Thesis (Ph.D.)--Boston University / The present study focused specifically on the following experimental issues: 1) The nature of the relationship between M.A.S. score and performance on a variety of simple and complex tasks performed by the same subjects. 2) The extent to which amphetamine alone affects performance of these same tasks. 3) The nature of inter-relationships between the following variables: a) type of learning material, b) drug, c) M.A.S. score. 4) The nature of the combined effects of two drives on the performance of the various tasks.

A neurosurgical method of the selective posterior rhizotomy (SPR) is used for a treatment of spasticity. The aim of this study is to evaluate an effect of the SPR on the reduction of the spasticity and on functional abilities of patients with cerebral palsy. Five patients (four males and a female) aged from 12 to 21 years with a spastic quadruplegia were tested by an Ashworth scale, modified Ashworth scale, Peacock scale and Barthel index of ADL. An initial assessment was preformed one day before the SPR. First assessment of changes was conducted one week after the SPR. An repeated follow-up assessment was done three to four years after the SPR procedure. In one week after SPR assessment a reduction of spasticity of lower and upper limb muscles and reduction of clonus were seen. A last three-year assessment detected some return of spasticity on hip adductors, plantar and dorsal flexors muscles. However, the return of the hypertonus did not reach initial values of spasticity. Powered by TCPDF (www.tcpdf.org)

Selective dorsal rhizotomy is a neurosurgical procedure for treating carefully selected patients with cerebral palsy. The aims of this thesis are to assess the influence of this treatment on changes in spasticity, functional abilities, locomotion and activities of daily living of these patients and also to assess the changes in these parameters in patients who were treated using this method at the neurosurgical department in University Hospital Motol in previous years. Six patients with CP diagnosis were tested - five 6 to 21 years old boys and one 35 years old woman. Ashworth and modified Ashworth scales were used to assess spasticity, goniometry was used to measure the range of passive movements. The Barthel index and Global care impairment scale by Dressler tested activities of daily living. Penn Spasm Frequency Score and Peacock's scale of locomotion were also used. The results showed a reduction in spasticity in lower as well as upper extremities, an increased range of passive movement of lower extremities, reduction of clonus the tendon of Achilles and an improvement of speech. Decreased pain and improved ability to perform activities of daily living were noted and hygienic care of a child was made easier thanks to this treatment. Powered by TCPDF (www.tcpdf.org)

Introdução: A toxina botulínica tipo A é uma das principais modalidades de tratamento para pacientes com espasticidade. Uma nova preparações de toxina botulínica sorotipo tipo A, Prosigne®, foi lançada sugerindo ter a mesma eficácia que Botox®. No entanto, não há ensaios clínicos randomizados comparando essas formulações no tratamento da espasticidade. Objetivos: O objetivo deste estudo foi comparar a eficácia ea segurança do Prosigne® com Botox® no tratamento da espasticidade. Métodos: Foi realizado um estudo duplo-cego, randomizado e cruzado com 57 pacientes com espasticidade clinicamente significativas. Os pacientes foram avaliados no início do estudo, 4 e 12 semanas após a injeção de Prosigne® ou Botox®. Resultados: Os principais resultados foram avaliados pelas mudanças na Escala de Ashworth Modificada (EAM), Medida de Independência Funcional MIF) e Pediatric Evaluation of Disability Inventory (PEDI) e os efeitos adversos relacionados ao uso da toxina botulínica. Ambas as toxinas foram significativamente eficazes em diminuir o grau de espasticidade, em adultos e crianças. Não houveram diferenças significativas entre os tratamentos Prosigne® e Botox® em relação aos escores MAS, e FIM PEDI. Da mesma forma, a incidência de efeitos adversos foi similar entre os dois grupos. Conclusão: Nossos resultados sugerem que Prosigne® e Botox® são comparáveis em relação a sua eficácia e segurança no tratamento de três meses da espasticidade. / Background: Botulinum toxin type A is one of the main treatment choices for patients with spasticity. Prosigne® a new released botulinum toxin serotype A may have the same effectiveness as Botox®. However, there are no randomized clinical trials comparing these formulations in spasticity treatment. Objective: The aim of our study was to compare the efficacy and safety of Prosigne® with Botox® in the treatment of spasticity. Methods: We performed a double-blind, randomized, crossover study consisting of 57 patients with clinically meaningful spasticity. The patients were assessed at baseline, 4 and 12 weeks after Prosigne® or Botox® administration. Results: The main outcomes were changes in the patients’ Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Pediatric Evaluation of Disability Inventory (PEDI) scores and adverse effects related to the botulinum toxin. Both of the toxins were significantly effective in relieving the level of spasticity in adults and children. There were no significant differences found between the Prosigne® and Botox® treatments regarding their MAS, FIM and PEDI scores. Likewise, the incidence of adverse effects was similar between the two groups. Conclusion: Our results suggest that Prosigne® and Botox® are both efficient and comparable with respect to their efficacy and safety for the three month treatment of spasticity.

