Introdução: A espasticidade é frequentemente observada após o acidente vascular cerebral (AVC); entretanto, os efeitos da mesma sobre a estrutura e função muscular não são totalmente conhecidos. A arquitetura muscular é um dos fatores determinantes da funcionalidade de músculos saudáveis, e está relacionada às propriedades mecânicas musculares, como a capacidade de produção de força. No entanto, a força desenvolvida pelo componente contrátil é afetada não somente pela arquitetura muscular, mas também pelas propriedades morfológicas e mecânicas das estruturas tendíneas, as quais são responsáveis pela transmissão de força durante atividades da vida diária. Este trabalho está dividido em dois artigos: o primeiro procura identificar os efeitos da espasticidade sobre a estrutura e função do músculo gastrocnêmio medial, enquanto o segundo, os efeitos dessa doença sobre as propriedades estruturais e mecânicas do tendão de Aquiles. Artigo I: O objetivo deste estudo foi investigar as propriedades mecânicas do músculo gastrocnêmio medial de pacientes pós-AVC com hemiparesia espástica e de indivíduos saudáveis. Foram avaliadas mudanças na arquitetura muscular e no torque em diferentes ângulos articulares nas condições repouso e contração voluntária máxima isométrica. Participaram do estudo 15 sujeitos pós-AVC com espasticidade de tornozelo e um grupo controle de 15 sujeitos saudáveis. Para o posicionamento articular e obtenção do torque isométrico máximo de flexão plantar foi utilizado um dinamômetro isocinético, enquanto imagens do músculo gastrocnêmio medial foram obtidas por ultrassonografia. As imagens foram coletadas em repouso e durante uma contração voluntária máxima isométrica nos ângulos de 30° de flexão plantar, 0° e na máxima dorsiflexão. As comparações foram realizadas entre os lados afetado e não afetado pela espasticidade nos indivíduos pós-AVC e lado direito dos indivíduos saudáveis. O lado afetado apresentou mudanças na estrutura muscular observada pelo menor comprimento de fascículo e espessura em repouso, bem como na funcionalidade muscular observada pelo menor torque e ângulo de penação durante a contração voluntária máxima isométrica além da menor excursão fascicular. O lado não afetado parece apresentar uma estrutura muscular semelhante aquela de indivíduos saudáveis em função da ausência de diferenças nos parâmetros de arquitetura muscular no repouso e contração voluntária máxima isométrica, mas demonstrou prejuízos na capacidade de produção de força. Artigo II: O objetivo do presente estudo foi avaliar, de forma ativa, as propriedades mecânicas do tendão de Aquiles de indivíduos pós-AVC com hemiparesia espástica e de indivíduos saudáveis. Participaram do estudo 15 sujeitos pós-AVC com espasticidade de tornozelo e um grupo controle de 15 sujeitos saudáveis. Para o posicionamento articular e realização dos protocolos foi utilizado um dinamômetro isocinético. As imagens do comprimento e área de secção transversa, bem como o deslocamento da junção miotendínea do tendão de Aquiles com o músculo gastrocnêmio medial, foram obtidos por meio da ultrassonografia. As imagens do comprimento e área de secção transversa foram coletadas em repouso, e o deslocamento da junção miotendínea do tendão de Aquiles durante uma contração voluntária máxima isométrica em rampa no ângulo de 0° do tornozelo. Foram avaliados a força, deformação, stress, strain, rigidez e módulo de Young do tendão de Aquiles. As comparações foram realizadas entre os lados afetado e não afetado pela espasticidade nos indivíduos pós-AVC e lado direito dos indivíduos saudáveis. Os lados afetado e não afetado do grupo AVC apresentaram alteração na morfologia do tendão de Aquiles observada pela área de secção transversa reduzida. Em relação às propriedades mecânicas, o lado afetado quando comparado ao lado não afetado e lado direito dos sujeitos saudáveis, demonstra estar prejudicado apresentando redução da força e deformação (absolutas e relativas) bem como menores valores de rigidez e módulo de Young. O membro não afetado apresentou redução da força, deformação e rigidez quando comparado ao lado direito dos sujeitos saudáveis. Entretanto, quando estas propriedades mecânicas do lado não afetado são normalizadas pelos parâmetros morfológicos (área de secção