The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia
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Hereditary Spastic Paraparesis: a Review of New Developments
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.69.2.150 on 1 August 2000. Downloaded from 150 J Neurol Neurosurg Psychiatry 2000;69:150–160 REVIEW Hereditary spastic paraparesis: a review of new developments CJ McDermott, K White, K Bushby, PJ Shaw Hereditary spastic paraparesis (HSP) or the reditary spastic paraparesis will no doubt Strümpell-Lorrain syndrome is the name given provide a more useful and relevant classifi- to a heterogeneous group of inherited disorders cation. in which the main clinical feature is progressive lower limb spasticity. Before the advent of Epidemiology molecular genetic studies into these disorders, The prevalence of HSP varies in diVerent several classifications had been proposed, studies. Such variation is probably due to a based on the mode of inheritance, the age of combination of diVering diagnostic criteria, onset of symptoms, and the presence or other- variable epidemiological methodology, and wise of additional clinical features. Families geographical factors. Some studies in which with autosomal dominant, autosomal recessive, similar criteria and methods were employed and X-linked inheritance have been described. found the prevalance of HSP/100 000 to be 2.7 in Molise Italy, 4.3 in Valle d’Aosta Italy, and 10–12 Historical aspects 2.0 in Portugal. These studies employed the In 1880 Strümpell published what is consid- diagnostic criteria suggested by Harding and ered to be the first clear description of HSP.He utilised all health institutions and various reported a family in which two brothers were health care professionals in ascertaining cases aVected by spastic paraplegia. The father was from the specific region. -
Outcomes Following Unilateral Selective Dorsal Rhizotomy In
Outcomes and Perioperative Considerations for Unilateral Selective Dorsal Rhizotomy in Children with Spastic Hemiplegia with Pre- and Postoperative Quantitative Gait Analysis Christine Hunt, D.O.1, Nicholas Wetjen, M.D.2, Kenton Kaufman, Ph.D.3, Krista Coleman Wood, P.T., Ph.D.3, Joline Brandenburg, M.D.1, Bradford Landry, D.O.1 1Department of Physical Medicine & Rehabilitation, 2Department of Neurologic Surgery, 3Department of Orthopedic Surgery Mayo Clinic, Rochester, MN Abstract Background & Objectives Methods Results: Postoperative Gait Analysis Discussion Background: Selective dorsal rhizotomy (SDR) is a Background Preoperative Baseline Characteristics Patient 1: Right SDR December 2013 • Pre-SDR, patients undergo an in-depth review of their medical procedure used to improve function, decrease pain and • Several human trials examining outcomes in SDR in children • Patient 1: 6 year old male, spastic right hemiplegia • 62.5% of sensory dorsal rootlets sectioned ( L2 to S1) history and imaging studies, consultation with a physiatrist, reduce spasticity in children and adults with cerebral palsy or neurosurgeon, and orthopedic surgeon, and evaluation with PT with spastic diplegia have been conducted, but there is a • GMFCS Level II • Normalized velocity and stride length stroke. Positive outcomes have been reported by numerous and OT. Testing includes QGA, MRI lumbar spine and brain, paucity of data describing outcomes following SDR for • 12 series of botulinum toxin • Improved hip and knee kinematics and kinetics authors but pediatric -
Cerebral Palsy the ABC's of CP
Cerebral Palsy The ABC’s of CP Toni Benton, M.D. Continuum of Care Project UNM HSC School of Medicine April 20, 2006 Cerebral Palsy Outline I. Definition II. Incidence, Epidemiology and Distribution III. Etiology IV. Types V. Medical Management VI. Psychosocial Issues VII. Aging Cerebral Palsy-Definition Cerebral palsy is a symptom complex, (not a disease) that has multiple etiologies. CP is a disorder of tone, posture or movement due to a lesion in the developing brain. Lesion results in paralysis, weakness, incoordination or abnormal movement Not contagious, no cure. It is static, but it symptoms may change with maturation Cerebral Palsy Brain damage Occurs during developmental period Motor dysfunction Not Curable Non-progressive (static) Any regression or deterioration of motor or intellectual skills should prompt a search for a degenerative disease Therapy can help improve function Cerebral Palsy There are 2 major types of CP, depending on location of lesions: Pyramidal (Spastic) Extrapyramidal There is overlap of both symptoms and anatomic lesions. The pyramidal system carries the signal for muscle contraction. The extrapyramidal system provides regulatory influences on that contraction. Cerebral Palsy Types of brain damage Bleeding Brain malformation Trauma to brain Lack of oxygen Infection Toxins Unknown Epidemiology The overall prevalence of cerebral palsy ranges from 1.5 to 2.5 per 1000 live births. The overall prevalence of CP has remained stable since the 1960’s. Speculations that the increased survival of the VLBW preemies would cause a rise in the prevalence of CP have proven wrong. Likewise the expected decrease in CP as a result of C-section and fetal monitoring has not happened. -
Effectiveness of Myofascial Release on Spasticity and Lower Extremity
hysical M f P ed l o ic a in n r e u & o R J International Journal of Kumar and Vaidya, Int J Phys Med Rehabil 2014, 3:1 l e a h n a DOI: 10.4172/2329-9096.1000253 o b i t i l a ISSN: 2329-9096i t a n r t i e o t n n I Physical Medicine & Rehabilitation Research Article Open Access Effectiveness of Myofascial Release on Spasticity and Lower Extremity Function in Diplegic Cerebral Palsy: Randomized Controlled Trial Chandan Kumar1* and Snehashri N Vaidya2 1Associate Professor, Smt Kashibai Navale College of Physiotherapy, Narhe, Pune, Maharashtra, India 2MGM’S School of Physiotherapy, Aurangabad, India Abstract Purpose: To find out the effectiveness of Myofascial Release in combination with conventional physiotherapy on spasticity of calf, hamstring and adductors of hip and on lower extremity function in spastic diplegic subjects. Methodology: 30 spastic diplegic subjects of age group 2-8 years were taken by random sampling method from MGM College and other private clinics in Aurangabad. 15 subjects were assigned in each group. Group A: Myofascial release and conventional PT treatment. Group B: conventional PT treatment. Both the groups received training for 4 weeks. Baseline and Post treatment measures of Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS) and Gross Motor Function Test (GMFM-88) were evaluated. Results: Mean difference of MAS and R2 value of MTS in group A was more than group B, for calf, hamstring and adductors, whereas GMFM showed nearly equal improvement in both groups. Conclusion: Overall, it can be concluded from our study that the MFR along with conventional treatment reduces spasticity in calf, hamstring and adductors of hip in spastic diplegic subjects. -
Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity
children Article Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity Piero Pavone 1 , Carmela Gulizia 2, Alice Le Pira 1, Filippo Greco 1, Pasquale Parisi 3 , Giuseppe Di Cara 4, Raffaele Falsaperla 5, Riccardo Lubrano 6, Carmelo Minardi 7 , Alberto Spalice 8 and Martino Ruggieri 9,* 1 Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU “Policlinico”, PO “G. Rodolico”, University of Catania, 95123 Catania, Italy; [email protected] (P.P.); [email protected] (A.L.P.); [email protected] (F.G.) 2 Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; [email protected] 3 NESMOS Department of Pediatrics, Sapienza University of Rome, Sant’Andrea University Hospital, 00161 Rome, Italy; [email protected] 4 Department of Pediatrics, University of Perugia, 06132 Perugia, Italy; [email protected] 5 Neonatal Intensive Care Unit (NICU), Neonatal COVID-19 Center, AOU “Policlinico”, PO San Marco, University of Catania, 95123 Catania, Italy; [email protected] 6 Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria, Neonatologia, Ospedale Santa Maria Goretti, Polo di Latina, 04010 Latina, Italy; [email protected] 7 Department of Anaesthesia and Intensive Care, University Hospital “G. Rodolico” of Catania, 95123 Catania, Italy; [email protected] 8 Child Neurology Division, Department of Pediatrics, -
Cerebral Palsy
Cerebral Palsy Cerebral palsy encompasses a group of non-progressive and non-contagious motor conditions that cause physical disability in various facets of body movement. Cerebral palsy is one of the most common crippling conditions of childhood, dating to events and brain injury before, during or soon after birth. Cerebral palsy is a debilitating condition in which the developing brain is irreversibly damaged, resulting in loss of motor function and sometimes also cognitive function. Despite the large increase in medical intervention during pregnancy and childbirth, the incidence of cerebral palsy has remained relatively stable for the last 60 years. In Australia, a baby is born with cerebral palsy about every 15 hours, equivalent to 1 in 400 births. Presently, there is no cure for cerebral palsy. Classification Cerebral palsy is divided into four major classifications to describe different movement impairments. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed. In most cases of cerebral palsy, the exact cause is unknown. Suggested possible causes include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, preterm birth, infection, and trauma. Spastic cerebral palsy leads to increased muscle tone and inability for muscles to relax (hypertonic). The brain injury usually stems from upper motor neuron in the brain. Spastic cerebral palsy is classified depending on the region of the body affected; these include: spastic hemiplegia; one side being affected, spastic monoplegia; a single limb being affected, spastic triplegia; three limbs being affected, spastic quadriplegia; all four limbs more or less equally affected. -
Treatment of Spastic Foot Deformities
