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Objective: Passive stiffness, a biomechanical parameter, has a potential influence on running economy, thus playing a pivotal role in performance. This study aimed to quantify passive stiffness of the Achilles tendon and gastrocnemius muscle using myotonometry throughout an incremental running protocol. Methods: Twenty-one male participants underwent a multistage incremental test (Bordeaux test) on a treadmill until exhaustion. Passive stiffness of the gastrocnemius muscle and Achilles tendon was measured using a MyotonPRO device. Measurements were taken before, during, and after the incremental test. Results: Our findings indicated that passive stiffness of the medial gastrocnemius decreased at rest between prerun and postrun assessments (−20.12 N·m−1, P =.012). Furthermore, during the test, stiffness increased at low intensity (at 50% of maximal aerobic speed: +104.8 N·m−1, P =.042), returning to baseline values as intensity increased. Conclusions: Throughout an incremental running protocol, both Achilles tendon and gastrocnemius muscle stiffness initially increased and then decreased with escalating percentages of maximal aerobic speed. A deeper understanding of stiffness in running can inform more effective recommendations for runners' strengthening and training. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the effects of the level of contraction during isometric shoulder abduction at different abduction angles on muscle thickness and stiffness of the shoulder girdle in asymptomatic individuals. Design: Measurement properties study. Setting: Biomechanics and motion analysis lab. Participants: Twenty individuals volunteered to participate in this study. Main Outcome Measure: The subjects were tested for morphological and mechanical properties, expressed by thickness and stiffness of the supraspinatus tendon and muscle, and upper trapezius muscle. Moreover, acromiohumeral distance was also evaluated using B-mode ultrasound and shear-wave elastography. Intervention: The thickness and stiffness of the supraspinatus and upper trapezius muscle were assessed at 3 angles of abduction (0°, 60°, and 90°) and 3 levels of contraction (0%, 10%, and 20% of the maximal voluntary isometric contraction) using ultrasonography with shear-wave imaging. Moreover, the acromiohumeral distance was measured to establish the occupation ratio during passive movement. Results: The supraspinatus and upper trapezius muscle thickness and stiffness were significantly greater at 60° shoulder abduction compared with 0°, and 90° compared with 60°, as well as significantly greater at 20% maximal voluntary isometric contraction compared with 0% and 10% maximal voluntary isometric contraction. Thickness and stiffness were significantly greater in the supraspinatus compared with the upper trapezius muscle at all 3 angles of shoulder abduction for all 3 level of contractions. The acromiohumeral distance decreased significantly from 0° to 60° and from 60° to 90°. Conclusion: Morphological and mechanical properties of the supraspinatus and upper trapezius muscles depended on the relative level of muscle contraction and the angle of shoulder abduction. [ABSTRACT FROM AUTHOR]

Background: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. Method: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Results: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. Conclusions: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently. [ABSTRACT FROM AUTHOR]

Context: Imbalances in upper-extremity soft tissue stiffness may play a role in the development of shoulder and elbow musculoskeletal injuries in tennis players. Ultrasound shear wave elastography provides quantifiable and specific data regarding muscle stiffness. The purpose of this study was to compare tendon and muscle stiffness in healthy tennis players to nontennis players. Design: Cross-sectional study. Methods: The shear wave modulus, measured in kilopascals, was obtained for the dominant pectoralis major, pectoralis minor, and common wrist-extensor tendon using 2-dimensional shear wave elastography ultrasound imaging (GE Logiq S8, L9 linear transducer). Independent t test was run to compare age, body mass index, and the activity index score between both groups. Within-day intrarater reliability was assessed using a within-examiner intraclass correlation coefficients (ICC [3, 1]) with 95% confidence intervals. A multivariate general linear model was run to compare the mean differences between the tennis and nontennis players for each of the soft tissues. Results: Twenty-six individuals (13 tennis players and 13 nontennis players) were recruited. Within-day ICCs were very good (ICC >.78 for the pectoralis musculature) and excellent (ICC >.94 for the common wrist extensor). Common extensor tendon stiffness was significantly higher in tennis players compared to nontennis players (mean difference = 114.8 [61.8], confidence interval, −22.8 to 252.5 kPa for the dominant arm [P =.039]). Mean pectoralis major and minor stiffness differences were not significant (P >.214). Conclusions: Common wrist-extensor stiffness in healthy recreational tennis players is higher than those who do not play tennis. Therefore, clinicians may need to facilitate a greater soft tissue stiffness response with resistance training when rehabilitating recreational tennis players as compared to those not playing tennis. Additional normative data on a larger sample of recreational tennis players should be collected. [ABSTRACT FROM AUTHOR]

Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment. [ABSTRACT FROM AUTHOR]

Alpha-tubulin 4A encoding gene (TUBA4A) has been associated with familial amyotrophic lateral sclerosis and frontotemporal dementia, based on identification of likely pathogenic variants in patients from distinct amyotrophic lateral sclerosis and frontotemporal dementia cohorts. By screening a multicentric French cohort of 448 unrelated probands presenting with cerebellar ataxia, we identified ultra-rare TUBA4A missense variants, all being absent from public databases and predicted pathogenic by multiple in silico tools. In addition, gene burden analyses in the 100 000 Genomes project (100KGP) showed enrichment of TUBA4A rare variants in the inherited ataxia group compared to controls [odds ratio: 57.0847 (10.2−576.7); P = 4.02 ×10−7]. Taken together, we report 12 patients presenting with spasticity and/or cerebellar ataxia and harbouring a predicted pathogenic TUBA4A missense mutation, including five confirmed de novo cases and a mutation previously reported in a large family presenting with spastic ataxia. Cultured fibroblasts from three patients harbouring distinct TUBA4A missense showed significant alterations in microtubule organization and dynamics, providing insight of TUBA4A variants pathogenicity. Our data confirm the identification of a hereditary spastic ataxia disease gene with variable age of onset, expanding the clinical spectrum of TUBA4A associated phenotypes. [ABSTRACT FROM AUTHOR]

The article discusses a case of α‐Methylacyl‐CoA racemase (AMACR) deficiency in a 56-year-old female with unique neurological features, including ataxia, spasticity, and segmental dystonia. AMACR deficiency is a rare disorder characterized by elevated levels of certain acids and can manifest in adulthood or the neonatal period. The patient's diagnosis was confirmed through genetic testing and laboratory findings, highlighting the importance of considering AMACR deficiency in patients with undiagnosed cerebellar ataxia and seizure. The article emphasizes the need for timely diagnosis and appropriate management in such cases. [Extracted from the article]

Background: Determining the optimal number of dry needling (DN) sessions to satisfactorily treat a stroke patient with spasticity is important from both clinical and economic perspective. Objective: To explore the effects of one versus three sessions of DN on spasticity of the wrist flexors and motor recovery after stroke. Methods: In this single-blind randomized clinical trial, 24 patients were randomly and equally divided into two groups: one group received one session of DN, while the other group received three sessions of DN in one week. Both groups received one minute of DN of the flexor carpi radialis and flexor carpi ulnaris. The outcome measures were the Modified Modified Ashworth Scale (MMAS), passive resistance torque (PRT), wrist active and passive extension range of motion (ROM), and the Brunnstrom Stages of Stroke Recovery (BSSR) measured before, immediately after, and one week after the last DN session. Results: Both groups demonstrated a significant improvement in all outcomes (p <.05). The MMAS scores in both groups meaningfully improved (p <.001). No significant differences were found between the two groups; however, a significant time-by-group interaction was observed for the PRT (p =.02; Cohen's d = 0.23–0.73), wrist active extension ROM (p =.001; Cohen's d = 0.37–0.67), and wrist passive extension ROM (p =.02; Cohen's d = 0.32–1.30). The BSSR significantly improved from 3 to 4 in both groups (p <.001). Conclusion: Administering three sessions of DN can effectively improve spasticity and motor function after stroke. [ABSTRACT FROM AUTHOR]

