Article

Effect of cold air therapy in relieving spasticity: Applied to spinalized rabbits

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Abstract

Before-After trial measured prior to cold air therapy, immediately following, after 30 and 60 min. To determine the effect of cold air therapy in relieving spasticity, the optimal intramuscular temperature, and the duration of spasticity relief attained by cold air therapy. Clinical research laboratory, Seoul, Korea. Forty-six spastic paraplegic rabbits with spinal cord injury. Spastic paraplegia was induced by transection of spinal cord in 46 rabbits. Cold air was applied to triceps surae muscles for 30 min at three different intramuscular temperatures (25, 30 and 32.5 degrees C). Clinical parameters of spasticity (muscle tone, Babinski's sign, muscle stretch reflex and ankle clonus) and electrophysiologic parameters (F/M ratio and H/M ratio) were measured immediately following, after 30 and 60 min. In the 32.5 degrees C group, relief in spasticity lasted less than 30 min. In the 30 and 25 degrees C groups, the decrease in spasticity lasted for at least 30 min clinically. The spasticity relief was observed only immediately following treatment when measured electrophysiologically. However, six out of 16 cases (37.5%) in the 25 degrees C group showed complete motor conduction block. To relieve spasticity with cold air therapy, the intramuscular temperature should be maintained at 30 degrees C. The duration of spasticity relief lasted from between 30-60 min after cold air therapy. We certify that all applicable institutional and governmental regulations concerning the ethical use of animals were followed during the course of this research.

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... A fisioterapia tem um papel primordial no tratamento desses pacientes e dispõe de uma gama de recursos que podem ser utilizados para reduzir o tônus muscular, a fim de promover a recuperação moto ra e prevenir complicações secundárias (Dietz e Sinkjaer, 2007), dentre os quais se encontram a crioterapia (Akinbo et al., 2007;Allison e Abrahan, 2001;Chesterton et al., 2002;Lee et al., 2002a;Westerlunda et al., 2003) e a EENM (Estimulação Elétrica NeuroMusucular) (Akinbo et al., 2007;Lima et al., 2008). ...
... A crioterapia é um procedimento físico que consiste na transferência de energia térmica através dos tecidos, a fim de diminuir a temperatura de certa região corporal com finalidades terapêuticas (Chesterton et al., 2002;Felice e Santana, 2009). Esta técnica tem sido utilizada recentemente na redução da espasticidade muscular, tanto na prática clínica quanto no meio científico (Allison e Abrahan, 2001;Chesterton et al., 2002;Lee et al., 2002a;Westerlunda et al., 2003). A aplicação terapêutica da crioterapia reduz gradativamente a transmissão dos impulsos nos nervos sensitivos por causa da diminuição da velocidade de condução nervosa. ...
... Segundo Felice e Santana (2009) os efeitos da crioterapia na redução da espasticidade podem perdurar por um período que varia de 30 minutos a 2 horas. Esses resultados também corroboram com os apresentados por Lee et al. (2002a), quando afirmaram em seu estudo em coelhos com lesão na medula espinal que a crioterapia foi efetiva na redução imediata da espasticidade e 30 minutos depois da aplicação. ...
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Spasticity often coexists with stroke due to an upper motor neuron lesion, which impacts the patient's quality of life. Therefore, the control of muscle tone through physical therapy such as cryotherapy and Neuromuscular Electrical Stimulation (NMES) is extremely important. Several studies have demonstrated their advantageous physiological effects. However, these studies have not provided sufficient scientific proof for the treatment of upper limb spasticity and the duration of the physiological effects after the therapy. Therefore, this work helps to establish an application protocol for cryotherapy and NMES in individuals with spastic hemiparesis. The resistance to movement of the elbow flexor and extensor muscles before and after application of cryotherapy and NMES was used to determine the effect of the therapies. The study included 15 stroke patients that required physical therapy for spastic hemiparesis. They included both sexes, mean age of 56 ± 16. An evaluation was performed before and after therapy, as well as 10, 20, and 30 minutes following the application, by means of surface electromyography (EMG). The resistance to movement was measured with an Isokinetic Dynamometer in the passive mode at an angular velocity of 30 and 150 º/s. Although not statistically significant (p < 0.05), the results showed a reduced resistance to passive movement of the elbow flexors and extensors after cryotherapy and NMES, allowing us to conclude that physical therapy effectively reduces the resistance to passive movement in spastic hemiparetic patients, however, they have different effects with respect to time.
... The effect of cryotherapy on knee extensor muscle torque has been less studied (6). Despite the potential utility of cryotherapy after an acute injury, some studies have shown that cooling the skin reduces the isokinetic knee extensor and plantar flexor muscle torque (15)(16)(17)(18), contractile properties, muscle power of triceps (16,19,20), and maximum handgrip strength (21,22). Some studies have reported that the muscle torque can be increased after cooling (23,24). ...
... The effect of cryotherapy on knee extensor muscle torque has been less studied (6). Despite the potential utility of cryotherapy after an acute injury, some studies have shown that cooling the skin reduces the isokinetic knee extensor and plantar flexor muscle torque (15)(16)(17)(18), contractile properties, muscle power of triceps (16,19,20), and maximum handgrip strength (21,22). Some studies have reported that the muscle torque can be increased after cooling (23,24). ...
... In addition, the effect of cryotherapy on proprioception is closely dependent on the skin temperature, at which it reduces after cryotherapy. Accordingly, lee et al. (16) reported that the conduction velocity of subcutaneous nerves is significantly reduced when the skin temperature is at approximately ≤ 25°C. Below the temperature of 15°C, nerve conduction can be failed. ...
Article
Objectives: This study was done to investigate the influences of cryotherapy on the joint position sense (JPS) and extensor muscles torque of the knee. Methods: Forty healthy volunteers (20 men, 20 women; age range, 21 – 30 y) participated. Two cooling pads were applied to the knee and anterior thigh for 15 minutes at 4°C. The accuracy of the knee JPS was evaluated before and after cooling in two angles, including 45° and 60° flexion. Extensor muscles torque of the knee was obtained in two velocities of 30°/s and 120°/s. Results: The effect of time and the interaction between the group and time were not significant for both active and passive repositioning error tests of the knee joint angles (P ≥ 0.05). The knee extensor's muscle torque increased significantly during both velocities of 30°/s and 120°/s, immediately and 30 minutes after the cryotherapy in the experimental group (P ≤ 0.01). Cooling for 15 minutes made a higher knee extensor muscle torque and did not change the JPS. Conclusions: These findings should be considered for therapeutic programs that involve exercise immediately after a period of cryotherapy.
... Cryotherapy is one of the therapeutic modalities that have been considered as a mean of decreasing symptoms of spasticity [3]. Cold hypersensitivity might limit rubbing with an ice cube or packs, and it is intolerable to apply prolonged cooling or the use of evaporative agents for more than ten minutes, which may produce pain, burning sensation or thermal shock [4]. A newly developed machine that produces cold air by its passage through dry ice or by compressing the air nitrogen, it is preferable to prolonged cooling because of its continuous, constant, and accurate low temperature airflow application that can be tolerated for longer than ten minutes [4,5]. ...
... Cold hypersensitivity might limit rubbing with an ice cube or packs, and it is intolerable to apply prolonged cooling or the use of evaporative agents for more than ten minutes, which may produce pain, burning sensation or thermal shock [4]. A newly developed machine that produces cold air by its passage through dry ice or by compressing the air nitrogen, it is preferable to prolonged cooling because of its continuous, constant, and accurate low temperature airflow application that can be tolerated for longer than ten minutes [4,5]. Therefore, the purpose of this study is to determine the effect of cryo-airflow therapy on spasticity especially of the calf muscle and its effect on ankle dorsiflexion range of motion (ROM) during the stance phase of gait in patients with stroke. ...
... Cryo-flow 700/1000 machine (GymnaUniphy NV -Version 01/2003, Pasweg 6A, 3740 Bilzen, Belgium); a mobile therapeutic device that generates controlled dosages of cold air by extracting air from the surrounding environment and cooling it. The patient rested in a prone position and the cold air was applied to the bulk of spastic calf muscle continuously for 30 minutes with a fixed temperature that could reach about ≤ 30°C intramuscular [4]. The cryotherapy used in this study did not show any adverse effects or complications in the treated patients. ...
