Spasticity Of Gastrocnemius Muscles Research Articles

Comparison of the Efficacy of 2 Different Botulinum Toxin Injection Techniques in Gastrocnemius Muscle Spasticity in Hemiplegic Patients: A Randomized Double-Blind Controlled Study

ObjectiveTo compare the efficacy of the innervation zone–targeted injection technique (EUROMUSCULUS/USPRM (Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) spasticity approach) and the injection technique along the muscle length. DesignA double-blind randomized controlled trial. SettingDepartment of rehabilitation medicine of a medical center. ParticipantsOne hundred patients with stroke experiencing ankle plantar flexor spasticity. InterventionsIn addition to conventional rehabilitation, eligible patients were randomly assigned to 2 groups. The experimental group was injected with botulinum toxin along the length of the muscle, whereas the control group was injected with the same dose and volume of botulinum toxin 25%-35% proximal to the medial head and 20%-30% proximal to the lateral aspect of the head of the gastrocnemius muscle. Main Outcome MeasuresModified Ashworth scale, modified Tardieu scale, ankle range of motion measurement, and 10-meter walk test were used before and 1 month after injection. ResultsThe study was completed by 60 participants with a mean age of 59.96±12.15 years. Both injection methods were found to be effective on range of motion, spasticity level, ambulation, and walking speed. There was no statistically significant difference between injection methods. ConclusionsBoth injection methods of botulinum toxin A produce similar clinical effects.

Effects of Dry Needling on Gastrocnemius Muscle Spasticity and Gait in Patients with Multiple Sclerosis: A Pilot Randomized Controlled Trial

Effects of Dry Needling on Gastrocnemius Muscle Spasticity and Gait in Patients with Multiple Sclerosis: A Pilot Randomized Controlled Trial

The effects of gastrocnemius muscle spasticity on gait symmetry and trunk control in chronic stroke patients

BackgroundAlthough reduced gait asymmetry and trunk control are generally accepted outcomes in stroke patients after having a stroke, the number of studies examining the factors affecting gait symmetry and trunk control is limited in the literature. Research questionWhat are the effects of gastrocnemius muscle spasticity on trunk control and gait symmetry in chronic stroke patients? MethodThe sample of the study included 29 individuals aged 40–70 who were diagnosed with stroke at least six months ago. The sociodemographic information of the patients was collected using a descriptive information form. Their gastrocnemius muscle spasticity levels were assessed using the Modified Ashworth Scale (MAS), their trunk control was assessed using the Trunk Impairment Scale (TIS), and their gait symmetry was assessed using software developed for the Kinect V2 camera. ResultsThere was a numerical difference between the gait symmetry results of the patients who had a MAS score lower than 2 and those who had a MAS score of 2 or higher, where MAS scores corresponded to gastrocnemius muscle spasticity levels, but this difference was not statistically significant (p > 0.05). There was a statistically significant difference between the total TIS scores and TIS coordination subscale scores of the patients who had a MAS score lower than 2 and those who had a MAS score of 2 or higher (p < 0.05). A negative significant relationship was determined between total TIS and TIS coordination subscale scores and the severity of gastrocnemius muscle spasticity. SignificanceAccording to the results of our study, to improve trunk control and gait in stroke survivors, the management of gastrocnemius muscle spasticity should be included in rehabilitation programs. We believe that our study will be guiding for future interventional studies aiming to improve trunk control and gait in stroke patients.

Use of shear wave elastography to analyze the muscle structure in children with spastic cerebral palsy.

In children with cerebral palsy (CP), gastrocnemius muscle spasticity may lead to pes equinus posture which causes insufficient ankle joint dorsiflexion for normal gait. The aim of this study was to analyze the stiffness of gastrocnemius and tibialis anterior muscles by shear wave elastography (SWE) in children with pes equinus deformity due to spastic CP. 24 legs of 12 children (6 females and 6 males, mean age 45.8 months) with CP were prospectively included in the study. Tissue stiffness quantification with shear-wave velocity (SWV) was analyzed. The mean SWVs of the gastrocnemius and tibialis anterior muscles were 3.91±0.26 m/s and 2.67±0.18 m/s, respectively. The stiffness of the gastrocnemius muscle was significantly higher than the stiffness of the tibialis anterior muscle (p < 0.0001). There was no correlation between the stiffness of these muscles (r = 0.129, p > 0.05). Gastrocnemius muscles were stiffer than tibialis anterior muscles in patients with spastic CP. But stiffness between these muscles was not correlated with each other. Pes equinus may be related to stiff gastrocnemius in these patients. This study demonstrates the clinical potential for SWE as a non-invasive tool for analyzing calf muscle stiffness.

