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Julliand S, Papaxanthis C, Delphin C, Mock A, Raumel MA, Gueugnon M, Ornetti P, Laroche D. IMPROVE study protocol, investigating post-stroke local muscle vibrations to promote cerebral plasticity and functional recovery: a single-blind randomised controlled trial. BMJ Open 2024; 14:e079918. [PMID: 38490651 PMCID: PMC10946362 DOI: 10.1136/bmjopen-2023-079918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Spasticity is a frequent disabling consequence following a stroke. Local muscle vibrations (LMVs) have been proposed as a treatment to address this problem. However, little is known about their clinical and neurophysiological impacts when used repeatedly during the subacute phase post-stroke. This project aims to evaluate the effects of a 6-week LMV protocol on the paretic limb on spasticity development in a post-stroke subacute population. METHODS AND ANALYSIS This is an interventional, controlled, randomised, single-blind (patient) trial. 100 participants over 18 years old will be recruited, within 6 weeks following a first stroke with hemiparesis or hemiplegia. All participants will receive a conventional rehabilitation programme, plus 18 sessions of LMV (ie, continuously for 30 min) on relaxed wrist and elbow flexors: either (1) at 80 Hz for the interventional group or (2) at 40 Hz plus a foam band between the skin and the device for the control group.Participants will be evaluated at baseline, at 3 weeks and 6 weeks, and at 6 months after the end of the intervention. Spasticity will be measured by the modified Ashworth scale and with an isokinetic dynamometer. Sensorimotor function will be assessed with the Fugl-Meyer assessment of the upper extremity. Corticospinal and spinal excitabilities will be measured each time. ETHICS AND DISSEMINATION This study was recorded in a clinical trial and obtained approval from the institutional review board (Comité de protection des personnes Ile de France IV, 2021-A03219-32). All participants will be required to provide informed consent. The results of this trial will be published in peer-reviewed journals to disseminate information to clinicians and impact their practice for an improved patient's care. TRIAL REGISTRATION NUMBER Clinical Trial: NCT05315726 DATASET: EUDRAct.
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Affiliation(s)
- Sophie Julliand
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
| | | | - Corentin Delphin
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
| | - Anne Mock
- Physical Medicine and Rehabilitation, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
| | - Marc-Antoine Raumel
- Physical Medicine and Rehabilitation, Hospital Centre Chalon-sur-Saône, Chalon-sur-Saône, France
| | - Mathieu Gueugnon
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
| | - Paul Ornetti
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
| | - Davy Laroche
- INSERM CIC 1432, Plateforme d'Investigation Technologique, CHU Dijon, Dijon, Bourgogne-Franche-Comté, France
- INSERM U1093, Dijon, France
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Scalia M, Borzuola R, Parrella M, Borriello G, Sica F, Monteleone F, Maida E, Macaluso A. Neuromuscular Electrical Stimulation Does Not Influence Spinal Excitability in Multiple Sclerosis Patients. J Clin Med 2024; 13:704. [PMID: 38337396 PMCID: PMC10856365 DOI: 10.3390/jcm13030704] [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: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability.
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Affiliation(s)
- Martina Scalia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Riccardo Borzuola
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Martina Parrella
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
| | - Giovanna Borriello
- Neurology Unit, San Pietro Fatebenefratelli Hospital, MS Centre, 00189 Rome, Italy
| | - Francesco Sica
- Santa Maria Goretti Hospital, 04100 Latina, Italy; (F.S.); (F.M.)
| | | | - Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (M.S.); (R.B.); (M.P.); (A.M.)
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Baum P, Metelmann M. Muskelzuckungen und Muskelkrämpfe –
Differenzialdiagnosen und elektrophysiologische Diagnostik. KLIN NEUROPHYSIOL 2023. [DOI: 10.1055/a-1895-5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Muskelzuckungen und -krämpfe sind Beschwerden, die vom harmlosen Symptom
bis hin zu Symptomen einer schwerwiegenden neurologischen Erkrankung reichen
können. Eine ausführliche Anamnese, gründliche
neurologische Untersuchung und elektrophysiologische Untersuchungen
ermöglichen die Unterscheidung der verschiedenen Ätiologien. In
diesem Artikel werden verschiedene Ursachen unter Berücksichtigung deren
Definition, der elektrophysiologisch zugrunde liegenden Phänomene und
deren differenzialdiagnostischer Einordnung dargestellt.
