Ashworth Score Research Articles

Surgical management of the spastic elbow.

We performed a retrospective review of patients undergoing surgery for elbow spasticity. We present our findings and expected outcomes according to degree of elbow fixed flexion contracture. Data collected included age, Modified Ashworth Score, pre and post-operative range of motion, indications for surgery and the Goal Attainment Score. Contracture severity was classified into five groups based on goniometric measurements. Surgical procedures were categorised into three groups. A total of 114 elbows underwent surgical release. The mean age at surgery was 18.5 years and the mean follow-up was 20 months. Preoperatively, the median Modified Ashworth Score was 2 and the mean contracture was 68° (35° fixed and 33° dynamic). The median number of structures released was 3 (range: 1-6). Surgical procedures were classified as biceps sparing (27%), biceps lengthening (53%) and extended releases (18%). Mean improvement in extension was 59°, and the mean improvement in Goal Attainment Score was 36 (mean attainment score 62). The mean residual contracture was 9°. Patient satisfaction was high with over 90% of surgical indications met. Contracture severity of the spastic elbow can be categorised by degree of fixed flexion deformity and therefore treatment can be allocated accordingly.

Effects of Functional Acupuncture on Upper Limb Spasticity After Ischemic Stroke: A Protocol for a Randomized Controlled Parallel Clinical Trial.

BackgroundUpper limb spasticity (ULS) is a common complication after stroke, which seriously affects the quality of life and rehabilitation of patients. There are different treatment methods for post-stroke spasticity (PSS). Our group found that functional acupuncture (FA) can effectively improve forearm spasticity and hand dysfunction after stroke, but the efficacy of ULS needs to be further verified. Therefore, this subject has mainly used clinical randomized controlled trials to evaluate the clinical efficacy of FA in the treatment of ULS after ischemic stroke.MethodThis is a parallel design and randomized controlled trial. We selected 108 patients who met the predefined criteria and randomized them into two groups, the experimental group and the control group. The experimental group receives FA and routine rehabilitation treatment. The control group received traditional acupuncture (TA) and routine rehabilitation treatment. All patients received 20 courses of treatment for 4 weeks, and the modified Ashworth score (MAS), clinical neurological deficit score (CSS), Fugl-Meyer upper extremity function assessment (FMA-UE), and the Modified Barthel Index (MBI) scores were evaluated before and after treatment.DiscussionThis trial is mainly to study the clinical efficacy of FA in the treatment of ULS after ischemic stroke. It will not only provide a new idea for the clinical treatment of upper limb post-stroke spasticity (ULPSS) but also will provide effective experimental support and a theoretical basis for the clinic.Trial registrationChina Clinical Trials Registry No. ChiCTR2100050440. Registered on 27 August 27 2021.

The Impact of Triangle Hierarchical Management on Self-Management Behavior and Quality of Survival in Parkinson's Patients.

ObjectiveTo investigate the effect of Triangle tiered and graded management on the self-management behavior and quality of survival of Parkinson's Disease (PD) patients.MethodsEighty ambulatory PD patients admitted to the neurology outpatient clinic of our hospital from June 2020 to January 2021 were selected for the study. Eighty patients were divided into 40 cases each in the test group and the control group using the random number table method. Patients in the control group were given conventional treatment and care, while in the test group, Triangle hierarchical management was applied on the basis of the control group. Non-motor symptoms [assessed by the Montreal Cognitive Inventory (MoCA), the Scale for Outcomes in PD for Autonomic Symptoms disability Scale (SCOPA-DS) and the Nocturnal Scale (SCOPA-NS)], motor symptoms [assessed by the Functional Gait Assessment (FGA), the Modified Ashworth Scale, and the Unified Parkinson's Disease Rating Scale (UPDRS-III)], quality of life (assessed by Barthel Index), medication adherence (self-administered medication adherence questionnaire), quality of survival (assessed by the 39-item Parkinson's Disease Quality of Survival Questionnaire, PDQ-39), and self-management effectiveness (assessed by the Chronic Disease Self-Efficacy Scale, symptom management and disease co-management) were compared between the two groups before and after the intervention. The two groups were also observed for satisfaction with care.ResultsAfter the intervention, the MoCA score, FGA score, Barthel Index, Medication adherence and all scores of self-management effectiveness were significantly higher in the test group than in the control group (P < 0.05); the SCOPA-DS score, SCOPA-NS score, Ashworth score, UPDRS-III score and PDQ-39 score were significantly lower than in the control group (P < 0.05). Satisfaction with nursing care was significantly higher in the test group than in the control group (P < 0.05).ConclusionThe application of Triangle's tiered and graded management to the home care of ambulatory PD patients was effective in improving their non-motor and motor symptoms, their ability to perform daily activities, medication adherence and self-management effectiveness, and their overall survival outcome.

