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Sensors (Basel, Switzerland) Feb 2022Spasticity is a disabling characteristic of neurological disorders, described by a velocity-dependent increase in muscle tone during passive stretch. During the last few... (Review)
Review
Spasticity is a disabling characteristic of neurological disorders, described by a velocity-dependent increase in muscle tone during passive stretch. During the last few years, many studies have been carried out to assess spasticity using wearable IMU (inertial measurements unit) sensors. This review aims to provide an updated framework of the current research on IMUs wearable sensors in people living with spasticity in recent studies published between 2017 and 2021. A total of 322 articles were screened, then finally 10 articles were selected. Results show the lack of homogenization of study procedures and missing apparatus information in some studies. Still, most studies performed adequately on measures of reporting and found that IMUs wearable data was successful in their respective purposes and goals. As IMUs estimate translational and rotational body motions, we believe there is a strong potential for these applications to estimate velocity-dependent exaggeration of stretch reflexes and spasticity-related characteristics in spasticity. This review also proposes new directions of research that should be challenged by larger study groups and could be of interest to both researchers as well as clinicians. The use of IMUs to evaluate spasticity is a promising avenue to provide an objective measurement as compared to non-instrumented traditional assessments.
Topics: Humans; Motion; Muscle Spasticity; Muscle Tonus; Reflex, Stretch; Wearable Electronic Devices
PubMed: 35270937
DOI: 10.3390/s22051791 -
European Journal of Physical and... Aug 2018The Modified Ashworth Scale is the most widely clinical scale used to measure the increase of muscle tone. Reliability is not an immutable property of a scale and can... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The Modified Ashworth Scale is the most widely clinical scale used to measure the increase of muscle tone. Reliability is not an immutable property of a scale and can vary as a function of the variability and composition of the sample to which it is administered. The best method to examine how the reliability of a test scores varies is by conducting a systematic review and meta-analysis of the reliability coefficients obtained in different applications of the test with the data at hand. The objectives of this systematic revision are: what is the mean inter- and intra-rater reliability of the Modified Ashworth Scale's scores in upper and lower extremities? Which study characteristics affect the reliability of the scores in this scale?
EVIDENCE ACQUISITION
The PubMed, Embase and CINAHL databases were searched from 1987 to February 2015. Two reviewers independently selected empirical studies published in English or in Spanish that applied the Modified Ashworth Scale and reported any reliability coefficient with the data at hand in children, adolescents or adults with spasticity.
EVIDENCE SYNTHESIS
Thirty-three studies reported any reliability estimate of Modified Ashworth Scale scores (N.=1065 participants). For lower extremities and inter-rater agreement, the mean intraclass correlation was ICC+=0.686 (95% CI: 0.563 and 0.780) and for kappa coefficients, κ+=0.360 (95% CI: 0.241 and 0.468); for intra-rater agreement: ICC+=0.644 (95% CI: 0.543 and 0.726) and κ+=0.488 (95% CI: 0.370 and 0.591). For upper extremities and inter-rater agreement: ICC+=0.781 (95% CI: 0.679 and 0.853) and κ+=0.625 (95% CI: 0.350 and 0.801); for intra-rater agreement: ICC+=0.748 (95% CI: 0.671 and 0.809) and κ+=0.593 (95% CI: 0.467 and 0.696). The type of design, the study focus, and the number of raters presented statistically significant relationships with ICC both for lower and upper extremities.
CONCLUSIONS
Inter- and intra-rater agreement for Modified Ashworth Scale scores was satisfactory. Modified Ashworth Scale' scores exhibited better reliability when measuring upper extremities than lower. Several characteristics of the studies were statistically associated to inter-rater reliability of the scores for lower and upper extremities.
Topics: Disability Evaluation; Evidence-Based Medicine; Female; Humans; Male; Muscle Spasticity; Muscle Tonus; Observer Variation; Physical and Rehabilitation Medicine; Severity of Illness Index
PubMed: 28901119
DOI: 10.23736/S1973-9087.17.04796-7 -
The Cochrane Database of Systematic... Jun 2017Exercise training is commonly recommended for individuals with fibromyalgia. This review is one of a series of reviews about exercise training for people with... (Review)
Review
BACKGROUND
Exercise training is commonly recommended for individuals with fibromyalgia. This review is one of a series of reviews about exercise training for people with fibromyalgia that will replace the "Exercise for treating fibromyalgia syndrome" review first published in 2002.
OBJECTIVES
• To evaluate the benefits and harms of aerobic exercise training for adults with fibromyalgia• To assess the following specific comparisons ० Aerobic versus control conditions (eg, treatment as usual, wait list control, physical activity as usual) ० Aerobic versus aerobic interventions (eg, running vs brisk walking) ० Aerobic versus non-exercise interventions (eg, medications, education) We did not assess specific comparisons involving aerobic exercise versus other exercise interventions (eg, resistance exercise, aquatic exercise, flexibility exercise, mixed exercise). Other systematic reviews have examined or will examine these comparisons (Bidonde 2014; Busch 2013).
SEARCH METHODS
We searched the Cochrane Library, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), Thesis and Dissertation Abstracts, the Allied and Complementary Medicine Database (AMED), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), and the ClinicalTrials.gov registry up to June 2016, unrestricted by language, and we reviewed the reference lists of retrieved trials to identify potentially relevant trials.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) in adults with a diagnosis of fibromyalgia that compared aerobic training interventions (dynamic physical activity that increases breathing and heart rate to submaximal levels for a prolonged period) versus no exercise or another intervention. Major outcomes were health-related quality of life (HRQL), pain intensity, stiffness, fatigue, physical function, withdrawals, and adverse events.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion, extracted data, performed a risk of bias assessment, and assessed the quality of the body of evidence for major outcomes using the GRADE approach. We used a 15% threshold for calculation of clinically relevant differences between groups.
