Effect of electroacupuncture at antagonistic muscle and agonistic muscle on motor function in patients with upper-extremity spasticity after stroke / 中国针灸

OBJECTIVE@#To compare the improvement effect between simultaneous electroacupuncture at antagonistic muscle and agonistic muscle and simple electroacupuncture at antagonistic muscle on spasticity degree, upper-extremity motor function and activity of daily living in patients with upper-extremity spasticity after stroke.@*METHODS@#A total of 60 patients with upper-extremity spasticity after stroke were randomized into a comprehensive group (30 cases, 1 case dropped off) and an antagonistic muscle group (30 cases, 2 cases dropped off). In the antagonistic muscle group, acupuncture was applied at Jianyu (LI 15), Binao (LI 14), Zhouliao (LI 12), Shousanli (LI 10), Waiguan (TE 5) and Houxi (SI 3), electric stimulation was attached to Jianyu (LI 15)-Binao (LI 14), Zhouliao (LI 12)-Shousanli (LI 10) and Waiguan (TE 5)-Houxi (SI 3), with discontinuous wave, 15 Hz in frequency. On the basis of the treatment in the antagonistic muscle group, acupuncture was applied at Tianquan (PC 2), Chize (LU 5), Jianshi (PC 5) and Daling (PC 7) in the comprehensive group, electric stimulation was attached to Tianquan (PC 2)-Chize (LU 5) and Jianshi (PC 5)-Daling (PC 7), with continuous wave, 5 Hz in frequency. The treatment was given once a day, 6 days a week for 4 weeks in the two groups. Before and after treatment, the scores of modified Ashworth scale (MAS), Fugl-Meyer assessment upper extremity scale (FMA-UE) and modified Barthel index (MBI) scale were observed in the two groups.@*RESULTS@#Compared before treatment, the MAS scores of elbow flexors and wrist flexors after treatment were decreased (P<0.05), the scores of FMA-UE and MBI scale after treatment were increased in the two groups (P<0.05). The scores of FMA-UE and MBI scale after treatment in the comprehensive group were higher than those in the antagonistic muscle group (P<0.05).@*CONCLUSION@#Simultaneous electroacupuncture at antagonistic muscle and agonistic muscle and simple electroacupuncture at antagonistic muscle can both improve the spasticity degree in patients with upper-extremity spasticity after stroke, however, the former can better restore motor function and improve activity of daily living.

Effect of electroacupuncture on motor function and gait in patients with post-stroke spasticity in lower limbs / 中国针灸

OBJECTIVE@#To observe the effect on motor function, spasticity degree, muscle strength and the relevant parameters of three-dimensional gait analysis in the patients with post-stroke spasticity in the lower limbs treated with the combined therapy of electroacupuncture (EA) and muscle electricity biofeedback or the simple muscle electricity biofeedback therapy on the base of rehabilitation medicine.@*METHODS@#A total of 60 patients with post-stroke spasticity in the lower limbs were randomized into an EA + biofeedback group, a biofeedback group and a rehabilitation group, 20 cases in each one. In the rehabilitation group, the basic rehabilitation training was provided, 45 min each time. In the biofeedback group, on the base of the treatment as the rehabilitation group, the biofeedback therapy was added, 30 min each time. In the EA + biofeedback group, besides the treatment as the biofeedback group, acupuncture was supplemented at Futu (ST 32), Liangqiu (ST 34), Zusanli (ST 36) and Fenglong (ST 40), etc, and EA was applid at Zusanli (ST 36) and Taichong (LR 3) with continuous wave and 5 Hz in frequency. In each group, the treatment was given once daily, 5 times a week, for 6 weeks totally. Separately, before and after treatment, the score of Fugle-Meyer assessment (FMA), the score of clinical spasticity index (CSI) in the lower limbs and the strength of the anterior tibial muscle on the affected side were assessed, and the spatial-temporal parameters (step frequency and steep speed) in the three-dimensional gait analysis and the kinematic parameters (maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side) were measured in the patients of three groups.@*RESULTS@#After treatment, FMA score was increased as compared with that before treatment in all of three groups (P<0.05). FMA score in the EA + biofeedback group and the biofeedback group was higher than the rehabilitation group respectively (P<0.05). CSI score in the EA + biofeedback group and the biofeedback group was lower than that before treatment respectively (P<0.05), and lower than the rehabilitation group (P<0.05). After treatment, the step frequency and speed were all improved and the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side were all increased as compared with those before treatment in the patients of three groups separately (P<0.05). The step frequency and speed, as well as the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side in either the EA + biofeedback group or the biofeedback group were all higher than the rehabilitation group (P<0.05), and the step speed in the EA + biofeedback group was higher than the biofeedback group (P<0.05). After treatment, the strength of the anterior tibial muscle on the affected side was increased as compared with that before treatment in the patients of each group (P<0.05); and the strength of the anterior tibial muscle in the EA + biofeedback group and the biofeedback group was larger than the rehabilitation group (P<0.05).@*CONCLUSION@#On the base of rehabilitation treatment, the combined regimen of EA and muscle electricity biofeedback therapy and the simple muscle electricity biofeedback therapy all effectively strengthen the motor functions and reduce spasticity as well as improve step frequency, step speed and the range of motion of ankle joint in the patients with post-stroke spasticity in the lower limbs. Regarding the gait improvement, the combined regimen of EA and muscle electricity biofeedback is better than the simple muscle electricity biofeedback.

