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Wissel J, Ri S, Kivi A. Early versus late injections of Botulinumtoxin type A in post-stroke spastic movement disorder: A literature review. Toxicon 2023; 229:107150. [PMID: 37146733 DOI: 10.1016/j.toxicon.2023.107150] [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: 03/17/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
Post-stroke spastic movement disorder (PS-SMD) is one of the main causes of severe disability in the chronic phase after stroke. The prevalence of SMD rises up with time after stroke to more than 28% in the chronic phase, and its secondary complications such as contracture, abnormal postures and/or movement patterns, spasticity-associated pain, also increases with time after stroke when physical and medical management of PS-SMD had been delayed in the early stroke phase. It has been published by several controlled studies that the earlier physical and medical measures, such as botulinum toxin type A (BoNT-A) therapy are included in rehabilitative strategies for the SMD, the lesser secondary complications, especially soft tissue contractures and pain occurred. Several studies showed that goal-orientated management of PS-SMD including BoNT-A therapy, applied within a few weeks and 3 months - in the early subacute phase after stroke onset - prevented or reduced the development of severe or disabling SMD and its secondary complications, more effective than late application of BoNT-A therapy - in the chronic phase after stroke. In multiple prospective cohort studies, various predictors and predictive approaches for detection of patients on risk to development PS-SMD were found. Based on that information and the controlled studies that showed reduction in PS-SMD complications following early treatment with BoNT-A nowadays, early treatment of PS-SMD in the early subacute phase following stroke is recommended to avoid or reduce the development of post-stroke disability and to improve the outcome of rehabilitation. In this review, we discuss on the optimal timing to apply BoNT-A therapy in patients with already present as well as in high risk of severe PS-SMD.
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Affiliation(s)
- Jörg Wissel
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany; Neurology at Wittenbergplatz, Ansbacher Strasse 197-19, 10787, Berlin, Germany.
| | - Songjin Ri
- Neurology at Wittenbergplatz, Ansbacher Strasse 197-19, 10787, Berlin, Germany; Department for Neurology, Meoclinic, Friedrichstraße 71, 10117, Berlin, Germany
| | - Anatol Kivi
- Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany; Neurology at Wittenbergplatz, Ansbacher Strasse 197-19, 10787, Berlin, Germany
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Hara T, Niimi M, Yamada N, Shimamoto Y, Masuda G, Hara H, Abo M. Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis. Disabil Rehabil 2022; 44:6815-6823. [PMID: 34547217 DOI: 10.1080/09638288.2021.1977394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement. MATERIALS AND METHODS In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl-Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis. RESULTS A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19-31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26-47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group. CONCLUSIONS In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist.IMPLICATIONS FOR REHABILITATIONHierarchical cluster analysis focusing on the Fugl-Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function.Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function.The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation.In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.
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Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Masachika Niimi
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Naoki Yamada
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Yusuke Shimamoto
- Department of Rehabilitaion Medicine, Kikyougahara Hospital, Nagano, Japan
| | - Go Masuda
- Department of Rehabilitaion Medicine, Kyoto Ohara Memorial Hospital, Kyoto, Japan
| | - Hiroyoshi Hara
- Department of Rehabilitaion Medicine, Isawa Kyoritsu Hospital, Yamanashi, Japan
| | - Masahiro Abo
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
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Şengül İ, Aşkın A, Tosun A. Effect of muscle selection for botulinum neurotoxin treatment on spasticity in patients with post-stroke elbow flexor muscle over-activity: an observational prospective study. Somatosens Mot Res 2021; 39:10-17. [PMID: 34632927 DOI: 10.1080/08990220.2021.1986383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE/AIM To investigate the effect of muscle selection for botulinum neurotoxin A (BoNT-A) treatment on spasticity in patients with post-stroke elbow flexor muscle over-activity. MATERIALS AND METHODS Chronic stroke patients with a deforming spastic paresis in the upper limb (elbow flexion with forearm pronation) who were injected BoNT-A into at least one of elbow flexor muscles (brachialis, brachioradialis, and biceps brachii) were included in this prospective observational study. The main outcome measure was spasticity angle by Tardieu Scale recorded at pre-treatment and week 4 after treatment. RESULTS Three muscle selection groups with sufficient sample size for statistical analysis were able to be created; brachialis (n = 14), biceps brachii (n = 21), and brachialis plus brachioradialis (n = 11). Although there was a significant improvement in spasticity angle within all groups over time (p < 0.05), the change in spasticity angle was not different between the groups (p > 0.05 for each pairwise comparison). However, the magnitude of the change in spasticity angle was larger in the groups in which brachialis was preferred. CONCLUSIONS In stroke patients with a spontaneous spastic posture of elbow flexion and forearm pronation, targeting brachialis for BoNT-A injection seems more effective in reducing the severity of spasticity. CLINICAL TRIAL REGISTRATION NO NCT04036981.
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Affiliation(s)
- İlker Şengül
- Department of Physical Medicine and Rehabilitation, School of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Ayhan Aşkın
- Department of Physical Medicine and Rehabilitation, School of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Aliye Tosun
- Department of Physical Medicine and Rehabilitation, School of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
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Hung JW, Chen YW, Chen YJ, Pong YP, Wu WC, Chang KC, Wu CY. The Effects of Distributed vs. Condensed Schedule for Robot-Assisted Training with Botulinum Toxin A Injection for Spastic Upper Limbs in Chronic Post-Stroke Subjects. Toxins (Basel) 2021; 13:toxins13080539. [PMID: 34437410 PMCID: PMC8402581 DOI: 10.3390/toxins13080539] [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: 05/26/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
Robot-assisted training (RT) combined with a Botulinum toxin A (BoNT-A) injection has been suggested as a means to optimize spasticity treatment outcomes. The optimal schedule of applying RT after a BoNT-A injection has not been defined. This single-blind, randomized controlled trial compared the effects of two predefined RT approaches as an adjunct to BoNT-A injections of spastic upper limbs in chronic post-stroke subjects. Thirty-six patients received a BoNT-A injection in the affected upper extremity and were randomly assigned to the condensed or distributed RT group. The condensed group received an intervention of four sessions/week for six consecutive weeks. The distributed group attended two sessions/week for 12 consecutive weeks. Each session included 45 min of RT using the InMotion 2.0 robot, followed by 30 min of functional training. The Fugl-Meyer Assessment, Modified Ashworth Scale, Wolf Motor Function Test, Motor Activity Log, and Stroke Self-Efficacy Questionnaire were assessed at pre-training, mid-term, post-training, and at 6 week follow-up, with the exception of the Motor Activity Log, which did not include mid-term measures. After the intervention, both groups had significant improvements in all outcome measures (within-group effects, p < 0.05), with the exception of the Wolf Motor Function Test time score. There were no significant differences between groups and interaction effects in all outcome measures. Our findings suggest that RT provided in a fixed dosage as an adjunct to a BoNT-A injection has a positive effect on participants' impairment and activity levels, regardless of treatment frequency. (ClinicalTrials.gov: NCT03321097).
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Affiliation(s)
- Jen-Wen Hung
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Yen-Wei Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Ju Chen
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
| | - Ya-Ping Pong
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Wen-Chi Wu
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
| | - Ku-Chou Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
- Correspondence:
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Kahn MB, Williams G, Mentiplay BF, Bower KJ, Olver J, Clark RA. Upper Limb Associated Reactions: The Relationship Between Movement Kinematics and Muscle Activity in Seated Versus Walking Testing. Am J Phys Med Rehabil 2021; 100:235-242. [PMID: 33595935 DOI: 10.1097/phm.0000000000001551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to (1) evaluate the relationships between stationary and dynamic associated reaction (AR) tests in people with acquired brain injury using surface electromyography (sEMG) muscle activity and three-dimensional motion analysis kinematic measures and (2) assess the test-retest reliability of sEMG and seated tests of ARs. DESIGN Forty-two adults with acquired brain injury underwent AR testing with seated contralateral maximal voluntary isometric contraction tests and walking (self-selected and fast speeds). Associated reaction measurements included biceps brachii sEMG, elbow goniometry, and three-dimensional motion analysis kinematics during walking. Pearson correlations evaluated the relationships between seated and dynamic walking AR tests and between muscle activity and kinematic measures. Chronic participants were reassessed 1 wk later for reliability. RESULTS A strong (r = 0.65) and moderate (r = 0.53) relationship existed for biceps brachii sEMG during seated and walking tests at self-selected and fast walk, respectively. A weak to moderate relationship existed between biceps brachii sEMG and kinematics during walking and between seated and walking measures of ARs (r = 0.23-0.53). All tests had strong to very strong test-retest reliability (intraclass correlation coefficients, >0.78). CONCLUSION Seated contralateral maximal voluntary isometric contraction tests correlate only weakly to moderately with AR walking kinematics and moderately to strongly with biceps brachii activation during walking. Moderate relationships exist between sEMG and kinematics, indicating that they may provide different information for ARs.
