Payenok Anzhelika V, Morozova Olga G, Payenok Oleksandr S, Mitelman Irina M, Bilianskyi Oleg Yu.
Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine
Kharkiv Medical Akademy Of Postgraduate Education, Kharkiv, Ukraine
Wiad Lek. 2019 Oct 31;72(10):1939-1941.
Recent scientific research has shown that post-stroke spasticity occurs in 20-30 % of cases. Very often spasticity impairs and gives discomfort for a person who has it. In that case it should be managed and relieved. The aim: To conduct standardization of determination of degrees of spasticity by means of foregoing scales and methodologies with further comparison of their sensitiveness and objectivity of the obtained data.
24 patients with post-stroke spasticity were treated during 14 days using the same centrally acting anti-spastic drug (oral tolperisone hydrochloride). The average duration of spasticity was 25 months (minimum 20 months and maximum 36 months). 24 patients were rated on the Modified Ashworth Scale and of those patients: 1 was rated stage “1”, 5 – stage “1+”, 7 – stage “2”, 7 – stage “3” and 3 patients were rated stage “4”. Assessment of muscle tone for each patient was performed daily during morning round. At our study we have used the Modified Ashworth Scale, the Modified Tardieu Scale, Functional Independence Measure, Visual Analog Scale for Pain and some parameters from ENMG study (Hoffmann’s reflex and F/M max measured for ulnar nerve at the side of paresis). The results were statistically analyzed through Microsoft Excel 2010 using Student’s method and Spearman’s rank correlation coefficient. P value less that 0,05 was considered as a significant level.
According to collected statistics we can advise for control of treatment of post-stroke spasticity using ENMG parameters and Visual Analog Scale for Pain during first 7 days of treatment, using of Modified Ashworth Scale and Tardieu Scale is more appropriate starting on 7th day of taking anti-spastic medications. Unfortunately, according to gathered statistics there is no correlation between Modified Ashworth Scale and parameters of ENMG.
For the estimation of efficiency of post-stroke spasticity treatment in the first 7 days of the therapy more informative are electroneuromyographic parameters and Visual Analog Scale. Muscle tone assessment scales (Modified Ashworth Scale and Modified Tardieu Scale) for the monitoring of dynamic changes of efficiency of the treatment can be recommended beginning from the seventh day of the therapy.
近期科学研究表明，中风后痉挛在20%至30%的病例中出现。痉挛常常会损害患者并给其带来不适。在这种情况下，应加以控制和缓解。目的：通过上述量表和方法对痉挛程度的判定进行标准化，并进一步比较所获数据的敏感性和客观性。
24例中风后痉挛患者接受了为期14天的治疗，使用相同的中枢性抗痉挛药物（口服盐酸托哌酮）。痉挛的平均持续时间为25个月（最短20个月，最长36个月）。24例患者按照改良Ashworth量表进行评级，其中：1例为“1”级，5例为“1+”级，7例为“2”级，7例为“3”级，3例为“4”级。每天早晨查房时对每位患者的肌张力进行评估。在我们的研究中，使用了改良Ashworth量表、改良Tardieu量表、功能独立性测量、视觉模拟疼痛量表以及肌电图研究（在瘫痪侧尺神经测量霍夫曼反射和F/M最大值）的一些参数。通过Microsoft Excel 2010使用学生方法和斯皮尔曼等级相关系数对结果进行统计分析。P值小于0.05被视为显著水平。
根据收集到的统计数据，我们建议在治疗的前7天使用肌电图参数和视觉模拟疼痛量表来控制中风后痉挛的治疗，从服用抗痉挛药物的第7天开始使用改良Ashworth量表和Tardieu量表更为合适。遗憾的是，根据收集到的统计数据，改良Ashworth量表与肌电图参数之间没有相关性。
在治疗的前7天，对于评估中风后痉挛治疗的效果，神经肌电图参数和视觉模拟量表更具信息量。从治疗的第7天开始，可以推荐使用肌张力评估量表（改良Ashworth量表和改良Tardieu量表）来监测治疗效果的动态变化。
