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Boissonnault È, Jeon A, Munin MC, Filippetti M, Picelli A, Haldane C, Reebye R. Assessing muscle architecture with ultrasound: implications for spasticity. Eur J Transl Myol 2024; 34:12397. [PMID: 38818772 PMCID: PMC11264226 DOI: 10.4081/ejtm.2024.12397] [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: 03/04/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity. Medline, CINAHL, and Embase databases were searched with keywords: ultrasonography, hypertonia, spasticity, fibrosis, and Heckmatt. Three physicians reviewed the results of the search to select relevant papers. Reviews identified in the search were used as a resource to identify additional studies. A total of 68 papers were included. Four themes were identified, including histopathological changes in spastic muscle, effects of BoNT-A on the muscle structure, available US modalities to assess the muscle, and utility of US assessment in clinical spasticity. Histopathological studies revealed atrophic and fibro-fatty changes after CNS lesions. Several papers described BoNT-A injections contributing to those modifications. These changes translated to increased EI. The exact significance of increased muscle EI remains unclear. The Modified Heckmatt Scale (MHS) is a validated tool for grading muscle EI in spasticity. The use of the US may be an important tool to assess muscle architecture changes in spasticity and improve spasticity management. Treatment algorithms may be developed based on the degree of EI. Further research is needed to determine the incidence and impact of these EI changes in spastic muscles.
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Affiliation(s)
- Ève Boissonnault
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston.
| | - April Jeon
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Michael C Munin
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Mirko Filippetti
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Alessandro Picelli
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Chloe Haldane
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
| | - Rajiv Reebye
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
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Zeng D, Lei W, Kong Y, Ma F, Zhao K, Ye X, Tan T. Effects of vibration therapy for post-stroke spasticity: a systematic review and meta-analysis of randomized controlled trials. Biomed Eng Online 2023; 22:121. [PMID: 38087275 PMCID: PMC10714496 DOI: 10.1186/s12938-023-01176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The efficacy of vibration therapy (VT) in people with post-stroke spasticity (PSS) remains uncertain. This study aims to conduct a comprehensive meta-analysis to assess the effectiveness of VT in PSS. METHODS PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, and Web of Science were searched from inception to October 2022 for randomized controlled trials (RCTs) of VT in people with PSS. The primary outcome was spasticity, and secondary outcomes included pain, motor function, gait performance, and adverse events. A meta‑analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS A total of 12 studies met the inclusion criteria. Overall, VT had significant effects on reducing spasticity (SMD = - 0.77, 95% CI - 1.17 to - 0.36, P < 0.01) and pain (SMD = - 1.09, 95% CI - 1.74 to - 0.45, P < 0.01), and improving motor function (SMD = 0.42, 95% CI 0.21 to 0.64, P < 0.01) in people with PSS. However, VT had no significant effect on gait performance (SMD = - 0.23, 95% CI - 0.56-0.10). In addition, subgroup differences in short-term anti-spasticity effects between different vibration subtypes, vibration frequencies, vibration durations, frequency of sessions, control therapy, spasticity distribution, and population classification were not significant. CONCLUSION We found that VT significantly alleviated spasticity and pain in people with PSS and improved motor function, but its effect on gait performance was unclear. However, further studies are needed to validate these findings.
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Affiliation(s)
- Duchun Zeng
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Wei Lei
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Yurou Kong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Fenghao Ma
- Department of Physiotherapy, Shanghai Sunshine Rehabilitation Center, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Tongcai Tan
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China.
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He J, Luo A, Yu J, Qian C, Liu D, Hou M, Ma Y. Quantitative assessment of spasticity: a narrative review of novel approaches and technologies. Front Neurol 2023; 14:1121323. [PMID: 37475737 PMCID: PMC10354649 DOI: 10.3389/fneur.2023.1121323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Spasticity is a complex neurological disorder, causing significant physical disabilities and affecting patients' independence and quality of daily lives. Current spasticity assessment methods are questioned for their non-standardized measurement protocols, limited reliabilities, and capabilities in distinguishing neuron or non-neuron factors in upper motor neuron lesion. A series of new approaches are developed for improving the effectiveness of current clinical used spasticity assessment methods with the developing technology in biosensors, robotics, medical imaging, biomechanics, telemedicine, and artificial intelligence. We investigated the reliabilities and effectiveness of current spasticity measures employed in clinical environments and the newly developed approaches, published from 2016 to date, which have the potential to be used in clinical environments. The new spasticity scales, taking advantage of quantified information such as torque, or echo intensity, the velocity-dependent feature and patients' self-reported information, grade spasticity semi-quantitatively, have competitive or better reliability than previous spasticity scales. Medical imaging technologies, including near-infrared spectroscopy, magnetic resonance imaging, ultrasound and thermography, can measure muscle hemodynamics and metabolism, muscle tissue properties, or temperature of tissue. Medical imaging-based methods are feasible to provide quantitative information in assessing and monitoring muscle spasticity. Portable devices, robotic based equipment or myotonometry, using information from angular, inertial, torque or surface EMG sensors, can quantify spasticity with the help of machine learning algorithms. However, spasticity measures using those devices are normally not physiological sound. Repetitive peripheral magnetic stimulation can assess patients with severe spasticity, which lost voluntary contractions. Neuromusculoskeletal modeling evaluates the neural and non-neural properties and may gain insights into the underlying pathology of spasticity muscles. Telemedicine technology enables outpatient spasticity assessment. The newly developed spasticity methods aim to standardize experimental protocols and outcome measures and enable quantified, accurate, and intelligent assessment. However, more work is needed to investigate and improve the effectiveness and accuracy of spasticity assessment.
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Affiliation(s)
- Jian He
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Anhua Luo
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Jiajia Yu
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Chengxi Qian
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
| | - Dongwei Liu
- School of Information Management and Artificial Intelligence, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Meijin Hou
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, China
| | - Ye Ma
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo, China
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, China
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Pinto MD, Silveira Pinto R, Nosaka K, Blazevich AJ. Do Intramuscular Temperature and Fascicle Angle Affect Ultrasound Echo Intensity Values? Med Sci Sports Exerc 2023; 55:740-750. [PMID: 36355345 DOI: 10.1249/mss.0000000000003082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Ultrasound-derived echo intensity (EI) has been used as a physiological marker for changes in skeletal muscle "quality" with physical training, disuse, aging, and neuromuscular disorders. However, the methodological and physiological factors influencing EI and its longitudinal change are still unclear. Here, we performed two separate experiments to investigate the effects of muscle temperature and fascicle angle, which are known to influence muscle tissue and sound wave properties and therefore affect EI. METHODS In experiment 1 ( n = 16, 28.0 ± 6.6 yr), vastus lateralis (VL) ultrasonographic images were acquired and intramuscular temperature continuously recorded for 15 min after 20 min of heating to 40.4°C ± 0.7°C using a microwave device. In experiment 2 ( n = 17, 30.2 ± 9.8 yr), VL sonographic images were obtained with the knee both fully extended (0°) and flexed to 90° and EI and fascicle angle measured post hoc . Fascicle movement was tracked during the passive knee flexion to ensure that sonographic images were obtained at the same muscle region. Knee flexion reduced muscle thickness, and we therefore reran analyses calculating EI using identical dimensions to minimize this effect. RESULTS EI decreased only immediately after the passive heating, and although a moderate, negative correlation was observed between EI and temperature ( rrm = -0.36), the effect of muscle temperature was small ( β = 0.97 (-1.89 to -0.06) per degree Celsius, P = 0.051). Nonetheless, EI increased as fascicle angle decreased, and a large, negative correlation ( rrm = -0.85) was observed; the effect of fascicle angle on EI was large ( β = 3.0 (-3.8 to -2.2) per degree, P < 0.01), and this was maintained when analyses were performed at a constant depth of the region of interest ( β = 3.5 (-4.4 to -2.7) per degree, P < 0.01). CONCLUSIONS These findings support the hypothesis that fascicle angle meaningfully affects VL EI but provides weak evidence of a temperature effect in vivo . Thus, acute fascicle angle alterations should be accounted for in studies using EI measurements, and longer-term studies should consider whether changes in EI might be partly explained by a change in fascicle angle.
