Posts Tagged Spasticity

[ARTICLE] Mechanisms Of Functional Adaptation Of Post Stroke Patients During Upper Limb Rehabilitation – Full Text

INTRODUCTION

Task oriented approach training of the patient with the arm weight unloading with feedback through the mirror.

Figure 1. Arm weight support training

Stroke is a leading cause of disability of the adult population worldwide. Successful recovery of upper limb motor function occurs only in 20% of cases [1]. Upper limb motor recovery is a most challenging goal, due to lack of patient’s motivation, training intensity and pathological synergy which is very difficult to correct using traditional methods. Poststroke upper limb paresis, spasticity and caused by them pathological synergies is the main problem on the way to daily living activities recovery. The problem of pathological synergies correction and transformation in rehabilitation practice are linked with the complexity of the required motor training approach [2]. A combination of cost-efficient, task-oriented, isolated and complex movement training with biofeedback is required to make synergy a compensatory mechanism for daily activities instead of pathological synkinesia.A promising but insufficiently studied method is virtual reality (VR), as well as its combination with other techniques like arm weight support training. Motor training in virtual reality (VR) with arm weight support creates the necessary facilitated environment for motor skills relearning [3].

MATERIALS AND METHODS.

45 patients (27 males and 18 females) with medium age 55 [45;65] years were enrolled in this study. All patients had one supratentorial lesion due to ischemic or hemorrhagic stroke (confirmed by MRI). Medium stroke age was 7 [4;12] months. All patients had moderate to severe upper limb paresis measured by Medical Research Council Scale for Muscle Strength and Fugl-Meyer assessment of physical performance (FMAS) upper extremity subscore 45 [35;55]. All patients received 2 weeks of a rehabilitation course, 5 days per week, 45 minutes daily.

Upper limb exoskeleton with weight support system and functional tasks in virtual environment.

Figure 2. Virtual reality with arm weight support training

Main group (n=25)  received 10 training sessions 45  minutes each on Armeo Spring system with separately adjusted weight support for shoulder and forearm and VR imitation of daily living activities such as reaching and grasping. The session includes 10 games like exercises and consistent increase of degrees of freedom from shoulder to the wrist. This condition allows teaching the patient voluntarily prevent pathologic synergy while performing a motor task.

The control group (n=20) received conventional therapy sessions with arm weight support (a system of pulleys), visual feedback (via mirror) and comparable set of tasks – reaching, grasping, manipulating objects.

The reaching test paradigm for motion analysis.

Figure 3. The reaching test.

For primary outcome assessment was used Fugl-Meyer assessment scale for upper limb, Action Research Arm Test (ARAT), Ashworth scale and Frenchay arm test. For motion analysis was used Russian Motion Capture System (Biosoft 3D). The paradigm for biomechanical analysis was presented with the functional reaching test. The reaching test was performed before and after the training course. Sitting at the table patient had to reach and grasp an empty glass located in front of him on the distance of extended healthy arm. For primary outcome were chosen reaching trajectory and arm kinematics, but patients were instructed to focus on the grasping movement to keep reaching movement more automatic. Normal reaching pattern was investigated on 10 healthy volunteers.

RESULTS.

FM and ARAT results on the main and control group before and after rehabilitation course.FM and ARAT results on the main and control group before and after rehabilitation course.
Figure 4. FM and ARAT scales before and after rehabilitation.
Table 1. Time of reaching test.
  Before rehabilitation After rehabilitation p-level
Moderate paresis, Ме [25%;75%] 1,5 [1,24; 1,71] 1,26 [0,9; 1,62] p=0,045
Severe paresis, Ме [25%;75%] 2,25 [1,65; 3,76] 2,66 [1,11; 3,05] p=0,043
Normal, Ме [25%;75%] 0,96 [0,87; 1,16]

In our study, the clinical assessment (FM and ARAT scales) showed that paretic hand recovery was found more in patients with moderate and severe paresis. Statistically significant improvements in the arm motor function (FMAS) were found in both groups. However, subsection analysis revealed that the patients of the main group compared to the control group had a more significant improvement in wrist movements. In ARAT was found that in patients with moderate paresis significant improvements occur in both main and control groups. In patients with severe paresis, improvements were observed only in the main group.

