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Mehraban Jahromi M, Vlček P, Grünerová Lippertová M. Stretching exercises in managing spasticity: effectiveness, risks, and adjunct therapies. Eur J Transl Myol 2024; 34. [PMID: 38872376 DOI: 10.4081/ejtm.2024.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024] Open
Abstract
Spasticity is a component of upper motor neuron disorders and can be seen in neurological conditions like stroke and multiple sclerosis. Although the incidence rate of spasticity is unknown, it can put pressure on the health condition of those with spasticity, and there is no absolute effective way to control it. In the past, stretching exercises were an accessible tool for physical therapists to manage and control spasticity, but opinions on the optimal dose, aftereffects, and mechanism of effects were controversial. Therefore, this article tries to provide an overview of the effectiveness and risks of stretching exercises. Furthermore, there are several adjunct therapies, such as brain stimulation and botulinum injection, that can increase the effectiveness of a simple stretch by increasing cortical excitability and reducing muscle tone and their role is evaluated in this regard. The results of this study propose that several prospective and case studies have demonstrated the benefits of stretching to control spasticity, but it seems that other methods such as casting can be more effective than a simple stretch. Therefore, it is better to use stretching in combination with other therapeutic regimes to increase its effectivity of it.
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Affiliation(s)
| | - Přemysl Vlček
- Third Faculty of Medicine, Charles University, Prague; National Institute of Mental Health, Klecany.
| | - Marcela Grünerová Lippertová
- Third Faculty of Medicine, Charles University, Prague; Department of Rehabilitation Medicine, FNKV University Hospital in Prague, Prague.
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Filippetti M, Tamburin S, Di Censo R, Adamo M, Manera E, Ingrà J, Mantovani E, Facciorusso S, Battaglia M, Baricich A, Santamato A, Smania N, Picelli A. Role of Diagnostic Nerve Blocks in the Goal-Oriented Treatment of Spasticity with Botulinum Toxin Type A: A Case-Control Study. Toxins (Basel) 2024; 16:258. [PMID: 38922151 PMCID: PMC11209555 DOI: 10.3390/toxins16060258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
The goal-setting process is pivotal in managing patients with disabling spasticity. This case-control study assessed the role of diagnostic nerve blocks in guiding the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A. In this case-control study, patients with disabling spasticity underwent either a goal-setting process based on the patient's needs and clinical evaluation (control group) or additional diagnostic nerve block procedures (case group). All enrolled patients underwent a focal treatment with botulinum neurotoxin-A injection and a 1-month follow-up evaluation during which goal achievement was quantified using the goal attainment scaling-light score system. Data showed a higher goal achievement rate in the case group (70%) than in the control group (40%). In conclusion, diagnostic nerve blocks may help guide the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A towards more realistic and achievable goals, thereby improving the outcomes of botulinum neurotoxin-A injection. Future studies should better explore the role of diagnostic nerve blocks to further personalize botulinum neurotoxin-A according to individual patients' preferences and requirements.
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Affiliation(s)
- Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Rita Di Censo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Martina Adamo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Elisa Manera
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Jessica Ingrà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Salvatore Facciorusso
- Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Marco Battaglia
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (M.B.); (A.B.)
| | - Alessio Baricich
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (M.B.); (A.B.)
| | - Andrea Santamato
- Spasticity and Movement Disorders ‘ReSTaRt’ Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti Hospital, University of Foggia, 71122 Foggia, Italy; (S.F.); (A.S.)
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37100 Verona, Italy; (M.F.); (R.D.C.); (M.A.); (E.M.); (E.M.); (N.S.); (A.P.)
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, ON K7K 1Z6, Canada
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Lee J, Yang SN. Effectiveness of Extracorporeal Shock Wave Therapy after Botulinum Toxin Injection for Post-Stroke Upper Extremity Spasticity: A Randomized Controlled Study. Toxins (Basel) 2024; 16:197. [PMID: 38668622 PMCID: PMC11054781 DOI: 10.3390/toxins16040197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
Post-stroke spasticity is a common complication that limits the functional performance of patients. Botulinum toxin (BTx) is an effective treatment for spasticity. Numerous researchers have applied extracorporeal shock wave therapy (ESWT) to address post-stroke spasticity, yielding positive clinical outcomes. We aimed to clarify the add-on effects of ESWT on BTx therapy for spasticity in patients with post-stroke. Sixteen eligible patients with upper extremity spasticity after stroke were recruited for this study. They were randomized to either a BTx with focused ESWT treatment group or a BTx alone group. Spasticity, measured using the modified Ashworth score (MAS) and modified Tardieu scale (MTS), showed statistically significant improvements in the elbow and wrist flexor muscles in both BTx + ESWT group and BTx alone groups. However, no significant differences were observed between the two groups with time flow. The BTx + ESWT group showed significantly decreased MAS of the finger flexors at follow-up and increased R1 (MTS) of the finger flexors at 3 weeks after treatment, which was not observed in the BTx alone group. This is the first study to identify the add-on effect of ESWT on BTx injections to improve post-stroke upper limb spasticity.
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Affiliation(s)
- Junhee Lee
- Department of Physical Medicine and Rehabilitation, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea;
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Suputtitada A, Chatromyen S, Chen CPC, Simpson DM. Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review. Toxins (Basel) 2024; 16:98. [PMID: 38393176 PMCID: PMC10892074 DOI: 10.3390/toxins16020098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
This article aims to provide a concise overview of the best available evidence for managing post-stroke spasticity. A modified scoping review, conducted following the PRISMA guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR), involved an intensive search on Medline and PubMed from 1 January 2000 to 31 August 2023. The focus was placed on high-quality (GRADE A) medical, rehabilitation, and surgical interventions. In total, 32 treatments for post-stroke spasticity were identified. Two independent reviewers rigorously assessed studies, extracting data, and evaluating bias using GRADE criteria. Only interventions with GRADE A evidence were considered. The data included the study type, number of trials, participant characteristics, interventions, parameters, controls, outcomes, and limitations. The results revealed eleven treatments supported by GRADE A evidence, comprising 14 studies. Thirteen were systematic reviews and meta-analyses, and one was randomized control trial. The GRADE A treatments included stretching exercises, static stretching with positional orthosis, transcutaneous electrical nerve stimulation, extracorporeal shock wave therapy, peripheral magnetic stimulation, non-invasive brain stimulation, botulinum toxin A injection, dry needling, intrathecal baclofen, whole body vibration, and localized muscle vibration. In conclusion, this modified scoping review highlights the multimodal treatments supported by GRADE A evidence as being effective for improving functional recovery and quality of life in post-stroke spasticity. Further research and exploration of new therapeutic options are encouraged.
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Affiliation(s)
- Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama 4 Road, Patumwan, Bangkok 10330, Thailand
- Principles and Practice of Clinical Research (PPCR) Program, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Supattana Chatromyen
- Neurological Institute of Thailand, Department of Medical Services, Ministry of Public Health, Bangkok 10400, Thailand;
| | - Carl P. C. Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan;
| | - David M. Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA;
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Rong H, Ramezani S, Ambro A, Lei CH, Choi H. Design and characterization of a variable-stiffness ankle-foot orthosis. Prosthet Orthot Int 2024:00006479-990000000-00213. [PMID: 38180143 DOI: 10.1097/pxr.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are a type of assistive device that can improve the walking ability of individuals with neurological disorders. Adjusting stiffness is a common way to customize settings according to individuals' impairment. OBJECTIVE This study aims to design a variable-stiffness AFO by stiffness module and characterize the AFO stiffness range to provide subject-specific settings for the users. METHODS We modeled AFO using bending beams with varying fulcrum positions to adjust the stiffness. To characterize the stiffness range and profile, we used the superposition method to generate the theoretical model to analyze the AFO numerically. The intrinsic deformation of the bending beam in the AFO is considered a combination of 2 bending deformations to replicate actual bending conditions. The corresponding experiments in different fulcrum positions were performed to compare with and optimize the theoretical model. The curve fitting method was applied to tune the theoretical model by adding a fulcrum position-related coefficient. RESULTS The AFO stiffness increased as the fulcrum moved to the proximal position. The maximum stiffness obtained was 1.77 Nm/° at a 6-cm fulcrum position, and the minimum stiffness was 0.82 Nm/° at a 0.5-cm fulcrum position with a 0.43-cm thick fiberglass beam. The corresponding theoretical model had maximum and minimum stiffness of 1.71 and 0.80 Nm/°, respectively. The theoretical model had a 4.08% difference compared with experimental values. CONCLUSIONS The stiffness module can provide adjustable stiffness with the fulcrum position and different kinds of fiberglass bars, especially the thickness and material of the beam. The theoretical model with different fulcrum positions can be used to profile the real-time stiffness of the AFO in a dynamic motion and to determine the appropriate dimensions of the bending beam.
