Improved Muscle Tone Research Articles

The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review.

Myofunctional therapy (MFT) may have a role in improving muscle tone and alleviating upper airway collapse in sleep-disordered breathing. The purposes of this state-of-the-art review are to first review systematically the current literature on the effectiveness of MFT in treating sleep-disordered breathing and then to provide an overview of the current understanding of patient selection, side effects, type and duration of exercises, guidance of exercise performance, evaluation of results, and how best to promote adherence. PubMed (Medline), the Cochrane Library, and the EMBASE, Scopus and SciELO databases were checked for relevant studies by three authors, and a total of 23 studies were included. This review focuses only on adults with sleep-disordered breathing. The available evidence shows a positive effect of MFT in reducing sleep apnoea, as measured using polysomnography and clinical variables (including snoring). There is no evidence of the utility of MFT for treating upper airway resistance syndrome, the duration of the effects of MFT, or regarding which MFT protocol is best. Despite these knowledge gaps, the available evidence suggests that MFT is a safe treatment modality.

신체활동 참여가 발달장애인의 하지 근 긴장도 변화와 신체 균형능력에 미치는 영향

The purpose of this study was to investigate the effects of physical activity on changes in lower limb muscle tone and body balance ability in people with developmental disabilities. In this study, subjects with developmental disabilities who showed voluntary participation as those diagnosed as developmental disabilities through medical examination were selected as subjects. These subjects were randomly assigned to the trampoline group (n=10) and the yoga group (n=10) as those who did not participate in the recent regular exercise program. The trampoline and yoga were performed twice a week for a total of 20 times for 10 weeks with 60 minutes each. The intensity of exercise was divided into 3 steps, and rating of perceived exertion(RPE) of 8-9, 10-11, and 12-13 were performed, respectively. Muscle tone was measured at rest in a total of three muscle groups of the quadriceps muscle, hamstring, and calf. Also, one leg standing test was used to test the static balance ability, and linear gait test was performed to test dynamic balance ability. Based on the results of the study, the following results were obtained. First, in the trampoline and yoga group, the quadriceps muscle tone increased(p<.05) significantly, and the hamstring(p=.056) and calf muscle tone increased(p<.05) only in the trampoline group. Second, the static balance ability was significantly increased(p<.01) in the trampoline and yoga group. Third, the dynamic balance ability S1 & S2 was significantly increased(p<.05) in the trampoline group, but increased(p=.07) only in the dynamic balance ability S1 in the yoga group. Therefore, a physical activity program using trampoline and yoga can be an effective intervention to improve muscle tone, and it is considered appropriate as an alternative physical activity to improve balance and exercise performance for people with developmental disabilities in the future.

Physical rehabilitation of children with perinatal lesion of the central nervous system

The article is dedicated to non-pharmacological rehabilitation of children with perinatal lesions of the central nervous system. Currently, the main methodological principles of the staged medical rehabilitation of newborns, mainly children with consequences of perinatal damage to the nervous system, have been determined. Special attention should be paid to the issue of the minimum use of drugs in children with perinatal pathology. In this regard, an important task is to develop and scientifically substantiate new non-drug technologies for medical rehabilitation, especially in children under 1 year of age. Medical rehabilitation has the following aims: stimulation of blood circulation in the tissues of the brain, improvement of muscle tone by acting on the central nervous system and the peripheral nervous system, activation of the processes of neuromuscular transmission and improvement of the psychomotor development of a child with perinatal pathology of the central nervous system. Medical rehabilitation of children with perinatal lesions of the central nervous system begins at the earliest possible date and is carried out by specialists of a multidisciplinary rehabilitation team based on an individual medical rehabilitation program. At present, a wide range of non-drug technologies for medical rehabilitation of children with the consequences of perinatal damage to the central nervous system is used: therapeutic gymnastics, massage, kinesitherapy with a neuroreflex component according to the V. Vojta’s method, Bobath therapy. The analysis of publications presented in the review has shown that the inclusion of modern technologies of kinesitherapy and massage in the complex of rehabilitation measures in children with perinatal lesions can increase the effectiveness of rehabilitation measures, reduce the severity of movement disorders, and decrease the incidence of cerebral palsy.

