Saturday, June 30, 2012

Saturdays News - Spasticity and Stroke

Spasticity and Stroke

From Wikipedia, the free encyclopedia

Spasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia; it is also referred to as an unusual "tightness", stiffness, and/or "pull" of muscles. The word spasm comes from the Greek word, σπασμός (spasmos), meaning to pull or drag.

Clinically spasticity is defined as velocity dependent resistance to stretch, where a lack of inhibition results in excessive contraction of the muscles, ultimately leading to hyperflexia (overly flexed joints). It mostly occurs in disorders of the central nervous system (CNS) impacting the upper motor neuron in the form of a lesion (stroke), such as spastic diplegia, but it can also present in various types of multiple sclerosis, where it occurs as a symptom of the progressively-worsening attacks on myelin sheaths and is thus unrelated to the types of spasticity present in neuromuscular cerebral palsy rooted spasticity disorders.

The clinical underpinnings of two of the most common spasticity conditions, spastic diplegia and multiple sclerosis, can be described as follows: in spastic diplegia, the upper motor neuron lesion arises often as a result of neonatal asphyxia, while in conditions like multiple sclerosis, spasticity is thought by some to be as a result of the autoimmune destruction of the myelin sheaths around nerve endings — which in turn can mimic the gamma amino butyric acid deficiencies present in the damaged nerves of spastic diplegics, leading to roughly the same presentation of spasticity, but which clinically is fundamentally different from the latter.

Spasticity Pathophysiology

The cause of spasticity isn't really known, but there are several theories. In general, spasticity develops when an imbalance occurs in the excitatory and inhibitory input to α motor neurons caused by damage to the spinal cord and/or central nervous system. The damage causes a change in the balance of signals between the nervous system and the muscles, leading to increased excitability in the muscles.

One factor that is thought to be related to spasticity is the stretch reflex. This reflex is important in coordinating normal movements in which muscles are contracted and relaxed and in keeping the muscle from stretching too far. Although the end result of spasticity is problems with the muscles, spasticity is actually caused by an injury to a part of the central nervous system (the brain or spinal cord) that controls voluntary movements. The damage causes a change in the balance of signals between the nervous system and the muscles. This imbalance leads to increased activity (excitability) in the muscles. Receptors in the muscles receive messages from the nervous system, which sense the amount of stretch in the muscle and sends that signal to the brain. The brain responds by sending a message back to reverse the stretch by contracting or shortening.

Overall, a defining feature of spasticity is that the increased resistance to passive stretch is velocity-dependent. Lance (1980) describes it this way: “...a motor disorder, characterised by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the upper motor neurone (UMN) syndrome."

Spasticity is found in conditions where the brain and/or spinal cord are damaged or fail to develop normally; these include cerebral palsy, multiple sclerosis, spinal cord injury and acquired brain injury including stroke.  ....

See the full article Spasticity and Stroke, From Wikipedia, the free encyclopedia.

Paralysis and Spasticity (Short but Good Explanation)

Paralysis and spasticity are two potential effects of stroke. Learn more about both here.

YouTube: What is Spasticity and Stroke?

Spasticity, a common and painful side effect of stroke, can lead to more serious complications if left uncontrolled. New research is making the recovery process a little easier to manage.

YouTube: Recovering from a Stroke

Stroke survivors may experience memory or problem-solving challenges, difficulty in reading, speaking or understanding language, and may experience personality changes. Physically, stroke may cause paralysis or weakness on one side of the body,  spasticity(time ≈1:30), vision problems, fatigue, and incontinence.

YouTube: Physical Therapy for Spasticity

Robin Kennedy-Hunter, a patient of Dr. Andrea Toomer and Culicchia Neurological Clinic, undergoes physical therapy as she continues treatment for spasticity.

YouTube: How Botox Works & Myobloc Injections

Botulinum Toxin A, commonly referred to as Botox®, Dysport®, or Xeomin®, is an artificially produced neuromuscular paralyzing agent that is now licensed by the FDA for blepharospasm hyperhidrosis, cervical dystonia and wrinkles. Botulinum Toxin B, commonly referred to as Myobloc® or Neurobloc®, is an artificially produced neuromuscular paralyzing agent that was more recently licensed by the FDA for cervical dystonia. When either botulinum toxin is injected into muscle the heavy chain binds to the nerve ending.
See the full article How Botox Works

Myobloc Injections - Spasticity

Dr. Andrea Toomer of Culicchia Neurological Clinic in New Orleans discusses the progress of a patient after receiving Myobloc injections for spasticity and limited movement following a stroke.

