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Kırmacı ZİK, Adigüzel H, Kırmacı YŞ, Taşvuran Horata E, Tuncel Berktaş D, Erel S. Turkish translation and transcultural validity and reliability of an assessment tool for spasticity: Leg Activity Measure (Leg A). Neurol Res 2024; 46:644-652. [PMID: 38695372 DOI: 10.1080/01616412.2024.2340878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/03/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The Leg Activity Measure is the only self-report measure that has been published to date that takes into account both the influence on quality of life and passive and active function in the literature. AIMS The purpose is to examine the translation, cross-cultural adaptation validity and reliability of the Turkish version of the Leg Activity Measure (Tr-LegA). METHODS Neurological patients (n = 52) with lower limb spasticity (aged 47.09 ± 14.74 years) were enrolled. The study consisted of two stages. At the first stage, the scale was translated into Turkish and culturally adapted. Validity and reliability analyses were conducted at the second stage. Construct validity was evaluated by exploratory factor analysis (EFA). The Rivermead Mobility Index (RMI), Nottingham Health Profile (NHP), and Functional Independence Measure (FIM) were used for convergent validity. The reproducibility (test-retest reliability) was assessed by the intraclass correlation coefficient (ICC). Furthermore, the standard error of measurement (SEM) was calculated. RESULTS EFA suggested one factor for the Passive Function and two factors for the Active Function and Impact on Quality of Life Scales (QoL). Tr-LegA Passive and Active Function Scales were correlated with the total RMI, NHP, and FIM (p < 0.05). Tr-LegA Impact on Quality of Life Scale was correlated with the RMI and NHP (p < 0.05). Tr-LegA Passive Function Scale (ICC = 0.997), Tr-LegA Active Function Scale (ICC = 0.996), and Tr-LegA Impact on Quality of Life Scale (ICC = 0.976) had good reliability. Only Passive Function Scale had a significant floor effect (25%). CONCLUSIONS Tr-LegA is a valid and reliable multidimensional scale for passive and active function and quality of life in patients with lower limb spasticity. THE CLINICAL TRIAL NUMBER NCT05182411.
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Affiliation(s)
- Zekiye İpek Katırcı Kırmacı
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Hatice Adigüzel
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Kahramanmaras Sutçu Imam University, Kahramanmaras, Turkey
| | - Yusuf Şinasi Kırmacı
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Emel Taşvuran Horata
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | | | - Suat Erel
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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Facciorusso S, Spina S, Picelli A, Baricich A, Francisco GE, Molteni F, Wissel J, Santamato A. The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis. Toxins (Basel) 2024; 16:184. [PMID: 38668609 PMCID: PMC11053519 DOI: 10.3390/toxins16040184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
Botulinum toxin type-A (BoNT-A) has emerged as a key therapeutic agent for the management of spasticity. This paper presents a comprehensive bibliometric and visual analysis of research concerning BoNT-A treatment of spasticity to elucidate current trends and future directions in this research area. A search was conducted in the Web of Science database for articles focused on the use of BoNT-A in spasticity published between 2000 and 2022. We extracted various metrics, including counts of publications and contributions from different countries, institutions, authors, and journals. Analytical methods in CiteSpace were employed for the examination of co-citations, collaborations, and the co-occurrence of keywords. Our search yielded 1489 publications. Analysis revealed a consistent annual increase in research output. The United States, United Kingdom, and Italy were the leading contributors. The top institution in this research was Assistance Publique Hopitaux, Paris. The journal containing the highest number of relevant publications was Toxins. Key frequently occurring keywords were 'stroke', 'cerebral palsy', 'adult spasticity', and 'upper extremity'. This study identified 12 clusters of keywords and 15 clusters of co-cited references, indicating the main focus areas and emerging themes in this field. This study comprehensively analyzed and summarized trends in BoNT-A research in the field of spasticity over the past 22 years.
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Affiliation(s)
- Salvatore Facciorusso
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy;
| | - Alessio Baricich
- Physical Medicine and Rehabilitation, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Gerard E. Francisco
- Department of Physical Medicine & Rehabilitation, University of Texas Health McGovern Medical School, Houston, TX 77030, USA;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital Como, 23845 Costa Masnaga, Italy;
| | - Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Hospital Spandau, 13585 Berlin, Germany;
| | - Andrea Santamato
- Spasticity and Movement Disorders “ReSTaRt”, Unit Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
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Chan NH, Ng SSM. Psychometric properties of the Chinese version of the Arm Activity Measure in people with chronic stroke. Front Neurol 2023; 14:1248589. [PMID: 37808490 PMCID: PMC10556664 DOI: 10.3389/fneur.2023.1248589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The Arm Activity Measure was developed to assess active and passive functions of the upper limb in people with unilateral paresis, but a Chinese version is not available and its psychometric properties have not been specifically tested in people with stroke. This study aimed to translate and culturally adapt the Chinese version of the Arm Activity Measure (ArmA-C) and establish its psychometric properties in people with chronic stroke. Methods The psychometric properties of ArmA-C were determined in 100 people with chronic stroke. Results The ArmA-C had good test-retest reliability (intraclass correlation coefficients [ICC] = 0.87-0.93; quadratic weighted Kappa coefficients = 0.53-1.00). A floor effect was identified in section A of the ArmA-C. The content validity and internal consistency (Cronbach's alpha coefficients = 0.75-0.95) were good. The construct validity of the ArmA-C was supported by acceptable fit to the two-factor structure model and significant correlations with the Fugl-Meyer Assessment for Upper Extremity score, grip strength, the Wolf Motor Function Test score, the Trail Walking Test completion time, and the Oxford Participation and Activities Questionnaire scores. Conclusions The ArmA-C is reliable and valid for assessing active and passive functions in people with chronic stroke.
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Affiliation(s)
- Nga Huen Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Hefter H, Nickels W, Rosenthal D, Samadzadeh S, Albrecht P. Continuous Increase of Efficacy under Repetitive Injections of Botulinum Toxin Type/A beyond the First Treatment for Adult Spastic Foot Drop. Toxins (Basel) 2021; 13:toxins13070466. [PMID: 34357938 PMCID: PMC8310361 DOI: 10.3390/toxins13070466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to quantify the increase in efficacy during the first four cycles of treatment with botulinum toxin type/A (BoNT/A) in 24 free-walking BoNT/A naïve adult patients with post-stroke hemispasticity and spastic foot drop. Patients were followed over 390 days and received five injections of 800 U aboBoNT/A every three months. Patients assessed the treatment effect at eight visits using a global assessment scale, physicians scored the muscle tone at the ankle joint, measured active and passive ranges of motion (aRoMs, pRoMs) at the knee and ankle joint and determined the distance patients succeeded to walk during a minute. Patients' assessments significantly (p < 0.006) increased with time and significantly correlated with all parameters measured. The best correlation (r = 0.927; p < 0.0001) was found with the sum of the aRoMs of knee and ankle joint. After one year of treatment outcome measures were better than and significantly correlated with the peak effect of the first injection. This correlation was higher for pRoMs (r = 0.855; p < 0.00001) compared to aRoMs (r = 0.567; p < 0.009). When BoNT/A treatment of the spastic foot in chronic hemispasticity is performed regularly every three months for at least one year, patients will experience a significant increase of benefit beyond the first treatment, but have to learn how to adapt to and use the new degree of freedom induced by the injections.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
- Correspondence:
| | - Werner Nickels
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
- Department of Neurology, Ruland-Kliniken, Neuenbürger Strasse 49, D-75335 Dobel, Germany
| | - Dietmar Rosenthal
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
| | - Sara Samadzadeh
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
| | - Philipp Albrecht
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
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Franck JA, Smeets RJEM, Elmanowski J, Renders K, Seelen HAM. Added-value of spasticity reduction to improve arm-hand skill performance in sub-acute stroke patients with a moderately to severely affected arm-hand. NeuroRehabilitation 2021; 48:321-336. [PMID: 33814471 PMCID: PMC8150539 DOI: 10.3233/nre-201622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE: Stroke patients with a moderately to severely affected hand may be impeded in exploiting their full arm-hand training potential during rehabilitation due to spasticity. Reducing early signs of spasticity in sub-acute stroke patients may lead to improvements in arm-hand-function and arm-hand-skill-performance. METHODS: Single-case-experimental-design and meta-analysis. Ten sub-acute stroke patients (Modified-Ashworth-Scale:1 + to 3) participated. Training: 2x6 weeks, using a well-described arm-hand regime (therapy-as-usual). Botulinum-toxin was administered once within 5 weeks after onset of therapy-as-usual. Measures: Action-Research-Arm-Test, ABILHAND, Fugl-Meyer-Assessment, grip-strength, Motricity-Index. RESULTS: At group level, after baseline trend correction, adjusting for spontaneous recovery and therapy-as-usual effects, the added-value of botulinum-toxin-A on arm-hand-function and arm-hand-skill-performance was not confirmed. However, non-detrended data revealed significant improvements over time on arm-hand-function and arm-hand-skill-performance level (p≤0.037). Conversely, at individual level, after baseline trend correction, 7/10 patients improved on arm-hand-function: Fugl-Meyer-Assessment (N = 4; p≤0.019), grip-strength (N = 3; p≤0.014), Motricity-Index (N = 4; p≤0.002), whereas 6/10 patients improved on arm-hand-skill-performance: Action-Research-Arm-Test (N = 3; p≤0.042), ABILHAND (N = 5; p≤0.034). CONCLUSION: Application of botulinum-toxin-A may have an added-value in a substantial part of sub-acute stroke patients suffering from spasticity early post-stroke and who, at the point of therapy admission, display no dexterity. It may improve their arm-hand performance when combined with a well– defined therapy-as-usual.