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Merlo A, Galletti M, Zerbinati P, Prati P, Mascioli F, Basini G, Rambelli C, Masiero S, Mazzoli D. Surgical quadriceps lengthening can reduce quadriceps spasticity in chronic stroke patients. A case-control study. Front Neurol 2022; 13:980692. [PMID: 36313503 PMCID: PMC9606420 DOI: 10.3389/fneur.2022.980692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Muscle overactivity is one of the positive signs of upper motor neuron lesions. In these patients, the loss of muscle length and extensibility resulting from soft tissue rearrangement has been suggested as a contributing cause of muscle overactivity in response to stretching. Objective To assess the effects of surgical lengthening of the quadriceps femoris (QF) muscle-tendon unit by aponeurectomy on muscle spasticity. Methods This is a case-control study on chronic stroke patients with hemiparesis that have undergone lower limb functional surgery over a 8-year period. CASEs underwent corrective surgery for both the foot and knee deviations, inclusive of a QF aponeurectomy. Controls (CTRLs) underwent corrective surgery for foot deviations only. QF spasticity was assessed with the Modified Tardieu Scale (MTS) before and 1 month after surgery. The Wilcoxon test was used to assess MTS variations over time and the Mann–Whitney test was used to verify the presence of group differences at the 1 month mark. Results Ninety-three patients were included: 57 cases (30F, 1–34 years from lesion) and 36 controls (12F, 1–35 years from lesion). Before surgery, both CASEs and CTRLs had similar MTS scores (median MTS = 3) and functional characteristics. One month after surgery, QF spasticity was significantly lower in the CASEs compared to CTRLs (p = 0.033) due to a significant reduction of the median MTS score from 3 to 0 in the CASE group (p < 0.001) and no variations in the CTRL group (p = 0.468). About half of the cases attained clinically significant MTS reductions and complete symptom relief even many years from the stroke. Conclusions Functional surgery inclusive of QF aponeurectomy can be effective in reducing or suppressing spasticity in chronic stroke patients. This is possibly a result of the reduction in neuromuscular spindle activation due to a decrease in muscle shortening, passive tension, and stiffness.
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Affiliation(s)
- Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Martina Galletti
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
- *Correspondence: Martina Galletti
| | | | - Paolo Prati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Francesca Mascioli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Giacomo Basini
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Chiara Rambelli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
- Section of Rehabilitation, Department of Neuroscience, University of Padova, Padua, Italy
| | - Stefano Masiero
- Section of Rehabilitation, Department of Neuroscience, University of Padova, Padua, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
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Soleus H-Reflex Change in Poststroke Spasticity: Modulation due to Body Position. Neural Plast 2021; 2021:9955153. [PMID: 34917144 PMCID: PMC8670919 DOI: 10.1155/2021/9955153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose This study is aimed at exploring how soleus H-reflex change in poststroke patients with spasticity influenced by body position. Materials and Methods Twenty-four stroke patients with spastic hemiplegia and twelve age-matched healthy controls were investigated. Maximal Hoffmann-reflex (Hmax) and motor potential (Mmax) were elicited at the popliteal fossa in both prone and standing positions, respectively, and the Hmax/Mmax ratio at each body position was determined. Compare changes in reflex behavior in both spastic and contralateral muscles of stroke survivors in prone and standing positions, and match healthy subjects in the same position. Results In healthy subjects, Hmax and Hmax/Mmax ratios were significantly decreased in the standing position compared to the prone position (Hmax: p = 0.000, Hmax/Mmax: p = 0.016). However, Hmax/Mmax ratios were increased in standing position on both sides in poststroke patients with spasticity (unaffected side: p = 0.006, affected side: p = 0.095). The Hmax and Hmax/Mmax ratios were significantly more increased on the affected side than unaffected side irrespective of the position. Conclusions The motor neuron excitability of both sides was not suppressed but instead upregulated in the standing position in subjects with spasticity, which may suggest that there was abnormal regulation of the Ia pathway on both sides.
