; 61:587-599. [PMID: 37640926 DOI: 10.1038/s41393-023-00928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis of clinical trials. OBJECTIVES To determine the effect of non-invasive transcutaneous spinal direct current stimulation (tsDCS) on spasticity, activity limitations and participation restrictions in various upper motor neuron diseases. METHODS Six databases including CINAHL plus, Cochrane CENTRAL, Embase, MEDLINE, SCOPUS and Web of Science were searched for the relevant records from January 2008 to December 2022. Two reviewers independently selected and extracted data on spasticity, activity limitations and participation restrictions. The risk of bias was evaluated using the PEDro scale while the GRADE approach established the certainty of the evidence. RESULTS Eleven studies were identified of which 5 (45.5%) were rated as having a low risk of bias and 8 (72.7%) were meta-analyzed. The meta-analyses did not show any significant differences between cathodal (SMD = -0.67, 95% CI = -1.50 to 0.15, P = 0.11, I2 = 75%, 6 RCTs) or anodal (SMD = 0.11, 95% CI = -0.43 to -0.64, p = 0.69, I2 = 0%, 2 RCTs) and sham tsDCS for spasticity. There was also no significant difference between active and sham tsDCS for activity limitations (SMD = -0.42, 95% CI = -0.04 to 0.21, p = 0.2, I2 = 0%, 2 RCTs) and participation restrictions (MD = -8.10, 95% CI = -18.02 to 1.82, p = 0.11, 1 RCT). CONCLUSIONS The meta-analysis of the available evidence provides an uncertain estimate of the effect of cathodal tsDCS on spasticity, activity limitation and participation restriction. It might be very helpful, or it may make no difference at all. However, considering the level of the evidence and the limitation in the quality of the majority of the included studies, further well-designed research may likely change the estimate of effect. TRIAL REGISTRATION PROSPERO CRD42021245601.
Collapse
Affiliation(s)
- Auwal B Hassan
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Abubakar T Salihu
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Mamman A Masta
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Hilary Gunn
- Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Jonathan Marsden
- Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Rufa'i Y Ahmad
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Musa S Danazumi
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, College of Sciences, Health and Engineering, La Trobe University, Bundoora, VIC, 3085, Australia.
| |
Collapse
|
7
|
Abreu-Corrales A, Velasco A, Cuesta-Gómez A, Sánchez-González JL. Impact of reflex locomotion and the Bobath concept on clinical and biomolecular parameters in people with multiple sclerosis: study protocol for a randomized controlled trial. Front Neurol 2023; 14:1209477. [PMID: 37602251 PMCID: PMC10438460 DOI: 10.3389/fneur.2023.1209477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is a progressive disease with a fluctuating and unpredictable course that has no curative treatment at present. One of its main characteristics is the variety of signs and symptoms that produce a high percentage of patients who present alterations in balance and gait during the development of the disease, decreased muscle strength, spasticity, or decreased pimax. Rehabilitative therapy, especially physiotherapy, is the main course of the treatment of these alterations using reflex locomotion and the Bobath concept as a form of kinesitherapy that activates the preorganized circuits of the central nervous system. Objective The objective of this study is to evaluate the reflex locomotion and Bobath concept effects on balance, spasticity, reaction time, respiratory parameters, and lacrimal biomolecular markers. Methods and analysis This is a randomized controlled trial on the effectiveness of two neurorehabilitation techniques in patients with multiple sclerosis conducted at the University of Salamanca. The research will take place at the Faculty of Nursing and Physiotherapy, University of Salamanca. The study will be conducted from June 2023 to June 2024. The reflex locomotion group will receive individual sessions of therapy (n = 27), and the Bobath concept group (n = 27) will receive the same number of sessions. Both groups will receive two sessions per week for 12 months. The measurement variables will be the Berg Balance Scale, the Tardieu Scale, the Cognitfit Program, Maximum Inspiratory Pressure, and Lacrimal Biomarkers. Ethics and dissemination This study has been approved by the Ethics Committee of the University of Salamanca on March 2023 (ref: 896). Limitations The main limitations of this study are the selection and number of patients, the delay in implementing the therapy within the initially scheduled period, inadequate sample collection, and inadequate sample processing. Trial registration number ClinicalTrials.gov; identifier: NCT05558683.
Collapse
Affiliation(s)
| | - Ana Velasco
- Department of Biochemistry and Molecular Biology, Institute of Neurosciences of Castilla and Leon (INCYL), Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Alicia Cuesta-Gómez
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | |
Collapse
|
8
|
Biktimirov A, Bryukhovetskiy I, Sharma A, Sharma HS. Neuromodulation and quality of life for patient with spasticity after spinal cord injury. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 172:79-99. [PMID: 37833019 DOI: 10.1016/bs.irn.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
RATIONALE Spasticity develops in 80% of spinal cord injury cases and negatively affects the patents' quality of life. The most common method of surgical treatment for severe spasticity is a long-term intrathecal baclofen therapy (ITB). Long-term spinal cord stimulation is another possible treatment technique. This paper aims to evaluate the changes in quality of life for patients with spasticity who have been treated with neuromodulation (SCS or ITB) in 12 months after the surgery, as well to compare the changes in quality of life for patients who have been treated with spinal cord stimulation and those who received long-term intrathecal baclofen therapy. MATERIALS AND METHODS The influence of spasticity, experienced by the patients with a spinal cord injury, on their quality of life was analyzed before the surgery and 12 months after it. The severity of the spinal cord damage was determined with the scale of the American Spinal Injury Association (ASIA); spasticity was evaluated with the modified Ashworth scale, Penn Spasm Frequency Scale; pain levels were determined with visual analogue scale (VAS), anxiety and depression levels - with HADS. Functional activity of the patients was evaluated with the help of the Functional Independence Measure (FIM). RESULTS The treatment results for 33 patients (25 men and 8 women), aged from 18 to 62, are presented. After the trial stimulation, the patients were randomly assigned to either SCS or ITB group (18 and 15 people respectively). The decrease of spasticity in both experimental groups caused lower levels of pain, less functional dependency on other people, lower stress and depression rates and, as a consequence, better quality of life and social adaptation. The obtained results for SCS and ITB groups are statistically similar.
Collapse
Affiliation(s)
- Artur Biktimirov
- Department of Neurosurgery, Far Eastern Federal University, Medical Center, Vladivostok, Russia.
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, Far Eastern Federal University, School of Biomedicine, Vladivostok, Russia
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| |
Collapse
|
9
|
Franz S, Heutehaus L, Tappe-Theodor A, Weidner N, Treede RD, Schuh-Hofer S. Noxious radiant heat evokes bi-component nociceptive withdrawal reflexes in spinal cord injured humans-A clinical tool to study neuroplastic changes of spinal neural circuits. Front Hum Neurosci 2023; 17:1141690. [PMID: 37200949 PMCID: PMC10185789 DOI: 10.3389/fnhum.2023.1141690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Investigating nocifensive withdrawal reflexes as potential surrogate marker for the spinal excitation level may widen the understanding of maladaptive nociceptive processing after spinal cord injury (SCI). The aim of this prospective, explorative cross-sectional observational study was to investigate the response behavior of individuals with SCI to noxious radiant heat (laser) stimuli and to assess its relation to spasticity and neuropathic pain, two clinical consequences of spinal hyperexcitability/spinal disinhibition. Laser stimuli were applied at the sole and dorsum of the foot and below the fibula head. Corresponding reflexes were electromyography (EMG) recorded ipsilateral. Motor responses to laser stimuli were analyzed and related to clinical readouts (severity of injury/spasticity/pain), using established clinical assessment tools. Twenty-seven participants, 15 with SCI (age 18-63; 6.5 years post-injury; AIS-A through D) and 12 non-disabled controls, [non-disabled controls (NDC); age 19-63] were included. The percentage of individuals with SCI responding to stimuli (70-77%; p < 0.001), their response rates (16-21%; p < 0.05) and their reflex magnitude (p < 0.05) were significantly higher compared to NDC. SCI-related reflexes clustered in two time-windows, indicating involvement of both A-delta- and C-fibers. Spasticity was associated with facilitated reflexes in SCI (Kendall-tau-b p ≤ 0.05) and inversely associated with the occurrence/severity of neuropathic pain (Fisher's exact p < 0.05; Eta-coefficient p < 0.05). However, neuropathic pain was not related to reflex behavior. Altogether, we found a bi-component motor hyperresponsiveness of SCI to noxious heat, which correlated with spasticity, but not neuropathic pain. Laser-evoked withdrawal reflexes may become a suitable outcome parameter to explore maladaptive spinal circuitries in SCI and to assess the effect of targeted treatment strategies. Registration: https://drks.de/search/de/trial/DRKS00006779.
