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72-514: The onset of paralysis ( spastic paraparesis ) is sudden and symmetrical and affects the legs more than the arms. The resulting disability is permanent but does not progress. Typically, a patient is standing and walking on the balls of the feet with rigid legs and often with ankle clonus . Initially, most patients experience generalized weakness during the first days and are bedridden for some days or weeks before trying to walk. Occasional blurred vision and/or speech difficulties typically clear during

144-416: A brain, cultured and then re-injected in a lesioned area of the same brain, they can help repair and rebuild it. The treatment using them would take some time to be available for general public use, as it has to clear regulations and trials. Historical progression of spasticity and the upper motor neuron lesion on which it is based has progressed considerably in recent decades. However, the term "spasticity"

216-415: 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,

288-455: A choice between starvation and risking lathyrism. This disease is prevalent in some areas of Bangladesh , Ethiopia , India and Nepal , and affects more men than women. Men between 25 and 40 are particularly vulnerable. The first mentioned intoxication goes back to ancient India and also Hippocrates mentions a neurological disorder 46 B.C. in Greece caused by Lathyrus seed. During

360-415: 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

432-604: A diet of bitter cassava. Konzo does not occur unless these conditions are met, which occurs only in remote villages in six tropical African countries. The total number of reported cases up to 2009 was 6788, but most cases are never reported and there was an estimate of 100,000 cases in DRC alone in 2002. Konzo is spreading geographically as cassava is being grown in new areas where there is little knowledge of processing methods to remove cyanogens. Konzo epidemics occur due to war which causes disruption of life in poor villages and drought, when

504-526: A measure of their cyanide intake. The importance of an adequate supply of protein sulfur amino acids is shown from three unrelated konzo epidemics in Mozambique, Tanzania, and the DRC. It was found that people of the same ethnic group, living only 5 km away from those with konzo, had near zero konzo prevalence. Some suspect this is due to diet; in the cases of Mozambique and Tanzania, healthier populations lived near bodies of water, providing fish, and in

576-954: A more [depolarized] state. The combination of decreased inhibition and an increased depolarized state of cell membranes, decreases action potential threshold for nerve signal conduction, and thus increases activity of structures innervated by the affected nerves (spasticity). Muscles affected in this way have many other potential features of altered performance in addition to spasticity, including muscle weakness ; decreased movement control; clonus (a series of involuntary rapid muscle contractions often symptomatic of muscle over-exertion and/or muscle fatigue); exaggerated deep tendon reflexes; and decreased endurance . Clonus (i.e. involuntary, rhythmic, muscular contractions and relaxations) tends to co-exist with spasticity in many cases of stroke and spinal cord injury likely due to their common physiological origins. Some consider clonus as simply an extended outcome of spasticity. Although closely linked, clonus

648-476: A potent mixture of toxic amino acids to poison monogastric (single stomached) animals. Particularly the toxin β-cyanoalanine from seeds of V. sativa enhances the toxicity of such a mixture through its inhibition of sulfur amino acid metabolism (conversion of methionine to cysteine leading to excretion of cystathionine in urine) and hence depletion of protective reduced thiols. Its use for sheep does not pose any lathyrism problems if doses do not exceed 50 percent of

720-449: A significant UMN lesion will have ongoing impairment, but most of these will be able to make progress. The most important factor to indicate ability to progress is seeing improvement, but improvement in many spastic movement disorders may not be seen until the affected individual receives help from a specialised team or health professional. Doublecortin positive cells, similar to stem cells, are extremely adaptable and, when extracted from

792-509: A standing frame to sustain a standing position. A general treatment guideline can be followed that involves: Medical interventions may include oral medications such as baclofen , clonazepam , clonidine , diazepam , or dantrolene . If refractive to oral agents, spasticity may be treated with intrathecal baclofen therapy (IBT) when spasticity. IBT may also be used in patients with limited tolerance to other modalities. Phenol injections can be used, or botulinum toxin injections into

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864-471: A stroke. 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 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

936-483: A tendon release in the case of a severe muscle imbalance leading to contracture. In spastic CP, selective dorsal rhizotomy has also been used to decrease muscle overactivity. Incorporating hydrotherapy in the treatment program may help decrease spasm severity, promote functional independence, improve motor recovery and decrease medication required for spasticity, which may help reduce the side effects that are possible with oral drug treatments. A 2004 study compared

