Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report.

BACKGROUND AND PURPOSE: The use of dry needling (DN) with other treatments may be more beneficial in managing post-stroke spasticity. We report the effects of DN plus exercise therapy (ET) on wrist flexor spasticity. PATIENT PRESENTATION: The patient was a 45-year-old man with an 8-year history of stroke. The outcome measures included the Modified Modified Ashworth Scale (MMAS), Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), and range of motion (ROM) which were assessed before (T1), after (T2), and after 3-week follow-up (T3). CONCLUSION: The MMAS was improved at T2 from "3" to "2". The Hmax/Mmax decreased from 0.77 to 0.53 at T3. The H-reflex latency increased from 15.4 ms to 18.5 ms at T3. The wrist active and passive ROM increased ∼30° and ∼20° at T2, respectively. A 4-session DN plus ET may improve spasticity and ROM. No meaningful improvement was observed in function.

A novel polycaprolactone/carbon nanofiber composite as a conductive neural guidance channel: an in vitro and in vivo study.

The current study aimed to investigate the potential of carbon nanofibers to promote peripheral nerve regeneration. The carbon nanofiber-imbedded scaffolds were produced from polycaprolactone and carbon nanofibers using thermally induced phase separation method. Electrospinning technique was utilized to fabricate polycaprolactone/collagen nanofibrous sheets. The incorporation of carbon nanofibers into polycaprolactone's matrix significantly reduced its electrical resistance from 4.3 × 109 ± 0.34 × 109 Ω to 8.7 × 104 ± 1.2 × 104 Ω. Further in vitro studies showed that polycaprolactone/carbon nanofiber scaffolds had the porosity of 82.9 ± 3.7% and degradation rate of 1.84 ± 0.37% after 30 days and 3.58 ± 0.39% after 60 days. The fabricated scaffolds were favorable for PC-12 cells attachment and proliferation. Neural guidance channels were produced from the polycaprolactone/carbon nanofiber composites using water jet cutter machine then incorporated with PCL/collagen nanofibrous sheets. The composites were implanted into severed rat sciatic nerve. After 12 weeks, the results of histopathological examinations and functional analysis proved that conductive conduit out-performed the non-conductive type and induced no toxicity or immunogenic reactions, suggesting its potential applicability to treat peripheral nerve damage in the clinic.

Evaluation of dexamethasone treated mesenchymal stem cells for recovery in neurotmesis model of peripheral nerve injury.

OBJECTIVE: Peripheral nerve injuries comprise significant portion of the nervous system injuries. Although peripheral nerves show some capacity of regeneration after injury, the extent of regeneration is not remarkable. The present study aimes to evaluate the regeneration of transected sciatic nerve by a therapeutic value of dexamethasone (DEX) associated with cell therapy (Cell) and biodegradable membrane (Mem) in rat. METHODS: Male Wistar rats (n = 42, 180-200g) were randomly divided into control (Ctrl), Membrane+ Cell, Mem, DEX, DEX+ Cell, DEX+ Mem and DEX+ Cell+ Mem groups. Functional recovery was evaluated at 2, 4, 6, 8 and 12 weeks after surgery using sciatic functional index (SFI), withdrawal reflex latency (WRL) test, electrophysiological and histological analyses. RESULTS: The rats in the DEX+ Cell+ Mem-treated group showed a significant improvement in SFI, WRL and electrophysiological findings during the 2nd to 12th weeks after surgery. In addition, histomorphological findings showed a significant improvement in the DEX+ Cell+ Memtreated group, at 12 weeks after surgery. DISCUSSION: Taken together, use of DEX associated with cell and biodegradable membrane could improve functional and histomorphological properties of the sciatic nerve after injury.

Curcumin and Biodegradable Membrane Promote Nerve Regeneration and Functional Recovery After Sciatic Nerve Transection in Adult Rats.

