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PubMedDate not supplied

[Functional evaluation of the perineum in pregnancy. Hypertonia of the levator ani muscles].

In this study, the role of "levator ani muscles hypertonia" among pathogenetic factors of perineal obstetric injuries is analysed. For this purpose, clinical data of 142 pregnant women, who underwent functional evaluation of perineum during pregnancy and 30 days after delivery were examined. Data here reported are not sufficient to confirm the importance of this factor within the pathogenesis of postpartum perineal deficiency. Levator ani hypertonia on one hand seems to be able to obstruct fetal progression, on the other hand it presumably constitutes, as an expression of a good voluntary control of perineal muscles, a favourable prognostic factor.

Adolescent↗
PubMed1991

Reflex activity and muscle tone during elbow movements in patients with spastic paresis.

Reflex behavior and tension development in upper limb muscles were analyzed and comparisons made between the unaffected and spastic sides of patients with spastic hemiparesis. During sinusoidal (0.3-Hz) isometric or isotonic elbow tracking, with a control either of joint position or of torque, randomly timed displacements were induced (at one of three velocities) stretching either the activated flexor or the extensor muscles. On the spastic side, exaggerated short-latency reflexes were apparent, but in contrast, the amplitude of long-latency electromyography (EMG) responses was reduced. The latter responses were differentially modulated on the unaffected side, predominantly by the acceleration signal during control of position and more by the velocity signal during control of torque, while the mode of muscle contraction (isometric or isotonic) had little influence on this behavior. This difference in reflex modulation was lost on the spastic side. The functional consequence of this reduced EMG modulation could be difficulty in performing finely controlled arm movements. The ratio of torque to EMG activity during displacements was higher for both background and reflex-induced EMG on the spastic limb than on the unaffected side. This effect was more pronounced for the flexor than for the extensor muscles. Consequently, the development of spastic muscle hypertonia cannot be attributed to an increase in EMG activity. It is suggested that secondary to a supraspinal lesion, mechanical muscle properties change in such a way that the activated spastic muscle develops more tension when it is stretched.

Adolescent↗
PubMed1979

[Malignant hyperthermia. Review of literature and case reports].

Malignant hyperthermia may appear during surgery. It has at least three features: 1) an anesthesiological trigger, usually the association of halothane and succinylcholine; 2) rapid increase in body temperature; 3) widespread muscle hypertonia. The literature is reviewed in an assessment of the physiopathological mechanism underlying the syndrome, with particular reference to the part played by calcium. Experimental data are cited and their similarity with the clinical, laboratory, anatomical, and histopathological picture in man is discussed. A detailed account is also given of two personal cases. Lastly, questions associated with the prevention and treatment of malignant hyperthermia are examined.

Acid-Base Equilibrium↗
PubMed1979

Relationship between plasma concentration and effect of dantrolene sodium in man.

Dantrolen sodium is a muscle relaxant, which is used in the treatment of spasticity. Although it is given chronically, little is known about its pharmacokinetic behaviour. The relationship between the effect of a single oral dose of dantrolene sodium and its plasma concentration in healthy volunteers was studied by measuring the effect on the twitch tension, and in spastic patients on the decrease in muscle hypertonia. On the twitch tension dantrolene gave a depression of 49.1 +/- 9.4% (+/- DS) within 1.15 and 3.45 h after ingestion of 100 mg. The mean maximal plasma concentration was 1.24 +/- 0.32 microgram/ml (+/- SD). The effect and the plasma concentration were correlated. No relationship between the plasma concentration of dantrolene sodium and its effect could be established in patients, although definite activity in 6 out of 7 patients was observed after a single oral dose of 100 mg, and plasma concentration of dantrolene sodium greater than 0.3 microgram/ml were consistenly associated with better results than placebo treatment in 6 out of 7 patients.

Adult↗
PubMed1991

[Partial blocking of the tibial nerve with phenol as treatment of gait disorders due to pes equinus in central paralysis].

