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Guzman E, Barbari C, Paganoni J, Cohen J, Delgado-Lebron J. Position-Dependent Intrathecal Baclofen System Catheter Failure Resulting in Debilitating Spasticity: A Case Report. Cureus 2024; 16:e53425. [PMID: 38435163 PMCID: PMC10908597 DOI: 10.7759/cureus.53425] [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] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
An intrathecal baclofen pump (ITB) can provide significant relief from excessive spasticity and pain that is difficult to control. However, it is not without its drawbacks. We present a case of a young quadriplegic male who underwent ITB pump placement, suffering four years of transient episodes of severe spasticity with withdrawal symptoms. Multiple adjustments were made to his ITB pump dosing without relief. Extensive workup including interrogation of the pump, serial abdominal radiographs, and fluoroscopic catheter dye study revealed no abnormalities. Intraoperatively, it was discovered that the initial catheter anchoring occurred directly adjacent to the vertebrae, leading to a position-dependent catheter occlusion. He underwent the replacement of his ITB pump and catheter. During surgical revision, emphasis was placed on reducing the length of the catheter outside the spine, anchoring to the supraspinous fascia with avoidance of bony prominences or post-laminectomy sites. After surgery, the patient's spasticity improved, and at the eight-month follow-up, he had no complications, resulting in a mean baclofen dose of 300.2 μg/day. This report highlights the potential risk of life-threatening intrathecal baclofen withdrawal secondary to postural changes, providing technical considerations to prevent recurrences. It also raises awareness regarding patients who are more susceptible to transient catheter occlusion after a spinal cord injury.
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Affiliation(s)
- Elvis Guzman
- Physical Medicine and Rehabilitation, Memorial Healthcare System, Hollywood, USA
| | - Cody Barbari
- Physical Medicine and Rehabilitation, Memorial Healthcare System, Hollywood, USA
| | - Joseph Paganoni
- Medical School, American University of the Caribbean School of Medicine, Cupecoy, MAF
| | - Jackson Cohen
- Physical Medicine and Rehabilitation, Memorial Healthcare System, Hollywood, USA
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Wissel J, Kivi A. Post-Stroke Spastic Movement Disorder and Botulinum Toxin A Therapy: Early Detection And Early Injection. Ann Rehabil Med 2023; 47:326-336. [PMID: 37907224 PMCID: PMC10620487 DOI: 10.5535/arm.23108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 11/02/2023] Open
Abstract
Post-stroke spastic movement disorder (PS-SMD) develops in up to 40% of stroke survivors after a first ever stroke within the first year. Chronic PS-SMD is often associated with severe disabilities and complications, emphasizing the importance of its early recognition and early adequate management. Extensive research has aimed to accurately predict and sensitively detect a PS-SMD. Symptomatic therapies include conventional rehabilitation and local intramuscular injections of botulinum toxin A (BoNT-A). The latter is widely used, but primarily in the chronic phase of stroke. However, recent studies have shown the safety and efficacy of BoNT-A therapy even in the acute phase and early sub-acute phase after stroke, i.e., within three months post-stroke, leading to an improved long-term outcome in stroke rehabilitation. Local BoNT-A injections evolve as the primary approach in focal, multifocal, and segmental chronic or acute/subacute PS-SMD. Patients at high risk for or manifest PS-SMD should be identified by an early spasticity risk assessment. By doing so, PS-SMD can be integral part of the patient-centered goal-setting process of a multiprofessional spasticity-experienced team. The benefit of an early PS-SMD treatment by BoNT-A should predominate putative degenerative muscle changes due to long-term BoNT-A therapy by far. This, as early treatment effectively avoids complications typically associated with a PS-SMD, i.e., contractures, pain, skin lesions. The management of PS-SMD requires a comprehensive and multidisciplinary approach. Early assessment, patient-centered goal setting, early intervention, and early use of BoNT-A therapy prevents from PS-SMD complications and may improve rehabilitation outcome after stroke.
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Affiliation(s)
- Jörg Wissel
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Berlin, Germany
- Neurology at Wittenbergplatz, Berlin, Germany
| | - Anatol Kivi
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Berlin, Germany
- Neurology at Wittenbergplatz, Berlin, Germany
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Wissel J, Ri S, Kivi A. Early versus late injections of Botulinumtoxin type A in post-stroke spastic movement disorder: A literature review. Toxicon 2023; 229:107150. [PMID: 37146733 DOI: 10.1016/j.toxicon.2023.107150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
Post-stroke spastic movement disorder (PS-SMD) is one of the main causes of severe disability in the chronic phase after stroke. The prevalence of SMD rises up with time after stroke to more than 28% in the chronic phase, and its secondary complications such as contracture, abnormal postures and/or movement patterns, spasticity-associated pain, also increases with time after stroke when physical and medical management of PS-SMD had been delayed in the early stroke phase. It has been published by several controlled studies that the earlier physical and medical measures, such as botulinum toxin type A (BoNT-A) therapy are included in rehabilitative strategies for the SMD, the lesser secondary complications, especially soft tissue contractures and pain occurred. Several studies showed that goal-orientated management of PS-SMD including BoNT-A therapy, applied within a few weeks and 3 months - in the early subacute phase after stroke onset - prevented or reduced the development of severe or disabling SMD and its secondary complications, more effective than late application of BoNT-A therapy - in the chronic phase after stroke. In multiple prospective cohort studies, various predictors and predictive approaches for detection of patients on risk to development PS-SMD were found. Based on that information and the controlled studies that showed reduction in PS-SMD complications following early treatment with BoNT-A nowadays, early treatment of PS-SMD in the early subacute phase following stroke is recommended to avoid or reduce the development of post-stroke disability and to improve the outcome of rehabilitation. In this review, we discuss on the optimal timing to apply BoNT-A therapy in patients with already present as well as in high risk of severe PS-SMD.