MAIN RESULTS
We included 13 RCTs (839 people). Studies were at risk of selection, performance, and detection bias (owing to lack of blinding for self-reported outcomes) and had low risk of attrition and reporting bias. We prioritized the findings when aerobic exercise was compared with no exercise control and present them fully here.Eight trials (with 456 participants) provided low-quality evidence for pain intensity, fatigue, stiffness, and physical function; and moderate-quality evidence for withdrawals and HRQL at completion of the intervention (6 to 24 weeks). With the exception of withdrawals and adverse events, major outcome measures were self-reported and were expressed on a 0 to 100 scale (lower values are best, negative mean differences (MDs)/standardized mean differences (SMDs) indicate improvement). Effects for aerobic exercise versus control were as follows: HRQL: mean 56.08; five studies; N = 372; MD -7.89, 95% CI -13.23 to -2.55; absolute improvement of 8% (3% to 13%) and relative improvement of 15% (5% to 24%); pain intensity: mean 65.31; six studies; N = 351; MD -11.06, 95% CI -18.34 to -3.77; absolute improvement of 11% (95% CI 4% to 18%) and relative improvement of 18% (7% to 30%); stiffness: mean 69; one study; N = 143; MD -7.96, 95% CI -14.95 to -0.97; absolute difference in improvement of 8% (1% to 15%) and relative change in improvement of 11.4% (21.4% to 1.4%); physical function: mean 38.32; three studies; N = 246; MD -10.16, 95% CI -15.39 to -4.94; absolute change in improvement of 10% (15% to 5%) and relative change in improvement of 21.9% (33% to 11%); and fatigue: mean 68; three studies; N = 286; MD -6.48, 95% CI -14.33 to 1.38; absolute change in improvement of 6% (12% improvement to 0.3% worse) and relative change in improvement of 8% (16% improvement to 0.4% worse). Pooled analysis resulted in a risk ratio (RR) of moderate quality for withdrawals (17 per 100 and 20 per 100 in control and intervention groups, respectively; eight studies; N = 456; RR 1.25, 95%CI 0.89 to 1.77; absolute change of 5% more withdrawals with exercise (3% fewer to 12% more).Three trials provided low-quality evidence on long-term effects (24 to 208 weeks post intervention) and reported that benefits for pain and function persisted but did not for HRQL or fatigue. Withdrawals were similar, and investigators did not assess stiffness and adverse events.We are uncertain about the effects of one aerobic intervention versus another, as the evidence was of low to very low quality and was derived from single trials only, precluding meta-analyses. Similarly, we are uncertain of the effects of aerobic exercise over active controls (ie, education, three studies; stress management training, one study; medication, one study) owing to evidence of low to very low quality provided by single trials. Most studies did not measure adverse events; thus we are uncertain about the risk of adverse events associated with aerobic exercise.
AUTHORS' CONCLUSIONS
When compared with control, moderate-quality evidence indicates that aerobic exercise probably improves HRQL and all-cause withdrawal, and low-quality evidence suggests that aerobic exercise may slightly decrease pain intensity, may slightly improve physical function, and may lead to little difference in fatigue and stiffness. Three of the reported outcomes reached clinical significance (HRQL, physical function, and pain). Long-term effects of aerobic exercise may include little or no difference in pain, physical function, and all-cause withdrawal, and we are uncertain about long-term effects on remaining outcomes. We downgraded the evidence owing to the small number of included trials and participants across trials, and because of issues related to unclear and high risks of bias (performance, selection, and detection biases). Aerobic exercise appears to be well tolerated (similar withdrawal rates across groups), although evidence on adverse events is scarce, so we are uncertain about its safety.
Topics: Adult; Exercise; Fatigue; Female; Fibromyalgia; Humans; Male; Middle Aged; Muscle Tonus; Pain Measurement; Patient Dropouts; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28636204
DOI: 10.1002/14651858.CD012700 -
Arquivos de Neuro-psiquiatria Sep 2008Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors. (Review)
Review
BACKGROUND
Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors.
OBJECTIVE
The treatment of snoring with methods to increase muscle tonus of upper airway has been controversial, and poorly reported, thus a review of evidence is necessary to evaluate the effectiveness of these methods.
METHOD
A review of randomized or quasi-randomized, double blind trials on snoring treatment that have employed any method to increase muscle tonus of upper airway like phonotherapy or physical therapy among others.
OUTCOMES
decrease or completely stop of snoring, sleep quality, quality of life, and adverse events.
RESULTS
Three eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analyses of one study showed improvement of snoring, although the objective sub-analyses and subjective analyses showed controversial results. The adverse events were not reported.
CONCLUSION
There is no enough evidence to support the recommendation of methods to increase muscle tonus of upper airways in treatment of snoring. Well designed randomized clinical trials are needed to asses the efficacy of such methods, and a standard and worldwide accepted method for snoring assessment would be useful for future researches.
Topics: Breathing Exercises; Exercise Therapy; Humans; Muscle Tonus; Randomized Controlled Trials as Topic; Respiratory Muscles; Snoring
PubMed: 18949285
DOI: 10.1590/s0004-282x2008000500037