Cross-sectional Observations on the Natural History of Mucolipidosis Type IV.

Background and ObjectivesMucolipidosis type IV (MLIV) is an ultra-rare lysosomal disorder initially described as a static neurodevelopmental condition. However, patient caregivers frequently report progressive muscular hypertonicity and functional decline. We evaluated a cohort of patients with MLIV to determine whether neurologic disability correlates with age.MethodsWe performed a cross-sectional, observational study of 26 patients with MLIV in the United States and Israel ranging in age from 2 to 40 years. Medical history was obtained from caregivers, and patients underwent a full neurologic examination. The Brief Assessment of Motor Function (BAMF), Gross Motor Function Classification System, and modified Ashworth scales were applied. Caregivers identified developmental skills on the Oregon Project for Visually Impaired and Blind Children checklist that their child had lost the ability to perform.ResultsThree patients were clinically classified as mildly affected and the remaining 23 patients as typical, severely affected cases. Timing of first symptom onset ranged from 1.5 months to 8 years of age (median 7.25 months). Across typical patients, modified Ashworth scores demonstrated a positive age dependence illustrating worsening spasticity across the lifespan. Signs of extrapyramidal motor dysfunction were also qualitatively observed. In parallel, gross and fine motor function assessed with the BAMF and Gross Motor Function Classification System scales declined across age. All typical patients had restricted tongue mobility and lacked rotary jaw movement when chewing, but BAMF scores for deglutition declined only in the oldest patients. In contrast, scores for articulation were low in all patients and did not correlate with age. Finally, loss of developmental skills frequently occurred in early adolescence.DiscussionThis cross-sectional natural history study of MLIV demonstrates worse motor function in older patients. These data support a neurodegenerative component of MLIV that manifests as developmental regression in the second decade of life. Whether the emergence of functional decline results from the cumulative, nonlinear interactions of steadily progressive neurodegenerative processes or reflects an inflection from impaired CNS development to degeneration is uncertain. However, understanding the relationship between CNS pathology and clinical course of disease will be imperative to guiding future interventional trials and optimizing patient care.

An Artificial Neural Network Algorithm for the Evaluation of Postoperative Rehabilitation of Patients.

In order to explore the application of artificial neural network in rehabilitation evaluation, a kind of ANN stable and reliable artificial intelligence algorithm is proposed. By learning the existing clinical gait data, this method extracted the gait characteristic parameters of patients with different ages, disease types and course of disease, and repeated data iteration and finally simulated the corresponding gait parameters of patients. Experiments showed that the trained ANN had the same score as the human for most of the data (82.2%, Cohen's kappa = 0.743). There was a strong correlation between ANN and improved Ashworth scores as assessed by human raters (r = 0.825, P < 0.01). As a stable and reliable artificial intelligence algorithm, ANN can provide new ideas and methods for clinical rehabilitation evaluation.

Does Intrathecal Baclofen Therapy Lead to an Improvement in Impairments and Functional Limitations in Patients With Acquired Brain Injury (ABI)? A Retrospective Study

Research Objectives To investigate effects of intrathecal baclofen (ITB) therapy on impairments and functional limitations in the acquired brain injury population(ABI). Design A retrospective study using chart reviews using a standardized data collection form on inpatient brain injury units to collect data on effects of ITB therapy on the ABI population with defined inclusion and exclusion criteria. A standardized data collection form was utilized along with a procedural manual for data abstraction. Setting Specialized acute and sub acute brain injury units. Participants Initially, 59 subjects were considered and a total of 15 medical records had sufficient data to analyze which met our criteria. 12 male patients (80%) and three female patients (20%). The mean age for ITB pump implantation was 35.5 years and the range was 18-67 years of age. Interventions Intrathecal Baclofen Pump Therapy with adjunctive therapies (for example skilled therapy, local Botox injections, serial casting, medication). Main Outcome Measures Modified Ashworth Scores, Passive Range of Motion, Mobility, JFK Coma Recovery Scale- Revised. Results The most significant change was noted with Modified Ashworth Scale (MAS) scores in the proximal hip muscle groups. Modified Ashworth Scale (MAS) scores with high significance (p-values ≤0.05) and large effect size (Cohen's D values >0.8) included right hip flexors, right hip extensors and R hip adductors. No statistically significant findings were found in other muscle groups, functional mobility, PROM and CRS-R (Coma Recovery Scale-Revised©) scales. Conclusions There were no significant changes noted in regards to functional status. However, data reflects improvements in spasticity of proximal hip musculature. This may result in improved positioning in bed or wheelchair as well as ease of hygiene and improved comfort. More research is recommended with a larger sample size and additional focus on pain and caregiver burden. Author(s) Disclosures All authors of this research study have no conflicts to disclose. To investigate effects of intrathecal baclofen (ITB) therapy on impairments and functional limitations in the acquired brain injury population(ABI). A retrospective study using chart reviews using a standardized data collection form on inpatient brain injury units to collect data on effects of ITB therapy on the ABI population with defined inclusion and exclusion criteria. A standardized data collection form was utilized along with a procedural manual for data abstraction. Specialized acute and sub acute brain injury units. Initially, 59 subjects were considered and a total of 15 medical records had sufficient data to analyze which met our criteria. 12 male patients (80%) and three female patients (20%). The mean age for ITB pump implantation was 35.5 years and the range was 18-67 years of age. Intrathecal Baclofen Pump Therapy with adjunctive therapies (for example skilled therapy, local Botox injections, serial casting, medication). Modified Ashworth Scores, Passive Range of Motion, Mobility, JFK Coma Recovery Scale- Revised. The most significant change was noted with Modified Ashworth Scale (MAS) scores in the proximal hip muscle groups. Modified Ashworth Scale (MAS) scores with high significance (p-values ≤0.05) and large effect size (Cohen's D values >0.8) included right hip flexors, right hip extensors and R hip adductors. No statistically significant findings were found in other muscle groups, functional mobility, PROM and CRS-R (Coma Recovery Scale-Revised©) scales. There were no significant changes noted in regards to functional status. However, data reflects improvements in spasticity of proximal hip musculature. This may result in improved positioning in bed or wheelchair as well as ease of hygiene and improved comfort. More research is recommended with a larger sample size and additional focus on pain and caregiver burden.

New scale for assessing spasticity based on the pendulum test

Quantified assessment of spasticity is essential for the rehabilitation of persons with paralysis. We introduce the new SPAsticity Scale (SPAS), which we found highly correlated with the Modified Ashworth Score (MAS); yet, with a delicate gradation of spasticity compared to the MAS. The parameters defining the SPAS show the level and the type of spasticity (flexion or extension). The SPAS is based on a complex model of the pendulum type oscillations of the lower leg, which includes the spastic torques. The data to calculate SPAS were collected by a wearable instrument with two inertial measurement units and two EMG recording units in subjects with a complete chronic spinal cord injury.

Do gait parameters improve after botulinum toxin injections in post stroke patients? A prospective study

The intramuscular injection of botulinum toxin is one of the most efficient ways to treat localized spasticity in patients suffering from Central Nervous System lesions like stroke, cerebral palsy and multiple sclerosis. The gait analysis based on kinetics and kinematics is a recognized way of measurement of the effect of intramuscular injection of botulinum toxin in spastic patients suffering from chronic stroke. The aim of this study is to provide evidence of the beneficial effect of botulinum toxin on characteristics of gait pattern on patients suffering from chronic stroke. So, thirteen patients with spasticity due to chronic stroke were included in the protocol and were treated by botulinum toxin injections in the lower extremity. All patients were evaluated before the injection as well as one month after the botulinum injection on a foot pressure sensitive walkway with a power plate and by the readings of seven inertial measurements units which recorded spatio-temporal specific parameters during walking, and the spasticity was measured according to modified Ashworth Scale. While all spatio-temporal parameters of motion analysis and balance improved for most of the patients after botulinum toxin injection, only one parameter, the normal to hemiplegic step length, reached statistical significant improvement (p < 0.03). Moreover the modified Ashworth score was statistically improved post injection (p < 0.001). In conclusion the use of botulinum toxin injections is beneficial in post stroke patients as this is depicted in gait parameters improvement which accompanies the spasticity reduction.

MEDICAL PROMOTION EFFECT OF PHYSICAL EXERCISE ON PARKINSON'S DISEASE

ABSTRACT Introduction: Parkinson's disease is a common neurodegenerative disease in middle-aged and older people. Some studies have shown that sports can reduce its impact on physical functions. Objective: Based on the abovementioned research background, this paper explores the effect of moderate physical exercise on muscle tone and body posture of patients with Parkinson's disease. Methods: The article selected 72 Parkinson patients admitted to our hospital's Parkinson's Medical Center from 2019 to 2020. These were divided into a basic drug treatment group and a sports intervention group. The Ashworth score, walking speed, walking cycle, and walking distance of the two groups were recorded. At the same time, we performed statistical data analysis on the two sets of data obtained. Results: Compared with the basic treatment group, the modified Ashworth score of the sports intervention group decreased after treatment (P&lt;0.01). The walking speed of the sports intervention group increased, the walking cycle was shortened, and the distance of repeated steps increased (P&lt;0.01). Conclusion: Appropriate physical exercise can reduce muscle tone in patients with Parkinson's disease. It helps them increase their pace and improve small gait symptoms. Sports can help Parkinson patients adjust their body posture and promote their clinical treatment. Level of evidence II; Therapeutic studies - investigation of treatment results.

Does extracorporeal shock wave therapy decrease spasticity of ankle plantar flexor muscles in patients with stroke: A randomized controlled trial

Objective: To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle. Design: Randomized controlled trial. Setting: Inpatient neuro-rehabilitation clinic of a university hospital. Participants: Stroke patients with ankle flexor spasticity. Interventions: Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation. Main measures: The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up. Results: Fifty-one participants were enrolled (active therapy n = 17, sham n = 17, control n = 17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47 ± 0.72 to 1.41 ± 0.62) compared to sham (from 2.19 ± 1.05 to 2.06 ± 1.12) and control (from 2.06 ± 0.85 to 2.00 ± 0.73) groups immediately after the treatment (P < 0.001). Tardieu results were also in concordance (P < 0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index (P < 0.001). However, there was no difference among the groups in terms of improvement in elastography. Conclusion: Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.

A Pilot Study of the Government Pharmaceutical Organization (GPO) Cannabis Extract for Multiple Sclerosis (MS) Spasticity Treatment in Thailand

