1/21. Hyper-reflexia without spasticity after unilateral infarct of the medullary pyramid.Whether or not a lesion confined to the pyramidal tract produces spasticity in humans remains an unresolved controversy. We have studied a patient with an ischemic lesion of the right medullary pyramid, using objective measures of hyper-reflexia, spasticity, and weakness. Electromyographic activity (EMG) of the biceps muscles was recorded under the following conditions: (1) in response to a tendon tap with an instrumental reflex hammer, (2) in response to imposed quick stretch with motion analysis, and (3) during an isometric holding task. Hyper-reflexia of the involved arm in response to tendon tap was shown to be due primarily to an increase in the gain of the reflex arc. No velocity-dependent increase in the response to quick stretch of the involved arm was present. This was consistent with the absence of detectable spasticity on the clinical exam. These findings suggest that a lesion confined to the medullary pyramid can give rise to weakness and hyper-reflexia without causing spasticity. Moreover, these findings suggest that different anatomical substrates may underlie the clinical phenomena of hyper-reflexia and spasticity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/21. hemorrhage after bone marrow harvest: a case presentation.The purpose of this article is to describe the usual procedure and postoperative recovery after an allogeneic bone marrow harvest and to present a case study of an unusual complication of hemorrhage. The case study describes a donor who experienced hemorrhage with severe pain, muscle spasms, and prolonged limitations in range of motion and ambulation. Oncology nurses should inform donors to promptly report persistent pain, spasms, and muscle weakness. Should hemorrhage occur, blood loss should be evaluated, bedrest should be maintained, and cold packs should be applied to the area. Although excessive bleeding is a rare occurrence, nurses should be alert for this complication to prevent pain and activity impairment.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/21. Motor control testing of upper limb function after botulinum toxin injection: a case study.OBJECTIVE: To evaluate changes in upper extremity function in a hemiparetic patient after treatment with botulinum toxin (BTX) using motor-control testing (MCT) techniques. DESIGN: Interventional with longitudinal study, open label. SETTING: A children's hospital and a motor-control laboratory at a major academic center. PARTICIPANTS: A 16-year-old male with right hemiparetic cerebral palsy and a healthy 12-year-old control subject. INTERVENTIONS: BTX injections to the elbow and wrist flexors. MAIN OUTCOME MEASURES: MCT was used to examine 4 upper extremity movements: forward reach, bilateral rhythmic movements (both muscle homologous and direction homologous), isometric pinch, and hand tapping. The patient was tested before treatment and at 2, 4, 6, 12, 18, and 24 weeks after treatment. In addition, range of motion (ROM), the Ashworth scale of spasticity, Functional Independence Measure, and the mobility and activities of daily living (ADL) sections of the Pediatric Evaluation of the Disability Inventory were performed. RESULTS: Forward reach demonstrated little change initially despite patient reports of "feeling looser." Improvement was noted after 18 weeks, but returned to baseline level at 24 weeks. Bilateral rhythmic movements also showed slight improvement at 18 weeks. Pinch force increased significantly after 2 weeks, but declined again at 6 weeks. Improvements occurred in ROM and the Ashworth rating of spasticity, but were not temporally associated with each other or with MCT results. Functional assessment data did not change during the study period. CONCLUSIONS: Improvements in more complex motor tasks were noted after significant delay from the time of treatment, while simpler tasks demonstrated a more rapid improvement, followed by a rapid return to baseline levels. This case suggests that MCT techniques can provide quantitative and qualitative data, which can add new information about upper extremity motor disability and the outcome of treatment.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/21. Stiff leg syndrome: case report.We report on a 28-year-old woman with insulin-resistant diabetes mellitus with a 5-year history of progressive stiffness and painful spasms of the right leg, exaggerated by sudden auditory and tactile stimuli or by emotional stress. There were no signs of truncal rigidity or exaggerated lumbar lordosis. Anti-glutamic acid decarboxylase antibodies were positive in her serum. She improved substantially with clonazepam 4 mg/day. She presented with electrophysiological findings not previously reported in stiff leg syndrome, which may suggest increased inhibition in the uninvolved upper extremities.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/21. Familial spastic paraplegia with distal muscle wasting in the Old Order amish; atypical Troyer syndrome or "new" syndrome.The Troyer syndrome was found by Cross & McKusick (1967) in 20 members of 12 Old Order amish families in Holmes County, ohio; it is a form of hereditary spastic paraplegia combined with distal muscle wasting, i.e. signs of involvement of lower motor neurons. The condition usually begins at 1 to 2 years and progresses at variable rates. Further manifestations include growth retardation, delayed speech development with dysarthria and drooling, and cerebellar signs; mental functions are usually not affected but severe emotional lability is a common finding. Brothers in a wisconsin Old Order amish family are reported with spastic diplegia, mental retardation, behavioral disorder and shortness of stature; the condition apparently is not progressive, and may be a "new" syndrome but could also represent a variant of the Troyer syndrome. Autosomal recessive inheritance is most likely, although consanguinity of the parents could not be proven. Another child in this family suffers from focal scleroderma (morphea) which is not related to the neurological syndrome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/21. Intrathecal