Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Femoral fractures during the physical therapy in two patients with spinal cord injury and consequent osteoporosis in the paralyzed limbs are reported. The fractures were caused by a minor trauma and the spasticity was considered to be an additional factor in the accident. During the physical therapy the patients were seated with hip abduction and flexion of the knee. It is important that the patients participate in a program of physiotherapy. This, however, should be performed under strict control.
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PMID:[Femoral fracture in patients with spinal cord injury]. 184 41

Two brothers with a recently described inborn error of metabolism characterized by glyceroluria, hyperglycerolemia, and generalized glycerol kinase deficiency had moderate psychomotor retardation, spasticity, growth failure, a nonspecific myopathy, osteoporosis, and adrenal insufficiency. Glycerol kinase activity in leukocytes and cultured fibroblasts was less than 5% of control values. Hepatic and renal tissue obtained at autopsy in one patient had similarly low enzyme activity. Thus the deficiency of glycerol kinase in these patients appears to be generalized and heritable, though the relationship of the clinical phenotype to the enzymatic defect is not yet established.
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PMID:Glycerol kinase deficiency with neuromuscular, skeletal, and adrenal abnormalities. 624 82

The effect of "standing" in a frame on spasticity (clinical assessment and H-reflex), contracture (lower extremity joint range of motion), and osteoporosis (dual photon absorptiometry) was studied in six paralyzed males (mean age 49 yr) who had been confined to wheelchairs for an average of 19 years. Standing time averaged 144 hours over a mean of 135 days. Clinical Assessment measured reflexes, tone, and clonus in the legs. Results revealed no important differences between initial and final scores for clinical assessment and joint range of motion. In three subjects for whom H-reflexes were found, latency and amplitude were not altered by "standing." Bone density was normal in the lumbar spine but significantly reduced in the femoral neck. "Standing" did not modify the bone density in any site. A follow-up interview revealed that 67% of subjects continued to "stand" and felt healthier because of it. In summary, "standing" had no ill effects, did not alter measured variables, and had a positive psychological impact.
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PMID:Effect of "standing" on spasticity, contracture, and osteoporosis in paralyzed males. 842 May 25

We have investigated physiological changes in 21 patients with a spinal cord injury who were fitted with the RGO-II hybrid orthosis. All parameters were measured before and after a training programme in order to evaluate the benefit of gait rehabilitation, cardiovascular adaptation, constipation, spasticity and osteoporosis. A tendency for the improvement in cardiovascular function was noticed, and a segmental decrease in right colonic transit time was observed. However there was no reproducible change in spasticity, and no gain in bone mineral density. These data suggest that the physiological benefits which occur when patients walk with the aid of a hybrid orthosis only correct the effects of immobility. In addition, we did not find any physiological improvement regarding the neurological lesion (spasticity or osteoporosis).
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PMID:Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation. 858

Osteoporosis that develops during immobilization is a severe condition that confers increased risk of fractures with their burden of mortality and disability. The aim of this study was to investigate the determinants of immobilization osteoporosis. As a model of this condition we studied hemiplegic subjects, measuring bone mineral density in the paralyzed lower limb as compared with the non-paralyzed one. In spite of the limits related to the loss of nervous stimulation, this model offers the advantage of a proper control for the complex genetic and environmental cofactors involved. We examined 48 hemiplegic subjects (31 men, 17 women in menopause) admitted consecutively over a 9-month period. Mean length immobilization was 10.9 months for men (range 1-48 months) and 7.8 months for women (range 1-40 months). The average time since menopause was 14.9 years (range 1.7-23.9 years). For each subject the following were performed: questionnaire, medical examination, anthropometric measurements, evaluation of the scores for spasticity and for lower limb motor capacity in order to account for the different degrees of disability among patients. Bone mineral density was measured using dual-energy X-ray absorptiometry (DXA) at both femoral necks. For each patient we defined a percentage difference in bone loss between the paralyzed and non-paralyzed limb. Regression coefficient were calculated by multiple logistic regression. There was significant bone loss in the paralyzed limb in both sexes, accounting for up to 6.3% in women. Multiple regression analysis showed that the degree of bone loss depends significantly and directly on the length of immobilization, even when controlling for age and sex in the regression model (R = 0.193, p = 0.034). However, when time since menopause was included in the regression model, with length of immobility as a covariate, it was the only significant determinant of bone loss (R = 0.312, p = 0.039). No additional factors were observed among men. No differences were shown with regard to anthropometric measurements or functional scores. Length of immobilization accounts only for a small fraction of bone loss, which does not exceed 5% of the total variance. Our data show that postmenopausal women should be considered at highest risk for osteoporosis in cases of immobility and that different factors, other than length of immobility, might come into play in determining bone loss in this condition.
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PMID:Determinants of bone mineral density in immobilization: a study on hemiplegic patients. 884

