Calf Muscle Spasticity Research Articles

The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: a randomized controlled trial

BackgroundExtracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients.MethodsIn this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT.ResultsWithin-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups.ConclusionsDouble-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus.Trial registrationNCT05878223.

Effect of cryotherapy in controlling spasticity of calf muscles in patients with multiple sclerosis.

Spasticity is a common symptom of multiple sclerosis (MS), affecting 80% of patients. Many studies have aimed to detect methods to reduce spasticity under these conditions and found that spasticity can be efficiently reduced using cryotherapy. To examine the impact of cryotherapy on spasticity among patients with MS. Thirty-two participants were randomized into two groups. The study group was given airflow cryotherapy and a selected physical therapy program, whereas the control group was only given a selected physical therapy program. The treatment was administered three times each week for a total of twelve consecutive sessions. The outcome measures were the modified Ashworth scale and the H/M ratio. The study group showed significant decrease in calf muscle spasticity, indicated by a reduction in spasticity grade (p = 0.001) and a decrease in the H/M ratio of 33.81% (p = 0.001). The control group also showed significant reduction in calf muscle spasticity, as indicated by a reduction in spasticity grade (p = 0.001) and a reduction in the H/M ratio of 19.58% (p = 0.001). There was a significant decrease in the spasticity grade and H/M ratio of the study group posttreatment compared with those of the control group (p = 0.02 and p = 0.001). The combined effect of cryotherapy and a selected physical therapy program are more effective in controlling the spasticity of calf muscles in patients with MS than a selected physical therapy program alone.

The effect of vibration-hinged ankle foot orthoses on gait and spasticity in children with cerebral palsy: A randomized clinical trial design.

Hinged ankle foot orthoses (HAFO) are commonly prescribed for children with cerebral palsy (CP) to improve their ambulatory function. The aim of this study was to compare the effect of vibration-HAFO with that of the same orthosis without vibration on gait, function, and spasticity in hemiplegic CP children. Randomized Control Trial Design (a pilot study). Twenty-three children with hemiplegic CP participated in this study. The control group (n = 12) used HAFO, and the intervention group (n = 11) used vibration-HAFO for four weeks. Pre-post three-dimensional gait analysis was done. Calf muscle spasticity and function were also measured. Results showed significant differences between the two groups in the one-minute walking test (p = 0.023) and spasticity (after intervention [p = 0.022], after follow-up [p = 0.020]). Also, significant differences were detected between the two groups in the step width (p = 0.042), maximum hip abduction (p = 0.008), stance maximum dorsiflexion (p = 0.036) and mean pelvic tilt (p = 0.004) in the barefoot condition. Gait cycle time (p = 0.005), maximum hip abduction (p = 0.042), and cadence (p = 0.001) were different between groups in the braced condition. We couldn't find any significant within and between groups differences in knee kinematic parameters. The mean time of using vibration was 16.83 minutes per day. The vibration-hinged AFO is feasible, safe, and acceptable for children with hemiplegic CP to be integrated into practice. Temporospatial and clinical parameters, especially spasticity, were improved. There were slight trends toward improvement in pelvic and knee kinematics. Vibration-HAFO is of benefit to ambulatory CP children with mild and moderate spasticity. It improved the walking capacity of the children.

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.

Is the Outcome of Diagnostic Nerve Block Related to Spastic Muscle Echo Intensity? A Retrospective Observational Study on Patients with Spastic Equinovarus Foot.

