Modified Ashworth Spasticity Scale Research Articles

Clinical Study of Opposing Needling Combined With Eye Acupuncture Therapy for Treatment of Muscle Spasm in Post-stroke Hemiplegia Patients Therapy for Treatment of Muscle Spasm in Post-Stroke Hemiplegia Patients

Objective: To observe the clinical efficacy of opposing needling combined with eye acupuncture therapy on muscle spasm in post-stroke hemiplegia patients.Methods: A total of 69 post-stroke hemiplegia patients with muscle spasm who were hospitalized in the Department of Encephalopathy Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were selected as the research participants. The randomized controlled clinical trial design method was used, and they were randomly divided into the basic treatment group and the combination treatment group. The basic treatment group did not use acupuncture treatment, but only basic rehabilitation treatment. The combination treatment group was treated with opposing needling combined with eye acupuncture therapy. Both groups were treated once a day, and two days were rested after five days of continuous treatment. Five days were a course of treatment, and a total of three courses were treated. The efficacy of opposing needling combined with eye acupuncture therapy for treatment of muscle spasm in post-stroke hemiplegia patients was evaluated. The clinical neurological deficit score scale (CSS), modified Ashworth spasticity scale (MAS), simplified Fugl-Meyer scale (FMA), Barthel index scale (BI) and total score were compared between the two groups before and after treatment. Results: There was no significant difference in CSS scores between the two groups before treatment (P>0.05). After 19 days of treatment, the CSS scores of the two groups were significantly decreased compared with those before treatment, and the difference was statistically significant (P<0.05). There was no significant difference in MAS scores between the two groups before treatment (P>0.05). After 19 days of treatment, the MAS scores of the two groups were significantly decreased compared with those before treatment, and the difference was statistically significant (P<0.05). There was no significant difference in FMA scores between the two groups before treatment (P>0.05). After 19 days of treatment, the FMA scores of the two groups were significantly improved compared with those before treatment, and the difference was statistically significant (P<0.05). There was no significant difference in BI scores between the two groups before treatment (P>0.05). After 19 days of treatment, the BI scores of the two groups were significantly improved compared with those before treatment, and the difference was statistically significant (P<0.05). Conclusion: Compared with the single treatment method, opposing needling combined with eye acupuncture in the treatment of muscle spasm in post-stroke hemiplegia patients has significant advantages in clinical neurological function, spastic improvement, motor function and daily living ability, and has obvious clinical significance in the long-term prognosis of patients.

Effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on brain function of pediatric patients with spastic cerebral palsy

ObjectiveTo observe the changes of Electroencephalogram (EEG) spectrum in children with spastic cerebral palsy before and after treatment, and to analyze the effects of scalp acupuncture combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) therapy on brain function. MethodsFrom January 2021 to December 2022, 90 children aged 2–6 with spastic cerebral palsy were treated at our hospital. The patients were divided into treatment and control groups. The treatment group (combined group, n = 30) received scalp acupuncture combined with low-frequency rTMS treatment. The control group received only scalp acupuncture treatment (n = 30) or rTMS treatment (n = 30). The Gross Motor Function Measure (GMFM), the modified Ashworth spasticity scale, and the Gesell scale were used to assess the motor and developmental functions of pediatric patients with spastic cerebral palsy in each group. ResultsThe patients in the three groups showed different degrees of improvement in EEG after treatment, mainly in wave amplitude reduction, background rhythm slowdown, background rhythm asymmetry improvement and spike and multi-spike/slow wave distribution reduction. The improvement in the scalp-acupuncture combined with low-frequency rTMS group was more significant than that in the other two groups. The GMFCS classification, modified Ashworth score, D and E areas of GMFM, and adaptability, gross motor, and language in Gesell Developmental Diagnostic Scale (GDDS) improved in all three groups after treatment (P < 0.05). In the combined group, the improvement in the modified Ashworth score, the E area of GMFM, and the adaptation, gross motor, and language in the GDDS was more significant than that in the other two groups (P < 0.05). ConclusionBy combining scalp acupuncture with low-frequency rTMS to treat children with spastic cerebral palsy, the brain function is improved by bringing the EEG spectrum towards the normal range, thus improving the mental and developmental functions of the child.