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Broser PJ, Lütschg J. Die Bedeutung neurophysiologischer Methoden in der Abklärung neuropädiatrischer und neuromuskulärer Erkrankungen. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hoque M, Borich M, Sabatier M, Backus D, Kesar T. Effects of downslope walking on Soleus H-reflexes and walking function in individuals with multiple sclerosis: A preliminary study. NeuroRehabilitation 2019; 44:587-597. [PMID: 31256089 DOI: 10.3233/nre-192701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Downslope walking (DSW) is an eccentric-based exercise intervention that promotes neuroplasticity of spinal reflex circuitry by inducing depression of Soleus Hoffman (H)-reflexes in young, neurologically unimpaired adults. OBJECTIVE The objective of the study was to evaluate the effects of DSW on spinal excitability (SE) and walking function (WF) in people with multiple sclerosis (PwMS). METHODS Our study comprised two experiments on 12 PwMS (11 women; 45.3±11.8 years). Experiment 1 evaluated acute effects of a single 20-minute session of treadmill walking at three different walking grades on SE, 0% or level walking (LW), - 7.5% DSW, and - 15% DSW. Experiment 2 evaluated the effects of 6 sessions of DSW, at - 7.5% DSW (with second session being - 15% DSW) on SE and WF. RESULTS Experiment 1 showed significantly greater acute % H-reflex depression following - 15% DSW compared to LW (p = 0.02) and - 7.5% DSW (p = 0.05). Experiment 2 demonstrated significant improvements in WF. PwMS who showed greater acute H-reflex depression during the - 15% DSW session also demonstrated greater physical activity, long-distance WF, and the ability to have greater H-reflex depression after DSW training. Significant changes were not observed in regards to SE. CONCLUSIONS Though significant changes were not observed in SE after DSW training, we observed an improvement in WF which merits further investigation of DSW in PwMS.
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Affiliation(s)
- Maruf Hoque
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Borich
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Manning Sabatier
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah Backus
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA.,Shepherd Center, Atlanta, GA, USA
| | - Trisha Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
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Martens G, Deltombe T, Foidart-Dessalle M, Laureys S, Thibaut A. Clinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury. Clin Neurophysiol 2018; 130:207-213. [PMID: 30580243 DOI: 10.1016/j.clinph.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC. METHODS We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well. RESULTS 21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios. CONCLUSIONS In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture. SIGNIFICANCE Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly.
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Affiliation(s)
- G Martens
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
| | - T Deltombe
- Departments of Physical Medicine and Rehabilitation, CHU UCL (Université catholique de Louvain) Namur site Godinne, Belgium
| | - M Foidart-Dessalle
- Departments of Physical Medicine and Rehabilitation, University and University Hospital of Liege, Liege, Belgium
| | - S Laureys
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
| | - A Thibaut
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
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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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Li X, Shin H, Zong Y, Li S, Zhou P. Assessing muscle compliance in stroke with the Myotonometer. Clin Biomech (Bristol, Avon) 2017; 50:110-113. [PMID: 29065349 PMCID: PMC6729130 DOI: 10.1016/j.clinbiomech.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 08/18/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study explores changes of the intrinsic biomechanical property in the biceps brachii muscle after a hemispheric stroke using the Myotonometry technique. METHODS Nineteen subjects with chronic hemiplegia participated in the study. Myotonometer was used to measure tissue displacement when compression force was applied at 8 levels from 2.45N to 19.6N. Muscle displacement and compliance were determined and averaged over multiple trials. FINDINGS Statistical analysis indicated a significant decrease in muscle displacement and compliance in the spastic muscles compared with the contralateral side (muscle displacements: spastic: 4.51 (0.31) mm, contralateral: 5.74 (0.37) mm, p<0.005; compliance: spastic: 0.17 (0.011) mm/N, contralateral: 0.22 (0.014) mm/N, p<0.005). Correlation analysis, however, did not show any association between clinical assessments and myotonometric measurement (p>0.1). INTERPRETATION Alterations of muscle compliance in the spastic side reflect changes in the contractile or intrinsic mechanical properties after a stroke. Findings of the study have demonstrated high sensitivity and effectiveness of the Myotonometer in assessing muscle compliance changes.
