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Verduzco-Gutierrez M, Raghavan P, Pruente J, Moon D, List CM, Hornyak JE, Gul F, Deshpande S, Biffl S, Al Lawati Z, Alfaro A. AAPM&R consensus guidance on spasticity assessment and management. PM R 2024; 16:864-887. [PMID: 38770827 DOI: 10.1002/pmrj.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus-based practice recommendations aimed at addressing gaps in spasticity care. OBJECTIVE To develop consensus-based practice recommendations to identify and address gaps in spasticity care. METHODS The Spasticity TEP engaged in a 16-month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations. RESULTS The TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence-based treatment options, intended for use by PM&R physicians caring for patients with spasticity. CONCLUSION This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.
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Affiliation(s)
- Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Pruente
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Moon
- Department of Physical Medicine and Rehabilitation, Jefferson Moss-Magee Rehabilitation Hospital, Elkins Park, Pennsylvania, USA
| | | | - Joseph Edward Hornyak
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Fatma Gul
- Department of Physical Medicine and Rehabilitation Department, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Supreet Deshpande
- Department of Pediatric Rehabilitation Medicine, Gillette Children's Hospital, St.Paul, Minnesota, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan Biffl
- Division Pediatric Rehabilitation Medicine Department of Orthopedic Surgery, UCSD Rady Children's Hospital, San Diego, California, USA
| | - Zainab Al Lawati
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abraham Alfaro
- Rehabilitation Medicine, AtlantiCare Health Services, Inc., Federally Qualified Health Center (FQHC), Atlantic City, New Jersey, USA
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Boulay C, Gracies JM, Garcia L, Authier G, Ulian A, Pradines M, Vieira TM, Pinto T, Gazzoni M, Desnous B, Parratte B, Pesenti S. Serious Game with Electromyography Feedback and Physical Therapy in Young Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: A Prospective Open-Label Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:1513. [PMID: 38475049 DOI: 10.3390/s24051513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
The clinical effects of a serious game with electromyography feedback (EMGs_SG) and physical therapy (PT) was investigated prospectively in children with unilateral spastic cerebral palsy (USCP). An additional aim was to better understand the influence of muscle shortening on function. Thirty children with USCP (age 7.6 ± 2.1 years) received four weeks of EMGs_SG sessions 2×/week including repetitive, active alternating training of dorsi- and plantar flexors in a seated position. In addition, each child received usual PT treatment ≤ 2×/week, involving plantar flexor stretching and command strengthening on dorsi- and plantar flexors. Five-Step Assessment parameters, including preferred gait velocity (normalized by height); plantar flexor extensibility (XV1); angle of catch (XV3); maximal active ankle dorsiflexion (XA); and derived coefficients of shortening, spasticity, and weakness for both soleus and gastrosoleus complex (GSC) were compared pre and post treatment (t-tests). Correlations were explored between the various coefficients and gait velocities at baseline. After four weeks of EMGs_SG + PT, there was an increase in normalized gait velocity from 0.72 ± 0.13 to 0.77 ± 0.13 m/s (p = 0.025, d = 0.43), a decrease in coefficients of shortening (soleus, 0.10 ± 0.07 pre vs. 0.07 ± 0.08 post, p = 0.004, d = 0.57; GSC 0.16 ± 0.08 vs. 0.13 ± 0.08, p = 0.003, d = 0.58), spasticity (soleus 0.14 ± 0.06 vs. 0.12 ± 0.07, p = 0.02, d = 0.46), and weakness (soleus 0.14 ± 0.07 vs. 0.11 ± 0.07, p = 0.005, d = 0.55). At baseline, normalized gait velocity correlated with the coefficient of GSC shortening (R = -0.43, p = 0.02). Four weeks of EMGs_SG and PT were associated with improved gait velocity and decreased plantar flexor shortening. A randomized controlled trial comparing EMGs_SG and conventional PT is needed.
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Affiliation(s)
- Christophe Boulay
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Jean-Michel Gracies
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
| | - Lauren Garcia
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Guillaume Authier
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Alexis Ulian
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
| | - Maud Pradines
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
| | - Taian Martins Vieira
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, 10129 Turin, Italy
- PoliToBIOMed Laboratory, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Talita Pinto
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94000 Créteil, France
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro 22281-100, Brazil
| | - Marco Gazzoni
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunication, Politecnico di Torino, 10129 Turin, Italy
- PoliToBIOMed Laboratory, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Béatrice Desnous
- Pediatric Neurology Department, Timone Children Hospital, 13005 Marseille, France
| | - Bernard Parratte
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
| | - Sébastien Pesenti
- Gait Laboratory, Pediatric Orthopaedic Surgery Department, Timone Children Hospital, 13385 Marseille, France
- Aix-Marseille University, CNRS, ISM UMR 7287, 13284 Marseille, France
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Huang L, Yi L, Huang H, Zhan S, Chen R, Yue Z. Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta Neurol Belg 2024; 124:25-36. [PMID: 37704780 PMCID: PMC10874326 DOI: 10.1007/s13760-023-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Stroke is the third leading cause of death and disability worldwide. Post-stroke spasticity (PSS) is the most common complication of stroke but represents only one of the many manifestations of upper motor neuron syndrome. As an upper motor neuron, the corticospinal tract (CST) is the only direct descending motor pathway that innervates the spinal motor neurons and is closely related to the recovery of limb function in patients with PSS. Therefore, promoting axonal remodeling in the CST may help identify new therapeutic strategies for PSS. In this review, we outline the pathological mechanisms of PSS, specifically their relationship with CST, and therapeutic strategies for axonal regeneration of the CST after stroke. We found it to be closely associated with astroglial scarring produced by astrocyte activation and its secretion of neurotrophic factors, mainly after the onset of cerebral ischemia. We hope that this review offers insight into the relationship between CST and PSS and provides a basis for further studies.
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Affiliation(s)
- Linxing Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Lizhen Yi
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Huiyuan Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Sheng Zhan
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Ruixue Chen
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zenghui Yue
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Thibaut A, Aloisi M, Dreessen J, Alnagger N, Lejeune N, Formisano R. Neuro-orthopaedic assessment and management in patients with prolonged disorders of consciousness: A review. NeuroRehabilitation 2024; 54:75-90. [PMID: 38251069 DOI: 10.3233/nre-230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Following a severe acquired brain injury, neuro-orthopaedic disorders are commonplace. While these disorders can impact patients' functional recovery and quality of life, little is known regarding the assessment, management and treatment of neuro-orthopaedic disorders in patients with disorders of consciousness (DoC). OBJECTIVE To describe neuro-orthopaedic disorders in the context of DoC and provide insights on their management and treatment. METHODS A review of the literature was conducted focusing on neuro-orthopaedic disorders in patients with prolonged DoC. RESULTS Few studies have investigated the prevalence of spastic paresis in patients with prolonged DoC, which is extremely high, as well as its correlation with pain. Pilot studies exploring the effects of pharmacological treatments and physical therapy show encouraging results yet have limited efficacy. Other neuro-orthopaedic disorders, such as heterotopic ossification, are still poorly investigated. CONCLUSION The literature of neuro-orthopaedic disorders in patients with prolonged DoC remains scarce, mainly focusing on spastic paresis. We recommend treating neuro-orthopaedic disorders in their early phases to prevent complications such as pain and improve patients' recovery. Additionally, this approach could enhance patients' ability to behaviourally demonstrate signs of consciousness, especially in the context of covert awareness.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Marta Aloisi
- Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Joëlle Dreessen
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Rita Formisano
- Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
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Vieira TM, Cerone GL, Botter A, Watanabe K, Vigotsky AD. The Sensitivity of Bipolar Electromyograms to Muscle Excitation Scales With the Inter-Electrode Distance. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4245-4255. [PMID: 37844006 DOI: 10.1109/tnsre.2023.3325132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
The value of surface electromyograms (EMGs) lies in their potential to non-invasively probe the neuromuscular system. Whether muscle excitation may be accurately inferred from bipolar EMGs depends on how much the detected signal is both sensitive and specific to the excitation of the target muscle. While both are known to be a function of the inter-electrode distance (IED), specificity has been of long concern in the physiological literature. In contrast, sensitivity, at best, has been implicitly assumed. Here we provide evidence that the IED imposes a biophysical constraint on the sensitivity of surface EMG. From 20 healthy subjects, we tested the hypothesis that excessively reducing the IED limits EMGs' physiological content. We detected bipolar EMGs with IEDs varying from 5 mm to 50 mm from two skeletal muscles with distinct architectures, gastrocnemius and biceps brachii. Non-parametric statistics and Bayesian hierarchical modelling were used to evaluate the dependence of the onset of muscle excitation and signal-to-noise ratio (SNR) on the IED. Experimental results revealed that IED critically affects the sensitivity of bipolar EMGs for both muscles-indeliberately reducing the IED yields EMGs that are not representative of the whole muscle, hampering validity. Simulation results substantiate the generalization of experimental results to small and large electrodes. Based on current and previous findings, we discuss a potentially valid procedure for defining the most appropriate IED for a single bipolar, surface recording-i.e., the distance from the electrode to the target muscle boundary may heuristically serve as a lower bound when choosing an IED.
