scholarly journals Bilateral and asymmetrical contributions of passive and active ankle plantar flexors stiffness to spasticity in humans with spinal cord injury

2020 ◽  
Vol 124 (3) ◽  
pp. 973-984
Author(s):  
Bing Chen ◽  
Sina Sangari ◽  
Jakob Lorentzen ◽  
Jens B. Nielsen ◽  
Monica A. Perez

Spasticity affects a number of people with spinal cord injury (SCI). Using biomechanical, electrophysiological, and clinical assessments, we found that passive muscle properties and active spinal reflex mechanisms contribute bilaterally and asymmetrically to spasticity in ankle plantarflexor muscles in humans with chronic SCI. A self-reported questionnaire had poor agreement with the Modified Ashworth Scale in detecting asymmetries in spasticity. The nature of these changes might contribute to the poor sensitivity of clinical exams.

Spinal Cord ◽  
2016 ◽  
Vol 54 (9) ◽  
pp. 702-708 ◽  
Author(s):  
C B Baunsgaard ◽  
U V Nissen ◽  
K B Christensen ◽  
F Biering-Sørensen

2021 ◽  
Vol 79 (7) ◽  
pp. 590-597
Author(s):  
Patrícia Lima do Amaral Santos ◽  
Roberta Caveiro Gaspar ◽  
Natália Padula ◽  
Daniela Melo Almeida ◽  
Mariana Callil Voos

ABSTRACT Background: Assessment of muscle tone is of great importance for evaluating people with spinal injuries. Objective: To translate and adapt the Modified Tardieu Scale (MTS) to Brazilian Portuguese and validate its use for evaluating patients with spinal cord injury. Methods: The translation and adaptation of the “Escala de Tardieu Modificada” went through the steps of translation, translation synthesis, back-translation and expert committee meeting. Two evaluators rated the tone of the elbow flexors/extensors, wrist extensors, knee flexors/extensors and ankle plantar flexors of 51 patients with spinal cord injury. These patients were reevaluated after one week. Validation included intra and inter-rater reliability (ICC) and internal and external consistency. The Modified Ashworth Scale (MAS) was used in the evaluations, to investigate the correlations. Results: The Brazilian Portuguese version of the MTS is presented in this study. ICCs ranged from 0.60 to 0.99 (intra and inter-examiner) and there was a moderate to strong correlation with MAS. Conclusions: The MTS proved to be adequate for assessing the muscle tone of people with spinal cord injury in Brazil.


Author(s):  
Lamprini Lili ◽  
Katharina S Sunnerhagen ◽  
Tiina Rekand ◽  
Margit Alt Murphy

Abstract Introduction More knowledge of the relationships between kinematic measures and clinical assessments is required to guide clinical decision making and future research. Objectives To determine which kinematic variables obtained during a drinking task were associated with clinical assessments of upper extremity functioning in people with spinal cord injury (SCI). Methods In total, 25 individuals with chronic cervical (n = 17) or thoracic (n = 8) complete (n = 14) or motor incomplete (n = 11) SCI (mean age 58.4, SD 13.8) were included. Kinematic data, including movement time, smoothness and joint angles was captured with a 5-camera optoelectronic system during a unimanual drinking task. Action Research Arm Test (ARAT), Sollerman Hand Function Test (SHFT) and basic hand classification of the Upper Extremity Data Set (ISCI-Hand) were used as clinical assessments. Multiple regression analysis was used to identify kinematic variables associated with clinical assessments after controlling for potential confounding factors, such as, age, severity of SCI, sensory function, and hand surgery. Results Movement time, smoothness and movement pattern kinematics including trunk displacement, elbow and wrist joint angles were correlated (p < 0.05) with all three clinical scales while the velocity-related kinematics and inter-joint coordination showed low correlations. Multiple regression analysis revealed that wrist angle combined with movement time or smoothness explained 82% and 77% of the total variance in ARAT and SHFT, respectively. Wrist angle alone explained 59% of the variance in ISCI-Hand. The proprioception of the hand increased the explanatory power in the models of ARAT and SHFT. Associations between kinematics and clinical assessments in the subgroup with cervical SCI were equivalent to the whole group analyses. The number of participants in the subgroup with thoracic SCI was small and only allowed limited analysis. Conclusions Wrist angle, movement time, movement smoothness are the most important kinematic variables associated with upper extremity clinical assessments in people with SCI. The results are most valid for individuals with cervical SCI. All three assessments are appropriate for SCI. Further research with larger representative sample of thoracic SCI needed.