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Affiliation(s)
- Johan Anton Franck
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | - Jule Elmanowski
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre, Hoensbroek, The Netherlands
| | - Karolien Renders
- Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre, Hoensbroek, The Netherlands
| | - Henk Alexander Maria Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
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Choudhry S, Patritti BL, Woodman R, Hakendorf P, Huang L. Goal Attainment: A Clinically Meaningful Measure of Success of Botulinum Toxin-A Treatment for Lower Limb Spasticity in Ambulatory Patients. Arch Rehabil Res Clin Transl 2021; 3:100129. [PMID: 34124643 PMCID: PMC8175278 DOI: 10.1016/j.arrct.2021.100129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The objectives of this study were to evaluate whether botulinum toxin type A (BoNT-A) treatment for lower limb spasticity leads to patient goal attainment and identify factors associated with positive goal attainment and to assess the effect of BoNT-A treatment on patients’ gait. Design Retrospective cohort study between June 2014 and February 2019. Setting Public outpatient spasticity clinic in a tertiary hospital. Participants Thirty patients (N=30; 50% female; average age, 50.5y) with lower limb spasticity of heterogenous etiologies (96.7% cerebral±spinal origin and 3.3% isolated spinal origin); 73.3% (N=22) of patients had previously received BoNT-A treatment. Interventions BoNT-A injection to lower limb muscles. Main Outcome Measures The primary outcome measure was goal attainment measured using Goal Attainment Scaling. The Modified Ashworth Scale (MAS) was used to assess spasticity. Gait was characterized by spatiotemporal parameters. Results Fifty-six treatment episodes were analyzed and showed that BoNT-A treatment resulted in a significant reduction in spasticity (pretreatment MAS=3.18±0.73; posttreatment MAS=2.27±0.89; P<.001) with no associated change in gait parameters. Logistic regression revealed that most patients (74.1%) achieved all of their goals, with younger patients having a high likelihood of goal attainment regardless of their gait profile identified by latent profile analysis of the gait parameters. Patients considered to have a low functioning gait profile demonstrated a significantly greater likelihood of goal attainment than patients with the other gait profiles combined (odds ratio, 45.6; 95% confidence interval, 1.3-1602.1; P=.036). Chronic spasticity and pretreatment severity of spasticity (MAS) and its reduction were not associated with likelihood of goal attainment. Conclusions The success and efficacy of BoNT-A treatment in improving patient perceived gait quality and reducing the negative symptoms of spasticity were best measured using Goal Attainment Scaling. The study emphasizes the importance of measuring patient goals as a clinical outcome. Gait parameters were most informative when used collectively to classify patients based on their overall gait profile, which assisted in identifying differences between patients’ likelihood of goal attainment after treatment.
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Affiliation(s)
- Subbuh Choudhry
- Division of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Adelaide
| | - Benjamin L Patritti
- Division of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Adelaide.,College of Medicine and Public Health, Flinders University, Adelaide
| | - Richard Woodman
- Flinders Health and Medical Research Institute, Health Data Sciences, College of Medicine and Public Health, Flinders University, Adelaide
| | - Paul Hakendorf
- Flinders Health and Medical Research Institute, Health Data Sciences, College of Medicine and Public Health, Flinders University, Adelaide.,Clinical Epidemiology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Lydia Huang
- Division of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Adelaide.,College of Medicine and Public Health, Flinders University, Adelaide
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Santamato A, Facciorusso S, Spina S, Cinone N, Avvantaggiato C, Santoro L, Ciritella C, Smania N, Picelli A, Gasperini G, Molteni F, Baricich A, Fiore P. Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity. Eur J Phys Rehabil Med 2020; 57:424-433. [PMID: 33263248 DOI: 10.23736/s1973-9087.20.06478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected health-care systems worldwide, including the outpatient spasticity care with botulinum neurotoxin toxin type A (BoNT-A). AIM The aim of this study was to investigate the impact of discontinuation of BoNT-A treatment on patients living with spasticity during the COVID-19 quarantine. DESIGN A multicentric cross-sectional study. SETTING Outpatients setting. POPULATION Patients with spasticity after stroke and traumatic brain injury treated with BoNT-A. METHODS A phone-based survey was conducted from March to May, 2020. Based on the International Classification of Functioning, Disability and Health (ICF), an ad hoc questionnaire CORTOX (CORonavirus TOXin survey) was developed to investigate patients' experiences following the discontinuation of their usual treatment for spasticity due to the lockdown and its implication on their health perception. It assessed patients' condition and explored different ICF domains related to spasticity: unpleasant sensations, mobility, self-care, facilitators and psychosocial factors. The sum of those represented the CORTOX score (Max 142). The questionnaire also collected data about the impact of COVID-19 on patients' wellbeing (mood, sleep, relationships, community life, motivation). RESULTS A total of 151 participants completed the survey. Most participants (72.2%) experienced a worsening in perceived spasticity, 53% got worse in independence and 70.9% had a negative impact on quality of life. The mean CORTOX score was 52.85±27.25, reflecting a perceived worsening in all ICF domains investigated. Moderate to strong correlations were found between different sub-scores of the questionnaire and severity of spasticity (P<0.001). COVID-19 psychosocial related factors were associated with loss of independence (P<0.05) but only mood was associated with worsening of spasticity (P<0.001). The lack of rehabilitation therapy was significantly associated with the worsening of independence but not with the worsening of spasticity. Finally, respondents reported that BoNT-A was useful to their condition and should not be discontinued. CONCLUSIONS The discontinuation of BoNT-A treatment was associated with worsening of activities and participation and perceived spasticity. COVID-19 related problems and rehabilitation showed an association with loss of independence. CLINICAL REHABILITATION IMPACT This study will provide useful information in the field of spasticity management using a patient's centred approach, with consistent quantitative and qualitative information.
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Affiliation(s)
- Andrea Santamato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy - .,"Fondazione Turati", Rehabilitation Center, Vieste, Foggia, Italy -
| | - Salvatore Facciorusso
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicoletta Cinone
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Christian Avvantaggiato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Luigi Santoro
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Chiara Ciritella
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicola Smania
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, Maggiore della Carità University Hospital, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
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Toro J, Martiny K. New perspectives on person-centered care: an affordance-based account. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:631-644. [PMID: 32886295 DOI: 10.1007/s11019-020-09977-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.
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Affiliation(s)
- Juan Toro
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark.
- The Enactlab, Copenhagen, Denmark.
| | - Kristian Martiny
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
- The Enactlab, Copenhagen, Denmark
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Gracies JM, Jech R, Valkovic P, Marque P, Vecchio M, Denes Z, Vilain C, Delafont B, Picaut P. When can maximal efficacy occur with repeat botulinum toxin injection in upper limb spastic paresis? Brain Commun 2020; 3:fcaa201. [PMID: 33543139 PMCID: PMC7850141 DOI: 10.1093/braincomms/fcaa201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/05/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022] Open
Abstract
Repeated injection cycles with abobotulinumtoxinA, a botulinum toxin type A, are recommended in current clinical guidelines as a treatment option for adults with upper limb spastic paresis. However, the magnitude of the maximal therapeutic effect of repeated abobotulinumtoxinA treatment across different efficacy parameters and the number of injection cycles required to reach maximal effect remain to be elucidated. Here, we present a post hoc exploratory analysis of a randomized, double-blind, placebo-controlled trial (12–24 weeks; NCT01313299) and open-label extension study (up to 12 months; NCT0131331), in patients aged 18–80 years with hemiparesis for ≥6 months after stroke/traumatic brain injury. Two inferential methods were used to assess the changes in efficacy parameters after repeat abobotulinumtoxinA treatment cycles: Mixed Model Repeated Measures analysis and Non-Linear Random Coefficients analysis. Using the latter model, the expected maximal effect size (not placebo-controlled) and the number of treatment cycles to reach 90% of this maximal effect were estimated. Treatment responses in terms of passive and perceived parameters (i.e. modified Ashworth scale in primary target muscle group, disability assessment scale for principal target for treatment or limb position, and angle of catch at fast speed) were estimated to reach near-maximal effect in two to three cycles. Near-maximal treatment effect for active parameters (i.e. active range of motion against the resistance of extrinsic finger flexors and active function, assessed by the Modified Frenchay Scale) was estimated to be reached one to two cycles later. In contrast to most parameters, active function showed greater improvements at Week 12 (estimated maximal change from baseline-modified Frenchay Scale overall score: +0.8 (95% confidence interval, 0.6; 1.0) than at Week 4 (+0.6 [95% confidence interval, 0.4; 0.8]). Overall, the analyses suggest that repeated treatment cycles with abobotulinumtoxinA in patients chronically affected with upper limb spastic paresis allow them to relearn how to use the affected arm with now looser antagonists. Future studies should assess active parameters as primary outcome measures over repeated treatment cycles, and assess efficacy at the 12-week time-point of each cycle, as the benefits of abobotulinumtoxinA may be underestimated in the studies of insufficient duration. Abbreviated summary In this post hoc analysis of repeated abobotulinumtoxinA injection cycles in upper limb spastic paresis, Gracies et al. used statistical modelling to elucidate the maximal therapeutic effect of abobotulinumtoxinA. Notably, the number of injections required to reach this maximal effect was higher for active (e.g. active function) compared with passive (e.g. tone) parameters.