transversa e comprimento do tendão), as mesmas apresentam-se semelhantes ao tendão de indivíduos saudáveis. / Introduction: Spasticity often occurs after a stroke; yet, its effects on muscle structure and function are not fully understood. Muscle architecture is one determinant factor of the functionality of healthy muscles, and it’s related to the mechanical properties of muscles, like the ability to produce force. However, the force developed by the contractile component is affected not only by the muscular architecture, but also by morphological and mechanical properties of tendon structures, which are responsible for force transmission during activities of daily living. This work is divided into two articles: the first one tries to identify the effects of spasticity on the structure and function of the medial gastrocnemius muscle, while the second one tries to describe the effects of this disease on the structural and mechanical properties of the Achilles tendon. Study I: The purpose of this study was to investigate the mechanical properties of the medial gastrocnemius muscle in post-stroke patients affected by spastic hemiparesis and healthy subjects. We evaluated changes in muscle architecture and torque at different joint angles in rest condition and in maximum voluntary isometric contraction. The study included 15 subjects that survived from a stroke with ankle spasticity and a control group of 15 healthy subjects. An isokinetic dynamometer was used for joint positioning and obtainment of maximal isometric torque for plantar flexion, while images of the medial gastrocnemius muscle were obtained using ultrasonography. Images were collected at rest and during a maximum voluntary isometric contraction at 30° of plantar flexion, 0° and maximum dorsiflexion. We compared both limbs in post-stroke individuals, affected and non-affected by spasticity, and only the right side in healthy subjects. The spastic side showed changes in muscle structure observed by the shortening in fascicle length and smaller muscle thickness at rest, and in muscular functionality seen by the lower torque and smaller pennation angle during maximum voluntary isometric contraction, as well as in the smaller fascicular excursion. The unaffected side appears to have a muscular structure similar to healthy subjects, because there were no differences in muscle architecture parameters at rest and at maximum voluntary isometric contraction, but it showed impairments in the ability to produce force. Study II: The purpose of this study was to evaluate, in an active way, the mechanical properties of the Achilles tendon in post-stroke individuals with spastic hemiparesis and in healthy subjects. The study included 15 stroke survivors with ankle spasticity and a control group of 15 healthy subjects. An isokinetic dynamometer was used for joint positioning and obtainment of maximal isometric torque for plantar flexion. The images of the length, cross-sectional area and the displacement of the myotendinous junction of Achilles tendon with the medial gastrocnemius muscle were obtained using ultrasonography. The images of length and cross-sectional area were collected at rest and during a maximum voluntary isometric contraction in ramp at the ankle angle of 0°. We evaluated the strength, deformation, stress, strain, stiffness and Young's modulus of the Achilles tendon. We compared both limbs in post-stroke individuals, affected and non-affected by spasticity, and only the right side in healthy subjects. Both affected and non-affected sides of the stroke survivors group showed abnormalities in the Achilles tendon’s morphology observed by the reduced cross-sectional area. Regarding the mechanical properties, the affected side, when compared to the unaffected side and to the dominant side of healthy subjects, proves to be impaired, showing decrease in strength and deformation (both absolute and relative) and lower values of stiffness and Young's modulus. The unaffected limb showed decreased strength, deformation and stiffness when compared to the dominant side of healthy subjects. However, when these mechanical properties of the unaffected side are normalized by morphological parameters (cross-sectional area and length), they become similar to healthy subjects’ tendons.

