Passive Ankle Range Of Motion Research Articles

Effects of dry needling on spasticity, cortical excitability, and range of motion in a patient with multiple sclerosis: a case report

BackgroundDry needling is an intervention used by physiotherapists to manage muscle spasticity. We report the effects of three sessions of dry needling on ankle plantar flexor muscle spasticity and cortical excitability in a patient with multiple sclerosis.Case presentationThe patient was a 40-year-old Iranian woman with an 11-year history of multiple sclerosis. The study outcomes were measured by the modified modified Ashworth scale, transcranial magnetic stimulation parameters, and active and passive ankle range of motion. They were assessed before (T0), after three sessions of dry needling (T1), and at 2-week follow-up (T2). Our result showed: the modified modified Ashworth scale was improved at T2 from, 2 to 1. The resting motor threshold decreased from 63 to 61 and 57 at T1 and T2, respectively. The single test motor evokes potential increased from 76.2 to 78.3. The short intracortical inhibition increased from 23.6 to 35.4 at T2. The intracortical facilitation increased from 52 to 76 at T2. The ankle active and passive dorsiflexion ROM increased ~ 10° and ~ 6° at T2, respectively.ConclusionThis case study presented a patient with multiple sclerosis who underwent dry needling of ankle plantar flexors with severe spasticity, and highlighted the successful use of dry needling in the management of spasticity, ankle dorsiflexion, and cortical excitability. Further rigorous investigations are warranted, employing randomized controlled trials with a sufficient sample of patients with multiple sclerosis.Trial registration IRCT20230206057343N1, registered 9 February 2023, https://en.irct.ir/trial/68454

Therapeutic effects of extracorporeal shock wave therapy on patients with spastic cerebral palsy and Rett syndrome: clinical and ultrasonographic findings

BackgroundExtracorporeal shock wave therapy (ESWT) is reportedly effective for improving spasticity and motor function in children with cerebral palsy (CP). Because late-stage Rett syndrome has a similar presentation, this study aimed to investigate the effects of ESWT on these two diseases.Material and MethodsPatients diagnosed with spastic CP and Rett syndrome received 1500 impulses of ESWT at 4 Hz and 0.1 mJ/mm2, on their spastic legsonce weekly for a total of 12 weeks. Outcomes were assessed before and 4 and 12 weeks after ESWT. Clinical assessments included the Modified Ashworth Scale (MAS), passive range of motion (PROM), and Gross Motor Function Measure 88 (GMFM-88). Ultrasonographic assessments included muscle thickness, acoustic radiation force impulse (ARFI), and strain elastography.ResultsFifteen patients with CP and six with Rett syndrome were enrolled in this study. After ESWT, patients with CP showed significant clinical improvement in the MAS (P = 0.011), ankle PROM (P = 0.002), walking/running/jumping function (P = 0.003), and total function (P < 0.001) of the GMFM-88. The patients with Rett syndrome showed improved MAS scores (P = 0.061) and significantly improved total gross motor function (P = 0.030). Under ARFI, patients with CP demonstrated decreased shear wave speed in the gastrocnemius medial head (P = 0.038). Conversely, patients with Rett syndrome show increased shear-wave speeds after ESWT.ConclusionOur study provides evidence that a weekly course of low-dose ESWT for 12 weeks is beneficial for children with both CP and Rett syndrome, with the clinical effects of reducing spasticity and improving the gross motor function of the lower limbs. The ARFI sonoelastography reveals improvement of muscle stiffness in patients with CP after ESWT, but deteriorated in patients with Rett syndrome. The diverse therapeutic response to ESWT may be caused by the MECP2 mutation in Rett syndrome, having a continuous impact and driving the pathophysiology differently as compared to CP, which is secondary to a static insult.Trial registration IRB 201700462A3. Registered 22March 2017, https://cghhrpms.cgmh.org.tw/HRPMS/Default.aspx.

Prevention of Equinus Deformity after External Fixation for Open Tibia Fractures: A Comparison between Plaster of Paris Backslab and Passive Ankle Physiotherapy.

Ankle equinus deformity is a common complication of prolonged external fixator use in tibia fractures with an incidence of 15%-16%. It affects gait and may lead to foot, leg, and back problems. Treatment of equinus deformity increases the cost of treatment of open tibia fractures and increases the time spent off work. Several preventive modalities have been suggested in literature with variable success, but no standard protocol exists. The aim of this study was to determine the most appropriate method of preventing equinus deformity of the ankle joint during the management of open tibia fractures with unilateral uniplanar external fixators by comparing plaster of paris (POP) backslab application with passive ankle physiotherapy using strips of car tyre inner tubing. The study was a prospective randomised study involving patients with open tibia fractures who were managed with external fixators at the Korle Bu Teaching Hospital between April 2020 and February 2021. Patients were randomised into two groups; one group had below knee POP backslab and the other group did passive ankle physiotherapy using a strip of car tyre inner tubing. The passive ankle range of motion was measured at the beginning and after 6 weeks using a goniometer. Fifty-six participants were recruited with 29 in the POP backslab group and 27 in the ankle physiotherapy group. The median age was 35.0 years. Male-to-female ratio was 4.6:1. Motor vehicle crash contributed to over 90% with 42.9% being motorbike riders. Initial and final mean ankle measurements for the POP backslab group were 6.79° and 10.14° for dorsiflexion and 29.93° and 34.52° for plantarflexion, respectively. The ankle physiotherapy group had initial and final dorsiflexion of 7.19° and 12.85° and plantarflexion of 30.44° and 34.52°, respectively. The ankle physiotherapy group had a better range of motion (47.37°) than the POP group (40.66°) with a P value of 0.008. One participant (3.7%) from the ankle physiotherapy group had equinus deformity compared with seven (24%) from the POP backslab group, a difference which gives a P value of 0.029. Passive ankle physiotherapy with car tyre inner tube is a better and cheaper modality of preventing ankle equinus deformity and maintaining ankle range of motion.

Evaluation of Static and Dynamic Plantar Pressure Distribution along with Other Musculoskeletal Parameters in Athletes with and without Medial Tibial Stress Syndrome

ABSTRACT Background: Medial tibial stress syndrome is one of the most common overuse injuries in all running-related activities. Despite the high prevalence, various controversy exist in the literature regarding the risk factors for MTSS. Purpose: The main purpose of the present study was to evaluate and compare the risk factors for MTSS such as passive ankle range of motion, static and dynamic plantar pressure distribution, navicular drop, hip flexors, and hamstring flexibility as well as the foot posture between the athletes with MTSS and normal athletes. Materials and Methods: Fourty-eight participants after detailed assessment were recruited in the present study and were divided into two groups, Group A (subjects with MTSS) and Group B (subjects without MTSS). They all went through a musculoskeletal examination for quantifying the navicular drop, foot posture, hamstring and hip flexor’s flexibility, ankle plantarflexion and dorsiflexion range of motion. Plantar pressure analysis was used to quantify plantar pressure while standing and running. Results: Independent t-test was used. Subjects with MTSS demonstrated deficit in hamstring flexibility (P = 0.0006), dorsiflexion range of motion (P = 0.0039), a greater navicular drop (P &lt; 0.0001), and a more pronated foot posture (P = 0.0245) when compared with the normal athletes. MTSS subjects also showed more total force and pressure under the forefoot region in both static and dynamic measurement of plantar pressure. Conclusion: The findings demonstrated that MTSS is multifactorial syndrome with passive ankle range of motion, foot posture and navicular drop, plantar pressure distributions, as well as flexibility playing a major role.

Video enhanced visual analysis of hemiparetic gait muscle selection: A pilot study

This paper summarizes the use of video enhanced visual analysis (VEVA) as a muscle selection assistance method for abnormal foot postures in adults with upper motor neuron syndrome (UMNS) treated with botulinum neurotoxin (BoNT-A) in a real-world setting.This pilot study used a prospective treatment study design with persons in an outpatient, rehabilitation hospital. Participants had acquired brain injury (ABI) of >6-month duration who had a spastic ankle foot deformity amenable to treatment with botulinum toxin A and able to independently ambulate a minimum of 10 m. Participants were evaluated before abobotulinumtoxinA injection (500 U–1500 U) to the identified lower limb muscles and four to five weeks post injection. Main Outcome Measures: Temporal spatial data (self-selected and maximal walking velocities (SSWV/MWV); step length and stance time); Modified Ashworth Scale (MAS); Tardieu Scale (TS) and ankle Passive Range of Motion (PROM) change from baseline to follow-up (f/u).Data is presented on ten of the eleven consecutive participants enrolled in the study. One participant withdrew due to study unrelated opposite ankle pain before reassessment. Mean SSWV increased post treatment by 21% in the barefoot condition and 8% when walking with shoes. For the MWV condition, there was a 15% mean increase post treatment in the barefoot condition and 10% when walking with shoes. Participants showed improved symmetry in step length and stance time in both post-treatment walking conditions. Ankle MAS and TS improved with knee flexed or extended. Ankle PROM increased post treatment with knee flexed by 8° and knee extended by 11.7°. VEVA in addition to clinical evaluation appears to facilitate muscle identification and selection of ankle deformities for treatment with BoNT-A. Our findings show marked improvement in ankle MAS, TS and PROM as indicators of pharmacological activity and increase in SSWV as a marker of functional improvement.

