Effect of tone-inhibiting casts and orthoses on gait. A case report.
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In the adult case presented, inhibitory casting proved successful in decreasing the positive support reaction. When casting was discontinued, the positive reaction returned. To provide a long-term solution for this problem, a polypropylene tone-inhibiting AFO was fabricated. It incorporated the same principles as the casts. The success achieved with casting was rapidly regained and then surpassed with the use of the tone-inhibiting AFO. Natural recovery might be cited by some as the cause for improvement in the patient presented. However, the loss of improvement during the interval between the removal of the inhibitory casts and the initiation of the use of the tone-inhibiting AFO demonstrates that the casting and the position provided by the casts had a positive effect on our patient. This notion is further supported by the fact that our patient still required use of the tone-inhibiting AFO as late as March 1980. We have no explanation for the rapid improvement following the cranioplasty. Suggestions for further research would include a similar study with a larger number of subjects and the use of cinematography and kinesiological EMG during walking with and without tone-inhibiting casts and orthoses to determine the effect of the devices on spastic muscle groups and gait patterns. (+info)
Use of a hand-held dynamometer and a Kin-Com dynamometer for evaluating spastic hypertonia in children: a reliability study.
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BACKGROUND AND PURPOSE: Studies in subjects with spastic hypertonia indicate that the higher resistance to stretch in the spastic muscles is not only due to hyperactive stretch reflexes but also to changes in the muscle-tendon unit (nonreflex components). The aim of this study was to compare the test-retest reliability of two methods: hand-held dynamometry and isokinetic dynamometry for the evaluation of nonreflex and reflex-mediated resistive force in the plantar flexors of young children with spastic cerebral palsy (CP). SUBJECTS: Ten children 2 to 7 years of age with a diagnosis of spastic CP (either diplegia [n = 7] or hemiplegia [n = 3]) participated in the study. METHODS: The resistive force recorded at 0 degrees of dorsiflexion during passive ankle dorsiflexions executed at low and high velocities was evaluated twice at a 1-month interval with a Penny and Giles myometer (a hand-held dynamometer) and a Kin-Com dynamometer. The electromyographic activity of the soleus and tibialis anterior muscles was recorded during Kin-Com testing to detect unwanted activity during low-velocity tests and to identify trials with a reflex response during high-velocity tests. RESULTS: High intraclass correlation coefficients (ICCs) for the resistive force values recorded at the test and retest were computed for both the myometer (ICCs = .79 and .90) and the Kin-Com (ICCs = .84 and .84) at low and high velocities, respectively. Coefficients of variation for force values measured at a 1-month interval at low and high velocities were 13.9% and 13.2% with the myometer and 11.8% and 12.8% with the Kin-Com. CONCLUSION AND DISCUSSION: The results suggest that the myometer can provide a measure of spastic hypertonia with a reproducibility and a variation in the measures that compare to those of a computer-controlled dynamometer. From a clinical point of view, the myometer is simpler and cheaper to use given the lower cost and the little time required for testing and data analysis. Care must be taken to select a velocity that is low enough not to evoke a stretch reflex (to isolate nonreflex components) and another that is high enough to elicit a reflex response, so that it becomes possible to differentiate the reflex and non-reflex components involved in spasticity. Such a distinction is important for the choice of treatment procedures. (+info)
Overcoming limitations in elbow movement in the presence of antagonist hyperactivity.
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BACKGROUND AND PURPOSE: A traditional perspective on rehabilitation of patients with abnormal muscular hyperactivity presumes that relaxation should be facilitated prior to recruitment of antagonists, if effective movement about a joint is to occur. The purpose of the study was to determine the effect of training weak triceps brachii muscles, with hyperactivity present in the opposing biceps brachii muscles, on elbow function in individuals at least 1 year poststroke. SUBJECTS: Sixteen patients with chronic stroke were randomly assigned to receive electromyographic biofeedback to retrain the triceps muscle (n = 8) or to receive conventional movement training (n = 8). METHODS: Both groups participated in 5 baseline and 10 training sessions involving tasks requiring elbow extension. Preintervention and postintervention measurements included elbow extension range of motion, triceps and biceps muscle electromyographic activity during performance of elbow extension, resisted elbow extension, and a reaching task. RESULTS: Two-sample t-test results of between-group comparisons for each variable were not significant. One-sample t-test results of within-group comparisons showed significant increases in triceps muscle mean electromyographic activity during two of the three tasks for the feedback group, but not for the nonfeedback group. Passive and active range of motion in both groups increased significantly, although biceps muscle co-contraction persisted. CONCLUSION AND DISCUSSION: These results suggest that functional improvements at the elbow may have been due to biomechanical (peripheral) rather than neuromuscular (central) changes about the joint. Furthermore, these preliminary data indicate that patients with stroke may be trained to increase movement without first being trained to specifically inhibit hyperactivity in muscles. (+info)
Microcephaly and congenital nephrotic syndrome owing to diffuse mesangial sclerosis: an autosomal recessive syndrome.
