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At least 937 records · Page 52Linked to original sources
PubMed1998

Spasticity: current and future management. Royal College of Physicians, November 13, 1997.

Tizanidine hydrochloride (Zanaflex), an alpha 2-adrenoreceptor agonist, is the first new antispasticity agent to become available in the UK for more than 20 years. It provides effective reduction of spasticity without affecting muscle strength. The mechanisms of spasticity, its measurement and management, together with the place of tizanidine in its treatment, were discussed at a symposium held at the Royal College of Physicians on November 13 1997.

Clinical Trials as Topic↗
PubMed1994

Passive, intrinsic and reflex-mediated stiffness in the ankle extensors of hemiparetic patients.

The total mechanical response to a stretch in a contracting muscle is the sum of the response from the properties of the fibres contracting prior to the stretch (intrinsic properties), the response from the passive tissues and the response from the stretch reflex-mediated contraction of the muscle fibres. The passive, the intrinsic and the reflex-mediated mechanical response to a 4 degrees stretch of the ankle extensors in both legs of nine spastic hemiparetic patients and, as control, the left ankle extensors in eight healthy subjects were measured. The stretch was imposed at the top of a maintained contraction, which was varied from zero to maximal contraction. The torque increments, measured 200 ms after stretch, were converted into stiffness by dividing by the amplitude of the stretch. We found that the reflex stiffness of the spastic and contralateral leg was within the normal range of the reflex stiffness in healthy subjects, and that the passive stiffness of the spastic and the contralateral leg is larger than the passive stiffness in healthy subjects, whereas the intrinsic stiffness is unchanged in the spastic extensor muscles.

Adult↗
PubMed1978

Sinusoidal oscillation of the ankle as a means of evaluating the spastic patient.

Sinusoidally modulated torque was applied to rotate the ankle joint of normal subjects and clinically spastic patients. Measurements were made of the effective joint compliance and of the evoked EMG activity. These procedures provide a well-quantified and reliable measure of muscle tone and hyperreflexia which is well correlated with the patient's clinical status.

Adult↗
PubMed2000

Anatomic motor point localization for partial quadriceps block in spasticity.

OBJECTIVE: To identify the location of the vastus intermedius nerve and its motor point (point M) and to precisely identify its coordinates in relation to anatomic surface landmarks. DESIGN: Descriptive study. SETTING: Anatomy institute of a university school of medicine. PARTICIPANTS: Twenty-nine adult cadaver limbs immobilized in anatomic position. INTERVENTION: Anatomic dissection to identify point M. Anatomic surface landmarks were point F, the issuing point of femoral nerve under the inguinal ligament; point R, the middle of superior edge of the patella; segment FR, which corresponds to thigh length; point M', point M orthogonal projection on segment FR. MEAN OUTCOME MEASURE: Absolute vertical coordinate, distance FM, relative vertical coordinate compared to the thigh length, FM'/FR ratio; absolute horizontal coordinate, distance MM'. RESULTS: The absolute vertical coordinate was 11.7+/-2 cm. The relative vertical coordinate was at .29+/-.04 of thigh length. The horizontal coordinate was at 2+/-.5 cm lateral to the FR line. CONCLUSION: Point M can be defined with relative precision by two coordinates. Application and clinical interest of nerve blocking using these coordinates in quadriceps spasticity should be studied.

Adult↗
PubMed1983

Stretch reflexes of triceps surae in patients with upper motor neuron syndromes.

Electromyographic responses of triceps surae to dorsiflexion stretch were studied in 47 patients with a variety of lesions producing an upper motor neuron syndrome. The short latency spinal reflexes, both when the patient was at rest and when he was exerting a voluntary plantarflexion, were frequently enhanced in magnitude and the rate of increase with acceleration was also enhanced. Long-latency reflexes were uncommon at rest. With background force long-latency reflexes were present unless the short latency reflex was very large. Long latency reflexes often were normal, but in some patients they were either excessively larger or even of abnormal shape with prolonged continuous activity. The clinical assessment of the ankle jerk correlated with the magnitude of the short latency reflex. The clinical assessment of tone correlated with the magnitude of the short latency reflex, the magnitude of the long latency reflex and the duration of the long latency reflex. There appear to be multiple physiological mechanisms underlying the clinical phenomenon of spasticity.

