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Jean-michel Gracies - One of the best experts on this subject based on the ideXlab platform.

  • Correlation between coefficients of impairment at various muscles and active function in the paretic upper limb
    Annals of Physical and Rehabilitation Medicine, 2018
    Co-Authors: Maud Pradines, Mouna Ghédira, V. Mardale, C.-m. Loche, Jean-michel Gracies, Emilie Hutin
    Abstract:

    Introduction/Background In hemiparesis, motor function may be hindered to various degrees by soft tissue contracture, spasticity, spastic co-contraction and agonist paresis. This retrospective study explores correlations between neuromuscular impairments at Shoulder, elbow, wrist and fingers and overall function in the paretic upper limb. Material and method Fifty-one patients with chronic hemiparesis [25 W, 48(±15) years (mean[±SD]), time since lesion, 7.7(±5.5) years] were assessed using the Five Step Assessment, at least three months after any botulinum toxin injection. The first step assessed motor function of the upper limb by the Modified Frenchay scale (MFS; score between 0 and 10). The 2nd, 3rd and 4th steps assessed coefficients of impairment in four key muscles: Shoulder Extensors, elbow flexors, wrist flexors and fingers flexors. These coefficients were calculated as: coefficient of shortening [CSH = (XN − XV1)/XN; XN, normally expected amplitude; XV1, angle of arrest upon slow stretch], coefficient of spasticity [CSP = (XV1 − XV3)/XV1; XV3, angle of catch upon fast stretch], coefficient of weakness [CW = (XV1 − XA)/XV1; XA, maximal active range of motion]. For each impairment factor, a mean coefficient across the four muscles was calculated (CSHmean, CSPmean, CWmean). For each muscle group and for the mean, multivariable correlations were explored between CSH, CSP, CW and MFS. Results The MFS correlated with CSH-Shoulder (r = −0.28, P = 0.03) and CW-Shoulder (r = −0.46, P = 0.001); CW-elbow (r = −0.45, P = 0.002); CW-wrist (r = −0.33, P = 0.003); CW-Fingers (r = −0.63, P  Conclusion The main factors impeding motor function in chronic spastic paresis are the combination of paresis in agonist and spastic co-contraction in antagonist (limiting active motion) for Shoulder Extensors and for elbow, wrist and finger flexors. Soft tissue contracture for Shoulder Extensors also contributed to hinder motor function. Spasticity was not correlated with the mean score of MFS, whichever the muscle considered.

  • Degree of muscle shortening in chronic hemiparesis in patients not treated with guided self-rehabilitation contracts (GSC)
    Annals of Physical and Rehabilitation Medicine, 2015
    Co-Authors: J. Vielotte, B. Bignami, E. James-belin, C. Colas, Catherine-marie Loche, Jean-michel Gracies
    Abstract:

    Objectives Antagonist muscle resistance, including due to muscle contracture, is a fundamental factor of motor impairment in spastic paresis. We aimed to quantify the degree of shortening in the main muscles involved in chronic hemiparesis (>1 year post-lesion), in patients following a conventional system of rehabilitation. Methods From their first clinic visit in the neurorehabilitation unit of the PMR time since lesion 3.7 ± 3.8 years) and 13 antagonists in the upper limb (n = 13 patients, age: 39 ± 13, mean ± SD; time since lesion 5.2 ± 3.9 years), then derived coefficients of shortening (CSH) by referring them to the normal expected amplitude (XN), CSH = (XN-XV1)/XN. Results The higher coefficients of shortening were: vertical adductors (latissimus dorsi – pectoralis major – teres major), 36 ± 3%; Shoulder Extensors with flexed elbow (long head of triceps; latissimus dorsi) 33 ± 4%; horizontal adductors (pectoralis major), 23 ± 1%; gastrocnemius, 20 ± 1%; soleus, 15 ± 2%; gluteus maximus, 16 ± 3%; rectus femoris, 12 ± 1% and pronator teres, 12 ± 4%. Conclusion Shoulder Extensors, plantar flexors and gluteus maximus in patients untreated with self-stretching postures have undergone major muscle shortening in chronic hemiparesis. A future study could assess the effectiveness of stretching postures taught and applied from the early phase of stroke on shortening of these muscles.

