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

Stroke is a common and disabling illness, adversely affecting the quality of life of hundreds of people each year. While there are many therapeutic approaches to stroke patient rehabilitation, encouraging patients to adopt "reflex-inhibiting" patterns of posture is a widely advocated strategy for helping patients to avoid complications of hemiplegia such as spasticity and contractures. However, while the central role of nurses in thus helping patients is recognized, the influence of posture on recovery from stroke has never been evaluated. Prior to undertaking such an evaluative study, texts on stroke patient care were reviewed to clarify the received view about the recommended positioning for patients with hemiplegia. Consensus on some issues was evident (such as positioning the patient with the affected shoulder protracted, spine straight, fingers extended and avoiding external rotation of the affected hip). However, opinion was divided on others and a number of potentially important aspects were ill-covered. This paper integrates a summary of the findings of this review with the physiological rationale for the recommendations. The main areas of agreement are highlighted and issues as yet unanswered are raised for further consideration.
 ...
PMID:Positioning of the stroke patient: a review of the literature. 142 1

The ability to objectively measure spasticity, related to cerebral stroke, is important in the rehabilitation therapies since many therapeutic modalities have been developed over the years to reduce spasticity. The unproven clinical expectation is that function would be improved were spasticity to be reduced. Unfortunately, the ability to measure spasticity to conduct efficacy studies of spasticity-reducing therapies is not possible. This relates to the multi-variable nature of the spastic syndrome with the result that no clinical measurement technique has been proven to be sensitive, valid and reliable. Therefore, it is important to develop a research-oriented spasticity measurement system to meet this need. We describe the current development of such a system. Details of our pilot study of a reflex excitability technique, designed to measure certain components of cerebral spasticity, are presented. The technique combined biomechanical and electrophysiological measures to investigate a homogenous stroke sample (n = 6); it incorporated the H-reflex in soleus, during passive ankle movements, as a measure of faulty neural inhibition. This component significantly (p < .05) differentiated the stroke sample from a matched, healthy control group (n = 6). Evocation of a cutaneous reflex in soleus was a condition that was problematic and it had to be dropped from the protocol. Joint stiffness, which is thought to affect measures of spasticity during passive movement, did not contaminate the measures. Further research in this direction is required to delineate and measure other neural components of spasticity while taking into account related non-neural variables. The final objective in this line of research is to develop a valid, reliable and sensitive spasticity measurement system that could be used to judge the efficacy of physical neurorehabilitation treatments currently employed to reduce spasticity following stroke.
 ...
PMID:Spasticity measurement in stroke: a pilot study. 146 49

The purpose of this investigation was to evaluate the alterations of flexor reflex parameters in spasticity and the possibilities to take advantage of them as a method for assessment of common interneurone activity. Clinical and electromyographical examinations were performed on 120 patients with spastic hemiparesis after stroke. The flexor reflex was obtained after supramaximal electrostimulation of the tibial nerve behind the ankle. The stimulus consisted of 50 msec train of 1 msec duration pulses given at 100 Hz. The reflex activity was recorded from the tibialis anterior muscle. As all patients were with hemiparesis the healthy side was used as a control. The patients were subdivided into four groups, each treated with different myorelaxants (Baclofen, Sirdalud, Myolastan and electroacupuncture). After about 25 days treatment the clinical and electromyographic examinations were repeated. The flexor reflex was recorded with two clearly distinguishable responses on the healthy, as well as on the spastic side. On the spastic side a reflex with prolonged latencies and durations, as well as with decreased amplitudes and thresholds of both reflex responses was found. On the spastic side the first reflex response had higher threshold than the second one, while on the healthy side it was vice versa. Moderate correlations were found between most of the reflex parameters. No correlations were found between the reflex parameters and the degree of spasticity. Only after Baclofen treatment all reflex parameters tended to normalized. After treatment with Myolastan, Sirdalud and electroacupuncture only the second response's duration shortened. In conclusion the flexor reflex is a sensitive method for assessment of altered common interneurone activity in spasticity.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Flexor reflex for assessment of common interneurone activity in spasticity. 149 77