Patients with spinal cord injury are predisposed to knee effusions owing to osteoporosis, heterotopic ossification, trauma, and benign hydrarthrosis. This retrospective review discusses 11 patients with spinal cord injury and knee effusions seen during two years. One objective is to correlate the initial diagnosis based on clinical findings with the final diagnosis based on synovial fluid analysis and radiographic studies. Another is to describe the variety and complexity of clinical situations that involve knee effusions in spinal cord injury. The initial diagnosis was different from the final diagnosis in all of our cases. The final diagnoses were trauma (6 cases), pseudogout (2 cases), spasticity, fracture of the tibial plateau, septic joint, and tears of the anterior cruciate and lateral collateral ligaments. Knee effusions in this unique population must be carefully investigated to avoid erroneous diagnoses based on the initial clinical presentation, which can be complicated by multiple medical problems.
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PMID:Common causes of knee effusions in spinal cord injury: a random study. 955 11

The interdisciplinary approach to the management of MS patients includes the services of both physical and occupational therapy. These professions complement one another in their concerted effort to mobilize the patient, thereby minimizing the symptoms of progressive weakness, fatigue, and spasticity. The ambulant patient is far less likely to develop complications of inactivity such as contractures, decubitus ulcers, venous thrombosis, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications.
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PMID:Physical and occupational therapy in the treatment of patients with multiple sclerosis. 989 12

Clinically significant pain has been found in as many as 65% of persons diagnosed with multiple sclerosis (MS). Acute pain conditions include trigeminal neuralgia, painful optic neuritis, and Lhermitte's syndrome. Chronic pain conditions such as dysesthesias in the limbs, joint pain, and other musculoskeletal or mechanical pain problems develop as a function of spasticity and deconditioning associated with MS. These painful conditions may respond to pharmacological, surgical, rehabilitation, and psychological interventions. However, unresolved pain, associated disability, and affective distress are common. In addition, efforts to manage MS and its associated symptoms, for example, may inadvertently cause osteoporosis and headache or other symptoms that may exacerbate pain and pain-related disability. Conversely, efforts to manage pain may have negative effects on the symptoms of MS (e.g., increased fatigue). A multidimensional approach to assessment and management that is guided by a comprehensive biopsychosocial model is recommended. Such an approach needs to consider the exacerbating nature of MS, MS-related pain, and interventions aimed at their management. Suggestions for future research on MS-related pain conclude the article.
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PMID:Pain in multiple sclerosis: a biopsychosocial perspective. 1205 66

The authors of this prospective, single-case study evaluated the potential for functional recovery from chronic spinal cord injury (SCI). The patient was motor complete with minimal and transient sensory perception in the left hemibody. His condition was classified as C-2 American Spinal Injury Association (ASIA) Grade A and he had experienced no substantial recovery in the first 5 years after traumatic SCI. Clinical experience and evidence from the scientific literature suggest that further recovery would not take place. When the study began in 1999, the patient was tetraplegic and unable to breathe without assisted ventilation; his condition classification persisted as C-2 ASIA Grade A. Magnetic resonance imaging revealed severe injury at the C-2 level that had left a central fluid-filled cyst surrounded by a narrow donutlike rim of white matter. Five years after the injury a program known as "activity-based recovery" was instituted. The hypothesis was that patterned neural activity might stimulate the central nervous system to become more functional, as it does during development. Over a 3-year period (5-8 years after injury), the patient's condition improved from ASIA Grade A to ASIA Grade C, an improvement of two ASIA grades. Motor scores improved from 0/100 to 20/100, and sensory scores rose from 5-7/112 to 58-77/112. Using electromyography, the authors documented voluntary control over important muscle groups, including the right hemidiaphragm (C3-5), extensor carpi radialis (C-6), and vastus medialis (L2-4). Reversal of osteoporosis and an increase in muscle mass was associated with this recovery. Moreover, spasticity decreased, the incidence of medical complications fell dramatically, and the incidence of infections and use of antibiotic medications was reduced by over 90%. These improvements occurred despite the fact that less than 25 mm2 of tissue (approximately 25%) of the outer cord (presumably white matter) had survived at the injury level. The primary novelty of this report is the demonstration that substantial recovery of function (two ASIA grades) is possible in a patient with severe C-2 ASIA Grade A injury, long after the initial SCI. Less severely injured (lower injury level, clinically incomplete lesions) individuals might achieve even more meaningful recovery. The role of patterned neural activity in regeneration and recovery of function after SCI therefore appears a fruitful area for future investigation.
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PMID:Late recovery following spinal cord injury. Case report and review of the literature. 1507 Jan 54

The ideal surgical treatment of multilevel cervical spondylosis remains unclear. This study analyzed the complications in using titanium cages and plating to reconstruct multilevel cervical corpectomies. This was a retrospective analysis of 21 consecutive patients who had multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. Sixteen had 2-level, one had 2.5-level, three had 3-level, and one had 3.5-level corpectomies. All had reconstruction with titanium cages and anterior plating. Thirty-three percent of the patients developed complications. Radiographs revealed bony consolidation in 95% of patients. Reconstructing multilevel cervical corpectomies with titanium cages and plating is associated with complications. Advantages include rigid immobilization and the avoidance of iliac crest bone graft harvesting. Major complications are largely the result of failures of the cage and plate construct, especially in patients with osteopenic bone. Supplemental posterior stabilization may be considered for cases with spasticity or greater than 2-level corpectomies with profound osteoporosis.
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PMID:Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. 1257 77


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