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Affiliation(s)
- Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA,Corresponding author at: TIRR Research Center, 1333B Moursund St, Houston, TX 77030, USA. (X. Li)
| | - Henry Shin
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Ya Zong
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, and TIRR Memorial Hermann Research Center, Houston, TX, USA,Guangdong Work Injury Rehabilitation Center, Guangzhou, China
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Correlation between stiffness and electromechanical delay components during muscle contraction and relaxation before and after static stretching. J Electromyogr Kinesiol 2017; 33:83-93. [PMID: 28232285 DOI: 10.1016/j.jelekin.2017.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/23/2016] [Accepted: 02/06/2017] [Indexed: 12/22/2022] Open
Abstract
The study was aimed at assessing possible correlations of the electromechanical delay components during muscle contraction (DelayTOT) and relaxation (R-DelayTOT), with muscle-tendon unit (MTU), muscle, and tendon stiffness before and after static stretching (SS). Plantarflexor muscles' maximum voluntary torque (Tmax) was measured in 18 male participants (age 24±3yrs; body mass 76.4±8.9kg; stature 1.78±0.09m; mean±SD). During Tmax, surface electromyogram (EMG), mechanomyogram, and force signals were detected. DelayTOT and R-DelayTOT with their electrochemical and mechanical components were calculated. Passive torque and myotendinous junction displacement were assessed at 0°, 10° and 20° of dorsiflexion to determine MTU, muscle and tendon stiffness. The same protocol was repeated after SS. DelayTOT, R-DelayTOT and their mainly mechanical components correlated with MTU, muscle and tendon stiffness, both before (R2 from 0.562 to 0.894; p<0.001) and after SS (R2 from 0.726 to 0.955; p<0.001). SS decreased Tmax (-14%; p<0.001) and lengthened almost all the DelayTOT and R-DelayTOT components (from +5.9% to +30.5%; p<0.05). Correlations were found only between stiffness and the mechanical components of DelayTOT and R-DelayTOT. Correlations persisted after SS but delays increased to a higher extent than stiffness, indicating a complexity of the relationship between stiffness and delays that will be discussed in the manuscript.
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Miramonti AA, Jenkins NDM, Oza PD, Weir JP, Cramer JT. Mechanomyographic responses during recruitment curves in the soleus muscle. Muscle Nerve 2017; 56:107-116. [PMID: 27718510 DOI: 10.1002/mus.25432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In this study we examined relationships among mechanomyographic (MMG), electromyographic (EMG), and peak twitch torque (PTT) responses as well as test-retest reliability when recorded during recruitment curves in the soleus muscle. METHODS PTT, EMG (M-wave, H-reflex), and MMG responses were recorded during recruitment curves in 16 subjects (age 24 ± 2 years) on 2 separate days. The sum of the M-wave and H-reflex (M+H) was calculated. Correlations among variables and test-retest reliability were determined. RESULTS MMG was correlated with PTT (mean r = 0.93, range r = 0.59-0.99), the M-wave (0.95, 0.04-0.98), and M+H (0.91, 0.42-0.97), but was unrelated to the H-reflex (-0.06, -0.56 to 0.47). Reliability was consistently high among most variables, but normalizing to the maximum value improved MMG reliability and the minimum detectable change. CONCLUSION MMG responses predicted 86%-90% of the variability in PTT, M-wave, and M+H; thus, MMG may be a useful alternative for estimating twitch torque and maximal activation. Muscle Nerve 56: 107-116, 2017.
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Affiliation(s)
- Amelia A Miramonti
- Department of Nutrition and Health Science, University of Nebraska, 211 Ruth Leverton Hall, Lincoln, Nebraska, 68583-0806, USA
| | - Nathaniel D M Jenkins
- Department of Health and Human Performance, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Preeti D Oza
- Department of Physical Therapy, University of the Pacific, Stockton, California, USA
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Joel T Cramer
- Department of Nutrition and Health Science, University of Nebraska, 211 Ruth Leverton Hall, Lincoln, Nebraska, 68583-0806, USA
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Santos EL, Santos MC, Krueger E, Nogueira-Neto GN, Nohama P. Mechanomyography signals in spastic muscle and the correlation with the modified Ashworth scale. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:3789-3792. [PMID: 28325000 DOI: 10.1109/embc.2016.7591553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The modified Ashworth scale (MAS) is the most widely used measurement technique to assess levels of spasticity. In MAS, the evaluator graduates spasticity considering his/her subjective analysis of the muscular endurance during passive stretching. Therefore, it is a subjective scale. Mechanomyography (MMG) allows registering the vibrations generated by muscle contraction and stretching events that propagate through the tissue until the surface of the skin. With this in mind, this study aimed to investigate possible correlations between MMG signal and muscle spasticity levels determined by MAS. We evaluated 34 limbs considered spastic by MAS, including upper and lower limbs of 22 individuals of both sexes. Simultaneously, the MMG signals of the spastic muscle group (agonists) were acquired. The features investigated involved, in the time domain, the median energy (MMGME) of the MMG Z-axis (perpendicular to the muscle fibers) and, in the frequency domain, the median frequency (MMGmf). The Kruskal-Wallis test (p<;0.001) determined that there were significant differences between intergroup MAS spasticity levels for MMGme. There was a high linear correlation between the MMGme and MAS (R2=0.9557) and also a high correlation as indicated by Spearman test (ρ=0.9856; p<;0.001). In spectral analysis, the Kruskal-Wallis test (p = 0.0059) showed that MMGmf did not present significant differences between MAS spasticity levels. There was moderate linear correlation between MAS and MMGmf (R2=0.4883 and Spearman test [ρ = 0.4590; p <; 0.001]). Between the two investigated features, we conclude that the median energy is the most viable feature to evaluate spasticity due to strong correlations with the MAS.