Social physique anxiety and physical activity

IntroductionSocial Physique Anxiety is defined as an emotional response that reflects individuals’ concerns regarding the way their body may be observed or judged by others.ObjectivesTo explore the relationship between physical activity and social physique anxiety.MethodsA literature review haw been made through pubmed database.ResultsSocial Physique Anxiety is negatively related to participation in physical activity and commitment to exercise. Studies examining the relationship between motivation and social physique anxiety have shown that external motivations, such as improving muscle tone and body attractiveness, are directly linked to social physique anxiety. In addition, social physique anxiety is negatively related to self-efficacy. Individuals who believe that they will be judged by others to be ineffective are less likely to be engaged in physical activity programs. Social Physique Anxiety has been linked to negative effects on mental health such as low self-esteem, smoking and eating disorders.ConclusionsGiven all the negative effects of social physique anxiety, as it is responsible for a wide range of health-related behaviors, it is important to identify physical activity-related motivational mechanisms in order to reduce the impact of social physique anxiety.DisclosureNo significant relationships.

Intensity and Dose of Neuromuscular Electrical Stimulation Influence Sensorimotor Cortical Excitability.

Neuromuscular electrical stimulation (NMES) of the nervous system has been extensively used in neurorehabilitation due to its capacity to engage the muscle fibers, improving muscle tone, and the neural pathways, sending afferent volleys toward the brain. Although different neuroimaging tools suggested the capability of NMES to regulate the excitability of sensorimotor cortex and corticospinal circuits, how the intensity and dose of NMES can neuromodulate the brain oscillatory activity measured with electroencephalography (EEG) is still unknown to date. We quantified the effect of NMES parameters on brain oscillatory activity of 12 healthy participants who underwent stimulation of wrist extensors during rest. Three different NMES intensities were included, two below and one above the individual motor threshold, fixing the stimulation frequency to 35 Hz and the pulse width to 300 μs. Firstly, we efficiently removed stimulation artifacts from the EEG recordings. Secondly, we analyzed the effect of amplitude and dose on the sensorimotor oscillatory activity. On the one hand, we observed a significant NMES intensity-dependent modulation of brain activity, demonstrating the direct effect of afferent receptor recruitment. On the other hand, we described a significant NMES intensity-dependent dose-effect on sensorimotor activity modulation over time, with below-motor-threshold intensities causing cortical inhibition and above-motor-threshold intensities causing cortical facilitation. Our results highlight the relevance of intensity and dose of NMES, and show that these parameters can influence the recruitment of the sensorimotor pathways from the muscle to the brain, which should be carefully considered for the design of novel neuromodulation interventions based on NMES.

Treating Shoulder Pain with Trigger Point Dry Needling: A Case Report

Shoulder pain is highly prevalent even in the young population and could have a multifactorial aetiology. Myofascial Trigger Points (MTrPs) could be one of the pathophysiological basis of shoulder pain. Dry needling has shown promising results in releasing MTrPs in different muscles. Hereby, authors present a case report of a 24-year-old male with a history of shoulder pain, with no history of trauma or injury, who was referred to the physiotherapist by orthopaedic surgeon with a diagnosis of shoulder strain of muscular origin. Being a flight attendant by profession, his job involved continuous picking, pushing and lifting things during his working hours in the flights. The patient presented with severe pain and with reduced Range of Motion (ROM) mainly on left side. Following thorough assessment of the patient by the physiotherapist, the trigger point dry needling was administered. The pain was reduced as measured by Numeric Pain Rating Scale (NPRS), increasing the Pain Pressure Threshold (PPT) as measured by algometer with increase in ROM of left shoulder. After the dry needling treatment session, there was an instant improvement in the restricted ROM of shoulder which may be a consequence of the decrease in pain and improvement in muscle tone and elasticity after treatment. Although there are few papers highlighting the effectiveness of dry needling but still, there is dearth of literature that highlight the quantification (PPT) in addition to reporting of pain (score based) and ROM. Thus, the results of the present case report can assist in providing insight for examining the effectiveness of dry needling, which are subdued literature but are important to frame body of knowledge.

Effect of Functional Progressive Resistance Exercise on Lower Extremity Structure, Muscle Tone, Dynamic Balance and Functional Ability in Children with Spastic Cerebral Palsy.

