Device to help stroke patients to recover moves

Many people who suffer strokes will subsequently experience spasticity, where the arm and leg muscles cramp or spasm as a result of message between the brain and muscle being blocked. This can cause long periods of contraction in major muscles resulting in bent elbows, pointed feet, arms pressed against the chest, or the distinctive curled hand common to many stroke survivors.

Neuroscientists at Newcastle University have developed a new device which aims to help stroke patients by strengthening a spinal connection known as the reticulospinal tract that can take over some of the function of more major neural pathways connecting the brain to spinal cord when they are damaged following a stroke. This strengthening can alleviate the symptoms of spasticity in the hand and arm of patients, allowing them additional control that can help them regain an important degree of independence in their life.

An article published in the Journal of Neuroscience reports on the early success of this device, which is about the size of a mobile phone and can deliver an audible click followed by a small electric shock to the arm of patients. Electrical stimulation has previously been used to improve nerve function in other types of injury, but the combination with an auditory signal is new. The study shows that the device is able to strengthen the connections in the reticulospinal tract – the nerve tract in the spine which passes messages from the brain to the limb muscles. After a stroke, the body tends to recover the strength of connections to flexor muscles  (which allow you to close your hand)  more than extensor muscles (which allow you to open your hand). This is why many stroke patients suffer from a curled (semi-closed) hand.

Stuart Baker, Professor of Movement Neuroscience at Newcastle University who has led the work said: “We were astonished to find that a small electric shock and the sound of a click had the potential to change the brain’s connections. However, our previous research in primates changed our thinking about how we could activate these pathways, leading to our study in humans.”

You can read more in “K.M. RIASHAD FOYSAL, FELIPE DE CARVALHO, STUART N. BAKEr. Spike-timing Dependent Plasticity in the Long Latency Stretch Reflex Following Paired Stimulation from a Wearable Electronic Device.  Journal of Neuroscience, October 2016, 36 (42).” Or in www.jneurosci.org/content/36/42/10823.

DNHS is a valid technique for Ictus too?

The DNHS (Dry Needling for Hypertonia and Spasticity) technique is a dry puncture technique whose objective is to reduce the spasticity and hypertonia of the patient with central nervous system injury and to improve its functionality.

In several articles, it is shown that the technique is effective in reducing hypertonia and spasticity in patients with central nervous system injury. Dry puncture has been demonstrated in the case of myofascial pain treatment as an effective technique, like the infiltration of substances such as botulinum toxin, with the advantage of having no side effects.

However, unlike the treatment of myofascial pain, the effectiveness of the DNHS technique in spasticity or hypertonia has not yet been compared with the infiltration of botulinum toxin, currently, investigations focus on analyzing the effectiveness of the technique compared to other treatments of Physiotherapy or in control groups.

But now, the Stroke Association of Aragon, in Spain, has signed an agreement of cooperation with specific Research Group iPhysio of San Jorge University (Zaragoza) to conduct a study with

DNHS technique in patients who have suffered a stroke in the chronic state. The technique DNHS is a dry needling technique specific to be applied to patients with impaired central nervous system and, in this case, has centered its focus on patients who have suffered a stroke more than six months ago, working on this case at the level of the upper limb.

For this reason, the Center for Neurorehabilitation of the Stroke Association, is the ideal place to develop the study since it is there where most patients receive rehabilitation when they discharge from the hospital.

The study has the support of the entire rehabilitation team and their own entity, provides the space to conduct this study. In addition, the Association will host its facilities to patients who are not current members but who are interested in participating in the study.

Treatment with Specific Enzyme May Keep Muscle Stiffness

A new study shows that an enzyme called hyaluronidase may be effective in reducing muscle spasticity resulting from neurological disorders.

The results were published in a study titled “Human Recombinant Hyaluronidase Injections For Upper Limb Muscle Stiffness in Individuals With Cerebral Injury: A Case Series,” in the journal EBioMedicine by a group of researchers from the NYU Langone Medical Center (North America).

Muscle spasticity is a condition characterized by muscle stiffness in one or more muscles and reduced joint movement, which causes pain and disability. This condition is associated with neurological damage caused by disorders that affect the connections between neurons that control muscle movement (motor neurons) and muscles, such as multiple sclerosis, stroke, traumatic brain injury, cerebral palsy, or spinal cord injury.

Existing treatments for muscle spasticity include drugs that relax the muscles, such as botulinum toxin, but these therapies can cause muscle weakness, making movement more difficult. The necessity for a treatment option that could effectively help patients with their movement problems led the team to consider the possible involvement of a sugar molecule, called hyaluronan. This molecule accumulates in the joints and muscles after neurological damage, promoting stiffness.

