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Xie Y, Zhang J, Jin X, Liu S, Song W. Development and validation of a nomogram for predicting heterotopic ossification following spinal cord injury. Clin Neurol Neurosurg 2024; 243:108348. [PMID: 38833809 DOI: 10.1016/j.clineuro.2024.108348] [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: 04/07/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Heterotopic ossification (HO) following spinal cord injury (SCI) can severely compromise patient mobility and quality of life. Precise identification of SCI patients at an elevated risk for HO is crucial for implementing early clinical interventions. While the literature presents diverse correlations between HO onset and purported risk factors, the development of a predictive model to quantify these risks is likely to bolster preventive approaches. This study is designed to develop and validate a nomogram-based predictive model that estimates the likelihood of HO in SCI patients, utilizing recognized risk factors to expedite clinical decision-making processes. METHODS We recruited a total of 145 patients with SCI and presenting with HO who were hospitalized at the China Rehabilitation Research Center, Beijing Boai Hospital, from June 2016 to December 2022. Additionally, 337 patients with SCI without HO were included as controls. Comprehensive data were collected for all study participants, and subsequently, the dataset was randomly partitioned into training and validation groups. Using Least Absolute Shrinkage and Selection Operator regression, variables were meticulously screened during the pretreatment phase to formulate the predictive model. The efficacy of the model was then assessed using metrics including receiver-operating characteristic (ROC) analysis, calibration assessment, and decision curve analysis. RESULTS The final prediction model incorporated age, sex, complete spinal cord injury status, spasm occurrence, and presence of deep vein thrombosis (DVT). Notably, the model exhibited commendable performance in both the training and validation groups, as evidenced by areas under the ROC curve (AUCs) of 0.756 and 0.738, respectively. These values surpassed the AUCs obtained for single variables, namely age (0.636), sex (0.589), complete spinal cord injury (0.681), spasm occurrence (0.563), and DVT presence (0.590). Furthermore, the calibration curve illustrated a congruence between the predicted and actual outcomes, indicating the high accuracy of the model. The decision curve analysis indicated substantial net benefits associated with the application of the model, thereby underscoring its practical utility. CONCLUSIONS HO following SCI correlates with several identifiable risk factors, including male gender, youthful age, complete SCI, spasm occurrence and DVT. Our predictive model effectively estimates the likelihood of HO development by leveraging these factors, assisting physicians in identifying patients at high risk. Subsequently, correct positioning to prevent spasm-related deformities and educating healthcare providers on safe lower limb mobilization techniques are crucial to minimize muscle injury risks from rapid iliopsoas muscle extension. Additionally, the importance of early DVT prevention through routine screening and anticoagulation is emphasized to further reduce the incidence of HO.
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Affiliation(s)
- Yulei Xie
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Junwei Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China; Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Orthopedics Surgery, Capital Medical University, Beijing, China.
| | - Xiaoqin Jin
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shujia Liu
- School of Rehabilitation, Capital Medical University, Beijing, China; Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Orthopedics Surgery, Capital Medical University, Beijing, China
| | - Wei Song
- Department of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, China.
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Bohart Z, Dashtipour K, Kim H, Schwartz M, Zuzek A, Singh R, Nelson M. Real-world differences in dosing and clinical utilization of OnabotulinumtoxinA and AbobotulinumtoxinA in the treatment of upper limb spasticity. Toxicon 2024:107678. [PMID: 38447766 DOI: 10.1016/j.toxicon.2024.107678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
According to prescribing information, potency units are not interchangeable between botulinum toxin A products. This exploratory study compared real-world dosing and utilization of onabotulinumtoxinA and abobotulinumtoxinA in adults with upper limb spasticity. In this retrospective study, 101 clinicians provided chart data via online surveys for 215 US post-stroke patients treated for upper limb spasticity with ≥3 onabotulinumtoxinA or abobotulinumtoxinA doses (phase 1: 9/18/2020-12/10/2020; phase 2: 9/30/2021-12/7/2021). Most participating clinicians were physicians (70.3%) specializing in neurology (71.3%) or physiatry (20.8%). In the onabotulinumtoxinA (n = 107) and abobotulinumtoxinA (n = 108) groups, ∼75% of patients had moderate-to-severe spasticity. A range of onabotulinumtoxinA:abobotulinumtoxinA dose ratios (1:2.2 [95%CI: 1.8-2.6] to 1:4.1 [95%CI: 3.0-6.0]) was observed across muscles. For the most recent dose, mean number of muscles injected was greater for onabotulinumtoxinA (4.3) versus abobotulinumtoxinA (3.1; P = 0.0003). For onabotulinumtoxinA versus abobotulinumtoxinA, the proportion of injections was 81.3% versus 63.9% (P = 0.0067) in forearm muscles and 23.4% versus 3.7% (P = 0.0001) in hand muscles. Mean injection intervals were similar (onabotulinumtoxinA: 102.0 days; abobotulinumtoxinA: 99.1 days). Differences in real-world dosing and utilization of onabotulinumtoxinA and abobotulinumtoxinA for upper limb spasticity were observed. There was no standard dose-conversion ratio, consistent with each product's prescribing information.
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Kazerooni R, Healy S, Verduzco-Gutierrez M. Disparities in Access to Spasticity Chemodenervation Specialists in the United States: A Retrospective Cross-Sectional Study. Am J Phys Med Rehabil 2024; 103:203-207. [PMID: 38014884 DOI: 10.1097/phm.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE The aim of the study is to explore variations in access to spasticity chemodenervation specialists across several geographical, ethnic, racial, and population density factors. DESIGN This is a retrospective cross-sectional study on Medicare Provider Utilization and Payment Data. Providers with substantial adult spasticity chemodenervation practices were included. Ratios were assessed across geographical regions as well as hospital referral regions. A multivariate linear regression model for the top 100 hospital referral regions by beneficiary population was created, using backward stepwise selection to eliminate variables with P values > 0.10 from final model. RESULTS A total of 566 providers with spasticity chemodenervation practices were included. Unadjusted results showed lower access in nonurban versus urban areas in the form of higher patient:provider ratios (83,106 vs. 51,897). Access was also lower in areas with ≥25% Hispanic populations (141,800 vs. 58,600). Multivariate linear regression results showed similar findings with urban hospital referral regions having significantly lower ratios (-45,764 [ P = 0.004] vs. nonurban) and areas with ≥25% Hispanic populations having significantly higher ratios (+96,249 [ P = 0.003] vs. <25% Hispanic areas). CONCLUSIONS Patients in nonurban and highly Hispanic communities face inequities in access to chemodenervation specialists. The Medicare data set analyzed only includes 12% of the US patient population; however, this elderly national cross-sectional cohort represents a saturated share of patients needing access to spasticity chemodenervation therapy. Future studies should venture to confirm whether findings are limited to this specialization, and strategies to improve access for these underserved communities should be explored.
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Affiliation(s)
- Rashid Kazerooni
- From the Merz Pharmaceuticals, LLC, Raleigh, North Carolina (RK); Department of Family and Community Medicine Residency Program, Mercy Health-Anderson Hospital, Cincinnati, Ohio (SH); and Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas (MV-G)
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Uz C, Umay E, Ballı Uz F, Cankurtaran D, Gundogdu I. Assessment of the quality and reliability of the information on spasticity on youtube. J Clin Neurosci 2023; 113:142-146. [PMID: 37269749 DOI: 10.1016/j.jocn.2023.05.018] [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: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Youtube has become an influential source of health. This study aimed to evaluate the reliability and quality of YouTube videos on spasticity. METHODS The keywords " spasticity, spasticity treatment, spasticity exercises" were used to search for videos. According to the search results, 180 videos were analyzed, videometric characteristics of the videos were recorded, and 2 groups were formed as health professionals and non-health professionals according to the video source. In addition, low, medium and high quality groups were formed using the global quality score (GQS). The reliability of the videos was evaluated using the modified DISCERN (mDISCERN) scale. Video popularity was assessed using the video power index (VPI). RESULTS After excluding videos that met the exclusion criteria, the remaining 68 videos were analyzed. The videos were uploaded by healthcare professionals (n = 47, 69.1%) and non-healthcare professionals (n = 21, 30.9%). The popularity (VPI), reliability (mDISCERN) and quality (GQS) of videos uploaded by healthcare professionals were significantly higher (p = 0.002, p = 0.001, p = 0.021, respectively). Most of the videos were of high quality according to GQS (n = 40, 58.8%). All of the high quality videos were of healthcare professionals. The number of sources from healthcare professionals was significantly higher in high quality videos than in both low (p = 0.001) and medium (p = 0.001) quality videos. CONCLUSION We can conclude that most of the YouTube videos on spasticity are reliable and of high quality. However, it should be kept in mind that patients may be exposed to low-quality and unreliable videos with misleading content.