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Affiliation(s)
- Jean-Michel Gracies
- UR 7377 BIOTN, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Peter Valkovic
- 2nd Department of Neurology, Comenius University Faculty of Medicine and University Hospital Bratislava, Bratislava, Slovak Republic
| | - Philippe Marque
- Service de médecine physique et réadaptation, Hôpital Rangueil, Toulouse, France
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Physical Medicine and Rehabilitation Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Zoltan Denes
- Brain Injury Rehabilitation Unit, National Institute for Medical Rehabilitation, Budapest, Hungary
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Deveci H. Evaluation of the Effectiveness of Treatment with Botulinum Toxin on Sleep Quality in Stroke-Related Spasticity. J Stroke Cerebrovasc Dis 2020; 29:105160. [PMID: 32912522 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/26/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Botulinum toxin (BoNT) is a commonly used agent in the treatment of stroke-related spasticity. Sleep disorders can often be seen as a comorbidity or complication in stroke patients. Based on the data that spasticity is associated with sleep disorders, in this study, we aimed to evaluate whether sleep quality has changed in patients with stroke treated with BoNT. METHODS Thirty five (17 female / 18 male) stroke patients with gastrocnemius and / or soleus spasticity were included in this observational cross-sectional study. In clinical evaluation before and three months after BoNT injection; for spasticity evaluation modified Ashworth scale (MAS), pain assessment visual analog scale (VAS), functional evaluation; passive joint range of motion (ROM) measurement, functional independence measurement (FIM), lower limb Brunstrom staging, life quality assessment short form-36 (SF-36) quality of life scale, and sleep quality assessment Pittsburgh sleep quality index (PSQI) scales were used. RESULTS After the BoNT injection, there was a statistically significant decrease in MAS and VAS scores, a significant increase in passive ROM measurements, FIM, lower limb Brunstrom staging, and SF-36 physical function sub parameter. There was also a significant decrease in PSQI scores. Before and after treatment, there was no correlation found between PSQI values with pain and spasticity. However, there was a weak negative correlation between post-treatment PSQI values, passive ROM, SF-36 physical function and SF-36 physical role sub parameters (respectively: r: -0.335 p: 0.049, r: -0.364, 0.032, r: -0.404, p: 0.016). Conlusion: The results of our study suggest that BoNT, which is frequently used in the treatment of spasticity in stroke patients, has positive effects on sleep quality.
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Affiliation(s)
- Hulya Deveci
- Department of Physical Medicine and Rehabilitation, Tokat Gaziosmanpasa University Medical Faculty, 60100 Tokat, Turkey.
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11
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Kaya CS, Yılmaz EO, Akdeniz-Doğan ZD, Yucesoy CA. Long-Term Effects With Potential Clinical Importance of Botulinum Toxin Type-A on Mechanics of Muscles Exposed. Front Bioeng Biotechnol 2020; 8:738. [PMID: 32695774 PMCID: PMC7338794 DOI: 10.3389/fbioe.2020.00738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Botulinum toxin type-A (BTX-A) is widely used for spasticity management and mechanically aims at reducing passive resistance at the joint and widening joint range of movement. However, recent experiments on acute BTX-A effects showed that the injected rat tibialis anterior (TA) muscle’s passive forces increased, and the length range of active force exertion (lrange) did not change. Additionally, BTX-A was shown to spread into non-injected muscles in the compartment and affect their mechanics. Whether those effects persist in the long term is highly important, but unknown. The aim was to test the following hypotheses with experiments conducted in the anterior crural compartment of the rat: In the long term, BTX-A (1) maintains lrange, (2) increases passive forces of the injected TA muscle, and (3) spreads into non-injected extensor digitorum longus (EDL) and the extensor hallucis longus (EHL) muscles, also affecting their active and passive forces. Male Wistar rats were divided into two groups: BTX-A and Control (0.1 units of BTX-A or only saline was injected into the TA). Isometric forces of the muscles were measured simultaneously 1-month post-injection. The targeted TA was lengthened, whereas the non-targeted EDL and EHL were kept at constant length. Hydroxyproline analysis was done to quantify changes in the collagen content of studied muscles. Two-way ANOVA test (for muscle forces, factors: TA length and animal group) and unpaired t or Mann-Whitney U test (for lrange and collagen content, where appropriate) were used for statistical analyses (P < 0.05). BTX-A caused significant effects. TA: active forces decreased (maximally by 75.2% at short and minimally by 48.3%, at long muscle lengths), lrange decreased (by 22.9%), passive forces increased (by 12.3%), and collagen content increased (approximately threefold). EDL and EHL: active forces decreased (up to 66.8%), passive force increased (minimally by 62.5%), and collagen content increased (approximately twofold). Therefore, hypothesis 1 was rejected and 2 and 3 were confirmed indicating that previously reported acute BTX-A effects persist and advance in the long term. A narrower lrange and an elevated passive resistance of the targeted muscle are unintended mechanical effects, whereas spread of BTX-A into other compartmental muscles indicates the presence of uncontrolled mechanical effects.
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Affiliation(s)
- Cemre S Kaya
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Evrim O Yılmaz
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Zeynep D Akdeniz-Doğan
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University, Istanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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12
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Wallace AC, Talelli P, Crook L, Austin D, Farrell R, Hoad D, O'Keeffe AG, Marsden JF, Fitzpatrick R, Greenwood R, Rothwell JC, Werring DJ. Exploratory Randomized Double-Blind Placebo-Controlled Trial of Botulinum Therapy on Grasp Release After Stroke (PrOMBiS). Neurorehabil Neural Repair 2019; 34:51-60. [PMID: 31747825 DOI: 10.1177/1545968319887682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. OnabotulinumtoxinA injections improve upper-limb spasticity after stroke, but their effect on arm function remains uncertain. Objective. To determine whether a single treatment with onabotulinumtoxinA injections combined with upper-limb physiotherapy improves grasp release compared with physiotherapy alone after stroke. Methods. A total of 28 patients, at least 1 month poststroke, were randomized to receive either onabotulinumtoxinA or placebo injections to the affected upper limb followed by standardized upper-limb physiotherapy (10 sessions over 4 weeks). The primary outcome was time to release grasp during a functionally relevant standardized task. Secondary outcomes included measures of wrist and finger spasticity and strength using a customized servomotor, clinical assessments of stiffness (modified Ashworth Scale), arm function (Action Research Arm Test [ARAT], Nine Hole Peg Test), arm use (Arm Measure of Activity), Goal Attainment Scale, and quality of life (EQ5D). Results. There was no significant difference between treatment groups in grasp release time 5 weeks post injection (placebo median = 3.0 s, treatment median = 2.0 s; t(24) = 1.20; P = .24; treatment effect = -0.44, 95% CI = -1.19 to 0.31). None of the secondary measures passed significance after correcting for multiple comparisons. Both groups achieved their treatment goals (placebo = 65%; treatment = 71%), and made improvements on the ARAT (placebo +3, treatment +5) and in active wrist extension (placebo +9°, treatment +11°). Conclusions. In this group of stroke patients with mild to moderate spastic hemiparesis, a single treatment with onabotulinumtoxinA did not augment the improvements seen in grasp release time after a standardized upper-limb physiotherapy program.
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Affiliation(s)
| | | | - Lucinda Crook
- UCL Institute of Neurology, Queen Square, London, UK
| | - Duncan Austin
- UCL Institute of Neurology, Queen Square, London, UK
| | - Rachel Farrell
- UCL Institute of Neurology, Queen Square, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Damon Hoad
- UCL Institute of Neurology, Queen Square, London, UK
| | | | | | | | - Richard Greenwood
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - David J Werring
- UCL Institute of Neurology, Queen Square, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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The Effect of Botulinum Toxin Injections on Gross Motor Function for Lower Limb Spasticity in Children with Cerebral Palsy. Toxins (Basel) 2019; 11:toxins11110651. [PMID: 31717282 PMCID: PMC6891294 DOI: 10.3390/toxins11110651] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the use of botulinum toxin type A (BoNT-A) injections and their efficacy on gross motor function for lower limb spasticity in children with spastic cerebral palsy (CP). This retrospective study included 919 injection occasions from 591 children with CP who received a lower limb BoNT-A injection between 2006 and 2016. The Gross Motor Function Measure (GMFM-88), the Modified Ashworth Scale, and the Modified Tardieu Scale were administered before and after injections. Injections were predominantly administered to children under the age of 6 years. The most common muscle injection site was the calf muscle for dynamic foot deformity. The second most commonly injected muscle was the hip adductor among 2–3 year olds and the hamstring muscle among 4–6 year olds. Distal injections were predominantly administered to high-functioning children, whereas proximal injections were typically administered to low-functioning children. Multilevel injections were mostly administered to midfunctioning children. GMFM-88 scores significantly increased post-injection for both high- and low-functioning groups. Younger age at injection and distal injection type were associated with larger improvements on the GMFM-88 at both short- and midterm follow-up. The target muscles for injection varied depending on gross motor functioning and age. Younger age at injection and distal injection type were significantly related with greater gain in gross motor function.