Background: The prevalence of spasticity in multiple sclerosis (MS) patients is nearly 90%. Most patients do not respond to current anti-spastic medications. Objective: To evaluate the efficacy and safety of Government Pharmaceutical Organization cannabis extract (GPOCE) in the treatment of spasticity in MS patients in Thailand. Materials and Methods: This prospective pilot study in patients diagnosed with MS whose spasticity was not relieved under current spasticity treatments, was performed between November 2019 and June 2020. The GPOCE formulation of THC:CBD 1:1 was administered to all patients. The treatment outcomes were determined at 12 weeks and compared with their baseline. Results: Seven patients participated in the present study. Among these, two patients withdrew after receiving only a small dose of GPOCE. Finally, five patients were included in the final analysis. The primary outcome was a reduction in the Modified Ashworth Score (MAS), which decreased among participants from a baseline of 15 (IQR 12 to 19) to 6 (IQR 1 to 12) (p=0.043). The key secondary outcome was a clinically relevant response (CRR), which was defined as a reduction of the spasticity Numeric Rating Scale (NRS) of more than thirty percent compared to baseline. Four patients (80%) achieved CRR. Moreover, the overall spasticity NRS decreased from a median of 6 (IQR5 to 7) to 2 (IQR2 to 3). A reduction of other NRS parameters, including fatigue, pain, tremor, sleep, spasm, anxiety, and depression, was also observed after treatment. Moreover, GPOCE was generally well tolerated. Conclusion: GPOCE is useful in treating spasticity in patients with MS. The safety profile is acceptable under the supervision of a health care provider. Keywords: Multiple sclerosis (MS), Cannabis extract, Spasticity

Comparison of Intraoperative Neuromonitoring Outcome in Treating Thoracic Ossification of the Ligamentum Flavum Through En Bloc Versus Piecemeal Laminectomy.

A retrospective cohort analysis. The aim of this study was to investigate the impact of piecemeal versus en bloc laminectomies on spinal cord in thoracic ossification of ligamentum flavum (TOLF) through intraoperative changes of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs). Surgical treatment is indicated for symptomatic TOLF, and both piecemeal and en bloc laminectomies are commonly used methods. However, few studies compared both intraoperative interference and prognostic impact of these two laminectomies on spinal cord in TOLF patients. MEPs were recorded from abductor hallucis (AH) and tibialis anterior, and SEPs were performed on tibial nerve in 55 TOLF patients (piecemeal vs. en bloc: 23 vs. 32). Patients were categorized based on MEP/SEP improvement, deterioration, and no change, and MEP/SEP improvement rates were measured in the improvement group. Additionally, all patients were assessed by American Spinal Injury Association (ASIA) scores, Ashworth scores, and modified Japanese Orthopedic association (mJOA) scores before and after operation. The incidences of both MEP/SEP improvement and deterioration were similar between the two laminectomy groups (P > 0.05), and no significant difference is noted in both MEP and SEP amplitudes between the baseline and different critical manipulations in both laminectomy groups (P > 0.05). In the improvement group, patients receiving en bloc laminectomy exhibited increased improvement rates of both MEPs in bilateral AH and left-side SEPs compared to piecemeal laminectomy (P < 0.05). Clinically, all functional scales clearly improved in both laminectomy groups after operation (P < 0.05), and postoperative 1-year mJOA improvement rates were highly correlated with MEP improvement rates (P < 0.05). Intraoperative changes of MEPs and SEPs potentially provide a valid method for quantitatively evaluating the safety of different intraoperative manipulations and their prognostic impacts on spinal cord. Both laminectomies are safe and effective methods to treat TOLF, and en bloc laminectomy may cause relatively better spinal cord functional recovery.Level of Evidence: 3.

Application of Quantitative CT Imaging in Rehabilitation Nursing of Cerebral Apoplexy Patients.

Objectives:Electronic computed tomography (CT) is an important imaging method for the diagnosis of cerebral infarction. This paper explores the preventive effects of quantitative CT imaging and early rehabilitation nursing on patients with cerebral apoplexy and shoulder-hand syndrome.Methods:Sixty cerebral apoplexy patients treated were included as control group and given routine care from September 2018 to May 2020. Sixty cerebral apoplexy patients were included as observation group, and early rehabilitation nursing intervention was given based on control group. The incidence of shoulder-hand syndrome and upper limb function were compared between the two groups, to explore the effectiveness of the CT examination in promoting the physical function restoration.Results:The incidence of shoulder-hand syndrome in observation group after three months of intervention was lower than that in control group, and the severity was less than that in control group (P<0.05); The Ashworth score of muscle tension in observation group after three months of intervention was lower than that in control group, and the simplified FMA score of the upper limbs was higher than that in control group.Conclusion:Early rehabilitation nursing intervention after CT examination can prevent the occurrence of cerebral apoplexy and shoulder-hand syndrome and improve upper limb function, which is worthy of promotion.

