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Li S, Winston P, Mas MF. Spasticity Treatment Beyond Botulinum Toxins. Phys Med Rehabil Clin N Am 2024; 35:399-418. [PMID: 38514226 DOI: 10.1016/j.pmr.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Botulinum toxin (BonT) is the mainstream treatment option for post-stroke spasticity. BoNT therapy may not be adequate in those with severe spasticity. There are a number of emerging treatment options for spasticity management. In this paper, we focus on innovative and revived treatment options that can be alternative or complementary to BoNT therapy, including phenol neurolysis, cryoneurolysis, and extracorporeal shock wave therapy.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, USA; TIRR Memorial Herman.
| | - Paul Winston
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Victoria, British Columbia, Canada
| | - Manuel F Mas
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
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Otero-Luis I, Cavero-Redondo I, Álvarez-Bueno C, Martinez-Rodrigo A, Pascual-Morena C, Moreno-Herráiz N, Saz-Lara A. Effectiveness of Extracorporeal Shock Wave Therapy in Treatment of Spasticity of Different Aetiologies: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1323. [PMID: 38592705 PMCID: PMC10932441 DOI: 10.3390/jcm13051323] [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: 12/13/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.
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Affiliation(s)
- Iris Otero-Luis
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (I.O.-L.); (C.Á.-B.); (C.P.-M.); (N.M.-H.); (A.S.-L.)
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autonoma de Chile, Talca 3460000, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (I.O.-L.); (C.Á.-B.); (C.P.-M.); (N.M.-H.); (A.S.-L.)
- Universidad Politécnica y Artística del Paraguay, Asunción 2024, Paraguay
| | - Arturo Martinez-Rodrigo
- Departamento de Sistemas Informáticos (DSI), Facultad de Comunicación de Cuenca, University of Castilla-La Mancha, 16071 Cuenca, Spain;
| | - Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (I.O.-L.); (C.Á.-B.); (C.P.-M.); (N.M.-H.); (A.S.-L.)
| | - Nerea Moreno-Herráiz
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (I.O.-L.); (C.Á.-B.); (C.P.-M.); (N.M.-H.); (A.S.-L.)
| | - Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (I.O.-L.); (C.Á.-B.); (C.P.-M.); (N.M.-H.); (A.S.-L.)
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Su TY, Huang YC, Ko JY, Hsin YJ, Yu MY, Hung PL. Therapeutic effects of extracorporeal shock wave therapy on patients with spastic cerebral palsy and Rett syndrome: clinical and ultrasonographic findings. Orphanet J Rare Dis 2024; 19:6. [PMID: 38172891 PMCID: PMC10763338 DOI: 10.1186/s13023-023-03010-y] [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: 08/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) is reportedly effective for improving spasticity and motor function in children with cerebral palsy (CP). Because late-stage Rett syndrome has a similar presentation, this study aimed to investigate the effects of ESWT on these two diseases. MATERIAL AND METHODS Patients diagnosed with spastic CP and Rett syndrome received 1500 impulses of ESWT at 4 Hz and 0.1 mJ/mm2, on their spastic legsonce weekly for a total of 12 weeks. Outcomes were assessed before and 4 and 12 weeks after ESWT. Clinical assessments included the Modified Ashworth Scale (MAS), passive range of motion (PROM), and Gross Motor Function Measure 88 (GMFM-88). Ultrasonographic assessments included muscle thickness, acoustic radiation force impulse (ARFI), and strain elastography. RESULTS Fifteen patients with CP and six with Rett syndrome were enrolled in this study. After ESWT, patients with CP showed significant clinical improvement in the MAS (P = 0.011), ankle PROM (P = 0.002), walking/running/jumping function (P = 0.003), and total function (P < 0.001) of the GMFM-88. The patients with Rett syndrome showed improved MAS scores (P = 0.061) and significantly improved total gross motor function (P = 0.030). Under ARFI, patients with CP demonstrated decreased shear wave speed in the gastrocnemius medial head (P = 0.038). Conversely, patients with Rett syndrome show increased shear-wave speeds after ESWT. CONCLUSION Our study provides evidence that a weekly course of low-dose ESWT for 12 weeks is beneficial for children with both CP and Rett syndrome, with the clinical effects of reducing spasticity and improving the gross motor function of the lower limbs. The ARFI sonoelastography reveals improvement of muscle stiffness in patients with CP after ESWT, but deteriorated in patients with Rett syndrome. The diverse therapeutic response to ESWT may be caused by the MECP2 mutation in Rett syndrome, having a continuous impact and driving the pathophysiology differently as compared to CP, which is secondary to a static insult. Trial registration IRB 201700462A3. Registered 22March 2017, https://cghhrpms.cgmh.org.tw/HRPMS/Default.aspx .
