Spasticity In Stroke Patients Research Articles

Electrophysiological evidence of dry needling efficacy on spasticity in poststroke patients: A randomized control trial

Abstract: CONTEXT: Therapists use dry needling (DN) to treat myofascial trigger points and various pain conditions. Need for study: A gap analysis showed that more information about how DN works on spastic muscles through alpha motor neurofiring and what role it plays in clinical and functional outcomes. Currently, the objective evidence for the usefulness of DN in neurological diseases is required. AIMS: The purpose of this research was to examine how DN affects spasticity in stroke patients using the H reflex and a Modified Tardieu Scale (MTS). SETTINGS AND DESIGN: We conducted a randomized controlled trial. We randomly assigned 81 stroke survivors to one of two groups: one group underwent six sessions of DN over the muscles with conventional treatment, whereas the other group received conventional care. We assessed spasticity using the H reflex and the MTS. We analyzed all outcome measures before, after, and 2 weeks later names as H1, H2, H3 and T1, T2, and T2 receptivity. RESULTS: After the intervention, people who received DN had improvement in spasticity. H3-H1 is statistically significant (P = 0.42) in the experimental group against the control group. T3-T1 and T2-T3 are statistically significant (P = 0.00) in the experimental group compared to the control group. CONCLUSIONS: The DN is effective for lowering spastic muscle tone and local muscle stiffness. This could be because DN diminishes the nodular zone of spastic muscle and reduces the firing of alpha motor neurons. These findings are very promising in terms of lowering spasticity.

Brain state-dependent repetitive transcranial magnetic stimulation for motor stroke rehabilitation: a proof of concept randomized controlled trial.

In healthy subjects, repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1) demonstrated plasticity effects contingent on electroencephalography (EEG)-derived excitability states, defined by the phase of the ongoing sensorimotor μ-oscillation. The therapeutic potential of brain state-dependent rTMS in the rehabilitation of upper limb motor impairment post-stroke remains unexplored. Proof-of-concept trial to assess the efficacy of rTMS, synchronized to the sensorimotor μ-oscillation, in improving motor impairment and reducing upper-limb spasticity in stroke patients. We conducted a parallel group, randomized double-blind controlled trial in 30 chronic stroke patients (clinical trial registration number: NCT05005780). The experimental intervention group received EEG-triggered rTMS of the ipsilesional M1 [1,200 pulses; 0.33 Hz; 100% of the resting motor threshold (RMT)], while the control group received low-frequency rTMS of the contralesional motor cortex (1,200 pulses; 1 Hz, 115% RMT), i.e., an established treatment protocol. Both groups received 12 rTMS sessions (20 min, 3× per week, 4 weeks) followed by 50 min of physiotherapy. The primary outcome measure was the change in upper-extremity Fugl-Meyer assessment (FMA-UE) scores between baseline, immediately post-treatment and 3 months' follow-up. Both groups showed significant improvement in the primary outcome measure (FMA-UE) and the secondary outcome measures. This included the reduction in spasticity, measured objectively using the hand-held dynamometer, and enhanced motor function as measured by the Wolf Motor Function Test (WMFT). There were no significant differences between the groups in any of the outcome measures. The application of brain state-dependent rTMS for rehabilitation in chronic stroke patients is feasible. This pilot study demonstrated that the brain oscillation-synchronized rTMS protocol produced beneficial effects on motor impairment, motor function and spasticity that were comparable to those observed with an established therapeutic rTMS protocol. ClinicalTrials.gov, identifier [NCT05005780].

Long-Term Enhancement of Botulinum Toxin Injections for Post-Stroke Spasticity by Use of Stretching Exercises-A Randomized Controlled Trial.

Botulinum toxin A (BONT/A) injections play a central role in the treatment of upper limb spasticity in stroke patients. We proposed structured stretching exercises to enhance the effect of post-stroke spasticity relief of the upper limbs following BONT/A injections. A total of 43 patients who had a stroke with grade 2 spasticity or higher on the Modified Ashworth Scale (MAS) in their upper-limb muscles were randomly assigned to the intervention (n = 21) or control group (n = 22). The former received structured stretching exercises after their BONT/A injections for 20 min, 5 days per week, for 6 months at a hospital, while the others conducted self-stretching exercises at home. The outcome measures were assessed before the intervention (T0) and after three (T1) and six months (T2). Significantly greater improvements in the MAS scores of the elbows, wrists, and fingers were found in the intervention group's patients at T1 and T2. The behavioral outcome measures, including shoulder pain, activities of daily living, and quality of life, and our electrophysiological studies also showed a significantly higher enhancement in this patient group. In conclusion, the structured stretching exercises plus BONT/A injections for six months showed a superior effect in relieving post-stroke upper-limb spasticity compared to self-stretching exercises.

Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke.

This article aimed to explore the rehabilitation efficacy of intelligent rehabilitation training systems in hemiplegic limb spasms after stroke and provided more theoretical basis for the application of intelligent rehabilitation systems in the rehabilitation of hemiplegic limb spasms after stroke. To explore the rehabilitation efficacy of intelligent rehabilitation training system (RTS for short here) in post-stroke hemiplegic limb spasms, this study selected 99 patients with post-stroke hemiplegic limb spasms admitted to a local tertiary hospital from March 2021 to March 2023 as the research subjects. This article used blind selection to randomly divide them into three groups: control group 1, control group 2, and study group, with 33 patients in each group. Control group 1 used a conventional RTS, group 2 used the brain-computer interface RTS from reference 9, and research group used the intelligent RTS from this article. This article compared the degree of spasticity, balance ability score, motor function score, and daily living activity score of three groups of patients after 10 weeks of treatment. After 10 weeks of treatment, the number of patients in the study group with no spasms at level 0 (24) was significantly higher than the number of patients in group 1 (7) and group 2 (10), with a statistically significant difference (P < 0.05); In the comparison of Barthel index scores, after ten weeks of treatment, the total number of people in the study group with scores starting at 71-80 and 81-100 was 23. The total number of people in the score range of 71-80 and 81-100 in group 1 was 5, while in group 2, the total number of people in this score range was 8. The study group scored considerably higher than the control group and the difference was found to be statistically relevant (P < 0.05). In the Berg balance assessment scale and motor function assessment scale, after 10 weeks of treatment, the scores of the study group patients on both scales were significantly higher than those of group 1 and group 2 (P < 0.05). The intelligent RTS is beneficial for promoting the improvement of spasticity in stroke patients with hemiplegic limb spasms, as well as improving their balance ability, motor ability, and daily life activities. Its rehabilitation effect is good.

Effects of Additional Radial Shock Wave Therapy on Spasticity of Upper Extremity Muscle

Background: Spasticity is one of the most common problems and greatly interferes with the functional capacity of chronic stroke patients. The most commonly used treatments are infrared therapy and stretching exercises, but they have not reduced spasticity effectively. The addition of Radial Shock Wave Therapy (RSWT) was expected to be more effective in reducing spasticity in chronic stroke patients. Aim: The purpose of this study is to prove that the addition of RSWT is more effective reducing spasticity of chronic stroke patients. Material and methods: This study was a simple randomized controlled pre- and post-experimental design. The total sample of 30 chronic spastic stroke patients with the Modified Asworth Scale 2-3 was divided into 2 groups: the study group and the control group. RSWT was provided once a week to the muscle belly of the flexor wist muscle on the ventral aspect of the forearm, the intrinsic muscle of the hand, and flexor digitorum tendon. They were added to infrared therapy and stretching exercises in the upper extremities which are provided three times a week for six weeks consecutively. The level of spasticity was measured by the Tardieu Scale, which measures quality and angle of resistance at the beginning and end of the study. Results: A significantly greater reduction was obtained (p&lt;0.05) from the level of spasticity measured by the Tardieu Scale, both on the quality and angle of resistance, in the study group. Conclusion: The addition of RSWT has been shown to have a greater reduction in spasticity in upper extremity muscle in chronic stroke patients.

Treatment effects of low-frequency repetitive transcranial magnetic stimulation combined with motor relearning procedure on spasticity and limb motor function in stroke patients.