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Campanini I, Bò MC, Bassi MC, Damiano B, Scaltriti S, Lusuardi M, Merlo A. Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review. PLoS One 2023; 18:e0287220. [PMID: 37824499 PMCID: PMC10569611 DOI: 10.1371/journal.pone.0287220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/01/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke. METHODS Scoping review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures. RESULTS Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of "spasticity" and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed. CONCLUSION This scoping review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.
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Affiliation(s)
- Isabella Campanini
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Maria Chiara Bò
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
- Merlo Bioengineering, Parma, Italy
| | | | - Benedetta Damiano
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Sara Scaltriti
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Mirco Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Reggio Emilia, Correggio, Italy
| | - Andrea Merlo
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
- Merlo Bioengineering, Parma, Italy
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Pradines M, Poitou T, Gál O, Hoskovcová M, Bayle N, Baude M, Gracies JM. Where is the zero of Tardieu for proximal trans-joint lower limb muscles? The relevance for the estimation of muscle shortening and weakness. Front Neurol 2023; 14:1108535. [PMID: 37188305 PMCID: PMC10175661 DOI: 10.3389/fneur.2023.1108535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Maud Pradines
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
- *Correspondence: Maud Pradines
| | - Tymothée Poitou
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Ota Gál
- Department of Neurology, Charles University, Prague, Czechia
| | | | - Nicolas Bayle
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Marjolaine Baude
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean-Michel Gracies
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Campanini I, Bò MC, Salsi F, Bassi MC, Damiano B, Scaltriti S, Lusuardi M, Merlo A. Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review. Front Neurol 2022; 13:1026850. [DOI: 10.3389/fneur.2022.1026850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveEquinus foot deformity (EFD) is the most common deformity following a stroke. Several approaches have been suggested for its correction, including pharmacological, surgical, and physical therapy (PT) interventions. This scoping review aims to map and synthesize the available evidence focusing on physical therapy treatments for EFD caused by triceps surae (TS) spasticity.MethodsScoping review methodological frameworks have been used. Pubmed, Cinahl, and Cochrane databases were searched for primary literature. Studies focusing on the treatment of EFD in adult stroke patients were included only when the intervention involved PT treatments and presented at least one outcome measure for the functional and/or structural condition of the TS. Data were systematically collected and reported in tables inclusive of type of intervention, sample characteristics, dosage, comparators, outcomes, follow-up timeline, and treatment efficacy. A narrative synthesis was also added.ResultsOf the 642 experimental or observational screened studies, 53 were included, focusing on stretching exercises, shock waves, electrical stimulation, dry needling, TENS, vibration therapy, ultrasounds, cryotherapy, and active physiotherapy. Patients with EFD benefited from specific physical therapy treatments. These usually resulted in Modified Ashworth Scale reduction, typically by 1 point, and an increase in ROM. Interventions consisting of shock waves, dry needling, and electrostimulation showed the best results in reducing EFD. Heterogeneous dosage and delivery mode generally limited conclusions.ConclusionsThis scoping review summarized available primary literature based on PT treatments for the correction of EFD. By highlighting the remaining gaps in knowledge, it provides a reference for future studies on this pathology. Further investigations are necessary to pinpoint the best dosage and delivery methods. Future studies should investigate whether early rehabilitation programs started during the acute phase might help prevent or limit the development of secondary deformities.
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Boulay C, Sangeux M, Authier G, Jacquemier M, Merlo A, Chabrol B, Jouve JL, Gracies JM, Pesenti S. Reduced plantar-flexors extensibility but improved selective motor control associated with age in young children with unilateral cerebral palsy and equinovalgus gait. J Electromyogr Kinesiol 2022; 65:102665. [DOI: 10.1016/j.jelekin.2022.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/20/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
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Pradines M, Ghédira M, Bignami B, Vielotte J, Bayle N, Marciniak C, Burke D, Hutin E, Gracies JM. Do Muscle Changes Contribute to the Neurological Disorder in Spastic Paresis? Front Neurol 2022; 13:817229. [PMID: 35370894 PMCID: PMC8964436 DOI: 10.3389/fneur.2022.817229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background At the onset of stroke-induced hemiparesis, muscle tissue is normal and motoneurones are not overactive. Muscle contracture and motoneuronal overactivity then develop. Motor command impairments are classically attributed to the neurological lesion, but the role played by muscle changes has not been investigated. Methods Interaction between muscle and command disorders was explored using quantified clinical methodology-the Five Step Assessment. Six key muscles of each of the lower and upper limbs in adults with chronic poststroke hemiparesis were examined by a single investigator, measuring the angle of arrest with slow muscle stretch (XV1) and the maximal active range of motion against the resistance of the tested muscle (XA). The coefficient of shortening CSH = (XN-XV1)/XN (XN, normally expected amplitude) and of weakness CW = (XV1-XA)/XV1) were calculated to estimate the muscle and command disorders, respectively. Composite CSH (CCSH) and CW (CCW) were then derived for each limb by averaging the six corresponding coefficients. For the shortened muscles of each limb (mean CSH > 0.10), linear regressions explored the relationships between coefficients of shortening and weakness below and above their median coefficient of shortening. Results A total of 80 persons with chronic hemiparesis with complete lower limb assessments [27 women, mean age 47 (SD 17), time since lesion 8.8 (7.2) years], and 32 with upper limb assessments [18 women, age 32 (15), time since lesion 6.4 (9.3) years] were identified. The composite coefficient of shortening was greater in the lower than in the upper limb (0.12 ± 0.04 vs. 0.08 ± 0.04; p = 0.0002, while the composite coefficient of weakness was greater in the upper limb (0.28 ± 0.12 vs. 0.15 ± 0.06, lower limb; p < 0.0001). In the lower limb shortened muscles, the coefficient of weakness correlated with the composite coefficient of shortening above the 0.15 median CSH (R = 0.43, p = 0.004) but not below (R = 0.14, p = 0.40). Conclusion In chronic hemiparesis, muscle shortening affects the lower limb particularly, and, beyond a threshold of severity, may alter descending commands. The latter might occur through chronically increased intramuscular tension, and thereby increased muscle afferent firing and activity-dependent synaptic sensitization at the spinal level.
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Affiliation(s)
- Maud Pradines
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Mouna Ghédira
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Blaise Bignami
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jordan Vielotte
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nicolas Bayle
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University and the Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Neurology, Northwestern University and the Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Emilie Hutin
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean-Michel Gracies
- UR 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, France
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Azzollini V, Dalise S, Chisari C. How Does Stroke Affect Skeletal Muscle? State of the Art and Rehabilitation Perspective. Front Neurol 2022; 12:797559. [PMID: 35002937 PMCID: PMC8733480 DOI: 10.3389/fneur.2021.797559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
Long-term disability caused by stroke is largely due to an impairment of motor function. The functional consequences after stroke are caused by central nervous system adaptations and modifications, but also by the peripheral skeletal muscle changes. The nervous and muscular systems work together and are strictly dependent in their structure and function, through afferent and efferent communication pathways with a reciprocal “modulation.” Knowing how altered interaction between these two important systems can modify the intrinsic properties of muscle tissue is essential in finding the best rehabilitative therapeutic approach. Traditionally, the rehabilitation effort has been oriented toward the treatment of the central nervous system damage with a central approach, overlooking the muscle tissue. However, to ensure greater effectiveness of treatments, it should not be forgotten that muscle can also be a target in the rehabilitation process. The purpose of this review is to summarize the current knowledge about the skeletal muscle changes, directly or indirectly induced by stroke, focusing on the changes induced by the treatments most applied in stroke rehabilitation. The results of this review highlight changes in several muscular features, suggesting specific treatments based on biological knowledge; on the other hand, in standard rehabilitative practice, a realist muscle function evaluation is rarely carried out. We provide some recommendations to improve a comprehensive muscle investigation, a specific rehabilitation approach, and to draw research protocol to solve the remaining conflicting data. Even if a complete multilevel muscular evaluation requires a great effort by a multidisciplinary team to optimize motor recovery after stroke.