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Affiliation(s)
- Ting-Yu Su
- Department of Pediatric Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Jih-Yang Ko
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Yi-Jung Hsin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Min-Yuan Yu
- Department of Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Pi-Lien Hung
- Department of Pediatric Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan.
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
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Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, Cappetta G, Borelli G, Farella GM, Foscan M, Viganò M, Sghedoni S, Perazza S, Sassi S. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Front Neurol 2023; 14:1171224. [PMID: 37305763 PMCID: PMC10248244 DOI: 10.3389/fneur.2023.1171224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Evidence regarding the management of several aspects of cerebral palsy improved in recent years. Still, discrepancies are reported in clinical practice. Italian professionals and stakeholders expressed the need of setting up updated, evidenced-based, shared statements, to address clinical practice in cerebral palsy rehabilitation. The objective of the present study was to provide an updated overview of the state of knowledge, regarding the management and motor rehabilitation of children and young people with cerebral palsy, as the framework to develop evidence-based recommendations on this topic. Methods Guidelines and systematic reviews were searched, relative to evidence-based management and motor treatment, aimed at improving gross motor and manual function and activities, in subjects with cerebral palsy, aged 2-18 years. A systematic search according to the Patients Intervention Control Outcome framework was executed on multiple sites. Independent evaluators provided selection and quality assessment of the studies and extraction of data. Results Four guidelines, 43 systematic reviews, and three primary studies were included. Agreement among guidelines was reported relative to the general requirements of management and motor treatment. Considering the subject's multidimensional profile, age and developmentally appropriate activities were recommended to set individual goals and interventions. Only a few approaches were supported by high-level evidence (i.e., bimanual therapy and constraint-induced movement therapy to enhance manual performance). Several task-specific active approaches, to improve gross motor function and gait, were reported (mobility and gait training, cycling, backward gait, and treadmill), based on low-level evidence. Increasing daily physical activity and countering sedentary behavior were advised. Based on the available evidence, non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs. Conclusion A multiple-disciplinary family-centered evidence-based management is recommended. All motor rehabilitation approaches to minors affected by cerebral palsy must share the following fundamental characteristics: engaging active involvement of the subject, individualized, age and developmentally appropriate, goal-directed, skill-based, and preferably intensive and time-limited, but suitable for the needs and preferences of the child or young person and their family, and feasible considering the implications for themselves and possible contextual limitations.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Ph.D. Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuela Pagliano
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Adriano Ferrari
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Maghini
- Functional Rehabilitation Unit, IRCCS E. Medea, Associazione La Nostra Famiglia, Bosisio Parini, Italy
| | - Maria F. Siani
- Physical Medicine and Rehabilitation Unit, S. Maria delle Croci Hospital, Azienda Unità Sanitaria Locale Romagna, Ravenna, Italy
| | - Giada Sgherri
- Developmental Neuroscience Clinical Department, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gina Cappetta
- Physical Medicine and Rehabilitation Unit, Infermi Hospital, Azienda Unità Sanitaria Locale Romagna, Rimini, Italy
| | - Giulia Borelli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina M. Farella
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Foscan
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marta Viganò
- Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Sghedoni
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Perazza
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Sassi
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Chino T, Kinoshita S, Abo M. Repetitive Transcranial Magnetic Stimulation and Rehabilitation Therapy for Upper Limb Hemiparesis in Stroke Patients: A Narrative Review. Prog Rehabil Med 2023; 8:20230005. [PMID: 36866154 PMCID: PMC9970844 DOI: 10.2490/prm.20230005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/31/2023] [Indexed: 03/04/2023] Open
Abstract
Recent technological advances in non-invasive brain stimulation (NIBS) have led to the development of therapies for post-stroke upper extremity paralysis. Repetitive transcranial magnetic stimulation (rTMS), a NIBS technique, controls regional activity by non-invasively stimulating selected areas of the cerebral cortex. The therapeutic principle by which rTMS is thought to work is the correction of interhemispheric inhibition imbalances. The guidelines for rTMS for post-stroke upper limb paralysis have graded it as a highly effective treatment, and, based on functional brain imaging and neurophysiological testing, it has been shown to result in progress toward normalization. Our research group has published many reports showing improvement in upper limb function after administration of the NovEl Intervention Using Repetitive TMS and intensive one-to-one therapy (NEURO), demonstrating its safety and efficacy. Based on the findings to date, rTMS should be considered as a treatment strategy based on a functional assessment of the severity of upper extremity paralysis (Fugl-Meyer Assessment), and NEURO should be combined with pharmacotherapy, botulinum treatment, and extracorporeal shockwave therapy to maximize therapeutic effects. In the future, it will be important to establish tailormade treatments in which stimulation frequency and sites are adjusted according to the pathological conditions of interhemispheric imbalance, as revealed by functional brain imaging.
