scholarly journals Association between Severe Upper Limb Spasticity and Brain Lesion Location in Stroke Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Alessandro Picelli ◽  
Stefano Tamburin ◽  
Francesca Gajofatto ◽  
Giampietro Zanette ◽  
Marialuigia Praitano ◽  
...  
Keyword(s):  
White Matter ◽  
Upper Limb ◽  
Brain Lesion ◽  
Mapping Method ◽  
Thalamic Nuclei ◽  
Stroke Patients ◽  
Lesion Location ◽  
Modified Ashworth Scale ◽  
Limb Spasticity ◽  
Ashworth Scale

Association between the site of brain injury and poststroke spasticity is poorly understood. The present study investigated whether lesion analysis could document brain regions associated with the development of severe upper limb poststroke spasticity. A retrospective analysis was conducted on 39 chronic stroke patients. Spasticity was assessed at the affected upper limb with the modified Ashworth scale (shoulder, elbow, wrist, and fingers). Brain lesions were traced from magnetic resonance imaging performed within the first 7 days after stroke and region of interest images were generated. The association between severe upper limb spasticity (modified Ashworth scale ≥2) and lesion location was determined with the voxel-based lesion-symptom mapping method implemented in MRIcro software. Colored maps representing thezstatistics were generated and overlaid onto the automated anatomical labeling and the Johns Hopkins University white matter templates provided with MRIcron. Thalamic nuclei were identified with the Talairach Daemon software. Injuries to the insula, the thalamus, the basal ganglia, and white matter tracts (internal capsule, corona radiata, external capsule, and superior longitudinal fasciculus) were significantly associated with severe upper limb poststroke spasticity. Further advances in our understanding of the neural correlates of spasticity may lead to early targeted rehabilitation when key regions are damaged.

scholarly journals Use of reliability tested clinically data towards a portable device measurement kit system for upper limb spasticity

2019 ◽  
Vol 15 (4) ◽  
pp. 622-625
Author(s):  
Khairunnisa Johar ◽  
Noor Ayuni Che Zakaria ◽  
Fazah Akhtar Hanapiah ◽  
Low Cheng Yee ◽  
Nurul Atiqah Othman ◽  
...  
Keyword(s):  
Upper Limb ◽  
Clinical Assessment ◽  
Intraclass Correlation ◽  
Medical Intervention ◽  
Portable Device ◽  
Modified Ashworth Scale ◽  
The Social ◽  
Limb Spasticity ◽  
Therapy Sessions ◽  
Ashworth Scale

Spasticity refers to the abnormal symptom of having resistance in the joints when patients tried to make a movement. Patients with spasticity need to undergo multiple therapy sessions with medical intervention to ensure that the upper limb achieve maximal function. Modified Ashworth Scale (MAS) is frequently used in clinical assessment with grading on a scale. However, this scale is limited in sensitivity and the accuracy of this evaluation is dependent on the physician’s and therapist’s experience. This study suggests developing a portable measurement device kit system during clinical assessment to reduce inter- and intra-rater variability, and to assist clinicians in making quick clinical evaluation of spasticity. In this study, 19 patients were involved in the data acquisition. Assessment data from upper limb of patients with spasticity were recorded using a Manual Muscle Tester (MMT) and digital goniometer to measure force and the angular motion. During the assessment, patients were examined through slow and fast motion for spasticity evaluation. The collected data were analyzed to study intra-rater reliability value by using Statistical Package for the Social Sciences (SPSS). The results of Intraclass Correlation Coefficient (ICC) values for all patients were in range 0.78 to 0.89. It can be considered that the collected data was reliable and can be used to formulate a model towards the development of a portable device measurement kit system for upper limb spasticity.

scholarly journals The Value of Real-Time Shear Wave Elastography before and after Rehabilitation of Upper Limb Spasm in Stroke Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jun Liu ◽  
Huijuan Pan ◽  
Yong Bao ◽  
Yanna Zhao ◽  
Li Huang ◽  
...  
Keyword(s):  
Shear Wave ◽  
Upper Limb ◽  
Biceps Brachii ◽  
Shear Wave Elastography ◽  
Stroke Patients ◽  
Rehabilitation Treatment ◽  
Modified Ashworth Scale ◽  
Significant Difference ◽  
Before And After ◽  
Ashworth Scale

