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Takeuchi K, Takebayashi T, Hanioka D, Okita Y, Shimada S. Comparison of tendon and muscle belly vibratory stimulation in the treatment of post-stroke upper extremity spasticity: a retrospective observational pilot study. Sci Rep 2024; 14:4151. [PMID: 38378862 PMCID: PMC10879534 DOI: 10.1038/s41598-024-54815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/16/2024] [Indexed: 02/22/2024] Open
Abstract
Previous studies have reported the effects of vibratory stimulation (VS) therapy in reducing upper extremity spasticity after stroke. However, the effective location of the VS in patients with stroke remains unclear. This study aimed to determine the VS location that is most effective in reducing post-stroke finger and wrist flexor spasticity. We enrolled 27 consecutive patients with stroke and upper extremity spasticity in this retrospective observational study. The participants received stretching, tendon vibration, and muscle belly vibration for 5 min over a period of 3 days. To evaluate spasticity, we assessed the Modified Ashworth Scale score before and immediately after each treatment and immediately after voluntary finger flexion. Participants who received tendon vibration showed greater improvement in flexor tone in the fingers than participants who received stretching and muscle belly vibration (P < 0.05 and < 0.001, respectively). Participants who underwent VS showed no significant improvement in the wrist flexor tone compared to those who underwent stretching. Our results suggest that the tendon may be the most effective location for treating spasticity of the finger flexor muscles and that VS may not significantly improve spasticity of the wrist flexors more than stretching.
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Affiliation(s)
- Kenta Takeuchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, 1-300-1, Nishino, Itami, Hyogo, Japan.
- Department of Occupational Therapy, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.
| | - Takashi Takebayashi
- Department of Occupational Therapy, Graduate School of Comprehensive Rehabilitation, Osaka Metropolitan University, Osaka, Japan
| | - Daiki Hanioka
- Department of Rehabilitation, Tsukazaki Hospital, Himeji, Japan
| | - Yuho Okita
- Soaring Health Sport, Wellness & Community Centre, Melbourne, Australia
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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2
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Moulaei K, Sheikhtaheri A, Haghdoost AA, Nezhadd MS, Bahaadinbeigy K. A data set for the design and implementation of the upper limb disability registry. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:130. [PMID: 37397108 PMCID: PMC10312779 DOI: 10.4103/jehp.jehp_721_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/14/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND If the data elements needed for patient registries are not identified, designing and implementing them can be very challenging. Identifying and introducing a Data Set (DS) can help solve this challenge. The aim of this study was to identify and present a DS for the design and implementation of the upper limb disability registry. MATERIALS AND METHODS This cross-sectional study was conducted in two phases. In the first phase, to identify the administrative and clinical data elements required for registry, a comprehensive study was conducted in PubMed, Web of Science, and Scopus databases. Then, the necessary data elements were extracted from the studies and a questionnaire was designed based on them. In the second phase, in order to confirm the DS, the questionnaire was distributed to 20 orthopedic, physical medicine and rehabilitation physicians and physiotherapists during a two-round Delphi. In order to analyze the data, the frequency and mean score of each data element were calculated. Data elements that received an agreement more than 75% in the first or two-round Delphi were considered for the final DS. RESULTS A total of 81 data elements in five categories of "demographic data", "clinical presentation", "past medical history", "psychological issues", and "pharmacological and non-pharmacological treatments" were extracted from the studies. Finally, 78 data elements were approved by experts as essential data elements for designing a patient registry for upper limb disabilities. CONCLUSION In this study, the data elements necessary for the design and implementation of the upper limb disability registry were suggested. This DS can help registry designers and health data administrators know what data needs to be included in the registry system in order to have a successful design and implementation. Moreover, this standardized DS can be effective for integrating and improving the information management of people with upper limb disabilities and used to accurately gather the upper limb disabilities data for research and policymaking purposes.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali A. Haghdoost