Collapse
Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Steffen Franz,
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Tappe-Theodor
- Department of Molecular Pharmacology, Medical Faculty Heidelberg, Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany
- *Correspondence: Sigrid Schuh-Hofer,
| |
Collapse
|
10
|
Fan J, Fu H, Xie X, Zhong D, Li Y, Liu X, Zhang H, Zhang J, Huang J, Li J, Jin R, Zheng Z. The effectiveness and safety of repetitive transcranial magnetic stimulation on spasticity after upper motor neuron injury: A systematic review and meta-analysis. Front Neural Circuits 2022; 16:973561. [PMID: 36426136 PMCID: PMC9679509 DOI: 10.3389/fncir.2022.973561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
To systematically evaluate the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on spasticity after upper motor neuron (UMN) injury. Eight electronic databases were searched from inception to August 6, 2022. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS on spasticity after UMN injury were retrieved. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Review Manager 5.3 and Stata 14.0 software were used to synthesize data. The certainty of the evidence was appraised with the Grade of Recommendation, Assessment, Development and Evaluation tool. Forty-two studies with a total of 2,108 patients were included. The results of meta-analysis revealed that, compared with control group, rTMS could significantly decrease scores of the Modified Ashworth Scale (MAS) in patients with UMN injury. The subgroup analysis discovered that rTMS effectively decreased the MAS scores in patients with stroke. Meanwhile, rTMS treatment > 10 sessions has better effect and rTMS could decrease the MAS scores of upper limb. Thirty-three patients complained of twitching facial muscles, headache and dizziness, etc. In summary, rTMS could be recommended as an effective and safe therapy to relieve spasticity in patients with UMN injury. However, due to high heterogeneity and limited RCTs, this conclusion should be treated with caution.
Collapse
Affiliation(s)
- Jin Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Hui Fu
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaolong Xie
- Department of Rehabilitation Medicine, The Affiliated Meishan Hospital of Chengdu University of Traditional Chinese Medicine, Meishan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huiling Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiaxi Huang
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Juan Li,
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,*Correspondence: Rongjiang Jin,
| | - Zhong Zheng
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China,Zhong Zheng,
| |
Collapse
|
11
|
Seim CE, Ritter B, Starner TE, Flavin K, Lansberg MG, Okamura AM. Design of a wearable vibrotactile stimulation device for individuals with upper-limb hemiparesis and spasticity. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1277-1287. [PMID: 35552152 PMCID: PMC10139869 DOI: 10.1109/tnsre.2022.3174808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vibratory stimulation may improve post-stroke symptoms such as spasticity; however, current studies are limited by the large, clinic-based apparatus used to apply this stimulation. A wearable device could provide vibratory stimulation in a mobile form, enabling further study of this technique. An initial device, the vibrotactile stimulation (VTS) Glove, was deployed in an eight-week clinical study in which sixteen individuals with stroke used the device for several hours daily. Participants reported wearing the glove during activities such as church, social events, and dining out. However, 69% of participants struggled to extend or insert their fingers to don the device. In a follow-up study, eight individuals with stroke evaluated new VTS device prototypes in a three-round iterative design study with the aims of creating the next generation of VTS devices and understanding features that influence interaction with a wearable device by individuals with impaired upper-limb function. Interviews and interaction tasks were used to define actionable design revisions between each round of evaluation. Our analysis identified six new themes from participants regarding device designs: hand supination is challenging, separate finger attachments inhibit fit and use, fingers may be flexed or open, fabric coverage impacts comfort, a reduced concern for social comfort, and the affected hand is infrequently used. Straps that wrap around the arm and fixtures on the anterior arm were other challenging features. We discuss potential accommodations for these challenges, as well as social comfort. New VTS device designs are presented and were donned in an average time of 48 seconds.
Collapse
|
12
|
Pradines M, Ghédira M, Bignami B, Vielotte J, Bayle N, Marciniak C, Burke D, Hutin E, Gracies JM. Do Muscle Changes Contribute to the Neurological Disorder in Spastic Paresis? Front Neurol 2022; 13:817229. [PMID: 35370894 PMCID: PMC8964436 DOI: 10.3389/fneur.2022.817229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background At the onset of stroke-induced hemiparesis, muscle tissue is normal and motoneurones are not overactive. Muscle contracture and motoneuronal overactivity then develop. Motor command impairments are classically attributed to the neurological lesion, but the role played by muscle changes has not been investigated. Methods Interaction between muscle and command disorders was explored using quantified clinical methodology-the Five Step Assessment. Six key muscles of each of the lower and upper limbs in adults with chronic poststroke hemiparesis were examined by a single investigator, measuring the angle of arrest with slow muscle stretch (XV1) and the maximal active range of motion against the resistance of the tested muscle (XA). The coefficient of shortening CSH = (XN-XV1)/XN (XN, normally expected amplitude) and of weakness CW = (XV1-XA)/XV1) were calculated to estimate the muscle and command disorders, respectively. Composite CSH (CCSH) and CW (CCW) were then derived for each limb by averaging the six corresponding coefficients. For the shortened muscles of each limb (mean CSH > 0.10), linear regressions explored the relationships between coefficients of shortening and weakness below and above their median coefficient of shortening. Results A total of 80 persons with chronic hemiparesis with complete lower limb assessments [27 women, mean age 47 (SD 17), time since lesion 8.8 (7.2) years], and 32 with upper limb assessments [18 women, age 32 (15), time since lesion 6.4 (9.3) years] were identified. The composite coefficient of shortening was greater in the lower than in the upper limb (0.12 ± 0.04 vs. 0.08 ± 0.04; p = 0.0002, while the composite coefficient of weakness was greater in the upper limb (0.28 ± 0.12 vs. 0.15 ± 0.06, lower limb; p < 0.0001). In the lower limb shortened muscles, the coefficient of weakness correlated with the composite coefficient of shortening above the 0.15 median CSH (R = 0.43, p = 0.004) but not below (R = 0.14, p = 0.40). Conclusion In chronic hemiparesis, muscle shortening affects the lower limb particularly, and, beyond a threshold of severity, may alter descending commands. The latter might occur through chronically increased intramuscular tension, and thereby increased muscle afferent firing and activity-dependent synaptic sensitization at the spinal level.