Spasticity following upper motor neuron lesion can be alleviated by few treatments such as physiotherapy, drugs and neurosurgery. However, they all have side effects, limitations or lack of selectivity. We tentatively used the paralyzing effects of botulinum toxin. Since the late 1970's the use of this toxin has increased and it has been extended to numerous muscles and diseases of various causes. In this pilot and open study we use botulinum toxin in spasticity. Eight patients (7 stroke, 1 head injury) with longstanding severe spasticity (minimum: 12 months, maximum: 15 years) were included. Spasticity greatly interfered with their activity in daily life and was resistant to oral antispastic medications. Six patients suffered from pain and 4 had cutaneous lesions especially maceration of the palm of the hand. A-botulinum toxin was injected with a 30-gauged needle. The sites chosen for injection were the following muscles: biceps brachii, brachioradialis, flexor digitorum, flexor carpi, tibialis anterior, flexor digitorum longus. Altogether 41 injections were performed. There were no side effects. Spasticity was improved in all patients. Five patients reported significant pain relief on a visual analogical scale. Most of them reported a benefit in their limb tone and referred to subjective improvement in the activity of daily life and nursing. The beneficial effects of one injection lasted more than 5 months. Seven patients received a second course of treatment. A double-blind study of botulinum toxin in spasticity is to be undertaken to assess its effectiveness and safety when prescribed in the required dose to treat this condition.
 ...
PMID:[Treatment of spasticity with botulinum toxin]. 160 36

The influence of vibration on the H-reflex and on the tendon reflex amplitudes was compared and the efficacy of both methods for the assessment of the presynaptic inhibition was studied. One hundred and twenty patients with post-stroke spastic hemiparesis were investigated. Muscle tone, muscle force and tendon reflexes were assessed. The H-reflex and the Achilles tendon reflex (TA) were recorded under identical experimental conditions. Vibration at a frequency of 100 Hz and an amplitude of 2 mm was applied to the TA. Just after vibration the maximal amplitudes of both reflexes were measured. The ratios of reflex amplitudes after vibration to normal maximal reflex amplitudes (Hvibr/Hmax and TAvibr/TAmax) were evaluated. In all patients with hemiparesis the healthy side was used as a control. Our results revealed significantly increased amplitude ratios on the spastic side. Hence it is concluded that presynaptic inhibition is decreased in spasticity. The amplitude ratios on the healthy and the spastic side were consistent. There was good positive correlation between Hvibr/Hmax and TAvibr/TAmax ratios, suggesting that they provide similar and reliable estimates of presynaptic inhibition.
 ...
PMID:A comparative study of methods for estimation of presynaptic inhibition. 160 93

This investigation estimated the mechanisms of baclofen action on spasticity using a battery of electromyographic methods. Thirty patients with old post-stroke spastic hemiparesis took part in the investigation. They were treated with baclofen-mean daily dose 54.3 alpha 11.6 mg for a mean of 26.3 alpha 4.9 days. A questionnaire for assessment of subjective improvement after treatment used a 5-point scale. For standardization of the neurological examination 5-point scales were used to assess muscle tone, muscle force and tendon reflexes. A battery of electromyographic methods was used to analyse different mechanisms of spasticity: for alpha motoneurone activity--the F wave parameters; for gamma motoneurone activity--the T/H reflex amplitude ratio; for presynaptic inhibition--the ratio of H reflex amplitudes before and after vibration on the achilles tendon (Hvibr./Hmax); for common interneurone activity--the flexor reflex parameters. Our results revealed that baclofen reduces spastically increased muscle tone and Babinski sign. It has no influence on muscle force, tendon reflexes and ankle clonus. Baclofen acts by normalizing the altered interneurone activity and decreasing of alpha motoneurone activity. When spasticity has altered interneurone activity and increased motoneurone activity, it is better to treat with baclofen.
 ...
PMID:Mechanisms of baclofen action on spasticity. 162 92

