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Results for “Muscle Spasticity”

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PubMed2004

[Muscle physiology and the effect of muscle-tendon surgery in cerebral palsy].

The muscle reacts physiologically in neuromuscular disorders which do not affect muscle tissue directly (such as muscular dystrophies), and adapts to altered demands. For this reason, alterations in the muscle-tendon apparatus are grossly secondary. Changing load stimulates an increase in muscle fibres, whereas continuous pull results in an increase in collagen fibres (fibrosis). The length range in which a muscle produces force must be considered with respect to the range of motion of the joint in order to plan soft tissue corrections and to understand the postoperative result. An optimal correction of muscle length can increase muscle force whereas overlengthening will reduce it. The latter is desired in cases where spastic muscle force needs to be reduced. In contrast shortening the muscle-tendon apparatus may be indicated in order to correct overlength and to increase muscle force. The effect of intramuscular lengthening procedures, performed as an aponeurotomy or an intramuscular tenotomy, depends on the stretching program after surgery. Extramuscular tendon lengthening, on the other hand, results in an immediate length gain. The danger of overlengthening and consecutive muscle weakening, however, is greater with the tendinous procedures.

Animals↗

PubMed2003

Arthrographic and clinical findings in patients with hemiplegic shoulder pain.

OBJECTIVES: To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN: Case series. SETTING: Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS: Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS: Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS: After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.

Adult↗

PubMed1990

Long-term morphology of spastic or flaccid muscles in spinal cord-transected rabbits.

Despite difficulty in long-term maintenance of spinalized rabbits, muscular pathologic changes in chronic spinalized rabbits could be observed for a period of four weeks. Rabbits were prepared by spinal cord transection at T10 (spastic paralysis) or by spinal cord removal below L7 (flaccid paralysis). Spastic preparations showed hind-limb spasticity and reflex incontinence one to two days after operation. Hypertrophic fibers began to appear in spastic muscles after two weeks. This hypertrophy, thought to be caused by phasic repetitive contraction, was verified by electron microscopy to be different from normal exercise hypertrophy. Flaccid preparations maintained hind-limb flaccidity and overflow incontinence. In flaccid muscle, marked muscle fiber necrosis indicated rapid atrophy. Spinal deformity and joint contracture inactivate spinalized rabbits, and cause pressure sores. However, feeding assistance and avoidance of complications make long-term maintenance possible.

Animals↗

PubMed2005

Significant reduction of the risk of venous thromboembolism in all long-term immobile patients a few months after the onset of immobility.

Prophylactic anticoagulation is a standard practice in patients with sudden lower limbs paralysis. Thromboprophylaxis is usually continued until the patient regains independent mobility. The duration of anticoagulation in long-term immobile patients is unknown. Spinal cord injury patients are the only population that was comprehensively studied and prophylactic anticoagulation is discontinued after 4 months as the risk of venous thromboembolism drops dramatically after 3-4 months. Development of muscle spasticity has been traditionally considered to be the reason for this low risk as lower limbs spasticity/spasms might be able to improve the calf muscle pump action. We are presenting the evidence from physiological studies of the lower limbs vascular system that cast doubt over this explanation and present an alternative hypothesis backed by several clinical circumstantial evidence suggesting that the vascular changes following long term lower limbs inactivity which are universal to all immobile patients is probably the main protecting factor. We suggest that prophylactic anticoagulation is necessary only on the first 4 months following the acute onset of immobility in all neurologically impaired immobile patients regardless of their muscle tone state.

Age Factors↗

PubMed1981

A histochemical and electron microscopic study of a fast- and a slow-twitch muscle in genetically spastic mice.

Fast and slow muscle fibers were studied in the flexor digitorum longus (FDL) and soleus (SOL) muscles, respectively, in control and spastic mice. HIstochemical and electron microscopic studies indicated an increased number of mitochondria, a decreased deposition of glycogen and a vesiculation and distension of the sarcoplasmic reticulum in many fast-twitch fibers of the spastic FDL. Similar findings were not evident in the slow-twitch fibers of the spastic SOL. Since the spastic condition causes increased muscular activity as a result of more rapid and prolonged nerve impulse firing, these findings reinforce the idea that a muscle fiber's oxidative capabilities are a function of its activity.

Adenosine Triphosphatases↗

PubMed2006

Measurement of muscle thickness as quantitative muscle evaluation for adults with severe cerebral palsy.