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Karakoyun A, Boyraz İ, Gunduz R, Karamercan A, Ozgirgin N. Electrophysiological and clinical evaluation of the effects of transcutaneous electrical nerve stimulation on the spasticity in the hemiplegic stroke patients. J Phys Ther Sci 2015; 27:3407-11. [PMID: 26696708 PMCID: PMC4681915 DOI: 10.1589/jpts.27.3407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/05/2015] [Indexed: 01/28/2023] Open
Abstract
To investigate whether transcutaneous electrical nerve stimulation (TENS) mitigates the spasticity of hemiplegic stroke patients, as assessed by electrophysiological variables, and the effects, if any, on the clinical appearance of spasticity. [Subjects and Methods] Twenty-seven subjects who had acute hemiplegia and 24 healthy people as the control group, were enrolled in this study. Some of the acute cerebrovascular disease patients could walk. Subjects who did not have spasticity, who were taking antispasticity medicine, or had a previous episode of cerebrovascular disease were excluded. The walking speed of the patients was recorded before and after TENS. EMG examinations were performed on the healthy controls and in the affected side of the patients. A 30-minute single session of TENS was applied to lower extremity. At 10 minutes after TENS, the EMG examinations were repeated. [Results] A statistically significant decrease in the spasticity variables, and increased walking speed were found post-TENS. The lower M amplitude and higher H reflex amplitude, H/M maximum amplitude ratio, H slope, and H slope/M slope ratio on the spastic side were found to be statistically significant. [Conclusion] TENS application for hemiplegic patients with spastic lower extremities due to cerebrovascular disease resulted in marked improvement in clinical scales of spasticity and significant changes in the electrophysiological variables.
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Affiliation(s)
- Ahmet Karakoyun
- Department of Physical Therapy and Rehabilitation, Aksaray State Hospital, Turkey
| | - İsmail Boyraz
- Department of Physical Therapy and Rehabilitation, School of Medicine, Abant Izzet Baysal University, Turkey
| | - Ramazan Gunduz
- Department of Physical Therapy and Rehabilitation, School of Medicine, Karabuk University, Turkey
| | | | - Nese Ozgirgin
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Turkey
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15
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Novel insights into skeletal muscle function by mechanomyography: from the laboratory to the field. SPORT SCIENCES FOR HEALTH 2015. [DOI: 10.1007/s11332-015-0219-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Yaeshima K, Negishi D, Yamamoto S, Ogata T, Nakazawa K, Kawashima N. Mechanical and neural changes in plantar-flexor muscles after spinal cord injury in humans. Spinal Cord 2015; 53:526-33. [PMID: 25665544 DOI: 10.1038/sc.2015.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To determine the effect of injury duration on plantar-flexor elastic properties in individuals with chronic spinal cord injury (SCI) and spasticity. SETTING National Rehabilitation Center for Persons with Disabilities, Japan. METHODS A total of 16 chronic SCI patients (age, 33±9.3 years; injury localization, C6-T12; injury duration, 11-371 months) participated. Spasticity of the ankle plantar-flexors was assessed using the Modified Ashworth Scale (MAS). The calf circumference and muscle thickness of the medial gastrocnemius (MG), lateral gastrocnemius and soleus were assessed using tape measure and ultrasonography. In addition, the ankle was rotated from 10° plantar-flexion to 20° dorsiflexion at 5 deg s(-1) with a dynamometer, and the ankle angle and torque were recorded. After normalizing the data (the initial points of angle and torque were set to zero), we calculated the peak torque and energy. Furthermore, angle-torque data (before and after normalization) were fitted with a second- and fourth-order polynomial, and exponential (Sten-Knudsen) models, and stiffness indices (SISOP, SIFOP, SISK) and AngleSLACK (the angle at which plantar-flexor passive torque equals zero) were calculated. The stretch reflex gain and offset were determined from 0-10° dorsiflexion at 50, 90, 120 and 150 deg s(-1). After logarithmic transformation, Pearson's correlation coefficients were calculated. RESULTS MAS, calf circumference, MG thickness, peak torque and SIFOP significantly decreased with injury duration (r log-log=-0.63, -0.69, -0.63, -0.53 and -0.55, respectively, P<0.05). The peak torque and SIFOP maintained significant relationships even after excluding impacts from muscle morphology. CONCLUSION Plantar-flexor elasticity in chronic SCI patients decreased with increased injury duration.
