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Objective To investigate the effect of traditional Chinese massage combined with traditional Chinese medicine package therapy on limb function and daily living ability in patients with spastic hemiplegia after stroke. Methods A total of 112 patients with spastic hemiplegia after stroke admitted to the hospital from September 2020 to September 2023 were selected, and they were randomly divided into the conventional group (conventional western medicine treatment) and the combined group (conventional western medicine treatment + traditional Chinese massage + package) by the random number table method. The clinical efficacy, muscle tension (improved Ashworth grade standard), motor function (Fugl-Meyer motor function assessment scale), balance ability (Berg balance scale), daily living ability (Barthel index) changes of the two groups were compared. Results The efficacy of the combined group (91.07%) was higher than that of the conventional group (73.21%), and the difference was statistically significant (P <0.05).After treatment, the modified Ashworth-grade of patients in the combined group was better than the conventional group, and the Fugl-Meyer motor function, Berg balance rating scale scores and Barthel index scores after treatment were higher than those in the conventional group points, the differences were statistical significance (P <0.05).Conclusion The application of traditional Chinese massage combined with traditional Chinese medicine package therapy in patients with spastic hemiplegia after stroke can significantly improve the curative effect, restore limb motor function and balance ability, relieve muscle tension, and improve daily living ability. [ABSTRACT FROM AUTHOR]

Introduction There are not enough published studies on the impact of early isolated triceps lengthening operations in hemiparesis on the state of motor characteristics and on the development of orthopedic complications in children with GMFCS II. Purpose Аnalyze motor locomotion in children with spastic hemiplegia who had not previously been operated on and those who had undergone isolated surgical lengthening of the triceps at an early age. Material and methods Four groups of children with spastic hemiplegia according to Rodda et Graham types: I) type 2a gait (4 children), II) type 3 (3 children), III) type 4 (7 children), IV) type 4 with previous triceps lengthening (9 children). Results The features revealed in gait types 2a, 3 and 4 in the sagittal plane correspond to the characteristic and previously described features. In all groups, asymmetric rotational movements of the pelvis and tilt asymmetry in the frontal plane were observed. In the group of early isolated tricep lengthening, a decrease in the moment of force by pushing with the foot at the end of the single-support phase was revealed, in combination with an increase in the moment of forces of knee joint extension in the single-support phase. Discussion Early isolated triceps lengthening that weakens its function leads to a compensatory increase in the work of the knee extensors which is similar to the mechanism to of iatrogenic crouch gait, but does not result in a complete loss of walking function in the conditions of a contralateral healthy limb. Conclusions Movement pathology is present in all three measurement planes in gait types 2a, 3, 4 according to the Rodda et Graham classification. The most pronounced deviations were found in gait type 3. The rotational turn of the pelvis is an initially compensatory mechanism due to intratorsion femur deformity. Isolated triceps lengthening surgeries performed at an early age lead to reduced plantar push strength, increased compensatory work of the knee extensors, and probably do not prevent the orthopedic pathology found in Rodda et Graham's gait type 4.

Contralateral C7 to C7 cross nerve transfer has been proved to be safe and effective for patients with spastic arm paralysis due to stroke and traumatic brain injury. For the lower limb, contralateral L5 to S1 cross nerve transfer serves as a novel surgical approach. In many cases, patients with hemiplegia have both upper and lower limb dysfunction and hope to restore all limb functions within one operation. To cope with this demand, we performed combined contralateral C7 to C7 and L5 to S1 cross nerve transfer in two cases successfully. Two patients were enrolled in this study. The first patient is a 36-year-old woman who had spasticity and hemiplegia in both upper and lower limbs on the left side after a right cerebral hemorrhage 14 years prior. The second patient is a 64-year-old man who suffered from permanent muscle weakness in his right limbs, especially the leg, after a left cerebral hemorrhage 7 years prior. Both patients underwent the combined nerve transfer to improve upper and lower limb motor functions simultaneously. During the 10-month follow-up after surgery, the limb functions of both patients improved significantly. This study demonstrates the safety and benefits of combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for hemiplegic patients after stroke. This novel combined surgical approach could provide an optimal choice for patients suffering from both upper and lower limb dysfunction, to reduce hospital stay while reducing financial burden. [ABSTRACT FROM AUTHOR]

Objective： To observe the clinical effect of portable functional electrical stimulator （FES） combined with scalp acupuncture therapy on walking function and plantar pressure in children with spastic cerebral palsy. Method： Total 40 children with spastic cerebral palsy were divided into experimental group （FES combined with scalp acupuncture group） and control group （scalp acupuncture group）, with 20 cases in each group. The former was treated with scalp acupuncture combined with FES and conventional rehabilitation treatment. The control group was given scalp acupuncture and conventional rehabilitation treatment. FES was treated once every other day, 20 minutes each time, 10 times for a small course of treatment, 1 small course in total. 10- meter walking speed, gross motor function test （GMFM-88） and plantar stress test scores were observed to evaluate the changes of walking function and plantar pressure before and after treatment. Result：After treatment, the C score, E score and total score of GMFM-88 in experimental group were increased, the 10- meter walking speed was increased, the deviation of left and right plantar pressure was decreased, and the differences were statistically significant （P<0.05). After treatment, the E score and total score of GMFM-88 in the control group were also increased with statistically significant differences（P<0.05). Compared with the control group, the E score, the total score of GMFM-88 and 10min walking speed in the experimental group were significantly increased after treatment, and the difference was statistically significant （P< 0.05). However, there was no statistically significant difference in the left and right foot plantar pressure deviation and body weight movement range between the two groups after treatment （P>0.05). Conclusion：The combination of limb FES and scalp acupuncture can improve the rehabilitation effect, walking function and plantar pressure in children with spastic hemiplegia to some extent. [ABSTRACT FROM AUTHOR]

