Improved Muscle Tone Research Articles

Pelvic Physical Therapy for Chronic Pain and Dysfunction Following Laparoscopic Excision of Endometriosis: Case Report

Background: Pelvic pain and abnormal pelvic floor muscle (PFM) tension frequently are present in individuals with endometriosis and often persist even after surgical excision of the endometriosis lesions. Physical therapists are educated in improving muscle tone and function for individuals who have sustained injury, have had surgery, or have required rehabilitation for various pelvic health conditions. More scientific evidence is needed to support the benefits of physical therapy (PT) interventions for individuals with a history of endometriosis. Case Description: The 50-year old female patient presented in this case report underwent laparoscopic excision of endometriosis, yet she continued to experience discomfort in her left lower abdomen and vaginal area after surgery. Within a four month period, the patient participated in ten sessions of pelvic physical therapy that included manual therapy, instruction in relaxation techniques, and a home program. Outcomes: At the time of her discharge from physical therapy, the patient reported a reduction in symptoms on the Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7) and was able to resume activities that she had not previously tolerated because of abdominal and pelvic pain. Discussion: Identifying effective interventions for patients that have received surgical management is important. Pelvic physical therapy may help individuals avoid surgery and eliminate or reduce the use of medications. Because of the positive outcomes of this case report, it is recommended that when endometriosis is suspected or diagnosed, a pelvic physical therapy evaluation should be considered. Further research is needed to assess physical therapy as part of the standard of care for women with suspected or diagnosed endometriosis.

Efekty hipoterapii. Przegląd aktualnych doniesień (2013–2017)

ABSTRAKTWstęp: Hipoterapia jest ważną metodą usprawniania osób z problemami natury zarówno psychicznej, jak i fizycznej. Oddziałuje ona w trzech podstawowych sferach funkcjonowania człowieka. W sferze fizycznej podnosi ogólną sprawność, normalizuje napięcie mięśniowe, toruje prawidłowy wzorzec chodu, poprawia koordynację zdolności motorycznych, w tym głównie równowagi i poczucia rytmu. Poprawia orientację w przestrzeni i schemacie własnego ciała oraz stymuluje normalizację czucia głębokiego i powierzchniowego. W sferze emocjonalno-motywacyjnej powoduje wzrost motywacji i akceptacji procesu terapeutycznego. Zwiększa poczucie własnej wartości i zmniejsza zaburzenia emocjonalne. W obrębie strefy poznawczej stymuluje odbiór wrażeń zmysłowych. Poprawia percepcję wzrokową i słuchową. Stymuluje uwagę, pamięć, myślenie, mowę oraz nabywanie i rozwijanie nowych umiejętności. Natomiast w strefie społecznej aktywizuje psychospołecznie i rozwija pozytywne relacje społeczne.Coraz częściej bada się efekty stosowania hipoterapii u dzieci i dorosłych z różnymi dolegliwościami. Badania te prowadzone są różnymi metodami i przynoszą odmienne wyniki. Celem niniejszej pracy był przegląd aktualnych doniesień z obrębu recenzowanych czasopism naukowych o zasięgu międzynarodowym dotyczących badań nad efektywnością terapii z udziałem konia.Wyniki i wnioski: Wyłoniono 13 publikacji z lat 2013–2017 spełniających kryteria wyszukiwania. Uzyskane wyniki wykazały, że najlepsze efekty osiągane są w zakresie usprawniania motorycznego, głównie w zakresie poprawy równowagi, postawy, chodu oraz komunikacji i percepcji społecznej.

