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Kamm CP, Mattle HP, Müri RM, Heldner MR, Blatter V, Bartlome S, Lüthy J, Imboden D, Pedrazzini G, Bohlhalter S, Hilfiker R, Vanbellingen T. Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial. Mult Scler 2015; 21:1546-56. [DOI: 10.1177/1352458514565959] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/04/2014] [Indexed: 11/15/2022]
Abstract
Background: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living (ADL) and quality of life. Objective: We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MS patients. Methods: This was a randomized, rater-blinded controlled trial. Thirty-nine MS patients acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. Patients trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test. Results: The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements. Conclusion: The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.
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Affiliation(s)
- Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - René M Müri
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Verena Blatter
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Sandrine Bartlome
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Judith Lüthy
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Debora Imboden
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Giovanna Pedrazzini
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Roger Hilfiker
- HES-SO Valais-Wallis, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais, Sion, Switzerland
| | - Tim Vanbellingen
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland/Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
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Pulman J, Buckley E. Assessing the Efficacy of Different Upper Limb Hemiparesis Interventions on Improving Health-Related Quality of Life in Stroke Patients: A Systematic Review. Top Stroke Rehabil 2015; 20:171-88. [DOI: 10.1310/tsr2002-171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Villafañe JH. Botulinum toxin type A combined with neurodynamic mobilization for lower limb spasticity: a case report. J Chiropr Med 2013; 12:39-44. [PMID: 23997723 PMCID: PMC3610952 DOI: 10.1016/j.jcm.2013.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 12/08/2012] [Accepted: 01/30/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This case report describes a patient with severe lower limb spasticity treated with botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM). CLINICAL FEATURES An 81-year-old male patient presented with a severe spastic lower limbs after total right hip replacement and severe alcoholic polyneuropathy. After the right hip replacement, he presented with generalized spasticity, crouched posture, and a large sacral pressure sore. The severe spasticity in his knees prevented walking. INTERVENTION AND OUTCOME The patient underwent combined treatment with BoNT-A and NM of the lower limb in 4 weekly applications. Evaluations were performed pretreatment, 4 weeks after the injection, and at a follow-up session 9 months after finishing treatment. We measured the following outcomes: pain by the Numerical Rating Scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. We found that the patient improved in all of the outcomes after treatment, and these results were maintained during the follow-up. After treatment, the patient was able to improve wound healing by properly positioning himself in bed or on his wheelchair and walking with help. At the follow-up evaluation, the results were maintained. The patient showed good acceptance and decreased anxiety/depression after treatment. CONCLUSION For this patient, the combination of NM and BoNT-A treatment decreased pain and spasticity and improved joint ranges of motion.
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Affiliation(s)
- Jorge H. Villafañe
- Corresponding author. Regione Generala 11/16. Piossasco (10045). Italy. Tel.: + 39 011 9065495 / + 39 339 5857563; + 39 011 9065495.
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Villafañe JH, Fernandez-de-las-Peñas C, Pillastrini P. Botulinum toxin type A combined with cervical spine manual therapy for masseteric hypertrophy in a patient with Alzheimer-type dementia: a case report. J Chiropr Med 2012; 11:280-5. [PMID: 23843761 PMCID: PMC3706701 DOI: 10.1016/j.jcm.2012.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The purpose of this case study is to present the findings of combining botulinum toxin type A (BoNT-A) and cervical spine manual therapy to address masseter muscle spasticity in a patient with Alzheimer-type dementia. CASE REPORT A 78-year-old woman with bilateral spasticity of the masseteric regions for 2 years was referred for physiotherapy. She had trismus and bruxism, and could neither close nor open her mouth normally; thus, she was unable to be fed orally in a normal manner. INTERVENTION AND OUTCOME The patient underwent combined treatment with BoNT-A and cervical spine manual therapy. A medical physician (neurologist) performed the BoNT-A injections into 2 points at the center of the lower third of the masseter muscle. A physical therapist performed manual therapy interventions targeted at the cervical spine. Manual therapy started the day after the BoNT-A injection and continued for 5 sessions per week for a total period of 2 weeks. Clinical outcomes were measured including spasticity (Modified Ashworth Scale), functionality (Barthel Index), and jaw opening. Outcomes were conducted at baseline, 2 weeks after treatment, and at 2-month follow-up session after finishing the treatment. The patient improved in all of the outcomes at the end of treatment, and these results were maintained during the follow-up. After treatment, the patient was able to feed with minimal caregiver dependency because oral feeding was possible. CONCLUSION The patient in this study responded positively to a combination of BoNT-A and manual therapy, resulting in decreased masseter muscles spasticity and improved trismus and bruxism.