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Affiliation(s)
- Matheus Daros Pinto
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, AUSTRALIA
| | | | - Kazunori Nosaka
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, AUSTRALIA
| | - Anthony John Blazevich
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, Joondalup, AUSTRALIA
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PICELLI A, CENSO RD, ZADRA A, FACCIOLI S, SMANIA N, FILIPPETTI M. Management Of Spastic Equinovarus Foot in Children with Cerebral Palsy: An Evaluation of Anatomical Landmarks for Selective Nerve Blocks of the Tibial Nerve Motor Branches. J Rehabil Med 2023; 55:jrm00370. [PMID: 36807992 PMCID: PMC9972165 DOI: 10.2340/jrm.v55.4538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/13/2022] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To define the anatomical landmarks of tibial motor nerve branches for selective motor nerve blocks of the gastrocnemii, soleus and tibialis posterior muscles in the management of spastic equinovarus foot. DESIGN Observational study. PATIENTS Twenty-four children with cerebral palsy with spastic equinovarus foot. METHODS Considering the affected leg length, motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles were tracked using ultrasonography, and located in the space (vertical, horizontal, deep) according to the position of fibular head (proximal/distal) and a virtual line from the middle of popliteal fossa to the Achilles tendon insertion (medial/lateral). RESULTS Location of motor branches was defined as percentage of the affected leg length. Mean coordinates were: for the gastrocnemius medialis 2.5 ± 1.2% vertical (proximal), 1.0 ± 0.7% horizontal (medial), 1.5 ± 0.4% deep; for the gastrocnemius lateralis 2.3 ± 1.4% vertical (proximal), 1.1 ± 0.9% horizontal (lateral), 1.6 ± 0.4% deep; for the soleus 2.1 ± 0.9% vertical (distal), 0.9 ± 0.7% horizontal (lateral), 2.2 ± 0.6% deep; for the tibialis posterior 2.6 ± 1.2% vertical (distal), 1.3 ± 1.1% horizontal (lateral), 3.0 ± 0.7% deep. CONCLUSION These findings may help the identification of tibial motor nerve branches to perform selective nerve blocks in patients with cerebral palsy with spastic equinovarus foot.
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Affiliation(s)
- Alessandro PICELLI
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy,Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, ON, Canada
| | - Rita Di CENSO
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro ZADRA
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia FACCIOLI
- AUSL IRCCS di Reggio Emilia, Reggio Emilia, Italy,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola SMANIA
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Mirko FILIPPETTI
- Neuromotor and Cognitive Rehabilitation Research Centre, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
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Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb. Toxins (Basel) 2022; 15:toxins15010014. [PMID: 36668834 PMCID: PMC9865964 DOI: 10.3390/toxins15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures.
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Guo X, Wallace R, Tan Y, Oetomo D, Klaic M, Crocher V. Technology-assisted assessment of spasticity: a systematic review. J Neuroeng Rehabil 2022; 19:138. [PMID: 36494721 PMCID: PMC9733065 DOI: 10.1186/s12984-022-01115-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spasticity is defined as "a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks". It is a highly prevalent condition following stroke and other neurological conditions. Clinical assessment of spasticity relies predominantly on manual, non-instrumented, clinical scales. Technology based solutions have been developed in the last decades to offer more specific, sensitive and accurate alternatives but no consensus exists on these different approaches. METHOD A systematic review of literature of technology-based methods aiming at the assessment of spasticity was performed. The approaches taken in the studies were classified based on the method used as well as their outcome measures. The psychometric properties and usability of the methods and outcome measures reported were evaluated. RESULTS 124 studies were included in the analysis. 78 different outcome measures were identified, among which seven were used in more than 10 different studies each. The different methods rely on a wide range of different equipment (from robotic systems to simple goniometers) affecting their cost and usability. Studies equivalently applied to the lower and upper limbs (48% and 52%, respectively). A majority of studies applied to a stroke population (N = 79). More than half the papers did not report thoroughly the psychometric properties of the measures. Analysis identified that only 54 studies used measures specific to spasticity. Repeatability and discriminant validity were found to be of good quality in respectively 25 and 42 studies but were most often not evaluated (N = 95 and N = 78). Clinical validity was commonly assessed only against clinical scales (N = 33). Sensitivity of the measure was assessed in only three studies. CONCLUSION The development of a large diversity of assessment approaches appears to be done at the expense of their careful evaluation. Still, among the well validated approaches, the ones based on manual stretching and measuring a muscle activity reaction and the ones leveraging controlled stretches while isolating the stretch-reflex torque component appear as the two promising practical alternatives to clinical scales. These methods should be further evaluated, including on their sensitivity, to fully inform on their potential.
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Affiliation(s)
- Xinliang Guo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Rebecca Wallace
- grid.416153.40000 0004 0624 1200Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ying Tan
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Denny Oetomo
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
| | - Marlena Klaic
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Vincent Crocher
- grid.1008.90000 0001 2179 088XUoM and Fourier Intelligence Joint Robotics Laboratory, Mechanical Engineering Department, The University of Melbourne, Melbourne, Australia
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Boulias C, Ismail F, Phadke CP. Acute neurophysiologic effects of botulinum toxin type A intramuscular injection on extensor digitorum brevis muscle in healthy adults. Toxicon 2022; 211:6-10. [DOI: 10.1016/j.toxicon.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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Kwon DR, Kwon DG. Botulinum Toxin a Injection Combined with Radial Extracorporeal Shock Wave Therapy in Children with Spastic Cerebral Palsy: Shear Wave Sonoelastographic Findings in the Medial Gastrocnemius Muscle, Preliminary Study. CHILDREN 2021; 8:children8111059. [PMID: 34828772 PMCID: PMC8622460 DOI: 10.3390/children8111059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Therapeutic strategies to boost the effect of botulinum toxin may lead to some advantages, such as long lasting effects, the injection of lower botulinum toxin dosages, fewer side effects, and lower costs. The aim of this study is to investigate the combined effect of botulinum toxin A (BTA) injection and extracorporeal shock wave therapy (ESWT) for the treatment of spasticity in children with spastic cerebral palsy (CP). Fifteen patients with spastic CP were recruited through a retrospective chart review to clarify what treatment they received. All patients received a BTA injection on gastrocnemius muscle (GCM), and patients in group 1 underwent one ESWT session for the GCM immediately after BTA injection and two consecutive ESWT sessions at weekly intervals. Ankle plantar flexor and the passive range of motion (PROM) of ankle dorsiflexion were measured by a modified Ashworth scale (MAS) before treatment and at 1 and 3 month(s) post-treatment. In group 1, the shear wave velocity (SWV) of GCM was measured. The PROM and MAS in group 1 and 2 before treatment significantly improved at 1 and 3 month(s) after treatment. The change in PROM was significantly different between the two groups at 1 and 3 month(s) after treatment. The SWV before treatment significantly decreased at 1 month and 3 months after treatment in group 1. Our study has shown that the combination of BTA injection and ESWT would be effective at controlling spasticity in children with spastic CP, with sustained improvement at 3 months after treatment.