Collapse
Affiliation(s)
- Maud Pradines
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Mouna Ghédira
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Blaise Bignami
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jordan Vielotte
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nicolas Bayle
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University and the Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Neurology, Northwestern University and the Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Emilie Hutin
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean-Michel Gracies
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| |
Collapse
|
13
|
Biktimirov A, Pak O, Bryukhovetskiy I, Sharma A, Sharma HS. Neuromodulation as a basic platform for neuroprotection and repair after spinal cord injury. PROGRESS IN BRAIN RESEARCH 2021; 266:269-300. [PMID: 34689861 DOI: 10.1016/bs.pbr.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Spinal cord injury (SCI) is one of the most challenging medical issues. Spasticity is a major complication of SCI. A combination of spinal cord stimulation, new methods of neuroprotection and biomedical cellular products provides fundamentally new options for SCI treatment and rehabilitation. The paper attempts to critically analyze the effectiveness of using these procedures for patients with SCI, suggesting a protocol for a step-by-step personalized treatment of SCI, based on continuity of modern conservative and surgical methods. The study argues the possibility of using neuromodulation as a basis for rehabilitating patients with SCI.
Collapse
Affiliation(s)
- Artur Biktimirov
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.
| | - Oleg Pak
- Department of Neurosurgery, Medical Center, Far Eastern Federal University, Vladivostok, Russia
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
14
|
Huang J, Qu Y, Liu L, Zhao K, Zhao Z. Efficacy and safety of transcranial direct current stimulation for post-stroke spasticity: A meta-analysis of randomised controlled trials. Clin Rehabil 2021; 36:158-171. [PMID: 34387103 DOI: 10.1177/02692155211038097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of transcranial direct current stimulation for post-stroke spasticity and to assess its evidence using a meta-analysis. METHODS We searched the Cochrane Library, EMBASE, MEDLINE (via PubMed), PEDro, CBM, CNKI and Wan Fang Data from their inception to June 2021 for randomised clinical trials published in English or Chinese, which aimed to explore the effects of transcranial direct current stimulation on post-stroke spasticity. Two reviewers independently extracted the data and evaluated the methodological quality and overall evidence quality. RESULTS Thirteen randomised clinical trials comprising 924 patients were included, 12 of which were included in the meta-analysis. The results showed that anodal stimulation (standard mean difference = -0.91; [95% CI; -1.63 to -0.19]) combined with other therapies was more effective in improving upper limb spasticity. More than 20 minutes of stimulation were found to be effective in improving spasticity. Transcranial direct current stimulation was superior to the control treatments for subacute (standard mean difference = -1.16; -1.75 to -0.57) and chronic stroke (standard mean difference = -0.68; -1.13 to -0.22) patients aged under 60 (standard mean difference = -1.07; -1.54 to -0.60). No severe adverse events were reported in any of the included studies. CONCLUSIONS Low-quality evidence demonstrates that anodal transcranial direct current stimulation as an adjunct is effective and safe in reducing upper limb post-stroke spasticity when applied for more than 20 minutes in subacute and chronic stroke survivors aged under 60. Further high-quality studies are needed to explore its long-term efficacy and safety.
Collapse
Affiliation(s)
- Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Neuro Rehabilitation, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Neuro Rehabilitation, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lini Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Neuro Rehabilitation, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Kehong Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Neuro Rehabilitation, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ziqi Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Neuro Rehabilitation, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
15
|
Abstract
Movement disorders in a pediatric population represent a spectrum of secondary functional deficits affecting ease of care, ambulation, and activities of daily living. Cerebral palsy represents the most common form of movement disorder seen in the pediatric population. Several medical and surgical options exist in the treatment of pediatric spasticity and dystonia, which can have profound effects on the functionality of these patients. Given the complex medical and surgical problems in these patients, children are well served by a multidisciplinary team of practitioners, including physical therapists, physical medicine and rehabilitation physicians, and surgeons.
Collapse
Affiliation(s)
- Samuel G McClugage
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin Street, Suite 1230.01, Houston, TX 77030, USA
| | - David F Bauer
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin Street, Suite 1230.01, Houston, TX 77030, USA.
| |
Collapse
|
16
|
Villegas-López FA, Armas-Salazar A, Beltrán JQ, Téllez-León N, Arellano-Alcántara A, Navarro-Olvera JL, Carrillo-Ruiz JD. A Case of Dentatotomy for Pain and Spasticity and Systematic Review. Stereotact Funct Neurosurg 2021; 99:521-525. [PMID: 34107470 DOI: 10.1159/000516423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical interventions for spasticity aim to improve motor function and pain in cases that are refractory to medical treatment. Ablation of the cerebellar dentate nucleus (dentatotomy) may be a useful alternative. CASE REPORT A 55-year-old male patient with spasticity, secondary to a traumatic cervical spinal cord injury with quadriparesis, had bilateral lumbar DREZotomy with an improvement that lasted for 6 years. Ten years after the DREZotomy, a progressive increased spasticity manifested as spastic diplegia (Ashworth 4) and spontaneous muscle painful spasms (Penn 4), as well as spasticity in the upper extremities, predominantly on the right side (Ashworth 3). A right radio frequency dentatotomy was performed with intraoperative electrophysiological monitoring. Spasticity scales were applied at the following times: preoperative and at 1 and 8 months after surgery. During the first month, the patient presented a clear decrease in spasticity ipsilateral to the side of lesioning (Ashworth 1) and of painful spasms in the lower extremities (Penn 1). After 8 months, spasticity ipsilateral to the injury decreased even more to Ashworth (0), but a progressive increase in muscle spasms of lower extremities was observed (Penn 2). CONCLUSION Stereotactic dentatotomy may be an effective surgical alternative for management of spasticity associated with painful spasms in selected patients.
Collapse
Affiliation(s)
| | - Armando Armas-Salazar
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Jesús Q Beltrán
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Noé Téllez-León
- Physical Medicine & Rehabilitation Service, General Hospital of México, Mexico City, Mexico
| | | | - José Luis Navarro-Olvera
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - José Damián Carrillo-Ruiz
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
- Research Direction of General Hospital of Mexico, Mexico City, Mexico
- Direction of Faculty of Health Sciences, Anahuac University Mexico, Mexico City, Mexico
| |
Collapse
|
17
|
Bilchak JN, Yeakle K, Caron G, Malloy D, Côté MP. Enhancing KCC2 activity decreases hyperreflexia and spasticity after chronic spinal cord injury. Exp Neurol 2021; 338:113605. [PMID: 33453210 PMCID: PMC7904648 DOI: 10.1016/j.expneurol.2021.113605] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 02/03/2023]
Abstract
After spinal cord injury (SCI), the majority of individuals develop spasticity, a debilitating condition involving involuntary movements, co-contraction of antagonistic muscles, and hyperreflexia. By acting on GABAergic and Ca2+-dependent signaling, current anti-spastic medications lead to serious side effects, including a drastic decrease in motoneuronal excitability which impairs motor function and rehabilitation efforts. Exercise, in contrast, decreases spastic symptoms without decreasing motoneuron excitability. These functional improvements coincide with an increase in expression of the chloride co-transporter KCC2 in lumbar motoneurons. Thus, we hypothesized that spastic symptoms can be alleviated directly through restoration of chloride homeostasis and endogenous inhibition by increasing KCC2 activity. Here, we used the recently developed KCC2 enhancer, CLP257, to evaluate the effects of acutely increasing KCC2 extrusion capability on spastic symptoms after chronic SCI. Sprague Dawley rats received a spinal cord transection at T12 and were either bike-trained or remained sedentary for 5 weeks. Increasing KCC2 activity in the lumbar enlargement improved the rate-dependent depression of the H-reflex and reduced both phasic and tonic EMG responses to muscle stretch in sedentary animals after chronic SCI. Furthermore, the improvements due to this pharmacological treatment mirror those of exercise. Together, our results suggest that pharmacologically increasing KCC2 activity is a promising approach to decrease spastic symptoms in individuals with SCI. By acting to directly restore endogenous inhibition, this strategy has potential to avoid severe side effects and improve the quality of life of affected individuals.
