Abstract: Introduction: Cerebral palsy (CP) in children can severely affect balance, movement and posture (Vitrikas et al., 2020). Children with CP seem to participate less in personal care and hygiene, home and school tasks. Participating in everyday life activities is fundamental for every person and seem to be important for independence (Parkes et al., 2010). Occupational therapy aims to provide engagement in activities of daily living and meaningful occupations (Soderback, 2009). Aim: The aim of this review is to identify intervention methods that facilitate activities of daily living for children with cerebral palsy. Method: For this scoping review three databases were used for data extraction: Cinahl, Pubmed and Psycinfo. All steps by the Johanna Briggs Institute (JBI) manual, were followed. Results: Seven interventions were proposed. Those were either activity focused or function focused. The methods were active vestibular intervention, goal-oriented program, group-task oriented program, constrained-Induced movement therapy, virtual reality intervention, “regular” occupational therapy program and Hand Arm Intensive Therapy (HABIT). Conclusions: Different interventions seemed appropriate for facilitation of daily activities for children with CP. In each intervention different assessment scales were used to measure outcomes and this may give an unclear view of which might be the most effective for this population.

Children with unilateral spastic cerebral palsy (USCP) have impairments affecting upper limb function, particularly in grasping abilities. Specifically, children with USCP may display precision grip impairments, which can lead to activity limitations. The interplay between feedforward and feedback control is essential for successful grasping, requiring somatosensory information to be integrated with the motor output. This integration occurs through the transmission of somatosensory information through the dorsal column medial lemniscus (DCML) pathway, while independent finger movement to grasp an object is controlled by the motor cortex via the corticospinal tract (CST). While previous studies demonstrated the CST relates to anticipatory control of grasping, this may not explain all the variance of grasp impairments in children with USCP. Although studies have highlighted the importance of sensory information in grasping in typically developing (TD) adults, there are no studies examining the relationship between brain structure and function in terms of precision grip impairments in children with USCP. Additionally, sensorimotor integration plays an important role in precision grip. In some children with USCP, the lesion that occurs in the brain can cause the CST to reorganize to the contralesional hemisphere. This results in the sensory and motor tracts in different hemispheres, impacting motor impairments. When this sensory-motor dissociation occurs or when there are successive lifts of an object with each hand, it is thought that the information is transferred through the corpus callosum (CC). However, damage to the CC can restrict somatosensory processing, which can further impair grasping abilities. Previous studies have only looked at precision grip impairments in relation to the CST. Therefore, an integrative approach is necessary to fully understand the mechanisms of precision grip impairments in children with USCP. In this study our aim was to examine the neural basis of precision grip in children with USCP. Twenty-seven children participated in an MRI assessment. This included the acquisition of structural and diffusion-weighted images (DWI) to extract diffusion metrics of the CST, DCML pathway, and CC. Children also participated in clinical sensory measures, including the stereognosis test, grating orientation task, and the two-point discrimination task. Additionally, children performed precision grip lifts using a custom-made object. All children were asked to grasp an object with interchangeable surfaces (i.e., sandpaper and rayon) to measure adaptation of grip force (GF) to object texture. They were also asked to grasp the same object, hold it in the air and slowly release their grip so that the object gradually slips from their fingertips. Twenty-seven children performed these tasks with their less affected hand, and 16 with their more affected hand. Additionally, 17 participants grasped an object with various weights with each lifting sequence consisting of lifting an object in succession with the same hand and then one lift with the contralateral hand. The results demonstrate the greater reduction of integrity (more damage) of the DCML pathway, the poorer the grasp task performance, as indicated through the safety margin (the difference between the minimum amount of force needed to prevent slipping and the applied grip force). Regression analyses and cluster analyses display that CST integrity and organization may also contribute to safety margin. This suggests that diffusion metrics of multiple pathways and CST organization when considered together contribute to grasping impairments in children with USCP. To assess this further, we examined the relative difference in the peak rate of force between objects with various weights during successive lifts with each hand. Children with USCP did demonstrate anticipatory control within hands and a generalization of anticipatory control between hands. However, a loss of the transfer information was shown when first grasping the object with their less affected hand and then their more affected hand, in children with an absent contralateral CST. Therefore, the results suggest precision grip impairments may not exclusively be due to sensory impairments, but instead how the sensory information is integrated with the motor output of the same hand.

