Spasticity Research Articles

Comparative assessment of a phased debridement strategy amidst treatment for masticatory muscle spasticity in children with cerebral palsy

Relevance. Dental care for children diagnosed with cerebral palsy (CP) presents substantial challenges to dental practitioners. These children not only necessitate individualized care strategies but also face challenges in mouth opening due to masticatory muscle spasticity, which limits operational access during treatments. This study introduces a phased approach to debridement that is integrated with interventions aimed at alleviating hypertonia in the masticatory muscles through adaptive myogymnastics and the use of a pneumatic mouth expander.Materials and methods. A clinical and functional assessment of the orofacial region was conducted on 34 compliant CP patients aged 6-12 years, with the mean age being 9.6 ± 0.3 years. These assessments considered the extent of motor activity and movement limitations in daily activities. Follow-up evaluations were performed six months post-intervention.Results. The phased debridement plan demonstrated significant effectiveness, integrating diagnostic and therapeutic strategies with tailored visitation schedules based on the clinical conditions of the patients.Conclusion. Uniform diagnostic and therapeutic protocols are recommended to enhance dental health and restrain the prevalence of dental diseases among children with spastic cerebral palsy.

Peran Zakat, Infaq dan Sedekah dalam Meningkatkan Kesejahteraan Difabel Cerebral Palsy melalui Program Jombang Sehat: Studi pada BAZNAS Jombang

Cerebral palsy is a child with special needs where cerebral paralysis occurs, which causes disturbances in the development and growth processes both physically and emotionally. People with cerebral palsy require special attention and regular care, which requires assistance. So, based on this problem, researchers want to examine how much ZIS funds are utilized for people with cerebral palsy, specifically in the Jombang Regency area. The type of research used is a descriptive qualitative approach. Descriptive qualitative research is a type of research in which a researcher investigates events and phenomena in the lives of individuals and asks a person or group of individuals to talk about their lives. The information obtained by the researcher is retold. by researchers in descriptive chronology. In this research, the data used is qualitative data sourced from primary data and secondary data. Primary data is collected through interviews and documents, and secondary data is analyzed through financial reports and annual magazines at BAZNAS Jombang Regency. This research shows that the distribution of Zakat, Infaq, and Alms at BAZNAS Jombang Regency has a role in improving the welfare of mustahiks who suffer from cerebral palsy. This role includes providing milk or nutritional assistance, vitamins, snacks, leg support, routine therapy every week, and helping the mustahik's daily economy.

Compression elastography in assessment of bicep muscle stiffness with controlled pressure in healthy adults

Background Ultrasound Shear Elastography (USE) is used to quantify the stiffness of biological tissues by measuring muscle deformation or displacement. Compression Elastography (CE) involves applying pressure to the skin using an ultrasound (US) transducer, resulting in tissue displacement, and is used to assess tissue stiffness based on the principle that compression produces strain. Methods In this study, we estimated the strain in the biceps brachialis of healthy volunteers (n=11) and patients with post-stroke spasticity (n=2). The arms were evaluated using the Tardieu scale and strain measurements were obtained using an ultrasound probe with the elbow flexed at 30°. A semi-automatic algorithm for muscle thickness measurement was employed to qualitatively measure muscle elasticity. The application of controlled pressure from an electromechanical actuator allows for strain estimation without direct intervention by an operator, thereby reducing subjectivity in the results. The main aim of this study was to utilize CE to characterize the normal range of muscle elasticity in the biceps brachialis of healthy volunteers who exhibited no changes and were rated 0 on the modified Tardieu scale. Results The normal range of strain for both healthy male and female volunteers demonstrated an acceptable deviation for each strain measurement, as the standard deviation was considered small and relatively constant (with higher values observed under maximum pressure). The proposed measurement mechanism is sensitive, allowing for the observation of strain differences between healthy and spastic muscles in both men and women. Conclusions Comparison of the average curve for the healthy group with two examples of curves from individuals with spasticity showed evident differences. Thus, it would be worthwhile to continue this research by evaluating a group of subjects with spastic muscles.