BACKGROUND: Curcumin has immunomodulatory anti-inflammatory, antioxidant, and neuroprotective properties. The goal of this study was to determine the effects of curcumin and biodegradable membrane on nerve healing in rat sciatic nerve transected injuries. METHODS: Rats were divided into groups: (1) control group (Ctrl), (2) curcumin group (Cur), (3) membrane group (Mem), and (4) membrane and curcumin group (Mem + Cur). Functional recovery was evaluated at 2, 4, 6, and 8 weeks after surgery. At the end of the eighth week after surgery, histological assessments were done. RESULTS: At the end of 8th week after surgery, functional assessments (sciatic nerve index, withdrawal reflex latency, and electromyography) in the Mem + Cur group improved compared with other groups (P < 0.05). Histological results (number of nerve fibers, diameter of nerve fibers, and myelin thickness) improved in the Mem + Cur group compared with the control, Cur, and Mem groups (P < 0.05). CONCLUSION: The present study showed the positive effects of Mem + Cur on nerve regeneration of transected sciatic nerve in rat model.

Polyurethane/Gelatin Nanofibrils Neural Guidance Conduit Containing Platelet-Rich Plasma and Melatonin for Transplantation of Schwann Cells.

The current study aimed to enhance the efficacy of peripheral nerve regeneration using a biodegradable porous neural guidance conduit as a carrier to transplant allogeneic Schwann cells (SCs). The conduit was prepared from polyurethane (PU) and gelatin nanofibrils (GNFs) using thermally induced phase separation technique and filled with melatonin (MLT) and platelet-rich plasma (PRP). The prepared conduit had the porosity of 87.17 ± 1.89%, the contact angle of 78.17 ± 5.30° and the ultimate tensile strength and Young's modulus of 5.40 ± 0.98 MPa and 3.13 ± 0.65 GPa, respectively. The conduit lost about 14% of its weight after 60 days in distilled water. The produced conduit enhanced the proliferation of SCs demonstrated by a tetrazolium salt-based assay. For functional analysis, the conduit was seeded with 1.50 × 104 SCs (PU/GNFs/PRP/MLT/SCs) and implanted into a 10-mm sciatic nerve defect of Wistar rat. Three control groups were used: (1) PU/GNFs/SCs, (2) PU/GNFs/PRP/SCs, and (3) Autograft. The results of sciatic functional index, hot plate latency, compound muscle action potential amplitude and latency, weight-loss percentage of wet gastrocnemius muscle and histopathological examination using hematoxylin-eosin and Luxol fast blue staining, demonstrated that using the PU/GNFs/PRP/MLT conduit to transplant SCs to the sciatic nerve defect resulted in a higher regenerative outcome than the PU/GNFs and PU/GNFs/PRP conduits.

Chitosan-film associated with mesenchymal stem cells enhanced regeneration of peripheral nerves: A rat sciatic nerve model.

OBJECTIVE: Peripheral nerve injuries comprise significant portion of the nervous system injuries. Although peripheral nerves show some capacity of regeneration after injury, but the extent of regeneration is not remarkable. Regeneration might be through the activity of the mesenchymal stem cells (MSCs) which can release growth factors or extracellular matrix components or by the therapeutic effect of some material with the MSCs. The present study aimed to evaluate the regeneration of transected sciatic nerve by a therapeutic value of mesenchymal stem cells (MSCs) associated with chitosan-film (Cs) in rat. MATERIALS & METHODS: Male Wistar rats (n=42, 180-200g) were randomly divided into intact; control; sham; Cs; MSCs; MSCs + Cs groups. Functional recovery was evaluated at 2, 4, 6 and 8 weeks after surgery using sciatic functional index (SFI), hot water paw immersion test, electrophysiological, histological analyses. RESULTS: The rats in the MSCs+Cs group showed significant decrease in SFI and hot water paw immersion test during the 2nd to 8th weeks after surgery. Electrophysiological findings showed a significant decrease in latency time in the MSCs +Cs group. Amplitude of the nerve impulses also increased. Number of nerve fibers with more than 6 µm diameters increased significantly in MSCs+Cs. The number of nerve fibers with less than 4 µm diameters also increased significantly in MSCs+Cs group. CONCLUSION: Taken together, mesenchymal stem cells associated with Cs could improve functional and histomorphological properties of the sciatic nerve after injury which may have some clinical outcomes as well.