Résumé : Suite à une lésion de la moelle épinière, divers comportements moteurs invalidants, tels des spasmes peuvent apparaître. Les traitements actuels pour la spasticité causent divers effets secondaires, dont une réduction de la capacité locomotrice des patients. La recherche de traitements non invasifs et non pharmacologiques permettant de réduire la spasticité sans affecter la récupération fonctionnelle du patient s’avère donc un enjeu prioritaire. Par ailleurs, une réduction des spasmes rythmiques peut être observée lorsque la peau lombosacrée est pincée. Ce potentiel inhibiteur d’une stimulation cutanée tonique est également perçu chez l’animal comme le lapin et le chat suite à une perte des voies supraspinales. Par contre, bien que ce type de stimulation semble efficace pour réduire la spasticité, son effet sur la capacité locomotrice n’a toujours pas été évalué. L’objectif du projet était de déterminer l’effet d’un pincement de la peau à divers niveaux lombaires sur la locomotion du chat ayant une lésion de la moelle épinière. Six chats implantés chroniquement pour l’électromyographie (EMG) ont subi une lésion complète de la moelle épinière au niveau thoracique et ont été entraînés sur tapis roulant pour récupérer une fonction locomotrice des pattes postérieures. L’effet d’une stimulation de 6 sites cutanés sur la ligne médiane au niveau des vertèbres lombaires L2 à L7 a été évalué lors de marche à 0.4 m/s via des analyses cinématiques et EMG. Les résultats obtenus démontrent que la zone cutanée perturbant le plus l’activité locomotrice se trouve sur la ligne médiane au niveau lombaire L4. À ce niveau, une diminution de l’activité des extenseurs et des fléchisseurs est perçue au niveau de l’EMG. De plus, des modifications du patron locomoteur comme un positionnement plus caudal de la patte lors de son contact et de son décollage sont également visibles, tout comme une perte du support de poids (force de réaction au sol). La coordination spatiale entre les pattes postérieures est également perturbée. Ces résultats suggèrent que bien que la stimulation cutanée puisse être une alternative intéressante pour le traitement non pharmacologique de la spasticité, celle-ci altère la capacité locomotrice. || Abstract : After a spinal cord injury, multiple abnormal motor activities can occur, such as rhythmic spasms. These activities can be invalidating and are treated with different drugs that cause various side effects, including a reduction of locomotor ability in patients. Therefore, there is a need for novel non-invasive and non-pharmacological treatments for spasticity that will not affect the functional recovery of patients. A reduction of rhythmic spasms can be observed when the lumbosacral skin is pinched in a spinal cord-injured patient. This inhibition of rhythmic activity by a tonic cutaneous stimulation is also present in cats and rabbits after the loss of supraspinal input. Although this stimulation seems effective to reduce spasticity, its effects on real locomotion have not been evaluated. The goal of this project was to determine the effect of stimulating the skin at different lumbar levels on hindlimb locomotion of the spinal cord-transected (spinalized) cat. Six cats chronically implanted for electromyography (EMG) recording were spinalized at low thoracic levels and trained to recover hindlimb locomotion on a treadmill. The effect of stimulating the skin over the midline of lumbar vertebrae was evaluated during locomotion at 0.4 m/s and compared to control trials (without stimulation) with kinematic, kinetic and EMG analyses. Stimulating the lumbar skin disrupted hindlimb locomotion, with the largest effects observed at mid-lumbar levels. Cutaneous stimulation reduced extensor and flexor EMG activity. Moreover, position of the paw at contact and lift-off was more caudal and there was a loss of body weight support with cutaneous stimulation. Spatial coordination between the hindlimb was also perturbed by the cutaneous stimulation. Thus, results suggest that despite the fact that cutaneous stimulation appears to be an interesting approach to diminish rhythmic spasms in spinal cord-injured patients, it disrupts spinal-mediated locomotor capacity.