Effects of whole body vibration combined with extracorporeal shock wave therapy on spasticity and balance gait parameters in hemiplegic patients with stroke / 中南大学学报(医学版)

OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.

Practical value and thought on "co-regulation of body and mind" in treatment of post-stroke spasticity with acupuncture / 中国针灸

This paper reviews the application of "co-regulation of body and mind" of acupuncture for post-stroke spasticity. It is found that acupoints on the head and the back of the governor vessel, as well as Jiaji (Ex-B 2) points are mainly used for regulating the mind, and the local sites of spastic muscles and the points on the antagonistic muscles are for regulating the body specially. It is believed that regulating the mind should be integrated with regulating the body, while, the acupoint selection be associated with needling methods so as to fully achieve the "co-regulation of body and mind" and enhance the practical value of acupuncture for post-stroke spasticity. It is proposed that the classical anti-spastic needling techniques, such as huici (relaxing needling) and guanci (joint needling), should be more considered.

A novel method for localizing nerve entry points during spasticity treatment / Un nuevo método para localizar los puntos de entrada del nervio durante el tratamiento de la espasticidad

The nerve entry points (NEPs) cannot be accurately localized for the treatment of muscle spasticity in neurolysis. The aim of this study was to develop a new method of accurately localizing nerve entry points in relation to bony landmarks. NEPs in human cadavers were coated with barium sulfate. Method 1 consisted of horizontal and longitudinal reference lines being designated based on bony landmarks, followed by radiography and measurements using picture archiving and communication system software. Method 2 involved sewing the barium sulfate-soaked suture thread into the skin to designate the horizontal and longitudinal reference lines, followed by computed tomography (CT) scanning to determine the skin surface location and puncture depth for the NEPs. Using method 1, the bony landmarks and nerve muscular branches labeled with barium sulfate were clearly visualized by radiography. NEPs were localized using the reference lines, but the resultant points were not on the skin surface, and information was not provided regarding puncture depth. Method 2 resulted in the bony landmarks, NEPs, and reference lines being clearly visualized using CT imaging. The NEPs were successfully projected onto the skin surface and localized using reference lines that were measured along the curve of the skin. Furthermore, method 2 provided measurements of puncture depth. NEPs, including depths, can be accurately localized in cadavers using CT. Therefore, this novel method is recommended for localizing neurolysis target points.

Los puntos de entrada de los nervios (PENs) no pueden localizarse con precisión para el tratamiento de la espasticidad muscular en la neurolisis. El objetivo de este estudio fue desarrollar un nuevo método de localización precisa de los puntos de entrada de los nervios en relación con puntos de referencia óseos. Los PENs en cadáveres humanos se recubrieron con sulfato de bario. En el método 1 se trazaron líneas de referencia horizontales y longitudinales que fueron elegidas basándose en puntos de referencia óseos, seguidos por radiografías y mediciones utilizando un software de archivo de imágenes y de sistemas de comunicación. El método 2 implicó coser hilo de sutura, impregnado con sulfato de bario, en la piel para designar las líneas de referencia horizontales y longitudinales, seguido de la realización de tomografía computarizada (TC) para determinar la ubicación en la superficie de la piel y la profundidad de punción de los PENs. Utilizando el método 1, las marcas óseas y los ramos musculares nerviosos, marcados con sulfato de bario, se visualizaron claramente mediante radiografía. Los PENs fueron localizados utilizando las líneas de referencia, sin embargo los puntos resultantes no se encontraron en la superficie de la piel, y no se proporcionó información sobre la profundidad de la punción. El método 2 dio como resultado la correcta visualización de los puntos de referencia óseos, los PENs y las líneas de referencia, utilizando imágenes de TC. Los PENs se proyectaron con éxito sobre la superficie de la piel y se localizaron usando líneas de referencia que se midieron a lo largo de la ésta. Además, el método 2 proporcionó mediciones acerca de la profundidad de punción. Los PENs, incluyendo las profundidades de punción, pueden ser localizados con exactitud en cadáveres usando TC. Por lo tanto, este nuevo método se recomienda para localizar los puntos objetivos de la neurolisis.