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Affiliation(s)
- Toshifumi Chino
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Zhang HL, Jin RJ, Guan L, Zhong DL, Li YX, Liu XB, Xiao QW, Xiao XL, Li J. Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2022; 101:615-623. [PMID: 35152251 PMCID: PMC9197142 DOI: 10.1097/phm.0000000000001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. DESIGN Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software. RESULTS Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies. CONCLUSIONS Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Wang J, Yue L, Chen Z, Bai B, Chen C. Effect of Hospital-Family Rehabilitation Intervention on Walking Function and Lower Limb Surface Electromyography in Children with Cerebral Palsy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7034670. [PMID: 35720026 PMCID: PMC9200566 DOI: 10.1155/2022/7034670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/06/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the effect of hospital-family rehabilitation intervention on walking function and lower limb surface electromyography in children with cerebral palsy (CP). Methods About 100 children with CP treated in our hospital from February 2019 to April 2021 were enrolled. The patients were randomly assigned into control group and study group. The control group received routine intervention, and the study group received hospital-family rehabilitation intervention. The intervention effect, GMFM88 scale score, IMMG value, CR value, lower limb surface EMG value, and compliance of gastrocnemius muscle and tibialis anterior muscle were compared. Results First of all, we compared the intervention effects. In the study group, 43 cases were markedly effective, 5 cases were effective, 1 case was improved, 1 case was ineffective, and the effective rate was 98.00%. In the control group, 22 cases were markedly effective, 14 cases were effective, 7 cases were improved, 7 cases were ineffective, and the effective rate of 86.00%. The intervention effect of the study group was better compared to the control group (P < 0.05). Secondly, we compared the scores of the GMFM88 scale. The scores of D area and E area and total score of the study group were higher compared to the control group (P < 0.05). The IEMG values of gastrocnemius muscle and tibialis anterior muscle were compared, and the IMMG values of passive and active gastrocnemius muscle and tibialis anterior muscle in the study group were higher compared to the control group (P < 0.05). There exhibited no significant difference in CR value before intervention (P > 0.05). After intervention, the CR values of gastrocnemius muscle and tibialis anterior muscle in the study group were significantly lower compared to the control group (P < 0.05). In terms of the surface EMG of lower limbs, the EMG value of passive activity (gastrocnemius muscle, tibialis anterior muscle) in the study group was higher compared to the control group, and the EMG value of active activity was significantly lower compared to the control group (P < 0.05). Finally, we compared the compliance. In the study group, there were 43 cases of complete compliance, 7 cases of compliance, and 0 cases of noncompliance, with a compliance rate of 100.00%. In the control group, there were 32 cases of complete compliance, 11 cases of compliance, and 7 cases of noncompliance with a compliance rate of 86.00%. The compliance rate of the study group was better compared to the control group (P < 0.05). Conclusion The intervention of hospital-family rehabilitation model is helpful to improve the self-care ability, cognitive function, and daily activities of children with CP, enhance the walking function and lower limb surface electromyography of children with SCP, and strengthen their qualities of life.