Effectiveness of multiple botulinum toxin sessions and the duration of effects in spasticity therapy in children with cerebral palsy

PurposeThe aim of this study was to assess the effectiveness of long-term therapy with multiply botulinum neurotoxin (BoNT) injections.MethodsIn 2004–2010, 60 children with spastic cerebral palsy aged 2–16 were treated multiple botulinum toxin sessions (injections in gastrocnemius muscle and soleus muscles). In each patient, we rated muscle tone by Modified Ashworth Scale, passive range of motion in ankle joint with extended, and flexed knee joint and gait using the Physician Rating Scale. Assessment was done before and after injection, up to eight BoNT sessions.ResultsThe generalized additive models showed that a single treatment effect was visible for 3 months. The number of injections did not impact the effectiveness. Improvement in muscle tone was greater in children with hemiplegia than diplegia (β = − 0.294; p = 0.014). Improvement in range of motion with extended knee joint was greater in hemiplegic than diplegic types (β = 0.414; p =0.002), and improvement in range of motion with flexed knee was greater in children with more severe impairment (Gross Motor Function Classification System III vs. I, β = 0.0603, p = 0.025; V vs. I, β = 0.691, p = 0.023). The gait improvement rate decreased with patient age (p = 0.007).ConclusionsBoNT therapy is effective regardless of the number of injection sessions and duration of treatment. However, it is affected by the patient’s age, type of cerebral palsy, and degree of impairment.

Зміст фітнес-програми силової спрямованості залежно від індивідуальних особливостей будови тіла студентів

Актуальність дослідження. Незважаючи на значну кількість новацій у системі фізичного виховання вищої школи, на практиці чинні програми з фізичного виховання дещо застарілі та наповнені видами спорту, які користуються низькою популярністю в студентської молоді, орієнтовані на професійно- або військово-прикладну й фізичну підготовку, складання контрольних нормативів, які вимагають певного рівня фізичної підготовки, а не спрямовані на корекцію фізичного стану молоді та виявлення й усунення недоліків чинної системи фізичного виховання з урахуванням інтересу та мотивації студентської молоді. Цікавим є й той факт, що кількість годин для цієї підготовки не передбачено програмою, а більшість ВНЗ у нашій державі відходять від класичної системи фізичного виховання. Тому, на нашу думку, доцільне використання видів спорту з урахуванням, передусім, інтересу та мотивації молоді, які забезпечать високий рівень морального задоволення від занять.
 Ефективним засобом залучення студентів до систематичної рухової активності є виконання нових, нетрадиційних фізичних вправ. Великі потенційні можливості для фізичного вдосконалення студентів має фітнес. Мета дослідження – розробити зміст фітнес-програм силової спрямованості залежно від індивідуальних особливостей будови тіла студентів. Результати роботи. Установлено, що в основі занять фітнесом лежить фітнес-програма, для якої характерна сукупність спеціально підібраних фізичних вправ, спрямованих на комплексну або вибіркову дію на системи організму чи окремі частини тіла залежно від морфофункціональних можливостей людини. У програмі потрібно чітко визначити вид (або спрямованість) рухової активності чи поєднання вправ, інтенсивність занять, тривалість вправ, характер відпочинку, кількість занять на тиждень, темпи збільшення навантаження протягом тижня або місяця. Виконання силових вправ передбачало використання різних рухів не лише з обтяженнями, але й на спеціальних тренажерах і власною вагою. Висновки. Для студентів астенічної будови тіла рекомендовано вправи силової спрямованості для збільшення маси тіла, окружностей частин тіла, покращення показників тонусу м’язів. Студенти гіперстенічної будови тіла виконували вправи на зниження маси тіла, зменшення окружностей частин, зменшення жирового компонента. Фізичні навантаження представникам нормостенічного типу статури спрямовували на поліпшення тонусу м’язів, зниження темпів приросту маси тіла та зменшення окружності таза.

Efficacy of physical therapy associated with botulinum toxin type A on functional performance in post-stroke spasticity: A randomized, double-blinded, placebo-controlled trial.

