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Upper limb spasticity

Natasha A Lannin, Louise Ada, Coralie English, Julie Ratcliffe, Maria Crotty
Rationale Although clinical practice guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin-A in conjunction with therapy, there is currently no evidence to support the addition of therapy. Aims To determine the effect and cost-benefit of adding evidence-based movement training to botulinum toxin-A. Sample size estimate A total of 136 participants will be recruited in order to be able to detect a between-group difference of seven points on the Goal Attainment Scale T-score with 80% power at a two-tailed significance level of 0...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Didem Yücel-Yılmaz, Emrah Yücesan, Dilek Yalnızoğlu, Kader Karlı Oğuz, Mahmut Şamil Sağıroğlu, Uğur Özbek, Esra Serdaroğlu, Başar Bilgiç, Sevim Erdem, Sibel Aylin Uğur İşeri, Haşmet Hanağası, Hakan Gürvit, Rıza Köksal Özgül, Ali Dursun
Hereditary spastic paraplegias (HSPs) are a group of genetic disorders resulting in pyramidal tract impairment, predominantly in lower limbs. KIF1C gene has recently been identified as one of the genetic causes of HSP and associated with pure or complicated HSP. We present three patients with complicated HSP from two unrelated families, who had early onset progressive cerebellar signs and developed pyramidal tract signs during follow-up. Whole exome sequencing in these patients followed by segregation analysis identified novel truncating KIF1C mutations (c...
March 12, 2018: Brain & Development
Rajani Singh, Rajnish Arora, Raj Kumar
Chiari malformations (CMs) are variant structural setup of cerebellum and brain stem at the craniovertebral junction. Normally the cerebellum and parts of the brain stem lie above the foramen magnum. When the part of the cerebellum and/or brainstem protrudes into the upper spinal canal through foramen magnum, it is defined as CM. Chiari malformations may develop when part of the skull is smaller than normal or misshapen, due to which the cerebellum herniates into spinal canal through foramen magnum. This compresses the cerebellum and brainstem affecting functions controlled by these parts and blocks the flow of cerebrospinal fluid that surrounds and cushions the brain and spinal cord...
March 14, 2018: Journal of Craniofacial Surgery
Davide Corbetta, Elisabetta Sarasso, Federica Agosta, Massimo Filippi, Roberto Gatti
Background: Treatment of central post-stroke pain (CPSP) after a thalamic-capsular stroke is generally based on pharmacological approach as it is low responsive to physiotherapy. In this case report, the use of mirror therapy (MT) for the reduction of CPSP in a subject after a stroke involving thalamus is presented. Case presentation: Five years after a right lenticular-capsular thalamic stroke, despite a good recovery of voluntary movement that guaranteed independence in daily life activities, a 50-year-old woman presented with mild weakness and spasticity, an important sensory loss and a burning pain in the left upper limb...
2018: Archives of Physiotherapy
Johanna Wangdell, Carina Reinholdt, Jan Fridén
Spasticity is a common and increasingly prevalent secondary complication of spinal cord injury. The aim of the study was to evaluate patient-experienced gains in prioritized activities after surgery to reduce the effects of spasticity in upper limbs in tetraplegia. The study includes evaluation of 30 operations for 27 patients performed on hypertonic tetraplegic hands during 2007-2015 using the Canadian Occupational Performance Measure. Activity performance increased at both 6 months and 12 months by a mean of 3...
January 1, 2018: Journal of Hand Surgery, European Volume
Baohua Hu, Xiufeng Zhang, Jingsong Mu, Ming Wu, Yong Wang
BACKGROUND: Most of the objective and quantitative methods proposed for spasticity measurement are not suitable for clinical application, and methods for surface electromyography (sEMG) signal processing are mainly limited to the time-domain. This study aims to quantify muscle activity in the time-frequency domain, and develop a practical clinical method for the objective and reliable evaluation of the spasticity based on the Hilbert-Huang transform marginal spectrum entropy (HMSEN) and the root mean square (RMS) of sEMG signals...