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour S. Nezhadd
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Mei J, Xue Y, Li J, Zhang L, Zhang J, Wang Y, Su K, Gao J, Guo J, Li R. Effects of Functional Acupuncture on Upper Limb Spasticity After Ischemic Stroke: A Protocol for a Randomized Controlled Parallel Clinical Trial. Front Neurol 2022; 13:835408. [PMID: 35665035 PMCID: PMC9157496 DOI: 10.3389/fneur.2022.835408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundUpper limb spasticity (ULS) is a common complication after stroke, which seriously affects the quality of life and rehabilitation of patients. There are different treatment methods for post-stroke spasticity (PSS). Our group found that functional acupuncture (FA) can effectively improve forearm spasticity and hand dysfunction after stroke, but the efficacy of ULS needs to be further verified. Therefore, this subject has mainly used clinical randomized controlled trials to evaluate the clinical efficacy of FA in the treatment of ULS after ischemic stroke.MethodThis is a parallel design and randomized controlled trial. We selected 108 patients who met the predefined criteria and randomized them into two groups, the experimental group and the control group. The experimental group receives FA and routine rehabilitation treatment. The control group received traditional acupuncture (TA) and routine rehabilitation treatment. All patients received 20 courses of treatment for 4 weeks, and the modified Ashworth score (MAS), clinical neurological deficit score (CSS), Fugl-Meyer upper extremity function assessment (FMA-UE), and the Modified Barthel Index (MBI) scores were evaluated before and after treatment.DiscussionThis trial is mainly to study the clinical efficacy of FA in the treatment of ULS after ischemic stroke. It will not only provide a new idea for the clinical treatment of upper limb post-stroke spasticity (ULPSS) but also will provide effective experimental support and a theoretical basis for the clinic.Trial registrationChina Clinical Trials Registry No. ChiCTR2100050440. Registered on 27 August 27 2021.
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Affiliation(s)
- Jinjin Mei
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xue
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jingwen Li
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Lihong Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Jianyun Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Yiying Wang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Kaiqi Su
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Jing Gao
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jian Guo
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Ruiqing Li
- Henan University of Chinese Medicine, Zhengzhou, China
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Ruiqing Li
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Wissel J, Ri S. Assessment, goal setting, and botulinum neurotoxin a therapy in the management of post-stroke spastic movement disorder: updated perspectives on best practice. Expert Rev Neurother 2021; 22:27-42. [PMID: 34933648 DOI: 10.1080/14737175.2021.2021072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Post-stroke spastic movement disorder (PS-SMD) appears up to 20% in the first week following stroke and 40% in the chronic phase. It may create major hurdles to overcome in early stroke rehabilitation and as one relevant factor that reduces quality of life to a major degree in the chronic phase. AREAS COVERED In this review, we discuss predictors,early identification, clinical assessments, goal setting, and management in multiprofessional team, including Botulinum neurotoxin A (BoNT-A) injection for early and chronic management of PS-SMD. EXPERT OPINION The earlier PS-SMD is recognized and managed, the better the outcome will be. The comprehensive management in the subacute or chronic phase of PS-SMD with BoNT-A injections requires detailed assessment, patient-centered goal setting, technical-guided injection, effective dosing of BoNT-A per site, muscle, and session and timed adjunctive treatment, delivered in a multi-professional team approach in conjunction with physical treatment. Evidence-based data showed BoNT-A injections are safe and effective in managing focal, multifocal, segmental PS-SMD and its complications. If indicated, BoNT-A therapy should be accompanied with adjunctive treatment in adequate time slots. BoNT-A could be added to oral, intrathecal, and surgical treatment in severe multisegmental or generalized PS-SMD to reach patient/caregiver's goals, especially in chronic PS-SMD.