The problem of this study concerns the reduction of spasticity in physically handicapped persons with CP. The hypotheses tested were: that there would be no significant difference between the mechanical efficiency (ME) of persons with spastic CP following application of the TENS Unit and following application of the placebo unit; that there would be no significant difference between the ME of males with spastic CP, following application of the TENS Unit or the placebo unit, and the ME of females with spastic CP, following application of the TENS Unit or the placebo unit; and that there would be no significant interaction between the treatment factor and the gender category.

O Acidente Vascular Cerebral (AVC) é um quadro de alta incidência e uma das principais causas de incapacidade no mundo. Uma de suas complicações frequentes e de grande impacto na funcionalidade é a Síndrome do Ombro Doloroso Hemiplégico (SODH). O presente trabalho consiste em revisar a literatura a respeito da eficácia do tratamento da SODH com toxina botulínica tipo A (TXB-A). Foram pesquisados os bancos de dados eletrônicos PubMed e ISI web of Science, no período de 1996 a 2014. Incluímos os estudos tipo ensaio clínico duplo-cego, randomizado e aleatorizado que utilizaram a TXB-A como tratamento da SODH. Os artigos deveriam obter pontuação 3 ou superior pelos critérios de Jadad. Seis estudos foram encontrados e dois foram considerados de baixa qualidade. Os quatro artigos restantes possuíam 114 participantes no total. Três autores avaliaram os artigos de forma independente quanto aos critérios de inclusão. A extração de dados incluiu as características dos pacientes, dose e marca comercial da TXB-A utilizada, músculos e efeitos na avaliação da dor. Houve grande variação de dose, técnicas de aplicação e músculos tratados, bem como das intervenções após a aplicação. Três estudos demonstraram efeitos positivos do tratamento da dor e função do membro superior. A meta-análise não pode ser realizada, pois a informação quantitativa necessária foi indisponível. Os resultados da literatura são discordantes e apesar dos indícios serem favoráveis, não há resultados estatisticamente significantes para corroborar tal prática. Maior investigação e pesquisa são necessários para definir a indicação da TXB-A como tratamento da SODH. Mesmo assim, esta abordagem pode ser considerada particularmente quando a espasticidade é relevante. A intervenção pode ser realizada como uma alternativa ou ser utilizada em combinação com outros tratamentos. Para melhores resultados, mais de um músculo deve ser alvo, preferencialmente os músculos peitoral maior e subescapular. / The Stroke presents a high incidence and is a major cause of disability the in the world. One of it`s frequent complications and a cause of great loss of quality of life is the post-stroke shoulder pain (PSSP). The purpose of this study is to explore the effectiveness of botulinum neurotoxin type A (BoNT-A) in the treatment of PSSP. The electronic databases PubMed and ISI web of Science were searched from 1996 to 2014. We included double-blind randomized controlled trials that used BoNT-A for the treatment of PSSP in spastic hemiplegic patients. Articles should be scored 3 or more with the Jadad criteria. Six studies fulfilled the first search and two were considered low quality. The four remaining studies comprised 114 participants. Three authors independently evaluated articles eligible for inclusions. Data extracted included patient characteristics, doses and types of commercialized BoNT-A used, muscles injected, and effects on pain evaluation. There was a large variation in doses, injection techniques and treated muscles, as well as post-injection interventions. Three studies demonstrated positive effects of BoNT-A in the treatment of pain or upper limb functioning. Meta-analysis was not performed because of unavailable quantitative data. Literature results are discordant and despite evidence be favorable, there are no statistically significant results to support this practice. Further investigation and research is needed to define the indication of BoNT-A on PSSP. Nevertheless, this approach can be seen particularly when the spasticity is relevant. The intervention may be performed as an alternative or used in combination with other treatments. For best results, more than one muscle should be targeted, preferably the pectoralis major and subscapularis muscles.

