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PubMed1991

Reciprocal inhibition between forearm muscles in spastic hemiplegia.

We studied reciprocal inhibition of H-reflexes in the forearm flexor and extensor muscles in 14 patients with spastic hemiplegia secondary to a focal cerebral lesion and 14 normal volunteers. In the spastic limb, the Hmax/Mmax ratio was increased in both flexor and particularly extensor wrist muscles. The 3 normal inhibitory phases of reciprocal inhibition between extensor and flexor forearm muscles were markedly reduced on the spastic side of patients. The early disynaptic phase showed the greatest alteration. Reduced or absent inhibition between forearm muscles associated with increased spinal motoneuron excitability may be typical to spastic hemiplegia.

Brain Diseases↗
PubMed1996

Determining consistency of elbow joint threshold angle in elbow flexor muscles with spastic hypertonia.

BACKGROUND AND PURPOSE: Threshold angle, the point in passive range of motion where a muscle response or torque change is elicited, may be a potentially valid measure of hypertonus. Because the relationship of initial muscle length to threshold angle has not been addressed previously, this preliminary study examined whether starting elbow joint position and speed of stretch to elbow flexor muscles affect threshold angle. SUBJECTS: Five subjects with stroke-induced hypertonia of the elbow flexor muscles participated. METHODS: Two starting angles and two designated stretch speeds were applied randomly by a torque motor at each of three testing sessions. RESULTS: Starting angle, subject, and session affected threshold angle. A 90-degree starting angle at a stretch speed of approximately 1.0 radian/s produced the most consistent threshold angles between sessions within subjects, and threshold angle was relatively consistent for some subjects, irrespective of speed. CONCLUSION AND DISCUSSION: If future research indicates that these data can be generalized, the use of threshold angle as a consistent measure of hypertonia will require comparison within individuals, use of a consistent starting angle, and a movement condition of a 90-degree starting angle and an approximate movement speed of 1.0 radian/s across sessions.

Adult↗
PubMed2005

Muscle force generation and force control of finger movements in children with spastic hemiplegia during isometric tasks.

Force control ability was investigated in 10 males and 10 females, between 5 and 15 years old with spastic hemiplegia (mild and moderate hand dysfunction), and an aged-matched control group (eight males, 12 females). An isometric force production task at five different levels of maximum voluntary contraction (MVC) was performed. Results showed that MVC generated with the affected hand (AH) was only one-third of that generated by the non-affected hand (NAH; p < 0.001), time to peak was almost twofold at the highest force level (p < 0.001), and the coefficient of variation was twice as high (p < 0.001). Results for the NAH did not differ from those of the control children. Correlations between clinical and experimental variables were significant for the relation between Ashworth score for elbow flexors, MVC and variability at the highest force level. In conclusion, the findings for the AH suggests that strength training should be considered for agonist spastic muscles.

Adolescent↗
PubMed1981

Treatment of extension contracture of the hip in cerebral palsy.

Twenty patients with cerebral palsy had a total of 35 extension contractures of the hip, resulting from tightness of the gluteus maximus or hamstring muscles, with associated quadricepts muscle spasticity. Associated deformities included anteriorly dislocated hips, patella alta, lumbar lordosis, thoracic kyphosis and calcaneus feet. Active and passive exercises, surgical release of contractures and reduction of anteriorly dislocated hips improved function. Hip flexor or adductor tenotomies must be considered cautiously for patients with spastic hip extensor muscles, because severe extension constricture may develop after either procedure.

Adolescent↗
PubMed1984

Percutaneous phenol blocks to motor points of spastic forearm muscles in head-injured adults.

The motor points of spastic wrist and finger flexors were identified using a nerve stimulator. These motor points were injected percutaneously with either a 3% or 5% aqueous solution of phenol in 11 patients with brain injury. The effectiveness of the blocks was assessed by recording the resting angle of the wrist, active extension of the wrist, and passive extension of the wrist--first with the fingers flexed and then with the fingers extended. The blocks were repeated once in two patients and twice in one patient for return of muscle tone which interfered with hand function. Relaxation of muscle tone persisted for up to two months following the injections. The resting angle of the wrist improved a mean of 25 degrees. Active wrist extension improved an average of 30 degrees. The changes in wrist measurements represent the effects of different processes: 1) the neurolytic effect of the phenol block; 2) improvement in the neurologic status of the patient; and 3) regeneration of the motor end plate. This procedure is an effective method of temporarily controlling spasticity and allowing functional hand training while neurologic recovery is occurring.

Adolescent↗
PubMed1984

Electromyographic results of inhibitory splinting.