A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke.

BACKGROUND: Spasticity is a common complication after stroke. Dry needling (DN) is suggested as a novel method for treatment of muscle spasticity. OBJECTIVE: To explore the effects of DN on wrist flexors spasticity poststroke. METHODS: A single group, pretest-posttest clinical trial was used. Twenty nine patients with stroke (16 male; mean age 54.3 years) were tested at baseline (T0), immediately after DN (T1), and one hour after DN (T2). DN was applied for flexor carpi radialis (FCR) and flexor carpi ulnaris on the affected arm for single session, one minute per muscle. The Modified Modified Ashworth Scale (MMAS), passive resistance force, wrist active and passive range of motion, Box and Block Test, and FCR H-reflex were outcome measures. RESULTS: Significant reductions in MMAS scores were seen both immediately after DN and at 1-hour follow-up (median 2 at T0 to 1 at T1 and T2). There were significant improvements in other measures between the baseline values at T0 and those recorded immediately after the DN at T1 or one hour later at T2. CONCLUSIONS: This study suggests that DN reduced wrist flexors spasticity and alpha motor neuron excitability in patients with stroke, and improvements persisted for one hour after DN.

Study of Transected Sciatic Nerve Repair by Amniotic Membrane with Betamethasone in Adult Albino Wistar Rats.

BACKGROUND: The aim of this study was to determine the effects of amniotic membrane impregnated with betamethasone on regeneration of transected sciatic nerve injury in adult albino Wister rats. METHODS: In this research, 42 male adult rats were divided into six equal groups. 1) Normal (intact) group: healthy rats without any injury; 2) CONTROL GROUP: sciatic nerve was cut and sutured; 3) Sham group: 0.2 mL culture medium was injected on the epineurium in the injury; 4) Amniotic membrane group (AM): Acellular amniotic membrane was used around the damaged sciatic nerve; 5) Betamethasone group (B): 0.2 mL Betamethasone (4 mg/mL) was injected in the site of damaged nerve and 6) Amniotic membrane group and Betamethasone (AM/B) group: Acellular amniotic membrane impregnated with 0.2 mL betamethasone was used around the damaged sciatic nerve. The rate of recovery was studied by Sciatic Functional Index (SFI), withdrawal reflex latency (WRL) test and electroctrophysiological assessments at 2, 4, 6 and 8 weeks after surgery. Histological assessment was done 8 weeks after surgery. RESULTS: At 8 weeks after surgery, SFI, WRL test and electrophysiological values in AM/B group were significantly improved compared to control and sham groups (P < 0.05). Histological results showed improvement in therapeutic groups, especially AM/B group compared to control and sham groups and other therapeutic groups (P < 0.05). CONCLUSION: The present study showed the positive effects of Amniotic membrane and Betamethasone on nerve regeneration of transected sciatic nerve in a rat model.

Lavandula angustifolia Extract Improves the Result of Human Umbilical Mesenchymal Wharton's Jelly Stem Cell Transplantation after Contusive Spinal Cord Injury in Wistar Rats.

Introduction. The primary trauma of spinal cord injury (SCI) results in severe damage to nervous functions. At the cellular level, SCI causes astrogliosis. Human umbilical mesenchymal stem cells (HUMSCs), isolated from Wharton's jelly of the umbilical cord, can be easily obtained. Previously, we showed that the neuroprotective effects of Lavandula angustifolia can lead to improvement in a contusive SCI model in rats. Objective. The aim of this study was to investigate the effect of L. angustifolia (Lav) on HUMSC transplantation after acute SCI. Materials and Methods. Sixty adult female rats were randomly divided into eight groups. Every week after SCI onset, all animals were evaluated for behavior outcomes. H&E staining was performed to examine the lesions after injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP) testing was performed to detect the recovery of neural conduction. Results. Behavioral tests showed that the HUMSC group improved in comparison with the SCI group, but HUMSC + Lav 400 was very effective, resulting in a significant increase in locomotion activity. Sensory tests and histomorphological and immunohistochemistry analyses verified the potentiation effects of Lav extract on HUMSC treatment. Conclusion. Transplantation of HUMSCs is beneficial for SCI in rats, and Lav extract can potentiate the functional and cellular recovery with HUMSC treatment in rats after SCI.