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Affiliation(s)
- K Yaeshima
- 1] Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan [2] Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - D Negishi
- Division of Functional Control System, Graduate School of System engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - S Yamamoto
- Division of Functional Control System, Graduate School of System engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - T Ogata
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - K Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - N Kawashima
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
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17
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Krueger E, Scheeren EM, Nogueira-Neto GN, Button VLDSN, Nohama P. Advances and perspectives of mechanomyography. ACTA ACUST UNITED AC 2014. [DOI: 10.1590/1517-3151.0541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eddy Krueger
- Universidade Tecnológica Federal do Paraná - UTFPR, Brasil
| | | | | | | | - Percy Nohama
- Universidade Tecnológica Federal do Paraná - UTFPR, Brasil; Pontifícia Universidade Católica do Paraná - PUCPR, Brasil; Universidade Estadual de Campinas - UNICAMP, Brasil
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18
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Wavelet-based intensity analysis of the mechanomyograph and electromyograph during the H-reflex. Eur J Appl Physiol 2014; 114:2571-8. [PMID: 25118839 DOI: 10.1007/s00421-014-2975-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The relationship between mechanomyography (MMG) and electromyography (sEMG) during electrically evoked muscle contraction was examined using the von Tscharner "intensity analysis," which describes the power of a non-stationary signal as a function of both frequency and time. METHOD Data for 8 college-aged participants (3 males; 5 females) with measurable H-reflexes were analyzed. Recruitment curves for H-reflex (H), M-wave (M) using sEMG, and peak-to-peak MMG (MMGp-p) were elicited through incremental tibial nerve stimulation. The maximum peak-to-peak values for H and M for each sample were summed (HM); and maximum intensity values were measured for MMG, H, and M following the intensity analysis and computation of total intensity (MMGCvT, HCvT, MCvT). HCvT and MCvT were subsequently added together (HMCvT) for comparisons. RESULTS Correlations of HM:MMGp-p, HM:MMGCvT, HMCvT:MMGCvT, HMCvT:MMGp-p, were low (r = 0.34, 0.33, 0.09, and 0.12, respectively, p < 0.001); and correlations of HM:HMCvT, MMGCvT:MMGp-p, were moderate-to-high (r = 0.69 and 0.97, respectively, p < 0.001). Correlations for individuals ranged from 0.61 to 0.99 across comparisons. The time at which maximal intensities occurred reflected the transition from a predominant H-reflex to the onset of the M-wave and declining lag times were noted with increasing intensity. CONCLUSIONS The intensity analysis provides insight into the frequency characteristics of the H-reflex and M-wave not seen in traditional analysis of the H-reflex. The intensity analysis may be a useful tool in studying individual variations and changes in the contraction velocities of skeletal muscle.
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Mottram CJ, Heckman CJ, Powers RK, Rymer WZ, Suresh NL. Disturbances of motor unit rate modulation are prevalent in muscles of spastic-paretic stroke survivors. J Neurophysiol 2014; 111:2017-28. [PMID: 24572092 DOI: 10.1152/jn.00389.2013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stroke survivors often exhibit abnormally low motor unit firing rates during voluntary muscle activation. Our purpose was to assess the prevalence of saturation in motor unit firing rates in the spastic-paretic biceps brachii muscle of stroke survivors. To achieve this objective, we recorded the incidence and duration of impaired lower- and higher-threshold motor unit firing rate modulation in spastic-paretic, contralateral, and healthy control muscle during increases in isometric force generated by the elbow flexor muscles. Impaired firing was considered to have occurred when firing rate became constant (i.e., saturated), despite increasing force. The duration of impaired firing rate modulation in the lower-threshold unit was longer for spastic-paretic (3.9 ± 2.2 s) than for contralateral (1.4 ± 0.9 s; P < 0.001) and control (1.1 ± 1.0 s; P = 0.005) muscles. The duration of impaired firing rate modulation in the higher-threshold unit was also longer for the spastic-paretic (1.7 ± 1.6 s) than contralateral (0.3 ± 0.3 s; P = 0.007) and control (0.1 ± 0.2 s; P = 0.009) muscles. This impaired firing rate of the lower-threshold unit arose, despite an increase in the overall descending command, as shown by the recruitment of the higher-threshold unit during the time that the lower-threshold unit was saturating, and by the continuous increase in averages of the rectified EMG of the biceps brachii muscle throughout the rising phase of the contraction. These results suggest that impairments in firing rate modulation are prevalent in motor units of spastic-paretic muscle, even when the overall descending command to the muscle is increasing.