baclofen for spasticity management in rett syndrome.Intrathecal baclofen infusions have proven to be effective for management of spasticity during the last two decades. Efficacy of intrathecal baclofen for spasticity of spinal origin has been well established and has shown promise in treatment of spasticity that is not spinal in origin. rett syndrome is a neurodevelopmental disorder primarily affecting girls and women. Manifested in the advanced stages of this syndrome is increased spasticity leading to functional decline. Presented is a case report of a 32-yr-old white woman with rett syndrome, diagnosed before the age of 2 yr, and significant spasticity that was successfully managed with intrathecal baclofen. After placement of an intrathecal baclofen pump, the dose was increased slowly during 1 yr to 800 microg/day with good clinical response. There was observed a significant decrease in upper and lower limb Ashworth scores, from an average of 3-4 to 2-3, during this 1-yr period. The decrease in spasticity in this patient eventually led to improved range of motion, positioning, skin care, hygiene, and quality of life. Intrathecal baclofen is an effective option in managing severe spasticity from rett syndrome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/21. Tibialis spastic varus foot caused by osteoid osteoma of the calcaneus.Tibialis spastic varus foot is an extremely rare condition. A 30-year-old man had tibialis spastic varus foot caused by juxtaarticular osteoid osteoma of the calcaneus. The correct diagnosis was delayed because the symptoms were similar to arthritis and the nidus was difficult to detect on plain radiographs. curettage of the tumor was done, and the osseous defect was filled with interporous hydroxyapatite. The pain was relieved immediately after surgery. The varus deformity of the foot and spasm of the tibialis anterior muscle gradually improved. Three years 10 months after surgery, the patient was pain-free and the spasm of the tibialis anterior muscle had disappeared. The varus deformity and motion of the foot improved, but a restricted range of motion remained. To the authors' knowledge, there have been no published descriptions of tibialis spastic varus foot caused by juxtaarticular osteoid osteoma of the calcaneus.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/21. Treatment of pain and limited movement of the shoulder in hemiplegic patients with botulinum toxin a in the subscapular muscle.Three poststroke hemiplegic patients were treated by injecting Botulinum toxin A (BtxA) into the subscapularis muscle, to reduce pain and increase the range of motion in the shoulder. According to the described procedure, 250 units of Dysport toxin were injected through a 0.8-mm diameter needle with electrostimulation guidance. In the 3 cases, injection of BtxA reduced pain and improved the range of motion, especially abduction and external rotation, of the hemiplegic shoulder. This result confirms the role of spasticity in hemiplegic shoulder pain and the beneficial effects of Botulinum toxin injection into the subscapularis muscle deserve to be confirmed in further series.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
9/21. phenol block for hip flexor muscle spasticity under ultrasonic monitoring.Hip flexor spasticity, which is often associated with central nervous system (CNS) diseases, is a major impediment in rehabilitation. In order to cope with this problem, lumbar nerve blocking techniques developed by Meelhuysen and major and minor psoas muscle blocking techniques developed by Awad have been used in combination with physical therapies. Based on these techniques, we conducted major and minor psoas muscle phenol block (motor point block or intramuscular nerve block) under ultrasonic monitoring. phenol block was conducted in nine patients with cerebral infarction (13 blocking procedures) and three with spinal cord injuries (six blocking procedures) while keeping them in a lateral position with the operation side upside. The beginning of the femoral nerves and part of the lumbar artery were visualized by ultrasound in some patients. As a result of the improvement of hip flexor spasticity, the range of hip joint motion (determined by the Mundale technique, prone hip extension and Thomas test) improved shortly after blocking. When physical therapy was conducted after blocking, improvement of skin care management was observed in eight cases, ability to keep in a stable sitting position in nine, improvement of a standing posture in three, increases in the ability to walk in two and alleviation of pain in three. Although nerve block is reported to result in hematoma, decreases in muscle force, pain, cystic/rectal disorders and hypogonadism, we have observed no such complication in our patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/21. Dynamic electromyography to assess elbow spasticity.Control of elbow motion was evaluated in 45 extremities of adults with spasticity resulting from traumatic brain injury with use of dynamic electromyography. Simultaneous recording of elbow motion was obtained using a double parallelogram goniometer. Thirty-four male and 9 female patients were studied. Mean elbow flexion was 85 degrees and mean extension was 20 degrees. The average time of elbow flexion was 1.8 seconds. Extension time was prolonged to a mean of 4.0 seconds. Dynamic electromyography revealed a consistent pattern of muscle activity. Severe spasticity was noted in the brachioradialis muscle. Moderate spasticity was present in the biceps and only mild spasticity was seen in the brachialis muscle. Normal phasic muscle activity was the rule in the triceps. All patients had active elbow flexion, but the flexor spasticity limited smooth extension. elbow flexor spasticity, especially of the brachioradialis and biceps muscles, commonly interferes with hand placement. Lengthening of the biceps and brachialis tendons combined with release of the brachioradialis enhances elbow motion and improves hand placement.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
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