Posts Tagged Spasticity

[ARTICLE] Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement – Full Text

Abstract

Background

Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients.

Objectives

Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed “reinforced feedback virtual environment” (RFVE).

Methods

The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total).

Results

The MAS and FAC reached statistical significance (P < 0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=−0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke.

Conclusions

The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools.

1. Introduction

Stroke patients suffer several deficits that affect (mildly to severely) the cognitive, psychological, or motor areas of the brain, at the expense of their quality of life []. Although rehabilitation techniques do not only act on the motor deficits [], the effects associated with the interruptions of the corticospinal tract, as well as the subsequent adaptive changes, commonly require specific interventions. Among them, the most important changes are muscle weakness, loss of dexterity, cocontraction, and increased tone and abnormal postures [].

Hemiparesis is the most common problem in poststroke patients, and its severity correlates with the functional capabilities of the individual [], being that impairment of gait function is one of the most important limitations. Furthermore, weakness of the ankle muscles caused by injury to supraspinal centres and spasticity are the most frequent phenomena that limit functionality []. The degree of spasticity of the affected ankle plantar flex (PF) muscles primarily influences gait asymmetry [], which is, in addition to depression, another independent factor for predicting falls in ambulatory stroke patients []. Physiological changes in the paretic muscles, passive or active restraint of agonist activation, and abnormal muscle activation patterns (coactivation of the opposing lower extremity (LE)) have been shown to occur after a stroke and can lead to joint stiffness (foot deformities are present in 30% of stroke patients) [], deficits in postural stabilization, and reduced muscle force generation []. To enhance this postural stability during gait, it seems that poststroke patients with impaired balance and paretic ankle muscle weakness use a compensation strategy of increased ankle muscle coactivation on the paretic side [].

Scientific evidence shows that the use of mixed techniques with different physiotherapy approaches under very broad classifications (i.e., neurophysiological, motor learning, and orthopaedic) provides significantly better results regarding recovery of autonomy, postural control, and recovery of LE in the hemiparetic patient (HP) as compared to no treatment or the use of placebo []. Within the latter techniques, we may emphasize the relearning of motor-oriented tasks [], as well as other approaches based on new technologies (e.g., treadmill [], robotics [], and functional electrical stimulation (FES) []), which are often used as additional treatments to traditional rehabilitation (TR). However, some of these emerging therapies, such as vibratory platforms [], have not been shown yet to produce as positive results as the prior ones. Thus, obtaining better results with mixed and more intensive rehabilitation treatment has been demonstrated []. Therefore, we propose to add the use of virtual reality (VR) techniques to TR to optimize results. We can use the label “VR-based therapy” because it acknowledges the VR system as the tool being used by the clinician in therapy, not as the therapy itself. It is essential to transfer the obtained gains in VR-based therapy to better functioning in the real world []. In this way, the intersection of a promising technological tool with the skills of confident and competent clinicians will more likely yield high-quality evidence and enhanced outcomes for physical rehabilitation patients [].

The application of VR to motor recovery of the hemiparetic LE (HLE) has been addressed by several authors in the last decade [], obtaining satisfactory results, in general terms, in the increase of walking speed [], cortical reorganization, balance, and kinetic-kinematic parameters. Other authors have reported improvements in the balance of patients treated with nonimmersive VR systems based on video games, using specific software and with the guidance of a therapist []. A recent study showed that VR-based eccentric training using a slow velocity is effective for improving LE muscle activity to the gastrocnemius muscle and balance in stroke []; however, the spasticity of PF muscles was not analysed in any of these studies.

Virtual reality acts as an augmented environment where feedback can be delivered in the form of enhanced information about knowledge of results and knowledge of performance (KP) []. There are systems that use this KP through the representation of trajectories during the execution of the movement, as well as visualizing these once performed, to visually check the amount of deviation from the path proposed by the physiotherapist. Several studies demonstrated that this treatment enriched by reinforced feedback in a virtual environment (RFVE) may be more effective than TR to improve the motor function of the upper limb after stroke []. In our study, the use of a VR-based system, together with a motion capture tool, allowed us to modify the artificial environment with which the patient could interact, exploiting some mechanisms of motor learning [], thus allowing greater flexibility and effective improvement in task learning. This system has been highly successful in the functional recovery of the hemiparetic upper extremity [], but its combined effect with TR on the LE has not yet reported conclusive data []. The continuous supply of feedback during voluntary movement makes it possible to continuously adjust contractile activity [], thus mitigating increments in spasticity and cocontraction processes of the patient. These settings are of great significance in motor control, and certain variables (such as the speed of the movement) can be controlled, having a direct influence on spasticity. In this line, the aim of this study is to determine if there is a decrease in the spasticity of the PF muscles and improved gait function, following a program that includes the combination of TR and VR with reinforced feedback, which is called “reinforced feedback virtual environment” (RFVE).

