Tag: spasticity

Body composition and spasticity in children with bilateral cerebral palsy

Lawia Szkoda, Andrzej Szopa, Ilona Kwiecień-Czerwieniec, Małgorzata Domagalska-Szopa


Lawia Szkoda, Andrzej Szopa, Ilona Kwiecień-Czerwieniec, Małgorzata Domagalska-Szopa – Body composition and spasticity in children with bilateral cerebral palsy. Fizjoterapia Polska 2022; 22(2); 174-185

Abstract
Objective. The objective of this study was to identify the correlation between body composition of children with cerebral palsy and the degree of spasticity in the muscles of the lower limbs.
Material and methods. The study included a group of 59 independently walking children aged 8 to 16 with spastic diplegia. The control group included 59 children without central movement disorders – students at Primary School No. 25 in Sosnowiec. The research included: 1) assessment of body composition and its components using the TANITA MC-780 S MA scale; 2) assessment of the degree of spasticity according to the modified Ashworth scale; 3) calculations of BMI indices in accordance with the recommendations of the World Health Organization (WHO) and BMI OLAF developed by the Children’s Memorial Health Institute in Warsaw.
Results. The most severe spasticity, both in the right and left lower limbs, was observed in the extensors of the ankle joint. In turn, the mildest spasticity was observed in the group of flexors of the knee joint of the right and left lower limbs. The greater the degree of spasticity in the muscles of the lower limbs, the greater the deficit in fat-free mass and muscle mass in the lower limbs.
Conclusions. Children with CP have deficits in terms of muscle mass. The deficit of muscle tissue depends on the degree of spasticity of the proximal muscle groups of the lower limbs.
Key words:
body composition, spasticity, cerebral palsy
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The impact of tolperisone iontophoresis on selected musculo-skeletal parameters in children with cerebral palsy

Mirosław Janiszewski, Adam Bandyra, Janusz Dobrowolski, Kazimierz Arabski, Aneta Hak, Jagoda Szner-Dobrowolska

Mirosław Janiszewski, Adam Bandyra, Janusz Dobrowolski, Kazimierz Arabski, Aneta Hak, Jagoda Szner-Dobrowolska – The impact of tolperisone iontophoresis on selected musculo-skeletal parameters in children with cerebral palsy. Fizjoterapia Polska 2004; 4(3); 250-253

Abstract

Background. Spasticity in children with cerebral palsy (CP) leads to disturbances of balance between various muscle groups (e. g. extensors and flexors), often causing significant impairment of limb function even when there is only slight paresis. The primary task of motor exercises is to remedy motor disturbances to the extent possible, with particular attention to mastery of locomotion skills and increased manual dexterity. The purpose of our research was to evaluate the impact of tolperisone iontophoresis as an adjuvant therapy in the rehabilitation of children with CP. Material and methods. We examined 70 children with spastic CP, hospitalized in the „Górka” Children’s Comprehensive Rehabilitation Hospital in Busko Zdrój, Poland. The experimental group included 35 patients, as did the control group. Tolperisone iontophoresis was performed in the experimental group on the main muscle groups, using horizontal electrotherapy. Results. When the results achieved by the children in both groups were compared, we found statistically significant differences. Conclusions. The application of tolperisone iontophoresis causes improved manual and locomotor skills, as indirectly demonstrated by better test results for grip strength, manual dexterity, and Katz test results. Tolperisone iontophoresis should always be combined with motor rehabilitation.

Key words:
horizontal electrotherapy, spasticity, grip strength
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The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna – The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy. Fizjoterapia Polska 2007; 7(1); 38-44

Abstract

Background. The efficacy of botulinum toxin type A (BTX-A) in the management of cerebral palsy was determined in the lower limb. Material and methods. The study was carried out on 51 children with cerebral palsy aged 2-17 years (mean age 8 years and 6 months). The patients were undergoing treatment with BTX-A to reduce spasticity and alleviate dynamic contractures. Between one and four target muscles were selected according to functional goals (improving the gait pattern, increasing the range of motion at joints) and biomechanical assessments and were injected at multiple sites with BTX-A. The patients were evaluated at baseline and at 3 and 12 weeks post-injection. Parameters evaluated comprised Joint Range of Motion (ROM), Modified Ashworth Scale (MAS), Modified Physician Rating Scale (MPRS), Gross Motor Function Measure (GMFM) and Global Clinical Impression (GCI). Patterns of gait were monitored by VHS registration. Results. The statistical tests showed a significant (one degree) improvement over baseline at 3 weeks after the first injection (p<0.05) in MAS, MPRS, and GCI. A deterioration of MPRS and joint range of motion was observed at 12 weeks after the first dose and before the second dose (p<0.01). Two patients started to walk without mobility devices after the BTX-A treatment. The outcomes were worse in the five patients who did not perform the required rehabilitation programme after the BTX-A treatment. Conclusions. The use of BTX-A is indicated in children with diplegia and spastic hemiplegia to improve locomotor ability, and in tetraplegic children to facilitate nursing care and enable the patients to assume a standing position.

