Diego Longo, Giulio Cherubini, Vanessa Mangé, P. Lippi, L. Longo, D. Melchiorre, M. Bagni
{"title":"激光治疗联合Grimaldi缩肌术对中枢神经系统损伤痉挛的影响","authors":"Diego Longo, Giulio Cherubini, Vanessa Mangé, P. Lippi, L. Longo, D. Melchiorre, M. Bagni","doi":"10.4081/ltj.2022.299","DOIUrl":null,"url":null,"abstract":"Background an Aims: For 2003 year until today we treated hundreds of patients with Central Nervous System Injuries (CNSI), using Non-Surgical Laser Therapy (NSLT) obtaining good results in terms of sensibility and movement. In order to increase muscle strength and to further explore new emerging synergies, we have also started using a physical therapy practice based on the most current knowledge about the motor control, called Grimaldi’s Muscle Shortening Maneuver (GMSM). Spasticity is often the most disabling symptom and the current therapies are still not able to heal it at all. The goal of our study is to suggest a new way of treatment of spasticity, supporting it with objective measurements of muscle thresholds. Materials and Methods: In 2016-2017, 36 patients with traumatic or degenerative CNSI were enrolled. Lasers used were 808 nm, 10600 nm, and 1064 nm, applied with a first cycle of 20 sessions, four a day. Patients were subjected to Grimaldi’s Muscle Shortening Maneuver (MSM) twice a day, ten sessions at all, working selectively on hypertonic muscles and their antagonists. Before treatment, tonic stretch reflex thresholds (TSRTs) in Gastrocnemius Lateralis (GL) were assessed through a surface electromyography (sEMG) device paired with an electrogoniometer. Antagonist muscle force (Tibialis Anterioris) was assessed by some electronic hand-held dynamometers. For the clinical measure, we used the Modified Ashworth Scale (MAS). All tests have been performed at the baseline (before starting treatments), after one week (at the end of the last treatment) and after a month. Results: Results were considered positive if the instrumental assessment procedure showed modifications in TSRT values and subjects improved their antagonist muscle strength. Results showed modifications in TSRT values at every follow up. The average comparison between the follow-ups was always statistically significant (p .000). The increase in Tibialis Anterioris muscle strength was statistically significant as well (p .000). MAS showed some differences between followups but not all of them are statistically significant (T0-T1 p .063, T1-T2 p .001, T0-T2 p .000). Encouraging results suggest a possible correlation between laser and MSM therapies and modifications of TSRT in spastic muscles. Conclusion: Associating laser treatment and Grimaldi’s Muscle Shortening Maneuver (MSM) seems to be effective on spasticity in patients affected by traumatic or degenerative CNSI. Obviously, this kind of study design showed a lot of limits however this clinical series could be an important hint for every researcher working in the complex field of spasticity, a symptom that is poorly defined and hardly treated.","PeriodicalId":17981,"journal":{"name":"Laser therapy","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of laser therapy and Grimaldi’s muscle shortening maneuver on spasticity in central nervous system injuries\",\"authors\":\"Diego Longo, Giulio Cherubini, Vanessa Mangé, P. Lippi, L. Longo, D. Melchiorre, M. Bagni\",\"doi\":\"10.4081/ltj.2022.299\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background an Aims: For 2003 year until today we treated hundreds of patients with Central Nervous System Injuries (CNSI), using Non-Surgical Laser Therapy (NSLT) obtaining good results in terms of sensibility and movement. In order to increase muscle strength and to further explore new emerging synergies, we have also started using a physical therapy practice based on the most current knowledge about the motor control, called Grimaldi’s Muscle Shortening Maneuver (GMSM). Spasticity is often the most disabling symptom and the current therapies are still not able to heal it at all. The goal of our study is to suggest a new way of treatment of spasticity, supporting it with objective measurements of muscle thresholds. Materials and Methods: In 2016-2017, 36 patients with traumatic or degenerative CNSI were enrolled. 