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Affiliation(s)
- Valentina Azzollini
- Department of Translational Research and New Technologies in Medicine and Surgery, DS Neurorehabilitation, University of Pisa, Pisa, Italy
| | - Stefania Dalise
- Department of Neurorehabilitation, Pisa University Hospital - Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, DS Neurorehabilitation, University of Pisa, Pisa, Italy
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Santos PLDA, Gaspar RC, Padula N, Almeida DM, Voos MC. Translation and cross-cultural adaptation to Brazilian Portuguese of the Modified Tardieu Scale for muscle tone assessment among patients with spinal cord injury. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:590-597. [PMID: 34468498 DOI: 10.1590/0004-282x-anp-2020-0366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Assessment of muscle tone is of great importance for evaluating people with spinal injuries. OBJECTIVE To translate and adapt the Modified Tardieu Scale (MTS) to Brazilian Portuguese and validate its use for evaluating patients with spinal cord injury. METHODS The translation and adaptation of the "Escala de Tardieu Modificada" went through the steps of translation, translation synthesis, back-translation and expert committee meeting. Two evaluators rated the tone of the elbow flexors/extensors, wrist extensors, knee flexors/extensors and ankle plantar flexors of 51 patients with spinal cord injury. These patients were reevaluated after one week. Validation included intra and inter-rater reliability (ICC) and internal and external consistency. The Modified Ashworth Scale (MAS) was used in the evaluations, to investigate the correlations. RESULTS The Brazilian Portuguese version of the MTS is presented in this study. ICCs ranged from 0.60 to 0.99 (intra and inter-examiner) and there was a moderate to strong correlation with MAS. CONCLUSIONS The MTS proved to be adequate for assessing the muscle tone of people with spinal cord injury in Brazil.
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Affiliation(s)
| | | | - Natália Padula
- Acreditando Centro de Recuperação Neuromotora Saúde e Bem-estar, São Paulo SP, Brazil
| | - Daniela Melo Almeida
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Mariana Callil Voos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, Curso de Fisioterapia, São Paulo SP, Brazil
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Can Incobotulinumtoxin-A Treatment Improve Quality of Life Better Than Conventional Therapy in Spastic Muscle Post-Stroke Patients? Results from a Pilot Study from a Single Center. Brain Sci 2021; 11:brainsci11070934. [PMID: 34356168 PMCID: PMC8303388 DOI: 10.3390/brainsci11070934] [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: 06/12/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 01/22/2023] Open
Abstract
Post-stroke spasticity frequently occurs in patients with stroke, and there is a need for more quality-of-life assessments for different therapies. We evaluated for the first time in Romania the quality of life among patients with post-stroke spasticity, comparing two therapies over a 6-month period: botulinum toxin type A (BOT) with conventional therapy (CON). We also assessed the reduction of spasticity and functionality secondary to the increase in the mobility in upper limbs. This study was based on a prospective, randomized design, including subjects with post-stroke spasticity (N = 34; 34–80 years of age): in the CON arm, patients received therapy against muscle spasticity and physiotherapy, and, in the BOT arm, patients received incobotulinumtoxin-A and additionally conventional treatment, if required. Among 34 treated subjects in the two arms, the quality of life was significantly higher after BOT therapy (p < 0.001), represented by improvement in movement (p < 0.001), usual activities (p = 0.018), and distress (p < 0.001). Improvements in muscle tone (Ashworth Scale) over 6 months of treatment period were greater in the BOT arm (100%) than in the CON arm (11.8%). These preliminary results suggested that incobotulinumtoxin-A increased quality of life by improving movement, daily activities, mental health, and muscle tone more effectively than conventional therapy and could form a basis for future comparator studies.
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Ghédira M, Pradines M, Mardale V, Gracies JM, Bayle N, Hutin E. Quantified clinical measures linked to ambulation speed in hemiparesis. Top Stroke Rehabil 2021; 29:411-422. [PMID: 34229567 DOI: 10.1080/10749357.2021.1943799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: In spastic paresis, the respective contributions to active function of antagonist hypoextensibility, spasticity, and impaired descending command remain unknown. Objectives: We explored correlations between ambulation speed and coefficients of shortening, spasticity and, weakness for three lower limb extensors.Methods: This retrospective study identified 140 subjects with chronic hemiparesis (>6 months since injury) assessed during a single visit with barefoot 10-meter ambulation at comfortable and fast speed, and measurements of passive range of motion (XV1), angle of catch at fast stretch (XV3) and active range of motion (XA) against the resistance of gastrocnemius, rectus femoris, and gluteus maximus. Coefficients of shortening (CSH=[XN-XV1]/XN; XN, normal expected amplitude based on anatomical values), spasticity (CSP=[XV1-XV3]/XV1), and weakness (CWK=[XV1-XA]/XV1) were derived. For each muscle, multivariable analysis explored CSH, CSP, and CWK as potential predictors of ambulation speed.Results: Ambulation speed was 0.62±0.28m/s (mean±SD, comfortable) and 0.84±0.38m/s (fast) and was correlated with CSH and CWK against gastrocnemius (CSH, comfortable, ns; fast, β=-0.20, p=.03; CWK, comfortable, β=-0.21, p=.010; fast, β=-0.21, p =.012), rectus femoris (CSH, comfortable, β=-0.41, p=6E-7; fast, β=-0.43, p=5E-7; CWK, comfortable, β=-0.36, p=5E-5; fast, β=-0.33, p=.0003) and gluteus maximus (CSH, comfortable, β=-0.19, p=.02; fast, β=-0.26, p=.002; CWK, comfortable, β=-0.26, p=.002; fast, β=-0.22, p=.010). Ambulation speed was not correlated with CSP.Conclusions: In chronic hemiparesis, ambulation speed correlates with coefficients of shortening and of weakness in lower limb extensors, but not with their spasticity level. This may encourage therapists to focus treatment primarily on muscle shortening by stretching programs and on impaired descending command by active training.
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Affiliation(s)
- Mouna Ghédira
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Maud Pradines
- EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Valentina Mardale
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP)
| | - Jean-Michel Gracies
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Nicolas Bayle
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Emilie Hutin
- Laboratoire analyse et restauration du Mouvement (ARM, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP).,EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), Créteil, France
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15
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Gracies JM, Francisco GE, Jech R, Khatkova S, Rios CD, Maisonobe P. Guided Self-rehabilitation Contracts Combined With AbobotulinumtoxinA in Adults With Spastic Paresis. J Neurol Phys Ther 2021; 45:203-213. [PMID: 34039905 PMCID: PMC8191476 DOI: 10.1097/npt.0000000000000359] [Citation(s) in RCA: 2] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Guided self-rehabilitation contracts (GSCs) are a diary-based rehabilitation strategy, wherein specific muscles are identified for prescription of high-load, home self-stretching techniques. We assessed the effect of GSCs combined with simultaneous upper limb (UL) and lower limb (LL) abobotulinumtoxinA injections on composite active range of motion (CXA) in adults with chronic spastic paresis. METHODS This was an international, prospective, single-arm, open-label study (ENGAGE, NCT02969356). Personalized GSCs were monitored by phone every other week, alongside 2 consecutive abobotulinumtoxinA injections (1500 U) across UL and LL, over 6 to 9 months. Primary outcomes were responder rates (CXA improvement ≥35° [UL] or ≥5° [LL]) at week 6 cycle 2. Secondary outcomes were active function (UL: Modified Frenchay Scale [MFS]; LL: 10-m barefoot maximal walking speed [WS]) and quality of life (12-item Short Form Health Survey, SF-12). RESULTS Of the 153 treated participants, 136 had primary endpoint data; 72.1% (95% confidence interval [CI], 64.0-78.9) were responders. Mean (SD) CXA changes from baseline to last study visit were +49.3° (63.4) for UL and +20.1° (27.6) for LL. Mean (95% CI) changes from baseline to week 12 cycle 2 were +0.55 (0.43-0.66) in MFS, +0.12 m/s (0.09-0.15) for WS, and +4.0 (2.8-5.2) for SF-12 physical scores. In the safety population (n = 157), 49.7% of participants reported treatment-emergent adverse events (AEs); 12.1% reported 25 serious AEs. DISCUSSION AND CONCLUSIONS GSC combined with simultaneous UL and LL abobotulinumtoxinA injections led to improvements in CXA and function in both limbs, and quality-of-life physical scores. These results suggest the beneficial effect of combined GSC and abobotulinumtoxinA therapy in the management of spastic paresis.Video Abstract available for more insight from the authors (see the Supplementary Video, available at: http://links.lww.com/JNPT/A346).