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Affiliation(s)
- Cuma Uz
- Etlik City Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey.
| | - Ebru Umay
- Etlik City Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
| | - Fatma Ballı Uz
- Etlik City Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
| | - Damla Cankurtaran
- Etlik City Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
| | - Ibrahim Gundogdu
- Etlik City Hospital, Physical Medicine and Rehabilitation Clinic, Ankara, Turkey
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Duan H, Lian Y, Jing Y, Xing J, Li Z. Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke. Front Neurol 2023; 14:1121026. [PMID: 36846123 PMCID: PMC9947654 DOI: 10.3389/fneur.2023.1121026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Spasticity is one of the most common complications after stroke. With the gradual intensification of spasticity, stroke patients will have a series of problems such as joint ankylosis and movement restriction, which affect the daily activities and increase the burden on patients' families, medical staff and society. There are many ways to treat post-stroke spasticity before, including physical therapy and exercise therapy, drug therapy, surgery and so on, but not satisfied because of a few shortcomings. In recent years, many researchers have applied extracorporeal shock wave therapy (ESWT) for the treatment of post-stroke spasm and achieved good clinical effect, because it is non-invasive, safe, easy to operate, low cost and other advantages compared with other treatment methods. This article reviews the research progress and existing problems of ESWT in the treatment of post-stroke spasticity.
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Affiliation(s)
- Haoyang Duan
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Yawen Lian
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Yuling Jing
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Jingsong Xing
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
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Stanciu LE, Iliescu MG, Vlădăreanu L, Ciota AE, Ionescu EV, Mihailov CI. Evidence of Improvement of Lower Limb Functioning Using Hydrotherapy on Spinal Cord Injury Patients. Biomedicines 2023; 11:biomedicines11020302. [PMID: 36830837 PMCID: PMC9953065 DOI: 10.3390/biomedicines11020302] [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: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a devastating problem for modern society, whether it affects young people in the most productive period of their lives or the elderly. The spinal cord injury is currently without curative treatment and the therapeutic intervention aims to minimize secondary complications and maximize residual function through rehabilitation medicine. The main objective of this scientific paper is to determine whether there is evidence in the literature regarding the importance and/or use of hydrotherapy, as part of the therapeutic management of the SCI patient, in order to decrease the degree of spasticity, of pain symptoms, increase or maintain range of motion, improve respiratory, cardiovascular, and metabolic status, as well as improve function and psychological benefits. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, the following databases were analyzed between 2000 and 2021: Pub Med, Pub Med Central, Science Direct, Scopus, and SpringerLink. Initial keywords: rehabilitation treatment, spinal cord injury. Additional keywords: hydrotherapy, aqua therapy, spasticity, human. For the scientific quality of the included articles, risk of bias was assessed using the Downs and Black Appraisal Modified Scale. RESULTS Our research used only four publications as per PRISMA protocol, assessed with Downs and Black Scale. The study models used in the individual studies included in the research are the following: two systematic reviews, one experimental non-randomized control, and one individual semi-structured interview. Due to the low number of studies, despite two of them being reviews, there is the necessity for a more standardized methodology to prove the benefits hydrotherapy for SCI patients for the improvement of lower limb functioning. CONCLUSION Hydrotherapy is an important component of the treatment of an SCI patient, despite the limited number of scientific studies that support this aspect. Clinical trials in the future are required.
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Affiliation(s)
- Liliana Elena Stanciu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Madalina Gabriela Iliescu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
- Correspondence:
| | - Liliana Vlădăreanu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Alexandra Ecaterina Ciota
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Elena-Valentina Ionescu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Claudia Ileana Mihailov
- Department of Reumatology, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
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Khalifeloo M, Naghdi S, Ansari NN, Dommerholt J, Sahraian MA. Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: a case report. Physiother Theory Pract 2022; 38:3248-3254. [PMID: 34546842 DOI: 10.1080/09593985.2021.1978118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spasticity is a common cause of disability in multiple sclerosis (MS), which can negatively affect the patient's walking and balance. OBJECTIVE To evaluate the immediate effect of dry needling (DN) on spasticity and mobility in a female with MS. CASE DESCRIPTION In this case, a 38-year-old female with a 4-year history of MS was treated. The hamstring muscles (biceps femoris and semitendinosus) were needled for 1 minute in a single session. The main outcome measures were the Modified Modified Ashworth Scale (MMAS) to evaluate spasticity, the Timed 25-Foot Walk (T25FW) for the assessment of mobility and leg function performance, and stiffness as a biomechanical index of spasticity measured by a dynamometer. The assessments were done before and immediately after DN. OUTCOMES The MMAS scores decreased in the hamstrings (1 to 0) and quadriceps (2 to 1). The mobility improved as the time for T25FW decreased from 16.30 to 9.29 seconds. The stiffness of hamstring decreased after treatment (0.451 to 0.312). CONCLUSION One session of DN for the hamstring muscle decreased spasticity and improved mobility in this patient with MS. Further studies are suggested.
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Affiliation(s)
- Maede Khalifeloo
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Ali Sahraian
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
- Sina Ms Research Center, Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Robotic Walking to Mitigate Bone Mineral Density Decline and Adverse Body Composition in Individuals With Incomplete Spinal Cord Injury: A Pilot Randomized Clinical Trial. Am J Phys Med Rehabil 2022; 101:931-936. [PMID: 34864766 DOI: 10.1097/phm.0000000000001937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether 24 wks of robotic locomotor training or activity-based training was sufficient time to induce bone mineral density and body composition changes in individuals with spinal cord injury. This study reports the secondary analysis of a randomized pilot trial. DESIGN Participants with chronic motor incomplete tetraplegia ( N = 16) were recruited. Interventions involved 60-min sessions, 3× per week, over 24 wks. Robotic locomotor training involved walking in the Ekso GT suit. Activity-based training involved a combination of resistance, cardiovascular, and weight-bearing exercise. RESULTS Hip bone mineral density was maintained during robotic locomotor training; however, it was significantly reduced ( P = 0.04, effect size = 0.86) during activity-based training by 0.03 (-0.29 to 0.23) g/cm 2 after intervention. Both interventions improved arm fat-free soft tissue mass, but neither group experienced changes in leg fat-free soft tissue mass. The activity-based training group had a significant decrease in visceral adipose tissue ( P = 0.04, effect size = 0.72) and gynoid fat mass ( P = 0.01, effect size = 0.62). CONCLUSIONS Twenty-four weeks of robotic locomotor training is possibly a sufficient duration to prevent the progressive decline of bone mineral density usually occurring in this population. A longitudinal period of activity-based training serves as an effective rehabilitation strategy to reduce indices of fat mass in individuals with spinal cord injury.