... Key receptors responsive to environmental cold include TRP cation channel subfamily M, member 8 (TRPM8), and, especially in the presence of other agonists, TRP cation channel subfamily A, member 1 (TRPA1), which has a role in cold hyperalgesia ( Figure 3) [54]. Decreasing muscle temperature also reduces muscle spasm via inhibition of a spinal cord reflex loop [55]. Sensory neurons express multiple TRP channels. ...
Article
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Abstract Nonpharmacological treatment strategies for acute musculoskeletal injury revolve around pain reduction and promotion of healing in order to facilitate a return to normal function and activity. Heat and cold therapy modalities are often used to facilitate this outcome despite prevalent confusion about which modality (heat vs cold) to use and when to use it. Most recommendations for the use of heat and cold therapy are based on empirical experience, with limited evidence to support the efficacy of specific modalities. This literature review provides information for practitioners on the use of heat and cold therapies based on the mechanisms of action, physiological effects, and the medical evidence to support their clinical use. The physiological effects of cold therapy include reductions in pain, blood flow, edema, inflammation, muscle spasm, and metabolic demand. There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness (DOMS). The physiological effects of heat therapy include pain relief and increases in blood flow, metabolism, and elasticity of connective tissues. There is limited overall evidence to support the use of topical heat in general; however, RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy. There remains an ongoing need for more sufficiently powered high-quality RCTs on the effects of cold and heat therapy on recovery from acute musculoskeletal injury and DOMS.
... A pesar de que en la práctica clínica diaria no es muy utilizada, la aplicación de frío localizado como medida antiespástica ha sido aceptada por la comunidad científica ( Adams et al., 2005;Chiara et al., 1998;Hummelsheim et al., 1993). Los métodos que se pueden emplear para esta práctica son la inmersión en agua fría, la aplicación de hielo, bolsas de frío o el uso de sprays ( Lee et al., 2002;Macías et al., 2003). De esta forma, teniendo en cuenta la dificultad de inmersiones analíticas de musculatura espástica y la limitación de los sprays ante pulverizaciones prolongadas, la aplicación de hielo y las bolsas de frío son las medidas de crioterapia más aconsejadas para combatir la espasticidad. ...
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... A pesar de que en la práctica clínica diaria no es muy utilizada, la aplicación de frío localizado como medida antiespástica ha sido aceptada por la comunidad científica (Adams et al., 2005;Chiara et al., 1998;Hummelsheim et al., 1993). Los métodos que se pueden emplear para esta práctica son la inmersión en agua fría, la aplicación de hielo, bolsas de frío o el uso de sprays (Lee et al., 2002;Macías et al., 2003). De esta forma, teniendo en cuenta la dificultad de inmersiones analíticas de musculatura espástica y la limitación de los sprays ante pulverizaciones prolongadas, la aplicación de hielo y las bolsas de frío son las medidas de crioterapia más aconsejadas para combatir la espasticidad. ...
Thesis
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INTRODUCCIÓN: La espasticidad es un trastorno sensitivo-motor con una alta prevalencia en la lesión medular que limita considerablemente la calidad de vida de estos pacientes. El objetivo de esta tesis doctoral se centra en detectar medidas neurofisiológicas durante el movimiento voluntario que cuantifiquen diferentes signos y fenómenos asociados a la espasticidad, así como evaluar nuevos tratamientos sensitivos que podrían normalizar la actividad inhibitoria de los circuitos moduladores espinales de pacientes con espasticidad. MATERIAL Y MÉTODOS: Se realizaron tres estudios experimentales independientes. En todos ellos se reclutaron pacientes con lesión medular incompleta motora con preservación de la musculatura de la pierna y se evalúo la hipertonía muscular y la frecuencia de espasmos. Todos los ensayos incluyeron un grupo control formado por sujetos voluntarios sanos. En el primer ensayo se realizó un seguimiento durante la fase subaguda de la lesión medular incompleta (2-5 meses, n=10). En cada sesión se analizó la actividad electromiográfica del tibial anterior y sóleo obtenida durante la realización de un movimiento de “pisar y mantener”, a diferentes intensidades de contracción. Al final del estudio se calculó la coactivación del tibial anterior y se dividieron a los pacientes según el criterio de haber desarrollado espasticidad. En el segundo estudio se cuantificó la actividad de los reflejos cutáneos del tibial anterior y del gemelo medial durante el reposo, la flexión plantar isotónica y la flexión plantar isométrica durante el movimiento de “pisar y mantener”, en pacientes sin (n=10) y con espasticidad (n=9). En el tercer ensayo se cuantificó, en sujetos sin (n=14) y con espasticidad (n=14), la modulación del reflejo cutáneo del tibial anterior y del reflejo H del sóleo mediante la aplicación de un estímulo vibratorio y otro eléctrico, sobre la planta del pie, en las mismas fases de movimiento que en el segundo estudio. RESULTADOS: En el primer ensayo se observó una menor actividad electromiográfica del tibial anterior durante la contracción voluntaria máxima de los pacientes con espasticidad. La coactivación del tibial anterior dependiente de la intensidad de contracción antagonista, aumentó en los pacientes sin espasticidad, pero mantuvo un nivel bajo y estable en los pacientes espásticos. En el segundo ensayo se detectó una mayor actividad del reflejo cutáneo planta-tibial anterior y una desinhibición de éste durante la flexión plantar de los pacientes con espasticidad. Se observó una correlación negativa entre el grado de hiperreflexia y la fuerza de flexión plantar. En el tercer ensayo, la aplicación de vibración redujo la hiperreflexia del tibial anterior durante el reposo y durante la flexión plantar isométrica, únicamente en los pacientes con espasticidad, mientras que la reducción de la hiperreflexia del tibial anterior mediante la aplicación de estimulación eléctrica únicamente se evidenció durante el reposo. CONCLUSIONES: El desarrollo de espasticidad impide el aumento de la coactivación muscular del tibial anterior durante la fase subaguda de la lesión medular y provoca una desinhibición del reflejo cutáneo flexor cuando ya está establecida. La vibración y la estimulación eléctrica plantar inhiben la hiperreflexia flexora de los pacientes con espasticidad. La estimulación sensitiva de la planta del pie podría ser una forma de tratamiento útil para el manejo rehabilitador de la espasticidad. Son necesarios un mayor número de estudios que midan la duración del efecto de la estimulación sensitiva sobre la espasticidad tras la lesión medular.
... A tenotomia é utilizada quando se tem um estágio avançado de contratura, que impede o mínimo de movimento funcional 16 . Em aplicação de ar frio sobre a pele de coelhos com paraplegia induzida, observou-se que a temperatura intramuscular mantinha-se em torno de 30ºC, mas o alívio da espasticidade permanecia ativo por 30-60 min após a experimentação 41 . Estímulos vibracionais são provenientes geralmente de indutores eletromagnéticos 42 ou rotores descentrados 43,44 . ...
Article
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The spasticity is a neurological disorder from a lesion in the upper motor neuron and from the disarrangement of neural circuits in the spinal cord, which causes sensorial and motor changes of vari- able degrees. Pharmacological, physical therapeutical, and surgical techniques are used to reduce spasticity. This study aims to show and argue the feasibility of using vibrational stimuli in the physi- cal therapeutic treatment. Oscillatory waves generated by vibrational stimuli applied to the patient are captured by peripheral receptors causing movement illusion. The neural plasticity is evoked by physi - cal stimuli such as movement of the leg, or artificially, with func - tional electrical stimulation. Applying vibrational stimulation on the Golgi tendon organ and using image analysis, researchers obtained activation of several brain regions, supporting the hypothesis that the vibrational stimulation is effective for movement disorder from neurological origin. In the literature, the parameters adjusted to pro- vide movement illusion are: frequency ranging between 1 and 140 Hz, force between 0.5 and 9 N, and amplitude ranging from 0,005 to 2 mm. As a conclusion from this study, vibration on sensorial receptors produces cortical activation and, sporadically, agonist or antagonist motor activation. From a clinical point of view, vibra- tional stimuli are effective in the treatment of spasticity.
