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Background. Stroke is a leading cause of long-term disability. Gait impairment post-stroke has a major implication for health and it is an essential predictor for functional independence. A common gait impairment is the presence of genu recurvatum in post-stroke patients, whether spastic or non-spastic. Aims. To evaluate the efficacy of the rehabilitation program and botulinum toxin upon gait spatial and temporal parameters, muscle spasticity, functionality of lower limb and risk of fall in post-stroke patients with spastic and non-spastic genu recurvatum. Methods. We conducted a two-year prospective study (April 2018 - April 2020) of forty hemiparetic patients with spastic (20) and non-spastic (20) genu recurvatum who underwent a rehabilitation program for three weeks and ultrasound guided botulinum toxin injection for the spastic group. Results. In the non-spastic group, statistically significant differences were observed post-treatment (after 3 weeks) in the case of gait speed from 0.457 meters/sec (T0) to 0.6265 m/sec (T1), TUG from 16.3 (T0) to 14.15 (T1) and LEFS from 32.45 (T0) to 34.7 (T1). In the spastic group, gait speed also had significant differences, from 0.467 (T0) to 0.7145 (T1). LEFS had an increase from 32.45 (T1) to 34.75 (T2). MAS had a decrease from 2.65 (T0) to 1.55 at (T1). Conclusions. Following a 3-week rehabilitation program and using ultrasound guided botulinum toxin injections, in the case of spasticity, improves gait spatiotemporal asymmetry and ameliorates functionality, lowering the risk of fall in hemiparetic patients with post-stroke genu recurvatum whether spastic or non-spastic. [ABSTRACT FROM AUTHOR]

Background. Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and the main cause of disability in young people. Drug therapy cannot completely control many disabling symptoms in MS, such as cramps, pain, depression, and cognitive impairment. Non-invasive brain stimulation (NIBS) technology can be used as a tool to regulate changes in cortical excitability and plasticity in MS patients, thereby improving the disability symptoms that affect such patients. Aims. Our objective was to explore the effectiveness and safety of non-invasive brain stimulation in the treatment of fatigue in patients with multiple sclerosis. Methods. We performed a literature review in different databases: PubMed, Web of Science, Cochrane Library, Medline, Google Scholar. Full text articles that used NIBS for exercise performance improvement in athletes were included (only articles in English were found). We searched for articles available in each database until 30 October 2019. We used articles published in journals, randomized or pseudo-randomized, sham-controlled clinical trials to evaluate the effects of noninvasive brain stimulation (NIBS). The main result is the fatigue score before and after stimulation; the secondary result is the adverse event. Results. The general inverse variance method was used to aggregate data from cross-group and parallel group studies. A total of 14 studies (tDCS 11, TMS 2 and tRNS 1) which recruited 186 patients were included in the study. No qualified tACS, transcranial electrical therapy stimulation or non-invasive cortical electrical stimulation study with reduced impedance was found. The short-term and long-term therapeutic effects are for tDCS, TMS is significant, and TMS and tRNS are not superior to sham stimulation. Existing evidence supports the effectiveness of the 1.5 mA subgroup and the bilateral S1 subgroup of tDCS. Adverse events are mild and transient, but are comparable between real and sham stimulation. Conclusions. tDCS is a safe and effective way to treat fatigue in MS patients. However, there is further research needed to confirm our results in a large population and investigate the effectiveness of other NIBS subtypes. [ABSTRACT FROM AUTHOR]

Background. The definition of genu recurvatum is the presence of more than 5° hyperextension of the knee. Biomechanically, genu recurvatum appears during the stance phase, with the ground reaction force line passing anterior to the knee. From a practical point of view, retraining the gait in patients with genu recurvatum is relatively complex because of diverse etiologies. Aims. To present multiple approaches of rehabilitation strategies and their outcomes for treating patients with genu recurvatum. Methods. We performed a systematic literature review in different databases, PubMed, Science Direct, using the following key words: "genu recurvatum", "knee hyperextension", "rehabilitation". Results. Ten articles met our selection criteria. Three assessed retraining methods (functional electric stimulation or electrogoniometric feedback), five articles focused on orthoses and two articles on botulinum toxin. Conclusions. Genu recurvatum has a multifactorial etiology mechanism such as spasticity, muscle weakness and many others, and among post-stroke patients almost half of them develop genu recurvatum. Genu recurvatum is a disability factor, affecting gait, the quality of life of patients, generating pain and increasing the risk of fall-related injuries. [ABSTRACT FROM AUTHOR]

