Rehabilitation training is believed to be an effectual strategy that canreduce the risk of dysfunction caused by spasticity.However,achieving visualizationrehabilitation training for patients remains clinically challe...Rehabilitation training is believed to be an effectual strategy that canreduce the risk of dysfunction caused by spasticity.However,achieving visualizationrehabilitation training for patients remains clinically challenging.Herein,wepropose visual rehabilitation training system including iontronic meta-fabrics withskin-friendly and large matrix features,as well as high-resolution image modules fordistribution of human muscle tension.Attributed to the dynamic connection and dissociationof the meta-fabric,the fabric exhibits outstanding tactile sensing properties,such as wide tactile sensing range(0~300 kPa)and high-resolution tactile perception(50 Pa or 0.058%).Meanwhile,thanks to the differential capillary effect,the meta-fabric exhibits a“hitting three birds with one stone”property(dryness wearing experience,long working time and cooling sensing).Based on this,the fabrics can be integrated with garmentsand advanced data analysis systems to manufacture a series of large matrix structure(40×40,1600 sensing units)training devices.Significantly,the tunability of piezo-ionic dynamics of the meta-fabric and the programmability of high-resolution imaging modules allowthis visualization training strategy extendable to various common disease monitoring.Therefore,we believe that our study overcomes theconstraint of standard spasticity rehabilitation training devices in terms of visual display and paves the way for future smart healthcare.展开更多
Objective:To analyze the impact of comprehensive rehabilitation therapy of traditional Chinese medicine(TCM)(based on modern rehabilitation training)on the spasticity and motor function in stroke patients with hemiple...Objective:To analyze the impact of comprehensive rehabilitation therapy of traditional Chinese medicine(TCM)(based on modern rehabilitation training)on the spasticity and motor function in stroke patients with hemiplegia.Methods:Seventy-nine stroke and hemiplegia patients admitted to the hospital from June 2021 to June 2023 were selected and randomly divided into a control group(39 cases)using modern rehabilitation training,and an observation group combined with comprehensive TCM rehabilitation therapy(40 cases),over 1 month.The clinical index data of the two groups were compared.Results:There were differences in the clinical index data between the two groups.The total effective rate after 2 treatment in the observation group(92.50%)was higher than that of the control group(74.36%)(χ^(2)=4.727,P<0.05).All central sensitization inventory(CSI)and stroke quality of life(PRO)scores in both groups were lower after treatment,with the observation group having lower scores as compared to the control group(P<0.05).The scores of FMA(upper limbs,lower limbs),Barthel index scores,and Functional Ambulation Categories(FAC)scores of both groups increased after treatment,with the observation group having higher scores as compared to the control group(P<0.05).Conclusion:Comprehensive TCM rehabilitation therapy had a significant therapeutic effect on patients with hemiplegia after stroke.It improved the patient’s spasticity,limb movement,and walking function.Their daily living abilities and quality of life were also enhanced.展开更多
Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited moto...Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited motor function of cerebral palsy patients,the quality of life of patients is reduced,and their ability to participate in society is reduced,so the improvement of patients’motor function has become an important goal of cerebral palsy rehabilitation.The motor function of cerebral palsy has become an important goal of cerebral palsy rehabilitation.Limb spasticity is one of the main clinical signs of cerebral palsy patients,and the more severe the limb spasticity is,the greater the impact on the patient's motor function,so improving limb spasticity in patients with cerebral palsy is particularly important.Acupuncture,as a Chinese medicine treatment method,has been widely used in the clinical treatment of cerebral palsy in China,and has shown certain efficacy.To promote the clinical application of acupuncture technique in cerebral palsy limb spasticity,this paper analyses and summarizes the relevant literature on acupuncture treatment of cerebral palsy limb spasticity summarizes the current status of the clinical application of acupuncture in cerebral palsy limb spasticity,and provides clinical references for the reasonable application of acupuncture in cerebral palsy limb spasticity.展开更多
Objective To observe the therapeutic effect of acupuncture and rehabilitation on poststroke hemiplegic spasticity, and probe into the indices of efficacy assessment of the disease. Methods According to the randomized,...Objective To observe the therapeutic effect of acupuncture and rehabilitation on poststroke hemiplegic spasticity, and probe into the indices of efficacy assessment of the disease. Methods According to the randomized, controlled and blind clinical trial design, 229 cases enrolled in accordance with the inclusive criteria were divided into 3 groups based on visiting sequence： treatment group 1 （74 cases）, treated with acupuncture [Jianyu （肩髃 LI 15）, Quchi （曲池 LI 11）, Waiguan （外关 TE 5） etc. on the affected side]; treatment group 2 （75 cases）, treated with acupuncture as treatment group 1 and combined with rehabilitation as control group; control group （80 cases）, treated with rehabilitation （Bobath facilitation technique）. 5 treatments were given each week, continuously for 4 weeks. The clinical efficacy on post-stroke hemiplegic spasticity was observed systematically after the treatment of acupuncture combined with rehabilitation. Results The research showed that the baseline situations of 3 groups were good, the group division was proportionate, indicating strong comparability （P〉0.05）. Based on the modified Ashworth Spasticity Scale （modified ASS）, the total effective rate was 63.01% （46/73） in treatment group 1, 66.67%（50/75） in treatment group 2 and 44.00% （33/75） in control group, indicating a statistical significant difference among 3 groups （P〈0.05）. Based on MAS motor function scale, the function improvement in treatment group 2 was superior to that in treatment group 1 and control group, indicating statistical significant differences among 3 groups （both P〈0.05）. Based on modified Barthel index, the daily life activity in treatment group 2 was superior in the improvement as compared with treatment group 1 and control group, but without statistical significant difference indicated （P〉0.05）. Conclusion The efficacy of post-stroke hemiplegic spasticity is definite with acupuncture combined with rehabilitation, and the acupuncture program is safe and effective.展开更多
