BACKGROUND: Spasticity is a common feature in patients with disruptions in corticospinal pathways. However, the term is used ambiguously. Here, spasticity is defined as enhanced velocity-dependent stretch reflexes and placed within the context of deforming spastic paresis encompassing other forms of muscle overactivity. OBJECTIVE: This scoping review aims at evaluating the clinimetric quality of clinical outcome assessments (COAs) for spasticity across different pathologies and to make recommendations for their use. METHODS: A literature search was conducted to identify COAs used to assess spasticity. An international expert panel evaluated the measurement properties in the included COAs. Recommendations were based on the MDS-COA program methodology based on three criteria: if the COA was (1) applied to patients with spastic paresis, (2) used by others beyond the developers, and (3) determined to be reliable, valid, and sensitive to change in patients with spasticity. RESULTS: We identified 72 COAs of which 17 clinician-reported outcomes (ClinROs) and 6 patient-reported outcomes (PROs) were reviewed. The Tardieu Scale was the only ClinRO recommended for assessing spasticity. One ClinRO-Composite Spasticity Index-and two PROs-Spasticity 0-10 Numeric Rating Scale and 88-Item Multiple Sclerosis Spasticity Scale-were recommended with caveats. The Ashworth-derived COAs were excluded after evaluation due to their focus on muscle tone rather than spasticity, as defined in this review. CONCLUSIONS: The Tardieu Scale is recommended for assessing spasticity, and two PROs are recommended with caveats. Consistent terminology about the various types of muscle overactivity is necessary to facilitate their assessment and treatment. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
- MeSH
- hodnocení výsledků zdravotní péče * normy MeSH
- lidé MeSH
- svalová spasticita * patofyziologie diagnóza etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Spasticity often results in significant disability, which complicates rehabilitation and daily activities. This review explores the role of botulinum toxin type A (BoNT-A) in the treatment of spasticity, focusing on its effects on muscle structure and activity, function, cortical reorganization, and pain. Our findings indicate that BoNT-A injections improve motor function and gait, particularly in stroke patients, by reducing abnormal muscle activity and enhancing postural control. However, BoNT-A may also induce unwanted biomechanical changes, such as muscle atrophy and alterations in contractile elements, which could impact long-term muscle function. Regarding pain management in spasticity, BoNT-A has shown promise by reducing both peripheral and central sensitization mechanisms. Additionally, BoNT-A influences the central nervous system (CNS) by inducing cortical reorganization, which may further contribute to clinical improvements. Lastly, BoNT-A treatment requires careful consideration of individual patient characteristics to optimize outcomes and minimize side effects. A multidisciplinary approach that combines BoNT-A with physical therapy is essential to maximize functional recovery and improve the quality of life in patients with spasticity.
- MeSH
- bolest * farmakoterapie MeSH
- botulotoxiny typu A * terapeutické užití farmakologie MeSH
- kosterní svaly * účinky léků MeSH
- lidé MeSH
- management bolesti MeSH
- nervosvalové látky * terapeutické užití farmakologie MeSH
- svalová spasticita * farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
2. rozšířené vydání ilustrace, fotografie, portréty, videa
Online atlas, který se zaměřuje na myosonologii při aplikaci botulotoxinu do svalů při léčbě spastické parézy a dystonie. Určeno odborné veřejnosti.