Partial chemical neurolysis by means of a peripheral nerve block induced with a phenol solution can result in decreasing local muscle hypertonia of central origin. In case of a walking disability resulting from a spastic or dystonic equinovarus position of the ankle the phenol block of the tibial nerve may be a valuable treatment that improves walking ability. The technique of the procedure is explained. A phenol block is induced only after a favourable result of a trial block with a local anaesthetic. In the group of 19 patients who underwent tibial nerve block given by the author in the period 1987-1989 there appears to exist a correlation between the functional results and the extent to which the patient had been active in walking prior to the nerve block. A group of 6 'sitters' and 'hardly walking' patients had poor to moderate results, a group of 13 'walkers' had moderate, good and excellent results. The difference in functional outcome is ascribed by the author to a better possibility to actually utilise a muscular balance improved by the phenol block. In the early--recovery--phase of stroke rehabilitation a phenol block of the tibial nerve may well be useful in cases with equinovarus position of the ankle which interferes with therapeutic exercise and functional progress.

Aged↗
PubMed1992

GM1 gangliosidosis in adults: clinical and molecular analysis of 16 Japanese patients.

Clinical findings were compared with the results of molecular analysis in 16 Japanese patients from 10 unrelated families with the adult/chronic form of GM1 gangliosidosis. Age of onset ranged from 3 to 30 years. Major clinical manifestations were gait and speech disturbances caused by persistent muscle hypertonia. Dystonic postures and movements, facial grimacing, and parkinsonian manifestations were commonly seen. Cerebellar signs, myoclonus, severe intellectual impairment, dysmorphism, or visceromegaly were not observed. A common single-base substitution, 51Ile(ATC)----Thr(ACC), reported in a previous study of ours, was confirmed in 14 patients by the Bsu36I restriction site analysis; one was a compound heterozygote with another mutation (457Arg[CGA]----Gln[CAA]) and the others were homozygotes of this mutation. Clinically, the compound-heterozygous patient showed more severe neurological manifestations and a more rapid clinical course than those of homozygotes. The homozygotes showed considerable variations in the age of onset and subsequent clinical course. The 51Ile----Thr mutant allele expressed a significant amount of beta-galactosidase activity, whereas the 457Arg----Gln mutant allele expressed extremely low activity in human GM1 gangliosidosis fibroblasts. We conclude that these gene mutations causing different residual enzyme activities are related to the severity of clinical manifestations, but some other genetic or environmental factors contribute to clinical heterogeneity. The Bsu36I restriction site analysis was performed in 7 families and provided clear results for the diagnosis of heterozygotes as well as homozygotes of this specific clinical form of GM1 gangliosidosis. The technique is applicable to prenatal diagnosis and genetic counseling.

Adult↗
PubMed1991

Biomechanical changes at the ankle joint after stroke.

The resistance of the relaxed ankle to slow displacement over the joint movement range was measured on both sides of a group of hemiparetic stroke patients, in whom spasticity had been established for at least one year and who showed no clinical signs of contractures. The ankle joints of the age-matched normal subjects were flexible over most of the movement range, showing dramatically increasing stiffness only when the foot was dorsiflexed beyond 70 degrees, with a neutral range between 90-100 degrees, and a less dramatic increase in stiffness during plantarflexion. Hemiparetic patients showed identical curves to the normal subjects on the "healthy" side, ipsilateral to the causative cerebral lesion, but were significantly stiffer in dorsiflexion on the contralateral side, without change in the minimum stiffness range or during plantarflexion. Therefore significant changes in passive biomechanical properties occur at the affected ankle of hemiparetic subjects, predominantly as the result of a loss of compliance in the Achilles tendon, although an increase in the passive stiffness of the triceps surae may also occur. The contribution of these changes to the locomotor disability of hemiparetic patients is discussed.

Ankle Joint↗
PubMed1976

Oxygen consumption in relation to work load in students with cerebral palsy.

Eighteen adolescents with various forms of cerebral palsy performed tests on a mechanically braked ergometer bicycle. VO2 was measured at different loads and net mechanical efficiency calculated. It was found that efficiency was poor at light loads for most of the students but that there were significant intergroup differences in mechanical efficiency at higher loads. The leveling-off plateau demonstrated by healthy adolescents was only attained by a few of the disabled students. It was concluded that the muscle hypertonia and involuntary movements were responsible for the high level of energy expended in the mechanical work performed.

Adolescent↗
PubMed1977

Clonazepam, baclofen and placebo in the treatment of spasticity.