BACKGROUND AND PURPOSE: The muscle strength of people with severe cerebral palsy (CP) is difficult to quantify because of cognitive and selective motor control problems. However, if muscle strength is related to muscle atrophy caused by activity limitation, quantitative morphological analysis such as analysis of muscle thickness (MTH), measured by ultrasound imaging, may be used to examine the muscle condition in daily use. The primary purpose of this investigation was to clarify the difference in MTH of several muscles by the motor functions used in daily activity in adults with CP with different levels of severity of involvement. The secondary purpose was to examine whether MTH is associated with age, body characteristics, and muscle spasticity. SUBJECTS: Data were collected from a convenience sample of 25 adults with severe CP. METHODS: The MTH of the biceps brachii (BB), quadriceps femoris (QF), triceps surae (TS), and longissimus (LO) muscles was measured with an ultrasound imaging device. The severity of the condition was classified with the Gross Motor Function Classification System (GMFCS), and functional status in sitting and standing was evaluated with a questionnaire administered to the staff assisting in the care of the subjects. Muscle spasticity was assessed with the Modified Ashworth Scale (MAS). RESULTS: The MTH of the QF, LO, and TS showed significant differences according to the GMFCS level, and the MTH of the QF and LO differed significantly depending on functional status during activities of daily living. Age and body mass index showed no significant correlation with the MTH of any muscle. Body weight was correlated with the MTH of the BB and LO. The girth of the extremity was correlated only with the MTH of the BB. There was no relationship between MTH and MAS scores. DISCUSSION AND CONCLUSION: These results suggest that the MTH of the QF and LO differed significantly depending on the subjects' motor function during daily activity. The measurement of MTH may be an alternative method of quantitative muscle evaluation for people with severe CP for whom direct measurement of muscle strength is difficult.

Activities of Daily Living↗

PubMed1995

Selective dorsal rhizotomy to decrease spasticity in cerebral palsy.

Until recently, treatment of muscle spasticity in children with cerebral palsy has consisted of physical therapy, bracing, and surgery to release and lengthen tight tendons of contracted muscles and correct muscle contractures. Selective dorsal rhizotomy is a surgical intervention that selectively cuts the spinal sensory nerve rootlets carrying the most abnormal signals, thereby reducing spasticity in all muscle groups of the affected extremities. It is not a cure for spastic cerebral palsy. Children who have this procedure can gain significant increases in knee and thigh ranges of motion and increased strength and muscle control if they have good family support and follow through with intensive postoperative physical therapy.

Cerebral Palsy↗

PubMed1984

Muscle growth in normal and spastic mice.

Longitudinal muscle growth was studied in normal and spastic mice. Muscle growth takes place at the musculotendinous junction--the 'muscle growth-plate'. In spastic mice muscle growth is reduced by 45 per cent, resulting in contractures.

Animals↗

PubMed1993

A double-blind study of L-threonine in patients with spinal spasticity.

We conducted a double-blind, placebo-controlled, crossover study of oral L-threonine at 6 g/day in patients with spinal spasticity. Muscle tone from selected leg muscles, measured by the Ashworth Scale, was the principal measure of spasticity and was evaluated before and at the end of each treatment period. A 10% reduction in Ashworth score was regarded as a positive response to a treatment. The results were analyzed sequentially, patients being classified as threonine-responders, placebo-responders or non-responders (those who responded to both treatments by either less or greater than 10%) and a level of significance of p = 0.05 was chosen. The trial concluded in favour of L-threonine after 33 patients. Side-effects were minimal. L-threonine has a modest but definite antispastic effect, and its possible role in modifying spinal glycinergic transmission is discussed.

Adolescent↗

PubMed2003

[Doxorubicin-induced chemomyectomy effects in rat skeletal muscle].

OBJECTIVES: This study was based on the assumption that decreased number of active muscle fibres in the spastic muscle may be associated with restoration of the balance. Hence, the effect of doxorubicin was evaluated in inducing permanent cell necrosis on skeletal muscle (chemomyectomy). METHODS: Eighteen Wistar rats were divided into two groups, equal in size, to receive doxorubicin injections (0.02 and 0.05 mg/0.5 ml) into the left quadriceps muscles under general anaesthesia. The right quadriceps muscles (controls) were assigned to receive 0.5 ml of physiologic saline solution. Three rats in each group were sacrificed on the 1st, 6th, and 10th post-injection weeks, after which all the quadriceps muscles were histologically evaluated. RESULTS: Histopathologic findings were normal in the control muscles. Dose-dependent acute inflammatory reactions were observed in both groups at the end of the first week, with a higher severity at 0.05 mg doses. The size of the inflammation areas were 2.5% and 10% at 0.02 mg and 0.05 mg doses, respectively. At the end of six weeks, acute inflammatory reactions were replaced by the development of regeneration and fibrosis accounting to 0.8% of all the areas, regardless of the dose given. Specimens of the 10th week exhibited no regeneration; there was a mean of 2.5% fragmentation within the impaired areas, with atrophic fibrils and marked fibrosis showing no dose-dependence. CONCLUSION: Doxorubicin induces a dose-dependent inflammatory reaction during the early postoperative period. In the long-term, permanent effects, which are not dose-dependent, are observed characterized by fragmentation, atrophy, fibrosis of muscle fibres, and losses in contractile muscle elements. These doxorubicin-induced chemomyectomy effects may prove therapeutic in the treatment of spasticity-associated diseases.