1008-460: Is a common focus of muscle strengthening programs. Spastic movement disorders also typically feature a loss of stabilisation of an affected limb or the head from the trunk , so a thorough assessment requires this to be analysed as well. Secondary effects are likely to impact on assessment of spastic muscles. If a muscle has impaired function following an upper motor neuron lesion, other changes such as increased muscle stiffness are likely to affect

1080-464: Is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia . It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles. Clinically, spasticity results from the loss of inhibition of motor neurons , causing excessive velocity-dependent muscle contraction . This ultimately leads to hyperreflexia , an exaggerated deep tendon reflex. Spasticity

1152-549: Is a poison of the mitochondria , leading to excess cell death , especially in motor neurons . Children can additionally develop bone deformity and reduced brain development . A related disease has been identified and named osteolathyrism , because it affects the bones and connecting tissues, instead of the nervous system. It is a skeletal disorder, caused by the toxin beta-aminopropionitrile (BAPN), and characterized by hernias , aortic dissection , exostoses , and kyphoscoliosis and other skeletal deformities, apparently as

1224-411: Is a uniform increase in the tone of agonist and antagonist muscles which is not related to the velocity at which the movement is performed passively and remains the same throughout the range of movement while spasticity is a velocity-dependent increase in tone resulting from the hyperexcitability of stretch reflexes. It primarily involves the antigravity muscles – flexors of the upper limb and extensors of

1296-583: Is adequate, but short soaking for only 1–2 days leaves too much cyanogens in the resulting flour and leads to konzo. In West Africa, a roasted product called garri is produced by a different method than that used to produce flour, which reduces the total cyanide content to 10–20 ppm. No cases of konzo are reported west of Cameroon, but another neurological disease called tropical ataxic neuropathy (TAN) occurs amongst older people in West Africa (including south-west Nigeria, Tanzania, Uganda, Kenya, and also in

1368-421: Is also a permanent neurosurgical treatment for spasticity, selective dorsal rhizotomy , that directly targets nerves in the spine that cause the spasticity, and destroys them, so that the spasticity cannot be activated at all. Creutzfeldt–Jakob disease Neurolathyrism Neurolathyrism , is a neurological disease of humans, caused by eating certain legumes of the genus Lathyrus . This disease

1440-582: 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 . Damage to the CNS as a result of stroke or spinal cord injury, alter the [net inhibition] of peripheral nerves in the affected region. This change in input to bodily structures tends to favor excitation and therefore increase nerve excitability. CNS damage also causes nerve cell membranes to rest in

1512-728: Is known as mantakassa), Tanzania , Central African Republic , Cameroon and Angola . The first reported outbreak occurred in Bandundu Province in present-day DR Congo in 1936–1937 and the second in Nampula Province of Northern Mozambique in 1981. Each of these outbreaks numbered more than 1000 cases. Familial clustering is common. Outbreaks typically occur in the dry season in households living in absolute poverty that have sustained themselves for weeks or months on insufficiently processed bitter cassava. Both smaller outbreaks and sporadic cases have been reported from all

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1584-462: Is mainly associated with the consumption of Lathyrus sativus (also known as grass pea , chickling pea , kesari dal , or almorta ) and to a lesser degree with Lathyrus cicera , Lathyrus ochrus and Lathyrus clymenum containing the toxin ODAP . This is not to be confused with osteolathyrism , a different type of lathyrism that affects the connective tissues. Osteolathyrism results from

1656-738: Is much cheaper and more effective in preventing konzo than broad based interventions. No treatment has been found, but affected individuals benefit considerably from rehabilitation and use of adequate walking aids. In the Central African Republic some children have been operated with an elongation of the Achilles tendon which improved the position of the foot but the long term consequence remains uncertain. Konzo has been reported in outbreaks mainly among women and children in remote rural populations in DR Congo , Mozambique (where it

1728-423: Is not seen in all patients with spasticity. Clonus tends to not be present with spasticity in patients with significantly increased muscle tone , as the muscles are constantly active and therefore not engaging in the characteristic on/off cycle of clonus. Clonus results due to an increased motor neuron excitation (decreased action potential threshold) and is common in muscles with long conduction delays, such as

