Muscle Spasticity In Children Research Articles

Comparative assessment of a phased debridement strategy amidst treatment for masticatory muscle spasticity in children with cerebral palsy

Relevance. Dental care for children diagnosed with cerebral palsy (CP) presents substantial challenges to dental practitioners. These children not only necessitate individualized care strategies but also face challenges in mouth opening due to masticatory muscle spasticity, which limits operational access during treatments. This study introduces a phased approach to debridement that is integrated with interventions aimed at alleviating hypertonia in the masticatory muscles through adaptive myogymnastics and the use of a pneumatic mouth expander.Materials and methods. A clinical and functional assessment of the orofacial region was conducted on 34 compliant CP patients aged 6-12 years, with the mean age being 9.6 ± 0.3 years. These assessments considered the extent of motor activity and movement limitations in daily activities. Follow-up evaluations were performed six months post-intervention.Results. The phased debridement plan demonstrated significant effectiveness, integrating diagnostic and therapeutic strategies with tailored visitation schedules based on the clinical conditions of the patients.Conclusion. Uniform diagnostic and therapeutic protocols are recommended to enhance dental health and restrain the prevalence of dental diseases among children with spastic cerebral palsy.

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

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

Effect of total number of pulses of radial extracorporeal shock wave therapy (rESWT) on hamstring muscle spasticity in children with spastic type cerebral palsy: A randomized clinical trial.

To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP). This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1,000 pulses, Group III: 1,500 pulses, and Group IV: 2,000 pulses. Australian Spasticity Assessment Scale (ASAS) was measured at four different time points (pre-ESWT, post-ESWT, 2 weeks post-ESWT, and 4 weeks post-ESWT). All four groups showed improvement in ASAS relative to pre-treatment, although only significant in Group III (1,500 pulses). There were no statistically significant differences in ASAS between all four groups in pre-ESWT [|2(2) = 3.907, p = 0.272], immediately post-ESWT [|2(2) = 1.250, p = 0.741], 2 weeks post-ESWT vs pre-ESWT [|2(2) = 3.367, p = 0.338], and 4 weeks post-ESWT vs pre-ESWT [|2(2) = 1.566, p = 0.667]. The effect of rESWT on spastic hamstring in children with spastic CP is not dependent on the number of pulses.

Inter- and intra-rater reliability of the modified modified ashworth scale in the assessment of muscle spasticity in cerebral palsy: A preliminary study.

The aim of the study was to investigate the inter- and intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of lower extremity spasticity in children with spastic cerebral palsy (CP). Fifteen children (10 boys) with a mean age of 8.7±3.4 years participated. Two physiotherapists rated the spasticity of the hip adductors, knee extensors, and ankle plantar flexors for inter-rater reliability. Each child was examined again by one of the physiotherapists (same physiotherapist for all of the children) for intra-rater reliability (mean interval = 7 days). A random sequence of raters and muscles tested was applied. The reliability of the intraclass correlation coefficients (ICC) for individual muscle groups ranged between good to excellent (ICCagreement of 0.60-0.83). The ICC values for overall inter-rater (ICCagreement = 0.82) and intra-rater reliability (ICCagreement = 0.85) were excellent. The MMAS showed excellent reliability for the assessment of lower extremity muscle spasticity in children with cerebral palsy. However, an interpretation should be made with caution due to the small sample size and wide range of confidence interval values.

The Short-term Effects of Hippotherapy and Therapeutic Horseback Riding on Spasticity in Children With Cerebral Palsy: A Meta-analysis.

Purpose:We systematically reviewed the short-term effects of hippotherapy and therapeutic horseback riding (THR) on lower-limb muscle spasticity in children with cerebral palsy (CP).Methods:PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for relevant quantitative studies. Treatment effects were coded using the Ashworth scale (AS) or modified Ashworth scale (MAS) in pre- and posttreatment evaluations. Of the 73 studies identified initially, 7 met the inclusion criteria.Results:Treatment was associated with positive effects on lower-limb muscle spasticity, as supported by the AS or MAS scores. However, repeated trials did not show a statistically significant difference from a single trial (Q = 2.95, P = .086).Conclusion:Hippotherapy and THR can be used to treat lower-limb muscle spasticity in children with CP. However, repeated sessions did not show a better effect in reducing spasticity.What this adds to the evidence:This is the first meta-analysis to confirm that hippotherapy or THR can reduce lower-limb muscle spasticity in children with CP in the short term, but long-term effects on function still require further studies.

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

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

Transcutaneous electrical nerve stimulation in the management of calf muscle spasticity in cerebral palsy: A pilot study.