Collapse
Affiliation(s)
- Jadwiga N Bilchak
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Kyle Yeakle
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Guillaume Caron
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Dillon Malloy
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Injury Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, United States of America.
| |
Collapse
|
18
|
Bhimani R, Gaugler JE, Felts J, Mathiason MA. Validation of the Muscle Tightness Measurement Tool. J Nurs Meas 2021; 29:106-120. [PMID: 33334849 DOI: 10.1891/jnm-d-19-00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE For nurses, muscle tightness is an important aspect of patient care, but no bedside tool is available that allows them to measure it. Therefore, a standardized tool that measures muscle tightness is needed. The purpose of this study was to validate a tool to measure muscle tightness. METHODS Using Delphi technique and quantitative design, the tool was validated in two phases. The phase 1 included 20 expert clinicians who established content validity with Lawshe's rating. In phase 2, divergent validity was established by administering the tool to one group that had muscle tightness (n = 26) and one group that did not (n = 20). RESULTS Findings indicate that the muscle tightness measurement tool has content and divergent validity. CONCLUSIONS Further tool refinement with validity and reliability studies are recommended for clinical practice.
Collapse
Affiliation(s)
| | | | - Jill Felts
- Hillcrest of Wayzata Rehabilitation & Health Care Center, Wayzata, MN
| | | |
Collapse
|
19
|
Seim CE, Wolf SL, Starner TE. Wearable vibrotactile stimulation for upper extremity rehabilitation in chronic stroke: clinical feasibility trial using the VTS Glove. J Neuroeng Rehabil 2021; 18:14. [PMID: 33485371 PMCID: PMC7824932 DOI: 10.1186/s12984-021-00813-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluate the feasibility and potential impacts on hand function using a wearable stimulation device (the VTS Glove) which provides mechanical, vibratory input to the affected limb of chronic stroke survivors. METHODS A double-blind, randomized, controlled feasibility study including sixteen chronic stroke survivors (mean age: 54; 1-13 years post-stroke) with diminished movement and tactile perception in their affected hand. Participants were given a wearable device to take home and asked to wear it for three hours daily over eight weeks. The device intervention was either (1) the VTS Glove, which provided vibrotactile stimulation to the hand, or (2) an identical glove with vibration disabled. Participants were randomly assigned to each condition. Hand and arm function were measured weekly at home and in local physical therapy clinics. RESULTS Participants using the VTS Glove showed significantly improved Semmes-Weinstein monofilament exam results, reduction in Modified Ashworth measures in the fingers, and some increased voluntary finger flexion, elbow and shoulder range of motion. CONCLUSIONS Vibrotactile stimulation applied to the disabled limb may impact tactile perception, tone and spasticity, and voluntary range of motion. Wearable devices allow extended application and study of stimulation methods outside of a clinical setting.
Collapse
Affiliation(s)
- Caitlyn E Seim
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thad E Starner
- College of Computing, Georgia Institute of Technology, Atlanta, CA, USA
| |
Collapse
|
20
|
Ledri LN, Pingel J, Hultborn H, Therkildsen ER, Wienecke J, Nielsen JB. Immobilization leads to reduced stretch reflexes but increased central reflex gain in the rat. J Neurophysiol 2020; 124:985-993. [PMID: 32783594 DOI: 10.1152/jn.00748.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Plastic adaptations are known to take place in muscles, tendons, joints, and the nervous system in response to changes in muscle activity. However, few studies have addressed how these plastic adaptations are related. Thus this study focuses on changes in the mechanical properties of the ankle plantarflexor muscle-tendon unit, stretch reflex activity, and spinal neuronal pathways in relation to cast immobilization. The left rat hindlimb from toes to hip was immobilized with a plaster cast for 1, 2, 4, or 8 wk followed by acute electrophysiological recordings to investigate muscle stiffness and stretch reflex torque. Moreover, additional acute experiments were performed after 4 wk of immobilization to investigate changes in the central gain of the stretch reflex. Monosynaptic reflexes (MSR) were recorded from the L4 and L5 ventral roots following stimulation of the corresponding dorsal roots. Rats developed reduced range of movement in the ankle joint 2 wk after immobilization. This was accompanied by significant increases in the stiffness of the muscle-tendon complex as well as an arthrosis at the ankle joint at 4 and 8 wk following immobilization. Stretch reflexes were significantly reduced at 4-8 wk following immobilization. This was associated with increased central gain of the stretch reflex. These data show that numerous interrelated plastic changes occur in muscles, connective tissue, and the central nervous system in response to changes in muscle use. The findings provide an understanding of coordinated adaptations in multiple tissues and have important implications for prevention and treatment of the negative consequences of immobilization following injuries of the nervous and musculoskeletal systems.NEW & NOTEWORTHY Immobilization leads to multiple simultaneous adaptive changes in muscle, connective tissue, and central nervous system.
Collapse
Affiliation(s)
| | - Jessica Pingel
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Hans Hultborn
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | | | - Jacob Wienecke
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Elsass Foundation, Holmegårdsvej, Charlottenlund, Denmark
| |
Collapse
|
21
|
Sato S, Lim J, Miehm JD, Buonaccorsi J, Rajala C, Khalighinejad F, Ionete C, Kent JA, van Emmerik RE. Rapid foot-tapping but not hand-tapping ability is different between relapsing-remitting and progressive multiple sclerosis. Mult Scler Relat Disord 2020; 41:102031. [DOI: 10.1016/j.msard.2020.102031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/07/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
|
22
|
Spastic movement disorder: should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement? Exp Brain Res 2020; 238:1627-1636. [DOI: 10.1007/s00221-020-05792-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/18/2020] [Indexed: 12/29/2022]
|
23
|
Dutt-Mazumder A, Segal RL, Thompson AK. Effect of Ankle Angles on the Soleus H-Reflex Excitability During Standing. Motor Control 2020; 24:189-203. [PMID: 31899887 PMCID: PMC7329593 DOI: 10.1123/mc.2018-0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
This study investigated effects of ankle joint angle on the Hoffman's reflex (H-reflex) excitability during loaded (weight borne with both legs) and unloaded (full body weight borne with the contralateral leg) standing in people without neurological injuries. Soleus H-reflex/M-wave recruitment curves were examined during upright standing on three different slopes that imposed plantar flexion (-15°), dorsiflexion (+15°), and neutral (0°) angles at the ankle, with the test leg loaded and unloaded. With the leg loaded and unloaded, maximum H-reflex/maximum M-wave ratio of -15° was significantly larger than those of 0° and +15° conditions. The maximum H-reflex/maximum M-wave ratios were 51%, 43%, and 41% with loaded and 56%, 46%, and 44% with unloaded for -15°, 0°, and +15° slope conditions, respectively. Thus, limb loading/unloading had limited impact on the extent of influence that ankle angles exert on the H-reflex excitability. This suggests that task-dependent central nervous system control of reflex excitability may regulate the influence of sensory input on the spinal reflex during standing.
