Spastic Condition Research Articles

The Auriculotemporal Nerve and TMJ region: anatomy and function

The studies on the auriculotemporal nerve in humans are limited. However, we considered crucial to investigate the topographic relation between the auriculotemporal nerve and the TMJ region that can explain some of the symptoms in TMDs. The results derived from our experience in the anatomic dissection on 16 adult cadaveric heads were compared with what literature describes from 1971 to 2023. The results confirm the existence of a particular anatomic position of the ATN within the infratemporal fossa in direct contact with the lateral pterygoid muscle and the TMJ capsular region. Therefore, there is evidence of a potential entrapment mechanism involving the ATN caused by an internal derangement of TMJ or a spastic condition of the lateral pterygoid muscle. Through a detailed anatomical description of the ATN the present study aims to offer an explanation to the main sensory and otological symptoms that patients with TMJ disorders often complaint, from facial pain and paresthesias to external ear pruritus.

Gastrocnemius Muscle Histopathology In Spastic Rats

ABSTRACT
 Introduction: Spasticity caused by the injury of the central nervous system. Muscle with spasticity causes muscle fibers to change in size and distribution.
 Methods: To analyze the structure of the spasticity of the muscles, study use the excisional biopsy of the gastrocnemius muscle of spastic rats. Experimental study was conducted on 42 spastic rats in 6 groups with different doses of calcium. Staining of gastrocnemius muscle tissue fibers using hematoxylin-eosin.Calcium staining using alizerin red.
 Results: Hematoxylin-eosin staining shown the muscle cell nucleus, cytoplasm or endoplasm appears roseate. Analysis of the spastic condition found that the distance between the muscle fibers dilated and the diameter smaller. Calcium deposits appear in spastic muscle tissue, by purplish-blue. The pearson correlation test showed a significant correlation between muscle fiber distance and spasticity after intervention (p<0.05). The spearman correlation test showed a significant correlation between spasticity after intervention (p=0.008) and each changes in spasticity (p=0.015).
 Conclusions: HE staining used to determine the arrangement of muscle tissue in spastic gastrocnemius muscles and alizerin red determined calcium deposits in spasticity muscle tissue. There is a significant correlation between the distance between muscle fibers with spasticity and between changes in spasticity after the intervention.Keywords: alizerin red staining, gastrocnemius muscle, hematoxylin-eosin staining, histopathology, spastic rats

Adolph Seeligmüller (1837-1912) and the first graphic illustration of the "toe phenomenon" (later called "Babiński sign") in the medical literature.

The "toe phenomenon" refers to the extension (dorsiflexion) of the great toe, which occurs instead of the normal flexion following stimulation of the foot sole. Its clinical significance was not fully appreciated until Joseph Jules François Félix Babiński (1857-1932) described it in 1896. In 1881, Ernst Strümpell (1853-1925) had described a continuous (tonic) extension of the big toe, a finding that years later the French neurologist Jean-Athanase Sicard (1872-1929) recognized as an equivalent of the "toe phenomenon", also indicating pyramidal tract dysfunction. Previously, this phenomenon had been mentioned in patients only passingly and without providing a picture of it. In 1887, the German neurologist Adolph Seeligmüller (1837-1912) mentioned the tonic extension of the big toe among the characteristic clinical features of spastic infantile hemiplegia-a condition first described by the Austrian physician Moritz Benedikt (1835-1920) in 1868. Seeligmüller incorrectly attributed the tonic extension of the big toe to spastic contracture of the extensor hallucis longus muscle. However, he put great emphasis on this sign and considered it worth being illustrated. Adolph Seeligmüller therefore provided the very first graphic illustration of the (tonic) "toe phenomenon" in the medical literature. Of note, the first photographic illustration of this sign made by Babiński appeared only in 1900, when it had already been adopted by neurologists all over the world.

Endoscopy and surgery for achalasia: the two sides of myotomy.

Achalasia is associated with four typical symptoms: dysphagia, thoracic pain, regurgitation and weight loss. The etiology finds its rationale in an autoimmune reaction that leaves the lower esophageal sphincter (LES) in a spastic condition associated with different grades of esophageal body impairment.

The lowest effective dose of botulinum toxin in detrusor sphincter dyssynergia

Detrusor sphincter dyssynergia is a spastic condition due to lack of coordination between the bladder and the external sphincter. It results in excessive bladder pressures and inability to empty the bladder completely. Botulinum toxin type A has been injected either transurethrally via cystoscope or transperineally under electromyographic control. The dose and dilution volume vary from author to author. This was a prospective, randomized, double-blind, dose-ranging clinical trial to define the lowest effective dose of botulinum toxin type A and safety in the treatment of detrusor sphincter dyssynergia. Twelve adult patients with detrusor sphincter dyssynergia are randomly divided into three groups by a random table, four patients in each group. Depending on randomization, BOTOX 50,75 or 100 U will be administered. The results indicate that BOTOX 75 and 100 U statistically reduce postvoiding residual urine and detrusor pressure at P Conclusion:The lowest effective dose of BOTOX in the treatment of detrusor sphincter dyssynergia is 75–100 U, which is slightly lower than in other studies.

Intra- and Interrater Reliabilities of the Myotonometer When Assessing the Spastic Condition of Children With Cerebral Palsy

The purposes of this study were to assess intra- and interrater reliabilities by novice users of the Myotonometer (Neurogenic Technologies, Inc., Missoula, MT), a portable electronic device that quantifies muscle tone (stiffness) and paresis, in assessing children with cerebral palsy. Two raters used the Myotonometer to assess the biceps brachii and medial gastrocnemius muscles of 10 children with spastic-type cerebral palsy. Muscles were measured in a relaxed state and during a voluntary isometric contraction. Intraclass correlation coefficients and repeatability coefficients were calculated for each muscle and for each condition (relaxed and contracted). Intrarater reliabilities ranged from 0.82 to 0.99 (biceps brachii muscles) and 0.88 to 0.99 (medial gastrocnemius muscles). Interrater reliabilities ranged from 0.74 to 0.99 (biceps brachii muscles) and 0.84 to 0.99 (medial gastrocnemius muscles). Repeatability coefficients indicated a 98% level of agreement between raters across all conditions. Novice users of the Myotonometer, with few exceptions, had high to very high intra- and interrater reliabilities for measurements of the biceps brachii and medial gastrocnemius muscles of children with spastic-type cerebral palsy.

Assessing the spastic condition of individuals with upper motoneuron involvement: Validity of the myotonometer

Leonard CT, Stephens JU, Stroppel SL. Assessing the spastic condition of individuals with upper motoneuron involvement: validity of the myotonometer. Arch Phys Med Rehabil 2001;82:1416-20. Objectives: To examine the validity of a newly developed tissue compliance device to measure muscle tone and to quantify the level of severity of the spastic condition. Design: Validity study. Setting: Research laboratory. Participants: Twenty subjects, 10 with upper motoneuron (UMN) disorders (spastic-type cerebral palsy or adult-onset cerebrovascular accident) who comprised the experimental group; and 10 nondisabled, age-equivalent subjects, who served as controls. Interventions: Not applicable. Main Outcome Measures: Muscle tone of the biceps brachii muscle was assessed with the Myotonometer and Modified Ashworth Scale (MAS). The Myotonometer was used to quantify the muscle's resistance to stretch in a relaxed state and during maximal voluntary isometric contractions. Analyses of variance determined differences among subjects. Correlations between Myotonometer measurements and MAS scores were calculated. Results: Significant differences (p < .05) were observed between experimental and control groups and between the involved and uninvolved extremities of the experimental group with Myotonometer measurements. Correlations between MAS scores and Myotonometer measurements ranged from .64 to .81. Conclusion: The Myotonometer effectively identified differences in the spastic condition of the biceps brachii muscle in subjects with UMN involvement. Correlations with the MAS were moderate to high. © 2001 by the American Congress of Rehabilitation Medicine and the Amercian Academy of Physical Medicine and Rehabilitation

Psychogenic lower urinary tract dysfunction in women: patho-physiological investigation for psychogenic frequency-urgency syndrome and psychogenic urinary retention

Psychogenic lower urinary tract dysfunction (PLUTD) is composed of two syndromes; psychogenic frequency-urgency syndrome (PFUS) and psychogenic urinary retention (PUR). We evaluated the patho-physiology of PFUS and PUR, and explored the different pathogenesis in these syndromes. Forty five patients with PLUTD, consisting of 23 patients with PFUS and 22 patients with PUR were investigated by using the psychological tests: CMI (Cornell Medical Index) and TEG (Todai's Egogram), a quantitative perspiration test in 45 females (23 patients with PFUS and 22 patients with PUR), and simultaneous measurements of voiding cysto-urethrography and urodynamic studies using the Life-Tech 6 channel polygraph in 35 patients (17 patients with PFUS and 18 patients with PUR). The prevalence in ages revealed two peaks, 20 years and 50 to 60 years. Over 25% of them had pyuria more than 10/hpf of WBC. Peak flow rate measured by uroflowmetry showed normal range in PFUS group and decreased in PUR group. The functional vesical volume was less than 100 ml in most patients with PFUS. Residual urine in PUR group was significantly greater. Capacity of the PFUS group were able to hold over 400 ml of contrast instilled through the urethral catheter, despite increased desire to void. Over 15% of the study group with PFUS showed uninhibited systolic contraction of detrusor (> 15 cm H2O) during filling phase. The measurement value of urodynamic parameters demonstrated that a periodic follow-up survey of the upper urinary tract should be performed because of the low compliance bladder in the patients with PLUTD. During voiding phase, the women with PFUS had a tendency to be divided into two groups, hypercontractile or acontractile detrusor. The voiding cysto-urethrography (VCUG) showed a tendency of bladder neck opening on patients with PFUS during filling phase. Most of PLUTD cases demonstrated a round to triangle shape on vesical configuration, which led to a spastic condition of detrusor muscle. We attempted to measure the quantitative perspiration using 3 kinds of loading tests; respiratory, arithmetic and psychological load. In the psychological loading test, we asked 98 questions about their daily lives including occupation, living condition, family relationship and sexual activities. Arithmetic loading test consisted of counting in reverse, subtraction and multiplication. The quantitative perspiration rate resulted in a "positive" in many patients with PFUS. Respiration loading test was performed to measure the respiration volume during 3 large inhales. Most patients with PUR tested within the normal range for respiration except for those patients with decreased or no perspiration during the psychiatric loading test. These results may reflect the psychological elements including suppression and subconscious defense mechanism. Neurosis which was diagnosed as having type III to type IV of the Cornell Medical Index was demonstrated in less than under 40% of patients with PFUS and more than 55% patients with PUR. There was no significant trend or difference between PFUS and PUR detected from Todai's Egogram. Due to the reflection of many psychological responses, it is necessary to investigate from various examinations including psychological, autonomical and classical urological studies for accurate diagnosis of PLUTD.

Surgical Treatment of Severe Constipation

Severe constipation may be treated surgically provided precise evaluation of colon-transit-time and rectal evacuation can be performed. Colon-transit-time may be studied by straight X-ray of the abdomen after oral intake of small plastic markers, and rectal evacuation may be evaluated by defecography. In patients, where Hirschsprung's disease with a short aganglionic segment is suspected, ano-rectal manometry with evaluation of the recto-anal reflex must be performed. Furthermore, electromyography of the external anal sphincter and puborectal muscle during simulated defecation will be necessary in order to evaluate whether obstructed defecation is due to a spastic condition in the anal sphincter or pelvic floor muscles (anismus). Surgical treatment of obstructed defecation depends on the specific pathology, while treatment of slow transit constipation is subtotal colectomy and ileo-rectal anastomosis. In patients, where constipation is based on a combination of obstructed defecation and prolonged colon-transit-time, surgery for obstructed defecation should be carried out first. In patients, where the constipation is due to prolonged colon-transit-time and an adynamic rectum (rectal inertia) without anatomical abnormalities the only possibility of surgical treatment is total colectomy with an ileo-anal pouch.

Nerve entrapment in the lateral pterygoid muscle

The posterior trunk of the mandibular division of the trigeminal nerve normally descends deep to the lateral pterygoid muscle. In three of 52 dissections the three main branches of the posterior trunk (lingual, inferior alveolar, and auriculotemporal nerves) were observed to pass through the medial fibers of the lower belly of the lateral pterygoid muscle. The mylohyoid and anterior deep temporal nerves also were observed to pass through the lateral pterygoid muscle in other specimens. These nerve entrapments in the infratemporal fossa provide new information concerning the anatomic and clinical relationships between the mandibular nerve and the lateral pterygoid muscle. These findings support the hypothesis that a spastic condition of the lateral pterygoid muscle may be causally related to compression of an entrapped nerve that leads to numbness, pain, or both in the respective areas of nerve distribution.

Phenol block in the treatment of spasticity.

Injection of dilute phenol to peripheral nerves or motor block areas when there is spasticity, can, by damage to the nerves or motor areas, relieve the spastic condition, allow better nursing care, free the patient from the embarrassment of a contorted limb and may allow voluntary movement to take place.

A histochemical and electron microscopic study of a fast- and a slow-twitch muscle in genetically spastic mice

Fast and slow muscle fibers were studied in the flexor digitorum longus (FDL) and soleus (SOL) muscles, respectively, in control and spastic mice. Histochemical and electron microscopic studies indicated an increased number of mitochondria, a decreased deposition of glycogen and a vesiculation and distension of the sarcoplasmic reticulum in many fast-twitch fibers of the spastic FDL. Similar findings were not evident in the slow-twitch fibers of the spastic SOL. Since the spastic condition causes increased muscular activity as a result of more rapid and prolonged nerve impulse firing, these findings reinforce the idea that a muscle fiber's oxidative capabilities are a function of its activity.

Spastic paresis in Friesian calves.

Introduction Spastic paresis of calves was first described as such by Gotze (1932) in Germany. The condition has also been referred to as “contraction of the Achilles tendon”, “straight hock” and “Elso-heel”, and had been described earlier by Hamoir (1922) in Belgium, and Wester ( 1922) in the Netherlands. Hickman (1964) considered the use of the term “spastic” misleading in describing this type of lameness as it implied neurological involvement, with increased tone, exaggerated reflexes and a degree of paralysis. As these signs are not a feature of the condition he considered “congenital shortening of the gastrocnemius and superficial flexor” a more accurate definition. Although Gotze (1932) described the occurrence of spastic paresis in calves from 3 t to 6 months of age, Rosenberger (1939) indicated that signs could appear at 2 years or later. Gotze (1932) described a form of spastic lameness in which one or both hind limbs could become affected. In the majority of cases only one leg is affected, but bilateral occurrence is by no means rare (Wintzer 1968). The first signs to become apparent in calves are a straightness of the hindlimbs and a tendency for the calcaneus to be drawn toward the tibia. Sometimes the abnormality of gait is found in the first few days of life, but usually the spastic condition is not seen till 6 weeks to 8 months of age when it becomes more obvious (Hickman 1964; Dirksen 1970). Both hind legs may become affected, but as the condition progresses over a period of a few weeks or months one hind leg becomes more severely involved. The pastern of the affected limb becomes more upright than the other with the foot still placed on the ground. Later the leg is held so that the foot just touches the ground with the toe. Eventually this leg becomes raised entirely free of the ground and a “pendulum” action results when the animal is moved. The gastrocnemius muscles appear under-developed and there is a characteristic raising of the tail. Spasticity affecting the gastrocnemius and superficial digital flexor muscles is especially

Program for the Cerebral Palsied

CEREBRAL PALSY is characterized by paralysis, weakness, incoordination, tremors, involuntary motion, excessive rigidity, or stiffness caused by pathology of the motor centers of the brain. This affliction may apply technically to adolescents, adults, or the aged. However, cerebral palsy is usually considered to mean those conditions resulting from an anomaly, injury, or disease that originates in the developing infant before or during birth or in the first years of growth (la). Daitmage to the brain may result in involvement of the upper and lower extremities and frequently includes the muscles of the trunk, neck, head, face, and breathing mechanism. Because cerebral inijury is not limited to a single area in the brain, numerous associated defects may accompany motor involvement. These may include one or more defects in speech, hearing, or vision, m-ental retardation, convulsions, and behavior disorders. The classificatioin of various types of cerebral palsy is based oni physical signls. A high percentage of cases may be classified either as spastic or athetoid types. In athetosis the individual displays involuntary, incoordinate, uncontrollable, purposeless movements. The spastic condition is characterized by the appearance of stiffness. Usually the spastic is able to move the affected limb voluntarily, but the motion may be explosive, jerky, slow, or poorly performed (B). The number of cerebral palsied in this country is difficult to determine. Three major studies analyzed in 1955 indicate that the prevalence rate of cerebral palsy is between 300 and 350 cases per 100,000 population (3). Of this number, 100 cases are under 21 years of age and 200 are 21 years of age and over. On the basis of the above figures it is estimated that the total number of cases in the United States falls between 495,000 and 577,500.

The reticulospinal apparatus and rigidity.

IT is commonly held that the vestibulo-spinal apparatus is responsible for maintaining the spastic condition which occurs after decerebration and other operations. Recently, Schreiner, Lindsley and Magoun1 and others have suggested that the reticulo-spinal mechanism is more likely to be implicated. In this connexion the following observations upon an anuran, Bufo marinus, are of interest.