Pre-op considerations in neuromuscular scoliosis deformity surgery: proceedings of the half day course at the 58th annual meeting of the Scoliosis Research Society.

Scoliosis is a common complication of neuromuscular disorders. These patients are frequently recalcitrant to nonoperative treatment. When treated surgically, they have the highest risk of complications of all forms of scoliosis. While recent studies have shown an improvement in the rate of complications, they still remain high ranging from 6.3 to 75% depending upon the underlying etiology and the treatment center (Mohamad et al. in J Pediatr Orthop 27:392-397, 2007; McElroy et al. in Spine, 2012; Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Cognetti et al. in Neurosurg Focus 43:E10, 2017). For those patients who are able to recover from the perioperative period without major complications, several recent studies have shown decreased long-term mortality and improved health-related quality of life in neuromuscular patients who have undergone spine fusion (Bohtz et al. in J Pediatr Orthop 31:668-673, 2011; Ahonen et al. in Neurology 101:e1787-e1792, 2023; Jain et al. in JBJS 98:1821-1828, 2016). It is critically important to optimize patients preoperatively to minimize the risk of post-operative complications and maximize long-term outcomes. In order to do so, one must familiarize themselves with the common complications and their treatment. The most common complications are pulmonary in nature. With reported rates as high as 23-29%, pre-operative optimization should be employed for these patients to minimize the risk of post-operative complications (Sharma et al. in Eur Spine J 22:1230-1249, 2013; Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). The next most common cause of complications are implant related, with 13-23% of patients experiencing an implant-related complication that may require a second procedure (Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Sharma et al. in Eur Spine J 22:1230-1249, 2013) Therefore optimization of bone quality prior to surgical intervention is important to help minimize the risk of instrumentation failure. Optimization of muscle tone and spasticity may help to decrease the risk of instrumentation complications, but may also contribute to the progression of scoliosis. While only 3% of patients have neurologic complication, significant equipoise remains regarding whether or not patients should undergo prophylactic detethering procedures to minimize those risks (Sharma et al. in Eur Spine J 22:1230-1249, 2013). Although only 1.8% of complications are classified as cardiac related, they can be among the most devastating (Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). Simply understanding the underlying etiology and the potential risks associated with each condition (i.e., conduction abnormalities in a patient with Rett syndrome or cardiomyopathies patients with muscular dystrophy) can be lifesaving. The following article is a summation of the half day course on neuromuscular scoliosis from the 58th annual SRS annual meeting, summarizing the recommendations from some of the world's experts on medical considerations in surgical treatment of neuromuscular scoliosis.

The Impact of Aquatic Rehabilitation Exercises on Improving Motor Abilities In Spastic Paralysis Patients Aged (6-8) Years

The researchers aim to address the rehabilitation of children with simple spastic cerebral palsy, emphasizing the importance of early intervention for faster and better rehabilitation. The study also aims to develop exercises and use an aquatic environment for the rehabilitation of children aged 6-8 years with simple spastic cerebral palsy, assessing the impact of aquatic exercises on the rehabilitation and motor abilities of this age group. The research sample, consisting of five individuals with simple spastic cerebral palsy, was purposively selected from the Happiness Institute for Physically Disabled Individuals in Baghdad. The researchers ensured homogeneity in variables such as height, weight, age, and severity of the condition to establish a common starting point for the intervention. The researchers condensed their findings into an aquatic therapy method, believing in the scientific and field capabilities of individuals, provided there is access to modern information, devices, and advanced means, conducting scientific experiments to enhance the effectiveness of the beneficiaries. The significance of the research lies in the rehabilitation of individuals with spastic cerebral palsy, aiming to save time and effort and increase motivation for faster, better, more advanced, and enjoyable rehabilitation for them. The designated place for treatment at the Happiness Institute for Physically Disabled Individuals with Simple Spastic Cerebral Palsy is for children aged 6-8 years, specifically males.

Prevalence of major depressive disorder and its associated factors among adult patients with neurolathyrism in Dawunt District, Ethiopia; 2022: community-based cross-sectional study.

