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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 -
Developmental Medicine and Child... Oct 2006Passive stretching is widely used for individuals with spasticity in a belief that tightness or contracture of soft tissues can be corrected and lengthened. Evidence for... (Review)
Review
Passive stretching is widely used for individuals with spasticity in a belief that tightness or contracture of soft tissues can be corrected and lengthened. Evidence for the efficacy of passive stretching on individuals with spasticity is limited. The aim of this review was to evaluate the evidence on the effectiveness of passive stretching in children with spastic cerebral palsy. Seven studies were selected according to the selection criteria and scored against the Physiotherapy Evidence Database scale. Effect size and 95% confidence intervals were calculated for comparison. There was limited evidence that manual stretching can increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity. It appeared that sustained stretching of longer duration was preferable to improve range of movements and to reduce spasticity of muscles around the targeted joints. Methods of passive stretching were varied. Further research is required given the present lack of knowledge about treatment outcomes and the wide use of this treatment modality.
Topics: Cerebral Palsy; Child; Child, Preschool; Humans; Muscle Spasticity; Physical Therapy Modalities; Range of Motion, Articular
PubMed: 16978468
DOI: 10.1017/S0012162206001836 -
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... Sep 2010Spasticity is a major disabling symptom in many patients with spinal and/or cerebral lesions. During functional movements, spasticity manifests itself within the complex... (Review)
Review
Spasticity is a major disabling symptom in many patients with spinal and/or cerebral lesions. During functional movements, spasticity manifests itself within the complex condition of the "spastic movement disorder". The pathophysiology of the spastic movement disorder relies on multiple factors including abnormal supraspinal drive, abnormal control of reflex activities, and changes in muscle mechanical properties. The most widely used procedures for management of spasticity are represented by pharmacological treatment aimed at inhibiting reflex hyperexcitability. In the last decades, several non pharmacological procedures for treating spasticity have been put forward, including muscle stretching, muscle reinforcement, physical agents and pain management. These procedures may have both neurophysiological and biomechanical effects on the spastic movement disorder. In the present paper, the literature concerning non-pharmacological procedures in the treatment of spasticity was reviewed and discussed, taking into account the multifaceted pathophysiology of the spastic movement disorder. Although further research in this field is recommended, existing evidence supports the potential role of rehabilitation interventions as a therapeutic tool, which could be integrated with traditional pharmacological procedures in the management of the spastic movement disorder.
Topics: Biofeedback, Psychology; Electric Stimulation Therapy; Humans; Muscle Spasticity; Muscle Stretching Exercises; Pain; Pain Management; Resistance Training; Short-Wave Therapy; Ultrasonic Therapy
PubMed: 20927008
DOI: No ID Found -
Toxins Nov 2022Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged... (Review)
Review
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
Topics: Child; Humans; Muscle Spasticity; Cerebral Palsy; Neuromuscular Agents; Quality of Life; Injections, Intramuscular; Botulinum Toxins, Type A; Muscle, Skeletal
PubMed: 36356022
DOI: 10.3390/toxins14110772 -
The Journal of Spinal Cord Medicine Jul 2018Spasticity following spinal cord injury (SCI) can impair function and affect quality of life. This study compared the effects of transcutaneous electrical nerve... (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial.
OBJECTIVE
Spasticity following spinal cord injury (SCI) can impair function and affect quality of life. This study compared the effects of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) on lower limb spasticity in patients with SCI.
DESIGN
Double blind randomized crossover design.
SETTING
Neuro-rehabilitation unit, Manipal University, India.
PARTICIPANTS
Ten participants (age: 39 ± 13.6 years, C1-T11, 1-26 months post SCI) with lower limb spasticity were enrolled in this study.
INTERVENTIONS
Participants were administered electrical stimulation with TENS and FES (duration - 30 minutes) in a cross over manner separated by 24 hours.
OUTCOME MEASURES
Spasticity was measured using modified Ashworth scale (MAS) [for hip abductors, knee extensors and ankle plantar flexors] and spinal cord assessment tool for spastic reflexes (SCATS). Assessments were performed at baseline, immediately, 1 hour, 4 hours, and 24 hours post intervention.
RESULTS
A between group analysis did not show statistically significant differences between FES and TENS (P > 0.05). In the within group analyses, TENS and FES significantly reduced spasticity up to 4 hours in hip adductors and knee extensors (P < 0.01). SCATS values showed significant reductions at 1 hour (P = 0.01) following TENS and 4 hours following FES (P = 0.01).
CONCLUSION
A single session of electrical stimulation with FES and TENS appears to have similar anti-spasticity effects that last for 4 hours. The findings of this preliminary study suggest that both TENS and FES have the potential to be used as therapeutic adjuncts to relieve spasticity in the clinic. In addition, FES may have better effects on patients presenting with spastic reflexes.