1800-442: Is often treated with the drug baclofen , which acts as an agonist at GABA receptors, which are inhibitory. Spastic cerebral palsy is the most common form of cerebral palsy , which is a group of permanent movement problems that do not get worse over time. GABA's inhibitory actions contribute to baclofen's efficacy as an anti-spasticity agent. Spasticity mostly occurs in disorders of the central nervous system (CNS) affecting

1872-447: Is one of several tropical neuropathies . A distinct myeloneuropathy also associated to cyanogen intake from cassava is tropical ataxic neuropathy (TAN), as first described in parts of Nigeria by B. O. Osuntokun in 1968. The disease is still occurring in the same areas. Konzo can be prevented by use of the "wetting method," which is used to remove residual cyanogens from cassava flour, as an additional processing method. Cassava flour

1944-405: Is placed in a bowl and the level marked on the inside of the bowl. Water is added with mixing until the height of the wet flour comes up to the mark. The wet flour is placed in a thin layer on a mat for 2 hours in the sun or 5 hours in the shade to allow the escape of hydrogen cyanide produced by the breakdown of linamarin by the enzyme linamarase . The damp flour is then cooked in boiling water in

2016-471: Is still often used interchangeably with "upper motor neuron syndrome" in the clinical settings, and it is not unusual to see patients labeled as "spastic" who actually demonstrate not just spasticity alone, but also an array of upper motor neuron findings. Research has clearly shown that exercise is beneficial for spastic muscles, even though in the very early days of research it was assumed that strength exercise would increase spasticity. Also, from at least

2088-411: 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 cerebral palsy children, leading to roughly the same presentation of spasticity, but which clinically is fundamentally different from the latter. Spasticity is assessed by feeling

2160-443: Is thought to be where 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 muscles. This is common in people who have cerebral palsy, brain injuries or a spinal cord injury, but it can happen to anybody e.g. having

2232-399: Is useful to reduce ODAP content. Moist heat ( boiling , steaming ) denatures protease inhibitors which otherwise add to the toxic effect of raw chickling pea through depletion of protective sulfur amino acids. During drought and famine, water for steeping and fuel for boiling are often also in short supply. Poor people sometimes know how to reduce the chance of developing lathyrism but face

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2304-529: The Spanish War of Independence against Napoleon, grasspea served as a famine food. This was the subject of one of Francisco de Goya 's famous aquatint prints titled Gracias a la Almorta ("Thanks to the Grasspea"), depicting poor people surviving on a porridge made from grasspea flour, one of them lying on the floor, already crippled by it. During WWII, on the order of Colonel I. Murgescu, commandant of

2376-667: The Vapniarka concentration camp in Transnistria, the detainees - most of them Jews - were fed nearly exclusively with fodder pea. Consequently, they became ill from lathyrism. During the post Civil war period in Spain, there were several outbreaks of lathyrism, caused by the shortage of food, which led people to consume excessive amounts of almorta flour. In Spain, a seed mixture known as comuña consisting of Lathyrus sativus , L. cicera , Vicia sativa and V. ervilia provides

2448-443: The neurotoxic glutamate analogue β-oxalyl-L-α,β-diaminopropionic acid (ODAP, also known as β- N -oxalyl-amino-L-alanine, or BOAA) causes paralysis, characterized by lack of strength in or inability to move the lower limbs, and may involve pyramidal tracts , producing signs of upper motor neuron damage. The toxin may also cause aortic aneurysm . A unique symptom of lathyrism is the atrophy of gluteal (buttocks) muscles . ODAP

2520-415: The upper motor neurons in the form of a lesion , such as spastic diplegia , or upper motor neuron syndrome , and can also be 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 cause of spasticity

2592-431: The 1950s through at least the 1980s, there was a strong focus on other interventions for spastic muscles, particularly stretching and splinting , but the evidence does not support these as effective. While splinting is not considered effective for decreasing spasticity, a range of different orthotics are effectively used for preventing muscle contractures on patients with spasticity. In the case of spastic diplegia there

2664-422: The DRC with a collective population of nearly 10,000 people. The time of the intervention has been reduced from 18 months in the first intervention, to 12 months in the second intervention, to 9 months in the third and fourth interventions. This has reduced the cost per person of the intervention to prevent konzo by removing cyanogens from cassava flour, to $ 16 per person. This targeted method to reduce cyanide intake