Słowa kluczowe:
spasticity, cerebral palsy, botulinum toxin type A (BTX-A), lower limbs
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The use of botulinum toxin in clinical practice

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta – The use of botulinum toxin in clinical practice. Fizjoterapia Polska 2008; 8(2); 105-114

Abstract
Botulinum toxin is increasingly used in clinical practice as a basic or adjunctive agent in many fields modern medicine. In the field of rehabilitation of the musculoskeletal system, the introduction of botulinum toxin has opened new unexpected therapeutic avenues. This method broadens the possibilities for therapeutic intervention of doctors and physiotherapists, for whom complete recovery or improvement of the patient’s overall physical capacity is the measure of success. Because of its effectiveness and high safety for the patient, it is considered to be a modern and promising medicinal agent. The possibility of applying botulinum toxin selectively and, at the same time, precisely makes for a good clinical effect, while an appropriate pharmacological safety margin is also maintained. Although the range of indications is broad, it is in the treatment of spasticity of particular muscle groups who received the treatment as quickly as possible. Absolute contraindications include: myasthenia gravis, myasthenic syndrome, blood coagulability disorders. The most serious relative contraindications are pregnancy and breast-feeding. Intensive clinical research as well as numerous scientific meetings are making it possible for the method to gain more popularity and also to the clinical experience. Current standards of botulinum toxin use have been elaborated and published by an interdisciplinary group of experts. These standards are guidelines for practicing physicians. The author’s experience and available literature have served to present a state-of-the-art review of the use of botulinum toxin in clinical practice.
Key words:
spasticity, botulinum toxin, cerebral palsy
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Possibilities for precise measurement of increased muscle tone secondary to spinal cord injury with surface electromyography

Aleksandra Zagłoba-Kaszuba Juliusz Huber, Wanda Stryła, Dorota Warzecha, Marcin Wytrążek, Joanna Lipiec

Aleksandra Zagłoba-Kaszuba Juliusz Huber, Wanda Stryła, Dorota Warzecha, Marcin Wytrążek, Joanna Lipiec – Possibilities for precise measurement of increased muscle tone secondary to spinal cord injury with surface electromyography. Fizjoterapia Polska 2011; 11(1); 9-19

Abstract
This paper presents the results of comparative bilateral global surface electromyography (gEMG) recordings from selected upper and lower extremity muscles in patients undergoing rehabilitation following spinal cord injuries at C4-Th8 levels. It was assumed that this technique can enable precise monitoring of changes in muscle tone during treatment in patients with spinal injuries.Surface gEMG recordings were obtained at rest (complete muscle relaxation) and during maximum muscle contraction in 12 patients (aged from 21 to 45 years) from the anterior tibial muscle, gastrocnemius muscle and abductor pollicis brevis muscle before and after four weeks of rehabilitation.Signs of increased muscle tone during surface gEMG recordings at rest observed in the patients were associated with elevated amplitude (mean 52μV). This parameter decreased to a mean of 37μV following rehabilitation. The observed decrease in muscle tone was accompanied by an increase in mean gEMG amplitude of the muscles during their maximum effort.Surface gEMG recordings are a precise diagnostic tool serving to evaluate not only muscle performance during maximum effort but also muscle tone at rest.
Key words:
spasticity, Electromyography, spinal injury
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Influence of proprioceptiveneuromuscular facilitation (PNF) on the degree of spasticity in late-stage stroke patients

Tomasz Wolny, Edward Saulicz, Rafał Gnat, Mirosław Kokosz, Andrzej Myśliwiec, Michał Kuszewski