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Affiliation(s)
- Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, Korea
- Correspondence:
| | - Dae Gil Kwon
- Department of Rehabilitation Medicine, Comprehensive and Integrative Medicine Hospital, Daegu 42473, Korea;
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Tanaka S, Ito D, Kimura Y, Ishiyama D, Suzuki M, Koyama S, Narita Y, Masuda H, Suzukawa K, Yamada M. Relationship between longitudinal changes in skeletal muscle characteristics over time and functional recovery during intensive rehabilitation of patients with subacute stroke. Top Stroke Rehabil 2021; 29:356-365. [PMID: 34180362 DOI: 10.1080/10749357.2021.1940724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stroke is a disease that easily impairs skeletal muscle characteristics, resulting in low quantity, low quality, and poor strength. However, the recovery process of skeletal muscles in patients with stroke is not well established. OBJECTIVES We aimed to determine the longitudinal changes in skeletal muscle characteristics in patients with stroke during intensive rehabilitation and examine their relationship with functional recovery. METHODS Eighty-five patients with stroke were prospectively recruited. We defined muscle quantity and quality as ultrasonographic muscle thickness and echo intensity, respectively, and muscle strength as knee extension strength. These skeletal muscle characteristics were compared at four time points: on admission, after 2 weeks, after 4 weeks, and at discharge. We also explored the relationship between changes in skeletal muscle characteristics and functional recovery. RESULTS Non-paretic knee extension torque (F = 5.838, P = .001), paretic quadriceps thickness (F = 2.943, P = .039), and paretic tibialis anterior thickness (F = 4.654, P = .004) improved over time, and changes in the paretic side quadriceps thickness were significantly associated with recovery for balance ability (odds ratio, 1.05; 95% confidence interval, 1.00-1.09; P = .048). CONCLUSIONS The present study revealed that knee extension muscle strength on the non-paretic side and quadriceps and tibialis anterior thickness on the paretic side significantly improved over time and that changes in the paretic side quadriceps thickness were associated with the recovery of balance ability.
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Affiliation(s)
- Shu Tanaka
- Department of Rehabilitation, Musashimurayama Hospital, Social Medical Corporation, Yamatokai Foundation, Tokyo, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Daisuke Ito
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan.,Department of Electrical Engineering, Health and Sports Technology Course, Kanto Gakuin University, Yokohama, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuya Narita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Katsumi Suzukawa
- Department of Rehabilitation, Musashimurayama Hospital, Social Medical Corporation, Yamatokai Foundation, Tokyo, Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
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Moron H, Gagnard-Landra C, Guiraud D, Dupeyron A. Contribution of Single-Fiber Evaluation on Monitoring Outcomes Following Injection of Botulinum Toxin-A: A Narrative Review of the Literature. Toxins (Basel) 2021; 13:toxins13050356. [PMID: 34067540 PMCID: PMC8156529 DOI: 10.3390/toxins13050356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Abstract
Botulinum toxin-A (BoNT-A) blocks acetylcholine release at the neuromuscular junction (NMJ) and is widely used for neuromuscular disorders (involuntary spasms, dystonic disorders and spasticity). However, its therapeutic effects are usually measured by clinical scales of questionable validity. Single-fiber electromyography (SFEMG) is a sensitive, validated diagnostic technique for NMJ impairment such as myasthenia. The jitter parameter (µs) represents the variability of interpotential intervals of two muscle fibers from the same motor unit. This narrative review reports SFEMG use in BoNT-A treatment. Twenty-four articles were selected from 175 eligible articles searched in Medline/Pubmed and Cochrane Library from their creation until May 2020. The results showed that jitter is sensitive to early NMJ modifications following BoNT-A injection, with an increase in the early days’ post-injection and a peak between Day 15 and 30, when symptoms diminish or disappear. The reappearance of symptoms accompanies a tendency for a decrease in jitter, but always precedes its normalization, either delayed or nonexistent. Increased jitter is observed in distant muscles from the injection site. No dose effect relationship was demonstrated. SFEMG could help physicians in their therapeutic evaluation according to the pathology considered. More data are needed to consider jitter as a predictor of BoNT-A clinical efficacy.
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Affiliation(s)
- Hélène Moron
- Department of Functional Exploration of the Nervous System and Acupuncture, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France;
- EuroMov DHM, IMT Ales, Univ Montpellier, 34090 Montpellier, France;
- CAMIN, INRIA, Univ Montpellier, 34090 Montpellier, France;
- Correspondence:
| | - Corine Gagnard-Landra
- Department of Functional Exploration of the Nervous System and Acupuncture, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France;
| | - David Guiraud
- CAMIN, INRIA, Univ Montpellier, 34090 Montpellier, France;
| | - Arnaud Dupeyron
- EuroMov DHM, IMT Ales, Univ Montpellier, 34090 Montpellier, France;
- Department of Physical and Rehabilitation Medicine, CHU Nîmes, Univ Montpellier, 30029 Nîmes, France
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12
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Does Botulinum Toxin Treatment Affect the Ultrasonographic Characteristics of Post-Stroke Spastic Equinus? A Retrospective Pilot Study. Toxins (Basel) 2020; 12:toxins12120797. [PMID: 33327423 PMCID: PMC7764832 DOI: 10.3390/toxins12120797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/17/2022] Open
Abstract
Equinovarus/equinus foot is a pattern most commonly treated with botulinum toxin type A in patients with post-stroke spasticity involving the lower limbs; the gastrocnemius is the muscle most frequently injected. Spastic equinovarus/equinus can present a mixture of conditions, including spasticity, muscle/tendon shortening, muscle weakness and imbalance. In this study, we wanted to determine whether botulinum toxin treatment affects the ultrasonographic characteristics of post-stroke spastic equinus. The same dose of AbobotulinumtoxinA was injected into the gastrocnemius medialis and lateralis of 21 chronic stroke patients with spastic equinus. Clinical (Ashworth scale and ankle range of motion) and ultrasound (conventional and sonoelastography) evaluation of the treated leg was carried out before and 4 weeks after injection. No significant effects of botulinum toxin treatment on the ultrasonographic characteristics of spastic equinus were observed. As expected, there were significant improvements in ankle passive dorsiflexion range of motion and calf muscle spasticity at 1 month after treatment. There was a direct association between Achilles tendon elasticity and calf muscle spasticity at baseline evaluation. Larger studies with a long-term timeline of serial evaluations are needed to further investigate the possible effects of botulinum toxin injection on spastic muscle characteristics in patients with post-stroke spasticity.
