Explore the vast range of titles available.

A Doody's Core Title 2012 Spasticity: Diagnosis and Management is the first book solely dedicated to the diagnosis and treatment of spasticity. This pioneering work defines spasticity in the broad context of Upper Motor Neuron Syndrome and focuses not on a single component, but on the entire constellation of conditions that make up the UMNS and often lead to disability. Spasticity: Diagnosis and Management clearly defines the process for the diagnosis of spasticity, the basic science behind its pathophysiology, the measurement tools used for evaluation, and reviews the available treatment options. Divided into five sections, this comprehensive clinical resource provides a roadmap for assessing the complicated picture of spasticity and choosing the appropriate interventions. Therapies including oral medications, intrathecal baclofen, botulinum toxin and phenol, and surgical options are thoroughly discussed, as are non-medical therapies and the role of the emerging technologies. The full spectrum of diseases involving spasticity in adults and children and the unique diagnostic and management challenges they present is addressed by experienced clinicians. This text is a one-stop source for physicians, therapists and other members of the spasticity management team tasked with the goal of improving patient care and outcomes.

Spinal cord injury and traumatic brain injury are major causes of long-term disability and are often complicated by spasticity, a motor disorder characterized by increased muscle tone and exaggerated reflexes that significantly impair quality of life. Current diagnostic methods lack the sensitivity needed to accurately predict the severity of injury or the onset and progression of spasticity. Trauma-induced calcium dysregulation activates calpains, a family of proteases that cleave sodium channels, disrupting their inactivation and increasing persistent sodium currents. This cascade drives the overexcitability of motoneurons, contributing to the development of spasticity. Consequently, sodium channel fragments have emerged as promising biomarkers that link injury mechanisms to clinical outcomes. The present SpasT-SCI-T clinical trial protocol aims to evaluate sodium channel fragments as blood biomarkers for assessing the severity of spinal cord and traumatic brain injuries, as well as their potential to predict clinical outcomes, including the development of spasticity. This prospective, multicenter, case-control and cohort study involves 40 participants: 20 individuals with spinal cord injury, 10 individuals with traumatic brain injury, and 10 healthy controls. Blood samples are collected within six hours of injury and at follow-up points over six months. Clinical outcomes, including spasticity (assessed using the Modified Ashworth Scale), neurological recovery (measured by the American Spinal Injury Association Impairment Scale and Glasgow Coma Scale), and quality of life (evaluated using the Short Form-36 Health Survey), are analyzed in correlation with biomarker levels. We anticipate that calpain-mediated sodium channel fragments will transform the management of central nervous system injuries by enabling early diagnosis, improving prognostic accuracy, and guiding personalized therapeutic strategies. The clinical trial is registered on ClinicalTrials.gov (NCT06532760, January 10, 2024), with Assistance Publique–Hôpitaux de Marseille as the sponsor.

Falls are the leading cause of injury in stroke patients. However, the cause of a fall is complicated, and several types of risk factors are involved. Therefore, a comprehensive model to predict falls with high sensitivity and specificity is needed. This study was a prospective study of 112 inpatients in a rehabilitation ward with follow-up interviews in patients' homes. Evaluations were performed 1 month after stroke and included the following factors: (1) status of cognition, depression, fear of fall and limb spasticity; (2) functional assessments [walking velocity and the Functional Independence Measure (FIM)]; and (3) objective, computerized gait and balance analyses. The outcome variable was the number of accidental falls during the 6-month follow-up period after baseline measurements. The non-faller group exhibited significantly better walking velocity and FIM scale compared to the faller group (P < .001). The faller group exhibited higher levels of spasticity in the affected limbs, asymmetry of gait parameters in single support (P < .001), double support (P = .027), and step time (P = .003), and lower stability of center of gravity in the medial-lateral direction (P = .008). Psychological assessments revealed that the faller group exhibited more severe depression and lower confidence without falling. A multivariate logistic regression model identified three independent predictors of falls with high sensitivity (82.6%) and specificity (86.5%): the asymmetry ratio of single support [adjusted odds ratio, aOR = 2.2, 95% CI (1.2-3.8)], the level of spasticity in the gastrocnemius [aOR = 3.2 (1.4-7.3)], and the degree of depression [aOR = 1.4 (1.2-1.8)]. This study revealed depression, in additional to gait asymmetry and spasticity, as another independent factor for predicting falls. These results suggest that appropriate gait training, reduction of ankle spasticity, and aggressive management of depression may be critical to prevent falls in stroke patients.