Objective: To observe the curative effect of fire needle combined with rehabilitation training on spastic hemiplegia after stroke (SHAS). Methods: A total of 130 SHAS patients admitted to the People’s Hospital of Funan County from January 2020 to November 2021 were selected. The selected patients were randomly divided into 2 groups according to a random number table method, as the control group and the study group. There were 65 cases in the control group, and they were given conventional drugs combined with rehabilitation training. There were 65 cases in the study group, and they were given fire needle on the basis of the control group. The curative effect, modified Ashworth grade, motor function, Fugl-Meyer assessment (FMA) score and modified Barthel index (MBI) score were compared. Results: After treatment, the total effective rate of the study group (91.80%) was significantly higher than that of the control group (78.69%), and the difference was statistically significant (P < 0.05). After treatment, the modified Ashworth grade of both study group and control group was better than that before treatment (P < 0.05). Moreover, the modified Ashworth grade of the study group was significantly better than that of the control group (P < 0.05) after treatment. After treatment, the FMA scores of upper limbs, FMA scores of lower limbs and MBI scores of study group and control group were higher than those before treatment (P < 0.05). Moreover, the FMA scores of upper limbs, FMA scores of lower limbs and MBI scores of the study group increased more significantly than those of the control group (P < 0.05) after treatment. Conclusion: The curative effect of fire needle combined with rehabilitation training on SHAS is certain, which can improve limb spasm, motor function and activities of daily living. [ABSTRACT FROM AUTHOR]

BackgroundSpastic hemiplegia following ischemic strokes seriously impedes the recovery of motor function posing a vast rehabilitation challenge. As the uncertain effects of recommended conventional treatments such as botulinum toxin injections on active functional improvement and potential adverse effects cannot be bypassed, there is an increasing need in alternative, more effective and safer modalities. Acupoints-based transcutaneous electrical nerve stimulation (Acu-TENS) and transcranial direct current stimulation (tDCS) are effective non-invasive modalities for stroke rehabilitation, particularly showing anti-spastic effect and functional improvements as well. However, the optimal stimulation frequency of Acu-TENS and whether combination of Acu-TENS and tDCS exert synergistic effect remain to be investigated.ObjectiveTo evaluate the effects of Acu-TENS combined with tDCS on spasticity and motor function in ischemic stroke patients with spastic hemiplegia and screen the optimal frequency of Acu-TENS.MethodsA total of 90 post-ischemic stroke patients with spastic hemiplegia will be intervened for 4 weeks and followed up for 4 weeks. They will be randomly assigned to three groups including two observation groups and a standard care control group in a 1:1:1 ratio. All patients will receive standard care and regular rehabilitation accordingly. In addition, the two observation groups will receive 12 sessions of Acu-TENS at 20 Hz or 100 Hz for 30 min combined with 1 mA tDCS for 20 min, three times a week, for 4 weeks. The primary outcome is the change in total modified Ashworth scale (MAS) score from baseline to week 4. Secondary outcomes include changes in surface electromyography (SEMG), Fugl-Meyer Motor Function Scale, Modified Barthel Index (MBI), and 10-meter walk test from baseline to week 4. MAS score will also be measured after 4 weeks of follow-up. Adverse events throughout the study will be recorded.DiscussionThis trial will evaluate, for the first time, the therapeutic potentials and safety of Acu-TENS combined with tDCS on spasticity and motor function in stroke patients. It will provide evidence for frequency-dependent anti-spastic effect of Acu-TENS, and a reference for rated parameter setting of new mixed transcutaneous and transcranial stimulation system for stroke rehabilitation, thereby promoting proactive healthcare consequently.Trial registration:Chinese Clinical Trials Register ChiCTR2200067186.

Objective To evaluate the efficacy and safety of selective posterior rhizotomy ( SPR) through unilateral keyhole microinvasive interlaminar approach in the treatment of spastic hemiplegia of lower limbs. Methods The clinical data of 23 patients with spastic hemiplegia of the lower extremities were randomly grouped and treated by SPR through unilateral keyhole microinvasive interlaminar approach and Peacock surgery, admitted to Department of Neurosurgery, Yuquan Hospital of Tsinghua University from July 2019 to July 2021, were analyzed retrospectively. The patients were followed up for 1 year. The general data, modified Ashworth score ( MAS) and gross motor function classification system score ( GMFCS) before and 1 year after surgery were analyzed. Results All 23 patients completed SPR through unilateral keyhole microinvasive interlaminar approach or Peacock surgery. The scores of MAS and GMFCS were significantly improved after operation and 1 year after the operation. Conclusions Unilateral keyhole microinvasive interlaminar approach provides a good exposure for the spinal nerve roots, the efficacy is as well as Peacock surgery. And SPR through unilateral keyhole microinvasive interlaminar approach causes less damage to the bony structure, preserve the stability of the spine, and does not increase the risk of operation. SPR by this approach has good efficacy and safety. [ABSTRACT FROM AUTHOR]

Spastic hemiplegia, also known as upper motor neuron paralysis and central hemiplegia, is one of the common symptoms and important complications of stroke sequelae, and it is a major problem in the rehabilitation treatment of stroke patients in the later stage, which seriously affects the patients’ daily life and social participation.it brings serious burden to the family and society, so exploring effective treatment methods has been paid more and more attention. In recent years, clinical observation and related studies have found that acupuncture combined with exercise therapy is significant in the treatment of this disease. This paper summarizes the relevant literature on acupuncture combined with exercise in the treatment of spastic hemiplegia after stroke, and reviews the clinical research situation of different acupuncture methods combined with exercise treatment for stroke spastic hemiplegia. [ABSTRACT FROM AUTHOR]