However, after motion analysis, a different stereotype of movement recovery was found in different groups of patients. In patients with severe paresis, an increase in the deviation of the movement pattern from the physiological movement was observed. At the same time, the normalization of the motor pattern was noted in patients with moderate paresis.

Table 2. Kinematics parameters in sever hand paresis.
Movement Before rehabilitation, Ме [25%;75%] After rehabilitation, Ме [25%;75%] p-level
Elbow extension 124 [116;126] 112 [109; 125] 0,01
Shoulder  flexion 36 [27; 41] 21 [20; 32] 0,02
Shoulder abduction 10 [10; 17] 19 [18; 22] 0,04
Velocity shoulder abduction 17 [13; 20] 48 [39; 65] 0,02
Velocity elbow extension 39 [26; 69] 29 [18,39] 0,02

The time of reaching test execution in patients with severe paresis after rehabilitation was longer than before and exceeded the normal time more than twice. Curiously,  these changes in patients with severe paresis were associated with an increase in functionality in the paretic arm (p>0,05).

The kinematic parameters such as elbow extension, shoulder abduction and angular velocity in shoulder and elbow joints after rehabilitation were worsened. After a rehabilitation course was founded decreasing of the angular velocity of the elbow joint extension, increasing of the angular velocity of the shoulder joint, decreasing of the flexion in the shoulder joint and angular speed of the elbow joint extension.

The analysis of trunk movements in severe paresis patients was shown that after rehabilitation course the trunk compensatory strategy was increased (trunk was mowed forward when patient reach the glass). These changes were associated with an increase in functionality in the paretic arm (p>0,05).

CONCLUSIONS.

Table 3. Body displacement in reaching test.
Shoulder displacement Before rehabilitation, Ме [25%;75%] After rehabilitation, Ме [25%;75%]
Healthy shoulder 23 [19,8; 57,44] 66 [49;81]
Paretic shoulder 169 [88; 178] 215 [162; 229]

If we summarized data of clinical and biomechanical parameters we see, that patients with severe paresis formed the new compensatory strategy of motion. Because of the significant changes in functional recovery are combined with worsened of biomechanical parameters.

It is believed that it is the resistance to pathological synergies and the forced training in physiological movement is the most effective method. However, correction of pathological synergies allows developing the most energy-efficient stereotype of movements for patients with regard to their individual capabilities. Combined VR and weight support training can be more effective to restore the impaired motor function after stroke than conventional weight support training. This approach contributes to the motor pattern reorganization through biomechanical and visual feedback, projected into the virtual space.

REFERENCES

[1] Beebe J.A., Lang C.E. Active range of motion predicts upper extremity function 3 months after stroke. Stroke. 2009 40 (5): 1772–1779.

[2] Cirstea M.C., Levin M.F. Compensatory strategies for reaching in stroke. Brain. 2000 123 (5): 940–953.

[3] Laver K.E., George S.,J.E. Thomas, M. Deutsch. Crotty Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev.  2015 12 (2): 83.

via Mechanisms Of Functional Adaptation Of Post Stroke Patients During Upper Limb Rehabilitation.

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[Abstract] Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton – Full Text PDF

Headline

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.

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via Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton – Researcher | An App For Academics

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[Abstract] Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial

The aim of this study was to compare the effects of two kinds of wrist-hand orthosis on wrist flexor spasticity in chronic stroke patients.

This is a randomized controlled trial.

The study was conducted in a rehabilitation center.

A total of 40 chronic hemiparetic stroke patients with wrist flexor spasticity were involved in the study.

Patients were randomly assigned to either an experimental group (conventional rehabilitation therapy + 3D-printed orthosis, 20 patients) or a control group (conventional rehabilitation therapy + low-temperature thermoplastic plate orthosis, 20 patients). The time of wearing orthosis was about 4–8 hours per day for six weeks.

Primary outcome measure: Modified Ashworth Scale was assessed three times (at baseline, three weeks, and six weeks). Secondary outcome measures: passive range of motion, Fugl-Meyer Assessment score, visual analogue scale score, and the swelling score were assessed twice (at baseline and six weeks). The subjective feeling score was assessed at six weeks.

