Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49
Filtrar
1.
Toxins (Basel) ; 16(4)2024 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-38668597

RESUMO

INTRODUCTION: The rehabilitation medical team is responsible for the therapeutic management of post-stroke patients and, therefore, for the complex therapeutic approach of spasticity. Considering the generous arsenal at our disposal in terms of both pharmacological treatment, through the possibility of administering botulinum toxin to combat spasticity, and in terms of accurate assessment through developed functional scales such as the GAS (Goal Attainment Scale), one of our purposes is to monitor the parameters that influence the achievement of functional goals set by patients together with the medical team in order to render the patients as close as possible to achieving their proposed functional goals, thus enhancing their quality of life. By assessing and establishing statistical and clinical correlations between the GAS and quantifiable parameters related to the affected post-stroke upper limb, namely degree of spasticity, motor control, pain level and evolution of pain under treatment with BoNT-A (abobotulinum toxin A), and patients' overall response to BoNT-A treatment, we aim to quantify the improvement of the therapeutic management of post-stroke patients with spasticity and develop a more personalized and effective approach to their disability and impairment. RESULTS AND DISCUSSIONS: The analysis concluded that there were two independent predictors of the Achieved GAS-T score (the study's endpoint parameter) motor control at any level of the upper limb and number of prior BoNT-A injections. The number of prior BoNT-A injections was an independent predictor of Achieved GAS-T score improvement but had no significant influence over Baseline GAS-T score. Enhancement in proximal and intermediate motor control showed a GAS score improvement of 3.3 points and a 0.93-point GAS score improvement for wrist motor control progress. From a separate viewpoint, patients with motor deficit on the left side have shown significantly greater improvement in Changed GAS-T scores by 2.5 points compared to patients with deficits on the right side; however, we note as a study limitation the fact that there was no statistical analysis over the dominant cerebral hemisphere of each patient. CONCLUSIONS: Improvement in the Achieved GAS-T score means better achievement of patients' goals. Thus, after the BoNT- A intervention, at follow-up evaluation, GAS was found to be directly correlated with improvement in motor control of the affected upper limb. Mobility of the corresponding limb was enhanced by pain decrease during p-ROM (passive range of motion) and by amelioration of spasticity. MATERIALS AND METHODS: We conducted an observational, non-randomized clinical study on 52 stroke patients, a representative sample of patients with post-stroke spasticity and disability from our neurological rehabilitation clinic, who have been treated and undergone a specific rehabilitation program in our tertiary diagnostic and treatment medical center, including BoNT-A focal treatment for spasticity in the affected upper limb. The primary objective of the study was to assess the influence of abobotulinum toxin A treatment on the Goal Attainment Scale. Secondary objectives of the study included the assessment of BoNT-A treatment efficacy on spasticity with the MAS (Modified Ashworth Scale), pain with the NRS (Numerical Rating Scale), and joint passive range of motion (p-ROM), identifying demographic, clinical, and pharmacological factors that influence the response to BoNT-A treatment, as well as to conduct a descriptive and exploratory analysis of the studied variables.


Assuntos
Toxinas Botulínicas Tipo A , Espasticidade Muscular , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/complicações , Masculino , Toxinas Botulínicas Tipo A/uso terapêutico , Feminino , Pessoa de Meia-Idade , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Resultado do Tratamento , Fármacos Neuromusculares/uso terapêutico , Extremidade Superior , Objetivos , Qualidade de Vida , Adulto
2.
Int J Oral Maxillofac Surg ; 53(6): 526-532, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38302300

RESUMO

The influence of age and region of the mouth was assessed in regard to mouth opening in fully guided implant placement. Ninety patients were included in this study, 30 in each of three age groups (20-34, 35-55, and >55 years). Maximum passive mouth opening was recorded in three locations: incisal, canine, and molar. The minimum distance required to allow the bone drilling sequence through a static fully guided approach was analysed for four implant systems: Straumann, MIS Dentsply, Astra Tech Dentsply, and Dentium. The mean ± standard deviation maximum mouth opening (all 90 patients) was 46.34 ± 7.70 mm, 36.82 ± 5.92 mm, and 30.99 ± 5.40 mm in the incisal, premolar, and molar region, respectively. No significant difference in mouth opening at any of the three locations was found between the age groups (all P > 0.05). However, a correlation was found between increasing age and decreasing average mouth opening in all three mouth regions; each additional 1 year resulted in a mean reduction of 0.13 mm, 0.09 mm, and 0.08 mm in the incisal, premolar, and molar region, respectively. The minimum required mouth opening was most likely to be met for implant placement in the incisal region (98.9% of all patients) and least likely to be met for placement in the molar region, particularly for older patients (as low as 30% of patients). Mouth opening remains a major limitation in fully guided implant surgery, especially in posterior areas and in older patients. The use of some implant systems in the posterior area may be limited to only one in three patients.