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Abstract Background Historically, strength exercise in children with CP is not recommended, because it may develop spasticity, which results in difficulty with walking. But, recently increasing studies and systemic reviews have reported that strength exercise can promote muscle strength in children with CP with no negative impact on spasticity. The study is aiming to compare the effect of functional resistance exercise and functional eccentric training on dynamic balance and functional ability in children with hemiplegia. For this purpose, forty participating children diagnosed with spastic hemiplegia were included and their ages ranged from 6 to 13 years. They were randomly allocated into two groups: functional resistance exercise (group I) or eccentric muscle control exercise (group II). The training was conducted three times a week for 6 weeks for both groups. Each group received one of the interventions in addition to designed physical therapy programs. Functional ability and dynamic balance were measured before and after 6 weeks of the intervention by gross motor function measure and functional reach test. Results Comparison between the two groups before treatment revealed no significant difference in all values of functional ability and dynamic balance. But comparison after treatment in values showed significant improvement in both groups with greater improvements in favor of group I (p

Background: Children with hemiparetic cerebral palsy experience fine motor ability and cognitive deficits. The development of fine motor skills is a necessary part of emotional, social, and cognitive growth. Objective: The aim of the current work was to study the correlation between fine motor skills and cognitive abilities in children with hemiparetic cerebral palsy. Subjects and Methods: This cross-sectional study included a total of 85 children with spastic hemiplegia of both sexes and aged from 6 to 8 years, recruited from the Outpatient Clinic, Faculty of Physical Therapy, Cairo University. Fine motor abilities were assessed by Quality of Upper Extremity Skills Test (QUEST) whereas; Cognitive abilities were assessed using RehaCom system. Results: The correlation between Fine motor skills and cognitive abilities measurements was weak positive significant correlation with reaction control (r = 0.260, p = 0.016), moderate positive significant correlation with working speed (r = 0.351, p = 0.001) and was strong positive significant correlation with working memory (r = 0.786, p = 0.001). The correlation between fine motor skills and other cognitive abilities was weak negative non-significant correlation with reaction speed (r = -0.110, p = 0.316) and with attention (r = -0.092, p = 0.403); and was weak positive non-significant correlation with neglect hemianopia (r = 0.124, p = 0.259) and with logical reasoning (r = 0.031, p = 0.778). Conclusion: It could be concluded that there are correlations between fine motor skills and cognitive abilities in children with hemiparetic cerebral palsy. [ABSTRACT FROM AUTHOR]

Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient's activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify the correlations between segmental body composition and the spasticity level of the affected lower limb in children with unilateral cerebral palsy (spastic hemiplegia). Additionally, an attempt was made to identify the differences in composition between the affected and unaffected lower limbs using segmental body composition analysis. This case–control study included 31 children with spastic hemiplegia aged 8 to 16 years with differing severities of spasticity in the lower limbs. The reference group consisted of a control group which included 31 peers with corresponding age and sex to the tested group. Negative correlations obtained in the statistical analysis showed that higher spasticity level in the iliopsoas muscle is associated with lower limb fat-free mass and lower limb muscle mass. Our results showed that children with spastic hemiplegia have worse parameters of body composition in the affected limb than in the unaffected one. To confirm the importance of these results, further studies are needed in a larger population which includes non-ambulatory children. [ABSTRACT FROM AUTHOR]

Recently Coronavirus Disease-2019 (COVID-19) pandemic has caused major problems throughout the world. Apart from all morbidity and deaths due to this virus many patients with other chronic illness have also suffered due to lack of follow-up. Many general and specialised hospitals were turned into COVID centres and partial or complete lockdown was enforced by Governments. Due to this, patient with Cerebral Palsy (CP) were not able to follow their scheduled physical appointments. Many CP patients who were taking calibrated medication for different complication and following individualised rehabilitation programs were in turmoil without guidance of specialist doctors. This has led to exponential rise in use of telemedicine appointments. Telemedicine has both advantages and disadvantages which are discussed in this review. This review also focuses on rehabilitation of cerebral palsy patients using telemedicine in this dire situation where it is difficult for most patients to visit hospitals for physical appointments. [ABSTRACT FROM AUTHOR]

Cerebral palsy is a disorder characterized by abnormal tone, posture, and movement. In clinical practice, it is often useful to approach cerebral palsy based on the predominant motor system findings - spastic hemiplegia, spastic diplegia, spastic quadriplegia, extrapyramidal or dyskinetic, and ataxic. The prevalence of cerebral palsy is between 1.5 and 3 per 1,000 live births with higher percentage of cases in low to middle income countries and geographic regions. Pre-term birth and low birthweight are recognized as the most frequent risk factors for cerebral palsy; other risk factors include hypoxic-ischemic encephalopathy, maternal infections, and multiple gestation. In most cases of cerebral palsy, the initial injury to the brain occurs during early fetal brain development. Intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop spastic cerebral palsy. The diagnosis of cerebral palsy is primarily based on clinical findings. Early recognition of infants at risk for cerebral palsy as well as those with cerebral palsy is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging; however, in clinical practice, cerebral palsy is more reliably diagnosed by 2 years of age. Magnetic resonance imaging scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic testing and tests for inborn errors of metabolism are indicated to identify specific disorders, especially treatable disorders. Because cerebral palsy is associated with multiple associated and secondary medical conditions, its management requires a sustained and consistent collaboration among multiple disciplines and specialties. With appropriate support, most children with cerebral palsy grow up to be adults with good functional abilities., Competing Interests: Declaration of competing interest The authors do not have any conflicts to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This paper summarized the nursing experience of partial thrombotic blockage of peripherally inserted central catheter (PICC) in a patient with spastic hemiplegia after stroke. Due to the higher nervous system dysfunction after stroke and the long-term flexor state of upper limbs, the patient was vulnerable to catheter-related complications, which increasing the difficulty in catheter maintenance. The partial thrombotic blockage had occurred at two months after PICC placement. After drugs medication and other treatments, PICC was finally safely retained. (本文回顾1例痉挛性偏瘫患者经外周静脉置入中心静脉导管(PICC)部分血栓性堵塞的护理措施。患者中风后高级神经中枢的功能被破坏, 上肢长期屈肌状态, 增加了护士导管维护难度。置管2个月后发生导管内部分血栓性堵塞, 在给予药物等处理后, PICC得以安全留置。)