... In addition to the increase in H-reflex amplitude, we observed an increase in the H-reflex latency, caused by nerve conduction velocity reduction due to cooling 16,37,38 . Similar results were found by Dewhurst et al. 39 , who assessed the H-reflex after cooling in a sample of 10 young and 10 elderly women. ...
Article
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The disorder of reflex and motor function in patients affected by stroke causes negative impact on the performance of movement patterns and affects the functional activities. To investigate the immediate effects of transcutaneous electrical nerve stimulation (TENS) and cryotherapy interventions on the spinal reflex excitability and in the voluntary electromyography (EMG) activity in people with chronic stroke. Randomized crossover trial. The maximum H-reflex (Hmax), the H-reflex latency and the maximum motor response (Mmax) of the soleus muscle and also the EMG of the tibialis muscle where evaluated before and after the application of TENS, cryotherapy and control conditions. The Hmax/Mmax ratio was statistically significant higher (p=0.0245) and the H-reflex latency was statistically significant lower (p=0.0375) in the soleus muscle of the affected limb. The EMG amplitude of the tibialis anterior was reduced in the compromised limb (p<0.0001). After the use of the TENS, a reduction in the Hmax/Mmax ratio (p=0.0006) was observed leading to lower reflex excitability. However, after the cryotherapy intervention an increase of the Hmax/Mmax ratio was observed, which was accompanied by an increase in the H-reflex latency (p=0.0001). The EMG amplitude has not changed by any of the interventions. Our findings suggest that TENS may be a choice for immediate reduction of reflex excitability, whereas cryotherapy intervention may increase reflex excitability in hemiparetic subjects. However, none of the changes mediated by either intervention were able to modify the electrical activity in the antagonist muscle of the spastic muscle.
... Symptoms of spasticity were induced by damaging the spinal cord. The study confirmed that cryotherapy effectively reduces muscle tone, 60 but studies investigating the clinical use of cryotherapy had been carried out for many years before this study was performed. Numerous articles published since 1978 referred to the effectiveness of cryotherapy, as, for instance, in the case of patients with spasticity. ...
Article
Even though not human, animals are not research equipment
... It is thought that reflexive reactions are impaired following cryotherapy because of convincing evidence that the reflex latencies of human Achilles tendons and rabbit patellar tendons are significantly decreased following ice treatment [29,30]. However, these findings were observed following direct muscle cooling. ...
Article
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PURPOSE To summarize evidence regarding efficacy of focal joint cooling on muscle function. METHODS Literature review was performed to determine effectiveness of focal joint cooling on muscle function. Therapeutic cooling, professionally termed cryotherapy, has a long history in sports medicine because it has been widely used for a variety of therapeutic purposes. However, it has been contraindicated in rehabilitation for patients with muscle dysfunction because it is believed that cryotherapy has detrimental effects on muscle function. It is clinically important to recognize that the negative outcomes may result from the common mode of cryotherapy involving the direct cooling of muscle fibers. In contrast, there is promising evidence that when cryotherapy targets joints where muscle fibers are not located, the negative effects on muscle function can be eliminated or there can even be positive effects on muscle function. RESULTS Focal joint cooling appears to be effective in increasing motor neuron activation in patients with joint pathology in the lower extremity, leading to greater muscle strength. In addition, joint cryotherapy may be capable of negating deficiencies in functional performance while it was not found to be neither beneficial nor harmful to reflexive action and postural control. CONCLUSIONS Joint cryotherapy can be a safe and effective intervention for improving muscle function, and it should be indicated for patients with persistent muscle dysfunction.
... The effectiveness of available drugs is still uncertain, and they may cause adverse effects. 2,[4][5][6][7][8][9][10][11] Hydrotherapy is one of the oldest therapeutic methods for managing physical dysfunctions. It is used for the effects on body tissues of heating, cooling, debridement, pain relief, muscle relaxation, treatment of joint stiffness, psychological relaxation, and warm-up to assist with exercises. ...
Article
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Spasticity is a major problem for the rehabilitation team. Physiotherapy is a vital component of therapy. Oral medication and other modalities such as heat, cold, ultrasound, electrical stimulation, and surgery (neuro-surgical or orthopedic) can also be used. The aim of this study was to compare the effects of hydrotherapy on spasticity and Functional Independence Measure (FIM) scores of patients with spinal cord injury (SCI). This is a control case matched study. Twenty SCI patients were divided into 2 groups and matched for age, gender, injury time, Ashworth scores, oral baclofen intake, American Spinal Injury Association, and FIM scores. The control group received passive range of motion exercise twice a day and oral baclofen for 10 weeks. The study group also received passive range of motion and oral baclofen, as well as 20 min of water exercises (at 71 degrees F, full immersion) 3 times per week. The authors evaluated spasm severity, FIM scores, oral baclofen intake, and Ashworth scales, between groups at the beginning and at the end of the treatment period. Both groups demonstrated a significant increase in FIM scores. However, the hydrotherapy group demonstrated a larger increase (P < 0.0001) than the control group. There was a statistically significant decrease in oral baclofen intake in the hydrotherapy group (P < 0.01). There was no statistical change in the control group. Spasticity was evaluated by the Ashworth scale. There was a statistical improvement in each group (P < 0.01, P < 0.02). However, when compared to the control group, the use of hydrotherapy produced a significant decrease in spasm severity (P < 0.02). Side effects are often seen when using oral drug treatment for spasticity. Adding hydrotherapy to the rehabilitation program can be helpful in decreasing the amount of medication required. Future studies must evaluate benefits of hydrotherapy for rehabilitation.
... Segundo a literatura, a crioterapia pode ser aplicada em qualquer situação na qual o controle da dor aguda ou crônica, a redução do espasmo e da espasticidade muscular se façam necessários [7][8][9][10]. Porém, sua maior aplicabilidade é vista nos estágios infl amatórios agudos e subagudos decorrentes de traumas músculo-esqueléticos [11,12] e no pós-operatório imediato [13,2]. ...
Article
Crioterapia, ou terapia com frio, é um método muito utilizado em traumas músculo-esqueléticos, pós-operatório, dor miofascial, espasmo muscular, espasticidade e condições inflamatórias. Diversas técnicas de crioterapia são aplicadas, entretanto, seu uso é realizado de forma indiscriminada. Apesar da maioria dos trabalhos na literatura apontar efeitos satisfatórios do uso do frio, ainda existem controvérsias em relação à real eficácia desse recurso, principalmente relacionadas à inflamação e ao edema. Este estudo teve como objetivo buscar fundamentações científicas que possam ajudar a esclarecer o papel da crioterapia no edema traumático, a fim de que o profissional de reabilitação possa utilizar essa modalidade com melhor embasamento científico. Para a realização deste trabalho, foi feita uma pesquisa documental de artigos científicos em revistas, jornais e sites, além de um levantamento bibliográfico em livros relacionados ao temaem questão. Existemevidências dos efeitos positivos da crioterapia no controle do edema. Entretanto, determinados trabalhos apontaram efeitos insatisfatórios. Vale a pena salientar que as disparidades observadas nesses estudos se devem ao fato de que, muitas vezes, a aplicação da crioterapia é feita de forma inadequada, gerando assim, conclusões precipitadas. Com base nesta revisão bibliográfica, sugere-se que a crioterapia é um recurso eficaz quando aplicado imediatamente ao trauma.Palavras-chave: lesão, inflamação, edema, crioterapia.
... The pursuance of non-pharmaceutical remedies for the treatment of CP leads to an increased consideration of physical factors. Cooling is one of it (Lee et al., 2002). Much information has been recently gathered on the positive dosed direct physical, reflex and neurohumoral effect of cooling on the human body. ...
Article
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Research background and hypothesis. Cryotherapy could reduce spasticity for children with cerebral palsy. Research aim. The aim of this study was to determine the effect of cryotherapy on the lower limb spasticity for children with cerebral palsy. Research methods. Fourteen children with cerebral palsy spastic Diplegia aged 6–12 years were examined. The procedures of cryotherapy and physical therapy were applied to children in the test group (n = 7), and only physical therapy – for the members in the control group (n = 7). For all the subjects, the following procedures were performed before and after the research: foot extension measurements, the determination of the spasticity of flexors and selective foot motion, the estimation of balance and gross motor functions. Research results. After physical exercises foot extension showed improvement, spasticity of foot flexors reduced, foot selective movements, balance and gross motor functions improved. There was no statistical difference between the results in both groups. Discussion and conclusions. The influence of cryotherapy on the lower limb spasticity for children with cerebral palsy was not statistically significant. Keywords: spasticity, cryotherapy, physical exercises.
