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Results for “Muscle Spasticity”

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PubMed2005

The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke.

OBJECTIVES: To examine test-retest reliability of the Timed Up & Go (TUG) test, its ability to differentiate subjects with chronic stroke from healthy elderly subjects, and its associations with ankle plantarflexor spasticity, ankle muscle strength, gait performance, and distance walked in 6 minutes in subjects with chronic stroke. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center in Hong Kong, China. PARTICIPANTS: Ten healthy elderly subjects and 11 subjects with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time taken to complete the TUG test was recorded. Plantarflexor spasticity and ankle muscle strength were assessed, respectively, by the Composite Spasticity Scale and a load-cell together with electromyography. Gait parameters and walking endurance were measured respectively by walkway system (GAITRite II) and 6-minute walk test. Intraclass correlation coefficients (ICCs) were calculated as measures of reliability, and all correlation analyses were conducted using Spearman correlation coefficients. RESULTS: The TUG test showed excellent reliability (ICC>.95). Subjects with chronic stroke had significantly more spastic and weaker plantarflexors, slower walking speeds, and poorer walking endurance when compared with healthy elderly subjects (all P<.003). The strength of the affected ankle plantarflexors (rho=-.860, P<.01), gait parameters (rho range, .620-.900; P<.05), and walking endurance (rho=-.960, P<.01) correlated with TUG scores. CONCLUSIONS: The TUG scores were reliable, were able to differentiate the patients from the healthy elderly subjects, and correlated well with plantarflexor strength, gait performance, and walking endurance in subjects with chronic stroke.

Aged↗
PubMed1988

Delta-aminovaleric acid antagonizes the pharmacological actions of baclofen in the central nervous system.

The action of delta-aminovaleric acid (AVA) on the muscle relaxant properties of baclofen, a GABAB receptor agonist, was investigated in two experimental models: (1) the pathologically increased muscle tone of the gastrocnemius muscle in spastic mutant Han-Wistar rats and (2) the Hoffmann (H)-reflex recorded from plantar foot muscles after electrical stimulation of the tibial nerve in barbiturate (60 mg/kg) anaesthetized rats. In both paradigms coadministration of AVA (500 nmol/5 microliter) antagonized the muscle relaxant action of intrathecally applied baclofen (0.2-2 nmol), but failed to affect the muscle relaxant effects of intrathecally injected muscimol (2-20 nmol). In contrast, coadministration of bicuculline (1 nmol) did block the muscle relaxant action of muscimol, but failed to alter the effects of baclofen. When administered alone, bicuculline (1 nmol), or AVA (500 nmol-2 mumol) were without intrinsic action in both paradigms. In an additional series of experiments we investigated the action of AVA on a supraspinal effect of baclofen. Coadministration of AVA (12.5 nmol/0.5 microliter) in the ventromedial thalamic nucleus antagonized the catalepsy induced by baclofen (ED50 10 pmol/0.5 microliter), as indicated by an increase in ED50 of baclofen by a factor of 4.835 and a parallel shift of the probit-log dosage regression line to the right. The parallel shift seems to be consistent with a competitive mechanism of action of AVA. This study presents evidence that AVA antagonizes central pharmacological actions of baclofen at both spinal and supraspinal sites without affecting the actions of a GABAA agonist, muscimol.

Animals↗
PubMed1980

The hip in cerebral palsy.

Orthopedic surgery can alleviate the hip flexion, adduction, and medial rotation deformities of the hip and improve the function and appearance of gait. To accomplish this, however, careful examination and prudence in the operative procedure to avoid overdoing and overcorrecting are important. Orthopedic surgery can prevent subluxation and dislocation of the hip before the age of seven years, and consequently repetitive radiographic examinations of the hip in children who have spastic paralysis of the hip musculature should be a routine procedure. Subluxation and dislocation of the hip, when established, can be successfully treated with orthopedic surgical procedures. Physicians must keep in mind that the spastic paralysis of cerebral palsy originates in the brain, and therefore the spasticity cannot be eliminated. The best that can be done is to weaken or remove some muscles as deforming forces and to achieve compromises for continued function. The goal should be optimal independence for the child and adolescent during development, and freedom from pain with deteriorating function due to degenerative arthritis in the adult.

Adolescent↗
PubMed2002

The management of pain in spasticity.

Pain is a common feature of spasticity and muscle spasms and the reasons for this are discussed in this article. However, the causes of this spasticity have to be determined and for successful management, knowing the underlying mechanisms, which produce spasticity, is necessary. In addition to knowing the range of available treatments, one has to know their particular contribution to the overall management of the patient. The assessment and management of the spastic patient is multi-disciplinary and painful spasticity changes over time. This therefore requires repeated assessments and the direction of the treatment may also change. Pain may be a dominant feature, but is rarely the sole symptom. This article looks at a strategy for the overall management of the patient with the focus on managing pain.

Administration, Oral↗
PubMedDate not supplied

Comparison of two injection techniques using botulinum toxin in spastic hemiplegia.

This study sought to test the hypothesis that injections of botulinum toxin type A (BTX-A) at the mid belly of the gastrocnemius muscle in spastic hemiplegic adults produce superior clinical results to proximal injections directed toward the muscular origin. We designed a randomized, double-blind, placebo-controlled intervention study at a university tertiary care setting. Seventeen subjects with chronic spastic hemiplegic gait were enrolled from a volunteer community sample; time range from acute neurologic insult was 0.75 to 31 yr; age range was 19 to 71 yr; gender consisted of 11 men and 4 women; diagnoses were 12 patients with stroke, 2 with traumatic brain injuries, and 1 with a brain tumor. Two subjects were withdrawn from the study because of (1) acute vascular occlusion before intervention and (2) noncompliance with follow-up visits. After baseline measurements, subjects were injected with 50 units of BTX-A (volume, 0.5 cc) into the medial or lateral gastrocnemius: (1) proximally at one site near the muscular origin; (2) distally at three sites along the mid belly. We measured outcome using the Fugl-Meyer score, Ashworth scale, ankle range of motion, and a timed 50-ft fastest walk. No outcome measures showed a significant effect attributable to site of injections. Confounding variables included physical therapy and varying duration of illness in the study cohort. We conclude that the results failed to support the hypothesis that BTX-A injections at the mid belly of the gastrocnemius produced superior functional improvements to injections located near the muscular origin using localization techniques described. Additional research comparing more precise localization methods for BTX-A injections might further establish the importance of electromyographic guidance using BTX-A in management of spasticity.

Adult↗