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Affiliation(s)
- Michelle B Kahn
- From the Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne (MBK, GW); School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast (MBK, RAC); School of Physiotherapy, The University of Melbourne, Melbourne (GW, KJB); La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne (BFM); and Epworth Monash Rehabilitation Unit (EMReM), Melbourne, Australia (JO)
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Jiang W, Wang S, Wu Q, Li X. Effects of Self-Assisted Shoulder Elevation of the Affected Side Combined with Balance Training on Associated Reactions of Upper Limb and Walking Function in Chronic Stroke Patients: A Randomized Controlled Trial. Med Sci Monit 2021; 27:e928549. [PMID: 33626033 PMCID: PMC7919230 DOI: 10.12659/msm.928549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Associated reactions of the upper limb are frequently seen in stroke patients, especially during dynamic activities, such as walking. The aim of this study was to assess the effect of a method to inhibit the affected upper limb flexors combined with balance training on associated reactions of the affected upper limb and walking function in chronic stroke patients. Material/Methods 60 patients were randomly allocated into 3 groups (n=20 per group): control group (no upper limb intervention), back group (the unaffected hand assists the affected upper limb in the low back and keep it in an extended position) and shoulder elevation group using the inhibition method (the unaffected hand assists the affected shoulder to elevate above 90°). Before and after the four-week balance training, the surface electromyography was used to evaluate the rate of contraction of affected elbow flexors. Fugl-Meyer Assessment of Upper Extremity (FMA-UE), 10 Meter Walking Test (10MWT) and Barthel Index (BI) were used to measure functional status. Results The shoulder elevation group had significant improvement in the percentage changes in the rate of contraction of the affected elbow flexors, 10WMT and FMA-UE (p<0.05) compared with back group and control group. We found no significant difference of 10WMT and FMA-UE between back group and control group. Conclusions The combination of the new inhibition method and the standing balance training could reduce the abnormal activity of affected elbow flexors during walking, increase walking speed, and improve the affected upper limb motor function.
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Affiliation(s)
- Wenjun Jiang
- Department of Rehabilitation Medicine, Suzhou Vocational Health College, Suzhou, Jiangsu, China (mainland)
| | - Sheng Wang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China (mainland)
| | - Qinfeng Wu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China (mainland)
| | - Xiangzhe Li
- Department of Rehabilitation Medicine, The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China (mainland)
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Kahn MB, Clark RA, Mentiplay BF, Bower KJ, Olver J, Williams G. Potential contributing factors to upper limb associated reactions in people with acquired brain injury: an exploratory study. Disabil Rehabil 2021; 44:3816-3824. [PMID: 33617385 DOI: 10.1080/09638288.2021.1887945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine which potential contributing factors are associated with upper limb associated reaction (AR) expression in individuals with acquired brain injury (ABI). METHODS Forty-two participants underwent three-dimensional motion analysis at self-selected walking speed to generate the AR outcome measure, quantifying their upper limb kinematic deviation compared to healthy controls. Clinical assessment included: upper and lower limb hypertonicity, spasticity and strength, balance, dynamic walking stability, arm and leg function, anxiety, arm pain/discomfort, and fear of falling. RESULTS Significant, moderate-to-strong correlations (r = 0.42-0.74, p < 0.05) existed between upper limb ARs and both hypertonicity and spasticity of the upper limb muscles and the knee extensors. Significant, moderate correlations to ARs (r = 0.42-0.59, p < 0.05) existed for balance, dynamic stability, upper limb strength, and arm function. The severity of AR was significantly different between those with and without hypertonicity of the four tested upper limb muscles, elbow and long finger flexor spasticity, knee extensor spasticity, and reduced dynamic stability (p < 0.05; effect sizes ≥0.80). However, these contributing factors were not present in all participants. CONCLUSIONS Associated reactions are complex and multi-factorial. There were several significant correlations indicating that factors may influence AR severity. While positive upper motor neuron syndrome features should be prioritised for clinical assessment, these factors are not prerequisites for ARs.IMPLICATIONS FOR REHABILITATIONUpper limb associated reactions are a complex and multi-factorial phenomenon.Upper limb muscle hypertonicity and spasticity should be prioritised for assessment; however, they are not prerequisites for associated reactions.Hypertonicity and spasticity should be differentiated as they may have differing relationships to associated reactions.Knee extensor hypertonicity and spasticity, postural stability, upper limb strength, and arm function may also be contributing factors to consider.
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Affiliation(s)
- Michelle B Kahn
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia.,School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - Ross A Clark
- School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Kelly J Bower
- School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - John Olver
- Epworth Monash Rehabilitation Unit (EMReM), Melbourne, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia.,School of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Kahn MB, Williams G, Mentiplay BF, Bower KJ, Olver J, Clark RA. Quantification of abnormal upper limb movement during walking in people with acquired brain injury. Gait Posture 2020; 81:273-280. [PMID: 32854069 DOI: 10.1016/j.gaitpost.2020.08.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormal upper limb movements frequently affect people with acquired brain injury (ABI) during walking. Three-dimensional motion analysis (3DMA) can quantify upper limb abnormality kinematically, with composite scores condensing multiple joint axes data into a single score. RESEARCH QUESTION Are 3DMA-derived composite scores valid (known-groups and convergent validity), reliable and able to quantify speed-related changes in abnormal upper limb movement during walking? METHODS This observational study compared 42 adults with ABI and abnormal upper limb movements during walking with 36 healthy controls (HC) at a matched walking speed intention. Participants underwent 3DMA assessment of self-selected and fast walking speeds. Composite scores quantified the affected upper limb's kinematic abnormality. The Arm Posture Score arithmetic mean version (APSam) and 1.96 standard deviation reference-range scaled versions; the Kinematic Deviation Score mean (KDSm) and worst score (KDSw) were evaluated for association with each other and subjective abnormality rating (Pearson's 'r' correlation), test-retest reliability (intra-class correlation coefficient (ICC)), and ability to quantify speed-related changes in abnormal upper limb movement (Cohen's d effect size (ES), % change scores). RESULTS Very strong correlations existed between composite scores. The KDSm under-classified upper limb abnormality, whereas the KDSw captured the majority of ABI participants. All scores had moderate-strong correlations with subjective rating of abnormal upper limb movements (r = 0.54 - 0.79) and very strong test-retest reliability (ICCs > 0.81). The APSam demonstrated a 16% (ES = 0.76) walking speed-related increase in upper limb abnormality, whilst decreases were demonstrated in the KDSm 26% (ES 0.90) and KDSw 35% (ES 0.96). SIGNIFICANCE The APSam, KDSw, and number of abnormal joint axes comprehensively assess the whole upper limb abnormal movements, accurately classifies abnormality, and quantifies severity. This study illustrated notable presence of abnormal upper limb movements at self-selected walking speed and small increase at fast speeds. However, when scaled to HC variability, the fast walk kinematics became less abnormal due to increased HC movement variability.
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Affiliation(s)
- Michelle B Kahn
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia; School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia.
| | - Gavin Williams
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia; School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - Kelly J Bower
- School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - John Olver
- Epworth Monash Rehabilitation Unit (EMReM), Melbourne, Australia
| | - Ross A Clark
- School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
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Singh R, Clarke A. Real-life outcomes in spasticity management: features affecting goal achievement. BMJ Neurol Open 2020; 2:e000015. [PMID: 33681772 PMCID: PMC7903178 DOI: 10.1136/bmjno-2019-000015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/27/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/OBJECTIVE Spasticity is a complex and common condition but there is a lack of 'real-world' data on goal setting and spasticity treatment, as well as identifying those features that might be associated with goal achievement. Our aim was to provide such data. METHODS Prospective attenders at a multi-disciplinary spasticity clinic over 2 years followed for consecutive appointments. Patient demographics and doses of botulinum toxin injected were documented. Main outcome was achievement of a primary goal but secondary goals were also recorded. Independent variables were examined for association to the outcome. RESULTS A total of 606 goals were set in 224 patients. The majority (75.2%) were achieved with similar levels across active (72.5%), passive (75.7%) and pain (78.6%) goals. However, in terms of the primary goal, active primary goals were achieved less frequently (59.7%) than non-active primary goal (74.2%). A logistic regression confirmed that this was the only independent variable associated with primary goal achievement. The majority of patients (61.6%) required changes to their treatment between appointments, irrespective of time since diagnosis, age or aetiology. CONCLUSIONS Most goals set in spasticity clinic can be achieved irrespective of type of goal. However, active goals may be harder to accomplish when they are set as a primary goal. This may reflect the desire of individuals to prioritise a desirable goal rather than one that is achievable. While goal setting is important in the management of spasticity patients, very few patient or treatment factors are associated with outcome prediction. Further work needs to identify features that may predict successful outcome.