Pectoralis major injuries are uncommon, typically affecting young male athletes engaging in high-intensity activities like weightlifting. A 62-yr-old man, who previously suffered a stroke leading to left hemiparesis, hemisensory loss, and spasticity, exhibited a left chest swelling during a rehabilitation clinic visit. Subsequent inquiries revealed his recent incorporation of a home-based pulley system for stretching exercises. On examination, the swelling was diffuse, firm, and nontender, located at the midclavicular line of his left chest, with a positive dropped nipple sign and loss of the left anterior axillary fold sign. An ultrasound confirmed a low-grade injury to the left pectoralis major tendon. Spastic muscle ruptures are extremely rare, with only three published reports linked to traumatic brain injury, multiple sclerosis, and spinal cord injury. Spasticity increases muscle vulnerability due to structural and mechanical changes to the skeletal muscles. This is the first report of a spastic pectoralis major tendon rupture and the first after a stroke. This case highlights the need for optimized multimodal spasticity management and reinforces the importance of comprehensive patient education on the safe execution of home-based stretching exercises. [ABSTRACT FROM AUTHOR]

A growing number of genes have been identified in individuals with cerebral palsy (CP); however, many of these studies have poor compliance with the cerebral palsy clinical description. This systematic review aimed to assess the quality of the cerebral palsy clinical description/phenotype in cerebral palsy genetic studies published between 2010 and 2024 and report clinically relevant genes based on the quality of the cerebral palsy phenotype. An expert panel developed 6 criteria to review the reported cerebral palsy phenotype/description for each included study. Clinically relevant genes were extracted from each study and stratified into 2 tiers based on the quality. Eighteen studies were included. There was high confidence in the reported cerebral palsy description/phenotype from 8 studies. Of the initial 373 clinically relevant genes, 85 were tier II genes. Individual cerebral palsy motor disorder and phenotype data were absent for 349 of these individuals, limiting further analysis. The tier I gene list was composed of 6 genes: ATL1, COL4A1, GNAO1, KIF1A, SPAST, and TUBA1A. Bilateral spasticity was the most common motor disorder reported in individuals with variants in all 6 genes, and most individuals had accompanying conditions. Prioritizing the accurate reporting of motor and nonmotor phenotypes is crucial for future cerebral palsy genetic studies to further understand the underlying neurobiology. [ABSTRACT FROM AUTHOR]

Background: Assessing the internal condition of swallowing‐related muscles and muscle strength and size is important because their deterioration may lead to dysphagia. However, there are few reports on stiffness of swallowing‐related muscles measured using shear‐wave elastography (SWE) and their qualitative characteristics. Objectives: We measured stiffness of swallowing‐related muscles using SWE to investigate the relationship between muscle stiffness and body composition as well as other relevant variables in healthy adults. Methods: Thirty healthy adults were included in this cross‐sectional study. We evaluated stiffness of the genioglossus muscle (GGM) and geniohyoid muscle (GHM) using SWE. Skeletal muscle mass index, body mass index (BMI), handgrip strength, tongue pressure, and cross‐sectional areas of the muscles were measured, and we determined their relationship with muscle stiffness. Results: For muscle stiffness, the mean value for the middle GGM was 7.08 ± 1.92 kPa, that for the posterior GGM was 9.31 ± 2.68 kPa, and that for the GHM was 8.84 ± 2.15 kPa. In multiple regression analysis, with stiffness of the posterior GGM as the dependent variable, BMI (β = −.473, p =.039) was a significant negative explanatory variable. However, with the GHM stiffness as the dependent variable, BMI (β =.419, p =.033) was a significant positive explanatory variable. Conclusion: Stiffness of the posterior GGM was positively correlated with BMI and that of the GHM was negatively correlated with BMI. Stiffness, as measured using SWE, has the potential to capture the intramuscular characteristics of swallowing‐related muscles, particularly the posterior GGM. [ABSTRACT FROM AUTHOR]

The article titled "A Hundred Faces for a Unique Disorder: Hereditary Spastic Paraplegia" provides an overview of Hereditary Spastic Paraplegia (HSP), a group of inherited neurodegenerative disorders characterized by lesions of the pyramidal tract. The disorder presents with progressive lower limb spasticity and weakness, and exhibits wide clinical and genetic variability. The article discusses the genetic causes of HSP, including various inheritance patterns and the involvement of over 80 genes. It also describes the clinical presentation of HSP, highlighting the differences based on age of onset and the presence of additional neurological or non-neurological features. This document provides information on hereditary spastic paraplegia (HSP), a rare and diverse clinical disorder characterized by progressive weakness and spasticity in the lower limbs. The diagnosis of HSP is based on symptoms, family history, and genetic analysis. Treatment aims to manage symptoms and prevent complications, but there is currently no cure for HSP. The prognosis varies, with some individuals experiencing severe disability and others having a normal life expectancy. Early diagnosis and treatment can help reduce symptoms associated with HSP. [Extracted from the article]

Introduction: Upper and lower limb spasticity is commonly associated with central nervous system disorders including stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, and spinal cord injury, but little is known about the concurrent treatment of upper and lower limb spasticity with botulinum toxins. Objective: To evaluate onabotulinumtoxinA (onabotA) utilization and to determine if concurrent onabotA treatment of the upper and lower limbs has supported improvements in participants with spasticity. Design: Sub‐analysis of a 2‐year, international, prospective, observational registry (ASPIRE, NCT01930786). Setting: International clinic sites (54). Participants: Adult spasticity participants across etiologies, who received ≥1 concurrent onabotA treatment of the upper and lower limbs during the study. Intervention: Participants were treated with onabotA at the clinician's discretion. Outcomes: Baseline characteristics and outcomes of disability (Disability Assessment Scale [DAS]), pain (Numeric Pain Rating Scale [NPRS]), participant satisfaction, physician satisfaction, and quality of life (QoL; Spasticity Impact Assessment [SIA]) were evaluated. Adverse events were monitored throughout the study. Results: Of 744 participants enrolled, 730 received ≥1 dose of onabotA; 275 participants received treatment with onabotA in both upper and lower limbs during ≥1 session; 39.3% of participants were naïve to onabotA for spasticity. The mean (SD) total dose per treatment session ranged from 421.2 (195.3) to 499.6 (188.6) U. The most common baseline upper limb presentation was clenched fist (n = 194, 70.5%); lower limb was equinovarus foot (n = 219, 66.9%). High physician and participant satisfaction and improvements in pain, disability and QoL were reported after most treatments. Nine participants (3.3%) reported nine treatment‐related adverse events; two participants (0.7%) reported three serious treatment‐related severe adverse events. No new safety signals were identified. Conclusion: More than a third of enrolled participants received at least one concurrent onabotA treatment of the upper and lower limbs, with reduced pain, disability, and improved QoL after treatment, consistent with the established safety profile of onabotA for the treatment of spasticity. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the prevalence of neuropathic pain in patients after surgical digital amputation. A total of 58 patients underwent digital amputation, with 30 participants providing data on 39 digits. The study found that 59% of patients experienced significant neuropathic pain at three months post-surgery. The study also assessed range of motion, grip strength, and return to work, with 24% of patients not returning to work at three months. The study highlighted the impact of neuropathic pain on patients undergoing digital amputation surgery. [Extracted from the article]

