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Ranzani R, Razzoli M, Sanson P, Song J, Galati S, Ferrarese C, Lambercy O, Kaelin-Lang A, Gassert R. Feasibility of Adjunct Therapy with a Robotic Hand Orthosis after Botulinum Toxin Injections in Persons with Spasticity: A Pilot Study. Toxins (Basel) 2024; 16:346. [PMID: 39195756 PMCID: PMC11360205 DOI: 10.3390/toxins16080346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Upper-limb spasticity, frequent after central nervous system lesions, is typically treated with botulinum neurotoxin type A (BoNT-A) injections to reduce muscle tone and increase range of motion. However, performing adjunct physical therapy post-BoNT-A can be challenging due to residual weakness or spasticity. This study evaluates the feasibility of hand therapy using a robotic hand orthosis (RELab tenoexo) with a mobile phone application as an adjunct to BoNT-A injections. Five chronic spastic patients participated in a two-session pilot study. Functional (Box and Block Test (BBT), Action Research Arm Test (ARAT)), and muscle tone (Modified Ashworth Scale (MAS)) assessments were conducted to assess functional abilities and impairment, along with usability evaluations. In the first session, subjects received BoNT-A injections, and then they performed a simulated unsupervised therapy session with the RELab tenoexo in a second session a month later. Results showed that BoNT-A reduced muscle tone (from 12.2 to 7.4 MAS points). The addition of RELab tenoexo therapy was safe, led to functional improvements in four subjects (two-cube increase in BBT as well as 2.8 points in grasp and 1.3 points in grip on ARAT). Usability results indicate that, with minor improvements, adjunct RELab tenoexo therapy could enhance therapy doses and, potentially, long-term outcomes.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
- Cereneo, Center for Neurology and Rehabilitation, Seestrasse 18, 6354 Vitznau, Switzerland
| | - Margherita Razzoli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Pierre Sanson
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Jaeyong Song
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Salvatore Galati
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Alain Kaelin-Lang
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
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Alashram AR. Dry needling effects on motor impairments in a patient with traumatic brain injury: A case study. J Bodyw Mov Ther 2024; 39:214-217. [PMID: 38876628 DOI: 10.1016/j.jbmt.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/18/2024] [Accepted: 03/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Motor impairments are common consequences of traumatic brain injury (TBI). It affects the individuals' participation in activities of daily living (ADLs). Dry needling treatment (DNT) uses a specialized needle to alter cortical activity. This case study aims to examine the effects of DNT on spasticity, balance, gait, and self-independence in a single patient with TBI. CASE DESCRIPTION A twenty-six-year-old male with a history of TBI, resulting in muscle weakness on the right side of the body, spasticity, distributed balance, and difficulties with independent gait participated in this study. The Berg balance scale (BBS), 6-min walk test (6MWT), Modified Ashworth Scale (MAS), and Functional Independence Measure (FIM) were used to evaluate balance, gait, spasticity, and functional performance, respectively. OUTCOME After 36 DNT sessions extended over 12 weeks, the patient demonstrated improvements in spasticity, balance, gait, and functional capacity both immediately after the intervention and at the 4-week follow-up. CONCLUSION This case study demonstrates that DNT is considered a novel intervention for treating spasticity and improving balance, gait, and functional capacity post-TBI. Further research is recommended to verify these findings.
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Affiliation(s)
- Anas R Alashram
- Physiotherapy Department, Middle East University, Amman, Jordan; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Brandenburg JE, Rabatin AE, Driscoll SW. Spasticity Interventions: Decision-Making and Management. Pediatr Clin North Am 2023; 70:483-500. [PMID: 37121638 DOI: 10.1016/j.pcl.2023.01.005] [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: 05/02/2023]
Abstract
Spasticity results from an abnormality of the central nervous system and is characterized by a velocity-dependent increase in muscle tone or stiffness. In children, it can cause functional impairments, delays in achieving developmental or motor milestones, participation restrictions, discomfort, and musculoskeletal differences. Unique to children is the ongoing process of a maturing central nervous system and body, which can create the appearance of worsening or changing spasticity. Treatment options include physical interventions such as stretching, serial casting, and bracing; oral and injectable medications; and neurosurgical procedures such as selective dorsal rhizotomy and intrathecal baclofen pump.
