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

The aims of this study were to determine whether changes in the non-reflex component of spastic plantarflexors had developed 2 and 4 months after stroke and to study their relationship with the level of impairment. One group of adults with hemiparesis (HPs) was tested 2 and 4 months after the onset of stroke, and data were compared with a control group (CTLs) tested once. Twenty-two patients (14 males) admitted over a 4-month period in a rehabilitation centre (mean = 62 yrs +/- 14), and 11 (6 males) non-disabled (CTLs) subjects (mean = 57yrs +/- 12.8) agreed to participate in the study. The resistive torque (RT) recorded with a myometer during slow (8-10 degrees/s) passive dorsiflexions imposed manually served as the primary outcome, whereas, the Ashworth score (spasticity), ankle ROM and Fugl-Meyer motor subscore were used as secondary measures to determine the level of impairment. The mean RT values measured at 0 degrees dorsiflexion on the affected and unaffected sides were compared with those in CTLs. As expected, the RT values 2 and 4 months post-stroke on the unaffected side did not differ from corresponding values in CTLs. Significantly higher RT values on the affected side when compared to the unaffected side were found both at 2 months (39%; p < 0.05) and at 4 months (43%; p < 0.01). No significant difference existed on the affected side between the 2nd and 4th months. A high (r = 0.80) and significant (p < 0.0001) correlation coefficient was calculated between the changes in RT values recorded at 2 and 4 months. Low and not significant correlations were computed between these RT changes and factors such as the ROM (r = -0.24), the Ashworth score (r = 0.23) and the Fugl-Meyer lower extremity motor subscore (r = -0.26). Present results indicate that: (1) changes in the non-reflex component are already present 2 months after stroke but do not increase significantly between the 2nd and 4th months; (2) these changes are not related to the level of impairment; and (3) myometry testing at 2 months could be used as a preventive measure to detect patients more at risk of developing severe passive muscle stiffness.
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PMID:Non-reflex mediated changes in plantarflexor muscles early after stroke. 927 Nov 48

A new hybrid functional electrical stimulation orthosis system for the upper limb has been designed to allow for ease of use in the home as a daily treatment modality, as well as offer the opportunity for function enhancement. In a pilot study, the system was used by ten patients with chronic stable hemiparesis secondary to cerebral vascular accident and head injuries. The patients were referred by their treating physicians or therapists after meeting the inclusion criteria of good general health, being greater than one year after head injury, or being ten months post-stroke, with no observed neurologic changes in the prior six weeks. Each of these patients had received prolonged physical therapy, either continuous from the initial inpatient rehabilitation treatment or on an intermittent basis over a period of years. The baseline status for factors related to increased muscle tone, i.e., passive range of motion at the wrist and elbow, posture at rest, posture immediately following activity, and spasticity were quantified before the treatment protocol with the functional electrical stimulation orthosis. Active range of motion and tests of functional use of the involved upper limb were also assessed. The patients were instructed in the protocol, trained in the use of the system, and then used the electrical orthosis at home for up to several hours per day. Follow-up assessments were at six months. A statistically significant improvement was noted in all muscle tone/spasticity parameters measured. A separate report will describe the effects on voluntary motion and functional capabilities.
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PMID:Hybrid functional electrical stimulation orthosis system for the upper limb: effects on spasticity in chronic stable hemiplegia. 971 14

Spasticity after a stroke interferes with the normal function of a limb. Electric stimulation has been used in a variety of ways to decrease spasticity. The purposes of this study were (1) to quantify the effectiveness of electric stimulation on decreasing ankle spasticity and (2) to develop a quantitative assessment of muscle tone, which could be replicated in the clinic. Ten patients with hemiparesis resulting from ischemic stroke participated in the study according to the selection criteria. Their mean age was 57 yr, with a mean stroke interval of 12.5 months. Patients received electric stimulation for 45 min through surface electrodes applied to the skin in the 12th thoracic and 1st lumbar areas. All patients received five electric stimulation treatment sessions. The electrical pulses were amplitude modulated frequency beat with a carry frequency of 2500 Hz and a stimulation frequency of 20 Hz. The stimulation intensity was adjusted to each patient to produce a sensory stimulation. The pre- and posttreatment evaluation included surface electromyography activity during passive ankle dorsiflexion, passive ankle dorsiflexion resistance at different angular velocities, as measured by an isokinetic machine and the modified Ashworth scale. Our results indicate that the surface spinal cord stimulation with middle frequency modulated to low frequency for sensory stimulation on the skin of 12th thoracic and first lumbar area is effective in reducing calf muscle spasticity of hemiplegic patients. The isokinetic torque measures for spasticity are a sensitive tool to document the effects of the treatment.
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PMID:Effects of surface spinal cord stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic patients. 971 15