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Affiliation(s)
- Jorge H. Villafañe
- Physical Therapist, Department of Physical Therapy, Residenza Sanitaria Assistenziale “A. Maritano,” Sangano, Italy
- Physical Therapist, Private Practitioner, Torino, Italy
| | - Cesar Fernandez-de-las-Peñas
- Physical Therapist, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Physical Therapist, Esthesiology Laboratory, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Paolo Pillastrini
- Physical Therapist, Department of Internal Medicine, Ageing and Nephrology, University of Bologna, Italy
- Physical Therapist and Associate Professor of Physiotherapy, University of Bologna, Italy
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Villafañe JH, Silva GB, Chiarotto A, Ragusa OL. Botulinum toxin type A combined with neurodynamic mobilization for upper limb spasticity after stroke: a case report. J Chiropr Med 2012; 11:186-91. [PMID: 23449315 PMCID: PMC3437341 DOI: 10.1016/j.jcm.2012.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 05/24/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this study is to report a case in which combinatory therapy of botulinum toxin type A (BoNT-A) and neurodynamic mobilization (NM) was used as treatment for a patient with severe upper limb spasticity and pain after stroke. CLINICAL FEATURES A 76-year-old male patient had spastic muscles in the upper limb 10 months after an ischemic stroke. INTERVENTION AND OUTCOME The patient underwent combined treatment with BoNT-A and NM of the upper limb in 6 monthly applications. Evaluation was performed pretreatment, 3 months after the first injection, 3 months after the second injection, and at a follow-up session 9 months after starting the treatment. The following outcomes were measured: pain by using a numeric rating scale, spasticity by the Modified Ashworth Scale for Grading Spasticity, acceptance and emotional reaction to the treatment by the Hospital Anxiety and Depression Scale, and functionality by ranges of motion. The patient improved in all outcomes after treatment, and results were maintained during the follow-up sessions. CONCLUSION The combined NM and BoNT-A treatment appeared to decrease pain and improve joint ranges of motion during treatment for this patient. The patient showed decreased anxiety and depression during and after the treatment.
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Affiliation(s)
- Jorge H. Villafañe
- Physical Therapist, Department of Physical Therapy, Residenze Sanitarie Assistenziali “A. Maritano,” Sangano, Italy
- Physical Therapist, Private Practitioner, Turin, Italy
| | - Guillermo B. Silva
- Principal Investigator, Department of Physiology and Hypertension, Mons. Carlos V. Cruvellier Foundation and J. Robert Cade Foundation, Cordoba, Argentina
- Assistant Professor, Departament of Research, Chemistry Sciences, Catholic University of Cordoba, Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Argentina
| | - Alessandro Chiarotto
- Physical Therapist, Education Office, Associazione Italiana Fisioterapisti Piemonte Valle d' Aosta, Turin, Italy
| | - Orazio L.F. Ragusa
- Physician, S.C. di Medicina Fisica e Riabilitazione, A.S.L. TO 3. Area Metropolitana, Italy
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Botulinum toxin treatment in neurological practice: how much does it really cost? A prospective cost-effectiveness study. J Neurol 2011; 258:1670-5. [DOI: 10.1007/s00415-011-5998-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 03/02/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
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Shaw LC, Price CIM, van Wijck FMJ, Shackley P, Steen N, Barnes MP, Ford GA, Graham LA, Rodgers H. Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial: effect on impairment, activity limitation, and pain. Stroke 2011; 42:1371-9. [PMID: 21415398 DOI: 10.1161/strokeaha.110.582197] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke, but its impact on arm function is unclear. We evaluated botulinum toxin for upper limb spasticity and function poststroke. METHODS Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter randomized controlled trial. The intervention group received botulinum toxin type A injection(s) plus a 4-week therapy program. The control group received the therapy program alone. Repeat injection(s) and therapy were available at 3, 6, and 9 months. The primary outcome was upper limb function at 1 month (Action Research Arm Test). Secondary outcomes included measures of impairment, activity limitation, and pain at 1, 3, and 12 months. Outcome assessments were blinded and analysis was by intention to treat. RESULTS There was no significant difference in achievement of improved arm function (Action Research Arm Test) at 1 month (intervention group: 42 of 167 [25.1%], control group 30 of 154 [19.5%]; P=0.232). Significant differences in favor of the intervention group were seen in muscle tone at 1 month; upper limb strength at 3 months; basic arm functional tasks (hand hygiene, facilitation of dressing) at 1, 3, and 12 months; and pain at 12 months. CONCLUSIONS Botulinum toxin type A is unlikely to be useful for improving active upper limb function (eg, reaching and grasping) in the majority of patients with spasticity after stroke, but it may improve basic upper limb tasks (hand hygiene, facilitation of dressing) and pain.
