The stiff-knee gait pattern of children diagnosed with cerebral palsy (CP) is assumed to be caused by spasticity of the quadriceps which interferes with knee flexion normally occurring during the swing phase of walking. In current clinical practice, the ability to assess quadriceps spasticity is limited by the lack of an objective and reliable test that discriminates the role spasticity plays in functional limitations. The primary purpose of this series of studies was to assess the pendulum test as an objective measure of quadriceps spasticity. The first study assessed the reliability of the pendulum test. Moderate to very high between day reliability for all thirteen measures of the pendulum test were found. The second study assessed the discriminant ability of the pendulum test to correctly identify a stiff-knee gait pattern. Because most clinicians do not have access to a three dimensional motion analysis system, the third study assessed the reliability and accuracy of visual observation of the pendulum test. Sixty-eight children with a primary diagnosis of cerebral palsy participated. A three-dimensional motion analysis system was used to measure the subjects knee motion while walking, and performing the pendulum test. Spasticity of the quadriceps was also assessed using traditional clinical measures i.e., the modified Ashworth scale (MAS), and the Ely tests. Forty-seven percent of the variance in the stiff-knee gait pattern was explained by a regression model using the pendulum test and traditional clinical measures. The only significant measure in the regression model was the magnitude of knee motion occurring during the first swing of the pendulum test (A1). Discriminant analysis revealed the A1 measure correctly classified 77% of the subjects knee-gait pattern. Four observers demonstrated moderate accuracy and repeatability in estimating A1 value. The visual assessment of A1 correctly classified 72-76% of the subjects knee-gait pattern with no prior knowledge of the subjects gait. This series of studies demonstrated the pendulum test is an objective, repeatable measure of quadriceps spasticity. A negative pendulum test (indicated by an A1 value greater than 45 degrees) is more useful for ruling out a stiff-knee gait pattern compared to the traditional clinical measures.

Studies suggest that deficits in central regulation of stretch reflex thresholds (SRT) underlie both spasticity and other disorders of motor control. We investigated intra- and inter-evaluator reliability to quantify spasticity based on tonic SRT (TSRT) and the relationship between TSRT and Modified Ashworth Scale (MAS, clinical assessment of resistance to stretch). Spasticity was evaluated in 20 subjects with chronic stroke-related spasticity in two different days, by three evaluators. Twenty different velocity-dependent dynamic SRT (angle where biceps brachii EMG signal increased for a given velocity of stretch) were recorded. TSRT (excitability of motoneurons at 0°/sec) was then computed. Spasticity was also estimated with MAS. Reliability was moderately good for subjects with moderately high spasticity (intra--evaluator: 0.46 to 0.68, inter--evaluator: 0.53 to 0.68). There was no correlation between TSRT and MAS since they measure different phenomena. TSRT is a promising new measure of spasticity. Further improvements for its quantification are suggested.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 57-59).

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 219-228).

Thesis (doctoral)--Rijksuniversiteit te Utrecht, 1964. / Includes bibliographical references (p. 81-82).

Orientador: Eliana Marisa ganem / Resumo: A espasticidade leva a perda na qualidade de vida, capacidade funcional do indivíduo e a alterações psicossociais. O baclofeno é fármaco relaxante muscular de ação central, utilizado no tratamento da espasticidade e é substância análoga ao ácido gama amino-butírico (GABA). Sua administração por via subaracnoidea permite que doses pequenas sejam utilizadas, minimizando efeitos adversos. A pesquisa consistiu em determinar os efeitos da administração de baclofeno em dose única, no espaço subaracnoideo de coelhos, sobre a medula espinal e as meninges. Foram utilizados coelhos, divididos em três grupos: G1, G2 e G3, com injeção no espaço subaracnoideo de soro fisiológico, baclofeno 100 μg e 200 μg respectivamente. Posteriormente foram realizadas as análises histológicas das meninges e medula dos coelhos. Os resultados da presente pesquisa mostram que o baclofeno, independe da dose administrada, causou lesão de tecido nervoso e de meninges em 20% (n=8) dos coelhos estudados. As alterações histológicas foram predominantemente observadas na região posterior das meninges. Podemos concluir que neste modelo experimental em coelhos o baclofeno desencadeou reação inflamatória no tecido nervoso e nas meninges. / Abstract: Spasticity leads to a reduced quality of life, functional capacity limitations, and changes in the psychosocial well-being of an individual. Baclofen is a centrally acting muscle relaxant that is used in the treatment of spasticity and is an analog of gammaamino-butyric acid. Its administration via the subarachnoid route allows the use of small doses, thus minimizing adverse effects. The aim of the study was to determine the effects of administration of a single dose of baclofen into the subarachnoid space of rabbits, on the spinal cord and meninges. Methods: The rabbits were divided into three groups. The first group (G1) was injected with saline solution. The second and third groups (G2 and G3) received 100 and 200 μg of baclofen in the subarachnoid space, respectively. Histological analysis of the meninges and spinal cord in rabbits was subsequently performed. The present findings showed that baclofen, regardless of the administered dose, caused damage to the nerve tissue and meninges in 20% (n = 8) of the tested rabbits. The histological changes were predominantly observed in the posterior portion of the meninges. We conclude that, in this rabbit experimental model, baclofen caused an inflammatory reaction in the nervous tissue and meninges. / Doutor