Moreover, as a complementary aim, we analysed the modulatory effects of demographic and clinical factors on the recovery of patients treated with TR and VR. The analysis of the influence of these modulatory variables was focused on better highlighting what type of patients would benefit most from the combined treatment of TR and VR. Particularly, we looked into the effects of age and time elapsed from the moment the stroke occurs until the patient starts neurorehabilitation. As shown in various studies, a better outcome for treatment can be expected for younger patients and for those who start the treatment earlier []. Also, comparisons were made between patients with an ischemic and haemorrhagic stroke, since differences in their recovery prognostic have been reported elsewhere, with better outcomes for the latter group [].[…]

Continue —-> Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement

An external file that holds a picture, illustration, etc.Object name is BMRI2019-6295263.002.jpg

Figure 2. Patient carrying out a task set out by the physiotherapist in front of the RFVE equipment.

, , , , , ,

Leave a comment

[Abstract] Effects of Robot-Aided Rehabilitation on Improving Ankle and Balance Performance of Stroke Survivors: A Randomized Controlled Trial

Abstract

Background: Stroke survivors often experience abnormal posture control, which affects balance and locomotion. The ankle strategy is important in maintaining static balance. Prolonged spasticity may result in biomechanical changes at the ankle joint, which may cause balance disorders. The intelligent stretching device may decrease the stiffness of the ankle and improve balance. The purpose of this study was to investigate the effects of robot-aided ankle rehabilitation of stroke survivors with ankle spasticity and the correlations between biomechanical properties and balance in these patients.

Methods: Twenty inpatients post stroke with ankle spasticity performed 20 minutes of stretching treatment for 2 weeks. The study group used a rehabilitation robot to stretch the spastic ankle plantar flexors under intelligent control and the control group received manual stretching. Outcome measures included biomechanical, clinical evaluations and Pro-Kin balance test.

Results: After training, significant improvements were found in both groups in the active range of motion, muscle strength, Berg Balance Scale, Fugl-Meyer Motor Assessment of Lower Extremity, Postural Assessment Scale for Stroke Patients, 6-minute walk test, and Modified Barthel Index (P<0.05); significant decreases were found in the study group in dorsiflexion stiffness, Modified Ashworth Scale, trajectory lengths, elliptical trajectory, standard deviation medial/lateral, average speed forward/backward with eyes closed, and standard deviation forward/backward with eyes open (P=0.001, P=0.037, P=0.028, P=0.019, P=0.016, P=0.001, and P=0.033, respectively); dorsiflexion stiffness was positively correlated with the Pro-Kin balance test outcomes: ellipse area, trajectory length, average speed forward/backward, average speed medial/lateral with eyes open ( =0.352, P=0.026; =0.522, P=0.001; =0.045, P=0.004; =0.433, P=0.005, respectively); dorsiflexion stiffness was correlated with the Modified Ashworth Scale ( =0.265, P=0.041); the study group improved significantly more than the control group in the activities of daily living after training (P =0 .017).

Conclusions: The results suggested that robot-aided ankle rehabilitation had a positive effect on the biomechanical properties of the spastic ankle, and it may be feasible to improve balance post-stroke. Ankle dorsiflexion stiffness affected balance poststroke significantly; it may be a sensitive indicator for evaluating balance.

Figure 1

Source: https://www.researchsquare.com/article/rs-30969/v1?utm_source=researcher_app&utm_medium=referral&utm_campaign=RESR_MRKT_Researcher_inbound

, , , ,

Leave a comment

[VIDEO] Sensory Electrical Stimulation Glove for Hand Rehab After Stroke – SaeboStim Micro Unboxing Video –YouTube

Unbox the SaeboStim Micro with Dr. Scott Thompson. Boost your hand therapy with this electrical stimulation glove that improves function, weakness, and spasticity.