Assessment of the Neuroprotective Effects of Lavandula angustifolia Extract on the Contusive Model of Spinal Cord Injury in Wistar Rats.

INTRODUCTION: Spinal cord injury (SCI) involves a primary trauma and secondary cellular processes that can lead to severe damage to the nervous system, resulting in long-term spinal deficits. At the cellular level, SCI causes astrogliosis, of which glial fibrillary acidic protein (GFAP) is a major index. OBJECTIVE: The aim of this study was to investigate the neuroprotective effects of Lavandula angustifolia (Lav) on the repair of spinal cord injuries in Wistar rats. MATERIALS AND METHODS: Forty-five female rats were randomly divided into six groups of seven rats each: the intact, sham, control (SCI), Lav 100, Lav 200, and Lav 400 groups. Every week after SCI onset, all animals were evaluated for behavior outcomes by the Basso, Beattie, and Bresnahan (BBB) score. H&E staining was performed to examine the lesions post-injury. GFAP expression was assessed for astrogliosis. Somatosensory evoked potential (SEP) testing was performed to detect the recovery of neural conduction. RESULTS: BBB scores were significantly increased and delayed responses on sensory tests were significantly decreased in the Lav 200 and Lav 400 groups compared to the control group. The greatest decrease of GFAP was evident in the Lav 200 and Lav 400 groups. EMG results showed significant improvement in the hindlimbs in the Lav 200 and Lav 400 groups compared to the control group. Cavity areas significantly decreased and the number of ventral motor neurons significantly increased in the Lav 200 and Lav 400 groups. CONCLUSION: Lav at doses of 200 and 400 mg/kg can promote structural and functional recovery after SCI. The neuroprotective effects of L. angustifolia can lead to improvement in the contusive model of SCI in Wistar rats.

Electrophysiological evaluation of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor spasticity.

BACKGROUND: Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. OBJECTIVE: To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. METHODS: A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2-R1 of the MTS; and the H-reflex indices of Hmax/Mmax ratio and Hslp/Mslp ratio. The Hslp and the latency of H-reflex were also measured. RESULTS: Correlations tests did not reveal significant associations between the clinical and H-reflex tests. CONCLUSIONS: This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke.

Evaluation of the Functional Recovery in Sciatic Nerve Injury following the Co-transplantation of Schwann and Bone Marrow Stromal Stem Cells in Rat.

INTRODUCTION: Transplantation of bone marrow stromal cells (BMSCs) or Schwann cells (SCs) can increase axonal regeneration in peripheral nerve injuries. Based on our previous investigations, the goal of the present work was to examine the individual and synergistic effects of the two different cell types in sciatic nerve injury. We pursued to evaluate the effects of BMSCs and SCs co-transplantation on the functional recovery after sciatic nerve injury in rat. METHODS: In this experimental research, adult male Wistar rats (n = 32, 250-300g) were used, BMSCs and SCs were cultured, and the SCs were confirmed with anti S100 antibody. Rats were randomly divided into 4 groups (n = 8 in each group): 1-control group: silicon tube filled with fibrin gel without cells; 2-BMSCs group: silicon tube filled with fibrin gel seeded with BMSCs; 3-SCs group: silicon tube filled with fibrin gel seeded with SCs and 4-co-transplantation group: silicone tube filled with fibrin gel seeded with BMSCs and SCs. The left sciatic nerve was exposed, a 10 mm segment removed, and a silicone tube interposed into this nerve gap. BMSCs and SCs were transplanted separately or in combination into the gap. BMSCs were labeled with anti-BrdU and SCs were labeled with DiI. After 12 weeks electromyographic and functional assessments were performed and analyzed by one-way analysis of variance (ANOVA). RESULTS: Electromyographic and functional assessments showed a significant difference between the experimental groups and controls. Electromyography measures were significantly more favourable in SCs transplantation group as compared to BMSCs transplantation and co-transplantation groups (p < 0.05). Functional assessments showed no statistically significant difference among the BMSCs, SCs and co-transplantation groups (p < 0.05). DISCUSSION: Transplantation of BMSCs and SCs separately or in combination have the potential to generate functional recovery after sciatic nerve injury in rat. The electromyography evaluation showed a greater improvement after SCs transplantation than BMSCs or the co-transplantation of BMSCs and SCs.

Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study.

INTRODUCTION: Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. There is a paucity of literature regarding the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS). No study, to date, has been performed to compare the validity of the MMAS and the MTS. This neurophysiological study protocol will compare the validity of the MMAS and the MTS in the assessment of poststroke wrist flexor spasticity. METHODS AND ANALYSIS: Thirty-two patients with stroke from the University Rehabilitation clinics will be recruited to participate in this cross-sectional, non-interventional study. All measurements will be taken in the Physical Medicine and Rehabilitation Department of Shafa University Hospital in Tehran, Iran. First, wrist flexor spasticity will be assessed clinically using the MMAS and MTS. The tests will be applied randomly. For the MTS, the components of R1, R2, R2-R1 and quality of muscle reaction will be measured. Second, neurophysiological measures of H-reflex latency, H(max)/M(max) ratio, H(slp) and H(slp)/M(slp) ratio will be collected from the affected side. The results will be analysed using Spearman's ρ test or Pearson's correlation test to determine the validity of the MMAS and the MTS as well as to compare the validity between the MMAS and the MTS. ETHICS AND DISSEMINATION: The Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences (TUMS) approved the study protocol.  The study results will be disseminated in peer-reviewed publications and presented at international congresses.

The effects of schwann and bone marrow stromal stem cells on sciatic nerve injury in rat: a comparison of functional recovery.

OBJECTIVE: Transplantation of bone marrow stromal cells (BMSCs) or Schwann cells (SCs) can facilitate axonal regeneration in peripheral nerve injuries. The aim of this study was to compare the effects of transplantation of BMSCs and SCs on functional recovery after injury to the sciatic nerve in the rat. MATERIALS AND METHODS: In this experimental research, adult male Wistar rats (n=24, 250-300 g) were used, BMSCs and SCs were cultured, and SCs were confirmed with anti S100 antibody. Rats were randomly divided into 3 groups (n=8 in each group): 1; control group: silicon tube filled with fibrin gel without the cells, 2; BMSCs group: silicon tube filled with fibrin gel seeded with BMSCs and 3; SCs group: silicon tube filled with fibrin gel seeded with SCs. The left sciatic nerve was exposed, a 10 mm segment removed, and a silicone tube interposed into this nerve gap. BMSCs and SCs were separately transplanted into the gap in the two experimental groups and were labeled with anti BrdU and DiI respectively. After 12 weeks electrophysiological and functional assessments were performed and analyzed by one-way analysis of variance (ANOVA). RESULTS: Electrophysiological and functional assessments showed a significant difference between the experimental groups compared with the control group. Electrophysiological measures were significantly better in the SCs transplantation group compared with the BMSCs treatment group (p <0.05). Functional assessments showed no statistically significant difference between the BMSCs and SCs groups (p <0.05). CONCLUSION: Although both BMSCs and SCs have the potential to produce functional recovery after injury to the sciatic nerve in rats, electrophysiological evaluation confirms that the improvement after SCs transplantation is greater than that after BMSCs transplantation.

A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke.

PRIMARY OBJECTIVE: To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS). RESEARCH DESIGN: A concurrent criterion-related validity study. INTERVENTIONS: Not applicable. METHODS AND PROCEDURES: Thirty patients (15 men and 15 women; mean ± SD = 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, H(max)/M(max) ratio and Hslp. MAIN OUTCOMES AND RESULTS: There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r = -0.81, p < 0.0001). CONCLUSIONS: The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia.