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Ashford S, Slade M, Turner-Stokes L. Conceptualisation and development of the arm activity measure (ArmA) for assessment of activity in the hemiparetic arm. Disabil Rehabil 2013; 35:1513-8. [PMID: 23294435 PMCID: PMC3741014 DOI: 10.3109/09638288.2012.743602] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To develop a patient reported outcome measure of active and passive function in the hemiparetic upper limb. METHODS Potential items for inclusion were identified through (a) systematic review and analysis of existing measures and (b) analysis of the primary goals for treatment in a spasticity service. Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n = 10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n = 36) and patients and carers (n = 13 pairs). RESULTS From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding 7 days. CONCLUSIONS The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process. The next phase of development has involved formal evaluation of psychometric properties. IMPLICATIONS FOR REHABILITATION In clinical practice or research, outcome measures in rehabilitation need to have face and content validity. Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb may be: to restore active function, if there is return of motor control or to improve passive function making it easier to care for the limb (e.g. maintain hygiene) if no motor return is possible, measurement of both constructs should be considered. This study describes the systematic development of the ArmA, a measure of active and passive function in the hemiparetic upper limb.
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Affiliation(s)
- Stephen Ashford
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK.
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Doan QV, Gillard P, Brashear A, Halperin M, Hayward E, Varon S, Lu ZJ. Cost-effectiveness of onabotulinumtoxinA for the treatment of wrist and hand disability due to upper-limb post-stroke spasticity in Scotland. Eur J Neurol 2012; 20:773-80. [DOI: 10.1111/ene.12062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Q. V. Doan
- Outcomes Insights, Inc.; Westlake Village; CA; USA
| | | | - A. Brashear
- Department of Neurology; Wake Forest Baptist Medical Center; Winston Salem; NC; USA
| | - M. Halperin
- Outcomes Insights, Inc.; Westlake Village; CA; USA
| | - E. Hayward
- Allergan, Ltd., Marlow International; Buckinghamshire; UK
| | | | - Z. J. Lu
- Outcomes Insights, Inc.; Westlake Village; CA; USA
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Foley N, Pereira S, Salter K, Fernandez MM, Speechley M, Sequeira K, Miller T, Teasell R. Treatment with botulinum toxin improves upper-extremity function post stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil 2012; 94:977-89. [PMID: 23262381 DOI: 10.1016/j.apmr.2012.12.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/22/2012] [Accepted: 12/07/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether treatment with botulinum toxin type A (BTX-A) is associated with improvements in activity capacity or performance associated with poststroke spasticity in the upper extremity. DATA SOURCES MEDLINE, EMBASE, Scopus, and ISI Web of Science databases were searched from 1985 to November 2011. DATA SELECTION Studies were included if (1) the study design was a randomized controlled trial comparing injection of BTX-A with placebo or a nonpharmacologic treatment condition; (2) at least 60% of the sample was composed of adult subjects recovering from either first or subsequent stroke; (3) subjects presented with moderate to severe upper-extremity spasticity of the wrist, finger, or shoulder; and (4) activity was assessed as an outcome. Studies were limited to those published in the English language. DATA EXTRACTION Data pertaining to participant characteristics, treatment contrasts, and outcomes assessing activity limitations were extracted from each trial. The World Health Organization's International Classification of Functioning, Disability and Health was used to identify outcomes that captured the domain of activity used within each of the included studies. Where possible, a treatment effect size was calculated for each study using the standardized mean difference ± standard error (95% confidence interval) and the results pooled. DATA SYNTHESIS Sixteen randomized controlled trials were identified, 10 of which reported sufficient data for inclusion in the pooled analysis (n=1000). Six different outcomes that assessed activity limitations had been used, including the Disability Assessment Scale, the Action Research Arm Test, and the Barthel Index. Overall, BTX-A was associated with a moderate treatment effect (standardized mean difference=.536±.094, 95% confidence interval=.352-.721, P<.0001). CONCLUSIONS The use of BTX-A was associated with moderate improvement in upper-extremity activity capacity or performance after stroke.
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Affiliation(s)
- Norine Foley
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital Site, London, Ontario, Canada.
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Schnitzler A, Roche N, Denormandie P, Lautridou C, Parratte B, Genet F. Manual needle placement: accuracy of botulinum toxin A injections. Muscle Nerve 2012; 46:531-4. [PMID: 22987693 DOI: 10.1002/mus.23410] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Electrophysiological or ultrasound guidance can facilitate botulinum toxin A (BoNt-A) injection accuracy, but clinical landmarks and palpation are often used for superficial muscles. We evaluated the accuracy of manual needle placement in the gastrocnemius muscles (GC) guided only by anatomical landmarks and palpation. METHODS Bilateral limbs from 30 cadavers were used to evaluate ink injection into the GC. One anatomist and one orthopedic surgeon verified the accuracy of manual needle placement postinjection by calf muscle dissection. Injection was considered a failure if the ink was not located in the head of the target GC. RESULTS One hundred twenty-one practitioners were evaluated. Fifty-two injections were successful (43%), and 69 failed (57%). This result was unrelated to injector experience (P = 0.097). CONCLUSIONS Our findings show a poor success rate, regardless of injector experience. Therefore, muscle palpation and anatomical landmarks are insufficient to ensure the accuracy of BoNt-A injections, even for large, superficial muscles.
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Affiliation(s)
- Alexis Schnitzler
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
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Roze S, Kurth H, Hunt B, Valentine W, Marty R. Evaluation of the cost per patient per injection of botulinum toxin A in upper limb spasticity: comparison of two preparations in 19 countries. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012. [PMID: 23204875 PMCID: PMC3508655 DOI: 10.2147/mder.s35563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Botulinum toxin A injections are indicated for the management of movement disorders, including upper limb spasticity. The aim of this study was to compare the cost per patient per injection for two botulinum toxin A preparations in 19 countries. Methods Doses of botulinum toxin A are expressed in noninterchangeable units (U), ie, Botox® in 100 Allergan units (100 U) and Dysport® in 500 Speywood units (500 U). Recommended dosages were derived from country-specific summaries of product characteristics or prescribing information. Cost analysis was based on official list prices and expressed in 2011 Euros. The cost per patient per injection was calculated using the recommended dosage in upper limb spasticity combined with price per vial in each country. Results For upper limb spasticity, the recommended dosage for Dysport in the summary of product characteristics is 1000 U per patient, whereas for Botox the recommended dosage when recommendations were made is 300 U. Allowing for different prices per vial in each country, the cost per patient per injection for upper limb spasticity was less for Dysport than for Botox in 18 (95%) of the 19 countries (mean 17% less across countries). The difference was 20% or higher in nearly half (47%) of the countries. Sensitivity analyses considering available “real-world” dosing showed consistent results, with Dysport being less costly than Botox in all 19 countries. Conclusion Considering costs per patient per injection based on analysis of recommended dosages in the summary of product characteristics, Dysport remains cheaper than Botox in most countries. Thus, when extrapolated to a national level, substantial savings could be realized by using Dysport in the treatment of upper limb spasticity.
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Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil 2012; 94:177-92. [PMID: 22982555 DOI: 10.1016/j.apmr.2012.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.
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Affiliation(s)
- Tamara Tse
- The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia.
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Villafañe JH, Silva GB, Chiarotto A, Ragusa OL. Botulinum toxin type A combined with neurodynamic mobilization for upper limb spasticity after stroke: a case report. J Chiropr Med 2012; 11:186-91. [PMID: 23449315 PMCID: PMC3437341 DOI: 10.1016/j.jcm.2012.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 05/24/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this study is to report a case in which combinatory therapy of botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM) was used as treatment for a patient with severe upper limb spasticity and pain after stroke. CLINICAL FEATURES A 76-year-old male patient had spastic muscles in the upper limb 10 months after an ischemic stroke. INTERVENTION AND OUTCOME The patient underwent combined treatment with BoNT-A and NM of the upper limb in 6 monthly applications. Evaluation was performed pretreatment, 3 months after the first injection, 3 months after the second injection, and at a follow-up session 9 months after starting the treatment. The following outcomes were measured: pain by using a numeric rating scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. The patient improved in all outcomes after treatment, and results were maintained during the follow-up sessions. CONCLUSION The combined NM and BoNT-A treatment appeared to decrease pain and improve joint ranges of motion during treatment for this patient. The patient showed decreased anxiety and depression during and after the treatment.