Want to learn more about electrical stimulation? Check out these FREE resources: https://www.saebo.com/blog/combining-…

https://www.saebo.com/blog/saebostim-…

https://www.saebo.com/blog/guide-elec…

For more information on the SaeboStim Micro:

https://www.saebo.com/shop/saebostim-…

https://www.saebo.com

Download your FREE Saebo Exercise Guide here:

https://www.saebo.com/stroke-exercise…

Saebo, Inc. is a medical device company primarily engaged in the discovery, development, and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 500,000 clients around the globe achieve a new level of independence.

, , , , , , , , ,

Leave a comment

[ARTICLE] Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients – Full Text

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery Cover ImageAbstract

Background

Approximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.

Objective

To investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.

Patients and methods

Thirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.

Results

There was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.

Conclusion

Combining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.

Introduction

Stroke is defined as a neurological deficit attributed to an acute vascular focal injury of the central nervous system [1]. It is a worldwide common disease that leads to serious disabilities [2]. Hemiparesis is the most common motor impairment after a stroke and frequently leads to persistent hand dysfunction [3]. Nearly about 50% of stroke patients show impaired upper limb and hand function and up to 74% rely on long-term help to perform their activities of daily living (ADL) [45]. The hand functions are complex as we use our hands in a vast variety of tasks such as grasping, pushing, holding objects, and expressing emotions [6].

Task-oriented training is a type of physiotherapy that encourages the active participation and focuses on functional tasks rather than simple repetitive training of normal motion patterns [7]. Joint mobilizations are used as an intervention to improve the range of motion (ROM), decreasing pain, and ultimately improving the upper extremity functions [8]. Joint mobilization technique proposed by Maitland is based on a graded system and is intended to restore the accessory movements of the joints by performing passive, rhythmic, and oscillatory movements [9].

After stroke, reduced ROM at joints occurs and it can be complicated by joint contractures. This occurs due to many factors such as reduced muscle length and increased stiffness of muscle and/or connective tissue. Such post stroke consequences can be solved by moving the joints through a full ROM with pressure at the end of range using the manual therapy [10]. Mobilization may help stroke patients in reducing the joint stiffness [11]. Moreover, it provides afferent input that can be used in facilitating the motor activity [1213]. Accordingly, we aimed to investigate the effect of adding joint mobilization to task-oriented training in order to help those patients in reaching a satisfactory level of recovery for their hand functions.[…]

Continue —-> Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

 

, , , , , , , , ,

Leave a comment

[Abstract + References] Unilateral Dorsiflexor Strengthening With Mirror Therapy to Improve Motor Function After Stroke: A Pilot Randomized Study

Abstract

Background: Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting.

Objectives: This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke.

Methods: Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining.

Results: Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity.

Conclusion: Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.