Recently Coronavirus Disease-2019 (COVID-19) pandemic has caused major problems throughout the world. Apart from all morbidity and deaths due to this virus many patients with other chronic illness have also suffered due to lack of follow-up. Many general and specialised hospitals were turned into COVID centres and partial or complete lockdown was enforced by Governments. Due to this, patient with Cerebral Palsy (CP) were not able to follow their scheduled physical appointments. Many CP patients who were taking calibrated medication for different complication and following individualised rehabilitation programs were in turmoil without guidance of specialist doctors. This has led to exponential rise in use of telemedicine appointments. Telemedicine has both advantages and disadvantages which are discussed in this review. This review also focuses on rehabilitation of cerebral palsy patients using telemedicine in this dire situation where it is difficult for most patients to visit hospitals for physical appointments.

Walking on sloped surfaces requires additional effort; how individuals with spastic hemiplegic cerebral palsy (CP) manage their gait on slopes remains unknown. Herein, we analyzed the difference in gait adaptation between the affected and unaffected legs according to changes in the incline by measuring spatiotemporal and kinematic data in children with spastic hemiplegic CP. Seventeen children underwent instrumented three-dimensional gait analysis on a dynamic pitch treadmill at an incline of +10° to −10° (intervals of 5°). While the step length of the affected legs increased during uphill gait and decreased during downhill gait, the unaffected legs showed no significance. During uphill gait, the hip, knee, and ankle joints of the affected and unaffected legs showed increased flexion, while the unaffected leg showed increased knee flexion throughout most of the stance phase compared with the affected leg. During downhill gait, hip and knee flexion increased in the affected leg, and knee flexion increased in the unaffected leg during the early swing phase. However, the ankle plantar flexion increased during the stance phase only in the unaffected leg. Although alterations in temporospatial variables and joint kinematics occurred in both legs as the slope angle changed, they showed different adaptation mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: Robot-assisted therapy is an innovative approach to upper-limb rehabilitation that uses intensive, repetitive, interactive, and individualized practice as an optimal strategy to enhance motor learning. An example of upper-limb robot-assisted therapy is the myoelectric orthosis MyoPro (Myomo Inc, Cambridge, USA). It is a custom-fabricated myoelectric elbow-wrist-hand orthosis (MEWHO) with built-in surface sensors that detect the user's electromyographic (EMG) signals during muscle contraction. Studies on the MEWHO have focused mostly on elderly chronic stroke patients. None have discussed its use on the adolescent population and the considerations they face in wearing the orthosis. Case Presentation : A 15-year-old male 10th grade student with a diagnosis of right spastic hemiplegia secondary to cerebral palsy was prescribed a MEWHO because of muscle weakness of his right upper extremity, decreased functional status, and fine motor skills deficits. Results : After two occupational therapy cycles, the patient demonstrated improvements in functional strength and performance of physical activities. Despite these improvements, the patient only used the MEWHO during therapy and was less engaged with its use at home and school. Discussion : This case report presents insights on why the patient was not as proficient and interested in using the orthosis at home and school. Recommendations to address these issues include peer modeling, community outings, early intervention, and the use of family-centered approaches. Future studies are also suggested to further understand MEWHO use and the considerations for successful orthotic management in this group of patients. [ABSTRACT FROM AUTHOR]

Objective To study the correlation between attention and motor function in children with spastic hemiplegia. Methods A small sample cross-sectional observational study was conducted. Spearman correlation analysis was used to statistically analyze the correlation between children’s attention and motor function.Results The three functional areas of gross motor function B,C,and D of children were positively correlated with the correct rate of children’s attention network; the four functional areas of gross motor function B,C,D,and E of children had negative correlation with the rate of missing attention network of children; B and C functional areas were negatively correlated with error rate; D (rs =-0.344,P = 0.052) and E (rs =-0.300,P = 0.100) functional areas were correlated with childrens’ error rate,there was no statistical difference. However,in children with spastic hemiplegia, there was no statistically significant correlation between the three sub-components of the network.Conclusions There is a correlation between attention and motor function in children with spastic hemiplegia. In the rehabilitation of motor function in children,it is suggested that attention should be included as a focus. [ABSTRACT FROM AUTHOR]

To perform a network meta-analysis on four commonly used acupuncture therapies (electroacupuncture, fire acupuncture, warm acupuncture, and filiform needling) and rehabilitation therapy in the treatment of post-stroke spastic hemiplegia so as to compare the differences in clinical therapeutic effect between acupuncture therapy and rehabilitation therapy as well as among different therapeutic methods of acupuncture. A computer-based retrieval was conducted in Chinese and English databases, i.e. CNKI, WanFang, VIP, SinoMed, PubMed, Embase, Web of Science and Cochrane library. The search period limit was from the database establishment to April 17, 2020. Data analysis was performed through Revman 5.3, Gemtc 0.14.3 and Stata 14.2. A total of 27 trials were finally eligible, including 1880 patients, 943 patients of which were in observation group and 937 patients in control group. In terms of the improvement of effective rate, electroacupuncture, fire needling, warm acupuncture and filiform needling methods were all better than rehabilitation therapy, and among which, warm acupuncture was the highest in probability to be the optimal measure. Regarding the improvement in Fugl-Meyer Assessment (FMA) motor function score, fire needling, warm acupuncture and filiform needling methods were all better than rehabilitation therapy, and among which, fire needling method was the highest in probability to be the optimal measure. In view of the improvement of BI score, fire needling method was better than electroacupuncture and filiform needling method, while, warm acupuncture was better than electroacupuncture, thus, fire needling method may be the optimal measure. For the modified Ashworth muscular tension assessment, there was no significant differences in pairwise comparison among different interventions and warm acupuncture was probably the optimal measure. The overall therapeutic effect of 4 acupuncture therapies is better than rehabilitation therapy on post-stroke spastic hemiplegia, respectively, among which, the therapeutic effect of warm acupuncture and fire needling method is the best. However, because of a limitation of the varieties of acupuncture-moxibustion therapy and the number of included trials, it needs to conduct more rigorous and scientific randomized controlled trials so that this conclusion can be further confirmed. [ABSTRACT FROM AUTHOR]

Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient’s activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care.

Background:  Cerebral palsy (CP) is a pediatric disorder characterized by a motor impairment resulting from a permanent, non-progressive lesion in the brain. Cerebral palsy is marked by movement and postural control impairments, which greatly affect body structure, function, daily activities, and participation., Objective: To compare the single-session auditory versus visual feedback on performance and postural balance in children with hemiplegic cerebral palsy., Method: The study was a crossover clinical trial involving a group of 25 patients diagnosed with CP hemiplegia, aged between 6 and 12 years, including both genders. Each patient underwent conventional balance therapy followed by either auditory feedback or visual feedback intervention. After a 48-hour wash-out period, they received conventional balance therapy again before undergoing the alternative intervention initially assigned. The Modified Ashworth scale (MAS), pediatric balance scale (PBS), timed one-leg stance, time up and go test (TUG), and center of pressure (CoP) displacements were assessed as the outcome measures before and after the interventions., Results: Based on the one-leg stand test, TUG, and CoP displacement outcome measures results, both interventions improved balance time, speed of movement, and postural stability in children with hemiplegic spastic cerebral palsy (P < 0.05). Moreover, after a single session of the intervention, the visual feedback group demonstrated a significantly greater improvement in the TUG test, one-leg stand test, and CoP displacement compared to the auditory group (P < 0.05)., Conclusions: The results of the study suggest that combining auditory or visual feedback with conventional balance therapy is effective in treating children with hemiplegic spastic cerebral palsy; furthermore, the utilization of visual feedback would be more effective. Further research is needed to determine the long-term effects of visual and auditory feedback on the assessed outcome measures., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Tehran University of Medical Sciences’ ethical committee issued approval IR.TUMS.FNM.REC.1402.158. The study was done after receiving the ethical approval of the Tehran University of Medical Sciences’ ethical committee with the reference number [NO: IR.TUMS.FNM.REC.1402.158] and registered in the Iranian registry of clinical trials under IRCT ID [IRCT20230903059340N1]. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alhashimi et al.)

The aim of this study was to identify the correlations between segmental body composition and the spasticity level of the affected lower limb in children with unilateral cerebral palsy (spastic hemiplegia). Additionally, an attempt was made to identify the differences in composition between the affected and unaffected lower limbs using segmental body composition analysis. This case–control study included 31 children with spastic hemiplegia aged 8 to 16 years with differing severities of spasticity in the lower limbs. The reference group consisted of a control group which included 31 peers with corresponding age and sex to the tested group. Negative correlations obtained in the statistical analysis showed that higher spasticity level in the iliopsoas muscle is associated with lower limb fat-free mass and lower limb muscle mass. Our results showed that children with spastic hemiplegia have worse parameters of body composition in the affected limb than in the unaffected one. To confirm the importance of these results, further studies are needed in a larger population which includes non-ambulatory children.

Purpose The aim of this study is to report the safety and efficacy of soft-tissue surgery incorporating split transfer of tibialis anterior to peroneus brevis (SPLATT-PB) for children with hemiplegic spastic equinovarus. Methods This was a retrospective case series of children and adolescents with spastic hemiplegia who had a novel combination of SPLATT-TB, intramuscular tenotomy of tibialis posterior and either spasticity management or gastrocsoleus lengthening as the index surgery. The principal outcome measures were changes in pain and difficulty with shoe wear and radiological parameters obtained from weight-bearing anteroposterior and lateral radiographs of the affected foot before and after surgery. Results A total of 63 patients with symptomatic spastic equinovarus met the inclusion criteria. Mean age at surgery was 9.8 years (6 to 18) and the mean follow-up was seven years (range 3 to 10 years). Foot pain and problems with shoe wear improved after surgery. Seven radiological criteria showed a clinically and statistically significant improvement at follow-up, the majority being in the normal range. There were 11 surgical adverse events, all classified as Modified Clavien-Dindo Grade II. Three patients required further surgery for recurrent equinus, eight patients required further surgery for valgus deformities and four patients required bony surgery for residual varus deformities. Conclusion Soft-tissue surgery for spastic equinovarus was successful in the majority of children with spastic hemiplegia, particularly between ages eight and 12 years, resulting in a plantigrade, flexible foot with minimal pain or limitations in shoe-wear. Children younger than 8 years at index surgery were more prone to overcorrection into valgus. Children older than 12 years had persistent varus deformities requiring bony surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy. Design: This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed. Results: The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R 2 = 0.38, P < 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R 2 = 0.15, P < 0.001) and the highest portion of the variance in spatial walking symmetry (R 2 = 0.18, P = 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R 2 = 0.10, P = 0.021). Conclusions: In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles. [ABSTRACT FROM AUTHOR]

Walking on sloped surfaces requires additional effort; how individuals with spastic hemiplegic cerebral palsy (CP) manage their gait on slopes remains unknown. Herein, we analyzed the difference in gait adaptation between the affected and unaffected legs according to changes in the incline by measuring spatiotemporal and kinematic data in children with spastic hemiplegic CP. Seventeen children underwent instrumented three-dimensional gait analysis on a dynamic pitch treadmill at an incline of +10° to −10° (intervals of 5°). While the step length of the affected legs increased during uphill gait and decreased during downhill gait, the unaffected legs showed no significance. During uphill gait, the hip, knee, and ankle joints of the affected and unaffected legs showed increased flexion, while the unaffected leg showed increased knee flexion throughout most of the stance phase compared with the affected leg. During downhill gait, hip and knee flexion increased in the affected leg, and knee flexion increased in the unaffected leg during the early swing phase. However, the ankle plantar flexion increased during the stance phase only in the unaffected leg. Although alterations in temporospatial variables and joint kinematics occurred in both legs as the slope angle changed, they showed different adaptation mechanisms.