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Affiliation(s)
- Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585 Berlin, Germany.,Neurology and Psychosomatics at Wittenbergplatz, Out-Patient-Clinic, Ansbacher straße 17-19, 10787 Berlin, Germany
| | - Songjin Ri
- Neurology and Psychosomatics at Wittenbergplatz, Out-Patient-Clinic, Ansbacher straße 17-19, 10787 Berlin, Germany.,Department of Neurology, Charité University Hospital (CBS), Hindenburgdamm 30, Berlin 12203, Germany
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5
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Marín J, Blanco T, Marín JJ, Moreno A, Martitegui E, Aragüés JC. Integrating a gait analysis test in hospital rehabilitation: A service design approach. PLoS One 2019; 14:e0224409. [PMID: 31665158 PMCID: PMC6821402 DOI: 10.1371/journal.pone.0224409] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gait analysis with motion capture (MoCap) during rehabilitation can provide objective information to facilitate treatment decision making. However, designing a test to be integrated into healthcare services requires considering multiple design factors. The difficulty of integrating a 'micro-service' (gait test) within a 'macro-service' (healthcare service) has received little attention in the gait analysis literature. It is a challenge that goes beyond the gait analysis case study because service design methods commonly focus on the entire service design (macro-level). OBJECTIVE This study aims to extract design considerations and generate guidelines to integrate MoCap technology for gait analysis in the hospital rehabilitation setting. Specifically, the aim is to design a gait test to assess the response of the applied treatments through pre- and post-measurement sessions. METHODS We focused on patients with spasticity who received botulinum toxin treatment. A qualitative research design was used to investigate the integration of a gait analysis system based on inertial measurement units in a rehabilitation service at a reference hospital. The methodological approach was based on contrasted methodologies from the service design field, which materialise through observation techniques (during system use), semi-structured interviews, and workshops with healthcare professionals (13 patients, 10 'proxies', and 6 doctors). RESULTS The analysis resulted in six themes: (1) patients' understanding, (2) guiding the gait tests, (3) which professionals guide the gait tests, (4) gait test reports, (5) requesting gait tests (doctors and test guide communication), and the (6) conceptual design of the service with the gait test. CONCLUSIONS The extracted design considerations and guidelines increase the applicability and usefulness of the gait analysis technology, improving the link between technologists and healthcare professionals. The proposed methodological approach can also be useful for service design teams that deal with the integration of one service into another.
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Affiliation(s)
- Javier Marín
- IDERGO (Research and Development in Ergonomics) Research Group, I3A (Aragon Institute of Engineering Research), University of Zaragoza, Zaragoza, Spain
- Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain
| | - Teresa Blanco
- HOWLab (Human Openware Research Lab) Research Group, I3A, University of Zaragoza, Zaragoza, Spain
- GeoSpatiumLab, S.L. Zaragoza, Spain
| | - José J. Marín
- IDERGO (Research and Development in Ergonomics) Research Group, I3A (Aragon Institute of Engineering Research), University of Zaragoza, Zaragoza, Spain
- Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain
| | - Alejandro Moreno
- IDERGO (Research and Development in Ergonomics) Research Group, I3A (Aragon Institute of Engineering Research), University of Zaragoza, Zaragoza, Spain
- Department of Health and Sports Sciences, University of Zaragoza, Zaragoza, Spain
| | - Elena Martitegui
- Rehabilitation and Physical Medicine Service, HUMS (Miguel Servet University Hospital), Zaragoza, Spain
| | - Juan C. Aragüés
- Rehabilitation and Physical Medicine Service, HUMS (Miguel Servet University Hospital), Zaragoza, Spain
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Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2019; 100:1703-1725. [DOI: 10.1016/j.apmr.2019.01.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
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7
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Marque P, Denis A, Gasq D, Chaleat-Valayer E, Yelnik A, Colin C, Pérennou D. Botuloscope: 1-year follow-up of upper limb post-stroke spasticity treated with botulinum toxin. Ann Phys Rehabil Med 2019; 62:207-213. [DOI: 10.1016/j.rehab.2019.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022]
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8
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Huang YC, Chen PC, Tso HH, Yang YC, Ho TL, Leong CP. Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study. Eur J Phys Rehabil Med 2019; 55:551-557. [PMID: 31199103 DOI: 10.23736/s1973-9087.19.05684-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke. AIM The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke. DESIGN A randomized controlled pilot study. SETTING A hospital center. POPULATION Participants with stroke within six months. METHODS Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week). RESULTS Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037). CONCLUSIONS Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke. CLINICAL REHABILITATION IMPACT Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.