The aim was to investigate if botulinum toxin type A (BTx-A) associated with physical therapy is superior to physical therapy alone in post stroke spasticity. A randomized, double-blinded controlled trial was performed in a rehabilitation unit on Northeastern, Brazil. Patients with post stroke spasticity were enrolled either to BTx-A injections and a pre-defined program of physical therapy or saline injections plus physical therapy. Primary endpoint was functional performance evaluated through time up and go test, six minutes walking test and Fugl-Meyer scale for upper limb. Secondary endpoint was spasticity improvement. Confidence interval was considered at 95%. Although there was a significant decrease in upper limbs flexor tonus (P<0.05) in the BTx-A group, there was no difference regarding functional performance after 9 months of treatment. When analyzing gait speed and performance, both groups showed a significant improvement in the third month of treatment, however it was not sustained over time. Although BTx-A shows superiority to improve muscle tone, physical therapy is the cornerstone to improve function in the upper limbs of post stroke patients.

Efficacy and safety of early use of abobotulinumtoxinA in adults with post-stroke spasticity: Results from the ONTIME and ABCDE-S studies

Initial muscle tone increase may be apparent within 6 weeks, and even days, post-stroke. Botulinum toxin-A (BoNT-A), an effective and well-tolerated treatment for upper limb spasticity (ULS), improves muscle tone and function, however most studies were conducted > 6 months post-stroke. The ONTIME and ABCDE-S studies assessed efficacy and safety of early use (2–12 weeks post-stroke) of abobotulinumtoxinA (aboBoNT-A) in ULS. ABCDE-S ( NCT00234546 ; 2008): 24-week, randomised (1:1 aboBoNT-A [ n = 80]: placebo [ n = 83]), study assessing muscle tone changes in patients treated within 2–12 weeks of first stroke, with a Modified Ashworth Scale (MAS) score ≥ 1+. ONTIME ( NCT02321436 ; 2016): 28-week, randomised study (2:1 aboBoNT-A [ n = 28]: placebo [ n = 14]), assessing time to appearance or reappearance of reinjection criteria in patients with MAS score ≥ 2 treated 2–12 weeks post-stroke. All observed or volunteered adverse events (AEs) were recorded. MAS score improvements at Week 4 were greater in aboBoNT-A-treated patients than placebo in both studies (ABCDE-S −1.5 vs. −0.5; ONTIME −1.25 vs. −0.25). At 12-weeks post-injection, fewer aboBoNT-A-treated patients versus placebo had MAS scores ≥ 2 in ONTIME (29.6 vs. 69.2%) and ABCDE (21.3 vs. 60.2%) ( Table 1 ). In ONTIME, 11 (39.3%) aboBoNT-A-treated patients did not require reinjection for ≥ 28 weeks versus 2 (14.3%) for placebo. AboBoNT-A was well-tolerated; most AEs were mild–moderate in intensity, with no clinically significant differences in AEs between groups ( Table 2 ). Six patients had treatment-related AEs: two in placebo groups (dysuria and complex regional pain syndrome), and four in aboBoNT-A groups (fatigue [ n = 2], pyrexia, muscular weakness). No serious AEs or deaths were considered treatment-related. Early treatment with aboBoNT-A (2–12 weeks) was well-tolerated and had a longer time to reinjection versus placebo.

Repeated abobotulinumtoxinA injections benefit walking speed, step length and cadence in adults with spastic hemiparesis due to stroke or traumatic brain injury

Patients with chronic hemiparesis following stroke or traumatic brain injury (TBI) often experience restricted walking performance. Our previous double-blind (DB) trial of 388 patients demonstrated that abobotulinumtoxinA (aboBoNT-A) treatment improves muscle tone and functional outcomes in adults with lower limb spastic paresis. This sub-analysis from the open-label (OL) study extension phase assesses changes in walking speed (WS), step length (SL) and cadence in these patients. Phase 3, prospective, multicentre, double-blind (DB), randomised study (single injection of aboBoNT-A 1000U or 1500U or placebo; NCT01249404 ), followed by an OL study extension (≤ 4 cycles of aboBoNT-A 1000U or 1500U; NCT01251367 ). Participants were ambulatory adults with spastic hemiparesis causing gait dysfunction, comfortable barefoot WS 0.1–0.8 m/s in 10-metre WS test without walking aids, and stroke or TBI ≥ 6 months before study enrolment. Patients receiving either aboBoNT-A dose were assessed relative to DB baseline for WS, SL and cadence using 10-metre WS tests under different conditions (maximal and comfortable WS, barefoot and with shoes). Week 12 data are shown for the last treatment cycle with available data (cycle 3). Relative to baseline, improvements in WS, SL and cadence by OL Cycle 3 Week 12 were observed in all four categories ( Table 1 ). Mean percentage of improvements in WS were +19.7–23.6% across categories. Mean percentage improvements of +9.4–13.8% and +7.2–9.7% were observed for SL and cadence, respectively. The highest mean percentage improvements were at comfortable barefoot WS for WS and SL, and at maximal barefoot WS for cadence. The least improvements from DB baseline were observed with shoes compared with barefoot, across all categories. Substantial improvements in WS, SL and cadence were achieved over time in hemiparetic adults with repeated administration of aboBoNT-A.