The team hypothesized that injections of an enzyme called hyaluronidase, which breaks down hyaluronan, would reverse its accumulation, reduce muscle stiffness, and increase joint movement. The team tested this idea by administering hyaluronidase injections in 20 patients ages 10 to 77 with moderate or severe spasticity in the arms resulting from neurological damage, and in whom other treatments had not been effective.

The neurological and musculoskeletal assessment of the patients was recorded in video in several time points: before the treatment; two, four, and six weeks after the injection; and three to five months after the injection.

Results showed that, whereas before the treatment the joints tested had moderate (50.6 percent) or severe (44.4 percent) stiffness, after the treatment these values decreased to 15.3 percent and 5.8 percent, respectively, within two weeks. The improvement in muscle stiffness induced by the injection lasted for at least three months, with no recorded muscle weakness or significant side effects.

“These findings fill a critical gap in the understanding of muscle stiffness, and present a promising treatment for spasticity, a vexing problem that affects millions of people worldwide,” Dr. Preeti Raghavan, the leading author of the study, said in a news release.

The team is planning to start a clinical trial to investigate the beneficial role of hyaluronidase injections and the effect of repeated administration of the treatment in a larger group of patients. Future studies are also warranted to determine whether hyaluronidase can be used to treat other disorders associated with muscle stiffness.

“This case series provides preliminary evidence for the safety and potential efficacy of hyaluronidase injections as a treatment for muscle stiffness that may enhance recovery in the spastic upper limb. More research may determine whether such a treatment is applicable to other disorders characterized by muscle stiffness,” Raghavan said.

If confirmed to be an effective therapy, hyaluronidase may provide a relatively less expensive option for patients with spasticity compared to other treatments. (one vial of hyaluronidase typically costs $50/±£50/±€45, and the complete treatment may require four to eight vials).

What is spasticity and how approach it?

“Convives con Espasticidad” (You live with Spasticity) is a Spanish entity that provides us a lot of useful information: more about it, and give us tips and guidelines to improve our welfare when we suffer.

Spasticity is a motor disorder associated with multiple diseases and disabilities. Its origin is in a central nervous system disorder that causes increased muscle tone making it difficult and/or impossible to move totally or partially the affected muscles.

What does spasticity feel like?

The feeling caused by spasticity is the sensation of having the legs and/or arms tied (according to the affected areas), generating a muscular tension that prevents the whole or a part of movement.

Who is affected by spasticity?

Children, adults, teenagers ... Those affected are as numerous as heterogeneous. This symptom is present in many diseases including: cerebral palsy, spina bifida, acquired brain injury, stroke, multiple sclerosis, amyotrophic lateral sclerosis, ataxias, spinal cord injuries, head injuries and other pathologies.

How to treat it?

The approach to spasticity has to be multidisciplinary. We must not forget that this is necessary and essential for proper diagnosis and better treatment. A specialist team should normally consist in a neurologist, a physiotherapist, an orthopaedic surgeon and rehabilitation physician. Although sometimes not provided, it is important the role of the psychologist as it will help both the family and the affected person, supporting them in the process of acceptance.

Does spasticity have a cure?

Spasticity does not have a cure, although it is possible to try to mitigate and prevent more serious symptoms, such as contractures or bone malformations.

Are there treatments?

Of course. Botulinum Toxin, Oral Baclofen, Orthotics, the Teratogs, hydrotherapy, practice sports, especially swimming, among others. The first four are indicated under the prescription and supervision of a specialist.

Moreover, we cannot forget the PHYSIOTHERAPY, essential in the life of a person with spasticity or any type of physical disability.

Other beneficial recommendations are maintaining proper postural hygiene and avoiding stressful situations or cold.

Among the surgical treatments, includes: rhizotomies and ITB (Intrathecal Baclofen Therapy).

Child spasticity can improve with THC according to a pilot study

A pilot study conducted in Germany has found evidence that the THC (Tetrahydrocannabinol is the principal psychoactive constituent of cannabis) can be helpful in cases of child spasticity. With the spasticity, some muscles of the body are permanently contracted, causing the appearance of stiffness and involuntary movements.

Researchers at the University of Dusseldorf administered an oily solution of THC to a group of 16 children with ages 1 to 26 years, suffering from spasticity resistant to other treatments. Patients were treated between 2010 and 2015 with doses of THC and variable treatment duration as appropriate.

Despite the small size of the study, the results were positive and indicate that cannabis may be an effective remedy. “Most paediatric palliative patients showed promising effects on spasticity resistant to treatment”, the researchers concluded.

