[Histological study of the muscles in infantile spastic cerebropathy].
Explore the source record for details and available documents.
Adolescent↗
SEARCH · PubMed Health
Results for “Muscle Spasticity”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Treatment of spasticity with injections of botulinum toxin. Review of the literature].
Botulinum toxin injections are a new treatment for limb spasticity. Intramuscular injections can be performed in spastic muscles; efficacy occurs one or two weeks later, with a mean duration of three months. Clinical action is related to chemical denervation of presynaptic motor end nerves by the botulinum toxin. Double blind studies versus placebo have demonstrated the improvement of limb spasticity after injections of botulinum toxin. Ashworth scales, articular angulations, pain and spasms improve both in upper and lower limb spasticity. Functional scores are not changed in the upper limb, but quality of life improves. Kinematic parameters of gait are improved in lower limb spasticity, especially in children with cerebral palsy disorders. There were no reports of serious side effects. Botulinum toxin is a safe and effective treatment of localized spasticity in adults and children.
Animals↗
Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients.
OBJECT: To manage refractory upper-limb spasticity, selective peripheral neurotomy (SPN) is proposed when the spastic muscles to be treated are under the control of a single or a few peripheral nerves. The aim of this study was to assess prospectively the long-term effects of SPN. METHODS: Thirty-one patients with disabling upper-limb spasticity were selected by a multidisciplinary team using clinical, analytical, and functional scales as well as nerve block tests for assessment. Sixty-four SPNs were performed at the level of the musculocutaneous (15 SPNs), the median (25 SPNs), and the ulnar (24 SPNs) nerves. Results of a long-term follow up (mean 4.5 years) showed statistically significant improvement on 1) analytical assessment (p < 0.01): resting position, active amplitude, and motor strength; 2) Ashworth Scale scoring (p < 0.01); 3) hand function assessment (p < 0.01); and 4) rating of daily activities. Four patients with severe painful spasticity experienced complete pain relief after surgery. On the basis of a Visual Analog Scale ranging from 0 to 100, the mean degree of patient satisfaction was 61.5. Complications occurred in five patients (15%): two postoperative hematomas, one (temporary) hypesthesia, and one transient paresia of the wrist and finger flexors. CONCLUSIONS: Selective peripheral neurotomy leads to long-term satisfactory improvement in function and/or comfort with a low morbidity rate in appropriately selected patients suffering from severe harmful spasticity of the upper limb that has been refractory to conservative therapy. Patients must be selected after complete assessment by a multidisciplinary team.
Adolescent↗
Topical anesthesia: a possible treatment method for spasticity.
Topical anesthesia was applied to the skin of the leg and thigh of a hemiparesis patient resulting from embolic infarction in the middle cerebral artery. After application of the anesthesia, the angular displacement of the ankle and knee joints measured during a full gait cycle showed a substantial shift towards normal. This response indicated a reduction in muscle spasticity which was confirmed by clinical tests. Neurophysiologic studies performed on the patient suggested that the reduction in muscular hypertonicity was mediated by reduced cutaneous inputs on the alpha - gamma motoneuron interaction. This conjecture is supported by studies of other investigators performed on animals as well as humans.
Administration, Topical↗
Intrathecal baclofen therapy and the child with cerebral palsy.
Children with cerebral palsy have tight, spastic muscles that often interfere with function, care, and, ultimately, quality of life. Until recently, treatment usually focused on the effects of the spasticity rather than the spasticity itself. Intrathecal Baclofen Therapy (ITB) administers a muscle-relaxing agent directly into the intrathecal space; thereby decreasing the amount of spasticity the child exhibits. This article discusses cerebral palsy and a new treatment for spasticity, ITB, and the development of an ITB program.
Baclofen↗
Spinal cord lesion: effects of and perspectives for treatment.