Effects of Negative Pressure Soft Tissue Therapy to Ankle Plantar Flexor on Muscle Tone, Muscle Stiffness, and Balance Ability in Patients with Stroke

The purpose of the study was to investigate the immediate effects of negative pressure soft tissue therapy on muscle tone, muscle stiffness and balance in patients with stroke. In total, 20 patients with stroke and assigned to the negative pressure soft tissue therapy group (NPST, n=10) or, placebo-negative pressure soft tissue therapy group(Placebo-NPST, n=10). Both groups underwent NPST or placebo-NPST once a day during the experimental period. MyotonPRO was used to assess the parameters for muscle tone and stiffness. Biorescue was used to assess the parameters for balance. Each group showed improvements in muscle tone, muscle stiffness, and balance ability (p<.05). Especially, Muscle tone, muscle stiffness, and anterior length in the limit of stability were the significant improvement on NPST group (p<.05). The results of the study suggest that the NPST is effective in improving muscle tone, muscle stiffness, and balance ability in patients with stroke.

Ozone therapy in multiple disabled children

Multiple disabilities is term for child with several disabilities sensory associated with motor disabilities. Growing number of children are presented with development issues caused by cerebral palsy , autism, learning disabilities, ADHD, Genetic disorder , global delayed development . Problem of this children are multifold and affects the daily life of whole family No such conventional treatment can cure these problems these problems. They are treating specific symptoms of Autism and global delay improve the child functioning and helping them in daily activity . It is ethically correct to take advantage of ozone therapy when the best orthodox treatment has failed . Anecdotal study was done in 47 children ranging from 8months to 12 yrs of age with multiple disabilities . Along with conventional treatment and various therapy like occupational therapy , physio therapy , sensory integration, speech therapy, ozone therapy i.e rectal insufflation (10mcg to 80mcg per kg) ear insufflation (10mcg / 120ml for 5 to 10 mins ) were given. In selected cases S/C injection, vacuum massage, matra basti with Ayurvedic medicated ghrut like “Bhrami Ghruth, Ashwagandha Ghruth, Mahakalyank Ghruth”. The rectal insufflation of ozone is a systemic routed which dissolves quickly in the luminal contents of the bowel, where mucoprotiens and other secretory products with antioxidants activity readily react with ozone to produce reactive oxygen species (ROS) and lipid peroxidation products. These compound penetrate the muscular mucosa and enter the circulation of venous and lymphatic capillaries. This non-invasive technique can be used without risk in pediatric and elderly patients. Ear insufflation through capillaries of ear: it is believed that it is absorbed, it secretes hormone endorphin which gives cool &amp; calm effect which improves the quality of sleep. Vacuum increases the blood flow and ozone can react better and S/C injection improves local blood circulation . Herbal drugs like centella acitica(Brahmi) shows significant improvement in neuron function in areas of the brain associated with learning and memory useful in ADHD. “Withenia Somnifera (Ashwagandh)” shows high affinity for GABA receptors that is helpful in memory loss, anxiety and ADHD “Ghrut” is a detoxifying agent makes the organ soft increases intelligence refine the intellect (dhi), improve the memory(Smruti), increases digestive AGNI ,cools the body and gives synergistic effect with ozone application (Yogwahi) OBSERVATION : 1. Improvement in Alertness, immunity, Digestion 2. Weight Gain 3. Improvement in muscle tone that enables child to perform daily physical activity It is very early to arrive at any conclusion, But results are encouraging and Very Safe

