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At least 91 records · Page 5Linked to original sources
PubMed2006

Linking clinical measurements and kinematic gait patterns of toe-walking using fuzzy decision trees.

Toe-walking is one of the most prevalent gait deviations and has been linked to many diseases. Three major ankle kinematic patterns have been identified in toe-walkers, but the relationships between the causes of toe-walking and these patterns remain unknown. This study aims to identify these relationships. Clearly, such knowledge would increase our understanding of this gait deviation, and could help clinicians plan treatment. The large quantity of data provided by gait analysis often makes interpretation a difficult task. Artificial intelligence techniques were used in this study to facilitate interpretation as well as to decrease subjective interpretation. Of the 716 limbs evaluated, 240 showed signs of toe-walking and met inclusion criteria. The ankle kinematic pattern of the evaluated limbs during gait was assigned to one of three toe-walking pattern groups to build the training data set. Toe-walker clinical measurements (range of movement, muscle spasticity and muscle strength) were coded in fuzzy modalities, and fuzzy decision trees were induced to create intelligible rules allowing toe-walkers to be assigned to one of the three groups. A stratified 10-fold cross validation situated the classification accuracy at 81%. Twelve rules depicting the causes of toe-walking were selected, discussed and characterized using kinematic, kinetic and EMG charts. This study proposes an original approach to linking the possible causes of toe-walking with gait patterns.

Biomechanical Phenomena↗
PubMed2006

Decreased capillarization and a shift to fast myosin heavy chain IIx in the biceps brachii muscle from young adults with spastic paresis.

Muscle spasticity and paresis are conditions that occur secondary to upper motor neuron lesions. The co-existence of decreased motor unit recruitment and intermittent over-activity generates confusion concerning the effect on muscle fiber characteristics. In order to increase the knowledge about the effect of upper motor lesion on capillarization and muscle fiber composition, the biceps brachii muscle from seven young adults with long duration of spastic paresis and seven age-matched controls were analyzed using morphological and enzyme- and immuno-histochemical techniques. The spastic muscles had a 38% lower capillary density (p=0.002), 30% fewer capillaries around each muscle fiber (p=0.02), and 16% fewer capillaries when related to the fiber size (p=0.04). The frequency of fibers expressing myosin heavy chain (MyHC) IIx increased (30% vs. 4%, p=0.006), while the percentage of fibers expressing MyHC I and MyHC IIa, respectively, decreased (22% vs. 46% and 7% vs. 29%, p<0.01). The high proportion of muscle fibers with low oxidative capacity and low capillary supply indicates that biceps brachii muscle from patients with upper motor lesions fatigue more easily than normal controls. We also observed a significantly higher variability in fiber size for fibers expressing MyHC I (p<0.04), and, in three of the subjects, a small amount of small fibers expressing developmental MyHCs was found. These results suggest that, although intermittent stretch reflex contractions might have an impact on the muscle characteristics in spastic paresis, the muscle phenotypic properties are more adapted to decreased voluntary motor unit recruitment.

Adolescent↗
PubMed1985

Electrical stimulation in treating spasticity resulting from spinal cord injury.

To study the efficacy of electrical stimulation in treating spasticity of six spinal cord injured patients, transcutaneous electrical nerve stimulation (TENS) was applied to the dermatomes belonging to the same spinal cord level as the selected spastic muscle group. Spasticity was assessed in knee extensors by a pendulum test in which the knee joint angle of a swinging lower leg was recorded with an electrogoniometer. TENS was found to produce a noticeable decrease of spasticity in three of the patients, but had little effect on the others.

Adult↗
PubMed2005

Differences in kinematic parameters and plantarflexor reflex responses between manual (Ashworth) and isokinetic mobilisations in spasticity assessment.

OBJECTIVE: The purpose of this study was first to compare the kinematic parameters of imposed ankle mobilizations measured during Ashworth or isokinetic tests and, second, to better understand why the stretch reflex was more or less easily elicited by one method or the other. METHODS: Passive dorsiflexions were applied on eight adult patients with plantarflexor spasticity in two conditions: (i) manually, using the Ashworth test where passive dorsiflexions were performed freely by seven rehabilitation clinicians, and (ii) instrumentally, using an isokinetic device (Cybex Norm) and a dorsiflexion velocity at 300 degrees /s. Mean values of initial ankle position, maximal angular velocity (theta;'(max)), maximal angular acceleration (theta;''(max)) and plantarflexor reflex responses obtained with each method were compared. RESULTS: During the Ashworth test, all the patients presented reflex activities in the triceps surae while, during the isokinetic mobilization, only three out of the eight patients tested shown reflex responses. theta;'(max) values were significantly higher (P<0.05) in the manual test (308+/-80 degrees /s vs 216+/-5.5 degrees /s for the isokinetic test). The most marked difference concerned the theta;''(max) values (5046+/-2181 degrees /s(2) for the Ashworth test vs 819+/-18 degrees /s(2) for the isokinetic test, P<0.001). This parameter was significantly correlated with the mean rms-EMG values of the gastrocnemius lateralis (GL) and the soleus (SOL). CONCLUSIONS: This study indicates that passive dorsiflexions imposed during Ashworth and isokinetic tests largely differ in velocity and acceleration, and the higher dynamic parameters evaluated during the Ashworth test could mainly explain that the stretch reflex was more easily elicited during this manual testing. SIGNIFICANCE: If isokinetic devices offer numerous advantages in the assessment of passive resistance to spastic muscle stretch, they cannot be used to simulate the manual test.

Adult↗
PubMed1984

The effect of the GABA-agonist, progabide, on stretch and flexor reflexes and on voluntary power in spastic patients.