YouTube: Early Communication on Adverse Events from Botox and Myobloc

FDA has issued an early communication about serious adverse events, including respiratory failure and death, from Botox and Botox Cosmetic (Botulinum toxin Type A), and Myobloc (Botulinum toxin Type B). These events were related to how the product was used, and not to a defect in the manufacturing process. The events occurred one day to several weeks after treatment, and from a wide range of dosages.

In the affected patients, the botulinum toxin may have spread beyond the injection site and caused symptoms associated with botulism, including dysphagia and respiratory insufficiency. The most severe effects were seen in children, and the most commonly reported use in children was for limb spasticity in cerebral palsy, which is an unapproved use. Adverse reactions also occurred in patients receiving the drug for approved indications.

FDA is evaluating all the adverse event reports, as well as the medical literature in this area, and will let health professionals and the public know about any new information or conclusions.

In the meantime, healthcare professionals who use botulinum toxins should be alert to the potential for systemic effects from local injections, including dysphagia, dysphonia, weakness, dyspnea, or respiratory distress. They should tell patients and caregivers about the symptoms of botulism and to seek immediate medical attention if they occur.

Finally, practitioners should understand that the potency of botulinum toxin, which is expressed in "Units" ("U"), is not comparable from one botulinum toxin product to the next.

YouTube: Botox for Post-Stroke Spasticity

Many people who suffer a brain injury or stroke are left with severe muscle contractions that prevents them from using their limbs. Dr. Andrea Toomer at New Orleans' Culicchia Neurological Clinic is treating patients using Botox to loosen those contractions. Three patients share their stories.

YouTube: Botox for Stroke Patients

Botox for stroke patients.

YouTube: Spasticity Management

Presentation from 2001 International Transverse Myelitis Symposium in Baltimore.
Scott Benjamin, MD

Saturdays Comics - June 30th / 2012

For Better and For Worse
Lynn Johnston / 2007-02-05
"Would you like a cup of tea, Jim?"

Scott Adams / 2012-06-23
"I finished the fraudulent analysis ..."

Jim Davis / 2012-06-24
"Pffffftt ..."

Delainey & Rasmussen / 2012-06-26 
"I'm not going to make this easy on you ..."
* For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).

** I tried to get low or free price at the people for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using and

*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.

Eclectic Stuff - June 30th / 2012

Definition:Eclectic(noun) a person who derives ideas, style, or taste from a broad and diverse range of sources.

Eclectic: Jackie - I called your house, but you weren't there

I called your house, but you weren't there.

I called at your house the other day, and was told you were down at your favorite biker bar with some friends.

I wasn't sure where that was, but was told I wouldn't have much trouble finding it.

Sure enough, I drove just a couple blocks and there it was ...

There is nothing like the feel of the sun on your face and the wind in your hair, is there ?

Electic: Randy - Edmonton Celebrates Canada Day

Edmonton Celebrates Canada Day
2012 SUNDAY, JUL 1, 2012

Event Venue: Alberta Legislature, City 
             Hall, Old Strathcona, Various 
             Locations, Winspear Centre, Other
Description: Celebrate Canada! activities have 
             become a annual tradition offering 
             Canadians the opportunity to
             share their pride in their country.
Event Category: Festivals, Museums / Attractions
Contact Name:   The City of Edmonton
Contact Phone:  311
Additional Information: Please see closer below for times and 

Edmonton celebrates Canada’s 144th birthday with barbecues, family events and birthday cake, all leading up to a spectacular Canada Day fireworks finale in the river valley. This year’s display is going to be bigger and better than ever before as Edmonton will be launching the biggest fireworks shell in Canada - don’t miss it!

City Hall
Time: 11:30am-4pm
Show off your Canadian pride by celebrating our nation's birthday with free Canada Day activities at City Hall. Enjoy the live entertainment, crafts, face painting, petting zoo, City Hall tours and displays. A Canada Day ceremony will take place at noon in the City Room.

