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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. [PMID: 38770827 DOI: 10.1002/pmrj.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Lee J, Yang SN. Effectiveness of Extracorporeal Shock Wave Therapy after Botulinum Toxin Injection for Post-Stroke Upper Extremity Spasticity: A Randomized Controlled Study. Toxins (Basel) 2024; 16:197. [PMID: 38668622 PMCID: PMC11054781 DOI: 10.3390/toxins16040197] [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: 03/14/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
Post-stroke spasticity is a common complication that limits the functional performance of patients. Botulinum toxin (BTx) is an effective treatment for spasticity. Numerous researchers have applied extracorporeal shock wave therapy (ESWT) to address post-stroke spasticity, yielding positive clinical outcomes. We aimed to clarify the add-on effects of ESWT on BTx therapy for spasticity in patients with post-stroke. Sixteen eligible patients with upper extremity spasticity after stroke were recruited for this study. They were randomized to either a BTx with focused ESWT treatment group or a BTx alone group. Spasticity, measured using the modified Ashworth score (MAS) and modified Tardieu scale (MTS), showed statistically significant improvements in the elbow and wrist flexor muscles in both BTx + ESWT group and BTx alone groups. However, no significant differences were observed between the two groups with time flow. The BTx + ESWT group showed significantly decreased MAS of the finger flexors at follow-up and increased R1 (MTS) of the finger flexors at 3 weeks after treatment, which was not observed in the BTx alone group. This is the first study to identify the add-on effect of ESWT on BTx injections to improve post-stroke upper limb spasticity.
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Affiliation(s)
- Junhee Lee
- Department of Physical Medicine and Rehabilitation, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea;
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Veronese S, Aggarwal R, Giovanelli T, Sbarbati A. Hyper- and Hypopigmentation in a Subject with Fitzpatrick Skin Phototype VI: A New Treatment Option. J Clin Med 2024; 13:1036. [PMID: 38398349 PMCID: PMC10889290 DOI: 10.3390/jcm13041036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Laser therapies can cause hyper- and hypopigmentation of the skin. There is little evidence in the literature of effective treatments for these types of problems in Fitzpatrick skin phototypes IV-VI. The main aim of this retrospective study is to evaluate the effects of a new therapy that combines the application of electromagnetic fields and vacuum on a subject with Fitzpatrick skin phototype VI, who presented extensive, laser-induced facial dyschromia. The secondary aim is to test the effectiveness of a free imaging software for assessing skin pigmentation. Methods: The level of improvement after therapy was evaluated, with a 5-point Likert scale, one month after the end of the treatment by the subject and by the doctor who performed the treatment, and by two blinded dermatologists. With the free software, a three-dimensional reconstruction of the treated area and the evaluation of the color distribution were performed. Results: Both the subject and the doctors involved in the study positively evaluated the effects of the treatment. The image analysis highlighted the homogenization of the skin color in the treated area. Conclusions: The combination of electromagnetic fields and vacuum for dyschromia treatments appears promising. The new method of assessing melanin levels resulted particularly efficient.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Rajeev Aggarwal
- Cardiff Cosmetic Clinic, Cardiff CF24 3WD, UK; (R.A.); (T.G.)
| | | | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
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Zschorlich VR, Qi F, Schorer J, Büsch D. Sensory Stimulation of the Triceps Surae Muscle Complex Modulates Spinal Reflex Responses-A Comparison between Tapotement Massage and Repetitive Peripheral Magnetic Stimulation (rPMS). Brain Sci 2024; 14:119. [PMID: 38391694 PMCID: PMC10887412 DOI: 10.3390/brainsci14020119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The reduction of muscular hypertonia is important in the treatment of various diseases or rehabilitation. This study aims to test the efficacy of a 5 Hz mechanical muscle stimulation (tapotement massage) in comparison to a 5 Hz repetitive peripheral magnetic stimulation (rPMS) on the neuromuscular reflex response. METHODS In a randomized control trial, 15 healthy volunteers were administered with either 5 Hz rPMS, tapotement massage, or rPMS sham stimulation. The posterior tibial nerve was stimulated with rPMS and sham stimulation. The Achilles tendon was exposed to a mechanically applied high-amplitude 5 Hz repetitive tendon tapotement massage (rTTM). The tendon reflex (TR) was measured for the spinal response of the soleus muscle. RESULTS After rPMS, there was a reduction of the TR response (-9.8%, p ≤ 0.034) with no significant changes after sham stimulation. Likewise, TR decreased significantly (-17.4%, p ≤ 0.002) after Achilles tendon tapotement intervention. CONCLUSIONS These findings support the hypothesis that both afferent 5 Hz sensory stimulations contributed to a modulation within the spinal and/or supraspinal circuits, which resulted in a reduction of the spinal reflex excitability. The effects could be beneficial for patients with muscle hypertonia and could improve the functional results of rehabilitation programs.