This systematic review is aim to comprehensively evaluate the efficacy of acupoint stimulation in managing of post-stroke spasticity. The eligible randomized controlled clinical trials （RCTs） and quasi-randomized co...This systematic review is aim to comprehensively evaluate the efficacy of acupoint stimulation in managing of post-stroke spasticity. The eligible randomized controlled clinical trials （RCTs） and quasi-randomized controlled clinical trials （quasi-RCTs） will be searched from the following databases： the Cochrane Central Register of Controlled Trials （CENTRAL）, MEDLINE, EMBASE, China National Knowledge Infrastructure （CNKI）, Chinese Scientific Journal Database （VIP）, Wanfang Database, Chinese BioMedical Literature Database （CBM）. The Cochrane risk of bias tool will be used to assess the trials. No patients or their family will be bothered in this systematic review, so there is no need for the permission of institutional review board （IRB）. The completed systematic review will be published in a peer-reviewed journal.展开更多
We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the...We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 patients. The initial causes were: stroke, cranial trauma, postoperative complications and multiple sclerosis. MSN procedures were performed on the median nerve (n = 40) for wrist and finger flexion;musculo-cutaneus nerve (n = 38) for elbow flexion;ulnaris nerve (n = 9) for cubital deviation of the hand;gastrocnemius nerve (n = 98) and soleus nerve (n = 49) for equinus foot, tibial posterior nerve (n = 45) for varus foot, and fascicles (or bundles) of the flexor digitorum for “claw” toes (n = 19). The main preoperative test to identify the responsible nerve was a neuromuscular block with local anesthesia (lidocaine or bupivacaine) injected into the site of the nerve connecting the spastic muscle. During surgery, the identified nerve was exposed and its epineurium opened. Nerve bundles were teased apart into individual rootlets and a number of rootlets cut were previously planned, according to the spasticity. Follow-up was performed for up to 10 years, with a mean period of 29 months. Results demonstrated a reduction of limb spasticity of 2 to 3 points: modified Ashworth scale (MAS). Pain and clonus were also diminished in the affected limb. In some cases, voluntary movement was once again possible. MSN is a useful alternative in those cases of focal spasticity where physiotherapy and nerve block with botulinum toxin or phenol no longer produce satisfactory results.展开更多
Objective To explore the effect of meridian sinew row needling combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis. Methods Four hundred and eighty-eight cases of post-str...Objective To explore the effect of meridian sinew row needling combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis. Methods Four hundred and eighty-eight cases of post-stroke patients with upper limb spasticity were randomly divided into two groups at the ratio of 1： 1, the group of meridian sinew row needling combined with dermal needling （group A, 244 cases） and western medication group （group B, 244 cases）. Coupled with rehabilitation, the patients in the group A were given meridian sinew row needling combined with dermal needling where five shu points were specifically selected, and three yang meridians of the hand were treated with acupuncture with muscle region, and three yin meridians of the hand were treated with dermal needles; the patients in the group B was treated with conventional western medication with piracetam injection and cerebroprotein hydrolysate included. Clinical efficacy was evaluated among patients in the two groups after three weeks of continuous treatment, and upper limb spasticity and motor functions were observed through modified Asworth Scale and FugI-Meyer Assessment Scale （FMA） before and after treatment. Results For Asworth Scale, group A was significantly superior to group B （3.04 ± 1.29 vs 3.88 ± 1.54, P〈0.05）; for FMA scale, group A was also significantly superior to group B （48.67± 15.64 vs 42.96±14.72, P〈0.05）; mitigations of motor status of upper limb joints in group A, such as remission of shoulder adduction （90.5%）, pronation of forearm （70.7%）, elbow joint flexion （73.1%）, wrist joint flexion （80.9%） and finger flexion （88.1%）, were superior to those of group B （70.0%, 60.0%, 61.9%, 57.4%, 63.2%, all P〈0.05）. Conclusion Good clinical efficacy of the treatment with combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis is achieved.展开更多
Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhib- its satisfactory outcomes...Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhib- its satisfactory outcomes in improving multiple sclerosis, stroke, spinal cord injury and cerebral palsy-induced spasticity. By contrast, transcranial direct current stimulation has only been studied in post-stroke spasticity. To better validate the efficacy of non-invasive brain stimulations in im- proving the spasticity post-stroke, more prospective cohort studies involving large sample sizes are needed.展开更多
The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female,who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously,which resulted in finger...The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female,who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously,which resulted in finger flexor spasticity and residual weak finger/wrist extension.The patient received 50 units of botulinum toxin type A injection each to the motor points(2 sites/muscle)of the left flexor digitorum superficialis and flexor digitorum profundus,respectively.Botulinum toxin injection led to weakness and tone reduction in the spastic finger flexors,but improved grip release time in grip initiation/release reaction time tasks.Improved release time was accompanied by shortened extensor electromyography activity,and improved release time likely correlated with blocked co-contraction of finger flexors during voluntary finger extension.This case report demonstrated that botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.展开更多