Study design: Psychometrics study. Objectives: To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). Setting: Inpatient rehabilitation clinics at two state hospitals. Methods: The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A–D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other’s scores. Results: Inter-rater and test–retest agreement for the MAS scores ( κ =0.531–0.774) was moderate to substantial. Inter-rater and test–retest agreement for the MTS X scores ( κ =0.692–0.917) was substantial to almost perfect. Inter-rater reliability and test–retest reliability of the MTS R2−R1 was excellent (intra-class correlation coefficient (ICC) 0.874–0.973, confidence interval (CI): 0.79–0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: −0.00 to 0.47 and ICC 0.094, CI: −0.16 to 0.34, respectively). The test–retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: −0.06 to 0.53). Conclusion: MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test–retest reliability of the MTS R2−R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset neurodegenerative disease that was originally discovered in the population from the Charlevoix-Saguenay-Lac-Saint-Jean (CSLSJ) region in Quebec. Although the disease progression of ARSACS may start in early childhood, cases with later onset have also been observed. Spasticity and ataxia could be common phenotypes, and retinal optic nerve hypermyelination is detected in the majority of patients. Other symptoms, such as pes cavus, ataxia and limb deformities, are also frequently observed in affected individuals. More than 200 mutations have been discovered in the SACS gene around the world. Besides French Canadians, SACS genetics have been extensively studied in Tunisia or Japan. Recently, emerging studies discovered SACS mutations in several other countries. SACS mutations could be associated with pathogenicity either in the homozygous or compound heterozygous stages. Sacsin has been confirmed to be involved in chaperon activities, controlling the microtubule balance or cell migration. Additionally, sacsin may also play a crucial role in regulating the mitochondrial functions. Through these mechanisms, it may share common mechanisms with other neurodegenerative diseases. Further studies are needed to define the exact functions of sacsin. This review introduces the genetic mutations discovered in the SACS gene and discusses its pathomechanisms and its possible involvement in other neurodegenerative diseases.

Spasticity in the upper limb is a common condition observed in individuals with Cerebral Palsy, post-stroke or following traumatic brain injury. Affected patients present with significant functional and care challenges. Advances in both conservative and surgical treatments necessitate improved assessment tools. This study aims to develop and validate an instrumented measurement procedure combining 3D motion analysis, surface electromyography (sEMG), and musculoskeletal modeling to assess wrist and finger spasticity and function. The goal is to create a preoperative assessment tool for surgical strategy determination and a postoperative outcome measurement. We hypothesize that this combination of technologies will offer superior assessment accuracy compared to traditional methods and provide predictive insights into therapeutical outcomes.

Aim:Many studies have been performed on the methodological qualities of the (modified) Ashworth Scale but overall these studies seem inconclusive. The aim of this study was to investigate the construct validity and inter-rater reliability of the Ashworth Scale (AS) for the assessment of spasticity in the upper and lower extremities.Method:A cross-sectional study on spasticity in the elbow flexors (part 1) and knee extensors (part 2) was carried out. In both parts AS was assessed while muscle activity and resistance were recorded simultaneously in patients with upper motor neuron syndrome. Each patient was measured by three raters.Results:30 patients participated, 19 in each part of the study. For elbow flexor muscles, AS was not significantly associated with electromyographic parameters, except for rater 2 (rho = 0.66, p<0.01). A significant moderate association was found with resistance (0.54⩽ rho ⩽0.61, p<0.05). For knee extensors, AS scores were moderately associated with muscle activity (0.56⩽ rho ⩽0.66, p<0.05) and also with resistance (0.55⩽ rho ⩽0.87, p<0.05). The intraclass correlation coefficient for absolute agreement was 0.58 for elbow flexors and 0.63 for knee extensors. In linear mixed model analysis, the factor rater appeared to be highly associated with AS.Conclusion:The validity and reliability of the AS is insufficient to be used as a measure of spasticity.