Objective. Our goal was to evaluate the efficacy of muscle spasm before and after rehabilitation by comparing shear wave propagation velocity (SWV) and Young’s modulus (YM) in the normal and spastic biceps brachii in stroke patients. Methods. A study of 60 stroke patients with upper limb spasm was performed; these patients were admitted from April 2018 to September 2019. The modified Ashworth scale (MAS) scores of the spastic biceps brachii before and after rehabilitation treatment were compared. SWV and YM on the spastic and normal biceps brachii before rehabilitation treatment, SWV and YM on the spastic and normal biceps brachii after rehabilitation treatment, and SWV and YM on the spastic biceps brachii before and after rehabilitation treatment were compared. Whether SWV and YM on the spastic biceps brachii are related to MAS was compared. Results. There was a statistically significant difference in SWV and YM between the normal and spastic biceps brachii before (P<0.01) and after (P<0.05) the rehabilitation treatment. There was no statistically significant difference in SWV and YM in the normal biceps brachii before and after the rehabilitation treatment (P>0.05). There was a statistically significant difference in SWV and YM in the spastic biceps brachii before and after the rehabilitation treatment (P<0.01). SWV and FM of the spastic biceps brachii are correlated with MAS before and after rehabilitation treatment, and the correlation coefficient for SWV was 0.563 and 0.605 for YM (P<0.05). Conclusion. SWE can be used as a means of assessment before and after rehabilitation treatment.

Safety and efficacy of letibotulinumtoxinA(BOTULAX®) in treatment of post stroke upper limb spasticity: a randomized, double blind, multi-center, phase III clinical trial

2017 ◽  
Vol 31 (9) ◽  
pp. 1179-1188 ◽  
Author(s):  
Kyung Hee Do ◽  
Min Ho Chun ◽  
Nam-Jong Paik ◽  
Yoon Ghil Park ◽  
Shi-Uk Lee ◽  
...  
Keyword(s):  
Upper Limb ◽  
Botulinum Neurotoxin ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Safety Measures ◽  
Modified Ashworth Scale ◽  
Burden Scale ◽  
Limb Spasticity ◽  
Ashworth Scale ◽  
Wrist Flexors

Objective: To investigate a new botulinum neurotoxin type A, termed letibotulinumtoxinA(Botulax®) and compare its efficacy and safety for post-stroke upper limb spasticity with that of onabotulinumtoxinA(Botox®). Design: A prospective, double-blinded, multicenter, randomized controlled clinical study. Setting: Six university hospitals in Korea. Subjects: A total of 187 stroke participants with upper limb spasticity. Interventions: Two kinds of botulinum neurotoxin type A were used. One set of injection was performed and total injected doses were 309.21±62.48U(Botulax) and 312.64±49.99U(Botox)( P>0.05). Main measures: Primary outcome was measured using the modified Ashworth scale for wrist flexors at week 4 and secondary outcome was measured using modified Ashworth scale for wrist flexors, elbow flexors, finger flexors, and thumb flexors as well as Global Assessment in spasticity, Disability Assessment Scale, and Caregiver Burden Scale. Safety measures including adverse events, vital signs and physical examination, and laboratory tests were also monitored. Results: The mean ages for the Botulax group were 56.81±9.49 and which for the Botox group were 56.93±11.93( P>0.05). In primary outcome, the change in modified Ashworth scale for wrist flexors was -1.45±0.61 in the Botulax group and -1.40±0.57 in the Botox group, and the difference between the two groups was -0.06(95% CI:-0.23–0.12, P>0.05). In secondary outcome, both groups demonstrated significant improvements with respect to modified Ashworth scale, Global Assessment in spasticity, Disability Assessment Scale, and Caregiver Burden Scale ( P<0.05), and no significant difference was observed between the two groups ( P>0.05). In addition, safety measures showed no significant differences between the two groups ( P>0.05). Conclusions: The efficacy and safety of Botulax were comparable with those of Botox in treatment of post-stoke upper limb spasticity.

scholarly journals An effective approach for botulinum toxin injection in patients with stroke for focal spasticity: dual guidance

2018 ◽  
Vol 5 (9) ◽  
pp. 326-330
Author(s):  
Emre Ata ◽  
Murat Kosem
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Botulinum Toxin Injection ◽  
Stroke Patients ◽  
Modified Ashworth Scale ◽  
Significant Difference ◽  
Limb Muscles ◽  
Botulinum Toxin Injections ◽  
Ashworth Scale ◽  
Electrical Muscle

