No description available.

Aim: A study to investigate the potential feasibility (including estimated effect-size), acceptability and health benefits of DEFO and physiotherapy in treatment of spasticity following intramuscular injection of BT. Participants: Adults living in the community with focal spasticity of the upper or lower limb (Modified Ashworth Scale 2-3) recruited at a regional Spasticity Clinic. Intervention: provision of an individually fitted DEFO (worn daily up to 8 hours) usual care and physiotherapy (as required) for 6 weeks. Methods: Mixed methods embedded design feasibility study: Quantitative: Feasibility single-blind RCT: Intervention Group: DEFO intervention protocol, usual care and physiotherapy, Control Group: usual care and physiotherapy. Qualitative: Topic guided interviews of the intervention group and clinicians. Measures: Goal Attainment Scale (GAS) primary measure and secondary measures for function and care benefit; Arm Activity measure (ArmA), Leeds Arm Impact Score (LASIS), VAS for pain, European Quality of Life-5 Dimensions (EQ-5D), gait velocity (10MTT). Variance and fidelity was captured with: DEFO wearing record, Activity Log, clinical records and Physiotherapy modalities. Analysis: ANCOVA adjusted means and statistical comparison for significance of measures (at baseline, after six weeks and twelve weeks) between groups and to inform power calculations. Thematic Analysis of clinician and participant transcribed interviews. Quantitative and qualitative findings were integrated and triangulated to inform a larger study. Results: Participants (n=25) recruited over twelve months, (n=22) completed study. Statistical analysis showed improvements in both groups with greater health benefit in the intervention group with mean difference in the GAS of 12.17 (95% CI: 3.16 to 21.18; p = 0.014) but no statistical significance in the secondary measures. Effect-size was estimated from the GAS findings for 200 per group for a larger study. Physiotherapy modalities for spasticity were linked to 'passive' and 'active' function. Feasibility and acceptability was established with Thematic Analysis providing valuable insight into patient and clinician perspectives on disability. Conclusions: Findings indicated potential added health benefits including carer benefit. Feasibility, acceptability and clinical application of DEFO as a potential new intervention were established. This has implications for future spasticity management with patient benefit for passive and active function. Further research is indicated with a fully powered study (based on the GAS sample results) to evaluate DEFO efficacy in people with spasticity following BT.

Title: Evaluation of sensation in hands area in patients with multiple sclerosis Objective: Summarize findings about multiple sclerosis and sensation in the hands area. Find suitable testing methods and use them to evaluate the quality of deep sensation in the hands area in patients with multiple sclerosis. Method: With help of selected tests to evaluate the quality of deep sensation in the fingers and palms area in selected probands with multiple sclerosis. Compare the results depending on the current spasticity and condition of the patient. Results: There were founded, that in people with multiple sclerosis the quality of vibrating and discriminating sensation and stereognosis in the hands area is reduced. The quality of statesthesia, kinesthesia, vibrating and discriminating sensation isn't directly linearly dependent on the current spasticity. The quality of stereognosis is directly linearly dependent on the current spasticity. Keywords: sensation, multiple sclerosis, spasticity

Thesis. 1976. M.S.--Massachusetts Institute of Technology. Dept. of Aeronautics and Astronautics. / Microfiche copy available in Archives and Barker. / Bibliography: p.80-81. / M.S.

Thesis. 1977. M.S.--Massachusetts Institute of Technology. Dept. of Aeronautics and Astronautics. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND AERONAUTICS. / Bibliography : leaves 222-229. / M.S.

