Lower Limb Spasms Research Articles

Acute suppression of lower limb spasm by sacral afferent stimulation for people with spinal cord injury: A pilot study.

Lower limb spasm and spasticity may develop following spinal cord injury (SCI), causing hyper-excitability and increased tone, which can impact function and quality of life. Pharmaceutical interventions for spasticity may cause unwanted side effects such as drowsiness and weakness. Invasive and non-invasive electrical stimulation has been shown to reduce spasticity without these side effects. The aim of this study was to investigate the effect of sacral afferent stimulation (SAS), through surface electrical stimulation of the dorsal genital nerve (N=7), and through implanted electrodes on the sacral afferent nerve roots, on lower limb spasm and spasticity (N=2). Provoked spasms were interrupted with conditional SAS, where stimulation commenced following a provoked spasm, or unconditional stimulation, which was applied continuously. Conditionally and unconditionally applied SAS was shown to suppress acute provoked spasms in people with SCI. There was a statistically significant reduction in area under the curve of quadriceps electromyography during acute spasm with SAS compared to a control spasm. These results show that SAS may provide a safe, low-cost method of reducing acute spasm and spasticity in people living with SCI. SAS through implanted electrodes may also provide an additional function to sacral nerve stimulation devices.

Relationship between Surface Electromyography Parameters and Balance Function in Patients with Lower Limb Spasm after Stroke

Relationship between Surface Electromyography Parameters and Balance Function in Patients with Lower Limb Spasm after Stroke

Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury

Background and aim: Anticholinergics such as tolterodine are notorious for their intolerability. Besides the commonly encountered side effects such as dry mouth and constipation, the medication has been shown to instigate cognitive impairment in the elderly population. In recent years, mirabegron, more commercially known as Betmiga, has garnered attention as an alternative to anticholinergics in treating Overactive Bladder (OAB) for its better tolerability and comparable efficacy. However, its usage in treating Neurogenic Detrusor Overactivity (NDO) is almost unheard of in rehabilitation. We present a case of young traumatic paraplegia who has been successfully treated with mirabegron. Methods: A 21-year-old man was transferred to the rehabilitation ward in August 2019. He had sustained a traumatic burst fracture of the T8 vertebra resulting in T8 complete paraplegia. He had multiple impairments, including neurogenic bladder, neurogenic bowel, and lower limb spasm. Single-channel cystometry was performed during the admission revealed a high-pressure bladder with poor compliance. He soon was started on tolterodine which subsequently worsened constipation, leading to autonomic dysreflexia. We switched to propiverine, the next available anticholinergic in our setting. Unfortunately, it perpetuated constipation and autonomic dysreflexia. The plan to remove the urinary catheter was abandoned. He was admitted for the second time in February 2020 for self-catheterisation training. Results: We started him on mirabegron 25 mg daily and trained him in self-catheterisation. The incontinence episodes reduced gradually, albeit not entirely. Therefore, we decided to optimise the dosage to 50 mg one month later, following which he no longer suffers leaking urine episodes. He tolerated the medication well without disturbance in the bowel routine and was free of autonomic dysreflexia ever since on mirabegron. Conclusion: Mirabegron is a promising treatment option in neurogenic bladder management. Marching forward, we should consider this novel avenue, especially in patients with sensitivity to anticholinergics.

Effects of Low Frequency RTMS Combined with Rehabilitation Nursing on Lower Limb Spasm and Functional Rehabilitation of Stroke Patients

Effects of Low Frequency RTMS Combined with Rehabilitation Nursing on Lower Limb Spasm and Functional Rehabilitation of Stroke Patients

Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of Lumbar Degenerative Disorders: A Retrospective Study.

Background The extracorporeal shock wave therapy (ESWT) has been fully utilized in orthopedics, but there are few studies in the treatment of lower limb spasm and pain caused by lumbar degenerative disorders (LDD). This study assesses the influence of ESWT in patients with LDD. Methods From October 2017 to June 2019, 126 patients with LDD were enrolled. All patients received shock wave therapy, once every two days for four weeks in total. Each treatment consisted of 2,000 shocks with a frequency of 8-10 shocks per second. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1- and 3-month follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) the frequency and duration of muscle cramps, and (3) Fugl-Meyer (LL). Results Mean BMI of the participants was 26.1 ± 3.0 kg/m2. There was no statistically significant difference in terms of age or BMI between the groups (p > 0.05). Although all scoring parameters improved in both groups, the improvement in the ESWT group was more pronounced in pain (p < 0.001 and p < 0.001, respectively). A review of the LMA scores of our patients demonstrated moderate functional limitations before treatment and increased functional status after treatment in all patients, while overall functional status was fully improved in patients of the ESWT group (p < 0.001). Conclusion The ESWT is particularly effective effect for patients with LDD. The use of ESWT has a significant long-term influence on the reduction of pain, leg cramps, and the improvement of the general functional state in relation to the conventional motor improvement program.

The effect of different localizing techniques in guiding botulinum toxin injection in the treatment of lower limb spasticity in cerebral palsy children

Objective To observe the effect of free muscle localization and ultrasound-guided injection of botulinum toxin type A (BTX-A) combined with rehabilitation training on lower limb spasm of cerebral palsy children. Methods Sixty-one cerebral palsy children with lower limb spasticity were randomly divided into a manual localizing group (31 cases) and an ultrasound-guided group (30 cases). The children of both groups underwent BTX-A injection at adductors, hamstrings and calf triceps. The former group was injected with bare hands, while the latter was injected under the guidance of ultrasound. Both groups were administered with rehabilitation training from the 3rd day onwards after injection. Before and 12 weeks after the injection, the modified Ashworth scale (MAS) and gross motor function scale (GMFM) were used to evaluate the lower limb spasticity and function in 2 groups. Results Before the injection, there was no significant difference between the 2 groups in terms of MAS and GMFM scores (P>0.05). However, 12 weeks after the injection, the average MAS scores of the two groups decreased, and that of the ultrasound-guided injection group (1.43±0.50) was significantly lower than that of the manual localizing group (1.77±0.56). After the injection, the average GMFM scores of both groups increased, and that of the ultrasound-guided injection group was significantly higher than the manual localizing group (67.10±11.25). Conclusion Ultrasound-guided injection of BTX-A with intensive rehabilitation training can significantly reduce the lower limb spasticity in children with cerebral palsy, and increase their motion of joint and motor function, and improve their posture and gait. Key words: Botulinum toxin type A; Ultrasound-guided; Manual localizing; Spasticity; Cerebral palsy

An unusual case of haematuria

A 40-YEAR-OLD MAN presented with a 3-month history of painless haematuria. He had been tetraplegic from the age of 21 following a road traffic accident, and had a neurogenic bladder with frequent episodes of urinary infection. He was otherwise well with no history of weight loss and no symptoms referable to the respiratory or cardiovascular systems. He was a life-long nonsmoker, lived with his wife and an adopted daughter. Despite his disability he was in full-time employment as a bank clerk. He had no prior exposure to chemicals or asbestos, and at presentation was taking only muscle relaxants for lower limb spasms. Examination on referral revealed that he was tetraplegic in keeping with his history of cervical trauma. He was otherwise well with no evidence of weight loss and no palpable lymphadenopathy. Examination of the chest and abdomen revealed no abnormality. At presentation he had an indwelling urinary catheter.