SPASTIC CHILDREN IN AN OUTPATIENT PSYCHOLOGIC CLINIC

During the past five years 123 spastic children have been examined in the children's psychologic clinic of the University of California Medical Center. Because of the frequent differences of opinion as to causation of spasticity in children and as to the role played by birth injury in the production of this condition, it has seemed desirable to analyze the records of these children with the purpose of determining as many as possible of the factors which may have played a part in theproduction of the condition. There is also included a brief summary of the spastic child's condition, his mental capacity and the extent of his physical disability. Of this whole group of 123 children, 10 were reported by the parents to have been normal until they had severe illnesses, after which paralysis and in some cases epilepsy remained. These 10 children have not been included in the analysis

THE PRESENT CONSIDERATION AND CARE OF THE COLON

It is my purpose in this contribution to call attention more specifically to those functional disturbances of the large bowel which are frequently the cause of considerable concern to the patient, and annoyance to the attending physician. It is not my purpose, on the other hand, to discuss chronic ulcerative colitis. That condition is at present receiving intensive study, especially in the bacteriologic laboratory, and a voluminous, controversial literature is about the only definite result as yet. Among the functional disturbances of the bowels are certain irregularities due to an atonic condition at times or, again, to a spastic condition of the colon. With these disturbances of motility there are also secondary disturbances, and these together may gradually develop a mild irritative condition of the mucous membrane, with a production of stringy mucus, ordinarily called mucous colitis, and attributed to a neurogenic origin. There may gradually develop a more or

Effect of lead salts and of the nitrites upon the movements of the intestines

Riegel (1875) and J. Pal (Die Gefässkrisen, 1906) suggested the use of amylnitrite for the control of pain in lead colic and in the gastric crises of tabes dorsalis, believing that the fall of blood pressure sufficed to bring about diminution in these symptoms. The present series of experiments was undertaken in order to determine whether the nitrites might not act by causing relaxation of a spastic condition of the intestinal walls. The experiments were carried out on rabbits whose intestinal movements were observed through a large window in the abdominal wall, which was closed from the outside air by inserting a crystallizing dish 10 cm. in diameter. The sides of the crystallizing dish were coated with thick beeswax and the window was held in place by fixing the abdominal walls around it with a purse string suture. The animals were lightly anæsthetized with ether. Injection of 5 mg. lead acetate per kg. immediately caused the onset of intense peristaltic movements which seemed to be due to stimulation of the preganglionic synapse, since they were abolished by injection of nicotin or by painting nicotin upon the intestine, but were not affected by extirpation of the spinal cord and section of the vagi. As was suspected from the clinical results reported by Riegal and Pal, this peristalsis could be inhibited by inhalation of amylnitrite, by placing two drops of nitroglycerin upon the tongue or by the injection of 80-100 mg. per kg. sodium nitrite. The effects of the two former drugs were most marked, though the effects of the latter were more prolonged. Atropin, either locally or intravenously, also inhibited the peristalsis, as had been shown by Harnack. The same effects were also obtained with the nitrites and with atropin when increased peristalsis was brought on by the local effect of heat, secured by placing warm water in the crystallizing dish window.

A NEW SIGN IN PNEUMOTHORAX, PARTICULARLY ARTIFICIAL PNEUMOTHORAX

PRELIMINARY REPORT In a careful study of over eleven cases of both spontaneous and artificial pneumothorax in pulmonary tuberculosis I have observed in every patient a condition of spasticity or rigidity of the rectus and abdominal muscles in the upper quadrant of the abdomen on the same side as the lesion. This sign, as I so designate it, has been constant in every case. I have repeatedly pointed it out and had it verified by my associates. In my most recent case, a physician, on whom I performed artificial pneumothorax for persistent hemoptysis, the spastic condition of the left rectus (upper segment) and region of the epigastrium was so marked as to make a visible tumor. The patient noticed this himself and was much interested, as it seemed to vary in tenseness with the tension in the chest. This area is also hyperesthetic. On account of the increasing amount of

THE PYLORUS, PYLOROSPASM AND ALLIED SPASMS IN INFANTS

In studying the extensive literature of pylorospasm, one is impressed time and again by the striking uncertainty attending its diagnosis and the difficulty of differentiating this condition from organic stenosis and even from simple vomiting. Most writers on the subject have drawn attention to the diagnostic difficulties and have grouped their cases under the title of pylorospasm in a rather tentative spirit, because, all things considered, the symptoms seemed to point most clearly to a spastic condition. Indeed, diagnosis has not always been possible even after post-mortem examination. The problem, however, is essentially a clinical one, as the majority of cases recover and do not reach autopsy. Few require surgical intervention; so that this opportunity for studying the condition is also not frequently afforded. As the result of clinical experience some observers have come to the conclusion that there is no pathognomonic sign or symptom which serves to differentiate functional