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Sumsuzzman DM, Khan ZA, Nila IS, Moran VMV, Rajesh M, Yang WJ, Hong Y. Effects of Botulinum Toxin-A for Spasticity and Nociceptive Pain in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis. Ann Rehabil Med 2024; 48:192-202. [PMID: 38950971 PMCID: PMC11217759 DOI: 10.5535/arm.240034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/26/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024] Open
Abstract
We conducted a systematic review and meta-analysis to examine the protective effects of botulinum toxin-A (Botox-A) on spasticity and nociceptive pain in individuals with spinal cord injuries (SCIs). PubMed, Embase, and Cochrane Library databases were searched from inception to July 2023. The primary outcome of interest was spasticity and nociceptive pain. We pooled the available data using the generic inverse variance method, and we used a fixed-effect/random-effects model. We then calculated standardized mean difference (SMD) and 95% confidence intervals (95% CIs) to estimate the effect size. A total of fourteen studies meeting the inclusion criteria comprised two randomized controlled trials, five pre-post studies, and seven case reports. Across the various study designs, the majority of trials were assessed to have fair to high quality. The meta-analysis shows that Botox-A significantly decreased spasticity (SMD, -1.73; 95% CI, -2.51 to -0.95; p<0.0001, I2=48%) and nociceptive pain (SMD, -1.79; 95% CI, -2.67 to -0.91; p<0.0001, I2=0%) in SCI patients. Furthermore, Botox-A intervention improved motor function, activities of daily living (ADL), and quality of life. Our study suggests that Botox-A may alleviate spasticity and nociceptive pain in SCI patients. Moreover, the observed improvements in motor function, ADL, and overall quality of life following Botox-A intervention underscore its pivotal role in enhancing patient outcomes.
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Affiliation(s)
- Dewan Md. Sumsuzzman
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, Korea
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Korea
- Research Center for Aged-life Redesign (RCAR), Inje University, Gimhae, Korea
| | - Zeeshan Ahmad Khan
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Korea
- Research Center for Aged-life Redesign (RCAR), Inje University, Gimhae, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Korea
| | - Irin Sultana Nila
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Korea
- Research Center for Aged-life Redesign (RCAR), Inje University, Gimhae, Korea
- Department of Digital Anti-aging Healthcare, Graduate School of Inje University, Gimhae, Korea
| | - Vanina Myuriel Villagra Moran
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Korea
- Research Center for Aged-life Redesign (RCAR), Inje University, Gimhae, Korea
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Korea
| | - Madhuvilakku Rajesh
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Korea
- Research Center for Aged-life Redesign (RCAR), Inje University, Gimhae, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Korea
| | - Won Jong Yang
- Department of Rehabilitation Medicine, Medical Corporation, Daegu Medical Foundation The K Hospital, Daegu, Korea
| | - Yonggeun Hong
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, Korea
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Korea
- Research Center for Aged-life Redesign (RCAR), Inje University, Gimhae, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Korea
- Department of Digital Anti-aging Healthcare, Graduate School of Inje University, Gimhae, Korea
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Korea
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De Santis D, Perez MA. A portable system to measure knee extensor spasticity after spinal cord injury. J Neuroeng Rehabil 2024; 21:50. [PMID: 38594696 PMCID: PMC11003160 DOI: 10.1186/s12984-024-01326-9] [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: 11/04/2023] [Accepted: 02/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The pendulum test is a quantitative method used to assess knee extensor spasticity in humans with spinal cord injury (SCI). Yet, the clinical implementation of this method remains limited. The goal of our study was to develop an objective and portable system to assess knee extensor spasticity during the pendulum test using inertial measurement units (IMU). METHODS Spasticity was quantified by measuring the first swing angle (FSA) using a 3-dimensional optical tracking system (with external markers over the iliotibial band, lateral knee epicondyle, and lateral malleolus) and two wireless IMUs (positioned over the iliotibial band and mid-part of the lower leg) as well as a clinical exam (Modified Ashworth Scale, MAS). RESULTS Measurements were taken on separate days to assess test-retest reliability and device agreement in humans with and without SCI. We found no differences between FSA values obtained with the optical tracking system and the IMU-based system in control subjects and individuals with SCI. FSA values from the IMU-based system showed excellent agreement with the optical tracking system in individuals with SCI (ICC > 0.98) and good agreement in controls (ICC > 0.82), excellent test-retest reliability across days in SCI (ICC = 0.93) and good in controls (ICC = 0.87). Notably, FSA values measured by both systems showed a strong association with MAS scores ( ρ ~ -0.8) being decreased in individuals with SCI with higher MAS scores, reflecting the presence of spasticity. CONCLUSIONS These findings suggest that our new portable IMU-based system provides a robust and flexible alternative to a camera-based optical tracking system to quantify knee extensor spasticity following SCI.
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Affiliation(s)
| | - Monica A Perez
- Shirley Ryan Abilitylab, Chicago, IL, 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
- Edward Hines Jr. VA Hospital, Hines, IL, 60141, USA.
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Farì G, Ranieri M, Marvulli R, Dell’Anna L, Fai A, Tognolo L, Bernetti A, Caforio L, Megna M, Losavio E. Is There a New Road to Spinal Cord Injury Rehabilitation? A Case Report about the Effects of Driving a Go-Kart on Muscle Spasticity. Diseases 2023; 11:107. [PMID: 37754303 PMCID: PMC10528365 DOI: 10.3390/diseases11030107] [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: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is a neurological disorder that causes a traumatic anatomical discontinuity of the spinal cord. SCI can lead to paraplegia, spastic, or motor impairments. Go-karting for people with SCI is an adapted sport that is becoming increasingly popular. The purpose of this case report is to shed light on the effects of driving a go-kart on a patient with SCI-related spasticity and to deepen understanding of the possible related role of whole-body vibration (WBV) and neuroendocrine reaction. METHODS The patient was a 50-year-old male with a spastic paraplegia due to traumatic SCI. He regularly practiced go-kart racing, reporting a transient reduction in spasticity. He was evaluated before (T0), immediately after (T1), 2 weeks after (T2), and 4 weeks after (T3) a go-kart driving session. On both sides, long adductor, femoral bicep, and medial and lateral gastrocnemius spasticity was assessed using the Modified Ashworth Scale (MAS), and tone and stiffness were assessed using MyotonPro. RESULTS It was observed that a go-kart driving session could reduce muscle spasticity, tone, and stiffness. CONCLUSIONS Go-kart driving can be a valid tool to obtain results similar to those of WBV and hormone production in the reduction of spasticity.