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Affiliation(s)
- Haochen Rong
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Sepehr Ramezani
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
| | - Alex Ambro
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Chi Hou Lei
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Hwan Choi
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
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Zeng D, Lei W, Kong Y, Ma F, Zhao K, Ye X, Tan T. Effects of vibration therapy for post-stroke spasticity: a systematic review and meta-analysis of randomized controlled trials. Biomed Eng Online 2023; 22:121. [PMID: 38087275 PMCID: PMC10714496 DOI: 10.1186/s12938-023-01176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The efficacy of vibration therapy (VT) in people with post-stroke spasticity (PSS) remains uncertain. This study aims to conduct a comprehensive meta-analysis to assess the effectiveness of VT in PSS. METHODS PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, and Web of Science were searched from inception to October 2022 for randomized controlled trials (RCTs) of VT in people with PSS. The primary outcome was spasticity, and secondary outcomes included pain, motor function, gait performance, and adverse events. A meta‑analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS A total of 12 studies met the inclusion criteria. Overall, VT had significant effects on reducing spasticity (SMD = - 0.77, 95% CI - 1.17 to - 0.36, P < 0.01) and pain (SMD = - 1.09, 95% CI - 1.74 to - 0.45, P < 0.01), and improving motor function (SMD = 0.42, 95% CI 0.21 to 0.64, P < 0.01) in people with PSS. However, VT had no significant effect on gait performance (SMD = - 0.23, 95% CI - 0.56-0.10). In addition, subgroup differences in short-term anti-spasticity effects between different vibration subtypes, vibration frequencies, vibration durations, frequency of sessions, control therapy, spasticity distribution, and population classification were not significant. CONCLUSION We found that VT significantly alleviated spasticity and pain in people with PSS and improved motor function, but its effect on gait performance was unclear. However, further studies are needed to validate these findings.
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Affiliation(s)
- Duchun Zeng
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Wei Lei
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Yurou Kong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Fenghao Ma
- Department of Physiotherapy, Shanghai Sunshine Rehabilitation Center, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China
| | - Tongcai Tan
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158, Shangtang Road, Hangzhou, 310014, China.
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Ye DH, Chun MH, Park YG, Paik NJ, Lee SU, Yoo SD, Kim DY. A Randomized, Double-Blind, Active Control, Multicenter, Phase 3 Study to Evaluate the Efficacy and Safety of Liztox ® versus Botox ® in Post-Stroke Upper Limb Spasticity. Toxins (Basel) 2023; 15:697. [PMID: 38133201 PMCID: PMC10748261 DOI: 10.3390/toxins15120697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Botulinum toxin type A (BTX-A) injection is a commonly used therapeutic intervention for upper limb spasticity in stroke patients. This study was designed as a randomized, active-drug-controlled, double-blind, multicenter, phase 3 clinical trial to evaluate the safety and efficacy of Liztox® in comparison to onabotulinum toxin A (Botox®) for individuals with post-stroke upper limb spasticity. The primary outcome was the alteration in wrist flexor muscle tone from the initial assessment to the fourth week, evaluated using the modified Ashworth scale (MAS). Secondary outcomes included MAS score changes for the wrist at weeks 8 and 12 from baseline; MAS score changes for finger and elbow flexors; and changes in the Disability Assessment Scale (DAS), Subject's Global Assessment (SGA), the Investigator's Global Assessment (IGA), and Caregiver Burden Scale (CBS) at weeks 4, 8, and 12 from baseline. The MAS score for wrist flexor spasticity decreased by -1.14 ± 0.59 in the Liztox® group and -1.22 ± 0.59 in the Botox® group from baseline to week 4. The difference [97.5% confidence interval (CI)] between the test and control groups was 0.08 [-∞, 0.26], confirming the non-inferiority of the test group compared to the control group. Furthermore, there were consistent improvements in the IGA, SGA, and CBS scores across all assessment intervals, with no statistically significant variances detected between the two groups. No safety-related concerns were reported during the study. In conclusion, Liztox® injection proved to be a secure and efficacious intervention for managing upper extremity spasticity in post-stroke patients.
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Affiliation(s)
- Dong Hyun Ye
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea;
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea;
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea;
- Department of Medicine (AgeTech-Service Convergence Major), Kyung Hee University, Seoul 05278, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
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Ashford SA, Morris G, Smith MJ. Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework. Arch Rehabil Res Clin Transl 2023; 5:100299. [PMID: 38163024 PMCID: PMC10757174 DOI: 10.1016/j.arrct.2023.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity. Design Delphi study. Setting International, web-based survey. Participants A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15). Interventions In round 1, open-ended questions were posed relating to potential scope of practice for 'ultrasound imaging in spasticity management'; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated. Outcome measures 5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above. Results Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated. Conclusion Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.
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Affiliation(s)
- Stephen A. Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University healthcare NHS Trust & Department of Palliative Care, King's College London, London, England
| | - Gary Morris
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
- Hywel Dda University Health Board, Carmarthen, Wales
| | - Michael J. Smith
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales
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Jacinto J, Balbert A, Bensmail D, Carda S, Draulans N, Deltombe T, Ketchum N, Molteni F, Reebye R. Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool. Toxins (Basel) 2023; 15:676. [PMID: 38133180 PMCID: PMC10748217 DOI: 10.3390/toxins15120676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spasticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patient-centred goal-setting; an algorithm for setting SMART (specific, measurable, attainable, realistic, and timed) treatment goals; goal-related target muscles and botulinum toxin type A dose determinants; goal attainment follow-up, scoring, and interpretation; and the multimodal approach to spasticity management. The Tool can enhance clinical practice by providing guided assistance with goal-setting and target muscle selection for botulinum toxin type A treatment. It also provides support with the follow-up evaluation of goal attainment and calculation of treatment success. The Tool is designed to be used by clinicians with varying levels of expertise in the field of neurological rehabilitation and post-stroke spasticity management, from those who are new to the field to those with many years of experience. A case study is presented in the Results Section of the article to illustrate the utility of the Tool in setting SMART treatment goals in the management of patients with post-stroke spasticity.
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Affiliation(s)
- Jorge Jacinto
- Alcoitão Medical Rehabilitation Centre, Rua Conde Barão, 2649-506 Alcabideche, Portugal
| | - Alexander Balbert
- Department of Adaptive Physical Training, Ural University of Physical Education, Sverdlovsk Regional Hospital for War Veterans, 620014 Yekaterinburg, Russia
| | - Djamel Bensmail
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, APHP, Université Paris-Saclay, 92380 Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France
| | - Stefano Carda
- Department of Clinical Neurosciences, Service of Neuropsychology and Neurorehabilitation, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Nathalie Draulans
- Department of Rehabilitation, Libra Rehabilitation and Audiology, 5022 KE Tilburg, The Netherlands
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, Université Catholique de Louvain, Centre Hospitalier Universitaire de Namur, Godinne Site, Avenue Docteur G Therasse, 5530 Yvoir, Belgium
| | - Nicholas Ketchum
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, 9200 W., Milwaukee, WI 53226, USA;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, 23845 Costa Masnaga, Italy;
| | - Rajiv Reebye
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
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10
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Esquenazi A, Zorowitz RD, Ashford S, Maisonobe P, Page S, Jacinto J. Clinical presentation of patients with lower limb spasticity undergoing routine treatment with botulinum toxin: baseline findings from an international observational study. J Rehabil Med 2023; 55:jrm4257. [PMID: 37794845 PMCID: PMC10562995 DOI: 10.2340/jrm.v55.4257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Describe how people with lower limb spasticity present for treatment in routine clinical practice. METHODS Prospective, observational study (Clinicaltrials.gov: NCT04050527) of ambulatory adult patients (≥ 18 years) with unilateral lower limb spasticity (able to take ≥ 5 steps with or without assistance) presenting for routine spasticity management, including treatment with abobotulinumtoxinA. RESULTS The study population included 430 adults with lower limb spasticity. Despite their relatively young age (mean ± standard deviation 53.7 ± 13.9 years), only 20% of patients were employed. Most patients had an acquired brain injury due to cerebrovascular disease; 84.1% reported having concomitant upper limb spasticity. Using the Leg Activity Measure, most patients reported no or only mild difficulties in performing hygiene/positioning tasks, while 80.7% had at least mild difficulty with indoor ambulation and 90.5% had at least mild difficulty with walking outdoors. Sensory, communication and/or cognitive impairments were also common. At the first treatment cycle, 50.7% of patients set active function primary goals, including locomotion transferring or standing. CONCLUSION These observations highlight the complexity of presentation that must be considered when setting treatment goals for lower limb spasticity and emphasize the types of impairment and activity (functional) limitations that treating teams may expect to encounter in their patients and should cover in their initial and follow-up assessments.