Post-stroke spasticity is associated with restriction in the range of motion of the shoulder.Reducing muscular dystrophy may help relieve muscular dysfunction in patients with post-stroke shoulder spasticity.Dry needl...Post-stroke spasticity is associated with restriction in the range of motion of the shoulder.Reducing muscular dystrophy may help relieve muscular dysfunction in patients with post-stroke shoulder spasticity.Dry needle therapy is a method of needling the trigger points using a syringe needle without the use of a drug.Dry needle therapy is commonly used for pain at the shoulder,neck,waist,and back.In this case study,a 62-year-old male patient affected with cerebral hemorrhage of the right frontal lobe had received rehabilitative treatment for 12 years.However,he still experienced shoulder spasticity.The patient received daily dry needling at the trigger points of infraspinatus,teres minor,posterior deltoid,and pectoralis major on 9 days.After the first and ninth treatment,the Modified Ashworth Scale and the passive range of motion of the shoulder was used to assess the effect of the treatment.The spasticity and range of motion of the shoulder showed obvious improvement.These results indicate that dry needling at the myofascial trigger points can effectively treat chronic poststroke shoulder spasticity.展开更多
OBJECTIVE: To investigate the effect of catgut implantation at acupoints on the expressions of γ-amino butyric acid B receptor(GABAB ) and metabotropic glutamate receptor 1(mGluR1) in the brain stem of rats with spas...OBJECTIVE: To investigate the effect of catgut implantation at acupoints on the expressions of γ-amino butyric acid B receptor(GABAB ) and metabotropic glutamate receptor 1(mGluR1) in the brain stem of rats with spasticity after stroke.METHODS: In total, 60 male Sprague-Dawley rats were randomly divided into three groups: a sham group(n=10), a model group(n=25) and a treatment group(n=25). The rats in both the model group and the treatment group were subjected to middle cerebral artery occlusion to establish a model of focal cerebral ischemia. Rats with limb-spasm met the inclusion criteria. Only the left carotid artery was isolated in sham group rats. Three days after modeling, the treatment group was subjected to catgut implantation at Dazhui(GV 14), Guanyuan(CV 4), and Zhongwan(CV 12). Neurological deficit symptoms were assessed with the Zea-Longa neurological deficit score. The Modified Ashworth Scale(MAS), and isolated muscle tone were used to evaluate spasticity before and after treatment. Immunohistochemistry was applied to determine the expression of GABAB and mGluR1 in the rat brain stem after treatment.RESULTS: After treatment, neural impairment symptoms had significantly improved in the treatment group when compared to the model group(P<0.05). Both MAS and isolated muscle tone in the treatment group were significantly decreased when compared with the model group(P<0.05),and were also lower than before treatment. GABAB expression was significantly higher and mGluR1 was lower in the treatment group when compared with the model group(P<0.01 and P<0.05, respectively).CONCLUSION: Catgut implantation at Dazhui(GV 14), Guanyuan(CV 4), and Zhongwan(CV 12), can relieve limb spasticity by increasing the expression of GABAB and reducing the expression of mGluR1 in the brain stem of rats after stroke.展开更多
The effect of high-frequency repetitive transcranial magnetic stimulation（r TMS） on potassium-chloride cotransporter-2（KCC2） protein expression following spinal cord injury（SCI） and the action mechanism were inv...The effect of high-frequency repetitive transcranial magnetic stimulation（r TMS） on potassium-chloride cotransporter-2（KCC2） protein expression following spinal cord injury（SCI） and the action mechanism were investigated. SCI models were established in SD rats. Five groups were set up randomly： normal control group, SCI 7-day（7 D） model group, SCI 14-day（14 D） model group, SCI-7 DrTMS group and SCI-14 DrTMS group（n=5 each）. The rats in SCI rTMS groups were treated with 10 Hz rTMS from 8 th day and 15 th day after SCI respectively, once every day, 5 days every week, a total of 4 weeks. After the model establishment, motor recovery and spasticity alleviation were evaluated with BBB scale once a week till the end of treatment. Finally, different parts of tissues were dissected out for detection of variations of KCC2 protein using Western blotting and polymerase chain reaction（PCR） technique. The results showed that the BBS scores after treatment were significantly higher in SCI-7 DrTMS group than in SCI-14 DrTMS group（P〈0.05）. As compared with normal control groups, The KCC2 protein in SCI model groups was down-regulated after SCI, and the decrease was much more significant in SCI-14 D model group than in SCI-7 D group（P〈0.05）. As compared with SCI model groups, KCC2 protein in rTMS groups was up-regulated after the treatment（P〈0.05）. The up-regulation of KCC2 protein content and expression was more obvious in SCI-7 DrTMS group than in SCI-14 DrTMS group（P〈0.05）. It was concluded that 10 Hz rTMS can alleviate spasticity in rats with SCI, which might be attributed to the up-regulation of KCC2 protein. It was also suggested that the high-frequency rTMS treatment after SCI at early stage might achieve more satisfactory curative effectiveness.展开更多
No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest res...No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.展开更多
BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when F...BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.展开更多
OBJECTIVE:To evaluate the efficacy of Baishao Luoshi decoction(白芍络石方,BD)on synaptic plasticity in rats with post stroke spasticity(PSS),and to study the mechanism behind the action.METHODS:The PSS model of rat wa...OBJECTIVE:To evaluate the efficacy of Baishao Luoshi decoction(白芍络石方,BD)on synaptic plasticity in rats with post stroke spasticity(PSS),and to study the mechanism behind the action.METHODS:The PSS model of rat was established by middle cerebral artery occlusion(MCAO).The neurological deficit symptoms were evaluated by modified neurological deficit score(mN SS).Muscle tension were evaluated by Modified Ashworth score(MAS).Transmission electron microscopy(TEM)was used to observe the synaptic ultrastructure.The expression of synaptic plasticity-related protein brain derived neurotrophic factor(BDNF),growth associated protein-43(GAP43),synaptophysin(p38)and microtubule-associated protein 2(MAP2)in the brain tissue around the infarct were detected by Western blotting.RESULTS:We found that mNSS were significantly improved and limb spasticity was ameliorated treated by BD.The thickness of postsynaptic density and the synaptic curvature increased significantly.The expression of synaptic plasticity-related protein BDNF,GAP43,p38,MAP2 in the brain tissue around the infarct were raised remarkably after treated by BD.CONCLUSIONS:Alleviating PSS by BD may be related to rescuing the synaptic plasticity,which provides a probable new therapeutic method for PSS.展开更多
Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and...Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and its development remain largely unknown.The goal of the present study was to find differences,if any,in metabolites of the left precentral gyrus and basal ganglia of patients who have spinal cord injury with or without spasticity,and to explore the relationship between the brain metabolite concentrations and clinical status.Thirty-six participants were recruited for magnetic resonance spectroscopic examination:23 with spinal cord injury(12 with spasticity and 11 without spasticity)and 13 healthy controls.We acquired localized proton spectra from the precentral gyrus and basal ganglia via 10 mm^(3) voxels.Notably,univariate linear regression analysis demonstrated that the lower that the N-acetylaspartate concentration(a marker for neuronal loss)was in the precentral gyrus of the patients,the lower their ASIA(American Spinal Injury Association)light-touch scores,pinprick scores,and motor scores.Additionally,longer durations of injury were associated with higher N-acetylaspartate levels in the precentral gyrus.Compared with the healthy participants and patients without spasticity,N-acetylaspartate levels in the patients with spasticity were significantly lower in both the precentral gyrus and basal ganglia.Lower N-acetylaspartate levels also correlated with greater sensory and motor dysfunction in the patients who had spinal cord injury with spasticity.展开更多
BACKGROUND Approximately 65%-78%of patients with a spinal cord injury(SCI)develop any symptom of spasticity.The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal sho...BACKGROUND Approximately 65%-78%of patients with a spinal cord injury(SCI)develop any symptom of spasticity.The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy(r ESWT)on plantar flexor spasticity in a patient with incomplete SCI.CASE SUMMARY An 18-year-old man with an incomplete SCI completed five sessions of r ESWT.The primary outcomes were the changes in ankle-passive range of motion(APROM)and passive resistive force to ankle dorsiflexion.The outcomes were assessed at baseline(T0),immediately after treatment(T1)and 1 wk after the end of treatment(T2).The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0.The passive resistive force to ankle dorsiflexion at low velocity decreased by 33%at T1 and 55%at T2 in the gastrocnemius muscle and by 41%at T1 and 39%at T2 in the soleus muscle compared with T0.At high velocity,it also decreased by 44%at T1 and 30%at T2 in the gastrocnemius muscle compared with T0.However,in the soleus muscle,the change was minor,with a decrease of 12%at T1 and increased by 39%at T2 compared with T0.CONCLUSION In this patient,the findings showed that r ESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term.Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the m...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> that</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is spasticity</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in </span><span style="font-family:Verdana;">Tizanidine</span><span style="font-family:Verdana;"> group and 35 patients were in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><span style="font-family:Verdana;">Furthermore</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 70 cerebral palsy children were taken as control who were treated with </span><span style="font-family:Verdana;">placebo</span><span style="font-family:Verdana;">. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using </span><span style="font-family:Verdana;">Modified</span><span style="font-family:Verdana;"> Ashworth scale in </span><span style="font-family:Verdana;">different</span> <span style="font-family:Verdana;">time period</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by </span><span style="font-family:Verdana;">physician</span><span style="font-family:Verdana;"> rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. </span><span style="font-family:Verdana;">Adverse</span><span style="font-family:Verdana;"> effect </span><span style="font-family:Verdana;">w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> more in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: For reducing generalized spasticity with regards to muscle tone, joint angle </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.</span></span></span></span>展开更多
BACKGROUND Cockayne syndrome(CS)is a rare inherited disease characterized by progressive motor symptoms including muscle weakness,joint contracture,ataxia,and spasticity.Botulinum neurotoxin type A has been used for c...BACKGROUND Cockayne syndrome(CS)is a rare inherited disease characterized by progressive motor symptoms including muscle weakness,joint contracture,ataxia,and spasticity.Botulinum neurotoxin type A has been used for conditions such as dystonia and spasticity,but it has rarely been used in patients with CS.CASE SUMMARY We report a 6-year-and-9-mo old girl diagnosed with CS who received an injection of botulinum neurotoxin type A to manage her difficulty with walking.A total dose of 210 units of botulinum neurotoxin type A was administered into the bilateral tibialis posterior and gastrocnemius muscles.To evaluate the treatment effects on spasticity,joint contracture,pain,and ataxia,measurement tools including the Modified Ashworth Scale,the passive range of motion,the Faces Pain Scale-Revised,and the Scale for the Assessment and Rating of Ataxia,were employed.The first week after the injection,the Modified Ashworth Scale score for the plantar flexors and foot invertors improved bilaterally,along with advancements in the passive range of motion of the bilateral ankles and a lower score for the Faces Pain Scale-Revised.These treatment effects persisted to the 8th week post-injection,but returned to baseline values at the 12th week post-injection,except for the pain scale.CONCLUSION Botulinum toxin injection can thus be considered as a treatment option for lower extremity spasticity,joint contracture,and pain derived from CS.展开更多
Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been sh...Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity;however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.展开更多
基金supported by the National Key Research and Development Program(2022YFB3805800)National Natural Science Foundation of China(52473307,22208178,62301290)+9 种基金Taishan Scholar Program of Shandong Province in China(tsqn202211116)Shandong Provincial Universities Youth Innovation Technology Plan Team(2023KJ223)Natural Science Foundation of Shandong Province of China(ZR2023YQ037,ZR2020QE074,ZR2023QE043,ZR2022QE174)Shandong Province Science and Technology Small and Medium sized Enterprise Innovation Ability Enhancement Project(2023TSGC0344,2023TSGC1006)Natural Science Foundation of Qingdao(23-2-1-249-zyyd-jch,24-4-4-zrjj-56-jch)Anhui Province Postdoctoral Researcher Research Activity Funding Project(2023B706)Qingdao Key Technology Research and Industrialization Demonstration Projects(23-1-7-zdfn-2-hz)Qingdao Shinan District Science and Technology Plan Project(2022-3-005-DZ)Suqian Key Research and Development Plan(H202310)Jinan City-School Integration Development Strategy Project for the Year 2023 under Grant(JNSX2023088).