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13
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Schillebeeckx F, DE Groef A, DE Beukelaer N, Desloovere K, Verheyden G, Peers K. Muscle and tendon properties of the spastic lower leg after stroke defined by ultrasonography: a systematic review. Eur J Phys Rehabil Med 2020; 57:495-510. [PMID: 33305547 DOI: 10.23736/s1973-9087.20.06462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Peripheral muscle and tendon changes after stroke can influence the functional outcome of patients. The aim of this systematic review was to summarize the evidence of ultrasonographic changes in morphological muscle and tendon properties of the spastic hemiparetic lower leg in patients with first ever stroke. EVIDENCE ACQUISITION A systematic search was conducted through PubMed, Embase, Scopus, Cinahl, Cochrane Library, and manual searches from inception until May 1, 2020. Observational case control or cohort studies were included. Risk of bias was evaluated by using the Newcastle-Ottawa Quality Assessment Scale. Outcome parameters of interest included muscle thickness, muscle and tendon length, fascicle length, pennation angle and echo-intensity. EVIDENCE SYNTHESIS Nine studies investigated outcome parameters beyond one-month after stroke. We are unable to make a comprehensive statement. Nevertheless, there are some arguments for reduced muscle thickness and reduced fascicle length of the hemiplegic, spastic leg. CONCLUSIONS Despite the fact that objective assessment by ultrasonography holds promise for diagnosis and follow-up of spastic hemiparesis after stroke, more evidence is needed to determine how changes in morphological muscle and tendon properties are related to muscle weakness, severity of spasticity and compensation strategies such as disuse or overuse in longitudinal studies starting early after stroke.
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Affiliation(s)
- Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium -
| | - An DE Groef
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium.,Department of Development and Regeneration, University of Leuven, Leuven, Belgium
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14
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Megna M, Marvulli R, Farì G, Gallo G, Dicuonzo F, Fiore P, Ianieri G. Pain and Muscles Properties Modifications After Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment. Endocr Metab Immune Disord Drug Targets 2020; 19:1127-1133. [PMID: 30843498 DOI: 10.2174/1871530319666190306101322] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Spasticity (most common disability in upper motor neuron syndrome or UMNS) caused an inability of patients' to perform daily activities and a decrease inquality of life. One of the promising methods nowadays, but still not widely used in everyday practice, for spasticity reduction is extracorporeal shock wave. The aim of this study was to evaluate the objective clinical effects of combined treatment botulinum toxin type A and radial Extracorporeal Shock Wave Therapy in spasticity post stroke. METHODS We considered 30 subjects (14 female and 16 male) with post stroke spasticity of Biceps Brachii, Superficial Flexor Digitorum, Gastrocnemius Medialis and Lateralis and we divided patients into two groups (group A received botulinum toxin injection and physiotherapy while group B received botulinum toxin injection, rESWT and physiotherapy). Assessments were performed before treatment (t0), after 1 (t1), 2 (t2) e 3 (t3) months using Modified Ahworth Scale, Visual Analogical Scale for pain and MyotonPro® device (to assessed myometric evaluation of muscles tone and stiffness). RESULTS Visual Analogical Scale, Modified Ahworth Scale, muscles tone and stiffness statistically decreased until t3 in the group A and in the group B, but the differences between the two groups were significant at the t1 only. CONCLUSION Radial Extracorporeal Shock Wave Therapy could be an effective physical treatment aimed at the reduction of upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke.
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Affiliation(s)
- Marisa Megna
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Riccardo Marvulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giacomo Farì
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giulia Gallo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Franca Dicuonzo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Pietro Fiore
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giancarlo Ianieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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15
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Berenpas F, Weerdesteyn V, Geurts AC, van Alfen N. Long-term use of implanted peroneal functional electrical stimulation for stroke-affected gait: the effects on muscle and motor nerve. J Neuroeng Rehabil 2019; 16:86. [PMID: 31292003 PMCID: PMC6621964 DOI: 10.1186/s12984-019-0556-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral changes to muscle and motor nerves occur following stroke, which may further impair functional capacity. We investigated whether a year-long use of an implanted peroneal FES system reverses stroke-related changes in muscles and motor nerves in people with foot drop in the chronic phase after supratentorial stroke. METHODS Thirteen persons with a chronic stroke (mean age 56.1 years, median Fugl-Meyer Assessment leg score 71%) were included and received an implanted peroneal FES system (ActiGait®). Quantitative muscle ultrasound (QMUS) images were obtained bilaterally from three leg muscles (i.e. tibialis anterior, rectus femoris, gastrocnemius). Echogenicity (muscle ultrasound gray value) and muscle thickness were assessed over a one-year follow-up and compared to age-, sex-, height- and weight-corrected reference values. Compound motor action potentials (CMAPs) and motor evoked potentials (MEPs) were obtained from the tibialis anterior muscle. Generalized estimated equation modeling was used to assess changes in QMUS, CMAPs and MEPs outcomes over the follow-up period. RESULTS Echogenicity of the tibialis anterior decreased significantly during the follow-up on the paretic side. Z-scores changed from 0.88 at baseline to - 0.15 after 52 weeks. This was accompanied by a significant increase in muscle thickness on the paretic side, where z-scores changed from - 0.32 at baseline to 0.48 after 52 weeks. Echogenicity of the rectus femoris normalized on both the paretic and non-paretic side (z-scores changed from - 1.09 and - 1.51 to 0.14 and - 0.49, respectively). Amplitudes of CMAP and MEP (normalized to CMAP) were reduced during follow-up, particularly on the paretic side (ΔCMAP = 20% and ΔMEP = 14%). CONCLUSIONS We show that the structural changes to muscles following stroke are reversible with FES and that these changes might not be limited to electrically stimulated muscles. No evidence for improvement of the motor nerves was found.