Major Depressive Disorder (MDD) is one of the commonest mental disorders affecting more than 250million people globally. Patients with chronic illnesses had higher risks for developing MDD than the general population. Neurolathyrism is a chronic illness characterized by lifelong incurable spastic paralysis of lower extremities; causing permanent disability. It is highly prevalent in Dawunt district, Ethiopia; with a point prevalence of 2.4%. Despite this, there were no previous studies assessing the prevalence of MDD among patients with neurolathyrism in Ethiopia. To assess the prevalence of MDD and to identify its associated factors among patients with neurolathyrism in Dawunt district, Ethiopia. A community based cross-sectional study was conducted on 260 samples in Dawunt district from February 01 to March 30/ 2021. Multistage sampling technique was used to select study participants. The patient Health Questionnaire-9 (PHQ-9) depression screening tool was used to diagnose MDD. PHQ-9 is a standardized depression screening tool and a PHQ-9 score of ≥ 10 has a sensitivity and specificity of 88.0% [95% CI (83.0-92.0%)] and 85.0% [95% CI (82.0-88.0%)] for screening MDD. Data were collected by interview; entered to EpiData version 4.2.0; exported to SPSS version 25.0 for analysis; descriptive statistics and binary logistic regression model were used; AOR with 95% CI was used to interpret the associations; and finally results were presented by texts, charts, graphs, and tables. A total of 256 adult patients with neurolathyrism were participated; and the prevalence of MDD was found to be 38.7%. Being female [AOR = 3.00; 95% CI (1.15, 7.84)], living alone [AOR = 2.77; 95% CI (1.02-7.53)], being on neurolathyrism stage-3 [AOR = 3.22; 95% CI (1.09, 9.54)] or stage-4 [AOR = 4.00; 95% CI (1.28, 12.48)], stigma [AOR = 2.69; 95% CI (1.34, 5.39)], and lack of social/ family support [AOR = 3.61; 95% CI (1.80, 7.24)] were found to have statistically significant association with an increased odds of MDD; while regular exercise and ever formal counselling were found to have statistically significant association with a decreased odds of MDD. The prevalence of MDD among neurolathyrism patients in Dawunt district was high. Lack of social support, stigma, not getting formal counselling, and not involving in regular exercise were modifiable risk factors. Therefore, social support, reducing stigma, formal counselling, and encouraging regular exercise might help to reduce the burden of MDD among neurolathyrism patients.

Effects of Transcutaneous Electrical Nerve Stimulation with Taping on Wrist Spasticity, Strength, and Upper Extremity Function in Patients with Stroke: A Randomized Control Trial.

Objective: Six months after the onset of stroke, over 60% of patients experience upper limb dysfunction, with spasticity being a major contributor alongside muscle weakness. This study investigated the effect of transcutaneous electrical nerve stimulation (TENS) with taping on wrist spasticity, strength, and upper extremity function in patients with stroke. Methods: In total, 40 patients with stroke were included and randomly divided into two groups: the TENS + taping (n = 20, age 52.4 ± 9.3 (range: 39 to 70)) and TENS (n = 20, age 53.5 ± 10.8 (range: 39 to 74)) groups. All subjects performed 30 sessions of task-related training, which included 10 min of postural control training and 20 min of task performance. Additionally, all subjects received TENS on the spastic muscle belly for 30 min before task-related training. In the TENS + taping group, taping was additionally applied to the forearm and wrist but not in the TENS group. The Modified Ashworth Scale was used to measure spasticity, and a handheld dynamometer was used to measure muscle strength. The Fugl-Meyer Assessment of Upper Extremity was used to evaluate the functional ability of the upper extremity. Results: In the TENS + taping group, spasticity and upper extremity function were significantly improved as compared to those in the TENS group (p < 0.05). However, no significant difference in muscle strength was observed between the two groups (p > 0.05). Conclusions: This study demonstrated that the combination of TENS and taping for spasticity and function of the upper extremity was more effective in relieving the spasticity than TENS alone. Therefore, we suggest this combination as an additional treatment for spasticity and function of the upper extremity.

