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      Using the International Classification of Functioning, Disability and Health as a tool for analysis of the effect of physical therapy on spasticity in HAM/TSP patients

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          Abstract

          INTRODUCTION: This study aimed to evaluate spasticity in human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients before and after physical therapy using the International Classification of Functioning, Disability and Health (ICF). METHODS: Nine subjects underwent physical therapy. Spasticity was evaluated using the Modified Ashworth Scale. The obtained scores were converted into ICF body functions scores. RESULTS: The majority of subjects had a high degree of spasticity in the quadriceps muscles. According to the ICF codes, the spasticity decreased after 20 sessions of physical therapy. CONCLUSIONS: The ICF was effective in evaluating spasticity in HAM/TSP patients.

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          Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity

          The state of areflexia and muscle weakness that immediately follows a spinal cord injury (SCI) is gradually replaced by the recovery of neuronal and network excitability, leading to both improvements in residual motor function and the development of spasticity. In this review we summarize recent animal and human studies that describe how motoneurons and their activation by sensory pathways become hyperexcitable to compensate for the reduction of functional activation of the spinal cord and the eventual impact on the muscle. Specifically, decreases in the inhibitory control of sensory transmission and increases in intrinsic motoneuron excitability are described. We present the idea that replacing lost patterned activation of the spinal cord by activating synaptic inputs via assisted movements, pharmacology or electrical stimulation may help to recover lost spinal inhibition. This may lead to a reduction of uncontrolled activation of the spinal cord and thus, improve its controlled activation by synaptic inputs to ultimately normalize circuit function. Increasing the excitation of the spinal cord with spared descending and/or peripheral inputs by facilitating movement, instead of suppressing it pharmacologically, may provide the best avenue to improve residual motor function and manage spasticity after SCI.
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            Mapping cortical and subcortical asymmetries in substance dependence: Findings from the ENIGMA Addiction Working Group

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              Pathophysiology of impairment in patients with spasticity and use of stretch as a treatment of spastic hypertonia.

              Paralysis, muscle shortening, and muscle overactivity are the three main disabling factors in patients with spasticity. Occurring after most central lesions, muscle overactivity and shortening are not equally spread throughout all muscles of the body. In an agonist-antagonist couple, there is invariably "greater" overactivity and shortening of one versus the other. This is the rationale for the use of targeted local treatments that train the weaker agonist and stretch and partially block the more overactive and shorter antagonist. Central paralysis, muscle shortening, and muscle overactivity are intertwined, and the three corresponding therapies, motor training, stretch, and local partial blocks, should be implemented in combination. This triple treatment is the main condition for any functional recovery. Muscle shortening occurs acutely after a central nervous system lesion; therefore its treatment should be implemented as rapidly as possible.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rsbmt
                Revista da Sociedade Brasileira de Medicina Tropical
                Rev. Soc. Bras. Med. Trop.
                Sociedade Brasileira de Medicina Tropical - SBMT (Uberaba )
                1678-9849
                April 2015
                : 48
                : 2
                : 202-205
                Affiliations
                [1 ] Universidade Federal do Pará Brazil
                [2 ] Universidade Federal do Pará Brazil
                Article
                S0037-86822015000200202
                10.1590/0037-8682-0222-2014
                25992936
                b7d466da-1d81-4acd-a583-08668f50c38d

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0037-8682&lng=en
                Categories
                TROPICAL MEDICINE

                Infectious disease & Microbiology
                Tropical spastic paraparesis,ICF,Spasticity
                Infectious disease & Microbiology
                Tropical spastic paraparesis, ICF, Spasticity

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