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Affiliation(s)
- Frank Berenpas
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Alexander C Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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16
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Carrasco JJ, Espí-López GV, Pérez-Alenda S. Cross-sectional study of quadriceps properties and postural stability in patients with chronic stroke and limited vs. non-limited community ambulation. Top Stroke Rehabil 2019; 26:503-510. [PMID: 31246150 DOI: 10.1080/10749357.2019.1634360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Changes in the paretic-side metabolism post-stroke and quadriceps muscle mechanical properties favour muscle wasting, affecting postural instability and walking impairment. Further clarification is needed in subjects post-stroke who show limited or non-limited community ambulation. Objectives: To analyze between-limb differences in quadriceps muscle thickness, strength and thigh cutaneous temperature, as well as investigate postural stability in subjects with chronic stroke and limited vs. non-limited community ambulation and compared against healthy controls. Methods: In this controlled cross-sectional study, 26 participants with chronic hemiparesis post-stroke (divided in a slow gait group (SG<0.8 m/s) (n = 13) and a fast gait group with full community ambulation speed (FG≥0.8 m/s)) and 18 healthy people were recruited. Thigh surface temperature, rectus femoris (RF) and vastus intermedius (VI) muscles thickness, quadriceps' isometric maximal voluntary contraction and postural stability were measured. Results: The SG presented significantly lower RF (P = .019) and VI (P = .006) muscle thickness, less peak force (P < .001) and lower temperature (P = .002) in the paretic vs the non-paretic limb. The FG showed significantly lower VI thickness (P = .036) and peak force (P < .001) in the paretic vs the non-paretic limb. Regarding balance, all indices were worse in the SG versus the FG and CG. Conclusions: Subjects of the FG, despite showing full community ambulation speed, had less quadriceps strength and VI muscle thickness but not RF muscle wasting in the paretic limb. The paretic VI muscle wasting may be an important factor to reach normal walking. The SG showed between-limb differences in all the studied variables and the worst postural stability.
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Affiliation(s)
- Maria-Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Juan J Carrasco
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain.,Intelligent Data Analysis Laboratory, University of Valencia , Valencia , Spain
| | - Gemma-Victoria Espí-López
- Research Unit in Manual Locomotor Therapy. Faculty of Physiotherapy, University of Valencia , Valencia , Spain.,Department of Physiotherapy, University of Valencia , Valencia , Spain
| | - Sofia Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia , Valencia , Spain
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17
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Picelli A, Tamburin S, Berto G, Chemello E, Gandolfi M, Saltuari L, Waldner A, Smania N. Electrodiagnostic and nerve ultrasonographic features in upper limb spasticity: an observational study. FUNCTIONAL NEUROLOGY 2018; 32:119-122. [PMID: 29041999 PMCID: PMC5726346 DOI: 10.11138/fneur/2017.32.3.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To better understand the effects of spasticity on peripheral nerves, we evaluated the electrodiagnostic and nerve ultrasonographic features of the median and ulnar nerves in adults with upper limb spasticity. Twenty chronic stroke patients with spastic hemiparesis underwent nerve conduction study and nerve ultrasonography of the median and ulnar nerves at both upper limbs. Affected versus unaffected upper limb comparisons showed significant differences in the median and ulnar nerve distal motor latencies, compound muscle action potentials and F-wave minimal latencies. Furthermore, we observed a significantly greater median nerve crosssectional area at the elbow of the affected upper limb compared with the unaffected one. Our findings confirmed electrodiagnostic asymmetries and nerve ultrasonographic abnormalities in the affected versus the unaffected upper limb after stroke. Slight changes in lower motor neuron activity and spasticity might contribute to these alterations.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Berto
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
- Research Unit of Neurorehabilitation, South Tyrol, Bolzano, Italy
| | - Andreas Waldner
- Research Unit of Neurorehabilitation, South Tyrol, Bolzano, Italy
- “Villa Melitta” Rehabilitation Clinic, Bolzano, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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18
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Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Akbarzadeh Baghban A, Ghasemi M. The Effect of Functional Stretching Exercises on Neural and Mechanical Properties of the Spastic Medial Gastrocnemius Muscle in Patients with Chronic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2018; 27:1733-1742. [PMID: 29706442 DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following spasticity, neural and mechanical changes of the paretic muscle often occur, which affect the muscle function. The aim of this study was to investigate the effect of functional stretching exercises on neural and mechanical properties of the spastic muscle in patients with stroke. MATERIALS AND METHODS This study was a single-blinded, randomized control trial. Forty five patients with stroke (experimental group: n = 30; control group: n = 15) participated in this study. Subjects in the experimental group participated in a functional stretching program 3 times a week for 4 weeks. Subjects in both groups were evaluated before the training, at the end of training, and then during a 2-month follow-up. Neural properties, including H-reflex latency and Hmax/Mmax ratio, were acquired. Mechanical properties, including fascicle length, pennation angle, and muscle thickness in the spastic medial gastrocnemius muscle, were evaluated. Repeated measure analysis of variance was used in the analysis. RESULTS Time by group interaction in the pennation angle (P = .006), and in muscle thickness (P = .030) was significant. The results indicated that the H-reflex latency (P = .006), pennation angle (P < .001), and muscle thickness (P = .001) were altered after stretching training program and these changes were at significant level after 2-month follow-up. CONCLUSION The results indicated that the use of functional stretching exercises can cause significant differences in neural and mechanical properties of spastic medial gastrocnemius muscle in patients with chronic stroke.
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Affiliation(s)
- Ehsan Ghasemi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Minoo Khalkhali-Zavieh
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Rezasoltani
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology & Isfahan Neurosciences Research Center, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Hadi S, Khadijeh O, Hadian M, Niloofar AY, Olyaei G, Hossein B, Calvo S, Herrero P. The effect of dry needling on spasticity, gait and muscle architecture in patients with chronic stroke: A case series study. Top Stroke Rehabil 2018; 25:326-332. [PMID: 29683410 DOI: 10.1080/10749357.2018.1460946] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives The objective of this study was to assess the short-term effects of dry needling on spasticity, gait, and muscle architecture of patients with chronic stroke. Methods A case series study was designed; and six chronic stroke patients with ankle spasticity and gait impairment received a single session of dry needling for gastrocnemius medialis, lateralis, and soleus muscles. The main outcome measures were the Modified Modified Ashworth Scale (MMAS), and Timed Up and Go test (TUG). In addition, ultrasonography measurements (e.g. thickness, pennation angle, and fascicle length) were performed for gastrocnemius medialis at baseline (T0), immediately after intervention (T1) and 30 min after intervention (T2), while the MMAS and TUG Test were only measured at T0 and T2. Results Based on the TUG test, there was a significant improvement in gait function (p = 0.023). Furthermore, the MMAS results (p = 0.014) showed a decrease in resistance to passive movements from plantar flexor muscles. Furthermore, a significant decrease in pennation angle (p = 0.014) and muscle thickness (p = 0.001), and also a significant increase in fascicle length of gastrocnemius medialis (p = 0.001) were observed after dry needling. Discussion & conclusions Based on the outcomes of this study, dry needling application seems to have short term effects in terms of reducing spasticity, improving gait, and muscle architecture of gastrocnemius medialis in patients with chronic stroke. The changes of muscle architecture may be interpreted as the positive effects of dry needling on the physical properties of hypertonic muscles.