... Another contribution to pain relief is from reduced muscle spasms. Cold applied directly to muscles inhibits the motor reflex loops that maintain contraction and spasticity, thereby relieving muscle spasm (Lee et al. 2002). Muscle spasm may be present in patients with both acute and chronic pain and is a major cause of discomfort (Malanga et al. 2015). ...
Article
en This is the fourth Capsule review article provided by the WSAVA Global Pain Council and which discusses the use of ice or cold therapy as a non‐pharmacologic modality for pain control in small animal practice. The physiological effects of cold therapy on tissues, receptors and ion channels are discussed; as well as indications, recommendations for, and limitations of use. Abstract ar توفر الجمعية العالمية World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) "كبسولات". هذه الكبسولات هي مقالات قصيرة تقدم تقييمًا موجزًا للأدلة العلمية والتوصيات العملية حول مواضيع مهمة ، وأحيانًا مثيرة للجدل في معالجة الألم. سيتم نشر الكبسولات في مجلة Journal of Small Animal Practice ، وهي الجريدة الرسمية ل World Small Animal Veterinary Association. هذه هي المقالة الثالثة التي تناقش استخدام الثلج أو العلاج البارد كطريقة غير دوائية للسيطرة على الألم لدى الحيوانات الأليفة. تمت مناقشة التأثيرات الفسيولوجية للعلاج البارد على الأنسجة والمستقبلات والقنوات الأيونية ؛ بالإضافة إلى المؤشرات والتوصيات وقيود الاستخدام. Abstract fr La World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) fournit des “capsules”. Ce sont de courts articles qui présentent une brève évaluation des preuves scientifiques et des recommandations pratiques sur des sujets importants et parfois controversés dans la gestion de la douleur. Les capsules seront publiées dans le Journal of Small Animal Practice, le journal officiel de la World Small Animal Veterinary Association. Ceci est le troisième article, qui traite de l'utilisation de la glace ou de la thérapie par le froid comme modalité non pharmacologique pour le contrôle de la douleur dans la pratique des petits animaux. Les effets physiologiques de la thérapie par le froid sur les tissus, les récepteurs et les canaux ioniques sont discutés; ainsi que les indications, recommandations et limites d'utilisation. Abstract de Das World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) veröffentlicht sogenannte “Capsule Reviews”. Das sind kurze Artikel, die eine Übersicht über die wissenschaftliche Evidenz und praktische Empfehlungen zu wichtigen und manchmal kontroversiellen Themen im Bereich Schmerzmanagement geben. Sie werden regelmäßig im Journal of Small Animal Practice, dem offiziellen Journal der World Small Animal Veterinary Association publiziert. In diesem, dritten, Artikel wird die Anwendung von Eis‐ bzw. Kältetherapie als nicht‐pharmakologische Methode zur unterstützenden Schmerztherapie in der Kleintierpraxis diskutiert. Die physiologische Wirkung von Kältetherapie auf Gewebe, Rezeptoren und Ionenkanäle, sowie Indikationen, Empfehlungen und Einschränkungen werden besprochen. Abstract it Il World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) produce delle “pillole”. Le “pillole” sono brevi articoli che sintetizzano le evidenze scientifiche disponibili e forniscono raccomandazioni pratiche su argomenti importanti, a volte controversi, correlati alla gestione del dolore negli animali. Le pillole saranno pubblicate nel Journal of Small Animal Practice, la rivista ufficiale della World Small Animal Veterinary Association. Questo è il terzo articolo, che discute l'uso del ghiaccio o della terapia del freddo come modalità non farmacologica per il controllo del dolore nella pratica dei piccoli animali. Vengono discussi gli effetti fisiologici della terapia del freddo su tessuti, recettori e canali ionici; così come indicazioni, raccomandazioni e limitazioni d'uso. Abstract ja World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) は“要約”を提供している。これらの要約は科学的エビデンスの簡潔な評価、疼痛管理における重要な、時には論争の的となるようなものに関する実用的な推奨事項について紹介している。これらの要約はWorld Small Animal Veterinary Association の公式雑誌である Journal of Small Animal Practice にて発表されていく。この論文は第三弾であり、小動物臨床における疼痛コントロールを目的とした非薬理学的な方法としての寒冷療法について議論している。組織、受容体、イオンチャネルにおける寒冷療法の生理学的な効果について、そして適応、推奨事項および使用に関する制限事項についても議論している。 Abstract ms World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) menyediakan "kapsul". Ini adalah artikel ringkas yang membentangkan penilaian ringkas mengenai bukti saintifik dan cadangan praktikal mengenai subjek yang penting, dan kadang‐kadang kontroversi, dalam pengurusan kesakitan. Kapsul‐kapsul tersebut akan diterbitkan dalam Journal of Small Animal Practice, jurnal rasmi WSAVA. Ini adalah artikel ketiga, yang membincangkan penggunaan ais atau terapi sejuk sebagai modaliti bukan farmakologi untuk mengawal kesakitan dalam amalan haiwan kecil. Kesan fisiologi terapi sejuk pada tisu, reseptor dan saluran ion; serta indikasi, cadangan, dan batasan penggunaan dibincangkan. Abstract pt A World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) fornece “cápsulas de revisão”. Elas são compostas de artigos curtos que apresentam uma breve avaliação das evidências científicas e recomendações práticas sobre aspectos importantes, e às vezes controversos, sobre o manejo da dor. As cápsulas serão publicadas no Journal of Small Animal Practice, o periódico oficial da World Small Animal Veterinary Association. Este é o terceiro artigo, que discute o uso de terapia com gelo ou por frio como modalidade não farmacológica para controle da dor em pequenos animais. Os efeitos fisiológicos da terapia por frio nos tecidos, receptores e canais iônicos são discutidos; incluindo suas indicações, recomendações e limitações. Abstract ru World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) предоставляет к публикации капсульные обзоры. В капсульных обзорах кратко освещаются научные данные и практические рекомендации касательно важных, а также иногда неоднозначных аспектов терапии боли. Капсульные обзоры будут опубликованы в Journal of Small Animal Practice, официальном издании World Small Animal Veterinary Association. Abstract zh World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) 提供了“精要”。这些简短的文章就疼痛管理中的重要且有时引起争议的主题进行了简要科学证据评估并提供实用建议。这些精要将在WSAVA的官方杂志Journal of Small Animal Practice上发表。 这是第三篇文章,讨论了在小型动物实践中使用冰或冷敷疗法作为控制疼痛的非药物方法。此文章讨论了冷敷疗法对组织,受体和离子通道的生理作用;以及使用的指示,建议和限制。 Abstract es La World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) proporciona "cápsulas". Estas son artículos breves que presentan una breve evaluación de la evidencia científica y recomendaciones prácticas sobre temas importantes y, a veces, controversiales en el tratamiento del dolor. Las cápsulas se publicarán en el Journal of Small Animal Practice, diario oficial de World Small Animal Veterinary Association. Este es el tercer artículo, que discute el uso de la terapia de hielo o fría como una modalidad no farmacológica para el control del dolor en la práctica de pequeños animales. Se discuten los efectos fisiológicos de la terapia fría en tejidos, receptores y canales iónicos; así como indicaciones, recomendaciones y limitaciones de uso. Abstract th World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) ได้มอบบทความสรุปสั้นๆ ซึ่งเป็นบทความที่สรุปถึงหลักฐานทางวิทยาศาสตร์ และการแนะนำในการใช้ในเชิงปฎิบัติที่สำคัญ และมีการโต้แย้งบางครั้งในการจัดการกับความปวด บทความนี้ได้มีการจัดพิมพ์ใน Journal of Small Animal Practice ซึ่งเป็นนิยสารอย่างเป็นทางการของ World Small Animal Veterinary Association ซึ่งบทความนี้เป็นบทความที่สาม ที่ได้พูดถึงการใช้น้ำแข็งหรือการบำบัดด้วยความเย็น ซึ่งไม่มีผลในทางเภสัจน์วิทยาในการควบคุมอาการปวดในสัตว์เล็ก มีการพูดถึงผลในเชิงชีวทยาของการใช้วิธีบำบัดด้วยความเย็นบนเนื้อเยื้อ และผลต่อ ion channels ตลอดจนข้อบ่งใช้, คำแนะนำในการใช้, และข้อจำกัดในการใช้ Abstract zh-Hant 在這些由World Small Animal Veterinary Association ‐ Global Pain Council(WSAVA‐GPC)所提供的「精要評論」短篇文章中,對於重要或具爭議的疼痛管理議題有關之科學證據進行快速的評估,並提供臨床運用上的建議。這些精要評論會發表在World Small Animal Veterinary Association的官方期刊Journal of Small Animal Practice上。在這第三篇精要評論中,探討了在小動物臨床上,冰敷(ice therapy)或冷療(cold therapy)作為非藥物形式疼痛管理的使用。我們將討論冷療對組織、受體及離子通道的生理作用,同時也探討其適應症、建議使用方法以及使用上的限制。 Abstract tr World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) “kapsüller” sağlar. Bunlar, ağrı yönetimindeki önemli ve bazen tartışmalı olan konular hakkında bilimsel kanıtların ve pratik önerilerin kısa bir değerlendirmesini sunan kısa makalelerdir. Kapsüller, World Small Animal Veterinary Association’ın resmi dergisi olan Journal of Small Animal Practice'te yayınlanacaktır. Bu makale, küçük hayvan pratiğinde ağrı kontrolü amacıyla; farmakolojik olmayan bir yöntem olan buz veya soğuk uygulama tedavisinin kullanımını tartışan üçüncü makaledir. Soğuk uygulama terapisinin; dokular, reseptörler ve iyon kanalları üzerindeki fizyolojik etkilerinin yanı sıra, endikasyonlar, öneriler ve sınırlamalar da tartışılmaktadır. Abstract vi World Small Animal Veterinary Association ‐ Global Pain Council (WSAVA‐GPC) cung cấp bài nhận xét. Đây là những bài nhận xét ngắn, trình bày đánh giá ngắn gọn về bằng chứng khoa học và khuyến nghị thực tế trên những chủ đề quan trọng và vẫn còn tranh cãi trong lĩnh vực kiểm soát đau. Bài nhận xét ngắn sẽ được xuất bản trên Journal of Small Animal Practice, tạp chí chính thức của World Small Animal Veterinary Association. Đây là chủ đề thứ ba, thảo luận về việc sử dụng liệu pháp lạnh hay đá lạnh như một phương thức không‐dùng‐thuốc cho việc kiểm soát đau trong lĩnh vực thực hành thú nhỏ. Những ảnh hưởng sinh lý của liệu pháp lạnh trong mô, thụ thể và kênh ion được thảo luận; cũng như chỉ định, khuyến cáo và các giới hạn trong cách sử dụng.