Introdução: A toxina botulínica tipo A é uma das principais modalidades de tratamento para pacientes com espasticidade. Uma nova preparações de toxina botulínica sorotipo tipo A, Prosigne®, foi lançada sugerindo ter a mesma eficácia que Botox®. No entanto, não há ensaios clínicos randomizados comparando essas formulações no tratamento da espasticidade. Objetivos: O objetivo deste estudo foi comparar a eficácia ea segurança do Prosigne® com Botox® no tratamento da espasticidade. Métodos: Foi realizado um estudo duplo-cego, randomizado e cruzado com 57 pacientes com espasticidade clinicamente significativas. Os pacientes foram avaliados no início do estudo, 4 e 12 semanas após a injeção de Prosigne® ou Botox®. Resultados: Os principais resultados foram avaliados pelas mudanças na Escala de Ashworth Modificada (EAM), Medida de Independência Funcional MIF) e Pediatric Evaluation of Disability Inventory (PEDI) e os efeitos adversos relacionados ao uso da toxina botulínica. Ambas as toxinas foram significativamente eficazes em diminuir o grau de espasticidade, em adultos e crianças. Não houveram diferenças significativas entre os tratamentos Prosigne® e Botox® em relação aos escores MAS, e FIM PEDI. Da mesma forma, a incidência de efeitos adversos foi similar entre os dois grupos. Conclusão: Nossos resultados sugerem que Prosigne® e Botox® são comparáveis em relação a sua eficácia e segurança no tratamento de três meses da espasticidade. / Background: Botulinum toxin type A is one of the main treatment choices for patients with spasticity. Prosigne® a new released botulinum toxin serotype A may have the same effectiveness as Botox®. However, there are no randomized clinical trials comparing these formulations in spasticity treatment. Objective: The aim of our study was to compare the efficacy and safety of Prosigne® with Botox® in the treatment of spasticity. Methods: We performed a double-blind, randomized, crossover study consisting of 57 patients with clinically meaningful spasticity. The patients were assessed at baseline, 4 and 12 weeks after Prosigne® or Botox® administration. Results: The main outcomes were changes in the patients’ Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Pediatric Evaluation of Disability Inventory (PEDI) scores and adverse effects related to the botulinum toxin. Both of the toxins were significantly effective in relieving the level of spasticity in adults and children. There were no significant differences found between the Prosigne® and Botox® treatments regarding their MAS, FIM and PEDI scores. Likewise, the incidence of adverse effects was similar between the two groups. Conclusion: Our results suggest that Prosigne® and Botox® are both efficient and comparable with respect to their efficacy and safety for the three month treatment of spasticity.