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Affiliation(s)
- Jörg Wissel
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany; Neurology at Wittenbergplatz, Ansbacher Strasse 197-19, 10787, Berlin, Germany.
| | - Songjin Ri
- Neurology at Wittenbergplatz, Ansbacher Strasse 197-19, 10787, Berlin, Germany; Department for Neurology, Meoclinic, Friedrichstraße 71, 10117, Berlin, Germany
| | - Anatol Kivi
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany; Neurology at Wittenbergplatz, Ansbacher Strasse 197-19, 10787, Berlin, Germany
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Cho MJ, Yeo SS, Lee SJ, Jang SH. Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage. Medicine (Baltimore) 2023; 102:e33604. [PMID: 37115067 PMCID: PMC10145725 DOI: 10.1097/md.0000000000033604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
We investigated the correlation between spasticity and the states of the corticospinal tract (CST) and corticoreticular tract (CRT) in stroke patients after early stage. Thirty-eight stroke patients and 26 healthy control subjects were recruited. The modified Ashworth scale (MAS) scale after the early stage (more than 1 month after onset) was used to determine the spasticity state of the stroke patients. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), fiber number (FN), and ipsilesional/contra-lesional ratios for diffusion tensor tractography (DTT) parameters of the CST and CRT after the early stage were measured in both ipsi- and contra-lesional hemispheres. This study was conducted retrospectively. The FA and FN CST-ratios in the patient group were significantly lower than those of the control group (P < .05), except for the ADC CST-ratio (P > .05). Regarding the DTT parameters of the CRT-ratio, the patient group FN value was significantly lower than that of the control group (P < .05), whereas the FA and ADC CRT-ratios did not show significant differences between the patient and control groups (P > .05). MAS scores showed a strong positive correlation with the ADC CRT-ratio (P < .05) and a moderate negative correlation with the FN CRT-ratio (P < .05). We observed that the injury severities of the CST and CRT were related to spasticity severity in chronic stroke patients; moreover, compared to the CST, CRT status was more closely related to spasticity severity.
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Affiliation(s)
- Min Jye Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Dongnamgu, Cheonan, Republic of Korea
| | - Sung Jun Lee
- Department of Physical Therapy, College of Health Sciences, Dankook University, Dongnamgu, Cheonan, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
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Cheng H, Fang X, Liao L, Tao Y, Gao C. Prevalence and factors influencing the occurrence of spasticity in stroke patients: a retrospective study. Neurol Res 2023; 45:166-172. [PMID: 36153827 DOI: 10.1080/01616412.2022.2127249] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND To describe the prevalence and clinical characteristics of stroke patients without spasticity, and simultaneously analyse the factors related to post-stroke non-spasticity. METHODS In this retrospective study, information on patients hospitalized in the department of rehabilitation, Daping Hospital, over the past eight years was collected. Demographic information and clinical characteristics were statistically analysed. RESULTS A total of 819 stroke patients with an average age of 61.66±13.72 years old were analysed, including 561 males (68.5%), and 258 females (31.5%). In this study, 201 (24.5%) patients developed spasticity, and 618 (75.5%) patients had no spasticity. Patients without spasticity were older than those with spasticity. Patients with ischemic stroke and mild functional impairment were also less likely to have spasticity. Post-stroke spasticity may be related to age [odd ratio (OR): 0.982; 95% CI:0.965 to 0.999; P = 0.042), hemorrhagic stroke (OR: 1.643; 95% CI: 1.029 to 2.626; P = 0.038), National Institute of Health Stroke Scale (NIHSS) Scores (OR: 1.132; 95% CI: 1.063 to 1.204; P = 0.000]. CONCLUSION Most stroke patients do not have spasticity, especially the elderly, patients with ischemic stroke, and those with mild functional impairment, suggesting that not all upper motor nerve injuries lead to increased muscle tension. For young individuals, patients with hemorrhagic stroke, and those with moderate to severe functional impairment, close follow-up is necessary to identify the occurrence of spasticity early on and then formulate corresponding rehabilitation strategies for prompt intervention.
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Affiliation(s)
- Huan Cheng
- 1 Department of Rehabilitation, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Xiangqin Fang
- 1 Department of Rehabilitation, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Lingyi Liao
- 1 Department of Rehabilitation, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Yong Tao
- 1 Department of Rehabilitation, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Changyue Gao
- 1 Department of Rehabilitation, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
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Application of Network Analysis to Uncover Variables Contributing to Functional Recovery after Stroke. Brain Sci 2022; 12:brainsci12081065. [PMID: 36009129 PMCID: PMC9405603 DOI: 10.3390/brainsci12081065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
To estimate network structures to discover the interrelationships among variables and distinguish the difference between networks. Three hundred and forty-eight stroke patients were enrolled in this retrospective study. A network analysis was used to investigate the association between those variables. A Network Comparison Test was performed to compare the correlation of variables between networks. Three hundred and twenty-five connections were identified, and 22 of these differed significantly between the high- and low-Functional Independence Measurement (FIM) groups. In the high-FIM network structure, brain-derived neurotrophic factor (BDNF) and length of stay (LOS) had associations with other nodes. However, there was no association with BDNF and LOS in the low-FIM network. In addition, the use of amantadine was associated with shorter LOS and lower FIM motor subscores in the high-FIM network, but there was no such connection in the low-FIM network. Centrality indices revealed that amantadine use had high centrality with others in the high-FIM network but not the low-FIM network. Coronary artery disease (CAD) had high centrality in the low-FIM network structure but not the high-FIM network. Network analysis revealed a new correlation of variables associated with stroke recovery. This approach might be a promising method to facilitate the discovery of novel factors important for stroke recovery.
