29,854 research outputs found
Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton
Background
Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. This study aimed to characterize the kinematic and proprioceptive deficits of individuals with upper limb spasticity after stroke using the Kinarm robotic exoskeleton.
Methods
Upper limb function was characterized using two tasks: Visually Guided Reaching, in which participants moved the limb from a central target to 1 of 4 or 1 of 8 outer targets when cued (measuring reaching function) and Arm Position Matching, in which participants moved the less-affected arm to mirror match the position of the affected arm (measuring proprioception), which was passively moved to 1 of 4 or 1 of 9 different positions. Comparisons were made between individuals with (n = 35) and without (n = 35) upper limb post-stroke spasticity.
Results
Statistically significant differences in affected limb performance between groups were observed in reaching-specific measures characterizing movement time and movement speed, as well as an overall metric for the Visually Guided Reaching task. While both groups demonstrated deficits in proprioception compared to normative values, no differences were observed between groups. Modified Ashworth Scale score was significantly correlated with these same measures.
Conclusions
The findings indicate that individuals with spasticity experience greater deficits in temporal features of movement while reaching, but not in proprioception in comparison to individuals with post-stroke motor impairment without spasticity. Temporal features of movement can be potential targets for rehabilitation in individuals with upper limb spasticity after stroke.York University Librarie
Treatments for spasticity and pain in multiple sclerosis: a systematic review
Objectives:
To identify the drug treatments currently
available for the management of spasticity and pain in
multiple sclerosis (MS), and to evaluate their clinical and
cost-effectiveness.
Data sources:
Electronic bibliographic databases,
National Research Register, MRC Clinical Trials Register
and the US National Institutes of Health Clinical Trials
Register.
Review methods:
Systematic searches identified 15
interventions for the treatment of spasticity and 15
interventions for treatment of pain. The quality and
outcomes of the studies were evaluated. Reviews of
the treatment of spasticity and pain when due to other
aetiologies were also sought.
Results:
There is limited evidence of the effectiveness
of four oral drugs for spasticity: baclofen, dantrolene,
diazepam and tizanidine. Tizanidine appears to be no
more effective than comparator drugs such as baclofen
and has a slightly different side-effects profile. Despite
claims that it causes less muscle weakness, there was
very little evidence that tizanidine performed any
better in this respect than other drugs, although it is
more expensive. The findings of this review are
consistent with reviews of the same treatments for
spasticity derived from other aetiologies. There is good
evidence that both botulinum toxin (BT) and intrathecal
baclofen are effective in reducing spasticity, and both
are associated with functional benefit. However, they
are invasive, and substantially more expensive. None of
the studies included in the review of pain were
designed specifically to evaluate the alleviation of pain
in patients with MS and there was no consistency
regarding the use of validated outcome measures. It
was suggested that, although expensive, the use of
intrathecal baclofen may be associated with significant
savings in hospitalisation costs in relation to bed-bound
patients who are at risk of developing pressure sores,
thus enhancing its cost-effectiveness. No studies of
cost-effectiveness were identified in the review
of pain. There is evidence, albeit limited, of the
clinical effectiveness of baclofen, dantrolene,
diazepam, tizanidine, intrathecal baclofen and BT
and of the potential cost-effectiveness of intrathecal
baclofen in the treatment of spasticity
in MS.
Conclusions:
Many of the interventions identified are
not licensed for the alleviation of pain or spasticity in
MS and the lack of evidence relating to their
effectiveness may also limit their widespread use.
Indeed, forthcoming information relating to the use of
cannabinoids in MS may result in there being better
evidence of the effectiveness of new treatments than of
any of the currently used drugs. It may therefore be of
value to carry out double-blind randomised controlled
trials of interventions used in current practice, where
outcomes could include functional benefit and impact
on quality of life. Further research into the
development and validation of outcomes measures for
pain and spasticity may also be useful, as perhaps would
cost–utility studies
A Brief Analysis Of The Rehabilitation Systems Of Children With Spastic Forms Of Motor Disorders
The article briefly analyzes the main studies in the field of overcoming spasticity within the confines of medical and partly pedagogical approaches. It was singled out the range of the main aspects that can be used as a basis for the correction of motor disorders spasmodic forms in children of early and preschool age by means of adaptive physical education from the position of pedagogy, medicine, physiology and neurology in their constituent components. The paper studies the methods of overcoming spasticity suggested by specialists of various profiles containing promising key ideas for further research. Efforts have been made to combine possibilities of medical methods of spastic motor disorders forms rehabilitation with pedagogical capabilities of adaptive physical education. Such an approach can guarantee the complexity of various forms of spastic motor disorders, which can positively affect the construction of an individualized correctional strategy and tactics in further rehabilitation work. Analyzing the literature sources, we did not find a single universal method for the complete or at least prevailing overcoming of spasticity in children and adults
Prevalence and time course of post-stroke pain: A multicenter prospective hospital-based study
OBJECTIVE:
Pain prevalence data for patients at various stages after stroke.