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Rubio-Arias JÁ. Can strength training modify voluntary activation, contractile properties and spasticity in Multiple Sclerosis?: a randomized controlled trial. Physiol Behav 2022; 255:113932. [PMID: 35905806 DOI: 10.1016/j.physbeh.2022.113932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A randomized controlled trial was conducted to analyze the effects of 10 weeks of strength training (ST) on voluntary activation, muscle activity, muscle contractile properties, and spasticity in people with MS. METHODS 30 participants were randomized to either an experimental [EG](n=18) or a control [CG](n=12) group. The EG carried out 10-weeks of ST, where the concentric phase at maximum voluntary velocity. Muscle activity of the vastus lateralis (surface electromyography (sEMG) during the first 200 ms of contraction), maximal neural drive (peak sEMG), voluntary activation (central activation ratio), and muscle contractile function (via electrical stimulation) of the knee extensor muscles, as well as spasticity, were measured pre- and post-intervention. RESULTS The EG showed a significant improvement with differences between groups in muscle activity in EMG0-200 (p=0.031;ES=-0.8) and maximal neural drive (p=0.038;ES=-0.8), as well as improvement in the ST group with a trend towards significance in EMG0-100 (p=0.068;ES=-0.6). CAR increased after intervention in ST group (p=0.010;ES=-0.4). Spasticity also improved in the ST group, with differences between group after intervention, in first swing excursion (right leg: p=0.006;ES=-1.4, left leg: p=0.031;ES=-1.2), number of oscillations (right leg: p=0.001;ES=-0.4, left leg: p=0.031;ES=-0.4) and duration of oscillations (left leg: p=0.002; ES=-0.6). Contractile properties remain unchanged in both ST group and control group. CONCLUSIONS 10 weeks of ST improves muscle activity during the first 200 ms of contraction, maximal neural conduction, and spasticity in people with MS. However, ST does not produce adaptations in muscle contractile properties in people with MS.
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Affiliation(s)
- Luis Andreu-Caravaca
- Faculty of Sport. Catholic University of Murcia. Murcia. Spain.; International Chair of Sports Medicine. Catholic University of Murcia. Murcia. Spain..
| | - Domingo J Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF. Madrid. Spain
| | - Linda H Chung
- UCAM Research Center for High Performance. Catholic University of Murcia. Murcia. Spain
| | - Jacobo Á Rubio-Arias
- Department of Education, Health Research Center, University of Almeria, Almeria, 04120 Spain..
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Effect of Early Radial Shock Wave Treatment on Spasticity in Subacute Stroke Patients: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8064548. [PMID: 35909493 PMCID: PMC9328978 DOI: 10.1155/2022/8064548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
Background. Spasticity is a complication that can start immediately after stroke. Radial extracorporeal shock wave therapy (rESWT) is a physical therapy tool used to manage chronic spasticity. However, the effect of rESWT’s early use to treat spasticity after stroke is still not clearly investigated. The aim of this study is to evaluate the efficacy of rESWT in improving poststroke spasticity of the upper limb in patients with a recent onset of spasticity compared to conventional physiotherapy alone. Methods. 40 stroke patients were randomly assigned to experimental (EG) or control group (CG). Both groups underwent two daily sessions of conventional rehabilitation therapy (CRT) 5 days per week; the EG underwent one rESWT session a week for 4 weeks. The modified Ashworth scale (MAS) tested at the shoulder, elbow, and wrist was used as outcome measure. MAS was evaluated at baseline, after 2 and 4 rESWT session, and one month after the last session (follow-up). Results. No significant differences between groups were found at baseline in terms of age, days from onset of spasticity after stroke, and MAS at each body segment. The sample lost eight drop-out patients. Except for the shoulder MAS values, the EG showed statistically significant lower MAS values already after the second rESWT session compared to CG. This significant difference was maintained until the follow-up. The CG showed a significant increase of wrist spasticity after the second evaluation, while the EG maintained constant MAS values throughout the observational period. The elbow spasticity was significantly higher in the CG at the follow-up evaluation. Conclusion. The rESWT combined with CRT seems to be effective in avoiding the increasing progression of spasticity after stroke.
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Abu-Dahab SMN, Almasri NA, Saleh M, Malkawi SH. Determinants of Manual Abilities of Children with Cerebral Palsy: A National Registry-Based Study. Dev Neurorehabil 2022; 25:145-150. [PMID: 33852816 DOI: 10.1080/17518423.2021.1914761] [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: 10/21/2022]
Abstract
PURPOSE This cross-sectional study aimed to identify determinants of manual abilities of children with cerebral palsy (CP), as measured by the Manual Ability Classification System (MACS), in terms of intrinsic (child-related) and extrinsic (service-related) variables. METHODS The participants were 106 children with a confirmed diagnosis of CP (aged 4-16 years). Two ordinal logistic regression models were conducted to identify intrinsic and extrinsic determinants of manual abilities. RESULTS Four child-related (intrinsic) variables were found to be significant determinants of manual abilities: bimanual ability, ability to maintain and assume chair sitting, presence of seizures, and gross motor function, and only one service-related (extrinsic) significant variable was identified, which was receiving spasticity medications. DISCUSSION The results highlight several determinants that should be considered when assessing and intervening to improve manual abilities of children with CP. The findings are discussed in relation to the intervention approach, contextual modification, and assistive device prescription.
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Affiliation(s)
- Sana M N Abu-Dahab
- Department of Occupational Therapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Nihad A Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Maysoun Saleh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Somaya H Malkawi
- Department of Occupational Therapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
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Rao S, Huang M, Chung SG, Zhang LQ. Effect of Stretching of Spastic Elbow Under Intelligent Control in Chronic Stroke Survivors-A Pilot Study. Front Neurol 2022; 12:742260. [PMID: 34970204 PMCID: PMC8713334 DOI: 10.3389/fneur.2021.742260] [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: 07/20/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To assess the short-term effects of strenuous dynamic stretching of the elbow joint using an intelligent stretching device in chronic spastic stroke survivors. Methods: The intelligent stretching device was utilized to provide a single session of intensive stretching to the spastic elbow joint in the sagittal plane (i.e., elbow flexion and extension). The stretching was provided to the extreme range, safely, with control of the stretching velocity and torque to increase the joint range of motion (ROM) and reduce spasticity and joint stiffness. Eight chronic stroke survivors (age: 52.6 ± 8.2 years, post-stroke duration: 9.5 ± 3.6 years) completed a single 40-min stretching intervention session. Elbow passive and active ROM, strength, passive stiffness (quantifying the non-reflex component of spasticity), and instrumented tendon reflex test of the biceps tendon (quantifying the reflex component of the spasticity) were measured before and after stretching. Results: After stretching, there was a significant increase in passive ROM of elbow flexion (p = 0.021, r = 0.59) and extension (p = 0.026, r = 0.59). Also, elbow active ROM and the spastic elbow flexors showed a trend of increase in their strength. Conclusion: The intelligent stretching had a short-term positive influence on the passive movement ROM. Hence, intelligent stretching can potentially be used to repeatedly and regularly stretch spastic elbow joints, which subsequently helps to reduce upper limb impairments post-stroke.
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Affiliation(s)
- Sanjana Rao
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Meizhen Huang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Sun Gun Chung
- Department of Rehabilitation Medicine, Seoul National University, Seoul, South Korea
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States.,Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
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Impact of Lockdown during COVID-19 Pandemic on Central Activation, Muscle Activity, Contractile Function, and Spasticity in People with Multiple Sclerosis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2624860. [PMID: 34692828 PMCID: PMC8531768 DOI: 10.1155/2021/2624860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Background People with multiple sclerosis (MS) suffer from symptoms related to neural control, such as reduced central activation, lower muscle activity, and accentuated spasticity. A forced 9-week home confinement related to COVID-19 in Spain may have worsened these symptoms. However, no study has demonstrated the impact of home confinement on neuromuscular mechanisms in the MS population. This study was aimed at analyzing the effects of a 9-week home confinement on central activation, muscle activity, contractile function, and spasticity in MS patients. Methods Eighteen participants were enrolled in the study. Left and right knee extensor maximum voluntary isometric contraction (MVIC), maximal neural drive via peak surface electromyography (EMG) of the vastus lateralis, central activation ratio (CAR), and muscle contractile function via electrical stimulation of the knee extensor muscles, as well as spasticity using the pendulum test, were measured immediately before and after home confinement. Results Seventeen participants completed the study. CAR significantly decreased after lockdown (ES = 1.271, p < 0.001). Regarding spasticity, there was a trend to decrease in the number of oscillations (ES = 0.511, p = 0.059) and a significant decrease in the duration of oscillations (ES = 0.568, p = 0.038). Furthermore, in the left leg, there was a significant decrease in the first swing excursion (ES = 0.612, p = 0.027) and in the relaxation index (ES = 0.992, p = 0.001). Muscle contractile properties, MVIC, and EMG variables were not modified after confinement. Conclusions The results suggest that a home confinement period of 9 weeks may lead to an increase in lower limb spasticity and a greater deficit in voluntary activation of the knee extensors.