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Affiliation(s)
- Jean-Michel Gracies
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Gerard E. Francisco
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Robert Jech
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Svetlana Khatkova
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Carl D. Rios
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
| | - Pascal Maisonobe
- UR 7377 BIOTN, Université Paris-Est Créteil, Albert Chenevier-Henri Mondor Hospital, Department of Neurorehabilitation, Créteil, France (J.M.G.); Department of Physical Medicine and Rehabilitation, the University of Texas Health Science Center at Houston McGovern Medical School, and the Neurorecovery Research Center at TIRR Memorial Hermann, Houston, Texas (G.E.F.); Department of Neurology, First Faculty of Medicine, Charles University, and General Faculty Hospital, Prague, Czech Republic (R.J.); Neurology Department, Federal State Hospital, Treatments and Rehabilitation, Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia (S.K.); and Ipsen Pharma, Boulogne- Billancourt, France (C.D.R., P.M)
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Laffont I. 2019 Sidney Licht lecture: Spasticity and related neuro-orthopedic deformities: A core topic in physical and rehabilitation medicine. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Effect of chronic stretching interventions on the mechanical properties of muscles in patients with stroke: A systematic review. Ann Phys Rehabil Med 2020; 63:222-229. [DOI: 10.1016/j.rehab.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 01/01/2023]
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Bayle N, Maisonobe P, Raymond R, Balcaitiene J, Gracies JM. Composite active range of motion (CX A) and relationship with active function in upper and lower limb spastic paresis. Clin Rehabil 2020; 34:803-811. [PMID: 32336148 PMCID: PMC7263039 DOI: 10.1177/0269215520911970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate a novel composite measure of active range of motion (XA) and determine whether this measure correlates with active function. DESIGN Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA. SETTING Tertiary rehabilitation centers in Australia, Europe, and the United States. SUBJECTS Adults with upper (n = 254) or lower (n = 345) limb spastic paresis following stroke or brain trauma. INTERVENTIONS AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb. MAIN MEASURES XA was used to calculate a novel composite measure (CXA), defined as the sum of XA against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CXA and active function at Weeks 4 and 12 of open-label cycles were explored. RESULTS CXA and active function were moderately correlated in the upper limb (P < 0.0001-0.0004, r = 0.476-0.636) and weakly correlated in the lower limb (P < 0.0001-0.0284, r = 0.186-0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CXA and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, P = 0.0160, r = 0.213; Cycle 3 Week 4, P = 0.0031, r = 0.296). Across cycles, CXA improvements peaked at Week 4, while functional improvements peaked at Week 12. CONCLUSION CXA is a valid measure for functional impairments in spastic paresis. CXA improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.
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Affiliation(s)
- Nicolas Bayle
- EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France
| | | | | | | | - Jean-Michel Gracies
- EA 7377 BIOTN, Service de Rééducation Neurolocomotrice, Université Paris-Est Créteil, Hospital Albert Chenevier-Henri Mondor, Créteil, France
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Khatkova SE, Kostenko EV, Akulov MA, Diagileva VP, Nikolaev EA, Orlova AS. [Modern aspects of the pathophysiology of walking disorders and their rehabilitation in post-stroke patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:43-50. [PMID: 32207717 DOI: 10.17116/jnevro201911912243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of rehabilitation of post-stroke patients with motor deficit remains relevant with growing prevalence of disability and decreasing mortality, despite all measures aimed at stroke prevention and morbidity reduction. One of the most common consequences of stroke is gait impairment as a result of spastic paresis of the lower limb (decreased gait velocity, shortened step, excessive loading of intact limb etc.), which leads to significant maladaptation, increased risk of falls, decrease in quality of life. The article presents a detailed review of motor action in normal and pathologic conditions, analysis of neuronal structures involved into a movement act in healthy individuals and in stroke patients, current aspects of gait pathophysiology, characteristics of post-stroke gait (speed and asymmetry of gain, balance control impairment). A separate paragraph is devoted to gait recovery after stroke with analysis of existing and developing strategies of rehabilitation, aimed at the improvement of vertical posture, balance control and movement, condition, tone and functioning of skeletal muscles. Authors also analyze new research information on the efficacy of botulinum toxin preparations and programs of Guided Self-Rehabilitation Contracts (GSC), present the results of clinical trials demonstrating the efficacy of combination of these two methods.
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Affiliation(s)
- S E Khatkova
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E V Kostenko
- Burdenko National Scientific and Practical Centre for Neurosurgery, Moscow, Russia
| | - M A Akulov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V P Diagileva
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E A Nikolaev
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - A S Orlova
- Sechenov First Moscow State Medical University, Moscow, Russia
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Chalard A, Amarantini D, Tisseyre J, Marque P, Gasq D. Spastic co-contraction is directly associated with altered cortical beta oscillations after stroke. Clin Neurophysiol 2020; 131:1345-1353. [PMID: 32304849 DOI: 10.1016/j.clinph.2020.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/16/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Spastic co-contraction is a motor-disabling form of muscle overactivity occurring after a stroke, contributing to a limitation in active movement and a certain level of motor impairment. The cortical mechanisms underlying spastic co-contraction remain to be more fully elucidated, the present study aimed to investigate the role of the cortical beta oscillations in spastic co-contraction after a stroke. METHOD We recruited fifteen post-stroke participants and nine healthy controls. The participants were asked to perform active elbow extensions. In the study, multimodal analysis was performed to combine the evaluation of three-dimensional elbow kinematics, the elbow muscles electromyographic activations, and the cortical oscillatory activity. RESULTS The movement-related beta desynchronization was significantly decreased in post-stroke participants compared to healthy participants. We found a significant correlation between the movement-related beta desynchronization and the elbow flexors activation during the active elbow extension in post-stroke participants. When compared to healthy participants, post-stroke participants exhibited significant alterations in the elbow kinematics and greater muscle activation levels. CONCLUSIONS Cortical beta oscillation alterations may reflect an important neural mechanism underlying spastic co-contraction after a stroke. SIGNIFICANCE Measuring the cortical oscillatory activity could be useful to further characterize neuromuscular plasticity induced by recovery or therapeutic interventions.
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Affiliation(s)
- Alexandre Chalard
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Ipsen Innovation, Les Ulis, France
| | - David Amarantini
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Joseph Tisseyre
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Neurological Rehabilitation, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Functional Physiological Explorations, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France.
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Gomes ALS, Mello FFD, Cocicov Neto J, Benedeti MC, Modolo LFM, Riberto M. Can the positions of the spastic upper limb in stroke survivors help muscle choice for botulinum toxin injections? ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:568-573. [PMID: 31508683 DOI: 10.1590/0004-282x20190087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/05/2019] [Indexed: 11/22/2022]
Abstract
Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. OBJECTIVE We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. METHODS Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. RESULTS Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. CONCLUSION Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.