OBJETIVO: A espasticidade de membro superior pós AVE é um grande desafio na medicina de reabilitação. O objetivo deste estudo foi avaliar a eficácia de um protocolo de tratamento composto de quadro modalidades de terapêuticas físicas na reabilitação de pacientes com espasticidade de membro superior pós AVE, avaliando desfechos clínicos, neurológicos e funcionais. MATERIAIS E MÉTODOS: Trinta e dois (32) pacientes com pelo menos seis meses de diagnóstico de AVE com espasticidade de membro superior foram aleatorizados para receber dez sessões de um protocolo que consistiu em estimulação elétrica transcraniana de baixa frequência usando-se agulhas subcutâneas no escalpo, bloqueios paraespinhosos, agulhamento de musculatura espástica e estimulação elétrica funcional, ou intervenções simuladas. Espasticidade, amplitude de movimento, dor, funcionalidade e qualidade de vida foram avaliados usando-se a Escala de Ashworth Modificada (EAM), goniometria, Escala Visual Análoga (VAS), Medida de Independência Funcional (MIF) e o questionário de qualidade de vida SF-36. Os pacientes e os avaliadores não possuíam conhecimento sobre o alocamento dos grupos. RESULTADOS: Os resultados mostraram uma diferença significativa em melhora da funcionalidade, amplitude de movimento e qualidade de vida no grupo de intervenções ativas. Ambos os grupos tiveram uma melhora significativa em dor. CONCLUSÃO: O protocolo composto é um tratamento válido para espasticidade de membro superior em pacientes hemiplégicos pós AVE, levando a resultados promissores em funcionalidade, qualidade de vida e espasticidade. Mais estudos devem ser realizados para melhor entender e aprimorar esta nova técnica observando seus efeitos por um período de tempo maior e em mais pacientes / Objective: Post-stroke upper limb spasticity is a major challenge in the rehabilitation field. The objective of this study was to evaluate the efficacy of a comprehensive four therapeutic modalities treatment protocol in the recovery of patients with upper limb spasticity after chronic stroke by evaluating clinical, neurological and functional outcomes. SUBJECTS AND METHODS: Thirty-two (32) subjects, at least six months post diagnosis of stroke with upper limb spasticity, were randomized to receive ten sessions of a protocol consisting of transcranial low frequency electric stimulation using subcutaneous needles over the scalp, paraspinous blocks, spastic muscle needling and functional electric stimulation, or sham interventions. Spasticity and range of motion, pain, functionality and quality of life were evaluated using the Modified Ashworth Scale (MAS), goniometry, Visual Analogue Scale (VAS), Functional Independence Measurement (FIM) and SF-36 quality of life questionnaires. The patients and the outcome assessor were blinded regarding the allocation group. RESULTS: Results showed that there was a significant difference in functionality improvement, range of motion and quality of life in the active group. Both groups had a significant improvement in pain. CONCLUSION: The comprehensive protocol is a valid treatment for post-stroke upper limb spasticity leading to promising results in functionality, quality of life, and spasticity itself. Further studies should be conducted to better understand and improve this novel technique by observing its effects for longer periods and in larger sample sizes

OBJETIVO: A espasticidade de membro superior pós AVE é um grande desafio na medicina de reabilitação. O objetivo deste estudo foi avaliar a eficácia de um protocolo de tratamento composto de quadro modalidades de terapêuticas físicas na reabilitação de pacientes com espasticidade de membro superior pós AVE, avaliando desfechos clínicos, neurológicos e funcionais. MATERIAIS E MÉTODOS: Trinta e dois (32) pacientes com pelo menos seis meses de diagnóstico de AVE com espasticidade de membro superior foram aleatorizados para receber dez sessões de um protocolo que consistiu em estimulação elétrica transcraniana de baixa frequência usando-se agulhas subcutâneas no escalpo, bloqueios paraespinhosos, agulhamento de musculatura espástica e estimulação elétrica funcional, ou intervenções simuladas. Espasticidade, amplitude de movimento, dor, funcionalidade e qualidade de vida foram avaliados usando-se a Escala de Ashworth Modificada (EAM), goniometria, Escala Visual Análoga (VAS), Medida de Independência Funcional (MIF) e o questionário de qualidade de vida SF-36. Os pacientes e os avaliadores não possuíam conhecimento sobre o alocamento dos grupos. RESULTADOS: Os resultados mostraram uma diferença significativa em melhora da funcionalidade, amplitude de movimento e qualidade de vida no grupo de intervenções ativas. Ambos os grupos tiveram uma melhora significativa em dor. CONCLUSÃO: O protocolo composto é um tratamento válido para espasticidade de membro superior em pacientes hemiplégicos pós AVE, levando a resultados promissores em funcionalidade, qualidade de vida e espasticidade. Mais estudos devem ser realizados para melhor entender e aprimorar