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Bieke Van Deun, Nele Van den Noortgate, Saucedo Cinthia, Anke Van Bladel, Cambier Dirk
BACKGROUND: Paratonia is a major underlying motor problem impeding functionality and locomotion in dementia. Despite its undeniable impact on patient's quality of life and daily care, there is a lack of evidence-based therapy on patients with this condition. METHODS: We surveyed physiotherapists working in nursing homes in Flanders (Belgium) concerning the use and perceived effect of therapeutic strategies and positioning methods/aids. RESULTS: Positioning and soft passive mobilization were the most applied and positively appraised therapeutic interventions...
June 2018: American Journal of Alzheimer's Disease and Other Dementias
Hans Drenth, Sytse U Zuidema, Wim P Krijnen, Ivan Bautmans, Cees van der Schans, Hans Hobbelen
OBJECTIVE: Paratonia, a distinctive form of hypertonia in patients with dementia, causes loss of functional mobility in early stage dementia to severe contractures and pain in the late stages. The pathogenesis of paratonia is not well understood. Patients in early stage dementia with diabetes mellitus showed a significantly higher risk for the development of paratonia. Both Alzheimer disease and diabetes mellitus are related to higher concentrations of advanced glycation end-products (AGEs)...
July 1, 2017: Journal of the American Medical Directors Association
Monica Ziff, Richard J Stark
BACKGROUND: Clinicians frequently experience difficulty in eliciting the reflexes of elderly patients using standard methods due to paratonia/frontal rigidity. If reflexes are incorrectly thought to be absent, important diagnostic errors may be made. Neurologists use alternative methods when technical difficulties require them, but these are not widely used by non-neurologists. METHODS: A neurologist and a medical student both used standard and non-standard techniques to assess reflexes of the lower limb in geriatric inpatients, aged over 65, to determine which method permitted the most confident assessment of the presence of knee and ankle reflexes...
January 15, 2017: Journal of the Neurological Sciences
Bieke Van Deun, Johannes S M Hobbelen, Barbara Cagnie, Birgit Van Eetvelde, Nele Van Den Noortgate, Dirk Cambier
BACKGROUND AND PURPOSE: The MyotonPRO is a portable device that measures muscle tone and biomechanical muscle properties objectively. MyotonPRO has already proven to be effective in measuring muscle properties in healthy and diseased populations. However, to the best of our knowledge, it has never been tested in individuals suffering from paratonia, a form of hypertonia frequently accompanying dementia. The aims of the present study were to (1) compare muscle tone, elasticity, and stiffness between 3 different subpopulations of young and old healthy adults and individuals with paratonia, and (2) investigate the intra- and interrater reproducibility of MyotonPRO measurements of the biceps brachii (BB) muscle in each subpopulation...
December 21, 2016: Journal of Geriatric Physical Therapy
Lucio Marinelli, Laura Mori, Matteo Pardini, David Beversdorf, Leonardo Cocito, Antonio Currà, Francesco Fattapposta, Maria Felice Ghilardi, Giovanni Abbruzzese, Carlo Trompetto
Many years after its initial description, paratonia remains a poorly understood concept. It is described as the inability to relax muscles during muscle tone assessment with the subject involuntary facilitating or opposing the examiner. Although related to cognitive impairment and frontal lobe function, the underlying mechanisms have not been clarified. Moreover, criteria to distinguish oppositional paratonia from parkinsonian rigidity or spasticity are not yet available. Paratonia is very frequently encountered in clinical practice and only semi-quantitative rating scales are available...
March 2017: Experimental Brain Research. Experimentelle Hirnforschung. Expérimentation Cérébrale
Galit Kleiner-Fisman, Edwin Khoo, Nikohl Moncrieffe, Triina Forbell, Pearl Gryfe, David Fisman
OBJECTIVE: Evaluate safety and efficacy of Incobotulinumtoxin A in elderly patients with dementia and paratonia. SETTING: University-affiliated hospital, spasticity management Clinic. PARTICIPANTS: Ten subjects were enrolled. INCLUSION CRITERIA: 1) severe cognitive impairment 2) diagnosis of Alzheimer's disease, vascular dementia, or frontotemporal dementia, and 3) score >3 on the paratonic assessment instrument, with posture in an arm(s) interfering with provision of care...