  • Comparative shortening of different muscles in patients with chronic hemiparesis treated in guided self-rehabilitation contracts
    Annals of Physical and Rehabilitation Medicine, 2015
    Co-Authors: B. Bignami, Maud Pradines, J. Vielotte, C. Colas, Catherine-marie Loche, Marjolaine Baude, Jean-michel Gracies
    Abstract:

    Objectives Muscle contracture is one of the main factors of motor impairment in spastic paresis, and particularly in hemiparesis. We aimed to quantify the degree of contracture in 8 key muscles at a chronic stage after the lesion. Methods Four independent raters assessed 18 adults with chronic hemiparesis (age: 50 ± 14, mean ± SD; time since lesion 5.3 ± 2.4 years) treated with guided self-rehabilitation contracts (GSC) [1] , using the 5-step clinical assessment [2] previously described, of which step 2 evaluates passive range of motion (angle of arrest at slow speed, X V1 ) and step 3 measures the angle of catch at fast speed (X V3 ). Data from the 4 investigators were averaged. Coefficients of shortening (C SH  = (X N  − X V1 )/X N ; X N , normal expected amplitude) and of spasticity (C SP  = (X V1  − X V3 )/X V1 ) were derived. Muscles assessed were Shoulder Extensors (SE), elbow flexors (EF), wrist flexors (WF), finger flexors (FF), gluteus maximus (GM), rectus femoris (RF), soleus (SO) and gastrocnemius muscles (GM). Results Mean values were: SE, C SH : 0.21 ± 0.03; C SP : 0.25 ± 0.03; EF, C SH : 0.04 ± 0.02; C SP : 0.27 ± 0.04; WF, C SH : 0.07 ± 0.02; C SP : 0.24 ± 0.04; FF, C SH : 0.16 ± 0.04; C SP : 0.32 ± 0.04; GM, C SH : 0.16 ± 0.03; C SP : 0.13 ± 0.02; RF, C SH : 0.09 ± 0.01; C SP : 0.26 ± 0.03; SO, C SH : 0.15 ± 0.02; C SP : 0.10 ± 0.01; GM, C SH : 0.21 ± 0.01; C SP : 0.12 ± 0.01. There was a suggestion of negative correlation between C SH and C SP (Pearson's r  = −0.37, NS). Conclusion In chronic hemiparesis, plantar flexors and Shoulder Extensors are the most shortened muscles, followed by gluteus maximus and finger flexors. This might represent an incentive to promote more aggressive posturing in the acute stages to maintain length of these important muscle groups.

  • Intra- and inter-raters reliabilities of a stepped clinical assessment of chronic spastic paresis in adults
    Annals of Physical and Rehabilitation Medicine, 2015
    Co-Authors: Marjolaine Baude, Maud Pradines, C.-m. Loche, C. Gault-colas, Jean-michel Gracies
    Abstract:

    Objective To determine intra- and inter-raters reliabilities of a stepped clinical assessment in chronic spastic paresis for upper and lower limbs in adults. Methods Eighteen adult subjects (age: 50 ± 14 years, women: 21%) with upper and lower limbs chronic hemiparesis were evaluated by four raters (3 PMR, 1 physiotherapist, age 47 ± 11 years; experience in spastic paresis 14 ± 9 years). This assessment involves performing a passive muscle stretch at 2 velocities, very slow and very fast, followed by an active maximal movement by the patient against the tested muscle and then a 15-second series of active movements of maximal amplitude of which only the last one is measured. Eight muscles were tested: Shoulder Extensors, elbow flexors, wrist flexors, fingers flexors, gluteus maximus, rectus femoris, soleus and gastrocnemii. Five parameters were collected: maximal range of passive motion X V1 , angle of catch X V3 , spasticity grade Y, maximal range of active motion X A , and residual range of motion X A15 after 15 seconds of rapid alternating movements. Each patient was evaluated on two occasions by each rater one week apart. After the first 9 patients, a 2-hour training was organized before assessing the last 9 patients. Main outcome measures were intra-class correlation coefficient (ICC) and its 95% confidence interval (CI95%) for quantitative data and agreement frequencies for ranges of movement (ordinal data). Results Before training, intra- and inter-reliabilities were excellent: intra-rater ICCs by parameter all muscles taken together: X V1 0.90 [0.60–0.98], X V3 0.84 [0.45–0.96], X A 0.92 [0.68–0.98], X A15 0.90 [0.68–0.98] and inter-raters ICCs, X V1 0.90 [0.72–0.97], X V3 0.83 [0.56–0.95], X A 0.95 [0.87–0.99], X A15 0.95 [0.86–0.98]. After training, both reliabilities improved: intra-rater ICCs, X V1 0.91 [0.65–0.98], X V3 0.92 [0.66–0.98], X A 0.94 [0.67–0.99], X A15 0.93 [0.64–0.99] and inter-raters ICCs, X V1 0.91 [0.74–0.98], X V3 0.91 [0.75–0.97], X A 0.94 [0.85–0.99], X A15 0.96 [0.87–0.99] ( P P Discussion The stepped clinical assessment shows an excellent reliability to evaluate resistance against movement in chronic spastic paresis in the upper and lower limbs of adults. Training, associated with further improvement in reliability, needed nevertheless to be strengthened for Shoulder Extensors, fingers flexors and rectus femoris.

  • Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial
    Lancet Neurology, 2015
    Co-Authors: Jean-michel Gracies, Allison Brashear, Robert Jech, Peter Mcallister, Marta Banach, Peter Valkovič, Heather W. Walker, Christina Marciniak, Thierry Deltombe, Alexander Skoromets
    Abstract:

    Summary Background Resistance from antagonistic muscle groups might be a crucial factor reducing function in chronic hemiparesis. The resistance due to spastic co-contraction might be reduced by botulinum toxin injections. We assessed the effects of abobotulinumtoxinA injection in the upper limb muscles on muscle tone, spasticity, active movement, and function. Methods In this randomised, placebo-controlled, double-blind study, we enrolled adults (aged 18–80 years) at least 6 months after stroke or brain trauma from 34 neurology or rehabilitation clinics in Europe and the USA. Eligible participants were randomly allocated in a 1:1:1 ratio with a computer-generated list to receive a single injection session of abobotulinumtoxinA 500 U or 1000 U or placebo into the most hypertonic muscle group among the elbow, wrist, or finger flexors (primary target muscle group [PTMG]), and into at least two additional muscle groups from the elbow, wrist, or finger flexors or Shoulder Extensors. Patients and investigators were masked to treatment allocation. The primary endpoint was the change in muscle tone (Modified Ashworth Scale [MAS]) in the PTMG from baseline to 4 weeks. Secondary endpoints were Physician Global Assessment (PGA) at week 4 and change from baseline to 4 weeks in the perceived function (Disability Assessment Scale [DAS]) in the principal target of treatment, selected by the patient together with physician from four functional domains (dressing, hygiene, limb position, and pain). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01313299. Findings 243 patients were randomly allocated to placebo (n=81), abobotulinumtoxinA 500 U (n=81), or abobotulinumtoxinA 1000 U (n=81). Mean change in MAS score from baseline at week 4 in the PTMG was −0·3 (SD 0·6) in the placebo group (n=79), −1·2 (1·0) in the abobotulinumtoxinA 500 U group (n=80; difference −0·9, 95% CI −1·2 to −0·6; p vs placebo), and −1·4 (1·1) in the abobotulinumtoxinA 1000 U group (n=79; −1·1, −1·4 to −0·8; p vs placebo). Mean PGA score at week 4 was 0·6 (SD 1·0) in the placebo group (n=78), 1·4 (1·1) in the abobotulinumtoxinA 500 U group (n=80; p=0·0003 vs placebo), and 1·8 (1·1) in the abobotulinumtoxinA 1000 U group (n=78; p vs placebo). Mean change from baseline at week 4 in DAS score for the principal target of treatment was −0·5 (0·7) in the placebo group (n=79), −0·7 (0·8) in the abobotulinumtoxinA 500 U group (n=80; p=0·2560 vs placebo), and −0·7 (0·7) in the abobotulinumtoxinA 1000 U group (n=78; p=0·0772 vs placebo). Three serious adverse events occurred in each group and none were treatment related; two resulted in death (from pulmonary oedema in the placebo group and a pre-existing unspecified cardiovascular disorder in the abobotulinumtoxinA 500 U group). Adverse events that were thought to be treatment related occurred in two (2%), six (7%), and seven (9%) patients in the placebo, abobotulinumtoxinA 500 U, and abobotulinumtoxinA 1000 U groups, respectively. The most common treatment-related adverse event was mild muscle weakness. All adverse events were mild or moderate. Interpretation AbobotulinumtoxinA at doses of 500 U or 1000 U injected into upper limb muscles provided tone reduction and clinical benefit in hemiparesis. Future research into the treatment of spastic paresis with botulinum toxin should use active movement and function as primary outcome measures. Funding Ipsen.

Adam Czaplicki - One of the best experts on this subject based on the ideXlab platform.

  • Biomechanical Assessment of Strength and Jumping Ability in Male Volleyball Players During the Annual Training Macrocycle
    Polish Journal of Sport and Tourism, 2017
    Co-Authors: Adam Czaplicki, Marcin Śliwa, Paulina Szyszka, Jerzy Sadowski
    Abstract:

    Introduction. The aim of the study was to determine the changes in the peak torque of the knee Extensors and flexors of the dominant lower limb, the Shoulder internal and external rotators of the dominant upper limb, and the Shoulder Extensors and flexors of the dominant upper limb as well as the changes in jump height in volleyball players during the annual training macrocycle.