Following central motor lesions, two forms of adaptation can be observed which lead to improved mobility: (1) the development of spastic muscle tone, and (2) the activation of spinal locomotor centers induced by specific treadmill training. Tension development during spastic gait is different from that during normal gait and appears to be independent of exaggerated monosynaptic stretch reflexes. Exaggerated stretch reflexes are associated with an absence or reduction of functionally essential polysynaptic reflexes. When supraspinal control of spinal reflexes is impaired, the inhibition of monosynaptic reflexes is missing in addition to a reduced facilitation of polysynaptic reflexes. Therefore, overall leg muscle activity becomes reduced and less well modulated in patients with spasticity. Electrophysiological and histological studies have shown that a transformation of motor units takes place following central motor lesions with the consequence that regulation of muscle tone is achieved at a lower level of neuronal organization which in turn enables the patient to walk. Based on observations of the locomotor capacity of the spinal cat, recent studies have indicated that spinal locomotor centers can be activated and trained in patients with complete or incomplete paraplegia when the body is partially unloaded. However, the level of electromyographic activity in the gastrocnemius (the main antigravity muscle during gait) is considerably lower in the patients compared to healthy subjects. During the course of a daily locomotor training program, the amplitude of gastrocnemius, electromyographic activity increases significantly during the stance phase, while inappropriate tibialis anterior activation decreases. Patients with incomplete paraplegia benefit from such training programs such that their walking ability on a stationary surface improves. The pathophysiology and functional significance of spastic muscle tone and the effects of treadmill training on the locomotor pattern underlying new attempts to improve the mobility of patients with paraplegia are reviewed.
Humans↗
Spasticity and strength changes as a function of selective dorsal rhizotomy.
OBJECT: The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. METHODS: Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque-angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work-velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque-angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. CONCLUSIONS: The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.
Adolescent↗
[The weakening of the inhibition of the H-reflex in patients who have had a stroke and its relation to spasticity of the skeletal musculature].
Inhibition of the soleus H-reflex was studied in hemiparetic postapoplectic patients and in control group of patients without motor disorders. The depression of H-reflex was caused by stimulation of ipsilateral peroneal nerve and presented in two successive waves (D1 and D2). The former of them corresponds to presynaptic inhibition. The size of both waves of inhibition was reduced in postapoplectic patients according to the degree of their muscle spasticity.
Adult↗
A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke.
OBJECTIVE: To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. METHODS: This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. RESULTS: Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. CONCLUSION: The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).
Aged↗
Effects of thoraco-lumbar electric sensory stimulation on knee extensor spasticity of persons who survived cerebrovascular accident (CVA).
Spasticity is mostly due to an excess of impulses to alpha motor neurons partly resulting from a change of interneuron activity. Low threshold afferent has been reported to change the activity in interneuron. The purpose of this study is to investigate the effects of surface spinal paravertebral stimulation on knee extensor spasticity. Ten survivors of stroke, with knee extensor spasticity, received electric stimulation for five 45-minute periods through surface electrodes applied to the skin in the twelfth thoracic and first lumbar areas. The electric stimulations had an amplitude modulated alternating current (AC), with a carrier frequency of 2500 Hz, modulated to "beats" frequency of 20 Hz. Stimulation amplitude was raised to elicit sensory stimulation. The pre- and post-treatment evaluation included the modified Ashworth scale, active torque during controlled knee movements at various velocities, and electromyographic (EMG) activity during the torque measurements. Our results indicate that nine of ten subjects demonstrated a decrease in the modified Ashworth scale post-treatment. The EMG activity of the spastic quadriceps during active knee flexion was decreased post-treatment as compared with the value before treatment. The active torque value of knee flexion or extension at 30 degrees, 60 degrees, or 90 degrees/sec of angular velocity did not change significantly post-treatment. A trend of increasing spastic quadriceps EMG activity with respect to the angular velocity during an active knee flexion was established, with Ashworth scale considered. The level of EMG activity is higher when the Ashworth scale is higher. According to our results, the surface paravertebral sensory stimulation was effective in reducing quadriceps muscle spasticity of the subjects. Both the modified Ashworth scale and the EMG activity of spastic quadriceps during eccentric contraction are suggested as sensitive tools for measuring spasticity of persons who survived cerebrovascular accident (CVA).
Adult↗
Excitatory synaptic potentials in spastic human motoneurons have a short rise-time.
This study assessed whether changes in size or time-course of excitatory postsynaptic potentials (EPSPs) in motoneurons innervating spastic muscle could induce a greater synaptic response, and thereby contribute to reflex hyperexcitability. We compared motor unit (MU) firing patterns elicited by tendon taps applied to both spastic and contralateral (nonspastic) biceps brachii muscle in hemiparetic stroke subjects. Based on recordings of 115 MUs, significantly shortened EPSP rise times were present on the spastic side, but with no significant differences in estimated EPSP amplitude. These changes may contribute to hyperexcitable reflex responses at short latency, but the EPSP amplitude changes appear insufficient to account for global differences in reflex excitability.
Excitatory Postsynaptic Potentials↗
autogenic effects of static muscle stretch in spastic man.
Explore the source record for details and available documents.
Electric Stimulation↗
[Transcutaneous electric stimulation at acupoints in the treatment of spinal spasticity: effects and mechanism].