Quantifying the effects of achilles tendon lengthening surgery: An intraoperative approach.

Achilles tendon lengthening (ATL) is frequently used in the treatment of foot deformities. However, there is currently no objective method to determine the optimal muscle length during surgery. We developed an intraoperative approach to evaluate the passive and active forces of the triceps surae muscle group before and after ATL and aimed to test the following hypotheses: 1) the ankle passive range of motion (ROM) increases, 2) passive muscle forces decrease post-ATL, and 3) forces measured from patients with non-neurological and neurological conditions demonstrate different characteristics. Passive forces at various ankle joint positions were measured in ten patients (11.3 ± 3.0years old) pre- and post-ATL using a force transducer attached to the Achilles tendon. In six patients, active isometric forces were measured by stimulating the triceps surae supramaximally. Passive forces decreased by 94.3% (p < 0.0001), and ROM increased by 89.4% (p < 0.0001) post-ATL. The pre-ATL passive forces were 70.8% ± 15.1% lower in patients with idiopathic foot deformities than in patients with neurological conditions (p < 0.001). The peak active force of 209.8 ± 114.3N was achieved at an ankle angle of 38.3° ± 16.0°, where the passive force was 6.3 ± 6.7N. The inter-individual variability was substantial in both groups. In conclusion, the hypotheses posed were supported. The present findings suggest that muscle passive and active force production as well as the inter-individual variability should be considered when planning further treatment.

Effectiveness of Extracorporeal Shockwave Therapy on Controlling Spasticity in Cerebral Palsy Patients: A Meta-Analysis of Timing of Outcome Measurement

Extracorporeal shockwave therapy (ESWT) has been suggested as an alternative treatment for reducing spasticity in patients with cerebral palsy (CP). However, the duration of its effect was rarely known. A meta-analysis was performed to investigate the effectiveness of ESWT at controlling spasticity in patients with CP according to the follow-up period. We included studies in which ESWT was used to manage spasticity in patients with CP, and the effect was compared with that in a control group. Finally, three studies were included. In the meta-analysis, spasticity, measured using the modified Ashworth scale (MAS), was significantly reduced after ESWT compared with that in the control group; however, it was sustained for only 1 month. After ESWT, significant increases in passive ankle range of motion (ROM) and plantar surface area in the standing position were observed compared with those in the control group and sustained for up to 3 months. Although spasticity measured using MAS was significantly reduced for only 1 month, improvement in spasticity-associated symptoms, such as ankle ROM and plantar surface area contacting the ground, persisted for over 3 months. ESWT appears to be a useful and effective therapeutic option for managing spasticity in patients with CP.

The relationship between triceps surae muscle-tendon morphology and stiffness across passive ankle range of motion in cerebral palsy

The relationship between triceps surae muscle-tendon morphology and stiffness across passive ankle range of motion in cerebral palsy

Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period

BackgroundTrimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls.MethodsThis was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test.ResultsPatients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050).ConclusionsPatients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.

P 69 Advantages of spasticity treatment with botulinum toxin A in combination with controlled dynamic stretching orthoses for the treatment of contractures compared to botulinum toxin A as the only therapy

Background: Spasticity occurs in about 80% of children with cerebral palsy. Secondary to spasticity, contractures may also occur. Botulinum toxin A (BTA) is used to treat spasticity but not contractures. Therefore, when spasticity and contracture are present, BTA is used in combination with serial casting. The positive effect of a serial casting is to improve passive range of motion (PROM), but it can also bring skin irritation/infection, compression damage and pain as common problems. In addition, active PT is usually not possible for 6 weeks while wearing the cast. Controlled-dynamic-stretching (CDS) orthoses offer the advantages of active PT after BTA, as well as easier control of the skin findings due to the removability. Hypothesis: The combination of BTA with CDS orthoses in the presence of spasticity and contracture produces more positive results in terms of ankle PROM than treatment with BTA alone. Method: The case group included treatment of the calf muscles with BTA in combination with CDS orthoses. The control group included treatment of the calf muscles with BTA only. Data from both treatment options were retrospectively compared with the primary endpoint of change in PROM of the ankle. Results: The case group showed significant improvements at 1 (median 10° (p=0.019)) and 3 months (median 10° (p=0.016)) post-injection. This decreased to a median of 0° (p=0.152) by 6 months after the injections. In the control group, no significant changes were observed at 1 (median 5° (p=0.340)), 3 (median 0° (p=0.453)) and 6 (median -5° (p=0.353)) months after injection. Conclusion: The combination therapy of BTA with CDS orthoses shows promising results in terms of improvement of PROM. This success could mean more comfortable treatment options for children with calf muscle spasticity in the future.

Biomechanical Comparison of Knotless Suture Anchor Versus Percutaneous End-to-End Technique for Mid-Substance Achilles Tendon Rupture Repair

Percutaneous Achilles tendon repairs can be performed with 2 distal fixation techniques: knotless suture anchor repair (KL) or percutaneous end-to-end repair (ETE). There is a paucity of literature comparing the biomechanical strength of these 2 distal fixation techniques. The aim of this study was to compare the strength of KL and ETE repairs using flat-braided suture for mid-substance Achilles tendon rupture during simulated progressive rehabilitation. Nine matched pairs of fresh-frozen below-knee cadaveric extremities were randomly assigned into these 2 repair groups. Each specimen was tested in 2 parts sequentially; Part I simulating passive ankle range of motion (cyclic: 20N-100N), and Part II simulating ambulation in a walking boot (cyclic: 20N-190N). The number of cycles, gap displacement, and the mode of failure were recorded for each repair. Achilles tendon repairs using the percutaneous methods of ETE and KL techniques showed no significant difference in the number of cycles to clinical failure, mean gap displacement, or overall failure rate. During Part I, the survival rate in terms of clinical failure for KL and ETE groups was 8 of 9 repairs and 7 of 9 repairs, respectively. During Part II, all repairs experienced clinical failure in both groups. Five repairs in the KL group experienced suture anchor pull out from the calcaneus, and 3 repairs failed at suture-tendon interface. Four repairs in the ETE group failed due to knot slippage and 5 repairs failed at suture-tendon interface. Both techniques are viable options in treating acute mid-substance Achilles tendon ruptures.

Does ultrasound imaging of the spastic muscle have an additive effect on clinical examination tools in patients with cerebral palsy?: A pilot study

Objective:The Modified Ashworth Scale, the Modified Tardieu Scale, and measuring the passive range of motion is commonly preferred examination tools for spasticity in cerebral palsy (CP). Ultrasonography has become increasingly used to provide relevant insight into spastic muscle morphology and structure recently. It was aimed to reveal associations between the clinical and ultrasonographic parameters of gastrocnemius medialis (GM) and lateralis muscles in this population.Methods:Thirty-four children with spastic CP aged between 4 and 12 years who did not have botulinum neurotoxin A intervention within 6 months or had no previous history of any orthopedic or neurological surgery were included. The spasticity of GM and lateralis was evaluated firstly by the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion. Then, the cross-sectional area (CSA), muscle thickness (MT), qualitative and quantitative echo intensity (EI) values of both muscles were measured from their ultrasonographic images.Results:The CSA of GM, and qualitative EI of both muscles were found to be mild-to-moderately correlated to all clinical examination tools (p<0.01), whereas the CSA of gastrocnemius lateralis was mildly related to Modified Ashworth Scale (p=0.009). The MT and quantitative EI of both muscles were not associated with any of the clinical tools (p>0.05).Conclusion:Ultrasonographic measurements of GM and lateralis partially reflect ankle spasticity in children with CP. Ultrasonography can be used as an alternative tool in this patient population where the clinical evaluation can not perform ideally.

What are the long-term outcomes of lateral column lengthening for pes planovalgus in cerebral palsy?

BackgroundLateral column lengthening (LCL) is commonly performed on children and adolescents with cerebral palsy (CP) for correction of pes planovalgus (PPV). There are limited reports of the long-term outcomes of this procedure. The purpose of this study was to examine the long-term results of LCL for correction of PPV in individuals with CP by evaluating subjects when they had transitioned to adulthood and were entering the workforce. MethodsClinical assessments, quantitative gait analysis including the Milwaukee Foot Model (MFM) for segmental foot kinematics, and patient reported outcomes were collected from 13 participants with CP treated with LCL for PPV in childhood (average age 24.4 ± 5.7 years, average 15.3 ± 8.5 years since LCL). Additionally, 27 healthy adults average age 24.5 ± 3.6 years functioned as controls. ResultsStrength and joint range of motion were reduced in the PPV group (p < 0.05). Sixty nine percent showed operative correction of PPV based on radiologic criteria. Gait analysis showed reduced walking speed and stride length, as well as midfoot break and residual forefoot abduction. Patient reported outcomes indicated that foot pain was not the only factor that caused limited activity and participation. LCL surgery for PPV in childhood resulted in long-term operative correction. Decreased ankle passive range of motion and strength, subtalar joint arthritic changes, inefficient and less stable ambulation, and problems with participation (difficulties in physical function, education, and employment) were observed in the long-term. ConclusionThis study identified postoperative impairments and limitations to guide future clinical decision-making. These results provide clinicians and researchers the common residual and recurrent issues for these individuals as they age. The inclusion of contextual factors that influence the disease and impairments can equip these individuals with enhanced skills they need as they transition into adulthood.

Effects of Dry Needling on Spinal Reciprocal Inhibition

<h3>Research Objectives</h3> Spinal reciprocal inhibition is an important spinal mechanism of motor control. It is often impaired in persons after stroke, negatively impacting locomotion; at the same time, it changes in response to therapeutic interventions (e.g., FES). An increasing number of physical therapists worldwide have been administering trigger point deep dry needling (DDN) to treat post-stroke spasticity. Yet, currently, effects of DDN on spinal somatosensory processing are not well understood. Thus, to understand neurophysiological mechanisms of DDN, we are investigating the effects of DDN on spinal pathways in persons with and without stroke. <h3>Design</h3> Before and 0, 90 minutes, and 72 hours after DDN of the medial gastrocnemius (MG) at myofascial trigger points, reciprocal inhibition of the soleus, MG and lateral gastrocnemius (LG) was examined while the participant stood and maintained his/her standing posture and triceps muscle activity. Passive ankle range of motion (ROM) was also measured before and after DDN. <h3>Setting</h3> University. <h3>Participants</h3> 11 adults 22-57 years old (median 37.5) without known neurological conditions. <h3>Interventions</h3> Trigger point dry needling to medial gastrocnemius <h3>Main Outcome Measures</h3> Reciprocal inhibition of ongoing muscle activity elicited by common peroneal nerve (CPN) stimulation. ROM. <h3>Results</h3> In the MG and LG, there was no systematic changes in the amount of inhibition across participants or measurement times. Soleus inhibition elicited by suprathreshold CPN stimulation was increased significantly at 0 minute and 72 hours post DDN (p>0.05). Ankle dorsiflexion ROM was increased by 4 deg at 0 minutes and 72 hours post DDN. <h3>Conclusions</h3> DDN alters soleus inhibition, which may partially explain increased ankle ROM post DDN. In order to understand how DDN affects reciprocal inhibition in the stroke-impaired CNS, studies of individuals after stroke are currently underway. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to declare.

