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post-stroke spasticity

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https://www.readbyqxmd.com/read/28634003/spasticity-video-challenge-a-look-at-methods-for-addressing-difficult-cases
#1
Katharine E Alter, Mark Gormley, Atul T Patel
As seen in this CME online activity (available at http://courses.elseviercme.com/spasticity/662e), treatment of patients with spasticity due to upper motor neuron syndromes, including traumatic brain injury, stroke, and cerebral palsy, is multifaceted, involving chemodenervation, systemic medications, surgical therapy, rehabilitation efforts, and home care. Optimal care begins with the recognition that each patient's impairments are unique and must be assessed carefully to determine the impact of muscle overactivity, loss of dexterity, and weakness on passive and active function in the context of the patients' goals...
June 19, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28629806/prevalence-of-bleeding-complications-following-ultrasound-guided-botulinum-toxin-injections-in-patiens-on-anticoagulation-or-antiplatelet-therapy
#2
Jeffrey Lavallee, Regan Royer, Geoffrey Smith
BACKGROUND: Patients on anticoagulation or antiplatelet therapy may be at higher risk of bleeding complications following intramuscular chemodenervation injections. Musculoskeletal ultrasound may be able to reduce the risk of bleeding complications by providing real time visualization of vascular structures and post-injection monitoring. Limited data exist addressing risk of bleeding complications following ultrasound-guided botulinum neurotoxin intramuscular chemodenervation procedures in the setting of anticoagulation or antiplatelet therapy...
June 16, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28629415/kaps-kinematic-assessment-of-passive-stretch-a-tool-to-assess-elbow-flexor-and-extensor-spasticity-after-stroke-using-a-robotic-exoskeleton
#3
Andrew Centen, Catherine R Lowrey, Stephen H Scott, Ting-Ting Yeh, George Mochizuki
BACKGROUND: Spasticity is a common sequela of stroke. Traditional assessment methods include relatively coarse scales that may not capture all characteristics of elevated muscle tone. Thus, the aim of this study was to develop a tool to quantitatively assess post-stroke spasticity in the upper extremity. METHODS: Ninety-six healthy individuals and 46 individuals with stroke participated in this study. The kinematic assessment of passive stretch (KAPS) protocol consisted of passive elbow stretch in flexion and extension across an 80° range in 5 movement durations...
June 19, 2017: Journal of Neuroengineering and Rehabilitation
https://www.readbyqxmd.com/read/28625615/efficacy-and-safety-of-abobotulinumtoxina-dysport%C3%A2-for-the-treatment-of-hemiparesis-in-adults-with-upper-limb-spasticity-previously-treated-with-botulinum-toxin-sub-analysis-from-a-phase-3-randomized-controlled-trial
#4
Christina Marciniak, Peter McAllister, Heather Walker, Allison Brashear, Steven Edgley, Thierry Deltombe, Svetlana Khatkova, Marta Banach, Fatma Gul, Claire Vilain, Philippe Picaut, Anne-Sophie Grandoulier, Jean-Michel Gracies
OBJECTIVE: To assess the efficacy and safety of abobotulinumtoxinA in adults with upper limb spasticity previously treated with botulinum toxin A (BoNT-A). DESIGN: A post-hoc analysis from a Phase 3, prospective, double-blind, randomized, placebo-controlled study SETTING: 34 neurology or rehabilitation clinics in nine countries. PARTICIPANTS: Adults aged 18-80 years with hemiparesis, ≥6 months after stroke or traumatic brain injury. This analysis focused on a subgroup of subjects with previous onabotulinumtoxinA or incobotulinumtoxinA treatment (n=105 of 243 in the total trial population) in the affected limb...
June 15, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28613178/biomechanical-reactions-of-exoskeleton-neurorehabilitation-robots-in-spastic-elbows-and-wrists
#5
Hyung Seok Nam, Sukgyu Koh, Yoon Jae Kim, Jaewon Beom, Woo Hyung Lee, Shi-Uk Lee, Sungwan Kim
Spasticity is an important factor in designing wearable and lightweight exoskeleton neurorehabilitation robots. The proposed study evaluates biomechanical reactions of an exoskeleton robot to spasticity and establishes relevant guidelines for robot design. A two-axis exoskeleton robot is used to evaluate a group of 20 patients post-stroke with spastic elbow and/or wrist joints. All subjects are given isokinetic movements at various angular velocities within the capable range of motion for both joints. The resistance torque and corresponding angular position at each joint are recorded continuously...
