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Background: Spinal cord injury causes significant impairments of both motor and pelvic organ functions. Latest studies have shown impressive potentials for using transcutaneous spinal cord electrical stimulation (TcSCES) in the late period of injury to restore motor functions. All results were obtained in a limited number of patients in the specific conditions of a physiological experiment. It remains unclear how effective a TcSCES cycle is in restoring motor activity in patients after spinal cord injury in real clinical conditions., Aim: The main objective of this investigation was to study the effectiveness of TcSCES in combination with the standard rehabilitation of patients after a spinal cord injury. An additional objective was to evaluate the effect of TcSCES to excretory functions in patients with spinal cord injury., Subjects and Methods: The studies were conducted at Saint Petersburg City Hospital Forty, which included 15 patients with thoracic spinal injury at 2.4±2.06 years after injury; the severity of the latter was American Spinal Injury Association (ASIA) Grades B and C. All the patients underwent a 2-week standard cycle of rehabilitation treatment; of them 7 patients (a study group) received additionally TcSCES. Standard scales were used to assess neurological status and muscle strength and sensitivity. The patients filled out a urinary diary; residual urine volume was monitored using bladder catheterization or ultrasound., Results: An increase in muscle strength was recorded in 6 patients of the study group and in 1 patient of the control one. The end of the treatment cycle was marked by a 1-score spasticity increase in 1 patient of the study group and in 2 patients in the control one. In the study group, the level of anesthesia decreased per segment in 1 patient; an improvement in deep and proprioceptive sensitivity was recorded in 2 patients; no change in sensitivity was observed in the control group. In the study group, 2 patients showed a reduction in the severity of injury from ASIA Grade B to ASIA Grade C. In three patients of the study group, the residual urine volume decreased and control and a sensation of urgency to urinate appeared; in the control group, these parameters remained unchanged after the treatment cycle., Discussion: The main result of the study is evidence for the efficiency of using TcSCES in the complex therapy of motor neurorehabilitation. The performed cycle of TcSCES in patients was noted to result in better motor and excretory functions., Conclusion: The use of a short-term TcSCES cycle in the motor rehabilitation program for patients with spinal cord injury contributes to recovery of severe motor disorders and is accompanied by an improvement in urinary functions.

Aim: The study was aimed at studying the efficacy of botulinum toxin A injections combined with EMG-control of the injections in patients with upper limb spasticity of various etiology for decreasing muscle tone and improving the passive limb function as well as at assessing the possibility of a botulinum toxin dose reduction under combination of these methods., Material and Methods: 61 patients with upper limb spasticity of different etiology were evaluated. The main group consisted of 29 patients who were injected with abobotulinum, the botulinum toxin A (500 U per vial), under EMG-control. The control group consisted of 32 patients who received BTA injections without EMG-control. A repeated BTA injection was performed on the 4th month of the study. Patients in both groups received standard rehabilitation therapy. The spasticity pattern was determined using the Arm Spasticity Pattern (ASP) scale. Evaluation of the treatment efficacy was performed using the modified Ashworth scale to determine upper limb spasticity and the modified Barthel Index scale to assess the quality of life as well as the Disability Assessment Scale (DAS) and Clinical Global Impression (CGI) scale., Results: The main spasticity patterns were as follows: the type III was in 13 (44.8%) and 17 (53.1%) patients, the type I was in 9 (31.0%) and 9 (28.1%) patients, and the type VI was in 7 (24.2%) and 6 (18.8%) patients of the main and control groups, respectively. One month after BTA treatment, a significant improvement was observed in both groups, but the improvement in the main group was more pronounced compared to that in the control group (р<0.05). This difference persisted for the whole treatment period (р<0.05). The DAS score demonstrated improvement in both groups, but only patients of the main group had a statistically significant improvement in putting the arm through a sleeve (р<0.05). EMG-control enabled a reduction in the BTA dose by 50-300 U., Conclusion: BTA injections under EMG-control in upper limb spasticity patients may improve the treatment efficacy.