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Affiliation(s)
| | - Richard D Zorowitz
- MedStar National Rehabilitation Network and Georgetown University School of Medicine, Washington, DC, USA
| | - Stephen Ashford
- London Northwest University Healthcare NHS Trust, Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK; Department of Palliative Care, Policy, and Rehabilitation, King's College, London, UK
| | | | | | - Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de adultos 3, Estoril, Portugal
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11
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Seim C, Chen B, Han C, Vacek D, Wu LS, Lansberg M, Okamura A. Relief of post-stroke spasticity with acute vibrotactile stimulation: controlled crossover study of muscle and skin stimulus methods. Front Hum Neurosci 2023; 17:1206027. [PMID: 37706171 PMCID: PMC10497102 DOI: 10.3389/fnhum.2023.1206027] [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: 04/14/2023] [Accepted: 08/02/2023] [Indexed: 09/15/2023] Open
Abstract
Background Prior work suggests that vibratory stimulation can reduce spasticity and hypertonia. It is unknown which of three predominant approaches (stimulation of the spastic muscle, antagonist muscle, or cutaneous regions) most reduces these symptoms. Objective Determine which vibrotactile stimulation approach is most effective at reducing spastic hypertonia among post-stroke patients. Methods Sham-controlled crossover study with random assignment of condition order in fourteen patients with post-stroke hand spasticity. All patients were studied in four conditions over four visits: three stimulation conditions and a sham control. The primary outcome measure was the Modified Ashworth Scale, and the secondary outcome measure was the Modified Tardieu Scale measured manually and using 3D motion capture. For each condition, measures of spastic hypertonia were taken at four time points: baseline, during stimulation, after stimulation was removed, and after a gripping exercise. Results A clinically meaningful difference in spastic hypertonia was found during and after cutaneous stimulation of the hand. Modified Ashworth and Modified Tardieu scores were reduced by a median of 1.1 (SD = 0.84, p = 0.001) and 0.75 (SD = 0.65, p = 0.003), respectively, during cutaneous stimulation, and by 1.25 (SD = 0.94, p = 0.001) and 0.71 (SD = 0.67, p = 0.003), respectively, at 15 min after cutaneous stimulation. Symptom reductions with spastic muscle stimulation and antagonist muscle stimulation were non-zero but not significant. There was no change with sham stimulation. Conclusions Cutaneous vibrotactile stimulation of the hand provides significant reductions in spastic hypertonia, compared to muscle stimulation. Clinical trial registration www.ClinicalTrials.gov, identifier: NCT03814889.
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Affiliation(s)
- Caitlyn Seim
- Stanford University Department of Mechanical Engineering, Stanford, CA, United States
| | - Bingxian Chen
- Stanford University Department of Bioengineering, Stanford, CA, United States
| | - Chuzhang Han
- Stanford University Department of Mechanical Engineering, Stanford, CA, United States
| | - David Vacek
- Stanford University Department of Mechanical Engineering, Stanford, CA, United States
| | - Laura Song Wu
- Stanford University Department of Mechanical Engineering, Stanford, CA, United States
| | - Maarten Lansberg
- Stanford University Department of Neurology and Neurological Sciences, Stanford, CA, United States
| | - Allison Okamura
- Stanford University Department of Mechanical Engineering, Stanford, CA, United States
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12
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Torres L, Lee J, Hachisu T, Puentes S. Validity of Accelerometer-Based Sensor System for Muscle Tightness Estimation through Vibration on the Upper Limb. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082951 DOI: 10.1109/embc40787.2023.10340051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Spasticity is a condition that profoundly impacts the ability to perform everyday tasks. However, its diagnosis requires trained physicians and subjective evaluations that may vary depending on the evaluator. Focal vibration of spastic muscles has been proposed as a non-invasive, pain-free alternative for spasticity modulation. We propose a system to estimate muscular tightness based on the propagation of elastic waves in the skin generated by focal vibration of the upper limb. The developed system generates focalized displacements on the biceps muscle at frequencies from 50 to 200 Hz, measures the vibration acceleration on the vibration source (input) and the distant location (output), and extracts features of ratios between input and output. The system was tested on 5 healthy volunteers while lifting 1.25 - 11.25 kg weights to increase muscle tone resembling spastic conditions, where the vibration frequency and weight were selected as explanatory variables. An increase in the ratio of the root mean squares proportional to the weight was found, validating the feasibility of the current approach to estimating muscle tightness.Clinical Relevance- This work presents the feasibility of a vibration-based system as an alternative method to objectively diagnose the degree of spasticity.
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Shirato R, Shimanuki R, Shoji T, Mugikura M. Inhibitory Effects of Prolonged Focal Muscle Vibration on Maximal Grip Strength and Muscle Activity of Wrist and Extrinsic Finger Flexor Muscles. J Chiropr Med 2023; 22:107-115. [PMID: 37346243 PMCID: PMC10280089 DOI: 10.1016/j.jcm.2023.03.003] [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: 04/01/2022] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The objective of this study was to identify effective stimulus time by quantifying the inhibitory effects of focal muscle vibration (FMV) on maximal grip strength and muscle activities of the wrist and extrinsic finger flexors. Methods A randomized repeated-measures design was used in this study. A total of 22 healthy volunteers (mean age, 20.9 years) participated. An FMV of 86 Hz was applied to the anterior surface of the distal forearm under the following 3 conditions: no FMV (control), 5-minute FMV, and 10-minute FMV. Maximal grip strength was measured before and after FMV. The muscle activities of the flexor digitorum superficialis, flexor digitorum profundus (FDP), and flexor carpi ulnaris were simultaneously recorded using surface electromyography. Discomfort and complications following FMV were also assessed. Results Compared with the control group, a significant decrease in muscle activity was observed in both the flexor digitorum superficialis and flexor carpi ulnaris after 5 and 10 minutes of FMV. In contrast, there was no significant decrease in the maximal grip strength or FDP muscle activity after either FMV condition. The discomfort was significantly higher immediately after both FMV conditions than in the control group, but it decreased 15 minutes after FMV, indicating no significant difference among the 3 conditions. Redness and/or swelling were observed in 13.6% and 36.3% of the participants after 5 and 10 minutes of FMV, respectively. Conclusion Five-minute FMV to the distal forearm could be a useful therapeutic method with few complications. However, the FMV in this area alone was not sufficient to suppress the muscle activity of the FDP located in the deep layer.
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Affiliation(s)
- Rikiya Shirato
- Department of Rehabilitation, Faculty of Healthcare and Science, Hokkaido Bunkyo University, Eniwa, Japan
| | - Ren Shimanuki
- Department of Occupational Therapy, Tokeidai Memorial Hospital, Sapporo, Japan
| | - Towa Shoji
- Department of Rehabilitation, Hokkaido Saiseikai Midori-no-Sato, Otaru, Japan
| | - Masaki Mugikura
- Department of Rehabilitation, Hanakawa Hospital, Ishikari, Japan
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Lee J, Park JE, Kang BH, Yang SN. Efficiency of botulinum toxin injection into the arm on postural balance and gait after stroke. Sci Rep 2023; 13:8426. [PMID: 37225852 DOI: 10.1038/s41598-023-35562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/20/2023] [Indexed: 05/26/2023] Open
Abstract
The purpose of this study was to clarify the association between improvement of spasticity in hemiplegic patient's upper extremity with Botulinum toxin injection and improvement in postural balance and gait function. For this prospective cohort study, sixteen hemiplegic stroke patients with upper extremity spasticity were recruited. The plantar pressure with gait parameters, postural balance parameters, Modified Ashworth Scale, and Modified Tardieu Scale were evaluated before, 3 weeks and 3 months after Botulinum toxin A (BTxA) injection. Spasticity of hemiplegic upper extremity before, and after BTxA injection were significantly changed. Plantar pressure overload in affected side was reduced after BTxA injection. The mean X-speed and the horizontal distance decreased in postural balance analysis with eyes-opened test. Improvement in hemiplegic upper extremity spasticity showed positive correlation with gait parameters. In addition, improvement in hemiplegic upper extremity spasticity was positively correlated with change in balance parameters in postural balance analysis with eyes-closed and dynamic tests. This study focused on the effect of stroke patient's hemiplegic upper extremity spasticity on their gait and balance parameters and identified that the BTxA injection on hemiplegic patient's spastic upper extremity improve postural balance and gait function.
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Affiliation(s)
- Junhee Lee
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Ji Eun Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Byung Heon Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
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Muacevic A, Adler JR. Rehabilitation of Post-Cerebral Venous Thrombosis. Cureus 2023; 15:e33512. [PMID: 36632374 PMCID: PMC9827895 DOI: 10.7759/cureus.33512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is rare and only accounts for 0.5% of all reported stroke cases. CVT includes severe headaches with neurological deficits, but the vague presentation of symptoms necessitates efficient clinical examination and imaging for a proper diagnosis. Here, we present a case of this rare type of stroke. Our patient exhibited continuous headaches, further complicated by other neurological deficits. We documented this case to aid in the diagnosis and rehabilitation management of CVT. We aim to demonstrate to physicians the importance of early rehabilitation in such stroke cases and improve the outcome for patients.
