Treatment for spasticity in amyotrophic lateral sclerosis/motor neuron disease

Abstract

Individualized, moderate intensity, endurance type exercises for the trunk and limbs may help to reduce spasticity in motor neuron disease. No other medical, surgical or alternative treatment and therapy has been evaluated in a randomized fashion in this patient population.

Absence of Subcerebral Projection Neurons Is Beneficial in a Mouse Model of Amyotrophic Lateral Sclerosis

“…In humans, degeneration or lesion of the corticospinal tract results in appearance of the upper motoneuron syndrome, 25 a series of signs that include muscular weakness, decreased motor control, hyper‐reflexia, including spasticity, and clonus 26 . In ALS patients, spasticity is typically evaluated using the modified Ashworth Scale, which measures the resistance to a passive soft‐tissue stretching performed by the physician 27 . Hyper‐reflexia instead is observed clinically as a hyperactive deep tendon reflex and electrophysiologically as an increase of the monosynaptic spinal reflex activity revealed by an increase of the ratio between the short‐latency Hoffman's reflex, or H‐reflex, to compound muscle action potentials (H/M ratio) 28 .…”

Absence of Subcerebral Projection Neurons Is Beneficial in a Mouse Model of Amyotrophic Lateral Sclerosis

“…In humans, degeneration or lesion of the corticospinal tract results in appearance of the upper motoneuron syndrome, 25 a series of signs that include muscular weakness, decreased motor control, hyper‐reflexia, including spasticity, and clonus 26 . In ALS patients, spasticity is typically evaluated using the modified Ashworth Scale, which measures the resistance to a passive soft‐tissue stretching performed by the physician 27 . Hyper‐reflexia instead is observed clinically as a hyperactive deep tendon reflex and electrophysiologically as an increase of the monosynaptic spinal reflex activity revealed by an increase of the ratio between the short‐latency Hoffman's reflex, or H‐reflex, to compound muscle action potentials (H/M ratio) 28 .…”

Outcomes of Physical Therapy, Speech Pathology, and Occupational Therapy for People with Motor Neuron Disease: A Systematic Review

“…No level I studies were found on the effects of physical therapy, occupational therapy, or speech pathology for PwMND. Ashworth and others 34 attempted a meta-analysis of the literature on the treatment of spasticity in MND yet only identified one level II RCT, 35 which assessed the effects of aerobic and endurance training. Twenty-five people with ALS were randomly allocated to either a group that received individualized, unsupervised, twice daily exercises aimed at improving muscle endurance and aerobic capacity or a group instructed not to engage in physical activity other than their usual tasks.…”

Lingual Strengthening and Swallowing

“…It has been my observation that this philosophy is not universally embraced by speech-language pathologists, particularly with respect to the management of dysphagia in the early stages of disease or in the case of stimulated exercise (i.e., neuromuscular electrical stimulation). We can be encouraged, however, by recent studies that have challenged this long-held clinical philosophy regarding exercise in degenerative conditions, demonstrating that exercise may indeed provide at least short term benefi ts for individuals with ALS and MS, without exacerbating spasticity or fatigue (Ashworth, Satkunam, & Deforge, 2004;Drory, Goltsman, Reznik, Mosek, & Korczyn, 2001;White & Dressendorfer, 2004). It is unknown, however, whether exercise similarly benefi ts the swallowing performance of individuals with neurodegenerative disease.…”

Absence of Subcerebral Projection Neurons Is Beneficial in a Mouse Model of Amyotrophic Lateral Sclerosis

“…In humans, degeneration or lesion of the corticospinal tract results in appearance of the upper motoneuron syndrome, 25 a series of signs that include muscular weakness, decreased motor control, hyper‐reflexia, including spasticity, and clonus 26 . In ALS patients, spasticity is typically evaluated using the modified Ashworth Scale, which measures the resistance to a passive soft‐tissue stretching performed by the physician 27 . Hyper‐reflexia instead is observed clinically as a hyperactive deep tendon reflex and electrophysiologically as an increase of the monosynaptic spinal reflex activity revealed by an increase of the ratio between the short‐latency Hoffman's reflex, or H‐reflex, to compound muscle action potentials (H/M ratio) 28 .…”