Collapse
|
24
|
Yoshikawa K, Koseki K, Endo Y, Yamamoto S, Kanae K, Takeuchi R, Yozu A, Mutsuzaki H. Adjusting Assistance Commensurates with Patient Effort During Robot-Assisted Upper Limb Training for a Patient with Spasticity After Cervical Spinal Cord Injury: A Case Report. ACTA ACUST UNITED AC 2019; 55:medicina55080404. [PMID: 31344963 PMCID: PMC6723405 DOI: 10.3390/medicina55080404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
Limited evidence is available on optimal patient effort and degree of assistance to achieve preferable changes during robot-assisted training (RAT) for spinal cord injury (SCI) patients with spasticity. To investigate the relationship between patient effort and robotic assistance, we performed training using an electromyography-based robotic assistance device (HAL-SJ) in an SCI patient at multiple settings adjusted to patient effort. In this exploratory study, we report immediate change in muscle contraction patterns, patient effort, and spasticity in a 64-year-old man, diagnosed with cervical SCI and with American Spinal Injury Association Impairment Scale C level and C4 neurological level, who underwent RAT using HAL-SJ from post-injury day 403. Three patient effort conditions (comfortable, somewhat hard, and no-effort) by adjusting HAL-SJ’s assists were set for each training session. Degree of effort during flexion and extension exercise was assessed by visual analog scale, muscle contraction pattern by electromyography, modified Ashworth scale, and maximum elbow extension and flexion torques, immediately before and after each training session, without HAL-SJ. The amount of effort during training with the HAL-SJ at each session was evaluated. The degree of effort during training can be set to three effort conditions as we intended by adjusting HAL-SJ. In sessions other than the no-effort setting, spasticity improved, and the level of effort was reduced immediately after training. Spasticity did not decrease in the training session using HAL-SJ with the no-effort setting, but co-contraction further increased during extension after training. Extension torque was unchanged in all sessions, and flexion torque decreased in all sessions. When performing upper-limb training with HAL-SJ in this SCI patient, the level of assistance with some effort may reduce spasticity and too strong assistance may increase co-contraction. Sometimes, a patient’s effort may be seemingly unmeasurable; hence, the degree of patient effort should be further measured.
Collapse
Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan.
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Yusuke Endo
- Department of Physical Therapy, Faculty of Health Science, Health Science University, 7187 Kodachi, Fujikawaguchiko-machi, Minamitsuru-gun, Yamanashi 401-0380, Japan
| | - Satoshi Yamamoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Kyoko Kanae
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Arito Yozu
- Department of Rehabilitation, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan
| |
Collapse
|
25
|
Modulation of soleus stretch reflexes during walking in people with chronic incomplete spinal cord injury. Exp Brain Res 2019; 237:2461-2479. [PMID: 31309252 PMCID: PMC6751142 DOI: 10.1007/s00221-019-05603-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022]
Abstract
In people with spasticity due to chronic incomplete spinal cord injury (SCI), it has been presumed that the abnormal stretch reflex activity impairs gait. However, locomotor stretch reflexes across all phases of walking have not been investigated in people with SCI. Thus, to understand modulation of stretch reflex excitability during spastic gait, we investigated soleus stretch reflexes across the entire gait cycle in nine neurologically normal participants and nine participants with spasticity due to chronic incomplete SCI (2.5–11 year post-injury). While the participant walked on the treadmill at his/her preferred speed, unexpected ankle dorsiflexion perturbations (6° at 250°/s) were imposed every 4–6 steps. The soleus H-reflex was also examined. In participants without SCI, spinal short-latency “M1”, spinal medium latency “M2”, and long-latency “M3” were clearly modulated throughout the step cycle; the responses were largest in the mid-stance and almost completely suppressed during the stance-swing transition and swing phases. In participants with SCI, M1 and M2 were abnormally large in the mid–late-swing phase, while M3 modulation was similar to that in participants without SCI. The H-reflex was also large in the mid–late-swing phase. Elicitation of H-reflex and stretch reflexes in the late swing often triggered clonus and affected the soleus activity in the following stance. In individuals without SCI, moderate positive correlation was found between H-reflex and stretch reflex sizes across the step cycle, whereas in participants with SCI, such correlation was weak to non-existing, suggesting that H-reflex investigation would not substitute for stretch reflex investigation in individuals after SCI.
Collapse
|
26
|
Mathevon L, Declemy A, Laffont I, Perennou D. Immunogenicity induced by botulinum toxin injections for limb spasticity: A systematic review. Ann Phys Rehabil Med 2019; 62:241-251. [PMID: 30980953 DOI: 10.1016/j.rehab.2019.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/03/2019] [Accepted: 03/30/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The imputability of neutralizing antibodies (NABs) in secondary non-response (SnR) to botulinum toxin (BoNT) injections for limb spasticity is still debated. OBJECTIVE This systematic literature review aimed to determine the prevalence of NABs after BoNT injections for limb spasticity and analyze their determinants and their causal role in SnR. METHODS We searched MEDLINE via PubMed, Cochrane and Embase databases for articles published during 1990-2018. Two independent reviewers extracted the data and assessed the quality of studies with a specific scale (according to PRISMA and STROBE guidelines). Because the techniques used to detect NABs did not influence the results, we calculated the global (all studies) sensitivity and specificity of NAB positivity to reveal SnR. RESULTS We included 14 articles published from 2002 to 2018 (including an epublication) describing 5 randomized controlled trials and 5 interventional and 4 observational studies. The quality was satisfactory (mean score 18/28 arbitrary units). NAB detection was the primary criterion in 5 studies and a secondary criterion in 9. In total, 1234 serum samples for 1234 participants (91% with stroke) were tested after injection. NAB prevalence was about 1%, with no significant difference among formulations. NAB positivity seemed favoured by long-duration therapy with high doses and a short interval between injections. The identification of non-response by NAB positivity had poor global sensitivity (56%) but very high specificity (99.6%). No consensual criteria were used to diagnose non-response to BoNT injection. CONCLUSIONS NAB prevalence is much lower after BoNT treatment for limb spasticity than cervical dystonia. Consensual criteria must be defined to diagnose non-response to BoNT injection. Because immunogenicity is not the most common cause of non-response to BoNT injection, NABs should be sought in individuals with SnR with no other cause explaining the treatment inefficacy. A test with 100% specificity is recommended. In cases for which immunogenicity is the most likely cause of non-response to BoNT injections, some biological arguments suggest trying another BoNT, but no clinical evidence supports this strategy.
Collapse
Affiliation(s)
- Laure Mathevon
- Department of Physical and Rehabilitation Medicine, Institute of Rehabilitation, South Hospital-University Hospital Grenoble-Alpes, 38130 Grenoble, France.
| | - Arnaud Declemy
- Department of Physical and Rehabilitation Medicine, University Hospital Nice, 06000 Nice, France
| | - Isabelle Laffont
- Department of Physical and Rehabilitation Medicine, Euromov, IFRH, Montpellier University Hospital, Montpellier University, 34090 Montpellier, France
| | - Dominic Perennou
- Department of Physical and Rehabilitation Medicine, Institute of Rehabilitation, South Hospital-University Hospital Grenoble-Alpes, 38130 Grenoble, France; University Hospital Grenoble-Alpes, CNRS, LPNC, 38000 Grenoble, France
| |
Collapse
|
27
|
Abstract
: Neuromuscular disorders are complex, difficult both to differentiate and to manage. Yet nurses, who encounter a symptomatically diverse neuromuscular patient population in various practice settings, are expected to be well versed in managing the variable associated symptoms of these disorders. Here the authors discuss how to assess such neuromuscular conditions as muscle tightness, spasticity, and clonus; the pathophysiology underlying each; and the available recommended treatments, an understanding of which is necessary for successful symptom management and clear provider-patient communication.
Collapse
|
28
|
Yamaguchi T, Hvass Petersen T, Kirk H, Forman C, Svane C, Kofoed-Hansen M, Boesen F, Lorentzen J. Spasticity in adults with cerebral palsy and multiple sclerosis measured by objective clinically applicable technique. Clin Neurophysiol 2018; 129:2010-2021. [PMID: 30053672 DOI: 10.1016/j.clinph.2018.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/19/2018] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study evaluated ankle stiffness in adults with and without neurological disorders and investigated the accuracy and reproducibility of a clinically applicable method using a dynamometer. METHODS Measurements were obtained from 8 healthy subjects (age 39.3), 9 subjects with spastic cerebral palsy (CP) (age 39.8) and 8 subjects with multiple sclerosis (MS) (age 49.9). Slow and fast dorsiflexion stretches of the ankle joint were performed to evaluate passive muscle-tendon-joint stiffness, reflex mediated stiffness and range of movement (ROM), respectively. Intra/inter-rater reliability for passive and reflex mediated ankle muscle stiffness was assessed for all groups. RESULTS Subjects with CP and MS showed significantly larger values of passive stiffness in the triceps surae muscle tendon complex and smaller ROM compared to healthy individuals, while no significant difference in reflex mediated stiffness. Measurements of passive muscle-tendon-joint stiffness and reflex mediated stiffness showed good to excellent inter- and intra-rater reliability (ICC: 0.62-0.91) in all groups. CONCLUSION Increased stiffness was found in subjects with CP and MS with a clinically applicable method that provides valid and reproducible measurement of passive ankle muscle-tendon-joint stiffness and reflex mediated stiffness. SIGNIFICANCE The present technique may provide important supplementary information for the clinician.