The purpose of this study was to compare the integrated EMG activity of spastic muscles in brain-damaged patients before and during splint application. Eight patients with spasticity that produced limb posturing were systematically monitored for EMG activity during a two-hour interval without a splint (Nonsplinted Condition), and during a subsequent two-hour period while wearing the splint (Splinted Condition). The goniometric measurement of the limb position also was taken during the two conditions. The limb postures monitored were ankle plantar flexion, wrist flexion, and elbow flexion. A paired t test showed a significant (p less than .001) increase in the position of the limb into extension in the Splinted Condition compared with the Nonsplinted Condition. No significant reduction in integrated EMG activity occurred during the Splinted Condition compared with the Nonsplinted Condition. Despite the significant change in joint position and elongation of spastic muscles produced by the splinting, the muscle groups accommodated to the position as evidenced by the lack of significant change in EMG activity. Therefore, splinting can effectively control postural defects caused by spastic limb posturing without significantly increasing muscle tone. Implications of the results and the use of EMG measurement to help identify patient candidates for splinting are discussed.

Adolescent↗
PubMed1994

Influence of sustained stretch on late muscular responses to magnetic brain stimulation in patients with upper motor neuron lesions.

Late muscular responses to transcranial magnetic stimulation occur in healthy subjects only in tonically active muscles with a proportional relationship between the amount of the EMG-response and the voluntary innervation strength. In hemiparetic stroke patients late potentials are elicited in chronically spastic hand flexors without voluntary background muscular activity probably reflecting enhanced excitability of spinal alpha-motoneurons in the spastic state. When spastic muscle hypertonus has been diminished by sustained muscle stretch late EMG-potentials are reduced or have disappeared completely. The relation between spastic muscle hypertonus and the late muscular response potentials as well as the possible mechanisms of sustained muscle stretch on the response characteristics to transcranial magnetic stimulation in spastic flexor muscles of the hand are discussed.

Action Potentials↗
PubMed1987

Stretch and vibration reflexes of wrist flexor muscles in spasticity.

The surface electromyographic (EMG) reflex responses of the voluntarily contracting flexor carpi radialis evoked by 'stretch' and by tendon vibration have been compared in patients with spasticity of the upper limb, arising from upper motor neuron lesions, and normal subjects. Reflex responses to 'stretch' comprised increases in EMG activity lasting up to 100 ms which were often divided into 'short' and 'long'-latency peaks. The short-latency responses of spastic patients were increased in size compared with those of normal subjects whereas later activity was commonly reduced or absent. In both groups vibration elicited short-latency, essentially phasic responses with activity falling back to or below the background level within 50 ms despite continuing stimulation. These initial reflex responses were exaggerated in the spastics as compared with the normals. In the relaxed state 'stretch' and vibration either failed to elicit reflex responses in normal subjects or reflexes were of small amplitude; in spastic patients both modes of stimulation regularly evoked well developed responses. These findings with 'stretch' and vibration, both of which forms of stimulation powerfully excite primary endings of muscle spindles, support the view that group Ia afferent-mediated reflex action is enhanced in spasticity. The observation that the normal long-latency responses evoked by stretch, which have been attributed to the action of spindle group II afferents (Matthews, 1984a) additionally excited with this stimulus, are depressed in many spastic patients is consistent with reduced group II effects. Observed abnormalities of stretch reflex behaviour did not readily explain the severity of accompanying spasticity of individual patients.

Adult↗
PubMed2005

Baclofen pump intervention for spasticity affecting pulmonary function.

INTRODUCTION: Muscle spasticity may adversely affect pulmonary function after spinal cord injury (SCI). However, there is limited information regarding the treatment of spasticity as a determinant of pulmonary function. This study presents the case of a man with C4 tetraplegia who had severe spasticity and difficulty weaning from ventilatory support. METHODS: Case presentation. RESULTS: Severe spasticity likely contributed to respiratory compromise in this patient. Successful and rapid weaning from the ventilator occurred within 3 weeks of baclofen pump placement. CONCLUSIONS: Randomized clinical trials among SCI patients with significant spasticity are needed to determine whether intervention with a baclofen pump facilitates earlier ventilatory weaning.

Baclofen↗
PubMed2006

Spastic tail muscles recover from myofiber atrophy and myosin heavy chain transformations in chronic spinal rats.

Without intervention after spinal cord injury (SCI), paralyzed skeletal muscles undergo myofiber atrophy and slow-to-fast myofiber type transformations. We hypothesized that chronic spasticity-associated neuromuscular activity after SCI would promote recovery from such deleterious changes. We examined segmental tail muscles of chronic spinal rats with long-standing tail spasticity (7 mo after sacral spinal cord transection; older chronic spinals), chronic spinal rats that experienced less spasticity early after injury (young chronic spinals), and rats without spasticity after transection and bilateral deafferentation (spinal isolated). These were compared with tail muscles of age-matched normal rats. Using immunohistochemistry, we observed myofiber distributions of 15.9 +/- 3.5% type I, 18.7 +/- 10.7% type IIA, 60.8 +/- 12.6% type IID(X), and 2.3 +/- 1.3% type IIB (means +/- SD) in young normals, which were not different in older normals. Young chronic spinals demonstrated transformations toward faster myofiber types with decreased type I and increased type IID(X) paralleled by atrophy of all myofiber types compared with young normals. Spinal isolated rats also demonstrated decreased type I myofiber proportions and increased type II myofiber proportions, and severe myofiber atrophy. After 4 mo of complete spasticity (older chronic spinals), myofiber type transformations were reversed, with no significant differences in type I, IIA, IID(X), or IIB proportions compared with age-matched normals. Moreover, after this prolonged spasticity, type I, IIA, and IIB myofibers recovered from atrophy, and type IID(X) myofibers partially recovered. Our results indicate that early after transection or after long-term spinal isolation, relatively inactive tail myofibers atrophy and transform toward faster myofiber types. However, long-term spasticity apparently produces neuromuscular activity that promotes recovery of myofiber types and myofiber sizes.