Introdução: A espasticidade é frequentemente observada após o acidente vascular cerebral (AVC); entretanto, os efeitos da mesma sobre a estrutura e função muscular não são totalmente conhecidos. A arquitetura muscular é um dos fatores determinantes da funcionalidade de músculos saudáveis, e está relacionada às propriedades mecânicas musculares, como a capacidade de produção de força. No entanto, a força desenvolvida pelo componente contrátil é afetada não somente pela arquitetura muscular, mas também pelas propriedades morfológicas e mecânicas das estruturas tendíneas, as quais são responsáveis pela transmissão de força durante atividades da vida diária. Este trabalho está dividido em dois artigos: o primeiro procura identificar os efeitos da espasticidade sobre a estrutura e função do músculo gastrocnêmio medial, enquanto o segundo, os efeitos dessa doença sobre as propriedades estruturais e mecânicas do tendão de Aquiles. Artigo I: O objetivo deste estudo foi investigar as propriedades mecânicas do músculo gastrocnêmio medial de pacientes pós-AVC com hemiparesia espástica e de indivíduos saudáveis. Foram avaliadas mudanças na arquitetura muscular e no torque em diferentes ângulos articulares nas condições repouso e contração voluntária máxima isométrica. Participaram do estudo 15 sujeitos pós-AVC com espasticidade de tornozelo e um grupo controle de 15 sujeitos saudáveis. Para o posicionamento articular e obtenção do torque isométrico máximo de flexão plantar foi utilizado um dinamômetro isocinético, enquanto imagens do músculo gastrocnêmio medial foram obtidas por ultrassonografia. As imagens foram coletadas em repouso e durante uma contração voluntária máxima isométrica nos ângulos de 30° de flexão plantar, 0° e na máxima dorsiflexão. As comparações foram realizadas entre os lados afetado e não afetado pela espasticidade nos indivíduos pós-AVC e lado direito dos indivíduos saudáveis. O lado afetado apresentou mudanças na estrutura muscular observada pelo menor comprimento de fascículo e espessura em repouso, bem como na funcionalidade muscular observada pelo menor torque e ângulo de penação durante a contração voluntária máxima isométrica além da menor excursão fascicular. O lado não afetado parece apresentar uma estrutura muscular semelhante aquela de indivíduos saudáveis em função da ausência de diferenças nos parâmetros de arquitetura muscular no repouso e contração voluntária máxima isométrica, mas demonstrou prejuízos na capacidade de produção de força. Artigo II: O objetivo do presente estudo foi avaliar, de forma ativa, as propriedades mecânicas do tendão de Aquiles de indivíduos pós-AVC com hemiparesia espástica e de indivíduos saudáveis. Participaram do estudo 15 sujeitos pós-AVC com espasticidade de tornozelo e um grupo controle de 15 sujeitos saudáveis. Para o posicionamento articular e realização dos protocolos foi utilizado um dinamômetro isocinético. As imagens do comprimento e área de secção transversa, bem como o deslocamento da junção miotendínea do tendão de Aquiles com o músculo gastrocnêmio medial, foram obtidos por meio da ultrassonografia. As imagens do comprimento e área de secção transversa foram coletadas em repouso, e o deslocamento da junção miotendínea do tendão de Aquiles durante uma contração voluntária máxima isométrica em rampa no ângulo de 0° do tornozelo. Foram avaliados a força, deformação, stress, strain, rigidez e módulo de Young do tendão de Aquiles. As comparações foram realizadas entre os lados afetado e não afetado pela espasticidade nos indivíduos pós-AVC e lado direito dos indivíduos saudáveis. Os lados afetado e não afetado do grupo AVC apresentaram alteração na morfologia do tendão de Aquiles observada pela área de secção transversa reduzida. Em relação às propriedades mecânicas, o lado afetado quando comparado ao lado não afetado e lado direito dos sujeitos saudáveis, demonstra estar prejudicado apresentando redução da força e deformação (absolutas e relativas) bem como menores valores de rigidez e módulo de Young. O membro não afetado apresentou redução da força, deformação e rigidez quando comparado ao lado direito dos sujeitos saudáveis. Entretanto, quando estas propriedades mecânicas do lado não afetado são normalizadas pelos parâmetros morfológicos (área de secção transversa e comprimento do