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

Electromyographic biofeedback training was used to facilitate finger and wrist extension movements in a mentally retarded individual with spastic hemiplegia. The client was a 29-year-old woman with profound mental retardation and cerebral palsy as a result of postnatal meningitis. During treatment, the client demonstrated a short attention span, lack of motivation, low frustration tolerance, and increased spasticity in her left hand. The client was able to hyperextend her fingers following finger extension training, although goniometric measurements showed a marked degree of wrist flexion and wrist ulnar deviation. Therefore, training was implemented to develop wrist extension movements. Biofeedback therapy resulted in a substantial increase in active wrist extension and a marked reduction in wrist ulnar deviation.
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PMID:EMG biofeedback training for a mentally retarded individual with cerebral palsy. 728 26

The syndrome of primary lateral sclerosis (PLS) has been reported clinically on many occasions. Pathologic confirmation in the modern era, however, has generally been lacking. In a recently reported case of PLS, the disorder was complicated by a pontine infarct. We describe a 65-year-old woman whose illness began with spastic dysarthria, which gradually worsened to the point that 18 months later she could barely utter a sound. Meanwhile, dysphagia, brisk reflexes, and a pseudobulbar affect had developed. Three years after onset she had a spastic contractured right-sided hemiplegia and walked with short shuffling steps. The spasticity slowly progressed, and she died of aspiration pneumonia 3.5 years after the onset of dysarthria. Neuropathologic examination showed bilateral atrophy of the precentral gyri, which microscopically showed a paucity of Betz cells. There was loss of myelin throughout the corticospinal system, yet the anterior-horn cells of the spinal cord and hypoglossal nuclei were well preserved. Intracytoplasmic eosinophilic inclusion bodies, of unknown cause and significance, were observed in occasional motor neurons, one in the hypoglossal nucleus and two in spinal cord anterior horns. Clinically and pathologically, this case meets the criteria for PLS.
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PMID:Primary lateral sclerosis: a case report. 729 6

During the last 15 years surgical interventions on the hands of 47 patients with cerebral palsy were performed. Most suffered from hemiplegia. Electromyographic analysis of arm- hand function showed 1. Decrease in maximal activity 2. Impulse irradiation preferably to flexor muscles 3. Associated activation of the affected contralateral limb 4. Identical patterns of activity in flexion or extension intentions 5. Occasionally reflex activity surmounts voluntary activity 6. Tendency towards tonic activation. By questionnaires the patients were asked to report their own impressions on the results of surgery as to function and appearance of the operated limb. In 30 replies 22 patients reported good results in appearance as well as in function and felt the procedure recommendable. Another 7 patients rated the result as fair, with partial improvement of appearance, without functional deterioration. The only patient who felt his condition worse suffered from epileptic disorder and related increase of spasticity with deterioration of gait to hand surgery, which, however, was without realistic grounds. It is concluded that corrective surgery in the hands of cerebral palsied patients may be fairly rewarding.
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PMID:[Orthopedic surgery of the hand in patients with cerebral palsy (author's transl)]. 742 24

Shoulder-hand syndrome developed in 36 (27%) of 132 hemiplegic patients in a prospective study. Subluxation, paresis of the shoulder girdle, moderate spasticity, and deficits in confrontation visual field testing were the major risk factors. In a placebo-controlled, nonblinded trial, 31 of the 36 patients became almost symptom free within 10 days' treatment with low doses of oral corticosteroids. Shoulder joint capsules taken at autopsy of 7 patients showed signs of previous trauma of the affected shoulder. In the second part of this study on another 86 patients, early awareness of potential injuries to shoulder joint structures reduced the frequency of shoulder-hand syndrome from 27 to 8%. These clinical findings suggest that shoulder-hand syndrome in hemiplegia is initiated by peripheral lesions. A self-perpetuating vicious cycle may be established, followed by the clinical picture of a "reflex sympathetic dystrophy." In the majority of stroke patients, this clinical phenomenon seems to be preventable by avoiding shoulder trauma.
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PMID:The shoulder-hand syndrome after stroke: a prospective clinical trial. 752 74

108 cases of spasticity of paralytic limbs were treated successfully with hyperselective posterior rhizotomy (SPR). Among them, 100 had cerebral palsy, 2 hemiplegia, 2 paraplegia, 3 sequelae of cerebral injury, and 1 multiple sclerosis. Cervical SPR was performed in 12 cases and lumbosacral SPR in 96 cases. After laminectomy, the posterior nerve roots were split into some rootlets, and the lower threshold rootlets were divided after electrical stimulation. Follow up for 6-30 months showed an effective rate of 95% and an improvement rate of 81%.
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PMID:[Hyperselective posterior rhizotomy in the treatment of spasticity of paralytic limbs]. 822 Dec 50