June 9, 2017: IEEE Transactions on Neural Systems and Rehabilitation Engineering
https://www.readbyqxmd.com/read/28566161/long-term-safety-of-repeated-high-doses-of-incobotulinumtoxina-injections-for-the-treatment-of-upper-and-lower-limb-spasticity-after-stroke
#6
Andrea Santamato, Francesco Panza, Domenico Intiso, Alessio Baricich, Alessandro Picelli, Nicola Smania, Francesca Fortunato, Davide Seripa, Pietro Fiore, Maurizio Ranieri
Current guidelines suggested a dosage up to 600units (U) of botulinum toxin type A (BoNT-A) (onabotulinumtoxinA or incobotulinumtoxinA) in reducing spastic hypertonia with low prevalence of complications, although a growing body of evidence showed efficacy with the use of high doses (>800U). The available evidence mainly referred to a single set of injections evaluating the efficacy and safety of the neurotoxin 30days after the treatment. In a prospective, non-randomized, open-label study, we studied the safety of repeated higher doses of incobotulinumtoxinA in post-stroke upper and lower limb spasticity...
July 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28553200/phase-ii-clinical-validation-of-a-powered-exoskeleton-for-the-treatment-of-elbow-spasticity
#7
Simona Crea, Marco Cempini, Stefano Mazzoleni, Maria Chiara Carrozza, Federico Posteraro, Nicola Vitiello
Introduction: Spasticity is a typical motor disorder in patients affected by stroke. Typically post-stroke rehabilitation consists of repetition of mobilization exercises on impaired limbs, aimed to reduce muscle hypertonia and mitigate spastic reflexes. It is currently strongly debated if the treatment's effectiveness improves with the timeliness of its adoption; in particular, starting intensive rehabilitation as close as possible to the stroke event may counteract the growth and postpone the onset of spasticity...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28541901/changes-of-shoulder-elbow-and-wrist-stiffness-matrix-post-stroke
#8
Li-Qun Zhang, Jongsang Son, Hyung-Soon Park, Sang Hoon Kang, Yunju Lee, Yupeng Ren
Stroke affects multiple joints in the arm with stereotypical patterns of arm deformity involving the shoulder, elbow, wrist and hand and with disrupted coordination of multiple joints in active movements. However, there is a lack of systematic methods to evaluate multi-joints and multi-degree of freedoms (DOF) neuromechanical changes, especially for complex systems with three or more joints/DOFs involved. This study used a novel systematic method to characterize dynamics and control of the shoulder, elbow and wrist of the human arm individually and simultaneously, including the couplings across the multiple joints during controlled movements...
May 23, 2017: IEEE Transactions on Neural Systems and Rehabilitation Engineering
https://www.readbyqxmd.com/read/28537343/practice-patterns-for-spasticity-management-with-phenol-neurolysis
#9
Jay Karri, Manuel F Mas, Gerard E Francisco, Sheng Li
OBJECTIVE: To present practice patterns for phenol neurolysis procedures conducted for spasticity management. DESIGN: A retrospective review of 185 persons with spasticity who underwent phenol neurolysis procedures (n = 293) at an academic rehabilitation hospital and clinic. Patient demographics, concomitant spasticity treatments, and procedure relevant information were collected. RESULTS: The cohort included 71.9% males and 61.6% inpatient procedures...
May 24, 2017: Journal of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28528818/patellar-tendon-vibration-reduces-the-increased-facilitation-from-quadriceps-to-soleus-in-post-stroke-hemiparetic-individuals
#10
Eric Maupas, Joseph-Omer Dyer, Sibele de Andrade Melo, Robert Forget
BACKGROUND: Stimulation of the femoral nerve in healthy people can facilitate soleus H-reflex and electromyography (EMG) activity. In stroke patients, such facilitation of transmission in spinal pathways linking the quadriceps and soleus muscles is enhanced and related to co-activation of knee and ankle extensors while sitting and walking. Soleus H-reflex facilitation can be depressed by vibration of the quadriceps in healthy people, but the effects of such vibration have never been studied on the abnormal soleus facilitation observed in people after stroke...