Assuntos
Implantação Dentária Endóssea , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Implantação Dentária Endóssea/métodos , Estudos Transversais , Fatores Etários , Idoso , Implantes Dentários , Cirurgia Assistida por Computador/métodos
3.
Occup Ther Health Care ; : 1-10, 2023 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-38019167

RESUMO

Brachial plexus birth injury (BPBI) occurs in almost 1/1000 live births potentially resulting in lifelong upper extremity weakness and joint contracture. Early referral and initiation of passive range of motion (PROM) are recommended but there is no standard of care to guide treatment. A descriptive survey study design was used to target occupational and physical therapists who work in brachial plexus clinics to identify current practices for early therapeutic intervention. With 26 respondents, therapists recommend initiating PROM by 4 wks of life performed at every diaper change. Seventy-four percent of therapists report differences in outcomes for children whose caregivers are more adherent, however, there was no significant relationship between frequency of PROM and outcomes. More outcome research is needed to identify an optimal frequency and duration, examine the efficacy of methods for parent education, and identify training methods to facilitate adherence.

4.
Children (Basel) ; 10(6)2023 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-37371319

RESUMO

The efficacy and frequency of physiotherapy in the prognosis of congenital muscular torticollis (CMT) that involves the entire sternocleidomastoid (SCM) muscle continues to be unclear. This study investigated the therapeutic effect of intensive inpatient therapy given to infants with CMT that involves the whole SCM using clinical measurements and ultrasound (US). This study included 54 infants (27 boys and 27 girls; mean corrected age of 18.57 days) evaluated for CMT at our outpatient clinic from January 2014 to May 2021. The included patients were divided into three groups (groups 1, 2, and 3). Patients in group 1 underwent outpatient treatment 12 times. Patients in groups 2 and 3 underwent therapeutic exercise followed by US diathermy with microcurrent twice daily for 1 or 2 weeks, respectively. Passive range of motion of the cervical rotation (PCRROM) and SCM thickness were evaluated pre- and post-treatment. Among the three groups, the demographic data at baseline were not significantly different, SCM thickness and PCRROM were significantly decreased/increased at post-treatment compared to pre-treatment (p < 0.05), mean PCRROM change was significantly greater in group 3 (p < 0.05), and mean SCM thickness reduction between pre-treatment and 3 months post-treatment was significantly greater in groups 2 and 3 (p < 0.05). Therefore, intensive inpatient therapeutic exercise and US diathermy with microcurrent may enhance the prognosis of CMT involving the entire SCM muscle.

5.
J Pediatr Rehabil Med ; 16(2): 331-336, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37005904

RESUMO

PURPOSE: This pilot study investigated the efficacy of passive range of motion (PROM) during the first year of life to prevent development of shoulder contractures in children with brachial plexus birth injury (BPBI) and identified facilitators and barriers to caregiver adherence with daily PROM. METHODS: Five caregivers of children with upper trunk BPBI participated in retrospective interviews about the frequency with which they performed PROM during their child's first year of life including facilitators and barriers to daily adherence. Medical records were reviewed for documentation of caregiver-reported adherence and documented evidence of shoulder contracture by age one. RESULTS: Three of the five children had documented shoulder contractures; all three had delayed initiation or inconsistent PROM in the first year of life. Two without shoulder contractures received consistent PROM throughout the first year of life. Making PROM part of the daily routine was a facilitator to adherence while family contextual factors were barriers. CONCLUSION: Absence of shoulder contracture may be related to consistent PROM throughout the first year of life; decreased frequency of PROM after the first month of life did not increase the risk of shoulder contracture. Consideration of family routines and context may facilitate adherence with PROM.


Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Plexo Braquial , Contratura , Articulação do Ombro , Criança , Humanos , Ombro , Projetos Piloto , Neuropatias do Plexo Braquial/complicações , Neuropatias do Plexo Braquial/prevenção & controle , Estudos Retrospectivos , Contratura/etiologia , Contratura/prevenção & controle , Amplitude de Movimento Articular , Traumatismos do Nascimento/complicações
6.
NeuroRehabilitation ; 51(3): 481-488, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35964208

RESUMO

BACKGROUND: To date little is known about factors affecting walking rehabilitation in Parkinson's disease (PD) patients. OBJECTIVE: This prospective observational cohort study evaluated the walking distance covered in 6 minutes (6 MWD) before and after conventional rehabilitation and verified which among PD motor disorders was the most important determinant of walking distance in PD patients undergoing rehabilitation. METHODS: Data were collected from 55 PD patients, performing a conventional outpatient motor rehabilitation program. The 6MWD at the end of rehabilitation and gain in 6MWD were the outcome measures. The Unified Parkinson's Disease Rating Scale, Hoehn and Yahr scale, Nine Hole Peg Test, Grip and Pinch test, ROM wrist motility, and Berg Balance Scale (BBS) were used to assess PD patients at admission and were considered as dependent variables. Backward multiple regression analyses identified the determinants of 6MWD outcomes. RESULTS: The 6MWD was 246.58±115 meters at admission and 286.90±116 at the end of rehabilitation. At end of rehabilitation, the 6MWD was 42.32±47 meters greater than admission (p < 0.001), corresponding to an increase of +17.16%. At the end of rehabilitation, the 6MWD was significantly longer in PD patients with stages 1-3 of the Hoehn and Yahr scale. Berg Balance Scale (ß= 0.47, p < 0.001) and right Grip and Pinch at admission (ß= 0.36, p = 0.001) were the only determinants of final 6MWD. The R2 value of the model was 0.47 (R2 adjusted 0.45). No variable was a determinant of gain in 6MWD. CONCLUSIONS: The study indicates that balance and generalized muscle strength are important determinants of walking rehabilitation in PD patients, in whom it is essential to maintain high levels of balance and muscle strength for a time as long as possible. These findings suggest planning more intensive rehabilitation treatments in PD patients with low levels of balance and muscle strength.


Assuntos
Doença de Parkinson , Humanos , Estudos Prospectivos , Caminhada , Força Muscular , Hospitalização
8.
Clin Rehabil ; 36(8): 1083-1096, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35369762

RESUMO

OBJECTIVE: To compare the effect of mechanical traction from different knee angles on pain, physical function, and range of motion in patients with knee osteoarthritis. DESIGN: A single-blinded, randomized controlled trial. SETTING: Outpatient public and governmental Hospital clinics. PARTICIPANTS: One hundred and twenty patients with knee osteoarthritis were randomly assigned into 4 equal groups with 30 patients in each group. INTERVENTIONS: Group (A) received conventional physiotherapy(CPT) treatment; group (B) received CPT with knee traction from full extension, group (C) received CPT with knee traction from 90° flexion, while group (D) received CPT with knee traction from 20° flexion. Interventions were applied 3 sessions a week for 4 weeks. OUTCOME MEASUREMENTS: Visual analog scale (VAS), knee passive range of motion and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured at baseline, immediately after 4 weeks of intervention, and after 4 weeks of no intervention as a follow-up. RESULTS: After eight weeks, the mean (SD) for VAS scores were 30.97 ± 8.68, 24.0 ± 8.8, 15.43 ± 6.31, and 16.17 ± 6.11 mm; for total WOMAC scores were 26.77 ± 9.19, 20.3 ± 8.52, 13.27 ± 6.25, and 13.43 ± 7.14 for groups A, B, C and D, respectively. The three traction groups showed statistically significant changes in pain scores, physical function, and total WOMAC, but not for knee passive range of motion, in favor of traction groups C and D than the conventional group (P < 0.05). CONCLUSIONS: Traction from 90°and 20° of knee flexion was found superior to full extension knee in improving pain and physical function, but not for knee passive range of motion, in patients with knee osteoarthritis.