This study sets out to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of calf muscle spasticity in children with cerebral palsy. The study follows a one group pre-test–post-test design involving fifteen children with spastic cerebral palsy, presenting with calf muscle spasticity. Spasticity was assessed before and after a 30 min application of TENS to the bilateral calf muscles. The H-reflex (electromyography) of the calf muscles and Modified Ashworth Scale (MAS) served as a measure of spasticity. A goniometer was used to measure the range of motion (ROM) angles for ankle dorsiflexion. We report here no significant difference (p > 0.05) between the left and right H-reflex responses, MAS scores, and ROM scores recorded at baseline (pre-test). Correlation analysis show no correlation (p > 0.05) between the pre-test HA Max (maximum H-reflex amplitude)/MA Max (maximum M-Wave Amplitude) ratio and MAS scores of both the left and right calf muscles. However, TENS significantly reduced (p < 0.05) the HA of the left calf muscle and MAS scores of the left and right calf muscles. Additionally, TENS significantly increased the ROM scores of the left and right calf muscles. Our findings lend support to existing evidence that TENS is effective in reducing spasticity. The potential mechanism underlying this effect is a reduction in neuron excitability.

Management of Muscle Spasticity in Children with Cerebral Palsy by Means of Extracorporeal Shockwave Therapy: A Systematic Review of the Literature

ABSTRACT The purpose of this systematic review was to investigate the effectiveness of extracorporeal shockwave therapy for the management of muscle spasticity in children with cerebral palsy. An electronic database search was performed to identify studies relevant to the research question. Assessment of the quality of evidence in all relevant studies was performed with the help of the Oxford Center for Evidence-based Medicine guide. Four studies met our inclusion criteria for review: one was a low-quality randomized controlled clinical trial, two were individual case–control studies and one was a case series study. Reduction in muscle stiffness and improvement in joint range of motion were the outcomes in all of the selected studies that used extracorporeal shockwave therapy. However, considering the limited evidence provided by these studies, further research is needed to support the use of extracorporeal shockwave therapy in the management of muscle spasticity in children with cerebral palsy.

Pengaruh Pemberian “Contrash Bathing” Terhadap Penurunan Spatisitas Otot Lengan Dan Tungkai Pada Anak Dengan Cerebral Palsy

Abstract: Muscle spasticity, Contrash bathing, Cerebral palsy, Ashworth Scale. CP or cerebral palsy is a condition brain damage in childhood where there is a motor limitations caused by static lesions, non-progressive brain. CP showed abnormalities in muscle tone, causing a disturbance in the form of uncontrolled muscle tension or spasticity so that children are not able to perform functional movements. The aim of this study was to determine the influence of granting contrash bathing or showering in contrast with the water cold temperature (18 degrees Celsius) and the water warm temperatures (38 degrees Celsius) alternately with the duration of a specified time so that the muscles will experience the relaxation or muscle relaxation in the hope of limbs in children can be moved easily. There is the effect of bathing contrash therapy to decrease muscle spasticity in children with cerebral palsy. This study is a quasiexperimental study with two group pre and post test design. The subjects were all patients with CP in Yogyakarta WKCP that meets the criteria of inclusion, exclusion and drop out. The study was conducted for 8 weeks. Data collected were analyzed using SPSS 16.0. The different test within groups measured with Wilcoxon test, and for between groups measured with Mann Whitney test. The significance level was set on 0,05. The Results is the contras bath can reduce spasticity muscles in your arms and legs to cerebral palsy (p = 0.011 and p = 0.025.

Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial

ObjectiveThe aim of the present study is to evaluate the effect of a 12 weeks hippotherapy intervention protocol on hip adductors spasticity in children with spastic cerebral palsy. DesignRandomized controlled trial. Settings/locationThe intervention was conducted in an Equestrian and Therapeutic Association. Patients were recruited from a Rehabilitation Unit of Cerebral Palsy. SubjectsA total of 44 children with spastic cerebral palsy (Gross Motor Function Classification System [GMFCS] levels IV-V; 28 boys and 16 girls; aged 8 years 10 months, SD 3 months) were assigned to a treatment (n = 22; mean age 9 years 6 months, SD 3 months) or a control group (n = 22; mean age 8 years 3 months, SD 3 months). InterventionsThe control group received conventional therapy, and the treatment group received hippotherapy in addition to their conventional treatment. The intervention consisted of a 12-weeks hippotherapy program (1 time/week, 45 min). Outcome measuresBoth groups were assessed before and after the full program with the Modified Ashworth Scale (MAS). ResultsThere were significant differences in the MAS scores between the treatment and the control group in both adductors (left adductors: p = 0,040; right adductors: p = 0,047), after a 12-weeks hippotherapy intervention. ConclusionsA hippotherapy based treatment in addition to conventional therapy, in children with cerebral palsy, produces statistically significant changes in hip adductors spasticity after a 12-weeks intervention. Thus, it seems to produce benefits in the short-term.