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Dragojlovic N, Romanoski NL, Verduzco-Gutierrez M, Francisco GE. Prevalence and Treatment Characteristics of Spastic Hypertonia on First-Time Admission to Acute Inpatient Rehabilitation. Am J Phys Med Rehabil 2022; 101:348-352. [PMID: 34121067 DOI: 10.1097/phm.0000000000001823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to report the prevalence of spasticity and treatment patterns during first-time admission to inpatient rehabilitation after acute stroke, traumatic brain injury, and spinal cord injury. DESIGN This is a retrospective cohort study. METHODS A review of 285 adult patients consecutively admitted to inpatient rehabilitation was conducted. Patients with a history of spasticity and inpatient rehabilitation course and those younger than 18 yrs were excluded. Main outcome measures are as follows: admitting diagnosis, length of stay, time from injury to admission, acute transfer rate, prevalence and severity of spasticity using Modified Ashworth Scale at admission and discharge, Functional Independence Measure scores at admission and discharge, Functional Independence Measure efficiency, and treatments for spasticity. RESULTS Stroke patients had the highest prevalence of spasticity: 68% on admission and 50% at discharge. In traumatic brain injury, spasticity prevalence was 55% on admission and 30% at discharge. In spinal cord injury, spasticity prevalence was 48% on admission and 46% at discharge. Patients with spinal cord injury received the most medications to control spasticity, whereas those with traumatic brain injury and stroke received the most procedural interventions. CONCLUSIONS Spasticity is a common sequela of upper motor neuron injury for patients admitted to inpatient rehabilitation. Early recognition and management are essential to prevent contractures, minimize pain, and maximize functional recovery.
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Affiliation(s)
- Nikola Dragojlovic
- From the Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth, Houston, Texas (ND, GEF); Department of Physical Medicine and Rehabilitation, Penn State Health, Hershey, Pennsylvania (NLR); and Department of Physical Medicine and Rehabilitation, UTHealth San Antonio, San Antonio, Texas (MV-G)
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Abal del Blanco J, Taboada-Iglesias Y. Effects of resistance exercise in patients with spasticity: Systematic review. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ahmedy F, Mohd Tuah N, Mohamad Hashim N, Sybil Shah S, Ahmedy I, Tan SF. Revisiting Spasticity After Stroke: Clustering Clinical Characteristics for Identifying At-Risk Individuals. J Multidiscip Healthc 2021; 14:2391-2396. [PMID: 34511922 PMCID: PMC8418315 DOI: 10.2147/jmdh.s320543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To collectively identify the clinical characteristics determining the risk of developing spasticity after stroke. Patients and Methods A cross-sectional study was conducted at a single rehabilitation outpatient clinic from June to December 2019. Inclusion criteria were stroke duration of over four weeks, aged 18 years and above. Exclusion criteria were presence of concurrent conditions other than stroke that could also lead to spasticity. Recruited patients were divided into “Spasticity” and “No spasticity” groups. Univariate analysis was deployed to identify significant predictive spasticity factors between the two groups followed by a two-step clustering approach for determining group of characteristics that collectively contributes to the risk of developing spasticity in the “Spasticity” group. Results A total of 216 post-stroke participants were recruited. The duration after stroke (p < 0.001) and the absence of hemisensory loss (p = 0.042) were two significant factors in the “Spasticity” group revealed by the univariate analysis. From a total of 98 participants with spasticity, the largest cluster of individuals (40 patients, 40.8%) was those within less than 20 months after stroke with moderate stroke and absence of hemisensory loss, while the smallest cluster was those within less than 20 months after severe stroke and absence of hemisensory loss (21 patients, 21.4%). Conclusion Analyzing collectively the significant factors of developing spasticity may have the potential to be more clinically relevant in a heterogeneous post-stroke population that may assist in the spasticity management and treatment.
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Affiliation(s)
- Fatimah Ahmedy
- Rehabilitation Medicine Unit, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nooralisa Mohd Tuah
- Faculty of Computing & Informatics, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Natiara Mohamad Hashim
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sg. Buloh, Selangor, Malaysia
| | - Syahiskandar Sybil Shah
- Department of Rehabilitation Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Ismail Ahmedy
- Department of Computer System & Technology, Faculty of Computer Science & Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Fun Tan
- Faculty of Computing & Informatics, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Cabanas-Valdés R, Calvo-Sanz J, Serra-Llobet P, Alcoba-Kait J, González-Rueda V, Rodríguez-Rubio PR. The Effectiveness of Massage Therapy for Improving Sequelae in Post-Stroke Survivors. A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094424. [PMID: 33919371 PMCID: PMC8122530 DOI: 10.3390/ijerph18094424] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022]
Abstract
Objective: To assess the effect of therapeutic massage for improving sequelae in stroke survivors. Methods: A systematic review of the nine medical databases from January 1961 to December 2020 was carried out. The bibliography was screened to identify randomized controlled clinical trials (RCTs). Two reviewers independently screened references, selected relevant studies, extracted data and assessed the risk of bias using the PEDro scale. The primary outcome was upper and lower limb motor function and spasticity. Results: A total of 3196 studies were identified and 18 RCT were finally included (1989 individuals). A meta-analysis of RCTs in the comparison of Chinese massage (Tuina) plus conventional physiotherapy versus conventional physiotherapy was performed. The mean difference (MD) in the subacute stage on upper limb motor-function using the Fugl Meyer Assessment was 2.75; (95% confidence interval (CI) from 0.97 to 4.53, p = 0.002, I2 = 36%). The MD on upper limb spasticity using modified Ashworth scale was −0.15; (95% CI from −0.24 to −0.06, p < 0.02, I2 = 0%).The MD on lower limb spasticity was −0.59; (95% CI from −0.78 to −0.40, p < 0.001, I2 = 0%) in the endpoint. Conclusions: Therapeutic massage, especially Tuina, in addition to conventional therapy is effective for improving motor function and for reducing spasticity in stroke survivors.
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Affiliation(s)
- Rosa Cabanas-Valdés
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (P.S.-L.); (J.A.-K.); (V.G.-R.); (P.R.R.-R.)
- Correspondence:
| | - Jordi Calvo-Sanz
- Physiotherapy Department, School of Health Sciences, Tecno Campus, Mataró-Pompeu Fabra University (TCM-UPF), 08302 Barcelona, Spain;
- Hospital Asepeyo Sant Cugat del Vallès, 08174 Barcelona, Spain
| | - Pol Serra-Llobet
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (P.S.-L.); (J.A.-K.); (V.G.-R.); (P.R.R.-R.)
| | - Joana Alcoba-Kait
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (P.S.-L.); (J.A.-K.); (V.G.-R.); (P.R.R.-R.)