文摘Rehabilitation training is believed to be an effectual strategy that canreduce the risk of dysfunction caused by spasticity.However,achieving visualizationrehabilitation training for patients remains clinically challenging.Herein,wepropose visual rehabilitation training system including iontronic meta-fabrics withskin-friendly and large matrix features,as well as high-resolution image modules fordistribution of human muscle tension.Attributed to the dynamic connection and dissociationof the meta-fabric,the fabric exhibits outstanding tactile sensing properties,such as wide tactile sensing range(0~300 kPa)and high-resolution tactile perception(50 Pa or 0.058%).Meanwhile,thanks to the differential capillary effect,the meta-fabric exhibits a“hitting three birds with one stone”property(dryness wearing experience,long working time and cooling sensing).Based on this,the fabrics can be integrated with garmentsand advanced data analysis systems to manufacture a series of large matrix structure(40×40,1600 sensing units)training devices.Significantly,the tunability of piezo-ionic dynamics of the meta-fabric and the programmability of high-resolution imaging modules allowthis visualization training strategy extendable to various common disease monitoring.Therefore,we believe that our study overcomes theconstraint of standard spasticity rehabilitation training devices in terms of visual display and paves the way for future smart healthcare.
文摘Objective:To analyze the impact of comprehensive rehabilitation therapy of traditional Chinese medicine(TCM)(based on modern rehabilitation training)on the spasticity and motor function in stroke patients with hemiplegia.Methods:Seventy-nine stroke and hemiplegia patients admitted to the hospital from June 2021 to June 2023 were selected and randomly divided into a control group(39 cases)using modern rehabilitation training,and an observation group combined with comprehensive TCM rehabilitation therapy(40 cases),over 1 month.The clinical index data of the two groups were compared.Results:There were differences in the clinical index data between the two groups.The total effective rate after 2 treatment in the observation group(92.50%)was higher than that of the control group(74.36%)(χ^(2)=4.727,P<0.05).All central sensitization inventory(CSI)and stroke quality of life(PRO)scores in both groups were lower after treatment,with the observation group having lower scores as compared to the control group(P<0.05).The scores of FMA(upper limbs,lower limbs),Barthel index scores,and Functional Ambulation Categories(FAC)scores of both groups increased after treatment,with the observation group having higher scores as compared to the control group(P<0.05).Conclusion:Comprehensive TCM rehabilitation therapy had a significant therapeutic effect on patients with hemiplegia after stroke.It improved the patient’s spasticity,limb movement,and walking function.Their daily living abilities and quality of life were also enhanced.
基金supported by the Science and Technology Fund of Chengdu Medical College(CYZ18-29)the Sichuan Science and Technology Program(2022JDRC0127).
文摘Cerebral palsy is a common chronic disabling disease in children with special needs,and rehabilitation for cerebral palsy is characterized by a long period,multiple methods and limited efficacy.Due to the limited motor function of cerebral palsy patients,the quality of life of patients is reduced,and their ability to participate in society is reduced,so the improvement of patients’motor function has become an important goal of cerebral palsy rehabilitation.The motor function of cerebral palsy has become an important goal of cerebral palsy rehabilitation.Limb spasticity is one of the main clinical signs of cerebral palsy patients,and the more severe the limb spasticity is,the greater the impact on the patient's motor function,so improving limb spasticity in patients with cerebral palsy is particularly important.Acupuncture,as a Chinese medicine treatment method,has been widely used in the clinical treatment of cerebral palsy in China,and has shown certain efficacy.To promote the clinical application of acupuncture technique in cerebral palsy limb spasticity,this paper analyses and summarizes the relevant literature on acupuncture treatment of cerebral palsy limb spasticity summarizes the current status of the clinical application of acupuncture in cerebral palsy limb spasticity,and provides clinical references for the reasonable application of acupuncture in cerebral palsy limb spasticity.
基金Key Launching Project of Science and Technology Ministry,Sichuan:2006 Z 08-079
文摘Objective To observe the therapeutic effect of acupuncture and rehabilitation on poststroke hemiplegic spasticity, and probe into the indices of efficacy assessment of the disease. Methods According to the randomized, controlled and blind clinical trial design, 229 cases enrolled in accordance with the inclusive criteria were divided into 3 groups based on visiting sequence： treatment group 1 （74 cases）, treated with acupuncture [Jianyu （肩髃 LI 15）, Quchi （曲池 LI 11）, Waiguan （外关 TE 5） etc. on the affected side]; treatment group 2 （75 cases）, treated with acupuncture as treatment group 1 and combined with rehabilitation as control group; control group （80 cases）, treated with rehabilitation （Bobath facilitation technique）. 5 treatments were given each week, continuously for 4 weeks. The clinical efficacy on post-stroke hemiplegic spasticity was observed systematically after the treatment of acupuncture combined with rehabilitation. Results The research showed that the baseline situations of 3 groups were good, the group division was proportionate, indicating strong comparability （P〉0.05）. Based on the modified Ashworth Spasticity Scale （modified ASS）, the total effective rate was 63.01% （46/73） in treatment group 1, 66.67%（50/75） in treatment group 2 and 44.00% （33/75） in control group, indicating a statistical significant difference among 3 groups （P〈0.05）. Based on MAS motor function scale, the function improvement in treatment group 2 was superior to that in treatment group 1 and control group, indicating statistical significant differences among 3 groups （both P〈0.05）. Based on modified Barthel index, the daily life activity in treatment group 2 was superior in the improvement as compared with treatment group 1 and control group, but without statistical significant difference indicated （P〉0.05）. Conclusion The efficacy of post-stroke hemiplegic spasticity is definite with acupuncture combined with rehabilitation, and the acupuncture program is safe and effective.