... In the literature, cryotherapy is reported to have physiologic benefits ranging from decreased local edema to the utilization of blood flow in the surgical area, decreased muscle spasm, oxygen utilization, and spinal-cord-mediated reflex arcs [3, [24][25][26]. Although some studies [7] have found that cryotherapy yields better results for postoperative pain and localized edema, we found that there was no difference between the groups in our study in this respect. ...
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... Changes resulting in a decreased neuromotor response could potentially render the athlete or physically active individual more susceptible to injury. Human Achilles tendon (Bell and Lehmann, 1987;Harlaar et al., 2001) and rabbit patellar tendon (Lee et al., 2002) stretch reflex latency and amplitude have been shown to decrease following respective cryotherapy treatment to the soleus and quadriceps musculature itself. Researchers have also shown that cooling the ankle joint directly results in significant facilitation of the soleus motoneuron pool (Krause et al., 2000;Hopkins and Stencil, 2002). ...
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The purpose of this study was to compare the effect of compressive cryotherapy (CC) vs. ice on postoperative pain in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. A commercial device was used for postoperative CC. A standard ice wrap (IW) was used for postoperative cryotherapy alone. Patients scheduled for rotator cuff repair or subacromial decompression were consented and randomized to 1 of 2 groups; patients were randomized to use either CC or a standard IW for the first postoperative week. All patients were asked to complete a "diary" each day, which included visual analog scale scores based on average daily pain and worst daily pain as well as total pain medication usage. Pain medications were then converted to a morphine equivalent dosage. Forty-six patients completed the study and were available for analysis; 25 patients were randomized to CC and 21 patients were randomized to standard IW. No significant differences were found in average pain, worst pain, or morphine equivalent dosage on any day. There does not appear to be a significant benefit to use of CC over standard IW in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. Further study is needed to determine if CC devices are a cost-effective option for postoperative pain management in this population of patients. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
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This chapter discusses basic principles that appear to be useful in the treatment and rehabilitation of musculoskeletal injuries. It provides some specific advice for reducing the risk of developing musculoskeletal disorders in the occupational setting. The chapter describes procedures that may help reduce the pain and promote the healing process when an injury does occur. It then focuses on some of the lifestyle habits that have been shown to be of benefit to musculoskeletal health. Dietary factors appear to be important with respect to musculoskeletal health. Obesity is a risk factor for musculoskeletal disorders in general. There are many ways in which cumulative damage may accrue. The cumulative damage development might be the result of a mono‐task job, or more often, jobs comprised of multiple tasks. Adoption of non‐neutral postures may have an important role in increasing stress on musculoskeletal tissues, which has an important impact on the fatigue life of tissues.
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Objective. To compare cooling of skin, subcutaneous fat and muscle, produced by an icepack, at rest and after short-duration exhaustive exercise. Methods. Eight male subjects were studied. With the subject supine, hypodermic needle-tip thermistors were inserted into the subcutaneous fat and the mid-portion of the left rectus femoris, to a depth of 1 cm plus the adipose thickness at the site, and a temperature probe was placed on the skin overlying the needle tips. A pack of crushed ice was applied for 15 minutes and temperatures were recorded before, during, and for 45 minutes after icepack application. Thereafter, subjects underwent a ramped, treadmill, VO2max test, an icepack was applied after temperature probes were inserted into the right leg and measurements were made as before. Results. After the treadmill run, skin (Sk), subcutaneous (SC) and muscle (Ms) temperatures (mean ± standard deviation (SD)) were 0.9 ± 1.3, 1.0 ± 0.7 and 1.3 ± 0.8°C higher than at rest. After 15 minutes of icepack cooling, temperatures fell in the exercised limb by 22.7 ± 1.5°C (Sk), 13.5 ± 4.2°C (SC) and 9.3 ± 5.5°C (Ms) and in the control limb by 20.7 ± 2.9°C (Sk), 11.4 ± 2.0°C (SC) and 8.7 ± 2.6°C (Ms). The reductions in temperature were significant in both the control and exercised limbs. Forty-five minutes after icepack cooling, muscle temperature was still approximately 5°C lower in both the rested and exercised muscle (p < 0.001). Individual variations in response to cooling were noted. Conclusions. Cooling of superficial muscle occurs after high-intensity exercise. The degree of cooling is not uniform. This may be due to differences in the sympathetic response to cooling, influencing haemodynamic and thermoregulatory changes after exercise. This needs further investigation. South African Journal of Sports Medicine Vol. 18 (3) 2006: pp. 60-66
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Introduccion: Existe controversia sobre los efectos terapeuticos de la crioterapia en el musculo espastico y las implicaciones clinicas que fundamentan su uso como coadyuvante en el proceso de rehabilitacion. Objetivo: Evaluar el efecto inmediato de la aplicacion del paquete de hielo sobre la excitabilidad refleja en la musculatura plantiflexora espastica en personas post-ECV. Metodos: Estudio experimental de mediciones repetidas con asignacion aleatoria a dos grupos de intervencion: Grupo Experimental (n=10) y Grupo Control (n=5). Se registro latencia (ms), duracion (ms) y amplitud (mV) de las ondas M y H y el indice de amplitud Hmaximo/Mmaximo (%) antes y despues de la crioterapia o reposo. Los participantes fueron quince individuos de ambos generos con hemiparesia espastica post-ECV, edad media de 60,7±10,7anos, mediana tiempo de evolucion 36 meses (RIC17-49). No hubo diferencias significativas en las caracteristicas basales entre los grupos de intervencion. Resultados: La crioterapia induce un aumento estadisticamente significativo en la latencia de la onda H (32,9±3,3 vs. 34,9±3,6ms, p<0,001) y M (8,0±1,9 vs. 9,4±2,4ms, p<0,05) y en la duracion de la onda M (6,3±1,3 vs. 9,8±2,2ms, p<0,001) y H (7,2±1,6 vs. 9,9± 2,0ms, p<0,001). No se determinaron cambios significativos en la amplitud, ni en el indice Hmax/Mmax. Conclusiones: Nuestros hallazgos sugieren que el enfriamiento puede ser util para el tratamiento de la espasticidad, pues retrasa la respuesta muscular evocada por estimulacion electrica directa y refleja. A su vez, prolonga el periodo refractario del potencial de accion, por lo cual se requeriria mas tiempo para activar las fibras musculares. Palabras clave: Espasticidad, reflejo H, crioterapia, electromiografia, conduccion nerviosa.