To investigate the relationship between spastic calf muscles echo intensity and the outcome of tibial nerve motor branches selective block in patients with spastic equinovarus foot. Retrospective observational study. Forty-eight patients with spastic equinovarus foot. Each patient was given selective diagnostic nerve block (lidocaine 2% perineural injection) of the tibial nerve motor branches. All patients were evaluated before and after block. Outcomes were: spastic calf muscles echo intensity measured with the Heckmatt scale; affected ankle dorsiflexion passive range of motion; calf muscles spasticity measured with the modified Ashworth scale and the Tardieu scale (grade and angle). Regarding the outcome of tibial nerve selective diagnostic block (difference between pre- and post-block condition), Spearman's correlation showed a significant inverse association of the spastic calf muscles echo intensity with the affected ankle dorsiflexion passive range of motion (p = 0.045; ρ = 00-0.269), modified Ashworth scale score (p = 0.014; ρ = -0.327), Tardieu grade (p = 0.008; ρ = -0.352) and Tardieu angle (p = 0.043; ρ = -0.306). These findings support the hypothesis that patients with spastic equinovarus foot with higher spastic calf muscles echo intensity have a poor response to selective nerve block of the tibial nerve motor branches.

Comparison of body structure, function, activity, and participation levels according to ankle foot orthosis wearing time in children with spastic cerebral palsy.

Ankle foot orthoses (AFOs) are usually recommended to prevent deformities and to increase the standing and walking performance in children with spastic cerebral palsy (CP). To compare the body functions and structures, activity and participation levels, and environmental factors according to AFO-wearing time in children with spastic CP. Prospective, cross-sectional-observational-clinical study. Eighty children with spastic CP (Gross Motor Function Classification System I-III; mean age 7.3 ± 3.9 years) were divided into two groups with equal ages and duration of AFO usage, which is provided as a part of routine clinical care: 6-12 hours per day group (n = 40) and 12-24 hours per day group (n = 40). The outcomes measured were calf muscle's spasticity with the modified Ashworth Scale (MAS), passive ankle dorsiflexion angle (DA), 66-item Gross Motor Function Measurement, Pediatric Berg Balance Scale, and Pediatric Quality of Life Inventory (PedsQL). Parental satisfaction was measured with a Visual Analog Scale. Multifactorial ANOVA was used to compare the groups, corrected for 66-item Gross Motor Function Measurement. No significant differences for the Pediatric Berg Balance Scale, MAS, and DA were found between the groups. Significant differences for the PedsQL (76.99 vs. 57.63; mean difference [MD], 15.60; 95% confidence interval [CI], 10.99∼20.22), daily living activities (65.30 vs. 35.92; MD, 25.72; 95% CI, 17.58∼33.86), fatigue (76.9 vs. 56.85; MD, 23.11; 95% CI, 16.87∼29.35), and satisfaction (8.08 vs. 5.21; MD, 2.46; 95% CI, 1.64∼3.27) were found between the groups; 6-12 hour group had superiority for each outcome (P < 0.001). Wearing time was significantly correlated with PedsQL (r = -0.524, P < 0.001) and satisfaction (r = -0.521, P < 0.001) but not with MAS or DA. AFO-wearing time seems to depend on the child's activity and participation levels rather than body functions and structures in children with spastic CP. Prolonged AFO-wearing time was negatively correlated with both the activity-participation level and parental satisfaction.

COMPARATIVE STUDY OF EFFICACY OF CRYOTHERAPY AND MYOFASCIAL RELEASE TECHNIQUE IN CALF MUSCLE SPASTICITY IN SPASTIC DIPLEGIC CEREBRAL PALSY CHILDREN

The greatest substantial consequence of juvenile impairment is cerebral palsy (CP). Spasticity of numerous muscle groupings is common after Central Nervous System damage. Spasticity causes functioning issues. For individuals suffering from CP ankle anomalies seem strongly tied to workable limits. Spastic CP is highest frequent type of CP, which limits child's responsive status and prohibits them from participating in communal activities. Soft tissue mobilisation procedures would be used in variety ways. Cryotherapy is interventional method for stiffness in neurological patients that has narrow advantage. MFR can potentially utilised against spasticity. The focus of this investigation is to evaluate Cryotherapy and MFR influence over calf muscle stiffness in participants who have Spastic Diplegic CP. The survey's goal is to determine efficacy of Cryotherapy and MFR in calf muscle spasticity in Spastic diplegic CP subjects. Thirty individuals suffering spastic diplegic CP were chosen using randomized sampling procedure. The subjects was categorised onto 3 subgroups, each of ten individuals. Cryotherapy was applied to Group A, MFR was applied to B and C Group was applied with combination of cryotherapy and MFR. Both before and after therapy, MAS and goniometry are used to assess calf muscle spasticity and ankle PROM. Overall validity of MAS and PROM comparing before and after in subgroup was determined using Tukey Test. Spasticity was reduced and range of motion was improved (p&lt;0.05) in intra group comparison. Cumulative influence of cryotherapy and MFR is beneficial in reducing calf muscle stiffness in spastic diplegic CP children, as per this investigation.