The purpose of this study was to investigate the effects of functional progressive resistance exercise (FPRE) on muscle tone, dynamic balance and functional ability in children with spastic cerebral palsy. Twenty-five subjects were randomized into two groups: the FPRE group (n = 13) and the control group (n = 12). The experimental group participated in an FPRE program for 30 min per day, three times per week for six weeks. Knee extensor strength, rehabilitative ultrasound imaging (RUSI), muscle tone, dynamic balance, and functional ability was evaluated. The results showed statistically significant time × group interaction effects on the dominant side for knee extensor strength and cross-sectional area (CSA) in RUSI (p < 0.05). On both sides for thickness of the quadriceps (TQ) in RUSI, muscle tone and dynamic balance were statistically significant time × group interaction effects (p < 0.05). Additionally, knee extensor strength, CSA, TQ in RUS, muscle tone, dynamic balance and gross motor function measure (GMFM) in functional ability were significantly increased between pre- and post-intervention within the FPRE group (p < 0.05). The results suggest that FPRE is both feasible and beneficial for improving muscle tone, dynamic balance and functional ability in children with spastic cerebral palsy.

Robotic therapy for the hemiplegic shoulder pain: a pilot study

BackgroundsExoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree.MethodsAn experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital “Dr. Juan Bruno Zayas Alfonso” in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher’s Exact Tests were used as comparison criteria.ResultsRobotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.

Real-world effectiveness of abobotulinumtoxinA (Dysport®) in adults with upper limb spasticity in routine clinical practice: an observational study.

AbobotulinumtoxinA (aboBoNT-A, Dysport®) is used in clinical practice as a well-tolerated and effective therapy for muscle spasticity. AboBoNT-A has been shown to reduce upper and lower limb spastic paresis in clinical trials, demonstrating improvements in muscle tone and limb function. This open-label, multicentre, observational, non-interventional study was the first to investigate aboBoNT-A's efficacy in adult patients with upper limb spasticity (ULS) in routine clinical practice in Poland. All enrolled patients received ≥1 aboBoNT-A injection cycles, per routine clinical practice (full analysis set, FAS), and ≥1 rehabilitation session. Patients attended a baseline visit (V1) and two follow-up visits (V2, V3) for retreatment, depending on the investigator's assessment of individual patient needs, with a mean interval (SD) between injections of 4.4 (1.4) and 4.5 (1.2) months. The primary effectiveness endpoint was patient- and physician-based evaluation using the Clinical Global Impression-Improvement Scale (CGII), a validated 7-point scale (1 = very much improved to 7 = very much worse) relative to baseline. CGI-I has not previously been used as a primary endpoint in studies evaluating ULS. Secondary endpoints included muscle tone in shoulder, elbow, carpal joint, and finger muscles, measured by the Modified Ashworth Scale (MAS), and muscle strength according to the Medical Research Council scale (MRC). Of 108 enrolled patients (FAS), 92 (85.2%) completed the study and 57 (52.8%) were included in the per protocol (PP) population. AboBoNT-A improved patient conditions in 96.4% and 98.6% at V2 and V3 (investigator assessment) and 92.8% and 98.6% (as reported by patient) of patients, respectively. Significant reductions in muscle tone from baseline were observed at both visits (p < 0.0001-0.0077) across muscle groups. Increased muscle strength by cumulative MRC was observed at V2 (p = 0.0566) and V3 (p = 0.0282) versus baseline. Safety was consistent with the known profile of aboBoNT-A. In conclusion, aboBoNT-A treatment is beneficial in patients with post-stroke ULS in routine clinical practice, assessed by patients and investigators.

Efficacy of botulinum toxin A for the treatment of hemiparesis in adults with chronic upper limb spasticity.