The potential role of Hypericum perforatum in wound healing: A literature review on the phytochemicals, pharmacological approaches, and mechanistic perspectives.

St. John's Wort, commonly known as Hypericum perforatum L., is a flowering plant in the Clusiaceae family that traditionally been employed for treating anxiety, depression, wounds, burns, sunburn, irritation, and stomach ailments. This review provides a synopsis of H. perforatum L. phytoconstituents and their biological effects, highlighting its beneficial therapeutic properties for dermatological indications, as well as its antioxidant, antimicrobial, anti-inflammatory, and anti-angiogenic activity in various applications including wound healing and skin conditions such as eczema, sun burn and minor burns also spastic paralysis, stiff neck and mood disorders as anti-depressant and nerve pains such as neuralgia. The data were collected from several databases as Web of Science PubMed, ScienceDirect, Scopus and Google Scholar using the terms: "H. perforatum L.", "H. perforatum L. /phytochemistry," and "H. perforatum extracts/wound healing" collected from 1994 to 2023. The findings suggest H. perforatum L. acts through various mechanisms and plays a role in each phase of the wound healing process, including re-epithelialization, angiogenesis, wound contraction, and connective tissue regeneration. H. perforatum L. enhances collagen deposition, decreases inflammation, inhibits fibroblast migration, and promotes epithelialization by increasing the number of fibroblasts with polygonal shape and the number of collagen fibers within fibroblasts. H. Perforatum L. extracts modulate the immune response and reduce inflammation were found to accelerate the wound healing process via inhibition of inflammatory mediators' production like interleukin-6, tumor necrosis factor-α, cyclooxygenase-2 gene expression, and inducible nitric oxide synthase. Thus, H. perforatum L. represents a potential remedy for a wide range of dermatological problems, owing to its constituents with beneficial therapeutic properties. H. perforatum L. could be utilized in the development of novel wound healing therapies.

Physical therapy of patients after cerebral ischemic stroke from the standpoint of a patient-centered approach

Acute cerebrovascular accident remains an important medical and social problem. An important area of intensification of rehabilitation care for patients after cerebral ischemic stroke is the using of a patient-centered approach, which is often associated with increased patient satisfaction and adherence to rehabilitation. The aim of the study was to balance the restoration of physical and functional capabilities of patients after cerebral ischemic stroke in the post-acute rehabilitation period using a patient-centered approach. A program of physical therapy for patients after cerebral ischemic stroke in the post-acute rehabilitation period was implemented from the standpoint of a patient-centered approach in accordance with the defined goals of rehabilitation intervention. The study included 37 patients, 22 men and 15 women with post-stroke muscle spasticity who were under a nine-month follow-up during the second stage of rehabilitation in the post-acute rehabilitation period. The average age of men was 52.1±8 years, the average age of women was 50±13 years. A comparative evaluation of the effectiveness of the physical therapy program was conducted, based on examination methods in accordance with the International Classification of Functioning, Disability and Health. At the end of the experimental study, the following changes in patients after cerebral ischemic stroke were found: decrease in the intensity of pain in the muscles of spastic limbs according to the visual analog pain scale by 12.9±1.02 points (p&lt;0.05); decrease in the severity of motor deficit by an average of 1.7±1.0 points (p&lt;0.05) according to the Motor Deficit Scale (Medical Research Council); the index of muscle tone of the adductor muscles of the shoulder decreased by 0.9±0.4 points (p&lt;0.05), the muscles of the forearm flexors by 0.4±0.2 (p&lt;0.05) points on the Ashworth Scale (Modified Ashworth Scale); assessment of motor function of the affected limb showed an increase in motor activity by 15±0.4 points (p&lt;0.05), before physical therapy the index was 29±0.2 points (p&lt;0.05), and after it – 44.3±0.8 points (p&lt;0.05) on the Action Research Arm Test scale; statistical impro­vement in self-care and functionality in patients by 1.2±0.1 points (p&lt;0.05) on the Modified Rankin Scale; the average walking and mobility score in patients increased by 3.7±0.1 points (p&lt;0.05) on the Rivermead mobility index. The results of the experimental study confirmed that the algorithm and content of the physical therapy program from the standpoint of a patient-centered approach were effective for patients who had suffered a cerebral ischemic stroke; this indicates the possibility and feasibility of their further using for post-stroke patients in the post-acute rehabilitation period.