Methods which on one hand can ensure the patient's mobility and on other hand activate afferents inputs are the main in rehabilitation treatment. Recent studies has shown that plasticity is structural base of recovery after central nervous system injury. Reorganization of cortical areas and increase of preserved structures functional effectiveness (intensification afferent input) are an anatomical basis of plasticity. However, sensory correction methods, without accounting of functional condition of patients, can lead to the formation of pathological symptoms: spasticity, hyperreflexia, etc. So the main aim is to study adequate management of the neuroplasticity process. This problem cannot be solving without modern methods of neuroimaging and brain mapping. The new approach for study cortical mechanisms of neuroplasticity, responsible for locomotion, was developed in the present study. This approach is complex use of functional magnetic resonance imaging (fMRI) and navigation transcranial magnetic stimulation (nTMS). It was showed that vast fMRI activation area in the first and the second sensorimotor area emerges with passive sensorimotor paradigm using that imitate backing load during walking. The mechanical stimulator footsteps backing zones "Corvit" uses for create this paradigm, nTMS examination, which used after fMRI, help localize the motor representation of muscles which control locomotion more accurately. We guess that new approach can be used for neuroplasticity process study and assessment of neuroplasticity changes during rehabilitation for restore and correct the walking.

We studied 67 children, aged 2-9 years, with cerebral palsy including 56 children with a spastic form. An electromyographic method was used for the development of optimal tactics of botulinum toxin type A injections in different clinical presentations of spasticity. The best clinical results were obtained in children with the following changes on EMG: 1) the tonic muscle activity in resting state was minimal (&lt;10 microvolts) and had local or regional distribution; 2) the pathological synkinetic activity during voluntary movements was minimal (synergetic activity coefficient for shin muscles was less than 0.45); 3) the disturbance of interactions between synergistic and antagonistic muscles was moderate (reciprocity coefficient was not less than 0.4); 4) EMG amplitude in voluntary muscle contraction should not be less than 150 microvolts. This approach to the treatment allowed to reach higher levels on The Gross Motor Function Classification System in part of children.

In this paper possible mechanism of improvement of the functional state of the brain areas, maintaining movement, visual, auditory, and higher functions of the brain during correction of generalized spastic syndrome (botulinotherapy with Xeomin) in patients in a vegetative state (VS) is discussed. If to consider the vegetative state as stable pathological condition (SPC) of the brain, then from the perspective of the theory of structural and functional organization of the brain with systems with rigid and flexible elements (N.P. Behtereva), the therapy led to an unbalance of SPC, "functional release" of neurons and redistribution of their functions to provide other activities, the formation of new interneuronal connections. Taking into account the functional variability of neurons (S.V. Medvedev), blocking neuromuscular transmission in spastic muscles leads to a reduction of abnormal afferent and efferent hyperactivity of motor and sensory neuronal circuits, which releases the brain for other activities. This allows to consider botulinotherapy of pharmacoresistant muscle spasticity in patients in VS and minimal consciousness, not only as a symptomatic treatment, but also as a "indirect neuroprotection".

The objective of the study was to assess factors modulating the efficacy of botulinum toxin injections in the correction of dynamic equinus and equinovarus foot deformities in children with hemiplegic cerebral palsy. The efficacy of treatment was evaluated in 40 children. Clinical data including spasticity assessment by the original Ashworth scale, postural and gate changes were collected. Spasticity grade 4-5 by the Ashworth scale and retraction 90-120 degrees reduce the likelihood of successful correction of equinus contracture. Botulinum injections can be used as basic therapy. In cases of transient contracture more than 120 degrees, combined methods of treatment are recommended. The hindfoot varus less 30 degrees, which can be passively corrected before treatment and in the presence of the positive Coleman block test, more likely needs injection in triceps muscle for correction. If the hindfoot varus is more than 30 degrees and the Coleman block test is negative, the combined treatment is necessary.