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Affiliation(s)
- Lisa C Shaw
- Institute for Ageing and Health, Stroke Research Group, 3-4 Claremont Terrace, Newcastle University, and Nwecastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, NE2 4AE
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Abstract
BACKGROUND Recent evidence suggests an anti-nociceptive effect of botulinum toxin. OBJECTIVES To compare the efficacy and safety of botulinum toxin in comparison to placebo or other treatment options for shoulder pain. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, CINAHL (via EBSCOhost), Ovid SPORTDiscus, EMBASE and Science Citation Index. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing botulinum toxin with placebo or active treatment in people with shoulder pain were included. DATA COLLECTION AND ANALYSIS For continuous measures we calculated mean difference (MD), and for categorical measures risk ratio (RR) (with 95% confidence interval (CI)). MAIN RESULTS Six RCTs with 164 patients were included. Five RCTs in participants with post-stroke shoulder pain indicated that compared with placebo, a single intramuscular injection of botulinum toxin A significantly reduced pain at three to six months post-injection (MD -1.2 points, 95% CI -2.4 to -0.07; 0 to 10 point scale) but not at one month (MD -1.1 points, 95% CI -2.9 to 0.7). Shoulder external rotation was increased at one month (MD 9.8 degrees , 95% CI 0.2 to 19.4) but not at three to six months. Shoulder abduction, external rotation or spasticity did not differ between groups, nor did the number of adverse events (RR 1.46, 95% CI 0.6 to 24.3).One RCT in arthritis-related shoulder pain indicated that botulinum toxin reduced pain severity (MD -2.0, 95% CI -3.7 to -0.3; 10 point scale) and shoulder disability with a reduction in Shoulder Pain and Disability Index score (MD -13.4, 95% CI -24.9 to -1.9; 100 point scale) when compared with placebo. Shoulder abduction was improved (MD 13.8 degrees, 95% CI 3.2 to 44.0). Serious adverse events did not differ between groups (RR 0.35, 95% CI: 0.11, 1.12). AUTHORS' CONCLUSIONS The results should be interpreted with caution due to few studies with small sample sizes and high risk of bias. Botulinum toxin A injections seem to reduce pain severity and improve shoulder function and range of motion when compared with placebo in patients with shoulder pain due to spastic hemiplegia or arthritis. It is unclear if the benefit of pain relief in post-stroke shoulder pain at three to six months but not at one month is due to limitations of the evidence, which includes small sample sizes with imprecise estimates, or a delayed onset of action. More studies with safety data are needed.