Transcutaneous electrical nerve stimulation in the management of calf muscle spasticity in cerebral palsy: A pilot study.

This study sets out to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of calf muscle spasticity in children with cerebral palsy. The study follows a one group pre-test–post-test design involving fifteen children with spastic cerebral palsy, presenting with calf muscle spasticity. Spasticity was assessed before and after a 30 min application of TENS to the bilateral calf muscles. The H-reflex (electromyography) of the calf muscles and Modified Ashworth Scale (MAS) served as a measure of spasticity. A goniometer was used to measure the range of motion (ROM) angles for ankle dorsiflexion. We report here no significant difference (p > 0.05) between the left and right H-reflex responses, MAS scores, and ROM scores recorded at baseline (pre-test). Correlation analysis show no correlation (p > 0.05) between the pre-test HA Max (maximum H-reflex amplitude)/MA Max (maximum M-Wave Amplitude) ratio and MAS scores of both the left and right calf muscles. However, TENS significantly reduced (p < 0.05) the HA of the left calf muscle and MAS scores of the left and right calf muscles. Additionally, TENS significantly increased the ROM scores of the left and right calf muscles. Our findings lend support to existing evidence that TENS is effective in reducing spasticity. The potential mechanism underlying this effect is a reduction in neuron excitability.

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.

A Protocol on Effect of Cryotherapy and Myofascial release Technique in Calf Muscle Spasticity of Spastic Diplegic Cerebral Palsy Children

Background: Cerebral Palsy is been one of the developmental disorders affecting the infants brain. Themost common form of Cerebral Paralysis being Spastic Cerebral Palsy affects children functionally andprevents their social functioning. Most of the physiotherapy interventions to treat spasticity are Cryotherapy,Myofascial Release technique. Cryotherapy is effective in reducing Spasticity and some suggest MyofascialRelease Technique is also effective in reducing spasticity. Aim: To find out the effect of Cryotherapy andMyofascial Release Technique in calf muscle of Spastic Diplegic Cerebral Palsy Children. Methods: 30Participants with Spastic Diplegia will be selected on the basis of inclusion as well as exclusion criteria. Thepatients will be evaluated using Modified Ashworth Scale and Modified Tardieu Scale for calf muscle priorto the treatment. The 30 participants will be divided into 3 groups. All the groups will receive Cryotherapy,MFR technique and combined effect of both the techniques separately. The patients will be again evaluatedafter the treatment by using MSA and MTS. Conclusion: This Study Concluded that there may be significantreduction in calf muscle spasticity in spastic diplegic cerebral palsy children by using combine effect of bothCryotherapy and Myofascial Release technique ore one of the method.

The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Post-Stroke Hemiplegia

Calf muscle spasticity leading spastic movement disorders during walking is the major complex functional problem in post stroke hemiplegia. And a recent RCT suggests that Whole Body Vibration (WBV) therapy of 40 hz/4 mm amplitude for 5 minutes totally 12 sessions improves walking speed in the long term and may be a complementary therapy in gait rehabilitation. Nevertheless, a 2015 systematic review and meta-analysis concludes that WBV training had no beneficial effects in muscle strength.