REFERENCES

    1. Aagaard, P., Simonsen, E. B., Andersen, J. L., Magnusson, P., & Dyhre-Poulsen, P. (2002). Increased rate of force development and neural drive of human skeletal muscle following resistance training. Journal of Applied Physiology (Bethesda, MD: 1985), 93(4), 1318-1326. https://doi.org/10.1152/japplphysiol.00283.2002
    1. ACSM (2009). American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise, 41(3), 687-708. https://doi.org/10.1249/MSS.0b013e3181915670
    1. AI Therapy Statistics (2017). Sample size calculator. Retrieved from https://www.ai-therapy.com/psychology-statistics/sample-size-calculator
    1. Barzi, Y., & Zehr, E. (2008). Rhythmic arm cycling suppresses hyperactive soleus H-reflex amplitude after stroke. Clinical Neurophysiology, 119(6), 1443-1452. https://doi.org/10.1016/j.clinph.2008.02.016
    1. Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., … Jiménez, M. C. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 135(10), e146-e603. https://doi.org/10.1161/cir.0000000000000485
    1. Biodex Medical Systems Inc. (2006). Biodex system 3 pro application/ operationmanual. Retrieved from http://www.biodex.com/sites/default/files/835000man_06159.pdf
    1. Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2005). Designing resistance training programmes to enhance muscular fitness: A review of the acute programme variables. Sports Medicine, 35(10), 841-851. https://doi.org/10.2165/00007256-200535100-00002
    1. Broderick, P., Horgan, F., Blake, C., Ehrensberger, M., Simpson, D., & Monaghan, K. (2018). Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis. Gait & Posture, 63, 208-220. https://doi.org/10.1016/j.gaitpost.2018.05.017
    1. Carroll, L. M., Volpe, D., Morris, M. E., Saunders, J., & Clifford, A. M. (2017). Aquatic exercise therapy for people with Parkinson disease: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 98(4), 631-638. https://doi.org/10.1016/j.apmr.2016.12.006
    1. Carson, R., Riek, S., Mackey, D., Meichenbaum, D., Willms, K., Forner, M., & Byblow, W. (2004). Excitability changes in human forearm corticospinal projections and spinal reflex pathways during rhythmic voluntary movement of the opposite limb. The Journal of Physiology, 560(Pt 3, 929-940. https://doi.org/10.1113/jphysiol.2004.069088
    1. Carvalho, D., Teixeira, S., Lucas, M., Yuan, T. F., Chaves, F., Peressutti, C., & Arias-Carrion, O. (2013). The mirror neuron system in post-stroke rehabilitation. International Archives of Medicine, 6(1), 41. https://doi.org/10.1186/1755-7682-6-41
    1. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159. https://doi.org/10.1037/0033-2909.112.1.155
    1. Collen, F. M., Wade, D. T., & Bradshaw, C. M. (1990). Mobility after stroke: Reliability of measures of impairment and disability. International Disability Studies, 12(1), 6-9. https://doi.org/10.3109/03790799009166594
    1. de Morton, N. A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. The Australian Journal of Physiotherapy, 55(2), 129-133. https://doi.org/10.1016/S0004-9514(09)70043-1
    1. Deconinck, F. J., Smorenburg, A. R., Benham, A., Ledebt, A., Feltham, M. G., & Savelsbergh, G. J. (2015). Reflections on mirror therapy: A systematic review of the effect of mirror visual feedback on the brain. Neurorehabilitation and Neural Repair, 29(4), 349-361. https://doi.org/10.1177/1545968314546134
    1. Dragert, K., & Zehr, E. P. (2013). High-intensity unilateral dorsiflexor resistance training results in bilateral neuromuscular plasticity after stroke. Experimental Brain Research, 225(1), 93-104. https://doi.org/10.1007/s00221-012-3351-x
    1. Ehrensberger, M., Simpson, D., Broderick, P., & Monaghan, K. (2016). Cross-education of strength has a positive impact on post-stroke rehabilitation: A systematic literature review. Topics in Stroke Rehabilitation, 23(2), 126-135. https://doi.org/10.1080/10749357.2015.1112062
    1. Eng, J. J., Kim, C. M., & Macintyre, D. L. (2002). Reliability of lower extremity strength measures in persons with chronic stroke. Archives of Physical Medicine and Rehabilitation, 83(3), 322-328. https://doi.org/10.1053/apmr.2002.29622
    1. Faber, J., & Fonseca, L. M. (2014). How sample size influences research outcomes. Dental Press Journal of Orthodontics, 19(4), 27-29. https://doi.org/10.1590/2176-9451.19.4.027-029.ebo