Effects of Dry Needling on Spinal Reflexes: The Hoffman-reflex

<h3>Research Objectives</h3> Spasticity can lead to changes in spinal and supraspinal pathways which can lead to decreased function and quality of life in persons with stroke. Physical therapists worldwide have been administering trigger point deep dry needling (DDN) to treat post-stroke spasticity. Yet, currently, effects of DDN on spinal somatosensory processing are not well understood. To understand the neurophysiological mechanisms of DDN, we are currently investigating the effects of DDN on spinal somatosensory pathways in persons with and without stroke. <h3>Design</h3> Before, 0 minutes, 90 minutes, and 72 hours after DDN of the medial gastrocnemius (MG) the H-reflex and M-wave recruitment curves are measured in the soleus, MG and lateral gastrocnemius (LG). Passive ankle range of motion (ROM) before and after DDN. <h3>Setting</h3> University. <h3>Participants</h3> 11 adults 22-57 years old (median 37.5) without known neurological conditions. <h3>Interventions</h3> Trigger point dry needling to medial gastrocnemius. <h3>Main Outcome Measures</h3> H-Reflex and ROM. <h3>Results</h3> MG H-reflex latency was prolonged by 1-3 ms at 0- and 90-minutes post (in 9/11 individuals) and in 5/11 in the soleus and 3/11 in the LG. In the MG, H-reflex amplitude was significantly decreased at 72 hours post (p=0.004 by paired t-test) by 12%. Dorsiflexion ROM was increased by »4 deg at 0 minutes and 72 hours post. <h3>Conclusions</h3> DDN produces acute short-term effects (shown in the H-reflex latency shift at 0- and 90-minutes post) and significant long-term effects (shown in the reduced H-reflex at 72 hours post) in spinal pathways of the treated MG. To understand whether DDN affects the intact CNS and stroke-impaired CNS similarly or differently, studies of individuals after stroke are currently underway. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to declare.

Short-wave diathermy for spastic equinus foot in chronic stroke patients: a proof-of-concept pilot study.

Physical modalities may be useful to manage poststroke spasticity. Shortwave diathermy has been demonstrated to improve extensibility of the myotendinous tissue. Spasticity may alter morphology of the muscle and its elastic properties. Our main aim was to evaluate the effects of shortwave diathermy on spastic equinus foot in stroke patients. Ten chronic stroke patients with spastic equinus foot received 10 shortwave diathermy sessions, 5 days/week for 2 consecutive weeks to the spastic calf muscles. Clinical (modified Ashworth Scale and ankle dorsiflexion passive range of motion) and ultrasound (spastic gastrocnemius muscle echo intensity and hardness percentage measured by sonoelastography) evaluation was done before, after treatment, and at two weeks of follow-up. A significant difference in calf muscle spasticity (P=0.004), ankle passive range of motion (P=0.014), and spastic gastrocnemius muscle hardness percentage (P=0.004) was found after treatment. A significant difference in calf muscle spasticity (P=0.004) was found also at the follow-up evaluation. Our preliminary findings support the hypothesis that shortwave diathermy might improve calf muscle tone, ankle passive range of motion, and gastrocnemius muscle elasticity in chronic stroke patients with spastic equinus. This might be due to the deep thermal effects coupled with the rheological direct action of shortwave diathermy on spastic muscles.

Effects of ankle continuous passive motion on soleus hypertonia in individuals with cerebral palsy: A case series

BackgroundContinuous passive motion device (CPM) provides repetitive movement over extended periods of time for those who have low functional ability. The purpose of this research was to evaluate the effects of a four-week program of continuous passive motion of the ankle joint on the changes in soleus hypertonia in individuals with cerebral palsy who suffered from life-long hypertonia. MethodsA single group, repeated-measures study was conducted. Eight individuals (7 males and 1 female with a mean age of 21.8 ± 8.5 years) with spastic cerebral palsy underwent bilateral ankle CPM for 1 h a day, 5 days a week, for 4 weeks. The outcome measures included the Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle, the ratio of maximum H reflex to maximum soleus M-response (H/M ratio), and post-activation depression (PAD). All outcomes were measured before and after the intervention. A paired t-test was used to examine treatment effects pre-versus post-intervention. ResultsPaired t-tests showed that the CPM program significantly decreased the MAS score (p = 0.006), decreased the maximum H/M ratio (p=0.001), improved PAD (p = 0.003, p = 0.040, and p = 0.032 at 0.2 Hz, 1 Hz, and 2 Hz, respectively), and increased the passive ankle range of motion (p = 0.049). ConclusionAnkle CPM not only reduced soleus hypertonia but also improved the PROM in individuals with cerebral palsy. The results of this study show ankle CPM to be an effective intervention for individuals with cerebral palsy.