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Gunnarsson S, Lemming D, Alehagen S, Berntsson S, Ertzgaard P, Samuelsson K. Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen. Rehabil Nurs 2021; 46:315-322. [PMID: 33788806 DOI: 10.1097/rnj.0000000000000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns. DESIGN A retrospective design. METHODS For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patient's doses were analyzed and grouped based on similarities in dosing pattern. FINDINGS The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating. CONCLUSION The results highlight the clinical challenge of predicting dose development over time. CLINICAL RELEVANCE TO REHABILITATION NURSING This study provides rehabilitation healthcare professionals with a better understanding of intrathecal baclofen dose development. Illustrations of the four subgroups can be used as an educational tool for patients, family, and caregivers.
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Affiliation(s)
- Stina Gunnarsson
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
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de Sousa N, Santos D, Monteiro S, Silva N, Barreiro-Iglesias A, Salgado AJ. Role of Baclofen in Modulating Spasticity and Neuroprotection in Spinal Cord Injury. J Neurotrauma 2021; 39:249-258. [PMID: 33599153 DOI: 10.1089/neu.2020.7591] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Spinal cord injury (SCI) affects an estimated three million persons worldwide, with ∼180,000 new cases reported each year leading to severe motor and sensory functional impairments that affect personal and social behaviors. To date, no effective treatment has been made available to promote neurological recovery after SCI. Deficits in motor function is the most visible consequence of SCI; however, other secondary complications produce a significant impact on the welfare of patients with SCI. Spasticity is a neurological impairment that affects the control of muscle tone as a consequence of an insult, trauma, or injury to the central nervous system, such as SCI. The management of spasticity can be achieved through the combination of both nonpharmacological and pharmacological approaches. Baclofen is the most effective drug for spasticity treatment, and it can be administered both orally and intrathecally, depending on spasticity location and severity. Interestingly, recent data are revealing that baclofen can also play a role in neuroprotection after SCI. This new function of baclofen in the SCI scope is promising for the prospect of developing new pharmacological strategies to promote functional recovery in patients with SCI.
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Affiliation(s)
- Nídia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - Diogo Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - Susana Monteiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | - Nuno Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
| | | | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's Associate Lab, PT Government Associated Lab, Braga/Guimarães, Portugal
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Fernández-de-Las-Peñas C, Pérez-Bellmunt A, Llurda-Almuzara L, Plaza-Manzano G, De-la-Llave-Rincón AI, Navarro-Santana MJ. Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:131-141. [PMID: 33338222 DOI: 10.1093/pm/pnaa392] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects of muscle dry needling alone or combined with other interventions on post-stroke spasticity (muscle tone), related pain, motor function, and pressure sensitivity. DATABASES AND DATA TREATMENT Electronic databases were searched for randomized controlled trials including post-stroke patients where at least one group received dry needling and outcomes were collected on spasticity and related pain. Secondary outcomes included motor function and pressure pain sensitivity. Data were extracted by two reviewers. The risk of bias was assessed with the Cochrane Risk of Bias tool, methodological quality was assessed with the Physiotherapy Evidence Database score, and the quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation approach. Between-groups mean differences (MDs) and standardized mean differences (SMDs) were calculated. RESULTS Seven studies (three within the lower extremity, four in the upper extremity) were included. The meta-analysis found significantly large effect sizes of dry needling for reducing spasticity (SMD: -1.01, 95%confidence interval [CI] -1.68 to -0.34), post-stroke pain (SMD -1.01, 95%CI -1.73 to -0.30), and pressure pain sensitivity (SMD 1.21, 95% CI: 0.62 to 1.80) as compared with a comparative group at short-term follow-up. The effect on spasticity was found mainly in the lower extremity (MD -1.05, 95% CI: -1.32 to -0.78) at short-term follow-up. No effect on spasticity was seen at 4 weeks. No significant effect on motor function (SMD 0.16, 95% CI: -0.13 to 0.44) was observed. The risk of bias was generally low, but the imprecision of the results downgraded the level of evidence. CONCLUSION Moderate evidence suggests a positive effect of dry needling on spasticity (muscle tone) in the lower extremity in post-stroke patients. The effects on related pain and motor function are inconclusive.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | | | | | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Ana I De-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
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Almoajil H, Theologis T, Dawes H, Parsonage J, Pierce J, Hopewell S, Toye F. Patients' and parents' views about lower limb orthopaedic surgery for ambulant children and young people with cerebral palsy: a qualitative evidence synthesis. J Child Orthop 2020; 14:562-573. [PMID: 33343752 PMCID: PMC7740689 DOI: 10.1302/1863-2548.14.200139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The article identifies the aspects of health and outcomes that are considered important from the perspective of ambulatory children with cerebral palsy (CP) and their parents regarding lower limb orthopaedic surgery and explores how they experience surgical interventions. METHODS Four databases (Embase, MEDLINE (Ovid), CINAHL and PsycINFO) were searched from inception to 11 April 2020. Studies were included if they: 1) they involved children or young adults diagnosed with ambulant CP or their family, 2) participants had experience with lower limb orthopaedic surgery and 3) studies employed qualitative research methods. The Critical Appraisal Skills Programme was used to appraise identified studies. The 'Best-fit framework' synthesis approach was used by applying the International Classification of Functioning-Children and Youth (ICF-CY) linking rules and thematic synthesis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Six studies were included. Four themes were generated which were linked to the ICF-CY framework: Body function and structure, Activity and participation, Environmental factors, Personal factors, as well as non-ICF-CY themes including Emotional well-being and Goal setting. Important surgical outcomes identified were pain, fatigue, movement-related function, mobility, walking ability, community life, emotional well-being, and adequate provision of public and health services. CONCLUSION These findings are important for understanding patient-centred outcomes in lower limb ortho-paedics surgery and providing focus for future interventional studies aimed at improving outcomes of importance to children with CP. These findings highlight the importance of long-term support to help people negotiate the challenge of surgical regimes and to achieve good outcomes after orthopaedic surgery. The outcomes identified will contribute to the development of a core outcome set in this field. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hajar Almoajil
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK,Department of Physical Therapy, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Saudi Arabia,Correspondence should be sent to Hajar Almoajil, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK. E-mail:
| | - Tim Theologis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University Oxford, UK,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jackie Parsonage
- Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University Oxford, UK
| | - Jo Pierce
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Oxford, UK
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Combination Therapy for Treatment of Spasticity in Stroke Patients: A Case Study. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:180-189. [PMID: 32874691 PMCID: PMC7445646 DOI: 10.12865/chsj.46.02.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Spasticity is a disorder of sensory-motor control that appears as an effect of a lesion in the upper motor neuron and demonstrates sustained or intermittent unintentional muscle activation. Many treatment interventions exist to treat spasticity, and in this study, three of them were combined: vibration, static positioning and transcutaneous nerve stimulation (TENS). Evidence exists regarding the application of each intervention per se, but not in combination. Hence, the aim of the study is to present an innovative treatment approach for spasticity and show the effects it produced on one patient. METHODS The study was a case report. The subject was a 31-year-old male patient who had ischemic stroke a year ago. He demonstrated severe plantar flexion of the left foot due to spasticity. There was a baseline assessment and measurement, one on the end of the intervention (10th week) and a follow-up 8 months after it. Assessment and measurement tools: a dynamic gait analysis on the treadmill by Zebris FDM-T system, electromyography testing (F-wave parameter and stretch reflex activity), the Modified Ashworth Scale (MAS), a standard goniometer, the Motricity index (MI) leg score and a pain dichotomous when stretching and while at rest. INTERVENTION The intervention lasted 10 weeks, 5 days per week for 30 minutes. The patient was standing on a 30-degree-inclination wedge. The wedge was positioned on a whole-body vibrator set to vibrate with 91Hz of frequency and 1.0mm amplitude. TENS was offered through surface electrodes which were placed on the tibialis anterior and triceps surae muscles, along the sural nerve (impulse frequency: 100Hz, pulse width: 250μs, intensity: 30mA). RESULTS The range of motion and the MI was increased and the swing-phase of the right foot as well as the standing-phase of the left foot were increased an hour after the intervention. The results were slightly diminished a day and a week after the intervention but a statistically significant improvement still remained. CONCLUSION Combination therapy intervention could offer an alternative for treating spasticity. Further studies are needed to establish a treatment protocol and maybe combine other spasticity-centered treatment modalities in order to produce new interventions.
