Posts Tagged Muscle spasticity

[Abstract] Association between postural patterns of spastic upper extremity and functional independence after TBI and stroke

Abstract

BACKGROUND:Spastic hypertonia of the upper limb after stroke or traumatic brain injuries (TBI) is a prevalent clinical sign causing abnormal postures and movement patterns due to hyperexcitability of the upper motor neurons and rheological alterations in the affected muscles. These alterations limit the use of the upper limb, restricting its functional activities and affecting the individual’s quality of life and social participation.

OBJECTIVE:To determine the association between spastic patterns of the upper limb, wrist, fingers and thumb, and independence in everyday activities after a stroke or TBI.

METHODS:The design is a cross-sectional descriptive and correlational study. The sample consisted of 206 individuals who complied with the eligibility criteria and signed an informed consent. Clinical evaluation was carried out, including determination of the postural pattern of the upper extremity according to Hefter’s taxonomy and postural pattern classification of the wrist, fingers and thumb. Functional independence was evaluated using the Functional Independence Measure (FIM) and the Barthel Index (BI).

RESULTS:Univariate between-subject ANOVAs were used to examine associations of the four pattern classifications with the two independence measures, FIM and BI. Results indicate that Pattern I of Hefter’s upper limb taxonomy is associated with lesser functional independence according to FIM and BI mean scores.

CONCLUSIONS:The postural pattern of the upper limb after TBI or stroke is related to the patient’s functional independence. Specifically, Pattern I tends to co-occur with low independence.

Source: https://content.iospress.com/articles/neurorehabilitation/nre203042

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[Abstract] Effectiveness of Dry Needling in the Management of Spasticity in Patients Post Stroke

Abstract

Objective: To determine the effectiveness of the dry needling technique (DNT) in the treatment of spasticity for individuals with stroke. 

Design: We reviewed the Embase, Pubmed/MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We also performed a manual search of the references that are included in the selected articles. Studies included were: i) randomized clinical trials (RCTs); ii) involving patients with a diagnosis of stroke; and iii) using DNT alone or in a multimodal treatment. Muscular spasticity was the primary outcome of the study. The additional outcomes included were: pressure pain sensitivity, range of motion and perception of pain. The analysis of the certainty of the evidence was analyzed using GRADE. The risk of bias of the included studies was assessed with the Cochrane Risk of Bias Tool for Randomized Controlled Trials. 

Results: A total of six RCTs with 221 patients were included in this systematic review, where a significant decrease in spasticity was observed in most of the muscles evaluated, though the certainty of the evidence was low. The effects were only evaluated in the short term in all included studies and the sample size was small. 

Conclusion: These results should be taken with caution because the included studies are few in number and have different comparators. More RCTs are needed to cover aspects of biases found in the literature, in particular the blinding of participants and personnel.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1052305720306546?dgcid=rss_sd_all&utm_campaign=RESR_MRKT_Researcher_inbound&utm_medium=referral&utm_source=researcher_app

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[ARTICLE] Balance trainer training with transcutaneous electrical nerve stimulation improves spasticity and balance in persons with chronic stroke – Full Text PDF

Abstract
Objective: The purpose of this study was determine the effect of Balance Trainer training with Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity and balance in persons with chronic stroke.
Design: Randomized controlled trial.
Methods: A total of 30 subjects with hemiparetic stroke were recruited and randomly divided into the Balance Trainer training with TENS group (n=15) and Balance Trainer training with placebo TENS group (n=15). The Balance Trainer training with TENS group practiced additional Balance Trainer training with TENS for 30 minutes a day, 5 days per a week during 4 weeks and the Balance Trainer training with placebo TENS group practiced additional Balance Trainer training with placebo TENS for the same period. Spasticity and balance were assessed by ability (static balance, dynamic balance) and were measured before and after the 4-week programs.
Results: The result of spasticity and dynamic balance were improved significantly in both groups (p<0.05). The Balance Trainer training with TENS group showed significantly greater improvement in spasticity of the gastrocnemius & dynamic balance, compared to the Balance Trainer training with placebo TENS group (p<0.05). The Balance trainer training with TENS group showed a significant improvement in static balance, especially during the eye-closed condition (p<0.05).
Conclusions: The Balance Trainer training with TENS was effective in improving spasticity and balance in subjects with chronic stroke. Based on these results, it is suggested that Balance Trainer training with TENS could clinically be used more actively in conjunction with conventional physical therapy.