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Affiliation(s)
- Rajiv Singh
- Department of Rehabilitation Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alison Clarke
- Mobility and Specialised Rehabilitation Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Doussoulin A, Bacco JL, Rivas C, Saiz JL. Association between postural patterns of spastic upper extremity and functional independence after TBI and stroke. NeuroRehabilitation 2020; 46:551-559. [PMID: 32508335 DOI: 10.3233/nre-203042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spastic hypertonia of the upper limb after stroke or traumatic brain injuries (TBI) is a prevalent clinical sign causing abnormal postures and movement patterns due to hyperexcitability of the upper motor neurons and rheological alterations in the affected muscles. These alterations limit the use of the upper limb, restricting its functional activities and affecting the individual's quality of life and social participation. OBJECTIVE To determine the association between spastic patterns of the upper limb, wrist, fingers and thumb, and independence in everyday activities after a stroke or TBI. METHODS The design is a cross-sectional descriptive and correlational study. The sample consisted of 206 individuals who complied with the eligibility criteria and signed an informed consent. Clinical evaluation was carried out, including determination of the postural pattern of the upper extremity according to Hefter's taxonomy and postural pattern classification of the wrist, fingers and thumb. Functional independence was evaluated using the Functional Independence Measure (FIM) and the Barthel Index (BI). RESULTS Univariate between-subject ANOVAs were used to examine associations of the four pattern classifications with the two independence measures, FIM and BI. Results indicate that Pattern I of Hefter's upper limb taxonomy is associated with lesser functional independence according to FIM and BI mean scores. CONCLUSIONS The postural pattern of the upper limb after TBI or stroke is related to the patient's functional independence. Specifically, Pattern I tends to co-occur with low independence.
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Affiliation(s)
- Arlette Doussoulin
- Department of Pediatrics and Child Surgery, Universidad de La Frontera, Temuco, Chile
| | | | | | - José L Saiz
- Department of Psychology, Universidad de La Frontera, Temuco, Chile
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Kerstens HCJW, Satink T, Nijkrake MJ, De Swart BJM, Nijhuis-van der Sanden MWG, Van der Wees PJ, Geurts ACH. Experienced consequences of spasticity and effects of botulinum toxin injections: a qualitative study amongst patients with disabling spasticity after stroke. Disabil Rehabil 2020; 43:3688-3695. [PMID: 32255361 DOI: 10.1080/09638288.2020.1746843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Chronic spasticity poses a major burden on patients after stroke. Intramuscular botulinum toxin injections constitute an important part of the treatment for patients suffering from troublesome focal spasticity. This study explores the experienced consequences of chronic spasticity amongst patients after stroke regarding physical impairments and activities, the experienced effects of botulinum toxin treatment on these domains, and whether current spasticity management addresses patients' needs.Materials and methods: Fourteen participants with chronic spasticity after stroke who were treated with cyclical botulinum toxin injections in the upper and/or lower extremity muscles were interviewed. Inductive thematic analysis generated representative themes.Results: Analyses of the interviews revealed three themes: (1) spasticity-related impairments and activity limitations; (2) fluctuations in spasticity related to botulinum toxin; (3) need for professional support and feedback. Besides motor impairments, participants experienced activity limitations in many domains of everyday life, with considerable day-to-day fluctuations. Moreover, treatment with botulinum toxin led to cyclical fluctuations in spasticity-related symptoms, which differed across participants. The participants called for shared responsibility for treatment, particularly regarding optimising the timing of injections.Conclusion: Incorporating patient-relevant outcomes into the current assessment of spasticity and monitoring these outcomes may improve spasticity management, particularly regarding the timing of botulinum toxin injections.Implications for rehabilitationBecause chronic spasticity after stroke impacts on almost all domains of everyday life, professionals should identify and target the most relevant problems in each individual patient.Monitoring patient-reported outcomes may help patients and professionals to get insight in the fluctuations of spasticity-related symptoms and may help to evaluate the effects of botulinum toxin injections from the patient's perspective.Patient education and providing insight in the fluctuations of spasticity-related symptoms may support self-management and shared decision-making in spasticity management.
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Affiliation(s)
- Hans C J W Kerstens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands.,HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Maarten J Nijkrake
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bert J M De Swart
- HAN University of Applied Sciences, Nijmegen, Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Philip J Van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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12
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Kahn MB, Clark RA, Williams G, Bower KJ, Banky M, Olver J, Mentiplay BF. The nature and extent of upper limb associated reactions during walking in people with acquired brain injury. J Neuroeng Rehabil 2019; 16:160. [PMID: 31881975 PMCID: PMC6935151 DOI: 10.1186/s12984-019-0637-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Upper limb associated reactions (ARs) are common in people with acquired brain injury (ABI). Despite this, there is no gold-standard outcome measure and no kinematic description of this movement disorder. The aim of this study was to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort at matched walking speed intention. METHODS A convenience sample of 36 healthy control adults (HCs) and 42 people with ABI who had upper limb ARs during walking were recruited and underwent assessment of their self-selected walking speed using the criterion-reference three dimensional motion analysis (3DMA) at Epworth Hospital, Melbourne. Shoulder flexion, abduction and rotation, elbow flexion, forearm rotation and wrist flexion were assessed. The mean angle, standard deviation (SD), peak joint angles and total joint angle range of motion (ROM) were calculated for each axis across the gait cycle. On a group level, ANCOVA was used to assess the between-group differences for each upper limb kinematic outcome variable. To quantify abnormality prevalence on an individual participant level, the percentage of ABI participants that were outside of the 95% confidence interval of the HC sample for each variable were calculated. RESULTS There were significant between-group differences for all elbow and shoulder abduction outcome variables (p < 0.01), most shoulder flexion variables (except for shoulder extension peak), forearm rotation SD and ROM and for wrist flexion ROM. Elbow flexion and shoulder abduction were the axes most frequently affected by ARs. Despite the elbow being the most prevalently affected (38/42, 90%), a large proportion of participants had abnormality, defined as ±1.96 SD of the HC mean, present at the shoulder (32/42, 76%), forearm (20/42, 48%) and wrist joints (10/42, 24%). CONCLUSION This study provides valuable information on ARs, and highlights the need for clinical assessment of ARs to include all of the major joints of the upper limb. This may inform the development of a criterion-reference outcome measure or classification system specific to ARs.
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Affiliation(s)
- Michelle B Kahn
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia. .,School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia.
| | - Ross A Clark
- School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia.,School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Kelly J Bower
- School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Megan Banky
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia.,School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - John Olver
- Epworth Monash Rehabilitation Unit (EMReM), Melbourne, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia
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13
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Lannin NA, Ada L, English C, Ratcliffe J, Faux SG, Palit M, Gonzalez S, Olver J, Cameron I, Crotty M. Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke: The InTENSE Trial. Stroke 2019; 51:556-562. [PMID: 31813359 PMCID: PMC7004444 DOI: 10.1161/strokeaha.119.027602] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text. The aim of this trial was to determine the effect of additional upper limb rehabilitation following botulinum toxin-A for upper limb activity in chronic stroke.
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Affiliation(s)
- Natasha A Lannin
- From the Department of Neurosciences, Central Clinical School (N.A.L.), Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia (N.A.L., M.P.)
| | - Louise Ada
- Faculty of Health Sciences (Physiotherapy) (L.A.), The University of Sydney, New South Wales, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, New South Wales, Australia (C.E.)
| | - Julie Ratcliffe
- College of Nursing and Health Sciences (J.R.), Flinders University, Adelaide, South Australia, Australia
| | - Steven G Faux
- Sacred Heart Rehabilitation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia (S.G.F.).,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia (S.G.F.)
| | - Mithu Palit
- Alfred Health, Melbourne, Victoria, Australia (N.A.L., M.P.)
| | | | - John Olver
- Epworth Monash Rehabilitation Medicine Research Unit (J.O.), Monash University, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research (I.C.), The University of Sydney, New South Wales, Australia
| | - Maria Crotty
- Rehabilitation and Aged Care, College of Medicine and Public Health (M.C.), Flinders University, Adelaide, South Australia, Australia
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Hara T, Momosaki R, Niimi M, Yamada N, Hara H, Abo M. Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function. Toxins (Basel) 2019; 11:toxins11120707. [PMID: 31817426 PMCID: PMC6950173 DOI: 10.3390/toxins11120707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022] Open
Abstract
Aim: The purpose of this study was to examine the effectiveness of botulinum toxin A (BoNT-A) therapy combined with rehabilitation on motor function in post-stroke patients. Methods: The following sources up to December 31, 2018, were searched from inception for articles in English: Pubmed, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL. Trials using injections of BoNT-A for upper and lower limb rehabilitation were examined. We excluded studies that were not performed for rehabilitation or were not evaluated for motor function. Results: Twenty-six studies were included. In addition to rehabilitation, nine studies used adjuvant treatment to improve spasticity or improve motor function. In the upper limbs, two of 14 articles indicated that significant improvement in upper limb motor function was observed compared to the control group. In the lower limbs, seven of 14 articles indicated that significant improvement in lower limb motor function was observed compared to the control group. Conclusions: The effect of combined with rehabilitation is limited after stroke, and there is not sufficient evidence, but results suggest that BoNT-A may help to improve motor function. In future studies, the establishment of optimal rehabilitation and evaluation times of BoNT-A treatment will be necessary for improving motor function and spasticity.