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Affiliation(s)
- André Luiz Salcedo Gomes
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Francisco Falleiros de Mello
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Jorge Cocicov Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Marcelo Causin Benedeti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Luis Felipe Miras Modolo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Marcelo Riberto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
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Mechanical and microstructural changes of skeletal muscle following immobilization and/or stroke. Biomech Model Mechanobiol 2019; 19:61-80. [DOI: 10.1007/s10237-019-01196-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022]
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Pradines M, Ghedira M, Portero R, Masson I, Marciniak C, Hicklin D, Hutin E, Portero P, Gracies JM, Bayle N. Ultrasound Structural Changes in Triceps Surae After a 1-Year Daily Self-stretch Program: A Prospective Randomized Controlled Trial in Chronic Hemiparesis. Neurorehabil Neural Repair 2019; 33:245-259. [PMID: 30900512 DOI: 10.1177/1545968319829455] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The effects of long-term stretching (>6 months) in hemiparesis are unknown. This prospective, randomized, single-blind controlled trial compared changes in architectural and clinical parameters in plantar flexors of individuals with chronic hemiparesis following a 1-year guided self-stretch program, compared with conventional rehabilitation alone. METHODS Adults with chronic stroke-induced hemiparesis (time since lesion >1 year) were randomized into 1 of 2, 1-year rehabilitation programs: conventional therapy (CONV) supplemented with the Guided Self-rehabilitation Contract (GSC) program, or CONV alone. In the GSC group, specific lower limb muscles, including plantar flexors, were identified for a diary-based treatment utilizing daily, high-load, home self-stretching. Blinded assessments included (1) ultrasonographic measurements of soleus and medial gastrocnemius (MG) fascicle length and thickness, with change in soleus fascicle length as primary outcome; (2) maximum passive muscle extensibility (XV1, Tardieu Scale); (3) 10-m maximal barefoot ambulation speed. RESULTS In all, 23 individuals (10 women; mean age [SD], 56 [±12] years; time since lesion, 9 [±8] years) were randomized into either the CONV (n = 11) or GSC (n = 12) group. After 1 year, all significant between-group differences favored the GSC group: soleus fascicle length, +18.1mm [9.3; 29.9]; MG fascicle length, +6.3mm [3.5; 9.1]; soleus thickness, +4.8mm [3.0; 7.7]; XV1 soleus, +4.1° [3.1; 7.2]; XV1 gastrocnemius, +7.0° [2.1; 11.9]; and ambulation speed, +0.07m/s [+0.02; +0.16]. CONCLUSIONS In chronic hemiparesis, daily self-stretch of the soleus and gastrocnemius over 1 year using GSC combined with conventional rehabilitation increased muscle fascicle length, extensibility, and ambulation speed more than conventional rehabilitation alone.
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Affiliation(s)
- Maud Pradines
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Mouna Ghedira
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Raphaël Portero
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France
| | - Ingrid Masson
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France
| | - Christina Marciniak
- 3 Northwestern University Feinberg School of Medicine, and the Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Dawn Hicklin
- 4 Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emilie Hutin
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Pierre Portero
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France
| | - Jean-Michel Gracies
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nicolas Bayle
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
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Gracies JM, Pradines M, Ghédira M, Loche CM, Mardale V, Hennegrave C, Gault-Colas C, Audureau E, Hutin E, Baude M, Bayle N. Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial. BMC Neurol 2019; 19:39. [PMID: 30871480 PMCID: PMC6419473 DOI: 10.1186/s12883-019-1257-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/14/2019] [Indexed: 12/30/2022] Open
Abstract
Background After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year. Methods One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections. Discussion This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis. Trial registration ClinicalTrials.gov: NCT02202954, July 29, 2014.
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Affiliation(s)
- Jean-Michel Gracies
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Maud Pradines
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France. .,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France.
| | - Mouna Ghédira
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Catherine-Marie Loche
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Valentina Mardale
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Catherine Hennegrave
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Caroline Gault-Colas
- AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Etienne Audureau
- AP-HP, Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France.,DHU A-TVB, IRMB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris Est-Créteil, F-94010, Créteil, France
| | - Emilie Hutin
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Marjolaine Baude
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
| | - Nicolas Bayle
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), F-94010, Créteil, France.,AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, F-94010, Créteil, France
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Baude M, Nielsen JB, Gracies JM. The neurophysiology of deforming spastic paresis: A revised taxonomy. Ann Phys Rehabil Med 2018; 62:426-430. [PMID: 30500361 DOI: 10.1016/j.rehab.2018.10.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 11/30/2022]
Abstract
This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor restriction and muscle hypo-mobilization in short position. Around each joint, the syndrome involves 2 disorders, muscular and neurologic. The muscular disorder is promoted by muscle hypo-mobilization in short position in the context of paresis, in the hours and days after paresis onset: this genetically mediated, evolving myopathy, is called spastic myopathy. The clinician may suspect it by feeling extensibility loss in a resting muscle, although long after the actual onset of the disease. The neurologic disorder, promoted by sensorimotor restriction in the context of paresis and by the muscle disorder itself, comprises 4 main components, mostly affecting antagonists to desired movements: the first is spastic dystonia, an unwanted, involuntary muscle activation at rest, in the absence of stretch or voluntary effort; spastic dystonia superimposes on spastic myopathy to cause visible, gradually increasing body deformities; the second is spastic cocontraction, an unwanted, involuntary antagonist muscle activation during voluntary effort directed to the agonist, aggravated by antagonist stretch; it is primarily due to misdirection of the supraspinal descending drive and contributes to reducing movement amplitude; and the third is spasticity, one form of hyperreflexia, defined by an enhancement of the velocity-dependent responses to phasic stretch, detected and measured at rest (another form of hyperreflexia is "nociceptive spasms", following flexor reflex afferent stimulation, particularly after spinal cord lesions). The 3 main forms of overactivity, spastic dystonia, spastic cocontraction and spasticity, share the same motor neuron hyperexcitability as a contributing factor, all being predominant in the muscles that are more affected by spastic myopathy. The fourth component of the neurologic disorder affects the agonist: it is stretch-sensitive paresis, which is a decreased access of the central command to the agonist, aggravated by antagonist stretch. Improved understanding of the pathophysiology of deforming spastic paresis should help clinicians select meaningful assessments and refined treatments, including the utmost need to preserve muscle tissue integrity as soon as paresis sets in.
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Affiliation(s)
- Marjolaine Baude
- Service de rééducation neurolocomotrice, EA 7377 BIOTN, laboratoire analyse et restauration du mouvement, université Paris-Est Créteil, hôpitaux universitaires Henri-Mondor, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark
| | - Jean-Michel Gracies
- Service de rééducation neurolocomotrice, EA 7377 BIOTN, laboratoire analyse et restauration du mouvement, université Paris-Est Créteil, hôpitaux universitaires Henri-Mondor, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Deltombe T, Lejeune T, Gustin T. Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? Ann Phys Rehabil Med 2018; 62:220-224. [PMID: 30107243 DOI: 10.1016/j.rehab.2018.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/21/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment. METHODS Expert opinion based on scientific evidence and personal experience. RESULTS Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed. CONCLUSION Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns.
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Affiliation(s)
- Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, B-5530 Yvoir, Belgium.
| | - Thierry Lejeune
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, NMSK, avenue Mounier 53, B-1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, service de médecine physique et réadaptation, avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, B-5530 Yvoir, Belgium
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Muscle Shortening and Spastic Cocontraction in Gastrocnemius Medialis and Peroneus Longus in Very Young Hemiparetic Children. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2328601. [PMID: 29951529 PMCID: PMC5987331 DOI: 10.1155/2018/2328601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022]
Abstract
Objectives Muscle shortening and spastic cocontraction in ankle plantar flexors may alter gait since early childhood in cerebral palsy (CP). We evaluated gastrosoleus complex (GSC) length, and gastrocnemius medialis (GM) and peroneus longus (PL) activity during swing phase, in very young hemiparetic children with equinovalgus. Methods This was an observational, retrospective, and monocentric outpatient study in a pediatric hospital. Ten very young hemiparetic children (age 3 ± 1 yrs) were enrolled. These CP children were assessed for muscle extensibility (Tardieu scale XV1) in GSC (angle of arrest during slow-speed passive ankle dorsiflexion with the knee extended) and monitored for GM and PL electromyography (EMG) during the swing phase of gait. The swing phase was divided into three periods (T1, T2, and T3), in which we measured a cocontraction index (CCI), ratio of the Root Mean Square EMG (RMS-EMG) from each muscle during that period to the peak 500 ms RMS-EMG obtained from voluntary plantar flexion during standing on tiptoes (from several 5-second series, the highest RMS value was computed over 500 ms around the peak). Results On the paretic side: (i) the mean XV1-GSC was 100° (8°) (median (SD)) versus 106° (3°) on the nonparetic side (p = 0.032, Mann-Whitney); (ii) XV1-GSC diminished with age between ages of 2 and 5 (Spearman, ρ = 0.019); (iii) CCIGM and CCIPL during swing phase were higher than on the nonparetic side (CCIGM, 0.32 (0.20) versus 0.15 (0.09), p < 0.01; CCIPL, 0.52 (0.30) versus 0.24 (0.17), p < 0.01), with an early difference significant for PL from T1 (p = 0.03). Conclusions In very young hemiparetic children, the paretic GSC may rapidly shorten in the first years of life. GM and PL cocontraction during swing phase are excessive, which contributes to dynamic equinovalgus. Muscle extensibility (XV1) may have to be monitored and preserved in the first years of life in children with CP. Additional measurements of cocontraction may further help target treatments with botulinum toxin, especially in peroneus longus.