Hipoparatireoidismo primário em cão: relato de caso

Primary hypoparathyroidism is a rare metabolic condition that can affect domestic animals. The resulting hypocalcemia and hyperphosphatemia can lead to neurological and respiratory changes, as well as cardiac arrhythmias. The aim of the present study is to report the occurrence of primary hypoparathyroidism in a dog and describe the clinical and diagnostic aspects. A 7-year-old male dog with convulsive seizures and spastic limb paralysis was attended to in the municipality of Resende-RJ. After previous therapy with no response to phenobarbital use, serum PTH and ionized calcium levels were measured, revealing a decrease in both. Therapeutic response was observed with the use of calcium gluconate and balancing of circulating potassium via ion channels. Clinical signs characterized by excitability, seizures, muscle fasciculations, and muscular tetany point to a thorough investigation of possible differential diagnoses of calcium disorders. Studies involving the etiological and pathophysiological mechanisms of primary hypoparathyroidism should be encouraged to suggest early therapeutic protocols.

Defining tibial anterior muscle morphology in first-ever chronic stroke patients using three-dimensional freehand ultrasound

ABSTRACT Background Drop foot is common post-stroke, elevating fall risks and mobility limitations. It is caused by weakness and lack of control of the tibialis anterior muscle (TA), for which various rehabilitation treatments are used. A reliable objective estimate of changes in TA muscle morphology and composition can enhance treatment optimization. Objectives We aimed to ascertain 3D freehand ultrasound (3DfUS) reliability in measuring TA muscle volume, length, and echo intensity in stroke patients and healthy controls and its validity by comparing these features across legs, between patients and controls, and between clinical subgroups (i.e. patients with and without ankle contracture, spastic muscle overactivity, and foot dorsiflexor paresis). Methods We included 9 stroke patients and 9 healthy controls to define reliability and 26 stroke patients and 28 healthy controls to define validity. For reliability, data were collected and processed by 2 different operators and processors. For inter- and intra-rater reliability, intra-class correlation coefficient (ICC) and standard error of measurement (SEM) were used. For validity, Wilcoxon-Signed-Ranked and Mann-Whitney U tests were used for comparisons between groups and subgroups. Results All measurements showed good to excellent inter- and intra-rater reliability (ICC: 0.816 to 0.997, SEM: 0.5% to 7.8%). Comparison analyses revealed no differences in muscle features among legs, groups, or subgroups. Conclusion While the 3DfUS is a reliable method to define TA morphology and composition, its clinical validity needs further investigation into factors influencing muscle property changes across various age groups and post-stroke time points. MeSH terms Stroke; Skeletal muscle morphology; muscle composition; 3D freehand ultrasonography, Anterior Tibial Muscle

Eperisone Hydrochloride, a Muscle Relaxant, Is a Potent P2X7 Receptor Antagonist.

Eperisone Hydrochloride was launched in Japan in 1983 and has been used to improve muscle tone and treat spastic paralysis (Originator: Eisai Co., Ltd.). However, its biochemical mechanism of action is unknown. SB Drug Discovery was used to evaluate purinergic P2X (P2X) receptor antagonism using fluorescence. In this study, we discovered that its target protein is the P2X7 receptor. Also, P2X receptor subtype selectivity was high. This finding demonstrates the (Eperisone-P2X7-pain linkage), the validity of P2X7 as a drug target, and the possibility of drug repositioning of Eperisone Hydrochloride.

Current perspectives on neuromodulation in ALS patients: A systematic review and meta-analysis.

