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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our knowledge of the specific root innervation of skeletal muscles is derived from accumulated clinical experience. While performing selective posterior rhizotomy for treatment of spasticity in children with cerebral palsy, we made direct electrophysiologic measurement of the root innervation of the lower extremity. We stimulated ventral roots from L2 to S2 while recording from all muscles simultaneously. The size of the evoked compound muscle action potential was used as an indication of the amount of innervation derived from stimulation of a given spinal root. We found the major root innervation for the 8 muscles studied to be: adductor longus, vastus medialis, and vastus lateralis, L3; tibialis anterior; L4; peroneus longus, L5; and medial gastrocnemius, lateral gastrocnemius, and gluteus maximus, S1. In general, each muscle received innervation from 3 or more roots. Prefixed or postfixed innervation patterns were found in 27.9% of legs examined, and there was asymmetry of innervation in 29.8%. We conclude that the segmental innervation of lower extremity muscles is broader than previously thought. Anomalous innervation occurs so frequently that caution should be used in attributing any pattern of clinical or EMG findings to a specific spinal level.
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PMID:Electrophysiologic mapping of the segmental anatomy of the muscles of the lower extremity. 149 14

The spastic type of cerebral palsy has become more prevalent due to improved survival rates of premature infants. Selective posterior rhizotomy is a neurosurgical procedure which is designed to reduce spasticity and has been successfully used for children with spastic cerebral palsy. Although the procedure of posterior rhizotomy is nearly 100 years old, a revised technique was introduced in 1981. Since that time, the procedure has been further refined and its use has altered the theory and practice of cerebral palsy management. This paper reviews the neurophysiological and anatomical facts that have influenced the development of the technique. The current practice of selective posterior rhizotomy is an evolving process which has stimulated scientific interest in spasticity, cerebral palsy and its management.
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PMID:Selective posterior rhizotomy: evolution of theory and practice. 181 26

Results of sensory rhizotomy for the treatment of spasticity have been dramatically improved by newer microsurgical techniques employing intraoperative electrophysiological monitoring. This is now the treatment of choice for spasticity related to cerebral palsy. The goal of surgery is to achieve a permanent reduction in spasticity thereby improving ambulation and activities of daily living.
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PMID:Selective posterior rhizotomy for relief of spasticity. 182 47

Activations of the triceps surae (TS) and tibialis anterior (TA) muscles during gait were studied in children with spastic cerebral palsy (CP) immediately before and after 30 min of standing on a tilt-table with the ankle dorsiflexed to stretch the TS in the experimental group (n = 8) or after a rest period in the control group (n = 11). The EMG activity from the TS and TA was recorded concomitantly with electronic footswitch signals by a computer. Video records were made of the sagittal gait movements. Effects of PMS were determined by comparing change scores for selected spatiotemporal and muscle activation parameters between the groups. The change scores defined for the muscle activations were: a post-test/pre-test ratio of the EMG activity in specific segments of the gait cycle and a locomotor spasticity index. PMS did not significantly (p greater than 0.05) affect any of the spatiotemporal parameters nor did it alter any of the TS and most of the TA activation parameters or the SI indexes for the TS and TA. Only the TA post/pre activation ratio for the 0-16% segment of the gait cycle was smaller (p less than 0.01), indicating a decrease in TA activation post-PMS.
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PMID:Effects of a single session of prolonged plantarflexor stretch on muscle activations during gait in spastic cerebral palsy. 189 34

Because clinicians are introducing joint mobilization into treatment programs for children with cerebral palsy, we felt that a review of the procedure and its scientific basis would be timely. The goals of the introductory section of this article are to define joint mobilization as it has been used for adults with musculoskeletal disabilities, to discuss various rationales for its effects, to describe contraindications and precautions for its use, and to discuss its efficacy as reported in the research literature. The latter part of the article deals with the use of joint mobilization for children with central nervous system (CNS) disorders. In an effort to understand precautions for the use of joint mobilization in children, musculoskeletal development will be described both for typically developing children and for children with spastic cerebral palsy. Indications for using joint mobilization techniques in children with spasticity will be outlined. Specific neurodevelopmental disabilities for which joint mobilization would be strongly contraindicated will be listed. Finally, future research directions in evaluating reliability of assessment of joint dysfunction and efficacy of joint mobilization in children will be discussed.
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PMID:Joint mobilization for children with central nervous system disorders: indications and precautions. 194 23