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Affiliation(s)
- Sarafraz Hadi
- a Department of Physiotherapy, School of Rehabilitation , International Campus, Tehran University of Medical Sciences (IC-TUMS) , Tehran , Iran.,b Students' Scientific Research Center (SSRC) , Tehran University of Medical Sciences , Tehran , Iran.,c Department of Neurology , Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences , Bandar Abbas , Iran
| | - Otadi Khadijeh
- d Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Mohammadreza Hadian
- e Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences, International Campus (TUMSIC-TUMS), Brain and Spinal Injury Research Center (BASIR) , Tehran , Iran
| | - Ayoobi Yazdi Niloofar
- f Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Department of Rdiology , Tehran University of Medical Sciences , Tehran , Iran
| | - Gholamreza Olyaei
- g Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Bagheri Hossein
- g Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Sandra Calvo
- h iPhysio Research Group , Universidad San Jorge , Zaragoza , Spain
| | - Pablo Herrero
- h iPhysio Research Group , Universidad San Jorge , Zaragoza , Spain
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20
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Ianieri G, Marvulli R, Gallo GA, Fiore P, Megna M. "Appropriate Treatment" and Therapeutic Window in Spasticity Treatment with IncobotulinumtoxinA: From 100 to 1000 Units. Toxins (Basel) 2018; 10:toxins10040140. [PMID: 29597251 PMCID: PMC5923306 DOI: 10.3390/toxins10040140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 01/13/2023] Open
Abstract
Many neurological diseases (ischemic and hemorrhagic stroke, multiple sclerosis, infant cerebral palsy, spinal cord injuries, traumatic brain injury, and other cerebrovascular disorders) may cause muscle spasticity. Different therapeutic strategies have been proposed for the treatment of spasticity. One of the major treatments for tone modulation is botulinum toxin type A (BTX-A), performed in addition to other rehabilitation strategies based on individualized multidisciplinary programs aimed at achieving certain goals for each patient. Therapeutic plans must be precisely defined as they must balance the reduction of spastic hypertonia and retention of residual motor function. To perform and optimize the treatment, an accurate clinical and instrumental evaluation of spasticity is needed to determine how this symptom is invalidating and to choose the best doses, muscles and times of injection in each patient. We introduce an “appropriate treatment” and no “standard or high dosage treatment” concept based on our retrospective observational study on 120 patients lasting two years, according to the larger Therapeutic Index and Therapeutic Window of Incobotulinumtoxin A doses from 100 to 1000 units. We studied the efficiency and safety of this drug considering the clinical spasticity significance for specialist physicians and patients.
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Affiliation(s)
- Giancarlo Ianieri
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy.
| | - Riccardo Marvulli
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy.
| | - Giulia Alessia Gallo
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy.
| | - Pietro Fiore
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy.
| | - Marisa Megna
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy.
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21
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Akazawa N, Harada K, Okawa N, Tamura K, Hayase A, Moriyama H. Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study. Physiotherapy 2017; 104:438-445. [PMID: 29290379 DOI: 10.1016/j.physio.2017.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/12/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine the relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors. DESIGN Cross-sectional study. SETTING Hospital-based research. PARTICIPANTS Seventeen chronic stroke survivors who were unable to walk independently (non-independent walker group) and 11 chronic stroke survivors who were able to walk independently (independent walker group) participated in this study. In addition, 25 healthy older adults (healthy group) were enrolled. INTERVENTIONS None. MAIN OUTCOME MEASURES The muscle mass and intramuscular adipose and fibrous tissues of the rectus femoris and vastus intermedius were assessed based on muscle thickness and echo intensity of ultrasound images, respectively. RESULTS The thicknesses of the rectus femoris and vastus intermedius on the paretic and non-paretic sides in the non-independent walker group were significantly lower than those in the healthy group (mean difference -0.5 to -0.2cm; P<0.001-0.037). The paretic side in the non-independent walker group had significantly higher rectus femoris and vastus intermedius echo intensity compared with the healthy group (mean difference 15.8-17.4; P=0.007-0.025). The thickness of the rectus femoris on the non-paretic side was significantly lower in the independent walker group than in the healthy group (mean difference -0.3cm; P=0.001). CONCLUSIONS These results suggest that chronic stroke survivors who are unable to walk independently are likely to experience secondary changes in skeletal muscle on both the paretic and non-paretic sides.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Boji 180, Nishihama, Yamashiro-cho, Tokushima, Tokushima 770-8514, Japan.
| | - Kazuhiro Harada
- Department of Physical Therapy, Faculty of Health, Medical Care and Welfare, Kibi International University, Takahashi, Okayama, Japan
| | - Naomi Okawa
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Atsushi Hayase
- Department of Rehabilitation, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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22
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Picelli A, Baricich A, Chemello E, Smania N, Cisari C, Gandolfi M, Cinone N, Ranieri M, Santamato A. Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study. Toxins (Basel) 2017; 9:toxins9110375. [PMID: 29156545 PMCID: PMC5705990 DOI: 10.3390/toxins9110375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Abstract
The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicineand Movement Sciences, University of Verona, Verona 37134, Italy.
| | - Alessio Baricich
- Health Sciences Department, Università del Piemonte Orientale, Novara 28100, Italy.
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicineand Movement Sciences, University of Verona, Verona 37134, Italy.
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicineand Movement Sciences, University of Verona, Verona 37134, Italy.
| | - Carlo Cisari
- Health Sciences Department, Università del Piemonte Orientale, Novara 28100, Italy.
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicineand Movement Sciences, University of Verona, Verona 37134, Italy.
| | - Nicoletta Cinone
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia 71122, Italy.
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia 71122, Italy.
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia 71122, Italy.
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23
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Hara T, Abo M, Hara H, Kobayashi K, Shimamoto Y, Shibata Y, Sasaki N, Yamada N, Niimi M. Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on lower limb spasticity classified by spastic muscle echo intensity in post-stroke patients. Int J Neurosci 2017; 128:412-420. [PMID: 28985683 DOI: 10.1080/00207454.2017.1389927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of the present study was to investigate retrospectively the relationship between botulinum toxin type A plus multidisciplinary rehabilitation and muscle echo intensity in post-stroke patients with spasticity. The primary aim was to investigate whether the effects of the intervention on the improvement of spasticity depend on muscle echo intensity, and the secondary aim was to investigate whether the motor function of the lower limbs depends on muscle echo intensity. METHODS A 12-day inpatient protocol was designed for 102 post-stroke patients with spasticity due to lower limb paralysis. Muscle echo intensity of the triceps surae muscle was measured by ultrasonography, and the patients were categorized into four groups based on Heckmatt scale grades (Grades I-IV). RESULTS All four groups classified by the Heckmatt scale showed significant pre-to-post-intervention differences in the knee and ankle modified Ashworth scale scores (p < 0.05). Grades I-III patient groups showed a significant improvement in lower limb motor function following intervention. Grade IV patients did not show a significant improvement in lower limb motor function. CONCLUSIONS We observed significant improvements in the modified Ashworth scale scores after botulinum toxin type A and multidisciplinary rehabilitation therapy on post-stroke patients with spasticity. Although patients with lower muscle echo intensity demonstrated improvements in motor function, the improvement was poor in those with higher muscle echo intensity.
