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Clinical Interventions in Aging 2020This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis...
PURPOSE
This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT).
METHODS
PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done.
RESULTS
A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: ∆=34.45% of grade for fESWT and ∆=34.97% for rESWT that gives a slightly better effect of rESWT (∆=0.52%) for spasticity (p<0.05), and ∆=38.83% of angular degrees for fESWT and ∆=32.26% for rESWT that determines the more beneficial effect of fESWT (∆=6.57%) for range of motion (p<0.05), and ∆=18.32% for fESWT and ∆=22.27% for rESWT that gives a slightly better effect of rESWT (∆=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70±2.5 points for fESWT and 5.71±2.21 points for rESWT, thus an overall quality of evidence grade of moderate ("fair" for fESWT and "good" for rESWT). Three studies in fESWT and four in rESWT obtained Sackett's grading system's highest Level 1 of evidence.
CONCLUSION
The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.
Topics: Extracorporeal Shockwave Therapy; Humans; Middle Aged; Muscle Spasticity; Recovery of Function; Stroke Rehabilitation; Treatment Outcome
PubMed: 32021129
DOI: 10.2147/CIA.S221032 -
The New England Journal of Medicine Jan 2018Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Spastic limb paralysis due to injury to a cerebral hemisphere can cause long-term disability. We investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with spastic arm paralysis due to chronic cerebral injury.
METHODS
We randomly assigned 36 patients who had had unilateral arm paralysis for more than 5 years to undergo C7 nerve transfer plus rehabilitation (18 patients) or to undergo rehabilitation alone (18 patients). The primary outcome was the change from baseline to month 12 in the total score on the Fugl-Meyer upper-extremity scale (scores range from 0 to 66, with higher scores indicating better function). Results The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft.
RESULTS
The mean increase in Fugl-Meyer score in the paralyzed arm was 17.7 in the surgery group and 2.6 in the control group (difference, 15.1; 95% confidence interval, 12.2 to 17.9; P<0.001). With regard to improvements in spasticity as measured on the Modified Ashworth Scale (an assessment of five joints, each scored from 0 to 5, with higher scores indicating more spasticity), the smallest between-group difference was in the thumb, with 6, 9, and 3 patients in the surgery group having a 2-unit improvement, a 1-unit improvement, or no change, respectively, as compared with 1, 6, and 7 patients in the control group (P=0.02). Transcranial magnetic stimulation and functional imaging showed connectivity between the ipsilateral hemisphere and the paralyzed arm. There were no significant differences from baseline to month 12 in power, tactile threshold, or two-point discrimination in the hand on the side of the donor graft.
CONCLUSIONS
In this single-center trial involving patients who had had unilateral arm paralysis due to chronic cerebral injury for more than 5 years, transfer of the C7 nerve from the nonparalyzed side to the side of the arm that was paralyzed was associated with a greater improvement in function and reduction of spasticity than rehabilitation alone over a period of 12 months. Physiological connectivity developed between the ipsilateral cerebral hemisphere and the paralyzed hand. (Funded by the National Natural Science Foundation of China and others; Chinese Clinical Trial Registry number, 13004466 .).
Topics: Action Potentials; Adolescent; Adult; Arm; Brain; Brain Injuries, Traumatic; Cerebral Palsy; Disability Evaluation; Hemiplegia; Humans; Male; Muscle Spasticity; Nerve Transfer; Peripheral Nerves; Stroke; Young Adult
PubMed: 29262271
DOI: 10.1056/NEJMoa1615208 -
Tidsskrift For Den Norske Laegeforening... Sep 2023Spasticity is a frequent complication of diseases of and injuries to the central nervous system. Early treatment prevents further loss of function and spasticity-related... (Review)
Review
BACKGROUND
Spasticity is a frequent complication of diseases of and injuries to the central nervous system. Early treatment prevents further loss of function and spasticity-related complications. Basic spasticity treatment begins in the primary healthcare service and includes physiotherapy, occupational therapy and oral spasmolytics, while treatment with botulinum toxin and baclofen pump is carried out by the specialist healthcare services. The objective of the study was to obtain an overview of the availability and organisation of these specialised forms of spasticity treatment in Norway.
MATERIAL AND METHOD
We conducted a survey in which a digital questionnaire was sent to hospitals that offer spasticity treatment.
RESULTS
A total of 30 of 47 hospital departments/outpatient clinics (hereafter referred to as 'hospital units') distributed across all Norwegian health regions responded to the questionnaire. Spasticity treatment with botulinum toxin and baclofen pump was available in all of the health regions. Median time from first referral was 10 weeks (interquartile range 7 weeks). A total of 14 of 30 hospital units expressed a need for more treatment days to cover the local demand. Of the 30 hospital units, 23 had interdisciplinary teams with doctors, physiotherapists, occupational therapists and/or nurses. For treatment with botulinum toxin, ultrasound was used as guidance in 22 of 26 hospital units, EMG was used in 15 units and electrical muscle stimulation was used in 11 units.