May 18, 2017: Annals of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/28475487/can-somatosensory-electrical-stimulation-relieve-spasticity-in-post-stroke-patients-a-tms-pilot-study
#11
André Salles Cunha Peres, Victor Hugo Souza, João Marcos Yamasaki Catunda, Kelley Cristine Mazzeto-Betti, Taiza Elaine Grespan Santos-Pontelli, Claudia Domingues Vargas, Oswaldo Baffa, Draulio Barros de Araújo, Octávio Marques Pontes-Neto, João Pereira Leite, Marco Antonio Cavalcanti Garcia
Evidence suggests that somatosensory electrical stimulation (SES) may decrease the degree of spasticity from neural drives, although there is no agreement between corticospinal modulation and the level of spasticity. Thus, stroke patients and healthy subjects were submitted to SES (3 Hz) for 30' on the impaired and dominant forearms, respectively. Motor evoked potentials induced by single-pulse transcranial magnetic stimulation were collected from two forearm muscles before and after SES. The passive resistance of the wrist joint was measured with an isokinetic system...
May 5, 2017: Biomedizinische Technik. Biomedical Engineering
https://www.readbyqxmd.com/read/28471469/influence-of-physician-empathy-on-the-outcome-of-botulinum-toxin-treatment-for-upper-limb-spasticity-in-patients-with-chronic-stroke-a-cohort-study
#12
Alessandro Picelli, Gabriella Vallies, Elena Chemello, Alessandro Gavras, Paola Castellazzi, Andrea Meschieri, Anna Serina, Marialuisa Gandolfi, Alessio Baricich, Andrea Santamato, Carlo Cisari, Nicola Smania
OBJECTIVE: To examine the relationship between patient-rated physician empathy and outcome of botulinum toxin treatment for post-stroke upper limb spasticity. DESIGN: Cohort study. SUBJECTS: Twenty chronic stroke patients with upper limb spasticity. METHODS: All patients received incobotulinumtoxinA injection in at least one muscle for each of the following patterns: flexed elbow, flexed wrist and clenched fist. Each treatment was performed by 1 of 5 physiatrists with equivalent clinical experience...
April 27, 2017: Journal of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28455191/electro-acupuncture-for-post-stroke-spasticity-a-systematic-review-and-meta-analysis
#13
REVIEW
Yiyi Cai, Claire Shuiqing Zhang, Shaonan Liu, Zehuai Wen, Anthony Lin Zhang, Xinfeng Guo, Chuanjian Lu, Charlie C Xue
OBJECTIVE: To evaluate the effects and safety of electro-acupuncture (EA) for stroke patients with spasticity. DATA SOURCES: Five English (PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and AMED) and four Chinese databases (CBM, CNKI, CQVIP and Wanfang) were searched from their inception to September 2016. DATA SELECTION: Randomized controlled trials were included if they measured spasticity with Modified Ashworth Scale in stroke patients and investigated the add-on effects of electro-acupuncture to routine pharmacotherapy and rehabilitation therapies...
April 25, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28433830/spasticity-management-the-current-state-of-transcranial-neuromodulation
#14
REVIEW
Antonino Leo, Antonino Naro, Francesco Molonia, Provvidenza Tomasello, Ileana Saccà, Alessia Bramanti, Margherita Russo, Placido Bramanti, Angelo Quartarone, Rocco Salvatore Calabrò
This narrative review aims to provide an objective view of the noninvasive neuromodulation (NINM) protocols available for treating spasticity, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). On the basis of the relevant randomized controlled trials, we infer that NINM is more effective in reducing spasticity when combined with the conventional therapies than used as a stand-alone treatment. However, the magnitude of NINM after-effects depends significantly on the applied hemisphere and the underlying pathology...
April 20, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28431452/-treatment-options-for-neurogenic-drop-foot-a-systematic-literature-research
#15
Eike Jakubowitz, Daiwei Yao, Henning Windhagen, Christina Stukenborg-Colsman, Anna Thomann, Kiriakos Daniilidis
Background Neurogenic drop foot may be caused by central or peripheral lesions of the nervous system. Depending on whether the first or second motor neuron is damaged, a flaccid or spastic drop foot develops. Spastic drop foot persists as a residual long-term complication after stroke in about 14 % of patients. Various conservative and surgical treatment options are available. Methods This article is based on a systematic literature review for medical evidence of functional electrical stimulation (FES) with the keywords "functional electrical stimulation AND drop foot" and "functional electrical stimulation AND gait AND stroke" in PubMed and Cochrane databases...
