Spasticity after stroke: Physiology, assessment and treatment

Thibaut, Aurore; Chatelle, Camille; Ziegler, Erik; Bruno, Marie-Aurélie; Laureys, Steven; Gosseries, Olivia

doi:10.3109/02699052.2013.804202

Cited by 352 publications

(282 citation statements)

References 114 publications

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“…Clinical manifestations of spasticity include muscle spasms, involuntary jerking motions, exaggerated reflexes, and stiff or tight muscles and joints [94]. Marked spasticity and the associated abnormal postures can cause pain and loss of strength, dexterity, and range of motion; interfere with performance of daily activities and sleep; disturb gait and balance; and impair quality of life [94,95].…”

Section: Treatment Of Spasticitymentioning

confidence: 99%

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Ilfeld

Preciado

Trescot

2016

Expert Review of Medical Devices

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Introduction: Cryoneurolysis is the direct application of low temperatures to reversibly ablate peripheral nerves to provide pain relief. Recent development of a handheld cryoneurolysis device with small gauge probes and an integrated skin warmer broadens the clinical applications to include treatment of superficial nerves, further enabling treatments for pre-operative pain, post-surgical pain, chronic pain, and muscle movement disorders. Areas covered: Cryoneurolysis is the direct application of cold temperatures to a peripheral nerve, resulting in reversible ablation due to Wallerian degeneration and nerve regeneration. Use over the last 50 years attests to a very low incidence of complications and adverse effects. Cryoprobes have traditionally been applied through a surgical incision; but, recent technical advances allow percutaneous administration. A new hand-held device is now approved for use within the United States. Cryoneurolysis has been used to treat postoperative and chronic pain states as well as spasticity. Expert commentary: Changes in the US healthcare system such as a push for the reduction of opioid use and the incorporation of Diagnostic Related Group codes, as well as recent technological advances including a handheld unit that allows for treatment of superficial nerves while protecting the skin from damage, may contribute to the resurgence of cryoneurolysis for the treatment of peripheral nerves. ARTICLE HISTORY

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Section: Treatment Of Spasticitymentioning

confidence: 99%

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Ilfeld

Preciado

Trescot

2016

Expert Review of Medical Devices

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“…It is believed that clonus occurs because of hyperactive stretch reflexes in the affected muscle [19] ( Fig. 7 (c1)).…”

Section: Man-machine Interaction and Motor Learningmentioning

confidence: 99%

Integrated Sit-to-Stand and Stand-to-Sit Training System Providing Biofeedback Information and Physical Assistance to Hemiplegic Patients

Shiraishi

Kawamoto

Sankai

2017

SICE Journal of Control, Measurement, and System Integration

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: This paper proposes a novel sit-to-stand and stand-to-sit (STS) training system for hemiplegic patients with clonus. Most hemiplegic patients depend on the unaffected leg and perform plantar flexion involuntarily during STS movements. The developed system integrates a visual biofeedback method with a movement assistance mechanism. The system provides users' ground reaction force (GRF) through a monitor and supports STS movements by moving the seat. We also proposed STS training with physical inhibition by using the developed orthosis to manage clonus. We performed an experiment on a hemiplegic patient who experienced clonus in the affected leg to verify that the user was able to increase the GRF of the heel part (GRFh) of the affected leg while performing STS movements using the system and that the system employing the orthosis reduced clonus. The results showed that GRFh in the intervention test that employed the proposed system was greater than that in the baseline test without the system. We also verified that a significant difference existed between the baseline and intervention test results (p < 0.05). In addition, when the orthosis was used, the participant was able to prevent muscle cramps resulting from the clonus by avoiding the contraction of the affected leg muscles. The results indicated that STS training using the system helped the user to increase GRFh and reduce the clonus. In addition, from the viewpoint of motor learning, we deduced that an integrated assistive system with informatics-based biofeedback and physical human-machine interaction would be effective in reconstructing the feedback loop in users' central nervous system.