Canada Day at the Edmonton Valley Zoo
Time: 9:30am-6pm
Celebrate Canada Day and the Edmonton Valley Zoo’s 52nd birthday! Visit the Canadian animals, eat a slice of birthday cake, and enjoy a wonderful mix of family activities and entertainment. Visit for more information.

Canada Day at the Muttart Conservatory
Time: 11am-5pm
Enjoy lively jazz with Six Feet Up, Canada crafts, planting activities, face painting and lots of family fun. Search the pyramids to find plants native to our home and native land and test your knowledge of Canadiana. Be sure to check out annual sculpture show! Visit for more information.

Dominion Day at Fort Edmonton Park
Time: 10am-6pm
Join the park-wide celebration of Dominion Day with a great variety show. Emcee Paul Wallace will be on hand to entertain with magic, dancing, juggling, improv and humour. A free shuttle will run from the South Campus LRT. Avoid the line ups; buy your tickets online at

Eclectic: Monty - Magic Google!

Magic Google!
(Translated from Deutsch to English)

Magic ... but not only with the O's! 
... In general, there are the following tricks: 
  • O's appear and disappear -- (0:05) 
  • blurred oo -- (0:16) 
  • Replacing the O's -- (0:24) 
  • Google blurs -- (0:37) 
  • Small google -- (0:47) 
  • turned G -- (0:57) 
  • Disappearing Google -- (1:07) 
  • G o o g l appearing e -- (1:11) 
  • Search Site-O's -- (1:53) 