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Affiliation(s)
- Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Riccardo Marvulli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Laura Dell’Anna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Annatonia Fai
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Lucrezia Tognolo
- Rehabilitation Unit, Department of Neuroscience, University of Padova, 35100 Padova, Italy;
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Laura Caforio
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy; (M.R.); (R.M.); (L.D.); (A.F.); (L.C.); (M.M.)
| | - Ernesto Losavio
- Neurorehabilitation and Spinal Unit, Clinical and Scientific Institutes Maugeri IRCCS, 70124 Bari, Italy;
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Caron G, Bilchak J, Marie-Pascale Côté. Bumetanide increases postsynaptic inhibition after chronic SCI and decreases presynaptic inhibition with step-training. J Physiol 2023; 601:1425-1447. [PMID: 36847245 PMCID: PMC10106440 DOI: 10.1113/jp283753] [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: 08/18/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
Current anti-spastic medication significantly compromises motor recovery after spinal cord injury (SCI), indicating a critical need for alternative interventions. Because a shift in chloride homeostasis decreases spinal inhibition and contributes to hyperreflexia after SCI, we investigated the effect of bumetanide, an FDA-approved sodium-potassium-chloride intruder (NKCC1) antagonist, on presynaptic and postsynaptic inhibition. We compared its effect with step-training as it is known to improve spinal inhibition by restoring chloride homeostasis. In SCI rats, a prolonged bumetanide treatment increased postynaptic inhibition but not presynaptic inhibition of the plantar H-reflex evoked by posterior biceps and semitendinosus (PBSt) group I afferents. By using in vivo intracellular recordings of motoneurons, we further show that a prolonged bumetanide increased postsynaptic inhibition by hyperpolarizing the reversal potential for inhibitory postsynaptic potentials (IPSPs) after SCI. However, in step-trained SCI rats an acute delivery of bumetanide decreased presynaptic inhibition of the H-reflex, but not postsynaptic inhibition. These results suggest that bumetanide might be a viable option to improve postsynaptic inhibition after SCI, but it also decreases the recovery of presynaptic inhibition with step-training. We discuss whether the effects of bumetanide are mediated by NKCC1 or by off-target effects. KEY POINTS: After spinal cord injury (SCI), chloride homeostasis is dysregulated over time in parallel with the decrease in presynaptic inhibition of Ia afferents and postsynaptic inhibition of motoneurons, and the development of spasticity. While step-training counteracts these effects, it cannot always be implemented in the clinic because of comorbidities. An alternative intervention is to use pharmacological strategies to decrease spasticity without hindering the recovery of motor function with step-training. Here we found that, after SCI, a prolonged bumetanide (an FDA-approved antagonist of the sodium-potassium-chloride intruder, NKCC1) treatment increases postsynaptic inhibition of the H-reflex, and it hyperpolarizes the reversal potential for inhibitory postsynaptic potentials in motoneurons. However, in step-trained SCI, an acute delivery of bumetanide decreases presynaptic inhibition of the H-reflex, but not postsynaptic inhibition. Our results suggest that bumetanide has the potential to decrease spastic symptoms related to a decrease in postsynaptic but not presynaptic inhibition after SCI.
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Affiliation(s)
- Guillaume Caron
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA 19129
| | - Jadwiga Bilchak
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA 19129
| | - Marie-Pascale Côté
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University, Philadelphia, PA 19129
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Franz S, Heutehaus L, Tappe-Theodor A, Weidner N, Treede RD, Schuh-Hofer S. Noxious radiant heat evokes bi-component nociceptive withdrawal reflexes in spinal cord injured humans-A clinical tool to study neuroplastic changes of spinal neural circuits. Front Hum Neurosci 2023; 17:1141690. [PMID: 37200949 PMCID: PMC10185789 DOI: 10.3389/fnhum.2023.1141690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Investigating nocifensive withdrawal reflexes as potential surrogate marker for the spinal excitation level may widen the understanding of maladaptive nociceptive processing after spinal cord injury (SCI). The aim of this prospective, explorative cross-sectional observational study was to investigate the response behavior of individuals with SCI to noxious radiant heat (laser) stimuli and to assess its relation to spasticity and neuropathic pain, two clinical consequences of spinal hyperexcitability/spinal disinhibition. Laser stimuli were applied at the sole and dorsum of the foot and below the fibula head. Corresponding reflexes were electromyography (EMG) recorded ipsilateral. Motor responses to laser stimuli were analyzed and related to clinical readouts (severity of injury/spasticity/pain), using established clinical assessment tools. Twenty-seven participants, 15 with SCI (age 18-63; 6.5 years post-injury; AIS-A through D) and 12 non-disabled controls, [non-disabled controls (NDC); age 19-63] were included. The percentage of individuals with SCI responding to stimuli (70-77%; p < 0.001), their response rates (16-21%; p < 0.05) and their reflex magnitude (p < 0.05) were significantly higher compared to NDC. SCI-related reflexes clustered in two time-windows, indicating involvement of both A-delta- and C-fibers. Spasticity was associated with facilitated reflexes in SCI (Kendall-tau-b p ≤ 0.05) and inversely associated with the occurrence/severity of neuropathic pain (Fisher's exact p < 0.05; Eta-coefficient p < 0.05). However, neuropathic pain was not related to reflex behavior. Altogether, we found a bi-component motor hyperresponsiveness of SCI to noxious heat, which correlated with spasticity, but not neuropathic pain. Laser-evoked withdrawal reflexes may become a suitable outcome parameter to explore maladaptive spinal circuitries in SCI and to assess the effect of targeted treatment strategies. Registration: https://drks.de/search/de/trial/DRKS00006779.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Steffen Franz,
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Anke Tappe-Theodor
- Department of Molecular Pharmacology, Medical Faculty Heidelberg, Institute of Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
- Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany
- *Correspondence: Sigrid Schuh-Hofer,
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Fodor R, Voiță-Mekeres F, Cheregi CD, Indrieș M, Noor H, Pop NO, Marian P, Platona RI, Lascu CF, Marcu OA. Epidemiological Study on Spinal Cord Injuries in a Hospital from North-West of Romania. PHARMACOPHORE 2023. [DOI: 10.51847/ht5jip60uc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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7
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Dietz N, Wagers S, Harkema SJ, D'Amico JM. Intrathecal and Oral Baclofen Use in Adults With Spinal Cord Injury: A Systematic Review of Efficacy in Spasticity Reduction, Functional Changes, Dosing, and Adverse Events. Arch Phys Med Rehabil 2023; 104:119-131. [PMID: 35750207 DOI: 10.1016/j.apmr.2022.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the efficacy, dosing, and safety profiles of intrathecal and oral baclofen in treating spasticity after spinal cord injury (SCI). DATA SOURCES PubMed and Cochrane Databases were searched from 1970-2018 with keywords baclofen, spinal cord injury, and efficacy. STUDY SELECTION The database search yielded 588 sources and 10 additional relevant publications. After removal of duplicates, 398 publications were screened. DATA EXTRACTION Data were extracted using the following population, intervention, comparator, outcomes, and study designs criteria: studies including adult patients with SCI with spasticity; the intervention could be oral or intrathecal administration of baclofen; selection was inclusive for control groups, surgical management, rehabilitation, and alternative pharmaceutical agents; outcomes were efficacy, dosing, and adverse events. Randomized controlled trials, observational studies, and case reports were included. Meta-analyses and systematic reviews were excluded. DATA SYNTHESIS A total of 98 studies were included with 1943 patients. Only 4 randomized, double-blinded, and placebo-controlled trials were reported. Thirty-nine studies examined changes in the Modified Ashworth Scale (MAS; 34 studies) and Penn Spasm scores (Penn Spasm Frequency; 19 studies), with average reductions of 1.7±1.3 and 1.6±1.4 in individuals with SCI, respectively. Of these data, a total of 6 of the 34 studies (MAS) and 2 of the 19 studies (Penn Spasm Frequency) analyzed oral baclofen. Forty-three studies addressed adverse events with muscle weakness and fatigue frequently reported. CONCLUSIONS Baclofen is the most commonly-prescribed antispasmodic after SCI. Surprisingly, there remains a significant lack of large, placebo-controlled, double-blinded clinical trials, with most efficacy data arising from small studies examining treatment across different etiologies. In the studies reviewed, baclofen effectively improved spasticity outcome measures, with increased efficacy through intrathecal administration. Few studies assessed how reduced neural excitability affected residual motor function and activities of daily living. A host of adverse events were reported that may negatively affect quality of life. Comparative randomized controlled trials of baclofen and alternative treatments are warranted because these have demonstrated promise in relieving spasticity with reduced adverse events and without negatively affecting residual motor function.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Sarah Wagers
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY
| | - Jessica M D'Amico
- Department of Neurological Surgery, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, Louisville, KY.