tendão), as mesmas apresentam-se semelhantes ao tendão de indivíduos saudáveis. / Introduction: Spasticity often occurs after a stroke; yet, its effects on muscle structure and function are not fully understood. Muscle architecture is one determinant factor of the functionality of healthy muscles, and it’s related to the mechanical properties of muscles, like the ability to produce force. However, the force developed by the contractile component is affected not only by the muscular architecture, but also by morphological and mechanical properties of tendon structures, which are responsible for force transmission during activities of daily living. This work is divided into two articles: the first one tries to identify the effects of spasticity on the structure and function of the medial gastrocnemius muscle, while the second one tries to describe the effects of this disease on the structural and mechanical properties of the Achilles tendon. Study I: The purpose of this study was to investigate the mechanical properties of the medial gastrocnemius muscle in post-stroke patients affected by spastic hemiparesis and healthy subjects. We evaluated changes in muscle architecture and torque at different joint angles in rest condition and in maximum voluntary isometric contraction. The study included 15 subjects that survived from a stroke with ankle spasticity and a control group of 15 healthy subjects. An isokinetic dynamometer was used for joint positioning and obtainment of maximal isometric torque for plantar flexion, while images of the medial gastrocnemius muscle were obtained using ultrasonography. Images were collected at rest and during a maximum voluntary isometric contraction at 30° of plantar flexion, 0° and maximum dorsiflexion. We compared both limbs in post-stroke individuals, affected and non-affected by spasticity, and only the right side in healthy subjects. The spastic side showed changes in muscle structure observed by the shortening in fascicle length and smaller muscle thickness at rest, and in muscular functionality seen by the lower torque and smaller pennation angle during maximum voluntary isometric contraction, as well as in the smaller fascicular excursion. The unaffected side appears to have a muscular structure similar to healthy subjects, because there were no differences in muscle architecture parameters at rest and at maximum voluntary isometric contraction, but it showed impairments in the ability to produce force. Study II: The purpose of this study was to evaluate, in an active way, the mechanical properties of the Achilles tendon in post-stroke individuals with spastic hemiparesis and in healthy subjects. The study included 15 stroke survivors with ankle spasticity and a control group of 15 healthy subjects. An isokinetic dynamometer was used for joint positioning and obtainment of maximal isometric torque for plantar flexion. The images of the length, cross-sectional area and the displacement of the myotendinous junction of Achilles tendon with the medial gastrocnemius muscle were obtained using ultrasonography. The images of length and cross-sectional area were collected at rest and during a maximum voluntary isometric contraction in ramp at the ankle angle of 0°. We evaluated the strength, deformation, stress, strain, stiffness and Young's modulus of the Achilles tendon. We compared both limbs in post-stroke individuals, affected and non-affected by spasticity, and only the right side in healthy subjects. Both affected and non-affected sides of the stroke survivors group showed abnormalities in the Achilles tendon’s morphology observed by the reduced cross-sectional area. Regarding the mechanical properties, the affected side, when compared to the unaffected side and to the dominant side of healthy subjects, proves to be impaired, showing decrease in strength and deformation (both absolute and relative) and lower values of stiffness and Young's modulus. The unaffected limb showed decreased strength, deformation and stiffness when compared to the dominant side of healthy subjects. However, when these mechanical properties of the unaffected side are normalized by morphological parameters (cross-sectional area and length), they become similar to healthy subjects’ tendons.

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.