Collapse
Affiliation(s)
- Tomofumi Yamaguchi
- Institute of Neuroscience, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | - Tue Hvass Petersen
- Research Unit on Brain Injury Neurorehabilitation, Rigshospitalet, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark
| | - Henrik Kirk
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
| | - Christian Forman
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | - Christian Svane
- Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| | | | - Finn Boesen
- The Danish MS Hospitals, Ringstedvej 106, DK-4650 Haslev, Denmark.
| | - Jakob Lorentzen
- Institute of Neuroscience, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark; Department of Nutrition, Exercise and Sports and Elsass Institute, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark.
| |
Collapse
|
29
|
McKay WB, Sweatman WM, Field-Fote EC. The experience of spasticity after spinal cord injury: perceived characteristics and impact on daily life. Spinal Cord 2018; 56:478-486. [DOI: 10.1038/s41393-017-0038-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022]
|
30
|
Lorentzen J, Pradines M, Gracies JM, Bo Nielsen J. On Denny-Brown's 'spastic dystonia' - What is it and what causes it? Clin Neurophysiol 2017; 129:89-94. [PMID: 29161622 DOI: 10.1016/j.clinph.2017.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 01/04/2023]
Abstract
In this review, we will work around two simple definitions of two different entities, which most often co-exist in patients with lesions to central motor pathways: Spasticity is "Enhanced excitability of velocity-dependent responses to phasic stretch at rest", which will not be the subject of this review, while Spastic dystonia is tonic, chronic, involuntary muscle contraction in the absence of any stretch or any voluntary command (Gracies, 2005). Spastic dystonia is a much less well understood entity that will be the subject this review. Denny-Brown (1966) observed involuntary sustained muscle activity in monkeys with lesions restricted to the motor cortices . He further observed that such involuntary muscle activity persisted following abolition of sensory input to the spinal cord and concluded that a central mechanism rather than exaggerated stretch reflex activity had to be involved. He coined the term spastic dystonia to describe this involuntary tonic activity in the context of otherwise exaggerated stretch reflexes. Sustained involuntary muscle activity in the absence of any stretch or any voluntary command contributes to burdensome and disabling body deformities in patients with spastic paresis. Yet, little has been done since Denny-Brown's studies to determine the pathophysiology of this non- stretch or effort related sustained involuntary muscle activity following motor lesions and there is a clear need for research studies in order to improve current therapy. The purpose of the present review is to discuss some of the possible mechanisms that may be involved in the hope that this may guide future research. We discuss the existence of persistent inward currents in spinal motoneurones and present the evidence that the channels involved may be upregulated following central motor lesions. We also discuss a possible contribution from alterations in synaptic inputs from surviving or abnormally branched sensory and descending fibres leading to over-activity and lack of motor coordination. We finally discuss evidence of alterations in motor cortical representational maps and basal ganglia lesions.
Collapse
Affiliation(s)
- Jakob Lorentzen
- Section for Integrative Neuroscience, Center for Neuroscience, University of Copenhagen, Denmark; Elsass Institute, Holmegårdsvej 28, 2920 Charlottenlund, Denmark.
| | - Maud Pradines
- EA 7377 BIOTN, Université Paris-Est, Hospital Albert Chenevier-Henri Mondor, Service de Rééducation Neurolocomotrice, APHP, Créteil, France
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est, Hospital Albert Chenevier-Henri Mondor, Service de Rééducation Neurolocomotrice, APHP, Créteil, France
| | - Jens Bo Nielsen
- Section for Integrative Neuroscience, Center for Neuroscience, University of Copenhagen, Denmark; Elsass Institute, Holmegårdsvej 28, 2920 Charlottenlund, Denmark
| |
Collapse
|
31
|
[Modern non-cosmetic treatment with botulinum toxins]. Internist (Berl) 2017; 58:1332-1340. [PMID: 29030680 DOI: 10.1007/s00108-017-0323-z] [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: 10/18/2022]
Abstract
Botulinum toxin has been known in medical history for a long time. The first scientific investigations and thoughts on possible indications in the treatment of muscular disorders were published by the German physician and poet Justinus Kerner in 1822. The physiological effect of botulinum toxin was identified in the middle of the twentieth century and the first clinical use was reported in 1977. It was first used in ophthalmology for the correction of strabismus and some years later the therapy of blepharospasm and cervical dystonia was established. Further indications, all supported by randomized controlled studies, are spastic tone increase of the limbs after lesions of the central nervous system, idiopathic axillar hyperhidrosis, chronic migraine and neurogenic or idiopathic bladder hyperactivity. In addition to these indications, a large number of further possible options have been published in the literature. Beside its effect on transmission at the neuromuscular synapses, botulinum toxin has also been shown to affect the sensory transmission of nociceptive fibers.
Collapse
|
32
|
Neuropathic pain and spasticity: intricate consequences of spinal cord injury. Spinal Cord 2017; 55:1046-1050. [PMID: 28695904 DOI: 10.1038/sc.2017.70] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN The 2016 International Spinal Cord Society Sir Ludwig Guttmann Lecture. OBJECTIVES The aim of this review is to identify different symptoms and signs of neuropathic pain and spasticity after spinal cord injury (SCI) and to present different methods of assessing them. The objective is to discuss how a careful characterization of different symptoms and signs, and a better translation of preclinical findings may improve our understanding of the complex and entangled mechanisms of neuropathic pain and spasticity. METHODS A MEDLINE search was performed using the following terms: 'pain', 'neuropathic', 'spasticity', 'spasms' and 'spinal cord injury'. RESULTS This review identified different domains of neuropathic pain and spasticity after SCI and methods to assess them in preclinical and clinical research. Different factors important for pain description include location, onset, pain descriptors and somatosensory function, while muscle tone, spasms, reflexes and clonus are important aspects of spasticity. Similarities and differences between neuropathic pain and spasticity are discussed. CONCLUSIONS Understanding that neuropathic pain and spasticity are multidimensional consequences of SCI, and a careful examination and characterization of the symptoms and signs, are a prerequisite for understanding the relationship between neuropathic pain and spasticity and the intricate underlying mechanisms.
