COMPARATIVE STUDY OF EFFICACY OF CRYOTHERAPY AND MYOFASCIAL RELEASE TECHNIQUE IN CALF MUSCLE SPASTICITY IN SPASTIC DIPLEGIC CEREBRAL PALSY CHILDREN

The greatest substantial consequence of juvenile impairment is cerebral palsy (CP). Spasticity of numerous muscle groupings is common after Central Nervous System damage. Spasticity causes functioning issues. For individuals suffering from CP ankle anomalies seem strongly tied to workable limits. Spastic CP is highest frequent type of CP, which limits child's responsive status and prohibits them from participating in communal activities. Soft tissue mobilisation procedures would be used in variety ways. Cryotherapy is interventional method for stiffness in neurological patients that has narrow advantage. MFR can potentially utilised against spasticity. The focus of this investigation is to evaluate Cryotherapy and MFR influence over calf muscle stiffness in participants who have Spastic Diplegic CP. The survey's goal is to determine efficacy of Cryotherapy and MFR in calf muscle spasticity in Spastic diplegic CP subjects. Thirty individuals suffering spastic diplegic CP were chosen using randomized sampling procedure. The subjects was categorised onto 3 subgroups, each of ten individuals. Cryotherapy was applied to Group A, MFR was applied to B and C Group was applied with combination of cryotherapy and MFR. Both before and after therapy, MAS and goniometry are used to assess calf muscle spasticity and ankle PROM. Overall validity of MAS and PROM comparing before and after in subgroup was determined using Tukey Test. Spasticity was reduced and range of motion was improved (p<0.05) in intra group comparison. Cumulative influence of cryotherapy and MFR is beneficial in reducing calf muscle stiffness in spastic diplegic CP children, as per this investigation.

Recent Advances in the Treatment of Spasticity: Extracorporeal Shock Wave Therapy

Spasticity is a common sequala of the upper motor neuron lesions. For instance, it often occurs in the first 4 weeks after stroke and is seen in more than one-third of stroke survivors after 12 months. In recent years, extracorporeal shock wave therapy (ESWT) has been recognized as a safe and effective method for reducing muscle spasticity. Possible/relevant mechanisms include nitric oxide production, motor neuron excitability reduction, induction of neuromuscular transmission dysfunction, and direct effects on rheological properties. There are two types of ESWT, focused and radial, with the radial type more commonly applied for treating muscle spasticity. Concerning the optimal location for applying ESWT, the belly muscles and myotendinous junction seem to produce comparable results. The effects of ESWT on spasticity are known to last at least four to six weeks, while some studies report durations of up to 12 weeks. In this review, the authors will focus on the current evidence regarding the effectiveness of ESWT in spasticity, as well as certain technical parameters of ESWT, e.g., the intensity, frequency, location, and number of sessions. The pertinent literature has been reviewed, with an emphasis on post-stroke upper limbs, post-stroke lower limbs, cerebral palsy, and multiple sclerosis. In short, while ESWT has positive effects on parameters such as the modified Ashworth scale, mixed results have been reported regarding functional recovery. Of note, as botulinum toxin injection is one of the most popular and effective pharmacological methods for treating spasticity, studies comparing the effects of ESWT and botulinum toxin injections, and studies reporting the results of their combination, are also reviewed in this paper.

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

Background Repetitive 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. Methods This 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. Results The 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. Conclusion Muscle 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.

Electrophysiological Evaluation of the Modified Ashworth Scale in Assessment of Post Stroke Ankle Plantar Spasticity

Background: Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measure of muscle spasticity, using validated tools to evaluate the outcome of therapies is important in clinical and research settings. Objective: To determine the concurrent criterion-related validity of the Modified Ashworth Scale in assessing post stroke Ankle flexor muscle spasticity based on its correlation with Modified Tardieu scale and the H-reflex tests. Methods: A total of 35 adult stroke participants underwent clinical and electrophysiological assessment of the ankle flexor muscle spasticity on the affected side. The primary outcome measures were: MMAS grade, R2−R1 of the MTS; and the H-reflex indices of H-max/M-max ratio. Results: Correlations tests revealed the correlation between the MMAS and MTS but did not reveal significant associations between the MMAS and the H-reflex tests. Conclusions: This study suggests that the MMAS may not be a valid tool to evaluate the ankle flexor muscle spasticity in these stroke participants. Key words: Stroke, spasticity, Modified Ashworth Scale, Tardieu Scale, H-reflex, criterion validity.

Study on The Likelihood Ratio Used to Evaluate the Muscle Tension of Upper Limb Spasm in Hemiplegia Patients

Aim: To evaluate the clinical usability of mechanomyography (MMG) in the evaluation of upper-limb spasticity states of hemiplegia patients with likelihood ratio analysis. Methods: The MMG signals from the 30 hemiplegia patients’ biceps and triceps were recorded with three-dimensional wireless accelerometer (Trigno Wireless System, Delsys Inc), when they extended or bent their elbow passively. At the same time, the physiotherapist assessed the MAS (Modified Ashworth Scale) of all the patients who participated in the study and would be divided them into four groups based on the MAS values (MAS0, MAS1, MAS1+ and MAS2). The MMG sensors were built with triaxial accelerometers named as X, Y and Z that represent the muscle fibers lengthwise movement, the cross movement and the vertical the muscle moving direction, respectively. The root mean square (RMS) value of the MMG signal was calculated for analysis. Likelihood ratio analysis were used in the study. Results: All of the variables of the X, Y, Z axis of signals of MMG of BB and TB have related with muscle spasticity grading during passive elbow flexion in multinomial logistic regression (P=0.000, P<0.001). The regression coefficient of Y axis signal of MMG of BB is the largest. The 5 variables of the X, Y, Z axis of signals of MMG of BB and X, Y axis of TB have related with Muscle spasticity grading during passive elbow extension in multinomial logistic regression (P=0.000, P<0.001). The regression coefficient of Y axis signal of MMG of BB is the largest in equation and the Y axis signal of MMG of TB is second large. Conclusions: The effect of agonist is more than the antagonist during the MAS assessment, especially the muscle fibers cross movement and the vertical movement by the MMG assessment.