Features of estimation of muscle tone and functional state of spinal motor neurons in patients with post-stroke spasticity on a background of a pharmacological correction

Introduction: Recent scientific research has shown that post-stroke spasticity occurs in 20-30 % of cases. Very often spasticity impairs and gives discomfort for a person who has it. In that case it should be managed and relieved. The aim: To conduct standardization of determination of degrees of spasticity by means of foregoing scales and methodologies with further comparison of their sensitiveness and objectivity of the obtained data. Material and methods: 24 patients with post-stroke spasticity were treated during 14 days using the same centrally acting anti-spastic drug (oral tolperisone hydrochloride). The average duration of spasticity was 25 months (minimum 20 months and maximum 36 months). 24 patients were rated on the Modified Ashworth Scale and of those patients: 1 was rated stage "1", 5 ­ stage "1+", 7 ­ stage "2", 7 ­ stage "3" and 3 patients were rated stage "4". Assessment of muscle tone for each patient was performed daily during morning round. At our study we have used the Modified Ashworth Scale, the Modified Tardieu Scale, Functional Independence Measure, Visual Analog Scale for Pain and some parameters from ENMG study (Hoffmann's reflex and F/M max measured for ulnar nerve at the side of paresis). The results were statistically analyzed through Microsoft Excel 2010 using Student's method and Spearman's rank correlation coefficient. P value less that 0,05 was considered as a significant level. Results: According to collected statistics we can advise for control of treatment of post-stroke spasticity using ENMG parameters and Visual Analog Scale for Pain during first 7 days of treatment, using of Modified Ashworth Scale and Tardieu Scale is more appropriate starting on 7th day of taking anti-spastic medications. Unfortunately, according to gathered statistics there is no correlation between Modified Ashworth Scale and parameters of ENMG. Conclusions: For the estimation of efficiency of post-stroke spasticity treatment in the first 7 days of the therapy more informative are electroneuromyographic parameters and Visual Analog Scale. Muscle tone assessment scales (Modified Ashworth Scale and Modified Tardieu Scale) for the monitoring of dynamic changes of efficiency of the treatment can be recommended beginning from the seventh day of the therapy.

Evalution of the effectiveness of multimodal approach to the management of cervical vertigo.

INTRODUCTION: Vertigo is one of the most common complaints among patients consulting neurologists and general practitioners - family medicine. A special form of dizziness is cervical vertigo. However, the presence of chronic vertigo and imbalance in this group of patients makes it possible to include the treatment of vestibular rehabilitation in the program. AIM: Evalution of the effectiveness of multimodal approach to the management of cervical vertigo. MATERIAL AND METHODS: 109 patients aged from 18 to 45 with vertigo together with myofascial pain syndrome of neck and shoulder area were examined. The survey included a sample of Dix-Hallpike, neurological and otoneurological examinations, Doppler ultrasound of the main arteries of the head and neck, brain MRI, functional spondylography of the cervical spine. For quantitive evaluation of the impact of vertigo on daily life the questionnaire DHI (Dizziness Handicap Inventory) was used. Testing was performed in two stages - before treatment and in 2 weeks' time. Patients were randomly divided into 3 groups which differ in their therapeutic tactics. RESULTS: In all three groups the normalization of the biomechanical pattern and elimination of musculo-tonic disorders accompanied by a decrease of a pain syndrome and a decrease in the severity or complete regression of dizziness and postural instability. At the same time, in groups 2 and 3, in which in addition to manual therapy, patients received acupuncture, there was a distinct positive dynamics of a pain syndrome according to VAS, Neck Disability Index and the Dizziness Handicap Inventory. A marked regression of vertigo and postural instability can be observed in patients in which the treatment along with manual therapy and acupuncture, a complex of vestibular rehabilitation was used. CONCLUSIONS: The multimodal approach using manual therapy in combination with acupuncture and vestibular rehabilitation showed the maximum therapeutic effect on elimination of musculo-tonic disorders, reduction of a pain syndrome with a complete regression of vertigo and postural instability.