No significant difference was found between the two groups in the change of Modified Ashworth Scale scores at three weeks (15% versus 25%, P = 0.496). At six weeks, the Modified Ashworth Scale scores (65% versus 30%, P = 0.02), passive range of wrist extension (P < 0.001), ulnar deviation (P = 0.028), Fugl-Meyer Assessment scores (P < 0.001), and swelling scores (P < 0.001) showed significant changes between the experimental group and the control group. No significant difference was found between the two groups in the change of visual analogue scale scores (P = 0.637) and the subjective feeling scores (P = 0.243).

3D-printed orthosis showed greater changes than low-temperature thermoplastic plate orthosis in reducing spasticity and swelling, improving motor function of the wrist and passive range of wrist extension for stroke patients.

via Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial – Yanan Zheng, Gongliang Liu, Long Yu, Yanmin Wang, Yuan Fang, Yikang Shen, Xiuling Huang, Lei Qiao, Jianzhong Yang, Ying Zhang, Zikai Hua,

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[Abstract] Ergometer training in stroke rehabilitation: systematic review and meta-analysis

Abstract

Objective

Ergometer training is routinely used in stroke rehabilitation. How robust is the evidence of its effects?

Data source

The PubMed database and PEDro database were reviewed prior to 22/01/2019.

Study selection

Randomized controlled trials investigating the effects of ergometer training on stroke recovery were selected.

Data extraction

Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.

Data synthesis

A total of 28 studies (including 1115 stroke subjects) were included. The data indicates that

(1) ergometer training leads to a significant improvement of walking ability, cardiorespiratory fitness, motor function and muscular force of lower limbs, balance and postural control, spasticity, cognitive abilities, as well as the brain’s resistance to damage and degeneration,

(2) neuromuscular functional electrical stimulation assisted ergometer training is more efficient than ergometer training alone,

(3) high-intensity ergometer training is more efficient that low-intensity ergometer training, and

(4) ergometer training is more efficient than other therapies in supporting cardiorespiratory fitness, independence in activities of daily living, and balance and postural control, but less efficient in improving walking ability.

Conclusion

Ergometer training can support motor recovery after stroke. However, current data is insufficient for evidence-based rehabilitation. More data is required about the effects of ergometer training on cognitive abilities, emotional status, and quality of life in stroke subjects.

via Ergometer training in stroke rehabilitation: systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Design of Powered Wearable Elbow Brace for Rehabilitation Applications at Clinic and Home – IEEE Conference Publication

Abstract

Spasticity and contractures are secondary to most neurological and orthopaedic pathologies. The most conservative method of management of spasticity and contractures is passive stretching exercises. Robotic rehabilitation aims to provide a solution to this problem. We describe in details the design of a powered wearable orthosis especially designed for managing spasticity and contractures. The device is fully portable, allowing the patient to undergo repeated-passive-dynamic exercises outside the hospital environment. The design of the device is modular to make it adaptable to different anatomies and pathologies. The device is also fitted with electrogoniometers and torque sensors to record kinematics and dynamics of the patient, improving the insight of the clinicians to the rehabilitation of the patient, as well as providing data for further clinical and scientific investigations. The mechanical integrity of the device elements is simulated and verified.

via Design of Powered Wearable Elbow Brace for Rehabilitation Applications at Clinic and Home – IEEE Conference Publication

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[ARTICLE] A comparison of the rehabilitation effectiveness of neuromuscular electrical stimulation robotic hand training and pure robotic hand training after stroke: A randomized controlled trial – Full Text

Highlights

The rehabilitation effects of the NMES robotic hand and robotic hand were compared.

Both training systems could significantly improve the motor function of upper limb.

The NMES robot was more effective than the pure robot.

NMES applied on distal muscle could benefit the recovery in the entire upper limb.

 

Abstract

Objective

To compare the rehabilitation effects of the electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand and EMG-driven robotic hand for chronic stroke.

Methods

This study was a randomized controlled trial with a 3-month follow-up. Thirty chronic stroke patients were randomly assigned to receive 20-session upper limb training with either EMG-driven NMES robotic hand (NMES group, n = 15) or EMG-driven robotic hand (pure group, n = 15). The training effects were evaluated before and after the training, as well as 3 months later, using the clinical scores of Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Action Research Arm Test (ARAT), and Functional Independence Measure (FIM). Session-by-session EMG parameters, including the normalized EMG activation level and co-contraction indexes (CIs) of the target muscles were applied to monitor the recovery progress in muscular coordination patterns.

Results

Both groups achieved significantly increased FMA and ARAT scores (p < 0.05), and the NMES group improved more (p < 0.05). A significant improvement in MAS was obtained in the NMES group (p < 0.05) but absence in the pure group. Meanwhile, better performance could be obtained in the NMES group in releasing the EMG activation levels and CIs than the pure group across the training sessions (p < 0.05).

Conclusion

Both training systems were effective in improving the long-term distal motor functions in upper limb, where the NMES robot-assisted training achieved better voluntary motor recovery and muscle coordination and more release in muscle spasticity.

Significance

This study indicated more effective distal rehabilitation using the NMES robot than the pure robot-assisted rehabilitation.

1. Introduction

Upper limb motor deficits are common after stroke, and observed in over 80% of stroke survivors [1,2]. Various rehabilitation devices have been purposed to assist human physical therapists to provide effective long-term rehabilitation programs [[3][4][5]]. Among them, rehabilitation robots and neuromuscular electrical stimulation (NMES) are most widely used in stroke rehabilitation practices. Rehabilitation robots have been recognized as efficient in such cases and could represent a cost-effective addition to conventional rehabilitation services because they provide highly intensive and repetitive training [[6][7][8][9]]. It has been reported that the integration of voluntary effort (e.g. electromyography, EMG) into robotic design could contribute significantly to motor recovery in stroke patients [6,10]. This is because an EMG-driven strategy can maximize the involvement of voluntary effort in the training, and its effectiveness at improving upper limb voluntary motor functions have been proved by many EMG-driven robot-assisted upper-limb training systems [[11][12][13]]. However, rehabilitation robots are unable to directly activate the desired muscle groups, which may only assist, or even dominate limb movement such as continuous passive motions (CPM) [14]. In addition, stroke patients usually cooperate with compensatory motions from other muscular activities to activate the target muscles, which may lead to ‘learned disuse’ [15]. However, NMES can effectively limit compensatory motions by stimulating specific muscles via cyclic electrical currents, which provides repetitive sensorimotor experiences [16]. With the advantage of precisely activating the target muscle, NMES has been reported to be effective in evoking sensory feedback, improving muscle force, and thus promoting motor function in stroke patients [17,18]. Nevertheless, training programs assisted by NMES alone are also suboptimal due to the difficulty of controlling movement trajectories and the early appearance of fatigue [19,20].

Accordingly, various NMES robot-assisted upper-limb training programs which combine these two unique techniques have been proposed to integrate the benefits and minimize the disadvantages [7,12,14,21,22]. The rehabilitation effectiveness of these combined systems has been investigated and reported to be effective in improving motor recovery. Several studies have compared the training outcomes of NMES robot-assisted training and other training programs. For example, Qian et al. [22] reported that NMES-robot-assisted upper-limb training could achieve better motor outcomes when compared with conventional therapies for subacute stroke patients. Meanwhile, another study which compared the training effects between robot-aided training with NMES and robot-aided training solely using the InMotion ARM™ Robot in the subacute period demonstrated that the active ranges of motion of the NMES robot-training group were significantly higher compared with the robot-training group [23]. Coincidentally, investigations into applications in chronic stroke patients have also been carried out. For instance, Hu et al. [14] proposed an EMG-driven NMES robot system for wrist training; this combined device improved muscle activation levels related to the wrist and reduced compensatory muscular activities at the elbow, while these training outcomes were absent for the EMG-driven robot-assisted training alone. Indeed, a similar study by another research group also achieved better rehabilitation outcomes on some clinical assessments using the combined system compared to robot-assisted therapy alone [21].

In the literature, most studies on current rehabilitation devices combining the NMES and robotic systems targeted the elbow and wrist joints [7,[21][22][23]], while very few focused on the hand and fingers [24]. In addition, a comparison of the training effects for hand rehabilitation between the NMES robot and other hand rehabilitation devices has not yet been adequately conducted. Indeed, the primary upper-limb disability post-stroke is the loss of hand function, and rehabilitation of the distal joints after stroke is much more difficult than the motor recovery of the proximal joints due to the compensatory motions from the proximal joints [25]. Hence, developing effective rehabilitation devices to minimize compensatory movements for hand motor recovery is especially meaningful for stroke rehabilitation. In our previous work, we developed an EMG-driven NMES robotic hand and suggested it for use in hand rehabilitation after stroke [26]. Our device provides fine control of hand movements and activates the target muscles selectively for finger extension/flexion, and its feasibility and effectiveness have been verified by a single group trial [12]. However, whether the long-term rehabilitation effect of this EMG-driven NMES robotic hand is comparable or even better than other hand rehabilitation devices are still unclear and need to be investigated quantitively. Therefore, the objective of this study is to compare the training effects of hand rehabilitation assisted by an NMES robotic hand and by a pure robotic hand though a randomized controlled trial with a 3-month follow-up (3MFU).

2. Methodology

2.1. Participants

This work was approved by the Human Subjects Ethics Sub-Committee of the Hong Kong Polytechnic University. A total of 53 stroke survivors were screened for the training from local districts. 30 participants with chronic stroke satisfied the following inclusion criteria: (1) The participants were at least 6 months after the onset of a singular and unilateral brain lesion due to stroke, (2) both the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints could be extended to 180° passively, (3) muscle spasticity during extension at the finger joints and the wrist joint was below 3 as measured by the Modified Ashworth Scale (MAS) [27], ranged from 0 (no increase in muscle tone) to 4 (affected part rigid), (4) detectable voluntary EMG signals from the driving muscle on the affected side (three times of the standard deviation (SD) above the EMG baseline), and (5) no visual deficit and able to understand and follow simple instructions as assessed by the Mini-Mental State Examination (MMSE > 21) [28].

This work involved a randomized controlled trial with a 3-month follow-up (3MFU). The potential participants were first told that the training program they would receive could be either NMES robotic hand training or pure robotic hand training, and all recruited participants submitted their written consent before randomization. Then, the recruited participants were randomly assigned into two groups according to a computer-based random number generator, i.e., the computer program generated either “1” (denoting the NMES robotic hand training group) or “2” (the pure robotic hand group) with an equal probability of 0.5 (Matlab, 2017, Mathworks, Inc.). Fig. 1 shows the Consolidated Standards of Reporting Trials flowchart of the training program.

Fig. 1

Fig. 1. The consolidated standards of reporting trials flowchart of the experimental design.

2.2. Interventions

For both groups, each participant was invited to attend a 20-session robotic hand training with an intensity of 3–5 sessions/week, completed within 7 consecutive weeks. The training setup of both groups is shown in Fig. 2. This robotic hand training system can assist with finger extension and flexion of the paretic limb for patients after stroke. In this work, real-time voluntary EMG detected from the abductor pollicis brevis (APB) and extensor digitorum (ED) muscles were used to control the respective hand closing and opening movements, and the threshold level of each motion phase was set at three times the SD above the EMG baseline at resting state [12]. For example, during the motions of finger flexion, once the EMG activation level of the APB muscle reached a preset threshold, the robotic hand would provide mechanical assistance for hand closing. Similarly, during the motions of finger extension, the robotic hand would assist with hand opening when the EMG activation level of the ED muscle reached a preset threshold. For the NMES robot group, synchronized support from the NMES and the robot were both provided. The NMES electrode pair (30 mm diameter; Axelgaard Corp., Fallbrook, CA, USA) was attached over the ED muscle to provide stimulation during finger extension. The outputs of NMES were square pulses with a constant amplitude of 70 V, a stimulation frequency of 40 Hz, and a manually adjustable pulse width in the range 0–300 μs. Before the training, the pulse width was set at the minimum intensity, which achieved a fully extended position of the fingers in each patient. During the training, NMES would be triggered by the EMG from the ED muscle first and then provided stimulation to the ED muscle to assist hand-opening motions for the entire phase of finger extension, while no assistance from NMES was provided during finger flexion to avoid the possible increase of finger spasticity after stimulation [29]. For the pure robot group, the difference between the two groups was that no NMES was applied in the pure robot group. A detailed account of the working principles of the robotic hand have been described in our previous work [12,30,31].