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Affiliation(s)
- Jorge H. Villafañe
- Physical Therapist, Department of Physical Therapy, Residenze Sanitarie Assistenziali “A. Maritano,” Sangano, Italy
- Physical Therapist, Private Practitioner, Turin, Italy
| | - Guillermo B. Silva
- Principal Investigator, Department of Physiology and Hypertension, Mons. Carlos V. Cruvellier Foundation and J. Robert Cade Foundation, Cordoba, Argentina
- Assistant Professor, Departament of Research, Chemistry Sciences, Catholic University of Cordoba, Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Argentina
| | - Alessandro Chiarotto
- Physical Therapist, Education Office, Associazione Italiana Fisioterapisti Piemonte Valle d' Aosta, Turin, Italy
| | - Orazio L.F. Ragusa
- Physician, S.C. di Medicina Fisica e Riabilitazione, A.S.L. TO 3. Area Metropolitana, Italy
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Clemenzi A, Formisano R, Matteis M, Gallinacci L, Cochi G, Savina P, Cicinelli P. Care management of spasticity with botulinum toxin-A in patients with severe acquired brain injury: a 1-year follow-up prospective study. Brain Inj 2012; 26:979-83. [PMID: 22571286 DOI: 10.3109/02699052.2012.660512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the efficacy and the safety of repeated botulinum toxin type A (BT-A) injections in patients with severe acquired brain injury (ABI) and to gain a better knowledge of possible clinical or demographic characteristics associated with a better rehabilitation outcome. DESIGN Prospective study with a 1-year follow-up period. SUBJECTS Twenty-one patients with spasticity due to severe ABI and no further improving with rehabilitation treatment and oral anti-spastic drugs. INTERVENTION Repeated BT-A injections associated to a rehabilitation programme. MAIN MEASURES Barthel Index (BI), Modified Ashworth Score (MAS) and VAS score for pain subjective perception were recorded. RESULTS At the end of the follow-up study, MAS, BI and VAS significantly improved. Despite the number of BT-A injections, a shorter interval between severe ABI onset and first BT-A treatment correlated to a better BI improvement. None of the patients experienced adverse events attributable to BT-A. CONCLUSION BT-A was effective and safe in the treatment of spasticity in severe ABI patients, with a better functional outcome in those subjects treated earlier after spasticity onset. The lack of correlation between clinical outcome and number of injections suggests, in addition to a direct inhibition at the neuromuscular junction, a more distant BT-A long-term effect.
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109
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Outcomes of tendon fractional lengthenings to improve shoulder function in patients with spastic hemiparesis. J Shoulder Elbow Surg 2012; 21:691-8. [PMID: 21719314 DOI: 10.1016/j.jse.2011.03.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/14/2011] [Accepted: 03/27/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with spastic hemiparesis after upper motor neuron (UMN) injury often exhibit limited shoulder movement. We evaluated the outcomes of shoulder tendon fractional lengthenings in patients with spasticity and preserved volitional control. METHODS A consecutive series of 34 adults with spastic hemiparesis from UMN injury (23 post-stroke, 11 post-traumatic brain injury) and limited shoulder movement with preserved volitional motor control who underwent shoulder tendon fractional lengthenings (pectoralis major, latissimus dorsi, teres major) were evaluated. Active and passive shoulder motion, spasticity, pain, and satisfaction were considered pre- and postoperatively. RESULTS There were 15 males and 19 females with a mean age of 44.1 years. Mean follow-up was 12.2 months. Mean Modified Ashworth spasticity score was 2.4 preoperatively compared to 1.9 postoperatively (P = .001). Active flexion, abduction, and external rotation improved compared to the normal contralateral side (P < .001) with most dramatic gains in external rotation. Similarly, passive extension, flexion, abduction, and external rotation improved compared to the normal contralateral side (P < .01). Ninety-four percent (15/16) with preoperative pain had improved pain relief postoperatively with 14 (88%) being pain-free. Thirty-one (92%) were satisfied with the outcome. CONCLUSION Shoulder tendon lengthenings can be an effective means of pain-relief, improved motion, enhanced active motor function, and decreased spasticity in patients with spastic hemiparesis from UMN injury.