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Hutin E, Ghédira M, Loche CM, Mardale V, Hennegrave C, Gracies JM, Bayle N. Intra- and inter-rater reliability of the 10-meter ambulation test in hemiparesis is better barefoot at maximal speed. Top Stroke Rehabil 2018; 25:345-350. [PMID: 29663851 DOI: 10.1080/10749357.2018.1460932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Reliability of clinical tests to evaluate ambulation in chronic hemiparesis may vary according to the testing condition. The 10-meter ambulation test (AT10) assesses walking speed and step length over 10 m, starting and ending in seated position. In the present study, we compared the intra- and inter-reliability of AT10 in chronic hemiparesis in four different conditions: with shoes and barefoot, at free and maximal safe speed. Methods Ten patients with hemiparesis, >1 year post-stroke (age 45 ± 12, time since stroke 16 ± 9 months, mean ± SD) participated in the reliability study (registration, ID-RCB-2017-A00090-53). All patients performed the AT10 twice, one week apart, in each of the four conditions. The number of steps and time to complete the task were manually recorded by four independent raters. The main outcome measurements were the intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean raw differences (DIFF) of the three parameters of AT10 (speed, step length, and cadence) in each of the four conditions. Effects of wearing shoes and speed condition were explored using ANOVA. Results Across all conditions, mean intra- and inter-rater ICCs were, respectively, 98.5 ± 0.1 and 99.9 ± 0.1% for speed, 98.3 ± 0.1 and 99.7 ± 0.2% for step length, and 96.5 ± 0.1 and 98.9 ± 0.6% for cadence. Mean intra- and inter-rater CV for speed were 0.051 ± 0.016 and 0.022 ± 0.002, respectively. Intra-rater reliability of speed assessments was higher at maximal than at free speed (ICC, CV, DIFF, p < 0.05). At free speed, intra-rater ICCs were higher barefoot than with shoes (p < 0.05). Discussion Performing the 10-meter ambulation test barefoot at maximal speed optimizes its reliability.
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Affiliation(s)
- Emilie Hutin
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France
| | - Mouna Ghédira
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France
| | - Catherine-Marie Loche
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Valentina Mardale
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Catherine Hennegrave
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Jean-Michel Gracies
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Nicolas Bayle
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
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Pradines M, Baude M, Marciniak C, Francisco G, Gracies JM, Hutin E, Bayle N. Effect on Passive Range of Motion and Functional Correlates After a Long-Term Lower Limb Self-Stretch Program in Patients With Chronic Spastic Paresis. PM R 2018; 10:1020-1031. [PMID: 29505896 DOI: 10.1016/j.pmrj.2018.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In current health care systems, long-duration stretching, performed daily, cannot be obtained through prescriptions of physical therapy. In addition, the short-term efficacy of the various stretching techniques is disputed, and their long-term effects remain undocumented. OBJECTIVE To evaluate changes in extensibility in 6 lower limb muscles and in ambulation speed after a ≥1-year self-stretch program, the Guided Self-rehabilitation Contract (GSC), in individuals with chronic spastic paresis. DESIGN Retrospective study. SETTING Neurorehabilitation clinic. PARTICIPANTS Patients diagnosed with hemiparesis or paraparesis at least 1 year before the initiation of a GSC and who were then involved in the GSC program for at least 1 year. INTERVENTIONS For each patient, specific muscles were identified for intervention among the following: gluteus maximus, hamstrings, vastus, rectus femoris, soleus, and gastrocnemius. Prescriptions and training for a daily, high-load, prolonged, home self-stretching program were primarily based on the baseline coefficient of shortening, defined as CSH = [(XN -XV1)/XN] (XV1 = PROM, passive range of motion; XN = normally expected amplitude). MAIN OUTCOME MEASUREMENTS Six assessments were performed per year, measuring the Tardieu XV1 or maximal slow stretch range of motion angle (PROM), CSH, 10-m ambulation speed, and its functional ambulation category (Perry's classification: household, limited, or full). Changes from baseline in self-stretched and nonself-stretched muscles were compared, with meaningful XV1 change defined as ΔXV1 >5° for plantar flexors and >10° for proximal muscles. Correlation between the composite XV1 (mean PROM for the 6 muscles) and ambulation speed also was evaluated. RESULTS Twenty-seven GSC participants were identified (14 women, mean age 44 years, range 29-59): 18 with hemiparesis and 9 with paraparesis. After 1 year, 47% of self-stretched muscles showed meaningful change in PROM (ΔXV1) versus 14% in nonself-stretched muscles (P < .0001, χ2). ΔCSH was -31% (95% confidence interval [95% CI] -41.5 to -15.2) in self-stretched versus -7% (95% CI -11.9 to -2.1) in nonself-stretched muscles (P < .0001, t-test). Ambulation speed increased by 41% (P < .0001) from 0.81 m/s (95% CI 0.67-0.95) to 1.15 m/s (95% CI 1.01-1.29). Eight of the 12 patients (67%) who were in limited or household categories at baseline moved to a higher functional ambulation category. There was a trend for a correlation between composite XV1 and ambulation speed (r = 0.44, P = .09) in hemiparetic patients. CONCLUSION Therapists should consider prescribing and monitoring a long-term lower limb self-stretch program using GSC, as this may increase muscle extensibility in adult-onset chronic paresis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maud Pradines
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, Cedex; and AP-HP, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Marjolaine Baude
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, Cedex; and AP-HP, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gerard Francisco
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science, Center at Houston (UTHealth), NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, Cedex; and AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Emilie Hutin
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, Cedex; and AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nicolas Bayle
- EA 7377 BIOTN, Laboratoire Analyse et Restauration du Mouvement, Université Paris Est Créteil (UPEC), Créteil, Cedex; and AP-HP, Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Gracies JM, Esquenazi A, Brashear A, Banach M, Kocer S, Jech R, Khatkova S, Benetin J, Vecchio M, McAllister P, Ilkowski J, Ochudlo S, Catus F, Grandoulier AS, Vilain C, Picaut P. Efficacy and safety of abobotulinumtoxinA in spastic lower limb: Randomized trial and extension. Neurology 2017; 89:2245-2253. [PMID: 29093068 PMCID: PMC5705248 DOI: 10.1212/wnl.0000000000004687] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/09/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To demonstrate single abobotulinumtoxinA injection efficacy in lower limb vs placebo for adults with chronic hemiparesis and assess long-term safety and efficacy of repeated injections. METHODS In a multicenter, double-blind, randomized, placebo-controlled, single-cycle study followed by a 1-year open-label, multiple-cycle extension, adults ≥6 months after stroke/brain injury received one lower limb injection (abobotulinumtoxinA 1,000 U, abobotulinumtoxinA 1,500 U, placebo) followed by ≤4 open-label cycles (1,000, 1,500 U) at ≥12-week intervals. Efficacy measures included Modified Ashworth Scale (MAS) in gastrocnemius-soleus complex (GSC; double-blind primary endpoint), physician global assessment (PGA), and comfortable barefoot walking speed. Safety was the open-label primary endpoint. RESULTS After a single injection, mean (95% confidence interval) MAS GSC changes from baseline at week 4 (double-blind, n = 381) were as follows: -0.5 (-0.7 to -0.4) (placebo, n = 128), -0.6 (-0.8 to -0.5) (abobotulinumtoxinA 1,000 U, n = 125; p = 0.28 vs placebo), and -0.8 (-0.9 to -0.7) (abobotulinumtoxinA 1,500 U, n = 128; p = 0.009 vs placebo). Mean week 4 PGA scores were as follows: 0.7 (0.5, 0.9) (placebo), 0.9 (0.7, 1.1) (1,000 U; p = 0.067 vs placebo), and 0.9 (0.7, 1.1) (1,500 U; p = 0.067); walking speed was not significantly improved vs placebo. At cycle 4, week 4 (open-label), mean MAS GSC change reached -1.0. Incremental improvements in PGA and walking speed occurred across open-label cycles; by cycle 4, week 4, mean PGA was 1.9, and walking speed increased +25.3% (17.5, 33.2), with 16% of participants walking >0.8 m/s (associated with community mobility; 0% at baseline). Tolerability was good and consistent with the known abobotulinumtoxinA safety profile. CONCLUSIONS In chronic hemiparesis, single abobotulinumtoxinA (Dysport Ipsen) administration reduced muscle tone. Repeated administration over a year was well-tolerated and improved walking speed and likelihood of achieving community ambulation. CLINICALTRIALGOV IDENTIFIERS NCT01249404, NCT01251367. CLASSIFICATION OF EVIDENCE The double-blind phase of this study provides Class I evidence that for adults with chronic spastic hemiparesis, a single abobotulinumtoxinA injection reduces lower extremity muscle tone.