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Affiliation(s)
- Jasvinder A Singh
- Department of Medicine, Birmingham VA Medical Center, Faculty Office Tower 805B, 510 20th Street South, Birmingham, USA, AL 35294
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Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Faux S, Price C, Middleton S, Lim J, Thrift AG, Donnan GA. Protocol and Pilot Data for Establishing the Australian Stroke Clinical Registry. Int J Stroke 2010; 5:217-26. [DOI: 10.1111/j.1747-4949.2010.00430.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Disease registries assist with clinical practice improvement. The Australian Stroke Clinical Registry aims to provide national, prospective, systematic data on processes and outcomes for stroke. We describe the methods of establishment and initial experience of operation. Methods Australian Stroke Clinical Registry conforms to new national operating principles and technical standards for clinical quality registers. Features include: online data capture from acute public and private hospital sites; opt-out consent; expert consensus agreed core minimum dataset with standard definitions; outcomes assessed at 3 months post-stroke; formal governance oversight; and formative evaluations for improvements. Results Qualitative feedback from sites indicates that the web-tool is simple to use and the user manuals, data dictionary, and training are appropriate. However, sites desire automated data-entry methods for routine demography variables and the opt-out consent protocol has sometimes been problematic. Data from 204 patients (median age 71 years, 54% males, 60% Australian) were collected from four pilot hospitals from June to October 2009 (mean, 50 cases per month) including ischaemic stroke (in 72%), intracerebral haemorrhage (16%), transient ischaemic attack (9%), and undetermined (3%), with only one case opting out. Conclusion Australian Stroke Clinical Registry has been well established, but further refinements and broad roll-out are required before realising its potential of improving patient care through clinician feedback and allowance of local, national, and international comparative data.
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Affiliation(s)
- Dominique A. Cadilhac
- National Stroke Research Institute a subsidiary of Florey Neuroscience Institutes, Heidelberg Heights, Vic., Australia
- Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
| | - Natasha A. Lannin
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Neurological and Mental Health Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig S. Anderson
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Neurological and Mental Health Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher R. Levi
- University of Newcastle & Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Steven Faux
- St Vincent's Hospital, Sydney, NSW, Australia
| | - Chris Price
- National Stroke Foundation, Acute Services Division, Melbourne, Vic., Australia
| | - Sandy Middleton
- St Vincent's Hospital, Sydney, NSW, Australia
- Australian Catholic University, Sydney, NSW, Australia
| | - Joyce Lim
- Neurological and Mental Health Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Amanda G. Thrift
- National Stroke Research Institute a subsidiary of Florey Neuroscience Institutes, Heidelberg Heights, Vic., Australia
- Department Epidemiology & Preventive Medicine, Monash University, Prahran, Vic., Australia
- Baker IDI Heart and Diabetes Institute, St Kilda Road Central, Melbourne, Vic., Australia
| | - Geoffrey A. Donnan
- National Stroke Research Institute a subsidiary of Florey Neuroscience Institutes, Heidelberg Heights, Vic., Australia
- Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
- Florey Neurosciences Institutes, Melbourne, Vic., Australia
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Shaw L, Rodgers H. Botulinum toxin type A for upper limb spasticity after stroke. Expert Rev Neurother 2010; 9:1713-25. [PMID: 19951131 DOI: 10.1586/ern.09.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spasticity is involuntary overactivity of muscles that occurs following upper motor neuron damage to the brain or spinal cord. Upper limb spasticity is common after stroke and can cause deformity, pain and reduced function. Botulinum toxin type A is a neurotoxin produced by the bacterium Clostridium botulinum that blocks the release of acetylcholine from cholinergic neurons. When given by intramuscular injection it causes temporary local paresis and has become an important component of focal spasticity treatment. Randomized controlled trials have shown that botulinum toxin type A can decrease upper limb spasticity and improve the ease of performing basic upper limb functional activities, such as cleaning the hand or dressing a sleeve. This article will review the pharmacology of botulinum toxin type A and its clinical efficacy when used to treat upper limb spasticity after stroke.
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Affiliation(s)
- Lisa Shaw
- Institute for Ageing and Health (Stroke Research Group), Newcastle University, The Medical School, Newcastle upon Tyne, NE2 4HH, UK.
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Lundström E, Smits A, Borg J, Terént A. Four-Fold Increase in Direct Costs of Stroke Survivors With Spasticity Compared With Stroke Survivors Without Spasticity. Stroke 2010; 41:319-24. [DOI: 10.1161/strokeaha.109.558619] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erik Lundström
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
| | - Anja Smits
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
| | - Jörgen Borg
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Terént
- From the Departments of Neuroscience and Neurology (E.L., A.S.), the Department of Medical Sciences, Stroke Unit (A.T.), and the Departments of Neuroscience and Rehabilitation Medicine (E.L., J.B.), Uppsala University Hospital, Uppsala, Sweden
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