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Limb accelerations during sleep are related to measures of strength, sensation, and spasticity among individuals with spinal cord injury. J Neuroeng Rehabil 2022; 19:118. [PMID: 36329467 PMCID: PMC9635075 DOI: 10.1186/s12984-022-01090-8] [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: 02/23/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate the relationship between measures of neuromuscular impairment and limb accelerations (LA) collected during sleep among individuals with chronic spinal cord injury (SCI) to provide evidence of construct and concurrent validity for LA as a clinically meaningful measure. METHODS The strength (lower extremity motor score), sensation (summed lower limb light touch scores), and spasticity (categorized lower limb Modified Ashworth Scale) were measured from 40 adults with chronic (≥ 1 year) SCI. Demographics, pain, sleep quality, and other covariate or confounding factors were measured using self-report questionnaires. Each participant then wore ActiGraph GT9X Link accelerometers on their ankles and wrist continuously for 1-5 days to measure LA from movements during sleep. Regression models with built-in feature selection were used to determine the most relevant LA features and the association to each measure of impairment. RESULTS LA features were related to measures of impairment with models explaining 69% and 73% of the variance (R²) in strength and sensation, respectively, and correctly classifying 81.6% (F1-score = 0.814) of the participants into spasticity categories. The most commonly selected LA features included measures of power and frequency (frequency domain), movement direction (correlation between axes), consistency between movements (relation to recent movements), and wavelet energy (signal characteristics). Rolling speed (change in angle of inclination) and movement smoothness (median crossings) were uniquely associated with strength. When LA features were included, an increase of 72% and 222% of the variance was explained for strength and sensation scores, respectively, and there was a 34% increase in spasticity classification accuracy compared to models containing only covariate features such as demographics, sleep quality, and pain. CONCLUSION LA features have shown evidence of having construct and concurrent validity, thus demonstrating that LA are a clinically-relevant measure related to lower limb strength, sensation, and spasticity after SCI. LA may be useful as a more detailed measure of impairment for applications such as clinical prediction models for ambulation.
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Liu H, Fan L, Li J, Dangol S, Talifu Z, Ma X, Gong H, Du L. Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients. Acta Neurochir (Wien) 2022; 164:2263-2269. [PMID: 35665860 PMCID: PMC9166246 DOI: 10.1007/s00701-022-05265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Objective To explore the therapeutic effect of combined selective peripheral neurotomy (cSPN) on the spasm of the lower limbs after spinal cord injury. Methods A prospective intervention (before-after trial) with an observational design was conducted in 14 spinal cord injury patients with severe lower limbs spasticity by cSPN. Given the severe spasm of hip adductor, triceps surae, and hamstring muscles in these patients, a total of 26 obturator nerve branches, 26 tibia nerve branches, and 4 sciatic nerve branches partial neurotomy were performed. The modified Ashworth scale, composite spasticity scale, surface electromyography, gait analysis, functional ambulation category, spinal cord independence measure, and modified spinal cord injury–spasticity evaluation tool were used before and after surgery. Results Compared with preoperative, the spasm of the hip adductor, triceps surae, and hamstrings of the lower limbs in the postoperative patients decreased significantly. The abnormal gait of knee flexion and varus in the standing stage were significantly reduced. The grading of walking ability and activities of daily living were significantly improved. Conclusions Combined selective peripheral neurotomy can significantly reduce the spasm of lower limbs post spinal cord injury, improve abnormal gait, and improve motor function and activities of daily living. Trial registration ChiCTR1800019003 (2018–10-20).
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Affiliation(s)
- Hongwei Liu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Lianghua Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Subarna Dangol
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Zuliyaer Talifu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiaodong Ma
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Han Gong
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Liangjie Du
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China.
- Department of Spinal and Neural Function Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.
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Reduced Muscle Activity of the Upper Extremity in Individuals with Spinal Cord Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084708. [PMID: 35457574 PMCID: PMC9027229 DOI: 10.3390/ijerph19084708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
Compromised physical ability due to musculoskeletal impairment among spinal cord injury (SCI) patients is known to negatively affect their quality of life. It is essential to comprehensively understand the muscle strength of the upper extremity among patients with SCI to enhance muscle function and capacity to engage in an active lifestyle. The objective of this study was to evaluate the muscle strength of 15 upper extremity muscles among patients with SCI and compare the relative weakness of individual muscles to the control group. Seven male patients with SCI with ASIA impairment scale D and E and 33 males in the control group participated in this study. Each participant performed maximal voluntary contraction of individual muscles, and the electromyography data were recorded. The results showed that the majority of the upper extremity muscles (12 out of 15) showed considerable weakness (24 to 53%) relative to the control group. Furthermore, the relative strength (ranking) of individual muscles among 15 upper extremity muscles was different between patients with SCI and the control group. This information would be useful to the selective strengthening of specific muscles as an intensive rehabilitation effort and prevent overuse and adverse injuries due to excessive muscle training.
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Body Weight-Supported Treadmill Training Ameliorates Motoneuronal Hyperexcitability by Increasing GAD-65/67 and KCC2 Expression via TrkB Signaling in Rats with Incomplete Spinal Cord Injury. Neurochem Res 2022; 47:1679-1691. [PMID: 35320460 PMCID: PMC9124175 DOI: 10.1007/s11064-022-03561-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/29/2022] [Accepted: 02/17/2022] [Indexed: 12/11/2022]
Abstract
Spasticity is a typical consequence after spinal cord injury (SCI). The critical reasons are reducing the synthesis of Gamma-Aminobutyric Acid (GABA), glycine and potassium chloride co-transporter 2 (KCC2) inside the distal spinal cord. The current work aimed to test whether exercise training could increase the expression of glutamic acid decarboxylase 65/67 (GAD-65/67, the key enzymes in GABA synthesis) and KCC2 in the distal spinal cord via tropomyosin-related kinase B (TrkB) signaling. The experimental rats were randomly assigned to the following five groups: Sham, SCI/phosphate-buffered saline (PBS), SCI-treadmill training (TT)/PBS, SCI/TrkB-IgG, and SCI-TT/TrkB-IgG. After that, the model of T10 contusion SCI was used, then TrkB-IgG was used to prevent TrkB activity at 7 days post-SCI. Body weight-supported treadmill training started on the 8th day post-SCI for four weeks. The Hmax/Mmax ratio and the rate-dependent depression of H-reflex were used to assess the excitability of spinal motoneuronal networks. Western blotting and Immunohistochemistry techniques were utilized for measuring the expression of GAD-65, GAD-67, and KCC2. The findings revealed that exercise training could reduce motoneuronal excitability and boost GAD-65, GAD-67, and KCC2 production in the distal region of the spinal cord after SCI. The effects of exercise training were decreased after the TrkB signaling was inhibited. The present exploration demonstrated that exercise training increases GAD-65, GAD-67, and KCC2 expression in the spinal cord via TrkB signaling and that this method could also improve rats with motoneuronal hyperexcitability and spasticity induced by incomplete SCI.