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Affiliation(s)
- Joline E Brandenburg
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Emamhadi M, Alijani B, Haghani Dogahe M, Emamhadi A. Hyper-selective neurectomy for knee flexion spasticity: anatomic bases and surgical technique. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2023; 45:201-205. [PMID: 36633655 DOI: 10.1007/s00276-022-03074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Spasticity may result from damage to neurons of the corticospinal tracts and loss of inhibitory supraspinal influences following head trauma. Traditionally, peripheral nerve surgeries for spasticity in lower limbs were limited to selective neurectomies. Here we used hyper-selective neurectomy (HSN) to release hamstring spasticity at the muscle spindle level. METHODS This study describes anatomic bases and surgical technique of HSN and its results in treating spastic knee flexion in a 23-year-old male who developed severe spasticity following severe brain injury. The spasticity was prominent in the left knee. The surgical technique including resection of over one centimeter of three-quarters of the overstimulated nerve rami at the entry point of the nerve into the muscle is shown in the video 1. RESULTS After the surgery Visual Analog Scale and Modified Ashworth Score reduced from 7 to 3 and 4 to 1, respectively. Popliteal angle improved from 118° to 73° at the second months after the surgery. CONCLUSION Hyper-selective neurectomy is a safe and reliable therapeutic option for the treatment of permanent trauma induced spasticity in the lower limb.
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Affiliation(s)
- Mohammadreza Emamhadi
- Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran. .,Brachial Plexus and Peripheral Nerve Injury Center, Rasht, Iran.
| | - Babak Alijani
- Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran
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Xie J, Zhong C, Wang T, He D, Lu L, Yang J, Yuan Z, Zhang J. Better Bioactivity, Cerebral Metabolism and Pharmacokinetics of Natural Medicine and Its Advanced Version. Front Pharmacol 2022; 13:937075. [PMID: 35833035 PMCID: PMC9271619 DOI: 10.3389/fphar.2022.937075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, many people are afflicted by cerebral diseases that cause dysfunction in the brain and perturb normal daily life of people. Cerebral diseases are greatly affected by cerebral metabolism, including the anabolism and catabolism of neurotransmitters, hormones, neurotrophic molecules and other brain-specific chemicals. Natural medicines (NMs) have the advantages of low cost and low toxicity. NMs are potential treatments for cerebral diseases due to their ability to regulate cerebral metabolism. However, most NMs have low bioavailability due to their low solubility/permeability. The study is to summarize the better bioactivity, cerebral metabolism and pharmacokinetics of NMs and its advanced version. This study sums up research articles on the NMs to treat brain diseases. NMs affect cerebral metabolism and the related mechanisms are revealed. Nanotechnologies are applied to deliver NMs. Appropriate delivery systems (exosomes, nanoparticles, liposomes, lipid polymer hybrid nanoparticles, nanoemulsions, protein conjugation and nanosuspensions, etc.) provide better pharmacological and pharmacokinetic characteristics of NMs. The structure-based metabolic reactions and enzyme-modulated catalytic reactions related to advanced versions of NMs alter the pharmacological activities of NMs.
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Affiliation(s)
- Jiaxi Xie
- Chongqing Research Center for Pharmaceutical Engineering, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Cailing Zhong
- Chongqing Research Center for Pharmaceutical Engineering, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Tingting Wang
- Biochemistry and Molecular Biology Laboratory, Experimental Teaching and Management Center, Chongqing Medical University, Chongqing, China
| | - Dan He
- Chongqing Research Center for Pharmaceutical Engineering, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Luyang Lu
- College of Pharmacy, Southwest Minzu University, Chengdu, China
| | - Jie Yang
- Chongqing Research Center for Pharmaceutical Engineering, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Ziyi Yuan
- Chongqing Research Center for Pharmaceutical Engineering, College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Jingqing Zhang
- Chongqing Research Center for Pharmaceutical Engineering, College of Pharmacy, Chongqing Medical University, Chongqing, China
- *Correspondence: Jingqing Zhang,
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Irzan H, Pozzi M, Chikhladze N, Cebanu S, Tadevosyan A, Calcii C, Tsiskaridze A, Melbourne A, Strazzer S, Modat M, Molteni E. Emerging Treatments for Disorders of Consciousness in Paediatric Age. Brain Sci 2022; 12:198. [PMID: 35203961 PMCID: PMC8870410 DOI: 10.3390/brainsci12020198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0-4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.
