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At least 811 records · Page 45Linked to original sources
PubMed1986

Old pulmonary embolus of the distal part of a Pudenz low-pressure ventriculoatrial shunt.

At the autopsy of a man, aged 21 years, who had suffered from spastic tetraplegia for 10 years, the distal 25 cm of the Pudenz low-pressure ventriculoatrial shunt was found in the pulmonary artery, partly adherent to and partly covered with intima. The site of the detachment was the connection at the entrance to the facial vein. It is mentioned in the literature that the entrance of the venous system is, indeed, the most common site of detachment. An x-ray film of the chest, taken 3 1/2 years previously, retrospectively disclosed the catheter at the same location as demonstrated at the autopsy, but it had been overlooked at the time. On the non-intima-coated parts of the catheter, fresh thrombotic material was found, and there was cor pulmonale. The cause of detachment may have been the long-standing spastic tension in the neck muscles.

Adult↗
PubMed2005

Excitability of chronic hemiparetic muscles: determination of chronaxie values and strength-duration curves and its implication in functional electrical stimulation.

Central nervous system disorders affect the anatomy and physiology of the lower motoneuron. This fact has an impact on the stimulation parameters, especially on the duration of the stimulating impulses, for functional electrical stimulation in chronic hemiparetic patients. The aim of this study was thus to test the excitability and to determine chronaxie values and strength-duration curves of weak wrist and finger extensor muscles and spastic finger and wrist flexor muscles in the hemiparetic arm. Twelve patients with chronic hemiplegia (>6 months after the onset of the cerebral lesion) participated in the study. A constant current stimulator was used. As to chronaxie values no significant differences were found between the extensor muscles (mean+/-SD: 0.44+/-0.16 ms) and flexor muscles (mean+/-SD: 0.36+/-0.22 ms). A moderate variability was seen for both extensor muscles (0.2-0.8 ms) and flexor muscles (0.1-0.9 ms). These values are well within the normal range determined for innervated muscles. All strength-duration curves were completely normal for each muscle. We conclude that in chronic hemiparetic muscles, impulses of the same duration can be used as in muscles of healthy subjects.

Adult↗
PubMed1999

Effects of hyperbaric oxygen therapy on children with spastic diplegic cerebral palsy: a pilot project.

Hyperbaric oxygen (HBO2) therapy for children with cerebral palsy (CP) is not new. Research documenting the effects in this population has been anecdotal. We evaluated the effects of HBO2 therapy for 25 children (X = 5.6 +/- 1.6 yr) with a functional diagnosis of spastic diplegic CP. Pre- and post-HBO2 evaluations consisted of the following measures: gross motor function measure (GMFM), fine motor function (Jebsen test for hand function), spasticity (modified Ashworth scale), video analysis, and parental questionnaire. The protocol for HBO2 therapy was 20 treatments of 95% oxygen at 1.75 atm abs for 60 min. The Wilcoxon matched-pairs signed-rank test for non-parametric measures was used to compare pre- and post-treatment data. Results showed improved gross motor function in three of the five items in the GMFM test, improved fine motor function in three of the six hand tests, reduced spasticity in three of four muscle groups when assessed by a physician specializing in CP, and improvements for four of nine questions posed to parents.

Cerebral Palsy↗
PubMed1989

Topical anesthetics: effects on the Achilles tendon and H-reflexes. II. Stroke patients.

This study determined whether the Achilles tendon reflex, H-reflex, and ankle range of motion (ROM) during ambulation undergo significant changes after application of benzocaine spray applied to the triceps surae skin area of eight stroke patients displaying spasticity in ankle plantar flexor muscles. The H-reflex amplitude increased significantly (p less than 0.05) at 30 minutes after both the benzocaine (0.346 +/- 0.101V) and the placebo (air spray, 0.324 +/- 0.078V) when the placebo was given first; however, there was no significant difference between the two interventions. A significant decrease in ankle ROM occurred during midswing at 20 (placebo administered first) and 30 (benzocaine administered first) minutes after the placebo, but this decrease was not significantly greater than the change after the benzocaine. Benzocaine spray did not change motor neuron excitability level or improve the subject's ability to perform a functional task.