February 27, 2018: Biomedical Engineering Online
Zhiqiang Huang, Ning Zhao, Zhaoyuan Su, Jiafu Su, Qiang Wu
OBJECTIVE: Based on rehabilitation training, to observe the clinical effect difference between pricking combined with cupping and western medication for elbow flexion spasticity of upper limb of stroke patients. METHODS: Sixty patients were randomly assigned by SPSS software random number generator into a comprehension group and a western medication group, 30 cases in each one. Rehabilitation was used in the two groups. Pricking and cupping were applied at the affected abdominal center of biceps brachii muscle on Tuesday and Friday continuously for 4 weeks in the comprehensive group...
February 12, 2018: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
Marco Franceschini, Michela Goffredo, Sanaz Pournajaf, Stefano Paravati, Maurizio Agosti, Francesco De Pisi, Daniele Galafate, Federico Posteraro
BACKGROUND: Upper limb recovery is one of the main goals of post-stroke rehabilitation due to its importance for autonomy in Activities of Daily Living (ADL). Although the efficacy of upper limb Robot-assisted Therapy (RT) is well established in literature, the impact of the initial status of the patient on the effects of RT is still understudied. This paper aims to identify whether demographic, clinical and motor characteristics of stroke patients may influence the ability to independently perform ADL after RT...
2018: PloS One
Cynthia Gagnon, Isabelle Lessard, Bernard Brais, Isabelle Côté, Caroline Lavoie, Matthis Synofzik, Jean Mathieu
OBJECTIVE: To document in adults affected by Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) the intra- and interrater reliability, standard error of measurement, agreement, minimal detectable change and construct validity of the Nine-Hole Peg Test (NHPT), Standardized Finger-to-Nose Test (SFNT), and grip strength. DESIGN: Metrological study. SETTING: Neuromuscular rehabilitation clinic. PARTICIPANTS: Genetically confirmed adult patients with ARSACS (n = 42, 21 females, mean age = 38...
February 17, 2018: Archives of Physical Medicine and Rehabilitation
Moisés Schabarum Dall'Agnol, Fernanda Cechetti
Consider the leading cause of disability in adults, stroke leads to different consequences, like hemiparesis and loss of function in the upper limb which can impair the performance of activities during daily life. Different techniques have been used to soften this process, like Acupuncture and Kinesio Taping (KT). However, there is no consensus on their concomitant effect on neurological patients. This study aimed to analyze the effects of acupuncture associated with KT on the upper limb of patients with chronic hemiparesis after stroke...
January 4, 2018: Journal of Acupuncture and Meridian Studies
Raikan Buyukavci, Semra Akturk, Yüksel Ersoy
BACKGROUND: Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach is not yet available in the literature. AIM: The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients...
February 7, 2018: European Journal of Physical and Rehabilitation Medicine
Jing Gao, Wen He, Li-Juan Du, Johnson Chen, David Park, Michael Wells, Brian Fowlkes, Michael O'Dell
We prospectively investigated the feasibility of using quantitative ultrasound imaging (QUI) to assess the biceps brachii muscle (BBM) in individuals with chronic post-stroke spasticity. To quantify muscle echogenicity and stiffness, we measured QUI parameters (gray-scale pixel value and shear wave velocity [SWV, m/s]) of the BBM in three groups: 16 healthy BBMs; 12 post-stroke, non-spastic BBMs; and 12 post-stroke, spastic BBMs. The QUI results were compared with the Modified Ashworth Scale and Tardieu Scale...
February 2, 2018: Ultrasound in Medicine & Biology
So Young Lee, Young Tae Jeon, Bo Ryun Kim, Eun Young Han
RATIONALE: Spasticity is a major complication after stroke, and botulinumtoxin A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve voluntary motor control or activities of daily living function of paretic upper limbs. This study investigated whether BoNT-A injection combined with robot-assisted upper limb therapy improves voluntary motor control or functions of upper limbs after stroke. PATIENT CONCERNS: Two subacute stroke patients were transferred to the Department of Rehabilitation...