- CENAC, 08028 Barcelona, Spain
| | - Vanessa González-Rueda
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (P.S.-L.); (J.A.-K.); (V.G.-R.); (P.R.R.-R.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primaria de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Pere Ramón Rodríguez-Rubio
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Barcelona, Spain; (P.S.-L.); (J.A.-K.); (V.G.-R.); (P.R.R.-R.)
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Zeng H, Chen J, Guo Y, Tan S. Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 11:616097. [PMID: 33551975 PMCID: PMC7855612 DOI: 10.3389/fneur.2020.616097] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Spasticity is a common sequela of stroke. The incidence of poststroke spasticity (PSS) has not been systematically reviewed in recent years, and some risk factors remain debated. This systematic review and meta-analysis was conducted to determine the prevalence and risk factors for PSS. Methods: We searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, WANFANG and CBM) inception to May 12, 2020. Observational studies summarizing the incidence or risk factors for PSS were included. Only cohort studies were enrolled in meta-analysis. For risk factors examined in at least three different studies, we combined effects into odds ratios (OR) and 95% confidence intervals (CI). Results: One thousand four hundred sixty-seven studies were retrieved and 23 were involved in meta-analysis. The pooled prevalence of spasticity after stroke was 25.3% and that after the first-ever stroke was 26.7%. The incidence of spasticity after the first-ever stroke with paresis was 39.5%. The prevalence of disabling or severe spasticity (MAS ≥ 3) in stroke patients with paresis was 9.4% (95% CI 0.056-0.133), and severe spasticity was 10.3% (95% CI 0.058-0.149). Moderate to severe paresis (OR = 6.573, 95% CI 2.579-16.755, I 2 = 0.0%), hemorrhagic stroke (OR = 1.879, 95% CI 1.418-2.490, I 2 = 27.3%) and sensory disorder were risk factors for PSS. Conclusions: The incidence of PSS was significantly higher in stroke patients with paresis. Patients with moderate to severe paresis and sensory disorder should be closely followed up. The role of hemorrhagic stroke in predicting PSS remains to be further explored.
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Affiliation(s)
- Huangling Zeng
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Tan
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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12
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Glaess-Leistner S, Ri SJ, Audebert HJ, Wissel J. Early clinical predictors of post stroke spasticity. Top Stroke Rehabil 2020; 28:508-518. [PMID: 33156735 DOI: 10.1080/10749357.2020.1843845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background and Purpose: Up to 40% of stroke patients with paresis develop post-stroke spasticity (PSS), which induces difficult complications including pain, contracture, posture disorder. The most important factor for PSS management is its early initiation, so that early recognition of PSS is required in clinical practice.Methods: This prospective observational cohort study was conducted with a high standard of PSS assessment and a comprehensive protocol investigating possible predictive factors to identify early predictors of PSS already in the acute phase following stroke (<7 days). PSS was assessed with the Resistance to Passive movement Scale (REPAS) for major joint movements in upper- and lower limbs, based on Ashworth scale, within 7 days following stroke and after 3 months. Binary logistic regression analysis with significant clinical parameters was applied with 95% of confidence intervals (CI) to find predictors of PSS.Results: Of 145 consecutive first-ever stroke patients, 34 patients (23.4%) exhibited PSS. The Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), and Mini-Mental State Examination (MMSE) were revealed as strong clinical predictors of PSS. The combination of an MRS >2 (Odds Ratio (OR): 56.538, 95% CI: 17.150-186.394), NIHSS >2 (OR: 57.137, 95% CI:15.685-208.142) and MMSE <27 (OR: 6.133, 95% CI:2.653-14.178) showed positive predictive (95.2%) value for prediction of PSS (sensitivity 94.4%, specificity 93.3%).Conclusions: Besides evaluating PSS itself with a reliable and valid rating scale the common clinical scales in stroke units practice (NIHSS, MRS, MMSE) allow early identification of patients at high risk for PSS.
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Affiliation(s)
| | - Song Jin Ri
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Jörg Wissel
- Department of Neurology and Rehabilitation Center, Neurological Rehabilitation and Physical Therapy, Vivantes Klinikum Spandau, Berlin, Germany
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13
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Béseler Soto MR, Montes García J, Máñez Añón I. [Stroke spasticity: Is age a risk factor? Observational study of spasticity in neurovascular patients in a retrospective series of two health sites]. Rev Esp Geriatr Gerontol 2020; 55:258-265. [PMID: 32768255 DOI: 10.1016/j.regg.2020.04.004] [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: 06/19/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Approximately one third of patients who have suffered a stroke develop spasticity. Since clinical observations that spasticity in the elderly population is lower after stroke, and disagreement about risk factors between different authors, an analysis is performed on the variables that influence the development of spasticity. The objective of the study is to determine the how many factors influence spasticity outcome, and the prevalence of spasticity in patients who have suffered a stroke and require intensive rehabilitation treatment. METHOD A retrospective assessment was carried out on a total of 554 patients from two neurorehabilitation centres. A record was made of sociodemographic data, aetiology, type and location of stroke, motor and sensory deficits, language and swallowing impairment, incontinence, cognitive and mood state. Spasticity levels at admission and at the third month were studied in 462 patients using the Ashworth scale. Multivariate regression analyses were used to assess the risk factors for spasticity present at the third month after stroke. RESULTS The mean age of the patients was 67.3 years, of which 67.1% were men, and with ischemic aetiology in 76.5%. On admission 31.4% of patients had spasticity, and this increased to 54.8% at the 3rd month. The absolute risk factor for spasticity was motor index (OR 1.04; 95% CI 1.03-1.05). When this factor was omitted, the variables with predictive ability were: age less than 75 years (OR 0.52; 95% CI 0.30-0.90), sensory impairment (OR 0.66; 95% CI 0.37-1.20), and lower Barthel index score (OR 1.02; 95% CI 1.01-1.03). There was no significant relationship for gender, physiopathological mechanism (ischaemic/haemorrhagic), stroke location, aphasia, or cognitive impairment. CONCLUSION The prevalence of spasticity in stroke at third month of follow-up was 54.8%. Motor index is the independent predictor of spasticity. Patients younger than 75 years old, with sensory impairment and low Barthel index score are more likely to develop spasticity.