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Santamato A, Cinone N, Panza F, Letizia S, Santoro L, Lozupone M, Daniele A, Picelli A, Baricich A, Intiso D, Ranieri M. Botulinum Toxin Type A for the Treatment of Lower Limb Spasticity after Stroke. Drugs 2019; 79:143-160. [PMID: 30623347 DOI: 10.1007/s40265-018-1042-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Post-stroke lower limb spasticity impairs balance and gait leading to reduced walking speed, often increasing wheelchair use and caregiver burden. Several studies have shown that appropriate treatments for lower limb spasticity after stroke include injections of botulinum toxin type A (BoNT-A), phenol or alcohol, surgical correction and a rehabilitation program. In the present article, we review the safety and effectiveness of BoNT-A for the treatment of lower limb spasticity after stroke, with a focus on higher doses of BoNT-A. The cumulative body of evidence coming from the randomized clinical trials and open-label studies selected in the article suggest BoNT-A to be safe and efficacious in reducing lower limb spasticity after stroke. Studies of high doses of BoNT-A also showed a greater reduction of severe post-stroke spasticity. In stroke survivors with spasticity of the ankle plantar-flexor muscles, a combined approach between surgery and BoNT-A can be indicated. However, controversy remains about improvement in motor function relative to post-stroke spasticity reduction after BoNT-A treatment.
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Affiliation(s)
- Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy.
- "Fondazione Turati" Rehabilitation Centre, Vieste, Foggia, Italy.
| | - Nicoletta Cinone
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Sara Letizia
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy
| | - Luigi Santoro
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
- Neurorehabilitation Unit, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Alessio Baricich
- Health Sciences Department, Università del Piemonte Orientale, Novara, Italy
| | - Domenico Intiso
- Department of Neuro-Rehabilitation IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy
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15
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Datta Gupta A, Wilson DH. Botulinum toxin for spasticity: a case for change to the Pharmaceutical Benefits Scheme. Med J Aust 2019; 208:379-381. [PMID: 29764344 DOI: 10.5694/mja17.00841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
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16
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Zahavi D, Martiny KM. Phenomenology in nursing studies: New perspectives. Int J Nurs Stud 2019; 93:155-162. [DOI: 10.1016/j.ijnurstu.2019.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/13/2018] [Accepted: 01/26/2019] [Indexed: 10/27/2022]
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17
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Beyond speed: Gait changes after botulinum toxin injections in chronic stroke survivors (a systematic review). Gait Posture 2019; 70:389-396. [PMID: 30974394 DOI: 10.1016/j.gaitpost.2019.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/03/2019] [Accepted: 03/31/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The mechanisms by which spasticity reductions after botulinum toxin A (BoNT) affect gait in stroke are not well understood. We systematically reviewed the effects of BoNT on spatiotemporal, kinematic, kinetic and electromyographic (EMG) measures during gait. QUESTION What are the effects of botulinum toxin on gait mechanics in stroke patients? METHODS Systematic search using PubMed and Web of Science. We considered all studies that reported laboratory-based and instrumented gait measures as primary or secondary outcomes to determine the effects of BoNT on walking performance in stroke populations only. Selected studies were classified and analysed based on the injection sites. RESULTS A total of 240 articles were identified of which 22 were selected for analysis. Overall, 91% of the studies reported spatiotemporal, 64% kinematics, 23% kinetics, 32% EMG and 23% other gait measures. All but one study found significant effects of BoNT on gait measures using instrumented assessments even when clinical measures (i.e. speed) did not significantly improve. However, the majority of the studies had a high risk of bias. Overall, BoNT improved: a) dorsiflexion during stance, propulsive forces and timing and activity of more proximal musculature with injections in the plantarflexors; b) hip, knee and ankle angles and velocities, coordination and energetic cost with injections in the rectus femoris; c) segmental coordination and energetic cost when several lower limb muscles were injected; and, d) elbow and trunk angles when upper limb muscles were injected. CONCLUSION Instrumented and laboratory measures of gait improve after BoNT injections in different muscle groups even in the absence of clinical changes.
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18
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Hwang J, Lee JA, You JSH. Multiple relationships between Tardieu, Kinematic data, and Wolf Motor Function Test with children with cerebral palsy. NeuroRehabilitation 2019; 44:191-197. [PMID: 30856130 DOI: 10.3233/nre-182610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has developed the International Classification of Functioning, Disability and Health (ICF) model in order to provide a theoretical foundation of physical therapy diagnosis and intervention. However, the multidirectional relationships between the body structure/function domain variables (spasticity and movement kinematics) and the activity domain variables (e.g. reaching, grasping, folding, and lifting abilities) using the Wolf Motor Function Test (WMFT) remain unknown. OBJECTIVE The purpose of the present study was to examine the directional relationships between the body function and structure domain variables and the activity domain variables using the WMFT. METHODS Nineteen children with cerebral palsy (CP) were recruited from a major rehabilitation center. Standardized clinical tests included Tardieu scale and WMFT, which were used to measure the body function and structure domain (spasticity) and activity domain (reaching, grasping, folding, and lifting abilities). An eight infrared motion capture system (VICON, Oxford, UK) was used to collect kinematics data during reaching, which represent the body function and structure domain variables. Correlational analysis was performed at P < 0.05. RESULTS Our results revealed a fair to strong relationship between the body function and structure domain variables (11 out of 18 kinematic data) and activity domain variables (WMFT). However, no significant correlation was observed between the Tardieu score and the kinematics data or between the Tardieu score and the WMFT variables. CONCLUSIONS The present findings suggest that the body structure/function domain variables (Kinematic data) are closely associated with activity domain variables (WMFT). However, the body function and structure domain variables within Tardieu spasticity and kinematic data variables were not associated each other, nor between Tardieu spasticity and activity domain variables (WMFT), indicating that Tardieu spasticity test does not seem to account for or reflect active kinematic movement or WFMT variables. This finding provides an important clinical insight when developing a comprehensive assessment and intervention for children with CP.
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Affiliation(s)
- Jongseok Hwang
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Jung Ah Lee
- Department of Motor and Cognitive Rehabilitation, Korea National Rehabilitation Research Institute, Seoul, Republic of Korea
| | - Joshua Sung Hyun You
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, The Graduate School, Yonsei University, Wonju, Republic of Korea
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Banky M, Clark RA, Mentiplay BF, Olver JH, Kahn MB, Williams G. Toward Accurate Clinical Spasticity Assessment: Validation of Movement Speed and Joint Angle Assessments Using Smartphones and Camera Tracking. Arch Phys Med Rehabil 2019; 100:1482-1491. [PMID: 30684484 DOI: 10.1016/j.apmr.2018.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether a three-dimensional (3-D) camera (Microsoft Kinect) and a smartphone can be used to accurately quantify the joint angular velocity and range of motion (ROM) compared to a criterion-standard 3-D motion analysis system during a lower limb spasticity assessment. DESIGN Observational, criterion-standard comparison study. SETTING Large rehabilitation center. PARTICIPANTS A convenience sample of 35 controls, 35 patients with a neurologic condition, and 34 rehabilitation professionals (physiotherapists and rehabilitation doctors) participated (N=104). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Modified Tardieu Scale was used to assess spasticity of the quadriceps, hamstrings, soleus, and gastrocnemius. Data for each trial were collected concurrently using the criterion-standard Optitrack 3-D motion analysis (3DMA) system, Microsoft Kinect, and a smartphone. Each healthy control participant was assessed by 1 health professional and each patient with a neurological condition was assessed by 3 health professionals. Spearman correlation coefficient and intraclass correlation coefficient with 95% confidence intervals were used to report the strength of the relationships investigated. RESULTS The smartphone and Microsoft Kinect demonstrated excellent concurrent validity with the 3DMA system. Overall, 74.8% of the relationships investigated demonstrated a very strong (≥0.80) correlation across all of the testing parameters. The Microsoft Kinect was superior to the smartphone for measuring joint start and end angle, the smartphone was superior for measuring joint angular velocity, and the 2 systems were comparable for measuring total joint ROM. CONCLUSIONS These findings provide preliminary evidence that user-friendly, low-cost technologies can be used to facilitate accurate measurements of joint angular velocity and angles during a lower limb spasticity assessment in a clinical setting.