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via Balance trainer training with transcutaneous electrical nerve stimulation improves spasticity and balance in persons with chronic stroke

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[Abstract] Exploratory Randomized Double-Blind Placebo-Controlled Trial of Botulinum Therapy on Grasp Release After Stroke (PrOMBiS)

Background. OnabotulinumtoxinA injections improve upper-limb spasticity after stroke, but their effect on arm function remains uncertain.

Objective. To determine whether a single treatment with onabotulinumtoxinA injections combined with upper-limb physiotherapy improves grasp release compared with physiotherapy alone after stroke.

Methods. A total of 28 patients, at least 1 month poststroke, were randomized to receive either onabotulinumtoxinA or placebo injections to the affected upper limb followed by standardized upper-limb physiotherapy (10 sessions over 4 weeks). The primary outcome was time to release grasp during a functionally relevant standardized task. Secondary outcomes included measures of wrist and finger spasticity and strength using a customized servomotor, clinical assessments of stiffness (modified Ashworth Scale), arm function (Action Research Arm Test [ARAT], Nine Hole Peg Test), arm use (Arm Measure of Activity), Goal Attainment Scale, and quality of life (EQ5D).

Results. There was no significant difference between treatment groups in grasp release time 5 weeks post injection (placebo median = 3.0 s, treatment median = 2.0 s; t(24) = 1.20; P = .24; treatment effect = −0.44, 95% CI = −1.19 to 0.31). None of the secondary measures passed significance after correcting for multiple comparisons. Both groups achieved their treatment goals (placebo = 65%; treatment = 71%), and made improvements on the ARAT (placebo +3, treatment +5) and in active wrist extension (placebo +9°, treatment +11°).

Conclusions. In this group of stroke patients with mild to moderate spastic hemiparesis, a single treatment with onabotulinumtoxinA did not augment the improvements seen in grasp release time after a standardized upper-limb physiotherapy program.

 

via Exploratory Randomized Double-Blind Placebo-Controlled Trial of Botulinum Therapy on Grasp Release After Stroke (PrOMBiS) 

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[Abstract] Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

Abstract

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A randomized controlled pilot study.
SETTING: A hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037).
CONCLUSIONS: Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

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via Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):551-7 – Minerva Medica – Journals

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[Abstract] Selective peripheral neurolysis using high frequency ultrasound imaging: a novel approach in the treatment of spasticity

 

BACKGROUND: Chemoneurolysis is used to treat focal spasticity in patients with upper motor neuron syndrome.
CASE REPORT: Neurolytic substances (phenol/alcohol) injected nearby/in the main trunk of peripheral nerves can cause not only motor but also cutaneous nerves destruction. The latter is thought to be responsible for considerable side effects such as dysesthesia and paresthesia. During injections, targeting the primary motor branches originating from the main trunk while sparing cutaneous nerves will result in decrease/elimination of these side effects and better clinical improvement.
CLINICAL REHABILITATION IMPACT: We suggest that high frequency ultrasound enabling the physician to scan peripheral nerves and their primary branches can be useful to perform this selective peripheral neurolysis in the treatment of spasticity.

via Selective peripheral neurolysis using high frequency ultrasound imaging: a novel approach in the treatment of spasticity – European Journal of Physical and Rehabilitation Medicine 2019 August;55(4):522-5 – Minerva Medica – Journals

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[Abstract] Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of Kinesiotaping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A Randomized Controlled Pilot Study.
SETTING: One hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into Kinesiotaping (KT) group or control group. In KT group, Kinesio tape was applied as an add- on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (p=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (p=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (p=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (p=0.037).
CONCLUSIONS: Kinesiotaping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesiotaping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

via Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 Jun 13 – Minerva Medica – Journals

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[Abstract + References] Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis

Abstract

Objectives

(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.

Data Sources

PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.

Study Selection

Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.

Data Extraction

Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.

Data Synthesis

Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.