Tomasz Wolny, Edward Saulicz, Rafał Gnat, Mirosław Kokosz, Andrzej Myśliwiec, Michał Kuszewski – Influence of proprioceptiveneuromuscular facilitation (PNF) on the degree of spasticity in late-stage stroke patients. Fizjoterapia Polska 2011; 11(1); 1-8

Abstract
The complex pathophysiology of spasticity depends on the interaction between facilitation and inhibition of spinal and supraspinal neural centres and pathways. Contemporary medicine has developed several methods to treat spasticity. However, none of them has offered superior efficacy. This study aimed to investigate differences in the degree of spasticity between patients subjected to traditional post-stroke rehabilitation and rehabilitation based on the PNF method.A total of 64 stroke patients were enrolled. They were randomly divided into Group A and Group B. The modified six-grade Ashworth scale was used to evaluate the level of spasticity. During a 21-day follow-up, all subjects underwent intensive comprehensive rehabilitation. Group A received traditional stroke therapy. Group B received kinesiotherapy based on the PNF method.Both groups demonstrated significant improvements. In Group A, the degree of improvement in the final examination was 1.8% compared to baseline. In Group B, an improvement of 7.8% was registered already after the first session. The degree of improvement at the end of treatment was 16.86%. No significant inter-group differences were noted at baseline. The final evaluation showed significant differences.A regimen based on the PNF method resulted in greater reduction in spasticity than the traditional approach.
Key words:
spasticity, PNF, physiotherapy, Stroke, Therapeutic effects
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ffect of locomotor training with a robotic-gait orthosis (lokomat) In Spasticity Modulation of Spastic Hemiplegic Children: A Randomized Controlled Trial

Mohamed Serag Eldein Mahgoub, Wagdy William Amin, Samah Saad Zahran

Mohamed Serag Eldein Mahgoub, Wagdy William Amin, Samah Saad Zahran – Effect of locomotor training with a robotic-gait orthosis (lokomat) In Spasticity Modulation of Spastic Hemiplegic Children: A Randomized Controlled Trial. Fizjoterapia Polska 2020; 20(4); 94-101

Abstract
Background. Studying of robotic-assisted locomotor training (lokomat) in spasticity modulation on cerebral palsied hemiplegic children is a strategy for determining its efficacy in reducing spasticity.
Objective. To investigate the efficacy of robotic-assisted locomotor training (lokomat) in spasticity modulation. Methods. Thirty spastic hemiplegic cerebral palsied children of both genders ranged in age from 7 to 14 years contributed in this study, they were being randomly selected from comprehensive rehabilitation center and assigned into two equal groups (15 children each). Control group (A) underwent traditional exercise treatment, while Study group (B) underwent lokomat gait training in addition to traditional exercise program. Lokomat training was performed 3 days/week for 4 weeks with up to 45 minutes of training per session. The 3-D kinematics gait analysis was carried out before and after intervention and used as an indicator for improvement and reduction of spasticity.
Results. there was a statistically significant improvement in the study group in comparison to control group. Conclusion. Lokomat gait training is an effective additional tool for physical therapy program in treatment of hemiparetic C.P. children as it plays an important role in decreasing spasticity and improving patient gait pattern.

Key words:
cerebral palsy, spasticity, 3-D measurement, Lokomat gait training

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Evaluation of manual dexterity after treatment with botulinum type A(B), selected kinesitherapeutic methods: a case study

Sebastian Głowiński, Karol Łosiński, Agnieszka Grochulska, Gabriela Płotka, Adam Hałaburda

S. Głowiński, K. Łosiński, A. Grochulska, G. Płotka, A. Hałaburda – Evaluation of manual dexterity after treatment with botulinum type A(B), selected kinesitherapeutic methods: a case study. Fizjoterapia Polska 2020; 20(4); 40-48