Introdução: A toxina botulínica tipo A é uma das principais modalidades de tratamento para pacientes com espasticidade. Uma nova preparações de toxina botulínica sorotipo tipo A, Prosigne®, foi lançada sugerindo ter a mesma eficácia que Botox®. No entanto, não há ensaios clínicos randomizados comparando essas formulações no tratamento da espasticidade. Objetivos: O objetivo deste estudo foi comparar a eficácia ea segurança do Prosigne® com Botox® no tratamento da espasticidade. Métodos: Foi realizado um estudo duplo-cego, randomizado e cruzado com 57 pacientes com espasticidade clinicamente significativas. Os pacientes foram avaliados no início do estudo, 4 e 12 semanas após a injeção de Prosigne® ou Botox®. Resultados: Os principais resultados foram avaliados pelas mudanças na Escala de Ashworth Modificada (EAM), Medida de Independência Funcional MIF) e Pediatric Evaluation of Disability Inventory (PEDI) e os efeitos adversos relacionados ao uso da toxina botulínica. Ambas as toxinas foram significativamente eficazes em diminuir o grau de espasticidade, em adultos e crianças. Não houveram diferenças significativas entre os tratamentos Prosigne® e Botox® em relação aos escores MAS, e FIM PEDI. Da mesma forma, a incidência de efeitos adversos foi similar entre os dois grupos. Conclusão: Nossos resultados sugerem que Prosigne® e Botox® são comparáveis em relação a sua eficácia e segurança no tratamento de três meses da espasticidade. / Background: Botulinum toxin type A is one of the main treatment choices for patients with spasticity. Prosigne® a new released botulinum toxin serotype A may have the same effectiveness as Botox®. However, there are no randomized clinical trials comparing these formulations in spasticity treatment. Objective: The aim of our study was to compare the efficacy and safety of Prosigne® with Botox® in the treatment of spasticity. Methods: We performed a double-blind, randomized, crossover study consisting of 57 patients with clinically meaningful spasticity. The patients were assessed at baseline, 4 and 12 weeks after Prosigne® or Botox® administration. Results: The main outcomes were changes in the patients’ Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Pediatric Evaluation of Disability Inventory (PEDI) scores and adverse effects related to the botulinum toxin. Both of the toxins were significantly effective in relieving the level of spasticity in adults and children. There were no significant differences found between the Prosigne® and Botox® treatments regarding their MAS, FIM and PEDI scores. Likewise, the incidence of adverse effects was similar between the two groups. Conclusion: Our results suggest that Prosigne® and Botox® are both efficient and comparable with respect to their efficacy and safety for the three month treatment of spasticity.

Background: Spasticity is a common symptom post-stroke which causes vast complications regarding important daily functions among patients. This manifests as a resistance in the muscle during a velocity-dependent passive motion and is commonly evaluated by using the Modified Ashworth Scale (MAS). Extra corporeal shock wave therapy (ESWT) is a relatively novel way to treat spasticity, with promising results. Purpose: The aim of the current study was to investigate the scientific evidence of ESWT as treatment regarding spasticity and function among patients with prolonged stroke. Methods: The purpose was tackled by conducting a literature review of randomized controlled trials with MAS as outcome measurement. PubMed was searched for relevant studies followed by a quality assessment through the PEDro Scale. The reliability of the evidence was assessed with the use of GRADEstud.  Results: The quality of the included articles was mainly deemed as good with eight of nine articles receiving a PEDro Score of 6 or higher. This review found generally positive effects from ESWT regarding spasticity with MAS as the outcome measurement. The results regarding function were equivocal. The reliability of the results was graded as very low due to the methodological heterogeneity of the included studies. Conclusion: ESWT showed positive results regarding spasticity and function, although the reliability of the evidence was considered very low. More research is inquired to further explore the potential effects of ESWT on spasticity and function among post-stroke patients. This could potentially increase the reliability of the evidence regarding ESWT as a treatment option. / Bakgrund: Spasticitet är ett vanligt förekommande funktionsnedsättande centralt symptom bland patienter med stroke och har tendens att öka med tiden efter insjuknandet. Spasticitet manifesteras i form av ett ökat muskelmotstånd vid hastighetsberoende passivt rörelseuttag och bedöms oftast med Modified Ashworth Scale (MAS). Stötvågsterapi (ESWT) är en relativt ny behandlingsmetod och visats ha en lovande effekt mot spasticitet.   Syfte: Syftet med arbetet har varit att undersöka det vetenskapliga underlaget för ESWT som behandling för spasticitet och funktion hos individer med långvarig stroke. Metod: Arbetets syfte har angripits genom en systematisk narrativ litteraturstudie. Sökning av relevanta studier gjordes i databasen PubMed och skulle uteslutande vara randomiserade kontrollerade studier med MAS som utfallsmått. Studierna utvärderades gällande risk för snedvridning genom PEDro Scale. Tillförlitligheten i evidensen av effekterna av ESWT har bedömts med GRADEstud.  Resultat: Arbetets urval bedömdes ha låg risk för snedvridning då åtta av nio artiklar fick ≥ 6 poäng på PEDro Scale. ESWT sågs övergripligt ha positiva effekter på spasticitet mätt med MAS, både som isolerad och kombinerad behandling. Gällande funktion var resultaten mer tvetydiga. Dock bedömdes tillförlitligheten gällande evidensen för effekterna som mycket låg pga. genomlöpande heterogenitet bland studierna gällande design och urval.   Slutsatser: Övergripligt visade ESWT-behandling ha en positiv effekt på spasticitet och funktion. Tillförlitligheten i evidensen bedömdes dock som mycket låg. Mer forskning efterfrågas i att belysa effekterna av ESWT på patienter med stroke för att uppnå högre tillförlitlighet.