基金Supported by Beijing Chinese medicine inheritance of double hundred project
文摘This systematic review is aim to comprehensively evaluate the efficacy of acupoint stimulation in managing of post-stroke spasticity. The eligible randomized controlled clinical trials （RCTs） and quasi-randomized controlled clinical trials （quasi-RCTs） will be searched from the following databases： the Cochrane Central Register of Controlled Trials （CENTRAL）, MEDLINE, EMBASE, China National Knowledge Infrastructure （CNKI）, Chinese Scientific Journal Database （VIP）, Wanfang Database, Chinese BioMedical Literature Database （CBM）. The Cochrane risk of bias tool will be used to assess the trials. No patients or their family will be bothered in this systematic review, so there is no need for the permission of institutional review board （IRB）. The completed systematic review will be published in a peer-reviewed journal.
文摘We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 patients. The initial causes were: stroke, cranial trauma, postoperative complications and multiple sclerosis. MSN procedures were performed on the median nerve (n = 40) for wrist and finger flexion;musculo-cutaneus nerve (n = 38) for elbow flexion;ulnaris nerve (n = 9) for cubital deviation of the hand;gastrocnemius nerve (n = 98) and soleus nerve (n = 49) for equinus foot, tibial posterior nerve (n = 45) for varus foot, and fascicles (or bundles) of the flexor digitorum for “claw” toes (n = 19). The main preoperative test to identify the responsible nerve was a neuromuscular block with local anesthesia (lidocaine or bupivacaine) injected into the site of the nerve connecting the spastic muscle. During surgery, the identified nerve was exposed and its epineurium opened. Nerve bundles were teased apart into individual rootlets and a number of rootlets cut were previously planned, according to the spasticity. Follow-up was performed for up to 10 years, with a mean period of 29 months. Results demonstrated a reduction of limb spasticity of 2 to 3 points: modified Ashworth scale (MAS). Pain and clonus were also diminished in the affected limb. In some cases, voluntary movement was once again possible. MSN is a useful alternative in those cases of focal spasticity where physiotherapy and nerve block with botulinum toxin or phenol no longer produce satisfactory results.
基金Supported by Hebei Administration of Traditional Chinese Medicine(2009180)
文摘Objective To explore the effect of meridian sinew row needling combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis. Methods Four hundred and eighty-eight cases of post-stroke patients with upper limb spasticity were randomly divided into two groups at the ratio of 1： 1, the group of meridian sinew row needling combined with dermal needling （group A, 244 cases） and western medication group （group B, 244 cases）. Coupled with rehabilitation, the patients in the group A were given meridian sinew row needling combined with dermal needling where five shu points were specifically selected, and three yang meridians of the hand were treated with acupuncture with muscle region, and three yin meridians of the hand were treated with dermal needles; the patients in the group B was treated with conventional western medication with piracetam injection and cerebroprotein hydrolysate included. Clinical efficacy was evaluated among patients in the two groups after three weeks of continuous treatment, and upper limb spasticity and motor functions were observed through modified Asworth Scale and FugI-Meyer Assessment Scale （FMA） before and after treatment. Results For Asworth Scale, group A was significantly superior to group B （3.04 ± 1.29 vs 3.88 ± 1.54, P〈0.05）; for FMA scale, group A was also significantly superior to group B （48.67± 15.64 vs 42.96±14.72, P〈0.05）; mitigations of motor status of upper limb joints in group A, such as remission of shoulder adduction （90.5%）, pronation of forearm （70.7%）, elbow joint flexion （73.1%）, wrist joint flexion （80.9%） and finger flexion （88.1%）, were superior to those of group B （70.0%, 60.0%, 61.9%, 57.4%, 63.2%, all P〈0.05）. Conclusion Good clinical efficacy of the treatment with combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis is achieved.
基金supported in part by grants from Foundation La MaratóTV3.No.PI110932
文摘Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhib- its satisfactory outcomes in improving multiple sclerosis, stroke, spinal cord injury and cerebral palsy-induced spasticity. By contrast, transcranial direct current stimulation has only been studied in post-stroke spasticity. To better validate the efficacy of non-invasive brain stimulations in im- proving the spasticity post-stroke, more prospective cohort studies involving large sample sizes are needed.
基金supported in part by NIH grants(NIH/NINDS R01NS060774NIH/NICHD/NCMRR R24 HD050821-08)under subcontract with the Rehabilitation Insti-tute of Chicago
文摘The effect of botulinum toxin type A injection on voluntary grip control was examined in a 53-year-old female,who sustained a hemorrhagic right middle cerebral artery stroke 3 years previously,which resulted in finger flexor spasticity and residual weak finger/wrist extension.The patient received 50 units of botulinum toxin type A injection each to the motor points(2 sites/muscle)of the left flexor digitorum superficialis and flexor digitorum profundus,respectively.Botulinum toxin injection led to weakness and tone reduction in the spastic finger flexors,but improved grip release time in grip initiation/release reaction time tasks.Improved release time was accompanied by shortened extensor electromyography activity,and improved release time likely correlated with blocked co-contraction of finger flexors during voluntary finger extension.This case report demonstrated that botulinum toxin injection improved voluntary motor control of the hand in a chronic stroke patient with residual finger extension.
文摘Post-stroke spasticity is associated with restriction in the range of motion of the shoulder.Reducing muscular dystrophy may help relieve muscular dysfunction in patients with post-stroke shoulder spasticity.Dry needle therapy is a method of needling the trigger points using a syringe needle without the use of a drug.Dry needle therapy is commonly used for pain at the shoulder,neck,waist,and back.In this case study,a 62-year-old male patient affected with cerebral hemorrhage of the right frontal lobe had received rehabilitative treatment for 12 years.However,he still experienced shoulder spasticity.The patient received daily dry needling at the trigger points of infraspinatus,teres minor,posterior deltoid,and pectoralis major on 9 days.After the first and ninth treatment,the Modified Ashworth Scale and the passive range of motion of the shoulder was used to assess the effect of the treatment.The spasticity and range of motion of the shoulder showed obvious improvement.These results indicate that dry needling at the myofascial trigger points can effectively treat chronic poststroke shoulder spasticity.