Effectiveness of Botulinum Toxin A First Injection on Gastrocnemius Muscle Spasticity in Children with Cerebral Palsy: Clinical and Elastosonography Study

Effectiveness of Botulinum Toxin A First Injection on Gastrocnemius Muscle Spasticity in Children with Cerebral Palsy: Clinical and Elastosonography Study

Effect of session frequency of radial extracorporeal shockwave therapy on gastrocnemius muscle spasticity in children with spastic cerebral palsy: a double-blinded, randomised clinical trial

Background/aims Extracorporeal shockwave therapy has been effective in reducing spasticity in patients with spastic cerebral palsy, but there has yet to be a recommended guideline for the treatment of spasticity in children using extracorporeal shockwave therapy. The aim of this study was to evaluate the effect of session frequency of radial extracorporeal shockwave therapy on gastrocnemius muscle spasticity in children with spastic cerebral palsy. Methods This was a double-blinded, randomised controlled trial consisting of 14 patients with spastic cerebral palsy (8 boys and 6 girls), aged 5 to 12 years, who were divided into two groups. Group 1 received five true radial extracorporeal shockwave therapy sessions. Group 2 received three true radial extracorporeal shockwave therapy sessions and two sham extracorporeal shockwave therapy sessions. The Australian Spasticity Assessment Scale was measured at nine time points: 1) pre-extracorporeal shockwave therapy, 2–6) immediately after each radial extracorporeal shockwave therapy session, 7) 4 weeks after the fifth radial extracorporeal shockwave therapy session, 8) 8 weeks after the fifth radial extracorporeal shockwave therapy session, and 9) 12 weeks after the fifth radial extracorporeal shockwave therapy session. Results Both groups had a significant reduction in degree of resistance to passive movements of ankle plantar-flexor muscles measured using the Australian Spasticity Assessment Scale at all time points, relative to baseline. The mean ankle Australian Spasticity Assessment Scale in the two groups were not significantly different after the fifth extracorporeal shockwave therapy treatment (group 1: 1.13 ± 0.62; group 2: 1.50 ± 0.90, P=0.28), 4 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.12 ± 0.66; Group 2: 1.50 ± 0.90, P=0.40), 8 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.25 ± 0.68; group 2: 1.50 ± 0.90, P=0.54) and 12 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.19 ± 0.75; Group 2: 1.58 ± 0.90, P=0.28). Conclusions: The effect of radial extracorporeal shockwave therapy on spastic gastrocnemius in children with spastic cerebral palsy is not dependent on session frequency. There has yet to be a recommended guideline and research showing the factors that affect the efficacy of radial extracorporeal shockwave therapy on spastic gastrocnemius muscles in children with spastic cerebral palsy.

The utility of shear wave elastography in the evaluation of muscle stiffness in patients with cerebral palsy after botulinum toxin A injection

The first aim of this study was to evaluate changes in the stiffness of the medial gastrocnemius muscle (GM) after a botulinum toxin A (BoNT-A) injection in children with cerebral palsy (CP) using shear wave elastography (SWE). We also wanted to investigate the usability of SWE for evaluating spasticity in a clinical setting. The second aim of this study was to show how treatment of the gastrocnemius muscle spasticity caused a change in the elasticity of the anterior tibial (TA) muscle. Twenty-four pediatric patients diagnosed with a spastic type of CP, who were scheduled to receive a BoNT-A injection in the gastrocnemius muscle, were included in the study. There was a total of 43 lower extremities to evaluate, and muscle stiffness was measured before the injection and a month post injection using SWE. The physiatrist evaluated muscle spasticity using the Modified Ashworth Scale (MAS) and the Modified Tardieu Scale at about the same time. SWE values of the GM (pre-BoNT-A: 45.9 ± 6.5kPa, post-BoNT-A: 25.0 ± 5.7kPa) decreased significantly post BoNT-A injection (P < 0.01). SWE measurements of the GM had positive correlations with MAS, V1X, V3X, and R2-R1 (P < 0.01); and negative correlations with R2 and R1 (P < 0.05). SWE values of the TA muscle (pre: 36.9 ± 7.9kPa, post: 28.4 ± 5.2kPa) decreased significantly (P < 0.01). Quantitative measurement of muscle stiffness using SWE may provide important information for the evaluation of spasticity and treatment efficiency in pediatric CP patients.

Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke.

Extracorporeal shock wave therapy (ESWT) has been suggested as a useful treatment for spasticity in patients with stroke. To date, most studies have used clinical or biomechanical assessments to determine the effects of treatment. To assess the effect of a single session of ESWT through ultrasonographic assessment on spasticity in patients with chronic stroke. Randomized controlled trial. Rehabilitation center. Eighteen patients with chronic stroke. Participants were randomly assigned to an ESWT group (n = 9) or control group (n = 9). In the ESWT group, a single session of ESWT was given in the medial head of the gastrocnemius muscle of the spastic side at 4 Hz, 2000 shots with intensity of stimulation using energy of 0.1 mJ/mm2 . Sham stimulation was provided by only making sound without putting the device into contact with the skin in the control group. The clinical trial registration number of this study is KCT0002582. Participants were evaluated prior to the treatment, 30 minutes, 1 week, and 4 weeks after treatment. Clinical measures included Modified Ashworth Scale (MAS), passive range of motion (PROM), and Fugl-Meyer Assessment (FMA). As the primary outcome measure, the ultrasonographic measures were Achilles tendon length (ATL), muscle fascicle length (MFL), muscle thickness (MT), and pennation angle (PA). There were no significant differences between the 2 groups for any demographic or baseline measures. At all follow-up evaluations, improvement was shown in MAS as well as changes from baseline of ultrasonographic measures in the ESWT group compared to the control group. In the case of ultrasonographic measures, the difference between the group was greatest at 4 weeks. At follow-up of 4 weeks, between-group difference was 0.66 points (P = .04) on MAS scores, 5.45 points (P = .004) on ATL scores, 4.95 points (P = .002) on MFL scores, 1.83 points (P < .001) on MT scores, and 3.73 points (P < .001) on PA scores. Some ultrasonographic measures of spasticity as well as MAS were improved after a single session of ESWT. Future studies with larger numbers of subjects compared with other spasticity metrics are necessary to further evaluate the treatment effect of ESWT. II.

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.

Developmental coordination disorder (DCD), an umbrella term for motor dysfunctions, which could associate minor neurological dysfunctions

Introduction Developmental Coordination Disorder (DCD) defines a heterogeneous class of children exhibiting marked impairment in motor coordination. Objectives Explore in depth a general group of deficits in fine and gross motricity (subtype mixed group) common to all research subtyping studies. We aimed to highlight discriminant features and specific comorbidities. Methods Data from DCD children aged between 6 and 13years were eligible for inclusion in this study on DSM-5 criteria. All children were assessed with a neuropsychological evaluation of all brain functions and with developmental standardized physical tasks in the neuropsychomotor battery (NP-MOT) which include detection of minor neurological dysfunction (MND) and neurological soft signs (NSS) using tone examination, never considered in most previous studies. Results Findings show in an unexpected way, a high incidence, in 33% of the children, of a motor pathway dysfunction, evidenced by mild spasticity of gastrocnemius muscles in the lower limbs, associated with NSS, for instance failure of standing tone ( P =0.004) and dysdiadochokinesia ( P =0.011) versus salient DCD markers of the mixed subtype as imitation of gestures, fingers digital perception, digital praxia, manual dexterity, and upper and lower limbs coordination. This mild spasticity (MND) appears as a comorbid disorder increasing impairment of coordination between upper and lower limbs and manual dexterity. It could explain why DCD appears as a collection of motor disorders in a heterogeneous groups in numerous studies. Conclusions Our results provide important new evidence to implement an extensive neuro-developmental assessment (mental and physical), including neuromuscular tone examination using appropriate standardized neurodevelopmental tools (common tasks across ages).