DESIGN:
Repeated cross-sectional, observational epidemiological study.
SETTING:
Hospital-based multicenter study.
SUBJECTS:
Four hundred forty-three prospectively enrolled stroke survivors.
METHODS:
All patients underwent bedside clinical examination. The different types of post-stroke pain (central post-stroke pain, musculoskeletal pains, shoulder pain, spasticity-related pain, and headache) were diagnosed with widely accepted criteria during the acute, subacute, and chronic stroke stages. Differences among the three stages were analyzed with χ(2)-tests.
RESULTS:
The mean overall prevalence of pain was 29.56% (14.06% in the acute, 42.73% in the subacute, and 31.90% in the chronic post-stroke stage). Time course differed significantly according to the various pain types (P < 0.001). The prevalence of musculoskeletal and shoulder pain was higher in the subacute and chronic than in the acute stages after stroke; the prevalence of spasticity-related pain peaked in the chronic stage. Conversely, headache manifested in the acute post-stroke stage. The prevalence of central post-stroke pain was higher in the subacute and chronic than in the acute post-stroke stage. Fewer than 25% of the patients with central post-stroke pain received drug treatment.
CONCLUSIONS:
Pain after stroke is more frequent in the subacute and chronic phase than in the acute phase, but it is still largely undertreated
Cost minimization analysis of BoNT-As in the treatment of upper limb spasticity and cervical dystonia
Botulinum toxin type A (BoNT-A) injections are recommended for the management of upper limb spasticity (ULS) and cervical dystonia (CD). The main aim of this cost minimization analysis (CMA) was to compare the annual cost per patient for three BoNT-As (Botox®, Dysport® and Xeomin®) in the treatment of ULS or CD in Italy. A budget impact analysis (BIA) was also conducted.
Methods
The CMA was conducted from the perspective of the Italian National Health Service. Only direct medical costs (BoNT-A and standard therapy) were considered. By using a Delphi panel of twelve Italian Experts in the treatment of ULS and CD, data was collected about BoNT-As (dose, number of administrations and acquisition price) and standard therapy (concomitant medications, visits, Day-Hospital, hospitalizations, etc.). Costs were assessed in Euros 2014. The BIA was conducted to evaluate the pharmaceutical expenditure for the three BoNT-As on a five-year time horizon. A sensitivity analysis was conducted.
Results
The mean annual cost per patient with ULS was €1,840.20 with Dysport®, €2,067.12 with Botox® and €2,171.05 with Xeomin®. The mean annual cost per patient with CD was €1,353.79 with Dysport®, €1,433.12 with Botox® and €1,503.60 with Xeomin®. In the time horizon considered, the substitution process of Botox® and Xeomin® by Dysport® would result in a total saving of €620,000 when treating ULS and a total saving of €481,000 in the case of CD. Sensitivity and probabilistic analyses showed the robustness of results.
Conclusions
From the Italian National Health Service's perspective, Dysport® appears to be the cost-saving therapeutic option compared with Botox® and Xeomin® in the treatment of ULS or CD
Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury: Distinctions Revealed by Different Analytical Methods.