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Affiliation(s)
- Takatoshi Hara
- a Department of Rehabilitaion Medicine , The Jikei University School of Medicine , Tokyo , Japan.,b Department of Rehabilitaion Medicine , Kikyougahara Hospital , Nagano , Japan
| | - Masahiro Abo
- a Department of Rehabilitaion Medicine , The Jikei University School of Medicine , Tokyo , Japan
| | - Hiroyoshi Hara
- b Department of Rehabilitaion Medicine , Kikyougahara Hospital , Nagano , Japan
| | - Kazushige Kobayashi
- a Department of Rehabilitaion Medicine , The Jikei University School of Medicine , Tokyo , Japan
| | - Yusuke Shimamoto
- b Department of Rehabilitaion Medicine , Kikyougahara Hospital , Nagano , Japan
| | - Yamato Shibata
- b Department of Rehabilitaion Medicine , Kikyougahara Hospital , Nagano , Japan
| | - Nobuyuki Sasaki
- a Department of Rehabilitaion Medicine , The Jikei University School of Medicine , Tokyo , Japan
| | - Naoki Yamada
- a Department of Rehabilitaion Medicine , The Jikei University School of Medicine , Tokyo , Japan
| | - Masachika Niimi
- a Department of Rehabilitaion Medicine , The Jikei University School of Medicine , Tokyo , Japan
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24
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Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Baghban AA, Ghasemi M. The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial. J Bodyw Mov Ther 2017; 22:1004-1012. [PMID: 30368324 DOI: 10.1016/j.jbmt.2017.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/04/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke is the biggest cause of disability in adults. Spasticity is a primary impairment of stroke with a highly variable prevalence. In the present research, we aimed to determine the impact of functional stretching exercises on functional outcomes in stroke patients. METHODS Thirty stroke patients were randomized into two groups-Experimental group and control group for the purposes of the study. The subjects in the experimental group participated in a functional stretching training program at the rehabilitation center thrice a week for four weeks. The subjects in both groups were evaluated in 3 intervals, once at baseline, once at the end of the program, and once at 2 months following the program. Clinical assessments, such as measuring spasticity, were conducted using the Modified Modified Ashworth Scale (MMAS). Functional outcomes were also evaluated, using the Timed Up and Go (TUG) test, as well as the Timed 10-Meter Walk Test (WTT). Friedman test in SPSS version 22.0 was used to analysis the response variables with respect to each stage of evaluation. Spearman rank correlation was also used to measure correlation among clinical assessments and functional outcomes. RESULTS The comparison between two groups showed significant differences only in the Modified Modified Ashworth Scale and Visual Analogue Scale (VAS) post treatment. The experimental group showed significant differences in the MMAS (p = 0.002), WTT (p < 0.001), and TUG (p < 0.001) scores. Nevertheless, the scores of the control group were not significantly different in different stages of evaluation. CONCLUSION The findings of the study suggest that using functional stretching exercises can improve functional outcomes in chronic spastic stroke patients.
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Affiliation(s)
- Ehsan Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Minoo Khalkhali-Zavieh
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Rezasoltani
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology& Isfahan Neurosciences Research Center, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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25
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Picelli A, Vallies G, Chemello E, Castellazzi P, Brugnera A, Gandolfi M, Baricich A, Cisari C, Santamato A, Saltuari L, Waldner A, Smania N. Is spasticity always the same? An observational study comparing the features of spastic equinus foot in patients with chronic stroke and multiple sclerosis. J Neurol Sci 2017; 380:132-136. [PMID: 28870553 DOI: 10.1016/j.jns.2017.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/20/2022]
Abstract
Spasticity is common in stroke and multiple sclerosis. To treat spasticity we have a wide range of interventions, whose application may depend not only on the severity of spasticity but also on its etiology. Consequently, a better understanding of muscle spasticity in different neurological diseases may inform clinicians as to the more appropriate therapeutic approach. Our aim was to compare the clinical and ultrasonographic features of spastic equinus in patients with chronic stroke and multiple sclerosis. Thirty-eight patients with secondary progressive multiple sclerosis and 38 chronic stroke patients with spastic equinus were evaluated at the affected ankle according to the following outcomes: modified Ashworth scale, Tardieu scale, passive range of motion, spastic gastrocnemius muscle echo intensity and thickness. Affected calf muscles tone was significantly greater in patients with chronic stroke (modified Ashworth scale P=0.008; Tardieu scale angle P=0.004) as well as spastic gastrocnemius muscle echo intensity (P<0.001). Affected ankle range of motion was significantly greater in patients with multiple sclerosis (P<0.001) as well as spastic gastrocnemius muscle thickness (medialis: P=0.003; lateralis: P=0.004). Our findings evidenced that the same pattern of spasticity (equinus foot) has some different features according to its etiology. This may help the management of spasticity.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Gabriella Vallies
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Castellazzi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Annalisa Brugnera
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Alessio Baricich
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
| | - Carlo Cisari
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
| | - Andrea Santamato
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Unit of Neurorehabilitation, South Tyrol, Bolzano, Italy
| | - Andreas Waldner
- Research Unit of Neurorehabilitation, South Tyrol, Bolzano, Italy; "Villa Melitta" Rehabilitation Clinic, Bolzano, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
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26
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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
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27
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Picelli A, La Marchina E, Gajofatto F, Pontillo A, Vangelista A, Filippini R, Baricich A, Cisari C, Smania N. Sonographic and clinical effects of botulinum toxin Type A combined with extracorporeal shock wave therapy on spastic muscles of children with cerebral palsy. Dev Neurorehabil 2017; 20:160-164. [PMID: 26890193 DOI: 10.3109/17518423.2015.1105320] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare the combined sonographic and clinical effects of botulinum toxin type A (BoNT-A) and extracorporeal shock wave therapy (ESWT) versus BoNT-A alone in children with cerebral palsy. METHODS Ten children with spastic cerebral palsy were randomly assigned to one of two groups. Group 1 received BoNT-A injection into the spastic muscles of the affected limbs plus three ESWT sessions. Group 2 received BoNT-A alone. Assessment was performed before and 1 month after injection. Sonographic outcomes were injected muscles echo intensity and their hardness percentage, and clinical outcomes the modified Ashworth scale and the Tardieu scale. RESULTS At 1-month evaluation, significant differences in the injected muscles percentage of hardness (P = 0.021) and the modified Ashworth scale (P = 0.001) were found between groups. CONCLUSIONS Our results support the hypothesis that the combined effects of BoNT-A and ESWT derive from their respective action on neurological and non-neural rheological components in spastic muscles.