Site-Specific Transmission of a Floor-Based, High-Frequency, Low-Magnitude Vibration Stimulus in Children With Spastic Cerebral Palsy

ObjectiveTo determine the degree to which a high-frequency, low-magnitude vibration signal emitted by a floor-based platform transmits to the distal tibia and distal femur of children with spastic cerebral palsy (CP) during standing. DesignCross-sectional study. SettingUniversity research laboratory. ParticipantsChildren with spastic CP who could stand independently (n=18) and typically developing children (n=10) (age range, 4–12y) participated in the study (N=28). InterventionsNot applicable. Main Outcome MeasuresThe vibration signal at the high-frequency, low-magnitude vibration platform (approximately 33Hz and 0.3g), distal tibia, and distal femur was measured using accelerometers. The degree of plantar flexor spasticity was assessed using the Modified Ashworth Scale. ResultsThe high-frequency, low-magnitude vibration signal was greater (P<.001) at the distal tibia than at the platform in children with CP (.36±.06g vs .29±.05g) and controls (.40±.09g vs .24±.07g). Although the vibration signal was also higher at the distal femur (.35±.09g, P<.001) than at the platform in controls, it was lower in children with CP (.20±.07g, P<.001). The degree of spasticity was negatively related to the vibration signal transmitted to the distal tibia (Spearman ρ=−.547) and distal femur (Spearman ρ=−.566) in children with CP (both P<.05). ConclusionsA high-frequency, low-magnitude vibration signal from a floor-based platform was amplified at the distal tibia, attenuated at the distal femur, and inversely related to the degree of muscle spasticity in children with spastic CP. Whether this transmission pattern affects the adaptation of the bones of children with CP to high-frequency, low-magnitude vibration requires further investigation.

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

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

Effect of radial shock wave therapy on muscle spasticity in children with cerebral palsy

Extracorporeal shock wave therapy is a treatment of choice in patients with musculoskeletal disorders. The aim of this study was to investigate the effect of radial shock wave therapy (RSWT) on muscle spasticity of plantar flexor muscles in children with cerebral palsy. This was an open, controlled, observational study with one placebo treatment session, followed 4 weeks later by one active treatment session. Procedures and measurements were performed on inpatients of the Physical and Rehabilitation department of the Medical University Hospital, Plovdiv, Bulgaria. Twenty-five children, mean age 4.84±3.11 years, with spastic diplegia and hemiplegia participated in the study. They received a single session of RSWT to the plantar flexors of the foot. The following clinical methods were used for outcome assessment before, after, and 2 and 4 weeks later: passive range of motion, Modified Ashworth Scale. Baropodometric measurements were performed before and after the placebo and active session. After placebo application, no changes measured by clinical or instrumental methods were found. After RSWT, a significant increase in passive range of motion was observed: 47.00±2.29° versus 33.25±2.20° (P<0.001), which persisted at the second (46.87±2.08°, P<0.001) and fourth week (44.12±1.93°, P<0.001) after treatment. The Modified Ashworth Scale score decreased from 2.77 to 2.00 points (P<0.001), which persisted at the second (mean 2.05±0.07 points, P<0.001) and fourth week (2.15±0.76 points, P<0.001) after treatment. Baropodometric measurement showed a significant increase in the contact plantar surface area of the affected foot (from 81.32±6.14 to 101.58±5.41 cm, P<0.001) and in heel pressure (from 50.47±6.61 to 75.17±3.42 N/cm, P<0.001). There is a significant reduction in the spasticity of plantar flexor muscles in children with cerebral palsy after a single session of RSWT and this improvement remains at the 4-week follow-up.

Effect of shock wave therapy on muscle spasticity in children with cerebral palsy

Effect of shock wave therapy on muscle spasticity in children with cerebral palsy

Botulinum toxin‐induced paralysis leads to slower myosin heavy chain isoform composition and reduced titin content in juvenile rat gastrocnemius muscle

Intramuscular injections of botulinum toxin A (Btx-A) and exercise are used in the treatment of muscle spasticity in children with cerebral palsy. However, little is known about the biological changes within muscle subsequent to Btx-A-induced paralysis and how the combination of Btx-A and exercise might affect the growing muscle. The wet mass, myosin heavy chain (MHC) composition, and titin content of the juvenile rat gastrocnemius muscle were determined 3 weeks after Btx-A injections and subsequent voluntary wheel-running exercise. Btx-A increased the proportion of type IIa (+121%) and IIx (+65%) MHC while decreasing the proportion of type IIb MHC (-51%) and reducing the titin content (-18%). Exercise did not amplify or reduce the changes induced by Btx-A. Thus, we conclude that although the sarcomeric stability of paralyzed muscle might be impaired, moderate mechanical loading does not seem to affect paralyzed muscle protein composition.