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons, resulting in muscle weakness, paralysis, and eventually patient mortality. In recent years, neuromodulation techniques have emerged as promising potential therapeutic approaches to slow disease progression and improve the quality of life of ALS patients. A systematic review was conducted until August 8, 2023, to evaluate the neuromodulation methods used and their potential in the treatment of ALS. The search strategy was applied in the Cochrane Central database, incorporating results from other databases such as PubMed, Embase, CTgov, CINAHL, and ICTRP. Following the exclusion of papers that did not fulfil the inclusion criteria, a total of 2090 records were found, leaving a total of 10 studies. R software was used to conduct meta-analyses based on the effect sizes between the experimental and control groups. This revealed differences in muscle stretch measures with manual muscle testing (p = 0.012) and resting motor threshold (p = 0.0457), but not with voluntary isometric contraction (p = 0.1883). The functionality of ALS was also different (p = 0.007), but not the quality of life. Although intracortical facilitation was not seen in motor cortex 1 (M1) (p = 0.1338), short-interval intracortical inhibition of M1 was significant (p = 0.0001). BDNF showed no differences that were statistically significant (p = 0.2297). Neuromodulation-based treatments are proposed as a promising therapeutic approach for ALS that can produce effects on muscle function, spasticity, and intracortical connections through electrical, magnetic, and photonic stimulation. Photobiomodulation stands out as an innovative approach that uses specific wavelengths to influence mitochondria, with the aim of improving mitochondrial function and reducing excitotoxicity. The lack of reliable placebo controls and the variation in stimulation frequency are some of the drawbacks of neuromodulation.

Methods of examination in physical therapy, and occupational therapy of people after stroke (clinical case)

the prognosis of recovery of patients after acute cerebrovascular accident depends on the type, severity, and area of brain damage. This article highlights standardized tests and scales for physical therapy and occupational therapy for patients after stroke. An example is given of a clinical case of a patient with stroke consequences, with right-sided spastic hemiplegia. Medical rehabilitation was provided in April 2023 at the Municipal Non-Profit Enterprise "Consultative and Diagnostic Center", branch №6, Sviatoshynskyi district, Kyiv, Department of Physical and Rehabilitation Medicine. After the patient visited the outpatient department of physical and rehabilitation medicine, the examination was conducted by the attending physician. A multidisciplinary team of a physical therapist and an occupational therapist was involved. An important step is the use of standardized tests and scales in physical therapy and occupational therapy. Based on the results of the examinations, the patient's goals are determined, and an individual rehabilitation program is built using evidence-based physical therapy and occupational therapy methods to provide a high-quality and effective rehabilitation cycle. Description of the objective. The standardized tests and scales in physical therapy, and occupational therapy are analyzed on the example of a clinical case of a patient after a stroke with right-sided spastic hemiplegia. Materials and methods. The clinician's handbook for 2020 on stroke rehabilitation was analyzed, with the justification of standardized tests and scales for physical therapy, and occupational therapy. A systematic review of the PubMed database was conducted, which included 44 scientific randomized trials and meta-analyses with accurate diagnoses of tests and scales for physical therapy and occupational therapy. The National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) were used to assess stroke. Modified Ashworth Scale for the assessment of spastic muscles in patients with neurological disorders. To determine cognitive outcomes and complications after stroke: Montreal Outcome Cognitive Assessment (MOCA); Modified Barthel Index (BI); Line Drawing Test. For motor function: Fugl-Meyer Assessment (FMA); Chedoke Arm and Hand Activity Instrument (CAHAI). Berg Balance Assessment; Morse Fall Risk Test; Stand and Walk Test. Results. The results of the initial examination in physical therapy and occupational therapy determined the patient's functional and cognitive state, consequences, and limitations arising after a stroke. The intermediate examination summarizes the effectiveness of the selected rehabilitation measures. If the patient's results remain unchanged, the physical and occupational therapist changes the approach and methods to achieve the goals. The final examination analyzes the dynamics of restoration of impaired functions, and achievement of goals by the end of the rehabilitation cycle. Therefore, we used the patient's clinical case to compare the initial, intermediate, and final examinations. This allowed us to analyze the results and determine the effectiveness of the selected individual rehabilitation program. Conclusions. The main principle of providing quality rehabilitation measures is the examination in the clinical practice of a physical therapist, and occupational therapist, which is used to measure the goals and compare the results achieved.