Assuntos
Osteoartrite do Joelho , Humanos , Articulação do Joelho , Osteoartrite do Joelho/terapia , Dor , Amplitude de Movimento Articular , Tração , Resultado do Tratamento
9.
Int J Cardiol ; 359: 28-34, 2022 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-35447274

RESUMO

BACKGROUND: Growth is often impaired in infants with congenital heart disease. Poor growth has been associated with worse neurodevelopment, abnormal behavioral state, and longer time to hospital discharge. Nutritional interventions, drug therapy, and surgical palliation have varying degrees of success enhancing growth. Passive range of motion (PROM) improves somatic growth in preterm infants and is safe and feasible in infants with hypoplastic left heart syndrome (HLHS), after their first palliative surgery (Norwood procedure). METHODS: This multicenter, Phase III randomized control trial of a 21-day PROM exercise or standard of care evaluates growth in infants with HLHS after the Norwood procedure. Growth (weight-, height- and head circumference-for-age z-scores) will be compared at 4 months of age or at the pre-superior cavopulmonary connection evaluation visit, whichever comes first. Secondary outcomes include neonatal neurobehavioral patterns, neurodevelopmental assessment, and bone mineral density. Eligibility include diagnosis of HLHS or other single right ventricle anomaly, birth at ≥37 weeks gestation and Norwood procedure at <30 days of age, and family consent. Infants with known chromosomal or recognizable phenotypic syndromes associated with growth failure, listed for transplant, or expected to be discharged within 14 days of screening are excluded. CONCLUSIONS: The TEAM 4 Growth trial will make an important contribution to understanding the role of PROM on growth, neurobehavior, neurodevelopment, and BMD in infants with complex cardiac anomalies, who are at high risk for growth failure and developmental concerns.


Assuntos
Cardiopatias Congênitas , Síndrome do Coração Esquerdo Hipoplásico , Procedimentos de Norwood , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Cuidados Paliativos/métodos , Resultado do Tratamento
10.
Brain Sci ; 12(4)2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35447984

RESUMO

Background and Objectives: Ankle foot orthoses (AFOs) are commonly used by stroke patients to walk safely and efficiently. Both posterior AFOs (PAFOs) and anterior AFOs (AAFOs) are available. The objective of this study was to compare the efficacy of AAFOs and PAFOs in the treatment of ankle spasticity. Materials and Methods: A crossover design with randomization for the interventions and blinded assessors was used. Twenty patients with chronic stroke, a Modified Ashworth Scale (MAS) score of the ankle joint of 2, and a Tardieu angle ≥20 degrees were recruited. The patients were assigned to wear either an AAFO or PAFO at random and subsequently crossover to the other AFO. Results: Twenty stroke patients with ankle spasticity were recruited. The mean age was 46.60 (38−60) years. The mean time since stroke onset was 9.35 (6−15) months. It was discovered that the AAFO improved walking speed as well as the stretch reflex dynamic electromyography (dEMG) and walking dEMG amplitudes of the medial gastrocnemius muscles more significantly than the PAFO (p < 0.05). Conclusions: The AAFO had greater efficacy in reducing both static and dynamic ankle spasticity, and allowed for faster walking than the PAFO. The stretch reflex and walking dEMG amplitudes could be used for quantitative spasticity assessment.

11.
S Afr J Physiother ; 78(1): 1589, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35281779

RESUMO

Background: Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce. Objectives: A randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM. Method: Eleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 × 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period. Results: Using combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation (p = 0.006). An average increase of 6.82° (± 9.20°) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation -7.27° ± 10.81°; angular mobilisation -5.45° ± 11.72°). Conclusion: These preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis. Clinical implications: Performing a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms.

12.
Front Bioeng Biotechnol ; 9: 714292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381767

RESUMO

Objective: To compare the mechanical parameters and trajectory while operating the oblique pulling manipulation and the cervical rotation-traction manipulation. Methods: An experimental research measuring kinematics parameter and recording motion trajectories of two cervical manipulations were carried out. A total of 48 healthy volunteers participated in this study, who were randomly divided into two groups of 24 representing each of the two manipulations. A clinician performed two manipulations in two groups separately. A motion capture system was used to monitor and analyze kinematics parameters during the operation. Results: The two cervical manipulations have similar thrust time, displacement, mean velocity, max velocity, and max acceleration. There were no significant differences in active and passive amplitudes between the two cervical rotation manipulations. The thrust amplitudes of the oblique pulling manipulation and the cervical rotation-traction manipulation were 5.735 ± 3.041° and 2.142 ± 1.742°, respectively. The thrust amplitudes of the oblique pulling manipulation was significantly greater than that of the cervical rotation-traction manipulation (P < 0.001). Conclusion: Compared with the oblique pulling manipulation, the cervical rotation-traction manipulation has a less thrust amplitudes.