Fig. 2

Fig. 2. The experimental setup of the robotic hand training: (A) pure robotic hand group; (B) neuromuscular electrical stimulation (NMES) robotic hand group.

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Continue —-> A comparison of the rehabilitation effectiveness of neuromuscular electrical stimulation robotic hand training and pure robotic hand training after stroke: A randomized controlled trial – ScienceDirect

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[NEWS] Botox is Now Approved for Lower-Limb Spasticity in Children

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The US Food and Drug Administration (FDA) has approved onabotulinumtoxinA (Botox, Allergan) to ease lower-limb spasticity in children and adolescents aged 2 years to 17 years, excluding spasticity caused by cerebral palsy (CP), Allergan announces.

“Lower limb spasticity can impact many aspects of a child’s life and have a drastic influence on their overall development and quality of life,” David Nicholson, Allergan’s chief research and development officer, says in a news release.

The FDA approved Botox for lower-limb spasticity on the basis of safety and efficacy data from a phase 3 study involving more than 300 children aged 2 years or older with lower-limb spasticity.

Participants in the trial had CP, but the approved indication excludes lower-limb spasticity caused by CP, owing to marketing exclusivity by another company, according to Allergan.

The approved recommended dose per treatment session is 4 to 8 units/kg divided among affected muscles of the lower limb. The total dose for pediatric patients should not exceed 8 units/kg body weight, or 300 units, whichever is lower.

When treating both lower limbs or upper and lower limbs in combination, the total dose for pediatric patients should not exceed 10 units/kg, or 340 units, whichever is lower, in a 3-month interval, the company states.

“Pediatric lower limb spasticity inhibits normal muscular movement and function and can result in delayed or impaired motor development, as well as difficulty with posture and positioning,” Mark Gormley, Jr, MD, of Gillette Children’s Specialty Healthcare–St. Paul, comments, in the release.

“Botox has a well-established safety and efficacy profile, and supports children and adolescents successfully manage both their upper and lower limb spasticity,” said Gormley.

Botox was approved for pediatric upper-limb spasticity in June.

[Source: Medscape]

 

via Botox is Now Approved for Lower-Limb Spasticity in Children – Rehab Managment

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[Abstract] Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke – a retrospective case-matched study.

Abstract

BACKGROUND:

Functional electrical stimulation (FES) plus body weight-supported treadmill training (BWSTT) provide effective gait training for poststroke patients with abnormal gait. These features promote a successful active motor relearning of ambulation in stroke survivors.

AIM:

This is a retrospective study to assess the effect of FES plus BWSTT for gait rehabilitation in patients poststroke.

DESIGN:

A retrospective case-matched study.

SETTING:

Participants were recruited from a rehabilitation department in an acute university-affiliated hospital.

POPULATION:

Ninety patients poststroke from Yue Bei People’s Hospital underwent BWSTT (A: control group) were compared to an equal number of cross-matched patients who received FES plus BWSTT (B: FES plus BWSTT group).

METHODS:

While B group received FES for 45 minutes plus BSWTT for 30 minutes in the program, group A received time-matched BWSTT alone. The walking speed, step length, step cadence, Fugl-Meyer lower-limb scale (LL-FMA), composite spasticity scale (CSS), 10-Meter Walk Test (10MWT), Tinetti Balance Test (TBT) and nerve physiology testing were collected before and after intervention.

RESULTS:

One hundred and eighty patients with poststroke abnormal gait were chosen. There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between baseline and post-intervention (P<0.05). There were significant differences in walking speed, step length, step cadence, LL-FMA, CSS, TBT, and 10MWT between two groups at the end of the eighth week (P<0.05), but not at baseline (P>0.05). In comparison with group A, the peak of somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitude increased, the latency was shortened, and the conduction velocity of sensory nerve (SCV) and motor nerve (MCV) was significantly increased in the group B (P < 0.05). No adverse events occurred during the study.

CONCLUSIONS:

This study suggests that FES plus BWSTT could be more effective than BWSTT alone in the improvement of gait, balance, spasticity, and function of the lower limb in patients poststroke.