2736-410: The DRC, they were adjacent to the forest and had access to animal protein. The dose–response relationship between konzo incidence and cyanide intake, together with the prevention of konzo in many villages by reducing cyanide intake from cassava (see below) and the importance of sulfur amino acids in prevention of konzo, shows that konzo is very likely due to high cyanide/low sulfur amino acid intake in

2808-553: The Golgi tendon organ on sustained muscle stretching resulting in sudden relaxation of the muscle. Another characteristic of spasticity, which may be referred to as "seatbelt effect" of spasticity, is different as the amount of resistance offered by the muscle is directly proportional to velocity of the passive movement. It is caused by increased muscle spindle excitability and velocity sensitivity of Ia spindle afferent nerve fibres, resulting in excessive activation of alpha motor neurons of

2880-566: The King's hypertonicity scale, the Tardieu, and the modified Ashworth . Of these three, only the King's hypertonicity scale measures a range of muscle changes from the UMN lesion, including active muscle performance as well as passive response to stretch. Assessment of a movement disorder featuring spasticity may involve several health professionals depending on the affected individual's situation, and

2952-476: The West Indies and South India). It is probably due to long term intake of cyanogens from cassava at a lower level than that needed to cause konzo. The WHO has recommended three criteria for the diagnosis of konzo: Depending on its severity, konzo is divided into three categories: mild when individuals are able to walk without support, moderate when individuals need one or two sticks to walk, and severe when

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3024-414: The affected person is unable to walk unsupported. The clinical symptoms are strikingly similar to those of Neurolathyrism . They are also similar to those of viral tropical spastic paraparesis and hereditary spastic paraparesis , but those two disorders have a slow onset. Konzo is clinically distinct from polio which is a flaccid paralysis and which most often affects a person asymmetrically. Konzo

3096-542: The combination of poverty and food insecurity leaves few other food options. There are no diagnostic criteria for neurolathyrism. Diagnosis is based on clinical features and exclusion of other diagnoses. Eating the chickling pea with legumes having high concentrations of sulphur-based amino acids reduces the risk of lathyrism if such grain is available. Food preparation is also an important factor. Toxic amino acids are readily soluble in water and can be leached. Bacterial ( lactic acid ) and fungal ( tempeh ) fermentation

3168-517: The countries above. "Konzo" means "tied legs" in the Yaka language of southwestern DR Congo and was the designation by the first affected population in DR Congo as reported by Dr G. Trolli in 1938. The name, taken up by Hans Rosling and colleagues, aptly describes the typical spastic gait of those affected. Spasticity Spasticity (from Greek spasmos-  'drawing, pulling')

3240-401: The detoxification in the body of cyanide to thiocyanate, which is removed in the urine. A number of studies implicate the combination of high cyanide intake from bitter cassava and low intake of sulfur amino acids as the cause. It has now been shown that the month by month incidence of konzo is significantly correlated with the percentage of children with high urinary thiocyanate content, which is

3312-507: The disease has been attributed to the neurotoxin ODAP which acts as a structural analogue of the neurotransmitter glutamate . Lathyrism can also be caused by deliberate food adulteration . Ingestion of legumes containing the toxin occurs despite an awareness of the means to detoxify Lathyrus. Drought conditions can lead to shortages of both fuel and water, preventing the necessary detoxification steps from being taken, particularly in impoverished countries. Lathyrism usually occurs where

3384-471: The effects of hydrotherapy on spasticity, oral baclofen dosage and Functional Independence Measure (FIM) scores of patients with a spinal cord injury (SCI). It was found that subjects who received hydrotherapy treatment obtained increased FIM scores and a decreased intake of oral baclofen medication. A 2009 study looked at the effect of hydrotherapy to decrease spasticity on post- stroke , hemiparetic patients with limited mobility and concluded that there

3456-416: The event of contracture there is no role for conservative treatment. Hip dislocation and ankle equinus deformity are known to arise from muscle spasticity primarily. Orthopedic surgical reconstruction of the hip is commonly practiced to improve sitting balance, nursing care and relieve hip pain. Treatment should be done with firm and constant manual contact positioned over nonspastic areas to avoid stimulating

3528-529: The feeling of resistance to passive stretch. Other secondary changes such as loss of muscle fibres following acquired muscle weakness are likely to compound the weakness arising from the upper motor neuron lesion. In severely affected spastic muscles, there may be marked secondary changes, such as muscle contracture , particularly if management has been delayed or absent. Treatment should be based on assessment by relevant health professionals. For spastic muscles with mild-to-moderate impairment, exercise should be