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16
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Younger DS. Motor sequela of adult and pediatric stroke: Imminent losses and ultimate gains. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:305-346. [PMID: 37620077 DOI: 10.1016/b978-0-323-98817-9.00025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Stroke is the leading cause of neurological disability in the United States and worldwide. Remarkable advances have been made over the past 20 years in acute vascular treatments to reduce infarct size and improve neurological outcome. Substantially less progress has been made in the understanding and clinical approaches to neurological recovery after stroke. This chapter reviews the epidemiology, bedside examination, localization approaches, and classification of stroke, with an emphasis on motor stroke presentations and management, and promising research approaches to enhancing motor aspects of stroke recovery.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Tamburin S, Filippetti M, Mantovani E, Smania N, Picelli A. Spasticity following brain and spinal cord injury: assessment and treatment. Curr Opin Neurol 2022; 35:728-740. [PMID: 36226708 DOI: 10.1097/wco.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Spasticity is a common sequela of brain and spinal cord injury and contributes to disability, reduces quality of life, and increases economic burden. Spasticity is still incompletely recognized and undertreated. We will provide an overview of recent published data on the definition, assessment, and prediction, therapeutic advances, with a focus on promising new approaches, and telemedicine applications for spasticity. RECENT FINDINGS Two new definitions of spasticity have been recently proposed, but operational criteria should be developed, and test-retest and inter-rater reliability should be explored. Cannabinoids proved to be effective in spasticity in multiple sclerosis, but evidence in other types of spasticity is lacking. Botulinum neurotoxin injection is the first-line therapy for focal spasticity, and recent literature focused on optimizing its efficacy. Several pharmacological, interventional, and nonpharmacological therapeutic approaches for spasticity have been explored but low-quality evidence impedes solid conclusions on their efficacy. The recent COVID-19 pandemic yielded guidelines/recommendations for the use of telemedicine in spasticity. SUMMARY Despite the frequency of spasticity, robust diagnostic criteria and reliable assessment scales are required. High-quality studies are needed to support the efficacy of current treatments for spasticity. Future studies should explore telemedicine tools for spasticity assessment and treatment.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
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18
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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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Campanella W, Corazza A, Puce L, Privitera L, Pedrini R, Mori L, Boccuni L, Turtulici G, Trompetto C, Marinelli L. Shear wave elastography combined with electromyography to assess the effect of botulinum toxin on spastic dystonia following stroke: A pilot study. Front Neurol 2022; 13:980746. [PMID: 36299267 PMCID: PMC9589110 DOI: 10.3389/fneur.2022.980746] [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] [Received: 06/28/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Shear wave elastography (SWE) is a method for carrying out a quantitative assessment of the mechanical properties of soft tissues in terms of stiffness. In stroke survivors, the paretic muscles may develop hypertonia due to both neural-mediated mechanisms and structural alterations with consequent muscular fibrous-fatty remodeling. Methods Fourteen adult patients with spastic dystonia following stroke were recruited. Muscle hypertonia was assessed using the modified Ashworth scale (MAS). Muscle activation was measured by surface electromyography (sEMG) with the selected muscle in shortened (spastic dystonia) and stretched (dynamic stretch reflex) positions. SWE was performed on a selected paretic muscle and on the contralateral non-paretic one to calculate shear wave velocities (SWV) along and across muscular fibers. The modified Heckmatt scale (MHS) pattern was also determined. All evaluations were performed shortly before BoNT-A injections (T0) and one month later (T1). Results All SWV on paretic muscles were higher than contralateral non-paretic ones (p < 0.01). After BoNT-A injection, a significant reduction in MAS (p = 0.0018), spastic dystonia (p = 0.0043), and longitudinal SWE measurements, both in shortened (p = 0.001) and in stretched muscular conditions (p = 0.0029), was observed. No significant changes in SWV on non-paretic muscles were observed. Higher SWV resulted along the direction of muscular fibers vs. across them (p = 0.001). No changes resulted from the MHS evaluations after BoNT-A. There was a positive correlation between MHS scores and SWV values while the muscle was in the shortened position, but not with spastic dystonia recorded by sEMG. Conclusions This is the first study evaluating the effect of BoNT-A on muscle hypertonia following stroke, assessed by both SWE and sEMG. These findings support SWE as a useful method to disclose intrinsic muscular remodeling, independently of the effect of spastic dystonia, in particular, while muscles were assessed in a neutral position. SWE measurements of muscle stiffness cannot tell apart neural-mediated and intrinsic muscle hypertonia. Interestingly, when sEMG activity is very limited, as in spastic muscles kept in a shortened position, SWE can provide a measurement of stiffness due almost completely to intrinsic muscle changes. Alongside sEMG, SWE could aid clinicians in the assessment of responses to treatments.
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Affiliation(s)
- William Campanella
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Angelo Corazza
- Unità di Radiologia Diagnostica ed Interventistica Istituto Ortopedico Galeazzi di Milano, Milan, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Laura Privitera
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Riccardo Pedrini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Giovanni Turtulici
- S.C. Radiodiagnostica Ospedale Evangelico Internazionale di Genova, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Clinical Neurophysiology, Genova, Italy
- *Correspondence: Lucio Marinelli
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Eftekhar P, Li MH, Semple MJ, Richardson D, Brooks D, Mochizuki G, Dutta T. Investigation of the Kinematic Upper-Limb Movement Assessment (KUMA): A Pilot Study. Physiother Can 2022. [DOI: 10.3138/ptc-2019-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Upper limb movement disorders are common after stroke and can severely impact activities of daily living. Available clinical measures of these disorders are subjective and may lack the sensitivity needed to track a patient’s progress and to compare different therapies. Kinematic analyses can provide clinicians with more objective measures for evaluating the effects of rehabilitation. We present a novel method to assess the quality of upper limb movement: the Kinematic Upper-limb Movement Assessment (KUMA). This assessment uses motion capture to provide three kinematic measures of upper limb movement: active range of motion, speed, and compensatory trunk movement. The researchers sought to evaluate the ability of the KUMA to distinguish motion in the affected versus unaffected limb. Method: We used the KUMA with three participants with stroke to assess three single-joint movements in: wrist flexion and extension, elbow flexion and extension, and shoulder flexion/extension and abduction/adduction. Participants also completed the Modified Ashworth Scale and the Chedoke-McMaster Stroke Assessment, two clinical measures of functional ability. Results: The KUMA distinguished between affected and unaffected upper limb motion. Conclusions: The KUMA provides clinicians with supplementary objective information for motion characterization that is not available through clinical measures alone. The KUMA can complement existing clinical measures such as the MAS and CMSA and can be helpful for monitoring patient progress.
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Affiliation(s)
- Parvin Eftekhar
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
| | - Michael H. Li
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Denyse Richardson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - George Mochizuki
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tilak Dutta
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Institute for Biomaterials and Biomechanical Engineering, University of Toronto, Toronto, Ontario, Canada
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21
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Williams G, Banky M. Association of Lower Limb Focal Spasticity With Kinematic Variables During Walking in Traumatic Brain Injury. J Neurol Phys Ther 2022; 46:213-218. [PMID: 35404881 DOI: 10.1097/npt.0000000000000400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Focal muscle spasticity is defined as spasticity that affects a localized group of muscles. It is prevalent in many adult-onset neurological conditions, yet the relationship of focal muscle spasticity with walking remains unclear. Therefore, the aim of this study was to determine the relationship of focal muscle spasticity with the kinematics of walking in traumatic brain injury (TBI). METHODS Ninety-one participants with TBI underwent clinical gait analysis and assessment of focal lower limb muscle spasticity in a prospective cross-sectional study. A matched group of 25 healthy controls (HCs) were recruited to establish a reference dataset. Kinematic data for each person with and without focal muscle spasticity following TBI were compared with the HC cohort at a matched walking speed. RESULTS The TBI and HC cohorts were well matched. Only those with focal hamstring muscle spasticity walked significantly different to those without. They had significantly greater knee flexion (23.4° compared with 10.5°, P < 0.01) at initial contact. There were no other significant differences in kinematic variables between those with and without focal muscle spasticity. There was no significant association between focal muscle spasticity and walking speed. DISCUSSION AND CONCLUSIONS Focal muscle spasticity and abnormal kinematics whilst walking were common in this cohort of people with TBI. However, focal muscle spasticity had little relationship with kinematic variables, and no significant relationship with walking speed. This finding has implications for the treatment of focal muscle spasticity to improve walking following TBI. Focal muscle spasticity had little relationship with kinematic variables and walking speed in this cohort of people with TBI who could walk without assistance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A381).
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Affiliation(s)
- Gavin Williams
- The University of Melbourne, Melbourne, Australia (G.W.); and Epworth Healthcare, Richmond, Australia (G.W., M.B.)
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22
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Marinelli L, Puce L, Mori L, Leandri M, Rosa GM, Currà A, Fattapposta F, Trompetto C. Cannabinoid Effect and Safety in Spasticity Following Stroke: A Double-Blind Randomized Placebo-Controlled Study. Front Neurol 2022; 13:892165. [PMID: 35812088 PMCID: PMC9261779 DOI: 10.3389/fneur.2022.892165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nabiximols is a cannabis-based drug to treat spasticity-associated symptoms currently approved for patients with multiple sclerosis only. Cannabinoids are useful in an increasing number of medical conditions but may bear an increased risk for cardiovascular events. SativexStroke is a double-blind randomized placebo-controlled crossover monocentric clinical trial investigating the efficacy and safety of nabiximols in patients with spasticity following stroke. Methods Patients were treated with nabiximols oromucosal spray or placebo and assessed before and after two phases of 1-month duration each. Cardiovascular safety was assessed before and during the trial. Primary endpoints were changes in spasticity numeric rating scale scores and electromyographic recording of the stretch reflex in affected wrist flexors. Secondary outcome measures were numeric rating scale scores for pain, sleep and bladder function, the number of daily spasms and clinical assessment of spasticity with the modified Ashworth scale. The study was registered with the EudraCT number 2016-001034-10. Results Between May 2, 2018, and February 20, 2020, 41 patients entered the study. Seven patients did not complete the study, so 34 were included in the analysis. Two serious adverse events occurred, but none related to cardiovascular function. Primary and secondary efficacy outcome measures did not change from baseline during nabiximols treatment relative to placebo. Conclusion This study suggests that nabiximols use is probably safe in stroke patients, therefore cannabinoid usefulness may be further investigated. The lack of nabiximols effect could be related to low pain levels in recruited patients or different spasticity mechanisms between post-stroke and multiple sclerosis patients. Similarly, a beneficial effect of nabiximols could have emerged if more patients with a higher level of spasticity at baseline were recruited. Clinical Trial Registration https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-001034-10/IT.