TREATMENT OF SPASTIC FOOT DEFORMITIES penn neuro-orthopaedics service Table of Contents OVERVIEW Severe loss of movement is often the result of neurological disorders, Overview .............................................................. 1 such as stroke or brain injury. As a result, ordinary daily activities Treatment ............................................................. 2 such as walking, eating and dressing can be difficult and sometimes impossible to accomplish. Procedures ........................................................... 4 The Penn Neuro-Orthopaedics Service assists patients with Achilles Tendon Lengthening .........................................4 orthopaedic problems caused by certain neurologic disorders. Our Toe Flexor Releases .....................................................5 team successfully treats a wide range of problems affecting the limbs including foot deformities and walking problems due to abnormal Toe Flexor Transfer .......................................................6 postures of the foot. Split Anterior Tibialis Tendon Transfer (SPLATT) ...............7 This booklet focuses on the treatment of spastic foot deformities The Extensor Tendon of the Big Toe (EHL) .......................8 under the supervision of Keith Baldwin, MD, MSPT, MPH. Lengthening the Tibialis Posterior Tendon .......................9 Care After Surgery .................................................10 Notes ..................................................................12 Pre-operative right foot. Post-operative -
Hereditary Spastic Paraplegias
Hereditary Spastic Paraplegias Authors: Doctors Enza Maria Valente1 and Marco Seri2 Creation date: January 2003 Update: April 2004 Scientific Editor: Doctor Franco Taroni 1Neurogenetics Istituto CSS Mendel, Viale Regina Margherita 261, 00198 Roma, Italy. e.valente@css- mendel.it 2Dipartimento di Medicina Interna, Cardioangiologia ed Epatologia, Università degli studi di Bologna, Laboratorio di Genetica Medica, Policlinico S.Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.mailto:[email protected] Abstract Keywords Disease name and synonyms Definition Classification Differential diagnosis Prevalence Clinical description Management including treatment Diagnostic methods Etiology Genetic counseling Antenatal diagnosis References Abstract Hereditary spastic paraplegias (HSP) comprise a genetically and clinically heterogeneous group of neurodegenerative disorders characterized by progressive spasticity and hyperreflexia of the lower limbs. Clinically, HSPs can be divided into two main groups: pure and complex forms. Pure HSPs are characterized by slowly progressive lower extremity spasticity and weakness, often associated with hypertonic urinary disturbances, mild reduction of lower extremity vibration sense, and, occasionally, of joint position sensation. Complex HSP forms are characterized by the presence of additional neurological or non-neurological features. Pure HSP is estimated to affect 9.6 individuals in 100.000. HSP may be inherited as an autosomal dominant, autosomal recessive or X-linked recessive trait, and multiple recessive and dominant forms exist. The majority of reported families (70-80%) displays autosomal dominant inheritance, while the remaining cases follow a recessive mode of transmission. To date, 24 different loci responsible for pure and complex HSP have been mapped. Despite the large and increasing number of HSP loci mapped, only 9 autosomal and 2 X-linked genes have been so far identified, and a clear genetic basis for most forms of HSP remains to be elucidated. -
Cerebral Palsy
Cerebral Palsy What is Cerebral Palsy? Doctors use the term cerebral palsy to refer to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but are not progressive, in other words, they do not get worse over time. • Cerebral refers to the motor area of the brain’s outer layer (called the cerebral cortex), the part of the brain that directs muscle movement. • Palsy refers to the loss or impairment of motor function. Even though cerebral palsy affects muscle movement, it is not caused by problems in the muscles or nerves. It is caused by abnormalities inside the brain that disrupt the brain’s ability to control movement and posture. In some cases of cerebral palsy, the cerebral motor cortex has not developed normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not repairable and the disabilities that result are permanent. Patients with cerebral palsy exhibit a wide variety of symptoms, including: • Lack of muscle coordination when performing voluntary movements (ataxia); • Stiff or tight muscles and exaggerated reflexes (spasticity); • Walking with one foot or leg dragging; • Walking on the toes, a crouched gait, or a “scissored” gait; • Variations in muscle tone, either too stiff or too floppy; • Excessive drooling or difficulties swallowing or speaking; • Shaking (tremor) or random involuntary movements; and • Difficulty with precise motions, such as writing or buttoning a shirt. The symptoms of cerebral palsy differ in type and severity from one person to the next, and may even change in an individual over time. -
Original Report