Background. TXB-A injections are the first-line treatment of many movement disorders, and the safety of doing them is essential to the effectiveness of therapy. Aims. Evaluation of safety of TXB-A guided injections in upper limb spasticity of post-stroke patients. Methods. The study group comprised 60 patients distributed in 3 subgroups of 20 based on background medication administered in post-stroke management: 20 patients in the antiplatelet background subgroup, 20 patients in the subgroup of anticoagulant background medication, and 20 without anticoagulant/antiplatelet background medication. From the 60 patient group, based on the number of TXB-A injection cycles, 3 other subgroups were produced: 20 patients performed 3 injection cycles, 20 performed 2 cycles, and 20 completed a single injection cycle. Every patient received a total dose of 1000 UI of TXB-A. After each set of local injections, ultrasounds were performed at the injection site searching for local hematomas. The moments evaluated were: T0 (the initial time - injection time), T1 (one month after the injection), T2 (3 months from T0 or 2 months from T1), T3 (1 month after T2), T4 (3 months after T2 or 2 months after T3) and T5 (1 month after T4). Results. The lowest p value of the 3 possible comparisons of the anticoagulant, antiplatelet, no anticoagulant/antiplatelet group of patients was 0.856, showing a purely random distribution of adverse effects manifested by local hematomas following ultrasound guided injections. Conclusions. Multiple cycles of US guided TXB-A injections with a minimum 3-month frequency between injections do not increase the risk of local haematomas. [ABSTRACT FROM AUTHOR]

Background. Spasticity is well known as one of the most common after stroke complications, providing a series of negative effects including decreased range of motion, muscle spasm, different levels of contracture, local pain in the affected area. Aims. Clinical-functional evaluation of the short and medium term effect of ultrasonographically guided injections with botulinum toxin type A (TxB-A) on the spasticity of the upper limb in post-stroke patients and the quantification of effects on international scales of spasticity and functionality. Methods. The groups studied were composed of 60 patients, which were divided based on the doses provided in each muscle of the hand and wrist flexors (250 IU versus 333 IU). Every patient received a total dose of 1000 IU of TxB-A. The parameters that were assessed were: Modified Ashworth Scale (MAS) and Activities of Daily Living Scale (ADL), international scales for spasticity and functionality. The moments evaluated were: T0 (the initial time - injection time), T1 (one month after the injection) and T2 (3 months from T0 or 2 months from T1). Results. Evaluation of MAS and ADL scales from T0 to T1 and T2 for the 250 IU group shows great improvements at T1 on both scales, MAS (<0.001) and ADL (<0.001), while maintaining the efficacy at T2, MAS (p-value 0.214 ), ADL (p-value 0.166). Evaluation of MAS and ADL scales from T0 to T1 and T2 for the 333 IU group also shows effective improvements on both scales at T1, MAS (<0.001), ADL (<0.001), and T2, MAS (0.849), ADL (0.013). Correlations between the two groups, 250 IU vs 333 IU, performed for each of the scales used in the study evidenced better results at T1 in favor of the 333 IU group on both MAS (p-value 0.034) and ADL score (p-value 0.078), with the proportion maintained in favor of the 333 IU group at T2, MAS (p-value 0.024), ADL (p-value 0.035). Conclusions. a) TxB-A is efficient as a prime line treatment for spasticity, helping the patients in the muscle neurorehabilitation effort; b) TxB A is effective in reducing spastic muscle tone (MAS); c) TxB A is a useful asset in managing hand function (ADL). [ABSTRACT FROM AUTHOR]