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Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
- Correspondence: ; Tel.: +81-3-3433-1111; Fax: +81-3-3431-1206
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa 213-8507, Japan
| | - Masachika Niimi
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Hiroyoshi Hara
- Rehabilitation Center, Ainomiyako Neurosurgery Hospital, Osaka 538-0044, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
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15
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Kahn MB, Clark RA, Bower KJ, Mentiplay BF, Yong Hao P, Olver J, Williams G. The reproducibility and responsiveness of subjective assessment of upper limb associated reactions in people with acquired brain injury during walking. Clin Rehabil 2019; 34:252-262. [DOI: 10.1177/0269215519888782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study is to determine inter-rater, test–retest and intra-rater reproducibility and responsiveness of subjective assessment of upper limb associated reactions in people with acquired brain injury using (1) the ‘Qualifiers Scale’ of the International Classification of Functioning, Disability and Health Framework, and (2) visually estimated elbow flexion angle during walking. Design: Observational study. Setting: A brain injury rehabilitation centre, Melbourne, Australia. Subjects: People with acquired brain injury and upper limb associated reactions and experienced neurological physiotherapists. Main measures: The Qualifiers Scale applied to individual upper limb joints and global associated reaction on a 5-point scale (0–4), a summed upper limb severity score and visually estimated elbow flexion angle. Results: A total of 42 people with acquired brain injury (mean age: 48.4 ± 16.5 years) were videoed walking at self-selected and fast speeds. A subset of 30 chronic brain injury participants (mean time post injury: 8.2 ± 9.3 years) were reassessed one week later for retest reproducibility. Three experienced neurological physiotherapists (mean experience: 22.7 ± 9.1 years) viewed these videos and subjectively rated the upper limb associated reactions. Strong-to-very strong test–retest, intra- and inter-rater reproducibility was found for elbow flexion angle (ICC > 0.86) and the Qualifiers Scale applied to global and individual upper limb joints (ICC > 0.60). Responsiveness of change from self-selected to fast walking speed (mean increase 0.46 m/s) was highest for elbow flexion angle (effect size = 0.83) and low-to-moderate for the Qualifiers Scale. Conclusion: Subjectively rated associated reactions during walking demonstrated strong reproducibility and moderate responsiveness to speed change. The Qualifiers Scale and elbow flexion angle can both subjectively quantify associated reactions during walking in a clinical setting.
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Affiliation(s)
- Michelle B Kahn
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, VIC, Australia
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Ross A Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Kelly J Bower
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | - John Olver
- Epworth Monash Rehabilitation Unit (EMReM), Melbourne, VIC, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
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16
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Ro T, Ota T, Saito T, Oikawa O. Spasticity and Range of Motion Over Time in Stroke Patients Who Received Multiple-Dose Botulinum Toxin Therapy. J Stroke Cerebrovasc Dis 2019; 29:104481. [PMID: 31699575 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/05/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study examined how the effects of botulinum toxin therapy changed over time by sequential evaluation of clinical improvements in spasticity and contracture in 24 chronic-stage stroke patients on repeated botulinum toxin therapy who were receiving fewer rehabilitation interventions. METHODS Botulinum toxin injection was administered into the spastic muscle of the paralyzed upper or lower limb 5 times with at least 3-month intervals. Modified Ashworth Scale and range of motion were measured before and 2 weeks after each dose in the extremities to compare the first measurement value with subsequent values. Each predose value was also compared with the first predose value. RESULTS Compared with predose scores, Modified Ashworth Scale significantly improved in all flexors after 2 weeks from the first to fifth doses. Range of motion significantly improved in wrist dorsiflexion and ankle dorsiflexion. Comparison of values before each dose versus the first predose value showed significant improvement both in the Modified Ashworth Scale score of wrist flexors, finger flexors, and ankle planter flexors, and the range of motion of elbow extension, wrist dorsiflexion, and ankle dorsiflexion. CONCLUSION The comparison of predose values versus 2-week postdose values indicated that the effect of botulinum toxin formulation would not lessen after repeated injections with continuous improvements of Modified Ashworth Scale and range of motion. The comparison of predose values versus the first predose value also suggested that multiple injections of botulinum toxin formulation could be more effective in reducing spasticity and increasing the range of motion than a single injection.
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Affiliation(s)
- Takanori Ro
- Rehabilitation Unit, Asahikawa Medical University Hospital, Asahikawa, Japan.
| | - Tetsuo Ota
- Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Tsukasa Saito
- Cardiovascular, Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Ou Oikawa
- Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Asahikawa, Japan
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17
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Gomes ALS, Mello FFD, Cocicov Neto J, Benedeti MC, Modolo LFM, Riberto M. Can the positions of the spastic upper limb in stroke survivors help muscle choice for botulinum toxin injections? ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:568-573. [PMID: 31508683 DOI: 10.1590/0004-282x20190087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/05/2019] [Indexed: 11/22/2022]
Abstract
Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. OBJECTIVE We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. METHODS Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. RESULTS Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. CONCLUSION Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.
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Affiliation(s)
- André Luiz Salcedo Gomes
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Francisco Falleiros de Mello
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Jorge Cocicov Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Marcelo Causin Benedeti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Luis Felipe Miras Modolo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
| | - Marcelo Riberto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto SP, Brasil
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18
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Kerstens HCJW, Satink T, Nijkrake MJ, De Swart BJM, Van Lith BJH, Geurts ACH, Nijhuis-van der Sanden MWG. Stumbling, struggling, and shame due to spasticity: a qualitative study of adult persons with hereditary spastic paraplegia. Disabil Rehabil 2019; 42:3744-3751. [PMID: 31079503 DOI: 10.1080/09638288.2019.1610084] [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: 01/23/2023]
Abstract
Purpose: Little is known concerning the impact of chronic spasticity on physical activities, social participation, and well-being, and whether patients' needs are addressed by current treatments. This study aims to investigate these lacunas in persons with a pure form of hereditary spastic paraplegia (HSP), in whom spasticity is a prominent symptom.Methods: Fourteen patients with a pure form of HSP were interviewed. These interviews were recorded, verbally transcribed, and thematically analyzed.Results: Four themes were identified which can be reflected by the phrases: (1) 'I stumble', (2) 'I struggle', (3) 'I feel ashamed', and (4) 'I need support'. Balance and gait problems led to limitations in domestic activities, employment, and recreation. 'Stumbling' also occurred due to pain, stiffness, and fatigue. Struggling was related to the continuous need for adaptation strategies, including the abandonment of some activities. Participants further reported feelings of shame, fear, and frustration. Lastly, they needed more support in daily activities than currently provided.Conclusion: Besides treating spasticity-related motor impairments, patients with HSP need practical support for optimizing their physical activities and social participation. They also seek attention for the non-motor consequences of their chronic spasticity to improve their well-being. Patient-reported outcomes might help to address these needs.Implications for rehabilitationAccording to patients with hereditary spastic paraplegia, interventions for spasticity should not only be aimed at reducing motor impairments, but also on reducing pain and fatigue, improving nighttime rest and general well-being, and optimizing the performance of relevant personal activities.Medical, role and emotional management in patients with hereditary spastic paraplegia can be improved only when individual needs are identified and monitored over the course of the disease.Besides assessment of bodily functions and physical capacities, systematic evaluation of patient-reported outcomes will help both patients and professionals to monitor the functional impact of disease progression and to evaluate the effects of interventions aimed at retarding this progression.
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Affiliation(s)
- Hans C J W Kerstens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maarten J Nijkrake
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Bert J M De Swart
- HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Bas J H Van Lith
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
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19
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Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, Ashford S. ULIS (Upper Limb International Spasticity), a 10-year Odyssey: An international, multicentric, longitudinal cohort of person-centered spasticity management in real-life practice. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019. [DOI: 10.4103/jisprm.jisprm_47_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Fheodoroff K, Dressler D, Woldag H, Koßmehl P, Koch M, Maisonobe P, Reichel G. [Treatment goals in patients with post-stroke upper limb spasticity following injection of botulinum toxin A : Results of the German-Austrian subgroup of the ULIS-II study]. DER NERVENARZT 2018; 90:361-370. [PMID: 30324541 DOI: 10.1007/s00115-018-0630-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ULIS-II was an international cohort study (NCT01020500) evaluating current treatment of upper limb spasticity in post-stroke adult patients with botulinum toxin A (BoNT-A) in real-life practice. OBJECTIVE Post hoc analysis to compare current management of post-stroke adult patients regarding goal setting and attainment with BoNT-A in Germany (D) and Austria (A) with the full cohort of ULIS-II. MATERIAL AND METHODS The ULIS-II was a global, open-label, prospective, multicenter observational study with 2 visits conducted in 84 centers worldwide. A total of 468 patients aged ≥18 years with post-stroke upper limb spasticity were included. The primary outcome measure was the responder rate defined as achievement of a goal attainment scale (GAS) score of 0, 1 or 2 after 1 cycle of BoNT-A. RESULTS A total of 57 patients from D/A were included in the efficacy analysis. The number of patients in D/A and the full cohort achieving the primary (78.9% vs. 79.6%) and secondary treatment goal (76.8% vs. 75.6%), respectively, was comparable. Deviating from the full cohort, the most common primary treatment goal in D/A was related to impairment (33.3%). Compared to baseline there was a marked reduction in concomitant therapies at the follow-up visit after 3-5 months in the D/A group: patients receiving oral anti-spastic medication 61.4% vs. 40.4%, positioning 50.9% vs. 36.8% and splinting 43.9% vs. 31.6%. Injection control techniques were less frequently used in the D/A group compared to the global study cohort (electrical stimulation: 26.3% vs. 45.8% and electromyography: 12.3% vs. 29.2%). No adverse events were documented in the D/A cohort. CONCLUSION A single injection of BoNT-A in adult patients with post-stroke spasticity of the arm led to a high response rate of approximately 80% in both cohorts. The BoNT-A injections in post-stroke adult patients contributed to an improvement in the daily life of patients and their carers beyond simple reduction of muscle tone or spasticity.