Socioeconomic status (SES) tends to influence an individual's access to health care. It is commonly assumed that a poorer SES is associated with a weaker physical health status, especially in disadvantaged populations such as people with cerebral palsy (CP). However, to our knowledge, no study has looked at this assumption. Therefore, the aim of this study was to describe and compare the physical health status of ambulant adults with bilateral CP with different SES backgrounds. In addition, the physical health status of the ambulatory adults with CP was compared to well‐matched, typically developing adults. Twenty‐eight ambulatory adults with CP (gross motor functional classification system Level I/II/III: n = 11/12/5; SES low/middle/high: n = 10/9/9), and 28 matched typically developing adults were recruited for this study. No differences were observed between adults with CP from different SES backgrounds. Differences in physical health status between typically developing adults and ambulatory adults with CP in all SES backgrounds were found in passive range of motion (p < 0.05), muscle strength (p < 0.001), selectivity (p < 0.001), and muscle tone (p < 0.001) and balance (p < 0.05). The main finding of this study is that physical health status did not differ between ambulatory adults with CP from different SES backgrounds. This finding shows that SES does not always directly impact physical health status in ambulatory adults with CP and highlights the importance of an individual approach. Future research should determine the impact of SES on nonambulatory adults with CP. [ABSTRACT FROM AUTHOR]

Objective: Intraventricular baclofen has been reported as an alternative to intrathecal baclofen for managing refractory spasticity and dystonia in some circumstances. In this report, we described a frame-based stereotactic approach for precisely positioning of the infusion catheter into the third ventricle. Material and methods: High resolution contrast-enhanced anatomical MR sequences was acquired prior to surgery for pre-planning. Catheter trajectory was planned to pass from the lateral ventricle to the third ventricle through the Foramen of Monro. The surgical procedure was adapted from the frame-based deep brain stimulation surgery. The Touch-Loc kit (SceneRay, China) was used to temporarily secure the catheter in place during the surgery. From July 2022 to December 2022, three patients suffering from intractable spasticity and/or secondary dystonia received IVB successfully using the described technique. Results: No severe adverse events, including death, intracranial hemorrhage, infection, catheter migration or fracture, were documented at the last follow-up (range: 12‒24 months). Transient side effects included mild nausea following the initiation of infusion or the increase in infusion rate. All three patients responded to the IVB. Conclusions: The described frame-based stereotactic technique for IVB catheter implant is feasible and could be quickly mastered by neurosurgeons in related fields. Larger prospective cohorts with longer follow-up periods are necessary to further evaluate the long-term safety and efficacy of this procedure. [ABSTRACT FROM AUTHOR]

Spasticity management should be provided within the context of a comprehensive person-centered rehabilitation program. Furthermore, active goal setting for specific spasticity interventions is also important, with a well-established "more is better" approach. It is critical to consider adjunctive therapy and multimodal approaches if patients are not attaining their treatment goals. Often used interchangeably, there may be confusion between the terms adjunctive and multimodal therapy. Yet it is imperative to understand the differences between these approaches to achieve treatment goals in spasticity management. Addition of a secondary pharmacologic or non-pharmacologic treatment to optimize the efficacy of the initial modality, such as adding electrical stimulation or casting to BoNT-A, is considered an adjunctive therapy. Adjunctive therapy is time-specific and requires the added therapy be initiated within a specific period to enhance the primary treatment; usually within 2 weeks. Multimodal therapy is an integrated, patient-centric program of pharmacologic and nonpharmacologic strategies utilized in a concurrent/integrated or sequential manner to enhance the overall treatment effect across a variety of spasticityassociated impairments (e.g., neural and non-neural components). Moreover, within a multimodal approach, adjunctive therapy can be used to help enhance the treatment effect of one specific modality. The objectives of this paper are to clarify the differences between adjunctive and multimodal therapies, provide a brief evidence-based review of such approaches, and highlight clinical insights on selecting multimodal and adjunctive therapies in spasticity management. [ABSTRACT FROM AUTHOR]

Purpose: Hamstring spasticity is prevalent following neurological injury. The standardized assessment involves passive knee extension, in a position of 90° hip flexion. This creates passive insufficiency of the muscle and lacks ecological validity for walking, whereby the hip typically flexes to a maximum of 40° during swing phase, while the knee extends. This study compared assessment outcomes when completed in 40° and 90° hip flexion. Methods: The Modified Ashworth Scale and Modified Tardieu Scale, were performed on 35 adults with a neurological condition. Each participant was assessed by three assessors, resulting in 105 trials at 40° and 90°. Results: There was a significant increase in the proportion of trials rated as spastic using the Modified Ashworth Scale (p=.012, phi=.27), and Modified Tardieu Scale (p<.001, phi=.36), and the severity of spasticity using the Modified Ashworth Scale (p<.001, effect size (ES)=.50), and Modified Tardieu Scale (p<.001 ES=.47), at 90° hip flexion. The angle of reaction occurred 32° earlier at 90° hip flexion (p<.001, ES = 1.61). Conclusions: Completing hamstring assessments in 40° hip flexion may reduce the passive insufficiency and improve the ecological validity of assessment, for walking. This may assist in the selection of patients requiring intervention, when their goal relates to walking. IMPLICATIONS FOR REHABILITATION: The position of the hip joint impacts hamstring spasticity assessment outcomes, regardless of the clinical outcome measure chosen The application of bedside assessment methods in a manner reflective of functional tasks may assist in selecting individuals who require active spasticity intervention As per international guidelines, the use of validated outcome measures in a goal directed and patient centered manner is required to maximize patient care [ABSTRACT FROM AUTHOR]

