Stroke survivors don't want spasticity 'managed'. They want it cured. GET THERE!
But there is no need to treat spaticity,
Dr. William M. Landau says so in his uninformed expert opinion.
Survivors would immediately disabuse him of that notion. When schadenfreude hits him with his stroke he'll regret his ideas on the matter.
His statement from here:
Spasticity After Stroke: Why Bother? Aug. 2004
The latest here:
The Effect of Neuromuscular Electrical Nerve Stimulation in the Management of Post-stroke Spasticity: A Scoping Review
Abstract
Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infraction or hemorrhage. One of the main symptoms in the majority of post-stroke patients is spasticity. The main therapeutic options of spasticity in post-stroke patients include pharmacological interventions, rehabilitation techniques, and surgery. This review aims to explore the effectiveness of Neuromuscular Electrical Stimulation (NMES) for post-stroke spastic hemiparetic limb (upper and lower). Thorough research of the PubMed Medline database was performed. Records were limited to clinical studies published between 01/01/2010 and 01/01/2022. The results were screened by the authors in pairs. The search identified 26 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. There were seven studies for spastic upper limbs and two for spastic lower limbs. The approaches investigated the effectiveness of electrical stimulation on post-stroke spastic upper or lower limb. Spasticity was measured through the modified Ashworth scale (MAS) and electromyographic recordings (EMG). In most cases, spasticity was decreased for at least two weeks post-intervention. In conclusion, NMES can be used either solo or in combination with different physical therapy modalities in order to produce optimal results, taking into consideration the specific needs and limitations of each individual patient. Based on the existing literature, as well as the limitations of the included studies, the authors believe that future studies on the subject of NMES in the management of post-stroke spasticity should focus on carefully examining each electrical parameter.
Introduction & Background
Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infarction or hemorrhage [1]. It is considered one of the leading causes of death due to cardiovascular disease (CVD) worldwide, reaching a mortality rate of 33% of CVD patients in 2020 [1]. Simultaneously, the majority of strokes (ischemics and hemorrhagics) lead to long-term disability affecting the patient’s motor and sensory function, cognitive status, bladder, bowel, and sexual function [2].
One of the main symptoms in the majority of post-stroke patients (pSps) is spastisticity, a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, which is a typical sign of upper motor-neuron syndrome (UMNS). Spasticity is considered a “positive” feature of UMNS due to the loss of inhibition of the lower motor neuron pathways resulting from a sensory-motion control disorder in the muscle regulation system. PSps usually present with an eclectic, lateralized sensory and motor disorder, with their affected upper limb exhibiting a hypertonic flexion pattern while the equilateral lower limb exhibits a hypertonic extension pattern [2].
With one out of five first-ever stroke patients developing spasticity, many studies have examined and demonstrated its negative impact on the quality of life (QoL) of pSps due to the reduction of the mobility and functional use of the affected limbs, which restricts the person from working, performing daily life activities (ADL) and socializing. In addition, a significant percent of pSps exhibits a high degree of disability, thus needing around-the-clock assistance from a caregiver (usually a family member) [2].
The main therapeutic options of spasticity in post-stroke patients include botulinum toxin intramuscular injections, baclofen (per os or via intrathecal pump), intraneural phenol injections, surgical procedures aiming at altering the muscular, neural, or tendon structures, and physical therapy, which consists of stretching and strengthening exercises, hydrotherapy, and electrical stimulation (ES) [3].
Electrical stimulation is a supplementary modality with a variety of types that is utilized to increase muscle strength, reduce pain, and reduce hypertonia in the affected limbs [3,4]. Neuromuscular nerve stimulation (NMES) is a specific type of electrical stimulation that is used to produce muscle contractions through the application of an electrical stimulus in the distal part of a specific nerve [3,5]. Since the electrical excitability of lower motor units (and their respective innervated muscles) is usually intact, NMES can be used to stimulate the neuromuscular activity of the affected limbs with either direct stimulation of the affected muscles or the stimulation of their antagonists solo or in parallel with robotic assistive devices [6,7].
The purpose of this scoping review is to investigate the effectiveness of NMES in increasing the mobility and/or functionality of the affected upper and lower limb in pSps.
More at link.
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