Quality of life and epidemiological profile of patients undergoing botulinum toxin treatment / Qualidade de vida e perfil epidemiológico de pacientes submetidos a tratamento com toxina botulínica

The botulinum toxin (BTX) is a therapeutic modality used in diverse range of diseases in neurology such as dystonia, tics and tremors and spasticity. The literature about the relation between the use of BTX and its impact in quality of life scales are conflicting, our study proposes to aid answering this question. We selected 110 patients between April 2014 and January 2015, from two tertiary hospitals (movement disorder outpatient clinic), which have been evaluated for age, gender, type of BTX applied, technic of application, adverse events, clinical syndrome and etiology. To evaluate quality of life we used the SF-36® scale. The most prevalent clinical syndromes were dystonia, spasticity and daytime bruxism. We applied the scale in 55 patients pre and post treatment to trace a clinical and epidemiological profile of patients treated with botulinum toxin, evaluating its impact on quality of life. Main etiologies were: idiopathic, stroke and peripheral facial palsy. SF-36® scale applied to 55 patients showed that 35 of them improved, with higher impact upon the mental health, vitality, physical functioning and body pain subsections. Incidence of adverse events (21,8%) was similar to the literature. Botulinum toxin application was associated with higher scores on SF-36®, therefore representing a good therapeutic option dystonia and spasticity. (AU)

A toxina botulínica (TB) é uma modalidade terapêutica utilizada em diversas condições em neurologia, dentre elas distonia, espasticidade, tremor e tique. A literatura médica é conflitante em estabelecer a relação entre o uso da TB e seu impacto nas escalas de qualidade de vida. O presente estudo se propõe a avaliar esta relação. Foram selecionados 110 pacientes, no período entre abril de 2014 e janeiro de 2015 provenientes do ambulatório de Distúrbios do Movimento de 2 hospitais terciários, que foram avaliados de acordo com a idade, gênero, tipo de TB aplicada, técnica de aplicação, eventos adversos, síndrome clínica e etiologia. Para avaliar a qualidade de vida foi utilizada a escala SF-36®. As síndromes mais prevalentes foram distonia, espasticidade e bruxismo diurno. Aplicamos a escala em 55 paciente pré e pós tratamento para traçar um perfil clínico e epidemiológico dos pacientes tratados com toxina botulínica, avaliando o seu impacto na qualidade de vida. As principais etiologias foram: idiopática, acidente vascular encefálico e paralisia facial periférica. A aplicação da escala SF-36® em 55 pacientes revelou que 35 deles apresentaram beneficio, com maior impacto na avaliação dos subitens: saúde mental, vitalidade, performance física e dor. A incidência de efeitos adversos foi de 21,8%, similar à literatura. A aplicação de toxina botulínica foi associada com maior pontuação na escala SF-36®, portanto trata-se de boa opção terapêutica nos casos de distonia e espasticidade. (AU)

Termoterapia para la espasticidad post accidente cerebro vascular: revisión sistem / Thermotherapy for spasticity post stroke: systematic review

Objective: Determine whether there is scientific evidence to support the effectiveness of thermotherapy in the management of spasticity in adult patients post stroke. Method: A systematic review of randomized trials were performed, the databases searched were Medline, Cinahl, Central, PEDro, SPORTDiscus and Lilacs. Results: 4 studies that metour eligibility criteria and selection were selected. Conclusion: There is controversial evidence that the US produces are duction in neural electrophysiological excitability compared to US placeboand IR; moderate evidence that US not produces clinical improvement in range of motion or level of spasticity, compared to US placebo, IR, TENS and botulinum toxin.