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Affiliation(s)
- Alessandro Picelli
- a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy
| | - Elisabetta La Marchina
- a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy
| | | | - Angelo Pontillo
- a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy
| | | | | | - Alessio Baricich
- c Physical and Rehabilitative Medicine , University Hospital "Maggiore della Carità" , Novara , Italy.,d Department of Health Sciences , Piemonte Orientale University , Novara , Italy
| | - Carlo Cisari
- c Physical and Rehabilitative Medicine , University Hospital "Maggiore della Carità" , Novara , Italy.,d Department of Health Sciences , Piemonte Orientale University , Novara , Italy
| | - Nicola Smania
- a Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological , Biomedical and Movement Sciences, University of Verona , Verona , Italy.,e Neurorehabilitation Unit , Hospital Trust of Verona , Verona , Italy
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28
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Berenpas F, Martens AM, Weerdesteyn V, Geurts AC, van Alfen N. Bilateral changes in muscle architecture of physically active people with chronic stroke: A quantitative muscle ultrasound study. Clin Neurophysiol 2016; 128:115-122. [PMID: 27888744 DOI: 10.1016/j.clinph.2016.10.096] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/05/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Changes in muscle architecture after stroke are usually assessed by investigating inter-limb differences. As a result bilateral changes of muscle architecture might be missed. Our aim was to investigate whether bilateral architectural changes in skeletal muscle can be detected in chronic, physically active stroke patients using quantitative muscle ultrasound (QMUS). METHODS Twenty-eight patients (mean time since stroke 5.2years, median Brunnström stage 4) were recruited. QMUS images were obtained bilaterally from 2 arm and 4 leg muscles. Corrected echogenicity (muscle ultrasound grayvalue) and muscle thickness were compared to reference values obtained from healthy subjects. Correlations of muscle changes with demographic, clinical and neurophysiological characteristics were explored. RESULTS Out of 6 muscles, a significant increase in mean echogenicity was found in 4 paretic and 3 non-paretic side muscles. Significant decreases in mean muscle thickness were found in 2 paretic side muscles and 1 non-paretic side muscle. Echogenicity of the medial gastrocnemius correlated moderately with walking speed (inversely) and time since stroke. CONCLUSIONS This study showed that QMUS is a feasible technique to investigate architectural changes in skeletal muscles in the chronic phase of stroke and that abnormalities can be found in muscles on both the hemiparetic and non-paretic side. SIGNIFICANCE Intriguing data on bilateral changes in muscles of people with stroke is presented. Directions for future research are provided.
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Affiliation(s)
- Frank Berenpas
- Radboud University Medical Center, Donders Centre for Neuroscience, Department of Rehabilitation, Nijmegen, The Netherlands.
| | - Anne-Marieke Martens
- Radboud University Medical Center, Donders Centre for Neuroscience, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Radboud University Medical Center, Donders Centre for Neuroscience, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Alexander C Geurts
- Radboud University Medical Center, Donders Centre for Neuroscience, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Nens van Alfen
- Radboud University Medical Center, Donders Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
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29
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Picelli A, Chemello E, Castellazzi P, Roncari L, Waldner A, Saltuari L, Smania N. Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial. Restor Neurol Neurosci 2016; 33:357-68. [PMID: 26410579 DOI: 10.3233/rnn-140474] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke. METHODS Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n = 10) or sham tDCS + cathodal tsDCS (group 2; n = 10) or tDCS + cathodal tsDCS (group 3; n = 10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment. RESULTS Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P = 0.015; 2-week follow-up P = 0.001) and between group 3 and group 2 (post-treatment P = 0.010; 2-week follow-up P = .015). No difference was found between group 2 and group 1. CONCLUSIONS Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Castellazzi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Roncari
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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30
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Volk GF, Leier C, Guntinas-lichius O. Correlation between electromyography and quantitative ultrasonography of facial muscles in patients with facial palsy. Muscle Nerve 2016; 53:755-61. [DOI: 10.1002/mus.24931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology; Jena University Hospital; Lessingstrasse 2 D-07740 Jena Germany
- Facial Nerve Center; Jena University Hospital; Jena Germany
| | - Christian Leier
- Department of Otorhinolaryngology; Jena University Hospital; Lessingstrasse 2 D-07740 Jena Germany
| | - Orlando Guntinas-lichius
- Department of Otorhinolaryngology; Jena University Hospital; Lessingstrasse 2 D-07740 Jena Germany
- Facial Nerve Center; Jena University Hospital; Jena Germany
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31
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Maia MON, Dantas CG, Xavier Filho L, Cândido EAF, Gomes MZ. The Effect ofAlpinia zerumbetEssential Oil on Post-Stroke Muscle Spasticity. Basic Clin Pharmacol Toxicol 2015; 118:58-62. [DOI: 10.1111/bcpt.12439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Camila Gomes Dantas
- Tiradentes University; Aracaju/SE Brazil
- Research and Technology Institute (ITP); Aracaju/SE Brazil
| | - Lauro Xavier Filho
- Tiradentes University; Aracaju/SE Brazil
- Research and Technology Institute (ITP); Aracaju/SE Brazil
| | | | - Margarete Zanardo Gomes
- Tiradentes University; Aracaju/SE Brazil
- Research and Technology Institute (ITP); Aracaju/SE Brazil
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32
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Ryan ED, Rosenberg JG, Scharville MJ, Sobolewski EJ, Tweedell AJ, Kleinberg CR. Pennation angle does not influence the age-related differences in echo intensity of the medial gastrocnemius. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:618-621. [PMID: 25438857 DOI: 10.1016/j.ultrasmedbio.2014.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 06/04/2023]
Abstract
The reflection of an ultrasound (US) wave is strongest when the propagation direction of the wave is perpendicular to muscle fascicles. Thus, it is possible that muscle echo intensity (EI), a gray-scale US measure of muscle quality, may be influenced by the angulation of muscle fascicles. Therefore, the purpose of this study was to determine if age-related differences in muscle EI values are influenced by differences in pennation angle (PA). Medial gastrocnemius EI and PA were examined using panoramic US imaging in 24 young (19.8 ± 1.7 y) and 21 older (69.3 ± 3.3 y) men. The young men had lower EI values (young = 74.1 ± 6.3 a.u., older = 89.1 ± 8.8 a.u.) and a greater PA (young = 20.0 ± 2.9°; older = 17.2 ± 2.5°) compared with the older men (p < 0.01). In addition, there was a negative relationship (r = -0.473, p < 0.01) between PA and EI with both groups combined, but no significant relationship when the young (r = -0.334, p = 0.111) and older (r = -0.147, p = 0.525) men were examined separately. An analysis of covariance revealed that muscle EI values remained different (p < 0.01) between age groups after adjustment for differences in PA. Thus, after statistically adjusting the mean EI values for the differences in PA, there were still significant age-related differences in EI. These findings may provide further support that the age-related changes in muscle EI values reflect changes in tissue composition (i.e., increase in intramuscular fat and/or connective tissue) commonly reported in older adults.
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Affiliation(s)
- Eric D Ryan
- Neuromuscular Research Laboratory, Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Joseph G Rosenberg
- Neuromuscular Research Laboratory, Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; Valencell, Inc., Raleigh, North Carolina, USA
| | - Michael J Scharville
- Neuromuscular Research Laboratory, Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric J Sobolewski
- Neuromuscular Research Laboratory, Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; Human Performance Laboratory, Department of Health, Exercise, and Sport Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Andrew J Tweedell
- Neuromuscular Research Laboratory, Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Craig R Kleinberg
- Neuromuscular Research Laboratory, Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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Santamato A, Micello MF, Panza F, Fortunato F, Baricich A, Cisari C, Pilotto A, Logroscino G, Fiore P, Ranieri M. Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques. J Neurol Sci 2014; 347:39-43. [PMID: 25263601 DOI: 10.1016/j.jns.2014.09.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/25/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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