The authors report the results of surgical treatment of the equinus deformity of the foot in adult hemiplegia performed on 23 patients with a long term follow-up for 20 of them. Surgical treatment required two phases. Firstly, a spasticity correction by scopiform neurotomy of the posterior tibial nerve: this operation had to be done 14 times because of the importance of the spasticity. Secondly, a phase of truly orthopaedic surgery which involved successively, a treatment of the equinus deformity by lengthening of the Achilles tendon, a restoration of the dorsal flexion by anterior muscle transfer and some complementary operations on the forefoot. An astragalo-scaphoid arthrodesis was associated in the 13 most recent cases. Results were subjectively judged very good or good for 17 patients. Objectively, walking appliances have been reduced, gait was more secure and a greater autonomy has been reached. However, the goals of this surgery are limited as it has no incidence on central interferent lesions and neuropsychological troubles resulting from brain damage. The quality of the result is, in other respects, conditional upon the gait pattern of the whole limb, particularly upon the importance of the flexion of the knee during the step cycle.
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PMID:[Surgery of the foot in equinus deformity in hemiplegic adults]. 828 67

One hundred and eight patients with spasticity of the paralytic limbs were treated successfully with hyperselective posterior rhizotomy (SPR). Of the 108 patients, 100 had cerebral palsy, 2 hemiplegia, 3 sequelae of cerebral injury, 2 paraplegia and 1 multiple sclerosis. Twelve patients received cervical SPR and 96 lumbosacral SPR. Laminectomy is performed to open the dura and to separate the posterior spinal root into several rootlets. The lower threshold rootlets were divided after electrical stimulation. Follow-up for 6 to 30 months showed that the effective rate of reducing spasticity was over 95% and functional improvement rate over 80%.
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PMID:Hyperselective posterior rhizotomy in treatment of spasticity of paralytic limbs. 828 2

The frequency of prolonged muscular flaccidity (PMF) was examined in a series of stroke patients in chronic phase suffering from hemiplegia with minimal spontaneous recovery (MSR). The results indicated that in such a population with poor motor recovery, PMF was significantly more frequent than spasticity. PMF was found to be associated with left-sided hemiplegia and unilateral spatial neglect. The minimal spontaneous recovery of the series of stroke patients we studied could be dependent on the interaction of three negative prognostic factors: left sided hemiplegia, unilateral spatial neglect and prolonged muscular flaccidity.
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PMID:Prolonged muscular flaccidity: frequency and association with unilateral spatial neglect after stroke. 829 27

In an attempt to investigate whether benzodiazepines at low dosage have a significant effect in reducing spasticity among children with cerebral palsy, we carried out a double-blind, placebo-controlled, cross-over study. Twelve children with either spastic diplegia or hemiplegia participated in this study. The mean age was 14 years. The restraint of passive knee movements was determined with a dynamic dynamometer and spastic stretch reflexes were measured as EMG activity in muscles stretched. Clonazepam was given at low dosage (0.02 mg/kg body weight). In each child measurements of passive restraint were made on 2 different days immediately before and 3 h after an i.m. injection of either clonazepam or placebo in randomized order. Clonazepam significantly reduced spastic restraint (P < 0.001) compared to non-significant reduction with placebo. The mean plasma concentration of clonazepam at time of spasticity evaluation was 21 mmol/l which is in the low dose range, far below conventional doses. The study thus shows a positive effect of low dose clonazepam in reducing spasticity in children when given as a single dose.
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PMID:Treatment of spasticity in children with low dose benzodiazepine. 841 67

The upper motor neuron lesion that causes hemiplegia impairs the patient's selective control and exposes primitive modes of muscle activation. Significant inconsistency between the clinical findings and the patient's gait may result. Dynamic electromyography revealed the primitive mechanisms leading to these inconsistencies. The rate of stretch does not differentiate spasticity from contracture, since either a quick or slow stretch frequently causes a sustained muscle response. Using knee flexion to differentiate gastrocnemius and soleus spasticity is not reliable, since the change in neurologic input with flexion may inhibit the extensor muscle's response to stretch so that the soleus is also relaxed. The change in body position from lying supine to sitting can double the intensity of soleus spasticity, and standing further increases the tone. Primitive patterns of mass extension and flexion, while voluntary, inhibit normal progression during walking. Simultaneous activation of the soleus and gastrocnemius with the knee's quadriceps causes premature ankle plantar flexion as the limb is loaded in stance. The primitive flexion synergy between the hip, knee, and ankle (dorsiflexion) inhibits terminal swing knee extension while the hip remains flexed. Consequently, surgical planning for the hemiparetic limb must rely heavily on gait analysis findings (systematic observation or by instrumentation).
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PMID:Determinants of muscle function in the spastic lower extremity. 845 21


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