Submitted by ROBERTO BEZERRA Vital (roberto_vital@hotmail.com) on 2018-04-04T15:41:01Z No. of bitstreams: 1 Projeto v20.pdf: 3872313 bytes, checksum: d68e1cb15df36178f16f81f28f1b8bc8 (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: Necessário fazer as seguintes correções no arquivo submetido: problema 1: o arquivo submetido não contém capa, item obrigatório de acordo com as normas do seu programa Assim que tiver efetuado as correções submeta o arquivo em PDF novamente. Agradecemos a compreensão. on 2018-04-06T13:09:41Z (GMT) / Submitted by ROBERTO BEZERRA Vital (roberto_vital@hotmail.com) on 2018-04-10T22:23:33Z No. of bitstreams: 1 Roberto Vital (pós-defesa) com capa.pdf: 967175 bytes, checksum: c356f4d0b76b71e6f5e73e048a0fb341 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-11T12:04:37Z (GMT) No. of bitstreams: 1 vital_rb_dr_bot.pdf: 967175 bytes, checksum: c356f4d0b76b71e6f5e73e048a0fb341 (MD5) / Made available in DSpace on 2018-04-11T12:04:37Z (GMT). No. of bitstreams: 1 vital_rb_dr_bot.pdf: 967175 bytes, checksum: c356f4d0b76b71e6f5e73e048a0fb341 (MD5) Previous issue date: 2018-03-01 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A espasticidade leva a perda na qualidade de vida, capacidade funcional do indivíduo e a alterações psicossociais. O baclofeno é fármaco relaxante muscular de ação central, utilizado no tratamento da espasticidade e é substância análoga ao ácido gama amino-butírico (GABA). Sua administração por via subaracnoidea permite que doses pequenas sejam utilizadas, minimizando efeitos adversos. A pesquisa consistiu em determinar os efeitos da administração de baclofeno em dose única, no espaço subaracnoideo de coelhos, sobre a medula espinal e as meninges. Foram utilizados coelhos, divididos em três grupos: G1, G2 e G3, com injeção no espaço subaracnoideo de soro fisiológico, baclofeno 100 μg e 200 μg respectivamente. Posteriormente foram realizadas as análises histológicas das meninges e medula dos coelhos. Os resultados da presente pesquisa mostram que o baclofeno, independe da dose administrada, causou lesão de tecido nervoso e de meninges em 20% (n=8) dos coelhos estudados. As alterações histológicas foram predominantemente observadas na região posterior das meninges. Podemos concluir que neste modelo experimental em coelhos o baclofeno desencadeou reação inflamatória no tecido nervoso e nas meninges. / Spasticity leads to a reduced quality of life, functional capacity limitations, and changes in the psychosocial well-being of an individual. Baclofen is a centrally acting muscle relaxant that is used in the treatment of spasticity and is an analog of gammaamino-butyric acid. Its administration via the subarachnoid route allows the use of small doses, thus minimizing adverse effects. The aim of the study was to determine the effects of administration of a single dose of baclofen into the subarachnoid space of rabbits, on the spinal cord and meninges. Methods: The rabbits were divided into three groups. The first group (G1) was injected with saline solution. The second and third groups (G2 and G3) received 100 and 200 μg of baclofen in the subarachnoid space, respectively. Histological analysis of the meninges and spinal cord in rabbits was subsequently performed. The present findings showed that baclofen, regardless of the administered dose, caused damage to the nerve tissue and meninges in 20% (n = 8) of the tested rabbits. The histological changes were predominantly observed in the posterior portion of the meninges. We conclude that, in this rabbit experimental model, baclofen caused an inflammatory reaction in the nervous tissue and meninges. / Fapesp 2011/ 22262-1