Abstract Introduction We previously reported transferring seventh cervical (C7) nerve from unaffected side to affected side in patients with spastic hemiplegia due to chronic cerebral injury, to improve function and reduce spasticity of paralyzed upper limb. In the clinics, some patients also reported changes of spasticity in their lower limb, which could not be detected by routine physical examinations. Pennation angle of muscle can indirectly reflect the condition of spasticity. The purpose of this study was to evaluate whether this upper limb procedure may affect spasticity of lower limb, using ultrasonography to detect changes of muscle pennation angle (PA). Methods Twelve spastic hemiplegia patients due to cerebral injury including stroke, cerebral palsy, and traumatic brain injury, who underwent C7 nerve transfer procedure, participated in this study. B‐mode ultrasonography was used to measure PA of the gastrocnemius medialis (GM) muscle at rest preoperatively and postoperatively. The plantar load distribution of the lower limbs was evaluated using a Zebris FDM platform preoperatively and postoperatively. Results The PA of the GM was significantly smaller on the affected side than that of unaffected side before surgery. On the affected side, the postoperative PA was significantly larger than preoperative PA. On the unaffected side, the postoperative PA was not significantly different compared to preoperative PA. The postoperative plantar load distribution of the affected forefoot was significantly smaller than preoperative load distribution, which was consistent with ultrasonography results. Conclusions This study indicates that C7 nerve transfer surgery for improving upper limb function can also affect muscle properties of lower limb in spastic hemiplegia patients, which reveals a link between the upper and lower limbs. The interlimb interactions should be considered in rehabilitation physiotherapy, and the regular pattern and mechanism need to be further studied.

This is a blinded randomized clinical trial. Sensorimotor exercises may be an effective, noninvasive treatment modality for treating patients with pediatric spastic hemiplegic cerebral palsy (CP). We aim to evaluate the effect of sensorimotor exercises on the proprioceptive capability among children with spastic hemiplegic CP. This randomized clinical trial was performed on children with spastic hemiplegic CP. Thirty children aged 8 to 12 years old, with spastic hemiplegic CP, were randomly selected and equally divided into experimental and control groups (N = 15 for each). A joint positioning test was used to measure the patients' baseline proprioceptive ability. The exercise program included sensory and motor exercises which lasted for 8 weeks (three 60-min sessions per week). The data were analyzed by using Welch and paired-sample t -test at the significance level of P <.05. The results indicated that the proprioceptive capability of the upper limb could significantly improve (P =.001, effect size = 0.41, observed power = 0.99) by using simultaneous exercising of the sensorimotor complex. The mean increased from 8.53 ± 1.6 to 10.53 ± 1.19 in the experimental group, whereas it changed from 6.66 ± 3.44 to 6.73 ± 3.15 in the control group. In consistent with other studies, the exercises used in the present study enhanced the proprioceptive capability but not sensory performance of the hands of children with hemiplegic. Synchronous sensory and motor training in children with hemiplegic CP may improve the function and organization of the somatosensory cortex and reduce sensory disturbances. Although parents were subjectively satisfied with the outcome of the exercises, such as independency and life style, however these recordings were not measured in this study. Implementing simultaneous sensorimotor exercises can improve the proprioceptive capability of the hand. Therefore, these exercises can be used in the rehabilitation programs to meet the children's needs with hemiplegic CP. • Importance of rehabilitation on hand skills of children with hemiplegic cerebral palsy. • Given the limits imposed on children with cerebral palsy and the role of hands in maintaining childhood independence and improving quality of life. • Creating sensory and motor opportunities for children with hemiplegic cerebral palsy. • Considering the neuroplasticity of the brain, it is recommended that sensorimotor rehabilitation should begin since childhood. [ABSTRACT FROM AUTHOR]

Objectives: Spastic hemiplegia cerebral palsy is the second type of cerebral palsy among pre-mature infants, which affects the mobility of one side of the body by impairing the brain’s ability to send nerve impulse to the muscles. The present research aims to examine the effect of motor training in mirror therapy on the gross motor skills in Spastic Hemiplegia Cerebral Palsy (SHCP) children. Methods: This experimental study, 14 children with SHCP were selected using convenience sampling and randomly divided into two groups, i.e. mirror therapy or therapy group (7 children) and the control group or without mirror therapy (7 children). The gross motor skills for both groups was measured using Box and Block Test in the first session as pre-test. Later, the first group participated in motor training such as wheeling shoulder, adduction and abduction arm, throwing tennis balls into the basket, pushing a cylinder, rolling a tennis ball, rowing with elastic bands, etc. Both groups participated in 16 sessions of 30 minutes each. The control group completed the above program without a mirror. The post-test was conducted using the same procedure as the pre-test. Results: Results showed that the gross manual dexterity significantly promoted from pre- to post-test in both groups (P