Introductionthis study aimed to evaluate the effectiveness of botulinum toxin A (BoNT-A) injection in hemiparetic patients with chronic spasticity in the upper limb resulting from stroke or traumatic brain injury.Methodswe conducted a retrospective study including 45 patients seen, in our department of Physical Medicine and Rehabilitation, between January 2014 and December 2016. All patients received an injection of BoNT-A (Dysport, 100 U/ml). Affected upper-extremity muscles could be injected as per the investigator’s discretion to a maximum total dose of 1000 U. We evaluated muscle tone using Modified Ashworth Scale (MAS). Functional disability was assessed using Modified Frenchay Scale (MFS), Nine Hole Peg Test (NHPT) and Barthel Index (BI). Quality of life (QoL) was assessed using the 36-Item Short Form Health Survey (SF-36). The achievement of treatment goal was assessed by the Goal Attainment Scaling (GAS).Resultspatients decreased their MAS score over the first and the third months (p<0.05). MFS showed improvement at 1 month after injection with a median change from baseline of 8 (range: 1-16; p<0.001). The change from baseline ranged from 0 to 5 points for NHPT at 1 month after injection (p< 0.001). This functional improvement was maintained to 3 months. Improvements in Barthel Index was observed at 3 months with a median change from baseline of 5 points (range 0-15; p<0.001). The mean change from baseline of SF-36 score was 4.77 ± 3.39 (p<0.001). The mean GAS T-score was 47.04 ±7.78 (median 50, IQR 7.7), giving a mean (SD) change from baseline of 25.36 ± 8.46 (95% CI 22.82 to 27.90; p <0.001). Binary logistic regression was used to identify the independent factors predicting a favorable functional outcome of Bon-T treatment. It showed that neglect was independent predictive factor treatment failure (p=0.009, OR=3.2) while previous injection of BoNT-A was an independent predictive factors of treatment success (p=0.009, OR=0.3).Conclusionour study showed a good response to BoNT-A injection delivered in the management of chronic upper limb spasticity resulting from stroke or traumatic brain injury. It demonstrated its outcome in improving muscle tone, function and QoL. It also showed that the majority of patients achieved their goal as defined at the start of the treatment, mainly for patients who received previous injection of BoNT-A.

Efficacy of a Combined Treatment of Botulinum Toxin and Intensive Physiotherapy in Hereditary Spastic Paraplegia.

IntroductionThe Hereditary Spastic Paraplegia (HSP) is a heterogeneous group of neurodegenerative disorders characterized by progressive spasticity and lower limbs (LL) weakness. There is no treatment to cure or halt the disease, except for symptomatic therapy. The use of botulinum toxin type A (BoNT-A) is one of the primary treatment for focal spasticity. Physiotherapy (PT) can help in maintaining residual functioning. We performed a retrospective study to evaluate the effect of the combined BoNT-A and intensive PT in patients with HSP.MethodsEighteen adult patients (50% females) with clinical diagnosis of HSP were recruited. Eleven patients had a genetic diagnosis of SPG4, 5, 7, 8, 11, 72. Patients were all autonomously deambulant or needed support. BoNT-A was injected in 36 LL in different spastic muscles under electromyographic guidance and followed by intensive PT sessions. Outcome measures included disease severity, motor functional measures, perceived pain self-report and quality of life. Assessments occurred at baseline, 1 and 3 months after BoNT-A injection.ResultsMost inoculated muscles were hamstrings, rectus femoris and gastrocnemius. We observed an improvement in muscle tone, in the gait velocity and distance length. Spastic Paraplegia Rating Scale was significantly reduced after treatment, in addition to improving pain and quality of life. These results were riconfirmed in 3 months time.ConclusionOur study indicates that combined treatment of BoNT-A and PT can lead to improvement of spasticity and quality of life in patients with HSP.

Fitness Programs Features According to the Body Types of High School Girls

The Actuality of the Research. Fitness is one of the most innovative approaches in the establishment of the physical training programme, which is good for shaping the body and body mass. Fitness contributes to the harmonization of physical development and improves the functional statement of body’s system. In the contemporary scientific researches it is expected that theoretical-methodological basis of fitness integration in the school system of physical education will contribute to increasing of physical preparedness level and motivation to practice sports among the teenagers, their physical development, health promotion, socialization and self-determination. The Methods of the Research. The analysis of academic papers, questionnaire, testing, medical examination of students, pedagogical experiment; determination of the level of physical development and physical preparedness; mathematical statistics method. The study was conducted on the basis of the Lutsk Middle School of General Education I–III levels № 18, Lutsk Middle School of General Education I– III levels № 25, Lutsk Jurisprudential Lyceum of Heavy Physical Training. 120 high school girls were involved in the study. The Results of the Research. Different physical types were taken into account by developing fitness programs (asthenic, hypersthenic, normosthenic). The results of the study show that 22 % of high school girls are asthenic body type, 19 % are hypersthenic, 59 % of high school girls are normosthenic body type. The strength exercises to increase the body mass and improve the muscle tone are recommended for girls of asthenic body type with slight stature, above average height, narrow shoulders, thin limbs and underweight. The high school girls of hypersthenic body type are with a massive body, average height, broad shoulders, short limbs and they are overweight. Physical exercises for them were focused on decrease in weight of a body, the reduction of body types (shoulders, thorax, stomach, pelvis, hips), the reduction of adipose tissue. The high school girls of normosthenic body type have relatively proportional body. That is why the physical activities are aimed at improvement of muscle tone, slowdown of body mass and reduction of the pelvis. Висновки . Результати дослідження будуть застосовані до створення програми з метою підвищення фізичної активності та поліпшення функціональної та фізичної підготовленості для дівчат середньої школи.