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Affiliation(s)
- K Fheodoroff
- Gailtal-Klinik, Radnigerstraße 12, 9620, Hermagor, Österreich.
| | - D Dressler
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Woldag
- Praxis Dr. Schäker, Leipzig, Deutschland
| | - P Koßmehl
- Kliniken Beelitz GmbH, Beelitz-Heilstätten, Beelitz, Deutschland
| | - M Koch
- Ipsen Pharma, Ettlingen, Deutschland
| | | | - G Reichel
- Paracelcus-Klinik Zwickau, Zwickau, Deutschland
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21
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Fheodoroff K, Bhidayasiri R, Jacinto LJ, Chung TM, Bhatia K, Landreau T, Colosimo C. Ixcellence Network®: an international educational network to improve current practice in the management of cervical dystonia or spastic paresis by botulinum toxin injection. FUNCTIONAL NEUROLOGY 2018; 32:103-110. [PMID: 28676144 DOI: 10.11138/fneur/2017.32.2.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Botulinum toxin is a well-established treatment for a number of conditions involving muscle hyperactivity, such as focal dystonia and spastic paresis. However, current injection practice is not standardized and there is a clear need for structured training. An international group of experts in the management of patients with cervical dystonia (CD) and spastic paresis created a steering committee (SC). For each therapeutic area, the SC developed a core slide set on best practice, based on the literature. International sites of expertise were identified for training and courses were designed to include lectures and casebased learning. Where possible, courses received accreditation from the European Union of Medical Specialists (UEMS). Each course was peer reviewed by the SC, the UEMS accreditation board and the attendees themselves (through evaluation questionnaires). Attendees' feedback was shared with the SC and the trainers to tailor future training sessions. From the program launch in 2012 to December 2014, 328 physicians from 34 countries were trained in a total of 58 courses; 67% of the courses focused on spastic paresis and 33% on CD. Of the 225 (69%) physicians who completed feedback forms, 95% rated their course as 'above average/excellent' in meeting the preset learning objectives. Most (90%) physicians declared that attending a course would lead them to change their practice. The development of the 'Ixcellence Network' for continuous medical education in the fields of spastic paresis and CD has provided a novel and interactive way of training physicians with previous experience in botulinum toxin injection.
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22
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Holmes RJ, Connell LA. A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK. Disabil Rehabil 2017; 41:720-726. [DOI: 10.1080/09638288.2017.1400596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Richard J. Holmes
- Physiotherapy Department, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - Louise A. Connell
- School of Health Sciences, University of Central Lancashire, Preston, UK
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23
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Abstract
The aim of this study is to develop a treatment diary for patients receiving spasticity treatment including botulinum toxin injection and physiotherapy and/or occupational therapy. The diary focuses on problems triggered by skeletal muscle overactivity; agreed goals for treatment and the patient’s self-evaluation of achievement on the Goal Attainment Scale; which skeletal muscles were injected; physiotherapists’ and occupational therapists’ evaluation of the patients’ achievement of objectives on the Goal Attainment Scale; and proposals for optimization of treatment and changing goals. The evaluation included a satisfaction questionnaire and the WHO-QoL BREF and WHO-5 well-being score. Overall, 10 patients were enrolled in the pilot study. The patients were generally satisfied with the diary, found that it involved them more in their treatment and made it easier to set personal goals, and found it worth the time spent using it. However, no clear advantage in relation to their quality of life (WHO-QoL BREF and WHO-5 well-being score) was reported.
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24
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Krylova LV, Khasanova DR. The features of botulinum therapy for different patterns of poststroke spasticity. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:42-48. [DOI: 10.17116/jnevro20171172142-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Rosales RL, Efendy F, Teleg ESA, Delos Santos MMD, Rosales MCE, Ostrea M, Tanglao MJ, Ng AR. Botulinum toxin as early intervention for spasticity after stroke or non-progressive brain lesion: A meta-analysis. J Neurol Sci 2016; 371:6-14. [DOI: 10.1016/j.jns.2016.10.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/01/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
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Genet F, Schnitzler A, Droz-Bartholet F, Salga M, Tatu L, Debaud C, Denormandie P, Parratte B. Successive motor nerve blocks to identify the muscles causing a spasticity pattern: example of the arm flexion pattern. J Anat 2016; 230:106-116. [PMID: 27595994 DOI: 10.1111/joa.12538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
Botulinum Toxin A has been the main treatment for spasticity since the beginning of the 1990s. Surprisingly, there is still no consensus regarding injection parameters or, importantly, how to determine which muscles to target to improve specific functions. The aim of this study was to develop a systematic approach to determine this, using the example of the arm flexion pattern. We first determined anatomical landmarks for selective motor block of the brachialis nerve, using 20 forearms from 10 fresh cadavers in Ecole Européenne de Chirurgie and a university-based dissection centre, Paris, France. We then carried out selective blocks of the motor nerves to the brachialis, brachioradialis and biceps brachii in patients with stroke with an arm flexion pattern, in a University Rehabilitation Hospital, Garches, France. We measured: the resting angle of the elbow angle in standing (manual goniometer), active and passive range of extension, and spasticity using the Held and Tardieu and the Modified Ashworth scales. Range of passive elbow extension was also measured with the shoulder in 90° of flexion. The resting angle of the elbow in standing decreased by 35.0° (from 87.6 ± 23.7 to 52.6 ± 24.2°) with inhibition of brachialis, by a further 3.9° (from 52.6 ± 24.2 to 48.7 ± 23.7°) with inhibition of brachioradialis and a further 14.5° (from 48.7 ± 23.7to 34.2 ± 20.7°) with inhibition of biceps brachii. These results were consistent with the clinical evaluation of passive elbow range of motion with the shoulder at 90°. Sequential blocking of the nerves to the three main elbow flexors revealed that the muscle that limited elbow extension the most, was brachialis. This muscle should be the main target to improve the arm flexion pattern. These results show that it is important not simply to inject the most superficial or powerful muscles to treat a spastic deformity. A comprehensive assessment is required. The strategy proposed in this paper should increase the effectiveness of botulinum toxin injections by ensuring that the relevant muscles are targeted.