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Affiliation(s)
- C J Mottram
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois;
| | - C J Heckman
- Departments of Physiology, Physical Medicine and Rehabilitation, and Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - R K Powers
- Department of Physiology & Biophysics, University of Washington, Seattle, Washington; and
| | - W Z Rymer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - N L Suresh
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois
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20
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Krueger E, Scheeren EM, Nogueira-Neto GN, Button VLDSN, Nohama P. A new approach to assess the spasticity in hamstrings muscles using mechanomyography antagonist muscular group. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:2060-3. [PMID: 23366325 DOI: 10.1109/embc.2012.6346364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several pathologies can cause muscle spasticity. Modified Ashworth scale (MAS) can rank spasticity, however its results depend on the physician subjective evaluation. This study aims to show a new approach to spasticity assessment by means of MMG analysis of hamstrings antagonist muscle group (quadriceps muscle). Four subjects participated in the study, divided into two groups regarding MAS (MAS0 and MAS1). MMG sensors were positioned over the muscle belly of rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM) muscles. The range of movement was acquired with an electrogoniometer placed laterally to the knee. The system was based on a LabVIEW acquisition program and the MMG sensors were built with triaxial accelerometers. The subjects were submitted to stretching reflexes and the integral of the MMG (MMG(INT)) signal was calculated to analysis. The results showed that the MMG(INT) was greater to MAS1 than to MAS0 [muscle RF (p = 0.004), VL (p = 0.001) and VM (p = 0.007)]. The results showed that MMG was viable to detect a muscular tonus increase in antagonist muscular group (quadriceps femoris) of spinal cord injured volunteers.
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Affiliation(s)
- Eddy Krueger
- CPGEI, Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brazil.
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Kipp K, Johnson ST, Hoffman MA. Effects of homosynaptic depression on spectral properties of H-reflex recordings. Somatosens Mot Res 2012; 29:38-43. [PMID: 22416782 DOI: 10.3109/08990220.2012.662184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to determine the effects of homosynaptic depression (HD) on spectral properties of the soleus (SOL) H-reflex. Paired stimulations, separated by 100 ms, were used to elicit an unconditioned and conditioned H-reflex in the SOL muscle of 20 participants during quiet standing. Wavelet and principal component analyses were used to analyze features of the time-varying spectral properties of the unconditioned and conditioned H-reflex. The effects of HD on spectral properties of the H-reflex signal were quantified by comparing extracted principal component scores. The analysis extracted two principal components: one associated with the intensity of the spectra and one associated with its frequency. The scores for both principal components were smaller for the conditioned H-reflex. HD decreases the spectral intensity and changes the spectral frequency of H-reflexes. These results suggest that HD changes the recruitment pattern of the motor units evoked during H-reflex stimulations, in that it not only decreases the intensity, but also changes the types of motor units that contribute to the H-reflex signal.
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Affiliation(s)
- Kristof Kipp
- Department of Physical Therapy, Marquette University, Milwaukee, WI 53201, USA.
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Bhatia BD, Kumar A, Prakash U. Effect of prematurity and intrauterine growth restriction on H-reflex recovery cycle in neonates. Neurosci Lett 2011; 488:107-11. [PMID: 20816919 DOI: 10.1016/j.neulet.2010.08.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/27/2010] [Accepted: 08/28/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this work was to assess the effects of prematurity and intrauterine growth restriction on spinal cord synapses using H-reflex. METHODS 33 babies were investigated at birth. 14 were full term appropriate for gestational age (FT AGA), 10 were full term intrauterine growth restricted (FT IUGR) and 9 were preterm appropriate for gestational age (PT AGA). The maximum amplitude of H-reflex (Hmax), H-reflex latency (HRL), H/M ratio, H-reflex conduction velocity (HRCV), and H-reflex response to double stimuli (conditioning and test) for H-reflex recovery cycle (HRRC) were recorded in right lower limb (soleus muscle) in all the three groups. RESULTS Percentage recovery values of H-reflex were significantly higher in FT AGA and FT IUGR babies compared to PT AGA neonates for most of inter-stimulus intervals. No significant differences were observed in H-reflex parameters between FT AGA and FT IUGR groups, but HRL and HRCV were significantly affected in PT AGA group. CONCLUSIONS Delayed H-reflex recovery in preterms may be due to a prolonged state of neurotransmitter delay in Ia terminals following initial activation by the conditioning stimuli. The cause of such prolonged depletion of neurotransmitters could be attributed to a poor neurotransmitter store in synaptic vesicles of spinal cord in preterm neonates.