Utility of intrathecal baclofen pump in primary lateral sclerosis

Primary lateral sclerosis is a disorder categorized by insidious onset of progressive upper motor neuron dysfunction without lower motor neuron involvement. PLS often presents with gradual-onset, progressive lower extremity stiffness and pain due to muscle spasticity. Intrathecal Baclofen pumps (ITB) have been used to effectively treat spasticity in several neurologic conditions including MS and spinal cord injury. This study aimed at reviewing a cohort of PLS patients with spasticity requiring ITB to assess the clinical course, benefits, and complications in these patients. A series of 5 patients were identified who were diagnosed with PLS and received ITB as treatment for spasticity. The average age of the patients at the time of ITB insertion was 56.4 years. The average length of treatment was 10.4 years with a range of 4–15 years. All patients reported improvement in spasticity as measured by clinical examinations and Ashworth scores; 1/5 had complications with the pump related to migration of catheter. No patients required permanent removal of the ITB. ITB is a safe and effective treatment for spasticity in PLS and should be considered in other patients.

Evaluation of the impact of intrathecal baclofen on the walking ability of people with Multiple Sclerosis related spasticity.

BackgroundSpasticity is a frequent and disabling symptom in people with Multiple Sclerosis (MS). Intrathecal baclofen (ITB) is an effective but infrequently used treatment in ambulant people. ObjectiveTo evaluate the impact of ITB on ambulation in people with moderate to severe MS related spasticity. MethodsData was collected prospectively regarding spasticity and ambulation at baseline, after ITB trial via lumbar puncture, 3 months and annually thereafter. Results30 subjects; Mean age 47.9 (26-64), 67% female, mean EDSS 6.5 [6.5-7.5]. Reduction in mean Ashworth score (pre 1.44: post 0.98, p<0.001) and Penn spasm score (pre 3: post 1; p<0.001) was shown. 20 people (67%) proceeded with implantation; lower limb MRC power was predictive of proceeding to pump (OR 2.98; 95% CI 1.01 - 8.7; p <0.05). In those proceeding to implantation there was no difference in 10mTW at 1 year (ANOVA (F(3,24) = 2.6, p=0.13). Currently, 15 (75%) remain ambulatory (mean 3.75 years, range 1-9). After implant, 17 (85%) discontinued all oral anti-spasticity treatments conferring other benefits. ConclusionAmbulation in people with MS can be preserved for several years whilst effectively treating spasticity with ITB with careful patient selection; ITB should not be considered a last resort.

Combined botulinum toxin type A and electrical stimulation in individuals with C5\u2013C6 and C6\u2013C7 tetraplegia: a pilot study

Study designSingle-blind pilot study.Objectives(1) To evaluate combined BoNT-A injection of spastic antagonistic muscles and ES of wrist extensors in order to improve hand function in incomplete cervical SCI patients. (2) To identify prognostic indicators of hand improvements, as a function of motor levels of injury.SettingTen incomplete asymmetric SCI tetraplegics admitted to San Camillo Hospital (Venezia, Italy), who were not able to perform automatic grasping, were enrolled in the study. A better motor level (BML) C6–C7 and worse motor level (WML) C5–C6 were assigned to take into account asymmetric motor strength.MethodsAdministration of 100–200 UI BoNT-A per limb into flexor carpi radialis (FCR), extensor digitorum communis (EDC), brachial biceps (BB), and pectoralis major (PM) was performed. This was in conjunction with 6 weeks of 30-min ES sessions repeated three times a day for 6 days a week in wrist extensor muscles, and 6 weeks of 30-min hand rehabilitation for 6 days a week. Assessments included wrist Range of Motion (w-RoM), Modified Ashworth Score (MAS), Functional Independence Measure motor scores (FIM motor), and Nine Hole Peg Test (NHPT).ResultsTreatments produced a significant reduction in motor spasticity (MAS) and better dexterity (NHPT) in the C6–C7 BML with respect to the WML cases (p level = 0.007; p = 0.01, respectively). FIM motor scores improved more in BML (median: 20; range 20/22) than in WML (median: 10; range 8/17).ConclusionsHand function improvement, determined by combined BONT-A and ES, was better in C6–C7 than in C5–C6 SCI patients.