esta nova técnica observando seus efeitos por um período de tempo maior e em mais pacientes / Objective: Post-stroke upper limb spasticity is a major challenge in the rehabilitation field. The objective of this study was to evaluate the efficacy of a comprehensive four therapeutic modalities treatment protocol in the recovery of patients with upper limb spasticity after chronic stroke by evaluating clinical, neurological and functional outcomes. SUBJECTS AND METHODS: Thirty-two (32) subjects, at least six months post diagnosis of stroke with upper limb spasticity, were randomized to receive ten sessions of a protocol consisting of transcranial low frequency electric stimulation using subcutaneous needles over the scalp, paraspinous blocks, spastic muscle needling and functional electric stimulation, or sham interventions. Spasticity and range of motion, pain, functionality and quality of life were evaluated using the Modified Ashworth Scale (MAS), goniometry, Visual Analogue Scale (VAS), Functional Independence Measurement (FIM) and SF-36 quality of life questionnaires. The patients and the outcome assessor were blinded regarding the allocation group. RESULTS: Results showed that there was a significant difference in functionality improvement, range of motion and quality of life in the active group. Both groups had a significant improvement in pain. CONCLUSION: The comprehensive protocol is a valid treatment for post-stroke upper limb spasticity leading to promising results in functionality, quality of life, and spasticity itself. Further studies should be conducted to better understand and improve this novel technique by observing its effects for longer periods and in larger sample sizes

Tendon transfer surgery is used to improve the hand function of patients with nerve injuries, spinal cord lesions, cerebral palsy (CP), stroke, or muscle injuries. The tendon of a muscle, usually with function opposite that of the lost muscle function, is transferred to the tendon of the deficient muscle. The aim is to balance the wrist and fingers to achieve better hand function. The position, function, and length at which the donor muscle is sutured is essential for the outcome for the procedure. In these studies the significance of the transferred muscle’s morphology, length and apillarization was investigated using both animal and human models. Immunohistochemical, biochemical, and laser diffraction techniques were used to examine muscle structure. In animal studies (rabbit), the effects of immobilization and of tendon transfers at different muscle lengths were analyzed. Immobilization of highly stretched muscles resulted in fibrosis and aberrant regeneration. A greater pull on the tendon while suturing a tendon transfer resulted in larger sarcomere lengths as measured in vivo. On examination of the number of sarcomeres per muscle fiber and the sarcomere lengths after 3 weeks of immobilization and healing time, we found a cut-off point up to which the sarcomerogenesis was optimal. Transfer at too long sarcomere lengths inhibited adaptation of the muscle to its new length, probably resulting in diminished function. In human studies we defined the sarcomere lengths of a normal human flexor carpi ulnaris muscle through the range of motion, and then again after a routinely performed tendon transfer to the finger extensor. A calculated model illustrated that after a transfer the largest force was predicted to occur with the wrist in extension. Morphological studies of spastic biceps brachii muscle showed, compared with control muscle, smaller fiber areas and higher variability in fiber size. Similar changes were also found in the more spastic wrist flexors comparing with wrist extensors in children with CP. In flexors, more type 2B fibers were found. These observations could all be due to the decreased use in the spastic limb, but might also represent a specific effect of the spasticity. In children and adults with spasticity very small fibers containing developmental myosin were present in all specimens, while none were found in controls. These fibers probably represent newly formed fibers originating from activated satellite cells. Impaired supraspinal control of active motion as well as of spinal reflexes, both typical of upper motor syndrome, could result in minor eccentric injuries of the muscle, causing activation of satellite cells. Spastic biceps muscles had fewer capillaries per cross-sectional area compared to age-matched controls, and also a smaller number of capillaries around each fiber. Nevertheless, the number of capillaries related to the specific fiber area was normal, and hence the spastic fibers are sufficiently supplied with capillaries. This study shows that the length of the muscle during tendon transfer is crucial for optimization of force output. Laser diffraction can be used for accurate measurement of sarcomere length during tendon transfer surgery. Wrist flexor muscles have more morphological alterations typical of spasticity compared to extensors.