Animals↗

PubMed1993

Anaerobic threshold in wheelchair athletes with cerebral palsy: validity and reliability.

This study examined the validity and reliability of the anaerobic threshold (AT) using blood lactate (ATLa) and respiratory gas exchange (ATg) criteria during cycle ergometry (CE) and wheelchair ergometry (WE) in athletes with spastic cerebral palsy (CP). Eleven subjects attempted a discontinuous incremental test protocol, two minutes work interspersed with one minute rest, twice each on the CE and WE. Only five out of the 11 subjects were able to complete the CE tests, whereas all the subjects were able to complete the WE test. Inadequate hip flexion due to muscle spasticity was the primary limiting factor during the CE tests. Although the maximal aerobic power using this protocol was reliable during WE (r = 0.89, p < .05), the validity and reliability of the AT identified by two independent evaluators using these two techniques was questionable. Evaluator 1 was able to identify ATLa and ATg in seven out of the 11 cases, whereas evaluator 2 was successful in five and seven cases, respectively. It is unclear from these results whether the poor validity and reliability of the AT was due to the discontinuous test protocol used, or whether it was due to inconsistencies in the rate of lactate diffusion from the muscle into the blood due to variations in muscle spasticity during the test.

Adult↗

PubMed1986

Skeletal muscle changes following myelotomy in paraplegic patients.

Pourpre's dorsal T-shaped myelotomy was performed on three paraplegic patients in which medical and electro-physiological procedures proved to be ineffective concerning muscle spasms. The myelotomy led to the elimination of spasms and of muscle hypertonicity in the lower limbs. Biopsies of the rectus femoris muscles were performed bilaterally one year before and two months following myelotomy. The first biopsy revealed fascicular atrophy, with type I fibre preferential atrophy, which is usually found in paraplegic patients. After myelotomy some histological differences were seen: reduction of type II fibre diameter and the presence of target-targetoid fibres and of atrophic dark fibres. There was a difference of fibre pattern type in hypertonic spastic muscles compared to that seen in spasm relieved by myelotomy. The morphological changes seen after myelotomy are interpreted as denervation changes because of the surgical lesion by the myelotomy on the anterior horn cells.

Adult↗

PubMed2005

Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up.

OBJECTIVE: To test the effectiveness and long term safety of cannabinoids in multiple sclerosis (MS), in a follow up to the main Cannabinoids in Multiple Sclerosis (CAMS) study. METHODS: In total, 630 patients with stable MS with muscle spasticity from 33 UK centres were randomised to receive oral Delta(9)-tetrahydrocannabinol (Delta(9)-THC), cannabis extract, or placebo in the main 15 week CAMS study. The primary outcome was change in the Ashworth spasticity scale. Secondary outcomes were the Rivermead Mobility Index, timed 10 metre walk, UK Neurological Disability Score, postal Barthel Index, General Health Questionnaire-30, and a series of nine category rating scales. Following the main study, patients were invited to continue medication, double blinded, for up to 12 months in the follow up study reported here. RESULTS: Intention to treat analysis of data from the 80% of patients followed up for 12 months showed evidence of a small treatment effect on muscle spasticity as measured by change in Ashworth score from baseline to 12 months (Delta(9)-THC mean reduction 1.82 (n = 154, 95% confidence interval (CI) 0.53 to 3.12), cannabis extract 0.10 (n = 172, 95% CI -0.99 to 1.19), placebo -0.23 (n = 176, 95% CI -1.41 to 0.94); p = 0.04 unadjusted for ambulatory status and centre, p = 0.01 adjusted). There was suggestive evidence for treatment effects of Delta(9)-THC on some aspects of disability. There were no major safety concerns. Overall, patients felt that these drugs were helpful in treating their disease. CONCLUSIONS: These data provide limited evidence for a longer term treatment effect of cannabinoids. A long term placebo controlled study is now needed to establish whether cannabinoids may have a role beyond symptom amelioration in MS.

Administration, Oral↗

PubMed1969