Spasticity In Post-stroke Patients Research Articles

Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Effect of Kinesio Taping on Muscle Spasticity in Post-Stroke Patients Receiving Infrared Therapy and Stretching Exercise : A Quasi-Experimental Study

BACKGROUND: Spasticity is one of the symptoms of a stroke. One of the muscles with increased tone is the plantar flexor (66%). Spasticity is commonly treated with infrared therapy and stretching exercises. Kinesio Taping is a skin-based therapeutic procedure that uses elastic tape and can be used with infrared therapy and stretching exercises. Kinesio Taping is predicted to reduce spasticity in the plantar flexor muscle as determined by the Tardieu scale, improving functional walking. OBJECTIVE: To demonstrate the efficacy of adding Kinesio Taping on lower extremity muscular spasticity in post-stroke patients who had previously received infrared and stretching exercises. METHOD: This study is a controlled group design with a quasi experimental pre and post test. Post-stroke patients were divided into two groups: the control group (16 patients) and the treatment group (16 patients) who received the addition of Kinesio Taping. Before and after 6 weeks of treatment, the Tardieu scale was measured. RESULT: Before and after treatment, there was a significant difference in Tardieu scale (both on quality and angle of resistance) in each group (p < 0.05), and there was a significant difference in Tardieu scale in the two groups (p < 0.05). CONCLUSION : Kinesio Taping has been demonstrated to significantly reduce plantar flexor muscle spasticity in stroke survivors.

Comparison of the Effects of Extracorporeal Shock Wave Therapy and Dry Needing on Spasticity in Poststroke Patients: A Randomized Controlled Trial

Introduction: The effective treatment of spasticity following a stroke is a critical and pressing concern. Various therapeutic approaches, such as physiotherapy (7, 8) and medication (9, 10), have been employed. In recent years, external corporeal shockwave therapy (ESWT) and dry needling (DN) have gained popularity for managing spasticity and post-stroke pain. This study aims to conduct a comparative analysis of the effectiveness of ESWT and DN in addressing spasticity, pain, as well as upper limb function and sensation in individuals with hemiplegia. Methods: In this study, individuals with hemiplegia were randomly assigned in a 1:1 ratio to either the External Corporeal Shockwave Therapy (ESWT) group (n = 10) or the Dry Needling (DN) group (n = 10). We assessed Upper Extremity Functions, Sensation, Spasticity, and Pain. All measurement indicators were evaluated before treatment and immediately after a single treatment session. To determine the presence of a group *time interaction effect on the treatment's impact for each outcome variable, we used mixed-model repeated-measures ANOVAs. The between-subjects variable was the group, and time served as the within-subjects variable. Results: Both Dry Needling (DN) and External Corporeal Shockwave Therapy (ESWT) demonstrated significant reductions in spasticity within the biceps brachii muscle, along with notable improvements in upper extremity function tests. Moreover, both DN and ESWT led to significant enhancements in the forearm, arm, and finger; however, the same level of improvement was not observed for the hand. Tactile sensitivity, pain sensation, and light touch did not show significant improvements in either treatment group. Nonetheless, both groups experienced a significant reduction in pain levels. When we conducted a comparative analysis between these two treatment groups across all measures, no significant differences were observed (p > 0.05). Conclusion: In individuals with hemiplegia, both External Corporeal Shockwave Therapy (ESWT) and Dry Needling (DN) have demonstrated the ability to effectively reduce pain and spasticity while enhancing upper extremity function. As a result, these treatments may be regarded as viable alternative methods for addressing the needs of individuals with hemiplegia.

Deep muscle stimulator in the treatment of post-stroke spasticity: A protocol for systematic review and meta-analysis.