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Affiliation(s)
| | | | | | - Marta Banach
- Author affiliations are provided at the end of the article
| | - Serdar Kocer
- Author affiliations are provided at the end of the article
| | - Robert Jech
- Author affiliations are provided at the end of the article
| | | | - Ján Benetin
- Author affiliations are provided at the end of the article
| | | | | | - Jan Ilkowski
- Author affiliations are provided at the end of the article
| | | | - France Catus
- Author affiliations are provided at the end of the article
| | | | - Claire Vilain
- Author affiliations are provided at the end of the article
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Gracies JM, O'Dell M, Vecchio M, Hedera P, Kocer S, Rudzinska-Bar M, Rubin B, Timerbaeva SL, Lusakowska A, Boyer FC, Grandoulier AS, Vilain C, Picaut P. Effects of repeated abobotulinumtoxinA injections in upper limb spasticity. Muscle Nerve 2017; 57:245-254. [PMID: 28590525 PMCID: PMC5811783 DOI: 10.1002/mus.25721] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 01/24/2023]
Abstract
Introduction: The efficacy of single injections of abobotulinumtoxinA (Dysport) is established in adults with upper limb spasticity. In this study we assessed the effects of repeated injections of abobotulinumtoxinA over 1 year. Methods: Patients (n = 258, safety population) received 500 U, 1,000 U, or 1,500 U (1,500‐U dose included 500‐U shoulder injections) for up to 4 or 5 treatment cycles. Assessments included treatment‐emergent adverse events (TEAEs), muscle tone, passive and active range of motion (XV1, XA), angle of catch (XV3), Disability Assessment Scale (DAS) score, Modified Frenchay Scale (MFS) score, and Physician Global Assessment (PGA) score. Results: The incidence of TEAEs decreased across cycles. Muscle tone reduction and XV1 remained stable across cycles, whereas XV3 and XA continued to improve at the finger, wrist, and elbow flexors. DAS and PGA improved across cycles. MFS improved best with 1,500 U. Discussion: A favorable safety profile and continuous improvements in active movements and perceived and active function were associated with repeated abobotulinumtoxinA injections in upper limb muscles. Muscle Nerve57: 245–254, 2018
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Affiliation(s)
- Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal De Lattre De Tassigny, 94010, Créteil, France
| | - Michael O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, Baker Pavilion, New York, New York, USA
| | - Michele Vecchio
- Department of U.O. Physical Medicine and Rehabilitation, Policlinico Vittorio Emanuele University Hospital, Catania, Italy
| | - Peter Hedera
- Department of Neurology, Division of Movement Disorders, Vanderbilt University, Nashville, Tennessee, USA
| | - Serdar Kocer
- Centre de Rééducation Hôpital du Jura, Porrentruy, Switzerland
| | - Monika Rudzinska-Bar
- Department of Neurology, Faculty of Medicine, Medical University of Silesia, Katowice, Poland
| | - Bruce Rubin
- Design Neuroscience Center, Doral, Florida, USA
| | | | - Anna Lusakowska
- Department of Neurology, Medical University of Warsaw, Poland
| | - François Constant Boyer
- EA 3797, Unités de Médecine Physique et de Réadaptation, Hôpital Universitaire Sébastopol, Champagne Ardenne, France
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Functional brain neuroimaging-guided repetitive transcranial magnetic stimulation in neurodevelopmental disorders: The case of a schizencephaly-related spastic dystonia. J Neurol Sci 2017; 378:167-169. [PMID: 28566157 DOI: 10.1016/j.jns.2017.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/17/2017] [Accepted: 05/06/2017] [Indexed: 11/21/2022]
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Vecchio M, Gracies JM, Panza F, Fortunato F, Vitaliti G, Malaguarnera G, Cinone N, Beatrice R, Ranieri M, Santamato A. Change in Coefficient of Fatigability Following Rapid, Repetitive Movement Training in Post-Stroke Spastic Paresis: A Prospective Open-Label Observational Study. J Stroke Cerebrovasc Dis 2017; 26:2536-2540. [PMID: 28666805 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND In post-stroke patients, the possibility of performing an active ankle dorsiflexion movement is favorable for the recovery of gait. Moreover, the fatigue due to repetitive active ankle dorsiflexion could reduce the speed gait. We assessed the change in coefficient of fatigability of active ankle dorsiflexion after a home-based self-rehabilitative procedure in post-stroke patients. METHODS In a prospective open-label observational study conducted in 2 university hospitals, a home-based self-rehabilitation treatment comprising two 12-minute sessions per day (3 times per week for 3 months) was performed by 10 outpatients with post-stroke lower limb impairment. Each session consisted of three 1-minute series of repeated active ankle dorsiflexion efforts at maximal speed on the paretic side, each one followed by 3-minute bouts of triceps surae stretch. Coefficients of fatigability of dorsiflexion and 10-meter barefoot ambulation speed were evaluated at baseline and at the end of the program. RESULTS At 3 months of follow-up, there was a decrease in the coefficients of fatigability of ankle dorsiflexion, both with knee flexed and extended (respectively from 8% to 2% and from 6% to 2%; P < .01), associated with an increase in comfortable ambulation speed (from .24 to .26 m/s; P < .05). CONCLUSIONS The reduction of coefficient of fatigability of ankle dorsiflexion, together with walking speed improvement, suggested the effectiveness of self-rehabilitation using alternated periods of self-stretch and rapid alternating efforts in the paretic lower limb after stroke.
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Affiliation(s)
- Michele Vecchio
- U.O. of Physical Medicine and Rehabilitation, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy
| | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est, Albert Chenevier-Henri Mondor Hospital, Service de Rééducation Neurolocomotrice, AP-HP, Créteil, France
| | - Francesco Panza
- U.O. of Physical Medicine and Rehabilitation, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy; Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
| | - Francesca Fortunato
- Section of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanna Vitaliti
- Institute of Pediatrics, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy
| | - Giulia Malaguarnera
- Research Center "The Great Senescence," University of Catania, Catania, Italy
| | - Nicoletta Cinone
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy
| | - Raffaele Beatrice
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy
| | - Maurizio Ranieri
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy
| | - Andrea Santamato
- "Physical Medicine and Rehabilitation" Unit, "OORR Hospital," University of Foggia, Foggia, Italy; "Fondazione Turati" Rehabilitation Centre, Vieste, Foggia, Italy.