Clinical Assessment and Pedobarographic Analysis after Radial Shock Wave Therapy of Ankle Plantar Flexor Spasticity in Stroke

Objective: Radial shock wave therapy (RSWT) has increasingly been utilized in the treatment of spasticity recently. The purpose of the current study is to assess the effectiveness of RSWT in the treatment of ankle plantar flexor muscles spasticity of stroke patients by pedobarography and clinical evaluation.&#x0D; Materials and Methods: A total of 23 stroke patients were enrolled into the study. Patients received an initial sham treatment of RSWT, followed by three separate interventional sessions received one week apart. Treatment success was assessed using the Modified Ashworth Scale (MAS), ankle passive range of motion (pROM) measurement and pedobarography.&#x0D; Results and Discussion: No significant change was observed in clinical and pedobarographic values following sham RSWT. In the intervention group, however, MAS decreased from3.34±0.7 to 2.39±0.89 after a single RSWT session and to 2.04±0.92 first week and to 2.52±0.89 fourth week after three RSWT sessions. As a result of the study, heel peak pressure and total plantar contact area were improved. In particular, three RSWT sessions were more effective than single RSWT session.&#x0D; Conclusions: We observed a significant improvement in plantar flexor spasticity in stroke patients after both a single and three RSWT sessions and this improvement persisted during the four-week study period.&#x0D; Bangladesh Journal of Medical Science Vol.20(3) 2021 p.586-593

The Ankle Joint Range of Motion and Its Effect on Squat Jump Performance with and without Arm Swing in Adolescent Female Volleyball Players

A flexible ankle joint is suggested to be a contributing factor for vertical squat jump (SQJ) performance. The purpose of the study was to investigate the effect of the active (ACT) and passive (PAS) ankle joint range of motion (ROM) on SQJ performed by adolescent female volleyball players. ACT and PAS ankle ROM at knee extension angles of 90, 140, and 180 degrees (180 degrees: full extension) were measured with a video analysis method for 35 female post-pubertal volleyball players (16.3 ± 1.1 yrs, 1.80 ± 0.04 m, 68.8 ± 6.8 kg). Additionally, the players fulfilling previously recommended criteria were assigned to the flexible (n = 10) and inflexible (n = 8) groups and executed SQJ with and without an arm swing on a force-plate. Results of the 2 × 2 × 3 MANOVA revealed a significant (p < 0.05) flexibility type and knee angle effect, as ankle ROM was larger in PAS compared to ACT and as the knee joint progressed from 90 to 180 degrees extension. The 2 × 2 ANOVA revealed a significant (p < 0.05) group effect, as flexible players jumped higher in the arm swing SQJ, along with a significant arm swing effect on key SQJ kinetic parameters. In conclusion, a more flexible ankle joint result in improved SQJ performance. Therefore, ankle flexibility training should be implemented in youth volleyball players.

Effects on Neuromuscular Function After Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial

ObjectiveThe purpose of this study was to evaluate changes in neuromuscular function, pain perception, and basic physical properties in latent myofascial trigger points (TrPs) after a single treatment session of ischemic compression in the gastrocnemius muscle. MethodsA randomized within-participant clinical trial with a blinded assessor was conducted. Twenty-nine asymptomatic volunteers with latent gastrocnemius-muscle TrPs were bilaterally explored. Each extremity was randomly assigned to the control group (no treatment) or the experimental group (90 seconds of ischemic compression over each TrP). Neuromuscular function of the gastrocnemius muscle was assessed using a MyotonPro. Muscle flexibility was analyzed using the lunge test and the passive ankle range of motion. The strength was determined with a handheld dynamometer (MicroFET2). Pain perception was analyzed with a 0-to-10 numerical pain rating scale and determination of pressure pain thresholds over each latent TrP. ResultsThe results revealed a reduction of 15.8% in pain perception and an increment of pressure tolerance of 9.9% without pain in the treatment group. Changes in muscle flexibility (active and passive) and most parameters for neuromuscular response (rigidity, elasticity, and relaxation) were also observed, but they were not significantly different between groups. The clinical effect sizes were moderate for pain perception (d = 0.69), pressure pain threshold (d = 0.78), muscle tone (d = 0.51), and elasticity (d = 0.54) in favor of the treated extremity. Small clinical effect sizes were observed for muscle physical outcomes. ConclusionThe present study shows that the use of a single session of ischemic compression for latent gastrocnemius-muscle TrPs improved some sensory outcomes. The effects on ankle range of motion and neuromuscular responses were inconclusive.