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Affiliation(s)
- Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Hsin Tso
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chien Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzai-Lun Ho
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan - .,Chang Gung University College of Medicine, Kaohsiung, Taiwan
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9
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Gao J, Rubin JM, Chen J, O'Dell M. Ultrasound Elastography to Assess Botulinum Toxin A Treatment for Post-stroke Spasticity: A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1094-1102. [PMID: 30898386 DOI: 10.1016/j.ultrasmedbio.2018.10.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
The aim of the study was to evaluate the feasibility of using ultrasound elastography to assess the effect of botulinum toxin A (BoNT-A) treatment on post-stroke spasticity of the upper limb. In this prospective study, we performed ultrasound elastography (strain imaging and acoustic radiation force impulse-based shear wave elastography) of the spastic biceps brachii muscle in seven patients (five men and two women, mean age: 45y) who underwent BoNT-A injection treatment for post-stroke spasticity of the upper limb. We measured ultrasound elasticity parameters including axial strain ratio (SR) (SR = muscle strain/reference strain), longitudinal SR and shear wave velocity of the biceps muscle immediately before and 17-30 d (mean: 22 d) after BoNT-A injection. Statistical analyses included a two-tailed paired t-test to examine the difference in ultrasound elasticity parameters of bilateral biceps muscles before and after BoNT-A treatment and a Spearman rank correlation coefficient (rs) to analyze the correlation of ultrasound elasticity parameters to clinical assessment with the Modified Ashworth Scale (MAS) and Tardieu Scale (TS). The difference in ultrasound elasticity parameters before and after BoNT-A treatment was significant (p < 0.05) in the treated spastic muscle. The correlation of ultrasound elasticity parameters with MAS and the angle of catch and range of motion in TS were also significant (rs = 0.55-0.95, p < 0.05). Our results suggest that ultrasound elastography is feasible in assessment of the effectiveness of BoNT-A treatment for post-stroke spasticity of the upper limb.
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Affiliation(s)
- Jing Gao
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, New York, USA; Rocky Vista University, Ivins, Utah, USA.
| | | | - Johnson Chen
- Department of Radiology, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Michael O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, Cornell University, New York, New York, USA
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10
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Abstract
There are many nonsurgical treatment options for patients with upper limb spasticity. This article presents an algorithmic approach to management, encompassing evidence-based rehabilitation therapies, medications, and promising new orthotic and robotic innovations.
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Affiliation(s)
- Laura Black
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 355 East Erie Street, 21st Floor, Suite 2127, Chicago, IL 60601, USA.
| | - Deborah Gaebler-Spira
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 355 East Erie Street, Chicago, IL 60601, USA
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11
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Cascaes LHFDS, Oliveira JCD. Evidências sobre relaxantes musculares de uso ambulatorial: uma revisão da literatura. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc12(39)1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Avaliar as evidências sobre eficácia e efeitos adversos dos relaxantes musculares de uso oral disponíveis no Brasil para espasticidade, condições musculoesqueléticas, fibromialgia e cefaleia tensional. Métodos: Realizou-se uma revisão da literatura a partir de revisões sistemáticas publicadas no Medline, BVS, biblioteca Cochrane e National Institute for Health and Care Excellence (NICE) até dezembro de 2016, que avaliaram os fármacos considerados relaxantes musculares pela Anatomical Therapeutic Chemical (ATC) e disponíveis no Brasil na forma oral: ciclobenzaprina, tizanidina, carisoprodol, orfenadrina e baclofeno. Resultados: Foram identificados 20 estudos, sendo 17 revisões sistemáticas e três meta-análises. As evidências de eficácia dos relaxantes musculares consistem principalmente em estudos com concepção metodológica ruim. Estudos de comparação não mostraram que um relaxante muscular esquelético seja superior a outro. Ciclobenzaprina demonstrou eficácia em condições musculoesqueléticas, como dor miofascial mandibular, fibromialgia e dor lombar. Na fibromialgia, demonstrou benefício na melhora geral e no sono. No manejo da dor lombar, a ciclobenzaprina mostrou efeito modesto, mais presente nos quatro primeiros dias. Carisoprodol na dor lombar baixa não parece ter diferença de ciclobenzaprina, mas esse medicamento pode causar dependência. Baclofeno e tizanidina parecem ser eficazes em comparação com placebo e equivalentes em doentes com espasticidade. Conclusões: Os relaxantes musculares em geral, comparados a placebo ou entre si, apresentaram poucas evidências com estatística significante. Portanto, a seleção do medicamento deve ser baseada no perfil de efeitos adversos, preferência do paciente, potencial de abuso, potencial de interação com outros medicamentos, custo e outras características dos fármacos.