13.
Arch Rehabil Res Clin Transl ; 3(1): 100104, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33778477

RESUMO

OBJECTIVE: To investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures measured as joint mobility or passive stiffness. DATA SOURCES: Embase, MEDLINE, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database in June-July 2019 and again in July 2020. STUDY SELECTION: The search resulted in 8020 records, which were screened by 2 authors based on our patient, intervention, comparison, outcome criteria. We included controlled trials of nonsurgical interventions administered to treat muscle contractures in individuals with neurologic disorders. DATA EXTRACTION: Authors, participant characteristics, intervention details, and joint mobility/passive stiffness before and after intervention were extracted. We assessed trials for risk of bias using the Downs and Black checklist. We conducted meta-analyses investigating the short-term effect on joint mobility using a random-effects model with the pooled effect from randomized controlled trials (RCTs) as the primary outcome. The minimal clinically important effect was set at 5°. DATA SYNTHESIS: A total of 70 trials (57 RCTs) were eligible for inclusion. Stretch had a pooled effect of 3° (95% CI, 1-4°; prediction interval (PI)=-2 to 7°; I 2=66%; P<.001), and robot-assisted rehabilitation had an effect of 1 (95% CI, 0-2; PI=-8 to 9; I 2=73%; P=.03). We found no effect of shockwave therapy (P=.56), physical activity (P=.27), electrical stimulation (P=.11), or botulinum toxin (P=.13). Although trials were generally of moderate to high quality according to the Downs and Black checklist, only 18 of the 70 trials used objective measures of muscle contractures. In 23 trials, nonobjective measures were used without use of assessor-blinding. CONCLUSIONS: We did not find convincing evidence supporting the use of any nonsurgical treatment option. We recommend that controlled trials using objective measures of muscle contractures and a sufficiently large number of participants be performed.

14.
J Int Med Res ; 49(3): 300060521998208, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33784844

RESUMO

OBJECTIVE: Outcome differences between selective abobotulinumtoxin type A (aboBoNT/A) injections into the soleus (SOL) and gastrocnemius (GAS) muscles were investigated in post-stroke patients with spastic foot drop. METHODS: A monocentric observational study was conducted at a university hospital botulinum toxin clinic including 24 free-walking adult, botulinum toxin-naive patients with post-stroke hemiplegia. AboBoNT/A (800 MU in 4 mL saline) was injected into the SOL or GAS muscle under electromyographic guidance. After 30 days post-injection, the effect of aboBoNT/A injection was assessed by patients. The treating physician scored spasticity and measured angles at the knee and ankle joint and gait speed. RESULTS: After 30 days, significant improvements of subjective and objective outcome measures were observed. No significant difference was observed in the modified Ashworth scale, gait speed, ankle and knee angles, or their angle combinations between the SOL and GAS groups. Tendencies toward greater active range of motion (RoM) improvement in the SOL group and passive RoM improvement in the GAS group were observed. The difference between active and passive ankle extensions plus knee flexions was significantly larger in the SOL group. CONCLUSIONS: Selective 800 MU aboBoNT/A injections into the SOL or GAS muscle were effective but without relevant clinical difference.


Assuntos
Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Fármacos Neuromusculares , Neuropatias Fibulares , Acidente Vascular Cerebral , Adulto , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Humanos , Injeções Intramusculares , Espasticidade Muscular/tratamento farmacológico , Músculo Esquelético , Fármacos Neuromusculares/uso terapêutico , Amplitude de Movimento Articular , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento
15.
Dev Neurorehabil ; 24(3): 205-213, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33356718

RESUMO

Objectives: To map the presence, severity, and distribution of spasticity and passive range of motion (pROM) deviations in dyskinetic cerebral palsy (DCP), and to explore their relation with dystonia, choreoathetosis, and functional abilities.Methods: This cross-sectional study included 53 participants with DCP. Spasticity was assessed with the Modified Ashworth Scale, limited- and increased pROM (hypermobility) with a goniometer, dystonia and choreoathetosis with the Dyskinesia Impairment Scale, gross motor and manual abilities with corresponding functional classification systems.Results: Spasticity and limited pROM were correlated with dystonia of the upper limbs (0.41< rs<0.47, <0.001 < p < .002) and lower limbs (0.31< rs<0.41, 0.002 < p < .025), and both functional systems of gross motor (0.32< rs<0.51, <0.001 < p < .018) and fine manual abilities (0.34< rs<0.44, 0.001 < p < .014). Hypermobility is correlated only with choreoathetosis of the lower limbs (0.44, p = .001).Conclusions: Coexisting spasticity and pROM deviations in DCP are functionally limiting and should be addressed accordingly. Hypermobility may lead to an increased luxation risk.