Orientador: Alberto Cliquet Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T19:00:11Z (GMT). No. of bitstreams: 1 Tancredo_JanainaRoland_M.pdf: 2653289 bytes, checksum: 0b7d643e5438e5de2faf4c696947403b (MD5) Previous issue date: 2012 / Resumo: A lesão medular tem como uma de suas conseqüências a espasticidade, que está geralmente presente em lesões acima do último nível torácico (T12) e pode ser avaliada através de indicadores quantitativos e qualitativos. Na pesquisa, foram avaliados dois grupos, o da Estimulação Elétrica Neuromuscular (EENM), com dezesseis pacientes e o grupo da Marcha em Esteira com EENM com oito pacientes; todos com diagnóstico de paraplegia e tetraplegia com algum grau de espasticidade. Foram utilizadas para esta avaliação as escalas: modificada de Ashworth, a de espasmos musculares, a subjetiva da espasticidade e o teste pendular. Para aplicação do teste pendular foi utilizado o Dispositivo de Teste Pendular (DTP) - (equipamento que foi elaborado e construído especificamente para avaliar a espasticidade, que possui um acelerômetro de transdutores de cristais de quartzo e um eletrogoniômetro de fibra óptica flexível que medem as tensões e os deslocamentos angulares, respectivamente) do Laboratório de Biomecânica e Reabilitação do Aparelho Locomotor. Os pacientes do grupo da EENM realizaram EENM nos músculos quadríceps e nervo fibular, sendo que os testes foram aplicados antes e logo após o procedimento. O mesmo foi realizado para o grupo da Marcha em Esteira com EENM. Os dados mostraram uma diminuição da espasticidade nos dois grupos, representado no grupo da EENM por variações nos parâmetros F1Ang, F1 Amp, E1 Amp, Plat Amp e ERI e no parâmetro E1 Ang no grupo da marcha. O grupo da EENM onde foi subdividido (pacientes com e sem medicação) notamos uma diferença significativa no subgrupo sem medicação na maioria dos parâmetros avaliados. Já o subgrupo com medicação apenas os parâmetros On Ang e RI foram significativos. Além disso, os dados da escala subjetiva e da escala modificada de Ashworth, após a estimulação elétrica neuromuscular também apresentaram uma redução nos valores da espasticidade, sendo que no grupo da marcha em esteira apenas a escala subjetiva foi significativa / Abstract: Spinal cord injury has as one of its consequences the spasticity, which is usually present in lesions above the last thoracic level (T12) and it can be assessed through quantitative and qualitative indicators. In the study it was evaluated two groups: Neuromuscular Electrical Stimulation (NMES) group with sixteen patients and the group of eight patients that performed treadmill gait with partial body weigth support and NMES, all of them were diagnosed with paraplegia or tetraplegia with some degree of spasticity. The following scales were used for assessment: Modified Ashworth Scale, Muscle Spasms Scale, Subjective Scale of Spasticity and the pendulum test. For application of the pendulum test it was used Pendular Test Device (PTD) was used, this equipment was designed and built specifically to evaluate spasticity, which has an accelerometer of quartz crystals transducer and a flexible fiber optic electrogoniometer to measure the acceleration and angular displacement, respectively. The patients in the NMES group performed NMES in the quadriceps muscle and fibular nerve, and the tests were applied before and after the procedure. The same was done for the treadmill gait with NMES group. The data showed a decrease in spasticity in both groups, represented in the NMES group by changes in the F1Ang, F1Amp, E1Amp, Plat Amp and ERI parameters of the PTD and the gait group also presented a change in the E1Ang. In the group NMES, which was divided (patients with and without drugs), it was noticed a significant difference in the subgroup without medication in most parameters. However, in the subgroup with medication only the OnAng and RI parameters were significant. In addition, data from the Subjective Scale of Spasticity and the Modified Ashworth Scale also showed a reduction in the values in the spasticity, and in the group of treadmill gait just a Subjective Scale of Spasticity was significant / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Background: Spasticity of the ankle can occur in multiple sclerosis and stroke, and can significantly reduce quality of life by impeding walking and other activities of daily living. Robot driven continuous passive motion (CPM) of the ankle may be a beneficial