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“…The level of spasticity is usually assessed with Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) [7][8][9][10][11][12][13][14][15]. MAS is a subjective evaluation method [16], while Key words:…”

Section: Introductionmentioning

confidence: 99%

A method of hand motor control assessment in patients with post-stroke spasticity

Zwolińska¹,

Drużbicki²,

Perenc³

et al. 2017

Advances in Rehabilitation

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A -opracowanie koncepcji i założeń (preparing concepts) B -opracowanie metod (formulating methods) C -przeprowadzenie badań (conducting research) D -opracowanie wyników (processing results) E -interpretacja i wnioski (interpretation and conclusions) F -redakcja ostatecznej wersji (editing the final version) StreszczenieWstęp: Do oceny stanu ręki niedowładnej u pacjentów po udarze mózgu niezbędna jest obiektywna i czuła metoda umożliwiająca charakterystykę kontroli motorycznej. Jest to istotne ze względu na konieczność monitorowania efektów procesu terapeutycznego zgodnie z wymogami Evidence Based Medicine (EBM). Celem badania była ocena przydatności pomiarów ciśnień generowanych w czasie maksymalnego chwytu cylindrycznego oraz jego zwalniania do oceny poziomu kontroli motorycznej ręki u pacjentów po udarze mózgu na tle skal subiektywnych.Materiał i metody: Do charakterystyki kontroli motorycznej zaproponowano wskaź-nik liczbowy wyliczony w oparciu o pomiary ciśnień generowanych podczas chwytu cylindrycznego ręki oraz jego zwolnienia. W celu przeprowadzenia pomiarów do badania włączono 12 osób z niedowładem połowiczym po przebytym udarze mózgu.Badanie obejmowało ocenę stopnia niedowładu ręki w skali Brunnström, ocenę stopnia nasilenia spastyczności w zmodyfikowanej skali Ashworth oraz ocenę sprawności ruchowej ręki według skali Fugl-Meyer (FMA). Dokonywano pomiaru ciśnień generowanych w czasie chwytu cylindrycznego, a następnie jego zwolnienia oraz pomiaru powierzchni ręki metodą fotometryczną. Badanie przeprowadzono dwukrotnie: w dniu przyjęcia do oddziału rehabilitacji stacjonarnej oraz po zakończeniu trzytygodniowej hospitalizacji.Wyniki: W badaniu drugim odnotowano nieznaczne zmniejszenie nasilenia niedowładu wyrażonego w skali Brunnström oraz obniżenie nasilenia spastyczności w skali Ashworth. Odnotowano wyższą punktację w skali FMA. Uzyskano zmianę wartości zaproponowanego wskaźnika, ale w żadnym przypadku zmiana nie była istotna statystycznie.Wnioski: 1. W odniesieniu do innych skal subiektywnych nie potwierdzono przydatności pomiarów ciśnień generowanych w czasie maksymalnego chwytu cylindrycznego oraz jego zwolnienia do oceny poziomu kontroli motorycznej ręki u pacjentów po udarze mózgu. 2. Dalsza weryfikacja przydatności proponowanej metody oceny kontroli motorycznej ręki z niedowładem spastycznym wymaga kontynuacji badań realizowanych zgodnie z wymogami EBM. In the case of post-stroke patients, it is significant to carry out objective assessment of the state of a paretic hand, including the intensity of spasticity and the level of motor control. These factors lead to the deterioration of limb function and disability [3][4][5]. In their research, Keng et al. revealed that 3 months post stroke, spasticity occurred in 33% of the patients [6]. The level of spasticity is usually assessed with Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) [7][8][9][10][11][12][13][14][15]. MAS is a subjective evaluation method [16], while Key words: WstępNabyte uszkodzenie górnego neuronu ruchowego ma negaty...

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Spasticity after stroke: Physiology, assessment and treatment

Cited by 352 publications

References 114 publications

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Integrated Sit-to-Stand and Stand-to-Sit Training System Providing Biofeedback Information and Physical Assistance to Hemiplegic Patients

A method of hand motor control assessment in patients with post-stroke spasticity

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