Collapse
|
33
|
Mathevon L, Michel F, Aubry S, Testa R, Lapole T, Arnaudeau LF, Fernandez B, Parratte B, Calmels P. Two-dimensional and shear wave elastography ultrasound: A reliable method to analyse spastic muscles? Muscle Nerve 2017; 57:222-228. [DOI: 10.1002/mus.25716] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Laure Mathevon
- Department of Physical and Rehabilitation Medicine; Saint-Etienne University Hospital; Saint-Etienne France
| | - F. Michel
- Department of Physical and Rehabilitation Medicine; Besançon University Hospital; Besançon France
| | - S. Aubry
- Department of Musculoskeletal Imaging; Besançon University Hospital; Besançon France
| | - R. Testa
- Laboratoire Interuniversitaire de biologie de la Motricité; University of Lyon, UJM-Saint-Etienne; Saint-Etienne France
| | - T. Lapole
- Laboratoire Interuniversitaire de biologie de la Motricité; University of Lyon, UJM-Saint-Etienne; Saint-Etienne France
| | - L. F. Arnaudeau
- Laboratoire Interuniversitaire de biologie de la Motricité; University of Lyon, UJM-Saint-Etienne; Saint-Etienne France
| | - B. Fernandez
- Department of Physical and Rehabilitation Medicine; Saint-Etienne University Hospital; Saint-Etienne France
| | - B. Parratte
- Department of Anatomy; University of Franche-Comté; Besançon France
| | - P. Calmels
- Department of Physical and Rehabilitation Medicine; Saint-Etienne University Hospital; Saint-Etienne France
| |
Collapse
|
34
|
Pingel J, Wienecke J, Lorentzen J, Nielsen JB. Botulinum toxin injection causes hyper-reflexia and increased muscle stiffness of the triceps surae muscle in the rat. J Neurophysiol 2016; 116:2615-2623. [PMID: 27628204 DOI: 10.1152/jn.00452.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022] Open
Abstract
Botulinum toxin is used with the intention of diminishing spasticity and reducing the risk of development of contractures. Here, we investigated changes in muscle stiffness caused by reflex activity or elastic muscle properties following botulinum toxin injection in the triceps surae muscle in rats. Forty-four rats received injection of botulinum toxin in the left triceps surae muscle. Control measurements were performed on the noninjected contralateral side in all rats. Acute experiments were performed, 1, 2, 4, and 8 wk following injection. The triceps surae muscle was dissected free, and the Achilles tendon was cut and attached to a muscle puller. The resistance of the muscle to stretches of different amplitudes and velocities was systematically investigated. Reflex-mediated torque was normalized to the maximal muscle force evoked by supramaximal stimulation of the tibial nerve. Botulinum toxin injection caused severe atrophy of the triceps surae muscle at all time points. The force generated by stretch reflex activity was also strongly diminished but not to the same extent as the maximal muscle force at 2 and 4 wk, signifying a relative reflex hyperexcitability. Passive muscle stiffness was unaltered at 1 wk but increased at 2, 4, and 8 wk (P < 0.01). These data demonstrate that botulinum toxin causes a relative increase in reflex stiffness, which is likely caused by compensatory neuroplastic changes. The stiffness of elastic elements in the muscles also increased. The data are not consistent with the ideas that botulinum toxin is an efficient antispastic medication or that it may prevent development of contractures.
Collapse
Affiliation(s)
- Jessica Pingel
- Neural Control of Movement Research Group, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Wienecke
- Department of Nutrition, Exercise and Sport, University of Copenhagen, Copenhagen, Denmark; and
| | - Jakob Lorentzen
- Neural Control of Movement Research Group, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Elsass Institute, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Neural Control of Movement Research Group, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark; .,Elsass Institute, Charlottenlund, Denmark
| |
Collapse
|
35
|
Mathevon L, Michel F, Decavel P, Fernandez B, Parratte B, Calmels P. Muscle structure and stiffness assessment after botulinum toxin type A injection. A systematic review. Ann Phys Rehabil Med 2015; 58:343-50. [DOI: 10.1016/j.rehab.2015.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 11/27/2022]
|
36
|
Geertsen SS, Kirk H, Lorentzen J, Jorsal M, Johansson CB, Nielsen JB. Impaired gait function in adults with cerebral palsy is associated with reduced rapid force generation and increased passive stiffness. Clin Neurophysiol 2015; 126:2320-9. [DOI: 10.1016/j.clinph.2015.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/05/2015] [Accepted: 02/15/2015] [Indexed: 10/24/2022]
|
37
|
Nielsen JB, Willerslev-Olsen M, Christiansen L, Lundbye-Jensen J, Lorentzen J. Science-Based Neurorehabilitation: Recommendations for Neurorehabilitation From Basic Science. J Mot Behav 2015; 47:7-17. [DOI: 10.1080/00222895.2014.931273] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
38
|
Lemmens S, Brône B, Dooley D, Hendrix S, Geurts N. Alpha-adrenoceptor modulation in central nervous system trauma: pain, spasms, and paralysis--an unlucky triad. Med Res Rev 2014; 35:653-77. [PMID: 25546087 DOI: 10.1002/med.21337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Many researchers have attempted to pharmacologically modulate the adrenergic system to control locomotion, pain, and spasms after central nervous system (CNS) trauma, although such efforts have led to conflicting results. Despite this, multiple studies highlight that α-adrenoceptors (α-ARs) are promising therapeutic targets because in the CNS, they are involved in reactivity to stressors and regulation of locomotion, pain, and spasms. These functions can be activated by direct modulation of these receptors on neuronal networks in the brain and the spinal cord. In addition, these multifunctional receptors are also broadly expressed on immune cells. This suggests that they might play a key role in modulating immunological responses, which may be crucial in treating spinal cord injury and traumatic brain injury as both diseases are characterized by a strong inflammatory component. Reducing the proinflammatory response will create a more permissive environment for axon regeneration and may support neuromodulation in combination therapies. However, pharmacological interventions are hindered by adrenergic system complexity and the even more complicated anatomical and physiological changes in the CNS after trauma. This review is the first concise overview of the pros and cons of α-AR modulation in the context of CNS trauma.
Collapse
Affiliation(s)
- Stefanie Lemmens
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Bert Brône
- Department of Physiology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Dearbhaile Dooley
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Sven Hendrix
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Nathalie Geurts
- Department of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
39
|
Estrada V, Müller HW. Spinal cord injury - there is not just one way of treating it. F1000PRIME REPORTS 2014; 6:84. [PMID: 25343041 PMCID: PMC4166939 DOI: 10.12703/p6-84] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the last century, research in the field of spinal cord trauma has brought insightful knowledge which has led to a detailed understanding of mechanisms that are involved in injury- and recovery-related processes. The quest for a cure for the yet generally incurable condition as well as the exponential rise in gained information has brought about the development of numerous treatment approaches while at the same time the abundance of data has become quite unmanageable. Owing to an enormous amount of preclinical therapeutic approaches, this report highlights important trends rather than specific treatment strategies. We focus on current advances in the treatment of spinal cord injury and want to further draw attention to arising problems in spinal cord injury (SCI) research and discuss possible solutions.
Collapse
Affiliation(s)
- Veronica Estrada
- Molecular Neurobiology Laboratory, Department of Neurology, Heinrich-Heine-University Medical Center Düsseldorf Moorenstr. 5, 40225 Düsseldorf Germany
| | - Hans Werner Müller
- Molecular Neurobiology Laboratory, Department of Neurology, Heinrich-Heine-University Medical Center Düsseldorf Moorenstr. 5, 40225 Düsseldorf Germany
| |
Collapse
|
40
|
Calabrò RS, D'Aleo G, Sessa E, Leo A, De Cola MC, Bramanti P. Sexual Dysfunction Induced by Intrathecal Baclofen Administration: Is This the Price to Pay for Severe Spasticity Management? J Sex Med 2014; 11:1807-15. [DOI: 10.1111/jsm.12569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Guertin PA. Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients. Front Hum Neurosci 2014; 8:272. [PMID: 24910602 PMCID: PMC4038974 DOI: 10.3389/fnhum.2014.00272] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/11/2014] [Indexed: 12/14/2022] Open
Abstract
Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs-from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar ways locomotor rhythm generation in most animal models. The aim of this article is to provide a comprehensive review of the known structural and functional features associated with central nervous system (CNS) networks that are involved in the control of ambulation and other stereotyped motor patterns-specifically Central Pattern Generators (CPGs) that produce basic rhythmic patterned outputs for locomotion, micturition, ejaculation, and defecation. Although there is compelling evidence of their existence in humans, CPGs have been most studied in reduced models including in vitro isolated preparations, genetically-engineered mice and spinal cord-transected animals. Compared with other structures of the CNS, the spinal cord is generally considered as being well-preserved phylogenetically. As such, most animal models of spinal cord-injured (SCI) should be considered as valuable tools for the development of novel pharmacological strategies aimed at modulating spinal activity and restoring corresponding functions in chronic SCI patients.