Background. Spinal cord injury (SCI) results in impaired function, and ankle joint spasticity is a common secondary complication. Different interventions have been trialed with variable results. Objective. We investigated the effects of pharmacological and physical (locomotor training) interventions on function in people living with incomplete motor function loss caused by SCI and used different analytical techniques to understand whether functional levels affect recovery with different interventions. Methods. Participants with an incomplete SCI were assigned to 3 groups: no intervention, Lokomat, or tizanidine. Outcome measures were the 10-m walk test, 6-minute walk test, and the Timed Up and Go. Participants were classified in 2 ways: (1) based on achieving an improvement above the minimally important difference (MID) and (2) using growth mixture modeling (GMM). Functional levels of participants who achieved the MID were compared and random coefficient regression (RCR) was used to assess recovery in GMM classes. Results. Overall, walking speed and endurance improved, with no difference between interventions. Only a small number of participants achieved the MID. Both MID and GMM-RCR analyses revealed that tizanidine improved endurance in high-functioning participants. GMM-RCR classification also showed that speed and mobility improved after locomotor training. Conclusions. Improvements in function were achieved in a limited number of people with SCI. Using the MID and GMM techniques, differences in responses to interventions between high-and low-functioning participants could be identified. These techniques may, therefore, have potential to be used for characterizing therapeutic effects resulting from different interventions
Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement
Background. Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients. Objectives. Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed "reinforced feedback virtual environment" (RFVE). Methods. The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total). Results. The MAS and FAC reached statistical significance (P<0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=-0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke. Conclusions. The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools
Increased Lower Limb Spasticity but Not Strength or Function Following a Single-Dose Serotonin Reuptake Inhibitor in Chronic Stroke
Objective: To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke.
Design: Double-blind, randomized, placebo-controlled crossover trial.
Setting: Outpatient research setting.
Participants: Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of \u3e1 year duration who completed all assessments.
Interventions: Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions.
Main Outcome Measures: Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s–120°/s) plantarflexor stretch reflexes under passive conditions, and separately during and after 3 superimposed maximal volitional drive to simulate conditions of increased serotonin release. Secondary measures included clinical measures of lower limb coordination and locomotion.
Results: SSRI administration significantly increased stretch reflex torques at higher stretch velocities (eg, 90°/s; P=.03), with reflexes at lower velocities enhanced by superimposed voluntary drive (P=.02). No significant improvements were seen in volitional peak torques or in clinical measures of lower limb function (lowest P=.10).
Conclusions: Increases in spasticity but not strength or lower limb function were observed with single-dose SSRI administration in individuals with chronic stroke. Further studies should evaluate whether repeated dosing of SSRIs, or as combined with specific interventions, is required to elicit significant benefit of these agents on lower limb function poststroke
Reciprocal Inhibition Post-stroke is Related to Reflex Excitability and Movement Ability
Objective Decreased reciprocal inhibition (RI) of motor neurons may contribute to spasticity after stroke. However, decreased RI is not a uniform observation among stroke survivors, suggesting that this spinal circuit may be influenced by other stroke-related characteristics. The purpose of this study was to measure RI post-stroke and to examine the relationship between RI and other features of stroke. Methods RI was examined in 15 stroke survivors (PAR) and 10 control subjects by quantifying the effect of peroneal nerve stimulation on soleus H-reflex amplitude. The relationship between RI and age, time post-stroke, lesion side, walking velocity, Fugl-Meyer, Ashworth, and Achilles reflex scores was examined. Results RI was absent and replaced by reciprocal facilitation in 10 of 15 PAR individuals. Reciprocal facilitation was associated with low Fugl-Meyer scores and slow walking velocities but not with hyperactive Achilles tendon reflexes. There was no relationship between RI or reciprocal facilitation and time post-stroke, lesion side, or Ashworth score. Conclusions Decreased RI is not a uniform finding post-stroke and is more closely related to walking ability and movement impairment than to spasticity. Significance Phenomena other than decreased RI may contribute to post-stroke spasticity
Mutations in SPG11, encoding spatacsin, are a major cause of spastic paraplegia with thin corpus callosum.
Autosomal recessive hereditary spastic paraplegia (ARHSP) with thin corpus
callosum (TCC) is a common and clinically distinct form of familial spastic
paraplegia that is linked to the SPG11 locus on chromosome 15 in most affected
families. We analyzed 12 ARHSP-TCC families, refined the SPG11 candidate interval
and identified ten mutations in a previously unidentified gene expressed
ubiquitously in the nervous system but most prominently in the cerebellum,
cerebral cortex, hippocampus and pineal gland. The mutations were either nonsense
or insertions and deletions leading to a frameshift, suggesting a
loss-of-function mechanism. The identification of the function of the gene will
provide insight into the mechanisms leading to the degeneration of the
corticospinal tract and other brain structures in this frequent form of ARHSP
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