Background and Purpose Experimental Approach Key Results Conclusions and Implications Botulinum neurotoxin type A1 (BoNT/A) is one of the most potent neurotoxins known. At the same time, it is also one of the safest therapeutic agents used for the treatment of several human disorders and in aesthetic medicine. Notwithstanding great effectiveness, strategies to accelerate the onset and prolong BoNT/A action would significantly ameliorate its pharmacological effects with beneficial outcomes for clinical use.Here, we combined BoNT/A with two fast‐acting inhibitors of excitation–contraction coupling inhibitors (ECCI), either the μ‐conotoxin CnIIIC or dantrolene, and tested the effect of their co‐injection on a model of hind‐limb paralysis in rodents using behavioural, biochemical, imaging and electrophysiological assays.The BoNT/A‐ECCI combinations accelerated the onset of muscle relaxation. Surprisingly, they also potentiated the peak effect and extended the duration of the three BoNT/A commercial preparations OnabotulinumtoxinA, AbobotulinumtoxinA and IncobotulinumtoxinA. ECCI co‐injection increased the number of BoNT/A molecules entering motoneuron terminals, which induced a faster and greater cleavage of SNAP‐25 during the onset and peak phases, and prolonged the attenuation of nerve‐muscle neurotransmission during the recovery phase. We estimate that ECCI co‐injection yields a threefold potentiation in BoNT/A pharmacological activity.Overall, our results show that the pharmacological activity of BoNT/A can be combined and synergized with other bioactive molecules and uncover a novel strategy to enhance the neuromuscular effects of BoNT/A without altering the neurotoxin moiety or intrinsic activity, thus maintaining its exceptional safety profile. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is one of the most common causes of disability. Spasticity is a common clinical impairment that occurs after a stroke. This study investigates the effect of Nintendo Wii games on the outcomes of spasticity, functional mobility, and quality of life in patients with stroke. Materials and Methods: In this single-blind clinical trial study, 30 patients with stroke were randomly assigned to one of the experimental and control groups. Subjects of both groups received conventional physiotherapy. In addition, the experimental group also received Nintendo Wii games for 30 min, three times a week for a total of 12 sessions. The primary outcomes spasticity and functional mobility that respectively evaluated using the modified modified Ashworth scale (MMAS) and the timed up-and-go test before and after the treatment. The assessor was blind about group assignment. Meanwhile, the secondary outcome included quality of life. All statistical analyses were performed using the SPSS software, version 20. Results: The intragroup results showed that in the experimental group, spasticity was significantly reduced (P=0.001), functional mobility improved (P=0.001), and the quality of life increased significantly (P<0.001); however, in the control group, only a significant improvement in functional mobility (P=0.04) was observed. The comparison between the two groups showed that there is no statistically significant difference in the results between the experimental and control groups (P>0.05). Conclusion: Considering these results, the use of Nintendo Wii can be suggested as a treatment modality alongside the usual treatments to achieve more and faster effectiveness in patients with stroke. [ABSTRACT FROM AUTHOR]

Background and Purpose: Developing technology in the field of rehabilitation is vital to accelerate recovery and decrease the side effects of current modalities. Rehabilitation is a challenging science in which the main challenge is not just treating the patient but also to shorten the rehabilitation time and avoid harmful effects. Thus, this review demonstrates the possible design and effects of air therapy as a novel treatment branch besides hydrotherapy, electrotherapy, and manual therapy in the field of rehabilitation. Methods: The search was conducted over clinical trials, literature reviews, and systematic reviews on the possible effects of treatments that may have similar effects to the newly developed air therapy. This search was conducted in the Web of Science, Scopus, EBSCO, and Medline databases. Results: Air therapy could be used to improve the function of mechanoreceptors, improve circulation and microcirculation, decrease pain, the release of trigger points, regain the elasticity of soft tissues, treat acute and chronic inflammations, decrease muscle cramps and spasticity, strengthen muscle, and decrease muscle fatigue and Decreasing muscle fatigue and delayed muscle soreness. Conclusion: Air therapy is a novel treatment modality that can be used effectively in the field of rehabilitation. Air therapy could be a valuable and safe treatment in rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Approximately 4.4 million people in England (8% of the total population) are living with a long‐term neurological condition. Within this group of vulnerable individuals, there will be individuals living with severe spasticity that requires regular outpatient treatment with botulinum toxin injection. The closure of outpatient spasticity services during the pandemic impacted individuals who required spasticity treatment and their carers, as well as the specialist clinicians responsible for service delivery. Objectives: We aimed to gain insight into the experiences of individuals living with spasticity, their carers and a clinical spasticity service lead during the pandemic, and to reflect on potential learning for the future. Methods: A qualitative study was designed using semi‐structured interviews conducted by telephone. Participants comprised patients living with a long‐term neurological condition who attended outpatient spasticity clinics before the start of the pandemic in England, primary carers who accompanied patients attending these clinics and a clinical spasticity service lead. Data were audio recorded, transcribed, anonymised and coded. Data analysis utilised the One Sheet of Paper thematic approach to identify themes, which were discussed and analysed by the interdisciplinary research team and two patient and carer participants. Results: Out of the 11 participants recruited, aged 36–77 years, seven comprised people living with spasticity related to a long‐term neurological condition, three were carers and one was a clinical spasticity service lead. Six participants were male and five were female. Among the participants, four were stroke survivors, two were living with spinal cord injury and one was living with multiple sclerosis. Analysis revealed six major themes: experience of living with spasticity during the pandemic; impact of the pandemic on patient, carer and clinician health; access to and experience of outpatient clinic appointments; coping strategies during the pandemic; system improvements; and learning from the pandemic period. Conclusion: These findings contribute research knowledge to a very limited research knowledge base and suggest that there is scope for improving system and service delivery through the allocation of research funding to senior clinicians working in this specialist area. [ABSTRACT FROM AUTHOR]

OnabotulinumtoxinA (onabotA) is approved in the US for 12 therapeutic indications. Real-world data on onabotA multi-indication use are limited, often leading to delayed or reduced treatment. This study provides real-world evidence on the safety of onabotA when treating multiple indications concomitantly. SYNCHRONIZE was a multicenter, retrospective, chart-review study evaluating onabotA's safety for adults treated for ≥2 therapeutic indications within a 3-month period. The primary outcome was treatment-emergent adverse events (TEAEs) within 6 months post-treatment. A total of 279 patients were included. The most common concomitant indications treated were cervical dystonia and chronic migraine (43.4%). The average 3-month cumulative dose for multiple indications was 282.2 U. The treatment interval for multiple indications was ≤24 h for most patients (62.4%). Overall, 28.7% of patients reported ≥1 TEAE with no apparent trends in TEAEs and dose interval or cumulative dose. Reported TEAEs included UTI (5.7%), neck pain (5.0%), and headache (4.3%). No patient had a lack of effect according to clinical objective measurements. SYNCHRONIZE described the real-world safety of onabotA for patients treated concomitantly for ≥2 indications within a 3-month period. TEAEs were generally consistent with the known safety profiles of individual indications. No new safety signals were identified). [ABSTRACT FROM AUTHOR]

The text discusses various medical studies and findings related to pediatric neurosurgery, traumatic brain injuries, and prenatal care in different regions. It highlights the importance of monitoring motor function in patients with myelomeningocele, the risk of subsequent primary neoplasms in survivors of certain brain tumors, and the impact of folic acid supplementation on hydrocephalus incidence. The studies also address post-traumatic seizures in pediatric TBI cases, the reduction of post-craniotomy motor syndrome with changes in surgical technique, and the potential therapeutic benefits of targeting HSP90 in medulloblastoma treatment. Additionally, the text includes information on different research projects and protocols in pediatric neurosurgery departments worldwide. [Extracted from the article]

group showed a significant improvement in motor function compared to the control group, as evidenced by higher scores on the GMFM. The home-based exercise program was effective in enhancing motor function in children with CP. This study highlights the importance of incorporating home-based exercise programs into the care of children with CP to improve their overall motor function. [Extracted from the article]

This article from the "Developmental Medicine & Child Neurology" journal discusses various studies on children with motor difficulties, cerebral palsy, arthrogryposis multiplex congenita, and other neurodevelopmental conditions. The research focuses on telecoaching interventions, epidemiology of cerebral palsy, health-related quality of life in arthrogryposis multiplex congenita, and early intervention models for children with cerebral palsy. Caregivers' insights into dystonia in children with cerebral palsy emphasize the complexity of movements, while another study highlights the multifaceted nature of fall concerns in individuals with cerebral palsy. Additionally, a study on muscle contractures in cerebral palsy reveals disruptions in the transcriptional regulation of muscle stem cells, offering potential insights for targeted therapies. [Extracted from the article]