In this study the energy cost of level walking was measured in 23 patients with stationary spastic paresis before and after a two-week treatment (45 min daily) of hydro-kinesi therapy, the latter consisting of passive and active movements in warm (32 degrees C) sea water, free swimming and water immersion walking. Among the subjects (80.2 +/- 13.2 kg body mass; 56.0 +/- 14.6 years of age; 10.7 +/- 6.6 years of duration of spasticity), 12 were affected by hemiparesis, 4 by multiple sclerosis and 7 by spinal cord injury. The energy cost of level walking (Cw) was measured before and after therapy from the ratio of the overall steady-state oxygen consumption to the effective speed of progression. The differences in Cw due to the treatment, at matched speeds, were found to be negligible at speeds higher than 0.75 m.s-1 (less than 5%) but to increase, with decreasing speed, up to about 17% at 0.1 m.s-1. The treatment was therefore effective in improving the gait characteristics of the subjects, through a decrease of their Cw, mainly at low speeds of progression.
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PMID:The energy cost of level walking before and after hydro-kinesi therapy in patients with spastic paresis. 976 44

In healthy subjects, functionally appropriate modulation of short latency leg muscle reflexes occurs during gait. This modulation has been ascribed, in part, to changes in presynaptic inhibition of Ia afferents. The changes in modulation of quadriceps tendon jerk reflexes during gait of healthy subjects were compared with those of hemi- or paraparetic spastic patients. The spasticity was due to unilateral cerebral infarction or traumatic spinal cord injury, respectively. The modulation of the quadriceps femoris tendon jerk reflex at 16 phases of the step cycle was studied. The reflex responses obtained during treadmill walking were compared with control values obtained during gait-mimicking standing postures with corresponding levels of voluntary muscle contraction and knee angles. In healthy subjects the size of the reflexes was profoundly modulated and was generally depressed throughout the step cycle. In patients with spinal lesion the reflex depression during gait was almost removed and was associated with weak or no modulation during the step cycle. In patients with cerebral lesion there was less depression of the reflex size associated with a reduced reflex modulation on the affected side compared with healthy subjects. On the 'unaffected' side of these patients reflex modulation was similar to that of healthy subjects, but the reflex size during gait was not significantly different from standing control values. These observations suggest that the mechanisms responsible for the depression of reflex size and the modulation normally seen during gait in healthy subjects are impaired to different extents in spasticity of spinal or cerebral origin, possibly due to the unilateral preservation of fibre tracts in hemiparesis.
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PMID:Impaired modulation of quadriceps tendon jerk reflex during spastic gait: differences between spinal and cerebral lesions. 1009 63

In this study the authors evaluated the effect of a new method--multichannel alternate electrostimulation using the new Bulgarian equipment Vita 2007 for regulating muscular imbalance, breaking the pathological synergic patterns and overcoming motor impairment after stroke. The subjects of the study were 15 patients with hemiparesis secondary to stroke. The beneficial results in accelerating motor recovery and assisting the physical exercise programme for recreating proper patterns of walking and manipulative activity were assigned to the change in the level of spasticity and to the new method of consecutive alternate stimulation of the muscles that take part in the normal movement.
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PMID:Multichannel alternate electrostimulation using the new Bulgarian Vita 2007 equipment in post-stroke rehabilitation. 1046 28