25 patients with multiple sclerosis (MS) and other spastic disorders, 33 MS patients and 10 control patients with MS were given clonazepam, baclofen or placebo over a period of 5 days to 20 weeks. Both clonazepam and baclofen were significantly more effective than placebo in the treatment of spasticity (p less than 0.005 or p less than 0.01). A clinical trial of clonazepam versus baclofen was carried out and this showed no significant difference between the two drugs. However, there was indication that clonazepam influenced with better improvement in patients with slight muscle hypertonia mainly of cerebral origin. Patients with more severe forms, mainly of spinal spasticity, benefited rather from baclofen treatment (Fisher's test, p = 0.003). There was suggestion that combination of the two drugs may be more effective in some patients than than clonazepam or baclofen alone.

Adolescent↗
PubMed1992

[The role of substance P in the modulation of myotension in paralyzed limbs after spinal transsection on rats].

It is a common clinical observation that stretch reflex excitability increases progressively after spinal transsection in man, and causes many severe complications. The purpose of the present study was to investigate the role and mechanism of substance P (SP) on the spinal reflex following spinal cord transsection. We first observed the changes of spontaneous electromyography (EMG) recorded in the paralyzed limbs of spinally transsected rats, and found that the EMG amplitude increased progressively within 40 days. The results were as follows: 1) Spontaneous EMG increased significantly following intrathecal injection of 1 microgram capsaicin, and the sensitivity of EMG to capsaicin increased progressively with time. But this effect could be partly blocked by pretreatment with SP antiserum. 2) Spontaneous EMG increased significantly following intrathecal injection of SP. Yet the time course was relatively short and the amplitude of EMG was lower. These results indicate that SP in the spinal dorsal horn participates in the regulation of myotension, and it is suggested that to decrease SP content in the spinal dorsal horn or block the afferent fibers of dorsal roots might be an effective therapy to reduce the hypermyotension caused by spinal cord injury, multiple sclerosis or other reasons.

Animals↗
PubMed1991

[Combined treatment of myodystonic pain syndromes by manual therapy and acupuncture].

Combination of manual therapy (++post-isometric relaxation) and acupuncture in the treatment of myodystonic syndromes is based from the standpoint of realization of the neurophysiological components of the pathogenesis of myofascicular hypertonus. The controlled afferent flow created by ++post-isometric relaxation and acupuncture exerts a varying effect on the structural and functional levels of the nervous system. The therapeutic effect of manual therapy is realized at the special segmental level, that of acupuncture with participation of the suprasegmental systems.

Acupuncture Analgesia↗
PubMed1991

[Pathologic muscle coactivation after injury of the brachial plexus].

As many as 58 patients with injury to the nerve trunks of brachial plexus were examined. As a consequence of the generation of nerve fibers after injury to brachial plexus or after surgical treatment, marked coactivation of muscles including antagonistic ones may not infrequently occur in patients at voluntary efforts. That coactivation may give rise to a noticeable decrease of the power effect of limb muscles. It may turn out at the same time that the same motoneurons act as representatives in different muscles. The most probable mechanism of pathological coactivation is the branching of axons during their branching into separate little branches each of which can, via the nerve membranes, grow towards different muscles including antagonistic ones. The branching of nerve fibers towards different muscles is likely to occur at anastomoses of the nerve trunk membranes. Thus, peculiar "nerve anastomoses" may occur. Via those anastomoses, nerve impulses have a possibility of "flowing" from one nerve to the other one. The phenomenon described should be taken into consideration in reconstructive surgery on brachial plexus.

Arm↗
PubMed1990

[Characteristics of the development of bilateral extrapyramidal symptomatology in patients with Parkinson disease].

The prevalence of extrapyramidal disorders was studied in 91 patients with bilateral parkinsonism. Formation of bilateral hyperkinesis or rigidity may take place according to the three variants: mirror, cross and mirror-cross. During the stage of the formed bilateral syndrome, the patients with rigid-trembling and trembling-rigid parkinsonism demonstrated predominant involvement into the pathological state of the upper limbs with a possible uniform of prevalent manifestation in them of extrapyramidal symptomatology.

Adult↗
PubMed1991

Skeletal muscle following tonic overload: functional and structural analysis.