Spasticity is one of the most common complications and sequelae of stroke, with the main clinical manifestations being increased muscle tension, pain, stiffness, and other disorders. It not only increases the length of hospitalization and medical costs but also affects the quality of daily life and the stress of returning to society, increasing the burden on patients and their families. At present, 2 driver types of deep muscle stimulator (DMS) have been used in the clinical treatment of post-stroke spasticity (PSS) with good clinical results, but there is no evidence of clinical efficacy and safety. Therefore, this study aims to integrate direct and indirect comparative clinical evidence through a systematic review and network meta-analysis (NMA). According to the data, different driver types for DMS with the same body of evidence will be collected, analyzed, and sequenced in a quantitative and comprehensive manner and then screened for the optimal driver type of DMS device for PSS treatment. The study also aims to provide reference value and an evidence-based theoretical basis for the clinical optimization of DMS equipment selection. A comprehensive retrieval of China National Knowledge Infrastructure, Chinese scientific journal database, China biological feature database, Wanfang Chinese databases and the Cochrane Library, PubMed, Web of Science, and Embase foreign databases will be conducted. Randomized controlled trials of these 2 driver types of DMS devices combined with conventional rehabilitation training of PSS will be searched and published. The retrieval time is from the establishment of the database to December 20, 2022. The 2 first authors will screen references that meet the inclusion criteria, independently extract data according to predesigned rules, and assess the quality of the included studies and the risk of bias according to the Cochrane 5.1 Handbook criteria. R programming and Aggregate Data Drug Information System software will be used to perform a combined NMA of the data and to evaluate the probability of ranking for all interventions. The NMA and probability ranking will determine the best driver type of DMS device for PSS. This study will offer a comprehensive evidence-based approach to DMS therapy and assist doctors, PSS patients, and decision-makers in selecting a more efficient, secure, and cost-effective treatment option.

Effects of transcranial combined with peripheral repetitive magnetic stimulation on limb spasticity and resting-state brain activity in stroke patients.

Transcranial magnetic stimulation and peripheral repetitive magnetic stimulation (rPMS), as non-invasive neuromodulation techniques, can promote functional recovery in patients with post-stroke spasticity (PSS), but the effects of transcranial magnetic stimulation combined with peripheral magnetic stimulation on PSS remain largely unknown. Therefore, we examined the effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with rPMS on PSS patients and its potential neural correlates to behavioral improvements. Forty-nine PSS patients were divided randomly into three groups: a combined group (n = 20), a LF-rTMS group (n = 15), and a control group (n = 14). The combined group received LF-rTMS and rPMS treatment, the rTMS group received LF-rTMS treatment, and the control group received only routine rehabilitation. All patients underwent Ashworth Spasm Scale (MAS), upper extremity Fugl-Meyer (FMA-UE), and modified Barthel Index (MBI) assessments before and after intervention. In addition, resting-state functional magnetic resonance imaging data were collected pre- and post-treatment to observe changes in the amplitude of low-frequency fluctuation (ALFF). The MAS score was decreased, FMA-UE score and MBI scores were increased in the three groups after therapy than before therapy (all P < 0.05). In particular, the combined group showed significant effect on improved motor function and relieved spasticity in PSS (P < 0.01). Moreover, the combined treatment increased ALFF values mainly in the right supplementary motor area, right middle frontal gyrus, and right cerebellum, while reduced ALFF values mainly in the right post-central gyrus compared with pre-treatment. Compared with the LF-rTMS and control groups, the combined treatment increased ALFF values in the right cerebellum and reduced ALFF values mainly in the frontoparietal cortex. Improvements in the MAS score were positively correlated with the change in ALFF values in the right cerebellum (r = 0.698, P = 0.001) and the right supplementary motor area (r = 0.700, P = 0.001) after combined treatment. Transcranial combined with peripheral repetitive magnetic stimulation could improve spastic state and motor function in PSS patients, and this effect may be associated with altered cerebellar and frontoparietal cortical activity. http://www.chictr.org.cn/index.aspx, identifier ChiCTR1800019452.

The Effect of Neuromuscular Electrical Nerve Stimulation in the Management of Post-stroke Spasticity: A Scoping Review.

Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infraction or hemorrhage. One of the main symptoms in the majority of post-stroke patients is spasticity. The main therapeutic options of spasticity in post-stroke patients include pharmacological interventions, rehabilitation techniques, and surgery. This review aims to explore the effectiveness of Neuromuscular Electrical Stimulation (NMES) for post-stroke spastic hemiparetic limb (upper and lower). Thorough research of the PubMed Medline database was performed. Records were limited to clinical studies published between 01/01/2010 and 01/01/2022. The results were screened by the authors in pairs. The search identified 26 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. There were seven studies for spastic upper limbs and two for spastic lower limbs. The approaches investigated the effectiveness of electrical stimulation on post-stroke spastic upper or lower limb. Spasticity was measured through the modified Ashworth scale (MAS) and electromyographic recordings (EMG). In most cases, spasticity was decreased for at least two weekspost-intervention. In conclusion, NMES can be used either solo or in combination with different physical therapy modalities in order to produce optimal results, taking into consideration the specific needs and limitations of each individual patient. Based on the existing literature, as well as the limitations of the included studies, the authors believe that future studies on the subject of NMES in the management of post-stroke spasticity should focus on carefully examining each electrical parameter.

PO256 / #977 CLINICAL CASE: ULTRASOUND-GUIDED TREATMENT OF SPASTICITY WITH INVASIVE GALVANIC NEUROMODULATION IN POST-STROKE PATIENT: E-POSTER VIEWING

This clinical case shows the effectiveness of the ultrasoundguided use of intratissue percutaneous electrolysis (EPI) in its PICA-f combined mode with a specific neurorehabilitative treatment of upper extremity spasticity in post-stroke patients. The novelty of the study is that improvements appear after years of chronic sequels and these improvements last over time. We present the clinical case in a 5 min video with English subtitles.

Modelling Long-Term Outcomes and Mortality Risk for Post-Stroke Spasticity Patients on AbobotulinumtoxinA Treatment and Rehabilitation Therapy

Modelling Long-Term Outcomes and Mortality Risk for Post-Stroke Spasticity Patients on AbobotulinumtoxinA Treatment and Rehabilitation Therapy

Effects of High-Intensity Electromagnetic Stimulation on Reducing Upper Limb Spasticity in Post-Stroke Patients

Super Inductive System (SIS) stimulation of spastic limbs by tissue-induced electromagnetic field may have the effect of reducing spasticity and improving functionality in patients with post-stroke spasticity. The aim of the study was to evaluate two different protocols for the application of SIS on upper limb spasticity after stroke. We included 60 patients with post-stroke upper limb spasticity, who were randomized into two groups: the study group, with a 9 min application protocol (1 min for agonist muscles, 8 min for antagonistic muscles); and the control group, with an 8 min protocol applied only to the antagonistic muscles. The duration of therapy was 10 days, and the results were assessed using the Modified Ashworth Scale (MAS) and the Barthel Index. Both the MAS and the Barthel Index improved significantly after 10 days of treatment (p &lt; 0.001), but 30 days after the completion of therapy, there was an attenuation of the effects in both study groups. The study group had a significantly higher percentage of patients with improved MAS after 10 days (p = 0.004) and within 30 days (p &lt; 0.001) than the control group. An SIS protocol applied on both agonist and antagonist muscles has a more pronounced and longer lasting spasticity-reducing and improved functionality effect than its application on only antagonistic muscles.

Dry needling in stroke

Stroke causes acute neurological deficit which is an important cause of morbidity and mortality. Neurorehabilitation is an important dimension in the management of post-stroke deficits. Spasticity, pain, and neurological deficits are contributors to post-stroke disability. Dry needling (DN) is a technique commonly used in the management of myofascial pain. Recent evidence suggests its efficacy in the management of post-stroke disability. The descriptive review on the use of DN summarises the evidence for the management of post-stroke patients such as spasticity, balance, pain, functional outcome, tremor, and ultrasonographic evidence. The filiform needle is inserted into the target muscle until a local twitch response is obtained. The effects of DN are produced by the local stretch of the spastic muscle and afferent modulation of the reflex arc that decreases the excitability of the alpha motor neuron. The DN reduces muscle spasticity in post-stroke patients. The improved spasticity is translated to better functional outcomes and balance. The procedure is also shown to reduce pain including post-stroke shoulder pain. It is also shown to improve tremors in post-stroke patients. Ultrasonographic evidence of the beneficial effects of DN shows improved measures in the pennate angle and mean muscle thickness. Concurrent use of DN and electrical stimulation improve spasticity, the effect which may be seen for longer periods. DN is emerging as a useful and cost-effective technique in the management of post-stroke patients. The evidence for the use of DN in the management of post-stroke spasticity is high. However, more research is required to assess its efficacy in functional outcomes and other aspects of the stroke.

Effects of low-frequency repetitive transcranial magnetic stimulation combined with cerebellar continuous theta burst stimulation on spasticity and limb dyskinesia in patients with stroke

BackgroundRepetitive transcranial magnetic stimulation (rTMS) has been reported to treat muscle spasticity in post-stroke patients. The purpose of this study was to explore whether combined low-frequency rTMS (LF-rTMS) and cerebellar continuous theta burst stimulation (cTBS) could provide better relief than different modalities alone for muscle spasticity and limb dyskinesia in stroke patients.MethodsThis study recruited ninety stroke patients with hemiplegia, who were divided into LF-rTMS+cTBS group (n=30), LF-rTMS group (n=30) and cTBS group (three pulse bursts at 50 Hz, n=30). The LF-rTMS group received 1 Hz rTMS stimulation of the motor cortical (M1) region on the unaffected side of the brain, the cTBS group received cTBS stimulation to the cerebellar region, and the LF-rTMS+cTBS group received 2 stimuli as described above. Each group received 4 weeks of stimulation followed by rehabilitation. Muscle spasticity, motor function of limb and activity of daily living (ADL) were evaluated by modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores, respectively.ResultsThe MAS score was markedly decreased, FMA and MBI scores were markedly increased in the three groups after therapy than before therapy. In addition, after therapy, LF-rTMS+cTBS group showed lower MAS score, higher FMA and MBI scores than the LF-rTMS group and cTBS group.ConclusionMuscle spasticity and limb dyskinesia of the three groups are all significantly improved after therapy. Combined LF-rTMS and cTBS treatment is more effective in improving muscle spasticity and limb dyskinesia of patients after stroke than LF-rTMS and cTBS treatment alone.

Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis

Purpose We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement. Materials and methods In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl–Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis. Results A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19–31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26–47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group. Conclusions In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist. IMPLICATIONS FOR REHABILITATION Hierarchical cluster analysis focusing on the Fugl–Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function. Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function. The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation. In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.

Extracorporeal shock wave as adjuvant therapy for wrist and hand spasticity in post-stroke patients: a randomized controlled trial

BackgroundStroke patients often present with upper limb spasticity which impairs the functional status of patients. Recently, extracorporeal shock wave therapy (ESWT) is reported to be a safe, non-invasive, alternative treatment for spasticity. Many articles have been published on the effect of ESWT on lower limb spasticity, but only few of them had focused on upper limb spasticity, so the aim of this study is to evaluate the clinical and electrophysiological effect of ESWT on wrist and hand spasticity of chronic stroke patients and its impact on functional performance. In this monocentric study, forty chronic stroke patients with upper limb spasticity were recruited and randomly allocated into two groups. Both groups continued to receive conventional stroke rehabilitative program, while group I received three sessions of radial extracorporeal shock wave therapy (rESWT) 1 week apart.ResultsThere was a significant decrease in wrist and hand spasticity after treatment and at follow-up in group I compared to group II (Modified Ashworth Scale after rESWT 1.45 ± 0.16, 2.90 ± 0.18 and follow-up 1.55 ± 0.13, 3.00 ± .0.15 in groups I and II, respectively). Also, there was a significant improvement of wrist control and hand function after treatment and at follow-up in group I compared to group II (p < 0.001). The improvement of pinch grip was noticed at follow-up with a significant difference relative to baseline in group I (p < 0.05). Hmax/Mmax ratio was significantly decreased at follow-up in group I compared to group II (p < 0.001).ConclusionESWT is a valuable adjuvant treatment for spasticity of the hand and wrist in stroke patients which is reflected as improvement of functional activity.Trial registrationClinicalTrials.gov, NCT04312581. Registered on 18 March 2020.

Clinical evaluation and monitoring of the effect of extracorporeal shockwave therapy in sub-acute and chronic post-stroke spasticity patients

IntroductionTo evaluate the efficacy and maintenance of extracorporeal shockwave therapy (ESWT) in sub-acute and chronic post-stroke spasticity patients in the Suez Canal region.MethodsAn interrupted time series study was conducted; 82 patients were recruited in accordance with the defined inclusion and exclusion criteria. They were divided into 2 subgroups depending on the stroke duration: a sub-acute group (35 patients) and a chronic group (47 patients). ESWT was applied over knee and ankle flexor muscle belly with the following setup parameters: energy: 0.068–0.093 mJ/mm; frequency: 5 Hz; number of shots: 1500. Modified Ashworth score, clonus score, 3-minute walk test, range of motion angle of both knee and ankle joint, and Fugl-Meyer Assessment were established at baseline, after the 1&lt;sup&gt;st&lt;/sup&gt; session, and at the 1&lt;sup&gt;st&lt;/sup&gt;, 4&lt;sup&gt;th&lt;/sup&gt;, and 8&lt;sup&gt;th&lt;/sup&gt; week for the 2 groups.ResultsRegarding the sub-acute group, there was a statistically significant improvement in the modified Ashworth score, clonus score, 3-minute walk test, and range of motion angle of both knee and ankle joint after the 1&lt;sup&gt;st&lt;/sup&gt; session and after the 1&lt;sup&gt;st&lt;/sup&gt; week of intervention. The differences were not statistically significant after 4&lt;sup&gt;th&lt;/sup&gt; or 8&lt;sup&gt;th&lt;/sup&gt; week. The chronic group showed no statistically significant improvement after the 1&lt;sup&gt;st&lt;/sup&gt; session or in the 1&lt;sup&gt;st&lt;/sup&gt;, 4&lt;sup&gt;th&lt;/sup&gt;, or 8&lt;sup&gt;th&lt;/sup&gt; week assessment.ConclusionsESWT was more effective in treatment of spasticity in patients with sub-acute stroke compared with those with chronic stroke.

Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review.

During the last decades, many studies have been carried out to understand the possible positive effects of vibration therapy in post-stroke rehabilitation. In particular, the use of localized muscle vibration (LMV) seems to have promising results. The aim of this systematic review was to describe the use of LMV in post-stroke patients to improve motor recovery, reducing spasticity and disability in both upper and lower limb. A search was conducted on PubMed, Scopus, Pedro and REHABDATA electronic database. Only randomized controlled trials have been included, excluding no-localized vibratory treatments and other pathological conditions. Fourteen studies met the inclusion criteria and were included in this review. Collectively, the studies involved 425 stroke patients. Most studies included chronic stroke patients (ten) and treated only the upper limb (eleven). There is evidence that LMV therapy is effective in reducing spasticity and improving motor recovery, especially when associated with conventional physical therapy. LMV may be a feasible and safe tool to be integrated into traditional and conventional neurorehabilitation programs for post-stroke patients to reduce spasticity. Analysis of the available clinical trials do not allow us to indicate vibration therapy as effective in functional motor recovery, despite some studies showed encouraging results. Further studies, with larger size of homogeneous patients and with a shared methodology are needed to produce more reliable data, especially on the lower limb.

Home-Based Rehabilitation System for Stroke Survivors: A Clinical Evaluation.

Recently, a home-based rehabilitation system for stroke survivors (Baptista et al. Comput. Meth. Prog. Biomed. 176:111-120 2019), composed of two linked applications (one for the therapist and another one for the patient), has been introduced. The proposed system has been previously tested on healthy subjects. However, for a fair evaluation, it is necessary to carry out a clinical study considering stroke survivors. This work aims at evaluating the home-based rehabilitation system on 10 chronic post-stroke spastic patients. For this purpose, each patient carries out two exercises implying the motion of the spastic upper limb using the home-based rehabilitation system. The impact of the color-based 3D skeletal feedback, guiding the patients during the training, is studied. The Time Variable Replacement (TVR)-based average distance, as well as the average postural angle used in Baptista et al. (Comput. Meth. Prog. Biomed. 176:111-120 2019), are reported to compare the movement and the posture of the patient with and without showing the feedback proposals, respectively. Furthermore, three different questionnaires, specifically designed for this study, are used to evaluate the user experience of the therapist and the patients. Overall, the reported results suggest the relevance of the proposed system for home-based rehabilitation of stroke survivors.

The Effect of Dry Needling on Lower Limb Dysfunction in Poststroke Survivors

Background: Spasticity is one of the main complications in poststroke survivors leading to difficulties in walking and standing resulting in high levels of disability. Objective: The aim of the study was to investigate the effects of deep dry needling on lower limb dysfunction in poststroke spastic patients. Methods: A randomized clinical trial conducted in poststroke survivors who were assigned to one of 2 groups: Deep dry needling (intervention group) and sham dry needling (control group). The primary outcome measures were Modified Modified Ashworth Scale (MMAS) and functional tests (timed up and go test, 10-meter walk test). Secondary outcome measures were active ankle dorsiflexion range of motion (AROM), passive ankle dorsiflexion range of motion (PROM), single leg stance test, and Barthel index. All measurements were assessed at baseline (T0), immediately after the third session 1 week later (T1), and 1 month after the end of the intervention (T2). Results: We recruited 24 patients (71% male; mean age 57 ± 10 years; 26.4 ± 1.8 kg•m−2; time since event: 25.2 ± 12.5 months). There were significant improvements in MMAS, timed up and go test, 10-meter walk test, Barthel scale, and PROM (P < .05) in the intervention group compared to controls across the time-points. There were no significant improvements in AROM assessments (P > .05). Conclusions: Deep dry needling decreases muscle spasticity and improves lower limb function and gait speed in poststroke survivors.

Botulinum Toxin Type A for Upper Limb Spasticity in Poststroke Patients: A Meta-analysis of Randomized Controlled Trials

Background and Aim: Botulinum toxin type A is considered to be an effective antispasmodic in recent years. We assess the effectiveness of botulinum toxin type A for the treatment of poststroke spasticity in the upper extremity using a meta-analysis. Methods: We searched several databases including PubMed, Web of Science, Embase, and Cochrane database for relevant studies, up until October 2017. All randomized controlled trials of botulinum toxin type A treat poststroke upper limb spasticity published were included. The primary outcome measure was modified ashworth score at the elbow, finger and wrist, pain score, and barthel index. Results: Ten randomized controlled trials were identified and reported sufficient data for inclusion in the pooled analysis (n = 950). The results of modified ashworth score at different joints, pain score, barthel index showed no difference was found in the effectiveness of botulinum toxin type A compared with placebo in the treatment of the upper limb spasticity after stroke. But modified ashworth score at the elbow was improver in Dysport subgroups (standardized mean difference [SMD] = −.39, 95%CI = −.67 to −.10, P = .008) compared with Botox subgroups (SMD = .08, 95%CI = −.68 to .83, P = .84). Conclusions: The meta-analysis of these studies showed that the overall effectiveness of botulinum toxin type A does not seem to differ from placebo for poststroke Patients. But the meta-analysis yielded a favorable effect of Dysport compared with placebo based on 4 trials.