    1. Faria, C. D., Teixeira-Salmela, L. F., Neto, M. G., & Rodrigues-de-Paula, F. (2012). Performance-based tests in subjects with stroke: Outcome scores, reliability and measurement errors. Clinical Rehabilitation, 26(5), 460-469. https://doi.org/10.1177/0269215511423849
    1. Farthing, J. P. (2009). Cross-education of strength depends on limb dominance: Implications for theory and application. Exercise and Sport Sciences Reviews, 37(4), 179-187. https://doi.org/10.1097/JES.0b013e3181b7e882
    1. Fimland, M. S., Helgerud, J., Solstad, G. M., Iversen, V. M., Leivseth, G., & Hoff, J. (2009). Neural adaptations underlying cross-education after unilateral strength training. European Journal of Applied Physiology, 107(6), 723-730. https://doi.org/10.1007/s00421-009-1190-7
    1. Flansbjer, U. B., Holmback, A. M., Downham, D., Patten, C., & Lexell, J. (2005). Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine, 37(2), 75-82. https://doi.org/10.1080/16501970410017215
    1. Gracies, J. M. (2005). Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle & Nerve, 31(5), 552-571. https://doi.org/10.1002/mus.20285
    1. Harbo, T., Brincks, J., & Andersen, H. (2012). Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. European Journal of Applied Physiology, 112(1), 267-275. https://doi.org/10.1007/s00421-011-1975-3
    1. Hendy, A. M., & Lamon, S. (2017). The cross-education phenomenon: Brain and beyond. Frontiers in Physiology, 8, 297. https://doi.org/10.3389/fphys.2017.00297
    1. Holmback, A. M., Porter, M. M., Downham, D., & Lexell, J. (1999). Reliability of isokinetic ankle dorsiflexor strength measurements in healthy young men and women. Scandinavian Journal of Rehabilitation Medicine, 31(4), 229-239.
    1. Hortobagyi, T. (2005). Cross education and the human central nervous system. IEEE Engineering in Medicine and Biology Magazine, 24(1), 22-28. https://doi.org/10.1109/MEMB.2005.1384096
    1. Hortobagyi, T., Taylor, J. L., Petersen, N. T., Russell, G., & Gandevia, S. C. (2003). Changes in segmental and motor cortical output with contralateral muscle contractions and altered sensory inputs in humans. Journal of Neurophysiology, 90(4), 2451-2459. https://doi.org/10.1152/jn.01001.2002
    1. Howatson, G., Zult, T., Farthing, J. P., Zijdewind, I., & Hortobagyi, T. (2013). Mirror training to augment cross-education during resistance training: A hypothesis. Frontiers in Human Neuroscience, 7, 396. https://doi.org/10.3389/fnhum.2013.00396
    1. Lee, M., & Carroll, T. J. (2007). Cross education: Possible mechanisms for the contralateral effects of unilateral resistance training. Sports Medicine, 37(1), 1-14. https://doi.org/10.2165/00007256-200737010-00001
    1. Magnus, C. R., Arnold, C. M., Johnston, G., Dal-Bello Haas, V., Basran, J., Krentz, J. R., & Farthing, J. P. (2013). Cross-education for improving strength and mobility after distal radius fractures: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 94(7), 1247-1255. https://doi.org/10.1016/j.apmr.2013.03.005
    1. Manca, A., Cabboi, M., Dragone, D., Ginatempo, F., Ortu, E., De Natale, E., … Deriu, F. (2017). Resistance training for muscle weakness in multiple sclerosis: Direct versus contralateral approach in individuals with ankle dorsiflexors’ disparity in strength. Archives of Physical Medicine and Rehabilitation, 98(7), 1348-1356. https://doi.org/10.1016/j.apmr.2017.02.019
    1. Manca, A., Dragone, D., Dvir, Z., & Deriu, F. (2017). Cross-education of muscular strength following unilateral resistance training: A meta-analysis. European Journal of Applied Physiology, 117(11), 2335-2354. https://doi.org/10.1007/s00421-017-3720-z
    1. Manca, A., Pisanu, F., Ortu, E., & Deriu, F. (2015). Isokinetic cross-training effect in foot drop following common peroneal nerve injury. Isokinetics and Exercise Science, 23(1), 17-20. https://doi.org/10.3233/IES-140559
    1. McElwaine, P., McCormack, J., & Harbison, J. (2015). National Stroke Audit 2015. Retrieved from http://www.irishheart.ie/media/pub/strokestudy2015/ihfhse_national_stroke_audit__mcelwaine.pdf
    1. Michielsen, M. E., Selles, R. W., van der Geest, J. N., Eckhardt, M., Yavuzer, G., Stam, H. J., … Bussmann, J. B. (2011). Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial. Neurorehabilitation and Neural Repair, 25(3), 223-233. https://doi.org/10.1177/1545968310385127
    1. Park, E., & Choi, Y. (2014). Rasch analysis of the London Handicap Scale in stroke patients: A cross-sectional study. Journal of Neuroengineering and Rehabilitation, 11, 114. https://doi.org/10.1186/1743-0003-11-114