Goal directed physiotherapy treatment program for improving lower extremity function in a child with spastic paraplegic cerebral palsy. A case report

Spastic Paraplegic Cerebral Palsy (CP) involves both the lower limbs which effects balance and gait in children. These individuals are treated by physiotherapy with various means like Stretching, Strengthening, application of Neurodevelopmental Therapy (NDT), Task oriented approach and Proprioceptive Neuromuscular Facilitation (PNF) but there is no evidence on goal oriented physiotherapy program using various approaches for the treatment of spastic paraplegic CP children. Here we report a case of a 9-year-old boy diagnosed with spastic paraplegic CP, who underwent 5 months of Goal directed Physiotherapy Program. Documented improvements in muscle tone, balance and various parameters of gait reveal promising outcome. Hence we propose goal directed physiotherapy treatment might improve balance and gait in children with spastic paraplegic CP.

Effect of physiotherapeutic intervention on the gait after the application of botulinum toxin in children with cerebral palsy: systematic review.

Cerebral palsy is a group of movement and posture development disorders. 90% of this population has gait impairment, often due to the presence of spasticity. A number of studies emphasize the importance of combined physical therapy with botulinum toxin A treatment. However, no consensus can be reached concerning the content of the physiotherapy program after treatment with botulinum toxin A. The purpose of the present study was to investigate, through a systematic review of the literature, the effects of physiotherapeutic intervention on gait after botulinum toxin application in children with cerebral palsy. PubMed, Scielo, Cochrane Library, OTseeker, and PEDro databases were searched for randomized trial published between January 2000 and January 2017. Sixty-eight articles were identified, four of which met the eligibility criteria and were selected for the present systematic review. A table was created showing the main characteristics of the studies (groups, inclusion criteria, dosage, injection site, physiotherapeutic intervention, evaluation and outcomes). This study offers a view on the increase in the therapeutic effectiveness of botulinum toxin A on the lower limbs when used in conjunction with a physiotherapeutic intervention, with improvements in mobility, gait pattern, range of motion and spasticity, which are maintained after the end of the physical therapy protocol. The use of botulinum toxin A on the lower limbs when used in conjunction with a physiotherapeutic intervention, can improve muscle tone, allowing a combined treatment and intended to provide improvement of motor ability and functional skills, and potentially, delay the need for surgery.

The Effect of Electrical Stimulation in Improving Muscle Tone (Clinical)

Electrical stimulation (ES) and also known as neuromuscular electrical stimulation (NMES) and transcutaneous electrical stimulation (TES) involves the use of electrical current to stimulate the nerves or nerve endings that innervate muscle beneath the skin. Electrical stimulation may be applied superficially on the skin (transcutaneously) or directly into a muscle or muscles (intramuscularly) for the primary purpose of enhancing muscle function. The basic theoretical premise is that if the peripheral nerve can be stimulated, the resulting excitation impulse will be transmitted along the nerve to the motor endplates in the muscle, producing a muscle contraction. In this work, the effect of mere electrical stimulation to the muscle bulk and strength are tested. This paper explains how electrical stimulation can affect the muscle bulk, muscle size, muscle tone, muscle atrophy and muscle strength. The experiment and data collection are performed on 5 subjects and the results obtained are analyzed. This research aims to understand the full potential of electrical stimulation and identifying its possible benefits or disadvantages to the muscle properties. The results indicated that electrical stimulation alone able to improve muscle properties but with certain limits and precautions which might be useful in rehabilitation programme.

