ABSTRACT
INTRODUCTION: Physiotherapy plays a key role in cerebral palsy rehabilitation, through addressing body function/structure deficits, minimizing activity limitations, and encouraging participation. The muscle shortening manoeuvre is an innovative therapeutic technique, characterized by the ability to induce changes in muscle strength in a short time. OBJECTIVE: To describe the applicability and estimate the effect of the muscle shortening manoeuvre applied to improve motor weakness and joint excursion of the ankle in children with hemiplegic cerebral palsy. METHODS: Nine children with hemiplegic cerebral palsy received 3 intervention sessions in one week. Muscle strength, passive and active range of motion were assessed before, during and after the training, and at 1-week follow-up. RESULTS: The children experienced an immediate increase in muscle strength and joint excursion of the ankle; the improvements were still present at follow-up after 7 days. CONCLUSION: The muscle shortening manoeuvre may be an effective intervention to induce an immediate increase in muscle strength and range of motion of the ankle in children affected by hemiplegia due to cerebral palsy, thus promoting better physical functioning.
ABSTRACT
Muscular spasticity represents one of the most common motor disorder associated to lesions of the Central Nervous System, such as Stroke, and affects joint mobility up to the complete prevention of skeletal muscle voluntary control. Its clinical evaluation is hence of fundamental relevance for an effective rehabilitation of the affected subjects. Standard assessment protocols are usually manually performed by humans, and hence their reliability strongly depends on the capabilities of the clinical operator performing the procedures. To overcome this limitation, one solution is the usage of mechatronic devices based on the estimation of the Tonic Stretch Reflex Threshold, which allows for a quite reliable and operator-independent evaluation. In this work, we present the design and characterization of a novel mechatronic device that targets the estimation of the Tonic Stretch Reflex Threshold at the elbow level, and, at the same time, it can potentially act as a rehabilitative system. Our device can deliver controllable torque/velocity stimulation and record functional parameters of the musculo-skeletal system (joint position, torque, and multi-channel ElectroMyoGraphyc patterns), with the ultimate goals of: i) providing significant information for the diagnosis and the classification of muscular spasticity, ii) enhancing the recovery evaluation of patients undergoing through therapeutic rehabilitation procedures and iii) enabling a future active usage of this device also as therapeutic tool.Clinical relevance- The contribution presented in this work proposes a technological advancement for a device-based evaluation of motion impairment related to spasticity, with a major potential impact on both the clinical appraisal and the rehabilitation procedures.
Subject(s)
Elbow , Reflex, Stretch , Electromyography , Humans , Muscle Spasticity/diagnosis , Reproducibility of ResultsABSTRACT
BACKGROUND AND OBJECTIVES: From year 2003 we treated positively 251 patients with Traumatic Spinal Cord Injuries (TSCI), using Non-Surgical Laser Therapy (NSLT). In order to increase muscle strength, we have also started using a physical therapy practice called Grimaldi's Muscle Shortening Manoeuvre (GMSM)The goal of our study is to obtain objective data suggesting the real effectiveness of the association of these two treatments. STUDY DESIGN AND METHODS: In 2015, 10 patients with incomplete TSCI were enrolled. Further 10 subjects with similar features were included as control group. All patients have subtotal sensory loss and motor paralysis below the level of the lesion. Lasers used were 808, 10600, and 1064 nm, applied with a first cycle of four sessions per day for a total of 20 sessions. The patients participated in specific physical therapy training (GMSM) twice a day, for a total of eight sessions.Each cycle of laser and GMSM was replicated each month. RESULTS: Results were considered positive if sensitivity increased at least two dermatomes per cycle under the level of the lesion. Results in muscle activity (on/off) were regarded as positive if sEMG showed modifications in CNS-muscle. Objective assessment of force displayed encouraging results. After each cycle, patients showed improvements in motor function and voluntary command. Follow-up is positive after 3 months. CONCLUSION: Associating laser treatment and Grimaldi's Muscle Shortening Manoeuvre (MSM) seems to be effective on muscle strength and motor control in patients affected by subtotal SCI compared to a control group.