J Rehabil Med 2015; 47: 917–923 ORIGINAL REPORT ALTERED FORCE PERCEPTION IN STROKE SURVIVORS WITH SPASTIC HEMIPLEGIA Jasper T. Yen, PhD1,2 and Sheng Li, MD, PhD1,2 From the 1Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center – Houston, Houston, TX and 2NeuroRehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA Objective: To investigate the effect of spasticity and involun- muscles is not fully understood. During volitional activation tary synergistic activation on force perception during volun- of spastic muscles in one part of the limb, muscle activation is tary activation of spastic paretic muscles. also seen in other muscles of the limb, i.e. spastic synergistic Methods: Eleven stroke subjects with spastic hemiparesis activation. For example, shoulder abduction causes involun- performed various isometric elbow-flexion force-matching tary activation of distal wrist and finger flexors much more in tasks. Subjects were instructed to generate a target refer- the impaired limb than in the non-impaired limb and control ence force with visual feedback using one arm (impaired or limb (4). Synergistic activation may be related to bulbospinal non-impaired) and then to produce a force with the other activation as a result of disinhibition following cortical dam- arm to match the magnitude of the reference force without age in stroke (4, 5). This divergent bulbospinal activation and visual feedback. The reference arm was at rest in unilateral resultant spontaneous motor unit activity are viewed as the pri- exertion trials and maintained contraction in bilateral exer- mary underlying mechanism mediating post-stroke spasticity tion trials during the matching force-production period. -
What Polio Is Or What It Affects Or Causes: by Marny Eulberg, M.D., Director, Post Polio Clinic at What Polio Is Or What It St
VOLUME 23 NUMBER 3 SUMMER 2008 IN THIS ISSUE What polio is or what it affects or causes: By Marny Eulberg, M.D., director, Post Polio Clinic at What Polio Is or What It St. Anthonys Hospital, Denver Affects or Causes . p. 1 9 Polio kills or damages the anterior horn cell(s) in the In My Opinion . p. 2 spinal cord and thus results in no information being Comorbidities & sent to the muscle fibers of any voluntary (striated) Secondary Disabilities . muscle i.e. any muscle that can be controlled by p. 4 thought such as I think Ill point at that object with my index finger; this includes the muscles of the Book Review: Living hand, arm, shoulder, neck, trunk, back, abdominal wall, With Polio by Daniel J. entire leg and foot, face including muscles used in Wilson . p. 5 chewing, and muscles used for breathing and for the initiation of swallowing (the latter are known as Martha Logan: Mother, bulbar muscles). It does not affect the cardiac Teacher, Homemaker . (heart) muscle or smooth muscle which is in the p. 7 walls of the GI tract (esophagus, stomach, The Colorado Post-Polio intestines) or the walls of the urinary bladder. Educational Conference . 9 Atrophy (wasting) of a muscle(s) or the skinny arm p. 10 or leg is a result of the muscle not getting any And By the Way . p. 12 messages from the nerve that it needs to work. Talking About Physical 9 Polio leg (the cold to the touch) happens because of Rehabilitation . p. 13 blood pooling in the weakened extremity, radiant heat loss, and some lack of blood vessel constriction that A special thanks to Oran normally happens when exposed to cold temperatures. -
Spastic Paraplegia Type 4
Spastic paraplegia type 4 Description Spastic paraplegia type 4 (also known as SPG4) is the most common of a group of genetic disorders known as hereditary spastic paraplegias. These disorders are characterized by progressive muscle stiffness (spasticity) in the legs and difficulty walking. Hereditary spastic paraplegias are divided into two types: pure and complex. The pure types generally involve only spasticity of the lower limbs and walking difficulties. The complex types involve more widespread problems with the nervous system; the structure or functioning of the brain; and the nerves connecting the brain and spinal cord to muscles and sensory cells that detect sensations such as touch, pain, heat, and sound (the peripheral nervous system). In complex forms, there can also be features outside of the nervous system. Spastic paraplegia type 4 is usually a pure hereditary spastic paraplegia, although a few complex cases have been reported. Like all hereditary spastic paraplegias, spastic paraplegia type 4 involves spasticity of the leg muscles and muscle weakness. People with this condition can also experience exaggerated reflexes (hyperreflexia), ankle spasms, high-arched feet (pes cavus), and reduced bladder control. Spastic paraplegia type 4 generally affects nerve and muscle function in the lower half of the body only. Frequency The prevalence of spastic paraplegia type 4 is estimated to be 2 to 6 in 100,000 people worldwide. Causes Mutations in the SPAST gene cause spastic paraplegia type 4. The SPAST gene provides instructions for producing a protein called spastin. Spastin is found throughout the body, particularly in certain nerve cells (neurons). The spastin protein plays a role in the function of microtubules, which are rigid, hollow fibers that make up the cell's structural framework (the cytoskeleton).