2014: PloS One
Robert Fekete
Catatonia, originally described by Karl Kahlbaum in 1874, may be regarded as a set of clinical features found in a subtype of schizophrenia, but the syndrome may also stem from organic causes including vascular parkinsonism, brain masses, globus pallidus lesions, metabolic derangements, and pharmacologic agents, especially first generation antipsychotics. Catatonia may include paratonia, waxy flexibility (cerea flexibilitas), stupor, mutism, echolalia, and catalepsy (abnormal posturing). A case of catatonia as a result of acute renal failure in a patient with dementia with Lewy bodies is described...
January 2013: Case Reports in Neurology
Imre Szirmai
UNLABELLED: The "arteriosclerotic parkinsonism", which is called vascular parkinsonism (VP), was first described by Critchley'. The broad based slow gait, reduced stride lenght, start hesitation, freezing and paratonia was mentioned as "lower body parkinsonism" (LBP) which can be associated by slow speech, dysexecutive syndrome, and hand tremor of predominantly postural character. In VP the DAT-scan proved normal dopamine content of the striatum in contrast with Parkinson's disease (PD)...
November 30, 2011: Ideggyógyászati Szemle
Johannes Hans S M Hobbelen, Frans E S Tan, Frans R J Verhey, Raymond T C M Koopmans, Rob A de Bie
BACKGROUND: Paratonia causes severe movement dysfunction in late stage dementia. Passive Movement Therapy (PMT) is often used to decrease high muscle tone, but the efficacy has never been shown. The objective of this study is to investigate the effect of PMT on muscle tone after two and four weeks of treatment. METHODS: This study comprised a multicenter single-blinded RCT. Nursing home residents with dementia (according to the DSM-IV-TR criteria) and moderate to severe paratonia were randomly assigned to either a PMT or control group...
May 2012: International Psychogeriatrics
Johannes S M Hobbelen, Frans E S Tan, Frans R J Verhey, Raymond T C M Koopmans, Rob A de Bie
BACKGROUND: Paratonia is a progressive motor problem that is observed in individuals with dementia and is not a well-known phenomenon. This study explores the development and risk factors of paratonia in moderate stage dementia patients. METHODS: A multi-center, longitudinal, one-year follow-up cohort study was performed. Patients with an established diagnosis of dementia, with a score of 6 or lower on the Global Deterioration Scale (GDS) were included. The participants were assessed using the Paratonia Assessment Instrument (PAI), the Timed Up and GO test, the Qualidem, the Global Deterioration Scale (Reisberg et al...
September 2011: International Psychogeriatrics
Kenji Kamogawa, Shinya Okuda, Hitomi Tomita, Kensho Okamoto, Bungo Okuda
We report a 75-year-old, right-handed man, presenting with supplementary motor area (SMA) seizure. The patient had suffered from frequent attacks of transient inability to speak and move without loss of awareness. On admission, he presented with vertical gaze paresis, axial rigidity, paratonia of extremities and gait disturbance. The attacks were preceded by discomfort on the head, followed by inability to move the whole body and arrest of vocalization with tonic posture and exaggerated breathing. Consciousness and cognitive function were preserved throughout the attacks...
July 2010: Rinshō Shinkeigaku, Clinical Neurology
Hal S Wortzel, Kimberly L Frey, C Alan Anderson, David B Arciniegas
The presence of paratonia and primitive reflexes ("frontal release signs"), such as glabellar, snout, suck, grasp, and palmomental responses, after traumatic brain injury predicts performance on bedside cognitive assessments, level of functional independence, and duration of acute inpatient rehabilitation.
2009: Journal of Neuropsychiatry and Clinical Neurosciences
Johannes S M Hobbelen, Raymond T C M Koopmans, Frans R J Verhey, Kitty M Habraken, Rob A de Bie
BACKGROUND: Paratonia is one of the associated movement disorders characteristic of dementia. The aim of this study was to develop an assessment tool (the Paratonia Assessment Instrument, PAI), based on the new consensus definition of paratonia. An additional aim was to investigate the reliability and validity of the PAI. METHODS: A three-phase cross-sectional survey was conducted. In the first two phases, the PAI was developed and validated. In the third phase, the inter-observer reliability and feasibility of the instrument was tested...