Optimized Home Rehabilitation Technology Reduces Upper Extremity Impairment Compared to a Conventional Home Exercise Program: A Randomized, Controlled, Single-Blind Trial in Subacute Stroke

Background Upper extremity (UE) stroke rehabilitation requires patients to perform exercises at home, yet patients show limited benefit from paper-based home exercise programs. Objective To compare the effectiveness of 2 home exercise programs for reducing UE impairment: a paper-based approach and a sensorized exercise system that incorporates recommended design features for home rehabilitation technology. Methods In this single-blind, randomized controlled trial, 27 participants in the subacute phase of stroke were assigned to the sensorized exercise (n = 14) or conventional therapy group (n = 13), though 2 participants in the conventional therapy group were lost to follow-up. Participants were instructed to perform self-guided movement training at home for at least 3 hours/week for 3 consecutive weeks. The sensorized exercise group used FitMi, a computer game with 2 puck-like sensors that encourages movement intensity and auto-progresses users through 40 exercises. The conventional group used a paper book of exercises. The primary outcome measure was the change in Upper Extremity Fugl–Meyer (UEFM) score from baseline to follow-up. Secondary measures included the Modified Ashworth Scale for spasticity (MAS) and the Visual Analog Pain (VAP) scale. Results Participants who used FitMi improved by an average of 8.0 ± 4.6 points on the UEFM scale compared to 3.0 ± 6.1 points for the conventional participants, a significant difference (t-test, P = .029). FitMi participants exhibited no significant changes in UE MAS or VAP scores. Conclusions A sensor-based exercise system incorporating a suite of recommended design features significantly and safely reduced UE impairment compared to a paper-based, home exercise program. Trial Registration: ClinicalTrials.gov Identifier: NCT03503617

Clinical Study of Opposing Needling Combined With Eye Acupuncture Therapy for Treatment of Muscle Spasm in Post-stroke Hemiplegia Patients

Objective: To observe the clinical efficacy of opposing needling combined with eye acupuncture therapy on muscle spasm in post-stroke hemiplegia patients. Methods: A total of 69 post-stroke hemiplegia patients with muscle spasm who were hospitalized in the Department of Encephalopathy Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were selected as the research participants. The randomized controlled clinical trial design method was used, and they were randomly divided into the basic treatment group and the combination treatment group. The basic treatment group did not use acupuncture treatment, but only basic rehabilitation treatment. The combination treatment group was treated with opposing needling combined with eye acupuncture therapy. Both groups were treated once a day, and two days were rested after five days of continuous treatment. Five days were a course of treatment, and a total of three courses were treated. The efficacy of opposing needling combined with eye acupuncture therapy for treatment of muscle spasm in post-stroke hemiplegia patients was evaluated. The clinical neurological deficit score scale (CSS), modified Ashworth spasticity scale (MAS), simplified Fugl-Meyer scale (FMA), Barthel index scale (BI) and total score were compared between the two groups before and after treatment. Results: There was no significant difference in CSS scores between the two groups before treatment (P&gt;0.05). After 19 days of treatment, the CSS scores of the two groups were significantly decreased compared with those before treatment, and the difference was statistically significant (P&lt;0.05). There was no significant difference in MAS scores between the two groups before treatment (P&gt;0.05). After 19 days of treatment, the MAS scores of the two groups were significantly decreased compared with those before treatment, and the difference was statistically significant (P&lt;0.05). There was no significant difference in FMA scores between the two groups before treatment (P&gt;0.05). After 19 days of treatment, the FMA scores of the two groups were significantly improved compared with those before treatment, and the difference was statistically significant (P&lt;0.05). There was no significant difference in BI scores between the two groups before treatment (P&gt;0.05). After 19 days of treatment, the BI scores of the two groups were significantly improved compared with those before treatment, and the difference was statistically significant (P&lt;0.05). Conclusion: Compared with the single treatment method, opposing needling combined with eye acupuncture in the treatment of muscle spasm in post-stroke hemiplegia patients has significant advantages in clinical neurological function, spastic improvement, motor function and daily living ability, and has obvious clinical significance in the long-term prognosis of patients.