  • Biomechanical Assessment of Motor Abilities in Male Handball Players During the Annual Training Macrocycle
    Polish Journal of Sport and Tourism, 2016
    Co-Authors: Tomasz Sacewicz, Sławomir Bodasiński, Marcin Śliwa, Paulina Szyszka, Zenon Mazur, Adam Czaplicki
    Abstract:

    Introduction. The aim of the study was to determine the torque of the knee Extensors and flexors of the lead lower limb, the torque of the Shoulder Extensors and flexors of the dominant upper limb, and the torque generated by the muscles of the kinematic chain going from the trail lower limb to the hand of the dominant limb in male handball players during the annual training macrocycle. Changes in jump height and throwing velocity were also investigated. Material and methods. The study involved 13 handball players from a Polish second-league team. The measurements were performed four times: at the beginning of the preparation period, at the beginning of the season, at the end of the first part of the season, and at the end of the second part of the season. Torque was measured in isokinetic and isometric conditions. Jumping ability was tested using a piezoelectric platform, and throwing velocity was measured with a speed radar gun. Results. The study found statistically significant differences between the relative torque values of the knee Extensors (p

W. Zev Rymer - One of the best experts on this subject based on the ideXlab platform.

  • Target-dependent differences between free and constrained arm movements in chronic hemiparesis
    Experimental Brain Research, 2004
    Co-Authors: Randall F. Beer, Julius P. A. Dewald, Michelle L. Dawson, W. Zev Rymer
    Abstract:

    This study compares the kinematic and kinetic characteristics of constrained and free upper limb movements in eight subjects with chronic hemiparesis. Movements of the dominant and nondominant limbs were also examined in five control subjects. Rapid movements were performed in the horizontal plane from a central starting point to five targets located to require various combinations of flexion/extension rotations at the elbow and Shoulder. Support of the upper limb against gravity loading was provided either by a low-friction air-bearing apparatus (constrained condition) or by voluntary generation of abduction and external rotation torques at the Shoulder (free condition). Data analysis focused on the peak joint torques generated during the acceleratory phase of movement, and on the net change in joint angles at the elbow and Shoulder. We found that movement parameters were broadly invariant with support condition for either limb of control subjects, as well as for the nonparetic limb of hemiparetic subjects. In contrast, support condition had a target-dependent effect on movements of the paretic limb. Relative to the constrained condition, peak torques for free arm movements were significantly reduced for distal targets requiring elbow extension and/or Shoulder flexion torques. However, peak elbow flexion and Shoulder extension joint torques for proximal targets were relatively unaffected by support condition. Of perhaps more functional importance, free movements were characterized by a target-dependent restriction in the hand’s work area that reflected a reduced range of active elbow extension, relative to constrained movements. The target-dependent effects of support condition on movements of the paretic limb are consistent with the existence of abnormal constraints on muscle activation patterns in subjects with chronic hemiparesis, namely an abnormal linkage between activation of the elbow flexors and Shoulder Extensors, abductors, and external rotators.

Magali Teresinha Quevedo Grave - One of the best experts on this subject based on the ideXlab platform.

  • Avaliação da Força Muscular e Capacidade Respiratória em Pacientes com Síndrome de Down Após Bad Ragaz Evaluation of Muscular Strength and Respiratory Capacity In Patients with Down Syndrome After Bad Ragaz
    2020
    Co-Authors: Anieli Castoldi, Eduardo Périco, Magali Teresinha Quevedo Grave
    Abstract:

    Introduction. The Down syndrome is a chromosomal syndrome re sulting from trisomy of human chromosome 21, causing hypotonia, general reduction of muscle strength, knee laxity and mental retardation. Objective. To assess possible changes in muscle strength and respiratory capacity of patients with Down syndrome by the use of Bad Ragaz. hydrotherapeutic method Method. It was selected in eight institutions in Vale do Taquari, RS, individuals who showed a diagnosis of Down syndrome. The sample comprised 54 individuals aged 16-31 years. Evaluations and hydrotherapy intervention occurred in ten meetings. In the 1st and 10th meetings, evaluations of muscle strength were made through manual muscle testing and respiratory muscle strength, using the Manovacuometer. In the others were applied the hydrotherapeutic method of Bad Ragaz. To compare the differences between the beginning and end of treatment was applied the t test. Results. It was observed significant differences in patients before and after intervention for the following parameters tested: the trunk Extensors, the Shoulder Extensors, Shoulder abductors, elbow flexors, elbow Extensors, hip flexors, knee Extensors and expiratory pressure. Conclusion. the method of Bad Ragaz has proved effec tive for increasing muscle strength and respiratory muscle strength for most tested parameters.

Jerzy Sadowski - One of the best experts on this subject based on the ideXlab platform.