Limb paralysis, which is a sequela of stroke, limits patients' activities of daily living and lowers their quality of life. The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with a motor relearning procedure (MRP) on motor function and limb spasticity in stroke patients. Stroke patients were randomly divided into a combined treatment group (rTMS + MRP) and a control group (MRP) (n = 30 per group). The control group was given MRP in addition to conventional rehabilitation, and the combined treatment group was given 1 Hz rTMS combined with MRP. The treatment efficacy was assessed by the modified Ashworth scale (MAS), Fugl-Meyer motor function scale, and motor evoked potential (MEP) testing. After 4 weeks of treatment, the Brunnstrom score, Fugl-Meyer lower extremity motor function, and Fugl-Meyer balance function were significantly higher in the combination treatment group compared to the control group, while the MAS score was lower in the combination treatment group compared to the control group. The MEP extraction rate was higher in the combined treatment group compared to the control group, while the threshold and central motor conduction time (CMCT) were lower in the combined treatment group compared to the control group. Low-frequency rTMS combined with MRP had better efficacy on spasticity and motor function in stroke patients with hemiparesis than MRP alone.

The Effectiveness of High Intensity Electromagnetic Stimulation in Spastic Stroke Patients

In stroke patients, spasticity level allows to predict the patient’s rehabilitation outcome. Objective: To evaluate the anti-spastic effectiveness of high intensity electromagnetic stimulation (HIES) in stroke patients. Methods: Twenty (n=20) spastic stroke patients were assigned randomly into two groups; the study participants were briefed about the aim &amp; methodology of the study &amp; written consent were taken. Ten therapy sessions were given to the stroke’s patient spastic muscles in the treatment group (TG) with HIES, while in the controlled group (CG) 10 electrotherapy session along with kinesiotherapy was delivered. The outcome measures of the study were MAS (Modified Ashworth scale) &amp; Barthel index (BI) was used as, for spasticity and for the patient’s quality life evaluation, respectively. After the one-month therapeutic plan results were obtained &amp; compared based on the pre-treatment score &amp; post-treatment score on the afore-mentioned specified outcome measures. Results: The analysis of data shows that treatment group score improved significantly, up to 68% &amp; similarly, spasticity decreased from 2.86±0.075 in the beginning to 0.58±0.86 points on MAS, while on the other hand, control group score up to 31% enhanced &amp; on the MAS scale, spasticity diminished from 2.45±0.57 in the start to 1.49±0.87 points. As per Barthel index, improvement for CG &amp; TG was 72% &amp; 80% respectively. Conclusions: This study results shows that high intensity electromagnetic stimulation (EMS) is highly effective in the reduction of stroke-specific spasticity.

A Comprehensive Review of the Effects of Extracorporeal Shock Wave Therapy on Stroke Patients: Balance, Pain, Spasticity.

Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient's condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits.

The Effects of Shock Wave Therapy on Spasticity and Walking Ability in People with Stroke: A Comparative Study of Different Application Sites

This study was conducted to investigate the effects of extracorporeal shock wave therapy on the improvement of walking ability through a reduction in spasticity in stroke patients. Thirty-three patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to three groups. The patients were divided into experimental group 1 in which shock waves were applied to the muscle-tendon junction, experimental group 2 in which shock waves were applied to the middle of the muscle, and experimental group 3 in which shock waves were applied to both the muscle-tendon junction and the middle of the muscle. The MAS was used to evaluate spasticity in the subjects, and the Dartfish software was used to measure knee and ankle angles during heel-off when walking. Based on the results of the study, a significant decrease in spasticity and increased joint angles were found in experimental groups 1 and 3 compared to experimental group 2, and the change in joint angle was significantly greater in experimental group 3 than in experimental groups 1 and 2. These results indicate that treatment effect may vary depending on the application site of the shock wave, and to obtain the best treatment effect, the shock wave should be applied to both the muscle-tendon junction and the middle part of the muscle.

RELATIONSHIP BETWEEN LENGTH OF STAY FOR REHABILITATION AND FUNCTIONAL OUTCOMES IN STROKE PATIENTS

Background: The comorbidities, age and disability of the stroke patients may influence the rehabilitation period. In the rehabilitation process of stroke patients, the length of stay in hospital is important because of its economic and psychological effects. Objective: The purpose of this study was to evaluate whether there is a relationship between the length of hospital stay for rehabilitation and functional outcomes of stroke patients. Methods: The medical records of 97 patients who were admitted to a rehabilitation unit were analyzed retrospectively. The functional output, the level of spasticity, and motor development at admission and discharge were determined using the Functional Independence Measure instrument, the Modified Ashworth Scale, and the Brunnstrom test, respectively. Based on the length of hospital stay, patients were divided into two groups: hospital stays ≤ 3 months (Group 1) and &gt; 3 months (Group 2). Clinical features and functional output were then compared between the groups. Results: The gain of Functional Independence Measure instrument -total and Functional Independence Measure instrument-motor scores were significantly higher in Group 1 (n=74) (p &lt; 0.05) than Group 2 (n=23). The Modified Ashworth Scale scores of the upper extremities and of the lower extremities at admission and discharge were significantly higher in Group 2 (p &lt; 0.05 for all). Conclusion: The findings of this study revealed that a prolonged length of hospital stay has no greater positive effect on improvement of functional outcomes and spasticity of stroke patients.

Prevalence and factors influencing the occurrence of spasticity in stroke patients: a retrospective study

ABSTRACT Background To describe the prevalence and clinical characteristics of stroke patients withoutspasticity, and simultaneously analyse the factors related to post-strokenon-spasticity. Methods In this retrospective study, information on patients hospitalized in thedepartment of rehabilitation, Daping Hospital, over the past eight years wascollected. Demographic information and clinical characteristics werestatistically analysed. Results A total of 819 stroke patients with an average age of 61.66±13.72 years old wereanalysed, including 561 males (68.5%), and 258 females (31.5%). In this study,201 (24.5%) patients developed spasticity, and 618 (75.5%) patients had nospasticity. Patients without spasticity were older than those with spasticity.Patients with ischemic stroke and mild functional impairment were also lesslikely to have spasticity. Post-stroke spasticity may be related to age [oddratio (OR): 0.982; 95% CI:0.965 to 0.999; P = 0.042), hemorrhagic stroke (OR:1.643; 95% CI: 1.029 to 2.626; P = 0.038), National Institute of Health StrokeScale (NIHSS) Scores (OR: 1.132; 95% CI: 1.063 to 1.204; P = 0.000]. Conclusion Most stroke patients do not have spasticity, especially the elderly, patients withischemic stroke, and those with mild functional impairment, suggesting that notall upper motor nerve injuries lead to increased muscle tension. For youngindividuals, patients with hemorrhagic stroke, and those with moderate tosevere functional impairment, close follow-up is necessary to identify theoccurrence of spasticity early on and then formulate corresponding rehabilitationstrategies for prompt intervention.

A Clinical Trial Protocol to Compare the Effect of Dry Needling and Acupoint Dry Needling on Wrist Flexor Spasticity after Stroke.

Stroke is the leading cause of disability in adults worldwide, with spasticity after stroke being one of the more common complications. Dry needling (DN) has been demonstrated to decrease spasticity in stroke patients, although its effects on improving function remain unclear. The purpose of this study protocol is to compare the short-term effects of DN versus acupoint DN on wrist flexor spasticity and upper extremity function in patients with stroke. A double-blind, randomized clinical trial will be conducted to include patients with stroke and upper extremity spasticity and functional disability. Twenty-four patients with stroke will be randomly assigned to either the DN or acupoint DN (DNap) group. These groups will receive three DN sessions during a one-week period of the wrist flexor muscles or at the LI4 & TE5 acupoints, respectively. The primary outcome measure is the Modified Modified Ashworth Scale (MMAS) of spasticity. The secondary outcomes are the Fugl-Meyer Assessment of motor function (FMA) and the goniometry to assess the active and passive range of motion of the wrist. Data will be collected at baseline, immediately after the end of three sessions DN, and at a one-week follow-up visit. The results of this comparative study will help to determine the more effective method for reducing spasticity and improving motor function in patients with stroke.

Efficacy and Safety of Botulinum Toxin Type A (NABOTA) for Post-stroke Upper Extremity Spasticity: A Multicenter Phase IV Trial.

ObjectiveTo evaluate the efficacy and safety of Daewoong botulinum toxin type A (NABOTA) after its launch in South Korea.MethodsThis prospective, multicenter, open-label phase IV clinical trial included 222 patients with stroke. All patients visited the clinic at baseline and at weeks 4, 8, and 12 after injection of upto 360 units of NABOTA into the wrist, elbow, and finger flexor muscles at the first visit. The primary outcome was the change in Modified Ashworth Scale (MAS) score for the wrist flexor muscles between baseline and week 4. The secondary outcomes were the changes in MAS, Disability Assessment Scale (DAS), and Caregiver Burden Scale (CBS) scores between baseline and each visit, and the Global Assessment Scale (GAS) score at week 12.ResultsThere was a statistically significant decrease in the MAS score for the wrist flexors between baseline and week 4 (−0.97±0.66, p<0.001). Compared with baseline, the MAS, DAS and CBS scores improved significantly during the study period. The GAS was rated as very good or good by 86.8% of physicians and by 60.0% of patients (or caregivers). The incidence of adverse events was 14.4%, which is smaller than that in a previous trial.ConclusionNABOTA showed considerable efficacy and safety in the management of upper limb spasticity in stroke patients.

Effects of Kinesio Taping in Management of Spasticity in Stroke Patients

Spasticity after stroke may be a common complication in patients with stroke and leads to impaired hand function after stroke. Objective: To examine the impacts of kinesis-taping on managing spasticity of upper extremity hence improving function. Methods: A randomized managed trial have a look at turned into performed in Al-Nafees medical institution Islamabad. Thirty Participants with stroke inside six months have been randomly enrolled into kinesis taping (Kt) organization or traditional organization. The tape turned into carried out on three days in line with week for 48/seventy-two hours for four weeks. The number one final result turned into muscle spasticity as measured through the Modified Ashworth Scale (MAS). Measurements have been taken earlier than the intervention, at once after the intervention (2nd week) and later after the intervention (fourth week). Results: Within the group comparison, in the KT group, significant differences were noted in MAS at the second and fourth week (P=0.00-0.00), as compared to control group at the second and fourth week (P=0.21-0.00). Between-group comparisons showed a significant difference at the fourth week (P=0.00). Conclusions: Kinesio taping may provide some benefit by reducing spasticity and improving motor performance of the affected hand in patients with subacute stroke. Kinesio Tape may be an option for clinicians to effectively manage spasticity after stroke.

Brain oscillatory activity correlates with the relief of post-stroke spasticity following focal vibration.

Some evidence has demonstrated that focal vibration (FV) contributes to the relief of post-stroke spasticity (PSS). Although the changes of cortical activity correlating with the relief of PSS induced by FV have been explored using transcranial magnetic stimulation, brain oscillatory activity during the above-mentioned process has not been fully understood. The main purpose of this study is to explore the correlation between the changes in brain oscillatory activity and the relief of PSS following FV. A clinical experiment was carried out, in which FV (87 Hz, 0.28 mm) was applied over the antagonist muscle's belly of the spastic muscle of ten chronic spastic stroke patients. An electroencephalogram was recorded following before-FV and three sessions of FV. Muscle properties to assess the relief of PSS were tested before-FV and immediately after three sessions of FV. EEG analysis has shown that FV can lead to the significant decrease in the relative power at C3 and C4 in the beta1 (13, 18 Hz), as well as C3 and C4 in the beta3 band (21, 30 Hz), indicating the activation of primary sensorimotor cortex (S1-M1). Muscle properties analysis has shown that, in the state of flexion of spastic muscle, muscle compliance and muscle displacement of the spastic muscle significantly increased right after FV, illustrating the relief of the spasticity. Moreover, the increase of muscle compliance is positively correlated with the reduction of difference index of the activation of bilateral S1-M1. This finding indicated that the relief of PSS can be associated with the activation of bilateral S1-M1 where the activation of the ipsilesional S1-M1 was higher than that of the contralesional one. This study showed the brain oscillatory activity in the bilateral S1-M1 correlating with the relief of PSS following FV, which could contribute to establishing cortex oscillatory activity as a biomarker of the relief of PSS and providing a potential mechanism explanation of the relief of PSS.

The Effects of the Biceps Brachii and Brachioradialis on Elbow Flexor Muscle Strength and Spasticity in Stroke Patients.

Objective Muscle weakness and spasticity are common consequences of stroke, leading to a decrease in physical activity. The effective implementation of precision rehabilitation requires detailed rehabilitation evaluation. We aimed to analyze the surface electromyography (sEMG) signal features of elbow flexor muscle (biceps brachii and brachioradialis) spasticity in maximum voluntary isometric contraction (MVIC) and fast passive extension (FPE) in stroke patients and to explore the main muscle groups that affect the active movement and spasticity of the elbow flexor muscles to provide an objective reference for optimizing stroke rehabilitation. Methods Fifteen patients with elbow flexor spasticity after stroke were enrolled in this study. sEMG signals of the paretic and nonparetic elbow flexor muscles (biceps and brachioradialis) were detected during MVIC and FPE, and root mean square (RMS) values were calculated. The RMS values (mean and peak) of the biceps and brachioradialis were compared between the paretic and nonparetic sides. Additionally, the correlation between the manual muscle test (MMT) score and the RMS values (mean and peak) of the paretic elbow flexors during MVIC was analyzed, and the correlation between the modified Ashworth scale (MAS) score and the RMS values (mean and peak) of the paretic elbow flexors during FPE was analyzed. Results During MVIC exercise, the RMS values (mean and peak) of the biceps and brachioradialis on the paretic side were significantly lower than those on the nonparetic side (p < 0.01), and the RMS values (mean and peak) of the bilateral biceps were significantly higher than those of the brachioradialis (p < 0.01). The MMT score was positively correlated with the mean and peak RMS values of the paretic biceps and brachioradialis (r = 0.89, r = 0.91, r = 0.82, r = 0.85; p < 0.001). During FPE exercise, the RMS values (mean and peak) of the biceps and brachioradialis on the paretic side were significantly higher than those on the nonparetic side (p < 0.01), and the RMS values (mean and peak) of the brachioradialis on the paretic side were significantly higher than those of the biceps (p < 0.01). TheMAS score was positively correlated with the mean RMS of the paretic biceps and brachioradialis (r = 0.62, p = 0.021; r = 0.74, p = 0.004), and the MAS score was positively correlated with the peak RMS of the paretic brachioradialis (r = 0.59, p = 0.029) but had no significant correlation with the peak RMS of the paretic biceps (r = 0.49, p > 0.05). Conclusions The results confirm that the biceps is a vital muscle in active elbow flexion and that the brachioradialis plays an important role in elbow flexor spasticity, suggesting that the biceps should be the focus of muscle strength training of the elbow flexors and that the role of the brachioradialis should not be ignored in the treatment of elbow flexor spasticity. This study also confirmed the application value of sEMG in the objective assessment of individual muscle strength and spasticity in stroke patients.

Reliability and diagnostic accuracy of corrected slack angle derived from 2D-SWE in quantitating muscle spasticity of stroke patients

BackgroundTo explore the feasibility of corrected slack angle acquired from two-dimensional shear wave elastography (2D-SWE) for quantitating the spasticity of medial gastrocnemius (MG) in stroke patients.MethodsConsecutive stroke patients with spastic MG and matched healthy controls were recruited. Intra- and interobserver reliability of 2D-SWE measurement were evaluated, and the correlation between corrected slack angle and modified Ashworth scale (MAS) score was examined. The corrected slack angle before and after botulinum toxin A (BoNT-A) injection was compared and its diagnostic performance in classifying the severity of spasticity were assessed with receiver operating characteristic (ROC) curve analysis.ResultsThe intra- (0.791 95% CI 0.432–0.932) and interobserver (0.751 95% CI 0.382–0.916) reliability of slack angle acquired with 2D-SWE were good. Significant correlation was found between corrected slack angle and MAS score (R = − 0.849, p < 0.001). The corrected slack angle increased after BoNT-A injection. The cutoff value of MAS ≥ 3 had the highest sensitivity (100%) and specificity (93.33%). The positive predictive value (PPV) for classification of MAS ≥ 1+ and the negative predictive value (NPV) for classification of MAS ≥ 3 were greater than 90%.Conclusion2D-SWE was a reliable method to quantitate the post-stroke spasticity. The corrected slack angle had advantage in classifying the severity of spasticity, especially in early identification of mild spasticity and confirmation of severe spasticity.