Application of complex medical rehabilitation in patients in the late recovery period after acute cerebrovascular accident

Many observations have shown a close relationship between post-stroke spasticity and pain syndrome due to stroke; with regard to that, in 72% of patients, spasticity was accompanied by pain and only 1,5% of patients experienced pain in the absence of spasticity.Purpose of the study: to substantiate the inclusion of combined physiotherapy methods, i. e. low-frequency electrostatic massage and broadband modulation currents, and multimodal physiotherapy methods from the Alpha LED Oxy Light — Spa™ device, in the standard complex of medical rehabilitation to relieve pain and reduce spasticity in the late recovery period in patients who have undergone acute cerebrovascular accident. Material and methods: the paper presents the data on the inclusion of various physiotherapy methods in the rehabilitation program in the late recovery period in 120 patients with spasticity of the upper limb who underwent acute cerebrovascular accident. The dynamics of pain syndrome intensity were assessed according to the Numerical Pain Rating Scale and the Verbal Descriptor Scale, and the severity of spasticity in the upper limb was evaluated according to the Modified Ashworth Spasticity Scale. All patients were divided into 3 groups comparable in terms of clinical and functional characteristics: group 1 (40 patients), who, in addition to the standard treatment complex (exercise therapy, medical massage, mechanotherapy), were prescribed massage with a pulsed low-frequency electrostatic field from the HIVAMAT device and broadband modulation currents; group 2 (40 patients), whose therapy included physiotherapy methods from the Alpha LED Oxy Light — Spa™ device, against the background of standard therapy and medical rehabilitation; group 3 — 40 patients who received standard drug therapy and medical rehabilitation. Results. Inclusion of pulsed low-frequency electrostatic massage and broadband modulation currents in medical rehabilitation of patients with spasticity of the upper limb who have undergone acute cerebrovascular accident in the late recovery period contributes to the formation of analgesic and antispasmodic effects to a greater extent, compared to the Alpha LED Oxy Light — Spa™ multimodal effects, which is manifested in a significant reduction in pain and a decrease in spasticity.

Effects of paired stimulation with specific waveforms on cortical and spinal plasticity in subjects with a chronic spinal cord injury

Paired stimulation can cause neuroplasticity in corticospinal and spinal pathways in subjects with a chronic spinal cord injury (SCI). We aimed to know the effects of different waveforms using paired stimulations with bicycling in subjects with a chronic SCI. Recruited subjects with an SCI underwent three treatment interventions in random order for 4-20 min followed by 30 min of bicycling (control, repetitive transcranial magnetic stimulation (TMS; rTMS) at 20 Hz with transspinal direct current stimulation (tsDCS), and intermittent theta burst stimulation (iTBS) with tsDCS with a 1-week gap period. A TMS method was employed to record the resting motor threshold (RMT), the 90% values of which was used as the stimulation intensity, and the Hoffman (H)-reflex was measured by stimulating the tibial nerve in the popliteal fossa. The RMT, motor evoked potential (MEP) latency, MEP peak-to-peak amplitude, and H-reflex latency as primary variables and lower extremity motor scale (LEMS) and modified Ashworth spasticity scale (MAS) as secondary variables were analyzed before and after the interventions. The MEP latency, MEP amplitude, and LEMS significantly improved with the rTMS-iTBS/tsDCS or the rTMS-20 Hz/tsDCS (p < 0.050) protocols compared to the control intervention. All other outcome measures, including RMT, H-reflex latency, and MAS score showed some changes but did not fully attain a level of significance. The paired stimulation with rTMS-iTBS/tsDCS was equally effective to produce neuroplastic effect in subjects with chronic SCI compared to the conventional TMS-20 Hz/tsDCS intervention.

Evolving diagnostic criteria in primary lateral sclerosis: The clinical and radiological basis of “probable PLS”

IntroductionPrimary lateral sclerosis is a rare neurodegenerative disorder of the upper motor neurons. Diagnostic criteria have changed considerably over the years, and the recent consensus criteria introduced ‘probable PLS’ for patients with a symptom duration of 2–4 years. The objective of this study is the systematic evaluation of clinical and neuroimaging characteristics in early PLS by studying a group of ‘probable PLS patients’ in comparison to a cohort of established PLS patients. MethodsIn a prospective neuroimaging study, thirty-nine patients were stratified by the new consensus criteria into ‘probable’ (symptom duration 2–4 years) or ‘definite’ PLS (symptom duration >4 years). Patients were evaluated with a standardised battery of clinical instruments (ALSFRS-r, Penn upper motor neuron score, the modified Ashworth spasticity scale), whole genome sequencing, and underwent structural and diffusion MRI. The imaging profile of the two PLS cohorts were contrasted to a dataset of 100 healthy controls. All ‘probable PLS’ patients subsequently fulfilled criteria for ‘definite’ PLS on longitudinal follow-up and none transitioned to develop ALS. ResultsPLS patients tested negative for known ALS- or HSP-associated mutations on whole genome sequencing. Despite their shorter symptom duration, ‘probable PLS’ patients already exhibited considerable functional disability, upper motor neuron disease burden and the majority of them required walking aids for safe ambulation. Their ALSFRS-r, UMN and modified Ashworth score means were 83%, 98% and 85% of the ‘definite’ group respectively. Motor cortex thickness was significantly reduced in both PLS groups in comparison to controls, but cortical changes were less widespread in ‘probable’ PLS on morphometric analyses. Corticospinal tract and corpus callosum metrics were relatively well preserved in the ‘probable’ group in contrast to the widespread white matter degeneration observed in the ‘definite’ group. ConclusionsOur clinical and radiological analyses support the recent introduction of the ‘probable’ PLS category, as this cohort already exhibits considerable disability and cerebral changes consistent with established PLS. Before the publication of the new consensus criteria, these patients would have not been diagnosed with PLS on the basis of their symptom duration despite their significant functional impairment and motor cortex atrophy. The introduction of this new category will facilitate earlier recruitment into clinical trials, and shorten the protracted diagnostic uncertainty the majority of PLS patients face.

Yin-yang balance penetrating acupuncture combined with rehabilitation training on upper limb spasticity in stroke hemiplegia

To compare the therapeutic effect of yin-yang balance penetrating acupuncture combined with rehabilitation training and single rehabilitation training on upper limb spasticity in patients with stroke hemiplegia. A total of 60 patients with upper limb spasticity of stroke hemiplegia were randomized into an observation group and a control group, 30 cases in each one. On the basis of conventional western medication, rehabilitation training was adopted in the control group. On the basis of treatment in the control group, yin-yang balance penetrating acupuncture was applied from Jianyu (LI 15) to Binao (LI 14), Quchi (LI 11) to Shaohai (HT 3), Yanglingquan (GB 34) to Yinlingquan (SP 9), Xuanzhong (GB 39) to Sanyinjiao (SP 6), etc. of the affected side in the observation group. The treatment was given once a day, 5 days were as one course, with a 2-day interval between two courses, 4 courses were required in both groups. The classification of modified Ashworth spasticity scale (MAS), surface integrated electromyogram (iEMG) of affected upper limb and the scores of National Institute of Health stroke scale (NIHSS), Fugl-Meyer assessment (FMA) of upper limb and modified Barthel index (MBI) before and after treatment were observed, the therapeutic effect was evaluated in both groups. ①After treatment, the MAS classification reduced in both groups (P<0.05), the cases of grade 0 to Ⅰ+ in the observation group were more than those in the control group (P<0.05); iEMG values of the maximum isometric voluntary contraction of affected usculus biceps brachii, musculus triceps brachii, musculus flexor carpi, musculus extensor carpi, extensor digitorum, aductor pollicis brevis were increased in both groups (P<0.05), and the variations of iEMG of above muscles on the affected side in the observation group were larger than those in the control group (P<0.05). ②After treatment, the scores of NIHSS were decreased (P<0.05), the scores of FMA, MBI were increased in both groups (P<0.05), and the variations of NIHSS, FMA and MBI scores were larger than those in the control group (P<0.05). ③The total effective rate was 93.3% (28/30) in the observation group, which was superior to 70.0% (21/30) in the control group (P<0.05). Yin-yang balance penetrating acupuncture combined with rehabilitation training can improve upper limb spasticity, heighten the motor function of upper limb and daily self care in patients with stroke hemiplegia, its therapeutic effect is superior to single rehabilitation training.