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19
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Implementing a Protocol of Ankle ROM Goniometry Measurement in the Neuroscience ICU. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000142] [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]
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20
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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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Liu DY, Zhong DL, Li J, Jin RJ. The effectiveness and safety of extracorporeal shock wave therapy (ESWT) on spasticity after upper motor neuron injury: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18932. [PMID: 32028402 PMCID: PMC7015647 DOI: 10.1097/md.0000000000018932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spasticity is one of the manifestations of motor dysfunction in upper motor neuron syndrome, which is characterized by increased muscle tone. Spasticity seriously affects the motor function and activity of daily life of patients. Some studies have shown that extracorporeal shock wave therapy (ESWT) can relieve spasticity in recent years. However, the effectiveness and safety of ESWT on spasticity after motor neuron injury have not been confirmed. The purpose of this systematic review (SR) is to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. METHODS We will search China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wan Fang Data, China Biology Medicine (CBM), PubMed, Embase, The Cochrane Library, and Web of Science systematically from their inception dates through October 2019 to obtain randomized controlled trials (RCTs) using ESWT to relieve spasticity in patients after upper motor neuron injury. The primary outcome will be the Modified Ashworth Scale (MAS). Secondary outcomes will include Composite Spasticity Scale (CSS), Spasm Frequency Scale, Modified Tardieu Scale (MTS), electrophysiological study (ratio of maximum H reflex to maximum M response, root mean square value, integrated electromyogram, co-contraction ratio, etc.), or other spasticity-related outcomes. In addition, adverse events will also be assessed as safety measurement. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager software (RevMan, version 5.3.5) and R (version 3.6.1) software. RESULTS We will synthesize current studies to evaluate the effectiveness and safety of ESWT on spasticity after upper motor neuron injury. CONCLUSION Our study will provide evidence of ESWT on spasticity after upper motor neuron injury. ETHICS AND DISSEMINATION The ethical approval is not required since SR is based on published studies. The results of this SR will be published in a peer-reviewed scientific journal according to the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines. PROSPERO REGISTRATION NUMBER CRD42019131059.
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22
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Amatya B, Cofré Lizama LE, Elmalik A, Bastani A, Galea MP, Khan F. Multidimensional evaluation of changes in limb function following botulinum toxin injection in persons with stroke. NeuroRehabilitation 2019; 45:67-78. [PMID: 31403954 DOI: 10.3233/nre-192722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are limited evidence of instrumented measures of gait and balance to determine the functional effects of botulinum toxin injections (BoNT-A) in spasticity after stroke. OBJECTIVE To evaluate the functional changes in gait and balance following upper limb and lower limb BoNT-A in persons with stroke. METHODS A pre-post prospective study of 35 stroke patients with upper and/or lower limb spasticity after focal treatment with BoNT-A. Assessments were at baseline (T0), 6-weeks (T1) and 12-weeks (T2), using validated subjective and objective physical activity measures. RESULTS After BoNT-A injections, significant improvements in most measures of impairments, activity and participation domains were found at T1 (p < 0.05, effect sizes (r) = 0.5-0.9). There was a significant increase in low intensity physical activity (at T1) and sedentary time reductions at both follow-up periods. Instrumented gait/balance measures showed a significant increase in cadence and turn velocity, but no changes in sway measures were found using posturography. Improvements in most outcome measures were maintained at 12-weeks. CONCLUSION BONT-A improved scores in most clinical measures but only in some of the objective gait/balance and physical activity measures. Further robust studies should utilize a larger sample size to better determine the benefits of BoNT-A for stroke-related spasticity.
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Affiliation(s)
- B Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, VIC, Australia
| | - L E Cofré Lizama
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, VIC, Australia
| | - A Elmalik
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, VIC, Australia
| | - A Bastani
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, VIC, Australia
| | - M P Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, VIC, Australia
| | - F Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia.,Australian Rehabilitation Research Centre, VIC, Australia
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Palazón-García R, Alcobendas-Maestro M, Esclarin-de Ruz A, Benavente-Valdepeñas AM. Treatment of spasticity in spinal cord injury with botulinum toxin. J Spinal Cord Med 2019; 42:281-287. [PMID: 29869974 PMCID: PMC6522928 DOI: 10.1080/10790268.2018.1479053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT Spasticity is one of the most frequent complications in spinal cord injury (SCI), and is routinely managed with oral pharmacologic therapy. Botulinum toxin (BT) is not accepted as a treatment for spasticity in SCI in Spain but may be used in certain cases of focal distribution. OBJECTIVE To report the results with BT for treatment of spasticity in SCI. DESIGN AND SETTING Descriptive retrospective study conducted at a specialist SCI rehabilitation center in Spain, covering patients first treated from 2012 through 2014, and successfully followed up for a minimum of 1 year. Data were collected on the following variables: demographic and SCI characteristics (level and grade); nature of spasticity, e.g. tone, distribution, spasms, articular involvement and pain; function; application of BT; tolerance and adverse reactions. RESULTS The study covered 90 patients, predominantly male with incomplete injuries. Improvement in tone as measured by the modified Ashworth scale was a mean of 1.17 points. Goniometric improvement was achieved in 65.6% and improvement in pain in 38.9% of cases. There were no adverse side-effects. Patients with focal spasticity showed a significantly greater improvement in tone (P < 0.0001). The earlier the BT injection, the greater the improvement in goniometric performance (P < 0.006) and pain (P < 0.033), with the best results being obtained within the first 6 months of clinical course. ASIA D injuries showed a greater improvement in tone (P < 0.0001). CONCLUSIONS BT can be both an effective treatment for focal spasticity in SCI and a good coadjuvant for oral treatments in generalized spasticity.
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Affiliation(s)
- Ramiro Palazón-García
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Toledo, Spain
| | - Mónica Alcobendas-Maestro
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Toledo, Spain
| | - Ana Esclarin-de Ruz
- Department of Physical Medicine and Rehabilitation, National Hospital for Paraplegics, Toledo, Spain
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Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke. PM R 2019; 11:363-371. [DOI: 10.1016/j.pmrj.2018.08.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/12/2018] [Indexed: 11/15/2022]
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de Souza JA, Corrêa JCF, Agnol LD, Dos Santos FR, Gomes MRP, Corrêa FI. Effects of transcranial direct current stimulation on the rehabilitation of painful shoulder following a stroke: protocol for a randomized, controlled, double-blind, clinical trial. Trials 2019; 20:165. [PMID: 30876431 PMCID: PMC6419802 DOI: 10.1186/s13063-019-3266-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 02/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background Shoulder pain is reported to be one of the major challenges faced in the functional recovery of patients in rehabilitation following a stroke. In such cases, transcranial direct current stimulation (tDCS) has been used as an additional therapeutic tool for improvements in central and peripheral pain. The aim of the proposed study is to evaluate the effect of tDCS when combined with upper limb physical therapy on pain intensity and functional improvement in stroke survivors with shoulder pain in the hemiplegic limb. Methods A randomized, placebo-controlled, double-blind, clinical trial is proposed. The volunteers will be randomly allocated to receive passive movement on the upper limb, which will be performed by the therapist for 20 min followed by either active tDCS or sham tDCS (current stimulation for 30 s) during simultaneous physical activity of the upper limb (“mini-bike”) for 20 min, totaling 40 min of intervention performed in 10 consecutive sessions. The anode electrode will be positioned over the primary motor cortex with a current of 2 mA and the cathode electrode will be positioned in the supraorbital region contralateral to the anode. The primary outcome will be shoulder pain intensity, which will be measured using the visual analog scale (VAS) on three occasions: 1) pre-intervention; 2) after 10 interventions (5 weekly sessions, for 2 weeks); and 3) 30 days after the end of the interventions. The secondary outcomes will be motor performance, upper limb function, and quality of life. Trial registration Brazilian Registry of Clinical Trials, RBR-8F5MNY. Registered on June 2, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3266-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janaina Andressa de Souza
- Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), Avenida Angélica, 1905-Apt161, São Paulo, SP, Brasil.