Assessment of Spasticity With Sonoelastography Following Stroke: A Feasibility Study

ObjectiveTo investigate the feasibility of sonoelastography to show muscle stiffness in poststroke spasticity, as well as the relationship between sonoelastography findings and muscle architecture features and clinical spasticity scores in the spastic gastrocnemius. DesignCross-sectional study. SettingUniversity rehabilitation center. ParticipantsA total of 26 stroke patients with gastrocnemius muscle spasticity (≥1 using the Modified Ashworth Scale score). InterventionsNone. Main outcomesSonoelastography parameters (elasticity index and elasticity ratio) and muscle architecture features (muscle fascicle length, fascicle pennation angle, muscle thickness and compressibility) were measured from the medial and lateral gastrocnemius muscle on both the affected and unaffected sides. ResultsBoth the elasticity index and elasticity ratio on the affected side were significantly increased in both the medial and lateral gastrocnemius compared with those on the unaffected side (P < .05). Of the muscle architecture parameters, the compressibility in the medial and lateral gastrocnemius and the fascicle pennation angle in the lateral gastrocnemius were significantly decreased on the affected side (P < .05). There was no significant difference in other parameters between the affected and unaffected side (P > .05). Sonoelastographic findings showed a weak negative correlation with compressibility and a weak positive correlation with the Modified Ashworth Scale score in the spastic medial gastrocnemius. ConclusionsIt was found to be feasible to assess stiffness in spastic gastrocnemius muscles of stroke patients with sonoelastography. Further studies are needed to confirm the potential role of sonoelastography to help guide treatment of spasticity and its sequelae.

Therapeutic Effect of Extracorporeal Shock Wave Therapy According to Treatment Session on Gastrocnemius Muscle Spasticity in Children With Spastic Cerebral Palsy: A Pilot Study.

ObjectiveTo investigate the therapeutic effect of extracorporeal shockwave therapy (ESWT) according to treatment session on gastrocnemius muscle spasticity in children with spastic cerebral palsy (CP).MethodsTwelve children with spastic CP underwent 1 ESWT and 2 sham ESWT sessions for gastrocnemius (group 1) or 3 ESWT sessions (group 2) once per week for 3 weeks. Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle plantar-flexor muscles with knee extension, and median red pixel intensity (RPI) of color histogram of medial gastrocnemius on real-time sonoelastography (RTS) were measured before ESWT, immediately after the first and third ESWT, and at 4 weeks after the third ESWT.ResultsMean ankle PROM was significantly increased whereas as mean ankle MAS and median gastrocnemius RPI were significantly decreased in both groups after the first ESWT. Clinical and RTS parameters before ESWT were not significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 1. However, they were significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 2. Mean ankle PROM, mean ankle MAS, and median gastrocnemius RPI in group 2 were significantly different from that in group 1 at 4 weeks or immediately after the third ESWT.ConclusionThe therapeutic effect of ESWT on spastic medial gastrocnemius in children with spastic CP is dependent on the number of ESWT sessions.

Anatomic motor point localization for the treatment of gastrocnemius muscle spasticity.

The location of the motor point of the gastrocnemius muscle was accurately defined relative to surrounding bony landmarks to facilitate the approach to the nerve of the gastrocnemius muscle during treatment for gastrocnemius muscle spasticity. Anatomic dissection of 40 cadaver knees was undertaken for morphometric measurement. The distances from the epicondyle of the femur to the motor branch, and from the motor branch to the motor point of the nerve to the medial head of the gastrocnemius muscle were 3.68 +/- 11.44 mm, and 37.79 +/- 7.80 mm, respectively; while those of the nerve to lateral head of the gastrocnemius muscle were 4.45 +/- 11.96 mm, and 32.16 +/- 4.64 mm, respectively. The tibial nerve lay 44.57 +/- 5.45% and 56.30 +/- 4.73% from the lateral margins of the epicondyle and the fibular head, respectively. Careful consideration of the morphometry of the motor point of the gastrocnemius muscle may provide accurate anatomical guidance, and hence reduce complications during the chemical blockage of these nerves.