Effect of An-pressing manipulation on post-stroke muscle spasticity in rats and its mechanism study

To explore the mechanism of An-pressing manipulation in improving post-stroke muscle spasticity, by observing the changes of γ-aminobutyric acid (GABA) and glycine (Gly) in plasma and gray matter of L1-L3 spinal cord anterior horn in post-stroke rats with muscle spasticity after An-pressing manipulation intervention. Ten of 80 adult male Sprague-Dawley (SD) rats were randomly selected as the blank group, and the remaining 70 were used for modeling. The middle cerebral artery occlusion (MCAO) rat model was established by insertion suture occlusion method in the left external carotid artery. Thirty rats with a Longa neurological score of 2-3 points and a modified Ashworth spasticity scale score of 1−, 1+, or 2 were included in the experiment. Using the random number table method, the 30 successfully modeled rats were randomly divided into a model group, an An-pressing tendon group and an An-pressing muscle belly group. Two days after modeling, rats in the An-pressing tendon group and An-pressing muscle belly group received An-pressing manipulation on the tendon and belly of quadriceps femoris muscle respectively, with the pressure of (350±50) g and the frequency of 5 s/time, 15 min per session, once a day for 5 continuous days. After the 5th treatment, the tension of the rat quadriceps femoris muscle was evaluated using the modified Ashworth spasticity scale. The Gly levels in rat plasma and L1-L3 segments of spinal cord were determined by enzyme-linked immunosorbent assay (ELISA). The GABA levels in rat plasma and L1-L3 segments of spinal cord were measured by high performance liquid chromatography (HPLC). The decrease in rat muscle tension scored by the modified Ashworth spasticity scale in the An-pressing tendon group was more significant than that in the An-pressing muscle belly group (P<0.01); the increases in Gly and GABA levels in the rat plasma and L1-L3 segments of spinal cord were more significant in the An-pressing tendon group than those in the An-pressing muscle belly group (all P<0.01). Based on the theory of ‘anti-stretch reflex’ of tendon organs, the use of An-pressing manipulation to induce the ‘anti-stretch reflex’ by stimulating the tendon organs can improve the muscle spasticity of rats, which is better than An-pressing the muscle belly. Increased levels of Gly and GABA in rat plasma and L1-L3 segments of spinal cord may be one mechanism of An-pressing manipulation to improve muscle spasticity by stimulating tendon organs.

Influences of the biofeedback content on robotic post-stroke gait rehabilitation: electromyographic vs joint torque biofeedback

BackgroundAdd-on robot-mediated therapy has proven to be more effective than conventional therapy alone in post-stroke gait rehabilitation. Such robot-mediated interventions routinely use also visual biofeedback tools. A better understanding of biofeedback content effects when used for robotic locomotor training may improve the rehabilitation process and outcomes.MethodsThis randomized cross-over pilot trial aimed to address the possible impact of different biofeedback contents on patients’ performance and experience during Lokomat training, by comparing a novel biofeedback based on online biological electromyographic information (EMGb) versus the commercial joint torque biofeedback (Rb) in sub-acute non ambulatory patients.12 patients were randomized into two treatment groups, A and B, based on two different biofeedback training. For both groups, study protocol consisted of 12 Lokomat sessions, 6 for each biofeedback condition, 40 min each, 3 sessions per week of frequency. All patients performed Lokomat trainings as an add-on therapy to the conventional one that was the same for both groups and consisted of 40 min per day, 5 days per week. The primary outcome was the Modified Ashworth Spasticity Scale, and secondary outcomes included clinical, neurological, mechanical, and personal experience variables collected before and after each biofeedback training.ResultsLokomat training significantly improved gait/daily living activity independence and trunk control, nevertheless, different effects due to biofeedback content were remarked. EMGb was more effective to reduce spasticity and improve muscle force at the ankle, knee and hip joints. Robot data suggest that Rb induces more adaptation to robotic movements than EMGb. Furthermore, Rb was perceived less demanding than EMGb, even though patient motivation was higher for EMGb. Robot was perceived to be effective, easy to use, reliable and safe: acceptability was rated as very high by all patients.ConclusionsSpecific effects can be related to biofeedback content: when muscular-based information is used, a more direct effect on lower limb spasticity and muscle activity is evidenced. In a similar manner, when biofeedback treatment is based on joint torque data, a higher patient compliance effect in terms of force exerted is achieved. Subjects who underwent EMGb seemed to be more motivated than those treated with Rb.