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110
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Lemmens RJM, Timmermans AAA, Janssen-Potten YJM, Smeets RJEM, Seelen HAM. Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review. BMC Neurol 2012; 12:21. [PMID: 22498041 PMCID: PMC3352056 DOI: 10.1186/1471-2377-12-21] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 04/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loss of arm-hand performance due to a hemiparesis as a result of stroke or cerebral palsy (CP), leads to large problems in daily life of these patients. Assessment of arm-hand performance is important in both clinical practice and research. To gain more insight in e.g. effectiveness of common therapies for different patient populations with similar clinical characteristics, consensus regarding the choice and use of outcome measures is paramount. To guide this choice, an overview of available instruments is necessary. The aim of this systematic review is to identify, evaluate and categorize instruments, reported to be valid and reliable, assessing arm-hand performance at the ICF activity level in patients with stroke or cerebral palsy. METHODS A systematic literature search was performed to identify articles containing instruments assessing arm-hand skilled performance in patients with stroke or cerebral palsy. Instruments were identified and divided into the categories capacity, perceived performance and actual performance. A second search was performed to obtain information on their content and psychometrics. RESULTS Regarding capacity, perceived performance and actual performance, 18, 9 and 3 instruments were included respectively. Only 3 of all included instruments were used and tested in both patient populations. The content of the instruments differed widely regarding the ICF levels measured, assessment of the amount of use versus the quality of use, the inclusion of unimanual and/or bimanual tasks and the inclusion of basic and/or extended tasks. CONCLUSIONS Although many instruments assess capacity and perceived performance, a dearth exists of instruments assessing actual performance. In addition, instruments appropriate for more than one patient population are sparse. For actual performance, new instruments have to be developed, with specific focus on the usability in different patient populations and the assessment of quality of use as well as amount of use. Also, consensus about the choice and use of instruments within and across populations is needed.
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Affiliation(s)
- Ryanne JM Lemmens
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Annick AA Timmermans
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Yvonne JM Janssen-Potten
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Rob JEM Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Henk AM Seelen
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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Rosales RL, Kong KH, Goh KJ, Kumthornthip W, Mok VCT, Delgado-De Los Santos MM, Chua KSG, Abdullah SJBF, Zakine B, Maisonobe P, Magis A, Wong KSL. Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: a randomized controlled trial. Neurorehabil Neural Repair 2012; 26:812-21. [PMID: 22371239 DOI: 10.1177/1545968311430824] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Botulinum neurotoxin type A (BoNT-A) reduces upper-extremity poststroke spasticity when given 6 or more months after stroke. Effects on functional use of the arm and hand are less apparent. OBJECTIVE To determine the effect and safety of very early use of BoNT-A for patients with upper-limb spasticity. METHODS The Asia Botulinum Toxin-A Clinical Trial DESIGN ed for Early Post-stroke Spasticity (ABCDE-S; NCT00234546) was a multicenter, randomized, placebo-controlled trial conducted in patients recruited within 2 -12 weeks of first-ever stroke. Participants with a Modified Ashworth Scale (MAS) score of 1+ or above received BoNT-A (Dysport) 500 U or placebo to one or more wrist and elbow mover muscles, plus unstructured rehabilitation. The primary outcome was the MAS score in the most affected joint 4 weeks after first injection. Follow-up was 24 weeks. RESULTS A total of 163 patients were enrolled and assigned to placebo (n = 83) or BoNT-A (n = 80). Mean time since stroke was about 7 weeks. At 4 weeks postinjection, BoNT-A significantly improved MAS scores. Treatment effect-size estimates increased with higher baseline MAS scores from 0.45 (Q1) to 0.70 (Q3). MAS scores for all secondary end points improved with BoNT-A versus placebo at all time points (P < .0001, all visits). The Functional Motor Assessment Scale did not reveal clinically significant differences. No group differences in adverse events were found. Interpretation. BoNT-A 500 U can provide a sustained reduction in poststroke upper-limb spasticity when combined with rehabilitation in Asian patients who have mild-to-moderate hypertonicity and voluntary movement, within 2 -12 weeks of stroke. Functional use of the arm and hand was not affected.
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112
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Rosales RL, Kanovsky P, Fernandez HH. What’s the “catch” in upper-limb post-stroke spasticity: Expanding the role of botulinum toxin applications. Parkinsonism Relat Disord 2011; 17 Suppl 1:S3-10. [PMID: 21999894 DOI: 10.1016/j.parkreldis.2011.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Phadke CP, Ismail F, Boulias C. Assessing the neurophysiological effects of botulinum toxin treatment for adults with focal limb spasticity: a systematic review. Disabil Rehabil 2011; 34:91-100. [PMID: 21950270 DOI: 10.3109/09638288.2011.591882] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED To examine effectiveness of botulinum toxin therapy (BoNT), accurate quantification of the neurological component of underlying spasticity is needed. PURPOSE Systematically identify and summarize literature on neurophysiological methods to test the effectiveness of BoNT, discuss methodological aspects, and recommend best techniques for clinical and research settings. METHODS Electronic databases were searched using specific keywords. Reviews and reference lists were hand-checked to find relevant studies. Studies in adults with focal limb spasticity were included. RESULTS Over 300 articles were scanned for relevance, and a list of 90 relevant articles was made. After excluding reviews and studies in healthy controls or non-spasticity related BoNT, 22 articles were reviewed. Neurophysiological techniques included electromyography (EMG; n = 11), electrical nerve stimulation (n = 13), transcranial magnetic stimulation (TMS; n = 1), functional magnetic resonance imaging (fMRI; n = 1), reflex threshold (n = 4), Achilles tendon reflex (n = 1), reflex latency (n = 1). DISCUSSION Maximum M-wave amplitude (M-max) and stretch reflex threshold techniques were successfully used to measure the neurophysiological effects of BoNT and have high test-retest reliability. EMG techniques require effective magnitude normalization techniques and establishing test-retest reliability. CONCLUSION Serial electrical nerve stimulation can be incorporated into clinical practice to assist in follow-up. We recommend using M-max and stretch reflex threshold techniques to assess the neurophysiological effects.