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Forte G, Leemhuis E, Favieri F, Casagrande M, Giannini AM, De Gennaro L, Pazzaglia M. Exoskeletons for Mobility after Spinal Cord Injury: A Personalized Embodied Approach. J Pers Med 2022; 12:jpm12030380. [PMID: 35330380 PMCID: PMC8954494 DOI: 10.3390/jpm12030380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Endowed with inherent flexibility, wearable robotic technologies are powerful devices that are known to extend bodily functionality to assist people with spinal cord injuries (SCIs). However, rather than considering the specific psychological and other physiological needs of their users, these devices are specifically designed to compensate for motor impairment. This could partially explain why they still cannot be adopted as an everyday solution, as only a small number of patients use lower-limb exoskeletons. It remains uncertain how these devices can be appropriately embedded in mental representations of the body. From this perspective, we aimed to highlight the homeostatic role of autonomic and interoceptive signals and their possible integration in a personalized experience of exoskeleton overground walking. To ensure personalized user-centered robotic technologies, optimal robotic devices should be designed and adjusted according to the patient's condition. We discuss how embodied approaches could emerge as a means of overcoming the hesitancy toward wearable robots.
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Affiliation(s)
- Giuseppe Forte
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (F.F.)
| | - Erik Leemhuis
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (F.F.)
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Rome “Sapienza”, Via Degli Apuli 1, 00185 Rome, Italy;
| | - Anna Maria Giannini
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
| | - Luigi De Gennaro
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
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13
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Abstract
Nerve transfer surgery has expanded reconstructive options for restoring upper extremity function following spinal cord injury. By adding new motor donors to the pool already available through tendon transfers, the effectiveness of treatment should improve. Planning which procedures and in which order to perform, along with their details must be delineated. To meet these demands, refined diagnostics are needed, along with awareness of the remaining challenges to restore intrinsic muscle function and to address spasticity and its consequences. This article summaries recent advances in surgical reanimation of upper extremity motor control, together with an overview of the development of neuro-prosthetic and neuromodulation techniques to modify recovery or substitute for functional losses after spinal cord injuries.
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Affiliation(s)
- Jan Fridén
- Department of Tetrahand Surgery, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - James House
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael Keith
- Departments of Orthopaedic Surgery, BioMedical Engineering, Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Silvia Schibli
- Department of Tetrahand Surgery, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Natasha van Zyl
- Department of Plastic and Reconstructive Surgery, Austin Health, Melbourne, VIC, Australia
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14
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Fang CY, Lien ASY, Tsai JL, Yang HC, Chan HL, Chen RS, Chang YJ. The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis. Front Physiol 2021; 12:756200. [PMID: 34867459 PMCID: PMC8640241 DOI: 10.3389/fphys.2021.756200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI). Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity. Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = - 1.538 to - 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = - 1.749 to - 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = - 0.0025, SE = 0.0129, p = 0.849, R 2 analog = 0.37). Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.
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Affiliation(s)
- Chia-Ying Fang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Angela Shin-Yu Lien
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jia-Ling Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Chu Yang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Lung Chan
- Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rou-Shayn Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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15
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Kayaci S, Aydin MD, Ozoner B, Cakir T, Bas O, Sipal S. Relationship between subarachnoid and central canal hemorrhage and spasticity: A first experimental study. J Spinal Cord Med 2021; 44:748-756. [PMID: 31647747 PMCID: PMC8477948 DOI: 10.1080/10790268.2019.1669956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: Spastic disorders are considered as important cerebral complications of subarachnoid hemorrhage (SAH). However, there has been no research concerning the pathophysiological mechanism of its link with the spinal cord. The present study aimed to assess the relationship between the development of spasticity and neuronal degeneration after SAH and increase in spinal cord pressure after central canal hemorrhage (CCH).Participants: Twenty-three rabbits were included.Outcome measures: Of all rabbits, 5, 5, and 13 were allocated in the control, SHAM and study groups, respectively. Moreover, 1 cc of saline and 1 cc of autologous arterial blood were injected into the cisterna magna of the SHAM and study groups, respectively. The Muscle spasticity tension values (MSTVs) were determined according to the modified Ashworth scale. Degenerated neuron densities (DND) in the gray matter (GM) of each animal's spinal cord were stereologically calculated.Results: The average MSTV of each group was as follows: control group (n = 5) 2; SHAM group (n = 5) 3-5; and study group (n = 13) 8-10. The DND values of the spinal cord of each group were as follows: control group, 2 ± 1/mm3; SHAM group, 12 ± 3/mm3; and study group, 34 ± 9/mm3. Results showed an important linear relationship between the MSTVs and the DND of the spinal cord (P < 0.001).Conclusion: Spasticity may be attributed to other causes such as ischemic neurodegenerative process that develops after spinal SAH and the de-synchronization of the flexor-extensor muscles due to the spontaneous discharge of interneuronal structures, which are crossed within the spinal cord owing to the build-up of pressure after CCH.
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Affiliation(s)
- Selim Kayaci
- Department of Neurosurgery Medical, Faculty of Erzincan Binali Yıldırım University, Erzincan, Turkey,Correspondence to: Selim Kayaci, Department of Neurosurgery Medical, Faculty of Erzincan Binali Yıldırım University, 24100 Erzincan, Turkey; Ph: 0446 212 22 22.
| | - Mehmet Dumlu Aydin
- Department of Neurosurgery, Medical Faculty of Ataturk University, Erzurum, Turkey,Mehmet Dumlu Aydin, Department of Neurosurgery, Medical Faculty of Ataturk University, Erzurum, Turkey.
| | - Baris Ozoner
- Department of Neurosurgery Medical, Faculty of Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Tayfun Cakir
- Department of Neurosurgery Medical, Faculty of Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Orhan Bas
- Department of Anatomy, Medical Faculty of Ordu University, Ordu, Turkey
| | - Sare Sipal
- Department of Pathology, Medical Faculty of Ataturk University, Erzurum, Turkey
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16
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Menon RG, Raghavan P, Regatte RR. Pilot study quantifying muscle glycosaminoglycan using bi-exponential T 1ρ mapping in patients with muscle stiffness after stroke. Sci Rep 2021; 11:13951. [PMID: 34230600 PMCID: PMC8260636 DOI: 10.1038/s41598-021-93304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/16/2021] [Indexed: 01/14/2023] Open
Abstract
Post stroke muscle stiffness is a common problem, which left untreated can lead to disabling muscle contractures. The purpose of this pilot study was to evaluate the feasibility of bi-exponential T1ρ mapping in patients with arm muscle stiffness after stroke and its ability to measure treatment related changes in muscle glycosaminoglycans (GAGs). Five patients with muscle stiffness after stroke and 5 healthy controls were recruited for imaging of the upper arm with 3D-T1ρ mapping. Patients were scanned before and after treatment with hyaluronidase injections, whereas the controls were scanned once. Wilcoxon Mann-Whitney tests compared patients vs. controls and patients pre-treatment vs. post-treatment. With bi-exponential modeling, the long component, T1ρl was significantly longer in the patients (biceps P = 0.01; triceps P = 0.004) compared to controls. There was also a significant difference in the signal fractions of the long and short components (biceps P = 0.03, triceps P = 0.04). The results suggest that muscle stiffness is characterized by increased muscle free water and GAG content. Post-treatment, the T1ρ parameters shifted toward control values. This pilot study demonstrates the application of bi-exponential T1ρ mapping as a marker for GAG content in muscle and as a potential treatment monitoring tool for patients with muscle stiffness after stroke.