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Affiliation(s)
- Volker R Zschorlich
- Institute of Sports Science, Faculty of Philosophy, University of Rostock, Ulmenstr. 69-House 2, 18057 Rostock, Germany
- Institute of Sport Science, School IV-School of Humanities and Social Sciences, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
- Department Aging of Individuals and Society, Faculty of Interdisciplinary Research, University of Rostock, Gehlsheimer Str. 20, 18051 Rostock, Germany
| | - Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing 100084, China
| | - Jörg Schorer
- Institute of Sport Science, School IV-School of Humanities and Social Sciences, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Dirk Büsch
- Institute of Sport Science, School IV-School of Humanities and Social Sciences, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
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Faccioli S, Cavalagli A, Falocci N, Mangano G, Sanfilippo I, Sassi S. Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: a systematic review and meta-analysis. Front Neurol 2023; 14:1256392. [PMID: 37799279 PMCID: PMC10548139 DOI: 10.3389/fneur.2023.1256392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
Background Hereditary spastic paraplegias (HSPs) are a group of inheritance diseases resulting in gait abnormalities, which may be detected using instrumented gait analysis. The aim of this systematic review was 2-fold: to identify specific gait analysis patterns and interventions improving gait in HSP subjects. Methods A systematic review was conducted in PubMed, Cochrane Library, REHABDATA, and PEDro databases, in accordance with reporting guidelines of PRISMA statement and Cochrane's recommendation. The review protocol was recorded on the PROSPERO register. Patients with pure and complicated HSP of any age were included. All types of studies were included. Risk of bias, quality assessment, and meta-analysis were performed. Results Forty-two studies were included: 19 were related to gait analysis patterns, and 24 were intervention studies. The latter ones were limited to adults. HSP gait patterns were similar to cerebral palsy in younger subjects and stroke in adults. Knee hyperextension, reduced range of motion at knee, ankle, and hip, reduced foot lift, and increased rapid trunk and arm movements were reported. Botulinum injections reduced spasticity but uncovered weakness and improved gait velocity at follow-up. Weak evidence supported intrathecal baclofen, active intensive physical therapy (i.e., robot-assisted gait training, functional exercises, and hydrotherapy), and functional electrical stimulation. Some improvements but adverse events were reported after transcranial magnetic stimulation, transcutaneous spinal direct current stimulation, and spinal cord stimulation implant. Conclusion Knee hyperextension, non-sagittal pelvic movements, and reduced ROM at the knee, ankle, and hip represent the most peculiar patterns in HSP, compared to diplegic cerebral palsy and stroke. Botulinum improved comfortable gait velocity after 2 months. Nonetheless, interventions reducing spasticity might result in ineffective functional outcomes unveiling weakness. Intensive active physical therapy and FES might improve gait velocity in the very short term.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Cavalagli
- Children Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - Nicola Falocci
- Office of Policy Evaluation and Statistical Studies, Umbria Legislative Assembly, Perugia, Italy
| | - Giulia Mangano
- Department of Physical Medicine and Rehabilitation, Azienda Sanitaria Provinciale 3 (ASP 3), Acireale Hospital, Catania, Italy
| | | | - Silvia Sassi
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Veronese S, Beatini A, Urbani C, Lanza E, Paz OM, Saussaye Y, Lomuto M, Sbarbati A. V-EMF treatment of facial scar: First results. J Tissue Viability 2022; 31:614-618. [PMID: 35853796 DOI: 10.1016/j.jtv.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
AIM OF STUDY This is a retrospective study aimed at evaluating the effectiveness of the use of electromagnetic fields and negative pressure treatment (V-EMF) for facial scars, from an aesthetic and functional point of view, and considering the variations in the levels of hydration. MATERIAL AND METHODS 25 subjects with facial scarring were re-evaluated after being treated with the V-EMF method. The hydration levels of the scars before and after treatment were compared. The results were evaluated considering the satisfaction levels of the patients with the VAS, and of the medical specialists who performed the treatment, and of 3 independent dermatologists with the Likert scale. RESULTS Mean hydration levels of scars went from 41.8 to 53.3, with mean hydration levels of healthy reference points equal to 54.6. The minimum patient satisfaction level was 2 in the VAS. The minimum level of satisfaction of specialists and dermatologists was equal to IV on the Likert scale for all patients, except for 1 subject in which it was III for the specialist who had treated him. Anti-aging and re-pigmentation effects were also noted as secondary results. CONCLUSIONS From an aesthetic and functional point of view, and for the overall anti-aging effect of the treated area, V-EMF applied to facial scars has shown extremely promising results.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy.