Comparison of Rehabilitation Outcomes with Acoustic Radiation Force (ARFI) Elastosonography in Hemiplegic Patients Treated with Neuromuscular Electrical Stimulation

To evaluate the gastrocnemius/soleus and biceps brachii muscle stiffness by Acoustic Radiation Force Impulse (ARFI) elastography in the hemiplegia patients, sixty patients with hemiplegia after stroke were recruited. Baseline data were collected including age, gender, body mass index, education level, dominant side, affected side, time since stroke, stroke etiology. All patients were evaluated with before treatment and posttreatment with Broonstroom staging, Modified Ashworth spasticity scale, and Functional Independence Measures scale. The patient was divided into 3 groups: 1) Neuromuscular electrical stimulation group, 2) Rehabilitation group, 3) Neurumusculer electrical stimulation + Rehabilitation group. Affected and unaffected side biceps and gastrocnemius, ARFI elastography measurements were used to measure thickness and elastic values. In addition, before and after treatment, length and thickness were measured from all patients. Of the 60 subjects, 28 were female (46.7%) and 32 (53.3%) were males, with an average age of 58.42 ± 9.03 years. There was a significant difference between the upper and lower limbs after the treatment in terms of Brunstroom staging. In terms of Modified Ashworth scale, there was a significant difference in lower extremity only after treatment. When compared to the affected/unaffected side, before and after treatment, there was a significant difference in the measurements in both the medial gastrocnemius and the lateral gastrocnemius in all three groups. Further research with larger numbers of patients for longer periods is needed to clarify the relationship between the muscle hardness and degree of spasticity.

Abstract 100: A Simple Bedside Grading Scale Can Effectively Predict Severe Post-stroke Upper-extremity Spasticity

Introduction: Upper-limb spasticity is a very disabling complication after stroke. There has been no simple clinical standard scale to predict spasticity immediately after stroke. This study aims to develop a simple bedside grading scale with the information collected during the acute phase to predict spasticity at 3 month post-stroke Methods: This is a prospective cohort study (Prediction and Imaging Biomarker of Post-stroke Motor Recovery) of patients with first-ever acute ischemic stroke with various degrees of motor impairment. NIH stroke scale (NIHSS) was assessed 2-7 days after onset of stroke symptoms. Modified Ashworth Spasticity Scale was used as an assessment tool in biceps, wrist flexors and finger flexors at 90 days (± 15 days) and score ≥2 at any muscle was considered as severe spasticity. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at 90 days were identified by multivariate logistic regression. A risk stratification scale was developed with weighting independent predictors based on beta coefficient. Results: One hundred twenty three patients were recruited for this study. Covariates associated with upper-limb spasticity are NIHSS arm score (p&lt;0.0001), sub-cortical location (p=0.004) and lesion volume &gt;65 cc (p=0.025). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (2 point), &lt;4 (0 point); infarct location: sub-cortical (1 point), non sub-cortical (0 point); infarct volume: ≥65 cc (1 point), &lt;65cc (0 point). The rates of severe upper limb spasticity for the bedside spasticity scale, in order 0-4, are 8.9%, 29.2%, 65%, 88.7%, 96.2%. In other words, the likelihood of developing severe spasticity increases steadily using the score. Conclusion: A simple bedside grading scale can effectively predict severe post-stroke upper-limb spasticity at 90 days. Validation with an independent external dataset is a planned next step.

Development of data mining method for medical prediction in neurology

Development of data mining method for medical prediction in neurology

Balneotherapy in treatment of spastic upper limb after stroke.

Introduction:After stroke, spasticity is often the main problem that prevents functional recovery. Pain occurs in up to 70% of patients during the first year post-stroke.Materials and methods:A total of 70 patients (30 female and 45 male) mean age (65.67) participated in prospective, controlled study. Inclusion criteria: ischaemic stroke, developed spasticity of upper limb, post-stroke interval <6 months. Exclusion criteria: contraindications for balneotherapy and inability to follow commands. Experimental group (Ex) (n=35) was treated with sulphurous baths (31°-33°C) and controlled group (Co) with taped water baths, during 21 days. All patients were additionally treated with kinesitherapy and cryotherapy. The outcome was evaluated using Modified Ashworth scale for spasticity and VAS scale for pain. The significance value was sat at p<0.05.Goal:To find out the effects of balneotherapy with sulphurous bath on spasticity and pain in affected upper limb.Results:Reduction in tone of affected upper limb muscles was significant in Ex group (p<0.05). Pain decreased significantly in Ex-group (p<0.01).Conclusion:Our results show that balneotherapy with sulphurous water reduces spasticity and pain significantly and can help in treatment of post-stroke patients.

A Comparative Study of Conventional Physiotherapy Versus Robotic Training Combined with Physiotherapy in Patients with Stroke

Background: There has been a growing interest in the use of robotic therapy to improve walking ability in individuals following stroke. Objectives: The aim of this retrospective study was to compare conventional physiotherapy (CP) with robotic training (RT) combined with CP and to measure the effects on gait, balance, functional status, cognitive function, and quality of life in patient with stroke. Methods: We retrospectively identified 107 cases of new cerebral stroke. They were allocated into 2 groups. In the RT group (n = 36), patients received RT (Lokomat; 2 times per week) combined with CP (3 times per week) for at least 30 sessions. In the CP group (n = 71), patients received a program at least 30 sessions, 5 times per week. The evaluation parameters included modified Ashworth Spasticity Scale (MASS), Brunnstrom Recovery Scale (BRS), Functional Independence Measure (FIM), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Short Form-36 (SF-36) Health Survey. Results: Posttreatment results showed significant improvements for all parameters (except lower extremity MASS scores) in both groups. However, when we compared the percentage changes of parameters at discharge relative to pretreatment values, improvements in FIM, MMSE, and all subparts of SF-36 were better in the RT group (P < .05). Comparison of posttreatment evaluation parameters for categorical variables showed that the lower extremity categories in the BRS were significantly better in the RT group than the CP group (P < .05). Conclusion: RT combined with CP produced better improvement in FIM, MMSE, BRS lower extremity categories, and all subparts of SF-36 of the patients with subacute and chronic stroke (up to 1 year) than the CP program.

Abstract T MP38: A Simple Bedside Grading Scale Can Predict Severe Post-Stroke Upper-Limb Spasticity

Background: Upper-limb spasticity is a disabling complication after stroke; however, there is no clinical standard grading scale to predict spasticity. This study aims to identify a bedside grading scale with the information collected during the acute stroke phase to predict upper-limb spasticity in the chronic phase. Methods: This is a prospective cohort study of 44 patients with first-ever acute ischemic strokes with various degrees of motor impairment. Modified Ashworth Spasticity Scale (MASS) was used as a clinical assessment tool for spasticity assessment with biceps, wrist and finger flexors at 90 days (± 14 days). The highest value was used and severe spasticity is defined as MASS&gt;=3. NIH Stroke Scale (NIHSS) is assessed between 2 to 5 days after stroke and 90 days (± 14 days) after stroke. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at days were identified by logistic regression. A risk stratification scale was developed with weighting of independent predictors based on strength of association. Results: Factors independently associated with upper-limb spasticity are NIHSS Arm score at baseline (p&lt;0.001), location of lesion (p=0.003) and stroke lesion volume (p=0.004). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (1 point), &lt;4(0 point); lnfarct location: subcortical lesion only or cortical lesion only (0 point), both subcortical and cortical lesions (1 point); infarct volume: &gt;=20 cc (1 point), &lt;20cc (0 point). None of 12 patients with score of 0 (0%) and 9 out of 10 patients with score of 3 (90%) developed severe spasticity. The likelihood of developing severe upper-limb spasticity increases steadily with grading scale score. Conclusion: A simple bedside grading scale can predict severe post-stroke limb spasticity at 90 days. It needs validation with an external dataset.

Intrathecal Baclofen Associated With Improvement of Consciousness Disorders in Spasticity Patients

Intrathecal baclofen (ITB) pump is a therapeutic option for persistent vegetative state and minimal conscious state patients that have associated spasticity. We investigated whether this treatment modality can affect their level of consciousness. In this prospective, open label, observational study, we implanted ITB pumps for the treatment of spasticity in eight patients with disorders of consciousness (vegetative state and minimally conscious state) and we followed them with the Coma Recovery Scale-Revised, the Eastern Cooperative Oncology Group (ECOG) performance scale, and the Modified Ashworth spasticity scale. Baclofen dose and complications also were noted. The offending pathologies were traumatic brain injury in six, anoxia due to cardiac arrest in one, acute obstructive hydrocephalus in one. Two of the patients showed a marked, persistent improvement that fulfilled the criteria of emergence from minimally conscious state. Two of patients had their ITB pumps prematurely removed because of complications. The ECOG score was 4 for all patients and did not change during the study. ITB might be associated with a significant improvement in the disorder of consciousness of two patients from a total of six that had a chronic ITB treatment.