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Affiliation(s)
- Hassna Irzan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Serghei Cebanu
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan 0025, Armenia;
| | - Cornelia Calcii
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Alexander Tsiskaridze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Sandra Strazzer
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
- Rehabilitation Service, “Usratuna” Health and Rehabilitation Centre, Juba, South Sudan
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
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Dehnadi Moghadam A, Hasanzadeh H, Dehnadi Moghadam F. Evaluation of the Effect of Intranasal Lidocaine in the Treatment of Spasticity in Patients with Traumatic Brain Injury. Anesth Pain Med 2021; 11:e115849. [PMID: 34692437 PMCID: PMC8520675 DOI: 10.5812/aapm.115849] [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: 05/08/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Spasticity following traumatic brain injury (TBI) is one of the most significant barriers of returning patients to their normal life. Spasticity caused by TBI does not have a specific or definitive treatment, and the clinical effect of pharmacologic treatments has not been significant. Methods In this single-arm study, we evaluated 15 patients. For each patient with spasticity, treatment with oral baclofen 25 mg was started three times a day as a part of standard therapy. After 48 hours, if the spasticity did not decrease by at least one score in the Modified Tardieu or Ashworth scales, lidocaine 0.5% was administered as a continuous intranasal infusion. The initial dose of lidocaine was 1 mg/min, which was gradually increased to 2 mg/min. Spasticity and the frequency of spasms were assessed by Ashworth and modified tardieu scales (MTS) and Spasm Frequency Score (SFS), respectively. Heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale (GCS), and arterial oxygen saturation (SPo2) of patients were recorded during nine days of treatment. All data were analyzed by SPSS version 21. P-value less than 0.05 was considered as statistically significant. Results Out of 15 participants in this study, 13 (86.7%) were male, and 2 (13.3%) were female (mean age: 29.26 ± 12.5 years). There were no significant differences in Ashworth Scale, Modified Tradieu Scale, RASS Score, GCS Score, MAP, SPo2 percentage, HR, RR, and the number of spasms per day between the time of initiation of treatment and the second day of baclofen treatment (P > 0.05). Evaluation of spasticity using Ashworth scale on the first and last days of lidocaine treatment showed a significant decrease in the mean spasticity (3.46 ± 0.51 and 1.46 ± 0.91, respectively; P < 0.001). Spasticity assessment using the MTS showed a significant reduction in the mean of the last day of treatment compared to the mean of the first day of treatment (3.6 ± 0.5 and 1.26 ± 0.51, respectively; P < 0.001). This decrease was also seen in the mean of the last day of treatment compared to the first day in SFS (13.3 ± 3.88 and 3.8 ± 0.51, respectively; P < 0.001). Comparison of HR, RR, MAP, RASS, GCS, and SPo2 on the first and last days of treatment did not show any statistical differences. Conclusions Although continuous intranasal treatment with lidocaine can be effective in spasm reduction of patients with TBI, further studies with larger sample sizes and longer follow-up periods are required.
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Affiliation(s)
| | - Hamed Hasanzadeh
- Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran.
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Zúñiga LDO, López CAG, González ER. Ultrasound Elastography in the Assessment of the Stiffness of Spastic Muscles: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1448-1464. [PMID: 33707090 DOI: 10.1016/j.ultrasmedbio.2021.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
The incidence of muscle spasticity is high in patients with diseases of the central nervous system. This condition leads to significant limitations in movement and impaired functional capacities. Muscle spasticity manifests as changes in the mechanical properties of the muscles. This muscle disorder is generally assessed using qualitative methods, whose validity, reliability and sensitivity are questionable. In recent years, ultrasound elastography (USE) has been used as a non-invasive technique for characterizing the stress response and mechanical properties of individual muscles in the evaluation of spasticity. This article presents a systematic review of the USE techniques, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guidelines, used for the evaluation of muscle stiffness caused by spasticity. The articles selected in this study were evaluated using the Quality Appraisal of Diagnostic Reliability (QAREL) tool. Mainly, studies on the assessment of spasticity involving the evaluation of muscle stiffness with USE techniques (i.e., shear-wave elastography [SWE] or compression elastography [CE]) were selected. Then, common topics related to the assessment of spastic muscles and the statistical results of these studies were classified. Of 21 articles, nine used only CE, 10 used only SWE and two used both techniques. In the studies, statistically significant differences were observed in the measurements of muscle stiffness between the paretic and non-paretic sides as well as between patients and healthy patients. The clinical measurements obtained, devices used and assessment and probe positions for both techniques were discussed. The most frequently studied muscles were the biceps (n = 7) and gastrocnemius (n = 11). On applying the QAREL tool, we found that only two studies showed compliance at 80%-90%, seven studies at 50%-70% and the remaining 12 at 10%-40%. The results showed that USE techniques have limitations in spasticity assessment, such as subjectivity because of the lack of standardized protocols. A deficit of studies on intra-operator and inter-operator measurements indicates that this technique is not yet mature for spasticity diagnosis, although it is a promising diagnostic tool for designing treatment plans and monitoring the effectiveness of therapeutic modalities.
