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Motor neurone disease
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
PLS is a type of MND similar to ALS (Lou Gehrig’s disease). The difference between the two types is that PLS is very slow progressing and only affects the upper motor neurones (ALS can affect upper and lower motor neurones). PLS leads to muscle hypertonia rather than atrophy. Occasionally, PLS may progress and convert to ALS.
Vulvodynia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
A cognitive-behavioural assessment has been suggested to complement the physical treatments [Ib].12 Over a series of sessions, a clinical psychologist can teach patients coping mechanisms and pain management strategies such as the pain-gate theory, and can address the patient’s expectations of treatment, which might not necessarily be a cure for pain, but rather the ability to have penetrative sex. Fig. 105.1 outlines a connection between the psychological and psychosexual aspects of vulval pain connecting thoughts, emotions, behaviours and symptoms. Hence there is an important role that psychological therapies play in the overall management of vulval pain. For many women with vestibulodynia, sexual rehabilitation may be required and this can be structured over several sessions with a psychosexual counsellor, preferably with the woman’s partner. It is important to stress that a referral for therapy does not mean that the pain is all in the mind.21 Improving physical noncoital sexual contact, helping to overcome pelvic floor muscle hypertonia using sensate focus therapy, and addressing secondary psychosexual dysfunction such as low libido and anorgasmia will be of help to many.8
Pain in neurological disease
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
A number of descriptive terms are used to differentiate patterns of disordered muscle tone and movement, and may give rise to confusion among non-neurologists. Some of these terms, and their corresponding meanings, are listed below: Spasticity is the type of muscle hypertonia seen following a lesion of the corticospinal tract.Resistance to passive movement of an affected limb is maximal at its outset and reduced once movement is initiated (“clasp-knife” effect). Tendon reflexes are increased. The Babinski response is extensor. Clonus (rhythmic repetitive contractions) may occur.Rigidity is a uniform increase of muscle tone seen in extrapyramidal lesions, notably parkinsonism. Resistance to passive movement is evenly encountered throughout the range (“lead-pipe” rigidity). In cases where tremor is superimposed, rapid fluctuations in the degree of resistance may be felt (“cog-wheel” effect).Dyskinesia is a term used to cover the range of involuntary movements seen in extrapyramidal disturbance: – chorea: jerky, quasi-purposive movements, typically of the face/upper limbs;– athetosis: slower, more writhing movements;– hemiballismus: violent excursions of an entire limb;– dystonia: sustained, often repetitive, muscle contraction, typically giving rise to twisting movements and/or abnormal postures;– tremor: rhythmic rapid oscillations;– myoclonus: brief isolated jerks which may involve part of a muscle, an entire muscle, or several muscle groups.
A synthesis and appraisal of clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of focal spasticity in adults and children
Published in Disability and Rehabilitation, 2022
Gavin Williams, Barby J. Singer, Stephen Ashford, Brian Hoare, Tandy Hastings-Ison, Klemens Fheodoroff, Steffen Berwick, Edwina Sutherland, Bridget Hill
Search terms included guideline/or practice guideline/or clinical pathway/consensus, AND muscle spasticity/or muscle hypertonia/or muscle rigidity/or muscle tonus/spasm/or dystonia/or paraparesis, spastic/or hypertonicity/or dystonia. Titles and abstracts of retrieved articles were independently evaluated by two reviewers with full text retrieved where data were not sufficient to determine eligibility. CPG and consensus statements were assessed for methodological rigor and transparency of development using the Appraisal of Guidelines, Research and Evaluation (AGREE II) [16] instrument by four authors. The AGREE collaboration is an international team of guideline developers and researchers. The AGREE II statement is a 23-item appraisal tool that evaluates guideline development, reporting and evaluation. It states what is required for clinical implementation of a guideline. The AGREE II instrument was not applied to the Cochrane systematic reviews. Data were independently extracted by two reviewers including study characteristics, principles of management, outcome measures and adjunctive treatment. A third reviewer was used to resolve any disagreement.
The impact of early spasticity on the intensive functional rehabilitation phase and community reintegration following traumatic spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Andréane Richard-Denis, Bich-Han Nguyen, Jean-Marc Mac-Thiong
A majority of our cohort (63.3%) developed signs and/or symptoms of spasticity (as defined in this study as the presence of the following: 1) velocity-dependant muscle hypertonia, 2) spasms reported by the patient or noted at physical examination, 3) clonus reported by the patient or noted at physical examination, during the acute care hospitalization. The incidence of spasticity observed in this study is in the lower range previously reported in the SCI population (65–78%).2,8 This result was expected since previous studies have investigated the incidence of spasticity in the subacute or chronic phases following TSCI. This study suggests that a great majority of individuals who will develop spasticity will present signs and/or symptoms within the first month following the injury. This finding may help in defining the natural history of spasticity, as the proportion of individuals who develop spasticity prior to admission to intensive functional rehabilitation has never been reported in the SCI literature, to our knowledge. It is important to note that our cohort was similar to the Canadian SCI population in term of baseline characteristics.26
Transcranial direct current stimulation in disorders of consciousness: a review
Published in International Journal of Neuroscience, 2018
Recently, the idea of combining tDCS and an individualized cognitive–behavioral psychosensory training was tested by Dimitri et al. in a case study in one MCS patient [31]. The patient benefited from three months of treatment, performed three times a week for 20 min. Anodal electrodes were applied on left DLPFC (F3) and cerebellar cortex, while cathode was on right sensorimotor cortex (C4). The main reason underlying such anodal electrodes location was to increase the excitability of the frontothalamocerebellar circuit according to the mesocircuit hypothesis [32–34], and cathode location was to decrease the left upper limb flexor hypertonia. The evaluation performed focused on disorders of consciousness scale (DOCS). Results showed an increase in DOC unit score and an improvement in muscle hypertonia for this dual stimulation modality.