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Objective. To compare cooling of skin, subcutaneous fat and muscle, produced by an icepack, at rest and after short-duration exhaustive exercise. Methods. Eight male subjects were studied. With the subject supine, hypodermic needle-tip thermistors were inserted into the subcutaneous fat and the mid-portion of the left rectus femoris, to a depth of 1 cm plus the adipose thickness at the site, and a temperature probe was placed on the skin overlying the needle tips. A pack of crushed ice was applied for 15 minutes and temperatures were recorded before, during, and for 45 minutes after icepack application. Thereafter, subjects underwent a ramped, treadmill, VO2max test, an icepack was applied after temperature probes were inserted into the right leg and measurements were made as before. Results. After the treadmill run, skin (Sk), subcutaneous (SC) and muscle (Ms) temperatures (mean ± standard deviation (SD)) were 0.9 ± 1.3, 1.0 ± 0.7 and 1.3 ± 0.8°C higher than at rest. After 15 minutes of icepack cooling, temperatures fell in the exercised limb by 22.7 ± 1.5°C (Sk), 13.5 ± 4.2°C (SC) and 9.3 ± 5.5°C (Ms) and in the control limb by 20.7 ± 2.9°C (Sk), 11.4 ± 2.0°C (SC) and 8.7 ± 2.6°C (Ms). The reductions in temperature were significant in both the control and exercised limbs. Forty-five minutes after icepack cooling, muscle temperature was still approximately 5°C lower in both the rested and exercised muscle (p < 0.001). Individual variations in response to cooling were noted. Conclusions. Cooling of superficial muscle occurs after high-intensity exercise. The degree of cooling is not uniform. This may be due to differences in the sympathetic response to cooling, influencing haemodynamic and thermoregulatory changes after exercise. This needs further investigation. South African Journal of Sports Medicine Vol. 18 (3) 2006: pp. 60-66
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary: To determine if physical treatment interventions are effective in preventing or minimising activity limitation and participation restrictions in those patients developing spasticity post stroke. Secondary: To determine if physical treatment interventions are effective in preventing or minimising impairment, burden of care, patient quality of life and economic burden in those patients developing spasticity post stroke. To identify any adverse effects of physical treatment interventions for spasticity post stroke. To determine whether, in stroke patients with established spasticity: standing is more effective than control, placebo or no intervention at managing spasticity; active exercise is more effective than control, placebo or no intervention at managing spasticity; passive exercising/stretching is more effective than control, placebo or no intervention at managing spasticity; positioning is more effective than control, placebo or no intervention at managing spasticity; and adjuncts to a physical programme are more effective than control, placebo or no intervention at managing spasticity. To explore the relationship between stroke characteristics, the extent of the established spasticity, acute (one to 12 months post stroke) versus chronic (greater than 12 months post stroke) spasticity, and the effect of physical interventions aimed at managing established spasticity post stroke, using subgroup analysis. standing is more effective than control, placebo or no intervention at managing spasticity; active exercise is more effective than control, placebo or no intervention at managing spasticity; passive exercising/stretching is more effective than control, placebo or no intervention at managing spasticity; positioning is more effective than control, placebo or no intervention at managing spasticity; and adjuncts to a physical programme are more effective than control, placebo or no intervention at managing spasticity. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article
The present paper aims at providing an objective narrative review of the existing non-pharmacological treatments for spasticity. Whereas pharmacologic and conventional physiotherapy approaches result well effective in managing spasticity due to stroke, multiple sclerosis, traumatic brain injury, cerebral palsy and incomplete spinal cord injury, the real usefulness of the non-pharmacological ones is still debated. We performed a narrative literature review of the contribution of non-pharmacological treatments to spasticity management, focusing on the role of non-invasive neurostimulation protocols (NINM). Spasticity therapeutic options available to the physicians include various pharmacological and non-pharmacological approaches (including NINM and vibration therapy), aimed at achieving functional goals for patients and their caregivers. A successful treatment of spasticity depends on a clear comprehension of the underlying pathophysiology, the natural history, and the impact on patient’s performances. Even though further studies aimed at validating non-pharmacological treatments for spasticity should be fostered, there is growing evidence supporting the usefulness of non-pharmacologic approaches in significantly helping conventional treatments (physiotherapy and drugs) to reduce spasticity and improving patient’s quality of life. Hence, non-pharmacological treatments should be considered as a crucial part of an effective management of spasticity.
Chapter
Physical modalities are tools that can be used to complement a patient's rehabilitation treatment plan through the use of thermal, sound, electrical, and light energy. They can be used to address pain, swelling, soft tissue restrictions, joint range of motion (ROM) limitations, and muscle weakness, as well as to promote tissue healing, thereby improving a patient's ability to participate in other aspects of rehabilitation therapy (e.g., therapeutic exercise, functional mobility retraining, etc.). A general overview of the physical modalities most commonly used in canine rehabilitation is presented, with a goal of assisting the therapist in determining if and when their use may improve treatment outcome. The modalities discussed are cryotherapy and superficial heating (superficial thermal agents), therapeutic ultrasound (TUS), neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS) (electrical stimulation modalities), low-level laser therapy (LLLT)/photobiomodulation, and extracorporeal shock wave therapy (ESWT). Patients affected by orthopedic and neurological injuries, working and sporting dogs, and the geriatric population can all benefit from use of physical modalities at some point during their rehabilitation program.
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Objective: The purpose of this research was the effect of massage and cryotherapy programs on spasticity and range of motion of upper limb in children with spastic cerebral palsy (CP).Method: It is a clinical research that used by semi-experimental method. 15 Spastic CP children were selected as in access subjects and divided in three groups. The massage and cryotheraphy are trained to subjects in 8 weeks (three sessions in each week). Control group continued the same program of rehabilitation and occupational therapy that usually did before the staring research. Differences within groups were tested via dependent t-test and between-groups differences by ANOVA; additionally we use Tukey test if there was significant differences between groups. Results; Intra-group results showed improvement in muscles spasticity and upper extremity joints' range of motion (ROM) in both groups (p<0.05), while between group results didn’t show any significant difference in post tests' parameters compared to control group except improvement in elbow ROM of cryotherapy group and wrist ROM of massage group. Conclusion: It seems adding each of massage program and cryotherapy to physiotherapy and occupational therapy program improve ROM in upper extremity of spastic children with 7-12 year but do not improve spasticity in this people.
Article
A number of different therapy interventions and modalities have been utilized in spasticity management. There is significant variation in the use of these therapies, which is often due to experience that the treating clinicians have with one type or another. Given the lack of well controlled studies, it is difficult to take an evidence-based approach regarding the use of these interventions at this time. This article examines the physiologic basis for the more common therapy interventions in the management of spasticity and discusses some of the literature that may help guide the clinician in choosing among these options.