Cerebral Cortex↗
PubMedDate not supplied

Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization.

All children with cerebral palsy who had a pelvic osteotomy performed by the senior author (F.M.) from 1989 through 1991 were reviewed. Indications for operative reconstruction were failed muscle lengthening in a child younger than 8 years or a painful hip. The operative procedure included adductor muscle lengthening, varus shortening femoral osteotomy, and peri-ilial pelvic osteotomy. Patients were immediately mobilized after surgery by physical therapy. Fifty-one children had reconstruction of 49 subluxated and 21 dislocated hips. Femoral and pelvic osteotomies were performed on 59 hips, and 11 hips had only a femoral osteotomy. Forty-nine hips had adductor muscle lengthening, and 27 hips had femoral osteotomy to provide for relief of contractures. At mean follow-up of 34 months, two hips in two patients had redislocated, requiring repeated surgery. Two hips remained subluxated and asymptomatic. Twenty-three hips in 18 patients were painful before surgery. One hip continued with severe pain after surgery, requiring further surgery. Three hips continued with mild pain not requiring surgery, and 14 (82%) hips had complete pain relief. Of 37 caretakers interviewed, 80% felt the procedure was beneficial and would recommend it to others. Eight percent were uncertain, and 6% (two caretakers) thought it was not helpful.

Acetabulum↗
PubMed1997

Gabapentin for the treatment of spasticity in patients with spinal cord injury.

Our serendipitous observations suggested that some patients with spasticity appeared to have improved following the administration of the anticonvulsant drug gabapentin. As some patients with spasticity are either refractory to or intolerant of established medical treatments, we conducted this study to investigate the effect of gabapentin on spasticity in patients with spinal cord injury. Twenty-five patients with spinal cord injury and spasticity received oral gabapentin (2400 mg over 48 h) in a randomized, double blind, placebo-controlled crossover study. We assessed responses by measuring the Ashworth spasticity scale, muscle stretch reflexes, presence of clonus and reflex response to noxious stimuli. Patient ratings were obtained using a Likert Scale. Administration of gabapentin, but not placebo, was associated with an 11% reduction in spasticity as measured by the Ashworth Scale (P = 0.04) and by a 20% reduction in the Likert Scale (P = 0.0013). Significant changes were not obtained for the other measures. The data obtained suggest that gabapentin may be useful in the management of spasticity associated with spinal cord injury.

Acetates↗
PubMed2003

Placement of a plate under the forefoot in stance: decreasing the excitability of the soleus motoneuron pool.

OBJECTIVE: To investigate the effect of the placement of a plate under the sole of the forefoot on the excitability of the soleus motoneuron pool in stance. DESIGN: While eight neurologically intact subjects remained in stance, a square plate (30 x 30 mm), either 3 mm or 6 mm in thickness, was placed under the left medial plantar eminence, under the left lateral plantar eminence, or under the left forefoot sole between the eminences, or a rectangular plate (120 x 30 mm), either 3 mm or 6 mm in thickness, was placed under the left metatarsal heads. To investigate the excitability of the soleus motoneuron pool, the Hmax/Mmax ratio was estimated. RESULTS: Analysis of variance revealed that the region under which the plate was placed had a significant effect and that the thickness of the plate had a nonsignificant effect on the Hmax/Mmax ratio, without significant interaction between the two factors. Post hoc analysis revealed a significant decrease in the Hmax/Mmax ratio when the square plate was placed under the lateral plantar eminence. CONCLUSIONS: A square plate placed under the lateral plantar eminence inhibited the excitability of the ipsilateral soleus motoneuron pool in stance. This intervention may be useful for reducing spasticity.

Adolescent↗