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Background: Spasticity is defined as "a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks". It is a highly prevalent condition following stroke and other neurological conditions. Clinical assessment of spasticity relies predominantly on manual, non-instrumented, clinical scales. Technology based solutions have been developed in the last decades to offer more specific, sensitive and accurate alternatives but no consensus exists on these different approaches. Method: A systematic review of literature of technology-based methods aiming at the assessment of spasticity was performed. The approaches taken in the studies were classified based on the method used as well as their outcome measures. The psychometric properties and usability of the methods and outcome measures reported were evaluated. Results: 124 studies were included in the analysis. 78 different outcome measures were identified, among which seven were used in more than 10 different studies each. The different methods rely on a wide range of different equipment (from robotic systems to simple goniometers) affecting their cost and usability. Studies equivalently applied to the lower and upper limbs (48% and 52%, respectively). A majority of studies applied to a stroke population (N = 79). More than half the papers did not report thoroughly the psychometric properties of the measures. Analysis identified that only 54 studies used measures specific to spasticity. Repeatability and discriminant validity were found to be of good quality in respectively 25 and 42 studies but were most often not evaluated (N = 95 and N = 78). Clinical validity was commonly assessed only against clinical scales (N = 33). Sensitivity of the measure was assessed in only three studies. Conclusion: The development of a large diversity of assessment approaches appears to be done at the expense of their careful evaluation. Still, among the well validated approaches, the ones based on manual stretching and measuring a muscle activity reaction and the ones leveraging controlled stretches while isolating the stretch-reflex torque component appear as the two promising practical alternatives to clinical scales. These methods should be further evaluated, including on their sensitivity, to fully inform on their potential. [ABSTRACT FROM AUTHOR]

Psoriasis is a complex immune-mediated inflammatory disorder that generates enormous interest within the scientific communities worldwide, with new therapeutic targets being constantly identified and tested. Despite the numerous topical and systemic medications available for the treatment of psoriasis, alternative therapies are still needed for the optimal management of some patients who present with localized, resistant lesions. Novel insights into the contribution of cutaneous neurogenic inflammation in the pathogenesis of psoriasis have yielded exciting new potential roles of nerve-targeting treatments, namely botulinum toxin type A (BoNT-A), for the management of this disease. This paper aims to review the existing literature on knowledge regarding the potential role of BoNT-A in psoriasis treatment, with a focus on its ability to interfere with the immunopathogenetic aspects of psoriatic disease. Furthermore, in our paper, we are also including the first report of psoriatic lesions remission following local BoNT-A injections that were administered for treating upper limb spasticity, in a patient that concomitantly suffered from psoriasis and post-stroke spasticity. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is a chronic congenital disorder as the result of abnormal brain development. Children suffering from CP often battle debilitating chronic spasticity, which has been the focus of recent academic literature. In this systematic review, the authors aim to update the current neuromodulation procedures for the treatment of spasticity associated with CP in all age groups. A systematic review following was conducted using PubMed from inception to 2020. After initial title and abstract screening, 489 articles were identified, and 48 studies met the inclusion criteria for this review. In total, a majority of the published articles of treatments for CP were reporting the use of selective dorsal rhizotomy (SDR) (54%), and the remainder were of intrathecal baclofen (ITB) pumps (29%) and extracorporeal shockwave therapy (ESWT) (17%). Each method was found to have improvement of spasticity at a rate that achieved statistical significance. ITB pump therapy is an all-encompassing method of treating spasticity in children from CP, as it allows for a less invasive treatment that can be titrated to individual patient needs; however, its disadvantages include its long-term maintenance requirements. SDR appears to be an effective method for permanent spasticity relief in young patients. ESWT is a more recent and innovative technique for offering relief of spasticity while being minimally invasiveness. Further studies are needed to establish optimal frequencies and sites of application for ESWT. [ABSTRACT FROM AUTHOR]

Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) can be used to manage post-stroke spasticity, but a meta-analysis of the recent randomized-controlled trials (RCTs) is lacking. Our aim is to perform a meta-analysis of the RCTs that investigated the efficacy of rTMS in patients with post-stroke spasticity. PubMed, Embase, and Cochrane Library databases were searched for eligible papers published up to February 2020. The primary outcome was the Modified Ashworth Scale (MAS), measured as the effect of rTMS compared with controls and after rTMS (using a change score calculated separately in the active and sham treatment groups). Finally, five papers and eight data sets were included. rTMS had no significant benefit on MAS in patients with post-stroke spasticity compared to sham treatment (WMD = − 0.29, 95% CI − 0.58, 0.00; P = 0.051). When analyzing the change score in the treatment groups, a significant effect of rTMS was observed (WMD = − 0.27, 95% CI − 0.51, − 0.04; P = 0.024). When analyzing the change score in the sham treatment groups, no significant effect of sham treatment was observed, indicating no placebo effect (WMD = 0.32, 95% CI: − 0.40, 1.04; P = 0.387). We included the sample size, year of publication, percentage of male patients, and age difference in each study as covariates, and performed a meta-regression. The results showed no association between these variables and the MAS. Compared with sham stimulation, rTMS did not show a significant reduction in MAS for the patients who experienced post-stroke spasticity, but the patients reported a better outcome in MAS on a before-after scenario. [ABSTRACT FROM AUTHOR]