Conclusion

There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151)

References

  1. Zorowitz, R.D., Gillard, P.J., Brainin, M. Poststroke spasticity. Neurology. 2013;80:S45–S52
  2. Wissel, J., Manack, A., Brainin, M. Toward an epidemiology of poststroke spasticity. Neurology. 2013;80:S13–S19
  3. Watkins, C.L., Leathley, M.J., Gregson, J.M., Smith, T.L., Moore, A.P. Prevalence of spasticity post stroke. Clin Rehabil. 2002;16:515–522
  4. Doan, Q.V., Brashear, A., Gillard, P.J. et al, Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity. PM R. 2012;4:4–10
  5. Lundström, E., Smits, A., Borg, J., Terént, A. Four-fold increase in direct costs of stroke survivors with without spasticity the first year after the event. Stroke. 2010;41:319–324
  6. Winstein, C.J., Stein, J., Arena, R. et al, Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47:e98–e169
  7. Thibaut, A., Laureys, S., Gosseries, O., Chatelle, C., Ziegler, E. Spasticity after stroke: physiology, assessment and treatment. Brain Inj. 2013;9052:1–13
  8. Richardson, D. Physical therapy in spasticity. Eur J Neurol. 2002;9:17–22
  9. Malas, B., Kacen, M. Orthotic management in patients with stroke. Top Stroke Rehabil. 2001;7:38–45
  10. Lehmann, J.F., Esselman, P.C., Ko, M.J., Smith, J.C., deLateur, B.J., Dralle, A.J. Plastic ankle-foot orthoses: evaluation of function. Arch Phys Med Rehabil. 1983;64:402–407
  11. Barnes, M.P. Medical management of spasticity in stroke. Age Ageing. 2001;30:13–16
  12. Kocabas, H. Comparison of phenol and alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for treatment of spastic foot after stroke: a randomized controlled pilot study.Eur J Phys Rehabil Med. 2010;46:5–10
  13. Fukuhara, T., Kamata, I. Selective posterior rhizotomy for painful spasticity in the lower limbs of hemiplegic patients after stroke: report of two cases. Neurosurgery. 2004;54:1268–1273
  14. Sheean, G., McGuire, J.R. Spastic hypertonia and movement disorders: pathophysiology, clinical presentation, and quantification. PM R. 2009;1:827–833
  15. Martins, F.L., Carvalho, L.C., Silva, C.C., Brasileiro, J.S., Souza, T.O., Lindquist, A.R. Immediate effects of TENS and cryotherapy in the reflex excitability and voluntary activity in hemiparetic subjects: a randomized crossover trial. Rev Bras Fisioter. 2012;16:337–344
  16. Kim, T.H., In, T.S., Cho, H. Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke. Tohoku J Exp Med. 2013;231:93–100
  17. Tinazzi, M., Zarattini, S., Valeriani, M. et al, Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation. Exp Brain Res. 2005;161:457–464
  18. Yan, T., Hui-Chan, C.W. Transcutaneous electrical stimulation on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial. J Rehabil Med. 2009;41:312–316
  19. Tekeoğlu, Y., Adak, B., Göksoy, T. Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel activities of daily living (ADL) index score following stroke. Clin Rehabil. 1998;12:277–280
  20. Sonde, L., Kalimo, H., Viitanen, M. Stimulation with high-frequency TENS — effects on lower limb spasticity after stroke. Adv Physiother. 2000;2:183–187
  21. Jung, K.-S., In, T.-S., Cho, H. Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study. Gait Posture. 2017;54:183–187
  22. Picelli, A., Dambruoso, F., Bronzato, M. et al, Efficacy of therapeutic ultrasound and transcutaneous electrical nerve stimulation compared with botulinum toxin type A in the treatment of spastic equinus in adults with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil. 2014;21:S8–S16
  23. Sonde, L., Gip, C., Fernaeus, S.E., Nilsson, C.G., Viitanen, M. Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm. Scand J Rehabil Med. 1998;30:95–99
  24. Branco Mills, P., Dossa, F. Transcutaneous electrical nerve stimulation for management of limb spasticity. Am J Phys Med Rehabil. 2016;95:309–318
  25. Lin, S., Sun, Q., Wang, H., Xie, G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: a systematic review and meta-analysis. J Rehabil Med. 2018;50:3–7
  26. Ng, S.S., Hui-Chan, C.W. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke. 2007;38:2953–2959
  27. Cho, H., In, T.S., Cho, K.H., Song, C.H. A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke. Tohoku J Exp Med. 2013;229:187–193