Analysis of 9 patients with adolescence-onset methylenetetrahydrofolate reductase deficiency

Objective: To explore the diagnosis and treatment of adolescence-onset methylenetetrahydrofolate reductase (MTHFR) deficiency. Methods: This was a retrospective case study. Nine patients with adolescence-onset MTHFR deficiency were diagnosed at Peking University First Hospital from January 2016 to December 2022, and followed up for more than 1 year. Their general information, clinical manifestations, laboratory tests, cranial images, MTHFR gene variants, diagnosis, treatment, and outcome were analyzed retrospectively. Results: The 9 patients came from 8 families. They had symptoms at age of 8.0 years to 17.0 years and diagnosed at 9.0 years to 17.5 years. Eight were male and 1 was female. Two patients were brothers, the elder brother developed abnormal gait at 17.0 years; and the younger brother was then diagnosed at 15.0 years of age and treated at the asymptomatic stage, who was 18.0 years old with normal condition during this study. The main manifestations of the 8 symptomatic patients included progressive dyskinesia and spastic paralysis of the lower limbs, with or without intellectual decline, cognitive impairment and behavioral abnormalities. Totally, 15 variants of MTHFR gene were identified in the 9 patients, including 8 novel variants. Five patients had brain image abnormalities. Increased plasma total homocysteine level (65-221 μmol/L) was found in all patients, and decreased to 20-70 μmol/L after treatment with betaine and calcium folinate. Besides, the 8 symptomatic patients had their behavior and cognitive problems significantly improved, with a legacy of lower limb motor disorders. Conclusions: Late-onset MTHFR deficiency can occur in adolescence. The diagnosis is usually delayed because of non-specific clinical symptoms. The test of blood total homocysteine could be used as a selective screening test. Eight novel varients of MTHFR gene were identified. Timely treatment can improve clinical condition significantly, and pre-symptomatic treatment may prevent brain damage.

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

Functional outcomes following surgery for spastic hip adductor muscles in ambulatory and non-ambulatory adults.

To evaluate functional outcomes of surgery of spastic hip adductor muscles (obturator neurotomy with or without adductor longus tenotomy) in ambulatory and non-ambulatory patients, using preoperatively defined personalized goals. Retrospective observational descriptive study. Twenty-three patients with adductor spasticity who underwent obturator neurotomy between May 2016 and May 2021 at the Clinique des Cèdres, Cornebarrieu, France, were included. Postoperative functional results were evaluated in accordance with the Goal Attainment Scaling method. Patients were considered "responders" if their score was ≥ 0. Secondary outcomes included spasticity, strength, hip range of motion and change in ambulatory capacity. When data were available, a comparison of pre- and postoperative 3-dimensional instrumented gait analysis was also performed. Among the 23 patients only 3 were non-walkers. Seventeen/22 patients achieved their main goal and 14/23 patients achieved all their goals. Results were broadly similar for both walking goals (inter-knee contact, inter-feet contact, fluidity, walking perimeter, toe drag) and non-walking goals (intimacy, transfer, pain, posture, dressing). Surgery of spastic hip adductor muscles results in functional improvement in ambulation, hygiene, dressing and posture and can be offered to patients with troublesome adductor overactivity. The use of a motor nerve block is recommended to define relevant goals before the surgery.

Combined Effects of Brunnstorm Movement Therapy and Low-Level Laser Therapy on Upper Limb Function and Hand Dexterity in Chronic Stroke Patient