Spasticity is a nervous system disorder that manifests with involuntary muscle contraction. His appearance is often related to trauma or disease affecting the brain or spinal cord. People who suffer from it can have difficulty sustaining activities such as speech, balance or swallowing.

Brazil performs symposium of spasticity for professionals and students

After suffering a stroke at 26 years old, H. Cardoso began to face a little known illness, but that affects many people with disabilities: spasticity.

This disease is related to an injury of the central nervous system, affecting both children born with cerebral palsy, for example, and adults suffering from head trauma in an accident or a stroke.

Spasticity causes the hardening of the muscles and involuntary contractions with muscle spasms. H. Cardoso had the fingers of his right foot deformed and the stiffening of the right elbow as he could not move his arm. “I suffer with spasticity in my right hand five years ago and I'm already going for my third surgery”, he says.

But H. Cardoso celebrates some progress. “Before, my right hand was completely closed, now it is already open. I'm also getting out of the wheelchair to take some steps, even if slowly”, he adds.

According to the physiotherapist neurofuncionnal Leonardo Raphael, spasticity causes disturbing pictures. “There are cases of people who have to sleep tied to not fall out of bed, because of the involuntary contractions caused by spasticity”, he explains.

By also cause hardening of the muscles, the disease hinders the development of children, in locomotion, in carrying out activities of daily life, such as cleaning and feeding, and especially in the treatment of these people.

It is on this that the Center for Integrated Rehabilitation of Piauí (Brazil) is promoting the First Symposium of Spasticity. “We want to bring out, within the scientific community, how much spasticity limits the disabled person in their quality of life and their treatment.”

Leonardo also agrees: “We will discuss from the basics of spasticity to the most modern treatments, as we often strive for results with the patient that are not achieved because of spasticity.”

The original news are here.

What is spasticity? What are the possible treatments?

What is spasticity? Why can it affect the stroke survivors? What causes spasticity? What can its effects be? What are the possible treatments?

The answers are in this animated video produced by the “National Stroke Association” (USA)!

Spasticity: how to control the muscles

A very interesting text discovered in an Italian blog, and adapted by me.

Many people (stroke survivors, with multiple sclerosis, and others cerebral diseases) have muscle stiffness and spasms, a condition called spasticity. It happens especially in the leg and arm muscles, and can keep them from moving their limbs freely.

Spasticity happens due to an imbalance in the electrical signals from the brain and spinal cord, frequently when nerves have been damaged there. This irregularity makes the muscles contract themselves and turns them tense.

The condition can worsen when it's too hot or cold, when you have an infection, or if you are wearing tight clothing.

Physical therapy, medication, surgery, or a combination of these treatments may relieve spasticity. To decide the best way to help you, your doctors will think about your overall health, how severe the symptoms are, and, most of the time, a therapist begins treatment of spasticity with a basic stretching program. The goal is to stretch the muscles to relieve the condition.

An occupational therapist can recommend several tools, such as splints, moulds, or braces, to maintain your range of motion and flexibility.

If the physical therapy and occupational do not help, your doctor may decide to try drugs.

Text translated and adapted from the blog Orlando.

Fight to overcome spasticity helped with injections of botulinum toxin!

I recently found an article about the effectiveness of botulinum toxin injections for the treatment of spasticity. This article is really encouraging and shows that with the correct treatment stroke survivors can overcome spasticity. Please see below for more details.
Jonathan suffered a serious brain injury six years ago, leaving him quadriplegic. With support of people like his mother, and hard-working healthcare professionals, the now 33-year-old made progress, but still suffered from muscle tightness and rigidity. His hands would clench so tightly, his nails would dig into the palms, the was difficult for nurses and painful for Jonathan. Physiotherapy was a key part of his care and recovery. 
Spasticity can be caused by strokes, as well as spinal cord injury, multiple sclerosis and a variety of other neurological illnesses. Those who have strokes may suffer weakness, but also stiffness that results in paralysis, such as when hands become clinched and cannot move, or knees become locked in place and interfere with walking. The condition may make it difficult for patients to tend to their personal hygiene, or for nursing home staff to change their dressing.

Injections of botulinum toxin, have proven to be an effective treatment for the condition when used as part of a multidisciplinary approach including physiotherapy.