rehabilitation strategy for lower limb spasticity management, but, objective measures of decreased spasticity and improved locomotion remains uncertain. Additionally, the acute and chronic effects of CPM on spinal cord excitability are unknown. Objectives: To evaluate: 1) the acute changes in spinal cord excitability induced by 30 min of CPM at the ankle joint, in neurologically intact individuals and in those with lower limb spasticity; and, 2) chronic training-induced effects of 6 weeks of bilateral CPM training on reflex excitability and locomotion in those with lower limb spasticity. Methods: Spinal cord excitability was assessed using Hoffmann (H-) reflex recruitment curves, collected immediately before and following 30 min of CPM of the right (neurologically intact) or more affected (clinical) ankle. A multiple baseline repeated measures study design was used to assess changes following 18 bilateral CPM training sessions. Spasticity and locomotion were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Results: Twenty-one neurologically intact (6 female, 15 male, mean age 24.5 ± 1.7y) and 9 participants with spasticity (3 female, 6 male, mean age 58.9 ± 9.7y) due to various neurological conditions including stroke (n=4), MS (n=3), spinal cord injury (n=1), and cerebral palsy (n=1). In the neurologically intact group, CPM produced a bi-directional modulation of H-reflex creating ‘facilitation’ (n=12) (31.4 ± 20.9% increase in H-reflex amplitude) and ‘suppression’ (n=9) (32.9 ± 21.0% decrease in H-reflex amplitude) groups. In the clinical participants, acute CPM before training significantly increased H-reflex recruitment curve variables H@Thres and H@50; but there was no significant effect of acute CPM post-training. Baseline reflex excitability following training was reduced on the MA side for H@Thres, H@50 and H@100 by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. On the less affected side there was a significant decrease in H@Thres and H@50 by 83.4 ± 29.0% and 76.0 ± 28.3%. Time to complete the 10 m Walk Test was not different (5.2 ± 7.9% change, p = 0.06), and time to complete the Timed Up and Go was decreased (9.5 ± 12.3% change, p = 0.05). Spasticity of the ankle plantar flexor muscles, assessed by the Modified Ashworth Scale, was reduced in 4 participants with spasticity. Conclusion: Acute and chronic CPM of the ankle can significantly alter spinal cord excitability. CPM training may be a useful strategy to decrease spasticity of the ankle plantar flexors. / Graduate / 2018-09-15

The aim of this master thesis is to evaluate the effect of selective dorsal rhizotomy (SDR) on gross motor functions in children with spastic cerebral palsy with Gross Motor Function Measure (GMFM). I had also collected knowlegdes about SDR and GMFM. I investigated four children undergoing selective dorsal rhizotomy in the Czech republic and I took data from 16 foreign studies to discuss it and to compare the results and conclusions. I tried to identify the factors responsible for different outcomes of the studies. Powered by TCPDF (www.tcpdf.org)

Objective To investigate the effect a supination splint would have on upper limb function of cerebral palsy children for six months after receiving Botox® injections. Design Ten children attending weekly therapy enrolled in this prospective Quasi-experimental design where each child acted as his own control. Intervention was a supination splint and stretch massage. Assessment was based on pre- and post-intervention records of Modified Ashworth Scale, goniometry, Quality of Upper Extremity Skills Test (QUEST), and an independent panel assessment of videotaped records of hand function. Results Results show that spasticity declined in the forearm pronators, wrist flexors and thumb adductors. Active movement improved significantly in forearm supination and wrist extension. The QUEST demonstrated a significant change. Improvement in the hand function assessment was evident from the second month. Conclusion Findings support the premise that the supination splint is effective in improving upper limb function of cerebral palsy children after Botox® injections. / Dissertation (M (Occupational Therapy))--University of Pretoria, 2007. / Occupational Therapy / M (Occupational Therapy) / unrestricted

