Poststroke Spasticity Management

Francisco, Gerard E.; McGuire, John R.

doi:10.1161/strokeaha.111.639831

Cited by 125 publications

(93 citation statements)

References 52 publications

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“…Two instruments for measuring perceived limitation of functioning, Patient Specific Complaints (PSK) and Goal Attainment Scaling (GAS) were both rejected because their measurement properties for the stroke population are unclear. [36] The Stroke Adapted Sickness Impact Profile (SA-SIP30) and Stroke Impact Scale (SIS) were assumed to be inferior to the Stroke Specific Quality of Life (SSQOL), because they are lengthy and less easy to administer in daily practice. [37] In the end, 24 ICF categories were selected in full consensus, with 19 measurement instruments retained from 2004 and 10 new instruments judged to be clinically relevant for physical therapy after stroke.…”

Section: Resultsmentioning

confidence: 99%

Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

Otterman

Veerbeek

Schiemanck

et al. 2016

Disability and Rehabilitation

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Purpose: To select relevant and feasible instruments for the revision of the Dutch clinical practice guideline for physical therapy in patients with stroke. Methods: In this implementation study a comprehensive proposal for ICF categories and matching instruments was developed, based on reliability and validity. Relevant instruments were then selected in a consensus round by 11 knowledge brokers who were responsible for the implementation of the selected instruments. The feasibility of the selected instruments was tested by 36 physical therapists at different work settings within stroke services. Finally, instruments that were deemed relevant and feasible were included in the revised guideline. Results: A total of 28 instruments were recommended for inclusion in the revised guideline. Nineteen instruments were retained from the previous guideline. Ten new instruments were tested in clinical practice, seven of which were found feasible. Two more instruments were added after critical appraisal of the set of the measurement instruments. Conclusions: The revised guideline contains 28 relevant and feasible instrument selected and tested in clinical practice by physical therapists. Further education and implementation is needed to integrate instruments in clinical practice. Further research is proposed for developing and implementing a core set of measurement instruments to be used at fixed time points to establish data registries that allow for continuous improvement of rehabilitation for stroke patients. ä IMPLICATIONS FOR REHABILITATIONThe revised Dutch Stroke Physical Therapy Guideline recommends a total of 28 instruments, that are relevant and feasible for clinical practice of physical therapist in the different settings of stroke rehabilitation. The selection of instrument in daily practice should be part of the clinical reasoning process of PTs and be tailored to individual patients' needs and the degree of priority of the affected ICF category. Suggested education strategies for further integration of instruments in of the daily practice of PTs in Stroke Rehabilitation are: 'Training on the job' and 'peer assessment in clinical situations'. ARTICLE HISTORY

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Section: Resultsmentioning

confidence: 99%

Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

Otterman

Veerbeek

Schiemanck

et al. 2016

Disability and Rehabilitation

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“…Регулярные физические нагрузки, ходьба, лечебная гимнастика -наиболее эффективное направление ведения пациентов с постинсультным гемипарезом, они направлены на тренировку движений в паретичных конечностях и предотвращение контрактур [10]. Регулярная физическая активность у пациентов, пере-несших инсульт, имеет большое значение и для первич-ной и вторичной профилактики сочетанных заболева-ний и состояний, таких как другие сердечно-сосудистые заболевания, сахарный диабет, избыточный вес, артери-альная гипертензия, онкологические заболевания лег-ких и кишечника, остеопороз, тревожные и депрессив-ные состояния [11].…”

Section: у больных перенесших инсульт имеющих легкий или умеренный unclassified

Post-Stroke Motor Disturbances

Парфенов¹

2016

Med. sov.