Evaluation of selective peripheral neurotomies in the treatment of refractory lower limb spasticity in adults

Background“Selective peripheral neurotomies” (SPNs) are indicated for the treatment of refractory focal and multifocal spasticity of lower limbs in adults. ObjectiveTo evaluate the surgical results of selective peripheral neurotomies in 20 adult patients who had refractory focal & multifocal spasticity of the lower limbs, follow up period of one year. Patients and MethodsProspective study included 20 adult patients who had refractory spasticity of the lower limbs. Preoperative evaluation for muscle tone using Modified Ashworth Score (MAS), muscle power using Medical Research Council Scale (MRCS), functional assessment using Oswestry Functional Scale (OFS) and Range Of Motion (ROM) using manual goniometry were done for all patients. All cases underwent surgery in the form of SPN of tibial, obturator, sciatic and/or femoral nerves. Follow up of the patients was done at 10th day, 3, 6months and one year postoperatively. ResultsThe mean age of patients was 31.35±12.42years. There were statistically significant improvement of muscle tone, muscle power, functional assessment and range of motion between preoperative and one year postoperative values. Improvement of the muscle tone was from a preoperative Mean±SD of 3.60±0.68 on MAS to a postoperative 2.30±0.86 at one year, improvement of muscle power on MRCS was from preoperative Mean±SD 3.75±1.08 to postoperative 4.08±0.69 at one year, There was a functional improvement from a preoperative Mean±SD of 3.0±0.73 on OFS to 3.60±0.60 at one year postoperatively. Also, there was a significant improvement between preoperative ROM Mean±SD 61.25±15.29 and one year postoperatively 72.25±12.19. ConclusionsSelective peripheral neurotomies could effectively improve muscle tone, muscle power, functional performance & range of motion in patients with refractory focal and multifocal spasticity in the lower limbs.

AbobotulinumtoxinA: A Review in Pediatric Lower Limb Spasticity.

AbobotulinumtoxinA (Dysport®) is currently the only botulinum toxin A formulation approved by the US FDA for the treatment of lower limb spasticity in pediatric patients aged ≥2 years. Intramuscular abobotulinumtoxinA was approved based on the results of a pivotal phase 3 trial in children with lower limb spasticity due to cerebral palsy. In this trial, a single treatment cycle with abobotulinumtoxinA 10-15 U/kg/leg injected into the gastrocnemius and soleus muscles significantly improved ankle plantar flexor muscle tone (primary endpoint), with abobotulinumtoxinA recipients showing a significant response to treatment relative to placebo. AbobotulinumtoxinA treatment also improved spasticity grade. The improvements in muscle tone and spasticity were associated with an improved ability to attain functional goals. Clinical benefits of abobotulinumtoxinA treatment lasted for 16-22 weeks in most patients, and were maintained with multiple treatment cycles during 1 year in an open-label extension study. AbobotulinumtoxinA was generally well tolerated, with a relatively low incidence of treatment-related adverse events. In summary, abobotulinumtoxinA is an effective and generally well tolerated treatment option for children with lower limb spasticity.

Physical exercise for those living with and beyond cancer: Changing perceptions in palliative caring.

The article considers the benefits of physical exercise for people undergoing cancer treatments such as chemotherapy and radiation, as well as its usefulness in palliative care. It reports that activity can help minimize fatigue, improve muscle tone, reduce anxiety, and improve mood.

RETRACTED: The comparative study of clinical efficacy and safety of baclofen vs tolperisone in spasticity caused by spinal cord injury

In the present study we compared the clinical efficacy and safety of baclofen vs tolperisone in spasticity caused by spinal cord injury. A total of 150 patients were enrolled in the present study and were divided into two groups with 75 patients in each group, receiving baclofen or tolperisone, respectively. We used Modified Ashworth Scale, Medical research council scale, Barthel Index, and Coefficient of efficacy to measure clinical efficacy. After 6-week treatment, both groups demonstrated significant improvement in muscle tone, muscle strength and functional outcome (Group I, 1.55 ± 0.053, 2.79 ± 0.032, 59.31 ± 1.32; Group II, 1.57 ± 0.053, 3.04 ± 0.032, 73 ± 1.32 respectively). There was no significant difference regarding improvement in muscle tone and muscle strength between the two groups (Group I, 1.055 ± 0.053 vs Group II, 1.57 ± 0.053; Group I, 2.79 ± 0.032 vs Group II, 3.04 ± 0.032, p > 0.05). However, the improvement in functional outcomes was greater in group II as compared to that in group I (Group I, 59.31 ± 1.32 vs Group II, 73 ± 1.32, p < 0.05). In addition, overall efficacy coefficient was greater for group II as compared to group I (Group I, 3.6 vs Group II, 2.3, p < 0.05). Group I had more side effects compared to Group II. Compared to baclofen, tolperisone offers greater improvement in activities of daily living compared to baclofen.