    1. Patten, C., Lexell, J., & Brown, H. E. (2004). Weakness and strength training in persons with poststroke hemiplegia: Rationale, method, and efficacy. Journal of Rehabilitation Research and Development, 41(3a), 293-312. https://doi.org/10.1682/JRRD.2004.03.0293
    1. Pekna, M., Pekny, M., & Nilsson, M. (2012). Modulation of neural plasticity as a basis for stroke rehabilitation. Stroke, 43(10), 2819-2828. https://doi.org/10.1161/strokeaha.112.654228
    1. Perera, S., Mody, S. H., Woodman, R. C., & Studenski, S. A. (2006). Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society, 54(5), 743-749. https://doi.org/10.1111/j.1532-5415.2006.00701
    1. Rossiter, H. E., Borrelli, M. R., Borchert, R. J., Bradbury, D., & Ward, N. S. (2015). Cortical mechanisms of mirror therapy after stroke. Neurorehabilitation and Neural Repair, 29(5), 444-452. https://doi.org/10.1177/1545968314554622
    1. Shaw, L., Rodgers, H., Price, C., van Wijck, F., Shackley, P., Steen, N., & Graham, L. (2010). BoTULS: A multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Health Technology Assessment, 14(26), 1-113. https://doi.org/10.3310/hta14260
    1. Stolberg, H. O., Norman, G., & Trop, I. (2004). Randomized controlled trials. AJR. American Journal of Roentgenology, 183(6), 1539-1544. https://doi.org/10.2214/ajr.183.6.01831539
    1. Thibaut, A., Chatelle, C., Ziegler, E., Bruno, M. A., Laureys, S., & Gosseries, O. (2013). Spasticity after stroke: Physiology, assessment and treatment. Brain Injury, 27(10), 1093-1105. https://doi.org/10.3109/02699052.2013.804202
    1. Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, (7), Cd008449. https://doi.org/10.1002/14651858.CD008449.pub3
    1. Touzalin-Chretien, P., Ehrler, S., & Dufour, A. (2010). Dominance of vision over proprioception on motor programming: Evidence from ERP. Cerebral Cortex, 20(8), 2007-2016. https://doi.org/10.1093/cercor/bhp271
    1. Trompetto, C., Marinelli, L., Mori, L., Pelosin, E., Currà, A., Molfetta, L., & Abbruzzese, G. (2014). Pathophysiology of spasticity: Implications for neurorehabilitation. BioMed Research International, 2014, 1-8. https://doi.org/10.1155/2014/354906
    1. Urban, P. P., Wolf, T., Uebele, M., Marx, J. J., Vogt, T., Stoeter, P., … Wissel, J. (2010). Occurence and clinical predictors of spasticity after ischemic stroke. Stroke, 41(9), 2016-2020. https://doi.org/10.1161/strokeaha.110.581991
    1. van Wijck, F. M., Pandyan, A. D., Johnson, G. R., & Barnes, M. P. (2001). Assessing motor deficits in neurological rehabilitation: Patterns of instrument usage. Neurorehabilitation and Neural Repair, 15(1), 23-30. https://doi.org/10.1177/154596830101500104
    1. Vattanasilp, W., Ada, L., & Crosbie, J. (2000). Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 69(1), 34-39. https://doi.org/10.1136/jnnp.69.1.34
    1. World Health Organization (2001). International classification of functioning, disability and health. Retrieved from http://unstats.un.org/unsd/disability/pdfs/ac.81-b4.pdf2001
    1. Wimpenny, P. (2016). Theory-Interpretation of results. Retrieved from http://www.isokinetics.net/index.php/2016-04-05-17-04-58/interpretation/general-interpretation
    1. Wissel, J., Schelosky, L. D., Scott, J., Christe, W., Faiss, J. H., & Mueller, J. (2010). Early development of spasticity following stroke: A prospective, observational trial. Journal of Neurology, 257(7), 1067-1072. https://doi.org/10.1007/s00415-010-5463-1
    1. Wolf, S. L., Catlin, P. A., Gage, K., Gurucharri, K., Robertson, R., & Stephen, K. (1999). Establishing the reliability and validity of measurements of walking time using the emory functional ambulation profile. Physical Therapy, 79(12), 1122-1133.
    1. Zipp, G., & Sullivan, J. (2010). Neurology section StrokEDGE taskforce. Retrieved from http://www.neuropt.org/docs/stroke-sig/strokeedge_taskforce_summary_document.pdf
    1. Zult, T., Goodall, S., Thomas, K., Solnik, S., Hortobagyi, T., & Howatson, G. (2016). Mirror training augments the cross-education of strength and affects inhibitory paths. Medicine and Science in Sports and Exercise, 48, 1001-1013. https://doi.org/10.1249/mss.0000000000000871
    1. Zult, T., Howatson, G., Kadar, E. E., Farthing, J. P., & Hortobagyi, T. (2014). Role of the mirror-neuron system in cross-education. Sports Medicine, 44(2), 159-178. https://doi.org/10.1007/s40279-013-0105-2
    1. Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3), 1057-1073. https://doi.org/10.1177/0962280215588241