nÃo hà / Background: Botulinum toxin type A (BTX-A), one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release and is a well-known treatment for poststroke spasticity, despite some variations among dose protocols. Spasticity is one of the factors that affect the functional rehabilitation process in stroke. Spasticity arises from the loss of myotatic reflex inhibition, resulting from upper motor neuron lesion. Equinus foot is common in lower limb spasticity after stroke worsening gait pattern and functional independence. The objective of this study is to evaluate the effects of BTX-A different doses on spastic foot in stroke patients in rehabilitation programme and on gait velocity and functional independence of these patients. Methods: This study was a randomized, prospective and double blind trial. Patients were recruited if they had diagnosis of stroke (ischemic or hemorrhagic) with a poststroke period of at least six months and hemiparesis with spastic equinus foot (Ashworth score 3 or 4 in a range from 0 to 5). Twenty-one hemiparetic stroke patients enrolled in a rehabilitation programme were divided into two groups. The first group (n=11) received BTX-A 300UI in spastic foot and the second group (n=10) received BTX-A 100UI. All patients were assessed at baseline and 2, 4, 8 and 12 weeks after injection for passive range of motion for ankle joint, Modified Ashworth Score, time walking 10 meters, clonus score and motor score of Functional Independence Measure (mFIM). Results: Higher dose group had significant improvement in range of motion on week 12 (p=0,021) and in Ashworth score on weeks 8 (p=0,012) and 12 (p < 0,0001) compared with lower dose group. There was slight improvement in clonus score in higher dose group on week 12 without statistical significance. Both groups had improvement in time walking 10 meters and mFIM without significant difference between them in the analyzed sample. There was no significant adverse effect. Conclusions: BTX-A is an important tool in poststroke rehabilitation for spasticity parameters improvement, but there was no significant difference between high and low doses of BTX-A for gait velocity neither for functional independence in the analyzed sample. Future studies with larger number of patients and evaluation of response to BTX-A reapplications are necessary to confirm these findings. / IntroduÃÃo: A toxina botulÃnica tipo A (TbA), uma das mais potentes toxinas biolÃgicas, age atravÃs do bloqueio da transmissÃo neuromuscular via inibiÃÃo da liberaÃÃo de acetilcolina e à um tratamento bem-estabelecido para espasticidade pÃs-AVE, apesar de variaÃÃes entre os protocolos de doses em diferentes centros. Espasticidade à um dos fatores que interferem no processo de reabilitaÃÃo funcional apÃs acidente vascular encefÃlico (AVE). Ela surge por causa da perda da inibiÃÃo do reflexo miotÃtico, resultante de lesÃo do neurÃnio motor superior. O pà equino à comum na espasticidade de membro inferior depois do AVE e sua instalaÃÃo piora o padrÃo de marcha e a independÃncia funcional. O objetivo desse estudo à avaliar os efeitos da TbA em diferentes doses sobre o pà espÃstico de pacientes com sequela de AVE inseridos em programa de reabilitaÃÃo e sobre a velocidade de marcha e independÃncia funcional desses pacientes. Metodologia: Este estudo foi realizado atravÃs de ensaio randomizado, prospectivo e duplo cego. Foram recrutados pacientes com diagnÃstico de AVE (isquÃmico ou hemorrÃgico) com perÃodo pÃs-AVE de pelo menos seis meses e hemiparesia com pà equino espÃstico (escore Ashworth 3 ou 4 em uma escala de 0 a 5). Vinte e um pacientes hemiparÃticos pÃs-AVE inseridos em programa de reabilitaÃÃo foram divididos em dois grupos. O primeiro grupo (n=11) recebeu aplicaÃÃo de 300UI de TbA no pà espÃstico e o segundo grupo (n=10) recebeu 100UI de TbA. Todos os pacientes foram avaliados no tempo zero e 2, 4, 8 e 12 semanas apÃs a injeÃÃo quanto aos seguintes parÃmetros: amplitude de movimento passivo da articulaÃÃo do tornozelo, escala de Ashworth modificada, tempo para andar 10 metros, escore clÃnus de aquileu e escore motor da Medida de IndependÃncia Funcional (MIFm). Resultados: O grupo 300UI TbA teve melhora significativa da amplitude de movimento na 12 semana (p=0,021) e da escala de Ashworth nas 8 (p=0,012) e 12 (p < 0,0001) semanas em comparaÃÃo ao grupo 100UI TbA. Houve tendÃncia à melhora do escore clÃnus na 12 semana no grupo 300UI TbA. Ambos os grupos apresentaram melhora durante o estudo no tempo para andar 10 metros e da MIFm sem diferenÃa significativa entre eles. NÃo foram observados efeitos adversos significativos no decorrer do estudo. ConclusÃes: TbA à uma importante ferramenta na reabilitaÃÃo pÃs-AVE para melhora dos parÃmetros de espasticidade, mas nÃo houve diferenÃa significativa entre dose alta e baixa de TbA para parÃmetros funcionais (velocidade de marcha e independÃncia funcional), na amostra analisada. Estudos futuros com um nÃmero maior de pacientes e avaliaÃÃo de resposta a reaplicaÃÃes de TbA sÃo necessÃrios para confirmaÃÃo desses achados.