Neurodynamic mechanisms underlying regulation of muscular tone are considered in the context of the integral systemic approach to the analysis of efficiency of adaptive preparation of spastic muscles to kinesitherapeutic procedures exemplified by myographic biological feedback (BFB) training of the affected muscles in children suffering cerebral paralysis. It is shown that the application of the post-isometric relaxation method immediately before biofeedback training seances increases effectiveness of these procedures and combined therapy of locomotor disorders at large.

The objective is to study the effect of dysport injections on the clinical and electromyographic changes in 35 patients (mean age 5,3+/-2,0 years) with spastic forms of cerebral palsy (26 with spastic diplegia, 9 with hemiparetic form) with equinus and equinovarus deformity. Depending on the clinical situation, dysport was injected in a total dose of 20-30 u per 1 kg of the body mass. Gastrocnemius muscles were injected more frequently than soleus and posterior tibial muscles. The treatment resulted in the significant reduction of spasticity on the Ashworth scale, decrease of equinus deformity, positive changes in the parameters of stepping on flat foot, independent standing and walking, the beginning of support period from the heel. During the arbitrary contraction, the amplitude of bioelectrical activity of target muscles of low extremities reduced, though not to the extent of the motor activity loss; the reciprocity coefficient decreased from 0,69+/-0,32 to 0,47+/-0,28 in patients with spastic diplegia and from 0,45+/-0,34 to 0,34+/-0,25 in patients with hemiparetic form. The effect of dysport was higher in hemiparetic form compared to spastic diplegia. The best results for spastic diplegia were revealed in patients with isolated spasticity without severe disturbances of reciprocal relations in shin muscles and pathological synkinesia.

To study the efficacy and safety of tolperisone--a centrally acting muscle relaxant with membrane stabilizing activity--in the treatment of stroke-related spasticity. This was a randomized, double-blind, placebo-controlled, multicenter study with parallel groups. Treatment lasted 12 weeks and was started with a titration period of variable length (dose range 300-900 mg tolperisone daily). The degree of spasticity determined on the Ashworth Scale in the most severely affected joint area was denned as primary target parameter. Hundred and twenty patients (43 females, 77 males) in a mean age of 63,3 +/- 10,6 years were recruited and received treatment. In the majority of patients both limbs of each side were affected by the spasticity which on average had been present for 3,3 +/- 4,4 years. A 62% of the patients were treated with a daily dose >600 mg tolperisone. Tolperisone reduced the mean Ashworth Score by a mean of 1,03 +/- 0,71 compared with a mean reduction of 0,47 +/- 0,54 in the placebo group (p<0,0001). A 78,3% of the patients on tolperisone versus 45% of the placebo patients experienced a reduction by at least 1 point on the Ashworth Scale (p<0,0001). Functional and overall assessments of efficacy confirmed superior efficacy of tolperisone. Adverse events occurred less often on active treatment (n=19) than on placebo (n=26) and were mostly of mild-to-moderate intensity. No withdrawals caused by adverse events were reported in the tolperisone group. The findings of the present study demonstrate the efficacy and excellent tolerance of tolperisone in the treatment of spastic hypertonia following cerebral stroke. Study data further suggest that an individual dose titration which may exceed the recommended maximum dose of 450 mg daily results in optimized therapeutic benefit.

We studied how different patterns of muscle tone disorders depend upon lesion site using CT. 111 patients not earlier 3 months after hemispheric stroke were studied. We showed the degree of spasticity to be determined by depth of hemispheric damage in relation to posterior limb of capsula intema. It also correlates with the degree of corticoreticular pathway damage. Even or irregular damage to this pathway which accompany pyramidal tract stipulates different patterns of spasticity, distribution and its interaction with structure of hemiparesis. Degree and structure of post-stroke muscle tone disorders after 3 months from the onset of stroke is depend on hemispheric damage but do not depend on the duration of recreative or residual period of the disease. It can be applied in medical expertise that pattern and prominence of post-stroke muscle tone disorders 3 months after stroke onset depend on lesion location, but not on the length of recovery period or period of residual changes.