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В.А. ПАРФЕНОВ, д.м.н., профессор, Первый Московский государственный медицинский университет им. И.М. Сеченова ПОСТИНСУЛЬТНЫЕ ДВИГАТЕЛЬНЫЕ НАРУШЕНИЯДвигательные нарушения в виде центрального гемипареза представляют наиболее частую причину инвалидности паци-ентов, перенесших инсульт. Активизация пациента составляет основу ведения пациентов с постинсультным гемипарезом, лечебная гимнастика направлена на тренировку движений в паретичных конечностях и предотвращение контрактур. У пациентов, у которых высокий мышечный тонус (спастичность) ухудшает двигательные функции, могут быть эффективны пероральные антиспастические средства и(или) местное ведение препаратов ботулинического токсина. Представлены результаты недавно опубликованного исследования CARS, в котором у 208 пациентов (средний возраст 64 года) изучалась эффективность церебролизина (30 мл внутривенно в течение 21 дня) в сравнении с плацебо; показано достоверное улуч-шение восстановления функции паретичной руки у пациентов, получавших церебролизин, в сравнении с группой плацебо. Внедрение в клиническую практику современных методов лечения последствий инсульта позволяет улучшить восстанов-ление и качество жизни больных. Ключевые слова: постинсультные двигательные нарушения, спастичность, лечебная гимнастика, антиспастические средства, исследование CARS, церебролизин. V.A. PARFENOV, MD, Prof., Sechenov Moscow State Medical University POST-STROKE MOTOR DISTURBANCESMotor disturbances demonstrating themselves as central hemiparesis is the most frequent reason of disability of patients who suffered a stroke. Activation of a patient makes the foundation of management of patients with post-stroke hemiparesis, the remedial gymnastics is aimed at training of movements in paretic extremities and prevention of contractions. In patients in whom high muscular tonus (spasticity) impairs motor functions, peroral anti-spastic drugs and (or) local injection of botulinic toxin can be effective. Results of the recently published study CARS are provided in which effectiveness of cerebrolysin (30 ml of intravenous injections for 21 day) was studied on 208 patients (mean age is 64 years) as compared to placebo; statistically significant improvement of the paretic hand function restoration was shown in patients who received cerebrolysin as compared to the placebo group. Implementation in the clinical practice of modern therapeutic methods of stroke consequences allows improving restoration and quality of life of patients.

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“…Muscle hypertonia will produce a series of complications causing changes in the components of muscles and subsequent stiffness in tendons and joints [4]. Different treatment methods have been used for treatment of spasticity include physical therapy, oral anti-spastic drugs, chemical nerve block and motor point block using phenol or ethyl alcohol and botulinum toxin injection [5,6]. It has been reported that muscular injections of botulinum toxin type A decreases muscular tone in hypertonic muscles of the hand, with improvement in the use of the upper limb and a decrease in complications [7][8][9][10].…”

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confidence: 99%

Effect of Different Energy Levels of Radial Shock Wave Therapy on Spasticity in Patients With Stroke

Fouda¹,

Mansour²

2018

IJPR

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Background and purpose: Spasticity in the hands and a wrist is a major problem in the management of stroke patients. Different energy levels of shock wave therapy (SWT) have been used for treatment of spasticity. So, the purpose of the study was to compare the effect of two different energy levels of radial SWT on spastic muscles of the hand and wrist in patients affected by stroke. Materials and Methods:Patients randomly assigned into two groups. Group A received the low energy radial SWT while group B received the medium energy radial SWT. Spasticity of wrist and fingers was evaluated using Modified Ashworth Scale (MAS), range of motion (ROM) of the wrist was evaluated using digital goniometer and pain was measured by Visual Analogue Scale (VAS).Results: there was a significant decrease in MAS scores of the wrist flexors and fingers flexors muscles post treatment for both groups (P<0.05). The ROM was significantly increased post treatment from (48.46±2.09) to (70.02±3.23) for group A and from (49.15±1.95) to (79.13±3.42) for group B. Also VAS scores was a significantly decreased in both groups post treatment. Conclusion:Radial SWT is an effective therapeutic tool in reducing flexor spasticity of the wrist and hand in patients with stroke. Moreover, the medium energy level was superior to the low energy level in regarding to the measured treatment outcomes.

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Poststroke Spasticity Management

Cited by 125 publications

References 52 publications

Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

Selecting relevant and feasible measurement instruments for the revised Dutch clinical practice guideline for physical therapy in patients after stroke

Post-Stroke Motor Disturbances

Effect of Different Energy Levels of Radial Shock Wave Therapy on Spasticity in Patients With Stroke

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