The aim of this investigation was to explore the correlations between some neurophysiological methods and spasticity. An examination of 120 patients with spastic hemiparesis was performed. The muscle tone, force and tendon reflexes were assessed using well-known five-point scales. The F wave, T, H and flexor reflex parameters and the Hvibrated/Hmaximal ratio were obtained. Our results revealed moderate correlations (0.3 < r < 0.5) between the amplitudes of F wave, T and H reflexes and muscle tone. The correlations between the amplitude ratios (Fmaximal/M, Fmean/M, T/M, H/M) and muscle tone were poor, as were the correlations between H reflex thresholds and muscle tone. Moderate correlations existed between Hvibration/Hmaximal ratio and muscle tone. Only the second flexor reflex response showed moderate correlations with muscle tone. In conclusion correlations between the neurophysiological methods employed and muscle tone are moderate. Evaluation of all the F wave, T, H reflex and flexor reflex parameters is not necessary, as only some of these parameters show good correlations with spasticity.
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PMID:Clinical and neurophysiological correlations of spasticity. 1071 92

Congenital hemiparesis is defined as an unilateral disorder of movement and posture, with clinical signs of spasticity with flexor hypertonicity, increased tendon reflexes and characteristic posturing. We have examined a group of 26 children with congenital hemiparesis (14 boys and 12 girls) with mean age of 3.5 years (range 6 months to 9 years). 24 had been born at term (% weeks gestation) and 2 were preterm (% completed weeks gestation). From the neuroimaging point of view, congenital hemiparesis form a rather heterogeneous group. CT scans revealed: porencephalic cyst (6), unilateral ventricular enlargement (2), cortical atrophy with unilateral ventricular enlargement (1), hypodense zones resulting from previous hemathermous (4), normal CT scans (6), and 7 cases have not had CT scans for technical reasons (war conditions). Congenital hemiparesis mainly affects term children with prenatal origin in majority of cases. Vascular occlusions (in utero stroke) originating from various pathophysiological factors, maternal or fetal, may result in congenital hemiparesis. Normal CT findings should be revised by using MRI, which provides direct evidence of white matter lesions.
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PMID:[Characteristics of computerized tomography of the brain in congenital hemiparesis]. 1075 57

This study provides a detailed analysis of disturbances in the kinematics and dynamics of the acceleration phase of multijoint arm movements in six patients with chronic hemiparesis. Movements of the dominant and nondominant limbs were also examined in three control subjects. Subjects performed rapid movements from a central starting point to 16 targets located equidistantly around the circumference of a circle. Support of the upper limb was provided by an air-bearing apparatus, which allowed very low friction movements in the horizontal plane. We found that patients retained the capacity to modulate, in response to target direction, the initial direction of movements performed with the paretic limb. However, in comparison to the nonparetic limb or control subjects, movements of the paretic limb were misdirected systematically. An inverse dynamics analysis revealed an abnormal spatial tuning of the muscle torque at the elbow used to initiate movements of the paretic limb. Based on electromyographic recordings, similar spatial abnormalities were also apparent in the initial activations of elbow muscles. We argue that these spatial abnormalities result from a systematic disturbance in the control signal to limb muscles that cannot be attributed to previously identified mechanisms such as weakness, spasticity mediated restraint, or stereotypic muscle activation patterns (muscle synergies). Instead, our analysis of movement dynamics and simulation studies demonstrate that the spatial abnormalities are consistent with an impaired feedforward control of the passive interaction torques which arise during multijoint movements. This impaired control is hypothesized to reflect a degradation of the internal representation of limb dynamics that occurs either as a primary consequence of brain injury or secondary to disuse.
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PMID:Deficits in the coordination of multijoint arm movements in patients with hemiparesis: evidence for disturbed control of limb dynamics. 1078 46

Spasticity treatment must be considered in relation to other impairments with functional goals defined prior to intervention. The effects of muscle co-contraction and involuntary limb movement associated with exaggerated cutaneous reflexes or effort as well as stretch reflex hyperexcitability need to be considered. Exacerbating factors such as pain must be identified. Physical therapy and conventional orthoses are the mainstays of spasticity management during acute rehabilitation. Botulinum toxin shows promise but needs further evaluation in the context of acute rehabilitation. Phenol chemodenervation can produce good results in spasticity refractory to standard treatments. Muscle strengthening exercises may be appropriate in chronic hemiparesis without adversely affecting tone. Electrical stimulation may be a useful adjunct to other spasticity treatments. Difficulty demonstrating functional benefit from antispasticity treatment may imply that interventions directed at single motor impairments whether weakness or spasticity are not likely to result in functional benefit, but it is their combination that is important.
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PMID:Management of spasticity in stroke. 1109 96


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