Evolving diagnostic criteria in primary lateral sclerosis: The clinical and radiological basis of “probable PLS”

IntroductionPrimary lateral sclerosis is a rare neurodegenerative disorder of the upper motor neurons. Diagnostic criteria have changed considerably over the years, and the recent consensus criteria introduced ‘probable PLS’ for patients with a symptom duration of 2–4 years. The objective of this study is the systematic evaluation of clinical and neuroimaging characteristics in early PLS by studying a group of ‘probable PLS patients’ in comparison to a cohort of established PLS patients. MethodsIn a prospective neuroimaging study, thirty-nine patients were stratified by the new consensus criteria into ‘probable’ (symptom duration 2–4 years) or ‘definite’ PLS (symptom duration >4 years). Patients were evaluated with a standardised battery of clinical instruments (ALSFRS-r, Penn upper motor neuron score, the modified Ashworth spasticity scale), whole genome sequencing, and underwent structural and diffusion MRI. The imaging profile of the two PLS cohorts were contrasted to a dataset of 100 healthy controls. All ‘probable PLS’ patients subsequently fulfilled criteria for ‘definite’ PLS on longitudinal follow-up and none transitioned to develop ALS. ResultsPLS patients tested negative for known ALS- or HSP-associated mutations on whole genome sequencing. Despite their shorter symptom duration, ‘probable PLS’ patients already exhibited considerable functional disability, upper motor neuron disease burden and the majority of them required walking aids for safe ambulation. Their ALSFRS-r, UMN and modified Ashworth score means were 83%, 98% and 85% of the ‘definite’ group respectively. Motor cortex thickness was significantly reduced in both PLS groups in comparison to controls, but cortical changes were less widespread in ‘probable’ PLS on morphometric analyses. Corticospinal tract and corpus callosum metrics were relatively well preserved in the ‘probable’ group in contrast to the widespread white matter degeneration observed in the ‘definite’ group. ConclusionsOur clinical and radiological analyses support the recent introduction of the ‘probable’ PLS category, as this cohort already exhibits considerable disability and cerebral changes consistent with established PLS. Before the publication of the new consensus criteria, these patients would have not been diagnosed with PLS on the basis of their symptom duration despite their significant functional impairment and motor cortex atrophy. The introduction of this new category will facilitate earlier recruitment into clinical trials, and shorten the protracted diagnostic uncertainty the majority of PLS patients face.

A Comparison of the Armeo to Tabletop-assisted Therapy Exercises as Supplemental Interventions in Acute Stroke Rehabilitation: A Randomized Single Blind Study.

To evaluate the feasibility of an additional therapeutic upper limb exercise (ULE) intervention in early phase post-stroke rehabilitation and to assess outcomes of therapy using the Armeo Spring (ARMEO) versus Therapist-assisted Table Top (TAT) interventions. Randomized, single-blind trial. Stroke acute inpatient rehabilitation unit. Forty-five participants early after first stroke, Fugl-Meyer Assessment (FMA) score >8, Modified Ashworth score (MAS) of <3. Participants were randomized to TAT or ARMEO ULE in addition to the required 3 hours of 1:1 standard of care provided in an inpatient rehabilitation facility (IRF). Completed number of treatments; withdrawals; serious/adverse events; Functional Independence Measure (FIM) motor; FIM efficiency; FMA; MAS; elbow active (A) and passive (P) range of motion (ROM); and therapist effort measured by the Modified Borg Rating of Perceived Exertion Scale (RPE). Post-intervention FIM and FMA scores increased but did not demonstrate any statistically significant differences between the intervention groups (P = .585, .962, partial n2 = .001, .001, respectively). There were no statistically significant differences in post-intervention MAS elbow flexion and extension (P = .332, .252, partial n2 = .009, .007, respectively) and A/P ROM elbow extension between training groups (P = .841, .731, partial n2 = .001, .003, respectively). There was a statistically significant difference in post-intervention A/P ROM elbow flexion between groups (P = .031, .018, partial n2 = .123, .146). Post-intervention RPE did not show any statistically significant differences between the training groups (P = .128, partial n2 = .063). Total elbow range showed larger adjusted mean gains for the ARMEO. No serious adverse events were reported. This study demonstrates that additional therapeutic ULE in the early phase of post-stroke inpatient rehabilitation is feasible and that both interventions showed positive changes in selected outcomes.