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Affiliation(s)
- Jing Wang
- Department of Neurorehabilitation, Hebei Children's Hospital, China
| | - Ling Yue
- Department of Neurorehabilitation, Hebei Children's Hospital, China
| | - Zhihong Chen
- Nursing Department, Hebei Children's Hospital, China
| | - Bing Bai
- Department of Neurorehabilitation, Hebei Children's Hospital, China
| | - Cuiying Chen
- Department of Neurorehabilitation, Hebei Children's Hospital, China
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Zhang C, Cheng J, Zhao W, Liu Z, Qian X, Zhao Y, Jin B, Zhou Y. Optimizing extracorporeal shock wave with the orthogonal array design in the treatment of the spasticity of cerebral palsy. JOURNAL OF NEURORESTORATOLOGY 2022. [DOI: 10.1016/j.jnrt.2022.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Effect of Two Different Rehabilitation Approaches on Pulmonary Functional Tests, Neuromuscular Functions and Quality of Life in Juvenile Myasthenia Gravis: A Randomized Controlled Trial Study. Medicina (B Aires) 2022; 58:medicina58030374. [PMID: 35334548 PMCID: PMC8955821 DOI: 10.3390/medicina58030374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Children with juvenile myasthenia gravis have a variety of symptoms, ranging from isolated intermittent ocular complaints to overall muscle weakness with or without respiratory insufficiency. This study aimed to investigate the efficacy of a specialized physical therapy with or without partial body weight supported treadmill training on pulmonary functional tests, neuromuscular functions, and quality of life. Materials and Methods: Thirty children, ranging in age from 13 to 16 years, were distributed randomly into two study groups (A or B). Both groups underwent a designed physical therapy program. In addition, group A underwent the partial body weight supported treadmill training. The treatment was conducted three times a week for 12 weeks successively. Pulmonary functional tests (FVC, FEV1, PEFR, and MVV), neuromuscular function tests (compound motor action potential, isometric muscle force of biceps brachii and rectus femoris, balance, walking endurance, and fatigue), and quality of life were measured before and after 12 successive weeks. Results: A significant improvement in all investigated variables were recorded in both groups in favor of group A. Conclusions: Both a specialized physical therapy and partial body weight supported treadmill training are effective in terms of enhancing pulmonary functional tests, neuromuscular functions, and quality of life. Partial body weight supported treadmill training is an excellent adjunctive to the physical therapy program.
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Fan T, Zhou X, He P, Zhan X, Zheng P, Chen R, Li R, Li R, Wei M, Zhang X, Huang G. Effects of Radial Extracorporeal Shock Wave Therapy on Flexor Spasticity of the Upper Limb in Post-stroke Patients: Study Protocol for a Randomized Controlled Trial. Front Neurol 2021; 12:712512. [PMID: 34566855 PMCID: PMC8459743 DOI: 10.3389/fneur.2021.712512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Flexor spasticity of the upper limb is common in poststroke patients and seriously affects the recovery of upper limb function. However, there are no standard management protocols for this condition. Radial extracorporeal shock wave therapy (rESWT) is widely used for various diseases, some studies reported the effects of ESWT on reducing spasticity, but the mechanism of ESWT to reduce spasticity by affecting the excitability of stretch reflex or non-neural rheological components in spastic muscles or both is not yet clear. A large randomized controlled trial with comprehensive evaluation indicators is still needed. The study is to observe the effect of rESWT on flexor spasticity of the upper limb after stroke and explore its mechanism. Methods: A prospective, randomized, double-blind controlled trial is to be performed. One hundred participants will be recruited from the Inpatient Department of Zhujiang Hospital. Eligible patients will be randomly allocated to either receive three sessions of active rESWT (group A) or sham-placebo rESWT (group B) with 3-day intervals between each session. Assessment will be performed at baseline and at 24 h after each rESWT (t1, t2, and t3). The primary assessment outcome will be the Modified Ashworth Scale, and other assessments include surface electromyography, MyotonPRO digital muscle function evaluation, and infrared thermal imaging. All data will be analyzed using intention-to-treat principles. Multiple imputation by chained equations will be used to address missing data caused by loss to follow-up and nonresponses. Per protocol, analyses will also be performed on the participants who complete other assessments. Statistical analysis will be performed using SPSS software (version 20.0) and the significance level set at p < 0.05. Discussion: This trial aims to analyze the application of rESWT for the management of spasticity after stroke via appropriate assessments. We hypothesized that after receiving active rESWT, patients would show greater improvement of upper limb muscles compared with patients within the sham-placebo group. The rESWT would be an alternative to traditional methods, and the results of this study may provide support for the further study of potential mechanisms. Clinical Trial Registration:www.chictr.org.cn, identifier: ChiCTR1800016144.