Made available in DSpace on 2014-12-17T15:16:07Z (GMT). No. of bitstreams: 1 FabioLM.pdf: 1201794 bytes, checksum: a0d59fd87797a00a671d5be8a4198404 (MD5) Previous issue date: 2009-10-29 / Funda??o de Amparo a Pesquisa do Estado de S?o Paulo / Cerebrovascular accident (CVA) is a term used to characterize an ischemic or hemorrhagic vascular injury, which has got as main clinic manifestations, the motor and reflex function disturbance. In the first stage there is flaccidity and loss of voluntary movements that afterwards is substituted by mass patterns and spasticity. The spasticity brings with itself functional deficits and can generate negative impacts in various motor patterns. The aim of this research was to investigate the hyperreflexia and identify the immediate effects of transcutaneous nervous stimulation (TENS) and cryotherapy in the spasticity and electromyographic activity of hemiparetic subjects. The study is characterized as an almost experimental type, in which were selected, to compose the sample, 16 patients of both sex with CVA sequel. These individuals were evaluated by collecting the amplitude peak to peak and H reflex latency, Motor response (M response) in solear muscle and the electromyography (EMG) of the injured and healthy legs anterior tibial muscles. In the injured limb the evaluations occurred in different days for cryotherapy, TENS and control, in two moments, before and after the interventions. The healthy limb was evaluated one single time to serve as baseline, for comparison with the injured limb. It was used an statistic analysis, the t paired student test to identify the H reflex differences, latency and EMG of the injured and healthy limbs and to compare the results before and after the recourses application. The ANOVA for related samples was used to identify the differences among the recourses used. It was attributed for the statistic tests a significance level of 5%. The amplitude peak to peak of normalized maximum H reflex through the maximum motor response (Hmax/Mmax), showed itself significantly increased in the injured limb (p=0.0245). The H reflex latency was presented reduced in the injured limb (p=0, 0375). The electromyographic activity was showed decreased in the injured limb (p< 0.0001). After the TENS there was a Hm?x/Mm?x ratio decrease (0.60?0.16 versus 0.49.?0.18; P = 0.0006). Nonetheless, Just after the cryotherapy application there was an increase of Hm?x/Mm?x ratio (0.58 ? 0,15 to 0.77 ? 0.13, P=0,0007) and increase of signal latency (30.41 ? 1.87 versus 33.24 ? 2.19; P=0.0001). The electromyographic activity wasn t altered significantly by any resource. It was met statistic significant differences when the Hm?x/Mm?x P<0.0001) ratio and H reflex latency (P<0.0001) were compared between the post TENS, cryotherapy and control. One can conclude that the TENS can be used to spasticity immediate reduction, and that the cryotherapy can increase the hyperreflexia state in spastic patients. Nonetheless, the spasticity decrease or increase didn t provoke lectromyographic activity change in the muscle that is opponent to the spastic one / Acidente Vascular Encef?lico (AVE) ? o termo empregado para caracterizar uma les?o vascular isqu?mica ou hemorr?gica, que tem como principais manifesta??es cl?nicas, o dist?rbio da fun??o motora e reflexa. No est?gio inicial h? presen?a de flacidez e falta de movimentos volunt?rios, que posteriormente ? substitu?do por padr?es em massa e espasticidade. A espasticidade traz consigo d?ficits funcionais e pode gerar impactos negativos em diversos padr?es motores. O objetivo da pesquisa foi investigar os efeitos imediatos da eletroestimula??o nervosa transcut?nea (TENS) e crioterapia na espasticidade e na