The Special Issue titled "Neurosurgery and Spine Surgery: From Up-to-Date Practitioners" offers a comprehensive overview of the latest advancements and best practices in neurosurgery and spine surgery. It includes research articles and reviews from leading experts in the field, covering topics such as surgical approaches, emerging technologies, patient outcomes, and interdisciplinary collaboration. This collection serves as a valuable resource for healthcare professionals, researchers, and students interested in staying current with developments in these medical specialties. [Extracted from the article]

Hyperreflexia associated with spasticity is a prevalent neurological condition characterized by excessive and exaggerated reflex responses to stimuli. Hyperreflexia can be caused by several diseases including multiple sclerosis, stroke and spinal cord injury (SCI). Although we have previously identified the contribution of the RAC1‐PAK1 pathway underlying spinal hyperreflexia with SCI‐induced spasticity, a feasible druggable target has not been validated. To assess the utility of targeting PAK1 to attenuate H‐reflex hyperexcitability, we administered Romidepsin, a clinically available PAK1 inhibitor, in Thy1‐YFP reporter mice. We performed longitudinal EMG studies with a study design that allowed us to assess pathological H‐reflex changes and drug intervention effects over time, before and after contusive SCI. As expected, our results show a significant loss of rate‐dependent depression – an indication of hyperreflexia and spasticity – 1 month following SCI as compared with baseline, uninjured controls (or before injury). Romidepsin treatment reduced signs of hyperreflexia in comparison with control cohorts and in pre‐ and post‐drug intervention in SCI animals. Neuroanatomical study further confirmed drug response, as romidepsin treatment also reduced the presence of SCI‐induced dendritic spine dysgenesis on α‐motor neurons. Taken together, our findings extend previous work demonstrating the utility of targeting PAK1 activity in SCI‐induced spasticity and support the novel use of romidepsin as an effective tool for managing spasticity. Key points: PAK1 plays a role in contributing to the development of spinal cord injury (SCI)‐induced spasticity by contributing to dendritic spine dysgenesis.In this study, we explored the preclinical utility of inhibiting PAK1 to reduce spasticity and dendritic spine dysgenesis in an SCI mouse model.Romidepsin is a PAK1 inhibitor approved in the US in 2009 for the treatment of cutaneous T‐cell lymphoma.Here we show that romidepsin treatment after SCI reduced SCI‐induced H‐reflex hyperexcitability and abnormal α‐motor neuron spine morphology.This study provides compelling evidence that romidepsin may be a promising therapeutic approach for attenuating SCI‐induced spasticity. [ABSTRACT FROM AUTHOR]

Purpose: Post-stroke patients constitute a large group suffering from disabilities that require rehabilitation long after discharge. Quality indicators (QIs) that specify the minimum expected standard of quality in outpatient rehabilitation could contribute to the valuation of the effectiveness of rehabilitation on decision-makers, health professionals, patients, and relatives. This review aims to identify QIs focusing on physiotherapists' outpatient rehabilitation of stroke patients. Materials and methods: The databases Cinahl, Cochrane, Embase, PubMed, and Scopus were searched for publications, and the grey literature was also searched. Through a pragmatic appraisal and assessment with the modified AGREE II-QI instrument, relevant QIs were selected. Results: A total of 1129 papers were retrieved, and five papers presenting 91 QIs were included. Thirty-six QIs were considered relevant to physiotherapy in outpatient rehabilitation. The QIs cover structure, process, and outcome and concern basic mobility, spasticity, organisation and content of the training, patient-reported outcome measures, education of patients and relatives, and follow-up and goal setting. Conclusions: The study appraised 36 QIs relevant for outpatient rehabilitation of stroke survivors conducted by physiotherapists. A Delphi panel is required to develop the final set of QIs for physiotherapists and, subsequently, the development of a core set of multidisciplinary QIs. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shockwave therapy (ESWT) has been proven beneficial for post-stroke spasticity (PSS) of ankle plantar flexor muscles. This study aims to investigate the dose-response effectiveness of focused-ESWT and the duration of its effect on the treatment of ankle PSS in stroke patients. Methods: In this double-blinded randomized controlled trial, stroke patients diagnosed with PSS in the ankle plantar flexor muscles were randomly assigned to two groups. The experimental group received double-dose ESWT (4000 pulses per session) targeting spastic calf muscles, while the control group received half the dose (2000 pulses per session). Both groups underwent four sessions over two weeks. The outcomes, including modified Ashworth Scale (MAS), modified Tardieu Scale (MTS), passive range of motion (PROM) of the ankle, Timed Up and Go (TUG) Test, Barthel index and strain elastography were evaluated at baseline, 1st, 4th, 12th, and 24th week after ESWT. Results: Within-group analysis revealed significant improvements in MAS, PROM, TUG Test, and Barthel index for the double-dose ESWT group and improvements in Barthel index for the control group. Between-group analysis revealed greater improvements in TUG Test, Barthel Index and strain elastography for the double-dose ESWT group. Generalized estimating equations analysis indicated that the double-dose ESWT group achieved superior outcomes in the TUG Test, Barthel Index, and strain elastography across various time points and groups. Conclusions: Double-dose ESWT showed better functional improvement and elastography compared to the control group. ESWT demonstrated dose-response effectiveness for PSS of ankle-equinus. Trial registration: NCT05878223. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the impact of combining transcranial direct current stimulation with end-effector robot-assisted treatment on upper limb function, spasticity, and hand dexterity in chronic stroke patients. Design: This was a prospective, double-blind randomized trial with 20 equally allocated stroke patients. The experimental group received dual transcranial direct current stimulation (anode over affected M1, cathode over contralateral M1) alongside robot-assisted treatment, while the control group received sham transcranial direct current stimulation with the same electrode placement + robot-assisted treatment. Each patient underwent 20 combined transcranial direct current stimulation and robot-assisted treatment sessions. The primary outcome measure was the Fugl-Meyer Upper Limb motor score, with secondary outcomes including AMADEO kinematic measures, Action Research Arm Test, and Functional Independence Measure. Assessments were conducted at baseline, after rehabilitation, and 3 mos later. Results: Combining bilateral transcranial direct current stimulation with robot-assisted treatment did not yield additional improvements in Fugl Meyer Upper Limb motor score, Functional Independence Measure, or Action Research Arm Test scores among stroke patients. However, the real transcranial direct current stimulation group showed enhanced finger flexion in the affected hand based on AMADEO kinematic measures. Conclusions: The addition of transcranial direct current stimulation to robot-assisted treatment did not result in significant overall functional improvements in chronic stroke patients. However, a benefit was observed in finger flexion of the affected hand. [ABSTRACT FROM AUTHOR]