The authors analyze the outcomes of surgical treatment in 15 CP patients with lower paraparesis who had been treated with selective dorsal rhizotomy at the L2-S2 level. All the patients were examined by neurological study, EMG, EEG, visual evoked potential (VEP) recording and motor reaction time estimation. Based on the findings, it is suggested that SPR lumbosacral spinal level may affect cerebral function. Some motor functional changes are associated with this impact. Possible mechanisms of these changes are discussed.

The paper gives the results of using selective dorsal rhizotomy at the lumbosacral level in 15 children with infantile cerebral paralysis, 12 of whom were at the age of 6 to 15 years. It also discusses surgical techniques, the use of intraoperative stimulation, and the impact of selective dorsal rhizotomy on muscle tone. The paper provides evidence for the benefits of surgery reducing the muscle tone at the expense of its spastic component. Based on the relationship between the number of cut fibers as part of each root and the degree of decreased muscle tone, a procedure is proposed for conservative surgical interventions to be used in patients employing spasticity for support.

Inhibition of the soleus H-reflex was studied in hemiparetic postapoplectic patients and in control group of patients without motor disorders. The depression of H-reflex was caused by stimulation of ipsilateral peroneal nerve and presented in two successive waves (D1 and D2). The former of them corresponds to presynaptic inhibition. The size of both waves of inhibition was reduced in postapoplectic patients according to the degree of their muscle spasticity.

The paper outlines the previously unknown smooth muscle insufficiency in terms of its etiology, pathogenesis, diagnosis and treatment. It has been shown that drug administration leads to smooth muscle insufficiency which is eliminated by serotonin both in vitro and in vivo. The clinical manifestations of smooth muscle (SM) insufficiency are eliminated by serotonin, irrespective of whether it has been caused by the use of drugs or impaired smooth muscle innervation. The mechanism of vascular rhythmic oscillations in the microcirculatory bed, the so-called endogenous vasomotility (EV) has been decoded. The mechanism of EV regulation is due to the fact that platelets constantly (continuously) adsorb serotonin from the enterochromaffin cells of the gastrointestinal tract and constantly (continuously) release it into the microcirculatory bed, thereby providing the continuum of entry of the stimulant to the SM fibers which are able to contract at this time. The summation of these contractions of smooth muscle contractions in the microcirculatory bed maintains their vascular tone and yields the pattern of EV. The paper also describes the earlier unknown properties of hemoglobin and myoglobin to cause smooth muscle spasm and to accelerate platelet destruction. A correlation between the EV and vascular platelet hemostasis is described in terms of these properties. The continuous mechanism of EV is impaired and it transforms to intermittent (final) vascular platelet hemostasis.

Excitability changes at the segmentary level of the spine were examined during functional bioregulation sessions administered to patients with various forms of infantile cerebral paralysis (spastic diplegia, spastic hemiparesis) by recording N- and M-responses of musculus soleus and musculus gastrocnemius medial head. Neurophysiologic disorders were revealed at the spinal level depending on the disease form. The authors suppose that presynaptic inhibition is to a greater measure impaired in spastic hemiparesis, whereas spastic diplegia is associated with more extensive involvement even of spinal inhibitory mechanisms proper. Sessions of functional bioregulation resulted in clinical improvement and in development of a trend to normalization of spinal reflectory excitability. Such changes were recorded in musculus soleus of children with spastic diplegia and in gastrocnemius muscle median head of those with spastic hemiparesis. Possible effects of directed afferent currents on structure and function of supraspinal systems regulating spinal mechanisms activity are discussed.

It is shown that manual therapy to abolish functional cervical and lumbar blocks is beneficial in reducing spasticity of the synergic muscles, biomechanic characteristics of the support and kinematic pace phases improve. Manual therapy in multimodality rehabilitation treatment of cerebral paralysis creates a functional base for neuromotor correction of a defective motor stereotype in these patients.