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Affiliation(s)
- Megan Banky
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia.
| | - Ross A Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Benjamin F Mentiplay
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - John H Olver
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Michelle B Kahn
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth HealthCare, Melbourne, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
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Tedesco Triccas L, Kennedy N, Smith T, Pomeroy V. Predictors of upper limb spasticity after stroke? A systematic review and meta-analysis. Physiotherapy 2019; 105:163-173. [PMID: 30745061 DOI: 10.1016/j.physio.2019.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 01/02/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the predictive markers for the occurrence of upper limb spasticity in the first 12 months after stroke. DATA SOURCES A systematic review was undertaken of the databases MEDLINE, EMBASE, CINAHL and PEDRO to 31st December 2017. STUDY SELECTION Non-experimental or experimental studies that included a control group with spasticity who did not receive an experimental intervention which investigated at least one variable (explanatory variable) measured at baseline against the development (or not) of spasticity at a future time point within 12 months post stroke were selected independently by two reviewers. Eleven papers met the selection criteria. STUDY APPRAISAL Data were extracted into tabular format using predefined data fields by two reviewers. Study quality was evaluated using the modified Downs and Black tool. Data were analysed using a meta-analysis or narrative review. RESULTS Ten studies, including 856 participants were analysed. The predictive markers of upper limb spasticity at one month post stroke were: motor 11.25 (odds ratio, OR); [95% CI:2.48, 51.04] and sensory impairments 4.91 (OR); [1.24, 19.46]; haemorrhagic stroke 3.70 (OR); [1.05, 12.98] and age 0.01 (OR) [0.00, 69.89]. Only motor impairment was found as a significant predictor at six months post stroke 30.68 (OR); [1.60, 587.06]. LIMITATIONS Low number of studies exploring biomechanical and neurophysiological in addition to behavioural predictors of spasticity were included. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Using the results, the identified predictive markers have potential to better inform clinical decision-making and to plan specific rehabilitation interventions by physiotherapists for stroke survivors with upper limb spasticity. Systematic Review Registration Number PROSPERO (ID: CRD42016027642).
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Affiliation(s)
- Lisa Tedesco Triccas
- Department of Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Niamh Kennedy
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK; School of Psychology, Ulster University, Cromore Road, Coleraine Co. Londonderry, Ulster, BT52 1SA UK.
| | - Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
| | - Valerie Pomeroy
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
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Botulinum Toxin Injections and Electrical Stimulation for Spastic Paresis Improve Active Hand Function Following Stroke. Toxins (Basel) 2018; 10:toxins10110426. [PMID: 30366407 PMCID: PMC6267216 DOI: 10.3390/toxins10110426] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 01/17/2023] Open
Abstract
Botulinum toxin type A (BTX-A) injections improve muscle tone and range of motion (ROM) among stroke patients with upper limb spasticity. However, the efficacy of BTX-A injections for improving active function is unclear. We aimed to determine whether BTX-A injections with electrical stimulation (ES) of hand muscles could improve active hand function (AHF) among chronic stroke patients. Our open-label, pilot study included 15 chronic stroke patients. Two weeks after BTX-A injections into the finger and/or wrist flexors, ES of finger extensors was performed while wearing a wrist brace for 4 weeks (5 days per week; 30-min sessions). Various outcomes were assessed at baseline, immediately before BTX-A injections, and 2 and 6 weeks after BTX-A injections. After the intervention, we noted significant improvements in Box and Block test results, Action Research Arm Test results, the number of repeated finger flexions/extensions, which reflect AHF, and flexor spasticity. Moreover, significant improvements in active ROM of wrist extension values were accompanied by marginally significant changes in Medical Research Council wrist extensor and active ROM of wrist flexion values. In conclusion, BTX-A injections into the finger and/or wrist flexors followed by ES of finger extensors improve AHF among chronic stroke patients.
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22
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Ateş F, Yucesoy CA. Botulinum toxin type-A affects mechanics of non-injected antagonistic rat muscles. J Mech Behav Biomed Mater 2018; 84:208-216. [DOI: 10.1016/j.jmbbm.2018.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
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Does botulinum toxin treatment improve upper limb active function? Ann Phys Rehabil Med 2018; 62:234-240. [PMID: 29960017 DOI: 10.1016/j.rehab.2018.05.1320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial. OBJECTIVE We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials. METHODS We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors' expertise. The review focused on stroke-related spasticity and disability. RESULTS Patients' therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection. CONCLUSION BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies' endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections.
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Santamato A, Panza F. Benefits and Risks of Non-Approved Injection Regimens for Botulinum Toxins in Spasticity. Drugs 2018; 77:1413-1422. [PMID: 28726023 DOI: 10.1007/s40265-017-0786-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spasticity with muscle paresis and loss of dexterity is a common feature of upper motor neuron syndrome due to injuries or the pyramidal tract in several neurological conditions. Botulinum toxin type A has been considered the gold standard treatment for spasticity and movement disorders, with efficacy, reversibility, and low prevalence of complications. During the last 30 years, thousands of studies of its use have been performed, but few guidelines are available. Therefore, there is great variability in both the doses and intervals of administration and the approaches taken by clinicians with considerable experience in spasticity and movement disorder treatment. In the present review article, we provide a short overview of the benefits and risks of non-approved injection regimens and doses for botulinum toxins, focusing on the treatment of post-stroke spasticity, where there is great interest in the potential for increasing the number of treatment/years and the dose of botulinum toxin treatment for subjects with upper and lower limb spasticity. However, many doubts exist regarding antibody development and possible adverse effects.
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Affiliation(s)
- Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Viale Pinto, 71100, Foggia, Italy.
- "Fondazione Turati" Rehabilitation Centre, Vieste, Foggia, Italy.
| | - Francesco Panza
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
- Unit of Neurodegenerative Disease, Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
- Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico", Tricase, Lecce, Italy
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Allison R, Kilbride C, Chynoweth J, Creanor S, Frampton I, Marsden J. What Is the Longitudinal Profile of Impairments and Can We Predict Difficulty Caring for the Profoundly Affected Arm in the First Year Poststroke? Arch Phys Med Rehabil 2018; 99:433-442. [DOI: 10.1016/j.apmr.2017.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
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Yucesoy CA, Ateş F. BTX-A has notable effects contradicting some treatment aims in the rat triceps surae compartment, which are not confined to the muscles injected. J Biomech 2018; 66:78-85. [DOI: 10.1016/j.jbiomech.2017.10.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/19/2017] [Accepted: 10/28/2017] [Indexed: 11/27/2022]
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Ding X, Huang L, Wang Q, Liu Y, Zhong J, Chen H. Clinical study of botulinum toxin A injection combined with spasmodic muscle therapeutic instrument on lower limb spasticity in patients with stroke. Exp Ther Med 2017; 13:3319-3326. [PMID: 28587407 PMCID: PMC5450567 DOI: 10.3892/etm.2017.4376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/15/2017] [Indexed: 12/03/2022] Open
Abstract
The clinical effect of botulinum toxin A (BTX-A) injection combined with spasmodic muscle therapeutic instrument with simple BTX-A injection was compared. Eighty patients with stroke were randomly divided into the treatment and control groups of 41 and 39 cases, respectively. The two groups of patients were given routine rehabilitation therapy. Ultrasound-guide positioning technology was used; treatment group was administered BTX-A injection combined spasmodic muscle therapeutic instrument while the control group received only BTX-A injection. Muscle tension and motor function were evaluated at 1, 4, 8 and 12 weeks after treatments by rehabilitation physician who was not aware of the grouping of the patients. Muscle tension was significantly reduced after BTX-A injection in the treatment and control groups. Modified Ashworth scale scores of the treatment and control groups 1 and 4 weeks after treatment were significantly lower than those before treatment. Motor function of lower limbs of patients, 1 and 4 weeks after treatment improved significantly. The comparison of step size and walking speed of the groups showed obvious differences with statistical significance (P<0.01). In conclusion, ultrasonic guidance BTX-A injection is easy to operate with good safety. It can effectively improve extensor myospasm of lower limb of patients with rapid onset and the spasm relief can last for three months. Spasmodic muscle therapeutic instrument can improve the spasm condition of lower limb muscle after stroke as well as motor function of lower limbs and activity of daily living, which can make spasmolysis of BTX-A last for a longer period of time.