Abstract
Introduction. Botulinum treatment involves the reduction of spasticity in patients qualified for this type of treatment. The main aim of this treatment is to increase the quality of life by improving functionality. In some situations, however, objective tests indicate a deterioration of movement parameters, and at the same time the patient reports improved performance of basic self-care activities. In this case, the decision to continue the therapy depends on the patient’s subjective feelings.
Material and methods. The study concerns a 20-year-old patient with right-sided spastic paresis resulting from the surgical treatment of left thalamic haemangioma in 2008. The patient was qualified for botulinum toxin treatment under the NFZ programme in 2019. The above-mentioned therapy was applied in combination with selected methods of neurophysiological rehabilitation. The aim was to maximize the positive effects of the therapy: to improve the range of mobility and reduce associated reactions, with minimal loss of manual activities of the right upper limb. Tests were performed to assess muscle tone according to the Ashworth scale, and precision grip according to the “Guidelines of the National Council of Physiotherapists for Health Services”. Additionally, the range of motion in the hand joints was measured using the vision system. A subjective 10-degree scale was proposed to assess the incidence of associated reactions during everyday activities.
Results. The results obtained indicated discrepancies between the objective results of standard tests and the patient’s subjective evaluation. According to the patient, despite the loss of some of her hard-earned mobility patterns, her quality of life improved.
Conclusion. Botulinum injection combined with physiotherapy slightly increased the range of motion in the hand joints, decreased the associated reactions, and slightly improved manual dexterity.

Key words:
spasticity, rehabilitation, physiotherapy, botulinum

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背神经根切断术 – 一种治疗脑瘫儿童痉挛状态的神经外科手术方法：目前的指示状况使

Monika Wolska, Marek Kiljański, Witold Rongies

M. Wolska, M. Kiljański, W. Rongies – Selective Dorsal Rhizotomy (SDR) – neurosurgical method in treatment of spasticity in CP: the current state of knowledge. Fizjoterapia Polska 2019; 19(2); 66-75

摘要
痉挛为脑瘫儿童的主要症状之一，对儿童的活动、日常生活中的参与有不利影响，也对其在社会中的功能有影响。慢性痉挛造成肌肉和结缔组织结构变化的发展，导致萎缩、僵硬，最后萎缩至无法接受药物治疗的程度。脑瘫儿童的生活舒适程度恶化及护理上的问题是促使我们寻求治疗痉挛的持久有效方法的主因。
为患者选择最佳治疗形式取决于以下要素：损伤的位置及其严重程度、临床症状、患者年龄及可用的治疗方法等。
背神经根切断术（SDR – 英文为Selective Dorsal Rhizotomy）为一种治疗儿童脑瘫痉挛状态的神经外科手术方法，治疗不可逆转，永久性地减少痉挛状态。关于手术资格、适应症和短期及长期效果等方面还存在许多争议。每年有越来越多的国际临床试验证实该治疗对患者功能状态改善具正面影响。研究目的在将治疗本身、资格标准、使用的研究工具和理疗治疗后报告等知识的收集和系统化，并指出手术治疗的效果。

关键词：
背神经根切断术、SDR、理疗、痉挛、脑麻痹

 

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Outcomes following inhibiting casts treatment in a 5 years old child with spastic hemplegic cerebral palsy – a case report

Małgorzata Domagalska–Szopa,  Andrzej Szopa,
Weronika Gallert–Kopyto, Krzysztof Bąk, Anna Dawczyk, Ryszard Plinta

M. Domagalska–Szopa,  A. Szopa, W. Gallert–Kopyto, K. Bąk, A. Dawczyk, R. Plinta – Outcomes following inhibiting casts treatment in a 5 years old child with spastic hemplegic cerebral palsy – a case report. FP 2015; 15(1); 24-34

Abstract

In children with Cerebral palsy (CP), according to the definition, motor disorders occur.
The primary aim of the rehabilitation in this group of children is to support the development of the best quality of motor and posture patterns. Presented study describes the effects of non-invasive physical therapy, based on Neurodevelopmental Treatment (NDT) connected with serial inhibiting casts application, on postural control and gait pattern improvement in 5 years old child with spastic hemiplegia.
Functional assessment, before and after treatment, included: clinical measures of spasticity, weight – bearing distribution between body sides, posturography testing and gait analysis. Applied therapy influenced on: reduction of spasticity in the affected limb and improvement in postural control and gait parameters. Both range of movement (ROM) deficit and spasticity angle (AOS) in knee and ankle decreased and effected on postural control and gait improvement.
Obtained results demonstrate that non-invasive procedures of physical intervention, connected with serial inhibiting casts application, can be successful method of spasticity reduction, postural control and gait improvement in young children with spastic unilateral CP. Early detection of spasticity of triceps contracture and proper physical intervention may eliminate the need for invasive intervention and its associated risks in this population.

Key words:
spasticity, dynamic assessment of range of movement, distribution of pressure forces of body weight on support plane, posturography, three-dimensional gait analysis

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