Psychometric and neuropsychological studies were carried out in 182 patients with three forms of infantile cerebral paralysis (ICP). Of these, 112 children presented with spastic diplegia, 50 with hemiparetic diplegia, and 20 with hyperkinetic diplegia. The children's age ranged from 8 to 14 years. Depending on the form of ICP, the structural characteristics of intellect were defined as were specific features of the development of higher cortical functions depending on the localization of the underdevelopment of different brain areas. The classification of the structure of the disorders with the aid of the methods used makes it possible to have a differentiated approach to the medical and pedagogical correction of those patients.

The excitability of flexors and extensors of the upper and low extremities was studied in healthy people and in patients with spasticity during local thermostimulation of their receptive fields using H-reflex (HR). In healthy people the HR was inhibited during cooling and was enhanced during warming. Thermostimulation of the contralateral side caused a contraverse reaction. In patients cooling of skin followed the rise of HR. The obtained data show that the condition of the thermoreceptive fields can influence reflex excitability of motoneurons. The character of this influence depends on the initial condition of the locomotor generator.

Stimulation electromyography was used to study inhibition of the soleus muscle H-reflex induced by stimulation of the common peroneal nerve in healthy individuals and in patients who had underwent cerebral apoplexy. Two successive inhibition waves (D1 and D2) were recorded; the first wave demonstrated the development of presynaptic inhibition of group Ia afferent fibers. In post-insult patients the depth of inhibition diminished depending on the degree of the pathologic increase of the tonus of the skeletal musculature. The role of presynaptic inhibition disorders in the pathogenesis of muscle spasticity is discussed.

The paper is concerned with a study into the mechanisms of central restructures in formation of a new motor stereotype using functional biomonitoring (FBM) after different pharmacological exposures. There were 117 patients aged 5 to 14 years with spastic forms of infantile cerebral paralysis. Biomonitoring sessions were carried out with the aid of portable indicators. Pharmacological correction was performed by midocalm or galanthamine or by combining the latter one with ganglerone++. The treatment course consisted of 15 training sessions. To study the EEG structure, use was made of the method of computing conditional probabilities of one wave of the EEG, provided it was preceded by any other one. Analysis of the dynamics of the biorhythmical structure of the EEG revealed the common mechanism of restructuring the central components of movements regulation for all the patients' groups using FBM. That mechanism lay in a highly significant increase of interrelated correlations of the main components of the EEG to the alpha-component together with formation or gain of the "alpha-nucleus". The patients' group who underwent biomonitoring sessions after galanthamine and gangleron administration manifested, as compared to the other groups, a highly significant transformation of teta- and delta-components to the alpha-frequency range and enhancement of interrelation of teta-components in the "working" hemisphere. This was coupled with the most beneficial data on the patients' status.

A study was made of pathological tonic reflexes (PTR) in adolescents afflicted with infantile cerebral paralysis (ICP) by means of assaying the tone of thigh muscles before and after treatment and in the presence of L-DOPA (nacom, 62.5 mg/day) intake. The drug minimized the manifestations of PTR because of changes in the function of brain structures involved in tonic reactions. It is recommended that during establishment of indications for +orthopedic-surgical treatment of ICP patients with marked PTR determining the formation of reflex contractures and deformities of limb joints, conservative treatment with L-DOPA drugs be preliminarily carried out.

An optimal method of rehabilitation is outlined for children with movement disorders due to spastic cerebral paralysis. It implies combined use of functional biocontrol and acupuncture. In drug intolerance the treatment acquires special significance. The effectiveness of these two modalities comes from mutual potentiation effect on central regulation of motor functions as shown by electrophysiological findings. Marked positive shifts in clinical and electrophysiological patterns develop within 15 training procedures with the external feedback in addition to 11 sessions of acupuncture.