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Affiliation(s)
- Rajiv G Menon
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 1st Ave, 4th Floor, New York, NY, 10016, USA.
| | - Preeti Raghavan
- Deparments of Physical Medicine and Rehabilitation and Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 1st Ave, 4th Floor, New York, NY, 10016, USA
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17
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Zarkou A, Field-Fote EC. The influence of physiologic and atmospheric variables on spasticity after spinal cord injury. NeuroRehabilitation 2021; 48:353-363. [PMID: 33814472 DOI: 10.3233/nre-201625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A number of physiological and atmospheric variables are believed to increase spasticity in persons with spinal cord injury (SCI) based on self-reported measures, however, there is limited objective evidence about the influence of these variables on spasticity. OBJECTIVE We investigated the relationship between physiological/ atmospheric variables and level of spasticity in individuals with SCI. METHODS In 53 participants with motor-incomplete SCI, we assessed the influence of age, time since injury, sex, injury severity, neurological level of injury, ability to walk, antispasmodic medication use, temperature, humidity, and barometric pressure on quadriceps spasticity. Spasticity was assessed using the pendulum test first swing excursion (FSE). To categorize participants based on spasticity severity, we performed cluster analysis. We used multivariate stepwise regression to determine variables associated with spasticity severity level. RESULTS Three spasticity groups were identified based on spasticity severity level: low, moderate, and high. The regression analysis revealed that only walking ability and temperature were significantly related to spasticity severity. CONCLUSIONS These outcomes validate the self-reported perception of people with SCI that low temperatures worsen spasticity. The findings refine prior evidence that people with motor-incomplete SCI have higher levels of spasticity, showing that those with sufficient motor function to walk have the highest levels of spasticity.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Edelle C Field-Fote
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA.,Division of Physical Therapy, School of Medicine, Emory University, Atlanta, GA, USA.,Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
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18
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Field-Fote EC, Furbish CL, Tripp NE, Zanca JM, Dyson-Hudson T, Kirshblum S, Heinemann AW, Chen D, Felix ER, Worobey L, Schmidt-Read M, Marino RJ, Hayat MJ. Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers. Arch Phys Med Rehabil 2021; 103:764-772.e2. [PMID: 34015348 DOI: 10.1016/j.apmr.2021.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. DESIGN Online cross-sectional survey. SETTING Multicenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. PARTICIPANTS Individuals with SCI (N=1076). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Qualities of Spasticity Questionnaire, modified Spinal Cord Injury-Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). RESULTS Respondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). CONCLUSIONS The experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.
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Affiliation(s)
- Edelle C Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Program in Applied Physiology, Georgia Institute of Technology, Atlanta, GA.
| | | | - Natalie E Tripp
- School of Public Health, Georgia State University, Atlanta, GA
| | | | | | - Steven Kirshblum
- Kessler Foundation, West Orange, NJ; Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, NJ
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - Lynn Worobey
- Departments of Physical Medicine and Rehabilitation, Bioengineering and Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | | | - Ralph J Marino
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadephia, PA
| | - Matthew J Hayat
- School of Public Health, Georgia State University, Atlanta, GA
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Pilusa SI, Myezwa H, Potterton J. Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: A qualitative study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1530. [PMID: 33937547 PMCID: PMC8063775 DOI: 10.4102/sajp.v77i1.1530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Secondary health conditions (SHCs) such as pain, pressure sores, sexual problems, bowel and bladder problems are prevalent throughout the lifespan of people with spinal cord injury (SCI). Studies have reported that SHCs decrease life expectancy and increase health care costs. Studies on the lived experience of SHCs are, however, limited. OBJECTIVES To explore the experiences of SHCs amongst people with SCI in a public rehabilitation hospital in South Africa. METHOD Face-to-face semi-structured interviews were conducted with people with SCI from August 2018 to July 2019. All interviews were transcribed verbatim and analysed using a content analysis approach. RESULTS Seventeen people with SCI were interviewed. Participants experienced a range of SHCs. The most common experienced SHC was pain (94%). The main theme that emerged from the analysis was 'the impact of secondary health conditions on health and well-being'. The categories linked to the impact were SHCs co-occurrence and how SHCs limit function, restrict participation, affect mental health and disrupt lives. CONCLUSION We found that SHCs were enormously impactful on our participants' lives and health, as illustrated by their stories of fear, embarrassment and shame. Understanding people with SCI experiences of SHCs can enhance communication between people with SCI and health professionals and may help develop prevention strategies. CLINICAL IMPLICATIONS To enhance patient-centred care, health professionals are encouraged to actively listen to patients' experiences of illness and the impact on health and wellbeing.
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Affiliation(s)
- Sonti I Pilusa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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20
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Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review. Spinal Cord 2021; 59:236-247. [PMID: 33564117 DOI: 10.1038/s41393-020-00610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries. SETTING Not applicable. METHODS A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial. RESULTS Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity. CONCLUSIONS There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.
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21
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Spasticity distribution and severity in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2020; 27:857-863. [PMID: 33021698 DOI: 10.1007/s13365-020-00911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
In individuals with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), spasticity is one of the main symptoms. The neurological signs of the disease are well defined, but details of how spasticity appears in these individuals have not been well explored. To describe spasticity location and severity of HAM/TSP individuals. Cross-sectional study with individuals older than 18 years, diagnosed with HAM/TSP and with lower limb spasticity. Pregnant women, individuals with other associated neurological diseases, and those using antispastic drugs were not included. Spasticity was assessed by the Modified Ashworth Scale (MAS), applied to the abductor, adductor, flexor, and extensor muscles of the hips, flexors, and extensors of the knees, dorsiflexors, plantiflexors, evertors, and inverters of the foot. Thirty participants were included. The plantiflexor muscles (90%), knee extensors (80%), knee flexors (63,3%), and adductors (50%) were most frequently affected by spasticity. Twenty-three (76.7%) individuals had mixed spasticity, 5 (16.7%) with distal spasticity and 2 (6.7%) with proximal spasticity. MAS was similar between the lower limbs in at least 6 of the 10 muscle groups of each individual. Spasticity was mostly mixed in the lower limbs, with more frequently mild severity. The individuals were partially symmetrical between the lower limbs. The most affected muscle groups were the plantiflexors, knee extensors and flexors and the hip adductors, consecutively, being predominantly symmetrical.