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Affiliation(s)
- Xudong Ding
- Department of Rehabilitation Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Li Huang
- Department of Rehabilitation Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Qingsong Wang
- Department of Rehabilitation Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Yanping Liu
- Department of Rehabilitation Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Jing Zhong
- Department of Ultrasound Imaging, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Huaxian Chen
- Department of Rehabilitation Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
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Banky M, Ryan HK, Clark R, Olver J, Williams G. Do clinical tests of spasticity accurately reflect muscle function during walking: A systematic review. Brain Inj 2017; 31:440-455. [DOI: 10.1080/02699052.2016.1271455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Megan Banky
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Hannah K. Ryan
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, The University of Sunshine Coast, Queensland, Australia
| | - John Olver
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
| | - Gavin Williams
- Physiotherapy Department, Epworth Hospital, Melbourne, Australia
- Epworth Monash Rehabilitation Medicine Unit, Melbourne, Australia
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia
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Hefter H, Rosenthal D. Improvement of upper trunk posture during walking in hemiplegic patients after injections of botulinum toxin into the arm. Clin Biomech (Bristol, Avon) 2017; 43:15-22. [PMID: 28187305 DOI: 10.1016/j.clinbiomech.2017.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/31/2016] [Accepted: 01/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been hypothesized that altered trunk movements during gait in post-stroke patients or children with cerebral palsy are compensatory to lower limb impairment. Improvement of trunk movements and posture after injections of botulinum toxin into the affected arm would be at variance with this hypothesis and hint towards a multifactorial trunk control deficit. PATIENTS AND METHODS Clinical gait analysis was performed in 11 consecutively recruited hemiplegic patients immediately before and 4weeks after a botulinum toxin type A-injection into the affected arm. Kinematic data were collected using an 8 camera optical motion-capturing system and reflective skin-markers were attached according to a standard plug-in-gait model. Deviation of the trunk in lateral and forward direction and the trajectory of the C7-marker in a sacrum-fixed horizontal plane were analyzed in addition to classical gait parameters. The Wilson-signed-rank test was used for pre/post-botulinum toxin comparisons. FINDINGS After botulinum toxin injections a significant improvement of forearm flexion scores from 2.57 to 2.0 (p<0.014), and a reduced lateral deviation of the upper trunk from 3.5degrees to 2.5degrees (p<0.014) were observed. Free-walkers tended to walk faster (p<0.046, 1-sided), with reduced pre-swing duration of both legs and an increased step length of the non-affected leg. The C7-marker trajectory was shifted towards the midline. INTERPRETATION Injections of botulinum toxin into the affected arm of hemiplegic patients improve abnormal trunk lateral flexion. This shift of the center of mass of the upper body towards the midline improves various gait parameters including gait speed.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
| | - Dietmar Rosenthal
- Department of Neurology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany
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Allison R, Shenton L, Bamforth K, Kilbride C, Richards D. Incidence, Time Course and Predictors of Impairments Relating to Caring for the Profoundly Affected arm After Stroke: A Systematic Review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 21:210-227. [PMID: 26015292 PMCID: PMC5157782 DOI: 10.1002/pri.1634] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/27/2014] [Accepted: 04/13/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND PURPOSE A significant number of stroke survivors will not recover the use of their affected arm. A proportion will experience pain, stiffness and difficulty with basic care activities. The purpose of the review was to identify predictors of difficulty caring for the profoundly affected arm and establish the incidence and time-course of the related impairments of pain, spasticity and contracture. METHOD Data sources: Databases (PubMED, MEDLINE, AMED, EMBASE, CINAHL and the Cochrane Controlled Trials Register) were searched from inception to December 2013. Additional studies were identified from citation tracking. REVIEW METHODS Independent reviewers used pre-defined criteria to identify eligible studies. Quality assessment and risk of bias were assessed using the McMasters Assessment Tool. A narrative evidence synthesis was performed. RESULTS Thirty-nine articles reporting 34 studies were included. No studies formally measured difficulty caring for the arm, but related impairments were common. Incidence of spasticity in those with weakness ranged from 33% to 78%, shoulder pain affected 22% to 90% and contracture was present in at least 50%. Spasticity and pain appear within 1 week of stroke, and contracture within two weeks. Impairments continued to develop over at least 3-6 months. The most frequent predictors of spasticity and contracture were weakness and reduced motor control, and the risk of pain is most commonly predicted by reduced sensation, shoulder subluxation, weakness and stroke severity. DISCUSSION There is no published evidence on predicting the likelihood of difficulty caring for the arm following stroke. However, the related impairments of spasticity, pain and contracture are common. Given the time-course of development, clinicians may need not only to intervene early but also be prepared to act over a longer time period. Further research is needed to examine difficulty caring for the arm and the relationship with associated impairments to enable researchers and clinicians to develop targeted interventions. © 2015 The Authors. Physiotheraphy Research International Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Rhoda Allison
- Stroke Service, Newton Abbot HospitalTorbay and Southern Devon Health and Care TrustNewton AbbotUK
| | - Laura Shenton
- Stroke Service, Newton Abbot HospitalTorbay and Southern Devon Health and Care TrustNewton AbbotUK
| | - Kathryn Bamforth
- Stroke Service, Newton Abbot HospitalTorbay and Southern Devon Health and Care TrustNewton AbbotUK
| | - Cherry Kilbride
- Brunel University LondonCentre for Research in RehabilitationLondonUK
| | - David Richards
- Mood Disorders Centre, College of Life and Environmental SciencesUniversity of ExeterExeterUK
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Abstract
AbstractDuring the last decades, research on cognition has undergone a reformation, which is necessary to take into account when evaluating the cognitive and behavioural aspects of therapy. This reformation is due to the research programme called Embodied Cognition (EC). Although EC may have become the theoretical authority in current cognitive science, there are only sporadic examples of EC-based therapy, and no established framework. We aim to build such a framework on the aims, methods and techniques of the current third-wave of CBT. There appears to be a possibility for cross-fertilization between EC and CBT that could contribute to the development of theory and practice for both of them. We present a case-study of an EC-based model of intervention for working with self-control in cerebral palsy. We centre the results of the study and its discussion on how we should understand and work with self-control in a more general sense from both an EC and a CBT perspective. We end by elaborating the five learning objectives and present suggestions for follow-up reading.
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Abstract
Botulinum neurotoxin (BoNT) is one of the mainstays in the treatment of pediatric spasticity and dystonia. When considering initiation of BoNT treatment for spasticity, treatment goals and responses to prior conservative measures such as passive range of motion exercises, splinting, and other medication trials should be reviewed. As a general rule, children should be engaged in therapy services around the time of the injections and have a robust home program in place. When managing spasticity in children with BoNT injections, the practitioner should be well versed in functional anatomy with specialized training in injection techniques. Localization techniques in addition to anatomical landmarks are recommended for improved efficacy and include limited electromyography, electrical stimulation, and/or ultrasound guidance. A follow-up visit for the purpose of reassessment during the peak effect of the drug is advised. It is known that BoNT is effective at reducing spasticity and improving range of motion, but it remains to be determined to what degree this translates into improved function, activity, and participation.
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Affiliation(s)
- Aloysia L Schwabe
- Department of Pediatric Physical Medicine and Rehabilitation, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Mullins D, Winter A, Fini N, Dixon C, Aldous S, Palit M, Holland AE. Frequency and characteristics of goal attainment following BoNT-A injection for management of spasticity. Disabil Rehabil 2015; 38:1927-33. [PMID: 26714558 DOI: 10.3109/09638288.2015.1107781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine which Goal Attainment Scale (GAS) goals are commonly achieved in patients with upper limb and/or lower limb spasticity following Botulinum Neurotoxin Type A (BoNT-A) injection. METHOD Adults who attended a Spasticity Management Clinic for upper and/or lower limb BoNT-A injection were included in this prospective cohort study. Goals were set by participants and/or carers in conjunction with the therapist using the GAS, prior to injection and reviewed at one month following the injection. Three out of the five categories of goals were passive. Goals were categorised into: mobility/transfers, pain/comfort, upper limb use, hygiene, and cosmesis. The number of responders for the GAS total score, and in each of the GAS categories, was calculated. RESULTS Sixty-seven participants were recruited (mean age 51 ± 16 years; range 18-85), 70% had a stroke. Responders for mobility and transfer goals were further post injury or disease onset than non-responders (median 5.9 vs. 1.2 years, p = 0.03). Clients with stroke were less likely than other participants to achieve mobility and transfer goals (p = 0.02). There was a trend for those who achieved mobility and transfer goals to be younger (mean 49 years vs. 55 years, p = 0.06). Although active goals are more commonly identified, passive goals were more likely to be achieved. CONCLUSIONS Although active goals are commonly identified by people with spasticity, passive goals were more likely to be achieved following BoNT-A injection. A long duration of spasticity does not preclude patients from achieving mobility and transfer goals. Non-stroke participants were more likely to achieve mobility and transfer goals. Implications for Rehabilitation Patients with chronic spasticity should be considered for BoNT-A as clinically meaningful outcomes can be achieved. When spasticity is present in multiple muscles, the GAS can be an assistive tool to guide clinicians in determining which muscles are a priority for injection, because the client will be more motivated to improve those specific goals. Although carers and patients are more willing to set active goals, these are more difficult to achieve possibly because follow up intervention or independent practise is required.
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Affiliation(s)
- Denita Mullins
- a Occupational Therapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Adele Winter
- b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Natalie Fini
- b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia ;,c Acquired Brain Injury Centre , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Caroline Dixon
- a Occupational Therapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | | | - Mithu Palit
- c Acquired Brain Injury Centre , Caulfield Hospital, Alfred Health , Caulfield , Australia
| | - Anne E Holland
- b Physiotherapy Department , Caulfield Hospital, Alfred Health , Caulfield , Australia ;,e La Trobe University , Bundoora , Australia
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Wang YH, Meng F, Zhang Y, Xu MY, Yue SW. Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: a randomized controlled study. Clin Rehabil 2015; 30:577-86. [PMID: 26292692 DOI: 10.1177/0269215515597048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 06/06/2015] [Indexed: 11/16/2022]
Abstract
Objective: To investigate whether full-movement neuromuscular electrical stimulation, which can generate full range of movement, reduces spasticity and/or improves motor function more effectively than control, sensory threshold—neuromuscular electrical stimulation, and motor threshold—neuromuscular electrical stimulation in sub-acute stroke patients. Design: A randomized, single-blind, controlled study. Setting: Physical therapy room and functional assessment room. Participants: A total of 72 adult patients with sub-acute post-stroke hemiplegia and plantar flexor spasticity. Method: Patients received 30-minute sessions of neuromuscular electrical stimulation on the motor points of the extensor hallucis and digitorum longus twice a day, five days per week for four weeks. Measures: Composite Spasticity Scale, Ankle Active Dorsiflexion Score, and walking time in the Timed Up and Go Test were assessed at pretreatment, posttreatment, and at two-week follow-up. Results: After four weeks of treatment, when comparing interclass pretreatment and posttreatment, only the full-movement neuromuscular electrical stimulation group had a significant reduction in the Composite Spasticity Scale (mean % reduction = 19.91(4.96)%, F = 3.878, p < 0.05) and improvement in the Ankle Active Dorsiflexion Score (mean scores = 3.29(0.91), F = 3.140, p < 0.05). Furthermore, these improvements were maintained two weeks after the treatment ended. However, there were no significant differences in the walking time after four weeks of treatment among the four groups (F = 1.861, p > 0.05). Conclusions: Full-movement neuromuscular electrical stimulation with a stimulus intensity capable of generating full movement can significantly reduce plantar flexor spasticity and improve ankle active dorsiflexion, but cannot decrease walking time in the Timed Up and Go Test in sub-acute stroke patients.