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Affiliation(s)
- F Genet
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.,'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France.,Ecole Européenne de Chirurgie (EEC), Paris, France
| | - A Schnitzler
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.,Ecole Européenne de Chirurgie (EEC), Paris, France
| | - F Droz-Bartholet
- Service de Médecine Physique et de Réadaptation, CHRU Besançon, Besançon Cedex, France
| | - M Salga
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.,'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France
| | - L Tatu
- Laboratoire d'anatomie UFR SMP, Université Bourgogne/Franche-Comté, Besançon Cedex, France.,Service d'Explorations et Pathologies Neuro-musculaires, CHRU Besançon, Besançon Cedex, France
| | - C Debaud
- 'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France.,Service de Chirurgie Orthopédique, Hôpital Européen Georges Pompidou, Paris, France
| | - P Denormandie
- 'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France.,Ecole Européenne de Chirurgie (EEC), Paris, France.,Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, Garches, France
| | - B Parratte
- Ecole Européenne de Chirurgie (EEC), Paris, France.,Service de Médecine Physique et de Réadaptation, CHRU Besançon, Besançon Cedex, France.,Laboratoire d'anatomie UFR SMP, Université Bourgogne/Franche-Comté, Besançon Cedex, France
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OnabotulinumtoxinA Injection for Poststroke Upper-Limb Spasticity: Guidance for Early Injectors From a Delphi Panel Process. PM R 2016; 9:136-148. [PMID: 27346090 DOI: 10.1016/j.pmrj.2016.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND OnabotulinumtoxinA reduces muscle hypertonia associated with poststroke spasticity (PSS). PSS manifests as several common postures. OBJECTIVE To define treatment paradigms for PSS upper-limb common postures. DESIGN Modified Delphi method. SETTING Expert panel. PARTICIPANTS Ten injectors experienced in the treatment and clinical research of PSS (physiatrists and neurologists) were invited to participate in the Delphi panel. METHODS The Delphi panel reviewed an electronic worksheet with PSS upper-limb postures to define onabotulinumtoxinA treatment paradigms (Round 1). During Round 2, panel members discussed in person Round 1 results and voted until consensus (≥66% agreement). Recommendations were geared toward those with new or early injection experience. MAIN OUTCOME MEASUREMENTS Expert consensus on onabotulinumtoxinA treatment parameters for PSS including muscles to inject, dose per muscle and posture, and treatment adjustments for suboptimal response. RESULTS For each posture, consensus was reached on targeted subsets of muscles. Doses ranged for individual muscles (10-100 U) and total doses per posture (50-200 U). An onabotulinumtoxinA dilution 50 U/mL (2:1 dilution ratio) was considered most appropriate; dilution ratios of 1:1 to 4:1 may be appropriate in some circumstances. The majority (89%) of panel members would increase the dose and/or the number of muscles treated for a suboptimal response to onabotulinumtoxinA. The panel identified 3 common aggregate upper-limb postures: (1) adducted shoulder + flexed elbow + pronated forearm + flexed wrist + clenched fist; (2) flexed elbow + pronated forearm + flexed wrist + clenched fist; and (3) flexed wrist + clenched fist. The recommended starting dose per aggregate was 300 U, 300 U, and 200 U, with a total maximum dose of 400 U, 400 U, and 300 U, respectively. Localization guidance techniques were considered essential for all postures. CONCLUSIONS Consensus on common muscles and onabotulinumtoxinA treatment paradigms for postures associated with upper-limb PSS was achieved via a modified Delphi method. The purpose of this analysis is to educate early onabotulinumtoxinA injectors rather than provide an evidence-based review. LEVEL OF EVIDENCE V.
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Turner-Stokes L, Ashford S, Jacinto J, Maisonobe P, Balcaitiene J, Fheodoroff K. Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III). BMJ Open 2016; 6:e011157. [PMID: 27315835 PMCID: PMC4916608 DOI: 10.1136/bmjopen-2016-011157] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Describe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study. DESIGN Large international longitudinal cohort study of integrated upper limb spasticity management, including BoNT-A. PARTICIPANTS AND SETTING ULIS-III is a 2-year study expected to enrol >1000 participants at 58 study centres across 14 countries. INTERVENTIONS The study design is non-interventional and intended to reflect real-life clinical practice. It will describe injection practices and additional treatment strategies, and record clinical decision-making in a serial approach to long-term spasticity management. OUTCOME MEASURES ULIS-III will use a goal-directed approach to selection of targeted standardised measures to capture the diversity of presentation, goals and outcomes. ULIS-III will implement the Upper Limb Spasticity Index, a battery of assessments including a structured approach to goal attainment scaling (Goal Attainment Scaling-Evaluation of Outcomes for Upper Limb Spasticity tool), alongside a limited set of standardised measures, chosen according to patients' selected goal areas. Concomitant therapy inputs, patient satisfaction with engagement in goal setting, health economic end points and health-related quality of life data will also be captured. RESULTS OF INITIAL EVALUATION OF GOAL QUALITY Recruitment started in January 2015. By June 2015, 58 sites had been identified and initial data collected for 79 patients across 13 sites in 3 countries. Goal setting data were quality-checked and centres rated on the basis of function-related and Specific, Measurable, Achievable, Realistic, Timed (SMART) characteristics of goal statements. Overall, 11/13 centres achieved the highest rating (A++). CONCLUSIONS ULIS-III will provide valuable information regarding treatment of and outcomes from real-life upper limb spasticity management worldwide. TRIAL REGISTRATION NUMBER NCT02454803; Pre-results.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, King's College London School of Medicine, Northwick Park Hospital, London, UK
| | - Stephen Ashford
- Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, King's College London School of Medicine, Northwick Park Hospital, London, UK
| | - Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos, Estoril, Portugal
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Dressler D, Rychlik R, Kreimendahl F, Schnur N, Lambert-Baumann J. Long-term efficacy and safety of incobotulinumtoxinA and conventional treatment of poststroke arm spasticity: a prospective, non-interventional, open-label, parallel-group study. BMJ Open 2015; 5:e009358. [PMID: 26719317 PMCID: PMC4710831 DOI: 10.1136/bmjopen-2015-009358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of incobotulinumtoxinA with conventional antispastic therapy for poststroke arm spasticity in routine clinical practice over a 1-year period. DESIGN Prospective, non-interventional, open-label, parallel-group study. SETTING 47 centres in Germany. PARTICIPANTS Patients with poststroke arm spasticity; 108 receiving incobotulinumtoxinA, 110 conventional therapy. INTERVENTION Conventional antispastic treatment including oral antispastic medications, physiotherapy and occupational therapy or 3-monthly incobotulinumtoxinA injections plus conventional therapy if required. MAIN OUTCOME MEASURES The main outcome measure was changes in muscle tone (Ashworth Scale) over the 1-year treatment period. Changes in functional disability (Disability Assessment Scale) and quality of life (Short-Form-12 Health Survey) were additionally assessed. Ratings for therapy outcome (Goal Attainment Scale), and efficacy and tolerability of treatment (Global Clinical Impression Scale) were also obtained. RESULTS Muscle tone improved for all spasticity patterns with the Ashworth Scale responder rates between 63% and 86% (incobotulinumtoxinA) and 16-27% (conventional therapy). Median improvement in functional disability was -1.0 (incobotulinumtoxinA) and 0.0 (conventional measures) for all domains. Treatment goals were attained by 93% of incobotulinumtoxinA patients and 30% of patients under conventional therapy. Most physicians (93%) and patients (90%) rated efficacy as good or very good under incobotulinumtoxinA; the proportions were much lower under conventional therapy (36% and 37%). Tolerability under incobotulinumtoxinA was considered good or very good by 99% of physicians and patients (76% and 66%, respectively, under conventional therapy). Quality of life under incobotulinumtoxinA improved by 8.0 (physical score) and 10.8 (mental score) and by 0.8 and 5.7, respectively, under conventional therapy. CONCLUSIONS IncobotulinumtoxinA combined with rehabilitation and oral medication produces a much more robust improvement in all aspects of arm spasticity than conventional antispastic treatment. Effects are stable over a period of 1 year, whereas adverse effects are negligible. IncobotulinumtoxinA should be considered the treatment of choice for poststroke arm spasticity.
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Affiliation(s)
- Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Germany
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Mazlan M, Rajasegaran S, Engkasan JP, Nawawi O, Goh KJ, Freddy SJ. A Double-Blind Randomized Controlled Trial Investigating the Most Efficacious Dose of Botulinum Toxin-A for Sialorrhea Treatment in Asian Adults with Neurological Diseases. Toxins (Basel) 2015; 7:3758-70. [PMID: 26402703 PMCID: PMC4591664 DOI: 10.3390/toxins7093758] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022] Open
Abstract
This study aims to determine the most efficacious dose of Botulinum neurotoxin type A (BoNT-A) in reducing sialorrhea in Asian adults with neurological diseases. A prospective, double-blind randomized controlled trial was conducted over 24 weeks. Thirty patients with significant sialorrhea were randomly assigned to receive a BoNT-A (Dysport®) injection into the submandibular and the parotid glands bilaterally via an ultrasound guidance. The total dose given per patient was either BoNT-A injection of (i) 50 U; (ii) 100 U; or (iii) 200 U. The primary outcome was the amount of saliva reduction, measured by the differential weight (wet versus dry) of intraoral dental gauze at baseline and at 2, 6, 12, and 24 weeks after injection. The secondary outcome was the subjective report of drooling using the Drooling Frequency and Severity Scale (DFS). Saliva reduction was observed in response to all BoNT-A doses in 17 patients who completed the assessments. Although no statistically significant difference among the doses was found, the measured reduction was greater in groups that received higher doses (100 U and 200 U). The group receiving 200 U of Dysport® showed the greatest reduction of saliva until 24 weeks and reported the most significant improvement in the DFS score.
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Affiliation(s)
- Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Shivani Rajasegaran
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Ouzreiah Nawawi
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Khean-Jin Goh
- Neurology Division, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia.
| | - Saini Jeffery Freddy
- KPJ KL Rehabilitation Centre, Tawakkal Health Centre, 202A, Jalan Pahang, 53000 Kuala Lumpur, Malaysia.
