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Toxins Apr 2021The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal... (Review)
Review
The simple definition of tone as the resistance to passive stretch is physiologically a complex interlaced network encompassing neural circuits in the brain, spinal cord, and muscle spindle. Disorders of muscle tone can arise from dysfunction in these pathways and manifest as hypertonia or hypotonia. The loss of supraspinal control mechanisms gives rise to hypertonia, resulting in spasticity or rigidity. On the other hand, dystonia and paratonia also manifest as abnormalities of muscle tone, but arise more due to the network dysfunction between the basal ganglia and the thalamo-cerebello-cortical connections. In this review, we have discussed the normal homeostatic mechanisms maintaining tone and the pathophysiology of spasticity and rigidity with its anatomical correlates. Thereafter, we have also highlighted the phenomenon of network dysfunction, cortical disinhibition, and neuroplastic alterations giving rise to dystonia and paratonia.
Topics: Animals; Brain; Dystonia; Humans; Muscle Contraction; Muscle Hypertonia; Muscle Rigidity; Muscle Spasticity; Muscle Tonus; Muscle, Skeletal; Neural Pathways; Spinal Cord
PubMed: 33923397
DOI: 10.3390/toxins13040282 -
Brain Injury 2013Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. (Review)
Review
BACKGROUND
Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood.
METHOD
This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder.
RESULTS
The lack of consensus is highlighted on the basis of spasticity and the associated absence of guidelines for treatment, use of drugs and rehabilitation programmes.
CONCLUSIONS
Future studies require controlled protocols to determine the efficiency of pharmacological and non-pharmacological treatments for spasticity. Neuroimaging may help predict the occurrence of spasticity and could provide insight into its neurological basis.
Topics: Botulinum Toxins, Type A; Disability Evaluation; Female; Humans; Male; Muscle Spasticity; Nerve Block; Neuroimaging; Neuromuscular Agents; Orthopedic Procedures; Orthotic Devices; Parasympatholytics; Physical Therapy Modalities; Practice Guidelines as Topic; Predictive Value of Tests; Stroke; Stroke Rehabilitation; Transcutaneous Electric Nerve Stimulation
PubMed: 23885710
DOI: 10.3109/02699052.2013.804202 -
Revista de Neurologia Jun 2020Spasticity is a frequent clinical sign in people with neurological diseases that affects mobility and causes serious complications: pain, joint limitation, muscular... (Review)
Review
INTRODUCTION
Spasticity is a frequent clinical sign in people with neurological diseases that affects mobility and causes serious complications: pain, joint limitation, muscular contractions and bed sores, which have a significant effect on the individual's functionality and quality of life.
AIM
To review the integration, description and critical interpretation of the most recent scientific evidence on the clinical variability of spasticity and associated symptoms, the different pathophysiological mechanisms and their relevance in the diagnostic and therapeutic approach.
DEVELOPMENT
A search was conducted in the scientific publications on the different aspects of spasticity grouped into two main categories: cerebral and spinal cord pathologies. The epidemiological, clinical and pathophysiological aspects, clinical and instrumental diagnoses, and the physiotherapeutic, pharmacological and surgical approach to spasticity in each group of pathologies were all reviewed.
CONCLUSION
Spasticity is related to structural lesions and maladaptive neuroplastic changes that determine an important variability in its clinical expression. Although its diagnosis presents important limitations, the use of clinical and neurophysiological diagnostic tools aimed at achieving different approaches in cases of neurological pathologies originating in the brain and in the spinal cord could optimise the effectiveness of spasticity therapies.
