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At least 1,063 records · Page 59Linked to original sources
PubMed2004

Repeated dosing of botulinum toxin type A for upper limb spasticity following stroke.

The authors evaluated the long-term efficacy and safety of botulinum toxin type A (BTX-A) in poststroke spasticity patients who completed a 12-week placebo-controlled study and received multiple open-label treatments with 200 to 240 U BTX-A for 42 weeks. Significant and sustained improvements were observed for Disability Assessment and Ashworth scores. Adverse events were generally mild. This extension of a double-blind study demonstrates that repeated treatments of BTX-A significantly improve function and tone in spasticity.

Activities of Daily Living↗
PubMed1978

Time course of clinical and physiological effects of stimulation of the cerebellar surface in patients with spasticity.

A double-blind study of the short-term (12--48 hours) effects of cerebellar stimulation was performed on 11 selected patients with spasticity. Six of patients had a good clinical long-term response to chronic stimulation, four had a moderate response, and one had no response. Each patient received stimulation for two periods of 24 hours and was off stimulation for two periods of 24 hours. The periods were randomised over four consecutive days. Neither the patients nor the observer could distinguish between the days on stimulation and the days off stimulation. Simple tests of function of the upper limbs during stimulation, measurements of H responses, tonic vibration responses, vibration-induced suppression of H responses, stretch responses, and co-contraction, showed no differences between the four days. These results are contrasted with acute physiological changes seen in some patients during stimulation and also with the slow progressive improvement in clinical function that characterises the successful clinical response. It is suggested that lack of either acute or short-term changes in response to cerebellar stimulation does not predict the clinical outcome. If the strength of stimulation is changed, at least three days and preferably 10 days should be allowed for the effects to appear. The mechanisms responsible for the alleviation of spasticity are likely to be more complex than those mediating acute and reversible changes in reflex activity.

Adolescent↗
PubMed1999

Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity.

OBJECTIVES: To establish reliability of the Tone Assessment Scale and modified Ashworth scale in acute stroke patients. SETTING: A North Liverpool university hospital. PATIENTS: Eighteen men and 14 women admitted with acute stroke and still in hospital at the study start date (median age, 74 yrs; median Barthel score, 8). MAIN OUTCOME MEASURES: The modified Ashworth scale and the Tone Assessment Scale. STUDY DESIGN: The 32 patients were examined with both scales on the same occasion by two raters (interrater comparison) and on two occasions by one rater (intrarater comparison). RESULTS: The reliability of the modified Ashworth scale was very good (kappa = .84 for interrater and .83 for intrarater comparisons). The reliability of the Tone Assessment Scale was not as strong as the modified Ashworth scale, with marked variability in the assessment of posture (kappa = .22 to .50 for interrater and .29 to .55 for intrarater comparisons) and associated reaction (kappa/kappaW = -.05 to .79 for interrater and .19 to .83 for intrarater comparisons). However, those aspects of the Tone Assessment Scale that addressed response to passive movement and that are scored similarly to the modified Ashworth scale showed good to very good interrater reliability (kappaW = .79 to .92) and good to very good intrarater reliability (kappaW = .72 to .86), except for the question related to movement at the ankle where agreement was only moderate (kappaW = .59). CONCLUSIONS: The modified Ashworth scale is reliable. The section of the Tone Assessment Scale relating to response to passive movement is reliable at various joints, except the ankle. It may assist in studies on the prevalence of spasticity after stroke and the relationship between tone and function. Further development of a measure of spasticity at the ankle is required. The Tone Assessment Scale is not reliable for measuring posture and associated reactions.

Aged↗
PubMed1993

Selective lumbosacral dorsal rhizotomy immediately caudal to the conus medullaris for cerebral palsy spasticity.

We describe a variation of selective dorsal rhizotomy for spastic cerebral palsy that involves sectioning of the dorsal spinal roots immediately caudal to the conus medullaris. The operation entails an L1-L2 laminectomy, ultrasonographic localization of the conus medullaris, and partial deafferentation of the L1-S2 roots with electromyographic testing under an operating microscope. In 66 children with cerebral palsy, the operation reduced spasticity in the lower extremity without complications, e.g., motor weakness, neurogenic bladder, and sensory loss. It offers several important advantages over alternative techniques.

Cerebral Palsy↗
PubMed2000

Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticité et de la Dystonie.

OBJECTIVE: This prospective, nonrandomized, noncontrolled study was performed to evaluate the results of a new type of neurotomy, namely the soleus neurotomy, for treatment of the spastic equinus foot. METHODS: Between May 1996 and March 1998, 46 patients were treated for a spastic equinus foot. Clinical status, spasticity (Ashworth Scale score), and kinematic parameters of the gait were determined before and after surgery. The neurotomy was performed on the upper nerve of the soleus in all cases and was associated with other neurotomies (lower nerve of the soleus, 21 patients; gastrocnemius, 9 patients, tibialis posterior, 18 patients; flexor hallucis longus, 16 patients; and flexor digitorum longus, 17 patients). RESULTS: The mean follow-up period was 15 months (range, 8-28 mo). The equinus deformity disappeared clinically in all patients. Before the operation, all patients had an Ashworth Scale score of 2, with an inexhaustible clonus present on knee extension and persisting with knee flexion (Tardieu Scale score, 4), which was abolished in 95% of the patients after surgery. Two patients still had some clonus on knee extension; this did not interfere with their clinical improvement. Knee recurvatum disappeared in eight patients. Analysis of kinematic parameters demonstrated a statistically significant increase in joint motion of the second rocker (P = 0.0026) of the ankle during stance. The duration of the stance or swing phase, length of the walking cycle, and velocity or rate of spontaneous walking were not significantly modified. CONCLUSION: The study demonstrated that soleus neurotomy is effective for the treatment of spastic equinus foot, leading to abolition of spasticity and improvement in the range of ankle motion during the stance phase of gait.

Adolescent↗