CLINICAL REHABILITATION IMPACT:

Introduce effective rehabilitation strategies for poststroke patients with abnormal gait.

 

via Effect of functional electrical stimulation plus body weight-supported treadmill training for gait rehabilitation in patients with poststroke-a ret… – PubMed – NCBI

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[BLOG POST] Home After a Stroke: What I Learned About Splints as a Stroke Survivor

What I Learned About Splints as a Stroke Survivor

When spasticity from a stroke holds muscles in one position, muscle fibers become short which restricts motion.  Lannin (1) concluded “splinting has little or no effect on the loss of range of motion” (p. 113).  Unfortunately, Lannin told therapists to stop all passive stretching and restrict active hand exercises to 10 minutes a day.  So the data does not tell us if a resting night splint is a useful addition to standard therapy.

I wondered what would happen if I continued to do passive stretching and active hand exercises, but stopped wearing my resting splint at night.  After a month of not wearing this splint I could feel my thumb getting tighter.  I resumed wearing my splint and the next morning I woke up with a wicked ache in my thumb.  My thumb is tight by bedtime so my splint has not eliminated spasticity.  Placing the hand in one static position does not retrain the brain to produce active range of motion (AROM).  Yet I believe my splint has prevented a painful permanent contracture.

I love my new SaeboStretch resting splint I wear at night.  The new soft straps do not cut into my skin the way the old plastic straps did.  This version also uses a new kind of “Velcro” that does not have spiky hooks that scratch my bare thigh.  Notice that there are now two finger straps and two thumb straps.  The cover zips off so it can be washed.

1.  Lannin N, Cusick A, McCluskey A, Herbert R. Effects of splinting on wrist contracture after stroke. Stroke. 2009;38:111-116.

 

via Home After a Stroke: What I Learned About Splints as a Stroke Survivor

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[WEB PAGE] Dysport is Now Approved for Upper Limb Spasticity as Well

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The United States Food and Drug Administration (FDA) has expanded the use of Dysport (abobotulinumtoxinA) for injection to include the treatment of upper limb spasticity in children two years of age and older, excluding spasticity caused by cerebral palsy (CP), Ipsen Biopharmaceuticals, an affiliate of Ipsen, announces in a news release.

This approval makes Dysport the first botulinum toxin approved by the FDA for both pediatric spasticity indications, following the previous approval to treat children with lower limb spasticity aged two and older received in July 2016.

“For physicians, it is reassuring to have a botulinum toxin treatment in Dysport which demonstrated sustained symptom relief for spasticity, which can be physically challenging for children,” says Ann Tilton, MD, study investigator and Professor of Clinical Neurology at the Louisiana State University Health Sciences Center New Orleans, in the release.

“This FDA decision for Dysport means we now have an approved therapy to offer children and adolescents seeking improvements in mobility in both upper and lower limbs.”

The approval is based on a Phase 3 study with children aged two to 17 years old being treated for upper limb spasticity. Due to Orphan Drug Exclusivity, this approval excludes use in children with upper limb spasticity caused by CP. Dysport demonstrated statistically significant improvements from baseline at Week 6 with doses of 8 Units/kg and 16 Units/kg vs. 2 Units/kg, as measured by the Modified Ashworth Scale (MAS) in the elbow or wrist flexors.

Dysport demonstrated a reduction in spasticity symptoms through 12 weeks for most children for both upper and lower limbs. In the upper limb study, a majority of patients were retreated between 16-28 weeks; however, some patients had a longer duration of response (ie, 34 weeks or more). The most frequent adverse reactions observed were upper respiratory tract infection and pharyngitis, the release explains.

“This approval is a testament to Ipsen’s legacy in neurotoxin research and continued commitment to advancing patient care,” states Kimberly Baldwin, Vice President, Franchise Head, Neuroscience Business Unit, Ipsen. “We believe the data for both pediatric upper and lower limb spasticity underscore the role of Dysport as an important treatment option for patients seeking long-lasting spasticity symptom relief.”

For more information, visit Ipsen.

[Source(s): Ipsen, Business Wire]

 

via Dysport is Now Approved for Upper Limb Spasticity as Well – Rehab Managment

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