To study the effect and mechanism of electrical stimulation in treating spinal spasticity, we used electroacupuncture (EA) on the surface of 2 couples of acupoints. The short term application (30 min) of high-frequency EA (100 Hz) produced an immediate antispastic effect in contrast to the low-frequency EA (2 Hz). After application of high-frequency EA (2 times/day, 30 min/time) for 3 months, antisplastic effect was stable. To keep this antispastic effect, the high-frequency EA must be used permanently. Recent experimental results showed that low and high frequency EA release MEK and dynorphin respectively from the spinal cord in humans. We infer that by enhancing the production of dynorphin in CSF, high-frequency EA decrease the excitability of the motor neurons in the anterior horns through the kappa opiate receptors, thus ameliorating the muscle spasticity of spinal origin.
Acupuncture Points↗
The treatment of cerebral palsy: What we know, what we don't know.
The treatment of cerebral palsy is directed at repair of the injured brain and at the management of the impairments and disabilities resulting from developmental brain injury. Currently, there are no clinically meaningful interventions that can successfully repair existing damage to the brain areas that control muscle coordination and movement. However, several interventions are available to diminish the degree of impairment (eg, muscle spasticity) and to increase participation in activities of daily living. Data on treatment compatible with evidence-based medicine are now being collected.
Activities of Daily Living↗
Outdoor winter activities of spinal cord-injured patients. With special reference to outdoor mobility.
Two hundred forty-seven patients with spinal cord injuries living in Hokkaido, the northern part of Japan, were mailed a questionnaire relating to winter outdoor activities. One hundred eight patients responded to the questionnaire, 98 males and 10 females, with ages ranging from 30 to 79 (mean, 53.3) yr. Injury levels of patients were: cervical in 23 patients, thoracic and thoracolumbar in 47, and lumbar in 38. All respondents were unable to walk independently because of quadriplegia or paraplegia. Approximately 90 percent of respondents found it necessary to go outside during the winter season. Eighty-five percent were outside during the coldest period. The most common reasons for outdoor activities were shopping and routine doctor's appointments. The main method of ambulating outside was a manual and/or electrically operated wheelchair, sometimes in conjunction with an automobile. However, there were many problems reported in using wheelchairs; for example, wheels and casters were very slippery on the snow and ice, casters were easily buried in the snow, and wheelchair rims were very cold to handle. It was also pointed out that exposure to cold weather induced physical problems such as muscle spasticity, pain, and numbness of lower extremities. This survey revealed that spinal cord-injured patients would benefit from a wheelchair specifically designed for winter conditions.
Accidental Falls↗
Evaluation of a muscle relaxant: dantrolene sodium (Dantrium).
Dantrolene sodium (Dantrium) is a skeletal muscle relaxant, unique in that it acts on the muscle itself. It should be considered for use in patients with skeletal muscle spasticity who are in a stable neurological state. After careful adjustment of the dose, a substantial number of such patients will experience one or more of the following benefits: (1) a reduction in pain, (2) an increased ability to make use of residual motor function, (3) a reduction in the level of nursing care required, (4) an increased ability to utilize devices, and (5) an increased ability to participate in rehabilitation. The drug should not be used when reduced spasticity will decrease functional ability. The adverse effects generally are transient; some are the result of central nervous system depression.
Activities of Daily Living↗
Orthopedic issues after cerebrovascular accident.
Patients who have had a cerebrovascular accident with resultant hemiplegia often present to the orthopedic surgeon with characteristic complaints and deformities. The most common of these include muscle spasticity and contracture, shoulder pain, hip fracture, and heterotopic ossification. Although some of these disorders are clinically evident, others may be easily overlooked. The purpose of this article is to summarize the most common orthopedic aspects of hemiplegic patients who have had a cerebrovascular accident.
Activities of Daily Living↗
Neurodevelopmental treatment stroke rehabilitation: a critique and extension for neuroscience nursing practice.
The aim of this article is to review neurodevelopmental treatment (NDT) literature and existing stroke NDT nursing research, as well as explore issues related to professional collaboration in stroke rehabilitation and implications for neuroscience nursing practice. NDT or the Bobath approach is used to encourage stroke patients to use the affected side of their body in order to promote and relearn normal movement and to reduce muscle spasticity. Neuroscience nurses have an important role in facilitating stroke patients to practise transferring out of bed and performing activities of daily living outside of physiotherapy and occupational therapy sessions. Neuroscience nurses also care for stroke patients over a 24-hour perio. Therefore, it is important that nurses understand physiotherapy and occupational therapy strategies in stroke rehabilitation.
Activities of Daily Living↗