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Affiliation(s)
- Tao Fan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Xiangying Zhou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peichen He
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojia Zhan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rongdong Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rihui Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingyang Wei
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xue Zhang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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Bilek F, Tekin F. Effectiveness of Extracorporeal Shock Wave Therapy on Postural Control and Balance in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial. Percept Mot Skills 2021; 128:2621-2637. [PMID: 34474622 DOI: 10.1177/00315125211044057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the effects of Extracorporeal Shock Wave Therapy (ESWT) applied to paraspinal muscles on balance and postural control in children with unilateral Cerebral Palsy (CP). A total of 32 children with unilateral CP were included in the study. The children participated in a one-session control to evaluate their reactions to ESWT before randomly assigning them into experimental and control groups. We evaluated children twice: before and after the treatment. We used the Trunk Control Measurement Scale, Trunk Impairment Scale, Pediatric Balance Scale (PBS), and Timed Up and Go (TUG) test in these assessments. Following the pre-test session, we applied Neuro-Developmental Treatment (NDT) programs to both groups at the rate of twice per week for eight weeks; additionally, we applied ESWT only to the experimental group at the rate of twice a week for eight weeks. While there were trends toward increased trunk control skills, PBS scores and TUG test performances from pre- to post-testing in both groups, these improvements were only statistically significant in the experimental group (p < 0.05). We conclude that for children with unilateral CP, ESWT applied to paraspinal muscles has significant additive value when combined with NDT to improve postural control and balance.
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Affiliation(s)
- Furkan Bilek
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Fatih Tekin
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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12
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Tarantino D, Gnasso R, Migliore F, Iommazzo I, Sirico F, Corrado B. The effects of COVID-19 pandemic countermeasures on patients receiving botulinum toxin therapy and on their caregivers: a study from an Italian cohort. Neurol Sci 2021; 42:3071-3077. [PMID: 33956258 PMCID: PMC8100930 DOI: 10.1007/s10072-021-05282-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 11/11/2022]
Abstract
COVID-19 outbreak had a huge worldwide impact, and several countermeasures to contain its spread have been adopted, such as the interruption of nonurgent outpatient clinics. We wanted to describe the effects of the national lockdown on the well-being of a cohort of Italian patients with cerebral palsy (CP) receiving botulinum toxin (BT) therapy and of their caregivers. Twenty-five patients receiving BT therapy were surveyed using the structuralized questionnaire by Dressler and Adib Saberi, while the caregivers were assessed using the Caregiver Burden Scale. The lockdown delayed BT therapy by 9 ± 2.8 months. Around 44% of the selected patients noticed increased muscle cramps, 24% increased muscle pain, and 32% both of them. Due to the lockdown, the patient’s quality of life was reduced by 68.4 ± 21.1%. After the lockdown, 100% of patients perceived BT therapy as more important than before. Around 76% of the patients perceived the lockdown as inadequate and felt that their rights were not respected. The overall score of the Caregiver Burden Scale, as regarded before the lockdown, was 29.12 ± 11.63, while the overall score as regarded after the lockdown was 37.44 ± 14.85. The overall score increased, from before the lockdown to after the lockdown, for 92% of caregivers. The BT outpatient clinic’s interruption was seen to significantly worsen the psychophysical condition of subjects with CP and the care burden of their caregivers, exposing them to greater stress than before. Therefore, any kind of BT treatment suspension or delay should be avoided.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Rossana Gnasso
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Federico Migliore
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Irene Iommazzo
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Felice Sirico
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Bruno Corrado
- Department of Public Health, University Federico II of Naples, Naples, Italy.
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Martínez IM, Sempere-Rubio N, Navarro O, Faubel R. Effectiveness of Shock Wave Therapy as a Treatment for Spasticity: A Systematic Review. Brain Sci 2020; 11:brainsci11010015. [PMID: 33374359 PMCID: PMC7823267 DOI: 10.3390/brainsci11010015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to collect and analyse the available scientific evidence on the effectiveness of shock wave therapy as a treatment for spasticity. METHODS the search was performed in the following databases: PubMed, PEDro, Cochrane, Embase, and the Virtual Health Library. All publications from November 2009 to November 2019 were selected that included a sample of patients with spasticity and prior suspension of botulinum toxin, to whom shock wave therapy was applied. The methodological quality of the articles was evaluated using the Jadad scale and the pyramid of quality of scientific evidence. RESULTS 25 studies involving 866 participants with spasticity were selected. The results obtained suggest that shock wave therapy appears to be effective in reducing spasticity levels irrespective of the age of the participants, the type of injury, and the tool used to measure the effect. CONCLUSIONS shock wave therapy reports evidence of improvement in motor function, motor impairment, pain, and functional independence, applied independently of botulinum toxin. However, due to the heterogeneity of the protocols, there is no optimum protocol for its application, and it would be appropriate to gain more high-quality scientific evidence through primary studies.