Assuntos
Paralisia Cerebral/diagnóstico , Discinesias/diagnóstico , Distonia/diagnóstico , Amplitude de Movimento Articular , Adulto , Paralisia Cerebral/classificação , Criança , Discinesias/classificação , Distonia/classificação , Feminino , Humanos , Masculino , Espasticidade Muscular/classificação , Espasticidade Muscular/diagnóstico , Extremidade Superior/fisiopatologia
16.
Clin Rehabil ; 34(6): 803-811, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32336148

RESUMO

OBJECTIVE: The aim of this study is to evaluate a novel composite measure of active range of motion (XA) and determine whether this measure correlates with active function. DESIGN: Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA. SETTING: Tertiary rehabilitation centers in Australia, Europe, and the United States. SUBJECTS: Adults with upper (n = 254) or lower (n = 345) limb spastic paresis following stroke or brain trauma. INTERVENTIONS: AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb. MAIN MEASURES: XA was used to calculate a novel composite measure (CXA), defined as the sum of XA against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CXA and active function at Weeks 4 and 12 of open-label cycles were explored. RESULTS: CXA and active function were moderately correlated in the upper limb (P < 0.0001-0.0004, r = 0.476-0.636) and weakly correlated in the lower limb (P < 0.0001-0.0284, r = 0.186-0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CXA and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, P = 0.0160, r = 0.213; Cycle 3 Week 4, P = 0.0031, r = 0.296). Across cycles, CXA improvements peaked at Week 4, while functional improvements peaked at Week 12. CONCLUSION: CXA is a valid measure for functional impairments in spastic paresis. CXA improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.


Assuntos
Extremidade Inferior/fisiopatologia , Espasticidade Muscular/fisiopatologia , Paresia/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Extremidade Superior/fisiopatologia , Inibidores da Liberação da Acetilcolina/uso terapêutico , Adulto , Idoso , Austrália , Toxinas Botulínicas Tipo A/uso terapêutico , Lesões Encefálicas/complicações , Lesões Encefálicas/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/complicações , Espasticidade Muscular/tratamento farmacológico , Músculo Esquelético/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Paresia/complicações , Paresia/tratamento farmacológico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Velocidade de Caminhada
17.
PeerJ ; 8: e8561, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32211225

RESUMO

PURPOSE: The aim of this study was to compare the effects of four months of two types of structured training regimes, static standing (StS) versus dynamic standing (DyS), on passive range of motion (PROM) and spasticity in the hip among non-ambulatory children with cerebral palsy. METHOD: Twenty non-ambulatory children with cerebral palsy participated in an exercise intervention study with a crossover design. During StS, the Non-ambulatory children with cerebral palsy were encouraged to exercise according to standard care recommendations, including daily supported StS for 30-90 min. During DyS, daily exercise for at least 30 min at a speed between 30 and 50 rpm in an Innowalk (Made for movement, Norway) was recommended. We assessed adaptive effects from the exercise programs through PROM in the hip assessed with a handheld goniometer, and spasticity in the hip assessed with the Modified Ashworth Scale before and after 30 min of StS or DyS. A trained physiotherapist performed the assessments. The exercise test and exercise training were performed in the children's habitual environment. Non-parametric statistics were used and each leg was used as its own control. RESULT: PROM increased in all directions after 30 min (p < 0.001), and after four months of exercise training (p < 0.001) of DyS. Thirty minutes of DyS lowered the spasticity in the muscles around the hip (p < 0.001) more than 30 min of StS (p < 0.001). CONCLUSION: Thirty minutes of DyS increased PROM and decreased spasticity among non-ambulatory children with CP. Four months of DyS increased PROM but did not decrease spasticity. These results can help inform individualised standing recommendations.