A espasticidade é uma das alterações decorrentes do Acidente Vascular Encefálico (AVE) que causa limitação no tônus muscular podendo gerar graves comprometimentos funcionais nos membros superiores. Pela característica do tecido neurológico lesado, frequentemente ocorre a cronificação das sequelas e incapacidades e atuar na minimização desses comprometimentos é objetivo dos profissionais da saúde. No entanto, há dificuldades na escolha da intervenção, análise de sua eficácia e aprimoramento dos estudos na área da reabilitação decorrentes da limitação nas estratégias de avaliação, sendo que nessa área as escalas são utilizadas com frequência. Dessa forma, esse estudo buscou desenvolver e validar a utilização clínica de um instrumento de medida da resistência isométrica ao estiramento passivo do grupo muscular flexor do punho em adultos e idosos com espasticidade decorrente do AVE. Foi desenvolvido um instrumento portátil capaz de medir a resistência da musculatura com um torquímetro. Foram realizados testes para analisar a validade, confiabilidade, sensibilidade e praticabilidade. Os testes foram feitos com os sujeitos sentados e com o antebraço e mão fixados no aparelho em seis diferentes posições do arco do movimento do punho, sendo que a articulação permaneceu estável por 20 segundos em cada posição. Foi realizada a avaliação de 108 sujeitos. A avaliação unilateral foi realizada em 21 sujeitos sem lesão neurológica e 27 sujeitos com AVE. A avaliação bilateral por dois examinadores foi realizada em 60 sujeitos, sendo 19 sem lesão e 41 com lesão neurológica. O instrumento mostrou-se capaz de mensurar as diferenças da resistência da musculatura em cinco das seis posições sendo relevante salientar que o instrumento foi sensível para apresentar a diferença entre população normal e com lesão e posteriormente apresentando a diferença entre lado comprometido e não comprometido. Os testes inter-examinadores mostraram boa correlação, no entanto, considerou-se a distribuição da segunda avaliação mais uniforme, sugerindo que se deve padronizar o uso para que o examinador realize a sequência de avaliação do arco do movimento por, no mínimo, duas vezes. Evidenciou-se ainda que o instrumento foi sensível para graduar a intensidade da sequela utilizando-se da comparação entre o lado não comprometido e o comprometido, sempre que a sequela seja apenas do hemicorpo visto que a graduação atribuída pela Escala Modificada de Ashworth possibilitou identificar correlação com as resistências apenas na avaliação grau 3, sendo que nos demais graus, não houve evidência estatística, corroborando com os também apresentados na literatura. Sugere-se, como continuidade do estudo, correlacionar os dados obtidos da avaliação da resistência estática à dinâmica. Esse instrumento desenvolvido pode ser utilizado para avaliação dos efeitos de órteses posicionadoras de punho, contribuindo assim, para o aprimoramento das estratégias de reabilitação. / Spasticity is one of the changes resulting from stroke which causes limitation in muscle tone and may cause severe functional impairment of the upper limbs. For the feature damaged neurological tissue often occurs chronicity of disabilities and act on these commitments is minimization objective of health professionals. However, there are difficulties in the choice of intervention, analysis and improvement of its effectiveness studies in rehabilitation due to limitations in assessment strategies, and this area scales are frequently used. Thus, this study sought to develop and validate the clinical use of an instrument for measuring isometric resistance to passive stretching of the wrist flexor muscle group in adult and elderly patients with spasticity due to stroke. We developed a portable instrument capable of measuring the muscular strength of a torquemeter. Tests were conducted to examine the validity, reliability, sensitivity and practicability. Tests were performed with the subjects seated with the forearm and hand set in the apparatus in six different positions of the arc of movement of the wrist, and the joint remained stable for 20 seconds at each position. Our evaluation of 108 subjects. The evaluation was performed unilaterally in 21 subjects without neurological injury and 27 subjects with stroke. A bilateral assessment by two examiners was performed in 60 subjects, 19 with and 41 without injury neurological injury. The instrument was able to measure differences in muscle strength in five of the six positions is important to note that the instrument was sensitive to show the difference between normal population and with injury and presents the difference between the affected and non-affected. The tests showed good inter-rater correlation, however, was considered a distribution more uniform the second evaluation, suggesting that it should use to standardize the examiner performs the evaluation sequence of the arc of movement by at least twice . It is further demonstrated that the instrument was sensitive to grade the intensity of the sequel using comparing the committed and uncommitted side where the sequel of the hemisphere is only seen that the graduation given by the Modified Ashworth Scale possible to identify a correlation with resistance only in the evaluation grade 3, and in the remaining degrees, there was no statistical evidence, corroborating also presented in the literature. It is suggested, as a continuation of the study, correlate data obtained from the evaluation of the resistance to static dynamic. This tool developed can be used to assess the effects of splint of wrist, thus contributing to the improvement of rehabilitation strategies.