atividade eletromiogr?fica de sujeitos hemipar?ticos. O estudo caracteriza-se por ser do tipo quase experimental, no qual foram selecionados para compor a amostra, 16 pacientes de ambos os sexos com sequela de AVE. Estes indiv?duos foram avaliados captando-se a amplitude pico a pico e lat?ncia do reflexo H, resposta Motora (resposta M) no m?sculo solear e o eletromiograma (EMG) do m?sculo tibial anterior do membro comprometido e n?o comprometido. No membro comprometido as avalia??es ocorreram em dias diferentes para crioterapia TENS e controle, em dois momentos, antes e depois das interven??es. O membro n?o comprometido foi avaliado uma ?nica vez para servir como linha de base, para compara??o com o membro comprometido. Utilizou-se na an?lise estat?stica, o test t de student pareado para identificar as diferen?as do reflexo H, lat?ncia e EMG do membro comprometido e n?o comprometido e para comparar os resultados antes e depois da aplica??o dos recursos. A ANOVA para amostras relacionadas foi utilizada para identificar as diferen?as entre os recursos utilizados. Atribuiu-se para os testes estat?sticos o n?vel de signific?ncia de 5%. A amplitude pico a pico do reflexo H m?ximo normalizado pela resposta motora m?xima (Hm?x/Mm?x), mostrou-se significativamente aumentada no membro comprometido (p=0.0245). A lat?ncia do reflexo H reduziu no membro comprometido, com essa redu??o sendo estatisticamente significativa (p=0,0375). A atividade eletromiogr?fica se mostrou diminu?da no membro comprometido (p< 0.0001). Depois da TENS houve uma diminui??o da rela??o Hm?x/Mm?x (0.60?0.16 versus 0.49.?0.18; P = 0.0006). No entanto, logo ap?s a aplica??o do gelo houve um aumento da rela??o Hm?x/Mm?x (0.58 ? 0,15 para 0.77 ? 0.13, P=0,0007) e aumento da lat?ncia do sinal (30.41 ? 1.87 versus 33.24 ? 2.19; P=0.0001). A atividade eletromiogr?fica n?o foi alterada significativamente por nenhum recurso. Foram encontradas diferen?as estatisticamente significativas quando a raz?o Hm?x/Mm?x (P<0.0001) e lat?ncia do reflexo H (P<0.0001) foram comparadas entre o p?s-TENS, P?s- crioterapia e controle. Pode-se concluir que a TENS pode ser utilizada para fins de redu??o imediata da espasticidade, e que a crioterapia pode aumentar o estado de hiperreflexia nos pacientes esp?ticos. Entretanto, a diminui??o ou o aumento da espasticidade n?o ocasionou altera??o na atividade eletromiogr?fica do m?sculo antagonista ao esp?stico

The electrical stimulation (ES) according to Jantsch was created with a primary aim to reduce spasticity, however its impact has been neither proved nor disproved by any study. Therefore, the aim of the thesis is to find out if this type of the ES can reduce spasticity of m. triceps surae within the patients with multiple sclerosis (MS). Apart from the spasticity, there was as well observed the influence of the ES on an active movement performed by the antagonists of spastic muscle and the walking speed. Fifteen probands participated in our pilot controlled non- randomized study, probands were divided into two groups - first with the application of the ES (STIM) and second without the application of the ES (NOSTIM) during the hospitalization. We used the concept of Jean-Michel Graciese - Five-step clinical assessment in spastic paresis during the examination process. From this protocol, we choose Tardieu scale to measure spasticity, examination to measure active range of motion and 10MWT. Furthermore, TUG was added. The measurements took place on the 1st, 4th and 8th day of the hospitalization. The intragroup difference was evaluated by the ANOVA for repetitive measures with Fisher's post- hoc test and the level of importance p=0.05. From acquired data it follows that the ES according to Jantsch...