| | | | | | - Eliana Lanza
- Estederm Studio di Dermatologia, Medicina Estetica e Chirurgia Plastica, 95127, Catania, Italy
| | | | | | - Michele Lomuto
- Ospedale Casa Sollievo della Sofferenza IRCCS, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italy
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Yoldaş Aslan Ş, Kutlay S, Düsünceli Atman E, Elhan AH, Gök H, Küçükdeveci AA. Does extracorporeal shock wave therapy decrease spasticity of ankle plantar flexor muscles in patients with stroke: A randomized controlled trial. Clin Rehabil 2021; 35:1442-1453. [PMID: 33906450 DOI: 10.1177/02692155211011320] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle. DESIGN Randomized controlled trial. SETTING Inpatient neuro-rehabilitation clinic of a university hospital. PARTICIPANTS Stroke patients with ankle flexor spasticity. INTERVENTIONS Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation. MAIN MEASURES The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up. RESULTS Fifty-one participants were enrolled (active therapy n = 17, sham n = 17, control n = 17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47 ± 0.72 to 1.41 ± 0.62) compared to sham (from 2.19 ± 1.05 to 2.06 ± 1.12) and control (from 2.06 ± 0.85 to 2.00 ± 0.73) groups immediately after the treatment (P < 0.001). Tardieu results were also in concordance (P < 0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index (P < 0.001). However, there was no difference among the groups in terms of improvement in elastography. CONCLUSION Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.
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Affiliation(s)
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Haydar Gök
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayse Adile Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
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Yu S, Chen Y, Cai Q, Ma K, Zheng H, Xie L. A Novel Quantitative Spasticity Evaluation Method Based on Surface Electromyogram Signals and Adaptive Neuro Fuzzy Inference System. Front Neurosci 2020; 14:462. [PMID: 32523505 PMCID: PMC7261936 DOI: 10.3389/fnins.2020.00462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
Stroke patients often suffer from spasticity. Before treatment of spasticity, there are often practical demands for objective and quantitative assessment of muscle spasticity. However, the common quantitative spasticity assessment method, the tonic stretch reflex threshold (TSRT), is time-consuming and complicated to implement due to the requirement of multiple passive stretches. To evaluate spasticity conveniently, a novel spasticity evaluation method based on surface electromyogram (sEMG) signals and adaptive neuro fuzzy inference system (i.e., the sEMG-ANFIS method) was presented in this paper. Eleven stroke patients with spasticity and four healthy subjects were recruited to participate in the experiment. During the experiment, the Modified Ashworth scale (MAS) scores of each subject was obtained and sEMG signals from four elbow flexors or extensors were collected from several times (4–5) repetitions of passive stretching. Four time-domain features (root mean square, the zero-cross rate, the wavelength and a 4th-order autoregressive model coefficient) and one frequency-domain feature (the mean power frequency) were extracted from the collected sEMG signals to reflect the spasticity information. Using the ANFIS classifier, excellent regression performance was achieved [mean accuracy = 0.96, mean root-mean-square error (RMSE) = 0.13], outperforming the classical TSRT method (accuracy = 0.88, RMSE = 0.28). The results showed that the sEMG-ANFIS method not only has higher accuracy but also is convenient to implement by requiring fewer repetitions (4–5) of passive stretches. The sEMG-ANFIS method can help stroke patients develop proper rehabilitation training programs and can potentially be used to provide therapeutic feedback for some new spasticity interventions, such as shockwave therapy and repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Song Yu
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Yan Chen
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
| | - Qing Cai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke Ma
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longhan Xie
- Shien-Ming Wu School of Intelligent Engineering, South China University of Technology, Guangzhou, China
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Miczak K, Padova J. Muscle Overactivity in the Upper Motor Neuron Syndrome: Assessment and Problem Solving for Complex Cases: the Role of Physical and Occupational Therapy. Phys Med Rehabil Clin N Am 2019; 29:529-536. [PMID: 30626513 DOI: 10.1016/j.pmr.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of the physical or occupational therapist in addressing muscle hyperexcitability is to carefully assess the implications that the abnormal tone has on function, especially active movement patterns. A thorough evaluation that includes neurologic and nonneurologic attributes allows the clinician to determine the most efficacious treatment interventions, especially when considering severity and chronicity of deficits. A holistic assessment that includes patient factors and resources guides the clinician's plan of care to allow for optimal functional outcomes.