基金Supported by Henan University of Traditional Chinese Medcine Innovation Team Projet(No.2011XCXTD05)
文摘OBJECTIVE: To investigate the effect of catgut implantation at acupoints on the expressions of γ-amino butyric acid B receptor(GABAB ) and metabotropic glutamate receptor 1(mGluR1) in the brain stem of rats with spasticity after stroke.METHODS: In total, 60 male Sprague-Dawley rats were randomly divided into three groups: a sham group(n=10), a model group(n=25) and a treatment group(n=25). The rats in both the model group and the treatment group were subjected to middle cerebral artery occlusion to establish a model of focal cerebral ischemia. Rats with limb-spasm met the inclusion criteria. Only the left carotid artery was isolated in sham group rats. Three days after modeling, the treatment group was subjected to catgut implantation at Dazhui(GV 14), Guanyuan(CV 4), and Zhongwan(CV 12). Neurological deficit symptoms were assessed with the Zea-Longa neurological deficit score. The Modified Ashworth Scale(MAS), and isolated muscle tone were used to evaluate spasticity before and after treatment. Immunohistochemistry was applied to determine the expression of GABAB and mGluR1 in the rat brain stem after treatment.RESULTS: After treatment, neural impairment symptoms had significantly improved in the treatment group when compared to the model group(P<0.05). Both MAS and isolated muscle tone in the treatment group were significantly decreased when compared with the model group(P<0.05),and were also lower than before treatment. GABAB expression was significantly higher and mGluR1 was lower in the treatment group when compared with the model group(P<0.01 and P<0.05, respectively).CONCLUSION: Catgut implantation at Dazhui(GV 14), Guanyuan(CV 4), and Zhongwan(CV 12), can relieve limb spasticity by increasing the expression of GABAB and reducing the expression of mGluR1 in the brain stem of rats after stroke.
基金supported by the National Natural Science Foundation of China(No.81101458)
文摘The effect of high-frequency repetitive transcranial magnetic stimulation（r TMS） on potassium-chloride cotransporter-2（KCC2） protein expression following spinal cord injury（SCI） and the action mechanism were investigated. SCI models were established in SD rats. Five groups were set up randomly： normal control group, SCI 7-day（7 D） model group, SCI 14-day（14 D） model group, SCI-7 DrTMS group and SCI-14 DrTMS group（n=5 each）. The rats in SCI rTMS groups were treated with 10 Hz rTMS from 8 th day and 15 th day after SCI respectively, once every day, 5 days every week, a total of 4 weeks. After the model establishment, motor recovery and spasticity alleviation were evaluated with BBB scale once a week till the end of treatment. Finally, different parts of tissues were dissected out for detection of variations of KCC2 protein using Western blotting and polymerase chain reaction（PCR） technique. The results showed that the BBS scores after treatment were significantly higher in SCI-7 DrTMS group than in SCI-14 DrTMS group（P〈0.05）. As compared with normal control groups, The KCC2 protein in SCI model groups was down-regulated after SCI, and the decrease was much more significant in SCI-14 D model group than in SCI-7 D group（P〈0.05）. As compared with SCI model groups, KCC2 protein in rTMS groups was up-regulated after the treatment（P〈0.05）. The up-regulation of KCC2 protein content and expression was more obvious in SCI-7 DrTMS group than in SCI-14 DrTMS group（P〈0.05）. It was concluded that 10 Hz rTMS can alleviate spasticity in rats with SCI, which might be attributed to the up-regulation of KCC2 protein. It was also suggested that the high-frequency rTMS treatment after SCI at early stage might achieve more satisfactory curative effectiveness.
文摘No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.
文摘BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.
基金Supported by the China Postdoctoral Science Foundation:Research on the Mechanism of Baishaoluoshi Decoction in Improving Poststroke Spasticity by KCC2-GABAAR Based on the Theory of“Gan Zhu Jin”(No.2020M682571)Natural Science Foundation of Hunan Province China:Research on the Mechanism of Post-stroke Spasticity by KCC2--GABAAR-Motoneuron Excitability and Chinese Traditional Medicine Intervention Based on the Theory of“Gan Zhu Jin”(No.2019JJ50343)the Scientific Research Project of Education Department of Hunan Province:Research on the Mechanism of Axonal Regeneration and TCM Intervention in Post-Stroke Spasticity Based on the Theory of“Gan Zhu Jin”by Slit-Robo Pathway(No.19C1423)。
文摘OBJECTIVE:To evaluate the efficacy of Baishao Luoshi decoction(白芍络石方,BD)on synaptic plasticity in rats with post stroke spasticity(PSS),and to study the mechanism behind the action.METHODS:The PSS model of rat was established by middle cerebral artery occlusion(MCAO).The neurological deficit symptoms were evaluated by modified neurological deficit score(mN SS).Muscle tension were evaluated by Modified Ashworth score(MAS).Transmission electron microscopy(TEM)was used to observe the synaptic ultrastructure.The expression of synaptic plasticity-related protein brain derived neurotrophic factor(BDNF),growth associated protein-43(GAP43),synaptophysin(p38)and microtubule-associated protein 2(MAP2)in the brain tissue around the infarct were detected by Western blotting.RESULTS:We found that mNSS were significantly improved and limb spasticity was ameliorated treated by BD.The thickness of postsynaptic density and the synaptic curvature increased significantly.The expression of synaptic plasticity-related protein BDNF,GAP43,p38,MAP2 in the brain tissue around the infarct were raised remarkably after treated by BD.CONCLUSIONS:Alleviating PSS by BD may be related to rescuing the synaptic plasticity,which provides a probable new therapeutic method for PSS.