A recent increase in the popularity of selective rhizotomy for reduction of spasticity in cerebral palsy has led to a demand for more objective studies of outcome and long-term follow-up results. The authors present the results of gait analysis on 14 children with spastic cerebral palsy, who underwent selective posterior rhizotomy in 1985. Sagittal plane gait patterns were studied before surgery and at 1 and 3 years after surgery using a digital camera system. The parameters measured included the range of motion at the knee and thigh, stride length, speed of walking, and cadence. The range of motion at the knee was significantly increased at 1 year after surgery and further improved to a nearly normal range at 3 years after surgery. In contrast, postoperative measurements of thigh range exceeded normal values at 1 year, but decreased toward normal range at 3 years. While improvements in range of motion continued between Years 1 and 3, the children developed a more extended thigh and knee position, which indicated a more upright walking posture. Stride length and speed of walking also improved, while cadence remained essentially unchanged. This 3-year follow-up study, the first to examine rhizotomy using an objective approach, has provided some encouraging results regarding early functional outcome.
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PMID:Cerebral palsy and rhizotomy. A 3-year follow-up evaluation with gait analysis. 198 85

The recent increase in popularity of selective posterior rhizotomy demands objective documentation of surgical outcome. For this reason, the authors have analyzed the status of 25 children with spastic cerebral palsy before and after rhizotomy to determine the effects of this therapy on muscle tone, range of movement, and motor function. Postoperative tests showed a reduction in muscle tone compared with preoperative assessments. Range of motion in the lower extremities was significantly increased and improvements in functional gross motor skills were noted. An increase in range of motion in the knees and thighs during gait was detected in 18 ambulatory patients studied with computerized two-dimensional motion analysis. Preliminary findings indicate that selective posterior rhizotomy reduced spasticity, thereby increasing range of motion and contributing to improvements in active functional mobility.
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PMID:Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. 199 2

Seventeen patients with congenital spastic cerebral palsy and six patients with other forms of spasticity were injected intrathecally with doses of placebo or baclofen, 25 micrograms, 50 micrograms, or 100 micrograms, in a randomized, double-blind manner. Muscle tone in the upper and lower extremities was assessed by Ashworth scores both before the injections and every 2 hours afterward for 8 hours. Function of the upper extremities was evaluated before the injections and 4 hours afterward. Muscle tone in the lower extremities was significantly decreased within 2 hours after baclofen injection and remained lower than baseline 8 hours afterward. Upper extremity tone and function were not significantly affected by these single doses. Confusion and drowsiness occurred in two of the youngest children in the study after the 50-micrograms dose, but cleared within 2 hours. Our findings indicate that intrathecal baclofen reduces spasticity in children with cerebral palsy, as it does in adults with spasticity of spinal origin.
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PMID:Intrathecal baclofen for spasticity in cerebral palsy. 204 30

The results from selective dorsal rhizotomy research suggest that therapists need to question some common clinical assumptions about movement dysfunction. The rationale for performing a selective dorsal rhizotomy is based on the clinical assumptions that spasticity is the underlying cause of disordered movement and that reducing or eliminating the spasticity will improve movement. This article reviews the literature related to movement dysfunction, the effects of selective dorsal rhizotomy, and the evidence for disordered motor control in children with spastic cerebral palsy. Selective dorsal rhizotomy appears to reduce spasticity and increase joint range of motion. Abnormal movement patterns, however, persist after the spasticity is reduced. Well-coordinated movement patterns are acquired slowly and appear to be related to an intense period of physical therapy. I argue that these results provide evidence that the presence of spasticity alone is an insufficient explanation for abnormal movement patterns. I propose that physical therapists redirect their efforts from developing methods for reducing spasticity to developing adequate assessment, treatment, and measurement techniques for assessing motor control in children with cerebral palsy. I believe we can maximize the functional potential of children with cerebral palsy by identifying problems related to motor control and applying sound principles of motor learning to treatment.
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PMID:Dorsal rhizotomy for children with cerebral palsy: support for concepts of motor control. 200 Apr 41

Although selective posterior rhizotomy has become an increasingly utilized surgical treatment for spasticity, the procedure is unstandardized and is performed differently at various medical centers. Most surgeons use some form of direct dorsal rootlet stimulation with intraoperative multichannel electromyographic response monitoring. Electrophysiological monitoring offers the theoretical advantage of identifying pathologic reflex circuits for interruption while preserving those pathways that are "normal." However, the monitoring technique most commonly used has not been critically evaluated and, therefore, its value remains uncertain. In 22 selective posterior rhizotomy procedures performed for spastic cerebral palsy, the authors were unable to identify a single electromyographic response that could be called normal by presently accepted criteria. Dorsal rootlets were chosen for division on the basis of relative degrees of abnormality. Intraoperative electromyographic monitoring of a nonspastic patient produced tracings suggestive of spasticity by presently accepted criteria. These discrepancies suggest that current electrophysiological monitoring in selective posterior rhizotomy should be reevaluated.
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PMID:How selective is selective posterior rhizotomy? 200 41


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