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1.
Nobuhito Morota 《Child's nervous system》2007,23(9):1007-1014
Purpose The author describes the history of functional posterior rhizotomy (FPR), the surgical procedure currently used, and the results
together with its future perspective in Japan. The modern form of FPR was introduced to Japan in 1995, and the first surgery
was carried out in 1996. Despite initial resistance from orthopedic surgeons, the procedure has eventually gained wide recognition
in the country.
Materials and Methods The author has operated on 98 patients (60 boys and 38 girls, aged from 2 to 19 years old) by the end of 2006. Most patients
were mild to severely disabled children with spastic hypertonia because of cerebral palsy and other diseases. The surgical
procedure used is based on the Peacock’s procedure with some modification for the mildly disabled children whose spasticity
was predominantly the muscles of the ankle joint. Intraoperative neurophysiology was an indispensable tool for preserving
urogenital function and for judging which root/rootlet to be cut.
Results Seventeen to 83% of the root/rootlets were found to be abnormal and were cut, clearly correlating with the degree of disability.
However, there was a wide difference in the cutting rate, even in children with the same degree of disability. The result
of surgery in this group of patients was the same as in previously published data. Twenty out of 51 patients (39%) followed
for more than a year at the current institute showed improved locomotion after FPR. Thirty patients (59%) demonstrated suprasegmental
effects after FPR.
Conclusion The role of FPR will grow in importance as a treatment for spasticity in Japan in the future. 相似文献
2.
《Gait & posture》2014,39(3):346-351
Clinical assessment of spasticity is compromised by the difficulty to distinguish neural from non-neural components of increased joint torque. Quantifying the contributions of each of these components is crucial to optimize the selection of anti-spasticity treatments such as botulinum toxin (BTX). The aim of this study was to compare different biomechanical parameters that quantify the neural contribution to ankle joint torque measured during manually-applied passive stretches to the gastrocsoleus in children with spastic cerebral palsy (CP). The gastrocsoleus of 53 children with CP (10.9 ± 3.7 y; females n = 14; bilateral/unilateral involvement n = 28/25; Gross Motor Functional Classification Score I–IV) and 10 age-matched typically developing (TD) children were assessed using a manually-applied, instrumented spasticity assessment. Joint angle characteristics, root mean square electromyography and joint torque were simultaneously recorded during passive stretches at increasing velocities. From the CP cohort, 10 muscles were re-assessed for between-session reliability and 19 muscles were re-assessed 6 weeks post-BTX. A parameter related to mechanical work, containing both neural and non-neural components, was compared to newly developed parameters that were based on the modeling of passive stiffness and viscosity. The difference between modeled and measured response provided a quantification of the neural component. Both types of parameters were reliable (ICC > 0.95) and distinguished TD from spastic muscles (p < 0.001). However, only the newly developed parameters significantly decreased post-BTX (p = 0.012). Identifying the neural and non-neural contributions to increased joint torque allows for the development of individually tailored tone management. 相似文献
3.
《Annals of physical and rehabilitation medicine》2014,57(1):11-23
ObjectiveBy proposing a new terminology (acquired deforming hypertonia or ADH) and a new definition for contractures, the main objective of this study was to establish their prevalence among institutionalized elderly patients. Secondary objectives were to analyze the negative impact of ADH and collect the opinions of clinicians on the possible treatments available.MethodologyA multicenter cross-sectional study was conducted among residents of 39 geriatric institutions (29 EHPAD and 10 USLD). All subjects presenting at least one ADH were surveyed over a one-week period.ResultsAmong 3145 observed patients (mean age 88.9 ± 9.7 years) 22% (n = 692) presented at least one ADH. In average, each patient presented 4.4 ± 3.2 ADHs. Negative consequences on self-care, nursing and difficulties in getting dressed were most frequently observed. Only 25.4% of clinicians considered the ADH to be potentially reversible. Physical therapy was the therapeutic option most frequently chosen over medication and surgery.ConclusionThis study confirms the important prevalence of ADH among elderly institutionalized patients. Consequences on the level of dependence were significant. It seems relevant to elaborate hierarchical therapeutic strategies in order to counter these disorders and the fatalism that ensues. 相似文献
4.
We studied the effects of hypertonia on voltage-gated currents of freshly isolated hippocampal CA1 neurons, using open pipette whole-cell as well as gramicidin-perforated patch-clamp recording. Extracellular osmolarity (πo) was raised by adding mannitol (50 or 100 mmol/l) to the bathing solution. Hypertonia depressed voltage-gated sodium, potassium and calcium currents in all trials. The threshold activation voltage of the currents did not change during hypertonic depression, but maximal activation of Ca2+ current shifted to a more negative potential, suggesting stronger depression of high- compared to low-voltage activated currents. During 30 min high πo treatment (recorded with open pipette), the depression reached maximum in 10–15 min of exposure. The depression of the computed transient component of the K+ current recorded by open pipette was statistically not significant. Following hypertonic treatment recovery of the INa, the sustained IK and sustained ICa were incomplete compared to control cells maintained in normal solution for an equal length of time. In hippocampal tissue slices hypertonia (+25, +50 and +100 mmol/l fructose) reversibly depressed excitatory postsynaptic currents (EPSCs). We conclude that the shutdown of membrane ion currents by elevated πo is not selective, but the degree of the suppression varies among current types. Raising πo in human patients, possibly combined with mild artificial acidosis, may be useful in the prevention and treatment of acute crises associated with excessive excitation or depolarization of neurons. 相似文献
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6.