基金supported by the National Natural Science Foundation of China,Nos.82071400,81870979the Scientific Research Foundation of China Rehabilitation Research Center,No.2020cz-01the Special Capital Health Research and Development of China,No.2018-1-6011(all to JJL)。
文摘Spinal cord injury is a severe and devastating disease,and spasticity is a common and severe complication that is notoriously refractory to treatment.However,the pathophysiological mechanisms underlying spasticity and its development remain largely unknown.The goal of the present study was to find differences,if any,in metabolites of the left precentral gyrus and basal ganglia of patients who have spinal cord injury with or without spasticity,and to explore the relationship between the brain metabolite concentrations and clinical status.Thirty-six participants were recruited for magnetic resonance spectroscopic examination:23 with spinal cord injury(12 with spasticity and 11 without spasticity)and 13 healthy controls.We acquired localized proton spectra from the precentral gyrus and basal ganglia via 10 mm^(3) voxels.Notably,univariate linear regression analysis demonstrated that the lower that the N-acetylaspartate concentration(a marker for neuronal loss)was in the precentral gyrus of the patients,the lower their ASIA(American Spinal Injury Association)light-touch scores,pinprick scores,and motor scores.Additionally,longer durations of injury were associated with higher N-acetylaspartate levels in the precentral gyrus.Compared with the healthy participants and patients without spasticity,N-acetylaspartate levels in the patients with spasticity were significantly lower in both the precentral gyrus and basal ganglia.Lower N-acetylaspartate levels also correlated with greater sensory and motor dysfunction in the patients who had spinal cord injury with spasticity.
基金Supported by BTL Industries Ltd.Prague,Czech Republic。
文摘BACKGROUND Approximately 65%-78%of patients with a spinal cord injury(SCI)develop any symptom of spasticity.The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy(r ESWT)on plantar flexor spasticity in a patient with incomplete SCI.CASE SUMMARY An 18-year-old man with an incomplete SCI completed five sessions of r ESWT.The primary outcomes were the changes in ankle-passive range of motion(APROM)and passive resistive force to ankle dorsiflexion.The outcomes were assessed at baseline(T0),immediately after treatment(T1)and 1 wk after the end of treatment(T2).The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0.The passive resistive force to ankle dorsiflexion at low velocity decreased by 33%at T1 and 55%at T2 in the gastrocnemius muscle and by 41%at T1 and 39%at T2 in the soleus muscle compared with T0.At high velocity,it also decreased by 44%at T1 and 30%at T2 in the gastrocnemius muscle compared with T0.However,in the soleus muscle,the change was minor,with a decrease of 12%at T1 and increased by 39%at T2 compared with T0.CONCLUSION In this patient,the findings showed that r ESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term.Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Cerebral palsy is the most common chronic motor disability that begins in childhood with the predominant motor abnormality</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> that</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is spasticity</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> <b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to compare the efficacy of oral baclofen and oral tizanidine in reducing spasticity in cerebral palsy patients. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This randomized controlled trial was conducted from January 2010 to December 2011 and it was carried out in the Out Patient Department (OPD) of Pediatrics at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh and Center for Neurodevelopment and Autism in Children (CNAC) of Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: A total number of 70 cerebral palsy children were recruited for this study of which 35 patients were in </span><span style="font-family:Verdana;">Tizanidine</span><span style="font-family:Verdana;"> group and 35 patients were in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><span style="font-family:Verdana;">Furthermore</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 70 cerebral palsy children were taken as control who were treated with </span><span style="font-family:Verdana;">placebo</span><span style="font-family:Verdana;">. Tizanidine had superior efficacy in reducing tone in spastic cerebral palsy over baclofen measured by using </span><span style="font-family:Verdana;">Modified</span><span style="font-family:Verdana;"> Ashworth scale in </span><span style="font-family:Verdana;">different</span> <span style="font-family:Verdana;">time period</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> from AS score-3 to score-2 (p < 0.05). Tizanidine was also superior in joint angle improvement in spastic cerebral palsy measured by </span><span style="font-family:Verdana;">physician</span><span style="font-family:Verdana;"> rating scale from AS score-3 to score-2 (crouch p < 0.0001) and foot contact from AS score-3 to score-2 (p < 0.0001);but no statistically significant improvement in gross motor function. </span><span style="font-family:Verdana;">Adverse</span><span style="font-family:Verdana;"> effect </span><span style="font-family:Verdana;">w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> more in </span><span style="font-family:Verdana;">baclofen</span><span style="font-family:Verdana;"> group. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: For reducing generalized spasticity with regards to muscle tone, joint angle </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> improvement in gait in cerebral palsy patients, tizanidine has superior efficacy and less adverse effects than baclofen.</span></span></span></span>
文摘BACKGROUND Cockayne syndrome(CS)is a rare inherited disease characterized by progressive motor symptoms including muscle weakness,joint contracture,ataxia,and spasticity.Botulinum neurotoxin type A has been used for conditions such as dystonia and spasticity,but it has rarely been used in patients with CS.CASE SUMMARY We report a 6-year-and-9-mo old girl diagnosed with CS who received an injection of botulinum neurotoxin type A to manage her difficulty with walking.A total dose of 210 units of botulinum neurotoxin type A was administered into the bilateral tibialis posterior and gastrocnemius muscles.To evaluate the treatment effects on spasticity,joint contracture,pain,and ataxia,measurement tools including the Modified Ashworth Scale,the passive range of motion,the Faces Pain Scale-Revised,and the Scale for the Assessment and Rating of Ataxia,were employed.The first week after the injection,the Modified Ashworth Scale score for the plantar flexors and foot invertors improved bilaterally,along with advancements in the passive range of motion of the bilateral ankles and a lower score for the Faces Pain Scale-Revised.These treatment effects persisted to the 8th week post-injection,but returned to baseline values at the 12th week post-injection,except for the pain scale.CONCLUSION Botulinum toxin injection can thus be considered as a treatment option for lower extremity spasticity,joint contracture,and pain derived from CS.
文摘Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity;however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.