INTERPRETATION
The study suggests that there may be a need for improvements to specialised spasticity treatment in Norway to ensure good patient care pathways, interdisciplinary assessments, and safe and efficient performance of the practical interventions.
Topics: Humans; Baclofen; Botulinum Toxins; Hospitals; Muscle Spasticity; Norway
PubMed: 37668130
DOI: 10.4045/tidsskr.22.0774 -
Journal of Musculoskeletal & Neuronal... Dec 2019To evaluate the effect of simultaneous proprioceptive - visual training on gait parameters in children with spastic diplegic cerebral palsy. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effect of simultaneous proprioceptive - visual training on gait parameters in children with spastic diplegic cerebral palsy.
METHOD
Gait parameters of 30 spastic diplegic children (age range 4-6 years) were evaluated before and after treatment by Tekscan's Walkway Pressure system. They were randomly and equally assigned into two groups (study and control). All children received regular therapeutic exercise program for one hour. In control group walked for 30 minutes without feedback, while those in study group walked for 30 minutes with proprioceptive-visual feedback. Duration of treatment was 3 times/week for 8 successive weeks.
RESULTS
There were significant differences after treatment in spatial parameters and temporal parameters of both groups with more improvement in study group than control one, and insignificant difference in kinetic gait parameters.
CONCLUSION
The simultaneous proprioceptive - visual training might improve spatial and temporal gait parameters with no effect on kinetic gait parameters of children with spastic diplegic cerebral palsy.
Topics: Cerebral Palsy; Child; Child, Preschool; Feedback, Sensory; Female; Gait; Humans; Male; Muscle Spasticity; Physical Therapy Modalities; Postural Balance; Proprioception; Treatment Outcome; Visual Perception; Walking
PubMed: 31789301
DOI: No ID Found -
Current Neurology and Neuroscience... Aug 2019The purpose of this review is to familiarize the reader with assessments and measurement of spasticity in people with multiple sclerosis (MS). Spasticity affects 60-84%... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to familiarize the reader with assessments and measurement of spasticity in people with multiple sclerosis (MS). Spasticity affects 60-84% of people with MS, worsening as disability worsens and impacting activity, participation, and quality of life. Spasticity manifests in many ways, including spasms, resistance to passive stretch, pain, and perception of tightness, and can affect muscles throughout the body, making assessment and quantification of spasticity challenging but important. Assessment tools include those quantified by clinicians, instrumentation, and patients.
RECENT FINDINGS
Most tools for measuring spasticity are based on clinician scoring, were developed many years ago, and have undergone minimal recent advances. More recent developments are patient-reported outcome measures for spasticity, including the Numeric Rating Scale for Spasticity (NRS-S) and the disease-specific Multiple Sclerosis Spasticity Scale-88 (MSSS), and, most recently, imaging through elastography. MS-related spasticity is common and often disabling. There are various spasticity measurement tools available, each with advantages and limitations. Newer tools are likely to be developed as our understanding of spasticity in MS grows.
Topics: Elasticity Imaging Techniques; Humans; Multiple Sclerosis; Muscle Spasticity; Severity of Illness Index
PubMed: 31471769
DOI: 10.1007/s11910-019-0991-2 -
Medicine Dec 2018This aims to investigate the effect of combined use of radial extracorporeal shock wave therapy (rESWT) and conventional rehabilitation therapy on postoperative... (Randomized Controlled Trial)
Randomized Controlled Trial
This aims to investigate the effect of combined use of radial extracorporeal shock wave therapy (rESWT) and conventional rehabilitation therapy on postoperative rehabilitation of children with spastic cerebral palsy.Children with spastic cerebral palsy 6 weeks after multistage surgery were randomly divided into treatment group (received rESWT and conventional rehabilitation therapy) and control group (received conventional rehabilitation only). Before treatment, 2 weeks and 1 month after treatment, the Gross Motor Function Measure (GMFM), modified Ashworth Scale (MAS) of the hamstrings and triceps, plantar area and plantar pressure were examined for efficacy assessment.A total of 82 children with spastic cerebral palsy were recruited, including 43 children in treatment group and 39 children in control group. There was no significant difference in the age, MAS score, and GMFM score between the 2 groups before treatment. There were statistically significant differences between the 2 groups at 2 weeks and 4 weeks after treatment, including the MAS score, GMFM score, plantar area and plantar pressure (P < .05). Within groups, there were also significant differences at different times (P < .05).The rESWT combined with rehabilitation can quickly and effectively relieve paralysis of lower extremities, reduce the tension of hamstrings and calf muscles, relieve muscle spasm, and rapidly improve limb function in children with spastic cerebral palsy.