| | - João Carlos Ferrari Corrêa
- Postgraduate program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Letizzia Dall' Agnol
- Undergraduate course in Physical Therapy, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | | | - Fernanda Ishida Corrêa
- Postgraduate program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Anwar F, Antiga S, Mee H, Al Khayer A. Management of spasticity with intrathecal phenol injections: The past and the present. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019. [DOI: 10.4103/jisprm.jisprm_49_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Edwards TA, Theologis T, Wright J. Predictors affecting outcome after single-event multilevel surgery in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2018; 60:1201-1208. [PMID: 30073667 DOI: 10.1111/dmcn.13981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 12/01/2022]
Abstract
AIM To review the potential predictors of outcome after single-event multilevel surgery (SEMLS) in children with cerebral palsy (CP). METHOD A literature search using the following criteria was performed in six electronic databases: (1) children with cerebral palsy; (2) analysed potential predictors of outcome after SEMLS; (3) minimum 12 months follow-up. The potential predictors were predefined: sex; topographical distribution; socio-economic status; Gross Motor Function Classification System (GMFCS) level; preoperative kinematic summary statistic; age at surgery. Study quality was appraised with the methodological index for non-randomized studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. RESULTS Of the seven studies identified, the MINORS scores ranged from 9 to 11 and all were graded 2b on the Oxford Centre for Evidence-Based Medicine scale. There was little or no evidence to support sex, topographical distribution, or socio-economic status as predictive factors after SEMLS. Preoperative Gait Profile Score (GPS) was the best measure of expected improvement in gait kinematics. Parent-reported satisfaction and GPS were best after SEMLS in children graded GMFCS II. The best long-term results were seen in those aged between 10 years and 12 years of age. INTERPRETATION The candidate who might expect to realize the most improvement from SEMLS is aged between 10 years and 12 years, is in GMFCS level II, and has a poor preoperative GPS. WHAT THIS PAPER ADDS Children aged 10 to 12 years, in Gross Motor Function Classification System level II, with a poor preoperative Gait Profile Score might expect to realize the most improvement after single-event multilevel surgery.
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Affiliation(s)
- Tomos A Edwards
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK
| | - Tim Theologis
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK
| | - James Wright
- Botnar Research Centre, University of Oxford, Oxford, UK
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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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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Intractable Rare Dis Res 2018; 7:164-171. [PMID: 30181935 PMCID: PMC6119673 DOI: 10.5582/irdr.2018.01060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neuromuscular disorder caused by the mutation of the SACS gene. Clinical symptoms of this disease include progressive ataxia, spasticity, and peripheral neuropathy. Similar to other neuromuscular disorders, these patients are prone to physical deconditioning which may lead to a loss of functional capacity. This paper aims to evaluate the impact of a training program on the physical fitness and the functional capacity of ARSACS patients. Twelve patients (age: 28.1 ± 8.2 years) participated in this study. They followed an eight-week training program including physical activities, strength-power and aerobic training. Compared to the initial evaluation, measures of physical fitness and functional capacity were significantly improved (p ≤ 0.05) for 11 of the 12 tests. Positive gains were also observed for fall frequency and for upper-limb incoordination. This paper supports the importance of a training program for ARSACS patients in order to improve their quality of life. Through these types of interventions, it may be possible to slow down the progression of the disease and help maintain functional capacity.
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Affiliation(s)
- Olivier Audet
- Deparment of Kinesiology, Université Laval, Québec, Canada
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Alain-Steve Comtois
- Department of Exercise Sciences, Université du Québec à Montréal, Montréal, Canada
| | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
- Address correspondence to:Dr. Mario Leone, Department of Health, Kinesiology Division, Université du Québec à Chicoutimi, 555 boulevard de l'Université, Saguenay (Québec), G7H 2B1, Canada. E-mail:
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. WITHDRAWN: Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Biosci Trends 2018. [PMID: 30012892 DOI: 10.5582/bst.2018.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ahead of Print article withdrawn by publisher. This withdrawal is for above article due to the misoperation of advance online publication.
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Affiliation(s)
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi
| | | | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi
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31
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Treatment of progressive multiple sclerosis: Challenges and promising perspectives. Rev Neurol (Paris) 2018; 174:441-448. [DOI: 10.1016/j.neurol.2018.01.370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/04/2018] [Indexed: 11/21/2022]
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32
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Gunnarsson S, Alehagen S, Lemming D, Ertzgaard P, Ghaderi Berntsson S, Samuelsson K. Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study. Disabil Rehabil 2018; 41:1037-1043. [PMID: 29307239 DOI: 10.1080/09638288.2017.1419291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction. METHODS A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1-4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients' general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test - revised, was used to measure general expectations/optimism. RESULTS General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported "much improved" or "very much improved." There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (rs = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such. CONCLUSIONS Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations. Implications for Rehabilitation Patients with intrathecal baclofen treatment report low levels of health and quality of life at the same time as they are highly satisfied with their treatment. Intrathecal baclofen should be equally offered to both optimistic and less optimistic patients. Patients who are able to/not able to communicate, differs in characteristics and should be informed and followed up in different ways in daily clinical practice.
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Affiliation(s)
- Stina Gunnarsson
- a Department of Rehabilitation Medicine and Department of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Siw Alehagen
- b Division of Nursing Science Department of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Dag Lemming
- c Department of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | - Per Ertzgaard
- a Department of Rehabilitation Medicine and Department of Medicine and Health Sciences , Linköping University , Linköping , Sweden
| | | | - Kersti Samuelsson
- a Department of Rehabilitation Medicine and Department of Medicine and Health Sciences , Linköping University , Linköping , Sweden
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Shin MA, Lee SH, Lee JM, Shin JH. Ultrasound-Guided Botulinum Toxin Injection with Factor VIII Administration for Post Stroke Spasticity in a Hemophilia A Patient. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Min A Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | | | - Jong-Min Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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Giacoppo S, Bramanti P, Mazzon E. Sativex in the management of multiple sclerosis-related spasticity: An overview of the last decade of clinical evaluation. Mult Scler Relat Disord 2017; 17:22-31. [DOI: 10.1016/j.msard.2017.06.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/20/2017] [Accepted: 06/25/2017] [Indexed: 01/28/2023]
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Ikumi A, Kubota S, Shimizu Y, Kadone H, Marushima A, Ueno T, Kawamoto H, Hada Y, Matsumura A, Sankai Y, Yamazaki M. Decrease of spasticity after hybrid assistive limb ® training for a patient with C4 quadriplegia due to chronic SCI. J Spinal Cord Med 2017; 40:573-578. [PMID: 27762171 PMCID: PMC5815155 DOI: 10.1080/10790268.2016.1225913] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Recently, locomotor training with robotic assistance has been found effective in treating spinal cord injury (SCI). Our case report examined locomotor training using the robotic suit hybrid assistive limb (HAL) in a patient with complete C4 quadriplegia due to chronic SCI. This is the first report examining HAL in complete C4 quadriplegia. FINDINGS The patient was a 19-year-old man who dislocated C3/4 during judo 4 years previously. Following the injury, he underwent C3/4 posterior spinal fusion but remained paralyzed despite rehabilitation. There was muscle atrophy under C5 level and no sensation around the anus, but partial sensation of pressure remained in the limbs. The American Spinal Injury Association impairment scale was Grade A (complete motor C4 lesion). HAL training was administered in 10 sessions (twice per week). The training sessions consisted of treadmill walking with HAL. For safety, 2 physicians and 1 therapist supported the subject for balance and weight-bearing. The device's cybernic autonomous control mode provides autonomic physical support based on predefined walking patterns. We evaluated the adverse events, walking time and distance, and the difference in muscle spasticity before and after HAL-training using a modified Ashworth scale (mAs). No adverse events were observed that required discontinuation of rehabilitation. Walking distance and time increased from 25.2 meters/7.6 minutes to 148.3 meter/15 minutes. The mAs score decreased after HAL training. CONCLUSION Our case report indicates that HAL training is feasible and effective for complete C4 quadriplegia in chronic SCI.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Correspondence to: Akira Ikumi, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiroaki Kawamoto
