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.

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.

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)

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

The aim of this paper was to define interrater reliability of "Muscle excitability scale" in assessment of lower extremities muscle spasticity in patiens with spinal cord injury. Raters were two students of 2nd grade of master study of physiotherapy. Testing was performed at Centrum Paraple o.p.s. and 48 patients took part in the research. Except the Muscle excitability scale, Modified Ashworth scale, Penn spasm frequency scale and Clonus scale were also assessed. Percentage rate of agreement and also value of kappa coefficient that state value of agreement between raters were assigned for each scale. Percent agreement for Muscle excitability scale was 54,2 % for right and 64,6 % for left lower extremity. Kappa coefficient and therefore interrater reliability of this test was assessed on 0,38 on the right side and 0,51 on the left. The results and thein comparison with other used scales are discussed in this thesis.

The subject of this thesis is spasticity in individuals with spinal lesions. The aim is to evaluate and compare a short-term effect of selected physio-therapeutic methods on spasticity of lower limbs in spinal patients. Two methods of comparison were chosen - passive stretching and the Vojta's reflex therapy. The work consists of two parts. The theoretical part describes the problems of spinal lesions, central motoneuron syndrome and spasticity, including its pathophysiology and investigation and therapeutic approaches. The practical part contains an attempt to verify and subsequently compare the immediate antispastic effect of the chosen methods, which is an important prerequisite for the following active exercises as an inseparable part of a physiotherapeutic exercise unit. Clinical evaluation scales are used to evaluate spasticity, namely Modified Ashworth Scale (MAS) and Muscle Excitability Scale (MES). The results are then compared with other studies and literature. Keywords spinal lesions, quadriplegia, Modified Ashworth Scale, Muscle Excitability Scale, Vojta's method, stretching