  28. Potisk, K.P., Gregoric, M., Vodovnik, L. Effect of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with hemiplegia. Scand J Rehabil Med. 1995;27:169–174
  29. Levin, M.F., Hui-Chan, C.W. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol. 1992;85:131–142
  30. Bernhardt, J., Hayward, K.S., Kwakkel, G. et al, Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017;12:444–450
  31. Cochrane Effective Practice and Organisation of Care. Suggested risk of bias criteria for EPOC reviews. (Available at:)http://epoc.cochrane.org/resources/epoc-resources-review-authors(Accessed August 22, 2018)
  32. Higgins, J.P., Green, S. Cochrane handbook for systematic reviews of interventions: version 5.1.0.(Available at:)http://handbook.cochrane.org(Accessed August 27, 2018)
  33. Hussain, T., Mohammad, H. The effect of transcutaneous electrical nerve stimulation (TENS) combined with Bobath on post stroke spasticity. A randomized controlled study. J Neurol Sci. 2013;4:22–29
  34. Park, J., Seo, D., Choi, W., Lee, S. The effects of exercise with tens on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial. Med Sci Monit. 2014;20:1890–1896
  35. Laddha, D., Ganesh, G.S., Pattnaik, M., Mohanty, P., Mishra, C. Effect of transcutaneous electrical nerve stimulation on plantar flexor muscle spasticity and walking speed in stroke patients. Physiother Res Int. 2016;21:247–256
  36. Hui-Chan, C.W., Levin, M.F. Stretch reflex latencies in spastic hemiparetic subjects are prolonged after transcutaneous electrical nerve stimulation. Can J Neurol Sci. 1993;20:97–106
  37. Karakoyun, A., Boyraz, İ., Gunduz, R., Karamercan, A., Ozgirgin, N. Electrophysiological and clinical evaluation of the effects of transcutaneous electrical nerve stimulation on the spasticity in the hemiplegic stroke patients. J Phys Ther Sci. 2015;27:3407–3411
  38. Koyama, S., Tanabe, S., Takeda, K., Sakurai, H., Kanada, Y. Modulation of spinal inhibitory reflexes depends on the frequency of transcutaneous electrical nerve stimulation in spastic stroke survivors.Somatosens Mot Res. 2016;33:8–15
  39. Okuma, Y., Lee, R.G. Reciprocal inhibition in hemiplegia: correlation with clinical features and recovery. Can J Neurol Sci. 1996;23:15–23
  40. Sommerfeld, D.K., Gripenstedt, U., Welmer, A.-K. Spasticity after stroke. Am J Phys Med Rehabil. 2012;91:814–820
  41. Fernández-Tenorio, E., Serrano-Muñoz, D., Avendaño-Coy, J., Gómez-Soriano, J. Transcutaneous electrical nerve stimulation for spasticity: a systematic review. Neurologia. 2016; (pii: S0213-4853(16)30111-6)
  42. Kwong, P.W., Ng, G.Y., Chung, R.C., Ng, S.S. Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis.Clin Rehabil. 2018;32:1203–1219

source:
https://www.archives-pmr.org/article/S0003-9993(18)31455-2/abstract

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[Abstract] Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

Abstract

OBJECTIVE:

To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.

METHODS:

This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.

RESULTS:

Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I238.5%, P=0.92). No data were available concerning the mobility of other joints.

CONCLUSION:

This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.

 

via Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. – PubMed – NCBI

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[Abstract] Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials

Purpose: To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials.

Methods: Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration’s risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval.

Results: Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (−0.52 [−0.74 to −0.30] p < 0.0001, 6 studies), especially in lower limbs (−0.58 [−0.82 to −0.34] p < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias.

Conclusion: Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.

  • Implications for Rehabilitation
  • Transcutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.

  • High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.

  • More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.

via Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials: Disability and Rehabilitation: Vol 0, No 0

 

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