2021 ◽  
Vol 11 (3) ◽  
pp. 257-262
Author(s):  
Roman V. Salyukov ◽  
Fedor A. Bushkov ◽  
Maria V. Frolova

Autonomic dysreflexia (AD) is a potentially life-threatening condition that develops in patients with spinal cord injury (SCI) at or above the T6 segment. First of all this condition is characterized by uncontrolled arterial hypertension, which can lead to catastrophic complications and even death. The trigger for the development of AD is often urological complications, as well as diagnostic and therapeutic manipulations on the lower urinary tract. It is important for urologists to be aware of the AD syndrome, clinical features of AD, acute and chronic management, as well as prevention episodes of AD in patients with neurogenic lower urinary dysfunction. AD is defined as an increase of systolic blood pressure of 20 mmHg from baseline in response to various afferent stimuli originating below the level of spinal cord injury. AD is based on exaltation of spinal reflex activity with irradiation of impulses in the spinal cord under conditions of dennervation preganglionic sympathetic neurons located above the T6 segment and hyperactivity of peripheral -adrenergic receptors. The main pathophysiological mechanism of AD is hypernoradrenalinemia, leading to vasoconstriction the vessels of the skin, abdominal cavity, muscles below the level of neurological injury.


2021 ◽  
Vol 27 (3) ◽  
pp. 33-53
Author(s):  
Volodymyr V. Medvediev ◽  
Ibrahim M. Abdallah ◽  
Natalya G. Draguntsova ◽  
Sergiy I. Savosko ◽  
Viktoria V. Vaslovych ◽  
...  

Purpose. To test the model of spinal cord lateral hemiexcision in young rats. Materials and methods. Animals ‒ male rats (age about 1 month, body weight about 50 g, inbred derivatives of the Wistar line); the number of experimental groups is: 1) lateral spinal cord hemisection at the level of segments about T12–T13 (Sect; n=11); 2) lateral spinal cord hemiexcision about 1 mm long at the similar level (Exc; n=8). Assessment of motor Function Index (FI) and the Spasticity Index (SI) of the paretic hindlimb was carried out using the Basso–Beattie–Bresnahan (BBB) scale and Ashworth scale, respectively, in our technical modifications. The non-inclusion criteria: the BBB score above 9 points of FI for the ipsilateral hindlimb in a week after injury ‒and / or BBB score less than or equal to 14 points of FI of the contralateral hindlimb during a long follow-up period (in general, 2 animals in the Sect group, 3 animals ‒ in the Exc group). Asymptotic differences in the timing of testing between subgroups and groups were revealed during the first three weeks of follow-up. Interpolation reproduction of individual values of FI and SI was used in exceptional cases. The total follow-up period was 5 months. Statistical analysis was performed using the Mann-Whitney U Test, Wilcoxon Matched Pairs Test, Spearman’s Rank Order Correlation. For pathomorphological study, the method of silver impregnation of the spinal cord longitudinal sections of the Exc group animals obtained in 5 months after the simulation of injury was used. Results. One week after injury, the FI in the Sect group was 5.9±1.1 according to BBB points, a statistically significant increase in the FI lasted for the first 3 weeks (p<0.05; Wilcoxon Matched Pairs Test), the FI maximum in the group was 10.1±1.1 BBB points, and the FI value at the end of the study was 9.5±1.0 BBB points. In the Exc group, 1 week after injury, the FI was 0.9±0.5 BBB points, during the next week it reached the actual maximum (1.9±0.7 BBB points), by the end of the 5th month it significantly decreased to 0.8±0.3 BBB points (p<0.05; Wilcoxon Matched Pairs Test). One week after injury, the SI value in the Sect group was 0.3±0.1 points according to Ashworth scale, in the Exc group ‒ 0.7±0.1 Ashworth points, a significant increase (p<0.05; Wilcoxon Matched Pairs Test) in SI in the Sect group was noted during the 2nd week and the 2nd month, in the Exc group ‒ during the 2nd and 6th week, as well as the 3rd and 5th month after injury. The SI final and maximal score for the Sect group was 0.8±0.2 Ashworth points, and for the Exc group ‒ 3.6±0.3 Ashworth points. For both groups, there was no correlation between the mean FI value and a significant positive correlation of the mean SI value with the value of the follow-up period (p<0.05; Spearman’s Rank Order Correlation), as well as the absence of correlation between the mean FI and SI values during the total follow-up period. A significant negative correlation (p<0.05; Spearman’s Rank Order Correlation) between individual FI and SI values was found after 1 and 4 weeks, 3 and 5 months after the injury for the Sect group, as well as after 5, 7, 8 weeks and after 3 and 4 months for the Exc group. At all periods of follow-up, the difference in both FI and SI mean values of both groups was significant (p<0.05; the Mann-Whitney U Test). Conclusions. The studied model of spinal cord injury in young rats is the means of choice for testing solid neural transplantation means for the spinal cord injury restorative treatment. The interpretation of data obtained using the BBB scale on models of lateral half spinal cord injury should be carried out with caution, and the methodology for verifying spasticity requires significant improvement. We recommend that the optimal timing for the FI and SI monitoring after lateral half spinal cord injury is 7 days, 14 days and in 1, 2, 3, 4, 5, 6, and 7 months.


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