Geroprotective effects of ethylmethylhydroxypyridine succinate in an experimental study

To study an effect of mexidol on the life expectancy, weight, seizure response thresholds, and impaired cognitive and motor functions during aging in male Wistar rats. In a long-term experiment, male Wistar rats, aged 3-26 months, were assessed for impaired cognitive functions (passive avoidance conditioned reflex test), convulsive threshold (test with pentylenetetrazole), motor deficits (tests of rotating rod and pulling on the crossbar), and life expectancy. The rats received mexidol in the form of 0,15% solution, which replaced drinking water, during two 2 month courses at the age of 18-20 and 22-24 month. A dose of mexidol consumed by the rat was 40-75 mg/kg/day. In old male Wistar rats, the long-term treatment with mexidol increases the life expectancy, improves learning, preservation and reproduction of the memory trace in the passive avoidance conditioned reflex test, increases the convulsive threshold and improves muscle tone and coordination of movements that are impaired during aging. Mexidol increases the threshold of convulsive reaction, restores cognitive and neurological deficits that occur during aging in male Wistar rats and increases the by its ability to influence mitochondriogenesis and antioxidant properties.

Electrical Stimulation in Combating Pressure Ulcer for Immobilize Subjects: A Conceptual Framework

A paradigm shift in health system did intensify the need for research on wearable electronics. There are numerous reasons that could lead to skin ulcers. The most common are lesion due to constant pressure, incontinence control, excessive humidity and postural changes. Over the years, there have been numerous interventions ranging from specific skin treatment, introducing prevention programs as well as to mechanical intervention. On the rise in such clinical rehabilitation program is the use of electrical stimulation (ES) at a therapeutic level, wound care and muscle function restoration. This paper presents a concept development and implementation process of a new pressure ulcer intervention system which can be used for both chairbound and bedridden patients. The concept here is to integrate the use of electrical stimulation, interface pressure mapping and redistribution with antimicrobial protection not only to act as therapeutic but at the same time as a means of prevention of pressure ulcers by improving muscle tone and decreasing atrophy among immobilized subjects.

The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits

Background/AimsThe Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits.MethodsA pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test.ResultsAlmost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved.ConclusionsThe 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.

EFFECT OF HYDROTHERAPY ON SPASTICITY AND GROSS MOTOR FUNCTIONS AMONG SPASTIC CEREBRAL PALSY CHILDREN

OBJECTIVES To determine the effects of hydrotherapy therapy on spastic cerebral palsy children using Modified ashworths scale and Gross motor functional classification scale after 32 weeks of training protocol. STUDY DESIGN Quasi experimental study STUDY SETTING Liaquat National Hospital PARTICIPANTS Spastic (diplegic, hemiplegic and quadriplegic) cerebral palsy children INTERVENTIONS 58 Spastic Cerebral Palsywere assessed on the basis of modified Ashworth scale and gross motor function measure for spasticity and change in gross motor function respectively. Assessment was done, before and at the end of 10th week. Each therapy session was of 40-45 minutes thrice a week in a pool with the temperature maintained at 32°C-34°C and at the end cool down activities were performed. RESULTS Results indicated marked improvement in Muscle tone and Gross Motor Functioning of the enrolled children with p=0.001. CONCLUSIONS It was concluded that pool therapy is effective in reducing spasticity and improving gross motor functions among CP.

Chemical Constituents, Biological Properties, and Uses of Tribulus terrestris: A Review