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Affiliation(s)
- Chetan P Phadke
- Upper Motorneuron Spasticity Research Program, West Park Healthcare Centre, Toronto, Canada.
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114
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Therapeutic use of botulinum toxin in neurorehabilitation. J Toxicol 2011; 2012:802893. [PMID: 21941544 PMCID: PMC3172973 DOI: 10.1155/2012/802893] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/28/2011] [Accepted: 07/13/2011] [Indexed: 12/14/2022] Open
Abstract
The botulinum toxins (BTX), type A and type B by blocking vesicle acetylcholine release at neuro-muscular and neuro-secretory junctions can result efficacious therapeutic agents for the treatment of numerous disorders in patients requiring neuro-rehabilitative intervention. Its use for the reduction of focal spasticity following stroke, brain injury, and cerebral palsy is provided. Although the reduction of spasticity is widely demonstrated with BTX type A injection, its impact on the improvement of dexterity and functional outcome remains controversial. The use of BTX for the rehabilitation of children with obstetrical brachial plexus palsy and in treating sialorrhea which can complicate the course of some severe neurological diseases such as amyotrophic lateral sclerosis and Parkinson's disease is also addressed. Adverse events and neutralizing antibodies formation after repeated BTX injections can occur. Since impaired neurological persons can have complex disabling feature, BTX treatment should be viewed as adjunct measure to other rehabilitative strategies that are based on the individual's residual ability and competence and targeted to achieve the best functional recovery. BTX therapy has high cost and transient effect, but its benefits outweigh these disadvantages. Future studies must clarify if this agent alone or adjunctive to other rehabilitative procedures works best on functional outcome.
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115
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Flu-like symptoms following botulinum toxin therapy. Toxicon 2011; 58:1-7. [DOI: 10.1016/j.toxicon.2011.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/24/2011] [Accepted: 04/27/2011] [Indexed: 01/12/2023]
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116
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Shaw LC, Barnes MP, Rodgers H. Response to Letter by Munin et al Regarding Article, “Botulinum Toxin for the Upper Limb After Stroke (BoTULS) Trial: Effect on Impairment, Activity Limitation, and Pain”. Stroke 2011. [DOI: 10.1161/strokeaha.111.621979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa C. Shaw
- Institute for Ageing and Health (Stroke Research Group)Newcastle UniversityNewcastle upon Tyne, England, UK (Shaw)
| | - Michael P. Barnes
- International Centre for NeurorehabilitationNewcastle upon Tyne, England, UK (Barnes)
| | - Helen Rodgers
- Institute for Ageing and Health (Stroke Research Group)Newcastle UniversityNewcastle upon Tyne, England, UK (Rodgers)
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Namdari S, Alosh H, Baldwin K, Mehta S, Keenan MA. Shoulder tenotomies to improve passive motion and relieve pain in patients with spastic hemiplegia after upper motor neuron injury. J Shoulder Elbow Surg 2011; 20:802-6. [PMID: 21232986 DOI: 10.1016/j.jse.2010.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/28/2010] [Accepted: 10/08/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Shoulder adduction and internal rotation contractures commonly develop in patients with spastic hemiplegia after upper motor neuron (UMN) injury. Contractures are often painful, macerate skin, and impair axillary hygiene. We hypothesize that shoulder tenotomies are an effective means of pain relief and passive motion restoration in patients without active upper extremity motor function. MATERIALS AND METHODS A consecutive series of 36 adults (10 men, 26 women) with spastic hemiplegia from UMN injury, shoulder adduction, and internal rotation contractures, and no active movement, who underwent shoulder tenotomies of the pectoralis major, latissimus dorsi, teres major, and subscapularis were evaluated. Patients were an average age of 52.2 years. Pain, passive motion, and satisfaction were considered preoperatively and postoperatively. RESULTS Average follow-up was 14.3 months. Preoperatively, all patients had limited passive motion that interfered with passive functions. Nineteen patients had pain. After surgery, passive extension, flexion, abduction, and external rotation improved from 50%, 27%, 27%, and 1% to 85%, 70%, 66%, and 56%, respectively, compared with the normal contralateral side (P < .001). All patients with preoperative pain had improved pain relief at follow-up, with 18 (95%) being pain-free. Thirty-five (97%) were satisfied with the outcome of surgery, and all patients reported improved axillary hygiene and skin care. Age, gender, etiology, and chronicity of UMN injury were not associated with improvement in motion. DISCUSSION We observed improvements in passive ROM and high patient satisfaction with surgery at early follow-up. Patients who had pain with passive motion preoperatively had significant improvements in pain after shoulder tenotomy. CONCLUSION Shoulder tenotomy to relieve spastic contractures resulting from UMN injury can be an effective means of pain relief and improved passive range of motion in patients without active motor function.
