Objectives
To determine the reliability and validity of the Modified Heckmatt scale in assessing muscle echotexture in spasticity.
Design
Prospective, observational, 2-center study. Two residents and 2 ultrasound experienced staff physicians each rated 100 ultrasound images that were also analyzed using quantitative gray-scale.
Setting
Academic ambulatory spasticity clinic.
Participants
Participants (N=50) included 45 patients with upper or lower extremity spasticity and 5 healthy references.
Interventions
Not applicable.
Main Outcome Measures
Modified Heckmatt scale ratings and quantitative gray-scale scores
Results
Inter- and intra-rater intraclass correlation coefficients were 0.76 and 0.81, respectively (
P
<.001), indicating good to excellent reliability. A significant relationship was found between Modified Heckmatt scores and quantitative gray-scale scores (
r
=0.829;
P
<.001).
Conclusions
The Modified Heckmatt scale demonstrated good reliability and validity to assess the pathologic muscle changes that occur in patients with spasticity.
BackgroundThere has been a noted increase in the diagnosis and reporting of sporting hip injuries and conditions in the medical literature but reporting at the minor hockey level is unknown. The purpose of this study is to investigate the trend of reporting hip injuries in amateur ice hockey players in Canada with a focus on injury type and mechanism.MethodsA retrospective review of the Hockey Canada insurance database was performed and data on ice hockey hip injuries reported between January 2005 and June 2011 were collected. The study population included all male hockey players from Peewee (aged 11–12 years) to Senior (aged 20+ years) participating in amateur level competition sanctioned by Hockey Canada. Reported cases of ice hockey hip injuries were analyzed according to age, mechanism of injury, and injury subtype. Annual injury reporting rates were determined and using a linear regression analysis trended to determine the change in ice hockey hip injury reporting rate over time.ResultsOne hundred and six cases of ice hockey-related hip injuries were reported in total. The majority of injuries (75.5%) occurred in players aged 15–20 years playing at the Junior level. Most injuries were caused by a noncontact mechanism (40.6%) and strains were the most common subtype (50.0%). From 2005 to 2010, the number of reported hip injuries increased by 5.31 cases per year and the rate of reported hip injury per 1,000 registered players increased by 0.02 cases annually.ConclusionReporting of hip injuries in amateur ice hockey players is increasing. A more accurate injury reporting system is critical for future epidemiologic studies to accurately document the rate and mechanism of hip injury in amateur ice hockey players.
Knee dislocations are rare but devastating injuries that can often be associated with concomitant nerve injury, most often of the common peroneal nerve. Prompt diagnosis, investigation, and appropriate treatment are important in this subset of patients. This article provides an overview of relevant injury demographics, anatomy, diagnosis, and prognosis, and suggests a treatment algorithm for nerve injury associated with multiligament knee injury.
Spasticity is a common and problematic consequence of neurological conditions affecting the brain and spinal cord. It is characterized by intermittent or sustained involuntary muscle activation that can limit function and quality of life. Intramuscular injection with botulinum toxin is a useful treatment in such patients in order to weaken the spastic muscle. This study reviewed the published evidence for the use of casting after botulinum toxin injection for limb spasticity in adults. Casting of a limb after botulinum toxin injection shows promise in improving function in patients with spasticity, although further research is needed to determine the best method to use. Objective: To determine current evidence for casting as an adjunct therapy following botulinum toxin injection for adult limb spasticity. Design: The databases MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials were searched for English language studies from 1990 to August 2018. Full-text studies using a casting protocol following botulinum toxin injection for adult participants for limb spasticity were included. Studies were graded according to Sackett's levels of evidence, and outcome measures were categorized using domains of the International Classification of Disability, Functioning and Health. The review was prepared and reported according to PRISMA guidelines. Results: Five studies, involving a total of 98 participants, met the inclusion criteria (2 randomized controlled trials, 1 pre-post study, 1 case series and 1 case report). Casting protocols varied widely between studies; all were on casting of the lower limbs. There is level 1b evidence that casting following botulinum toxin injection improves spasticity outcomes compared with stretching and taping, and that casting after either botulinum toxin or saline injections is better than physical therapy alone. Conclusion: The evidence suggests that adjunct casting of the lower limbs may improve outcomes following botulinum toxin injection. Casting protocols vary widely in the literature and priority needs to be given to future studies that determine which protocol yields the best results.
: Ulnar neuropathy at the wrist is a common consequence of long-duration cycling, a condition termed “cyclist palsy.” Although cyclist palsy has been clinically well described in the literature, a gap exists regarding its electrodiagnostic evaluation and management. Patients with cyclist palsy present with a wide variety of sensory or motor impairments, depending on the location of the lesion. Electrodiagnostic studies are essential for accurate localization, with studies suggesting that pure motor lesions sparing the hypothenar muscles are most common among cyclists. This article aims to provide the electromyographer and physiatrist with a clinical approach to cyclist palsy and management strategies, including patient education, equipment changes, and alterations to bicycle fit.To Claim CME CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME ObjectivesAt the conclusion of this educational module, participants will be able to: (1) Describe the possible clinical presentations of Cyclist Palsy based on Ulnar nerve anatomy in the wrist and hand; (2) State the cycling-related risk factors for Cyclist Palsy; and (3) Outline the principles in management for Cyclist Palsy.LevelAdvancedAccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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