The aim of the study was to evaluate the effect of specific rehabilitation concept on the motor deficit in patients after stroke. This concept is used at the Department of inpatient rehabilitation FN Motol, the main component is exercise on the principles of dynamic neuromuscular stabilization (DNS) and is based on the principles of developmental kinesiology. The study included 12 patients after stroke. Probands participated in the 3 week therapy, exercise was carried out twice a day. Significant (p <0.05) improvement in motor function of the arm, hand, leg and foot was demonstrated by using Student`s paired t-test. There was a statistically significant improvement in postural control and reducing shoulder pain (all assessed using a specific scale: Chedoke McMaster Stroke Assessment). Changes in the degree of spasticity were evaluated by Modified Ashworth scale. A statistically significant improvement in the degree of spasticity was observed in these muscle groups: the elbow flexors , adductors of lower limb, knee extensors and hamstrings. It has been shown that the concept of dynamic neuromuscular stabilization can be advantageously used in selected patients after stroke. It is appropriate to supplement the DNS therapy with training of ADL.

One of the most important questions facing legal philosophers concerns the legitimacy of state institutions of legal punishment which visit citizens who have broken the law with condemnation and hard treatment. The purpose of this thesis is to attempt to answer the question of how we ought to respond to criminal offenders whose guilt has been established. The Canadian approach to criminal sentencing is evaluated, as are prominent restorative justice sentencing models. A novel composite-aims restorative justice model of responding to convicted offenders is introduced and the model’s aims and limits are specified. The thesis attempts to establish that a composite-aims model which encompasses certain restorative justice values and processes can provide a desirable framework for responding to convicted offenders. The implication for Canadian criminal justice policy is that the practice of applying punitive sanctions that are proportional to the moral gravity of the criminal offence should be abandoned in favour of a model based on securing censure, amends, crime control and reformation.

The aim of the thesis was to assess a construct validity of "Muscle Excitability Scale" in assessment of spasticity in patients with spinal cord injury. The correlation between this scale and other clinical tests evaluating various aspects of spasticity was investigated. 48 participants with symptoms of a spasticity were included in the study. The Spearman rank correlation coefficient was used for quantification of correlation between each two tests. The most significant correlation was found between the Muscle Excitability Scale and the Modified Ashworth Scale (rs=0,26 - 0,35, p<0,05). Less significant correlation was found in comparison with the Clonus Scale (rs=0,27, p<0,05) and with the SCI-SET (rs=0,25 - 0,26, p<0,05). There was no correlation between the Muscle Excitability Scale and the Penn Spasm Frequency Scale. Additionally every test was compared to each other and then the outcomes was discussed and compared to results of other similar studies. Keywords Muscle Excitability Scale, validity, spasticity, spinal cord injury, Modified Ashworth Scale, Penn Spasm Frequency Scale, Clonus Scale, SCI-SET