The action of the GABA-receptor agonist, progabide , was investigated in a double-blind study with cross-over to placebo. The stretch and flexor reflexes and voluntary power were measured in 16 patients with spasticity. 2-week treatment periods were used; the median daily oral dosage of progabide was 24.3 mg/kg. The Achilles tendon (T) reflex was significantly suppressed whereas the Hoffmann (H) reflex remained unchanged: the T/H ratio was thus reduced. Hmax /M (direct motor)max ratio and the vibration-induced suppression of the T- and H-reflexes were unchanged. These findings indicate an effect of progabide on the spindles or on the controlling fusimotor system (probably acting on spinal interneurons), whereas influence on presynaptic inhibition and alpha-motoneuron excitability is unlikely. The flexor reflex threshold was increased during progabide treatment and latency at threshold decreased towards normal latency. This indicates some influence of progabide on flexor reflex activity attributed to reinforcement of action of GABAergic interneurons at the spinal level. Isokinetic measurement of voluntary power of knee extension revealed particularly good progress for the fastest movements during progabide treatment, whereas isometric measurement of sustained handgrip remained unchanged, probably reflecting a reduction of spasticity without reduction of voluntary power in non-spastic muscles.

Achilles Tendon↗
PubMed2000

Evaluation of botulinum toxin A therapy in children with adductor spasm by gross motor function measure.

Intramuscular injection of botulinum neurotoxin A is a relatively new method for treating spastic movement disorders in children. One major goal of any therapy for patients with movement disorders is to improve gross motor function. In this study, 18 patients with adductor spasm were treated with botulinum neurotoxin A. Treatment effect was determined with the Gross Motor Function Measure, a standardized, validated instrument designed to assist in assessment of gross motor function. Spastic muscle hyperactivity and joint mobility were evaluated by the modified Ashworth Scale and by range of motion, respectively. Compared to pretreatment values, significant improvement in gross motor function (P < .010), decrease in the modified Ashworth Scale, and increase in the range of motion (P < .010) were achieved. Patients with moderate impairment of gross motor function (classed at level III and level IV in the Gross Motor Function Classification System) benefited most from treatment. In patients with severe handicap (level V), only one of five treated patients showed improvement in gross motor function. Nevertheless, all patients in this subgroup benefited from improved ease in hygienic care. In conclusion, we have demonstrated that for most children with moderate functional impairment, the Gross Motor Function Measure is a useful instrument for objective documentation of improvements of gross motor function following treatment with botulinum neurotoxin A.

Adolescent↗
PubMed1982

Testing and modelling of spasticity.

The aim of this investigation was to develop a clinically applicable method for quantitative evaluation of spasticity about the knee and to determine the minimum instrumentation necessary for a quick and simple estimation of spasticity. Skeletal muscle spasticity is assessed by physical therapists as increased resistance of a particular muscle group to manually induced passive movement. In this study the passive movement was produced by the force of gravity while the resistance was observed from the joint goniogram. Spasticity of the knee extensors was measured on patients with spinal cord injuries. Records of severe, moderate, and slight spasticity are presented in the paper. A mathematical model has been developed describing the behaviour of healthy and spastic extremity.

Electromyography↗
PubMed1999

[Reduction of spastic increased muscle tone in multiple sclerosis by the nonopioid analgesic flupirtine].

OBJECTIVES: A reduction of muscle tone in rats can be found after intraperitoneal or intrathecal injection of flupirtine in analgetic doses. However, a muscle-relaxing effect in patients with spasticity has not yet been shown. In this study we investigated whether flupirtine can reduce the increased muscle tone in patients with spasticity. METHODS: The muscle-relaxing effect of flupirtine was compared to that of tetrazepam and of placebo in a randomised, double-blind, cross-over design. Altogether 9 patients with spastically increased muscle tone of the lower limbs were investigated. The EMG activity integral of the rectus femoris muscle was chosen as quantitative parameter for degree and change of muscle tone. The EMG activity integral was measured using a dynamic bicycle ergometer 60, 120 and 180 min after administration of the tested drugs. The degree of spasticity was measured as the quotient of the EMG activity integral of the active and passive rotation phase. This quotient is inversely proportional to the spastic muscle activity. RESULTS: With flupirtine a significant increase in the EMG activity integral was found after 60 min (maximum effect). From 120 min it showed a slow decline. With tetrazepam the maximal effect was reached after 180 min. Placebo did not change the EMG activity integral during the experiment. CONCLUSION: These results support the thesis that flupirtine has a muscle-relaxing effect in patients with pathologically increased muscle tone.

Clinical Trial↗
PubMed2001

Botulinum toxin for the management of muscle overactivity and spasticity after stroke.

Stroke is a major cause of disability involving the arm and leg. This disability results from the upper motoneuron syndrome (UMN) evident after stroke. It is commonly associated with spasticity and muscle overactivity, which can lead to abnormal limb posturing that interferes with active and passive function. The origin of limb deformity in patients with UMN is based on the concept of unbalanced agonist and antagonist muscle forces acting across joints. In the past decade, botulinum toxin A (BTX-A) a new medication that modifies muscle force and, hence, can treat muscle imbalance, has become available and has renewed interest in the management of muscle overactivity and spasticity after stroke. A reduction in muscle tone, painful spasms, and improved functionality can be obtained. Research and clinical reports support the concept that chemodenervation with BTX-A is an excellent intervention for treating focal muscle overactivity and spasticity secondary to stroke. Many muscles differing in size, shape, and location have been injected, and clinical effectiveness is particularly notable in elbow flexors, ankle plantar flexors, and smaller limb muscles, such as intrinsics of the hand and wrist. Smaller muscles are readily accessible for injection and require smaller amounts of toxin.

Botulinum Toxins↗