3600-422: The first month, except in severely affected patients. Spasticity is present from the first day, without any initial phase of flaccidity . After the initial weeks of functional improvement, the spastic paraparesis remains stable for the rest of the patient's life. Some patients may experience an abrupt aggravating episode, e.g. a sudden and permanent worsening of the spastic paraparesis. Such episodes are identical to

3672-510: The ingestion of Lathyrus odoratus seeds ( sweet peas ) and is often referred to as odoratism. It is caused by a different toxin ( beta-aminopropionitrile ) which affects the linking of collagen , a protein of connective tissues . Another type of lathyrism is angiolathyrism which is similar to osteolathyrism in its effects on connective tissue. However, the blood vessels are affected as opposed to bone. The consumption of large quantities of Lathyrus seeds containing high concentrations of

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3744-441: The initial onset and can therefore be interpreted as a second onset . The severity of konzo varies; cases range from only hyperreflexia in the lower limbs to a severely disabled patient with spastic paraparesis, associated weakness of the trunk and arms, impaired eye movements, speech and possibly visual impairment. Although the severity varies from patient to patient, the longest upper motor neurons are invariably more affected than

3816-537: The location and severity of the upper motor neuron damage. The result for the affected individual, is that they may have any degree of impairment, ranging from a mild to a severe movement disorder. A relatively mild movement disorder may contribute to a loss of dexterity in an arm, or difficulty with high level mobility such as running or walking on stairs. A severe movement disorder may result in marked loss of function with minimal or no volitional muscle activation. There are several scales used to measure spasticity, such as

3888-440: The long reflex tracts found in distal muscle groups. Clonus is commonly seen in the ankle but may exist in other distal structures as well, such as the knee or spine. A commonly known feature of spasticity, known as Clasp-knife response is the sudden decrease of tone after initial resistance, also referred to as a lengthening reaction or a "catch-yield sequence". This is because of inverse stretch reflex activation mediated by

3960-469: The lower limb. During the passive stretch, a brief "free interval" is appreciated in spasticity but not in rigidity because the resting muscle is electromyographically silent in spasticity. In contrast, in rigidity, the resting muscle shows firing. As there are many features of the upper motor neuron syndrome , there are likely to be multiple other changes in affected musculature and surrounding bones, such as progressive malalignments of bone structure around

4032-592: The main treatment modality of spasticity is conservative in the form of botulinum toxin A injection and various physical therapy modalities such as serial casting, sustained stretching and medical pharmacologic treatment. Spasticity in cerebral palsy children is usually generalized although with varying degrees of severity across the affected extremities and trunk musculature. Neglected or inappropriately treated spasticity can eventually lead to joint contractures. Both spasticity and contractures can cause joint subluxations or dislocations and severe gait difficulties. In

4104-449: The mainstay of management, and is likely needed to be prescribed by a physiatrist (a doctor specialized in rehabilitation medicine), occupational therapist, physical therapist, accredited exercise physiologist (AEP) or other health professional skilled in neurological rehabilitation. Muscles with severe spasticity are likely to be more limited in their ability to exercise, and may require help to do this. In spastic cerebral palsy children

4176-410: The method and during the intervention there were no new konzo cases and the urinary thiocyanate content of the school children fell to safe levels. Konzo had been prevented for the first time ever in the same health zone in which it had first been discovered by Dr Trolli in 1938. Fourteen months after the intervention ceased the village was visited again. It was found that there were no new cases of konzo,

4248-539: The muscle belly, to attempt to dampen the signals between nerve and muscle. The effectiveness of medications vary between individuals, and vary based on location of the upper motor neuron lesion (in the brain or the spinal cord). Medications are commonly used for spastic movement disorders, but research has not shown functional benefit for some drugs. Some studies have shown that medications have been effective in decreasing spasticity, but that this has not been accompanied by functional benefits. Surgery could be required for

4320-425: The muscle to stretch). Spastic muscles typically demonstrate a loss of selective movement, including a loss of eccentric control (decreased ability to actively lengthen). While multiple muscles in a limb are usually affected in the upper motor neuron syndrome, there is usually an imbalance of activity, such that there is a stronger pull in one direction, such as into elbow flexion. Decreasing the degree of this imbalance