via Unilateral Dorsiflexor Strengthening With Mirror Therapy to Improve Motor Function After Stroke: A Pilot Randomized Study – PubMed

, , , , , , , , ,

Leave a comment

[Abstract] The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis

Objective: To assess the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) to reduce lower limb spasticity in adult stroke survivors.

Data Sources: A systematic review of Medline/Pubmed, CENTRAL, CINAHL, PEDro database, REHABDATA, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos from 1980 to December 2018 was carried out.

Review Methods: The bibliography was screened to identify clinical trials (controlled and before-after) that used ESWT to reduce spasticity in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed risk of bias by PEDro scale. The primary outcome was spasticity.

Results: A total of 12 studies (278 participants) were included (5 randomized controlled trials, 1 controlled trial, and 6 before-after studies). A meta-analysis was performed by randomized controlled trials. A beneficial effect on spasticity was found. The mean difference (MD) was 0.58; 95% confidence interval (CI) 0.30 to 0.86 and also in subgroup analysis (short, medium, and long term). The MD for range of motion was 1.81; CI −0.20 to 3.82 and for lower limb function the standard mean difference (SMD) was 0.34; 95% CI −0.09 to 0.77. Sensitivity analysis demonstrated a better beneficial effect for myotendinous junction. MD was 1.5; 95% CI −2.44 to 5.44 at long-term (9 weeks).

Conclusion: The ESWT (radial/focused) would be a good non-invasive rehabilitation strategy in chronic stroke survivors to reduce lower limb spasticity, increase ankle range of motion, and improve lower limb function. It does not show any adverse events and it is a safe and effective method.

, , , , , , , ,

Leave a comment

[Abstract] Does Casting After Botulinum Toxin Injection Improve Outcomes in Adults With Limb Spasticity? A Systematic Review – Full Text PDF

Abstract

Objective: To determine current evidence for casting as an adjunct therapy following botulinum toxin injection for adult limb spasticity.

Design: The databases MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials were searched for English language studies from 1990 to August 2018. Full-text studies using a casting protocol following botulinum toxin injection for adult participants for limb spasticity were included. Studies were graded according to Sackett’s levels of evidence, and outcome measures were categorized using domains of the International Classification of Disability, Functioning and Health. The review was prepared and reported according to PRISMA guidelines.

Results: Five studies, involving a total of 98 participants, met the inclusion criteria (2 randomized controlled trials, 1 pre-post study, 1 case series and 1 case report). Casting protocols varied widely between studies; all were on casting of the lower limbs. There is level 1b evidence that casting following botulinum toxin injection improves spasticity outcomes compared with stretching and taping, and that casting after either botulinum toxin or saline injections is better than physical therapy alone.

Conclusion: The evidence suggests that adjunct casting of the lower limbs may improve outcomes following botulinum toxin injection. Casting protocols vary widely in the literature and priority needs to be given to future studies that determine which protocol yields the best results.

Full Text PDF

via Does Casting After Botulinum Toxin Injection Improve Outcomes in Adults With Limb Spasticity? A Systematic Review – PubMed

, , , ,

Leave a comment

[BLOG POST] Botox for Spasticity


What exactly is spasticity, and how does Botox help? If you have undergone damage to your brain or spinal cord, two parts of the body that control voluntary movement, you could potentially have a spasticity condition.

Spasticity is where certain muscles continuously contract, causing stiffness and tightness, which then disrupts speech, gait, and movements.

Symptoms of spasticity include involuntary muscle spasms, exaggeration of reflexes, unusual posture, muscle and joint stiffness, and more.