Topics: Algorithms; Humans; Muscle Spasticity; Nervous System Diseases
PubMed: 32500524
DOI: 10.33588/rn.7012.2019474 -
BioMed Research International 2014Spasticity is the velocity-dependent increase in muscle tone due to the exaggeration of stretch reflex. It is only one of the several components of the upper motor... (Review)
Review
Spasticity is the velocity-dependent increase in muscle tone due to the exaggeration of stretch reflex. It is only one of the several components of the upper motor neuron syndrome (UMNS). The central lesion causing the UMNS disrupts the balance of supraspinal inhibitory and excitatory inputs directed to the spinal cord, leading to a state of disinhibition of the stretch reflex. However, the delay between the acute neurological insult (trauma or stroke) and the appearance of spasticity argues against it simply being a release phenomenon and suggests some sort of plastic changes, occurring in the spinal cord and also in the brain. An important plastic change in the spinal cord could be the progressive reduction of postactivation depression due to limb immobilization. As well as hyperexcitable stretch reflexes, secondary soft tissue changes in the paretic limbs enhance muscle resistance to passive displacements. Therefore, in patients with UMNS, hypertonia can be divided into two components: hypertonia mediated by the stretch reflex, which corresponds to spasticity, and hypertonia due to soft tissue changes, which is often referred as nonreflex hypertonia or intrinsic hypertonia. Compelling evidences state that limb mobilisation in patients with UMNS is essential to prevent and treat both spasticity and intrinsic hypertonia.
Topics: Humans; Motor Neuron Disease; Motor Neurons; Muscle Hypertonia; Muscle Spasticity; Spinal Cord; Stroke; Stroke Rehabilitation
PubMed: 25530960
DOI: 10.1155/2014/354906 -
Polish Archives of Internal Medicine Nov 2017Recently, many countries have enacted new cannabis policies, including decriminalization of cannabis possession as well as legalization of medical and recreational... (Review)
Review
Recently, many countries have enacted new cannabis policies, including decriminalization of cannabis possession as well as legalization of medical and recreational cannabis. In this context, patients and their physicians have had an increasing number of conversations about the risks and benefits of cannabis. While cannabis and cannabinoids continue to be evaluated as pharmacotherapy for medical conditions, the best evidence currently exists for the following medical conditions: chronic pain, neuropathic pain, and spasticity resulting from multiple sclerosis. We also reviewed the current state of evidence for cannabis and cannabinoids for several other medical conditions, while addressing the potential acute and chronic effects of cannabis use, which are issues that physicians must consider before making an official recommendation on the use of medical cannabis to a patient. As the number of patient requests for medical cannabis has been increasing, physicians must become knowledgeable on the science of medical cannabis and open to a discussion about why the patient feels that medical cannabis may be helpful.
Topics: Chronic Pain; Epilepsy; Humans; Medical Marijuana; Multiple Sclerosis; Muscle Spasticity
PubMed: 29067992
DOI: 10.20452/pamw.4123 -
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 -
Current Neuropharmacology 2015Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side-effect that can occur in response to treatment with antipsychotic drugs. Symptoms... (Review)
Review
Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side-effect that can occur in response to treatment with antipsychotic drugs. Symptoms commonly include hyperpyrexia, muscle rigidity, autonomic dysfunction and altered mental status. In the current review we provide an overview on past and current developments in understanding the causes and treatment of NMS. Studies on the epidemiological incidence of NMS are evaluated, and we provide new data from the Canada Vigilance Adverse Reaction Online database to elaborate on drug-specific and antipsychotic drug polypharmacy instances of NMS reported between 1965 and 2012. Established risk factors are summarized with an emphasis on pharmacological and environmental causes. Leading theories about the etiopathology of NMS are discussed, including the potential contribution of the impact of dopamine receptor blockade and musculoskeletal fiber toxicity. A clinical perspective is provided whereby the clinical presentation and phenomenology of NMS is detailed, while the diagnosis of NMS and its differential is expounded. Current therapeutic strategies are outlined and the role for both pharmacological and non-pharmacological treatment strategies in alleviating the symptoms of NMS are discussed.
Topics: Animals; Antipsychotic Agents; Diagnosis, Differential; Humans; Incidence; Muscle Rigidity; Neuroleptic Malignant Syndrome; Risk Factors
PubMed: 26411967
DOI: 10.2174/1570159x13999150424113345 -
Annals of Physical and Rehabilitation... Jul 2019Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of...
OBJECTIVES
Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes.