Topics: Adult; Female; Humans; Male; Middle Aged; Muscle Spasticity; Spinal Cord Injuries; Transcutaneous Electric Nerve Stimulation
PubMed: 29067867
DOI: 10.1080/10790268.2017.1390930 -
Annals of Physical and Rehabilitation... Nov 2017Ankle foot orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with cerebral palsy (CP). One of the aims of orthotic... (Review)
Review
BACKGROUND
Ankle foot orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with cerebral palsy (CP). One of the aims of orthotic management is to produce a more normal gait pattern by positioning joints in the proper position to reduce pathological reflex or spasticity.
OBJECTIVE
To conduct a systematic review of the literature and establish the effect of treatment with various types of AFOs on gait patterns of children with CP.
METHODS
PubMed, Scopus, ISI Web of knowledge, Cochrane Library, EMBASE and Google Scholar were searched for articles published between 2007 and 2015 of studies of children with CP wearing the following AFOs: hinged (HAFO), solid (SAFO), floor reaction (FRO), posterior leaf spring (PLS) and dynamic (DAFO). Studies that combined treatment options were excluded. Outcomes investigated were a change in gait pattern and subsequent walking ability. The PEDro scale used to assess the methodological quality of relevant studies.
RESULTS
We included 17 studies investigating a total of 1139 children with CP. The PEDro score was poor for most studies (3/10). Only 4 studies, of 209 children in total, were randomized controlled trials, for a good PEDro score (5, 7, 9/10) and an appropriate level of evidence. One study used a case-based series and the remainder a cross-sectional design. In general, the use of AFOs improved speed and stride length. The HAFO was effective for improving gait parameters and decreasing energy expenditure with hemiplegic CP as compared with the barefoot condition. It also improved stride length, speed of walking, single limb support and gait symmetry with hemiplegic CP. The plastic SAFO and FRO were effective in reducing energy expenditure with diplegic CP. With diplegic CP, the HAFO and SAFO improved gross motor function.
CONCLUSION
For children with CP, use of specific types of AFOs improved gait parameters, including ankle and knee range of motion, walking speed and stride length. AFOs reduced energy expenditure in children with spastic CP. However, further studies with good PEDro scores are required for more conclusive evidence regarding the effectiveness of AFOs in children with CP.
Topics: Adolescent; Ankle; Biomechanical Phenomena; Cerebral Palsy; Child; Child, Preschool; Equipment Design; Female; Foot; Foot Orthoses; Gait; Humans; Infant; Knee; Male; Muscle Spasticity; Range of Motion, Articular; Treatment Outcome; Walking
PubMed: 28713039
DOI: 10.1016/j.rehab.2017.05.004 -
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 -
JPMA. the Journal of the Pakistan... Mar 2021To evaluate the effect of positioning on gross motor function and spasticity in spastic quadriplegic cerebral palsy children with Gross Motor Function Classification...
OBJECTIVES
To evaluate the effect of positioning on gross motor function and spasticity in spastic quadriplegic cerebral palsy children with Gross Motor Function Classification System level IV and V.
METHODS
A quasi-experimental study was conducted at two Paediatric Physical Therapy Centres from November 2018 to July 2019. The study comprised of seventy four children with quadriplegic cerebral palsy aged between 3 to 8 years. Data was obtained and gross motor functional abilities and spasticity were assessed by GMFM-88 and Modified Ashworth Scale, respectively. Twenty four-hour positioning in specific seats, night positioning and standing frames for six months. The child was being positioned 24 hours according to his challenges for the period of six months. Semi reclined positioning was performed to manage aspiration, oral leak and to develop retention. Prone positioning was done to develop righting reactions, functional sitting position was used in the treatment regime to attain better upright position and neutral pelvic standing using standing frames. SPSS 24 was used to analyse the data.
RESULTS
Paired t-test reported significant improvement in the test scores in lying position, rolling, sitting position, crawling, kneeling, standing, walking or running. Fifty-nine subjects exhibited improvement in spasticity before and after interventional procedures, while 15 showed no improvement (p<0.05).
CONCLUSIONS
Twenty-Four-hour proper body positioning and postural techniques improved gross motor functioning in all five dimensions of functioning. The overall spasticity in quadriplegic cerebral palsy children was also reduced due to appropriate positioning techniques.
Topics: Activities of Daily Living; Cerebral Palsy; Child; Child, Preschool; Humans; Muscle Spasticity; Posture; Walking
PubMed: 34057924
DOI: 10.47391/JPMA.1213