Physiotherapy on the back of the moved horse has two important dimensions: 1) The somatotropic effect regards mainly spasticity, ataxia, the vertebral column, the basis of the pelvis and the skin. 2) A general psychotherapeutic and psychohygienic effect is created by joy, change and new impetus in rehabilitation and by the emotional contact with the "comrade animal". Or unit was the first to introduce hippotherapy with adults in Austria. There is specially good experience with the spastic atactic component in multiple sclerosis. However other diagnosis as well showed good profit, such as stroke, etc. Some good effects in cephalaea patients indicate transition to riding as a medical pedagogic instrument with further transitions to psychosomatic patients. We want to proceed in this direction. Well organized hippotherapy is cheaper than the hydrotherapy (being current almost everywhere. Therefore opposition against the valuable hippotherapy by reasons of economics should be ruled out. Today's medicine goes farther and farther away from natural possibilities (slogan: "overtechnologized"). We see in hippotherapy an important counterweight in the sense of a valuable methodology towards holistic therapy especially in rehabilitation.
 ...
PMID:[The horse as an aid in therapy]. 176 15

Stimulation electromyography was used to study inhibition of the soleus muscle H-reflex induced by stimulation of the common peroneal nerve in healthy individuals and in patients who had underwent cerebral apoplexy. Two successive inhibition waves (D1 and D2) were recorded; the first wave demonstrated the development of presynaptic inhibition of group Ia afferent fibers. In post-insult patients the depth of inhibition diminished depending on the degree of the pathologic increase of the tonus of the skeletal musculature. The role of presynaptic inhibition disorders in the pathogenesis of muscle spasticity is discussed.
 ...
PMID:[Relationship between decreased presynaptic inhibition and muscle spasticity in patients with a history of cerebral insult]. 188 96

Short, rapid dorsiflexion of the normal human ankle induces a single, synchronised reflex EMG response in the initially relaxed triceps surae muscle (TS). In subjects in whom hemiparesis is present as a result of a unilateral ischaemic cerebral lesion, a reflex EMG response can be elicited on either side with timing identical to that of the normal response. The magnitude of the response in hemiparetic subjects, however, differs from the normal on both the side contralateral and that ipsilateral to the causative lesion. Furthermore, the magnitude of this response varies over the time-course of spasticity. Contralaterally to the lesion, a gradual increase in the magnitude of the response to imposed displacement occurs. One year after stroke, the response has reached a level significantly larger than normal. Changes in the magnitude of the contralateral Achilles tendon jerk reflex EMG are apparent earlier than changes in the response to imposed displacement, with exaggerated tendon jerks already being apparent between 1 and 3 months after stroke. On the side ipsilateral to the lesion, a profound depression of the response to imposed displacement is visible as early as a month after stroke. This depression diminishes over the 1st year, but the response has not even then returned to normal values. These changes are not reflected in the ipsilateral tendon jerk response, which remains normal throughout this period.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:The time-course of bilateral changes in the reflex excitability of relaxed triceps surae muscle in human hemiparetic spasticity. 191 13

The resistance of the relaxed ankle to slow displacement over the joint movement range was measured on both sides of a group of hemiparetic stroke patients, in whom spasticity had been established for at least one year and who showed no clinical signs of contractures. The ankle joints of the age-matched normal subjects were flexible over most of the movement range, showing dramatically increasing stiffness only when the foot was dorsiflexed beyond 70 degrees, with a neutral range between 90-100 degrees, and a less dramatic increase in stiffness during plantarflexion. Hemiparetic patients showed identical curves to the normal subjects on the "healthy" side, ipsilateral to the causative cerebral lesion, but were significantly stiffer in dorsiflexion on the contralateral side, without change in the minimum stiffness range or during plantarflexion. Therefore significant changes in passive biomechanical properties occur at the affected ankle of hemiparetic subjects, predominantly as the result of a loss of compliance in the Achilles tendon, although an increase in the passive stiffness of the triceps surae may also occur. The contribution of these changes to the locomotor disability of hemiparetic patients is discussed.
 ...
PMID:Biomechanical changes at the ankle joint after stroke. 201 38


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>