A Study to Co-Relate the Foot Posture Index, H/M Ratio and Spatial Gait Parameters in Post-Stroke Patients with Ankle Planter-Flexor(Calf) Spasticity- An Observational Study

Background: Stroke is one of the most commonly occurring disease which leads to hemiparesis along with other symptoms like spasticity, sensory disturbances etc. considered to be a part of positive signs of upper motor neuron (UMN) syndrome. Spasticity is a common disorder in patients with injury of the brain and spinal cord. Aim: The aim of the present study was to corelate the foot posture index, H/M ratio and spatial gait parameters in the assessment of poststroke patients with ankle planter-flexor spasticity. Methodology: It was an observational study which consisted of 32 chronic stroke patients. Both male and female with age group 45-70 years and stroke duration more than 3 months were included in the study. Spasticity was assessed using H/M ratio, foot posture was assessed by Foot Posture Index (FPI) and Step length and Stride length were taken. Result: Statistical analysis was done using SPSS 20 for windows. The correlation between Hmax/Mmax ratio, FPI, step length and Stride length were evaluated using Spearman’s correlation coefficient test. It was suggestive of strong negative correlation between FPI and Hmax/Mmax ratio, weak negative correlation between step length Hmax/Mmax ratio, strong negative co-relation between stride length and H/M ratio, moderate positive co-relation between Foot Posture Index (FPI) and step length and strong positive co relation between FPI and stride length. (p&lt;0.05) Conclusion: From the present study it can be concluded that there is co-relation between Spasticity, Foot posture and Gait parameters in planter-flexor spasticity in post-stroke patients. It can also be concluded that Hmax/Mmax ratio and FPI are needed to be assessed in every post stroke patient as it has influence on Gait parameters such as step length and stride length.

Spasticity Assessment Based on the Maximum Isometrics Voluntary Contraction of Upper Limb Muscles in Post-stroke Hemiplegia

Background: The assessment of muscle properties is an essential prerequisite in the treatment of post-stroke patients with limb spasticity. Most existing spasticity assessment approaches do not consider the muscle activation with voluntary contraction. Including voluntary movements of spastic muscles may provide a new way for the reliable assessment of muscle spasticity.Objective: In this study, we investigated the effectiveness and reliability of maximum isometrics voluntary contraction (MIVC) based method for spasticity assessment in post-stroke hemiplegia.Methods: Fourteen post-stroke hemiplegic patients with arm spasticity were asked to perform two tasks: MIVC and passive isokinetic movements. Three biomechanical signals, torque, position, and time, were recorded from the impaired and non-impaired arms of the patients. Three features, peak torque, keep time of the peak torque, and rise time, were computed from the recorded MIVC signals and used to evaluate the muscle voluntary activation characteristics, respectively. For passive movements, two features, the maximum resistance torque and muscle stiffness, were also obtained to characterize the properties of spastic stretch reflexes. Subsequently, the effectiveness and reliability of the MIVC-based spasticity assessment method were evaluated with spearman correlation analysis and intra class correlation coefficients (ICCs) metrics.Results: The results indicated that the keep time of peak torque and rise time in the impaired arm were higher in comparison to those in the contralateral arm, whereas the peak torque in the impaired side was significantly lower than their contralateral arm. Our results also showed a significant positive correlation (r = 0.503, p = 0.047) between the keep time (tk) and the passive resistant torque. Furthermore, a significantly positive correlation was observed between the keep time (tk) and the muscle stiffness (r = 0.653, p = 0.011). Meanwhile, the ICCs for intra-time measurements of MIVC ranged between 0.815 and 0.988 with one outlier.Conclusion: The findings from this study suggested that the proposed MIVC-based approach would be promising for the reliable and accurate assessment of spasticity in post-stroke patients.