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Affiliation(s)
- Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Division of Clinical Neurophysiology, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- *Correspondence: Lucio Marinelli
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Division of Neurorehabilitation, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Massimo Leandri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Gian Marco Rosa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, A. Fiorini Hospital, Terracina, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Division of Neurorehabilitation, Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Seim CE, Ritter B, Starner TE, Flavin K, Lansberg MG, Okamura AM. Design of a wearable vibrotactile stimulation device for individuals with upper-limb hemiparesis and spasticity. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1277-1287. [PMID: 35552152 PMCID: PMC10139869 DOI: 10.1109/tnsre.2022.3174808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vibratory stimulation may improve post-stroke symptoms such as spasticity; however, current studies are limited by the large, clinic-based apparatus used to apply this stimulation. A wearable device could provide vibratory stimulation in a mobile form, enabling further study of this technique. An initial device, the vibrotactile stimulation (VTS) Glove, was deployed in an eight-week clinical study in which sixteen individuals with stroke used the device for several hours daily. Participants reported wearing the glove during activities such as church, social events, and dining out. However, 69% of participants struggled to extend or insert their fingers to don the device. In a follow-up study, eight individuals with stroke evaluated new VTS device prototypes in a three-round iterative design study with the aims of creating the next generation of VTS devices and understanding features that influence interaction with a wearable device by individuals with impaired upper-limb function. Interviews and interaction tasks were used to define actionable design revisions between each round of evaluation. Our analysis identified six new themes from participants regarding device designs: hand supination is challenging, separate finger attachments inhibit fit and use, fingers may be flexed or open, fabric coverage impacts comfort, a reduced concern for social comfort, and the affected hand is infrequently used. Straps that wrap around the arm and fixtures on the anterior arm were other challenging features. We discuss potential accommodations for these challenges, as well as social comfort. New VTS device designs are presented and were donned in an average time of 48 seconds.
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Bayram KB, Şengül İ, Aşkin A, Tosun A. Inter-rater reliability of the Australian Spasticity Assessment Scale in poststroke spasticity. Int J Rehabil Res 2022; 45:86-92. [PMID: 35044994 DOI: 10.1097/mrr.0000000000000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the inter-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adult stroke patients with spasticity, two experienced clinicians rated the elbow flexor, wrist flexor, and ankle plantar flexor spasticity by using the ASAS in 85 persons with stroke. Unweighted and weighted (linear and quadratic) kappa statistics were used to calculate the inter-rater reliability for each muscle group. Unweighted kappa coefficients for elbow flexors (n = 83), wrist flexors (n = 80), and ankle plantar flexors (n = 77) were 0.67, 0.60, and 0.55, respectively. Linear and quadratic weighted kappa coefficients, respectively, were 0.77 and 0.87 for elbow flexors, 0.72 and 0.82 for wrist flexors, and 0.72 and 0.85 for ankle plantar flexors. The raters never disagreed by more than a single score in the rating of elbow flexors. On the contrary, the raters disagreed by more than a single score in three patients in the rating of ankle plantar flexors and in one patient in the rating of wrist flexors. The results suggested that inter-rater reliability of the ASAS differed according to the spastic muscle group assessed and the statistical method used. The strength of the agreement on the ASAS, an ordinal scale, ranged from good to very good when the weighted kappa values were considered.
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Affiliation(s)
- Korhan Bariş Bayram
- Department of Physical Medicine and Rehabilitation, İzmir Kâtip Çelebi University, Atatürk Training and Research Hospital
| | - İlker Şengül
- Department of Physical Medicine and Rehabilitation, School of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Ayhan Aşkin
- 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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A Systematic Review of Non-Pharmacological Interventions to Improve Gait Asymmetries in Neurological Populations. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Gait asymmetries are commonly observed in neurological populations and linked to decreased gait velocity, balance decrements, increased fall risk, and heightened metabolic cost. Interventions designed to improve gait asymmetries have varying methods and results. The purpose of this systematic review was to investigate non-pharmacological interventions to improve gait asymmetries in neurological populations. Keyword searches were conducted using PubMed, CINAHL, and Academic Search Complete. The search yielded 14 studies for inclusion. Gait was assessed using 3D motion capture systems (n = 7), pressure-sensitive mats (e.g., GAITRite; n = 5), and positional sensors (n = 2). The gait variables most commonly analyzed for asymmetry were step length (n = 11), stance time (n = 9), and swing time (n = 5). Interventions to improve gait asymmetries predominantly used gait training techniques via a split-belt treadmill (n = 6), followed by insoles/orthoses (n = 3). The literature suggests that a wide range of methods can be used to improve spatiotemporal asymmetries. However, future research should further examine kinematic and kinetic gait asymmetries. Additionally, researchers should explore the necessary frequency and duration of various intervention strategies to achieve the greatest improvement in gait asymmetries, and to determine the best symmetry equation for quantifying gait asymmetries.
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Hsu CH, Lin YC, Hsu HY, Chieh HF, Lin CJ, Ling SF, Su FC, Kuo LC. A Novel and Clinically Feasible Instrument for Quantifying Upper Limb Muscle Tone and Motor Function via Indirect Measure Methods. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:2100208. [PMID: 34984110 PMCID: PMC8719648 DOI: 10.1109/jtehm.2021.3136754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
Objective: Quantifying muscle tone is often based on a tester’s subjective judgment in clinical settings. There is, however, a lack of suitable tools that can be used to objectively assess muscle tone. This study thus introduces a reliable, clinically-feasible device, called the Arm Circumference Motor Evaluation System (ACMES), for quantifying the muscle tone of upper limbs without using mechanical torque transducers. Methods: While the ACMES conducts continuously passive arm circumduction motions, the voltage and current of the driving motor is transduced into torque values via a least square approximation. A torque sensor and springs with different spring constants were used for the validity and reliability test in the first part of this study. Fifteen healthy adults and two patients who had experienced a stroke participated in the second part, which was a clinical experiment used to examine the in-vivo test-retest reliability and to explore the inspection differences between healthy and patient participants. Results: The results showed that the ACMES has high validity (R2: ~0.99) and reliability (R2: 0.96~0.99). The reliability of the ACMES used on human subjects was acceptable (R2: 0.83~0.85). The various muscle tone patterns could be found among healthy and stroke subjects via the ACMES. Conclusion: Clinically, abnormal muscle tone, which seriously affects motion performance, will be found in many diagnoses, such as stroke or cerebral palsy. However, objectively and feasibly measuring abnormal tone in modern clinical settings is still a challenging task. Thus, the ACMES was developed and tested to verify its feasibility as a measurement system for detecting the mechanical torque associated with muscle tone.
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Affiliation(s)
- Chieh-Hsiang Hsu
- Department of Biomedical EngineeringCollege of EngineeringNational Cheng Kung University Tainan 70101 Taiwan
| | - Yu-Chen Lin
- Department of Occupational TherapyCollege of MedicineNational Cheng Kung University Tainan 70101 Taiwan
| | - Hsiu-Yun Hsu
- Department of Physical Medicine and RehabilitationNational Cheng Kung University Hospital Tainan 70101 Taiwan
| | - Hsiao-Feng Chieh
- Medical Device Innovation CenterNational Cheng Kung University Tainan 70101 Taiwan
| | - Chien-Ju Lin
- Medical Device Innovation CenterNational Cheng Kung University Tainan 70101 Taiwan
| | - Shih-Fu Ling
- Medical Device Innovation CenterNational Cheng Kung University Tainan 70101 Taiwan
| | - Fong-Chin Su
- Department of Biomedical EngineeringCollege of EngineeringNational Cheng Kung University Tainan 70101 Taiwan
- Medical Device Innovation CenterNational Cheng Kung University Tainan 70101 Taiwan
| | - Li-Chieh Kuo
- Department of Biomedical EngineeringCollege of EngineeringNational Cheng Kung University Tainan 70101 Taiwan
- Department of Occupational TherapyCollege of MedicineNational Cheng Kung University Tainan 70101 Taiwan
- Medical Device Innovation CenterNational Cheng Kung University Tainan 70101 Taiwan
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Predictors of Clinically Important Improvements in Motor Function and Daily Use of Affected Arm after a Botulinum Toxin A Injection in Patients with Chronic Stroke. Toxins (Basel) 2021; 14:toxins14010013. [PMID: 35050990 PMCID: PMC8778339 DOI: 10.3390/toxins14010013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Identifying patients who can gain minimal clinically important difference (MCID) in active motor function in the affected upper extremity (UE) after a botulinum toxin A (BoNT-A) injection for post-stroke spasticity is important. Eighty-eight participants received a BoNT-A injection in the affected UE. Two outcome measures, Fugl–Meyer Assessment Upper Extremity (FMA-UE) and Motor Activity Log (MAL), were assessed at pre-injection and after 24 rehabilitation sessions. We defined favorable response as an FMA-UE change score ≥5 or MAL change score ≥0.5.Statistical analysis revealed that the time since stroke less than 36 months (odds ratio (OR) = 4.902 (1.219–13.732); p = 0.023) was a significant predictor of gaining MCID in the FMA-UE. Medical Research Council scale -proximal UE (OR = 1.930 (1.004–3.710); p = 0.049) and post-injection duration (OR = 1.039 (1.006–1.074); p =0.021) were two significant predictors of MAL amount of use. The time since stroke less than 36 months (OR = 3.759 (1.149–12.292); p = 0.028), naivety to BoNT-A (OR = 3.322 (1.091–10.118); p = 0.035), and education years (OR = 1.282 (1.050–1.565); p = 0.015) were significant predictors of MAL quality of movement. The findings of our study can help optimize BoNT-A treatment planning.