- MeSH
- botulotoxiny MeSH
- dystonie MeSH
- injekce intramuskulární MeSH
- paréza MeSH
- svalová spasticita MeSH
- ultrasonografie MeSH
- Publikační typ
- atlasy MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- radiologie, nukleární medicína a zobrazovací metody
- neurologie
- ortopedie
- NLK Publikační typ
- software
- MeSH
- bolest farmakoterapie MeSH
- lidé MeSH
- roztroušená skleróza * terapie MeSH
- sexuální dysfunkce fyziologická farmakoterapie MeSH
- svalová spasticita farmakoterapie MeSH
- únava farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
STUDY DESIGN: A psychometric study. OBJECTIVES: To introduce a novel simple tool designed to evaluate the intensity of the phasic (dynamic) component of spastic motor behavior in spinal cord injury (SCI) people and to assess its reliability and validity. SETTING: The study was developed in the Spinal Cord Unit at University Hospital Motol and Paraple Centre in Prague, Czech Republic. METHODS: The Muscle Excitability Scale (MES) is designed to rate muscle motor response to exteroceptive and proprioceptive stimuli. The impairment rating ranges from zero muscle/muscle group spasm or clonus to generalized spastic response. The selected 0 to 4 scale allows for comparing the MES results with those of the Modified Ashworth Scale (MAS). After long-term use and repeated revisions, a psychometric analysis was conducted. According to the algorithm, two physiotherapists examined 50 individuals in the chronic stage after SCI. RESULTS: The inter-rater reliability of MES for both legs showed κ = 0.52. The intra-rater reliability of MES for both legs showed κ = 0.50. The inter-rater reliability of simultaneously assessed MAS for both legs was higher, with κ = 0.69. The intra-rater reliability of MAS for both legs showed κ = 0.72. Spearman's rank correlation coefficient between MES and spasm frequency of Penn Spasm Frequency Scale (PSFS) was low, while the correlation coefficient between MES and the severity part of PSFS was moderate. CONCLUSIONS: The MES is a complementary tool for assessing the dynamic component of spastic motor behavior in SCI people. It allows a more comprehensive clinical characterization of spastic reflexes when used along with the MAS.
- MeSH
- dospělí MeSH
- kosterní svaly patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- poranění míchy * patofyziologie diagnóza komplikace MeSH
- psychometrie * MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- svalová spasticita * patofyziologie diagnóza etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- afázie rehabilitace MeSH
- časné pohybování * MeSH
- heterotopická osifikace terapie MeSH
- lidé MeSH
- management bolesti MeSH
- neurogenní močový měchýř rehabilitace MeSH
- neurorehabilitace * MeSH
- poruchy polykání rehabilitace MeSH
- svalová spasticita diagnóza rehabilitace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dospělí MeSH
- kombinovaná farmakoterapie metody MeSH
- lidé středního věku MeSH
- mladiství MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- senioři MeSH
- svalová spasticita etiologie MeSH
- tetanový toxoid terapeutické užití MeSH
- tetanus * prevence a kontrola terapie MeSH
- trismus etiologie MeSH
- vakcinace metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Geografické názvy
- Arménie MeSH
- Česká republika MeSH
- Indonésie MeSH
- Kanada MeSH
- Kostarika MeSH
- Maroko MeSH
- Peru MeSH
- Turecko MeSH
- Uganda MeSH
Centrální poiktový bolestivý syndrom (Central Post‐Stroke Pain, CPSP) je definován jako bolestivý stav po proběhlé centrální mozkové příhodě s prokázanou lézí v centrálním nervovém systému (CNS). Klinické příznaky se objevují již 1-3 měsíce po proběhlém iktu, ale u většiny postižených pacientů je to doba až 6 měsíců. Mezi hlavní klinické projevy patří bolest hlavy tenzního charakteru, bolest spojená se svalovou spasticitou a syndrom bolestivého ramene s možným rozvojem komplexního regionálního bolestivého syndromu (KRBS). Léčba kombinuje užívání analgetik (amitriptylin, karbamazepin, gabapentinoidy), fyzioterapii a psychoterapeutické postupy.
Central Post-Stroke Pain (CPSP) is defined as a painful condition after a central stroke with a proven lesion in the central nervous system (CNS). Clinical signs appear as early as 1-3 months after the stroke, but in most affected patients it is up to 6 months. Major clinical manifestations include tension headache, pain associated with muscle spasticity and pain shoulder syndrome with possible development of complex regional pain syndrome (CRPS). The treatment combines the use of analgesics (amitriptyline, carbamazepine, gabapentinoids), physiotherapy and psychotherapeutic procedures.
- Klíčová slova
- centrální poiktový syndrom,
- MeSH
- analgetika farmakologie klasifikace terapeutické užití MeSH
- cévní mozková příhoda * diagnóza komplikace MeSH
- elektrostimulační terapie klasifikace metody přístrojové vybavení MeSH
- komplexní regionální syndromy bolesti * diagnóza etiologie farmakoterapie MeSH
- lidé MeSH
- management nemoci MeSH
- svalová spasticita diagnóza etiologie MeSH
- tenzní bolesti hlavy diagnóza etiologie farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