Some people experience spasticity more often during nighttime, and for some, it can be quite painful. The encounter will vary from person to person, but typically, you will feel stiff with jerky movements.

As someone with Spasticity, it is crucial to know your options for treatment, including Botox for spasticity.

What Does Botox Do For Spasticity?

Now that you understand what spasticity is, you should understand how Botox affects it. However, first, what is Botox?

Botox, otherwise known as “Botulinum toxin,” is a neurotoxic protein. In fact, it is the exact same toxin that causes “botulism” –  a life-threatening type of food poisoning. Before you get too concerned, though, you need to understand the way it is used that makes it relatively safe.

Doctors typically use Botox in small doses to treat various health problems, such as facial wrinkles and otherwise improving your looks. Because it is a toxin, your body cannot have too much at any one time, so it is used gradually in small amounts.

It paralyzes the underlying muscles to prevent conditions such as migraines, muscular disorders, and more. There are many who use it to treat their chronic migraines and headaches after a traumatic brain injury. Botox is inserted into your scalp in an effort to reduce headaches.

How does Botox for spasticity work, though?

It works by blocking the chemical signal between your nerves and muscles, which causes muscle contractions or tightening. As a result, your muscles can relax.

Botox has been found to be highly effective at providing relief from spasticity, most notably the pain and muscle stiffness that accompanies the condition.

Thousands of patients have seen safe results from using it to treat their spasticity, over the span of 25 years.

How Does It Work?

If you have a spasticity condition and are considering using Botox as a form of treatment, you should know the process behind it.

Botox for spasticity is administered directly to the affected area through an injection. The procedure usually involves multiple injections, and doctors will help minimize your discomfort as much as possible through the use of freezing sprays and oral versed. They also often encourage you to bring items from home that may bring comfort, including music.

The injections themselves are quite quick, usually only taking a few minutes, with follow-up care instructions provided afterward.

The length of time before relief occurs can vary based on several factors. However, generally, relief occurs in approximately a week and can last for about 3 months before symptoms may return.

After about three months have passed, you might begin noticing how the relieving effects of the Botox treatment gradually fade over several weeks, which is normal.

Botox might be among one of the first treatments recommended by your doctor before surgery is necessary. It’s important to remember that Botox may not be successful, though, depending on your circumstances.

In my case, I received Botox in my legs for my foot contractions. Prior to using these Botox treatments, my physical therapist attempted to cast my feet in a neutral position. However, they would not stay in place.

One week following the Botox injections, I was able to stand flat-footed for about one month before my feet retracted back into clonus. I was eventually referred to undergo tendon lengthening surgery to solve my issue.

While Botox for spasticity wasn’t successful in my case, I can understand how it relaxes the muscles to correct foot positioning, and it could be a potential solution for you.

Botox for spasticity is a recurring procedure that is often undertaken for a considerable amount of time to achieve the desired result, and it might be worthwhile considering for your spasticity condition.

The Benefits + Side Effects Of Botox For Spasticity

The benefits of using Botox for spasticity vary, again, depending on your circumstances and personal health issues. The most common benefits include:Improved gaitDecreased pain and stiffnessGreater ease when stretchingImproved range of motionDelays in the need for surgery

There are more benefits involved based on your personal experiences and goals.

Moreover, you should also know the potential side effects of using Botox for spasticity. This will help you know what to expect.Temporary general weaknessFalling (if Botox is given in lower body)Injection site painInjection site infection

These side effects will also vary from person to person.

Since spasticity is such a disruptive condition, in which it interferes with many motor activities, it’s not something you can simply ignore.

If it’s going to hinder your recovery, it needs to be addressed as soon as possible, and you should be consulting with your trusted doctor and/or physical therapist to discuss possible solutions – including Botox for spasticity.

Furthermore, if you have recently been a victim of traumatic brain injury, spasticity is one of the first health conditions you should be aware of and take action immediately before it progressively gets worse.

As always, consult a trusted physician and know all of your available options before proceeding with the desired treatment.

Source: BOTOX FOR SPASTICITY

,

Leave a comment

[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.

, , , , , , , , , , , ,

Leave a comment

[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.

Download Full Text PDF

 

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

, , , , , , ,

Leave a comment

%d bloggers like this: