Effects of Acupuncture Treatment on Lower Limb Spasticity in Patients Following Hemorrhagic Stroke: A Pilot Study

2019 ◽  
Vol 81 (1-2) ◽  
pp. 5-12 ◽  
Author(s):  
Hai-Qiao Wang ◽  
Mei Hou ◽  
Chun-Ling Bao ◽  
Liang Min ◽  
He Li
Keyword(s):  
Lower Limb ◽  
Conventional Treatment ◽  
Hemorrhagic Stroke ◽  
Acupuncture Treatment ◽  
Motor Evoked Potential ◽  
Intracortical Inhibition ◽  
Control Group ◽  
Antagonist Muscles ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Background and Purpose: Lower limb spasticity is often a significant problem in stoke rehabilitation. The purpose of this study was to investigate the effects of acupuncture treatment on lower limb spasticity in patients following hemorrhagic stroke. Methods: Fifty-nine patients following hemorrhagic stroke were randomized to receive acupuncture treatment combined with conventional treatment (treatment group [TG]) or conventional treatment only (control group [CG]). Acupuncture treatments were given in 24 sessions over 4 weeks. Blinded evaluation was based on Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio as the primary outcomes. In addition, Fugl-Meyer Assessment (FMA), Barthel Index (BI), motor evoked potential (MEP) and surface integrated electromyogram (IEMG) were employed as the secondary outcomes. All the evaluations were performed at 14 and 28 days after the start of the treatment. Results: Compared with the CG, the TG showed a significantly greater over-time decrease in MAS for knee (p = 0.022) and ankle (p = 0.017), SICI (p = 0.000) and Hmax/Mmax ratio (p = 0.000). In all patients of TG, we found a greater improvement in lower-limb FMA and MEP but not in BI. IEMG show that TG obtained a greater reduction in spastic agonist muscles and a greater enhancement in spastic antagonist muscles. A significant correlation between a greater decrease in ankle MAS and a greater increase in SICI for spastic muscles was found (r = 0.390, p = 0.002). Conclusions: Acupuncture could improve the lower limb spasticity and motor function, thus providing a safe and economical approach for treating stroke patients. The potential mechanism underpinning the greater improvement may be attributed to a reshape of corticospinal plasticity induced by acupuncture.

scholarly journals The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy classified on Gross Motor Function Classification System (GMFCS) levels III–V: a randomized and controlled clinical study

2020 ◽  
Author(s):  
Zhen Huan Liu ◽  
Shangsheng Dong ◽  
Chuntao Zhang ◽  
Yuan Zhou ◽  
Fang Huang ◽  
...  
Keyword(s):  
Lower Limb ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Pulsed Current ◽  
Electrical Nerve Stimulation ◽  
Limb Spasticity ◽  
Lower Limb Spasticity ◽  
Novel Strategy ◽  
Experimental Group

Abstract BackgroundIn the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III–V of the Gross Motor Function Classification System (GMFCS) with minimal side effects.Methods63 SCP children aged 2–12 years who were classified on levels III–V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz TENS, max 10 mA) for 30 min, followed by 30 min of physiotherapy daily for 12 weeks. The control group underwent physiotherapy only 30 mins per day for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed three days before and after treatment.ResultsWe found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p £ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group.ConclusionThese results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III–V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP.Trial registration: ChiCTR.org, ChiCTR1800020283, Registration22 December 2018, (URL: http://www.chictr.org.cn/edit.aspx?pid=33953&htm=4).

scholarly journals Combined Effects of Isokinetic Training and Botulinum Toxin Type A on Spastic Equinus Foot in Patients with Chronic Stroke: A Pilot, Single-blind, Randomized Controlled Trial

Toxins ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 210 ◽  
Author(s):  
Nicoletta Cinone ◽  
Sara Letizia ◽  
Luigi Santoro ◽  
Salvatore Facciorusso ◽  
Raffaella Armiento ◽  
...  
Keyword(s):  
Lower Limb ◽  
Stretch Reflex ◽  
Controlled Trial ◽  
Control Group ◽  
Isokinetic Dynamometer ◽  
Randomized Controlled ◽  
Limb Spasticity ◽  
Lower Limb Spasticity ◽  
Experimental Group ◽  
Single Blind

Botulinum toxin A (BoNT-A) has been shown effective for poststroke lower limb spasticity. Following injections, a wide range of multidisciplinary approach has been previously provided. The purpose of this pilot, single-blind, randomized controlled trial was to determine whether BoNT-A combined with a regime of a four-week ankle isokinetic treatment has a positive effect on function and spasticity, compared with BoNT-A alone. Secondly, the validity of the use of an isokinetic dynamometer to measure the stretch reflex at the ankle joint and residual strength has been investigated. Twenty-five chronic stroke patients were randomized to receive combined treatment (n = 12; experimental group) or BoNT-A alone (n = 13; control group). Outcome measures were based on the International Classification of Functioning, Disability and Health. An isokinetic dynamometer was also used for stretch reflex and strength assessment. Patients were evaluated at baseline (t0), after five (t1) and eight weeks after the injection (t2). The experimental group reported significantly greater improvements on lower limb spasticity, especially after eight weeks from baseline. Gait speed (10-m walk test) and walking capacity (6-min walking test) revealed statistically significantly better improvement in the experimental than in control group. Peak resistive ankle torque during growing angular velocities showed a significant reduction at the higher velocities after BoNT-A injections in the experimental group. Peak dorsiflexor torque was significantly increased in the experimental group and peak plantarflexor torque was significantly decreased in control group. Alternative rehabilitation strategies that combine BoNT-A and an intense ankle isokinetic treatment are effective in reducing tone and improving residual strength and motor function in patients with chronic hemiparesis.

scholarly journals The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy: a randomized and controlled clinical study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhenhuan Liu ◽  
Shangsheng Dong ◽  
Sandra Zhong ◽  
Fang Huang ◽  
Chuntao Zhang ◽  
...  
Keyword(s):  
Lower Limb ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Pulsed Current ◽  
Electrical Nerve Stimulation ◽  
Limb Spasticity ◽  
Lower Limb Spasticity ◽  
Novel Strategy ◽  
Experimental Group

Abstract Background In the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III–V of the Gross Motor Function Classification System (GMFCS) with minimal side effects. Methods Sixty-three SCP children aged 2–12 years, who were classified on levels III–V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz, max 10 mA) for 30 min, followed by 30 min of physiotherapy five times per week for 12 weeks. The control group underwent physiotherapy only 30 mins per day five times per week for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed 3 days before and after treatment. Results We found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p ≤ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group. Conclusion These results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III–V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP. Trial registration ChiCTR.org, ChiCTR1800020283, Registration: 22 December 2018 (URL: http://www.chictr.org.cn/showproj.aspx?proj=33953).

scholarly journals The Influence of Cryotherapy on the Lower Limb Spasticity for Children with Cerebral Palsy

2018 ◽  
Vol 2 (85) ◽  
Author(s):  
Saulė Sipavičenė ◽  
Antanas Damašauskas ◽  
Irina Klizienė ◽  
Gražina Krutulytė ◽  
Aiva Karpavičienė ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Lower Limb ◽  
Control Group ◽  
Gross Motor ◽  
Motor Functions ◽  
Physical Exercises ◽  
Children With Cerebral Palsy ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Research background and hypothesis. Cryotherapy could reduce spasticity for children with cerebral palsy.Research aim. The aim of this study was to determine the effect of cryotherapy on the lower limb spasticity for children with cerebral palsy.Research methods. Fourteen children with cerebral palsy spastic Diplegia aged 6–12 years were examined. The procedures of cryotherapy and physical therapy were applied to children in the test group (n = 7), and only physical therapy – for the members in the control group (n = 7). For all the subjects, the following procedures were performed before and after the research: foot extension measurements, the determination of the spasticity of flexors and selective foot motion, the estimation of balance and gross motor functions. Research  results.  After  physical  exercises  foot  extension  showed  improvement,  spasticity  of  foot  flexors reduced, foot selective movements, balance and gross motor functions improved. There was no statistical difference between the results in both groups.Discussion and conclusions. The influence of cryotherapy on the lower limb spasticity for children with cerebral palsy was not statistically significant.Keywords: spasticity, cryotherapy, physical exercises.

scholarly journals Using Surface Electromyography to Evaluate the Efficacy of Governor Vessel Electroacupuncture in Poststroke Lower Limb Spasticity: Study Protocol for a Randomized Controlled Parallel Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jingwen Li ◽  
Kaiqi Su ◽  
Jinjin Mei ◽  
Yiying Wang ◽  
Shuai Yin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Surface Electromyography ◽  
Controlled Trial ◽  
Therapeutic Drug ◽  
Control Group ◽  
Rehabilitation Treatment ◽  
Randomized Controlled ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Background. Lower limb spasticity is a common complication after stroke, which seriously affects the quality of life and rehabilitation of patients. There are different treatment methods for poststroke spasticity. It has been found in clinical practice that governor vessel electroacupuncture (GV-EA) can effectively relieve poststroke upper extremity spasticity, but the efficacy of treatment of lower extremity spasticity needs to be further verified. This study aims to design a randomized controlled trial to evaluate the efficacy of GV-EA in the treatment of poststroke lower limb spasticity. Methods/Design. This is a randomized, controlled trial. Patients (N = 177) will be randomized to receive routine therapeutic drug and rehabilitation treatment plus GV-EA (experimental group) or routine therapeutic drug and rehabilitation treatment plus EA (control group 1) or routine therapeutic drug and rehabilitation treatment (control group 2). All patients will receive 20 sessions of treatment for 4 weeks. The primary outcomes are the RMS value and the Modified Ashworth Scale. Secondary outcomes include the Fugl–Meyer Assessment for Lower Extremity (FMA-LE) and the Modified Barthel Index score. All outcome measures will be evaluated at the beginning and after the intervention (4 weeks). Discussion. This trial will observe the clinical effect of GV-EA on lower extremity spasticity after stroke, especially its influence on surface electromyography characteristics, and provide high-quality experimental evidence for the clinical application of GV-EA based on surface electromyography in the treatment of poststroke lower limb spasticity. Trial Registration. China Clinical Trials Registry No. ChiCTR1900027969. Registered on 7 December 2019.

scholarly journals Motor disability in patients with multiple sclerosis: transcranial magnetic stimulation study

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Anssam Bassem Mohy ◽  
Aqeel Kareem Hatem ◽  
Hussein Ghani Kadoori ◽  
Farqad Bader Hamdan
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Motor Evoked Potential ◽  
Invasive Procedure ◽  
Single Pulse ◽  
Lower Limbs ◽  
Control Group ◽  
Conduction Time ◽  
Motor Disability

Abstract Background Transcranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS. Objectives The study aims to investigate whether single-pulse TMS measures differ between patients with MS and healthy controls and to consider if these measures are associated with clinical disability. Patients and methods Single-pulse TMS was performed in 26 patients with MS who hand an Expanded Disability Status Scale (EDSS) score between 0 and 9.5 and in 26 normal subjects. Different TMS parameters from upper and lower limbs were investigated. Results TMS disclosed no difference in all MEP parameters between the right and left side of the upper and lower limbs in patients with MS and controls. In all patients, TMS parameters were different from the control group. Upper limb central motor conduction time (CMCT) was prolonged in MS patients with pyramidal signs. Upper and lower limb CMCT and CMCT-f wave (CMCT-f) were prolonged in patients with ataxia. Moreover, CMCT and CMCT-f were prolonged in MS patients with EDSS of 5–9.5 as compared to those with a score of 0–4.5. EDSS correlated with upper and lower limb cortical latency (CL), CMCT, and CMCT-f whereas motor evoked potential (MEP) amplitude not. Conclusion TMS yields objective data to evaluate clinical disability and its parameters correlated well with EDSS.

Poster 75: Exploring Real-World OnabotulinumtoxinA Utilization Patterns for the Treatment of Lower Limb Spasticity: The Adult Spasticity International Registry (ASPIRE) Study

PM&R ◽  
2018 ◽  
Vol 10 ◽  
pp. S31-S31
Author(s):  
Alberto Esquenazi ◽  
Wolfgang H. Jost ◽  
Ganesh Bavikatte ◽  
Daniel S. Bandari ◽  
Michael C. Munin ◽  
...  
Keyword(s):  
Real World ◽  
Lower Limb ◽  
International Registry ◽  
Utilization Patterns ◽  
Limb Spasticity ◽  
Lower Limb Spasticity
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