Functional overloading of skeletal muscle induces a compensatory hypertrophy as an adaptive response to increased functional demand. Overload of the extensor digitorum longus (EDL) muscle (129 ReJ strain male mouse) was induced by unilateral surgical removal of a synergistic muscle, tibialis anterior (TA). Response of the EDL to overload for 7, 21, and 42 d was analyzed for changes in 1) muscle weight, 2) myofiber type distribution, 3) myofiber cross-sectional area by fiber type, 4) speed of contraction and relaxation of the muscle, 5) force of contraction, and 6) myofiber morphologic integrity. The weight of the EDL significantly increased. The overload caused no impairment of muscle contractility and did not have a significant effect on isometric twitch contraction time to peak tension or the time to one-half relaxation of the twitch. Overloaded muscles demonstrated a transient shift in fiber type profile with preferential hypertrophy of Type IIA fibers that occurred in the early phase of overload while type IIB fibers were recruited by 42 d. No significant increase in myofiber number in overloaded muscles occurred. Some morphologic changes in over-loaded muscles parallel those found in patients with neurogenic muscular disorders. However, overloaded muscle did not exhibit a significant occurrence of fiber branching from controls in the midbelly region of the muscle.

Adaptation, Physiological↗
PubMed1990

[Simplified defecography technique. Description and results].

Defecography is a useful paraclinical examination to explore disturbances of continence or defecation. The purpose of this study was to present a simplified defecography technique and assess its validity in subjects without defecation problems (n = 10) and in patients complaining of idiopathic chronic constipation (n = 35). The anorectal angle at rest (RAA) and when straining at stool was not significantly different in constipated patients and in controls. Defecography often gave abnormal results. Anterior rectocele was found in almost 50 percent (17/35) of constipated patients and in 20 percent (2/10) of controls (P less than 0.05). None of the patients had posterior rectocele. Persistent imprint of the puborectal muscle during straining was present in 36 percent (9/35) of constipated patients and in 10 percent (1/10) of controls (NS). The imprint was not always associated with closure of the RAA between rest and straining; this closure was never found in controls but was observed in 6 out of 17 constipated patients (35 percent; P less than 0.05). Perineal descent (PD) varied from 0.6 to 3.7 cm (mean +/- s.e.m.: 2.0 +/- 0.63 cm) in controls, as against 0.6 to 7.9 cm (mean +/- s.e.m.: 2.7 +/- 0.45 cm) in constipated patients. In 24 percent of the constipated patients PD was greater than 3.7 cm (the maximum value recorded in controls). All constipated patients with closure of the RAA during defecation had a PD of less than 1 cm, thus confirming the concept of "pelvic floor muscle hypertonia". Disorders of rectal statics are more frequent in subjects with constipation, but their significance is varied. Some abnormalities could be the cause of constipation (e.g. anismus) and others its consequence (anterior rectal prolapse, anterior rectocele, PD).

Adult↗
PubMed1976

[Clinical problems of neural lesions in the phase of rehabilitation. Their significance and importance in final success of rehabilitation therapy].

The frequency and significance of associated diseases and clinical problems in patients with nerve injuries in the recovery stage was statistically assessed. A variety of clinical situations are observed in practically all such patients. Half of the symptoms and diseases encountered relate to the nervous system and cardiocirculatory apparatus, while there is also a high incidence of skeletal muscle and urinary affections. The significance of these signs as far as rehabilitation is concerned can be seen in the fact that psychological and micturition disturbances are observed, along with muscle hypertonia, fibromyositis, cystitis and arthrosis. These form the more common obstacles to the regular execution of a rehabilitation programme, whereas no such significance is possessed by such serious diseases as valvular cardiopathy, hypertension and neoplasia of the neuraxis.

Constipation↗
PubMed1979

Muscular hypertonia: quantitative analysis.

By a statistical method of analysis, the force applied to move a limb passively can be translated into physiologically relevant parameters relating to the muscle. The parameters identified and measured are the dynamic and static activity of the muscle and their interactions with the varying length of the muscle during stretch. This method of analysis has been shown to be of assistance in evaluating the reflex status of persons with central nervous system disorders in preparation for treatment and in measuring the effects of treatment.

Humans↗