18.
J Pediatr Rehabil Med ; 12(2): 151-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31227665

RESUMO

PURPOSE: To investigate how the onset of independent walking in children with Cerebral Palsy (CP) influences the Passive Range of Motion (PROM) of lower limb joints. METHOD: Sixteen children with CP, GMFCS levels I and II, and 16 Typical Development (TD) children who had just begun independent walking participated in the study. The PROM of the hip abduction and external rotation, knee extension, popliteal angle, and ankle dorsiflexion was recorded with a goniometer at the onset of independent walking and 8 months later. A repeated-measures two-way ANOVA was conducted to compare the main effects of "walking experience" and "group of children" and the interaction effect between them on PROM of lower extremities' joints. RESULTS: The effect of "group of children" in the PROM was significant; differences were observed between children with CP and TD children for all joints (p< 0.05). The effect of "walking experience" did not have a significant impact on PROM changes and the interaction effect of "group of children" and "walking experience" was also not significant for all the variables. CONCLUSIONS: The alternative gait pattern spontaneously adopted by children with CP does not significantly impact their PROM during the initial stages of walking development. The lower PROM in highly functional children with CP compared to TD children cannot be attributed to gait initiation with an "atypical" pattern, but possibly to other factors such as reduced voluntary movement and age.


Assuntos
Paralisia Cerebral/fisiopatologia , Amplitude de Movimento Articular , Caminhada/fisiologia , Estudos de Casos e Controles , Pré-Escolar , Quadril/fisiopatologia , Humanos , Joelho/fisiopatologia , Perna (Membro)/fisiopatologia , Masculino , Amplitude de Movimento Articular/fisiologia
19.
J Orthop ; 16(5): 426-429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31193088

RESUMO

BACKGROUND: The purpose of this study was to investigate the relationship between retear after arthroscopic rotator cuff repair and passive range of motion of the shoulder. METHODS: Passive range of motion before and after surgery was compared between the two groups. RESULTS: The healed and retear groups comprised 86.4% and 13.6% shoulders, respectively. Passive external rotation with the arm at the side at 3 months postoperatively was significantly smaller in the healed group than retear group. CONCLUSIONS: This difference seemed to be associated with stiffness in external rotation of the shoulder and the process of cuff healing after surgery. LEVEL OF EVIDENCE: Level III, Case-Control Study, Treatment Study.

20.
Arch Rehabil Res Clin Transl ; 1(3-4): 100030, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33543059

RESUMO

OBJECTIVE: To provide a proof-of-concept study demonstrating that the decades old procedure of cryoneurotomy, used traditionally for analgesia, is a safe adjunctive and effective treatment for limb spasticity. DESIGN: Case series. SETTING: Publicly funded outpatient hospital spasticity clinic and community interventional anesthesia clinic. PARTICIPANTS: Patients (N=3) who had plateaued with standard of care spasticity treatments including botulinum toxin. Two hemiplegic stroke patients with elbow spasticity and 1 pregnant patient with multiple sclerosis and a spastic equinovarus foot for whom botulinum toxin was now contraindicated. INTERVENTIONS: Selective anesthetic diagnostic motor nerve blocks with ultrasound and e-stimulation with 1cc of 1% lidocaine to the motor nerve to the targeted spastic muscle were performed to either the musculocutaneous nerve to brachialis, radial nerve to the brachioradialis or the tibial nerve. If the benefits included improved active and passive range motion and or decreased clonus, a percutaneous cryoneurotomy was performed. MAIN OUTCOME MEASURES: Active and passive range of motion were measured using the Modified Tardieu Scale. The change in resistance to passive stretch was measured using the Modified Ashworth Scale (MAS). Videos of the before and after treatment were collected. RESULTS: Both elbows' treatments resulted in MAS improving from a 3 to a 1+. Greatly improved active range of motion was noted at 94 and 64 degrees, respectively, as well as improvements in passive range on the Modified Tardieu Scale. The tibial nerve cryoneurotomy resulted in improvements in all parameters with a much improved gait. Results were maintained up to 17 months of follow-up. CONCLUSION: Cryoneurotomy as a treatment for spasticity is a novel safe adjuvant treatment. Our initial results suggest patients can achieve significantly increased active and passive range of motion in the upper extremity and decreased clonus, and improved gait after tibial nerve cryoneurotomy.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...