Confirmatory factor analysis in osteopathic medicine: fascial and spinal motion restrictions as correlates of muscle spasticity in children with cerebral palsy.

While numerous measures are available to assist physicians in assessing patients with cerebral palsy, there is a paucity of instruments that capture data relevant to osteopathic assessment. The lack of such tools limits the reach of research in key osteopathic indicators. A structured objective form designed to assist osteopathic physicians in the evaluation of fascial restriction, restriction of spinal motion, and muscle spasticity was developed for use during osteopathic musculoskeletal structural examinations. Data were collected as part of a larger study investigating the effects of osteopathic manipulative treatment versus acupuncture in children with cerebral palsy. In the present study, confirmatory factor analysis was used to examine the relationships between fascial and spinal motion restrictions in addition to spasticity. In 57 children with spastic cerebral palsy, latent factors for fascial restrictions and spinal motion restriction fit the data well and both factors were correlated with a visual analog scale rating of the child's muscle spasticity. These findings provide preliminary evidence for the factorial and concurrent validity of fascial and spinal motion restrictions, demonstrating the benefits of an instrument for assessing the results of osteopathic musculoskeletal structural examinations.

Does botulinum toxin A reduce adductor muscle spasticity in children with cerebral palsy?

Does botulinum toxin A reduce adductor muscle spasticity in children with cerebral palsy?

Effects of botulinum toxin A injection and exercise on the growth of juvenile rat gastrocnemius muscle.

Botulinum toxin A (Btx) injections and supervised exercise are often used concurrently to treat calf muscle spasticity in children. This study has analyzed the early effects of Btx-induced paralysis and increased activity by voluntary wheel running on cell growth-related processes in juvenile rat gastrocnemius muscle. Btx injection at 29 days of age prevented the normal increases in wet mass (50%) and fiber cross-sectional area (34%) seen by 36 days of age in control rats. Btx-injected vs. contralateral muscles had 22% fewer myonuclei per fiber length but greater than twofold the number of MyoD-positive nuclei at 36 days of age. The accretion of 5-bromo-2'-deoxyuridine-labeled newly produced myonuclei did not differ between limbs. Voluntary exercise during the 7 days increased the mass (18%) and fiber size (23%) of Btx-injected and contralateral muscles but did not affect any other variable. Thus Btx injection and exercise had early effects on muscle and fiber size without consistently associated changes in myonuclear production or number. This suggests the presence of noncontractile activity-dependent, growth-promoting cytoplasmic events in juvenile muscle.

Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity

Botulinum toxin A (BTX-A) is widely used in the management of muscle spasticity in children. However, at present the dose of BTX-A for a given patient is selected empirically. The aim of this study is to provide dosage guidelines that are based on risk/benefit assessment. This was a multicentre retrospective study of the safety profile and efficacy of BTX-A in children with chronic muscle spasticity. Data in 758 patients who received a total of 1594 treatments were analysed (mean age 7.2 years; 429 males, 329 females). Spastic cerebral palsy (CP) was the most common diagnosis (94% of the study sample). Of all treatments 7% resulted in adverse events; incidence was related to the total dose rather than the dose calculated on the basis of body weight. The highest incidence of adverse events was observed in patients who received >1000 IU of BTX-A per treatment session. The odds of an adverse event was 5.1 times greater for this group of patients than for those who had 250 IU or less (p<0.001). A good overall response to treatment was reported in 82% and treatment goals were fully or partially achieved in 3% and 94% of participants respectively. More patients in the highest dose group reported functional deterioration. Interestingly, multilevel treatments resulted in a better response than single-level treatments (odds ratio 1.7, 95% CI 1.3 to 2.2,p=0.001).

Selective Dorsal Rhizotomy to Decrease Spasticity in Cerebral Palsy

Until recently, treatment of muscle spasticity in children with cerebral palsy has consisted of physical therapy, bracing, and surgery to release and lengthen tight tendons of contracted muscles and correct muscle contractures. Selective dorsal rhizotomy is a surgical intervention that selectively cuts the spinal sensory nerve rootlets carrying the most abnormal signals, thereby reducing spasticity in all muscle groups of the affected extremities. It is not a cure for spastic cerebral palsy. Children who have this procedure can gain significant increases in knee and thigh ranges of motion and increased strength and muscle control if they have good family support and follow through with intensive postoperative physical therapy.