Peripheral muscle fatigue is a common experience in daily life. Every individual at some point in their life has realized the inability to maintain muscle contraction, a phenomenon known as fatigue. Interestingly, neurological patients with peripheral sequelae such as spastic muscle contraction are able to remain in a pattern of muscle contraction for prolonged periods. The effects of laser therapy are already recognized in muscle contraction to delay skeletal muscle fatigue, prolong physical activity, and reduce delayed onset muscle soreness. However, the effects of photobiomodulation on neurological patients with muscular spasticity are still not well established. The present literature review seeks to recognize articles about the application of laser irradiation, also known as photobiomodulation, to patients with muscle fatigue and/or spastic palsy. To perform a literature review, we used the systematic review methodology for the literature search. The following keywords were searched: (skeletal muscle fatigue) AND (spastic patients) AND (low-level laser therapy OR low intensity laser therapy OR low energy laser therapy OR LLLT OR LILT OR LELT OR infrared laser OR IR laser OR diode laser), and these were used for search on the following databases: PubMed, Embase, Web of Science, BIREME, Scopus, and SciELO. Besides that, a literature review concerning on muscle physiology, fatigue, and LLLT was made. No language filter was applied, and altogether, 689 papers were identified. A group of 3 physiotherapists and 01 pharmaceutical scientist performed the literature review, and every exclusion was confirmed by at least two reviewers. After inclusion and exclusion criteria, 128 studies were included in this review. Conclusion, the LLLT can contribute to the recovery of spastic patients and muscles in fatigue. However, the real effect of laser photobiomodulation on muscle spasticity remains to be established. Only a much reduced number of clinical trials have been performed with a small number of participants. There is a lack of clinical trials from different research groups that could help to understand and elucidate the effects of laser in prolonged muscle contraction in spastic palsy. [ABSTRACT FROM AUTHOR]

Apart from the known efficacy of Botulinum Neurotoxin Type A (BoNT/A) in hyperactive striated and smooth muscles, different pain states have become potential targets of toxin effects. This present study determined the comparative toxin effectiveness in pain reduction among those patients injected with BoNT/A in muscle-based and in non-muscle-based conditions. Randomized controlled trials (RCTs) on the effect of BoNT/A on selected pain conditions were included. The conditions were spasticity and dystonia for muscle-based pain. For non-muscle-based pain, conditions included were painful diabetic neuropathy (PDN), post-herpetic neuralgia (PHN), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), and spinal cord injury (SCI). In view of possibly differing pathophysiology, myofascial pain, temporomandibular joint (TMJ), other joint or tendon pains, cervicogenic and lumbar pains, migraine and visceral pain syndromes were excluded. Standardized mean difference was used as the effect measure and computed with STATA. 25 RCTs were analyzed. Pooled estimates showed significantly lower pain score in the Treatment group (z = 5.23, p < 0.01, 95% CI = – 0.75, – 0.34). Subgroup analyses showed that BoNT/A significantly reduced both muscle-based (z = 3.78, p < 0.01, 95% CI = – 0.72, – 0.23) and non-muscle-based (z = 3.37, p = 0.001, 95% CI = – 1.00, – 0.27) pain. Meta-regression using four covariates namely dosage, route, frequency and duration was done which revealed that dosage significantly affects standardized mean differences, while the other three covariates were insignificant. The joint F-test was found to be insignificant (p value = 0.1182). The application of the model with these covariates does not significantly explain the derived heterogeneity of standardized mean differences. In conclusion, BoNT/A can be effectively used in muscle-based and non-muscle-based pain disorders. We detected no difference between the presence and magnitude of pain relief favoring muscle-based compared to non-muscle-based pain. Thus, we cannot say whether or not there might be independent mechanisms of toxin-induced pain relief for pain generated from either muscle or nerve hyperactivity. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is an autoimmune disease of the central nervous system, is characterized by the appearance of an inflammatory and demyelinating process, which causes alterations of brain functions that give rise to a wide range of signs and symptoms. The objective of this review is to offer a conceptualization of current treatments to treat some of the main symptoms caused by multiple sclerosis. A bibliographical review of articles in the PubMed, Cochrane, Science Direct, Scielo and non indexed scientific literature of Google Scholar databases was carried out. At present there is no curative treatment for the disease, but there are some drugs and therapeutic actions that allow delaying the onset of symptoms most common as fatigue, spasticity, pain and bladder dysfunction, as well as a decrease in them. [ABSTRACT FROM AUTHOR]

Reviews the book "Spasticity. Mechanism, Measurement, Management," by Ejner Pedersen.

The article reviews the book "Spasticity Management: A Practical Multidisciplinary Guide," edited by Valerie L. Stevenson and Louise Jarrett.

Reviews the book 'Clinical Evaluation and Management of Spasticity,' edited by D. Gelber and D. Jeffery.

Reviews the book 'Clinical Evaluation and Management of Spasticity,' edited by D.A. Gelber and D.R. Jeffery.

Reviews the book "Educating Spastic Children," F.E. Schonell.