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Maupas E, Dyer JO, Melo SDA, Forget R. Patellar tendon vibration reduces the increased facilitation from quadriceps to soleus in post-stroke hemiparetic individuals. Ann Phys Rehabil Med 2017; 60:319-328. [PMID: 28528818 DOI: 10.1016/j.rehab.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Stimulation of the femoral nerve in healthy people can facilitate soleus H-reflex and electromyography (EMG) activity. In stroke patients, such facilitation of transmission in spinal pathways linking the quadriceps and soleus muscles is enhanced and related to co-activation of knee and ankle extensors while sitting and walking. Soleus H-reflex facilitation can be depressed by vibration of the quadriceps in healthy people, but the effects of such vibration have never been studied on the abnormal soleus facilitation observed in people after stroke. OBJECTIVES To determine whether vibration of the quadriceps can modify the enhanced heteronymous facilitation of the soleus muscle observed in people with spastic stroke after femoral nerve stimulation and compare post-vibration effects on soleus facilitation in control and stroke individuals. METHODS Modulation of voluntary soleus EMG activity induced by femoral nerve stimulation (2×motor threshold) was assessed before, during and after vibration of the patellar tendon in 10 healthy controls and 17 stroke participants. RESULTS Voluntary soleus EMG activity was facilitated by femoral nerve stimulation in 4/10 (40%) controls and 11/17 (65%) stroke participants. The level of facilitation was greater in the stroke than control group. Vibration significantly reduced early heteronymous facilitation in both groups (50% of pre-vibration values). However, the delay in recovery of soleus facilitation after vibration was shorter for the stroke than control group. The control condition with the vibrator turned off had no effect on the modulation. CONCLUSIONS Patellar tendon vibration can reduce the facilitation between knee and ankle extensors, which suggests effective presynaptic inhibition but decreased post-activation depression in the lower limb of people after chronic hemiparetic stroke. Further studies are warranted to determine whether such vibration could be used to reduce the abnormal extension synergy of knee and ankle extensors in people after hemiparetic stroke.
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Affiliation(s)
- Eric Maupas
- ASEI, centre Paul-Dottin, 31520 Ramonville-Saint-Agne, France; Laboratoire de physiologie de la posture et du mouvement PoM, université Champollion, 81000 Albi, France.
| | - Joseph-Omer Dyer
- Centre de recherche interdisciplinaire en réadaptation, institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS du centre-Sud-de-l'Île-de-Montréal, Québec, Canada; École de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
| | - Sibele de Andrade Melo
- Centre de recherche interdisciplinaire en réadaptation, institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS du centre-Sud-de-l'Île-de-Montréal, Québec, Canada; École de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
| | - Robert Forget
- Centre de recherche interdisciplinaire en réadaptation, institut de réadaptation Gingras-Lindsay de Montréal, CIUSSS du centre-Sud-de-l'Île-de-Montréal, Québec, Canada; École de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
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Ghédira M, Albertsen IM, Mardale V, Gracies JM, Bayle N, Hutin É. Wireless, accelerometry-triggered functional electrical stimulation of the peroneal nerve in spastic paresis: A randomized, controlled pilot study. Assist Technol 2016; 29:99-105. [PMID: 27646824 DOI: 10.1080/10400435.2016.1214933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In hemiparesis, Wireless, Accelerometry-Triggered Functional Electrical Stimulation (WAFES) of the common peroneal nerve may hold intrinsic rehabilitative properties. The present pilot study analyzes WAFES against conventional therapy. Twenty adults with chronic hemiparesis (time since lesion 7(6) years; median (interquartile range)) were randomized into 2 10-week rehabilitation programs: a 45-minute (min) daily walk using WAFES (n = 10) and conventional physical therapy (CPT), 3 × 45 min per week (n = 10). The outcomes were 3D sagittal speed measurements, step length, cadence, maximal amplitude and velocity of hip, knee, and ankle during gait at free and fast speed without WAFES and clinical assessments of plantar flexor angles of shortening, spasticity, and weakness, before (D1) and after the program (W10). Kinematic and spasticity improvements occurred in the WAFES group only: (i) ankle dorsiflexion velocity (D1 versus W10, free speed, WAFES, +4(5)°/sec, p = 0.002; CPT, -3(8)°/sec, p = 0.007; fast, WAFES, +8(6)°/sec, p = 0.03; CPT, -1(4)°/sec, NS); (ii) maximal passive ankle dorsiflexion (WAFES,+26(85)%; CPT,+0(27)%; group-visit, p = 0.007) and knee flexion (WAFES, +13(17)%; CPT, -1(11)%; group-visit, p = 0.006) at fast speed only; (iii) 15% plantar flexor spasticity grade reduction with WAFES. Over 10 weeks, gait training using WAFES improved ankle and knee kinematics and reduced plantar flexor spasticity compared with CPT. Studies with longer WAFES use should explore functional effects.
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Affiliation(s)
- Mouna Ghédira
- a Laboratoire Analyse et Restauration du Mouvement, BIOTN-EA 7377, IMRB , Université Paris-Est, Fédération de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Créteil , France
| | - Inke Marie Albertsen
- a Laboratoire Analyse et Restauration du Mouvement, BIOTN-EA 7377, IMRB , Université Paris-Est, Fédération de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Créteil , France
| | - Valentina Mardale
- a Laboratoire Analyse et Restauration du Mouvement, BIOTN-EA 7377, IMRB , Université Paris-Est, Fédération de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Créteil , France
| | - Jean-Michel Gracies
- a Laboratoire Analyse et Restauration du Mouvement, BIOTN-EA 7377, IMRB , Université Paris-Est, Fédération de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Créteil , France
| | - Nicolas Bayle
- a Laboratoire Analyse et Restauration du Mouvement, BIOTN-EA 7377, IMRB , Université Paris-Est, Fédération de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Créteil , France
| | - Émilie Hutin
- a Laboratoire Analyse et Restauration du Mouvement, BIOTN-EA 7377, IMRB , Université Paris-Est, Fédération de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris , Créteil , France
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Delgado MR, Tilton A, Russman B, Benavides O, Bonikowski M, Carranza J, Dabrowski E, Dursun N, Gormley M, Jozwiak M, Matthews D, Maciag-Tymecka I, Unlu E, Pham E, Tse A, Picaut P. AbobotulinumtoxinA for Equinus Foot Deformity in Cerebral Palsy: A Randomized Controlled Trial. Pediatrics 2016; 137:e20152830. [PMID: 26812925 DOI: 10.1542/peds.2015-2830] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although botulinum toxin is a well-established treatment of focal spasticity in cerebral palsy, most trials have been small, and few have simultaneously assessed measures of muscle tone and clinical benefit. METHODS Global, randomized, controlled study to assess the efficacy and safety of abobotulinumtoxinA versus placebo in cerebral palsy children with dynamic equinus foot deformity. Patients were randomized (1:1:1) to abobotulinumtoxinA 10 U/kg/leg, 15 U/kg/leg, or placebo injections into the gastrocnemius-soleus complex (1 or both legs injected). In the primary hierarchical analysis, demonstration of benefit for each dose required superiority to placebo on the primary (change in Modified Ashworth Scale from baseline to week 4) and first key secondary (Physician's Global Assessment at week 4) end points. RESULTS Two hundred and forty-one patients were randomized, and 226 completed the study; the intention to treat population included 235 patients (98%). At week 4, Modified Ashworth Scale scores significantly improved with abobotulinumtoxinA; mean (95% confidence interval) treatment differences versus placebo were -0.49 (-0.75 to -0.23; P = .0002) for 15 U/kg/leg and -0.38 (-0.64 to -0.13; P = .003) for 10 U/kg/leg. The Physician's Global Assessment treatment differences versus placebo of 0.77 (0.45 to 1.10) for 15 U/kg/leg and 0.82 (0.50 to 1.14) for 10 U/kg/leg were also significant (both Ps < .0001). The most common treatment-related adverse event was muscular weakness (10 U/Kg/leg = 2; placebo = 1). CONCLUSIONS AbobotulinumtoxinA improves muscle tone in children with dynamic equinus resulting in an improved overall clinical impression and is well tolerated.
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Affiliation(s)
- Mauricio R Delgado
- Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Texas Southwestern Medical Center, Dallas, Texas;
| | - Ann Tilton
- Louisiana State University Health Center and Children's Hospital New Orleans, New Orleans, Louisiana
| | | | | | - Marcin Bonikowski
- Non-public Healthcare Unit Mazovian Neurorehabilitation and Psychiatry Center in Zagorze, Wiazowna, Poland
| | | | | | - Nigar Dursun
- Kocaeli University Medical Faculty, Izmit, Turkey
| | - Mark Gormley
- Gillette Children's Specialty Healthcare, St Paul, Minnesota
| | - Marek Jozwiak
- Department of Pediatric Orthopedics and Traumatology K. Marcinkowski University of Medical Sciences, Poznan, Poland
| | | | | | - Ece Unlu
- Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; and
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