Objetivo: Determinar si existe evidencia científica que avale la efectividad de la termoterapia en el manejo de la espasticidad en pacientes adultos post accidente cerebro vascular. Método: Se realizó una revisión sistemática de estudios clínicos aleatorizados, las bases de datos consultadas fueron: Medline, Cinahl, Central, PEDro, SPORTDiscus y Lilacs. Resultados: Se seleccionaron 4 artículos que cumplían con nuestros criterios de elegibilidad y selección. Conclusión: Existe evidencia contradictoria que el US produce una reducción electrofisiológica de la excitabilidad neural comparado con US apagado e IR; existe moderada evidencia que el US no produce una mejoría clínica del rango de movimiento ni del nivel de espasticidad, comparado con US apagado, IR, TENS y toxina botulínica.

Neuroplasticidade na reabilitação de pacientes acometidos por AVC espástico / Neuroplasticity in the rehabilitation of patients affected by spastic stroke

O Acidente Vascular Cerebral (AVC) é uma das principais causas de incapacidades no mundo, tendo como um dos principais prejuízos a sequela de espasticidade. A partir dopotencial de neuroplasticidade cerebral, a reabilitação desenvolve técnicas como a Terapia de Restrição e Indução do Movimento, que visa a melhora o desempenho motor. O objetivo desteestudo é analisar os resultados benéficos de estudos baseados noprincípio da neuroplasticidade como mecanismo de reabilitação em pacientes com AVC espástico. O estudo constituiu-se através de revisão de literatura impressa e digital com publicações nacionais e internacionais, a qual foi consultada em bases como SciELO, portal de periódicos da Capes, PubMed e em acervos da biblioteca dainstituição de ensino. Foram utilizadas as palavras chaves Acidente Vascular Cerebral; Espasticidade; Neuroplasticidade e a buscavisou publicações entre 2000 e 2013. Dos 38 artigos pesquisados apenas 4 contemplaram o objetivo do trabalho, e apresentaram resultados positivos sobre a utilização da Terapia de Restrição eIndução do Movimentos que promove a reorganização cortical.

Stroke (CVA) is one of the leading causes of disability in the world, having as one of the major losses torehab the sequel of spasticity. From the known potential of neuroplasticity, the rehabilitation with techniques that use this principle, as the restriction and induction Therapy, improve engineperformance. The aim of this study is to analyze the beneficial results of works that use the neuroplasticity the rehabilitation mechanism in patients with spastic STROKE. This study consisted in a literature review from searches in databases the Virtual Health Library, SciELO, portal de periodicos Capes and PubMed, withpublication dates between 2000 and 2013, as well as in books. Of the 38 articles surveyed “seal only 4 had the objective of this work, and showed positive results in relation to the benefi ts of Movement induction and restriction Therapy which promotesthe cortical reorganization. However it is necessary to fi nd more directly the effectiveness of this technique in the re-establishment of DLAS. Therefore, there is a vast area of occupational therapist to the closest possible rehabilitation of functional independence.

Efeitos agudos da eletroestimulação no membro superior espástico e associação com variáveis respiratórias / Acute effects of electrostimulation on upper limb spasticity and association with respiratory variables

Introdução: Eletroestimulação funcional (EEF) é um recurso valioso no tratamento de padrões espásticos. Objetivos: Avaliar o efeito agudo da EEF sobre variáveis físico-funcionais do membro superior espástico e a associação destas com variáveis respiratórias. Métodos: Dezenove pacientes receberam intervenção placebo (no limiar sensitivo) e EEF (f=30 Hz, largura de pulso= 0,3 ms, 30 min) no membro espástico (secundário a AVE) em dias diferentes. Antes das intervenções, foram avaliadas as atividades de vida diária pelo Índice de Barthel (IB), função pulmonar e força muscular respiratória. Antes e após as intervenções foram avaliadas função sensório-motora pela Escala de Fugl-Meyer (EFM) e amplitude de movimento. Resultados: A EEF aumentou a abdução e rotação interna de ombro, extensão de cotovelo e EFM. A pressão expiratória máxima se correlacionou com IB e flexão de ombro. Conclusões: A aplicação de EEF melhorou variáveis físico-funcionais do membro espástico, que estiveram associadas com a força muscular expiratória.

Introduction: Functional electrical stimulation (FES) is a valuable resource in the treatment of spastic patterns. Objectives: Evaluate the acute effect of FES on physical and functional variables of the spastic upper limb and its association with respiratory variables. Methods: Nineteen patients received placebo intervention (on the sensory threshold) and FES (f=30 Hz, pulse width=0.3 ms, 30 min) in the spastic limb (secondary to stroke) on different days. Before the interventions, activities of daily living by the Barthel Index (BI), pulmonary function and respiratory muscle strength were evaluated. Before and after the interventions, sensory motor function by Fugl-Meyer Scale (FMS) and movement amplitude were evaluated. Results: FES increased shoulder abduction and internal rotation, elbow extension and FMS. The maximum expiratory pressure was related to BI and shoulder flexion. Conclusions: The application of FES improved physical and functional variables of the spastic limb, which were associated with expiratory muscle strength.