Objective: This study has aimed to compare the efficacy of botulinum toxin (BTX) injections, applied to the upper limb muscles of the stroke patients in our clinic who have being diagnosed with focal spasticity, that are performed via ultrasonography and ultrasonography + electrical muscle (EM) stimulator guidance. Literature didn’t include detailed crosscheck of ultrasound guided BTX and EM treatment applications for upper limb focal spasticity patients Materials and Methods: Electronic data on 62 hemiplegic stroke patients with grade 2 and 3 focal spasticity who had received botulinum toxin injections into their upper limb muscles by the same physician, who used similar protocol and recorded the results, were scanned retrospectively. The spasticity of the patients in both groups was assessed with the Modified Ashworth Scale at the end of two weeks and three months. Results: A statistically significant difference was found between the Modified Ashworth Scale values of both groups in terms of all muscles, compared to the values seen in the pre-treatment period (p<0.05). The Modified Ashworth Scale values at 3 months posttreatment in ultrasonography + electrical muscle stimulator group were not statistically different from those at 2 weeks posttreatment, with respect to wrist flexion and finger flexion. In intergroup comparison, there was no statistically significant difference between the Modified Ashworth Scale values of at pretreatment and 2 weeks posttreatment. However, statistically significant difference in all muscle groups was found in favor of the ultrasonography + electrical muscle stimulator group at 3 months posttreatment controls (p<0.05). Conclusion: Upper limb spasticity due to stroke can be substantially recovered with botulinum toxin injections that are applied via only ultrasonography guidance or via ultrasonography + electrical muscle stimulator guidance.. According to data from the assessment at 3 months posttreatment, the botulinum toxin injection performed via ultrasonography + electrical muscle stimulator guidance had more positive effects .

Upper Limb Motor Function Affects the Outcome after Treatment with Botulinum Toxin A

2019 ◽  
Vol 81 (1-2) ◽  
pp. 30-36 ◽  
Author(s):  
Kenta Fujimura ◽  
Hitoshi Kagaya ◽  
Hisae Onaka ◽  
Nao Nagasawa ◽  
Akihito Ishihara ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Lower Score ◽  
Disability Assessment ◽  
Limb Position ◽  
Modified Ashworth Scale ◽  
Limb Spasticity ◽  
The Mean ◽  
Ashworth Scale

Background: Treatment with Botulinum toxin A (BoNT-A) is effective in decreasing upper limb spasticity. Objective: This study aimed to determine the differences in the outcome based on the upper limb motor function before BoNT-A treatment. Methods: The subjects were 61 patients who underwent BoNT-A treatment for upper limb spasticity. Limb function was evaluated using the Fugl-Meyer Assessment upper extremity (FMA-UE), modified Ashworth scale, passive range of motion and disability assessment scale before treatment as well as 2, 6, and 12 weeks after treatment. We divided the total and each subscale of FMA-UE before BoNT-A administration into beyond-the-mean-score group (higher score group) and below-the-mean-score group (lower score group). Results: In both the higher and lower score groups of the FMA-UE total and modified Ashworth scale scores improved significantly after treatment. In FMA-UE, the higher score group of subscale A improved significantly, but subscale C decreased significantly at 2 and 6 weeks after the administration. The lower score group of total, subscale A, and B improved significantly. In the disability assessment scale, the self-dressing capability at 6 weeks and limb position at 2, 6 and 12 weeks after the administration improved significantly in the higher score group. In the lower score group, the hygiene capability at 2 weeks as well as the dressing capability and limb position improved significantly at 2, 6 and 12 weeks after administration. Conclusions: The time course after administration of BoNT-A differed based on upper limb motor function before injection. When administering BoNT-A into the finger flexor muscles of a patient, we should carefully judge the indications for administration.

Data-Driven Model for Upper Limb Spasticity Detection

2021 ◽  
Vol 13 (4) ◽  
Author(s):  
Jingye Yee ◽  
◽  
Cheng Yee Low ◽  
Natiara Mohamad Hashim ◽  
Fazah Akhtar Hanapiah ◽  
...  
Keyword(s):  
Upper Limb ◽  
Structural Damage ◽  
Data Driven ◽  
Modified Ashworth Scale ◽  
The Central Nervous System ◽  
Limb Spasticity ◽  
Objective Value ◽  
Brain And Spinal Cord ◽  
Ashworth Scale ◽  
Machine Learning Models

Upper limb spasticity (ULS) is a common pathophysiological changes manifest by a structural damage towards the central nervous system (CNS) that includes brain and spinal cord. The current clinical practice of spasticity assessment utilizes Modified Ashworth Scale (MAS) as a subjective tool to measure the severity of spasticity. Lack of objective value, poor sensitivity in detecting minimal changes, and dependency to the interpretation by the assessing clinicians are the several reasons of the inter and intra-rater variability of the measurement using MAS. These limit the use of MAS in diagnosing, treating, and monitoring spasticity especially in inexperienced clinicians, hence leading to inadequate spasticity management. To overcome this problem, a study is carried out to quantify and develop a data-driven model of ULS detection based on MAS. The characteristics that detect the existence of ULS according to MAS are identified and adopted to train the machine learning models for smart diagnosis purpose to assist the physicians to effectively manage spasticity.

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