April 21, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28289789/-medical-care-of-patients-with-spasticity-following-stroke-evaluation-of-the-treatment-situation-in-germany-with-focus-on-the-use-of-botulinum-toxin
#16
L Kerkemeyer, G Lux, A Walendzik, J Wasem, A Neumann
BACKGROUND: Upper limb spasticity is a common complication following stroke. Cohort studies found 19% of post-stroke patients had upper limb spasticity at 3 months and 38% of patients at 12 months. For focal spasticity, intramuscular injections of botulinum toxin are indicated. In Germany, it is assumed that patients with the described indication are undersupplied with botulinum toxin. OBJECTIVE: The aim of the present study is to evaluate the medical care of patients with upper limb spasticity post-stroke with the focus on the use of botulinum toxin as one treatment option...
March 13, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28286053/onabotulinumtoxina-for-lower-limb-spasticity-guidance-from-a%C3%A2-delphi-panel-approach
#17
Alberto Esquenazi, Abraham Alfaro, Ziyad Ayyoub, David Charles, Khashayar Dashtipour, Glenn D Graham, John R McGuire, Ib R Odderson, Atul T Patel, David M Simpson
BACKGROUND: OnabotulinumtoxinA is approved for the treatment of upper and lower limb spasticity in adults. Guidance on common postures and onabotulinumtoxinA injection paradigms for upper limb spasticity has been developed via a Delphi Panel; however, similar guidance for lower limb spasticity has not been established. OBJECTIVE: To define a clinically recommended treatment paradigm for the use of onabotulinumtoxinA for each common posture among patients with poststroke lower limb spasticity (PSLLS) and to identify the most common PSLLS aggregate postures...
March 7, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28285729/evaluation-of-post-stroke-spastic-muscle-stiffness-using-shear-wave-ultrasound-elastography
#18
Chueh-Hung Wu, Yu-Chun Ho, Ming-Yen Hsiao, Wen-Shiang Chen, Tyng-Guey Wang
Current clinical evaluations of post-stroke upper limb spasticity are subjective and qualitative. We proposed a quantitative measurement of post-stroke spastic muscle stiffness by using shear-wave ultrasound elastography and tested its reliability. Acoustic radiation force impulse with shear wave velocity (SWV) detection was used to evaluate stiffness of the biceps brachii muscles at 90° and 0° elbow flexion. In 21 control subjects, SWV did not significantly differ between dominant and non-dominant sides at either flexion angle (0°: p = 0...
June 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28275351/botulinum-toxin-is-effective-in-the-management-of-neurogenic-dysphagia-clinical-electrophysiological-findings-and-tips-on-safety-in-different-neurological-disorders
#19
Enrico Alfonsi, Domenico A Restivo, Giuseppe Cosentino, Roberto De Icco, Giulia Bertino, Antonio Schindler, Massimiliano Todisco, Mauro Fresia, Andrea Cortese, Paolo Prunetti, Matteo C Ramusino, Arrigo Moglia, Giorgio Sandrini, Cristina Tassorelli
Background and Aims: Neurogenic dysphagia linked to failed relaxation of the upper esophageal sphincter (UES) can be treated by injecting botulinum toxin (BTX) into the cricopharyngeal (CP) muscle. We compared the effects of this treatment in different neurological disorders with dysphagia, to evaluate its efficacy over time including the response to a second injection. Materials and Methods: Sixty-seven patients with neurogenic dysphagia associated with incomplete or absent opening of the UES (24 with brainstem or hemispheric stroke, 21 with parkinsonian syndromes, 12 with multiple sclerosis, and 10 with spastic-dystonic syndromes secondary to post-traumatic encephalopathy) were treated with the injection of IncobotulinumtoxinA (dose 15-20 U) into the CP muscle under electromyographic guidance...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28272726/-measurement-of-the-outcomes-in-acquired-brain-injury-in-a-neurorehabilitation-unit-a-long-term-study
#20
V Cruz-Guisado, P Diaz-Borrego, B Romero-Romero, M Rodriguez-Pinero Duran
INTRODUCTION: Following sudden brain damage, there is a loss of capabilities that affects the person's autonomy. Recovery from the physical, psychic and cognitive sequelae requires the application of multiple therapies, the outcomes of which need to be measured objectively. Our aim is to analyse the application of standardised instruments in determining the therapeutic outcomes in acquired brain injury. PATIENTS AND METHODS: We conducted a retrospective descriptive observational study lasting 13 months...
March 16, 2017: Revista de Neurologia
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