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Modified PRISM and SCI-SET Spasticity Measures for Persons With Traumatic Spinal Cord Injury: Results of a Rasch Analyses. Arch Phys Med Rehabil 2020; 101:1570-1579. [DOI: 10.1016/j.apmr.2020.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/28/2020] [Accepted: 05/09/2020] [Indexed: 11/23/2022]
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Mu X, Deng B, Zeng J, Zhang H, Zhao Y, Sun Q, Xu J, Wang L, Xu L. Orthopedic treatment of the lower limbs in spastic paralysis. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2020.9050001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Spastic paralysis of the limb mainly results from the central lesion, in which spastic cerebral palsy is the common cause. Due to durative muscle spasm in spastic cerebral palsy, it is often accompanied by the formation of secondary musculoskeletal deformities, resulting in limb motor disability. Based on its pathogenesis, surgical treatment is currently applied: selective posterior rhizotomy (SPR) or orthopedic surgery. The primary purpose of early orthopedic surgery was simply to correct limb deformities, which usually led to the recurrence of deformity as a result of the presence of spasticity. With the application of SPR, high muscle tone was successfully relieved, but limb deformity was still present postoperatively. Therefore, this study aimed to elaborate on the management of orthopedic surgery, common deformities of the lower limb, and orthopedic operative methods; discuss the relationship between SPR and orthopedic procedure for limb deformity; and focus on the indications, timing of intervention, and postoperative outcome of different surgical methods.
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Affiliation(s)
- Xiaohong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Bowen Deng
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Jie Zeng
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Houjun Zhang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yi Zhao
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Qi Sun
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Jie Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Le Wang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Lin Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
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Hon AJ, Kraus P. Spasticity Management After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00280-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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DeForest BA, Bohorquez J, Perez MA. Vibration attenuates spasm-like activity in humans with spinal cord injury. J Physiol 2020; 598:2703-2717. [PMID: 32298483 DOI: 10.1113/jp279478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/17/2020] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Cutaneous reflexes were tested to examine the neuronal mechanisms contributing to muscle spasms in humans with chronic spinal cord injury (SCI). Specifically, we tested the effect of Achilles and tibialis anterior tendon vibration on the early and late components of the cutaneous reflex and reciprocal Ia inhibition in the soleus and tibialis anterior muscles in humans with chronic SCI. We found that tendon vibration reduced the amplitude of later but not earlier cutaneous reflex in the antagonist but not in the agonist muscle relative to the location of the vibration. In addition, reciprocal Ia inhibition between antagonist ankle muscles increased with tendon vibration and participants with a larger suppression of the later component of the cutaneous reflex had stronger reciprocal Ia inhibition from the antagonistic muscle. Our study is the first to provide evidence that tendon vibration attenuates late cutaneous spasm-like reflex activity, likely via reciprocal inhibitory mechanisms, and may represent a method, when properly targeted, for controlling spasms in humans with SCI. ABSTRACT The neuronal mechanisms contributing to the generation of involuntary muscle contractions (spasms) in humans with spinal cord injury (SCI) remain poorly understood. To address this question, we examined the effect of Achilles and tibialis anterior tendon vibration at 20, 40, 80 and 120 Hz on the amplitude of the long-polysynaptic (LPR, from reflex onset to 500 ms) and long-lasting (LLR, from 500 ms to reflex offset) cutaneous reflex evoked by medial plantar nerve stimulation in the soleus and tibialis anterior, and reciprocal Ia inhibition between these muscles, in 25 individuals with chronic SCI. We found that Achilles tendon vibration at 40 and 80 Hz, but not other frequencies, reduced the amplitude of the LLR in the tibialis anterior, but not the soleus muscle, without affecting the amplitude of the LPR. Vibratory effects were stronger at 80 than 40 Hz. Similar results were found in the soleus muscle when the tibialis anterior tendon was vibrated. Notably, tendon vibration at 80 Hz increased reciprocal Ia inhibition between antagonistic ankle muscles and vibratory-induced increases in reciprocal Ia inhibition were correlated with decreases in the LLR, suggesting that participants with a larger suppression of later cutaneous reflex activity had stronger reciprocal Ia inhibition from the antagonistic muscle. Our study is the first to provide evidence that tendon vibration suppresses late spasm-like activity in antagonist but not agonist muscles, likely via reciprocal inhibitory mechanisms, in humans with chronic SCI. We argue that targeted vibration of antagonistic tendons might help to control spasms after SCI.
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Affiliation(s)
- Bradley A DeForest
- Department of Neurological Surgery, The Miami Project to Cure Paralysis and Bruce W. Carter Department of Veterans Affairs Medical Center, University of Miami, Miami, FL, 33136.,Shirley Ryan AbilityLab and Edward Jr. Hines VA Hospital, Chicago, IL, 60141
| | - Jorge Bohorquez
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, 33124
| | - Monica A Perez
- Department of Neurological Surgery, The Miami Project to Cure Paralysis and Bruce W. Carter Department of Veterans Affairs Medical Center, University of Miami, Miami, FL, 33136.,Shirley Ryan AbilityLab and Edward Jr. Hines VA Hospital, Chicago, IL, 60141
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Cruz-Montecinos C, Núñez-Cortés R, Bruna-Melo T, Tapia C, Becerra P, Pavez N, Pérez-Alenda S. Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report. J Spinal Cord Med 2020; 43:414-418. [PMID: 30346254 PMCID: PMC7241526 DOI: 10.1080/10790268.2018.1533316] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Context: Spasticity in neurological disorders (i.e. stroke patients and cerebral palsy) is positively improved by dry needling. However, reports are scarce regarding the potential effects of dry needling in reducing spasticity and improving functionality in patients with an incomplete spinal cord injury. The aim of this case report was to study the immediate, short-term effects of dry needling treatment (10 weeks) on spasticity, dynamic stability, walking velocity, self-independence, and pain in a single patient with an incomplete spinal cord injury.Findings: The dry needling treatment resulted in immediate, short-time effects on basal spasticity in the upper (reduction from 2 to 0 point median) and lower (reduction from 2 to 0 point median) limbs, as measured by the modified Ashworth Scale. Dynamic-stability, assessed by trunk accelerometry, improved more than 50% (Root Mean Squared of acceleration, Root Mean Squared of Jerk and step variability), and gait speed improved by 24.7 s (i.e. time to walk 20 m). Self-independence and pain were respectively scored by the Spinal Cord Independence Measure (21 points improvement) and visual analog scale (4 points improvement).Conclusions: This case report demonstrates that dry needling treatment can have positive effects on spasticity, dynamic stability, walking velocity, self-independence, and pain in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to deeply understand the mechanism(s) associated with the obtained results and regarding the clinical significances of dry needling treatment for incomplete spinal cord injury.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Biomechanics and Kinesiology Laboratory, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Service of Physical Therapy, Hospital Clínico La Florida, Santiago, Chile
| | - Trinidad Bruna-Melo
- Biomechanics and Kinesiology Laboratory, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Claudio Tapia
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Universidad Tecnológica de Chile INACAP, Escuela Salud, Santiago, Chile
| | - Pablo Becerra
- Biomechanics and Kinesiology Laboratory, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Nicolás Pavez
- Biomechanics and Kinesiology Laboratory, Kinesiology Unit, San José Hospital, Santiago, Chile
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Ayoub S, Smith JG, Cary I, Dalton C, Pinto A, Ward C, Saverino A. The positive and the negative impacts of spasticity in patients with long-term neurological conditions: an observational study. Disabil Rehabil 2020; 43:3357-3364. [PMID: 32223455 DOI: 10.1080/09638288.2020.1742803] [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] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe the positive and negative impacts of spasticity across different neurological disorders using the Patient Reported Impact of Spasticity Measure (PRISM), deduce any associations between severity of spasticity and its impact, and assess for differences across diagnostic subgroups. MATERIALS AND METHODS PRISM, a spasticity-specific quality of life questionnaire validated in patients with spinal cord injuries, was given to 97 follow-up patients attending a spasticity clinic prior to symptom assessment using the REsistance to PAssive movement Scale (REPAS). RESULTS Patients described a minor level of positive impact and a marked negative impact in the domains of "Psychological Agitation," "Daily Activities," "Need for Assistance/Positioning" and "Social Avoidance/Anxiety." Spasticity severity was, in general, a poor predictor of perceived impact, although severity and localisation of spasticity was modestly correlated with "Need for Assistance/Positioning" and "Social Embarrassment" levels. Despite comparable levels of spasticity severity, people with MS expressed a more substantial impact across some PRISM domains than did patients in other groups. CONCLUSION PRISM can be useful to assess the impact of spasticity in various neurological conditions although further validation studies are needed.Implications for RehabilitationThe localisation of spasticity in both legs or the right arm can produce a significant impact on 'Need for Assistance/Positioning' and 'Social Embarrassment'.People with MS may experience a greater impact of spasticity than those with other neurological conditions, particularly in the domains of Social Avoidance/Anxiety and Psychological Agitation.Coexisting factors such as anxiety, depression, fatigue and pain should be investigated together with spasticity.PRISM can assist in goal setting and treatment of people with spasticity secondary to different neurological conditions.