August 2008: International Psychogeriatrics
Johannes S M Hobbelen, Frans R J Verhey, Jacobus H J Bor, Rob A de Bie, Raymond T C M Koopmans
BACKGROUND: Paratonia, a form of hypertonia, is associated with loss of mobility and with the development of contractures especially in the late stages of the dementia. Passive movement therapy (PMT) currently is the main physiotherapeutic intervention. General doubt about the beneficial effects of this widely used therapy necessitates a randomised clinical trial (RCT) to study the efficacy of PMT on the severity of paratonia and on the improvement of daily care. METHODS/DESIGN: A RCT with a 4-week follow-up period...
2007: BMC Geriatrics
Ipsit Vahia, Carl I Cohen, Alla Prehogan, Zaitoon Memon
OBJECTIVE: Paratonia is an external stimulus dependent increase in muscle tone that is absent at rest. It is thought to occur commonly in Alzheimer disease (AD) but is understudied. This study examines paratonia in a multiracial sample. METHODS: The sample consisted of 80 patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for AD. They received a battery of neuropsychiatric assessments. The authors examined the relationship between paratonia and multiple variables...
April 2007: American Journal of Geriatric Psychiatry
Johannes S M Hobbelen, Raymond T C M Koopmans, Frans R J Verhey, Roland P S Van Peppen, Rob A de Bie
BACKGROUND AND PURPOSE: Paratonia is a motor problem that develops during the course of dementia. Definitions of paratonia used in the literature differ considerably, which has clinical implications and may lead to an undesirable heterogeneity in study populations. For this reason, we initiated a Delphi procedure with known experts in the field to establish an operational consensus definition of paratonia. METHODS: The Delphi procedure involved an anonymous and multistage approach presented as a questionnaire, with each stage building on the results of the previous one in order to reach consensus on the definition of paratonia...
2006: Journal of Geriatric Physical Therapy
Alfredo Damasceno, Adriane M Delicio, Daniel F C Mazo, João F D Zullo, Patricia Scherer, Ronny T Y Ng, Benito P Damasceno
BACKGROUND: Data on the prevalence of primitive reflexes (PR) in adulthood, their pathological significance and relationship to age and cognition are controversial. OBJECTIVE: To study the relationship between PR and cognition in 30 patients with probable Alzheimer's disease (AD) and 154 control subjects. METHOD: Diagnosis of probable AD was based on DSM-IV, NINCDS-ADRDA, and CAMDEX criteria. Primitive reflexes were quantified from zero (absent) to 1 (mild) or 2 (markedly present)...
September 2005: Arquivos de Neuro-psiquiatria
Hayley P Bennett, Alastair J Corbett, Susan Gaden, David A Grayson, Jillian J Kril, G Anthony Broe
OBJECTIVES: To identify predictors of activity of daily living (ADL) and instrumental activity of daily living (IADL) decline in a population with subcortical vascular dementia (SVD) and to evaluate potential mechanism of decline. DESIGN: Longitudinal. SETTING: Hospital-based. PARTICIPANTS: Computed tomographic (CT) scanning identified 77 participants as having subcortical infarction. MEASUREMENTS: Participants were neurologically, neuropsychologically, behaviorally, and functionally assessed four times over 5...
December 2002: Journal of the American Geriatrics Society
R Rao
As the contribution of carotid stenosis to cognitive impairment still remains unclear, neuropsychological function and soft neurological signs were examined in patients aged 65 and over. Twenty-five patients with symptomatic carotid stenosis (CS) of 75% or more were compared with 25 patients with first anterior circulation stroke, 25 with peripheral vascular disease and 25 healthy controls. All patients were assessed using CAMCOG (Cambridge Cognitive Examination), tests examining frontal lobe function (Behavioural Dyscontrol Scale [BDYS], Trail-Making Tests A and B, Controlled Word Association Test) and a scale for primitive reflexes (Frontal Release Signs Scale)...
November 15, 2002: Journal of the Neurological Sciences
R Kurlan, I H Richard, M Papka, F Marshall
Rigidity, slowness, gait impairment, and other disorders of movement accompany Alzheimer's disease (AD) at various stages of the illness. The presence of these so-called extrapyramidal features have been reported to predict disease prognosis and pathologic localization. Unfortunately, failure to accurately characterize the movement disorder, particularly to distinguish parkinsonism from cortically based motor disturbances (that is, paratonia, apraxia), makes the results of many published studies difficult to interpret...
January 2000: Movement Disorders: Official Journal of the Movement Disorder Society
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