Collapse
Affiliation(s)
- Pierre A. Guertin
- Department of Psychiatry and Neurosciences, Laval UniversityQuebec City, QC, Canada
- Spinal Cord Injury and Functional Recovery Laboratory, Laval University Medical Center (CHU de Quebec)Quebec City, QC, Canada
| |
Collapse
|
42
|
Venturelli M, Amann M, Layec G, McDaniel J, Trinity JD, Fjeldstad AS, Ives SJ, Yonnet G, Richardson RS. Passive leg movement-induced hyperaemia with a spinal cord lesion: evidence of preserved vascular function. Acta Physiol (Oxf) 2014; 210:429-39. [PMID: 24119139 DOI: 10.1111/apha.12173] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/21/2013] [Accepted: 09/20/2013] [Indexed: 12/21/2022]
Abstract
UNLABELLED A spinal cord injury (SCI) clearly results in greater cardiovascular risk; however, accompanying changes in peripheral vascular structure below the lesion mean that the real impact of a SCI on vascular function is unclear. AIM Therefore, utilizing passive leg movement-induced (PLM) hyperaemia, an index of nitric oxide (NO)-dependent vascular function and the central hemodynamic response to this intervention, we studied eight individuals with a SCI and eight age-matched controls (CTRL). METHODS Specifically, we assessed heart rate (HR), stroke volume (SV), cardiac output (CO), mean arterial pressure (MAP), leg blood flow (LBF) and thigh composition. RESULTS In CTRL, passive movement transiently decreased MAP and increased HR and CO from baseline by 2.5 ± 1 mmHg, 7 ± 2 bpm and 0.5 ± 0.1 L min(-1) respectively. In SCI, HR and CO responses were unidentifiable. LBF increased to a greater extent in CTRL (515 ± 41 ∆mL min(-1)) compared with SCI, (126 ± 25 ∆mL min(-1)) (P < 0.05). There was a strong relationship between ∆LBF and thigh muscle volume (r = 0.95). After normalizing ∆LBF for this strong relationship (∆LBF/muscle volume), there was evidence of preserved vascular function in SCI (CTRL: 120 ± 9; SCI 104 ± 11 mL min(-1) L(-1)). A comparison of ∆LBF in the passively moved and stationary leg, to partition the contribution of the blood flow response, implied that 35% of the hyperaemia resulted from cardioacceleration in the CTRL, whereas all the hyperaemia appeared peripheral in origin in the SCI. CONCLUSION Thus, utilizing PLM-induced hyperaemia as marker of vascular function, it is evident that peripheral vascular impairment is not an obligatory accompaniment to a SCI.
Collapse
Affiliation(s)
- M. Venturelli
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences; University of Verona; Verona Italy
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
| | - M. Amann
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
- Geriatric Research, Education, and Clinical Center; George E. Whalen VA Medical Center; Salt Lake City UT USA
- Department of Exercise and Sport Science; University of Utah; Salt Lake City UT USA
| | - G. Layec
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
| | - J. McDaniel
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
- Geriatric Research, Education, and Clinical Center; George E. Whalen VA Medical Center; Salt Lake City UT USA
| | - J. D. Trinity
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
- Geriatric Research, Education, and Clinical Center; George E. Whalen VA Medical Center; Salt Lake City UT USA
| | - A. S. Fjeldstad
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
| | - S. J. Ives
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
- Geriatric Research, Education, and Clinical Center; George E. Whalen VA Medical Center; Salt Lake City UT USA
| | - G. Yonnet
- Department of Neurology; University of Utah; Salt Lake City UT USA
| | - R. S. Richardson
- Department of Internal Medicine; Division of Geriatrics; University of Utah; Salt Lake City UT USA
- Geriatric Research, Education, and Clinical Center; George E. Whalen VA Medical Center; Salt Lake City UT USA
- Department of Exercise and Sport Science; University of Utah; Salt Lake City UT USA
| |
Collapse
|
43
|
The effect of arm position and bed adjustment on comfort and pressure under the shoulders in people with tetraplegia: a randomized cross-over study. Spinal Cord 2013; 52:152-6. [PMID: 24322216 DOI: 10.1038/sc.2013.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/08/2013] [Accepted: 10/27/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Randomized, within-in participant cross-over study. OBJECTIVE The purpose of this study was to determine the effect on comfort and pressure of lying with the shoulders and bed in different positions for people with tetraplegia. SETTING Rehabilitation hospital. METHODS Twenty people with tetraplegia were tested lying supine with the shoulders and bed in seven different positions. The positions used a combination of three arm and two bed positions. Six of the positions reflected what is commonly recommended in acute spinal cord injury units including a crucifix-type position. The seventh position was selected by participants and reflected their preferred sleeping position. There were five outcomes: general comfort, shoulder comfort, participant choice of preferred position, peak pressure under the shoulders and areal pressure under the shoulders. Pressure was measured using a pressure mapping system and comfort using a visual analogue scale (VAS). RESULTS The participants reported significantly higher (P<0.01) general comfort and shoulder comfort in their self-selected position compared with all other positions. There was no statistical difference in peak pressure (P=0.15) or areal pressure (P=0.08) under the shoulders between the seven positions. Most participants indicated that they preferred to lie with their shoulders adducted and internally rotated and the hands either by their sides or on their stomachs. CONCLUSION The position of the shoulders has little effect on pressure but a notable effect on comfort. Participants preferred to sleep with their arms beside their bodies, not with their arms in a crucifix position as commonly advocated.
Collapse
|
44
|
Guertin PA. Central pattern generator for locomotion: anatomical, physiological, and pathophysiological considerations. Front Neurol 2013; 3:183. [PMID: 23403923 PMCID: PMC3567435 DOI: 10.3389/fneur.2012.00183] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 12/14/2012] [Indexed: 12/14/2022] Open
Abstract
This article provides a perspective on major innovations over the past century in research on the spinal cord and, specifically, on specialized spinal circuits involved in the control of rhythmic locomotor pattern generation and modulation. Pioneers such as Charles Sherrington and Thomas Graham Brown have conducted experiments in the early twentieth century that changed our views of the neural control of locomotion. Their seminal work supported subsequently by several decades of evidence has led to the conclusion that walking, flying, and swimming are largely controlled by a network of spinal neurons generally referred to as the central pattern generator (CPG) for locomotion. It has been subsequently demonstrated across all vertebrate species examined, from lampreys to humans, that this CPG is capable, under some conditions, to self-produce, even in absence of descending or peripheral inputs, basic rhythmic, and coordinated locomotor movements. Recent evidence suggests, in turn, that plasticity changes of some CPG elements may contribute to the development of specific pathophysiological conditions associated with impaired locomotion or spontaneous locomotor-like movements. This article constitutes a comprehensive review summarizing key findings on the CPG as well as on its potential role in Restless Leg Syndrome, Periodic Leg Movement, and Alternating Leg Muscle Activation. Special attention will be paid to the role of the CPG in a recently identified, and uniquely different neurological disorder, called the Uner Tan Syndrome.
Collapse
Affiliation(s)
- Pierre A. Guertin
- Department of Psychiatry and Neurosciences, Laval UniversityQuebec City, QC, Canada
- Laval University Medical Center (CHU de Quebec)Quebec City, QC, Canada
| |
Collapse
|