Outcomes of Physical Therapy, Speech Pathology, and Occupational Therapy for People with Motor Neuron Disease: A Systematic Review

“…No level I studies were found on the effects of physical therapy, occupational therapy, or speech pathology for PwMND. Ashworth and others 34 attempted a meta-analysis of the literature on the treatment of spasticity in MND yet only identified one level II RCT, 35 which assessed the effects of aerobic and endurance training. Twenty-five people with ALS were randomly allocated to either a group that received individualized, unsupervised, twice daily exercises aimed at improving muscle endurance and aerobic capacity or a group instructed not to engage in physical activity other than their usual tasks.…”

Lingual Strengthening and Swallowing

“…It has been my observation that this philosophy is not universally embraced by speech-language pathologists, particularly with respect to the management of dysphagia in the early stages of disease or in the case of stimulated exercise (i.e., neuromuscular electrical stimulation). We can be encouraged, however, by recent studies that have challenged this long-held clinical philosophy regarding exercise in degenerative conditions, demonstrating that exercise may indeed provide at least short term benefi ts for individuals with ALS and MS, without exacerbating spasticity or fatigue (Ashworth, Satkunam, & Deforge, 2004;Drory, Goltsman, Reznik, Mosek, & Korczyn, 2001;White & Dressendorfer, 2004). It is unknown, however, whether exercise similarly benefi ts the swallowing performance of individuals with neurodegenerative disease.…”

Absence of Subcerebral Projection Neurons Is Beneficial in a Mouse Model of Amyotrophic Lateral Sclerosis

“…In humans, degeneration or lesion of the corticospinal tract results in appearance of the upper motoneuron syndrome, 25 a series of signs that include muscular weakness, decreased motor control, hyper‐reflexia, including spasticity, and clonus 26 . In ALS patients, spasticity is typically evaluated using the modified Ashworth Scale, which measures the resistance to a passive soft‐tissue stretching performed by the physician 27 . Hyper‐reflexia instead is observed clinically as a hyperactive deep tendon reflex and electrophysiologically as an increase of the monosynaptic spinal reflex activity revealed by an increase of the ratio between the short‐latency Hoffman's reflex, or H‐reflex, to compound muscle action potentials (H/M ratio) 28 .…”

Outcomes of Physical Therapy, Speech Pathology, and Occupational Therapy for People with Motor Neuron Disease: A Systematic Review

“…No level I studies were found on the effects of physical therapy, occupational therapy, or speech pathology for PwMND. Ashworth and others 34 attempted a meta-analysis of the literature on the treatment of spasticity in MND yet only identified one level II RCT, 35 which assessed the effects of aerobic and endurance training. Twenty-five people with ALS were randomly allocated to either a group that received individualized, unsupervised, twice daily exercises aimed at improving muscle endurance and aerobic capacity or a group instructed not to engage in physical activity other than their usual tasks.…”

Lingual Strengthening and Swallowing

“…It has been my observation that this philosophy is not universally embraced by speech-language pathologists, particularly with respect to the management of dysphagia in the early stages of disease or in the case of stimulated exercise (i.e., neuromuscular electrical stimulation). We can be encouraged, however, by recent studies that have challenged this long-held clinical philosophy regarding exercise in degenerative conditions, demonstrating that exercise may indeed provide at least short term benefi ts for individuals with ALS and MS, without exacerbating spasticity or fatigue (Ashworth, Satkunam, & Deforge, 2004;Drory, Goltsman, Reznik, Mosek, & Korczyn, 2001;White & Dressendorfer, 2004). It is unknown, however, whether exercise similarly benefi ts the swallowing performance of individuals with neurodegenerative disease.…”