Aging↗
PubMed1983

Non-invasive circulatory evaluation and electro-acupuncture & TES treatment of diseases difficult to treat in Western medicine.

Even in the presence of normal blood pressure (B.P.) in both arms in some individuals, abnormal B.P. and circulatory disturbances can be found in the brain and lower extremities. The author discovered the following five types of abnormal B.P. in the brain in the presence or absence of normal B.P. in the arms: unilateral cephalic hypertension; bilateral cephalic hypertension; unilateral cephalic hypotension; bilateral cephalic hypotension; mixed cephalic hypertension and hypotension. When the B.P. of the head exceeds about 160 mm Hg, patients experience sensation of increased pressure buildup in the head to moderate headache. When it exceeds over 220 mm Hg, most of them experience severe headache in that side of the head. When the B.P. is very low (less than 30 mm Hg in both sides), majority of the subjects experience sleep disturbance pattern, mainly insomnia and some develop excessive sleepiness; difficulty in concentration and easy forgetfulness of recent events; various degrees of irritability. They are often associated with injury of neck-shoulder area with the presence of spastic muscles in the area. Relaxation of the spastic muscles by acupuncture, TES or soft laser beam from He-Ne (7 approximately 15m Watts) often change the abnormal cephalic B.P. toward normal. Among individuals with cephalic hypotension some of them develop eye problems. Blind patients with macular degeneration and retinitis pigmentosa often have severe cephalic hypotension and reduced blood flow. Improvement of B.P. and blood flow induced by safe and effective electrical stimulation resulted in significant improvement in vision. In some patients, abnormal B.P. and blood flow of the brain are dependent on the position of the head and neck which can be classified as "Cephalo-cervical Position Dependent Dysfunction Syndrome" which interferes with the function of some of the internal organs. In many psychiatric patients with schizophrenia or severe depression, cephalic B.P. and blood flow are often reduced significantly with additional abnormal function of pancreas, thyroid gland or liver. These abnormalities can explain some of the abnormal behavior, particularly when hypoglycemia, decrease in serotonin level and decreased circulation in the brain coexist.(ABSTRACT TRUNCATED AT 400 WORDS)

Acupuncture Therapy↗
PubMed1990

Smooth muscles from spastic coronary artery segments show hypercontractility to histamine.

An animal model of coronary spasm was produced in Göttingen miniature pigs by a selective endothelial denudation of the coronary artery. Five months after the denudation, intracoronary bolus administration of 10 micrograms/kg histamine reduced the luminal diameter angiographically by 57 +/- 16 and 17 +/- 10% (P less than 0.01) in the previously denuded and contralateral control coronary arteries. Muscle fibers of 0.08-0.1 mm wide were prepared from circumferential bundles of the medial smooth muscle in the spastic and nonspastic coronary arteries. Upward shifts of either dose-tonic contraction relationships in Ca2(+)-containing solution or dose-monophasic contraction relationships in Ca2(+)-free solution were noted in muscle fibers taken from the spastic site compared with those from the nonspastic site with no difference between the mean effective dose values. After skinning the muscle fibers with saponin, there was no significant difference in the Ca2+ concentration-tension relationships between the two fibers. These findings suggest that an increased number of histaminergic receptors and/or augmentation of signal transduction, but not Ca2+ sensitivity of the contractile proteins in the medial smooth muscle cells, cause histamine-induced coronary hypercontraction.

Animals↗
PubMed1988

Spasticity in head trauma and CVA patients: etiology and management.

Spasticity is a common problem in patients following head trauma and cerebral vascular accident (CVA). Spasticity interferes with mobility and self-care activities which are critical for successful rehabilitative outcomes. While a patient with a spastic muscle about a joint may be able to voluntarily contract the muscle, relaxation of the muscle may be impossible. Severe spasticity can result in joint contractures which further impair function. Shearing movements due to spastic responses precipitate skin breakdown and may disrupt pressure sore repair. In addition, the inability to perform functional activities produces frustration and anxiety for patients and their significant others. The purpose of this article is to review the pathophysiologic basis of spasticity, outline treatment methods used to decrease spasticity, and suggest clinical management strategies for the nurse working with head trauma and CVA patients who exhibit spasticity.

Brain Injuries↗