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Affiliation(s)
- M Rosario Béseler Soto
- Servicio de Medicina Física y Rehabilitación, Hospital Universitari Dr. Peset, Valencia, España.
| | - José Montes García
- Departamento de Biometría, Effice Servicios para la Investigación S.L., Madrid, España
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Persson CU, Holmegaard L, Redfors P, Jern C, Blomstrand C, Jood K. Increased muscle tone and contracture late after ischemic stroke. Brain Behav 2020; 10:e01509. [PMID: 31893564 PMCID: PMC7010575 DOI: 10.1002/brb3.1509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/21/2019] [Accepted: 11/24/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Systematic studies on increased muscle tone and spasticity late after ischemic stroke, without any selection, are limited. Therefore, we aimed to determine the prevalence of increased muscle tone, classical spasticity and contracture and predictors of increased muscle tone seven years after stroke. METHODS Consecutive patients with acute ischemic stroke <70 years of age (n = 411) were recruited to the Sahlgrenska Academy Study on Ischemic Stroke. Symptoms at index stroke were assessed using the Scandinavian Stroke Scale. Seven years after stroke, survivors (n = 358) were invited for follow-up assessments, of whom 292 agreed to participate and 288 contributed data. Muscle tone according to the Modified Ashworth scale, classical spasticity, and contracture was assessed by a neurologist. The associations between increased muscle tone and characteristics at index stroke and recurrent strokes during follow-up were investigated using logistic regression analysis. RESULTS Increased muscle tone was recognized in 99 participants (34%): 94 (33%) in the upper limbs, and 72 (25%) in the lower limbs. Classical spasticity was found in 51 participants (18%) and contracture in 26 (9%). Age (odds ratio [OR] 1.03 [95% confidence interval [CI] 1.00-1.06]), arm paresis (OR 1.76 [95% CI 1.40-2.2]), aphasia (OR 1.68 [95% CI 1.12-2.51]), and facial palsy (OR 2.12 [95% CI 1.10-4.07]) were independent predictors of increased muscle tone. CONCLUSIONS One-third of patients with ischemic stroke before 70 years of age showed increased muscle tone at 7-year follow-up. Half of them also had classical spasticity. Age, arm paresis, aphasia, and facial palsy at index stroke were predictors of increased muscle tone poststroke.
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Affiliation(s)
- Carina U Persson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Jern
- Department of Clinical Pathology and Genetics, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Stroke Centre West, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Stroke Centre West, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Association Between Spasticity and Functional Impairments During the First Year After Stroke in Korea: The KOSCO Study. Am J Phys Med Rehabil 2019; 97:557-564. [PMID: 29509548 DOI: 10.1097/phm.0000000000000916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the correlation between spasticity severity and functional outcomes during the first year after stroke. DESIGN The Korean Stroke Cohort for Functioning and Rehabilitation is a large, multicenter, prospective cohort study of all patients with acute first-ever stroke admitted to participating hospitals in nine Korean areas. To investigate the correlation between spasticity severity and functional status measured by using the Institutes of Health Stroke Scale (NIHSS), Modified Barthel Index (MBI), Functional Independence Measurement (FIM), Fugl-Meyer Assessment (FMA), Functional Ambulatory Category (FAC), modified Rankin scale (mRS), and American Speech-Language Hearing Association National Outcome Measurement System Swallowing Scale (ASHA-NOMS), data were analyzed at 3, 6, and 12 mos after the occurrence of stroke. RESULTS A total of 7359 stroke patients, 3056 were finally included. Prevalence rates of spasticity in patients after stroke were 6.8% at 3 mos, 6.9% at 6 mos, and 7.6% at 12 mos. The scores of mRS and NIHSS were higher and those of K-MBI, FIM, FMA, and ASHA-NOMS were lower in more severe spastic patients, indicating poorer functional outcomes (P < 0.05). CONCLUSIONS This study demonstrated the coexistence of spasticity and poor functional outcome during the first year after first-ever stroke patients.
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Sandrini G, Baricich A, Cisari C, Paolucci S, Smania N, Picelli A. Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey. FUNCTIONAL NEUROLOGY 2019; 33:37-43. [PMID: 29633695 DOI: 10.11138/fneur/2018.33.1.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present paper provides practical guidance on the management of adult spasticity with OnabotulinumtoxinA. Advisory Board members reviewed the available evidence and discussed their personal experiences in order to address the unmet needs in the management of spasticity with botulinum toxin type A identified by the recent Italian Real-Life Post-Stroke Spasticity Survey. Stroke patients should be referred to spasticity services that have adequate facilities and multidisciplinary teams with the necessary training, competence and expertise. The current literature shows a strong correlation between the development of post-stroke spasticity and the degree of central sensorimotor system destruction/disorganization. Use of tools such as the Poststroke Checklist may help clinicians in the long-term follow-up of stroke patients. The maximum dose of onabotulinumtoxinA - according to the current literature this ranges from 300U to 400U for upper limb and from 500U to 600U for lower limb aggregate postures - should be re-considered. In addition, there is a need for future consensus (also based on pharmacoeconomic considerations) on consistent clinical care models for the management of patients with post-stroke spasticity.
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Comley-White N, Mudzi W, Musenge E. Effects of shoulder strapping in patients with stroke: A randomised control trial. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:430. [PMID: 30214946 PMCID: PMC6131703 DOI: 10.4102/sajp.v74i1.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/23/2018] [Indexed: 11/09/2022] Open
Abstract
Background Disability post stroke remains a global problem, with upper limb involvement playing a key role. Shoulder strapping is one of the techniques used clinically to address this. Objectives To compare the effect of two shoulder strapping techniques in patients with stroke. Method A longitudinal randomised controlled trial included baseline, weeks one, two and six assessments of 56 participants with upper limb hemiplegia. The participants were assessed for shoulder subluxation, shoulder pain, upper limb motor function and muscle tone. They were randomised into control, longitudinal strapping or circumferential strapping groups. Results Longitudinal strapping had a non-significant decrease in shoulder subluxation and pain (p > 0.05). Circumferential strapping had no significant effect on any outcomes; however, it prevented the shoulder pain from worsening as much as in the control group (p > 0.05). General improvement in upper limb motor function was observed for all three groups. Conclusion Trends in improvement showed that longitudinal strapping could be recommended because it positively influenced shoulder subluxation and pain. Even without significant changes, strapping creates awareness of the limb in patients and caregivers and could be of clinical benefit. Clinical implication Longitudinal strapping of the shoulder in patients with stroke seems to positively influence shoulder subluxation and pain.