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Affiliation(s)
- Yong-hui Wang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Fei Meng
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Yang Zhang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Mao-yu Xu
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Shou-wei Yue
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
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Baker JA, Pereira G. The efficacy of Botulinum Toxin A for limb spasticity on improving activity restriction and quality of life: a systematic review and meta-analysis using the GRADE approach. Clin Rehabil 2015; 30:549-58. [DOI: 10.1177/0269215515593609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/07/2015] [Indexed: 01/23/2023]
Abstract
Objectives: A systematic review and meta analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. The aim was to evaluate the efficacy of Botulinum Toxin type A for limb spasticity on improving activity restriction and quality of life outcomes. Data sources: Pubmed, Cinahl, Amed, Embase and Cochrane databases. English Language. Search to January 2015. Review methods: All randomized, placebo controlled trials on adults with active function or quality of life measures for the arm and leg relating to spasticity of any origin and treated with a single dose of Botulinum Toxin A. Evidence quality was assessed by GRADE. Results: Twenty-five studies were reviewed. Meta analysis was carried out on six upper limb and six lower limb studies. Evidence quality for the upper limb was low/very low. A significant result for Botulinum Toxin A was found at four to twelve weeks for the upper limb for active function (SMD 0.32 CI 0.01, 0.62, P=0.04) These effects were maintained for up to six months for Active Research Arm Test (ARAT) only (MD 1.87 CI 0.53, 3.21, P=0.006). Evidence quality was very low for the lower limb. No significant effect was found. Meta analysis was not possible for quality of life measures. Conclusion: Botulinum Toxin A may improve active outcomes in the upper limb but further evidence is needed. No conclusion can be drawn about the effect on active outcomes for the lower limb or for quality of life measures in either limb.
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Pike S, Lannin NA, Cusick A, Wales K, Turner-Stokes L, Ashford S. A systematic review protocol to evaluate the psychometric properties of measures of function within adult neuro-rehabilitation. Syst Rev 2015; 4:86. [PMID: 26071172 PMCID: PMC4470035 DOI: 10.1186/s13643-015-0076-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/08/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spasticity in the upper limb is common after acquired brain impairment and may have a significant impact on the ability to perform meaningful daily activities. Traditionally, outcome measurement in spasticity rehabilitation has focused on impairment, however, improvements in impairments do not necessarily translate to improvements in an individual's ability to perform activities or engage in life roles. There is an increasing need for outcome measures that capture change in activity performance and life participation. METHODS/DESIGN We will conduct a systematic review of the psychometric properties of instruments used to measure upper limb functional outcomes (activity performance and participation) in patients with spasticity. Assessments (n = 27) will be identified from a recently published systematic review of assessments that measure upper limb function in neurological rehabilitation for adults with focal spasticity, and a systematic review of each assessment will then be conducted. The databases MEDLINE, CINAHL and EMBASE will be searched from inception. Search strategies will include the name of the assessment and the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) published search strategy for identifying studies of measurement properties. The methodological rigour of the testing of the psychometric quality of instruments will be undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. International Classification of Functioning, Disability and Health (ICF) definitions of impairment, activity and participation will be used for content analysis of items to determine the extent to which assessments are valid measures of activity performance and life participation. We will present a narrative synthesis on the psychometric properties and utility of all instruments and make recommendations for assessment selection in practice. DISCUSSION This systematic review will present a narrative synthesis on the psychometric properties and utility of assessments used to evaluate function in adults with upper limb focal spasticity. Recommendations for assessment selection in practice will be made which will aid clinicians, managers and funding bodies to select an instrument fit for purpose. Importantly, appropriate assessment selection will provide a mechanism for capturing how applicable to everyday life the outcomes from individualised rehabilitation programs for the upper limb really are. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013190.
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Affiliation(s)
- Shannon Pike
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia. .,Wagga Wagga Ambulatory Rehabilitation Service, Wagga Wagga Health Service, Wagga Wagga, Australia.
| | - Natasha Anne Lannin
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia. .,Occupational Therapy Department, Alfred Health, Melbourne, Australia.
| | - Anne Cusick
- School of Health and Society, University of Wollongong, Wollongong, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
| | - Kylie Wales
- Ageing Work and Health Research Unit, The University of Sydney, Sydney, Australia. .,The Centre for Excellence in Population Ageing Research, The University of Sydney, Sydney, Australia.
| | - Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK. .,Department of Palliative Care, Policy and Rehabilitation, King's College London, School of Medicine, London, UK.
| | - Stephen Ashford
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK. .,Department of Palliative Care, Policy and Rehabilitation, King's College London, School of Medicine, London, UK.
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Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review. Spinal Cord 2015; 53:252-64. [PMID: 25582713 DOI: 10.1038/sc.2014.241] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). SETTING British Columbia, Canada. METHODS EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. RESULTS No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. CONCLUSION Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.
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Santamato A, Micello MF, Panza F, Fortunato F, Baricich A, Cisari C, Pilotto A, Logroscino G, Fiore P, Ranieri M. Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques. J Neurol Sci 2014; 347:39-43. [PMID: 25263601 DOI: 10.1016/j.jns.2014.09.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/25/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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Yucesoy CA, Turkoğlu AN, Umur S, Ateş F. Intact muscle compartment exposed to botulinum toxin type a shows compromised intermuscular mechanical interaction. Muscle Nerve 2014; 51:106-16. [DOI: 10.1002/mus.24275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Can A. Yucesoy
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
| | - Ahu Nur Turkoğlu
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
| | - Sevgi Umur
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
| | - Filiz Ateş
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
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Baker JA, Pereira G. The efficacy of Botulinum Toxin A on improving ease of care in the upper and lower limbs: a systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation approach. Clin Rehabil 2014; 29:731-40. [PMID: 25352614 DOI: 10.1177/0269215514555036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 09/20/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES A systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach; evaluating Botulinum Toxin type A efficacy on improving ease of care in the upper/lower limb. DATA SOURCES Pubmed, Cinahl, Amed, Embase and Cochrane databases. English Language. Search to July 2014. REVIEW METHODS All randomized, placebo controlled trials on adults with difficulty in caring for the upper/lower limb resulting from spasticity of any origin and treated with a single dose of Botulinum Toxin A. Evidence quality was assessed by GRADE. RESULTS A total of 32 studies were reviewed. Meta-analysis was carried out on 11 upper limb and three lower limb studies. Evidence quality for the upper limb was moderate. A significant result for Botulinum Toxin A was found at four to 12 weeks for the upper limb (SMD 0.80, CI 0.55, 1.06, p < 0.0001). The effects were maintained for up to six months (SMD 0.48, CI 0.34, 0.62, p < 0.0001). Evidence quality was very low for the lower limb. Meta-analysis was only possible for global assessment of benefit. No significant effect was found. ( PATIENT RR 1.37 CI (0.94, 2.00) p = 0.11; clinician: RR 1.06 (0.84, 1.34) p = 0.60.) CONCLUSION Botulinum Toxin A improves ease of care in the upper limb for up to six months. No conclusion can be drawn for the lower limb.