Interest in medical cannabis and cannabis-based medicinal products (CBMPs) has increased greatly in recent years. Two cannabinoids are of principal importance; delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive component, and also cannabidiol (CBD), considered non-intoxicating. Each has distinct mechanisms of action and different therapeutic potentials. CBMPs differ in their ∆9-THC and CBD components; predominantly ∆9-THC, balanced formulations with equivalent ∆9-THC and CBD elements, and CBD-predominant products. In this narrative review, we evaluate the published evidence for the clinical benefits of CBMPs and overall benefits in well-being. We also review the overall safety profile and discuss the potential for dependence with CBMPs. Evidence can be drawn from a wide range of randomized and other controlled studies and from observational real-world studies. Most data from observational registry studies are supportive of ∆9-THC-based products (∆9-THC-predominant or balanced CBMPs) in the management of chronic neuropathic pain. Balanced products are also effective in reducing spasticity in multiple sclerosis. Most CBMPs show benefit in providing symptomatic benefits in reducing anxiety, nausea, and in improving sleep, but the place of specific products is more subtle, and choice guided by specific circumstances. Symptomatic improvements are accompanied by improved quality of life and well-being. Safety data indicate that CBMPs are generally well tolerated in most patients without specific contraindications. The majority of adverse effects are non-serious, and transient; most are principally associated with ∆9-THC and are dose-dependent. In contrast to recreational cannabis use, there is little evidence from clinical studies that CBMPs have any potential for dependence. [ABSTRACT FROM AUTHOR]

MPDZ, a gene with diverse functions mediating cell–cell junction interactions, receptor signaling, and binding multivalent scaffold proteins, is associated with a spectrum of clinically heterogeneous phenotypes with biallelic perturbation. Despite its clinical relevance, the mechanistic underpinnings of these variants remain elusive, underscoring the need for extensive case series and functional investigations. In this study, we conducted a systematic review of cases in the literature through two electronic databases following the PRISMA guidelines. We selected nine studies, including 18 patients, with homozygous or compound heterozygous variants in MPDZ and added five patients from four unrelated families with novel MPDZ variants. To evaluate the role of Mpdz on hearing, we analyzed available auditory electrophysiology data from a knockout murine model (Mpdzem1(IMPC)J/em1(IMPC)J) generated by the International Mouse Phenotyping Consortium. Using exome and genome sequencing, we identified three families with compound heterozygous variants, and one family with a homozygous frameshift variant. MPDZ‐related disease is clinically heterogenous with hydrocephaly, vision impairment, hearing impairment and cardiovascular disease occurring most frequently. Additionally, we describe two unrelated patients with spasticity, expanding the phenotypic spectrum. Our murine analysis of the Mpdzem1(IMPC)J/em1(IMPC)J allele showed severe hearing impairment. Overall, we expand understanding of MPDZ‐related phenotypes and highlight hearing impairment and spasticity among the heterogeneous phenotypes. [ABSTRACT FROM AUTHOR]

Identification of neuromuscular impairments in cerebral palsy (CP) is essential to providing effective treatment. However, clinical recognition of neuromuscular impairments in CP and their contribution to gait abnormalities is limited, resulting in suboptimal treatment outcomes. While CP is the most common childhood movement disorder, clinical evaluations often do not accurately identify and delineate the primary neuromuscular and secondary musculoskeletal impairments or their specific impact on mobility. Here we discuss the primary neuromuscular impairments of CP that arise from early brain injury and the progressive secondary musculoskeletal impairments, with a focus on spastic CP, the most common form of CP. Spastic CP is characterized by four primary interrelated neuromuscular impairments: 1. muscle weakness, 2. short muscle-tendon units due to slow muscle growth relative to skeletal growth, 3. muscle spasticity characterized by increased sensitivity to stretch, and 4. impaired selective motor control including flexor and extensor muscle synergies. Specific gait events are affected by the four primary neuromuscular impairments of spastic CP and their delineation can improve evaluation to guide targeted treatment, prevent deformities and improve mobility. Emerging information on neural correlates of neuromuscular impairments in CP provides the clinician with a more complete context with which to evaluate and develop effective treatment plans. Specifically, addressing the primary neuromuscular impairments and reducing secondary musculoskeletal impairments are important treatment goals. This perspective on neuromuscular mechanisms underlying gait abnormalities in spastic CP aims to inform clinical evaluation of CP, focus treatment more strategically, and guide research priorities to provide targeted treatments for CP. [ABSTRACT FROM AUTHOR]

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Posterior spinal instrumented fusion (PSIF) is a treatment option for adolescent spinal deformity. PSIF leads to loss of spinal segment motion. It is unclear the extent to which spinal stiffness is perceived by adolescent patients after fusion. Focus groups of adolescents between ages 11 and 21 years who underwent PSIF for spinal deformity were performed. Focus groups were evaluated for common themes, and a 36-question survey was designed. Survey responses were analyzed relative to last instrumented vertebra (LIV) and Scoliosis Research Society-22 (SRS-22) scores. Five focus groups were held with 18 patients in total. Three main themes were identified by participants: 56% identified difficulty bending forward, 44% identified difficulty hunching while sitting, and 56% identified difficulty with twisting motions. Patients with more distal LIV reported significant more difficulty with self-care/grooming (P =.014) and chores (P <.001). SRS-22 function/activity scores correlated well with survey categories in self-care/grooming (r =.61; P =.049) and recreation (r =.69; P =.019). Focus groups suggest that spinal stiffness is frequently perceived and leads to alteration in daily tasks in adolescents after spinal fusion. [ABSTRACT FROM AUTHOR]

Objective: To assess the reliability and validity of the Chinese version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy (CP). Methods: Forty-five children with spastic CP (mean age 7.29 years, SD 2.87 years, rang 4-16 years) were recruited. Internal consistency was measured using Cronbach's α, while test--retest and inter-rater reliability were evaluated using intra-class correlation coefficients (ICC). Construct validity was established through correlation and confirmatory factor analyses. Discriminative validity was assessed by comparing SCALE scores across varying GMFCS levels. Results: The Chinese version of SCALE demonstrates high internal consistency (Cronbach's α = 0.91) and good reliability with ICCs exceeding 0.76 for test--retest and inter-rater assessments. It shows significant correlations with GMFCS (r = -0.76, p < 0.001) and Fugl-Meyer scales (r = 0.79, p < 0.001), confirming its validity. Confirmatory factor analysis supports a well-fitting model (χ²/df = 1.58, RMSEA = 0.08, SRMR <0.001, GFI = 0.98, AGFI = 0.90, CFI = 0.99, TLI = 0.98), with the latent variable's AVE at 0.59 and CR at 0.88. Discriminative validity is evident in significant differences across GMFCS levels (p < 0.001), notably between levels I and II, I and III, and I and IV (p < 0.05). Conclusion: The Chinese version of SCALE shows good reliability and validity for assessing lower limb selective movement control in children with spastic cerebral palsy in China. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=205380, identifier ChiCTR2400083880. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. Methods: 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. Results: After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. Conclusion: ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients. Implications for Rehabilitation: Extracorporeal shock wave therapy represents a useful non-invasive, additional modality for reduction of foot spasticity and equinus deformity in chronic stroke patients. The application of such a modality improves limb posture, range of motion, and muscle extensibility. Early extracorporeal shock wave rehabilitative intervention in stroke patients reduces fat infiltration and fibrosis replacement of spastic muscle. [ABSTRACT FROM AUTHOR]