Topics: Cerebral Palsy; Child; Disability Evaluation; Extracorporeal Shockwave Therapy; Humans; Muscle Spasticity; Physical Therapy Modalities; Prospective Studies; Treatment Outcome
PubMed: 30572548
DOI: 10.1097/MD.0000000000013828 -
Neurology India 2020Spasticity is a major cause of disability following upper motor neuron (UMN) injury. The diagnosis and treatment of spasticity has been a focus of clinicians and... (Review)
Review
Spasticity is a major cause of disability following upper motor neuron (UMN) injury. The diagnosis and treatment of spasticity has been a focus of clinicians and researchers alike. In recent years, there have been significant advances both in strategies for spasticity assessment and in the development of novel treatments. Currently, several well-established spasticity management techniques fall into the major categories of physiotherapy, pharmacotherapy, and surgical management. The majority of recent developments in all of these broad categories have focused more on methods of neuromodulation instead of simple symptomatic treatment, attempting to address the underlying cause of spasticity more directly. The following narrative review briefly discusses the causes and clinical assessment of spasticity and also details the wide variety of current and developing treatment approaches for this often-debilitating condition.
Topics: Humans; Muscle Spasticity
PubMed: 33318358
DOI: 10.4103/0028-3886.302464 -
Psychopharmacology Bulletin Oct 2020This review will cover seminal and emerging evidence on interventional therapy chronic pain in cerebral palsy (CP). It will cover the background and burden of disease,... (Review)
Review
PURPOSE OF REVIEW
This review will cover seminal and emerging evidence on interventional therapy chronic pain in cerebral palsy (CP). It will cover the background and burden of disease, present the current options, and then weigh the evidence that is available to support interventional therapy and the current indications.
RECENT FINDINGS
CP is a permanent posture and movement disorder from in-utero brain development defects with a 3-4/1,000 incidence in the US. The cost of care for each child is estimated at $921,000. Pain in CP is attributed to musculoskeletal deformities, spasticity, increased muscle tone, dislocations, and GI dysfunction. First-line treatments include physical and occupational therapy and oral pharmacological agents; however, a significant amount of patients remain refractory to these and require further therapy. Injection therapy includes botulinum toxin A (BTA) injections and intrathecal baclofen. BTA injections were shown to control chronic pain effectively and are FDA approved for spastic pain; intra-thecal baclofen, in contrast, was only shown to improve comfort and quality of life with a focus on the pain. Surgical intervention includes selection dorsal rhizotomy (SDR). It may increase range of motion and quality of life and reduce spasticity and pain; however, most evidence is anecdotal, and more research is required.
SUMMARY
Interventional therapy, including injection and surgical, is the last line of therapy for chronic pain in CP. It extends the possibility of therapy in hard-to-treat individuals; however, more data is required to provide strong evidence to the efficacy of these treatments and guide proper patient selection.
Topics: Cerebral Palsy; Child; Humans; Muscle Spasticity; Pain; Quality of Life; Rhizotomy
PubMed: 33633421
DOI: No ID Found -
Canadian Family Physician Medecin de... Oct 2019To raise awareness of spasticity in primary care and clarify how to identify, diagnose, and manage it effectively and efficiently in patients with pre-existing... (Review)
Review
OBJECTIVE
To raise awareness of spasticity in primary care and clarify how to identify, diagnose, and manage it effectively and efficiently in patients with pre-existing neurologic conditions.
SOURCES OF INFORMATION
PubMed was searched for articles published from 1970 to May 2018 using the terms and . Other relevant guidelines and resources were reviewed and used.
MAIN MESSAGE
Spasticity is a common secondary complication in conditions such as spinal cord injury, multiple sclerosis, stroke, cerebral palsy, and other neuromuscular physical disabilities and can have a negative effect on health and quality of life. Factors such as inconsistent definition, poorly understood mechanism, and relatively low prevalence make spasticity seem like a daunting condition to manage. Furthermore, its variable presentation and effect on a patient's quality of life, and its range of treatments with varying levels of evidence, can make treatment challenging in primary care and in other clinical settings. Family physicians play an important role in recognizing and inquiring about spasticity and its changes, triggers, and effects on function. Ruling out reversible causes is important. Many management strategies can be instituted by family physicians.
CONCLUSION
Managing spasticity might be unfamiliar to many practitioners. It is important for physicians to understand spasticity and the potential treatment options available to improve quality of life. The current review provides concise information on the clinical relevance of spasticity in primary care and how to assess and manage it effectively and efficiently in those with chronic neurologic conditions.
Topics: Adult; Disease Management; Humans; Male; Muscle Spasticity; Primary Health Care; Quality of Life; Spinal Cord Injuries
PubMed: 31604736
DOI: No ID Found -
Developmental Medicine and Child... Sep 2017
Topics: Cerebral Palsy; Humans; Movement; Muscle Spasticity
PubMed: 28833051
DOI: 10.1111/dmcn.13496