Quantitative Elbow Spasticity Measurement Based on Muscle Activation Estimation Using Maximal Voluntary Contraction

Conventional measurement of spasticity in stroke patients, e.g., modified Ashworth scale (MAS), has been challenged about its reliability issues. Surface electromyography (sEMG) has been used to identify neuromuscular abnormalities since it directly measures electrical activity in the muscle, however its performance is affected by the placement of electrodes and crosstalk, and it cannot detect the activities of deep muscles. This study proposes a novel spasticity measurement method by quantifying the difference between the impaired and unaffected sides in the elbow maximal voluntary contraction (MVC) task. Five inertial measurement units (IMUs) and a force sensor were used to capture the movement dynamics for the MVC test, by which a neuromusculoskeletal model is established to estimate the muscle activation using the inverse dynamics and optimization techniques. Normalized keeping time of peak activation is a quantitative feature that identifies the disparity between the impaired and unaffected side in the MVC test is defined as a measurement of spasticity. Six stroke patients and eight healthy subjects were recruited to evaluate the muscle activation estimation model. The outcomes of our measurement for patients were compared with the spasticity rated by an experienced physical therapist (PT) using MAS. The estimated muscle activation shows promising accuracy compared to the sEMG profiles (patients: mean <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$R^{2} \approx 0.705$ </tex-math></inline-formula> ; healthy: mean <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$R^{2} \approx 0.91$ </tex-math></inline-formula> ). The outcomes of our approach are highly correlated with MAS (Pearson’s <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$r \approx 0.96$ </tex-math></inline-formula> , <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$p &lt; 0.05$ </tex-math></inline-formula> ). These findings indicate that our approach can provide a quantitative measure of spasticity and can be used as a complementary measurement along with the existing clinical methods. This approach will also enhance the efficiency of upper limb robot-aided rehabilitation in stroke patients.

Splint efficacy in chronic post-stroke spasticity: a pilot study

IntroductionHand spasticity after stroke is a serious issue and may lead to hygiene problems, range of motion limitations, or contractures. Hand splints are often used to reduce spasticity and prevent movement limitations; however, there is little research available on the efficacy of splints in spasticity. The study aimed to investigate the efficacy of a reflex inhibitory splint (RIS) for upper extremity spasticity in stroke patients by using clinical and electrophysiological studies.MethodsStroke patients with elbow and hand spasticity were allocated into 2 groups. The splint group (&lt;i&gt;n&lt;/i&gt; = 16) wore RIS. The control group (&lt;i&gt;n&lt;/i&gt; = 13) did not wear any upper extremity splint. Both groups received the same rehabilitation program during this period. They were evaluated for motion in the upper extremity with the Brunnstrom scale and Fugl-Meyer upper extremity scale. Electrophysiological measurements showing motor neuron excitability such as the ratio between the maximum amplitude of H-reflex and the maximum amplitude of M-response (H&lt;sub&gt;max&lt;/sub&gt;/M&lt;sub&gt;max&lt;/sub&gt; ratio), H-reflex latency, and F-wave persistence and latency were also studied. All clinical and electrophysiological measurements were performed in both groups on days 0 and 15.ResultsAt the end of the treatment, elbow and finger flexion tonus decreased and active wrist extension angle increased in the splint treatment group compared with both baseline and the control group. Compared with the pre-treatment status, a correlation was detected between the H&lt;sub&gt;max&lt;/sub&gt;/M&lt;sub&gt;max&lt;/sub&gt; ratio and the wrist flexion tonus in the splint group.ConclusionsRIS may be useful for the management of post-stroke upper-limb spasticity.

Ultrasound-guided ethyl alcohol injection to the deep branch of the ulnar nerve to relieve hand spasticity in stroke patients: A case series.

Hand spasticity with a flexor pattern is a common problem affecting stroke patients and can result in pain, contractures, esthetic concerns, skin maceration, and overall loss of function. Poststroke (≥6 months) hemiparetic adult patients having a Modified Ashworth Scale (MAS) score of ≥1 for metacarpophalangeal flexion and thumb adduction spasticity were selected to receive an ultrasound-guided 20% ethyl alcohol block performed perineurally at the level of the deep branch of the ulnar nerve. Their MAS scores were evaluated pretreatment at 1 month and the change in MAS scores was assessed using Wilcoxon’s test. The threshold for statistical significance was set at p < 0.05. The mean MAS score for the flexor muscles of the 5 MCP joints and for thumb adduction was reduced from 3.3 ± 0.5 at pretreatment to 0.9 ± 0.5 at 1 month after the injection for the 10 patients. One month after the injection, the MAS scores were significantly reduced compared with those at pretreatment (p < 0.001), without complications. These are encouraging results showing that ultrasound-guided alcohol blocks of the deep branch of the ulnar nerve are safe and can help chronic stroke patients with metacarpophalangeal flexion and thumb adduction spasticity at 1 month.