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Affiliation(s)
- Laura Daniela Ordierez Zúñiga
- University of Cauca, Electronics and Telecommunications Engineering Faculty, Electronics Deparment, Automation research group, Popayán, Colombia.
| | - Carlos Alberto Gaviria López
- University of Cauca, Electronics and Telecommunications Engineering Faculty, Electronics Deparment, Automation research group, Popayán, Colombia
| | - Elizabeth Roldán González
- Fundación Universitaria María Cano, Physiotherapy program, research group importance of movement of human development, Fisioter, Colombia
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Pozzi M, Galbiati S, Locatelli F, Carnovale C, Radice S, Strazzer S, Clementi E. Drug Use in Pediatric Patients Admitted to Rehabilitation For Severe Acquired Brain Injury: Analysis of the Associations With Rehabilitation Outcomes. Paediatr Drugs 2021; 23:75-86. [PMID: 33230677 DOI: 10.1007/s40272-020-00429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Patients with severe acquired brain injuries require drug therapies in intensive care for life support and injury treatment. Patients who then access rehabilitation usually maintain their drug treatments long term, with a potential influence on the rehabilitation course. Whereas drug effects have been reported for specific drugs and clinical issues in adults, comprehensive data on pediatric patients with traumatic and non-traumatic injuries are scant. OBJECTIVES The aims of this study were to describe the therapeutic classes and groups of drugs prescribed to pediatric inpatients recovering from severe acquired brain injury when they enter rehabilitation; to assess whether clinical variables may determine the use of drug classes; and to assess whether the use of drug classes may be associated with differences in rehabilitation outcomes. METHODS We carried out a retrospective chart review, following a previous study on the clinical-epidemiological characteristics of our patients. We collected information on drug therapies present at admittance to rehabilitation and analyzed their distribution according to therapeutic classes and groups. We verified the associations of drug groups with clinical variables (putatively antecedents to drug use) and with rehabilitation outcomes (putatively resultant of drug use and of clinical variables) in regression models. The clinical variables considered were injury etiology, Glasgow Outcome Score (GOS) at admittance to rehabilitation, sex, age at injury, plus two aggregate factors resulting from the previous work, 'neurological dysfunction' regarding the use of devices and 'injury severity' regarding the neurological status. The rehabilitation outcomes used were death after rehabilitation, persistence of a vegetative/minimally conscious state, coma duration, duration of the rehabilitation stay, rehabilitation efficiency (GOS at discharge minus GOS at admittance, divided by the length of rehabilitation stay). RESULTS We described the distribution of drug classes and groups among pediatric patients with severe acquired brain injuries. Regarding the associations between drug classes and clinical variables, we found greater use of cardiovascular agents with higher patient age, 'neurological dysfunction' score, and with an etiology of hypoxic brain injury. The use of antithrombotic agents was greater with higher patient age and 'neurological dysfunction' score. Glucocorticoid use was greater with higher GOS at admittance and with several etiologies: brain tumor, infective encephalitis, and autoimmune encephalitis. Regarding drug classes and rehabilitation outcomes, we found that the use of cardiovascular drugs was associated with increased occurrence of death after rehabilitation. The use of antispastic drugs was associated with a more frequent permanence in vegetative/minimally conscious states. The use of antispastic drugs and melatonin was associated with longer coma duration. The use of glucocorticoid drugs was associated with decreased rehabilitation efficiency. CONCLUSIONS We provided a description of drug use in pediatric rehabilitation after severe acquired brain injuries, which was lacking in the literature. Prospective studies should verify our associative observations regarding clinical variables, drugs use, and outcomes, to assess causality.