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12
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Prevalence of Bleeding Complications Following Ultrasound-Guided Botulinum Toxin Injections in Patients on Anticoagulation or Antiplatelet Therapy. PM R 2017. [DOI: 10.1016/j.pmrj.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Naro A, Leo A, Russo M, Casella C, Buda A, Crespantini A, Porcari B, Carioti L, Billeri L, Bramanti A, Bramanti P, Calabrò RS. Breakthroughs in the spasticity management: Are non-pharmacological treatments the future? J Clin Neurosci 2017; 39:16-27. [DOI: 10.1016/j.jocn.2017.02.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
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14
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Kim DY, Kim YH, Lee J, Chang WH, Kim MW, Pyun SB, Yoo WK, Ohn SH, Park KD, Oh BM, Lim SH, Jung KJ, Ryu BJ, Im S, Jee SJ, Seo HG, Rah UW, Park JH, Sohn MK, Chun MH, Shin HS, Lee SJ, Lee YS, Park SW, Park YG, Paik NJ, Lee SG, Lee JK, Koh SE, Kim DK, Park GY, Shin YI, Ko MH, Kim YW, Yoo SD, Kim EJ, Oh MK, Chang JH, Jung SH, Kim TW, Kim WS, Kim DH, Park TH, Lee KS, Hwang BY, Song YJ. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Kang Jae Jung
- Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hee Suk Shin
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Nam Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea
| | - Kwan-Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Byong-Yong Hwang
- Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea
| | - Young Jin Song
- Department of Rehabilitation Medicine, Asan Medical Center, Korea
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Procedure-Oriented Torsional Anatomy of the Hand for Spasticity Injection. J Comput Assist Tomogr 2017; 41:336-338. [DOI: 10.1097/rct.0000000000000580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rosales RL, Efendy F, Teleg ESA, Delos Santos MMD, Rosales MCE, Ostrea M, Tanglao MJ, Ng AR. Botulinum toxin as early intervention for spasticity after stroke or non-progressive brain lesion: A meta-analysis. J Neurol Sci 2016; 371:6-14. [DOI: 10.1016/j.jns.2016.10.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/01/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
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Lindsay C, Kouzouna A, Simcox C, Pandyan AD. Pharmacological interventions other than botulinum toxin for spasticity after stroke. Cochrane Database Syst Rev 2016; 10:CD010362. [PMID: 27711973 PMCID: PMC6457886 DOI: 10.1002/14651858.cd010362.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The long-term risk of stroke increases with age, and stroke is a common cause of disability in the community. Spasticity is considered a significantly disabling impairment that develops in people who have had a stroke. The burden of care is higher in stroke survivors who have spasticity when compared with stroke survivors without spasticity with regard to treatment costs, quality of life, and caregiver burden. OBJECTIVES To assess if pharmacological interventions for spasticity are more effective than no intervention, normal practice, or control at improving function following stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 5), MEDLINE (1946 to May 2016), Embase (2008 to May 2016), CINAHL (1982 to May 2016), AMED (1985 to May 2016), and eight further databases and trial registers. In an effort to identify further studies, we undertook handsearches of reference lists and contacted study authors and commercial companies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared any systemically acting or locally acting drug versus placebo, control, or comparative drug with the aim of treating spasticity. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion and extracted the data. We assessed the included studies for both quality and risk of bias. We contacted study authors to request further information when necessary. MAIN RESULTS We included seven RCTs with a total 403 participants. We found a high risk of bias in all but one RCT. Two of the seven RCTs assessed a systemic drug versus placebo. We pooled data on an indirect measure of spasticity (160 participants) from these two studies but found no significant effect (odds ratio (OR) 1.66, 95% confidence interval (CI) 0.21 to 13.07; I2 = 85%). We identified a significant risk of adverse events per participant occurring in the treatment group versus placebo group (risk ratio (RR) 1.65, 95% CI 1.12 to 2.42; 160 participants; I2 = 0%). Only one of these studies used a functional outcome measure, and we found no significant difference between groups.Of the other five studies, two assessed a systemic drug versus another systemic drug, one assessed a systemic drug versus local drug, and the final two assessed a local drug versus another local drug. AUTHORS' CONCLUSIONS The lack of high-quality RCTs limited our ability to make specific conclusions. Evidence is insufficient to determine if systemic antispasmodics are effective at improving function following stroke.
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Affiliation(s)
- Cameron Lindsay
- South Eastern Health and Social Care TrustDepartment of PhysiotherapyUpper Newtownards RoadBelfastCo Down, Northern IrelandUKBT161RH
| | - Aphrodite Kouzouna
- Keele UniversitySchool of Health and RehabilitationMacKay BuildingKeeleUKST5 5BG
| | - Christopher Simcox
- Derbyshire Community Health ServicesCommunity Rehabilitation ServiceChesterfieldDerbyshireUK
| | - Anand D Pandyan
- Keele UniversitySchool of Health and RehabilitationMacKay BuildingKeeleUKST5 5BG
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1538] [Impact Index Per Article: 192.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Chiou-Tan F, Cianca J, John J, Furr-Stimming E, Pandit S, Taber KH. Procedure Oriented Torsional Anatomy of the Forearm for Spasticity Injection. J Comput Assist Tomogr 2015; 39:820-3. [PMID: 26248152 DOI: 10.1097/rct.0000000000000290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED : This is the second in a series of articles related to the concept of "torsional" anatomy. The objective of this article is to provide musculoskeletal ultrasound (MSKUS) anatomy of the forearm in the position of hemispastic flexion as a reference relevant to needle procedures. METHODS The MSKUS images were obtained in a healthy human subject. Marker dots were placed over common injection sites in the forearm for spasticity. The MSKUS probe was centered over each dot to obtain a cross-sectional view. A pair of MSKUS images was recorded for each site: the first in anatomic neutral and second in hemiparetic spastic position. The images were compared side to side. In addition, a video recording was made at each site to track the movement of the muscles and nerves during internal rotation. RESULTS The pronator teres (PT) rotated medially and the brachialis and biceps tendon rotated in view. In addition, the median nerve became more superficial. The flexor carpi radialis rotated medially and was replaced by PT and the median nerve. The flexor carpi ulnaris and flexor digitorum profundus rotated medially and were replaced by the flexor carpi radialis, PT and median nerve. The flexor digitorum superficialis was replaced by the brachioradialis, extensor carpi radialis brevis, and radial nerve. The brachioradialis was replaced by the extensor carpi radialis brevis and extensor digitorum communis. DISCUSSION Intended muscle targets rotate out of view and injection range. These are replaced by other muscles and nerves that could inadvertently be injected. This potentially could result in both increased complications and decreased efficacy of the procedure. CONCLUSIONS It is hoped that this series of images will increase the accuracy and safety of needle placement for spasticity injections in the forearm.