Thanks to MaherZainFansClub for the translation

~~~ FAQ ~~~

  • Music: Baby Elephant Walk by Henry Mancini
  • This video was not cut, paused etc.
  • The one and only website I've used is
  • it ISN'T a touch screen. I'm not joking.
  • the video is NOT cutted or edited after filmed
  • ah, and the window you can see on the top of the screen isn't an editing program or something like that. It's the top menu bar of an older version of the Internet Explorer. (I wouldn't record an editing program and say it's a trick, that would be a bit stupid.)
  • at the ending you con see the credit "windows movie maker" because the intro and outro was made with movie maker. The original video which I filmed was not edited.
  • there is no cursor blinking in the search bar because I haven't clicked in it, simply.

Saturday Articles - June 30th / 2012


What Is Spasticity?

Sometimes spasticity is called tone or just “tight muscles”. Funnily enough, there is not one definition for spasticity (Ward, 2012).  What you, as a stroke survivor, experiences is that some muscles are very strong and highly excitable and others are weak. Many stroke survivors find that if they cough their arm tightens or if they start to walk faster their toe drops and they will sometimes trip on their toe.

Post-stroke spasticity is highly variable.   Stroke spasticity does not conform to many of the standard definitions for spasticity.

More information:

  • Ward’s (2012) Review Of Spasticity if you prefer the scientific version.
  • StrokEngine  This is the Canadian Stroke Networks website for families and health professionals.
  • Wikipedia also has information on Spasticity

Treatment to Reduce Spasticity

This section is just meant to provide you with a very brief overview of treatments for spasticity, mainly some keywords for you to look for if you have spasticity.

According to the Canadian Stroke Network best practices, spasticity and contractures should be treated or prevented by antispastic pattern positioning, range-of-motion exercises, stretching and/or splinting (Canadian Stroke Network, StrokEngine).

The treatment by health professionals is designed to strengthen weak muscles and relax the strong and over-excitable muscles.   Check  StrokEngine and  the U-tube videos for more information and demonstrations of various techniques for reducing spasticity.

The first line of treatment is exercise, but splinting, muscle relaxant medications (Baclofen and  Botox), functional electric stimulation,  and Transcranial Magnetic Stimulation or repetitive  Transcranial Magnetic Stimulation (rTMS)  are also options. You might ask your health professionals about using treatment combinations -- for example you may want to use exercise, constraint therapy, and Botox.

Exercise: A physiotherapist, occupational therapist, or kinesiologist with training in stroke should show you how to stretch tight muscles and strengthen weak muscles.  Constraint therapy and robotic therapy can make the exercise more intensive and sometimes more interesting.

Splints and Stretching

Splints passively stretch tight muscles and may prevent contractures.   The ankle foot orthosis can help keep your foot and toe in the right position so you can walk better.  Check with your health professionals to see what would work best for you.

Splints and AFO’s don’t need to be expensive; many are actually preformed and can be ordered online. Ask your therapist about the right type and size for you.


There are several medications that attempt to dampen the signals between nerve and muscle.   Sometimes muscle relaxant medications as baclofen, or dantrolene are used. These relax all the muscles, both tight and weak muscles, so make sure you talk to your health professional about the pros and cons of these medications for you.  Another option is Botox or botulinum toxin

Robert Teasell and his team in London, Ontario reviewed the evidence for use of Botox to reduce spasticity. There is strong evidence that Botox is an effective treatment to reduce focal tone, spasticity, and helps to reduce pain from very tight, spastic muscles.  In other words — it will relax those tight muscles into which the Botox was specifically injected.

There is not as much evidence that Botox increases function in arms or legs.  One review provides strong evidence that Botox administration associated with a small, but significant improvement in gait velocity.  However, it is important to note that in many of these studies, the research just administered Botox and didn’t provide physio or occupational therapy or provide exercises.   More research which tests Botox with other interventions like constraint therapy or robotic therapy is needed.

Reference: Teasell et al. (2012). Evidence to Practice: Botulinum Toxin in the Treatment of Spasticity Post Stroke: TOPICS IN STROKE REHABILITATION, 19 (2)  115-121  

Spasticity is often used as an indicator of stroke severity and how much function you will get. 

In a recent review, the best predictor of arm recovery was how severely the arm was affected to begin with.  However, one can question whether that finding starts with the assumption that the arm is severely affected so there is little or no therapy for the arm.

See the article Review of Arm Recovery.

Literature Review on Spasticity

A Literature Review of the Pathophysiology and Onset of Post-Stroke Spasticity
Anthony B. Ward
Faculty of Health, Staffordshire University, Stoke on Trent, UK

Background: Spasticity occurs after stroke and gives rise to substantial burden for patients and caregivers. Although it has been studied for many years, its definition continues to undergo reconsideration and revision. This partly reflects the diversity of its manifestations and that its pathophysiology, although well studied, is still debated.

Methods: A literature review was carried out to define the pathophysiology and risk factors for onset of post-stroke spasticity.

Results: It is clear that an acquired brain injury, including stroke, results in an imbalance of inhibitory and excitatory impulses that leads to upper motor neuron symptoms and that the location and extent of the lesions result in differing symptoms and degrees of spastic severity. The onset of spasticity is highly variable and may occur shortly or more than 1 year after stroke. The current understanding of spasticity onset is complicated by the role of contractures, which have been assumed to arise out of spasticity but may have a role in its cause. Other possibly predictive factors for the risk of post-stroke spasticity have been identified, including early arm and leg weakness, left- sided weakness, early reduction in activities of daily living, and a history of smoking.