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Recent studies involving patients with CNS lesions have clearly demonstrated that agonist paresis rather than antagonist spasticity is the primary factor limiting torque production.1,2 The presence of spasticity can, nonetheless, be important because of its effect on the quality of movement and because of the propensity of spastic muscles toward contracture.³ Therefore, methods for more precisely documenting spasticity remain of value to those clinicians who include among their therapeutic goals the reduction of spasticity. Among the methods proposed for measuring spasticity (resistance to passive movement) are the Ashworth test⁴ and the goniometric pendulum test.5–7 Alfieri reported that the Ashworth test can provide an indication of therapeutic efficacy but is of limited objectivity because it uses an ordinal scale.⁸ The pendulum test, on the other hand, provides a more objective measurement on a continuous ratio scale.
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The application of cryotherapy to temporarily reduce spasticity is a widespread clinical practice. A method of quantifying spasticity, based on viscoelastic stiffness measurements at the ankle, was applied to objectively determine the efficacy of cryotherapy in reducing spasticity of the calf. Baseline, cryotherapy and one-hour postcryotherapy measurements of spasticity were performed in 25 subjects with clinical signs of spasticity secondary to traumatic brain injury, spinal cord injury, and stroke. A statistically significant reduction in spasticity occurred during cryotherapy. Postcryotherapy results were equivocal, although there was a tendency for diminished spasticity relative to the baseline measurement. Two subjects showed a clear aggravation of spasticity following cryotherapy, thus leading to the conclusion that dichotomous results are possible.
Article
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Resistive force and electromyograms from triceps surae muscles were measured during dorsiflexion of both ankles of awake cats before and after interruption of one dorsolateral funiculus (DLF). DLF lesions produced ipsilateral increases in dynamic and static reflex force that persisted over 66 weeks. The increase in dynamic reflex force was velocity sensitive, as demonstrated by a greater effect for 60 degrees /sec than for 10 degrees /sec dorsiflexion. Also, the lesions increased dynamic force to a greater extent than static force (increased dynamic index). Background force (recorded immediately before each reflex response) was elevated ipsilaterally. However, increases in reflex force were observed when preoperative and postoperative background forces were matched within 10% and were associated with equivalent resting levels of electromyographic (EMG) activity. Resistive reflex force was significantly correlated with EMG responses to dorsiflexion and was not determined by nonreflexive mechanical stiffness of the muscles. Contralateral background and reflex force and associated EMG activity were decreased slightly, comparing preoperative and postoperative records. Clinical testing revealed ipsilateral postoperative increases in extensor tone, increased resistance to hindlimb flexion, hypermetria during positive support responses, and appearance of the Babinski reflex. However, the most reliable tests of DLF lesion effects were the quantitative measures of dynamic and static reflex amplitude. The enhancement of stretch reflexes is suggestive of spasticity. However, hyperactive stretch reflexes, hypertonicity, and the Babinski reflex were observed soon after interruption of the ipsilateral DLF, in contrast to a gradual development of positive signs that is characteristic of a more broadly defined spastic syndrome from large spinal lesions. Also, other signs that often are included in the spastic syndrome, including clonus, increased flexor reflex activity, and flexor spasms, did not result from DLF lesions. Thus, unilateral DLF lesions provide a model of spasticity but produce only several components of a more inclusive spastic syndrome.
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We have investigated sacral spinal cord lesions in rats with the goal of developing a rat model of muscular spasticity that is minimally disruptive, not interfering with bladder, bowel, or hindlimb locomotor function. Spinal transections were made at the S2 sacral level and, thus, only affected the tail musculature. After spinal transection, the muscles of the tail were inactive for 2 weeks. Following this initial period, hypertonia, hyperreflexia, and clonus developed in the tail, and grew more pronounced with time. These changes were assessed in the awake rat, since the tail is readily accessible and easy to manipulate. Muscle stretch or cutaneous stimulation of the tail produced muscle spasms and marked increases in muscle tone, as measured with force and electromyographic recordings. When the tail was unconstrained, spontaneous or reflex induced flexor and extensor spasms coiled the tail. Movement during the spasms often triggered clonus in the end of the tail. The tail hair and skin were extremely hyperreflexive to light touch, withdrawing quickly at contact, and at times clonus could be entrained by repeated contact of the tail on a surface. Segmental tail muscle reflexes, e.g., Hoffman reflexes (H-reflexes), were measured before and after spinalization, and increased significantly 2 weeks after transection. These results suggest that sacral spinal rats develop symptoms of spasticity in tail muscles with similar characteristics to those seen in limb muscles of humans with spinal cord injury, and thus provide a convenient preparation for studying this condition.
Article
The depression of neural activity which takes place in the distal spinal cord abruptly separated from rostral control is the classical model for interpreting the transient disturbances of neural function that follow acute lesions of the nervous system. The behavior of isolated spinal cord has been relatively easy to analyze because its afferent and efferent pathways are so accessible. Modern neurological thinking is firmly based upon the observations of spinal cord behavior made in animals by Sherrington and in man by many clinicians of his generation. The riddle of spinal shock and the even more puzzling recovery to a hyperactive state which evolves out of it are little nearer solution now than when originally described. The most widely accepted explanation of shock is that the cord's internuncial pool and final common path are depressed below normal levels of excitability by the sudden transection of descending, largely excitatory pathways.1 Some
Article
The amplitude of 32 averaged F responses (F32) recorded with surface electrodes was 1 percent of the amplitude of the M wave. The largest F response (Fmax) was 4.5 percent of the M wave. In spasticity, Fmax did not increase in amplitude but became more persistent, resulting in a significant increase of F32. There was a positive correlation between the amplitude of F32 and the M wave, and this relationship was abnormal in 60 percent of the studies of patients with spasticity.
Article
The neurophysiological effects of prolonged cooling were examined in seven patients with complete spinal lesions. The twitch tension of the soleus muscle, the direct (M-wave) and relfex (H-wave) response to electrical stimulation of the popliteal nerve, the Achilles tendon reflex (ATR) and the degree of inhibition of the H-wave by muscle vibration were recorded before and after a minimum of forty-five minutes cooling of the calf. Changes in the configuration of the M-wave occurred, suggesting that cooling results in slowing of conduction in muscle or motor nerve fibers. Prolongation of the twitch contraction and half relaxation time was observed, implying that the contractile mechanism of the muscle is affected. A significant decrease in the ATR/M ratio was observed, indicating that cooling, in addition, affects the muscle spindle or its connections. No significant alterations in the H/M ratio or in the degree of suppression of the H-wave by vibration were observed.
Article
The resistance of the relaxed ankle to slow displacement over the joint movement range was measured on both sides of a group of hemiparetic stroke patients, in whom spasticity had been established for at least one year and who showed no clinical signs of contractures. The ankle joints of the age-matched normal subjects were flexible over most of the movement range, showing dramatically increasing stiffness only when the foot was dorsiflexed beyond 70 degrees, with a neutral range between 90-100 degrees, and a less dramatic increase in stiffness during plantarflexion. Hemiparetic patients showed identical curves to the normal subjects on the "healthy" side, ipsilateral to the causative cerebral lesion, but were significantly stiffer in dorsiflexion on the contralateral side, without change in the minimum stiffness range or during plantarflexion. Therefore significant changes in passive biomechanical properties occur at the affected ankle of hemiparetic subjects, predominantly as the result of a loss of compliance in the Achilles tendon, although an increase in the passive stiffness of the triceps surae may also occur. The contribution of these changes to the locomotor disability of hemiparetic patients is discussed.