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Affiliation(s)
- Surena Namdari
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Brainin M, Norrving B, Sunnerhagen KS, Goldstein LB, Cramer SC, Donnan GA, Duncan PW, Francisco G, Good D, Graham G, Kissela BM, Olver J, Ward A, Wissel J, Zorowitz R. Poststroke Chronic Disease Management: Towards Improved Identification and Interventions for Poststroke Spasticity-Related Complications. Int J Stroke 2011; 6:42-6. [PMID: 21205240 DOI: 10.1111/j.1747-4949.2010.00539.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper represents the opinion of a group of researchers and clinicians with an established interest in poststroke care and is based on the recognised need for long-term care following stroke, especially in view of the global increase of disability due to stroke. Among the more frequent long-term complications following stroke are spasticity-related disabilities. Although spasticity alone occurs in up to 60% of stroke survivors, disabling spasticity affects only 4–10%. Spasticity further interferes with important functions of daily life when it occurs in association with pain, motor impairment, and overall declines of cognitive and neurological function. It is proposed that the aftermath of stroke be considered a chronic disease requiring a multifactorial and multilevel approach. There are, however, knowledge gaps related to the prediction and recognition of poststroke disability. Interventions to prevent or minimise such disabilities require further development and evaluation. Poststroke spasticity research should focus on reducing disability and be considered as part of a continuum of chronic care requirements and should be recognised as a part of a comprehensive poststroke disease management programme.
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Affiliation(s)
- Michael Brainin
- Department of Clinical Medicine and Prevention and Center for Clinical Neurosciences, Danube University Krems, Krems, Austria
| | - Bo Norrving
- Department of Clinical Neuroscience, Lund University Hospital, Lund, Sweden
| | - Katharina S. Sunnerhagen
- Rehabilitation Medicine Institute of Neuroscience and Physiology, Göteborg University, Göteborg, Sweden
| | - Larry B. Goldstein
- Department of Medicine (Neurology), Duke Stroke Center, Duke University and Durham VA Medical Centers, Durham, NC, USA
| | - Steven C. Cramer
- Department of Anatomy and Neurobiology, University of California at Irvine, Orange, CA, USA
| | | | - Pamela W. Duncan
- Division of Doctor of Physical Therapy and Duke Center on Aging and Human Development, Duke University, Durham, NC, USA
| | - Gerard Francisco
- Department of Physical Medicine & Rehabilitation, University of Texas, Houston, TX, USA
| | - David Good
- Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Glenn Graham
- New Mexico VA Healthcare System/University of New Mexico, Albuquerque, NM, USA
| | - Brett M. Kissela
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - John Olver
- Epworth Hospital, Richmond Victoria, Australia/Monash University, Clayton, Vic., Australia
| | - Anthony Ward
- North Staffordshire Rehabilitation Centre, University Hospitals of North Staffordshire, Staffordshire University, Stoke on Trent, UK
| | - Jörg Wissel
- Kliniken Beelitz GmbH, Beelitz-Heilstätten, Germany
| | - Richard Zorowitz
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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119
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Olvey EL, Armstrong EP, Grizzle AJ. Contemporary Pharmacologic Treatments for Spasticity of the Upper Limb After Stroke: A Systematic Review. Clin Ther 2010; 32:2282-303. [DOI: 10.1016/j.clinthera.2011.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
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