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Affiliation(s)
- Isabel María Martínez
- Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Asociación de Familiares y Enfermos de Parkinson de Villarrobledo, Centro de Rehabilitación Neurológica (Neurovilla), 02600 Albacete, Spain
| | - Nuria Sempere-Rubio
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Olga Navarro
- Department of Nursery, Catholic University of Valencia, 46001 Valencia, Spain;
- Isntituto ITACA, Universitat Politècnica de València, 46022 València, Spain
| | - Raquel Faubel
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Joint Research Unit in Biomedical Engineering, IIS La Fe-Universitat Politècnica de València, 46026 Valencia, Spain
- PTinMOTION, Physiotherapy in Motion, Multispeciality Research Group, Department of Physiotherapy, Universitat de València, 46010 València, Spain
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Corrado B, Giardulli B, Costa M. Evidence-Based Practice in Rehabilitation of Myasthenia Gravis. A Systematic Review of the Literature. J Funct Morphol Kinesiol 2020; 5:jfmk5040071. [PMID: 33467286 PMCID: PMC7739309 DOI: 10.3390/jfmk5040071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/28/2022] Open
Abstract
Myasthenia gravis is a rare neuromuscular disorder characterized by muscle weakness and fatigue. This review analyzes the most recent evidence regarding the effectiveness and safety of different rehabilitative approaches to the disease. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 365 articles were found in the main scientific databases. Applying the inclusion/exclusion criteria, 11 studies were admitted to the final phase of the review. Three different rehabilitative approaches were identified: physical training, respiratory training, and balance training. All rehabilitative modalities contributed to enhancing functional outcomes, reducing fatigue, and improving quality of life, but currently none can be recommended over another for the lack of cross-comparative studies. The included studies showed methodological quality from low to fair. Despite the range of rehabilitative interventions available, there is a lack of high-quality evidence. However, this review suggests that a multidisciplinary rehabilitation approach should be recommended to people with myasthenia gravis, and above all, for those with mild to moderate symptomatology.
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Affiliation(s)
- Bruno Corrado
- Department of Public Health, University Federico II of Naples, Via S. Pansini n.5, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-0817462796; Fax: +39-0817462881
| | - Benedetto Giardulli
- Department of Public Health, University Federico II of Naples, Via S. Pansini n.5, 80131 Naples, Italy;
| | - Massimo Costa
- Department of Polyspecialistic Medicine, Cardarelli Hospital, Via A. Cardarelli, 80131 Naples, Italy;
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Evidence-Based Physical Therapy for Individuals with Rett Syndrome: A Systematic Review. Brain Sci 2020; 10:brainsci10070410. [PMID: 32630125 PMCID: PMC7407501 DOI: 10.3390/brainsci10070410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
Rett syndrome is a rare genetic disorder that affects brain development and causes severe mental and physical disability. This systematic review analyzes the most recent evidence concerning the role of physical therapy in the management of individuals with Rett syndrome. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 17319 studies were found in the main scientific databases. Applying the inclusion/exclusion criteria, 22 studies were admitted to the final phase of the review. Level of evidence of the included studies was assessed using the Oxford Centre for Evidence-Based Medicine—Levels of Evidence guide. Nine approaches to physical therapy for patients with Rett syndrome were identified: applied behavior analysis, conductive education, environmental enrichment, traditional physiotherapy with or without aids, hydrotherapy, treadmill, music therapy, computerized systems, and sensory-based treatment. It has been reported that patients had clinically benefited from the analysed approaches despite the fact that they did not have strong research evidence. According to the results, a multimodal individualized physical therapy program should be regularly recommended to patients with Rett syndrome in order to preserve autonomy and to improve quality of life. However, more high-quality studies are needed to confirm these findings.
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