Does Botulinum Toxin Treatment Affect the Ultrasonographic Characteristics of Post-Stroke Spastic Equinus? A Retrospective Pilot Study.

Equinovarus/equinus foot is a pattern most commonly treated with botulinum toxin type A in patients with post-stroke spasticity involving the lower limbs; the gastrocnemius is the muscle most frequently injected. Spastic equinovarus/equinus can present a mixture of conditions, including spasticity, muscle/tendon shortening, muscle weakness and imbalance. In this study, we wanted to determine whether botulinum toxin treatment affects the ultrasonographic characteristics of post-stroke spastic equinus. The same dose of AbobotulinumtoxinA was injected into the gastrocnemius medialis and lateralis of 21 chronic stroke patients with spastic equinus. Clinical (Ashworth scale and ankle range of motion) and ultrasound (conventional and sonoelastography) evaluation of the treated leg was carried out before and 4 weeks after injection. No significant effects of botulinum toxin treatment on the ultrasonographic characteristics of spastic equinus were observed. As expected, there were significant improvements in ankle passive dorsiflexion range of motion and calf muscle spasticity at 1 month after treatment. There was a direct association between Achilles tendon elasticity and calf muscle spasticity at baseline evaluation. Larger studies with a long-term timeline of serial evaluations are needed to further investigate the possible effects of botulinum toxin injection on spastic muscle characteristics in patients with post-stroke spasticity.

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A retrospective observational study.

To evaluate the role of diagnostic nerve block in predicting the outcome of subsequent botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke. Retrospective observational study. Fifty chronic stroke patients with spastic equinovarus foot. Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale. Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection. This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.

Effect of Intermittent Serial Casting on Equinus Ankle Deformity in Children with Hemiplegic Cerebral Palsy

AbstractBackground: Equinus is the most common problem in ambulatory children with spastic hemiplegic cerebral palsy, which results in an unstable and inefficient gait pattern. Without proper management at an early stage, it can lead to permanent foot deformities.Aim of Study: The aim of this study was to evaluate the effect of serial casting on ankle range of motion, tone of the calf muscle and ankle kinematics during gait in children with spastic hemiplegic cerebral palsy.Material and Methods: Twenty-five spastic hemiplegic cerebral palsy children of both sexes (15 boys and 10 girls) participated in this study. Patients were selected at level I according to Gross Motor Function Classification System and the degree of spasticity ranged from 2 to 3 according to Modified Ashworth Scale with true equinus, with their mean age were 4.8±0.8 years. They were randomly assigned to two groups. The first group, 12 children, Group (A) who received a selected physical therapy program once a day/3 times a week for three successive weeks; while the second group, 13 children, Group (B) who received three consecutive casts for five days each and removed in the last two days in each week to conduct the same selected physical therapy program which conducted for the Group (A). Ankle range of motion was assessed by electronic goniometer, calf muscle spasticity was assessed by modified ashworth scale and ankle kinematics during gait was assessed by observational gait scale.Results: The results of the present study revealed that Group (B) showed statistically significant improvement in ankle range of motion, tone of calf muscle and ankle kinematics during gait (p=0.0001 for all) than those of the Group (A).Conclusion: Serial casting of equinus ankle deformity could improve ankle range of motion, tone of calf muscle and ankle kinematics during gait in children with spastic hemiplegic cerebral palsy.

Efficacy of cryo-airflow therapy on calf muscle spasticity in stroke patients: a randomized controlled trial

Efficacy of cryo-airflow therapy on calf muscle spasticity in stroke patients: a randomized controlled trial

Effects of Ultrasound Therapy on Balance and Gait in Stroke Patients with Gastrocnemius Muscle Spasticity

The purpose of this study is to investigate the effect of ultrasound therapy on calf muscle spasticity of stroke patients. Ten patients who were diagnosed with stroke by a specialist in rehabilitation medicine were divided into two groups by random assignment method. The control group received a 10-minute ultrasound placebo effect after general physiotherapy. In the experimental group, ultrasound therapy was given for 10 minutes after general physical therapy. In this study, muscle tone was assessed using MAS(modified ashworth scale), balance was assessed using TUG(time up amp go), and gait was assessed using a 10m walk test. There was a significant difference between the experimental group and the muscle tone, balance, and gait. However, there was no significant difference in the control group. There was a significant difference between the groups in balance and gait, but not in muscle tone. Ultrasound therapy should be adapted to reduce spasticity and improve function in stroke patients.