《Annals of physical and rehabilitation medicine》2019,62(6):418-425
BackgroundSpasticity management in severely brain-injured patients with disorders of consciousness (DOC) is a major challenge because it leads to complications and severe pain that can seriously affect quality of life.ObjectivesWe aimed to determine the feasibility of a single session of transcranial direct current stimulations (tDCS) to reduce spasticity in chronic patients with DOC.MethodsWe enrolled 14 patients in this double-blind, sham-controlled randomized crossover pilot study. Two cathodes were placed over the left and right primary motor cortex and 2 anodes over the left and right prefrontal cortex. Hypertonia of the upper limbs and level of consciousness were assessed by the Modified Ashworth Scale (MAS) and the Coma Recovery Scale-Revised (CRS-R). Resting state electroencephalography was also performed.ResultsAt the group level, spasticity was reduced in only finger flexors. Four responders (29%) showed reduced hypertonicity in at least 2 joints after active but not sham stimulation. We found no behavioural changes by the CRS-R total score. At the group level, connectivity values in beta2 were higher with active versus sham stimulation. Relative power in the theta band and connectivity in the beta band were higher for responders than non-responders after the active stimulation.ConclusionThis pilot study highlights the potential benefit of using tDCS for reducing upper-limb hypertonia in patients with chronic DOC. Large-sample clinical trials are needed to optimize and validate the technique. 相似文献
7.
The aim of this pilot study was to determine if exaggerated patellar tendon jerk affects knee joint position sense (JPS) in cerebral palsy (CP) patients, by comparing JPS of the knee between participants with normal and exaggerated reflexes. The thresholds for reflex classification were based upon the data from able-bodied volunteers. JPS was measured as the ability of a subject (with eyes closed) to replicate a knee joint position demonstrated by an examiner. Tendon jerk was measured as the moment of force in response to patellar tendon taps. Data was collected from 27 limbs of CP patients (N = 14) and 36 limbs of able-bodied volunteers (N = 18). JPS was less accurate (p = 0.014) in limbs with non-exaggerated reflexes (50.28 ± 43.63%) than in control limbs (11.84 ± 10.85%). There was no significant difference (p = 0.08) in JPS accuracy between limbs with exaggerated reflexes (18.66 ± 15.50%) and control limbs.Our data suggests that one component of sensorimotor impairment, JPS, is not as commonly affected in CP patients as previously reported. JPS of the knee is reduced in limbs with non-exaggerated reflexes; however in limbs with exaggerated reflexes which is seen in the majority of CP patients, JPS is not affected. 相似文献
8.
V. Labadie Mazoyer 《Motricité Cérébrale》2018,39(1):21-29
This paper presents the case study of Julie, a 5-year-old child presenting a cerebral palsy. Her motor function level is rated V on the Gross Motor Function Classification System for cerebral palsy (GMFCS) and her manual ability is rated V on the Manual Ability Classification Scale (MACS). Her communication level is rated IV on the Système de classification des fonction de communication (SCFC). Our work focuses on the major hypertonia observed with this child and which massively alter her voluntary motor skills. The analysis was led through an interdisciplinary re-education team and enabled us to consider the different roots for these contractions. Not only is the neuromotor function altered by the brain injury leading to an inflated basal state of contraction, but the sensory, psychological and emotional dimensions were also taken into account to understand Julie's behavior in relation to her exaggerated contractions. Based on this multidimensional diagnosis, a collective process led to a physiological and educative therapy in order to allow this young girl with multiple disabilities to achieve a certain level of control over her contractions. The installations, the organization of her environment and an adapted educational framework were the three areas chosen to answer the three identified dimensions of pathological contraction. Regulating her state of contraction appears as a necessary step towards optimizing her expression and accessing an improved state of relaxation and comfort – a key element to support her general development. 相似文献
9.
E. Fernández-Tenorio D. Serrano-Muñoz J. Avendaño-Coy J. Gómez-Soriano 《Neurología (Barcelona, Spain)》2019,34(7):451-460
IntroductionAlthough transcutaneous electrical nerve stimulation (TENS) has traditionally been used to treat pain, some studies have observed decreased spasticity after use of this technique. However, its use in clinical practice is still limited. Our purpose was twofold: to determine whether TENS is effective for treating spasticity or associated symptoms in patients with neurological involvement, and to determine which stimulation parameters exert the greatest effect on variables associated with spasticity.DevelopmentTwo independent reviewers used PubMed, PEDro, and Cochrane databases to search for randomised clinical trials addressing TENS and spasticity published before 12 May 2015, and selected the articles that met the inclusion criteria. Of the initial 96 articles, 86 were excluded. The remaining 10 articles present results from 207 patients with a cerebrovascular accident, 84 with multiple sclerosis, and 39 with spinal cord lesions.ConclusionsIn light of our results, we recommend TENS as a treatment for spasticity due to its low cost, ease of use, and absence of adverse reactions. However, the great variability in the types of stimulation used in the studies, and the differences in parameters and variables, make it difficult to assess and compare any results that might objectively determine the effectiveness of this technique and show how to optimise parameters. 相似文献
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