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Affiliation(s)
- Sandy Ayoub
- Medical School Department, St George's, University of London, London, UK
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Isabel Cary
- Spasticity Service at the Wolfson Neuro Rehabilitation Centre, Queen Mary Hospital, London, UK
| | - Catherine Dalton
- Spasticity Service at the Wolfson Neuro Rehabilitation Centre, Queen Mary Hospital, London, UK
| | - Aimee Pinto
- Spasticity Service at the Wolfson Neuro Rehabilitation Centre, Queen Mary Hospital, London, UK
| | - Claire Ward
- Spasticity Service at the Wolfson Neuro Rehabilitation Centre, Queen Mary Hospital, London, UK
| | - Alessia Saverino
- Spasticity Service at the Wolfson Neuro Rehabilitation Centre, Queen Mary Hospital, London, UK
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Hope JM, Koter RZ, Estes SP, Field-Fote EC. Disrupted Ankle Control and Spasticity in Persons With Spinal Cord Injury: The Association Between Neurophysiologic Measures and Function. A Scoping Review. Front Neurol 2020; 11:166. [PMID: 32218765 PMCID: PMC7078326 DOI: 10.3389/fneur.2020.00166] [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] [Received: 09/25/2019] [Accepted: 02/21/2020] [Indexed: 12/03/2022] Open
Abstract
Control of muscles about the ankle joint is an important component of locomotion and balance that is negatively impacted by spinal cord injury (SCI). Volitional control of the ankle dorsiflexors (DF) is impaired by damage to pathways descending from supraspinal centers. Concurrently, spasticity arising from disrupted organization of spinal reflex circuits, further erodes control. The association between neurophysiological changes (corticospinal and spinal) with volitional ankle control (VAC) and spasticity remains unclear. The goal of this scoping review was to synthesize what is known about how changes in corticospinal transmission and spinal reflex excitability contribute to disrupted ankle control after SCI. We followed published guidelines for conducting a scoping review, appraising studies that contained a measure of corticospinal transmission and/or spinal reflex excitability paired with a measure of VAC and/or spasticity. We examined studies for evidence of a relationship between neurophysiological measures (either corticospinal tract transmission or spinal reflex excitability) with VAC and/or spasticity. Of 1,538 records identified, 17 studies were included in the review. Ten of 17 studies investigated spinal reflex excitability, while 7/17 assessed corticospinal tract transmission. Four of the 10 spinal reflex studies examined VAC, while 9/10 examined ankle spasticity. The corticospinal tract transmission studies examined only VAC. While current evidence suggests there is a relationship between neurophysiological measures and ankle function after SCI, more studies are needed. Understanding the relationship between neurophysiology and ankle function is important for advancing therapeutic outcomes after SCI. Future studies to capture an array of corticospinal, spinal, and functional measures are warranted.
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Affiliation(s)
- Jasmine M Hope
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States.,Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Ryan Z Koter
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Stephen P Estes
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Edelle C Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States.,Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States.,Division of Physical Therapy, School of Medicine, Emory University, Atlanta, GA, United States.,Georgia Institute of Technology, School of Biological Sciences, Program in Applied Physiology, Atlanta, GA, United States
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Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2102785. [PMID: 32280681 PMCID: PMC7115057 DOI: 10.1155/2020/2102785] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 12/20/2022]
Abstract
Background To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6-minute walk test, 10-meter walk test). Results A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non-RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non-RCTs (AS: 95%CI = −0.202 to -0.068, p ≤ 0.001; MAS: 95%CI = −2.886 to -1.412, p ≤ 0.001). The results on pain did not show significant change after RAGT in either RCTs or non-RCTs. LEMS and walking ability significantly increased in favor of RAGT. Conclusions RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.
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30
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Cabahug P, Pickard C, Edmiston T, Lieberman JA. A Primary Care Provider's Guide to Spasticity Management in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:157-165. [PMID: 33192042 PMCID: PMC7640908 DOI: 10.46292/sci2603-157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Muscle spasticity is a common sequela of spinal cord injury (SCI) that may impact daily function. Spasticity dynamically varies and is an important physiologic response to illness or other stressors. The challenge for the general practitioner is in recognizing, treating, and developing an effective plan focused on the patient's individual goals. Objective: To provide the general practitioner with a basic contextual, diagnostic, and therapeutic approach to spasticity management for individuals with neurologic injury such as SCI. Discussion: Muscle spasticity can be disabling and can be managed effectively by using a comprehensive approach. We discuss a representative case and the assessment and planning for individuals with SCI and spasticity. Through an understanding of pathophysiology, careful history taking, and physical exam, a cause for increased spasticity can be identified, such as infection, constipation, or pregnancy. Symptomatology of these triggers is often quite different in the SCI population than in the general population. Management includes the treatment of this causative stressor as well as the thoughtful management of spasticity itself. Conclusion: Muscle spasticity is dynamic and requires a patient-centered approach. The general practitioner can play a key role in recognizing and treating spasticity in an individual with SCI. Comprehensive management to meet patient and caregiver goals involves primary care providers, specialists, and allied health practitioners.