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Affiliation(s)
| | - Gavin Pereira
- Telethon Institute for Child Health Research, The University of Western Australia, Perth, Australia
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Effects of botulinum toxin type A on non-injected bi-articular muscle include a narrower length range of force exertion and increased passive force. Muscle Nerve 2014; 49:866-78. [DOI: 10.1002/mus.23993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 01/09/2023]
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Turkoglu AN, Huijing PA, Yucesoy CA. Mechanical principles of effects of botulinum toxin on muscle length–force characteristics: An assessment by finite element modeling. J Biomech 2014; 47:1565-71. [DOI: 10.1016/j.jbiomech.2014.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 11/27/2022]
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Ashford S, Slade M, Nair A, Turner-Stokes L. Arm Activity measure (ArmA) application for recording functional gain following focal spasticity treatment. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.1.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen Ashford
- Consultant Physiotherapist and Clinical Lecturer at the Regional Rehabilitation Unit, North West London Hospitals NHS Trust and King's College london, London, UK
| | - Mike Slade
- Professor of Health Services Research at King's College London, Health Service and Population Research Department, London, UK
| | - Ajoy Nair
- Consultant in Rehabilitation Medicine at Alderbourne Rehabilitation Unit, Hillingdon Hospital, London, UK
| | - Lynne Turner-Stokes
- Herbert Dunhill Chair of Rehabilitation and Director Regional at the Rehabilitation Unit, King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation
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Demetrios M, Khan F, Turner-Stokes L, Brand C, McSweeney S. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database Syst Rev 2013:CD009689. [PMID: 23740539 DOI: 10.1002/14651858.cd009689.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spasticity may affect stroke survivors by contributing to activity limitations, caregiver burden, pain and reduced quality of life (QoL). Spasticity management guidelines recommend multidisciplinary (MD) rehabilitation programmes following botulinum toxin (BoNT) treatment for post-stroke spasticity. However, the evidence base for the effectiveness of MD rehabilitation is unclear. OBJECTIVES To assess the effectiveness of MD rehabilitation, following BoNT and other focal intramuscular treatments such as phenol, in improving activity limitations and other outcomes in adults and children with post-stroke spasticity. To explore what settings, types and intensities of rehabilitation programmes are effective. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (February 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 12), MEDLINE (1948 to December 2011), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), AMED (1985 to January 2012), LILACS (1982 to September 2012), PEDro, REHABDATA and OpenGrey (September 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registries and reference lists, handsearched journals and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared MD rehabilitation (delivered by two or more disciplines in conjunction with medical input) following BoNT and other focal intramuscular treatments for post-stroke spasticity with placebo, routinely available local services, or lower levels of intervention; or studies that compared MD rehabilitation in different settings, of different types, or at different levels of intensity. We excluded RCTs that assessed the effectiveness of unidisciplinary therapy (for example physiotherapy only) or a single modality (for example stretching, casting, electrical stimulation or splinting only). The primary outcomes were validated measures of activity level (active and passive function) according to the World Health Organization's International Classification of Functioning, Disability and Health. Secondary outcomes included measures of symptoms, impairments, participation, QoL, impact on caregivers and adverse events. DATA COLLECTION AND ANALYSIS We independently selected the trials, extracted data, and assessed methodological quality using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Due to the limited number of included studies, with clinical, methodological and statistical heterogeneity, quantitative meta-analysis was not possible. Therefore, GRADE provided qualitative synthesis of 'best evidence'. MAIN RESULTS We included three RCTs involving 91 participants. All three studies scored 'low quality' on the methodological quality assessment, implying high risk of bias. All studies investigated various types and intensities of outpatient rehabilitation programmes following BoNT for upper limb spasticity in adults with chronic stroke. Rehabilitation programmes included: modified constraint-induced movement therapy (mCIMT) compared with a neurodevelopmental therapy programme; task practice therapy with cyclic functional electrical stimulation (FES) compared with task practice therapy only; and occupational, manual therapy with dynamic elbow extension splinting compared with occupational therapy only. There was 'low quality' evidence for mCIMT improving upper limb motor function and spasticity in chronic stroke survivors with residual voluntary upper limb activity, up to six months, and 'very low quality' evidence for dynamic elbow splinting and occupational therapy reducing elbow range of movement at 14 weeks. Task practice therapy with cyclic FES did not improve upper limb function more than task practice therapy alone, only at 12 weeks. No studies addressed interventions in children and those with lower limb spasticity, or after other focal intramuscular treatments for spasticity. AUTHORS' CONCLUSIONS At best there was 'low level' evidence for the effectiveness of outpatient MD rehabilitation in improving active function and impairments following BoNT for upper limb spasticity in adults with chronic stroke. No trials explored the effect of MD rehabilitation on 'passive function' (caring for the affected limb), caregiver burden, or the individual's priority goals for treatment. The optimal types (modalities, therapy approaches, settings) and intensities of therapy for improving activity (active and passive function) in adults and children with post-stroke spasticity, in the short and longer term, are unclear. Further research is required to build evidence in this area.
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Affiliation(s)
- Marina Demetrios
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia.
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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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Seo NJ, Fischer HW, Bogey RA, Rymer WZ, Kamper DG. Effect of a serotonin antagonist on delay in grip muscle relaxation for persons with chronic hemiparetic stroke. Clin Neurophysiol 2011; 122:796-802. [DOI: 10.1016/j.clinph.2010.10.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/12/2010] [Accepted: 10/24/2010] [Indexed: 11/24/2022]
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Shaw LC, Price CIM, van Wijck FMJ, Shackley P, Steen N, Barnes MP, Ford GA, Graham LA, Rodgers H. Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial: effect on impairment, activity limitation, and pain. Stroke 2011; 42:1371-9. [PMID: 21415398 DOI: 10.1161/strokeaha.110.582197] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke, but its impact on arm function is unclear. We evaluated botulinum toxin for upper limb spasticity and function poststroke. METHODS Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter randomized controlled trial. The intervention group received botulinum toxin type A injection(s) plus a 4-week therapy program. The control group received the therapy program alone. Repeat injection(s) and therapy were available at 3, 6, and 9 months. The primary outcome was upper limb function at 1 month (Action Research Arm Test). Secondary outcomes included measures of impairment, activity limitation, and pain at 1, 3, and 12 months. Outcome assessments were blinded and analysis was by intention to treat. RESULTS There was no significant difference in achievement of improved arm function (Action Research Arm Test) at 1 month (intervention group: 42 of 167 [25.1%], control group 30 of 154 [19.5%]; P=0.232). Significant differences in favor of the intervention group were seen in muscle tone at 1 month; upper limb strength at 3 months; basic arm functional tasks (hand hygiene, facilitation of dressing) at 1, 3, and 12 months; and pain at 12 months. CONCLUSIONS Botulinum toxin type A is unlikely to be useful for improving active upper limb function (eg, reaching and grasping) in the majority of patients with spasticity after stroke, but it may improve basic upper limb tasks (hand hygiene, facilitation of dressing) and pain.
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Affiliation(s)
- Lisa C Shaw
- Institute for Ageing and Health, Stroke Research Group, 3-4 Claremont Terrace, Newcastle University, and Nwecastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, NE2 4AE
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Foley N, Murie-Fernandez M, Speechley M, Salter K, Sequeira K, Teasell R. Does the treatment of spastic equinovarus deformity following stroke with botulinum toxin increase gait velocity? A systematic review and meta-analysis. Eur J Neurol 2011; 17:1419-27. [PMID: 20491885 DOI: 10.1111/j.1468-1331.2010.03084.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
While botulinum toxin-A (BT-A) has been used to treat lower-limb focal spasticity successfully, its effect on characteristics of gait has not been well defined. The objective of this systematic review was to establish the treatment effect associated with the use of BT-A for equinovarus to improve gait velocity following stroke, using a meta-analytic technique. Relevant studies were identified through a literature search encompassing the years 1985 to November 2009. Studies were included if (i) the sample was composed of adult subjects recovering from either first or subsequent stroke, presenting with spastic equinovarus deformity of the ankle preventing full active dorsiflexion, and (ii) subjects who received BT-A were compared with subjects who had received a placebo, or (iii) in the absence of a placebo-controlled condition, subject had received BT-A and was assessed before and after treatment. A standardized mean difference (SMD) ± standard error and 95% confidence interval (CI) for gait velocity between the treatment and control group was calculated for each study, using Hedges's g, and the results pooled. Eight trials, five randomized controlled trials, and three single group intervention studies were included. Data representing 228 subjects were available for pooled analysis. Treatment with BT-A was associated with a small improvement in gait velocity (Hedge's g = 0.193 ± 0.081; 95% CI: 0.033 to 0.353, P < 0.018) representing an increase of 0.044 meters/s. The use of BT-A for lower-limb post-stroke equinovarus because of spasticity was associated with a small, but statistically significant increase in gait velocity.
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Affiliation(s)
- N Foley
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital site, London, ON, Canada.
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Henzel MK, Munin MC, Niyonkuru C, Skidmore ER, Weber DJ, Zafonte RD. Comparison of surface and ultrasound localization to identify forearm flexor muscles for botulinum toxin injections. PM R 2010; 2:642-6. [PMID: 20659720 DOI: 10.1016/j.pmrj.2010.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 04/07/2010] [Accepted: 05/04/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine if ultrasound (US) localization is equivalent to surface landmark localization to identify botulinum toxin injection targets for forearm muscle spasticity. DESIGN Observational. SETTING Outpatient spasticity clinic in a tertiary care center. SUBJECTS Eighteen patients with upper-extremity flexor spasticity that interferes with function were included. Individuals with severe fixed contractures or traumatic injury of the involved forearm were excluded. METHODS Flexor pollicis longus, flexor carpi radialis, pronator teres, and flexor digitorum superficialis (FDS) were identified by 2 separate localization techniques: the method of Delagi et al for flexor carpi radialis, pronator teres, and flexor pollicis longus; and a surface landmark technique by Bickerton et al to identify the 4 muscle bellies of FDS. Proximodistal and lateral (radial) coordinates were recorded relative to a landmark line from the medial epicondyle to pisiform bone, and percentage of landmark line distance was calculated. After surface measurements were collected, the best point for injection was determined by using real-time US with a 12-MHz linear transducer. US measurements were recorded by using the same landmark line system. RESULTS Localization techniques were compared by using the Wilcoxon signed rank test. One-sample t-tests compared surface-mapped lateral coordinates to US-derived lateral coordinates with controls for multiple testing. Significant differences were observed between surface and US proximodistal and lateral coordinates for several flexor muscles. CONCLUSIONS US should be considered as an adjunct for localization in patients with upper-limb spasticity. US can improve accuracy of toxin placement and help to avoid injection into vascular and nerve structures.
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Affiliation(s)
- M Kristi Henzel
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Sheean G, Lannin NA, Turner-Stokes L, Rawicki B, Snow BJ. Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: international consensus statement. Eur J Neurol 2010; 17 Suppl 2:74-93. [DOI: 10.1111/j.1468-1331.2010.03129.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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