Jonathan is one of several patients to receive relief, however, through injections of botulinum toxin, an effective treatment for limb spasticity, a painful and debilitating condition affecting the muscles and joints.
“What we try to do is loosen the joints so they have greater range of motion and it's less painful” said Mirsattari, a physical medicine and rehabilitation specialist. “Spasticity is traditionally treated with medications or with surgery. The medications tend to have a lot of side effects and are not well tolerated and with surgeries, you have to cut the muscle to release them from the tension they have.” Botulinum toxin is an alternative where, instead of cutting the muscle or instead of taking a pill by mouth, you are injecting the muscle at the site of the problem, so you isolate the muscles that are the source of the problem and determine which ones are contributing to the abnormal posture and treat them locally, with a local injection into those muscles.
This is part of the spasticity treatment; by itself, it won't accomplish all the objectives. You still need physiotherapy, occupational therapy, range-of-motion exercises, nursing care, or medications if they are partially working, but not fully effective.
“There's always a functional gain. Either there’s pain relief or they have a reduction in a tremor or the hand that was tightly fisted that's putting fingernails into the palm print, there's relief, so now you can give good care and a good stretch. Even tight shoulders, tight arms can affect getting a shirt on effectively, tight legs make it impossible to do good hygiene and to be able to dress properly, ankle issues can impact gait - we always have a functional goal. It's not just for good looks and it's not just to relax - there's always a purpose in mind.”

For more information please click this link.

New Study Underway: Shock waves for stroke survivors with spasticity

The Galician Society of Physical and Rehabilitation Medicine have been awarded a prize for their pioneering scientific work conducted at the University Hospital of Vigo (Spain).
The work awarded best scientific poster of the year has been presented by Dr. Antonio Lopez Moya and consists of a study which was devised in the hospital Meixoeiro, but also had the collaboration of other hospitals in Spain.
The aim of the study is to test the behaviour of patients who have suffered a stroke and who experience spasticity or stiffness in the body if they apply shock waves.*
In the tests the patient's progress is measured before and after the treatment with waves at specific muscles such as the lower limbs. If the results are good further research will investigate other body locations. Work is still underway so the results of the investigation which is expected to be presented at the national congress are not yet know. 
Please click this link to find out more information about the project.

* During shock wave therapy, an acoustic wave of high energy is transported to points, fibrosis and tender musculoskeletal tissues. This process results in a number of beneficial effects, such as increased neovascularization, chronic inflammation reversal, collagen stimulation and calcification solution fibroblasts.

North-America: Advocates Join Forces to Fight Spasticity!

Last June in America a website was developed which is dedicated to providing information and resources to help raise awareness about spasticity. 

The National Stroke Association has brought together advocacy organizations in a Spasticity Alliance, the organisations involved include the Brain Injury Association of America, Multiple Sclerosis Association of America, United Cerebral Palsy and United Spinal Association.

The Spasticity Alliance web site aims to:

• Provide a clearinghouse of best-of-class patient educational tools and resources
• Act as the go-to source for spasticity-related conditions
• Increase awareness of spasticity
• Address the onset of spasticity and its symptoms
• Offer management options which can include a combination of medications and therapies
• Empower patients and caregivers to discuss their symptoms with their healthcare professionals
• Build a strong alliance of patient advocacy organizations to create a united voice for spasticity messaging, tools and resources.

You can read all the news here, and visit www.spasticityalliance.org to learn more!

The Infographic is very interesting, which you can find on their website (http://www.spasticityalliance.org/wp-content/uploads/2016/06/Spasticity-Infographic-web.pdf) or here!

Hope for spastic people: Marseille University test two treatments

The team "Plasticity and pathophysiology rhythmic motor networks" at the Institute of Neurosciences of La Timone (CNRS / Aix-Marseille University) has identified one of the molecular mechanisms responsible for spasticity. It also proposed two convincing therapeutic solutions in animals, one of which will be tested in Phase 2 of clinical trials since 2016. This work, published in the journal Nature Medicine in March 2016, can offer new opportunities to reduce this mobility impairment.
The research team tested two treatments on rats with spinal cord injuries. One of the molecules is an inhibitor of calpain. It’s used for a short time (ten days) restores the proper functioning of the sodium channel and sustainably reduces the extent of spasticity. Indeed, one month after the end of treatment, the positive effects continue. The other molecule tested, riluzole, acts as an inhibitor of persistent sodium current. It also reduces spasticity, even if its effects are temporary as it reappeared two weeks after the end of treatment. Yet the molecule is of great interest since it is already administered to patients with amyotrophic lateral sclerosis. Clinical trials phase 2, which will begin in 2016 in La Timone hospital, will test its effectiveness in the treatment of spasticity in patients with spinal cord injuries. In parallel, the team of Frederic Brocard continues to decipher the phenomenon of spasticity - specifically the involvement of calpain in the deregulation of the motor neurons – and to test other inhibitors of this enzyme that can be administered to humans.
For more information please click the link below:

http://www2.cnrs.fr/presse/communique/4463.htm