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Three sibs born to consanguineous parents had congenital nephrotic syndrome, microcephaly, and psychomotor retardation. Pathology of the kidneys showed diffuse mesangial sclerosis with deposits of IgG and C3 in the mesangium and glomerular basement membranes. All three children died before the age of 3 years. Of 19 published cases of children with the association of congenital nephrotic syndrome and microcephaly, only four had histological evidence of diffuse mesangial sclerosis, and two of their sibs probably had the same disease. The association of nephrotic syndrome owing to congenital diffuse mesangial sclerosis, microcephaly, and mental retardation appears to be a distinct syndrome with an autosomal recessive mode of inheritance. (+info)
Movement dysfunction following central nervous system lesions: a problem of neurologic or muscular impairment?
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In most of the scientific literature that discusses the common problem of resistance to passive movement in patients with central nervous system lesions, this clinical problem is ascribed to a mechanism involving uninhibited neural activity. This article reviews the literature related to an alternative explanation of stiffness in such patients, an explanation involving the mechanical orientation of myosin crossbridges. The conventional view of the crossbridge is that it is detached from actin filaments during the relaxed state of muscle. Information is presented, however, from animal studies indicating that a certain proportion of crossbridges bind weakly to actin even in the relaxed state. The muscles of patients with hypertonicity may undergo an adaptation that involves formation of a higher proportion of binding crossbridges. This results in abnormal stiffness in the muscle and impairs movement. Such crossbridge stiffness may be particularly elevated immediately after a previous contraction. (+info)
Analysis of GLRA1 in hereditary and sporadic hyperekplexia: a novel mutation in a family cosegregating for hyperekplexia and spastic paraparesis.
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Hyperekplexia is a rare condition characterised by the presence of neonatal hypertonia and an exaggerated startle response. Mutations have been described in GLRA1, the gene encoding the alpha 1 subunit of the glycine receptor, in dominant families with hyperekplexia and in a single sporadic case, thought to represent an autosomal recessive form of the disease. In this study the coding region of the GLRA1 was analysed in eight probands with hyperekplexia by restriction digest and sequencing. Two familial cases were found to possess the previously described G1192A (R271Q) mutation in exon 6. In an additional family in which hyperekplexia cosegregates with spastic paraparesis, a novel A to G transversion at nucleotide 1206 in exon 6 was detected that changes a lysine at amino acid 276 to a glutamate (K276E). In four sporadic cases no mutations were found. In addition, one familial case did not have a mutation in the coding region of the gene. (+info)
Truncal muscle tonus in progressive supranuclear palsy.
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OBJECTIVE: To elucidate the character and distribution of the abnormal muscle tonus in the body axis in progressive supranuclear palsy. Although neck hypertonus has been well described in progressive supranuclear palsy, little is known about the involvement of the truncal muscles. METHODS: Muscle tonus of the neck and trunk was separately investigated in 13 patients with progressive supranuclear palsy by clinical examination and surface EMG during passive rotation. Muscle hypertonus was graded according to a four point scale, and subjected to statistical analysis. The results were compared with those from 13 age matched patients with Parkinson's disease and six healthy volunteers. RESULTS: In all but one patient with progressive supranuclear palsy, there was a distinct difference in muscle tonus between the neck and trunk. A tonic shortening reaction characteristic of dystonia and an increased tonic stretch reflex (rigidity) were present in the neck muscles of patients with progressive supranuclear palsy, whereas only normal to moderately increased tonus was noted in the truncal muscles (neck v trunk, shortening reaction p=0.0001; stretch reflex p=0.0241). Follow up studies disclosed an increase in axial muscle tonus with predilection for the neck in three of four patients. In the 13 patients with Parkinson's disease, however, no significant difference was found in muscle rigidity between the neck and trunk. CONCLUSION: Mild changes in truncal muscle tonus with prominent neck dystonia and rigidity are characteristic of progressive supranuclear palsy. It is suggested that separate clinical evaluation of muscle tonus in the neck and trunk may be helpful for distinguishing progressive supranuclear palsy from Parkinson's disease. (+info)