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Affiliation(s)
- Kimberly Miczak
- Drucker Brain Injury Center, MossRehab Hospital, 60 Township Line Road, Elkins Park, PA 19027, USA.
| | - Joseph Padova
- MossRehab Outpatient Center, 60 Township Line Road, Elkins Park, PA 19027, USA
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Picelli A, Santamato A, Chemello E, Cinone N, Cisari C, Gandolfi M, Ranieri M, Smania N, Baricich A. Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature. Ann Phys Rehabil Med 2018; 62:291-296. [PMID: 30219307 DOI: 10.1016/j.rehab.2018.08.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE A wide range of adjunct therapies after botulinum toxin administration have been proposed. The aim of the present paper is to provide an overview of major writings dealing with adjuvant (non-pharmacological) treatments associated with botulinum toxin for managing spasticity in order to provide some up-to-date information about the usefulness of the most commonly used procedures. METHODS The literature in PubMed was searched with the MeSH terms botulinum toxins, muscle spasticity, physical therapy modalities, and rehabilitation. The results were limited to studies focusing on adjuvant treatments associated with botulinum toxin for managing spasticity. We excluded papers on the use of non-drug treatments for spasticity not associated with botulinum toxin serotype A (BoNT-A) injection. Relevant literature known to the authors along with this complementary search represented the basis for this overview of the literature. RESULTS Adhesive taping and casting effectively improved the botulinum toxin effect in patients with upper- and lower-limb spasticity. There is level 1 evidence that casting is better than taping for outcomes including spasticity, range of motion and gait. However, consensus about their most appropriate timing, duration, target and material is lacking. In terms of physical modalities combined with botulinum toxin injection, we found level 1 evidence that extracorporeal shock wave therapy is better than electrical stimulation for some post-injection outcomes including spasticity and pain. Furthermore, electrical stimulation of injected muscles might be useful to boost the toxin effect. However, the best stimulation protocol has not been defined. In addition, we found level 2b evidence that whole-body vibration therapy might reduce spasticity with cerebral palsy. CONCLUSION Future research in this field should focus on investigating the most appropriate post-injection treatment protocol for each goal to achieve.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy.
| | - Andrea Santamato
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicoletta Cinone
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Carlo Cisari
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Maurizio Ranieri
- Physical Medicine & Rehabilitation Section, 'OORR' Hospital, University of Foggia, Foggia, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Alessio Baricich
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
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Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study. Neural Plast 2018; 2018:8105480. [PMID: 29780410 PMCID: PMC5892248 DOI: 10.1155/2018/8105480] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/01/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022] Open
Abstract
Background Bilateral arm training (BAT) has shown promise in expediting progress toward upper limb recovery in chronic stroke patients, but its neural correlates are poorly understood. Objective To evaluate changes in upper limb function and EEG power after a robot-assisted BAT in chronic stroke patients. Methods In a within-subject design, seven right-handed chronic stroke patients with upper limb paresis received 21 sessions (3 days/week) of the robot-assisted BAT. The outcomes were changes in score on the upper limb section of the Fugl-Meyer assessment (FM), Motricity Index (MI), and Modified Ashworth Scale (MAS) evaluated at the baseline (T0), posttraining (T1), and 1-month follow-up (T2). Event-related desynchronization/synchronization were calculated in the upper alpha and the beta frequency ranges. Results Significant improvement in all outcomes was measured over the course of the study. Changes in FM were significant at T2, and in MAS at T1 and T2. After training, desynchronization on the ipsilesional sensorimotor areas increased during passive and active movement, as compared with T0. Conclusions A repetitive robotic-assisted BAT program may improve upper limb motor function and reduce spasticity in the chronically impaired paretic arm. Effects on spasticity were associated with EEG changes over the ipsilesional sensorimotor network.