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Vinehout K, Tynes K, Sotelo MR, Hyngstrom AS, McGuire JR, Schmit BD. Changes in Cortical Activity in Stroke Survivors Undergoing Botulinum Neurotoxin Therapy for Treatment of Focal Spasticity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:735819. [PMID: 36188774 PMCID: PMC9397708 DOI: 10.3389/fresc.2021.735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Background: Botulinum NeuroToxin-A (BoNT-A) relieves muscle spasticity and increases range of motion necessary for stroke rehabilitation. Determining the effects of BoNT-A therapy on brain neuroplasticity could help physicians customize its use and predict its outcome. Objective: The purpose of this study was to investigate the effects of Botulinum Toxin-A therapy for treatment of focal spasticity on brain activation and functional connectivity. Design: We used functional Magnetic Resonance Imaging (fMRI) to track changes in blood oxygen-level dependent (BOLD) activation and functional connectivity associated with BoNT-A therapy in nine chronic stroke participants, and eight age-matched controls. Scans were acquired before BoNT-A injections (W0) and 6 weeks after the injections (W6). The task fMRI scan consisted of a block design of alternating mass finger flexion and extension. The voxel-level changes in BOLD activation, and pairwise changes in functional connectivity were analyzed for BoNT-A treatment (stroke W0 vs. W6). Results: BoNT-A injection therapy resulted in significant increases in brain activation in the contralesional premotor cortex, cingulate gyrus, thalamus, superior cerebellum, and in the ipsilesional sensory integration area. Lastly, cerebellar connectivity correlated with the Fugl-Meyer assessment of motor impairment before injection, while premotor connectivity correlated with the Fugl-Meyer score after injection. Conclusion: BoNT-A therapy for treatment of focal spasticity resulted in increased brain activation in areas associated with motor control, and cerebellar connectivity correlated with motor impairment before injection. These results suggest that neuroplastic effects might take place in response to improvements in focal spasticity.
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Affiliation(s)
- Kaleb Vinehout
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kelsey Tynes
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miguel R. Sotelo
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison S. Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - John R. McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Schmit
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Hakakzadeh A, Shariat A, Honarpishe R, Moradi V, Ghannadi S, Sangelaji B, Ansari NN, Hasson S, Ingle L. Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study. Physiother Theory Pract 2021; 37:1368-1376. [PMID: 31663796 DOI: 10.1080/09593985.2019.1685035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4 = male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ± 4.3; since onset of stroke: 30.8 ± 10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and 1 month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (P< .05), while ankle plantar flexors spasticity (P = .135), and knee extensors spasticity (P = .368) did not show any significant decrease. Conclusions: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors. In contrast, no significant decreases were identified in the spasticity of the ankle plantar flexors and knee extensors muscles.
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Affiliation(s)
- Azadeh Hakakzadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardalan Shariat
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Honarpishe
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Moradi
- Department of Orthotics and Prosthetics, Faculty of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Ghannadi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Sangelaji
- Department of Physiotherapy, School of Physiotherapy, Otago University, Dunedin, New Zealand
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
| | - Lee Ingle
- Department of Sport, Health Exercise Science, University of Hull, Kingston-upon-Hull, UK
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Okuno T, Takeuchi T, Takeda E, Izumi Y, Kaji R. Clinical Uses of a Robot (Hybrid-Assisted Limb or HAL™) in Patients with Post-stroke Spasticity after Botulinum Toxin Injections. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:297-301. [PMID: 34759148 DOI: 10.2152/jmi.68.297] [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: 11/14/2022]
Abstract
Spasticity is the major cause of disabilities in stroke-survivors. Botulinum neurotoxin (BoNT) injections have been used to reduce the muscle tone in those patients, but its efficacy in functional outcome is not well delineated. We have studied the effect of a robot (Hybrid-Assisted Limb or HAL™) designed for assisting the elbow flexion and extension in those who underwent BoNT injections with reduced muscle tone. We enrolled 15 post stroke patients who had BoNT injections for more than 12 months. They were measured for active ROM (range of motion) with video recordings before and after the use of HAL for 40 minutes. Active ROM was measured by a rater who were blinded as to the use of the robot. Significant increase of active ROM was observed immediately after the use of HAL, and the effect was maintained for another 12 months by repeating the sessions. It is suggested from present study that the combined use of BoNT and robotics is effective efficacious for regaining the active function of the upper limb in stroke survivors. J. Med. Invest. 68 : 297-301, August, 2021.
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Affiliation(s)
- Tsuyoshi Okuno
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan.,Department of Neurology, Tokushima University, Tokushima, Japan
| | - Toshiaki Takeuchi
- Department of Neurology, Tokushima University, Tokushima, Japan.,Department of Neurology, Utano National Hospital, Kyoto, Japan
| | - Eiji Takeda
- Kenshokai Gakuen College for Health and Welfare, Tokushima, Japan
| | - Yuisin Izumi
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Ryuji Kaji
- Department of Neurology, Tokushima University, Tokushima, Japan.,Department of Neurology, Utano National Hospital, Kyoto, Japan
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Abal del Blanco J, Taboada-Iglesias Y. Effects of resistance exercise in patients with spasticity: Systematic review. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations. J Cent Nerv Syst Dis 2021; 13:11795735211036576. [PMID: 34566442 PMCID: PMC8461119 DOI: 10.1177/11795735211036576] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/27/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke patients with spasticity usually require long-lasting care and interventions but frequently report that outpatient and community treatment is limited, reflecting a significant unmet need in health and social care provision. Rehabilitation and spasticity management services are essential for patient recovery, with improvements in both activity and participation reducing the burden on patients, family and society. Current clinical guidance provides scope for improvements in both post-stroke management and spasticity prevention. However, access to specialist services can be limited and the patient journey does not always match national recommendations. Identification of spasticity and its predictors and lack of subsequent referral to rehabilitation or specialist spasticity services are key issues in the management of post-stroke spasticity. Implementation of a traffic light classification system prioritises patients at an increased risk of spasticity and promotes early and consistent management across the spectrum of primary and secondary care. The proposed system is based on clinical evidence, expert consensus and recent clinical guidelines. It provides simple and straightforward criteria for management, multidisciplinary consultation and referral to specialist spasticity services, with patients allocated by monitoring requirements and a low (green/periodic monitoring), medium (amber/routine referral) or high risk (red/urgent referral) of spasticity.
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Affiliation(s)
- Ganesh Bavikatte
- Neuro-Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ganesh Subramanian
- Department of Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust; King’s College London & Centre for Nursing Midwifery and Allied Health Research, University College London Hospitals/University College London, London, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torbay, Devon, UK
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Alamer A, Melese H, Getie K, Deme S, Tsega M, Ayhualem S, Birhanie G, Abich Y, Yitayeh Gelaw A. Effect of Ankle Joint Mobilization with Movement on Range of Motion, Balance and Gait Function in Chronic Stroke Survivors: Systematic Review of Randomized Controlled Trials. Degener Neurol Neuromuscul Dis 2021; 11:51-60. [PMID: 34512072 PMCID: PMC8420562 DOI: 10.2147/dnnd.s317865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ankle joint mobilization with movement has been speculated to be an important intervention for enhancing range of motion, balance, and gait functions in chronic stroke survivors. Nonetheless, there is a scarcity of recent conclusive evidence that evaluates its efficacy in chronic stroke patients. The purpose of this review was to synthesize existing evidence on the efficacy of mobilization with movement therapy on range of motion, balance, and gait performance in subjects after stroke. Methods A comprehensive systematic search of literature was performed using the following databases: PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of included trials. The primary outcome measures of this review were dorsiflexion range of motion (DF-ROM), and Berg balance scale (BBS). This review was reported in accordance with PRISMA statement guidelines. Due to variations in relevant trials, meta-analysis was not carried out. Results and Conclusions Seven randomized controlled trials with a total of 224 subjects were analyzed. Evidence of overall quality was graded from moderate to high. This review found that mobilization with movement therapy could be an alternative rehabilitative intervention for subjects with chronic stroke to increase range of motion, balance, and gait ability. However, the evidence remains preliminary due to the small number of participants. Large-scale RCTs in the future are warranted to investigate the efficacy of mobilization with movement in subgroups of chronic stroke subjects.