Safety and efficacy of incobotulinumtoxinA doses up to 800 U in limb spasticity: The TOWER study.

Objective:To evaluate safety (primary objective) and efficacy of increasing doses (400 U up to 800 U) of incobotulinumtoxinA (Xeomin, Merz Pharmaceuticals GmbH) for patients with limb spasticity.Methods:In this prospective, single-arm, dose-titration study (NCT01603459), patients (18–80 years) with spasticity due to cerebral causes, who were clinically deemed to require total doses of 800 U incobotulinumtoxinA, received 3 consecutive injection cycles (ICs) with 400 U, 600 U, and 600–800 U incobotulinumtoxinA, respectively, each followed by 12–16 weeks' observation. Outcomes included adverse events (AEs), antibody testing, Resistance to Passive Movement Scale (REPAS; based on the Ashworth Scale), and Goal Attainment Scale.Results:In total, 155 patients were enrolled. IncobotulinumtoxinA dose escalation did not lead to an increased incidence of treatment-related AEs (IC1: 4.5%; IC2: 5.3%; IC3: 2.9%). No treatment-related serious AEs occurred. The most frequent AEs overall were falls (7.7%), nasopharyngitis, arthralgia, and diarrhea (6.5% each). Five patients (3.2%) discontinued due to AEs. No patient developed secondary nonresponse due to neutralizing antibodies. Mean (SD) REPAS score improvements from each injection to 4 weeks postinjection increased throughout the study (IC1: −4.6 [3.9]; IC2: −5.9 [4.2]; IC3: −7.1 [4.8]; p < 0.0001 for all). The proportion of patients achieving ≥3 (of 4) treatment goals also increased (IC1: 25.2%; IC2: 50.7%; IC3: 68.6%).Conclusion:Escalating incobotulinumtoxinA doses (400 U up to 800 U) did not compromise safety or tolerability, enabled treatment in a greater number of muscles/spasticity patterns, and was associated with increased treatment efficacy, improved muscle tone, and goal attainment.ClinicalTrials.gov identifier:NCT01603459.Classification of evidence:This study provides Class IV evidence that, for patients with limb spasticity, escalating incobotulinumtoxinA doses (400 U up to 800 U) increases treatment efficacy without compromising safety or tolerability.

Muscle-Nerve-Muscle Grafting for Facial Reanimation in Rats.

Facial paralysis is a devastating condition leaving patients with a myriad of aesthetic and functional consequences. Muscle-nerve-muscle (MNM) neurotization is a reinnervation technique that involves implanting an autogenous nerve graft as a conduit between an innervated "donor" muscle and a denervated "recipient" muscle. We investigated the use of MNM reinnervation, alone or in combination with electrical stimulation (ES) and testosterone propionate (TP) in comparison to nerve reanastomosis (RE), on functional recovery following rat facial nerve injury. Thirty-one male, Sprague-Dawley rats were assigned to groups: no graft (control), MNM grafting alone (MNM), MNM grafting with ES and TP (MNM+ES+TP), or RE. Harvested right facial nerve branches were used as the MNM graft. Functional recovery was assessed by behavioral observations and electromyographic recordings. The MNM grafting improved muscle tone and vibrissae movement. The ES+TP treatment further enhanced muscle tone as well as reduced recovery time for coordinated movement in a manner that is comparable to those of RE. Electromyographic recordings demonstrated electrical conductance across all MNM grafts. These data have important implications for patients with unilateral paralysis from facial or laryngeal nerve injury, particularly those who are not candidates for nerve reanastomosis.