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Affiliation(s)
- Nicolette Comley-White
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, South Africa
| | - Witness Mudzi
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, South Africa
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Gholami S, Ansari NN, Naghdi S, Tabatabaei A, Jannat D, Senobari M, Dadgoo M. Biomechanical investigation of the modified Tardieu Scale in assessing knee extensor spasticity poststroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23. [PMID: 29148611 DOI: 10.1002/pri.1698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/15/2017] [Accepted: 10/10/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The modified Tardieu Scale (MTS) is a clinical tool for the measurement of muscle spasticity. The present study aimed to investigate the relationship between the MTS and the slope of the work-velocity curve as a biomechanical measure in assessing knee extensor muscle spasticity in patients with stroke. METHODS Thirty patients with stroke (22 female, 8 male; mean age 55.4 ± 12.0 years) participated in this study. The knee extensor spasticity was assessed with the MTS. An isokinetic dynamometer was used to move the knee passively from full extension to 90° flexion at speeds of 60°/s, 120°/s, 180°/s, and 240°/s to collect torque-angle data. The slope of the work-velocity curve was calculated using linear regression [J/(°/s)]. RESULTS The mean of R2-R1 component of MTS was 19.73 (SD 29.85). The mean work significantly decreased as the speed increased (p < .001). The mean (SD) slope for the work-velocity curve was -0.83 (SD 0.73, range -2.6-0.3). There was no significant relationship between the R2 -R1 and the slope of work-velocity curve (r = 0.09, p = .62). CONCLUSIONS The lack of significant relationship between the MTS and the slope of work-velocity curve may question the usefulness of the MTS as a valid measure of muscle spasticity after stroke.
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Affiliation(s)
- Samaneh Gholami
- School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Tabatabaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Jannat
- Industrial Engineering, Tarbiat Modares University, Tehran, Iran
| | - Maryam Senobari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Dadgoo
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Guo P, Gao F, Zhao T, Sun W, Wang B, Li Z. Positive Effects of Extracorporeal Shock Wave Therapy on Spasticity in Poststroke Patients: A Meta-Analysis. J Stroke Cerebrovasc Dis 2017; 26:2470-2476. [PMID: 28918085 DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/20/2017] [Accepted: 08/13/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Spasticity is a common and serious complication following a stroke, and many clinical research have been conducted to evaluate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity in poststroke patients. This meta-analysis aimed to evaluate the therapeutic effect on decreasing spasticity caused by a stroke immediately and 4 weeks after the application of shock wave therapy. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases for relevant studies through November 2016 using the following item: (Hypertonia OR Spasticity) and (Shock Wave or ESWT) and (Stroke). The outcomes were evaluated by Modified Ashworth Scale (MAS) grades and pooled by Stata 12.0 (Stata Corp, College Station, TX, USA). RESULTS Six studies consisting of 9 groups were included in this meta-analysis. The MAS grades immediately after ESWT were significantly improved compared with the baseline values (standardized mean difference [SMD], -1.57; 95% confidence intervals [CIs], -2.20, -.94). Similarly, the MAS grades judged at 4 weeks after ESWT were also showed to be significantly lower than the baseline values (SMD, -1.93; 95% CIs, -2.71, -1.15). CONCLUSIONS ESWT for the spasticity of patients after a stroke is effective, as measured by MAS grades. Moreover, no serious side effects were observed in any patients after shock wave therapy. Nevertheless, our current study with some limitations such as the limited sample size only provided limited quality of evidence; confirmation from a further systematic review or meta-analysis with large-scale, well-designed randomized control trials is required.
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Affiliation(s)
- Peipei Guo
- The Graduate School of Peking Union Medical College, Beijing
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Tingting Zhao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China.
| | - Bailiang Wang
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
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Hesam-Shariati N, Trinh T, Thompson-Butel AG, Shiner CT, McNulty PA. A Longitudinal Electromyography Study of Complex Movements in Poststroke Therapy. 1: Heterogeneous Changes Despite Consistent Improvements in Clinical Assessments. Front Neurol 2017; 8:340. [PMID: 28804474 PMCID: PMC5532386 DOI: 10.3389/fneur.2017.00340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/29/2017] [Indexed: 12/29/2022] Open
Abstract
Poststroke weakness on the more-affected side may arise from reduced corticospinal drive, disuse muscle atrophy, spasticity, and abnormal coordination. This study investigated changes in muscle activation patterns to understand therapy-induced improvements in motor-function in chronic stroke compared to clinical assessments and to identify the effect of motor-function level on muscle activation changes. Electromyography (EMG) was recorded from five upper limb muscles on the more-affected side of 24 patients during early and late therapy sessions of an intensive 14-day program of Wii-based Movement Therapy (WMT) and for a subset of 13 patients at 6-month follow-up. Patients were classified according to residual voluntary motor capacity with low, moderate, or high motor-function levels. The area under the curve was calculated from EMG amplitude and movement duration. Clinical assessments of upper limb motor-function pre- and post-therapy included the Wolf Motor Function Test, Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale. Clinical assessments improved over time (p < 0.01) with an effect of motor-function level (p < 0.001). The pattern of EMG change by late therapy was complex and variable, with differences between patients with low compared to moderate or high motor-function levels. The area under the curve (p = 0.028) and peak amplitude (p = 0.043) during Wii-tennis backhand increased for patients with low motor-function, whereas EMG decreased for patients with moderate and high motor-function levels. The reductions included movement duration during Wii-golf (p = 0.048, moderate; p = 0.026, high) and Wii-tennis backhand (p = 0.046, moderate; p = 0.023, high) and forehand (p = 0.009, high) and the area under the curve during Wii-golf (p = 0.018, moderate) and Wii-baseball (p = 0.036, moderate). For the pooled data over time, there was an effect of motor-function (p = 0.016) and an interaction between time and motor-function (p = 0.009) for Wii-golf movement duration. Wii-baseball movement duration decreased as a function of time (p = 0.022). There was an effect on Wii-tennis forehand duration for time (p = 0.002), an interaction of time and motor-function (p = 0.005) and an effect of motor-function level on the area under the curve (p = 0.034) for Wii-golf. This study demonstrated different patterns of EMG changes according to residual voluntary motor-function levels, despite heterogeneity within each level that was not evident following clinical assessments alone. Thus, rehabilitation efficacy might be underestimated by analyses of pooled data.