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Affiliation(s)
- Faye Chiou-Tan
- From the *Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Center for Trauma Rehabilitation Research, Quentin Mease Hospital, Harris County Hospital District; †Department of Neurology, University of Texas School of Medicine, Houston, TX; ‡Veterans Affairs Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center, Durham; and §Research and Education Service Line, W G Hefner Veterans Affairs Medical Center, Salisbury, NC
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Procedure-oriented torsional anatomy of the proximal arm for spasticity injection. J Comput Assist Tomogr 2015; 39:449-52. [PMID: 25938215 DOI: 10.1097/rct.0000000000000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED This is the first in a series of papers related to the new concept of "torsional" anatomy. The objective of this article is to provide musculoskeletal ultrasound (MSKUS) anatomy of the upper arm in the position of hemispastic flexion as a reference relevant to needle procedures. METHODS The MSKUS images were obtained in a healthy human subject. A pair of MSKUS images was recorded for each level: the first in anatomic neutral and second in hemispastic position. RESULTS At the proximal 1/3 level of the upper arm, the pectoralis major rotated out of view. At the middle of the upper arm, the biceps rotated medially, and the brachialis rotated from far lateral to the middle of the screen. At the distal 1/3 level of the upper arm, the radial nerve rotated more anteriorly. At the distal 1/6 level of the upper arm, the biceps shifted and was replaced by the brachialis and brachioradialis. The radial nerve also rotated more anteriorly and superficially. DISCUSSION With torsion, it is possible that intended muscle targets, such as the pectoralis, are missed, and unintended targets, such as the radial nerve, are accidentally injected in the upper arm. CONCLUSIONS It is hoped that this series of images will increase the accuracy and safety of needle placement for spasticity and nerve block injections in the proximal upper arm.
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
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Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
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Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: Physiology, assessment and treatment. Brain Inj 2013; 27:1093-105. [PMID: 23885710 DOI: 10.3109/02699052.2013.804202] [Citation(s) in RCA: 236] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aurore Thibaut
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Camille Chatelle
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Erik Ziegler
- Cyclotron Research Centre, University of Liège
LiègeBelgium
| | - Marie-Aurélie Bruno
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
| | - Olivia Gosseries
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège
LiègeBelgium
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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: 76] [Impact Index Per Article: 6.3] [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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Geller AI, Nopkhun W, Dows-Martinez MN, Strasser DC. Polypharmacy and the role of physical medicine and rehabilitation. PM R 2012; 4:198-219. [PMID: 22443958 DOI: 10.1016/j.pmrj.2012.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/08/2012] [Accepted: 02/10/2012] [Indexed: 02/07/2023]
Abstract
Polypharmacy and inappropriate prescribing practices lead to higher rates of mortality and morbidity, particularly in vulnerable populations, such as the elderly and those with complex medical conditions. Physical medicine and physiatrists face particular challenges given the array of symptoms treated across a spectrum of conditions. This clinical review focuses on polypharmacy and the associated issue of potentially inappropriate prescribing. The article begins with a review of polypharmacy along with relevant aspects of pharmacokinetics and pharmacodynamics in the elderly. The adverse effects and potential hazards of selected medications commonly initiated and managed by rehabilitation specialists are then discussed with specific attention to pain medications, neurostimulants, antipsychotics, antidepressants, antispasmodics, sleep medications, and antiepileptics. Of particular concern is the notion that an adverse effect of one medication can mimic an indication for another and lead to a prescribing cascade and further adverse medication events. Appropriate prescribing practices mandate an accurate, current medication list, yet errors and inaccuracies often plague such lists. The evidence to support explicit (medications to avoid) and implicit (how to evaluate) criteria is presented along with the role of physicians and patients in prescribing medications. A brief discussion of "medication debridement" or de-prescribing strategies follows. In the last section, we draw on the essence of physiatry as a team-based endeavor to discuss the potential benefits of collaboration. In working to optimize medication prescribing, efforts should be made to collaborate not only with pharmacists and other medical specialties but with members of inpatient rehabilitation teams as well.
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Affiliation(s)
- Andrew I Geller
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, USA
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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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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e3182434f58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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