Background Evaluating muscle spasticity in children with cerebral palsy (CP) is essential for determining the most effective treatment strategies. This scoping review assesses the current methods used to evaluate muscle spasticity, highlighting both traditional and innovative technologies, and their respective advantages and limitations. Methods A search (to April 2024) used keywords such as muscle spasticity, cerebral palsy, and assessment methods. Selection criteria included articles involving CP children, assessing spasticity objectively/subjectively, comparing methods, or evaluating method effectiveness. Results From an initial pool of 1971 articles, 30 met our inclusion criteria. These studies collectively appraised a variety of techniques ranging from well-established clinical scales like the modified Ashworth Scale and Tardieu Scale, to cutting-edge technologies such as real-time sonoelastography and inertial sensors. Notably, innovative methods such as the dynamic evaluation of range of motion scale and the stiffness tool were highlighted for their potential to provide more nuanced and precise assessments of spasticity. The review unveiled a critical insight: while traditional methods are convenient and widely used, they often fall short in reliability and objectivity. Conclusion The review discussed the strengths and limitations of each method and concluded that more reliable methods are needed to measure the level of muscle spasticity more accurately.

(1) Background: The Modified Ashworth Scale (MAS) is commonly used clinically to evaluate spasticity, but its qualitative nature introduces subjectivity. We propose a novel metric scale to quantitatively measure spasticity using mechanomyography (MMG) to mitigate these subjective effects. (2) Methods: The flexor and extensor muscles of knee and elbow joints were assessed with the Modified Ashworth Scale (MAS) during the acquisition of mechanomyography (MMG) data. The median absolute amplitude of the MMG signals was utilized as a key descriptor. An algorithm was developed to normalize the MMG signals to a universal gravitational (G) acceleration scale, aligning them with the limits and range of MAS. (3) Results: We evaluated 34 lower and upper limbs from 22 volunteers (average age 39.91 ± 13.77 years) of both genders. Polynomial regression provided the best fit (R2 = 0.987), with negligible differences (mean of 0.001 G) between the MAS and MMG. We established three numerical sets for the median, minimum, and maximum MMG(G) values corresponding to each MAS range, ensuring consistent alignment of the Modified Ashworth levels with our proposed scale. (4) Conclusions: Muscle spasticity can now be quantitatively and semi-automatically evaluated using our algorithm and instrumentation, enhancing the objectivity and reliability of spasticity assessments.

Spasticity is a disabling characteristic of neurological disorders, described by a velocity-dependent increase in muscle tone during passive stretch. During the last few years, many studies have been carried out to assess spasticity using wearable IMU (inertial measurements unit) sensors. This review aims to provide an updated framework of the current research on IMUs wearable sensors in people living with spasticity in recent studies published between 2017 and 2021. A total of 322 articles were screened, then finally 10 articles were selected. Results show the lack of homogenization of study procedures and missing apparatus information in some studies. Still, most studies performed adequately on measures of reporting and found that IMUs wearable data was successful in their respective purposes and goals. As IMUs estimate translational and rotational body motions, we believe there is a strong potential for these applications to estimate velocity-dependent exaggeration of stretch reflexes and spasticity-related characteristics in spasticity. This review also proposes new directions of research that should be challenged by larger study groups and could be of interest to both researchers as well as clinicians. The use of IMUs to evaluate spasticity is a promising avenue to provide an objective measurement as compared to non-instrumented traditional assessments.