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Affiliation(s)
- Negin Hesam-Shariati
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Terry Trinh
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Angelica G. Thompson-Butel
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Christine T. Shiner
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
| | - Penelope A. McNulty
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Science, University of New South Wales, Sydney, NSW, Australia
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CHEN S, GUO SN, Marmori F, NAN YN, WANG J, ZHAO JP. Acupoint stimulation for post-stroke spasticity: a systematic review protocol. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2017. [DOI: 10.1016/s1003-5257(17)30100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Cha EG, Kim SY, Lee HI, Kim DY, Lee J, Sohn MK, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Han J, Chang WH, Shin YI, Kim YH. Prevalence Rate of Spasticity at 3 Months after Stroke in Korea: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BRAIN & NEUROREHABILITATION 2016. [DOI: 10.12786/bn.2016.9.e6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Eun Gyeom Cha
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hae In Lee
- Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Division of Biostatistics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Deog Young Kim
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Junhee Han
- Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Division of Biostatistics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
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Cheung DK, Climans SA, Black SE, Gao F, Szilagyi GM, Mochizuki G. Lesion Characteristics of Individuals With Upper Limb Spasticity After Stroke. Neurorehabil Neural Repair 2015; 30:63-70. [PMID: 25995383 DOI: 10.1177/1545968315585357] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores the relationship between lesion location and volume and upper limb spasticity after stroke. Ninety-seven stroke patients (51 with spasticity) were included in the analysis (age = 67.5 ± 13.3 years, 57 males). Lesions were traced from computed tomography and magnetic resonance images and coregistered to a symmetrical brain template. Lesion overlays from the nonspastic group were subtracted from the spastic group to determine the regions of the brain more commonly lesioned in spastic patients. Similar analysis was performed across groups of participants whose upper limb (elbow or wrist) Modified Ashworth Scale (MAS) score ranged from 1 (mild) to 4 (severe). Following subtraction analysis and Fisher's exact test, the putamen was identified as the area most frequently lesioned in individuals with spasticity. More severe spasticity was associated with a higher lesion volume. This study establishes the neuroanatomical correlates of poststroke spasticity and describes the relationship between lesion characteristics and the severity of spasticity using mixed brain imaging modalities, including computed tomography imaging, which is more readily available to clinicians. Understanding the association between lesion location and volume with the development and severity of spasticity is an important first step toward predicting the development of spasticity after stroke. Such information could inform the implementation of intervention strategies during the recovery process to minimize the extent of impairment.
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Affiliation(s)
- Daniel K Cheung
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
| | | | - Sandra E Black
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Fuqiang Gao
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Gregory M Szilagyi
- Sunnybrook Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
| | - George Mochizuki
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
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Wissel J, Verrier M, Simpson DM, Charles D, Guinto P, Papapetropoulos S, Sunnerhagen KS. Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention. PM R 2014; 7:60-7. [PMID: 25171879 DOI: 10.1016/j.pmrj.2014.08.946] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The complexities of post-stroke spasticity (PSS), and the resultant difficulties in treating the disability, present a significant challenge to patients, stroke rehabilitation teams, and caregivers. Reducing the severity of spasticity and its long-term complications may be facilitated by early intervention, making identification of stroke patients at high risk for developing spasticity essential. Factors that predict which patients are at risk for the development of PSS are identified. TYPE: Systematic search and review LITERATURE SURVEY A PubMed search of the following terms was conducted: predictors OR risk factors AND stroke AND spasticity. Studies discussing predictors of early PSS development and factors predictive of motor/functional outcomes and recovery were selected and reviewed in detail. SYNTHESIS Several predictors of PSS have been proposed, based on studies conducted in patients within 6 months after stroke, including development of increased muscle tone, greater severity of paresis, hemihypesthesia, and low Barthel Index score. Predictors identified in later stages post-stroke (within 12 months) have also proved useful for clinicians, as has the consideration of predictors of motor and functional outcomes and recovery; yet there is a need for additional studies in this area. An understanding of these and other potential predictive factors--such as motor impairment, neurologic and sensory deficit, lesion volume and location, and associated diseases--has not progressed to the same extent and warrants further investigation. CONCLUSION The studies discussed in this review support the notion that early identification of factors predictive of PSS should significantly affect the course of intervention, help target individuals who would benefit most from specific types and intensities of therapy, and possibly provide better motor and functional outcomes.