Achilles Tendon↗
PubMed1994

Eccentric and concentric muscle performance in patients with spastic paresis secondary to motor neuron disease. A preliminary report.

This study investigated the potential value of eccentric (ECC) and concentric (CONC) isokinetic testing for quantifying motor deficit in patients with spastic paresis secondary to motor neuron disease. We hypothesized that, at a moderately fast (120 degrees s-1) angular velocity, spastic patients would demonstrate different ECC-CONC torque relationships from healthy controls or patients with non-spastic neuromuscular disorders. Eleven patients with motor neuron disease having clinical evidence of spasticity, and 11 disease-control patients (with non-spastic disorders, e.g. lower motor neuron disease or myopathy) underwent isokinetic testing. One healthy subject was matched to each of the 22 patients. The average torque generated during maximal voluntary ECC and CONC knee flexion (KF) and extension (KE) was measured using an isokinetic dynamometer (Kin-Com). Reliability was established (all ICC > or = 0.97) for patient torque measurements. Relative strength (% of control subject torque) in spastic patients was significantly higher for ECC than for CONC actions in both KF and KE; conversely, in non-spastic disease-control patients relative strength was not affected by the type of muscle action. The ECC/CONC average torque ratios for KE and KF at 120 degrees s-1 were significantly greater in spastic patients than controls, but did not differ from controls in non-spastic patients. In spastic patients the ECC-CONC imbalances were related to ambulatory dysfunction. In four spastic patients followed with serial testing, the disproportion between ECC and CONC voluntary capacity persisted over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The influence of eccentric contractions and stretch on alpha motoneuron excitability in normal subjects and subjects with spasticity.

Application of eccentric contractions and muscle stretch are clinically effective in reducing spasticity and increasing ROM (7). This may be explained by a change in the excitability of motoneurons supplying the spastic muscle. Excitability of motoneurons can be indirectly assessed using the H-reflex. Experiments were performed on 20 normal subjects and 17 subjects with spasticity resulting from neurological disorder. Subjects were seated in a secure position and the ankle joint was moved from 30 degrees plantarflexion to 20 degrees dorsiflexion at a velocity of 30 degrees/sec. Sixty eccentric contractions of the triceps surae muscle were performed using a Kin-Com dynamometer (Chattanooga Corp, Tennessee). Two protocols were used: (1) eccentric contractions only, and (2) eccentric contractions with a 5s stretch of the relaxed triceps surae after each contraction. Two sets of 10 H-reflexes were collected from the soleus muscle before (trial 1 & 2) and after (trial 3 & 4) eccentric and eccentric + stretch protocols. The mean peak to peak H-reflex amplitude was calculated for each trial and compared using ANOVA. Eccentric contractions resulted in a significant and maintained increase in the H-reflex in neurological compared to normal subjects (P < 0.05). Eccentric contractions in subjects with spasticity resulted in an increase in motoneuron excitability which may assist in corticospinal activation of motoneurons during voluntary movement. The eccentric + stretch protocol, resulted in a decrease in the mean amplitude of H-reflexes in neurological subjects, however, this was not significant. The application of a stretch following eccentric contractions decreased motoneuron excitability and may thus be beneficial to decrease spasticity whilst strengthening muscle.

Adult↗
PubMed2003

The use of botulinum toxin type A treatment in children with spasticity.