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12
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Guo P, Gao F, Zhao T, Sun W, Wang B, Li Z. Positive Effects of Extracorporeal Shock Wave Therapy on Spasticity in Poststroke Patients: A Meta-Analysis. J Stroke Cerebrovasc Dis 2017; 26:2470-2476. [PMID: 28918085 DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/20/2017] [Accepted: 08/13/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Spasticity is a common and serious complication following a stroke, and many clinical research have been conducted to evaluate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity in poststroke patients. This meta-analysis aimed to evaluate the therapeutic effect on decreasing spasticity caused by a stroke immediately and 4 weeks after the application of shock wave therapy. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases for relevant studies through November 2016 using the following item: (Hypertonia OR Spasticity) and (Shock Wave or ESWT) and (Stroke). The outcomes were evaluated by Modified Ashworth Scale (MAS) grades and pooled by Stata 12.0 (Stata Corp, College Station, TX, USA). RESULTS Six studies consisting of 9 groups were included in this meta-analysis. The MAS grades immediately after ESWT were significantly improved compared with the baseline values (standardized mean difference [SMD], -1.57; 95% confidence intervals [CIs], -2.20, -.94). Similarly, the MAS grades judged at 4 weeks after ESWT were also showed to be significantly lower than the baseline values (SMD, -1.93; 95% CIs, -2.71, -1.15). CONCLUSIONS ESWT for the spasticity of patients after a stroke is effective, as measured by MAS grades. Moreover, no serious side effects were observed in any patients after shock wave therapy. Nevertheless, our current study with some limitations such as the limited sample size only provided limited quality of evidence; confirmation from a further systematic review or meta-analysis with large-scale, well-designed randomized control trials is required.
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Affiliation(s)
- Peipei Guo
- The Graduate School of Peking Union Medical College, Beijing
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Tingting Zhao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China.
| | - Bailiang Wang
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
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Naro A, Leo A, Russo M, Casella C, Buda A, Crespantini A, Porcari B, Carioti L, Billeri L, Bramanti A, Bramanti P, Calabrò RS. Breakthroughs in the spasticity management: Are non-pharmacological treatments the future? J Clin Neurosci 2017; 39:16-27. [DOI: 10.1016/j.jocn.2017.02.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
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Radinmehr H, Nakhostin Ansari N, Naghdi S, Olyaei G, Tabatabaei A. Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial. Disabil Rehabil 2017; 39:483-490. [PMID: 26971745 DOI: 10.3109/09638288.2016.1148785] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340 mJ/mm2, 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T0), immediately after treatment (T1) and one hour after the end of the treatment (T2). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T1, but there was no significant effect on Hmax/Mmax ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability. Implications for Rehabilitation One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability. The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT. The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus. The rESWT had no significant effects on alpha motorneuron excitability.
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Affiliation(s)
- Hojjat Radinmehr
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Noureddin Nakhostin Ansari
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Soofia Naghdi
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Gholamreza Olyaei
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Azadeh Tabatabaei
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
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Paganoni S, Karam C, Joyce N, Bedlack R, Carter GT. Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis. NeuroRehabilitation 2015; 37:53-68. [PMID: 26409693 PMCID: PMC5223769 DOI: 10.3233/nre-151240] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) is a neurodegenerative disease that results in progressive muscle weakness and wasting. There is no known cure and the disease is uniformly fatal. PURPOSE This review discusses current concepts in ALS care, from breaking the diagnosis to end-of-life care. People with ALS have several multidisciplinary needs due to a complex and dynamic disease process. They benefit from rehabilitation interventions that are individualized and have the goal of optimizing independence, function, and safety. These strategies also help minimize symptomatic burden and maximize quality of life. CONCLUSION Patient-centered, multidisciplinary care has a significant impact on the life of people with ALS and is the current standard of care for this patient population.