Orientador: Alberto Cliquet Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T14:27:31Z (GMT). No. of bitstreams: 1 Maria_RenataManzano_M.pdf: 4254573 bytes, checksum: 97e60ced203868705d6cd26bf4a3e1a6 (MD5) Previous issue date: 2014 / Resumo: Neste projeto é apresentada uma proposta de um sistema completo para coletar, processar e analisar sinais resultantes do teste pendular, com a finalidade de avaliar a espasticidade na prática clínica. Comumente apresentado por lesados medulares, a espasticidade pode ser quantificada pela análise dos sinais de ângulo da articulação do joelho e de vibração do quadríceps durante o balanço, monitorados por um eletrogoniômetro e um acelerômetro triaxial, respectivamente. O acompanhamento de cinco pacientes, durante o programa de reabilitação, permitiu estabelecer uma relação entre os indicadores calculados, evidenciando uma relação positiva entre índice de relaxamento - R2n, razão de amplitude - R1, valor quadrático médio ¿ RMS e envoltórias do sinal para casos de espasticidade severa. Comprova-se assim a maior aplicabilidade do acelerômetro nestes casos, e a possibilidade de utilização do acelerômetro no teste pendular para quantificação da espasticidade como forma complementar / Abstract: In this project is presented a proposal of a complete system to acquire, process and analyze pendulum test signals, aiming to assess spasticity in clinical practice. Often presented by spinal cord injured people, spasticity can be quantified by signals of knee joint angle and quadriceps vibration during the swing, monitored by an electrogoniometer and a triaxial accelerometer, respectively. Five patients following, through the rehabilitation program, made possible to establish a relation between relaxation index - R2n, amplitude ratio - R1, root mean square (RMS) and wrapped signals to severe spasticity. Thus, it is confirmed that, in these cases, accelerometer is more efficient and its feasibility is ratified as a possibility in pendulum test to quantify spasticity / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

Introduction: Cerebral palsy (CP) is a CNS related permanent disorder following a lesion on the developing brain. Spasticity and muscle weakness are the most commonly reported impairments. Aim: To describe spasticity measured instrumentally as the muscle resistance and muscle strength in children with CP and in typically developing children (TD), and explore the relationship between muscle resistance, muscle strength and functional mobility. Method: Measurements of the muscle resistance in plantarflexors with Neuroflexor®. Muscle strength measurements in the lower leg with a rig-fixed dynamometry in n= 4 children with CP and in n = 11 TD children. Timed Up and Go (TUG) test measured in seconds in 4 children with CP. Results: Mann- Whitney U test showed a significant increased muscle resistance in plantarflexors during a fast movement between children with CP and TD children (p = 0.044). It was significantly shown that the children with CP were weaker in their dorsiflexors compared to the group of TD children (p = 0,001). Analysis for muscle resistance and TUG was collected for 2 children with CP and therefore no correlation analysis could be made. Conclusion: This pilot study indicates that the children with CP were weaker in their dorsiflexors compared to TD children and that muscle resistance measured during a passive elongation was higher, but no statistically significant conclusion can be made due to few included numbers of participants.

Botulinum neurotoxin (BoNT), for more than a hundred years, has been a recognized poisonous principle in spoiled food. As its chemical structure became unraveled, and as more knowledge was gained over its mechanism of toxicity, it became clear that BoNT had the potential to act therapeutically as a targeted toxin that could inactivate specific nerve populations, and thus achieve a therapeutic goal. BoNT has evolved over the past 25 years into a viable therapeutic, now being a first line treatment for dystonia, overtly altering the course of progression of this disorder. BoNT is used for hyperhidrosis and gustatory sweating syndrome, alleviation of pain, as a treatment for overactive bladder, achalasia and anal fissure; and it has gained popularity as a cosmetic aid. Many other possible uses are being explored. The greatest potential for BoNT may lie in its being a molecular Trojan Horse - able to carry a specific enzyme or specific drug to the inside of a cancer or other type of cell while bypassing other cells and thereby having little or no ill effect. BoNTs pharmaceutical potential is boundless.