Featured Application: We found that more students could reproduce therapeutic movement techniques by practicing with a robot that simulates the patient's pathological movements than by performing simulation exercises with other students. These results suggest that the use of simulation robots that can reproduce the pathological movements of patients may be effective in teaching therapeutic movement techniques. Furthermore, we believe that it is an effective new learning method for therapeutic movement techniques considering interpersonal infections. We aimed to compare the effects of practical learning using an educational robot arm (Samothrace: SAMO) and a student simulating a patient in students' acquisition of therapeutic motion techniques. For this study, twenty-five fourth-year students and eight therapists were included. Students were randomly assigned to the robot practice (Robo) group (n = 13) or conventional practice (Human) group (n = 12), wherein students practiced among themselves. The experimental procedure comprised a pre-practice test, practice, and post-practice test. We calculated the peak angle ratio, peak velocity, and movement time during flexion and extension using the elbow joint angle data. Machine learning was performed on students' pre-practice and used therapists' data to create identifiers that distinguish students and therapists to determine whether the students' skills improved to the level of a therapist. However, regarding other kinematics data, there were no main effects or interactions between groups pre- and post-practice. Identifiers were created from machine learning of kinematics data pre-practice, and the effect was evaluated post-practice. A higher number of students in the Robo group were determined to possess skills at a therapist's level. This study suggests the effectiveness of a simulation robot that can reproduce a patient's pathological motions in educating students on upper limb exercise therapy. [ABSTRACT FROM AUTHOR]

Assessment of muscle tone in a clinical setting is important for the physiotherapist to better analyse and establish appropriate treatments for CNS disorders. This study aims to review and summarise how to assess changes in tone in the context of adult rehabilitation. Secondarily, this study aimed to identify the central nervous system disorders, the respective variable/concept under study, and the testing procedures employed. PRISMA-ScR guidelines were followed using the "population", "concept", and "context" to define the eligibility criteria and to delineate the research question. PubMed®, Science Direct®, Web of Science™, and Google Scholar® databases were used to search the literature. The search included studies published between 2011 and March 2023 in Portuguese, English, French, and Spanish that assessed an adult population (>19 years) with CNS injury. Review articles, qualitative studies, conference proceedings, letters to the editor, and editorials were excluded. Initially, 1519 references were identified, of which eight met the eligibility criteria. The measurement instruments included the Modified Ashworth Scale (n = 5), the Modified Modified Ashworth Scale (n = 3), the BioTone™ system (n = 2), the Montreal Spasticity Measurement (n = 1), and the Tone Evaluation Scale (n = 1). The health conditions considered included stroke sequelae (n = 7), multiple sclerosis (n = 4), spinal cord injuries (n = 4), cerebral palsy (n = 2), brain tumour (n = 2), and traumatic brain injuries (n = 3). The concepts of spasticity (n = 7) and muscle tone (n = 2) were explored. Considering the variables spasticity and muscle tone in different CNS disorders, mainly stroke, subjective instruments were preferred compared to objective ones, with the Modified Ashworth Scale being highlighted. [ABSTRACT FROM AUTHOR]

Hydrocephalus is a common comorbidity associated with brain injuries, including cerebral palsy (CP). In CP, hydrocephalus typically presents in infancy or early childhood. This report describes a patient in their mid 20 s with mixed dyskinetic-spastic CP with adult-onset hydrocephalus of unknown cause initially presenting with new-onset bilateral lower extremity spasms. Multiple interventions were trialed, including ischial bursal steroid injections, botulinum toxin injections, trigger point injections, multiple oral medications, and physical and massage therapies without benefit. Given lack of treatment response, imaging of the neuraxis was obtained. Magnetic resonance imaging (MRI) of the brain demonstrated new diffuse moderate ventriculomegaly compared to prior MRI. Ophthalmologic evaluation demonstrated papilledema, and opening pressure on lumbar puncture was elevated to 44 mmHg H2O. The patient underwent ventriculoperitoneal shunt placement with rapid and near-resolution of their spasms and pain. This patient represents a unique case of new-onset hydrocephalus in an adult with CP. To ensure appropriate and timely diagnosis and treatment, individuals with neurologic conditions such as CP should have ongoing surveillance and comprehensive evaluation for any neurologic or functional changes, including changes in baseline tone. Future research is needed to better understand if adults with CP are at higher risk for the development of hydrocephalus in adulthood. [ABSTRACT FROM AUTHOR]

Background: In healthy subjects, repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1) demonstrated plasticity effects contingent on electroencephalography (EEG)-derived excitability states, defined by the phase of the ongoing sensorimotor μ-oscillation. The therapeutic potential of brain state-dependent rTMS in the rehabilitation of upper limb motor impairment post-stroke remains unexplored. Objective: Proof-of-concept trial to assess the efficacy of rTMS, synchronized to the sensorimotor μ-oscillation, in improving motor impairment and reducing upper-limb spasticity in stroke patients. Methods: We conducted a parallel group, randomized double-blind controlled trial in 30 chronic stroke patients (clinical trial registration number: NCT05005780). The experimental intervention group received EEG-triggered rTMS of the ipsilesional M1 [1,200 pulses; 0.33 Hz; 100% of the resting motor threshold (RMT)], while the control group received low-frequency rTMS of the contralesional motor cortex (1,200 pulses; 1 Hz, 115% RMT), i.e., an established treatment protocol. Both groups received 12 rTMS sessions (20 min, 3x per week, 4 weeks) followed by 50 min of physiotherapy. The primary outcome measure was the change in upper-extremity Fugl-Meyer assessment (FMA-UE) scores between baseline, immediately post-treatment and 3 months' follow-up. Results: Both groups showed significant improvement in the primary outcome measure (FMA-UE) and the secondary outcome measures. This included the reduction in spasticity, measured objectively using the hand-held dynamometer, and enhanced motor function as measured by the Wolf Motor Function Test (WMFT). There were no significant differences between the groups in any of the outcome measures. Conclusion: The application of brain state-dependent rTMS for rehabilitation in chronic stroke patients is feasible. This pilot study demonstrated that the brain oscillation-synchronized rTMS protocol produced beneficial effects on motor impairment, motor function and spasticity that were comparable to those observed with an established therapeutic rTMS protocol. Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT05005780]. [ABSTRACT FROM AUTHOR]

This document provides summaries of various research studies related to multiple sclerosis (MS) treatment and management. The studies cover a range of topics, including cognitive impairment, quality of life, treatment approaches, and the impact of COVID-19 on MS patients. The findings highlight the importance of considering gender differences, providing support for couples affected by MS, and exploring potential interventions for managing symptoms and improving quality of life. The studies also emphasize the need for personalized treatment approaches, early intervention, and collaborative care in managing MS. [Extracted from the article]

Baclofen is an active pharmaceutical ingredient used for the treatment of muscle spasticity. We describe our efforts to develop a novel synthetic approach through C–C bond formation and a cost-effective route to baclofen. The synthesis involved a two-step approach through C–C bond formation using the extensively and commercially available starting material 4-chlorobenzyl cyanide with chloroacetic acid as a reagent in an aprotic solvent, followed by reduction of the nitrile functional group. The synthetic route to baclofen has been demonstrated to be commercially viable, cost-effective, and environmentally friendly. Execution of the developed process led to the isolation of (+)-baclofen in an overall yield of 60% at a multikilogram scale with >99.5% HPLC purity. This article also discusses the cost-effectiveness of the process, the impurity profiling, and the product quality. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a chronic inflammatory disorder with an unpredictable progression that affects the central nervous system and has significant emotional, social, and professional implications. The therapeutic approach is multifactorial and requires complex management coordinated by a specialized, multidisciplinary team over the long term. Current non-pharmacological treatment strategies under study, which may improve the course of the disease, focus on the gut microbiome and include the administration of probiotics and fecal transplantation. This study presents a case of secondary progressive multiple sclerosis in a young patient, with rapidly progressive evolution despite ongoing background therapy. The study analyzed literature data regarding both medical rehabilitation programs used in secondary progressive multiple sclerosis and other therapeutic strategies that can improve the quality of life. Medical rehabilitation has no proven impact on disease progression but can enhance the quality of life for patients with multiple sclerosis through spasticity management, improved mental health, increased mobility, and muscle strength. These therapeutic strategies can improve involvement in professional activities and participation in social and family life for patients with multiple sclerosis. [ABSTRACT FROM AUTHOR]