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Affiliation(s)
- Sabrina Paganoni
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Boston VA Healthcare System, Boston, MA, USA
| | - Chafic Karam
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nanette Joyce
- Department of Physical Medicine and Rehabilitation, Neuromuscular Section, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Richard Bedlack
- Duke University School of Medicine and Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Gregory T Carter
- Department of Physical Medicine and Rehabilitation, St Luke's Rehabilitation Institute, Spokane, WA, USA
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16
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Matsumoto S, Shimodozono M, Etoh S, Noma T, Uema T, Ikeda K, Miyara K, Tanaka N, Kawahira K. Anti-spastic effects of footbaths in post-stroke patients: A proof-of-principle study. Complement Ther Med 2014; 22:1001-9. [DOI: 10.1016/j.ctim.2014.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 08/31/2014] [Accepted: 09/21/2014] [Indexed: 11/16/2022] Open
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Majmudar S, Wu J, Paganoni S. Rehabilitation in amyotrophic lateral sclerosis: why it matters. Muscle Nerve 2014; 50:4-13. [PMID: 24510737 PMCID: PMC4433000 DOI: 10.1002/mus.24202] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that results in a constellation of problematic symptoms and a high patient and caregiver burden. Multidisciplinary care includes rehabilitation interventions that have the goal of assisting people to teach their fullest potential despite the presence of a disabling disease. Given the progressive nature of ALS, the clinician must be aware of the expected disease trajectory and apply appropriate interventions at each stage. This review will present rehabilitation strategies that can be utilized to maximize patient independence, function, safety, and quality of life, and to minimize disease-related symptoms. The role of bracing, exercise, assistive devices, and adaptive equipment will be discussed. At each disease stage, an experienced rehabilitation team is well positioned to make a significant impact on the life of ALS patients.
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Affiliation(s)
- Salony Majmudar
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: Physiology, assessment and treatment. Brain Inj 2013; 27:1093-105. [PMID: 23885710 DOI: 10.3109/02699052.2013.804202] [Citation(s) in RCA: 236] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aurore Thibaut
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Camille Chatelle
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Erik Ziegler
- Cyclotron Research Centre, University of Liège
LiègeBelgium
| | - Marie-Aurélie Bruno
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Olivia Gosseries
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
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Fiore P, Santamato A, Ranieri M, Bellomo R, Saggini R, Panza F, Megna G, Cristella G, Megna M. Treatment of Upper Limb Spasticity after Stroke: One-Year Safety and Efficacy of Botulinum Toxin Type A NT201. Int J Immunopathol Pharmacol 2012; 25:57S-62S. [DOI: 10.1177/03946320120250s109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- P. Fiore
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Mow” University — Italy
| | - A. Santamato
- Department of Physical Medicine And Rehabilitation University of Foggia Oo Rr
| | - M. Ranieri
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Mow” University — Italy
| | - R.G. Bellomo
- Dept. Human Movement, “G. D 'annunzio” University, Chieti, Italy
| | - R. Saggini
- Dept. Neuroscience And Imaging, “G. D 'annunzio” University, Chieti, Italy
| | - F. Panza
- Geriatric Unit And Gerontology — Geriatric Research Laboratory Irccs Casa Sollievo La Sofferenza San Giovanni Rotondo Italy
| | - G. Megna
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Mow” University — Italy
| | - G. Cristella
- Osmairm Neuropsychomotor Rehabilitation Center Laterza (Ta) Italy
| | - M. Megna
- Neuroscience and Sense Organs Department Physical Medicine and Rehabilitation Bari “Aldo Mow” University — Italy
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20
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Bayram S, Sivrioglu K, Karli N, Ozcan O. Combined therapeutic application of botulinum toxin type A, low-frequency rTMS, and intensive occupational therapy for post-stroke spastic upper limb hemiparesis. Eur J Phys Rehabil Med 2011; 85:75-81. [PMID: 16357552 DOI: 10.1097/01.phm.0000193505.85874.61] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND For spastic upper limb hemiparesis after stroke, we developed triple-element protocol of botulinum toxin type A (BoNTA) injection, low-frequency repetitive transcranial magnetic stimulation (LF-rTMS), and intensive occupational therapy (OT). Aim. To investigate the safety and feasibility of the protocol. Design. A preliminary study. Setting. At a university hospital. Population. Fourteen post-stroke patients with spastic upper limb hemiparesis (mean age: 54.9±9.2 years, time after onset: 87.1±48.2 months, ±SD). METHODS In all patients, BoNTA was injected into spastic muscles of the affected upper limb (maximum total dose: 240 units). Four weeks later, they were hospitalized to receive 22 sessions of 20-min LF-rTMS and 120-min intensive OT daily over 15 days. Motor function of the affected upper limb was evaluated mainly using Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), motor activity log (MAL), and the severity of spasticity was measured with modified Ashworth scale (MAS) at BoNTA injection, discharge and four weeks post-discharge. RESULTS All patients completed the protocol without any adverse effects. The FMA score and MAL scores, but not WMFT performance time, improved significantly at discharge. The MAS score of all examined muscles decreased significantly between BoNTA and discharge. The beneficial effect of the protocol on motor function and spasticity was almost maintained until four weeks after discharge. CONCLUSION The protocol is safe and feasible, although further larger studies are needed to confirm its efficacy. CLINICAL REHABILITATION IMPACT The protocol is a potentially useful neurorehabilitative approach for this patient population.