The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Poststroke Hemiplegia.

Objective To determine if whole body vibration therapy (WBV) effectively improves functional outcome in patients with poststroke hemiplegia. Materials and Methods In this single-blind RCT, WBV group (n = 10) had 40 hz frequency/4 mm amplitude vibration during 5 minutes/session, 3 days a week, for a duration of 4 weeks. The control group (n = 11) had no vibration therapy for the same duration while standing on the same platform. Patients in both of the groups did 15 minutes of stretching and active range of motion exercises before the intervention. Outcome measures were Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM), and Timed 10-Meter Walk Test (10 mWT). Results Only 10 mWT improved at the 1st week (p = 0.002), 1st month (p < 0.001), and 3rd month (p < 0.001) in favor of the intervention group. There was positive correlation also between 10 mWT and ankle spasticity (p < 0.001, r = 0.931). Conclusion This study suggests that WBV therapy may be a complementary therapy in gait rehabilitation and functional outcome of the patients with calf muscle spasticity.

The effects of focal muscle vibration to reduce calf muscle spasticity in chronic stroke patients: Preliminary study

Recently, several studies have investigated the anti spastic effect of focal muscle vibration in patients with stroke. It was also reported than vibratory stimulation on hemiplegic lower limb increased gait speed in stroke patients.

Contrast-enhanced ultrasound assessment of the microcirculation of spastic calf muscles prior to botulinum toxin type a injection in patients with long-standing lower limb spasticity (initial experience)

Contrast-enhanced ultrasound assessment of the microcirculation of spastic calf muscles prior to botulinum toxin type a injection in patients with long-standing lower limb spasticity (initial experience)

Effect of Focal Muscle Vibration on Calf Muscle Spasticity: A Proof-of-Concept Study

BackgroundFocal vibration has been studied for its ability to reduce spasticity in patients with upper motor neuron lesions, but adequate stimulation parameters remain unclear. Focal muscle vibration with adequate parameters may facilitate gait rehabilitation in patients with lower limb spasticity. ObjectiveTo determine focal muscle vibration parameters that effectively inhibit the H-reflex of the gastrocnemius in healthy subjects. DesignA proof-of-concept exploratory study. SettingUniversity hospital laboratory. SubjectsThirteen healthy volunteers. MethodsFocal muscle vibrations of 40, 80, and 120 Hz and amplitudes of 0.1, 0.3, and 0.5 mm were tested on the calf muscles of 10 healthy subjects, respectively. The H-reflex and M-response were recorded baseline, during vibration, and after vibration for each stimulation parameter. The mean vibratory inhibition index (VII) during vibration, the maximum amplitude of the H-reflex and M-response (Hmax and Mmax), minimal onset latency of the H-reflex, and the ratio of Hmax to Mmax (HMR) at each time point were measured. ResultsNo significant difference was found among mean VIIs at 40, 80, and 120 Hz in the healthy subjects. However, a relatively consistent reduction of Hmax and HMR was observed at 80 Hz. Mean VIIs at 0.3 and 0.5 mm were significantly lower than that at 0.1 mm (P < .001). ConclusionThis study suggests that focal muscle vibration may be an adjuvant therapy during gait rehabilitation in patients with calf muscle spasticity. Focal vibration at 80 Hz and 0.3 mm amplitude applied to the gastrocnemius effectively inhibits the segmental reflex pathway. A future clinical trial on this topic is warranted. Level of EvidenceII