One of the aims of diagnostic nerve blocks is to identify the overactive muscles that lead to a specific spasticity pattern. However, to date, there is no evidence on how nerve blocks may affect botulinum neurotoxin-A (BoNT-A) dose in patients with spasticity. This case-control study aims to assess the role of diagnostic nerve block in defining BoNT-A starting dose at first treatment. Patients with upper and lower limb spasticity treated for the first time with BoNT-A were retrospectively divided into two groups: Group 1 (n = 43) was evaluated with clinical assessment and diagnostic nerve block; Group 2 (n = 56) underwent clinical assessment only. Group 1 was injected with higher BoNT-A doses in some muscles (i.e., flexor digitorum profundus, soleus), and received a higher BoNT-A cumulative dose with a larger number of injected muscles for some spasticity patterns (i.e., "clenched fist", "flexed fingers", "adducted thigh"). Diagnostic nerve block may help the clinician to optimize and personalize the BoNT-A dose since the first BoNT-A treatment. [ABSTRACT FROM AUTHOR]

Stroke-induced spasticity is a prevalent condition affecting stroke survivors, significantly impacting their quality of life. Botulinum Toxin A injections are widely used for its management, yet the long-term effects and optimal management strategies remain uncertain. This retrospective study analyzed medical records of 95 chronic stroke patients undergoing long-term BoNT-A treatment for spasticity. Demographic data, treatment duration, dosage variability, and dropout rates were assessed over a period ranging from 2 to 14 years. The study revealed a notable extension of the interval between BoNT-A injections throughout the treatment duration. Dropout rates peaked during the initial 5 years of treatment, perhaps due to perceived treatment ineffectiveness. Additionally, a trend of escalating dosage was observed across all groups, indicating a potential rise in the severity of spasticity or changes in treatment response over time. BoNT-A injections emerged as the predominant treatment choice for managing post-stroke spasticity. The delayed initiation of BoNT-A treatment underscores the need for heightened awareness among healthcare providers to recognize and manage spasticity promptly post-stroke. Patients' expectations and treatment goals should be clearly defined to optimize treatment adherence, while the observed escalation in dosage and treatment intervals emphasizes the dynamic nature of spasticity and underscores the importance of monitoring long-term treatment outcomes. [ABSTRACT FROM AUTHOR]

Study design: Prospective observational qualitative study. Objective: Cannabis is used by patients for the treatment of chronic pain, spasticity, sleep issues or mood disorders such as anxiety and depression. Since 2018, it has been authorised in the United Kingdom for medical use as an unlicensed medicine. This study aims to determine if patients are using cannabis for the management of symptoms related to spinal cord injury, and if so, whether they are using medical or illicit cannabis. Methods: Spinal cord injury patients from the Yorkshire Regional Spinal Injuries Centre and SPINE Community in the United Kingdom were surveyed. Participants were sent a 7-point electronic survey. All results were anonymous, and confidentiality was maintained throughout the process. Results: In total, 223 patients completed the survey. Not all patients answered every question. Of those who responded 65.35% (n = 132) were paraplegic and 34.65% (n = 70) were tetraplegic. Patients were suffering from chronic pain (longer than 3 months), spasticity, loss of/difficulty in sleeping or anxiety/depression. Almost 15% (14.93%, n = 33 out of 221) used cannabis to manage their symptoms, out of those the majority used street cannabis (79.41%, n = 27 out of 34) were using street cannabis. Conclusion: This study demonstrates that there are spinal cord injury patients in the UK using cannabis to treat their symptoms. A majority appear to be using illicit cannabis. Given that cannabis can interact with other medications, and that the quality and content of illicit cannabis can be highly variable and at times dangerous, it is important for physicians to discuss cannabis use with their patients. This can inform prescribing and allow them to educate patients on the dangers of medical cannabis and potential alternatives. [ABSTRACT FROM AUTHOR]

Background: Injury of the spinal cord causes motor and sensory dysfunction as well as pathological reflexes, leading to paraplegia or tetraplegia. The sequelae of traumatic spinal cord injury (SCI) are a significant burden and impact on healthcare systems. Despite constant progress in medicine, traumatic SCI still remains irreversible. To date, no satisfying treatment that can enable neuronal regeneration and recovery of function at the damaged level has been found. Hundreds of experiments have been conducted on various possibilities of influencing spinal regeneration; some of them have yielded promising results, but unfortunately, the successes obtained in experimental animals have not translated into humans. Methods: This narrative review article presents the application of extracorporeal shock wave therapy (eSWT) in patients with SCI. The article has been divided into parts: 1) use of extracorporeal shock wave therapy for regeneration of the spinal cord after traumatic spinal cord injury; 2) application of extracorporeal shock wave therapy in spasticity after spinal cord injury. In both cases, the hypotheses of possible mechanisms of action will be described. Results and conclusions: A small number of clinical trials have demonstrated the potential of eSWT to influence the regeneration of the spine, as an innovative, safe, and cost-effective treatment option for patients with SCI. Some reports have shown that eSWT can improve spasticity, walking ability, urological function, quality of life, and independence in daily life. [ABSTRACT FROM AUTHOR]

Within the field of pediatric neurosurgery, insurance status has been shown to be associated with surgical delay, longer time to referral, and longer hospitalization in epilepsy treatment, myelomeningocele repair, and spasticity surgery.1,2 The aim of this study was to investigate the association of insurance status with inpatient adverse events (AEs), length of stay (LOS), and costs for newborns diagnosed with intraventricular hemorrhage (IVH). A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample database. Patients with a primary diagnosis of intraventricular hemorrhage were identified using ICD-10-CM diagnostic and procedural codes. Patients were categorized based on insurance status: Medicaid or Private Insurance (PI). Multivariate logistic regression analyses were used to identify the impact of insurance status on extended LOS (defined as >75th percentile of LOS) and exorbitant cost (defined as >75th percentile of cost). Demographics differed significantly between groups, with the majority of newborns in the PI cohort being White (Medicaid: 35.8% vs. PI: 60.3%, P < 0.001) and the majority of Medicaid patients being in the 0–25th quartile of household income (Medicaid: 40.9% vs. PI: 12.9%, P < 0.001). While insurance status was not independently associated with increased odds of extended LOS or exorbitant cost, Medicaid patients had a greater mean LOS and total cost of admission than PI patients. Demographic characteristics, mean LOS, and mean total cost differed significantly between Medicaid and PI patients, indicating potential disparities based on insurance status. However, insurance status was not independently associated with increased healthcare utilization, necessitating further research in this area of study. [ABSTRACT FROM AUTHOR]