Therapeutic effects of massage and electrotherapy on muscle tone, stiffness and muscle contraction following gastrocnemius muscle fatigue

[Purpose] This study aimed to examine the effects of a combined intervention consisting of massage therapy and transcutaneous electrical nerve stimulation on gastrocnemius muscle fatigue, assessing whether the intervention improved muscle tone, stiffness, and muscle contraction. [Subjects and Methods] The subjects were 20 healthy males in their 20s who were equally divided into a transcutaneous electrical nerve stimulation group and a combined therapy group that received a combination of massage therapy and transcutaneous electrical nerve stimulation. Muscle fatigue was triggered on the gastrocnemius muscle, and the effects of intervention method on muscle tone, stiffness, and muscle contraction were examined over time. [Results] Lateral and medial gastrocnemius muscle tone and stiffness significantly increased and gastrocnemius muscle contraction significantly decreased in each group immediately after fatigue was triggered on the gastrocnemius muscle. There was no difference in the effects of the two intervention methods over time. [Conclusion] This study verified that a combined therapy of massage therapy and transcutaneous electrical nerve stimulation was able to be used effectively in improving muscle tone, stiffness, muscle contraction, thereby reducing gastrocnemius muscle fatigue.

Efficacy and safety of botulinum toxin type A for upper limb spasticity after stroke or traumatic brain injury: a systematic review with meta-analysis and trial sequential analysis.

Muscle spasticity is a positive symptom after stroke and traumatic brain injury. Botulinum toxin type A (BoNT-A) injection is widely used for treating post stroke and traumatic brain injury spasticity. This study aimed to evaluate efficacy and safety of BoNT-A for upper limb spasticity after stroke and traumatic brain injury and investigate reliability and conclusiveness of available evidence for BoNT-A intervention. We searched electronic databases from inception to September 10 of 2016. Randomized controlled trials comparing the effectiveness between BoNT-A and placebo in stroke or traumatic brain injury adults with upper limb spasticity were included. Reliability and conclusiveness of the available evidence were examined with trial sequential analysis. From 489 citations identified, 22 studies were included, reporting results for 1804 participants. A statistically significant decrease of muscle tone was observed at each time point after BoNT-A injection compared to placebo (SMD at week 4=-0.98, 95% CI: -1.28 to -0.68; I2=66%, P=0.004; SMD at week 6=-0.85, 95% CI: -1.11 to -0.59, I2=1.2%, P=0.409; SMD at week 8=-0.87, 95% CI: -1.15 to -0.6, I2=0%, P=0.713; SMD at week 12=-0.67, 95% CI: -0.88 to -0.46, I2=0%, P=0.896; and SMD over week 12=-0.73, 95% CI: -1.21 to -0.24, I2=63.5%, P=0.065).Trial sequential analysis showed that as of year 2004 sufficient evidence had been accrued to show significant benefit of BoNT-A four weeks after injection over placebo control. BoNT-A treatment also significantly reduced Disability Assessment Scale Score than placebo at 4, 6 and 12-week follow-up period (WMD=-0.33, 95% CI: -0.63 to -0.03, I2=60%, P=0.114; WMD=-0.54, 95% CI: -0.74 to -0.33, I2= 0%, P=0.596 and WMD=-0.3, 95% CI: -0.45 to -0.14, I2=0%, P=0.426 respectively), and significantly increased patients' global assessment score at week 4 and 6 after injection (SMD=0.56, 95% CI: 0.28 to 0.83; I2=0%, P=0.681 and SMD=1.11, 95% CI: 0.4 to 1.77; I2=72.8%, P=0.025 respectively). No statistical difference was observed in the frequency of adverse events between BoNT-A and placebo group (RR=1.36, 95% CI [0.82, 2.27]; I2=0%, P=0.619). As compared with placebo, BoNT-A injections have beneficial effects with improved muscle tone and well-tolerated treatment for patients with upper limb spasticity post stroke or traumatic brain injury.