December 2017: Medicine (Baltimore)
Theresa Sukal-Moulton, Deborah Gaebler-Spira, Kristin J Krosschell
AIM: This study examined the reliability and validity of the Test of Arm Selective Control (TASC) to examine upper extremity selective voluntary motor control in children and adolescents with all types of spastic cerebral palsy (CP). METHOD: Fifty-six participants with CP, ranging in age from 5 years 9 months to 18 years 11 months (average 11y 7mo, SD 3y 9mo; 25 males, 31 females), participated in this prospective cross-sectional study. They were evaluated using the TASC and several clinical measures...
January 31, 2018: Developmental Medicine and Child Neurology
Maria Pais de Carvalho, Daniela Pinto, Melissa Gorayeb, Jorge Jacinto
Background Botulinum toxin type-A (BoNTA) is a recognized treatment for upper limb spasticity (ULS) after stroke, but there aren't many studies analyzing its effect in shoulder muscles. Objective To evaluate the efficacy of BoNTA injections for ULS, when shoulder muscles are included. Methods A cross-sectional study. Data from clinical forms of outpatients, treated at a Rehabilitation Center (2001-2016). Analyzes: goals of treatment; demographic characteristics/goal; treatment success, using Goal Attainment Scaling...
January 11, 2018: Topics in Stroke Rehabilitation
Liam Johnson, Marie-Louise Bird, Makii Muthalib, Wei-Peng Teo
INTRODUCTION: The STRoke Interactive Virtual thErapy (STRIVE) intervention provides community-dwelling stroke survivors access to individualised, remotely supervised progressive exercise training via an online platform. This trial aims to determine the clinical efficacy of the STRIVE intervention and its effect on brain activity in community-dwelling stroke survivors. METHODS AND ANALYSIS: In a multisite, assessor-blinded randomised controlled trial, 60 stroke survivors >3 months poststroke with mild-to-moderate upper extremity impairment will be recruited and equally randomised by location (Melbourne, Victoria or Launceston, Tasmania) to receive 8 weeks of virtual therapy (VT) at a local exercise training facility or usual care...
January 9, 2018: BMJ Open
Lorenzo Ugga, Cinzia Coppola, Sirio Cocozza, Dario Saracino, Ferdinando Caranci, Francesco Tuccillo, Elisabetta Signoriello, Sara Casertano, Giuseppe Di Iorio, Enrico Tedeschi
Motor neuron disease (MND) is a neurodegenerative disease determining progressive and relentless motor deterioration involving both upper and lower motor neurons (UMN and LMN); several variants at onset are described. Here we describe a case of MND presenting as pure spastic monoparesis in which magnetic resonance imaging (MRI) gave a substantial contribution in confirming the diagnosis and assessing the severity of UMN involvement. An isolated pyramidal syndrome, with complete absence of LMN signs, is a rare phenotype in the context of MND (less than 4% of total cases), especially if restricted to only one limb...
December 2017: Quantitative Imaging in Medicine and Surgery
Mindy F Levin, Melanie C Baniña, Silvi Frenkel-Toledo, Sigal Berman, Nachum Soroker, John M Solomon, Dario G Liebermann
BACKGROUND: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved ("active control zone") after identification of a "spasticity zone"...
January 4, 2018: Trials
Susan Taylor, Belinda McLean, Eve Blair, Leeanne Mary Carey, Jane Valentine, Sonya Girdler, Catherine Elliott
BACKGROUND: The sense_assess© kids is a standardised, norm-referenced assessment designed to measure the functional somatosensation capacity of the upper limb of children with cerebral palsy. The objective of the current study was to determine if the sense_assess© kids was clinically acceptable to children and youth. METHODS: A questionnaire was completed by participants following administration of the sense_assess© kids by a trained occupational therapist. Twenty-six children with spastic hemiplegic cerebral palsy (aged 6-15 years six months; mean 10 years eight months; 16 boys) were recruited...
December 28, 2017: Australian Occupational Therapy Journal
Mou-Xiong Zheng, Xu-Yun Hua, Jun-Tao Feng, Tie Li, Ye-Chen Lu, Yun-Dong Shen, Xiao-Hua Cao, Nai-Qing Zhao, Jia-Ying Lyu, Jian-Guang Xu, Yu-Dong Gu, Wen-Dong Xu
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)...
December 20, 2017: New England Journal of Medicine
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