Article
The functional impairment due to spasticity must be carefully assessed before any treatment is considered. Therapeutic intervention is best individualized to a particular patient. Basic principles of treatment to ameliorate spastic hypertonia are: 1) avoid noxious stimuli and 2) provide frequent range of motion. Therapeutic exercise, cold or topical anesthesia may decrease reflex activity for short periods of time in order to facilitate minimal motor function. Casting and splinting techniques are extremely valuable to extend joint range diminished by hypertonicity. Baclofen, diazepam and dantrolene remain the three most commonly used pharmacologic agents in the treatment of spastic hypertonia. Baclofen is generally the drug of choice for spinal cord types of spasticity, while sodium dantrolene is the only agent which acts directly on muscle tissue. Phenytoin with chlorpromazine may be potentially useful if sedation does not limit their use. Tizanidine and ketazolam, not yet available in the United States, may be significant additions to the pharmacologic armamentarium. Intrathecal administration of antispastic medications allows high concentrations of drug near the site of action, which limits side effects. This form of treatment is the most exciting recent development in the treatment of spastic hypertonia. Peripheral electrical stimulation may have limited use in diminishing tone and facilitating paretic muscles. Dorsal column stimulation via electrodes within the spinal column was initially hailed as a therapeutic advance, but has subsequently been shown to be minimally effective. Phenol injections provide a valuable transition between short-term and long-term treatments and offer remediation of hypertonia in selected muscle groups. Tenotomies and tendon transfers offer significant benefit in carefully chosen patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The local application of cold has been used to decrease spasticity and facilitate neuromuscular function, but previous attempts to identify its effect on the stretch reflex have not been entirely successful. We examined the effects of cold on the Hoffmann (H) reflex and on the tendon tap (T) reflex in 16 subjects. A series of H/M recruitment curves and T-reflexes were recorded via surface EMG electrodes before and during cooling of the triceps surae. Skin and intramuscular temperatures were recorded with average decreases of 18.4C and 12.1C, respectively. Peak-to-peak amplitude of the M, H, and T compound action potentials (CAPs) was measured. In all cases, the amplitude of the maximal M-wave decreased (p less than 0.001) in response to cooling. These changes in the recording of CAPs should be considered when cooling experiments result in alterations in H or T waveforms. When using the M-wave as a covariant in our analysis, there were no significant changes in the H-reflex amplitude; the height of CAPs elicited by T decreased (p = 0.025). Our findings do not support earlier claims that simple cooling facilitates the excitatory alpha motoneuron pool as measured by the H-reflex; we do confirm that muscle spindle activity, as measured by the T-reflex, is decreased by muscle cooling.
Article
Changes in both central synaptic excitability (CSE) and peripheral sensitivity of muscle spindle stretch receptors have been hypothesized to contribute to hyperactive stretch reflexes of spasticity. To assess CSE, the monosynaptic H-reflex to the triceps surae muscles was tested serially over the first six months after traumatic spinal cord injury (SCI). Six clinically complete SCI patients were compared to age-matched control subjects. As a measure of H-reflex excitability, H/M ratios were calculated by dividing maximum H-reflex by maximum M-response amplitude. Analysis of variance over the testing trials showed significant change in H/M ratios for SCI patients (p less than 0.01). T-tests comparing mean H/M ratios at different time periods after SCI revealed a significant increment after three months (p less than 0.01). H-reflex amplitude also increased significantly over this time period (p less than 0.04), but M-response amplitude did not change significantly. These increases in H/M ratio and H-reflex amplitude suggest that an increase in CSE may contribute to the appearance of hyperreflexia after SCI.
Article
The relief of spasticity following cold application has been well documented. Recent data have thrown some light and increased our understanding on the mechanisms involved behind the favorable effects of cold. In the present study, the action of cold on spasticity was further explored in a group of 40 spastic patients. The characteristics of the mechanical contraction of the triceps surae and the clonus frequency were measured before, during, and after immersion of the leg in 7°C water for 10,20, and 30 minutes. Muscle contraction became markedly prolonged and clonus was abolished in a large number of patients. No correlation, however, could be found between prolongation of the mechanical response and clonus absence. The results suggest that the relief of clonus in spasticity, following local cold application, is not related to changes in the mechanical contraction of the muscle, but to a direct effect of cold on muscle spindle excitability.
Article
Spasticity, a common symptom of upper motor neuron lesions, may actually aid the patient and should be treated only if it interferes with function, comfort or nursing care. Stretching exercises and elimination of nociceptive stimuli are the first steps in management. If problems persist, medication should be considered. Tenotomies are useful. Motor-point blocks and peripheral nerve blocks are temporary aids, while neurectomies usually provide permanent relief. More drastic neurosurgical procedures are reserved for uncontrolled, incapacitating cases.
Article
The surface electromyogram (EMG) of mm. tibialis anterior and triceps surae was recorded in 10 patients with spasticity, 10 patients with rigidity and 20 normal subjects and correlated with the changes in ankle joint angle during the different phases of the gait cycle. While the strength and timing of EMG activity recorded from triceps surae during the stance phase of gait did not differ from that of normal subjects, the EMG of tibialis anterior was significantly stronger during the swing phase in both groups of patients. Although the reciprocally organized innervation pattern of the leg muscles was preserved, spastic patients could hardly lift up the affected foot during the swing phase despite the enhanced activity of tibialis anterior. There was no coactivation of the calf muscles during the hyperactivity of tibialis anterior. Therefore, no electrophysiological explanation could be found for the increased muscle tone in either group of patients. The possibilities of reduced force development by the muscle fibres of tibialis anterior or of some mechanical obstruction in the ankle joint were largely excluded as alternative explanations underlying the impeded elevation of the foot. We suppose that in both diseases the muscle fibres undergo changes which are responsible for increased muscle tone in spasticity and rigidity. The pathophysiological mechanism of these changes remains unknown.
Article
We measured low-frequency depression of soleus H-reflexes in individuals with acute (n=5) and chronic (n=7) spinal-cord injury and in able-bodied controls (n=7). In one acute subject, we monitored longitudinal changes in low-frequency depression of H-reflexes over 44 weeks and examined the relationship between H-reflex depression and soleus-muscle fatigue properties. Soleus H-reflexes were elicited at 0.1, 0.2, 1, 5, and 10 Hz. The mean peak-to-peak amplitude of ten reflexes at each frequency was calculated, and values obtained at each frequency were normalized to 0.1 Hz. H-reflex amplitude decreased with increasing stimulation frequency in all three groups, but H-reflex suppression was significantly larger in the able-bodied and acute groups than in the chronic group. The acute subject who was monitored longitudinally displayed reduced low-frequency depression with increasing time post injury. At 44 weeks post injury, the acute subject's H-reflex depression was similar to that of chronic subjects, and his soleus fatigue index (assessed with a modified Burke fatigue protocol) dropped substantially, consistent with transformation to faster muscle. There was a significant inverse correlation over the 44 weeks between the fatigue index and the mean normalized H-reflex amplitude at 1, 5, and 10 Hz. We conclude that: (1) the chronically paralyzed soleus muscle displays impaired low-frequency depression of H-reflexes, (2) attenuation of rate-sensitive depression in humans with spinal-cord injury occurs gradually, and (3) changes in H-reflex excitability are generally correlated with adaptation of the neuromuscular system. Possible mechanisms underlying changes in low-frequency depression and their association with neuromuscular adaptation are discussed.
Article
Under appropriate conditions, a single shock to the human tibial nerve will evoke two discrete action potentials in the calf muscles. The first potential, the M wave, results from direct stimulation of motor nerve fibers. The second potential, the H wave, is the expression of a monosynaptic reflex, which runs in afferents from the muscle and back again through efferents of the same muscle.11,13 Since no internuncial neurons are involved, the size of the second action potential will provide a measure of motoneuron excitability under a variety of experimental and pathological conditions.2 The H reflex has been widely used in the study of human physiology, both normal3,6,11,13,18,19 and abnormal.12,14,15,16,17 It holds especial interest in connection with disease states that affect the excitability of spinal motoneurons. The present investigation deals with the H reflex in normal subjects and in patients with spasticity or rigidity. Material and Methods
  • J S Young
Young JS et al. Spinal cord injury statistics. Phoenix: Good Samaritan Medial Center, 1985.
Interater reliability of a modified Ashworth scale of muscle spasticity
  • R W Bohannon
  • B S Mellissa
  • RW Bohannon
Bohannon RW, Mellissa BS. Interater reliability of a modi®ed Ashworth scale of muscle spasticity. Phys Ther 1985; 65: 46 ± 47.
Dierent eects on tonic and phasic mechanisms produced by vibration of muscle in man
  • P Degail
  • J Lance
  • P Nielson
DeGail P, Lance J, Nielson P. Dierent eects on tonic and phasic mechanisms produced by vibration of muscle in man. J Neurol Neurosurg Psychiatry 1966; 29: 1 ± 11.
Relaxation of spasticity by physiological techniques
  • M G Levine
  • MG Levine