Treatment of Upper Limb Spasticity after Stroke: One-Year Safety and Efficacy of Botulinum Toxin Type A NT201

A new preparation of botulinum toxin type A called NT 201, free from complexing proteins, potentially with low antigenicity has been used in the therapy of spasticity in stroke patients. This was an open-label study reported the safety and the efficacy of one-year treatment with NT 201 evaluating the therapeutic effect on functional disability and on quality of life in upper limb spasticity after stroke. Patients received a botulinum toxin therapy in the upper injected intramuscularly. After inoculation, patients were submitted to a motor rehabilitation program for upper limb injected three times/week. Re-treatment was permitted at 12 weeks after the prior treatment. Safety assessment included evaluation of adverse events and efficacy was measured by Modified Ashworth Scale for spasticity (MAS), Spasm Frequency Score (SFS) for the daily spasms, and Disability Assessment Scale (DAS) for disability. Of 35 consecutive patients (13 women and 12 men) screened for study eligibility, 20 (6 women and 14 men) patients (mean age 63,4±7,03) were included in this study and were submitted to NT 201 therapy for one year. At the baseline, botulinum toxin dose in the upper limb ranged from 160 to 450U, whereas total dose in the last treatment administrated was reduced respect the first injections ranging from 120 to 350U. All the enrolled patients completed the year-long study and reported an improvement of clinical picture. MAS, was statistically (px003C;0,001) reduced in all muscles at T1 (mean score ±SD: 2.65±0.67) and T2 (mean score±SD: 2.55±0.60) in comparison to the baseline T0 (mean score±SD: 3.9 ±0.78). Significant reduction (px003C;0,001) from baseline T0 (mean score ±SD: 3.25±0.78) was also noted in SFS at T1 (mean score ±SD: 1.55±0.51) and T2 (mean score±SD :1.30±0.47). The DAS score showed a reduction of the T1score (mean score ±SD: 1.70±0.47) and T2 score (mean score ±SD: 1,40 ±0,50) respect to baseline T0 score (mean score ±SD: 2,65 ±0,48) statistically significant (p≤003C;0,001). No adverse effects were observed in these patients. NT 201 appeared to be an efficacious and well-tolerated long-term treatment option for patients with upper limb spasticity after stroke, obtaining a substantial improvement in functional disability, muscle hypertone, and daily spasms.

The Correlation between Modified Ashworth Scale and Biceps T-reflex and Inter-rater and Intra-rater Reliability of Biceps T-reflex

ObjectiveTo establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke.MethodA total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3±0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs).ResultsAmplitude of the biceps T-reflex increased with increasing level of MAS (rs=0.464 and 0.573, respectively, p<0.01). ICCs of latency and amplitude of biceps T-reflex were 0.914 and 0.822. The Spearman correlation coefficients of latency and amplitude of biceps T-reflex were 0.937 and 0.635, respectively (p<0.01).ConclusionBiceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.

Functional Assessment of Lower Extremities in Hereditary Spastic Paraplegia

Braschinsky M, Parts K, Maamägi H, Gross-Paju K, Haldre S. Functional assessment of lower extremities in hereditary spastic paraplegia. Objectives To characterize the spasticity and range of motion (ROM) in patients with hereditary spastic paraplegia (HSP) and to correlate these parameters with walking speed. Design An observational population-based cohort study. Setting Patient data were acquired from a population-based epidemiologic study performed earlier in Estonia. Participants Persons (N=46) (mean age, 50.1y) with clinically confirmed HSP diagnosis (mean duration, 20.9y) participated in the study. Interventions Active and passive ROMs were measured with a plastic 360° goniometer. Spasticity was evaluated by using the modified Ashworth scale (MAS). The time it took a patient to walk 10m was recorded. Main Outcome Measures Measurements included testing of active and passive ROM as a marker for mobility, the MAS for spasticity, and time to complete a 10-m walk. Results A higher degree of spasticity in hip muscles was associated with lower values of active ROM and slower walking. Walking speed was negatively correlated to disease duration and participant age. Conclusions The present study provides analysis of the contributions of spasticity and ROM to walking speed in HSP, both factors negatively influence gait in persons with HSP.