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Affiliation(s)
- Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Kefale Getie
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Sisay Deme
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Molla Tsega
- Department of Internal Medicine, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Sileshi Ayhualem
- Department of Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremeskel Birhanie
- Department of Physiotherapy, School of Medicine, College of Health Sciences, TibebeGhion Comprehensive Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yohannes Abich
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmare Yitayeh Gelaw
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Effectiveness of Transcutaneous Electrical Nerve Stimulation with Taping for Stroke Rehabilitation. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9912094. [PMID: 34485529 PMCID: PMC8410308 DOI: 10.1155/2021/9912094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
Background Spasticity is a factor that impairs the independent functional ability of stroke patients, and noninvasive methods such as electrical stimulation or taping have been reported to have antispastic effects. The purpose of this study was to investigate the effects of transcutaneous electrical nerve stimulation (TENS) combined with taping on spasticity, muscle strength, and gait ability in stroke patients. Methods From July to October 2020, 46 stroke patients with moderate spasticity in the plantar flexors participated and were randomly assigned to the TENS group (n = 23) and the TENS+taping group (n = 23). All subjects performed a total of 30 sessions of functional training for 30 min/session, 5 days/week, for 6 weeks. For therapeutic exercise, sit-to-standing, indoor walking, and stair walking were performed for 10 min each. In addition, all participants in both groups received TENS stimulation around the peroneal nerve for 30 min before performing functional training. In the TENS+taping group, taping was additionally applied to the feet, ankles, and shin area after TENS, and the taping was replaced once a day. The composite spasticity score and handheld dynamometer measurements were used to assess the intensity of spasticity and muscle strength, respectively. Gait ability was measured using a 10 m walk test. Results The spasticity score and muscle strength were significantly improved in the TENS+taping group compared to those in the TENS group (p < 0.05). A significant improvement in gait speed was observed in the TENS+taping group relative to that in the TENS group (p < 0.05). Conclusions Thus, TENS combined with taping may be useful in improving spasticity, muscle strength, and gait ability in stroke patients. Based on these results, an additional application of taping could be used to enhance the antispastic effect of TENS or other electrical stimulation treatments in the clinic. A long-term follow-up study is needed to determine whether the spasticity relieving effect persists after taping is removed.
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Hashemi M, Sturbois-Nachef N, Keenan MA, Winston P. Surgical Approaches to Upper Limb Spasticity in Adult Patients: A Literature Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:709969. [PMID: 36188802 PMCID: PMC9397894 DOI: 10.3389/fresc.2021.709969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Spasticity is the main complication of many upper motor neuron disorders. Many studies describe neuro-orthopedic surgeries for the correction of joint and limb deformities due to spasticity, though less in the upper extremity. The bulk of care provided to patients with spasticity is provided by rehabilitation clinicians, however, few of the surgical outcomes have been summarized or appraised in the rehabilitation literature. Objective: To review the literature for neuro-orthopedic surgical techniques in the upper limb and evaluate the level of evidence for their efficacy in adult patients with spasticity. Method: Electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for English, French as well as Farsi languages human studies from 1980 to July 2, 2020. After removing duplicated articles, 2,855 studies were screened and 80 were found to be included based on the criteria. The studies were then divided into two groups, with 40 in each trial and non-trial. The results of the 40 trial articles were summarized in three groups: shoulder, elbow and forearm, and wrist and finger, and each group was subdivided based on the types of intervention. Results: The level of evidence was evaluated by Sackett's approach. There were no randomized control trial studies found. About, 4 studies for shoulder, 8 studies for elbow and forearm, 26 studies for wrist and finger (including 4 for the thumb in palm deformity), and 2 systematic reviews were found. Around, two out of 40 trial articles were published in the rehabilitation journals, one systematic review in Cochrane, and the remaining 38 were published in the surgical journals. Conclusion: Most surgical procedures are complex, consisting of several techniques based on the problems and goals of the patient. This complexity interferes with the evaluation of every single procedure. Heterogenicity of the participants and the absence of clinical trial studies are other factors of not having a single conclusion. This review reveals that almost all the studies suggested good results after the surgery in carefully selected cases with goals of reducing spasticity and improvement in function, pain, hygiene, and appearance. A more unified approach and criteria are needed to facilitate a collaborative, evidence-based, patient referral, and surgical selection pathway.
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Affiliation(s)
- Mahdis Hashemi
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Vancouver Island Health Authority, Victoria, BC, Canada
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Orthopédic and Traumatologic Département, University Hospital of Lille, Lille, France
| | - Marry Ann Keenan
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Neuro-Orthopaedics, MossRehab Hospital, Elkins Park, PA, United States
- Orthopaedic Surgery (Ret), University of Pennsylvania, Philadelphia, PA, United States
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada
- Vancouver Island Health Authority, Victoria, BC, Canada
- Department of Physical Medicine and Rehabilitation, University of British Colombia, Vancouver, BC, Canada
- *Correspondence: Paul Winston orcid.org/0000-0002-8403-6988
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Menon RG, Raghavan P, Regatte RR. Pilot study quantifying muscle glycosaminoglycan using bi-exponential T 1ρ mapping in patients with muscle stiffness after stroke. Sci Rep 2021; 11:13951. [PMID: 34230600 PMCID: PMC8260636 DOI: 10.1038/s41598-021-93304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/16/2021] [Indexed: 01/14/2023] Open
Abstract
Post stroke muscle stiffness is a common problem, which left untreated can lead to disabling muscle contractures. The purpose of this pilot study was to evaluate the feasibility of bi-exponential T1ρ mapping in patients with arm muscle stiffness after stroke and its ability to measure treatment related changes in muscle glycosaminoglycans (GAGs). Five patients with muscle stiffness after stroke and 5 healthy controls were recruited for imaging of the upper arm with 3D-T1ρ mapping. Patients were scanned before and after treatment with hyaluronidase injections, whereas the controls were scanned once. Wilcoxon Mann-Whitney tests compared patients vs. controls and patients pre-treatment vs. post-treatment. With bi-exponential modeling, the long component, T1ρl was significantly longer in the patients (biceps P = 0.01; triceps P = 0.004) compared to controls. There was also a significant difference in the signal fractions of the long and short components (biceps P = 0.03, triceps P = 0.04). The results suggest that muscle stiffness is characterized by increased muscle free water and GAG content. Post-treatment, the T1ρ parameters shifted toward control values. This pilot study demonstrates the application of bi-exponential T1ρ mapping as a marker for GAG content in muscle and as a potential treatment monitoring tool for patients with muscle stiffness after stroke.
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Affiliation(s)
- Rajiv G Menon
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 1st Ave, 4th Floor, New York, NY, 10016, USA.
| | - Preeti Raghavan
- Deparments of Physical Medicine and Rehabilitation and Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ravinder R Regatte
- Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 1st Ave, 4th Floor, New York, NY, 10016, USA
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Hefter H, Nickels W, Rosenthal D, Samadzadeh S, Albrecht P. Continuous Increase of Efficacy under Repetitive Injections of Botulinum Toxin Type/A beyond the First Treatment for Adult Spastic Foot Drop. Toxins (Basel) 2021; 13:toxins13070466. [PMID: 34357938 PMCID: PMC8310361 DOI: 10.3390/toxins13070466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to quantify the increase in efficacy during the first four cycles of treatment with botulinum toxin type/A (BoNT/A) in 24 free-walking BoNT/A naïve adult patients with post-stroke hemispasticity and spastic foot drop. Patients were followed over 390 days and received five injections of 800 U aboBoNT/A every three months. Patients assessed the treatment effect at eight visits using a global assessment scale, physicians scored the muscle tone at the ankle joint, measured active and passive ranges of motion (aRoMs, pRoMs) at the knee and ankle joint and determined the distance patients succeeded to walk during a minute. Patients' assessments significantly (p < 0.006) increased with time and significantly correlated with all parameters measured. The best correlation (r = 0.927; p < 0.0001) was found with the sum of the aRoMs of knee and ankle joint. After one year of treatment outcome measures were better than and significantly correlated with the peak effect of the first injection. This correlation was higher for pRoMs (r = 0.855; p < 0.00001) compared to aRoMs (r = 0.567; p < 0.009). When BoNT/A treatment of the spastic foot in chronic hemispasticity is performed regularly every three months for at least one year, patients will experience a significant increase of benefit beyond the first treatment, but have to learn how to adapt to and use the new degree of freedom induced by the injections.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
- Correspondence:
| | - Werner Nickels
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
- Department of Neurology, Ruland-Kliniken, Neuenbürger Strasse 49, D-75335 Dobel, Germany
| | - Dietmar Rosenthal
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
| | - Sara Samadzadeh
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
| | - Philipp Albrecht
- Department of Neurology, University Hospital, Moorenstrasse 5, D-40225 Düsseldorf, Germany; (W.N.); (D.R.); (S.S.); (P.A.)
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Aoyama T, Kanazawa A, Kohno Y, Watanabe S, Tomita K, Kaneko F. Influence of Visual Stimulation-Induced Passive Reproduction of Motor Images in the Brain on Motor Paralysis After Stroke. Front Hum Neurosci 2021; 15:674139. [PMID: 34239429 PMCID: PMC8258409 DOI: 10.3389/fnhum.2021.674139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Finger flexor spasticity, which is commonly observed among patients with stroke, disrupts finger extension movement, consequently influencing not only upper limb function in daily life but also the outcomes of upper limb therapeutic exercise. Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as a potential treatment for spasticity in patients with stroke. However, it remains unclear whether KINVIS intervention alone could improve finger flexor spasticity and finger extension movements without other intervention modalities. Therefore, the current study investigated the effects of a single KINVIS session on finger flexor spasticity, including its underlying neurophysiological mechanisms, and finger extension movements. To this end, 14 patients who experienced their first episode of stroke participated in this study. A computer screen placed over the patient's forearm displayed a pre-recorded mirror image video of the patient's non-paretic hand performing flexion-extension movements during KINVIS. The position and size of the artificial hand were adjusted appropriately to create a perception that the artificial hand was the patient's own. Before and after the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range of finger extension movements of the paretic hand were determined. Accordingly, MAS scores and active metacarpophalangeal joint extension range of motion improved significantly after the intervention. Moreover, additional experimentation was performed using F-waves on eight patients whose spasticity was reduced by KINVIS to determine whether the same intervention also decreased spinal excitability. Our results showed no change in F-wave amplitude and persistence after the intervention. These results demonstrate the potential clinical significance of KINVIS as a novel intervention for improving finger flexor spasticity and extension movements, one of the most significant impairments among patients with stroke. The decrease in finger flexor spasticity following KINVIS may be attributed to neurophysiological changes not detectable by the F-wave, such as changes in presynaptic inhibition of Ia afferents. Further studies are certainly needed to determine the long-term effects of KINVIS on finger spasticity, as well as the neurophysiological mechanisms explaining the reduction in spasticity.