Tribulus terrestris L. (TT) (puncturevine) is a common weed that grows in many countries worldwide and in some places is considered as a noxious weed. The plant has been used in traditional Chinese and Indian medicines and is now considered as one of the most popular aphrodisiacs. It is known for its healing properties for sexual difficulties, impotence, and human and animal hormonal imbalance. It is also used as a sexual booster. Because of the plant’s active substances that can be used for curing sexual and other disorders, interest in it is increasing, and it is currently one of the most studied medicinal plants. The products and preparations manufactured from the aboveground plant parts are especially popular among athletes and people with health issues and diseases such as hormonal imbalance, sexual problems, heart problems, and various kidney and skin diseases. The aim of this review is a comprehensive and critical assessment of the scientific publications involving TT, with special reference to its chemical constituents and biological properties that may facilitate current understanding and future studies of this fascinating plant species. The objectives of this review were (1) to find knowledge gaps, (2) to discuss critically relevant publications and issues with materials and methods that may be prerequisites for contradictory results, and (3) to identify research and development areas. It was found that some of the studies on TT extracts as aphrodisiacs are controversial. A significant number of research publications claim that TT extracts and nutritional supplements containing TT improve muscle tone, have a common biostimulating effect, and improve spermogenesis. However, there are a growing number of publications that dispute these claims, as there are no empirical data on commonly accepted mechanisms of action. The main biologically active substances in TT are steroidal saponins, flavonoids, alkaloids, and lignan amides, the most studied being the steroidal saponins. Multiyear data on the metabolic profile of the species are generally lacking. There are a variety of methods used for extracting plant material, differences in methodologies and saponin analyses, and scientific instruments that were used. Lack of common standards could be a reason for differences in the pharmacological activity and composition of the TT preparations. Development of standard procedures and methods for collection of plant material and analyses are recommended. Selection and breeding efforts and agronomic studies of promising clones of TT would need to be conducted in order to develop TT as a new crop. This will provide consistency of supply and quality of the feedstock for the pharmaceutical industry and could provide a new cash crop for growers.

Efficacy and Safety of Botulinum Toxin Type A for Limb Spasticity after Stroke: A Meta-Analysis of Randomized Controlled Trials.

Background Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke. Methods An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively. Results Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949). Conclusions BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.

Effects of Posterior-Anterior Mobilization of Lumbar Spine on Muscle Tone and Stiffness of Superficial Back Muscles and Lumbar Mobility

Background: Previous researchers have investigated the mechanical and neurophysiological effects of manual mobilization, however little research has been done on muscle tone and muscle stiffness. Objective: To compare the effects of posterior-anterior (PA) mobilization with weight bearing on sling and conventional PA mobilization on the bed. Design: Randomized controlled trial (single blind) Methods: The subjects were 16 male university students and randomized to sling mobilization group (SMG, n=8) or conventional mobilization group (CMG, n=8). SMG received PA mobilization using a sling and CMG received traditional mobilization on the bed during lumbar mobilization. Results: Both left and right muscle tones of SMG increased, but left muscle tone of SMG were increased and right muscle tone was decreased after intervention. In addition, both left and right muscle stiffness of SMG were also increased, however left muscle stiffness of SMG was increased and right muscle stiffness was decreased. The muscle tone and muscle stiffness of SMG were higher than those of DMG, especially the right side was statistically significantly higher. Extension of SMG, extension and flexion of CMG were increased statistically significantly except for Flexion of SMG (p<.05). There were no significant differences between the groups in Extension and Flexion. Conclusions: This study suggests that lumbar spine PA mobilization using sling is beneficial in improving muscle tone, muscle stiffness, and trunk movement.

Effect of segmental muscle vibration on upper extremity functional ability poststroke: A randomized controlled trial.

Background:Upper extremity functional impairments are common consequences of stroke. Therefore, continuous investigation of effective interventions for upper extremity functions after stroke is a necessity. Segmental muscle vibration (SMV) is one of the interventions that incorporate sensory stimulation to improve motor cortical excitability. The aim of this study was to investigate the influence of 5-minute SMV application along with supervised physical therapy (SPT) on improving activities of daily living and motor recovery on the hemiparetic upper extremity in patients with stroke.Methods:A sample of 37 patients poststroke (29 males) was randomly allocated to either SPT control group (n = 18) or SPT and SMV (SPT-SMV) experimental group (n = 19). All patients received 3 sessions per week of SPT for 8 weeks. The SPT-SMV experimental group received SMV at the end of each SPT session. Outcome measures used were Barthel index (BI), modified Ashworth scale, manual muscle testing, and goniometry for range of motion (ROM) assessment.Results:Thirty-four patients completed the study. Patients in both groups improved significantly after treatment in BI, elbow ROM, and elbow muscles strength. However, muscle tone in elbow joint of the hemiplegic upper extremity improved significantly after SMV only in the experimental group (SPT-SMV).Conclusion:The SPT intervention can improve functional outcomes of upper extremity in people after stroke. However, using SMV may have superior effect on improving muscle tone after stroke.