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Results showed modifications in TSRT values at every follow up. The average comparison between the follow-ups was always statistically significant (p .000). The increase in Tibialis Anterioris muscle strength was statistically significant as well (p .000). MAS showed some differences between followups but not all of them are statistically significant (T0-T1 p .063, T1-T2 p .001, T0-T2 p .000). Encouraging results suggest a possible correlation between laser and MSM therapies and modifications of TSRT in spastic muscles. Conclusion: Associating laser treatment and Grimaldi’s Muscle Shortening Maneuver (MSM) seems to be effective on spasticity in patients affected by traumatic or degenerative CNSI. 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引用次数: 0
摘要
背景和目的:2003年至今,我们治疗了数百名中枢神经系统损伤(CNSI)患者,使用非手术激光治疗(NSLT)在敏感性和运动方面取得了良好的效果。为了增加肌肉力量并进一步探索新的协同作用,我们也开始使用基于最新运动控制知识的物理治疗实践,称为Grimaldi肌肉缩短操作(GMSM)。痉挛通常是最致残的症状,目前的治疗方法仍然不能完全治愈它。我们研究的目的是提出一种治疗痉挛的新方法,并通过客观测量肌肉阈值来支持它。材料与方法:2016-2017年,入选36例外伤性或退行性CNSI患者。使用的激光分别为808 nm、10600 nm和1064 nm,第一个周期为20次,每天4次。患者接受格里马尔迪肌肉缩短术(MSM),每天两次,共10次,选择性地对高张力肌肉及其拮抗剂起作用。治疗前,通过表面肌电图(sEMG)装置与角电计配对评估腓肠肌外侧肌(GL)的强直性拉伸反射阈值(TSRTs)。拮抗剂肌力(胫骨前肌)由一些电子手持式测功机评估。临床测量采用改良Ashworth量表(MAS)。所有测试均在基线(开始治疗前)、一周后(最后一次治疗结束时)和一个月后进行。结果:如果仪器评估程序显示TSRT值的改变和受试者拮抗剂肌肉力量的提高,则结果被认为是阳性的。结果显示每次随访时TSRT值有所改变。随访之间的平均比较具有统计学意义(p .000)。胫骨前肌力量的增加也有统计学意义(p .000)。MAS在随访期间有一定差异,但并非全部具有统计学意义(T0-T1 p .063, T1-T2 p .001, T0-T2 p .000)。令人鼓舞的结果表明,激光和MSM治疗与痉挛肌肉中TSRT的改变之间可能存在相关性。结论:联合激光治疗和Grimaldi肌短缩术(MSM)对外伤性或退行性CNSI患者的痉挛是有效的。显然,这种研究设计有很多局限性,然而,这个临床系列可能是一个重要的提示,每一个研究人员在痉挛的复杂领域工作,这是一个定义不清,几乎没有治疗的症状。
Effects of laser therapy and Grimaldi’s muscle shortening maneuver on spasticity in central nervous system injuries
Background an Aims: For 2003 year until today we treated hundreds of patients with Central Nervous System Injuries (CNSI), using Non-Surgical Laser Therapy (NSLT) obtaining good results in terms of sensibility and movement. In order to increase muscle strength and to further explore new emerging synergies, we have also started using a physical therapy practice based on the most current knowledge about the motor control, called Grimaldi’s Muscle Shortening Maneuver (GMSM). Spasticity is often the most disabling symptom and the current therapies are still not able to heal it at all. The goal of our study is to suggest a new way of treatment of spasticity, supporting it with objective measurements of muscle thresholds. Materials and Methods: In 2016-2017, 36 patients with traumatic or degenerative CNSI were enrolled. Lasers used were 808 nm, 10600 nm, and 1064 nm, applied with a first cycle of 20 sessions, four a day. Patients were subjected to Grimaldi’s Muscle Shortening Maneuver (MSM) twice a day, ten sessions at all, working selectively on hypertonic muscles and their antagonists. Before treatment, tonic stretch reflex thresholds (TSRTs) in Gastrocnemius Lateralis (GL) were assessed through a surface electromyography (sEMG) device paired with an electrogoniometer. Antagonist muscle force (Tibialis Anterioris) was assessed by some electronic hand-held dynamometers. For the clinical measure, we used the Modified Ashworth Scale (MAS). All tests have been performed at the baseline (before starting treatments), after one week (at the end of the last treatment) and after a month. Results: Results were considered positive if the instrumental assessment procedure showed modifications in TSRT values and subjects improved their antagonist muscle strength. Results showed modifications in TSRT values at every follow up. The average comparison between the follow-ups was always statistically significant (p .000). The increase in Tibialis Anterioris muscle strength was statistically significant as well (p .000). MAS showed some differences between followups but not all of them are statistically significant (T0-T1 p .063, T1-T2 p .001, T0-T2 p .000). Encouraging results suggest a possible correlation between laser and MSM therapies and modifications of TSRT in spastic muscles. Conclusion: Associating laser treatment and Grimaldi’s Muscle Shortening Maneuver (MSM) seems to be effective on spasticity in patients affected by traumatic or degenerative CNSI. Obviously, this kind of study design showed a lot of limits however this clinical series could be an important hint for every researcher working in the complex field of spasticity, a symptom that is poorly defined and hardly treated.