A neurólise química do músculo íliopsoas: abordagem através da técnica Santa Casa / The lipsoasmusclechemical block neurolysis: Santa Casa technique approach

A espasticidade da musculatura flexora do quadril é um grande obstáculo encontrado pela equipe de reabilitação e seu tratamento é relevante para o médico fisiatra, pois interfere nas atividades de vida diária do paciente uma vez que dificulta a sedestação, ortotatismo, o posicionamento no leito, cuidados de higiene, vestuário e em especial na biomecânica da marcha. O intuito deste trabalho é demonstrar a técnica da Santa Casa de neurólise química do músculo ileopsoas.

Hip flexor spasticity is one of the biggest obstacle that the Physiatrist finds during the treatment once it interfers in daily living, orthotatism, positioning in bed, vestment and even during gait biomechanical. This study's aim is demonstrate Santa Casa"s Technique of iliopsoas muscle chemical block neurolisis.

Spasticity - pathogenesis, prevention and treatment strategies

This review of the long-term management of spasticity addresses some of the clinical dilemmas in the management of patients with chronic disability. It is important for clinicians to have clear objectives in patient treatment and the available treatment strategies. The review reiterates the role of physical treatment in the management, and thereafter the maintenance of patients with spasticity. Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome, and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. Optimum management is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach, and management options available to the general practitioner in such a complex condition

O uso da toxina botulínica tipo A no tratamento da espasticidade em crianças com paralisia cerebral / The use of botulinum toxin type A in the treatment of spasticity in children with cerebral palsy

A BTX-A é uma exotoxina que vem sendo utilizada, na última década, no tratamento da espasticidade. Essa toxina produz uma desinervação química na musculatura em que é aplicada. O objetivo deste estudo é revisar a literatura específica da área para demonstrar os principais efeitos, utilização e importância da BTX-A no tratamento da espasticidade em crianças com paralisia cerebral (PC). Esta revisão está dividida em cinco sessões: 1) o uso da BTX-A, no qual se procura definir o que é a toxina, descrever um breve histórico e citar as áreas em que a toxina é utilizada; 2) efeitos da BTX-A na excitação do músculo-esquelético, quando é descrito o mecanismo de ação da toxina na junção neuromuscular; 3) espasticidade, em que esta é conceituada e caracterizada; 4) efetividade da BTX-A na espasticidade, quando são apresentados os resultados de estudos que usaram essa toxina no tratamento da espasticidade; e 5) utilização da BTX-A na criança com PC, quando são levantados os principais achados científicos relativos à utilização da toxina no tratamento da espasticidade nessas crianças. A conclusão final do estudo é que a BTX-A é eficaz, segura e capaz de diminuir a espasticidade em crianças com PC. Porém, novos estudos sobre os efeitos de longo prazo dessa toxina sobre o sistema neuromuscular são necessários.

[Effect of adjustable wrist hand splint on upper limb spasticity in post stroke patients]

Spasticity is common problem in stroke patients. Spasticity couse dysfunction and restricted activity. The most of patients have hand dysfunction due to stroke. This study was done to determine the effect of adjustable wrist hand splint on upper limb spasticity in post stroke patients. This randomized clinical trial study was carried out on 15 patients with stroke referred to rehabilitation centers in Tehran-Iran during 2009. Patients randomly were divided into interventional [4 female, 3 men] and control [5 female, 3 men] groups. Common occupational therapy practice was carried out for 4 weeks for both groups equally. In treatment group intervention was based on the use of adjustable wrist hand splint moreover common occupational therapy practice. Upper limb spasticity pre and post intervention based on the Modified Ashworth Scale was evaluated. Data were analyzed by SPPS-17 software, pair-t-test and independent t-test. Mean age of patients in interventional and control groups were 61.37 +/- 4.10 and 58.85 +/- 5.01 years respectively. After 4 weeks of treatment, the mean of spasticity was not significant between interventional and control groups, but internal analysis of spasticity were significant in interventional and control groups [P<0.05]. This study showed that the adjustable wrist hand splint is not useful in reduction of upper limb spasticity in post stroke patients

Avaliação da funcionalidade da criança com paralisia cerebral espástica / Functionality evaluation of children with spastic cerebral palsy

A paralisia cerebral é resultante de uma lesão não progressiva sobre o sistema nervoso central em desenvolvimento e que pode levar a disfunções motoras, distúrbios no movimento, deficiências mentais e alterações funcionais. A espasticidade é a anormalidade motora e postural mais comumente vista na paralisia cerebral. Considerando as múltiplas repercussões da espasticidade sobre a funcionalidade do indivíduo com paralisia cerebral, torna-se claro que uma avaliação do quadro clínico deve ser precisa e direcionar-se aos aspectos específicos que exigem intervenção. Este texto tem como objetivo servir de guia aos médicos ou terapeutas na escolha de instrumentos de medição quantitativa e qualitativa.