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Affiliation(s)
- Suheda Bayram
- Department of Physical Medicine and Rehabilitation, Uludag University School of Medicine, Bursa, Turkey
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21
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Nakhostin Ansari N, Naghdi S, Hasson S, Rastgoo M. Efficacy of therapeutic ultrasound and infrared in the management of muscle spasticity. Brain Inj 2009; 23:632-8. [PMID: 19557566 DOI: 10.1080/02699050902973939] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PRIMARY OBJECTIVE This study was designed to compare the short-term effects of infrared (IR) and therapeutic ultrasound (US) on clinical and electrophysiological measures of spasticity and range of motion (ROM) in hemiplegic patients with plantar flexor muscle spasticity. RESEARCH DESIGN A cross-sectional, single centre trial. INTERVENTIONS Ultrasound and Infrared were used. METHODS AND PROCEDURES Twenty-one patients (13 males and eight females) aged 27-78 years (mean +/- SD: 60.4 +/- 13.2) were randomly assigned into either the US or IR treatment groups. The IR and US were delivered for 20 and 10 minutes, respectively. The H-reflex, Ashworth scale (AS) and ROM were collected before, immediately after and 15 minutes after the end of the treatment. MAIN OUTCOMES AND RESULTS Both groups were statistically similar on all variables at the beginning of the study. Results indicated that the dependent variables were not significantly different between groups at the end of study. The use of IR and US was not associated with significant reductions of H-reflex and Ashworth scores. A significant main effect for time on active and passive ROM was obtained. CONCLUSIONS It was concluded neither IR nor US reduced electrophysiological or clinical measures of spasticity in this sample of patients.
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22
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Lee GPS, Ng GYF. Effects of stretching and heat treatment on hamstring extensibility in children with severe mental retardation and hypertonia. Clin Rehabil 2008; 22:771-9. [DOI: 10.1177/0269215508090067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To examine the effect of heat and duration of stretching on the extensibility of hamstring muscles and their electromyographic responses to passive stretch in children with hypertonia and severe mental retardation. Design: Randomized cross-over trial. Setting: Developmental disability unit in a local hospital. Participants: Twenty-nine subjects (9 females) with ages ranged from 4 to 13 years with spastic and/or dystonic hypertonia and hamstring tightness. Interventions: Subjects received four treatment sessions in random order with each consisting of five repetitions of stretching: (A) 10-second stretching, (B) 30-second stretching, (C) hot pack followed by 10-second stretching, and (D) hot pack followed by 30-second stretching. Each treatment session comprised five repetitions of stretch and successive treatments were separated by at least 24 hours. Main outcome measures: The distance between greater trochanter and lateral malleolus and hamstring electromyographic (EMG) activity during passive knee extension stretching. Results: Two-way ANOVA showed a larger increase in hamstring extensibility in conditions C and D (1.3 ± 1.1 cm) than conditions A and B (0.7 ± 0.9 cm) (P<0.001). For the EMG recordings, conditions B and D (-25.1 ± 58.4μV) had greater decrease than conditions A and C (-3.5 ± 36.6 μV) (P= 0.039). Conclusions: Heat application to the hamstrings before stretching could result in greater increase in extensibility than stretching alone in children with hypertonia and severe mental retardation. Stretching could promote relaxation of the hamstring muscles regardless of prior heat treatment. Stretching sustained for 30 seconds led to greater relaxation than that for 10 seconds.
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Affiliation(s)
| | - Gabriel YF Ng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China,
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Abstract
The co-occurrence of traumatic brain injury (TBI) and pain is quite frequent and presents a number of challenges to the medical practitioner. The distinct nature and extent of these challenges calls for considering the co-existence of TBI and pain a unique medical entity. Clearly, from a research standpoint, the area is in its infancy. The clinician is often left with adapting standard techniques effective for evaluating and treating pain in patients without TBI. Such adaptations require a readiness to recognize how pain affects the presence and course of TBI-related symptoms and, in turn, how TBI symptoms affect the presence and course of pain. Given the myriad factors that can affect outcome, effective evaluation and treatment of this co-occurring problem need to rely on a biopsychosocial model, which encourages consideration of a broad perspective of possible causes and care approaches as well as use of multiple disciplines.