METHODS
Data sources: a literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15th June 2017.
DATA EXTRACTION AND SYNTHESIS
two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE).
RESULTS
Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is "moderate" evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care (pharmacological and rehabilitation) in persons following stroke. "Low" quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with MS, vibration therapy for SCI and stretching for other neurological condition. For other interventions, evidence was inconclusive.
CONCLUSIONS
Despite the available range of non-pharmacological interventions for spasticity, there is lack of high-quality evidence for many modalities. Further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions.
Topics: Acupuncture Therapy; Adult; Brain Injuries; Electric Stimulation Therapy; Evidence-Based Medicine; Extracorporeal Shockwave Therapy; Humans; Multiple Sclerosis; Muscle Spasticity; Physical Therapy Modalities; Spinal Cord Injuries; Stroke
PubMed: 29042299
DOI: 10.1016/j.rehab.2017.10.001 -
Neurologia Sep 2019Although transcutaneous electrical nerve stimulation (TENS) has traditionally been used to treat pain, some studies have observed decreased spasticity after use of this...
INTRODUCTION
Although transcutaneous electrical nerve stimulation (TENS) has traditionally been used to treat pain, some studies have observed decreased spasticity after use of this technique. However, its use in clinical practice is still limited. Our purpose was twofold: to determine whether TENS is effective for treating spasticity or associated symptoms in patients with neurological involvement, and to determine which stimulation parameters exert the greatest effect on variables associated with spasticity.
DEVELOPMENT
Two independent reviewers used PubMed, PEDro, and Cochrane databases to search for randomised clinical trials addressing TENS and spasticity published before 12 May 2015, and selected the articles that met the inclusion criteria. Of the initial 96 articles, 86 were excluded. The remaining 10 articles present results from 207 patients with a cerebrovascular accident, 84 with multiple sclerosis, and 39 with spinal cord lesions.
CONCLUSIONS
In light of our results, we recommend TENS as a treatment for spasticity due to its low cost, ease of use, and absence of adverse reactions. However, the great variability in the types of stimulation used in the studies, and the differences in parameters and variables, make it difficult to assess and compare any results that might objectively determine the effectiveness of this technique and show how to optimise parameters.
Topics: Humans; Muscle Spasticity; Transcutaneous Electric Nerve Stimulation
PubMed: 27474366
DOI: 10.1016/j.nrl.2016.06.009 -
International Journal of Rehabilitation... Mar 2019Mirror therapy is a simple, inexpensive, and patient-oriented method that has been shown to reduce phantom sensations and pain caused by amputation and improve range of... (Randomized Controlled Trial)
Randomized Controlled Trial
Mirror therapy is a simple, inexpensive, and patient-oriented method that has been shown to reduce phantom sensations and pain caused by amputation and improve range of motion, speed, and accuracy of arm movement and function. Extracorporeal shock wave therapy (ESWT) is a new, reversible, and noninvasive method for the treatment of spasticity after stroke. To investigate the therapeutic effect of the combination of mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients. We randomly assigned 120 patients into four groups: A, B, C, and D. All groups received conventional rehabilitation training for 30 min per day, five times a week, for 4 weeks. Moreover, participants in groups A, B, and C also added mirror therapy, ESWT, and a combination of mirror and ESWT, respectively, for 20 min per day. Motor recovery and spasticity were measured using Fugl-Meyer assessment and modified Ashworth scale. The differences in the Fugl-Meyer assessment and modified Ashworth scale scores in group C were significantly greater than those of group D at all observed time points after treatment and were significantly greater than those of groups A and B (P<0.05), but no significant differences were observed between groups A and B until 12 months. Upper extremity spasticity was improved by combined mirror and ESWT.
Topics: Adult; Aged; Exercise Therapy; Extracorporeal Shockwave Therapy; Female; Humans; Male; Middle Aged; Muscle Spasticity; Occupational Therapy; Stroke Rehabilitation; Upper Extremity
PubMed: 30211721
DOI: 10.1097/MRR.0000000000000316