Effect of Baixiao moxibustion at meridian sinew nodal points on upper limb motor function in children with spastic hemiplegic cerebral palsy

To investigate the effect of Baixiao moxibustion at meridian sinew nodal points combined with routine rehabilitation on upper limb motor function in children with spastic hemiplegic cerebral palsy. A total of 50 children with spastic hemiplegic cerebral palsy were divided into control group and treatment group using a random number table, with 25 children in each group. The children in the control group were given routine rehabilitation training of the ipsilateral upper and lower limbs, and those in the treatment group were given Baixiao moxibustion at the meridian sinew nodal points of the ipsilateral upper limb in addition to the treatment in the control group, once a day and five times a week. Each course of treatment was 4 consecutive weeks, and both groups were treated for 3 courses. Before treatment and at weeks 4 and 12 of treatment, modified Ashworth score was used to evaluate muscle tension of the ipsilateral upper limb, and 88-item version of the Gross Motor Function Measure (GMFM-88) and Carroll upper extremities functional test (UEFT) were used to assess the motor function of the ipsilateral upper limb. At weeks 4 and 12 of treatment, both groups had a significant reduction in modified Ashworth score (P<0.05) and significant increases in GMFM-88 and UEFT scores (P<0.05). Both groups had significant changes in modified Ashworth score, GMFM-88 score, and UEFT score from week 4 to week 12 of treatment (P<0.05). Compared with the control group at week 12 of treatment, the treatment group had a significant reduction in modified Ashworth score (P<0.05) and significant increases in GMFM-88 and UEFT scores (P<0.05). Baixiao moxibustion at meridian sinew nodal points can significantly improve the muscle tension and motor function of the ipsilateral upper limb in children with spastic hemiplegic cerebral palsy, and the improvement becomes more apparent as the treatment lasts longer.

Effect of Botulinum Toxin on Equinus Foot Deformity in Cerebral Palsy Patients: A Systematic Review and Network Meta-analysis

Cerebral palsy (CP) is a brain disorder that affects the development, movement and posture leading to limitation of Range of Movement (ROM) in the growing children. CP leads to deformities such as equinus foot deformity. We aim to investigate the efficacy of different botulinum toxin (BTX) products with or without serial casting in reducing the muscle spasticity in equinus foot deformity in patients with CP. A systematic review of the literature was performed by searching different electronic databases. Pub- Med, Scopus, Web of Science (WOS), and GHL databases were used. We analyzed the extracted data by network meta-analysis method using the R software package (version 3.5.0). Regarding Modified Ashworth score (MAS), BTX-A was superior compared to placebo and BTX-A plus immediate casting (MD = -0.39, 95% CI [-0.60; -0.18]) and (MD = -0.50, 95% CI [-0.98; -0.02]), respectively. Concerning growth motor function movement Classification System (GMFM), Neuronox ranked above at 3 months (MD = -1.60, 95% CI [-2.87; -0.33]) and at six months (MD = -1.90, 95% CI [-3.48; -0.32]) compared to BTX-A. Regarding the Modified Tardieu scale (MTS) with knee flexion, BTX-A was superior to BTX-A plus immediate casting (MD = 8.60, 95% CI [1.76; 15.44]). Concerning passive range of movement (PROM) with Knee flexion or extension at 3 months, BTX-A showed a significant improvement compared to BTX-A plus immediate casting. BTX-A ranked best on a physician rating scale (PRS), MAS, MTS with knee flexion and PROM (Knee flexion and extension) compared to Neuronox and Botulax. BTX-A alone was also better than BTX-A plus immediate casting.