Background: Stroke remains a leading cause of disability worldwide, necessitating innovative rehabilitation strategies to enhance recovery and improve quality of life. The integration of Brunnstrom movement therapy and low-level laser therapy (LLLT) presents a novel approach to addressing the complexities of stroke rehabilitation, focusing on improving upper limb function and hand dexterity. Objective: This study aimed to evaluate the combined effects of Brunnstrom movement therapy and LLLT on upper limb function and hand dexterity in chronic stroke patients, providing insights into potentially enhancing rehabilitation outcomes. Methods: A randomized controlled trial was conducted involving 48 chronic stroke patients, divided equally into two groups to receive either Brunnstrom movement therapy or LLLT. The study spanned six months, with assessments including the Modified Ashworth Scale (MAS), Nine-Hole Peg Test, Box and Block Test, Fugl-Meyer Assessment, and Handheld Dynamometer. Data were analyzed using SPSS version 25, employing descriptive statistics, chi-square tests, and Mann-Whitney U tests to compare outcomes between groups. Results: Significant improvements were noted in both groups, with the LLLT group showing superior performance in the Nine-Hole Peg Test (p&lt;0.001), Box and Block Test (p&lt;0.001), and Fugl-Meyer Assessment (p&lt;0.001) compared to baseline. The MAS scores indicated a significant reduction in muscle spasticity over time in both groups, with the LLLT group exhibiting a more substantial decrease (p=0.003 at week 6). Conclusion: The study demonstrated that combining Brunnstrom movement therapy with LLLT could significantly enhance upper limb function and hand dexterity in chronic stroke patients. These findings advocate for the integration of innovative and non-invasive therapies into rehabilitation programs, potentially setting a new benchmark in stroke recovery practices.

Peran Fisioterapi Pada Individu Dengan Hemiparesis Sinistra Post Stroke : A Case Study

Introduction: Stroke occurs when the blood supply to the brain is blocked and blood vessels in the brain burst. The brain can't get the blood and oxygen it needs, so brain cells die. In this case, the patient complained of a feeling of weakness and heaviness in the left side of the body, which made it difficult for him to carry out everyday activities. Objective: To determine the role of physical therapy in individuals with left hemiparesis after stroke on muscle strength, spasticity, and functional ability using infrared intervention, electrical stimulation, and exercise therapy. Method: Subjective and objective examinations were carried out, followed by physiotherapeutic intervention in 3 weeks. Results: After physiotherapeutic intervention, the results showed an increase muscle strength using manual muscle testing (MMT) of the hip muscle group T1=2 to T3=2+, the knee muscle group T1=2 to T3=-3. Reduced muscle tone according to the Asworth scale in the shoulder area T1=1+ to T3=1, as well as functional ability according to the Barthel index with results from T1=65 to T3=70. Conclusion: Physiotherapeutic interventions using infrared, electrical stimulation, and exercise therapy can increase muscle strength, reduce spasticity, and improve functional ability in individuals with left-sided hemiparesis after stroke

To what extent are guidelines used in spasticity clinics? A qualitative study of facilitators and barriers to spasticity guideline implementation

Objective To determine the common understanding of focal muscle spasticity guidelines amongst clinicians working in spasticity clinics. To examine the facilitators and barriers to their implementation as well as their influence on clinic processes. Design A qualitative study based on a phenomenological approach. Setting Online videoconferencing platform. Participants Sixteen experienced multi-disciplinary clinicians providing specialised care across 12 spasticity clinics in Victoria, Australia. Intervention Observational. Main measures Two independent reviewers performed line by line coding of transcripts. Reflexive thematic analysis was undertaken with themes/subthemes inductively derived. Results Seven key themes emerged. First, knowledge of specific guideline recommendations was low amongst some clinicians. Second, there is a lack of health service resources to support guideline implementation. Third, a limited evidence base for guidelines affected clinicians’ willingness to implement the recommendations. Fourth, peer support was highly valued but opportunities to collaborate were limited. Fifth, a large amount of intrinsic motivation and personal time was required from clinicians to successfully implement guideline recommendations. Sixth, the standardisation of clinic processes was one way in which clinicians felt they could better align their clinical practice to guidelines. Lastly, guidelines overall had a moderate influence on spasticity clinic processes. Conclusions Knowledge of recommendations varied but, overall, guidelines had an influence on clinic processes and staff perceptions across the state-wide services. Health service resources, limited evidence for guideline recommendations and time constraints were considered barriers to spasticity guideline implementation. Multi-disciplinary expertise and teamwork, the individual's motivation to change and inter-clinic collaboration were considered to be the facilitators.