Cerebral palsy is the result of a non-progressive lesion on the developing central nervous system and can lead to motor dysfunction, movement disorders, mental and functional changes. Spasticity is a motor and postural abnormality most commonly seen in cerebral palsy. Considering the multiple spasticity effects on the functionality of the individual with cerebral palsy, it becomes clear that a clinical evaluation must be precise and direct itself to the specific aspects that require intervention. This text is intended as a guide to the doctors or therapists in choosing the quantitative and qualitative measurements.

Efficacy of different modalities on spasticity management of spinal cord injury: clinical and electrophysiological study

To evaluate the effectiveness of TENS [versus oral anti- spasticity drugs and physical therapy alone] on management of spinal cord injury [SCI] spasticity. Also, to study the role of the clinical and electrophysiological methods of assessment of spasticity. This study was performed on 40 patients with traumatic spinal cord injury suffering from spasticity. They were 24 males [60%] and 16 females [40%], their ages ranged from 35 to 45 years with a mean + SD of 38.9 +2.9 years. The patients were randomized into 3 treatment groups: Group[I]: included 15 patients who were taking oral anti-spasticity drugs in the form of baclofen and tizanidine and performed physical therapy program [1 session daily] for 6 weeks. Group [II]: included 15 patients who were subjected to TENS therapy applied to spastic lower limbs, lasting for 15 minutes daily and performed the same previous physical therapy program for 6 weeks. Group [III]: included 10 patients who were subjected to the same previous physical therapy program only daily for 6 weeks. Spasticity of these patients was evaluated clinically by: Lower Limb Ashworth score [LLAS], ankle clonus scale, Modified Barthel Index [MBI], and Walking Index for Spinal Cord Injury [WISCI] and electrophysiologically by: H reflex including H amplitude, H[max]/M [max] ratio and H latency. These evaluations were performed at the initial presentation and after 6 weeks of the treatment program. There was a highly significant difference [p<0.001] between the pre and post treatment assessments in group [II] in all clinical parameters and H amplitude and H [max] / M [max] ratio, the same results were obtained in group [I] except for ankle clonus scale which showed significant difference [p<0.05], while in group [III] this significant difference was shown as regards MBI, H amplitude and H [max] / M [max] ratio. There was significant difference in all clinical and electrophysiological parameters when comparing groups [II] and [III], but when comparing groups [I] and [III], this result was seen as the previous except in ankle clonus scale and MBI. But when comparing groups [I] and [II], there was non significant difference in all parameters. Also, group [I] showed significant correlation between H amplitude and all clinical parameters except WISCI [showed non significant correlation], while H max / M max ratio showed highly significant correlation between it and LLAS and significant correlation between it and ankle clonus scale and WISCI. In group [II] there were non significant correlation between both H amplitude and H max/ M max ratio and LL AS and ankle clonus scale and significant correlation between them and MBI and WISCI. But, group [III] showed significant correlation between the electrophysiological [H amplitude and H [max] / M [max] ratio] and the clinical parameters except between H max/ M max ratio and MBI, there was no significant correlation detected. TENS is an effective, economic, non- invasive and readily applicable method that has few side effects. It can be used as a supplement to other treatment methods [oral medication, TENS and physical therapy] in its management

Recent advances in management of cerebral palsy.

Recent advances in clinical research have increased our understanding of causal pathways, opportunities for primary prevention, and the value of specific intervention strategies in the management of Cerebral Palsy (CP). Despite the increasing popularity of newer treatment alternatives, e.g., Botulinum Toxin and Intrathecal Baclofen, single event multilevel Orthopaedic bony and soft tissue surgery, in the context of a multi-disciplinary rehabilitation team, remains a vital component in the overall management plan. A meticulous clinical examination, augmented in some cases by instrumented gait analysis, allows for a comprehensive treatment plan addressing the entire extremity. This paper provides a critical review of the currently available treatment modalities.