Conclusions: Further understanding of spasticity risk factors is necessary for the development and integration of early interventions and preventive measures to reduce spasticity onset and severity.

See the full article Literature Review on Spasticity

Predicting Arm Recovering

Predictors of Upper Limb Recovery After Stroke: a Systematic Review and Meta-Analysis
Fiona Coupar, Alex Pollock, Phil Rowe, Christopher Weir and Peter Langhorne


Objective: To systematically review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke. To identify which, if any variables predict upper limb recovery following stroke.

Data Sources: We completed searches in MEDLINE, EMBASE, AMED, CINAHL and Cochrane CENTRAL databases. Searches were completed in November 2010.

Review Methods: Studies were included if predictor variables were measured at baseline and linked to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to response to treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Two independent reviewers completed data extraction and assessed study quality. Results: Fifty-eight studies met the inclusion criteria. Predictor variables which have been considered within these studies include; age, sex, lesion site, initial motor impairment, motor-evoked potentials and somatosensory-evoked potentials. Initial measures of upper limb impairment and function were found to be the most significant predictors of upper limb recovery; odds ratio 14.84 (95% confidence intervals (CI) 9.08–24.25) and 38.62 (95% CI 8.40–177.53), respectively.

Conclusions: Interpretation of these results is complicated by methodological factors including variations in study populations, upper limb motor outcome scales, timing of baseline and outcome assessments and predictors selected. The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function.

See the full article Predicting Arm Recovering


Saturday, June 23, 2012

Saturdays News - Sleep Apnea

Sleep Apnea

Sleep apnoea (or sleep apnea in American English; /æpˈniːə/) is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or "sleep study".

Regardless of type, an individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance ...

See the full article Sleep Apnea and Obstructive Sleep Apnea From Wikipedia, the free encyclopedia.


Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. In some cases the sound may be soft, but in other cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of Obstructive Sleep Apnea (OSA) ...

See the full article Snoring From Wikipedia, the free encyclopedia.

Audio: Sleep - Good Night and Good Luck

Sunday, June 17, 2012
On CBC Radio - The Sunday Edition with Michael Enright

Someone once called sleep, God's greatest gift to humankind. That being the case, the lack of sleep seems like a product of the devil. Canada is suffering from a devastating deficit, a sleep deficit. Michael explores the history and the science of sleep, and the horror of not being able to sleep at all. (Listen ≈ 54 Minutes).

YouTube: Insidermedicine - Stroke (3X for men)

From Maryland - Obstructive sleep apnea is associated with an increased risk of stroke in middle-aged and older adults, especially among men, according to a report published online ahead of print in the American Journal of Respiratory and Critical Care Medicine. Men with moderate to severe sleep apnea were nearly three times more likely to have a stroke than those with no or mild sleep apnea. In women, the link was only found in patients with severe sleep apnea.

YouTube: Sleep Apnea Associated @ Stroke (mask/machine)

Snoring can be irritating or funny - depending on whether or not it's disturbing your sleep. But it can also be deadly, especially when someone suffers from sleep apnea, a condition where a person stops breathing for a while and then gasps for air. Increasingly, evidence points to a relationship between sleep apnea and stroke.

YouTube: CPAP

1. Continuous Positive Airway Pressure and,
2. Setting Up (mask/machine)

The Largest CPAP Store Online: --
Learn how to set up and use a standard CPAP machine to ensure you get the rest you need.

YouTube: Sleep Apnea and Snoring (Tongue Device)

A new video released on CNBC highlights the threat of problem snoring and obstructive sleep apnea to your health, and introduces the aveo Tongue Stabilizing Device, aveoTSD, as a uniquely simple and highly effective clinically proven treatment.

YouTube: How Sleep Apnea Can Lead to a Stroke (minor surgery)

YouTube: How Sleep Apnea Can Lead to a Stroke (minor surgery)
Snoring Center medical director Dr. Craig Schwimmer discusses obstructive sleep apnea on WFAA's Good Morning Texas, including potential warning signs and the increased risk for heart attack or stroke. Learn more about treatments for sleep apnea at

YouTube: Minimally Invasive Sleep Apnea Treatments (minor surgery)

Dr. Craig Schwimmer of the Snoring Center discusses new minimally invasive, office-based treatments for sleep apnea and snoring. Locations in Dallas, Fort Worth, Houston, Chicago, Beverly Hills, Newport Beach, Atlanta and Ocean Springs, MS. Learn more at

YouTube: Helps Cure Sleep Apnea (major Surgery)

Obstructive sleep apnea can result in exhaustion, diabetes, high blood pressure, and even stroke or heart attack. A new procedure to treat sleep apnea uses a plasma blade to make incisions without burning the sensitive tissue. Find out more on this segment from The Doctors TV show, including lifestyle changes to ensure you sleep well each night.

Saturdays Comics - June 23th / 2012

For Better and For Worse
Lynn Johnston / 2006-12-31
"Just the way they taught us."

Scott Adams / 2012-06-17
"I reprogrammed our pointy-haired boss..."

Jim Davis / 2012-06-15
"You're a good liar!"

Delainey & Rasmussen / 2012-06-20 
"You've become 'A glass half empty' person."

* For Better and For Worse" is a serious topic of stroke but with a very nice cartoons. It is all about Grandpa Jim had a stroke and 88 further cartoon "strips" that happened to Grandpa Jim. (See as well  the author Lynn Johnston).

** I tried to get low or free price at the people for the images for the cartoons. It was too high for Stroke Survivors Tattler i.e. we are not a regular newspaper and our budget is very low. Fortunately, you will have to do only 1-click more to see the cartoon image, it is legit and it is free using and

*** Changed from "Pickles" to "Betty" -- "Betty" is a excellent cartoon and Gary Delainey & Gerry Rasmussen are authors/artists/cartoon-strips and they live in Edmonton.