The article describes the results of electromyographic examination of the muscles of the neck in 26 patients with spasmodic torticollis. Electromyography was performed before and after stereotaxic operative interventions on the nucleus of Cajal or in combination with the diencephalic structures. It is shown that electromyographic examination of patients, especially with the use of functional motor and oculomotor tests, widens essentially the possibilities of the diagnosis by facilitating the identification or specification of the predominantly involved group of muscles. The discovery of concurrent oculographic and electromyographic changes in the dominant muscles of the neck during oculomotor tests is evidence of the connection of the system of concurrent movements of the eyes and head with the motor systems participating in the pathology of torticollis. Analysis of the dynamics of electromyographic changes in patients with predominance of the tonic component in the early and late postoperative periods is indicative of gradual increase of positive changes in the motor sphere, which, evidently, is due to the dynamic reorganizations in the previously formed stable pathological system.

The authors investigated the characteristics of motor disorders in patients with spastic torticollis. The study involved registration of volitional tensions of the neck muscles in isometric conditions, i.e., when the patient's head was rigidly fixed with regard to the body. Using a tensometric dynamometer the following three moments of force were measured: one responsible for bending the head forward or backward; the second, for bending the head to the right or left shoulder; and the third, for turning the head round the longitudinal axis. The electrical activity of the neck muscles was recorded with the help of surface electrodes. It has been established that the development of volitional efforts by the neck muscles under isometric conditions is difficult or impossible if directed to the side where the patient's forcible turn of the head is directed.

Examination of functional asymmetry of the cerebral hemispheres by dichotic auscultation in 83 patients (aged 12-19 years) with infantile cerebral paralysis and 228 normal subjects showed left-side dominance in 76% (right ear coefficient REC = +22.01) of patients with spastic diplegia (n = 45) and in 76% (REC = +26.0) of normal subjects; in cases of left-side hemispheres (n = 13) this parameter was 100% (REC = +35.5) and in right-side hemiparetic form 60% (REC = +22.8). The findings confirm a genetic nature of functional asymmetry of the cerebral hemispheres and indicate a high degree of cerebral hemisphere dominance.

The method is offered using the functional biocontrol techniques with combined galanthamine and ganglerone treatment in mild to moderate spastic forms of infantile cerebral paralysis. The method helps to attain a considerable clinical restitutive effect that was confirmed by electromyographic studies. The optimizing effect is due to a cross-potentiating interaction of the three components leading promptly to substantial improvement in antagonist muscles coordination of the diseased limb.

For studying the mechanisms of spasticity electromyographic examinations were carried out in 54 patients suffering from lateral amyotrophic sclerosis at various stages of the disease. At the beginning of the spasticity formation disturbances of the functions of the checking spinal mechanisms and the gamma-system were revealed, while those of alpha-mononeurons (tested by the H-reflex) showed no statistically significant changes. In the late period (pronounced spasticity) disturbances of all the motor systems mentioned were noted. The role of various mechanisms in the development of muscular hypertonicity in lateral amyotrophic sclerosis is discussed.

In 34 patients general electromyography was used to assess the duration of muscle spastic contraction. H-reflex values ratio before and after vibration was calculated. These 2 techniques allowed a quantitative evaluation of spasticity.

The results of the examination of the muscle tone by passive movement of the extremity at a low and high rate in patients with spasticity are discussed. In parkinsonism high resistance was noted to passive movements of the extremity at a low rate (with a period of oscillatory movement of 100 s and more) as well as in the first cycles of rapid sinusoidal movement (with a period of 1 s) if the extremity had been at rest for a lengthy period of time. In spasticity of other etiology, there was a gradual increase of the amplitude on the mechanomyogram in high rates of passive movements, which was evidently due to growth of stimulation in the stretch-reflex arc from cycle to cycle as the result of sumation with trace stimulation from the preceding cycles. The shape of the spectromechanomyogram, which is marked by a rise in the region of the high rates, is considered to be a sign of spasticity, whereas the size of this rise is accepted as a quantitative index of the spastic component of the muscle tone.

The article presents the results of clinico-electromyographic examinations of 75 patients with a history of acute impairment of circulation in the carotid system. The study revealed differences in changes in the antidromic excitability of spinal motoneurons as judged from the amplitude parameters of the F wave in relation to the time elapsed from the moment of the stroke and to the nature of neurologic disturbances. Examination of the F wave is shown to be informative in monitoring the recovery of motor functions.