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Khat'kova SE, Khasanova DR, Korenko LA, Antipova LN, Shperling LP, Popov DV, Pokhabov DV, Poznyakova EV. [The study of the efficacy of Botulinum toxin type A in patients with poststroke upper-limb spasticity ULIS-II: an analysis of Russian patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:89-97. [PMID: 26356520 DOI: 10.17116/jnevro20151157189-97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM To assess the efficacy of Botulinum toxin type A (BoNT-A) injections in routine practice. MATERIAL AND METHODS An international, post-marketing, multi-center, observational, prospective, longitudinal study included patients ≥18 years with poststroke upper-limb spasticity in whom a decision to inject BoNT-A had already been made, and who had no previous treatment with BoNT-A or BoNT-B within the last 12 weeks. The responder rate was assessed by the patient-centered goal attainment scaling (GAS). RESULTS AND CONCLUSION The study included 7 Russian research centers (41 patients). Sixteen patients (39%) received BoNT-A injections prior to entering the study. During the treatment, 29 patients (70.7%) received dysport injections; 2 (4.9%) botox injections, 8 (19.5%) xeomin injections and 2 (4.9%) other BoNT-A agents. The primary treatment goals were successfully attained in 87.8%, secondary treatment goals in 88.3%. An improvement in passive function as primary goal and as secondary goal were achieved in 100%, in the range of movement in 94.9%, pain reduction in 82.4%, improvement in active function of the upper limb in 76.5%, reduction in involuntary movements (associated reactions) in 83.3% of cases. Investigators' global assessment of benefits revealed that 97.6% of patients showed positive effects from BoNT-A injections. Pateitnts' assessment of global benefits was slightly lower - 90,2% of patients reported positive treatment effects When assessed by patients, the rate of global benefits was 90.2%. Botulinum-toxin therapy is an effective treatment option. In the vast majority of patients, it allows both for reduction in muscle tone and functional benefits that could improve quality of life of the patients.
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Affiliation(s)
- S E Khat'kova
- Treatment and Rehabilitation Centre, Ministry of Health, Moscow
| | - D R Khasanova
- Interregional Clinical and Diagnostic Center , Kazan
| | - L A Korenko
- Pavlov St-Petersburg State Medical University, St-Petersburg
| | - L N Antipova
- Krasnodar Multi-Profile Treatment and Diagnostic Unity, City Hospital #2, Krasnodar
| | - L P Shperling
- State Novosibirsk Regional Diagnostic Centre, Novosibirsk
| | - D V Popov
- Regional Clinical Hospital #3, Chelyabinsk
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Barden HLH, Baguley IJ, Nott MT, Chapparo C. Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management. Brain Inj 2015; 29:1452-9. [DOI: 10.3109/02699052.2015.1071429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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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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Ashford S, Siegert RJ, Alexandrescu R. Rasch measurement: the Arm Activity measure (ArmA) passive function sub-scale. Disabil Rehabil 2015; 38:384-90. [PMID: 25918961 DOI: 10.3109/09638288.2015.1041613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the conformity of the Arm Activity measure (ArmA) passive function sub-scale to the Rasch model. METHODS A consecutive cohort of patients (n = 92) undergoing rehabilitation, including upper limb rehabilitation and spasticity management, at two specialist rehabilitation units were included. Rasch analysis was used to examine scaling and conformity to the model. Responses were analysed using Rasch unidimensional measurement models (RUMM 2030). The following aspects were considered: overall model and individual item fit statistics and fit residuals, internal reliability, item response threshold ordering, item bias, local dependency and unidimensionality. RESULTS ArmA contains both active and passive function sub-scales, but in this analysis only the passive function sub-scale was considered. Four of the seven items in the ArmA passive function sub-scale initially had disordered thresholds. These items were rescored to four response options, which resulted in ordered thresholds for all items. Once the items with disordered thresholds had been rescored, item bias was not identified for age, global disability level or diagnosis, but with a small difference in difficulty between males and females for one item of the scale. Local dependency was not observed and the unidimensionality of the sub-scale was supported and good fit to the Rasch model was identified. The person separation index (PSI) was 0.95 indicating that the scale is able to reliably differentiate at least two groups of patients. CONCLUSIONS The ArmA passive function sub-scale was shown in this evaluation to conform to the Rasch model once disordered thresholds had been addressed. Using the logit scores produced by the Rasch model it was possible to convert this back to the original scale range. Implications for Rehabilitation The ArmA passive function sub-scale was shown, in this evaluation, to conform to the Rasch model once disordered thresholds had been addressed and therefore to be a clinically applicable and potentially useful hierarchical measure. Using Rasch logit scores it has be possible to convert back to the original ordinal scale range and provide an indication of real change to enable evaluation of clinical outcome of importance to patients and clinicians.
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Affiliation(s)
- Stephen Ashford
- a Regional Rehabilitation Unit , Northwick Park Hospital , Middlesex , UK .,b Department of Palliative Care, Policy and Rehabilitation , King's College London, School of Medicine , London , UK , and
| | - Richard J Siegert
- c Department of Psychology, Faculty of Health and Environmental Sciences , AUT University , Auckland , New Zealand
| | - Roxana Alexandrescu
- b Department of Palliative Care, Policy and Rehabilitation , King's College London, School of Medicine , London , UK , and
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Efficacy and safety of botulinum toxin type A (Dysport) for the treatment of post-stroke arm spasticity: Results of the German–Austrian open-label post-marketing surveillance prospective study. J Neurol Sci 2014; 337:86-90. [DOI: 10.1016/j.jns.2013.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/22/2013] [Accepted: 11/15/2013] [Indexed: 11/20/2022]
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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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Takekawa T, Abo M, Ebihara K, Taguchi K, Sase Y, Kakuda W. Long-term effects of injection of botulinum toxin type A combined with home-based functional training for post-stroke patients with spastic upper limb hemiparesis. Acta Neurol Belg 2013; 113:469-75. [PMID: 23716062 DOI: 10.1007/s13760-013-0208-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 05/09/2013] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the effects of botulinum toxin type A (BoNT-A) injection with home-based functional training for passive and active motor function, over a 6-month period in post-stroke patients with upper limb spasticity. We studied 190 patients with at least 6-month history of stroke. They received injections of BoNT-A in upper limb muscles and detailed one-to-one instructions for home-based functional training. At baseline (before therapy), and at 1-, 3- and 6-month follow-up, Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT) were used to assess active motor function, the modified Ashworth scale (MAS) for assessment of spasticity, and the range of motion (ROM) for passive motor function. The total score for upper limb and scores of categories A and B of the FMA increased significantly at 1, 3 and 6 months, while the FMA score for category D increased significantly at 3 and 6 months, but not at 1 month. Significant decreases in the MAS scores were noted in all muscles examined at 1, 3 and 6 months, compared with baseline. The ROM for elbow joint extension significantly improved at 1, 3, and 6 months, while that for wrist joint extension increased significantly at 1 month, but not 3 or 6 months, compared with baseline. The results suggest that comprehensive improvement of motor function requires improvement of motor function in the proximal part of the upper limb and that BoNT-A followed by rehabilitation reduces spasticity and improves motor function of fingers.
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Affiliation(s)
- Toru Takekawa
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P. Results from the Upper Limb International Spasticity Study-II (ULISII):a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management. BMJ Open 2013; 3:bmjopen-2013-002771. [PMID: 23794582 PMCID: PMC3686177 DOI: 10.1136/bmjopen-2013-002771] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To describe real-life practice and person-centred outcomes in the treatment of poststroke upper limb spasticity with botulinum toxin A (BoNT-A). DESIGN Observational, prospective study. SETTING 84 secondary care centres in 22 countries. PARTICIPANTS 456 adults (≥18 years) with poststroke upper limb spasticity treated with one cycle of BoNT-A. METHODS/OUTCOMES Muscle selection, BoNT-A preparation, injection technique and timing of follow-up were conducted according to routine practice for each centre. PRIMARY OUTCOME achievement of the patient's primary goal for treatment using goal-attainment scaling (GAS). Measurements of spasticity, standardised outcome measures and global benefits were also recorded. RESULTS The median number of injected muscles was 5 (range 1-15) and the most frequently injected muscles were the long finger flexors, followed by biceps and brachioradialis. The median (range) follow-up time was 14 (2.6 to 32.3) weeks. The common primary treatment goals were passive function (132 (28.9%)), active function (104 (22.8%)), pain (61 (13.4%)), impairment (105 (23%)), involuntary movement (41 (9%)) and mobility (10 (2.2%)). Overall, 363 (79.6%) (95% CI 75.6% to 83.2%) patients achieved (or overachieved) their primary goal and 355 (75.4%) (95% CI 71.2% to 79.2%) achieved their secondary goal. Mean (SD) change from baseline in GAS T-scores was 17.6 (11.0) (95% CI 16.4 to 18.8; p<0.001). GAS T-scores were strongly correlated with global benefit and other standard measures (correlations of 0.38 and 0.63, respectively; p<0.001). CONCLUSIONS BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper-limb spasticity following stroke. The study confirms the feasibility of a common international data set to collect systematic prospective data, and of using GAS to capture person-centred outcomes relating to passive and active functions and to pain. REGISTRATION ClinicalTrials.gov identifier: NCT01020500.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King’s College London, London, UK.
| | | | - Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de adultos 3, Estoril, Portugal
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Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, Zakine B. Upper limb international spasticity study: rationale and protocol for a large, international, multicentre prospective cohort study investigating management and goal attainment following treatment with botulinum toxin A in real-life clinical practice. BMJ Open 2013; 3:bmjopen-2012-002230. [PMID: 23512837 PMCID: PMC3612778 DOI: 10.1136/bmjopen-2012-002230] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This article provides an overview of the Upper Limb International Spasticity (ULIS) programme, which aims to develop a common core dataset for evaluation of real-life practice and outcomes in the treatment of upper-limb spasticity with botulinum toxin A (BoNT-A). Here we present the study protocol for ULIS-II, a large, international cohort study, to describe the rationale and steps to ensure the validity of goal attainment scaling (GAS) as the primary outcome measure. METHODS AND ANALYSIS DESIGN: An international, multicentre, observational, prospective, before-and-after study, conducted at 84 centres in 22 countries across three continents. PARTICIPANTS 468 adults presenting with poststroke upper limb spasticity in whom a decision had already been made to inject BoNT-A (5-12 consecutive participants recruited per centre). INTERVENTIONS Physicians were free to choose targeted muscles, BoNT-A preparation, injected doses/technique and timing of follow-up in accordance with their usual practice and the goals for treatment. PRIMARY OUTCOME MEASURE GAS. SECONDARY OUTCOMES Measurements of spasticity, standardised outcome measures and global benefits. Steps to ensure validity included: (1) targeted training of all investigators in the use of GAS; (2) within-study validation of goal statements and (3) establishment of an electronic case report form with an in-built tracking facility for separation of baseline/follow-up data. ANALYSIS Efficacy population: all participants who had (1) BoNT-A injection and (2) subsequent assessment of GAS. Primary efficacy variable: percentage (95% CI) achievement of the primary goal from GAS following one BoNT-A injection cycle. ETHICS AND DISSEMINATION This non-interventional study is conducted in compliance with guidelines for good pharmacoepidemiology practices. Appropriate ethical approvals were obtained according to local regulations. ULIS-II will provide important information regarding treatment and outcomes from BoNT-A in real-life upper limb spasticity management. The results will be published separately. REGISTRATION ClinicalTrials.gov identifier: NCT01020500.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, School of Medicine, King's College London, London, UK
| | | | - Jorge Jacinto
- Serviço de Reabilitação de adultos 3, Centro de Medicina de Reabilitaçãode Alcoitão, Estoril, Portugal
| | - Pascal Maisonobe
- Departments of Biostatistics & Data Management, Medical Affairs, Ipsen Pharma, Boulogne-Billancourt, France
| | - Benjamin Zakine
- Departments of Biostatistics & Data Management, Medical Affairs, Ipsen Pharma, Boulogne-Billancourt, France
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Ashford S, Turner-Stokes L, Siegert R, Slade M. Initial psychometric evaluation of the Arm Activity Measure (ArmA): a measure of activity in the hemiparetic arm. Clin Rehabil 2013; 27:728-40. [DOI: 10.1177/0269215512474942] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To evaluate the psychometric properties of the Arm Activity Measure (ArmA), a patient-reported measure of active and passive function in the paretic upper limb. Design: Psychometric evaluation study. Setting: Two specialist rehabilitation and spasticity management services. Method: Patients ( n = 92) with upper limb paresis were recruited from two specialist neurorehabilitation centres. Mean age 44.5 (SD 16.7). Diagnostic distribution: stroke 48 (52%); other brain injury 28 (31%); or other neurological condition 16 (17%). Evaluation of convergent and divergent validity; unidimensionality, scaling, reliability (internal consistency and test–retest); responsiveness to change and feasibility of the ArmA were undertaken. Results: Expected convergent and divergent relationships were seen with the Leeds Adult Spasticity Impact Scale and the Disabilities of Arm Shoulder and Hand (DASH) (rho 0.5–0.63). Principal components analysis confirmed that active and passive function formed two separate constructs in each sub-scale. Mokken analysis corroborated the findings of the principal components analysis and demonstrated scaling using the monotone homogeneity model (Item H>0.5 for all items). Cronbach’s alpha was 0.85 and 0.96, respectively, for the passive and active function subscales. Item level test–retest agreement ranged from 92-97.5% (quadratic-weighted Kappa 0.71-0.94). In the subgroup treated for spasticity with botulinum toxin ( n = 58), the ArmA passive function scale identified a significant difference between responder and non-responder groups (Mann Whitney U = 0.85, p < 0.01). Respondents reported the ArmA to be relevant (77%), easy to use (90%) and timely to complete (83% under 10 minutes). Conclusion: The ArmA is a valid and reliable tool feasible for use in the evaluation of upper limb function in the context of treatment for spasticity.
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Affiliation(s)
- Stephen Ashford
- Regional Rehabilitation Unit, Northwick Park Hospital, UK
- Department of Palliative Care, Policy and Rehabilitation, King’s College London, UK
| | - Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park Hospital, UK
- Department of Palliative Care, Policy and Rehabilitation, King’s College London, UK
| | | | - Mike Slade
- Health Service and Population Research Department, King’s College London, Institute of Psychiatry, UK
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Roze S, Kurth H, Hunt B, Valentine W, Marty R. Evaluation of the cost per patient per injection of botulinum toxin A in upper limb spasticity: comparison of two preparations in 19 countries. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012. [PMID: 23204875 PMCID: PMC3508655 DOI: 10.2147/mder.s35563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Botulinum toxin A injections are indicated for the management of movement disorders, including upper limb spasticity. The aim of this study was to compare the cost per patient per injection for two botulinum toxin A preparations in 19 countries. Methods Doses of botulinum toxin A are expressed in noninterchangeable units (U), ie, Botox® in 100 Allergan units (100 U) and Dysport® in 500 Speywood units (500 U). Recommended dosages were derived from country-specific summaries of product characteristics or prescribing information. Cost analysis was based on official list prices and expressed in 2011 Euros. The cost per patient per injection was calculated using the recommended dosage in upper limb spasticity combined with price per vial in each country. Results For upper limb spasticity, the recommended dosage for Dysport in the summary of product characteristics is 1000 U per patient, whereas for Botox the recommended dosage when recommendations were made is 300 U. Allowing for different prices per vial in each country, the cost per patient per injection for upper limb spasticity was less for Dysport than for Botox in 18 (95%) of the 19 countries (mean 17% less across countries). The difference was 20% or higher in nearly half (47%) of the countries. Sensitivity analyses considering available “real-world” dosing showed consistent results, with Dysport being less costly than Botox in all 19 countries. Conclusion Considering costs per patient per injection based on analysis of recommended dosages in the summary of product characteristics, Dysport remains cheaper than Botox in most countries. Thus, when extrapolated to a national level, substantial savings could be realized by using Dysport in the treatment of upper limb spasticity.
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Rosales RL, Kong KH, Goh KJ, Kumthornthip W, Mok VCT, Delgado-De Los Santos MM, Chua KSG, Abdullah SJBF, Zakine B, Maisonobe P, Magis A, Wong KSL. Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: a randomized controlled trial. Neurorehabil Neural Repair 2012; 26:812-21. [PMID: 22371239 DOI: 10.1177/1545968311430824] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Botulinum neurotoxin type A (BoNT-A) reduces upper-extremity poststroke spasticity when given 6 or more months after stroke. Effects on functional use of the arm and hand are less apparent. OBJECTIVE To determine the effect and safety of very early use of BoNT-A for patients with upper-limb spasticity. METHODS The Asia Botulinum Toxin-A Clinical Trial DESIGN ed for Early Post-stroke Spasticity (ABCDE-S; NCT00234546) was a multicenter, randomized, placebo-controlled trial conducted in patients recruited within 2 -12 weeks of first-ever stroke. Participants with a Modified Ashworth Scale (MAS) score of 1+ or above received BoNT-A (Dysport) 500 U or placebo to one or more wrist and elbow mover muscles, plus unstructured rehabilitation. The primary outcome was the MAS score in the most affected joint 4 weeks after first injection. Follow-up was 24 weeks. RESULTS A total of 163 patients were enrolled and assigned to placebo (n = 83) or BoNT-A (n = 80). Mean time since stroke was about 7 weeks. At 4 weeks postinjection, BoNT-A significantly improved MAS scores. Treatment effect-size estimates increased with higher baseline MAS scores from 0.45 (Q1) to 0.70 (Q3). MAS scores for all secondary end points improved with BoNT-A versus placebo at all time points (P < .0001, all visits). The Functional Motor Assessment Scale did not reveal clinically significant differences. No group differences in adverse events were found. Interpretation. BoNT-A 500 U can provide a sustained reduction in poststroke upper-limb spasticity when combined with rehabilitation in Asian patients who have mild-to-moderate hypertonicity and voluntary movement, within 2 -12 weeks of stroke. Functional use of the arm and hand was not affected.
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Rosales RL, Kanovsky P, Fernandez HH. What’s the “catch” in upper-limb post-stroke spasticity: Expanding the role of botulinum toxin applications. Parkinsonism Relat Disord 2011; 17 Suppl 1:S3-10. [PMID: 21999894 DOI: 10.1016/j.parkreldis.2011.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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