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Affiliation(s)
- Jörg Wissel
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Neue Bergstrasse 6, D-13585, Berlin, Germany(∗).
| | - Molly Verrier
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada(†)
| | - David M Simpson
- Clinical Neurophysiology Laboratories, Department of Neurology, Mount Sinai Medical Center, New York, NY(‡)
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN(§)
| | - Pia Guinto
- Imprint Publication Science, New York, NY(‖)
| | - Spyros Papapetropoulos
- Allergan, Inc., Irvine, CA, and University of Miami, Miller School of Medicine, Miami, FL(¶)
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Gothenburg, Sweden(#)
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Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors. Stroke Res Treat 2014; 2014:306325. [PMID: 25101190 PMCID: PMC4101928 DOI: 10.1155/2014/306325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/23/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Arm spasticity is a challenge in the care of chronic stroke survivors with motor deficits. In order to advance spasticity treatments, a better understanding of the mechanism of spasticity-related neuroplasticity is needed. Objective. To investigate brain function correlates of spasticity in chronic stroke and to identify specific regional functional brain changes related to rehabilitation-induced mitigation of spasticity. Methods. 23 stroke survivors (>6 months) were treated with an arm motor learning and spasticity therapy (5 d/wk for 12 weeks). Outcome measures included Modified Ashworth scale, sensory tests, and functional magnetic resonance imaging (fMRI) for wrist and hand movement. Results. First, at baseline, greater spasticity correlated with poorer motor function (P = 0.001) and greater sensory deficits (P = 0.003). Second, rehabilitation produced improvement in upper limb spasticity and motor function (P < 0.0001). Third, at baseline, greater spasticity correlated with higher fMRI activation in the ipsilesional thalamus (rho = 0.49, P = 0.03). Fourth, following rehabilitation, greater mitigation of spasticity correlated with enhanced fMRI activation in the contralesional primary motor (r = -0.755, P = 0.003), premotor (r = -0.565, P = 0.04), primary sensory (r = -0.614, P = 0.03), and associative sensory (r = -0.597, P = 0.03) regions while controlling for changes in motor function. Conclusions. Contralesional motor regions may contribute to restoring control of muscle tone in chronic stroke.
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Nalysnyk L, Papapetropoulos S, Rotella P, Simeone JC, Alter KE, Esquenazi A. OnabotulinumtoxinA muscle injection patterns in adult spasticity: a systematic literature review. BMC Neurol 2013; 13:118. [PMID: 24011236 PMCID: PMC3848723 DOI: 10.1186/1471-2377-13-118] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/03/2013] [Indexed: 01/22/2023] Open
Abstract
Background OnabotulinumtoxinA has demonstrated significant benefit in adult focal spasticity. This study reviews the injection patterns (i.e., muscle distribution, dosing) of onabotulinumtoxinA for treatment of adult spasticity, as reported in published studies. Methods A systematic review of clinical trials and observational studies published between 1990 and 2011 reporting data on muscles injected with onabotulinumtoxinA in adult patients treated for any cause of spasticity. Results 28 randomized, 5 nonrandomized, and 37 single-arm studies evaluating 2,163 adult patients were included. The most frequently injected upper-limb muscles were flexor carpi radialis (64.0% of patients), flexor carpi ulnaris (59.1%), flexor digitorum superficialis (57.2%), flexor digitorum profundus (52.5%), and biceps brachii (38.8%). The most frequently injected lower-limb muscles were the gastrocnemius (66.1% of patients), soleus (54.7%), and tibialis posterior (50.5%). The overall dose range reported was 5–200 U for upper-limb muscles and 10–400 U for lower-limb muscles. Conclusions The reviewed evidence indicates that the muscles most frequently injected with onabotulinumtoxinA in adults with spasticity were the wrist, elbow, and finger flexors and the ankle plantar flexors. OnabotulinumtoxinA was injected over a broad range of doses per muscle among the studies included in this review, but individual practitioners should be mindful of local regulatory approvals and regulations.
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Affiliation(s)
- Luba Nalysnyk
- Epidemiology & Database Analytics, United BioSource Corporation, Lexington, MA, USA.
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Bailey T, Doherty P, Rouse S. Impairment and function: the difficulty with definition and measurement of outcome in clinical practice. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.8.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The term function is used in rehabilitation both as an expression of patient status (e.g. low functional capacity) and also as a term to capture the extent of change following rehabilitation interventions (e.g. improved walking efficiency); however there is a lack of consensus as to the possible terms used to encompass the term function. There is uncertainty about the primary focus of interventions within rehabilitation in the sense that some clinicians work on reducing impairment whereas others believe they are working at a functional level. This suggests that the terms are used interchangeably in clinical practice and that an assumed link exists between altering the impairment and improving function. Aim: This analysis paper investigates the distinctiveness and commonality between function and impairment in rehabilitation within a conceptual framework and encourages clinicians to discuss and debate the potential for a universally recognised definition of function. Conclusion: Function and impairment are not always considered as being distinct, resulting in attributing observed changes in impairment to a change in functional status without the evidence to support the process.
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Affiliation(s)
| | - Patrick Doherty
- Rehabilitation & Research at York St John University, UK, and
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Abolhasani H, Ansari NN, Naghdi S, Mansouri K, Ghotbi N, Hasson S. Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study. BMJ Open 2012; 2:bmjopen-2012-001394. [PMID: 23166123 PMCID: PMC3532966 DOI: 10.1136/bmjopen-2012-001394] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. There is a paucity of literature regarding the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS). No study, to date, has been performed to compare the validity of the MMAS and the MTS. This neurophysiological study protocol will compare the validity of the MMAS and the MTS in the assessment of poststroke wrist flexor spasticity. METHODS AND ANALYSIS Thirty-two patients with stroke from the University Rehabilitation clinics will be recruited to participate in this cross-sectional, non-interventional study. All measurements will be taken in the Physical Medicine and Rehabilitation Department of Shafa University Hospital in Tehran, Iran. First, wrist flexor spasticity will be assessed clinically using the MMAS and MTS. The tests will be applied randomly. For the MTS, the components of R1, R2, R2-R1 and quality of muscle reaction will be measured. Second, neurophysiological measures of H-reflex latency, H(max)/M(max) ratio, H(slp) and H(slp)/M(slp) ratio will be collected from the affected side. The results will be analysed using Spearman's ρ test or Pearson's correlation test to determine the validity of the MMAS and the MTS as well as to compare the validity between the MMAS and the MTS. ETHICS AND DISSEMINATION The Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences (TUMS) approved the study protocol. The study results will be disseminated in peer-reviewed publications and presented at international congresses.
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Affiliation(s)
- Hamid Abolhasani
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- 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
| | - Korosh Mansouri
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Georgia Health Sciences University, Augusta, Georgia, USA
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