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Affiliation(s)
- Philippines Cabahug
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Charles Pickard
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - Travis Edmiston
- Rancho Los Amigos National Rehabilitation Center, Downey, California
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31
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Menon RG, Raghavan P, Regatte RR. Quantifying muscle glycosaminoglycan levels in patients with post-stroke muscle stiffness using T 1ρ MRI. Sci Rep 2019; 9:14513. [PMID: 31601831 PMCID: PMC6787087 DOI: 10.1038/s41598-019-50715-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to provide imaging evidence of increased glycosaminoglycan (GAG) content in patients with post-stroke muscle stiffness; and to determine the effect of hyaluronidase treatment on intramuscular GAG content. In this prospective study, we used 3D-T1ρ (T1rho) magnetic resonance (MR) mapping of the upper arm muscles to quantify GAG content in patients with post-stroke muscle stiffness before and after hyaluronidase injection treatment. For this study, healthy controls (n = 5), and patients with post-stroke muscle stiffness (n = 5) were recruited (March 2017-April 2018). T1ρ MR imaging and Dixon water-fat MR imaging of the affected upper arms were performed before and after off-label treatment with hyaluronidase injections. T1ρ mapping was done using a three-parameter non-linear mono-exponential fit. Wilcoxon Mann-Whitney test was used to compare patients' vs controls and pre- vs post-treatment conditions. The T1ρ values in the biceps were significantly higher in patients before treatment (34.04 ± 4.39 ms) compared with controls (26.70 ± 0.54 ms; P = 0.006). Significant improvement was seen in the biceps of patients before (35.48 ± 3.38 ms) and after treatment (29.45 ± 1.23 ms; P = 0.077). Dixon water-fat distribution was not significantly different in the patients compared to the controls (biceps P = 0.063; triceps P = 0.190). These results suggest that T1ρ mapping can be used to quantify GAG content in the muscles of patients with post-stroke muscle stiffness, and that muscle hyaluronan content is increased in stiff muscles compared with controls, providing imaging corroboration for the hyaluronan hypothesis of muscle stiffness.
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Affiliation(s)
- Rajiv G Menon
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
| | - Preeti Raghavan
- Depts. of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Rusk Rehabilitation, New York University School of Medicine, New York, NY, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
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Tibbett JA, Field‐Fote EC, Thomas CK, Widerström‐Noga EG. Spasticity and Pain after Spinal Cord Injury: Impact on Daily Life and the Influence of Psychological Factors. PM R 2019; 12:119-129. [DOI: 10.1002/pmrj.12218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/30/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Jacqueline A. Tibbett
- The Miami Project to Cure Paralysis University of Miami Miami FL
- Department of Physiology and BiophysicsUniversity of Miami Miami FL
| | - Edelle C. Field‐Fote
- Shepherd Center, Crawford Research Institute Atlanta GA
- Division of Physical TherapyEmory University School of Medicine Atlanta GA
| | - Christine K. Thomas
- The Miami Project to Cure Paralysis University of Miami Miami FL
- Department of Physiology and BiophysicsUniversity of Miami Miami FL
- Department of Neurological SurgeryUniversity of Miami Miami FL
| | - Eva G. Widerström‐Noga
- The Miami Project to Cure Paralysis University of Miami Miami FL
- Department of Neurological SurgeryUniversity of Miami Miami FL
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Managing Spasticity in a Pregnant Woman with Spinal Cord Injury: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0198-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Estes S, Iddings JA, Ray S, Kirk-Sanchez NJ, Field-Fote EC. Comparison of Single-Session Dose Response Effects of Whole Body Vibration on Spasticity and Walking Speed in Persons with Spinal Cord Injury. Neurotherapeutics 2018; 15:684-696. [PMID: 29959653 PMCID: PMC6095785 DOI: 10.1007/s13311-018-0644-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Spasticity affects approximately 65% of persons with spinal cord injury (SCI) and negatively impacts function and quality of life. Whole body vibration (WBV) appears to reduce spasticity and improve walking function; however, the optimal dose (frequency/duration) is not known. We compared single-session effects of four different WBV frequency/duration dose conditions on spasticity and walking speed, in preparation for a planned multi-session study. Thirty-five participants with motor-incomplete SCI received four different doses of WBV: high frequency (50 Hz)/short duration (180 s), high frequency/long duration (360 s), low frequency (30 Hz)/short duration, and low frequency/long duration, plus a control intervention consisting of sham electrical stimulation. In all conditions, participants stood on the WBV platform for 45-s bouts with 1 min rest between bouts until the requisite duration was achieved. The frequency/duration dose order was randomized across participants; sessions were separated by at least 1 week. Quadriceps spasticity was measured using the pendulum test at four time points during each session: before, immediately after, 15 min after, and 45 min after WBV. Walking speed was quantified using the 10-m walk test at three time points during each session: baseline, immediately after, and 45 min after WBV. In the full group analysis, no frequency/duration combination was significantly different from the sham-control condition. In participants with more severe spasticity, a greater reduction in stretch reflex excitability was associated with the high frequency/long duration WBV condition. The sham-control condition was associated with effects, indicating that the activity of repeated sitting and standing may have a beneficial influence on spasticity. TRIAL REGISTRATION NCT02340910 (assigned 01/19/2015).
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Affiliation(s)
- Stephen Estes
- Shepherd Center - Crawford Research Institute, Atlanta, GA, USA
| | | | - Somu Ray
- Shepherd Center - Crawford Research Institute, Atlanta, GA, USA
| | - Neva J Kirk-Sanchez
- Department of Physical Therapy, University of Miami - Miller School of Medicine, Coral Gables, FL, USA
| | - Edelle C Field-Fote
- Shepherd Center - Crawford Research Institute, Atlanta, GA, USA.
- Division of Physical Therapy, Emory University - School of Medicine, Atlanta, GA, USA.
- Program in Applied Physiology, Georgia Institute of Technology - School ofBiological Sciences, Atlanta, GA, USA.
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35
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Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study. Spinal Cord 2018; 56:1176-1183. [PMID: 29904191 DOI: 10.1038/s41393-018-0165-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective cohort study using the Rick Hansen SCI Registry (RHSCIR) and retrospective medical chart review. OBJECTIVE To describe treatment patterns of in-patient anti-spasticity medication use following traumatic spinal cord injury (SCI) in acute and rehabilitation hospital settings in British Columbia, Canada. SETTING Quaternary trauma center, rehabilitation center. METHODS Individuals with traumatic SCI between 2005 and 2014 enrolled in the Vancouver RHSCIR site (N = 917) were eligible for inclusion. Oral and injectable anti-spasticity medication use were the main outcome measures. RESULTS In 769 participants, higher neurological level and injury severity were associated with in-patient anti-spasticity medication use (p < 0.001 for both). Of individuals with cervical and thoracic injuries (n = 589), 37% were prescribed anti-spasticity medication during hospital admission. Baclofen was the most commonly used first line oral therapy. Mean (SD) and median time from injury to Baclofen initiation was 70 (69) and 50 days, respectively. The probability of having initiated an in-patient anti-spasticity medication was 55% (95% CI (49, 60)) for individuals 6 months post-injury, and 71% (95% CI (62, 79)) for individuals 12 months post-injury. At community discharge, the prevalence of oral and injectable anti-spasticity medication use was 26 and 5%. Practice patterns of anti-spasticity medication use (2005-2009 vs. 2010-2014) have not changed significantly over time. CONCLUSIONS This is the first large prospective cohort study of in-patient anti-spasticity medication use following traumatic SCI. Results from our study inform clinicians and individuals of "real world" anti-spasticity medication use among individuals with traumatic SCI and may help guide care for this population in the community.
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