Background: Spastic hemiplegia following ischemic strokes seriously impedes the recovery of motor function posing a vast rehabilitation challenge. As the uncertain effects of recommended conventional treatments such as botulinum toxin injections on active functional improvement and potential adverse effects cannot be bypassed, there is an increasing need in alternative, more effective and safer modalities. Acupoints-based transcutaneous electrical nerve stimulation (Acu-TENS) and transcranial direct current stimulation (tDCS) are effective non-invasive modalities for stroke rehabilitation, particularly showing anti-spastic effect and functional improvements as well. However, the optimal stimulation frequency of Acu-TENS and whether combination of Acu-TENS and tDCS exert synergistic effect remain to be investigated., Objective: To evaluate the effects of Acu-TENS combined with tDCS on spasticity and motor function in ischemic stroke patients with spastic hemiplegia and screen the optimal frequency of Acu-TENS., Methods: A total of 90 post-ischemic stroke patients with spastic hemiplegia will be intervened for 4 weeks and followed up for 4 weeks. They will be randomly assigned to three groups including two observation groups and a standard care control group in a 1:1:1 ratio. All patients will receive standard care and regular rehabilitation accordingly. In addition, the two observation groups will receive 12 sessions of Acu-TENS at 20 Hz or 100 Hz for 30 min combined with 1 mA tDCS for 20 min, three times a week, for 4 weeks. The primary outcome is the change in total modified Ashworth scale (MAS) score from baseline to week 4. Secondary outcomes include changes in surface electromyography (SEMG), Fugl-Meyer Motor Function Scale, Modified Barthel Index (MBI), and 10-meter walk test from baseline to week 4. MAS score will also be measured after 4 weeks of follow-up. Adverse events throughout the study will be recorded., Discussion: This trial will evaluate, for the first time, the therapeutic potentials and safety of Acu-TENS combined with tDCS on spasticity and motor function in stroke patients. It will provide evidence for frequency-dependent anti-spastic effect of Acu-TENS, and a reference for rated parameter setting of new mixed transcutaneous and transcranial stimulation system for stroke rehabilitation, thereby promoting proactive healthcare consequently., Trial Registration: Chinese Clinical Trials Register ChiCTR2200067186., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Qian, Ma, Ma, Zhang, Xiu, Wang and Sun.)

Objective: Spastic arm paralysis after central neurological injury has a long-term effect on the patient's quality of life. Effective neurosurgical treatment for this dysfunction has been described in our previous studies. It is of great significance to determine a set of unified and concise clinical standards for motor function grading in the neurosurgical treatment and management.Methods: We first conducted a retrospective study that included 51 hemiplegic patients from the Neurosurgery and Microsurgery outpatient database of Huashan Hospital. The neurosurgeons cooperated with rehabilitation experts to design and administer the new rating system (Hua-Shan Grading of Upper Extremity, H-S grading) after analyzing the scale scores and video records of these patients. We then randomly enrolled 64 patients with unilateral spastic arm paralysis after stroke or brain trauma. The Fugl-Meyer Assessment, the Ashworth scale and the new grading system were applied and analyzed to evaluate the participants' motor function.Results: Based on rehabilitation medicine scales and long-term follow-up, a feasible and concise grading system was applied that was based on the patients' characteristics and the examination experiences of neurosurgeons and rehabilitation experts in clinical practice. This method could effectively grade upper extremity motor function, usually in 3-5 minutes. A significant correlation was found between H-S grading and the Fugl-Meyer score by the Spearman test (r = .937, P < .01). The mean difference between any two levels of the new grading system was significant (P < .05). And good test-retest reliability, the Cronbach's alpha coefficient and the validity indices were presented. In addition, it was more sensitive to motor function compared with the Ashworth scale.Conclusion: As a supplement to the classic scales, H-S grading was developed in the area of spastic hemiplegia treatment. It is standardized and simplified for patients in the chronic stage after central neurological injury. [ABSTRACT FROM AUTHOR]

This research aims to model fuzzy characteristics of hemiplegic indicators in the pelvis. These indicators are consistent with those used by specialists to classify spastic hemiplegia following the classification proposed by Dr. Gage. The sample consisted of 83 patients with motor dysfunction subtype of spastic hemiplegia. These patients have been treated with protocols of Children's Orthopedic Hospital (HOI) in Caracas, Venezuela, between 1999 and 2008. Using statistical tools to indicators in pelvis, the average, the standard deviation and analysis of variance (ANOVA) are calculated. These statistics are suitable for building a fuzzy model with membership functions to discriminate types of hemiplegia comparable to the real world. If ANOVA has a value of p << 0.05; hemiplegic indicators in the pelvis are appropriate for the classification. 75% of records were processed and the remaining 25% were used to validate the results according to membership degree and sensitivity. The sensitivity obtained was 89% for type 1, 100% for type 2, 67% for type 3 and 90% for type 4. Experts said that the terms that describe the indicators pelvis, have a natural language, which allows classifying hemiplegic patients in a fuzzy way by degrees of membership

Objective To investigate the effectiveness of task-oriented bilateral arm training on upper limb function in children with spastic hemiplegia. Methods 27 children within 4-6 years with spastic hemiplegic were randomly divided into control group （n＝13） and experiment group （n＝14） . The children in control group received routine occupational therapy. The bilateral arm task-oriented training was added for children in experiment group. The Peabody development motor scale-2 （PDMS-2） and Upper Limb Physician's Rating Scale （ULPRS） were used to assess the upper limb function before and after 10 weeks intervention. Results After treatment, the scores of grasping function and visual-motor integration in PDMS-2 were significantly higher than those before treatment （P ＜0.05），and the scores of experimental group werehigher than that of control group （P ＜0.05）, and the difference of the added value between two groups were statistically significant （P ＜0.05）.The ULPRS scores of both groups increased after treatment （P ＜0.05），scores between the treatment group and the control group were not statisti cally significant （ P＞0.05），and the difference of the added value between two groups was not statistically significant（ P＞0.05） . Conclusion The task-oriented bilateral arm training can promote recovery for upper limb and hand function in children with spastic hemiplegia compared with routine occupational therapy. [ABSTRACT FROM AUTHOR]