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Center for Innovating Medicine and Engineering (CIME), University of Tsukuba Hospital, Ibaraki, Japan
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Use of medicines, adherence and attitudes to medicines among persons with chronic spinal cord injury. Spinal Cord 2017; 56:35-40. [DOI: 10.1038/sc.2017.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 02/01/2023]
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Naro A, Leo A, Russo M, Casella C, Buda A, Crespantini A, Porcari B, Carioti L, Billeri L, Bramanti A, Bramanti P, Calabrò RS. Breakthroughs in the spasticity management: Are non-pharmacological treatments the future? J Clin Neurosci 2017; 39:16-27. [DOI: 10.1016/j.jocn.2017.02.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
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Monaghan K, Horgan F, Blake C, Cornall C, Hickey PPM, Lyons BE, Langhorne P. Physical treatment interventions for managing spasticity after stroke. Cochrane Database Syst Rev 2017; 2017:CD009188. [PMCID: PMC6472515 DOI: 10.1002/14651858.cd009188.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
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Affiliation(s)
- Kenneth Monaghan
- St Angela's CollegeSchool of Nursing and Health StudiesLough GillSligoIreland
| | - Frances Horgan
- Royal College of Surgeons in IrelandSchool of Physiotherapy123 St Stephens GreenDublin 2Ireland
| | - Catherine Blake
- University College DublinSchool of Physiotherapy & Performance ScienceUCD Health Sciences CentreBelfieldDublin 4Ireland
| | - Catherine Cornall
- National Rehabilitation HospitalPhysiotherapy DepartmentRochestown AvenueDun LaoghaireIreland
| | - Paula PM Hickey
- Sligo General HospitalDepartment of MedicineThe MallSligoIreland
| | | | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
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39
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Eftekhar P, Mochizuki G, Dutta T, Richardson D, Brooks D. Goal Attainment Scaling in Individuals with Upper Limb Spasticity Post Stroke. Occup Ther Int 2016; 23:379-389. [PMID: 27696580 DOI: 10.1002/oti.1440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 11/07/2022] Open
Abstract
Focusing on rehabilitation goals is an effective approach for improving function in individuals with spasticity after stroke. The objectives of this study were to examine and map goals of post-stroke individuals with spasticity using the Goal Attainment Scale (GAS) and International Classification of Functioning, Disability and Health (ICF), and to evaluate the impact of botulinum toxin A (BoNTA) on occupational performance based on the type of rehabilitation goals. Thirty-one patients were recruited from an outpatient spasticity management clinic. Each patient set one goal, was injected with BoNTA in their spastic upper limb muscles and received standard rehabilitation services twice a week for four weeks. Twenty-seven participants achieved the expected level, and four exceeded the expected level of their rehabilitation goals. Fifty-five percent of the goals were related to Activity/Participation, and 45% of the goals were categorized in the Body Structures and Function domain of the ICF. Fifteen goals focused on positioning, while 16 goals focused on (independent) activities of daily living (ADL/IADL). Both the positioning and ADL/IADL groups experienced a reduction in MAS following the administration of BoNTA. The positioning group was older and more impaired. Mapping goals to ICF identifies specific targets for intervention, establishes a common language within the interdisciplinary team and contextualizes the ways disability impacts goals. This study is limited by a relatively small sample size and absence of a functional measure. Further studies can explore the development of goal/item banks to advance the use of GAS for spasticity management. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Parvin Eftekhar
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
| | - George Mochizuki
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
| | - Tilak Dutta
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Faculty of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.,Institute for Biomaterials and Biomechanical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Denyse Richardson
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
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40
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Greenwood R, Caine D, Hammerbeck U, Leff A, Playford D, Stevenson V, Ward N. Restorative Neurology, Rehabilitation and Brain Injury. Neurology 2016. [DOI: 10.1002/9781118486160.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Diana Caine
- National Hospital for Neurology & Neurosurgery
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Kaku M, Simpson DM. Spotlight on botulinum toxin and its potential in the treatment of stroke-related spasticity. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1085-99. [PMID: 27022247 PMCID: PMC4789850 DOI: 10.2147/dddt.s80804] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Poststroke spasticity affects up to one-half of stroke patients and has debilitating effects, contributing to diminished activities of daily living, quality of life, pain, and functional impairments. Botulinum toxin (BoNT) is proven to be safe and effective in the treatment of focal poststroke spasticity. The aim of this review is to highlight BoNT and its potential in the treatment of upper and lower limb poststroke spasticity. We review evidence for the efficacy of BoNT type A and B formulations and address considerations of optimal injection technique, patient and caregiver satisfaction, and potential adverse effects of BoNT.
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Affiliation(s)
- Michelle Kaku
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David M Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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42
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Gras A, Broughton J. A cost-effectiveness model for the use of a cannabis-derived oromucosal spray for the treatment of spasticity in multiple sclerosis. Expert Rev Pharmacoecon Outcomes Res 2016; 16:771-779. [PMID: 26750641 DOI: 10.1586/14737167.2016.1140574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Severity of spasticity in multiple sclerosis (MS) directly correlates with the level and cost of care required. This study assessed whether a tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray for treatment of moderate-severe MS spasticity is a cost-effective use of healthcare resources in Wales. METHODS A Markov model was developed to compare THC/CBD plus standard of care (SoC) treatments with SoC alone. RESULTS At 30 years, total incremental cost for THC/CBD plus SoC treatment was estimated at £3,836/patient (ICER: £10,891/quality-adjusted life year [QALY]). Hospital admission costs had the greatest effect on the base case ICER. Inclusion of carer cost led to incremental cost of -£33,609/patient (ICER: -£95,423/QALY). CONCLUSIONS The THC/CBD spray was found to be cost-effective for the treatment of spasticity in MS, and dominant, if home carer costs were included. Use of THC/CBD has the potential to generate cost savings by significantly improving the symptoms of moderate to severe MS spasticity.
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Affiliation(s)
| | - Julie Broughton
- b Health Economics Outcomes Research , Bayer plc , Newbury , UK
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43
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Wei YX, Zhao X, Zhang BC. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia. Complement Ther Med 2016; 26:55-60. [PMID: 27261982 DOI: 10.1016/j.ctim.2016.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/26/2016] [Accepted: 02/17/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the therapeutic benefit of combining moxibustion and rehabilitation training for functional recovery in post-stroke spastic hemiplegic patients. METHODS We randomly divided 84 cases subjecting to inclusion criteria into moxibustion plus rehabilitation training group (MRT group, n=44) and rehabilitation training group (RT group, n=40). Evaluation of therapeutic effect was observed before treatment, 2 weeks during treatment and 6 months after treatment. Spasticity was evaluated using modified Ashworth scale (MAS) and Clinical Spasticity Index (CSI), recovery of motor function was assessed by Brunnstrom recovery stages and Simplified Fugl-Meyer Motor Scale, and performance of activities of daily living (ADL) was measured, and the quality of life was assessed by Patient Reported Outcomes (PRO). RESULTS Evaluation of upper limbs, hands and lower limbs based on CSI and MAS revealed significant improvements in patients treated with MRT, compared to RT alone, both during and after therapy. CSI and MAS also showed significant improvement in patients at each time point in the MRT group, compared to RT group. Marked improvement in Fugl-Meyer Motor Scale was also observed in MRT group at each time point. Based on Brunnstrom grades of upper limbs, hands and lower limbs, significant differences between the two groups were recorded at all time points during and after therapy. Barthel index (BI) and PRO also confirmed the dramatic differences between the two therapy groups. CONCLUSIONS Our results demonstrate that combination therapy with moxibustion and rehabilitation training offers greater clinical benefits in relieving spasticity, promoting function recovery of motion, improving the performance of ADL, and increasing quality of life in post-stroke spastic hemiplegic patients, compared to RT alone.
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Affiliation(s)
- Yan-Xia Wei
- Department of Rehabilitation, the Affiliated Hospital of Zhengzhou University, Nanyang 473009, China
| | - Xia Zhao
- Department of ENT, the Affiliated Hospital of Zhengzhou University, Nanyang 473009, China
| | - Bao-Chao Zhang
- Department of Neurology, the Affiliated Hospital of Zhengzhou University, Nanyang 473009, China.