The current modalities in managing spastic children have some limitations; thus, alternative therapeutic agents are in need. The purpose of this study is to investigate whether intramuscular botulinum toxin type A administration may be an alternative agent in the treatment of children with cerebral palsy. Eighteen children who were aged between 3 and 17 years and manifested cerebral palsy were administered intramuscular botulinum toxin type A with a total dose of 6 U/kg body weight. Outcome measurements were determined with four methods, including Ashworth Spasticity Scale, standardized videotape assessments, observational gait analysis, and walking velocity. Ashworth Spasticity Scale and videotape assessments were statistically significant before and after treatment in all muscles (P < 0.001). The best improvement in video gait analysis was evident at week 8. The botulinum toxin type A injections yielded an improved walking velocity at all visits. The observational gait analysis and walking velocity demonstrated an improvement after treatment in the gastrocnemius-injected group (P < 0.001). In conclusion, intramuscular botulinum toxin type A administration may be effective in children with cerebral palsy, especially at week 4 and when injected in gastrocnemius.

Adolescent↗
PubMed2005

Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke.

BACKGROUND AND PURPOSE: Spasticity is a disabling complication of stroke and different noninvasive treatments are used to reduce muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses largely used in the treatment of diseases involving bone and tendon as well as muscular contractures. The effect and duration of extracorporeal shock wave therapy (ESWT) was investigated on muscle hypertonia of the hand and wrist. METHODS: A total of 20 patients affected by stroke associated with severe hypertonia in upper limbs were evaluated. Placebo stimulation was performed 1 week before active stimulation in each patient. Evaluation was performed using the National Institutes of Health and Ashworth scales and video monitoring with a digital goniometer before and immediately after placebo or active stimulation. Motor nerve conduction velocity from abductor digiti minimi were recorded. Patients were monitored at 1, 4, and 12 weeks after active treatment. RESULTS: After active ESWT, patients showed greater improvement in flexor tone of wrist and fingers compared with placebo stimulation. At the 1- and 4-week follow-up visits, a significant decrease of passive muscle tonicity was noted on muscles in all patients receiving active treatment. At 12 weeks after therapy, 10 of the 20 patients showed persistent reduction in muscle tone. There were no adverse events associated with ESWT. CONCLUSIONS: ESWT reduces hypertonia of the wrist and finger muscles for > or =12 weeks after treatment. The possible mechanisms of action of ESWT are discussed.

Adult↗
PubMed1975

[Methods for recording and quantitative measurement of rigidity and spasticity (author's transl)].

First pathophysiological aspects of rigidity and spasticity are described with special regard to the possibilities of errors during the measurement of muscle tone in man. The following methods are explained and discussed: Psychometric techniques, physical analysis of movements (kinesiology, photobadismography, kinetometry), pendulousness tests, investigations of reflexes (T-reflex, H-reflex, H/M-ratio), electromyographic methods (after-activity, silent period, unloading-reflex, stretch-reflex, release-phaenomen), and torque measurements. In the main we discussed these techniques with the view-point of diagnosis and drug effects. Furthermore we expressed our opinion on the relevance of the different methods. Last the most important sources of errors are tabulated.

Electromyography↗
PubMed1995

H-reflex modulation during gait in multiple sclerosis patients with spasticity.

The aim of the present study was to quantitate the Hoffmann (H-) reflex modulation in the soleus muscle of spastic multiple sclerosis patients during walking at different stimulus strengths, and to quantitate the influence of the excitation level of the soleus muscle on the H-reflex. The H-reflex modulation was quantified by the minimum H-reflex in the swing phase and the modulation index introduced by Yang et al. (1). Stimulus strengths were matched between subjects, and only stimuli intensities, which reflect modulation in the H-reflex with true neurophysiological origin, were used. Based on this approach, we found that the reflex modulation is impaired in moderate spastic patients at both a strong and a weak afferent input to the motoneuron pool in consistency with studies on severe spastic patients. This study concludes that the H-reflex modulation in the spastic patients is only related to the excitation level of the muscles, whereas both the excitation level and other factors than the excitation level are known to influence the H-reflex modulation in healthy subjects.

Adult↗