Introduction: Spastic hemiplegia is one of the most common types of cerebral palsy. Pathology of the central nervous system can alter normal development of the somatosensory cortex and develop sensory deficits. These deficits can decrease upper limp motor performances and skills and reduce the tendency to use the affected upper limp, so the quality of life is impaired in these children. Therefore, in this study, the effect of sensory interventions (as part of occupational therapy services that impact on the performance of these children have been less reported) on motor function of affected upper limb children with spastic hemiplegia was investigated. Material and Methods: In this study, three children with spastic hemiplegia participated using single-subject (A-B) design. During the baseline phase, motor function was measured by Box and Block for three sessions a week to record changes pattern. After an initial assessment, treatment phase began. In this phase, children received sensory training interventions in 12 sessions and 3 times a week. Treatment program was included two parts: tactile and proprioceptive stimulation as active, passive and playfulness. Training for each child was provided according to his/her condition and was graded so that progress, activities got more difficult with the child’s progress. At the end of each week, evaluation was done to record regularly changes after the treatment phase. As follow-up, children were evaluated in three sessions, every other day. Then results of 3 phases were analyzed. Results: In a visual analysis for each three children, slope in both treatment and baseline phases was accelerating but in treatment was more than baseline. The effect size was large in all of them. In 2SD method, the results of second and third subjects were approved. However, it was not significant for the first one. Conclusion: Sensory interventions as training program based on sensory deficits can be effective in upper limb motor function in spastic hemiplegia.

Purpose: To assess the ocular motor functions in children with spastic hemiplegia by using the Ocular Motor Score (OMS). Material: This study included 34 children, median age 11 years. The children were divided into 3 groups according to the underlying brain lesion; group 1 malformations, group 2 white matter damage of immaturity (WMDI), and group 3 cortical/subcortical lesions. Methods: The OMS protocol consists of 15 different subtests evaluating ocular motor functions. The OMS is divided into 2 parts, a static and a dynamic. The results from each subtest are scored 0, 0.3, 0.5, or 1, according to the level of disturbance, where 0 corresponds to normal function and 1 represents the maximum disability in the certain subtest. A total OMS (tOMS) between 0 and 15 can be obtained. Results: The median tOMS in the whole spastic hemiplegia group was 2.5 (range 1.3–5.8). The highest median tOMS 5.2 was seen in group 1, in the children with malformations. Strabismus was found in 45% (15/34) of the children, with an equal percentage in all 3 groups. Conclusions: The children with spastic hemiplegia had a median tOMS of 2.7 and the highest median tOMS was seen in children with malformations. The OMS protocol is easy to use clinically and gives a quick overview of the patient´s ocular motor functions. [ABSTRACT FROM PUBLISHER]

Objectives: Spastic hemiplegia cerebral palsy is the second type of cerebral palsy among premature infants, which affects the mobility of one side of the body by impairing the brain's ability to send nerve impulse to the muscles. The present research aims to examine the effect of motor training in mirror therapy on the gross motor skills in Spastic Hemiplegia Cerebral Palsy (SHCP) children. Methods: This experimental study, 14 children with SHCP were selected using convenience sampling and randomly divided into two groups, i.e. mirror therapy or therapy group (7 children) and the control group or without mirror therapy (7 children). The gross motor skills for both groups was measured using Box and Block Test in the first session as pre-test. Later, the first group participated in motor training such as wheeling shoulder, adduction and abduction arm, throwing tennis balls into the basket, pushing a cylinder, rolling a tennis ball, rowing with elastic bands, etc. Both groups participated in 16 sessions of 30 minutes each. The control group completed the above program without a mirror. The post-test was conducted using the same procedure as the pre-test. Results: Results showed that the gross manual dexterity significantly promoted from pre- to post-test in both groups (P<0.05), but comparisons showed that the therapy group outperformed the control group in gross motor skills of their affected hand (P<0.05). Discussion: The finding of this study suggests that though motor training were beneficial for gross manual dexterity, mirror therapy had higher efficiency and efficacy. Therefore occupational therapists can benefit from this program in their remedial sessions for SHCP children. [ABSTRACT FROM AUTHOR]

Abstract Botulinum neurotoxin injection therapy and rehabilitation have been conducted for stroke patients to reduce the spasticity of their affected limbs and improve their walking ability and daily living. Furthermore, their disability was reported to be related to muscle wasting. Supplementation of l -carnitine was reported to improve physical endurance and was used to treat sarcopenia in, for example, patients with cancer. Here, we report a case of chronic stroke with muscle wasting in a patient with improved walking endurance by l -carnitine supplementation, botulinum neurotoxin injection, and rehabilitation. A 58-year-old woman had a left putamen hemorrhage 9 years before, and right spastic hemiplegia and walking disability. She could walk no more than 20 m. Botulinum neurotoxin injection and rehabilitation were performed 6 times every 3 months. The first time, walking speed and continuous walking distance increased as her spasticity decreased. However, the improvement declined after the second and third treatments. She had right leg pain during walking, accompanied by muscle wasting. The l -carnitine prescription contributed to the attenuation of her leg pain during walking and rapid improvement of her continuous walking distance. Walking speed and endurance further improved. In addition, the withdrawal of l -carnitine did not decrease her walking ability or induce a recurrence of her leg pain. Interestingly, creatine phosphokinase increased after l -carnitine was stopped, indicating that l -carnitine had helped to reduce muscle damage during rehabilitation. This case suggests that chronic stroke patients with muscle wasting have an abnormality in the mitochondrial energy metabolism of their muscles. [ABSTRACT FROM AUTHOR]