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Tupimai T, Peungsuwan P, Prasertnoo J, Yamauchi J. Effect of combining passive muscle stretching and whole body vibration on spasticity and physical performance of children and adolescents with cerebral palsy. J Phys Ther Sci 2016; 28:7-13. [PMID: 26957720 PMCID: PMC4755966 DOI: 10.1589/jpts.28.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated the immediate and short-term effects of a combination of
prolonged passive muscle stretching (PMS) and whole body vibration (WBV) on the
spasticity, strength and balance of children and adolescents with cerebral palsy.
[Subjects and Methods] A randomized two-period crossover trial was designed. Twelve
subjects with cerebral palsy aged 10.6 ± 2.4 years received both PMS alone as a control
group (CG) and a combination of PMS and WBV as an experimental group (EG). After random
allocation to the trial schedules of either EG-CG or CG-EG, CG received prolonged PMS
while standing on a tilt-table for 40 minutes/day, and EG received prolonged PMS for 30
minutes, followed by 10 minutes WBV. Both CG and EG received the treatment 5 days/week for
6 weeks. [Results] Immediately after one treatment, EG resulted in better improvement in
scores on the Modified Ashworth Scale than CG. After the 6-week intervention, EG also
showed significantly decreased scores on the Modified Ashworth Scale compared to CG. Both
CG and EG showed significantly reduced the performance times in the five times sit to
stand test, and EG also showed significantly increased scores on the pediatric balance
scale. [Conclusion] This study showed that 6 weeks of combined prolonged PMS and WBV had
beneficial effects on the spasticity, muscle strength and balance of children and
adolescents with CP.
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Affiliation(s)
- Teeraporn Tupimai
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand
| | - Punnee Peungsuwan
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand; School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
| | | | - Juinichiro Yamauchi
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Thailand; Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan; Future Institute for Sport Sciences, Japan
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45
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Milinis K, Tennant A, Young C. Spasticity in multiple sclerosis: Associations with impairments and overall quality of life. Mult Scler Relat Disord 2016; 5:34-9. [DOI: 10.1016/j.msard.2015.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/06/2015] [Accepted: 10/20/2015] [Indexed: 02/04/2023]
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Zettl UK, Rommer P, Hipp P, Patejdl R. Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis. Ther Adv Neurol Disord 2016; 9:9-30. [PMID: 26788128 PMCID: PMC4710104 DOI: 10.1177/1756285615612659] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Spasticity, one of the main symptoms of multiple sclerosis (MS), can affect more than 80% of MS patients during the course of their disease and is often not treated adequately. δ-9-Tetrahydrocannabinol-cannabidiol (THC-CBD) oromucosal spray is a plant-derived, standardized cannabinoid-based oromucosal spray medicine for add-on treatment of moderate to severe, resistant multiple sclerosis-induced spasticity. This article reviews the current evidence for the efficacy and safety, with dizziness and fatigue as the most common treatment-related adverse events, being mostly mild to moderate in severity. Results from both randomized controlled phase III studies involving about,1600 MS patients or 1500 patient-years and recently published studies on everyday clinical practice involving more than 1000 patients or more than,1000 patient-years are presented.
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Affiliation(s)
- Uwe K. Zettl
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, D-18147 Rostock, Germany
| | - Paulus Rommer
- Department of Neurology, University of Rostock, Germany
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Robert Patejdl
- Department of Neurology, University of Rostock, Germany Oscar-Langendorff-Institute of Physiology, University of Rostock, Germany
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Tintoré M. Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis. Neurodegener Dis Manag 2015; 5:15-7. [DOI: 10.2217/nmt.15.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0–10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control.
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Affiliation(s)
- Mar Tintoré
- Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron, 119–129, 08035 Barcelona, Spain
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Meca-Lallana JE, Hernández-Clares R, Carreón-Guarnizo E. Spasticity in multiple sclerosis and role of glatiramer acetate treatment. Brain Behav 2015; 5:e00367. [PMID: 26445705 PMCID: PMC4589813 DOI: 10.1002/brb3.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/28/2015] [Accepted: 06/07/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Spasticity is one of the most disabling and difficult-to-treat symptoms shown by patients with multiple sclerosis, who often show a suboptimal and unsatisfactory response to classic treatment and new available nonpharmacological alternatives. Due to the progressive nature of this condition, the early management should be essential to improve long-term outcomes. METHODS We performed a narrative literature review of the contribution of spasticity to the burden of multiple sclerosis and the potential role of classic disease-modifying drugs. RESULTS Added to the underlying pathophysiology of spasticity, certain external factors and drugs such as interferon may exacerbate the existing condition, hence their awareness is crucial as part of an effective management of spasticity. Furthermore, the evidence for the effectiveness of glatiramer acetate in preventing spasticity in naïve patients and in those switching from interferon should not be ignored. CONCLUSIONS This literature review proposes the examination of spasticity and the influence of classic disease-modifying agents on the level of existing condition among the variables to be considered when deciding on therapy for multiple sclerosis in clinical practice.
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Affiliation(s)
- Jose Eustasio Meca-Lallana
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
| | - Rocío Hernández-Clares
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
| | - Ester Carreón-Guarnizo
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
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Feinstein A, Freeman J, Lo AC. Treatment of progressive multiple sclerosis: what works, what does not, and what is needed. Lancet Neurol 2015; 14:194-207. [PMID: 25772898 DOI: 10.1016/s1474-4422(14)70231-5] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Disease-modifying drugs have mostly failed as treatments for progressive multiple sclerosis. Management of the disease therefore solely aims to minimise symptoms and, if possible, improve function. The degree to which this approach is based on empirical data derived from studies of progressive disease or whether treatment decisions are based on what is known about relapsing-remitting disease remains unclear. Symptoms rated as important by patients with multiple sclerosis include balance and mobility impairments, weakness, reduced cardiovascular fitness, ataxia, fatigue, bladder dysfunction, spasticity, pain, cognitive deficits, depression, and pseudobulbar affect; a comprehensive literature search shows a notable paucity of studies devoted solely to these symptoms in progressive multiple sclerosis, which translates to few proven therapeutic options in the clinic. A new strategy that can be used in future rehabilitation trials is therefore needed, with the adoption of approaches that look beyond single interventions to concurrent, potentially synergistic, treatments that maximise what remains of neural plasticity in patients with progressive multiple sclerosis.
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Affiliation(s)
- Anthony Feinstein
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Jenny Freeman
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Albert C Lo
- Departments of Neurology and Epidemiology, Brown University, Providence, RI, USA
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Slof J, Ruiz L, Vila C. Cost-effectiveness of Sativex in multiple sclerosis spasticity: new data and application to Italy. Expert Rev Pharmacoecon Outcomes Res 2015; 15:379-91. [PMID: 25771713 DOI: 10.1586/14737167.2015.1025759] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple sclerosis (MS) is a chronic progressive disease that carries a high socioeconomic burden. Spasticity (rigidity and spasms) is common in MS and contributes to MS-related disability. This study aims to evaluate the cost-effectiveness of Sativex(®) (9-delta-tetrahydrocannabinol plus cannabidiol oromucosal spray) when used as add-on therapy for management of resistant MS-related spasticity in the context of the Italian healthcare system. A previously published Markov model-based analysis for the German and Spanish context was replicated, adapting it to the Italian setting. Model parameters were updated to reflect recent findings about MS-related spasticity and use of Sativex in daily clinical practice. The base case incremental cost-effectiveness ratio for Sativex use in Italy over a 5-year period was estimated to be €4968 per quality-adjusted life-year gained (year of costing: 2013). Sativex remained an efficient option in the Italian healthcare context - below the commonly accepted incremental threshold of €30,000 per quality-adjusted life-year gained - when deterministic and probabilistic sensitivity analyses were conducted. Sativex can be regarded as a cost-effective treatment option for patients with MS-related spasticity in Italy.
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Affiliation(s)
- John Slof
- Universitat Autònoma de Barcelona, Campus de la UAB, 08193, Bellaterra, Spain
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