4392-444: The plant increases the cyanogen content of roots 2–4 times and the cyanide content of cassava flour also increases greatly. Konzo is also endemic in certain areas. In East Africa, the traditional methods of processing cassava to remove cyanogens consist of sun drying and heap fermentation, which inadequately remove the cyanogens even in a year of normal rainfall. In Central Africa, soaking (retting) of cassava roots in water for 4–5 days

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4464-479: The ration. Ronald Hamilton suggested in his paper The Silent Fire: ODAP and the death of Christopher McCandless that itinerant traveler Christopher McCandless may have died from starvation after being unable to hunt or gather food due to lathyrism-induced paralysis of his legs caused by eating the seeds of Hedysarum alpinum . In 2014, a preliminary lab analysis indicated that the seeds did contain ODAP. However,

4536-444: The resistance of the muscle to passive lengthening in its most relaxed state. A spastic muscle will have immediately noticeable, often quite forceful, increased resistance to passive stretch when moved with speed and/or while attempting to be stretched out, as compared to the non-spastic muscles in the same person's body (if any exist). Spasticity can be differentiated from rigidity with the help of simple clinical examination, as rigidity

4608-449: The result of defective aging of collagen tissue . The cause of this disease is attributed to beta-aminopropionitrile, which inhibits the copper-containing enzyme lysyl oxidase , responsible for cross-linking procollagen and proelastin. BAPN is also a metabolic product of a compound present in sprouts of grasspea, pea and lentils. Disorders that are clinically similar are konzo and lytico-bodig disease . The toxicological cause of

4680-473: The school children had low urinary thiocyanate levels, the wetting method was still being used and it had spread by word of mouth to three nearby villages. It is important to teach the women that konzo is due to a poison present in their food, to get them to regularly use the wetting method and posters are available in 13 different languages as a teaching aid as an additional method to remove residual cyanogens. The wetting method has now been used in 13 villages in

4752-512: The severity of their condition. This may include physical therapists , physicians (including neurologists and rehabilitation physicians ), orthotists and occupational therapists . Assessment is needed of the affected individual's goals, their function, and any symptoms that may be related to the movement disorder, such as pain. A thorough assessment will include analysis of posture, active movement, muscle strength, movement control and coordination, and endurance, as well as spasticity (response of

4824-433: The shorter ones. Thus, a konzo patient with speech impairment always shows severe symptoms in the legs and arms. Recently, neuropsychological effects of konzo have been described from DR Congo. The character of the neurological injury is not clear. The disease onset is associated with high intake of cyanide from a diet of mostly bitter cassava, which is low in protein, particularly sulfur amino acids. These are essential for

4896-484: The spastic muscle(s). Alternatively, rehabilitation robotics can be used to provide high volumes of passive or assisted movement, depending on the individual's requirements; this form of therapy can be useful if therapists are at a premium, and has been found effective at reducing spasticity in patients with strokes . For muscles that lack any volitional control, such as after complete spinal cord injury , exercise may be assisted, and may require equipment, such as using

4968-475: The spastic muscles (leading for example to the scissor gait and tip-toeing gait due to ankle equinus or ankle planter flexion deformity in spastic cerebral palsy children, scissor gait is caused by spasticity of the hip adductor muscles while tip-toeing gait is caused by spasticity of the gastrocnemius-soleus muscle complex or calf musculature. Also, following an upper motor neuron lesion, there may be multiple muscles affected, to varying degrees, depending on

5040-471: The spinal cord. It is similar to the tug we feel initially while pulling the seatbelt of a car beyond a certain velocity, hence the name "seatbelt effect" The clinical underpinnings of two of the most common spasticity conditions, spastic cerebral palsy 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

5112-539: The traditional way to produce a thick porridge called "fufu" or "ugali", which is flavoured by some means such as a sauce. The wetting method is accepted by rural women because it requires little extra work or equipment and produces fufu which is not bitter, because the bitter tasting linamarin has gone. In 2010 the wetting method was taught to the women in Kay Kalenge village, Popokabaka Health Zone, Bandundu Province, DRC, where there were 34 konzo cases. The women used

5184-492: Was a significantly larger increase in FIM scores compared to the control group that did not receive hydrotherapy. The prognosis for those with spastic muscles depends on multiple factors, including the severity of the spasticity and the associated movement disorder, access to specialised and intensive management, and ability of the affected individual to maintain the management plan (particularly an exercise program). Most people with

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