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Affiliation(s)
- Marco Pozzi
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Sara Galbiati
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Federica Locatelli
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Sandra Strazzer
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.
| | - Emilio Clementi
- U.O. Gravi Cerebrolesioni Acquisite NR3, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
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Gyimesi M, Horváth ÁI, Túrós D, Suthar SK, Pénzes M, Kurdi C, Canon L, Kikuti C, Ruppel KM, Trivedi DV, Spudich JA, Lőrincz I, Rauscher AÁ, Kovács M, Pál E, Komoly S, Houdusse A, Málnási-Csizmadia A. Single Residue Variation in Skeletal Muscle Myosin Enables Direct and Selective Drug Targeting for Spasticity and Muscle Stiffness. Cell 2020; 183:335-346.e13. [PMID: 33035452 DOI: 10.1016/j.cell.2020.08.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/24/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
Muscle spasticity after nervous system injuries and painful low back spasm affect more than 10% of global population. Current medications are of limited efficacy and cause neurological and cardiovascular side effects because they target upstream regulators of muscle contraction. Direct myosin inhibition could provide optimal muscle relaxation; however, targeting skeletal myosin is particularly challenging because of its similarity to the cardiac isoform. We identified a key residue difference between these myosin isoforms, located in the communication center of the functional regions, which allowed us to design a selective inhibitor, MPH-220. Mutagenic analysis and the atomic structure of MPH-220-bound skeletal muscle myosin confirmed the mechanism of specificity. Targeting skeletal muscle myosin by MPH-220 enabled muscle relaxation, in human and model systems, without cardiovascular side effects and improved spastic gait disorders after brain injury in a disease model. MPH-220 provides a potential nervous-system-independent option to treat spasticity and muscle stiffness.
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Affiliation(s)
- Máté Gyimesi
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary; Motorpharma, Ltd., Szilágyi Erzsébet fasor 27, 1026 Budapest, Hungary.
| | - Ádám I Horváth
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary
| | - Demeter Túrós
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary
| | - Sharad Kumar Suthar
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary; Printnet, Ltd., Kisgömb utca 25-27, 1135 Budapest, Hungary
| | - Máté Pénzes
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary
| | - Csilla Kurdi
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary
| | - Louise Canon
- Structural Motility, Institut Curie, Paris Université Sciences et Lettres, Sorbonne Université, CNRS UMR144, 75005 Paris, France
| | - Carlos Kikuti
- Structural Motility, Institut Curie, Paris Université Sciences et Lettres, Sorbonne Université, CNRS UMR144, 75005 Paris, France
| | - Kathleen M Ruppel
- Department of Biochemistry, Stanford University School of Medicine, Beckman Center B400, 279 W. Campus Drive, Stanford, CA 94305, USA
| | - Darshan V Trivedi
- Department of Biochemistry, Stanford University School of Medicine, Beckman Center B400, 279 W. Campus Drive, Stanford, CA 94305, USA
| | - James A Spudich
- Department of Biochemistry, Stanford University School of Medicine, Beckman Center B400, 279 W. Campus Drive, Stanford, CA 94305, USA
| | - István Lőrincz
- Printnet, Ltd., Kisgömb utca 25-27, 1135 Budapest, Hungary
| | - Anna Á Rauscher
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary; Motorpharma, Ltd., Szilágyi Erzsébet fasor 27, 1026 Budapest, Hungary
| | - Mihály Kovács
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary; Department of Biochemistry, Eötvös Loránd University, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary and Brunszvik u. 2, 2462 Martonvásár, Hungary
| | - Endre Pál
- Department of Neurology, University of Pécs, Rét utca 2, 7623 Pécs, Hungary
| | - Sámuel Komoly
- Department of Neurology, University of Pécs, Rét utca 2, 7623 Pécs, Hungary
| | - Anne Houdusse
- Structural Motility, Institut Curie, Paris Université Sciences et Lettres, Sorbonne Université, CNRS UMR144, 75005 Paris, France
| | - András Málnási-Csizmadia
- MTA-ELTE Motor Pharmacology Research Group, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary; Department of Biochemistry, Eötvös Loránd University, Pázmány Péter sétány 1/c, 1117 Budapest, Hungary and Brunszvik u. 2, 2462 Martonvásár, Hungary.
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