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Affiliation(s)
- B D Bhatia
- Department of Pediatrics, Unit of Neonatology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. baldev
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Yaşar E, Tok F, Safaz I, Balaban B, Yilmaz B, Alaca R. The efficacy of serial casting after botulinum toxin type A injection in improving equinovarus deformity in patients with chronic stroke. Brain Inj 2010; 24:736-9. [PMID: 20334469 DOI: 10.3109/02699051003610524] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Spasticity is an important early complication of stroke, which may lead to shortening of gastrocnemius and soleus muscles and contracture in the Achilles tendon and soft tissues of the ankle. Botulinum toxin A (BTX-A) is a promising drug for the management of focal spasticity. Serial casting is another alternative method for reducing contractures due to spasticity. The present study aimed to determine if serial casting after BTX-A injection could help to limit the development of calf contracture in chronic hemiplegic patients. METHOD The records of patients with stroke that were treated in the brain injury rehabilitation clinic between January 2007 and December 2008 were screened. In all, 10 patients that underwent a serial casting programme for 24 days following BTX-A injection were included in the study. Goniometric scores for ankle ROM, Physician Rating Scale (PRS) and Functional Independence Measurement (FIM) scores were recorded. RESULTS Mean age of the patients was 33.2 years. Mean time interval after stroke onset was 35.0 months. Improvements in ROM were quite significant after serial casting. Moreover, FIM and PRS scores improved significantly. CONCLUSION Serial casting may be an appropriate intervention following BTX-A injection to prevent equinovarus deformity and improve the quality of walking in chronic stroke patients. The role of casting and splinting are important topics that require further research.
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Affiliation(s)
- Evren Yaşar
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, GMMA TAF Rehabilitation Center, Ankara, Turkey
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Mottram CJ, Suresh NL, Heckman CJ, Gorassini MA, Rymer WZ. Origins of abnormal excitability in biceps brachii motoneurons of spastic-paretic stroke survivors. J Neurophysiol 2009; 102:2026-38. [PMID: 19587321 DOI: 10.1152/jn.00151.2009] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stroke survivors often exhibit abnormal motoneuron excitability, manifested clinically as spasticity with exaggerated stretch reflexes in resting muscles. We examined whether this abnormal excitability is a result of increased activation of intrinsic voltage-dependent persistent inward currents (PICs) or whether it is a result of enhanced synaptic inputs to the motoneuron. This distinction was made by recording firing rate profiles of pairs of motor units during isometric contractions of elbow flexor muscles. To estimate PIC amplitude, the discharge of the lower-threshold (reporter) motor unit of the pair was used to estimate the synaptic input to the higher-threshold (test) motor unit. The estimated synaptic input required to recruit the test unit was compared with the synaptic input when the test unit was derecruited (DeltaF) and this served as an estimate of the intrinsic (PIC) contribution to motoneuron firing. We found that PIC estimates were not larger in spastic-paretic motoneurons (DeltaF = 4.0 +/- 1.6 pps) compared with contralateral (4.6 +/- 1.4 pps) and age-matched healthy control motoneurons (3.8 +/- 1.7, all P > 0.1). Instead, following the voluntary contractions, the majority of lower-threshold motor units in spastic-paretic muscles (83%) exhibited spontaneous discharge, compared with 14% of contralateral and 0% of control motor units. Furthermore, there was strong co-modulation of simultaneously active units in spastic muscle. The presence of ongoing, correlated unit activity at "rest," coupled with firing behavior at recruitment unique to lower-threshold motor units in spastic muscles, suggested that firing changes are likely a result of a low-level depolarizing synaptic drive to the resting motoneuron pool.
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Affiliation(s)
- Carol J Mottram
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA.
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Effects of Age and Stimulus on Submental Mechanomyography Signals During Swallowing. Dysphagia 2009; 24:265-73. [DOI: 10.1007/s00455-008-9200-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
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