Individuals with spinal cord injury (SCI) demonstrate reduced limb blood flow and muscle spasticity. It is plausible that the accumulation of metabolites, resulting from reduced perfusion, could exacerbate spasticity via activation of fusimotor neurons by Group III and IV afferents. PURPOSE: To determine the association between peripheral blood flow and muscle spasticity in persons with SCI. METHODS: A total of 16 individuals with SCI were classified into high (N=6), low (N=5), and no (N=5) spasticity groups according to their spasticity levels indicated by the modified Ashworth scale scores. Blood flow was measured in femoral and brachial arteries using duplex Doppler ultrasound and was normalized to limb lean mass obtained with dual energy X-ray absorptiometry. RESULTS: There were no significant group differences in age (30.5±4.15, 38.48±4.61, 32.6±4.89 years), time post SCI (8.5±4.2, 12.6±4.74, 6.8±1.66 years), American SCI Association motor scores (39.2±7.78, 59±12.34, 53.4±1.08), or sensory scores (96±22.1, 144.4±13.97, 130±13.8). Femoral artery blood flow, adjusted for limb lean mass, was significantly different (p=0.002) across the three leg spasticity groups (high 76.03±6.44, low 95.12±15.49, no 142.53±10.86 ml/min/kg).Total leg muscle spasticity scores were significantly and negatively correlated with femoral artery blood flow (r=-0.60, p=0.014). There was no significant difference in brachial artery blood flow between the three groups, indicating that the reduction in blood flow was confined to injured limbs and not due to systemic cardiovascular disorder. CONCLUSION: Among SCI patients, whole-leg blood flow is progressively lower in individuals with greater spasticity scores. These results suggest that a reduction in lower limb perfusion, among other factors, plays a significant role in the pathogenesis leading to muscle spasticity after SCI. / text

No description available.

Brainstem derived serotonin (5-HT) normally facilitates spinal motoneuron excitability and inhibits sensory afferent transmission and associated spinal reflexes. Because the 5-HT innervation of the spinal cord is almost exclusively derived from brainstem neurons, spinal cord injury leads to an immediate and dramatic loss of 5-HT and this in turn leads to the simultaneous loss of motoneuron excitability and increase (disinhibition) of sensory afferent transmission. This thesis examined how spinal cord 5-HT receptors adapt over the months after SCI (chronic injury) to compensate for the loss of 5-HT. We showed that after SCI 5-HT2B and 5-HT2C receptors become constitutively active (active in the absence of 5-HT) with chronic injury, and this leads to a recovery of motoneuron excitability and contributes to the recovery of locomotor function. Unfortunately, this also contributes to the development of muscle spasms when combined with the disinhibition of sensory afferent transmission. In contrast, 5-HT1 receptors that modulate sensory afferent transmission do not become constitutively active after chronic SCI, and this contributes to the continued disinhibition of sensory afferent transmission and associated hyperreflexia and muscle spasms after chronic SCI. However, exogenous application of 5-HT1B and 5-HT1F receptor agonists can restore inhibition over sensory afferent transmission and ultimately reduce muscle spasms. In summary, 5-HT2 receptors exhibit a remarkable adaptation to the loss of 5-HT with SCI, whereas 5-HT1 receptors do not. Understanding and promoting this natural plasticity may help in the development of better therapeutic interventions for treating SCI.

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