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Affiliation(s)
- Kristen Brewer Sherman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195-6490, USA
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Reabilitação funcional em lesões vértebro-medulares – A intervenção tradicional e as novas abordagens em fisioterapia. REVISTA PORTUGUESA DE PNEUMOLOGIA 2006; 12:S55-65. [DOI: 10.1016/s0873-2159(15)30469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Alaca R, Goktepe AS, Yildiz N, Yilmaz B, Gunduz S. Effect of Penile Vibratory Stimulation on Spasticity in Men with Spinal Cord Injury. Am J Phys Med Rehabil 2005; 84:875-9. [PMID: 16244525 DOI: 10.1097/01.phm.0000184235.32803.ca] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Penile vibratory stimulation is the first treatment option for anejaculation in men with spinal cord injury. It has been postulated that it also has an antispasticity effect. The purpose of this study was to determine the effect of penile vibratory stimulation on spasticity in patients with spinal cord injury. DESIGN Ten male patients with spinal cord injury were included in the study. They were examined at the baseline and 3, 6, 24, and 48 hrs later. After their baseline examination, they performed penile vibratory stimulation. The outcome variables were spasticity (Ashworth scale), spasm frequency, spasm severity, painful spasms, plantar stimulation response, deep tendon reflexes, clonus, and effect on function. RESULTS Ashworth grade showed a statistically significant decrease at hour 3 and hour 6 examinations (P = 0.001 and P = 0.03, respectively, with Tukey test). The patients showed a tendency toward having less frequent and less severe spasms throughout the study; however, it did not reach to a significant level. Similarly, clonus showed a nonsignificant decrease during follow-up examinations. The other variables did not change considerably. CONCLUSIONS Penile vibratory stimulation may contribute to the relief of the spasticity in men with spinal cord injury. In treating spasticity, all the factors that increase or decrease the tone should be considered.
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Affiliation(s)
- Ridvan Alaca
- Turkish Armed Forces Rehabilitation Center, Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Ankara, Turkey
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Aydin G, Tomruk S, Keleş I, Demir SO, Orkun S. Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison. Am J Phys Med Rehabil 2005; 84:584-92. [PMID: 16034227 DOI: 10.1097/01.phm.0000171173.86312.69] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Clinical and electrophysiologic comparison of the efficacy of transcutaneous electrical nerve stimulation (TENS) and oral baclofen in the treatment of spasticity. DESIGN Patients with spinal cord injury and spasticity were included in the study. Ten patients were assigned to oral baclofen and 11 to TENS groups. For the comparison of H-reflex variables, 20 healthy individuals were allocated to a control group. TENS was applied to the tibial nerve for 15 days at a frequency of 100 Hz. Clinical (spasm frequency scale, painful spasm scale, lower limb Ashworth score, clonus score, deep tendon reflex score, plantar stimulation response score) and electrophysiologic evaluations (H-reflex response at the highest amplitude, latency of maximum H-reflex, and ratio of H-reflex response at the highest amplitude to M response at maximum amplitude) of the lower limb and functional evaluations (functional disability score and FIM) were carried out in baclofen and TENS groups before and after treatment. Posttreatment evaluation was made 24 hrs after the 15th session in the TENS group. In addition, clinical spasticity scores and electrophysiologic variables were measured 15 mins after the first application and 15 mins after the 15th session. RESULTS Significant improvement was detected in lower limb Ashworth score, spasm frequency scale, deep tendon reflex score, functional disability score, and FIM in the baclofen (P = 0.011, P = 0.014, P = 0.025, P = 0.004, and P = 0.005, respectively) and TENS (P = 0.020, P = 0.014, P = 0.025, P = 0.003, and P = 0.003, respectively) group after treatment. Decrease in H-reflex maximum amplitude was significant in the TENS group (P = 0.026). Most marked improvement was observed in the third evaluation, 15 mins after the 15th session, particularly in lower limb Ashworth score (P = 0.006) and H-reflex maximum amplitude (P = 0.006) in the TENS group. The percentage change in clinical, electrophysiologic, and functional variables caused by baclofen was not different from that caused by repeated applications of TENS in the short- and long-term evaluations (P > 0.05). CONCLUSION TENS may be recommended as a supplement to medical treatment in the management of spasticity.
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Affiliation(s)
- Gülümser Aydin
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
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