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Affiliation(s)
- Toshiyuki Aoyama
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Atsushi Kanazawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Shinya Watanabe
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Fuminari Kaneko
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Japan
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In TS, Jung JH, Jung KS, Cho HY. Effect of Sit-to-Stand Training Combined with Taping on Spasticity, Strength, Gait Speed and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. Life (Basel) 2021; 11:life11060511. [PMID: 34073094 PMCID: PMC8226448 DOI: 10.3390/life11060511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Spasticity is one of the factors that make it more difficult to control posture in stroke patients. Taping has been used to manage muscle stiffness in various musculoskeletal disorders. Recently, it has been used to decrease spasticity in stroke patients, but the effect of taping combined with therapeutic exercise is still unclear. The purpose of the present study was to determine whether the sit-to-stand (STS) training combined with taping improves the ankle spasticity, muscle strength, gait speed, and quality of life in stroke patients. Material and Methods: The study recruited 40 stroke patients, who were randomly divided into two groups: the taping and STS training (TSTS) group (n = 20) and the STS group (n = 20). The subjects in the TSTS group underwent STS training with Kinesio taping on the tibialis anterior, calf and ankle joint, whereas the subjects in the STS group underwent only STS training. All participants underwent 30 sessions of STS training (30 minutes, 5 days per week for 6 weeks). The present study evaluated the spasticity of ankle plantar flexors by the mean of the composite spasticity score; the muscle strength and gait speed were evaluated using the handheld dynamometer and the 10-meter walk test, respectively, and the quality of life was assessed using the stroke-specific quality of life scale. Result: The TSTS group and the STS group showed significant improvements in spasticity, muscle strength, walking speed, and quality of life after the intervention (p < 0.05). The level of improvement in the TSTS group was significantly higher in spasticity, muscle strength, and walking speed compared to the STS group (p < 0.05). Conclusions: The present study demonstrated that STS training is effective for decreasing spasticity in stroke patients and suggested that additional taping intervention further improved this effect. In addition, improvement of muscle strength and gait function was observed with a significant decrease of ankle spasticity.
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Affiliation(s)
- Tae-sung In
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
| | - Jin-hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Korea;
| | - Kyoung-sim Jung
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
- Correspondence: (K.-s.J.); (H.-y.C.)
| | - Hwi-young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: (K.-s.J.); (H.-y.C.)
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Hefter H, Nickels W, Samadzadeh S, Rosenthal D. Comparing soleus injections and gastrocnemius injections of botulinum toxin for treating adult spastic foot drop: a monocentric observational study. J Int Med Res 2021; 49:300060521998208. [PMID: 33784844 PMCID: PMC8020232 DOI: 10.1177/0300060521998208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Outcome differences between selective abobotulinumtoxin type A (aboBoNT/A)
injections into the soleus (SOL) and gastrocnemius (GAS) muscles were
investigated in post-stroke patients with spastic foot drop. Methods A monocentric observational study was conducted at a university hospital
botulinum toxin clinic including 24 free-walking adult, botulinum
toxin-naive patients with post-stroke hemiplegia. AboBoNT/A (800 MU in 4 mL
saline) was injected into the SOL or GAS muscle under electromyographic
guidance. After 30 days post-injection, the effect of aboBoNT/A injection
was assessed by patients. The treating physician scored spasticity and
measured angles at the knee and ankle joint and gait speed. Results After 30 days, significant improvements of subjective and objective outcome
measures were observed. No significant difference was observed in the
modified Ashworth scale, gait speed, ankle and knee angles, or their angle
combinations between the SOL and GAS groups. Tendencies toward greater
active range of motion (RoM) improvement in the SOL group and passive RoM
improvement in the GAS group were observed. The difference between active
and passive ankle extensions plus knee flexions was significantly larger in
the SOL group. Conclusions Selective 800 MU aboBoNT/A injections into the SOL or GAS muscle were
effective but without relevant clinical difference.
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Affiliation(s)
- Harald Hefter
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
| | - Werner Nickels
- Department of Neurology, SRH Health Center, Bad Wimpfen, Germany
| | - Sara Samadzadeh
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
| | - Dietmar Rosenthal
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
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Tabra SAA, Zaghloul MI, Alashkar DS. Extracorporeal shock wave as adjuvant therapy for wrist and hand spasticity in post-stroke patients: a randomized controlled trial. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00068-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Stroke patients often present with upper limb spasticity which impairs the functional status of patients. Recently, extracorporeal shock wave therapy (ESWT) is reported to be a safe, non-invasive, alternative treatment for spasticity. Many articles have been published on the effect of ESWT on lower limb spasticity, but only few of them had focused on upper limb spasticity, so the aim of this study is to evaluate the clinical and electrophysiological effect of ESWT on wrist and hand spasticity of chronic stroke patients and its impact on functional performance. In this monocentric study, forty chronic stroke patients with upper limb spasticity were recruited and randomly allocated into two groups. Both groups continued to receive conventional stroke rehabilitative program, while group I received three sessions of radial extracorporeal shock wave therapy (rESWT) 1 week apart.
Results
There was a significant decrease in wrist and hand spasticity after treatment and at follow-up in group I compared to group II (Modified Ashworth Scale after rESWT 1.45 ± 0.16, 2.90 ± 0.18 and follow-up 1.55 ± 0.13, 3.00 ± .0.15 in groups I and II, respectively). Also, there was a significant improvement of wrist control and hand function after treatment and at follow-up in group I compared to group II (p < 0.001). The improvement of pinch grip was noticed at follow-up with a significant difference relative to baseline in group I (p < 0.05). Hmax/Mmax ratio was significantly decreased at follow-up in group I compared to group II (p < 0.001).
Conclusion
ESWT is a valuable adjuvant treatment for spasticity of the hand and wrist in stroke patients which is reflected as improvement of functional activity.
Trial registration
ClinicalTrials.gov, NCT04312581. Registered on 18 March 2020.
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Barry AJ, Kamper DG, Stoykov ME, Triandafilou K, Roth E. Characteristics of the severely impaired hand in survivors of stroke with chronic impairments. Top Stroke Rehabil 2021; 29:181-191. [PMID: 33657985 DOI: 10.1080/10749357.2021.1894660] [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
Background: Diminished sensorimotor control of the hand is one of the most common outcomes following stroke. This hand impairment substantially impacts overall function and quality of life; standard therapy often results in limited improvement. Mechanisms of dysfunction of the severely impaired post-stroke hand are still incompletely understood, thereby impeding the development of new targeted treatments.Objective: To identify and determine potential relationships among the mechanisms responsible for hand impairment following strokeMethods: This cohort study observed stroke survivors (n = 95) with severe, chronic hand impairment (Chedoke-McMaster Hand score = 2-3). Custom instrumentation created precise perturbations and measured kinematic responses. Muscle activation was recorded through electromyography. Strength, spasticity, muscle relaxation time, and muscle coactivation were quantified.Results: Maximum grip strength in the paretic hand was only 12% of that achieved by the nonparetic hand, and only 6 of 95 participants were able to produce any net extension force. Despite force deficits, spastic reflex response of the finger flexor evoked by imposed stretch averaged 90.1 ± 26.8% of maximum voluntary activation, relaxation time averaged 3.8 ± 0.8 seconds, and coactivation during voluntary extension exceeded 30% of maximum contraction, thereby resulting in substantial net flexion. Surprisingly, these hypertonicity measures were not significantly correlated with each other.Conclusions: Survivors of severe, chronic hemiparetic stroke experience profound weakness of both flexion and extension that arises from increased involuntary antagonist activation and decreased voluntary activation. The lack of correlation amongst hypertonicity measures suggests that these phenomena may arise from multiple, potentially independent mechanisms that could require different treatments.
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Affiliation(s)
| | - Derek G Kamper
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,UNC/NC State Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA.,Closed-Loop Engineering for Advanced Rehabilitation Research Core, North Carolina State University, Raleigh, North Carolina, USA
| | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, Illinios, USA.,Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Elliot Roth
- Shirley Ryan AbilityLab, Arms + Hands Lab, Chicago, Illinios, USA.,Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Seim CE, Wolf SL, Starner TE. Wearable vibrotactile stimulation for upper extremity rehabilitation in chronic stroke: clinical feasibility trial using the VTS Glove. J Neuroeng Rehabil 2021; 18:14. [PMID: 33485371 PMCID: PMC7824932 DOI: 10.1186/s12984-021-00813-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluate the feasibility and potential impacts on hand function using a wearable stimulation device (the VTS Glove) which provides mechanical, vibratory input to the affected limb of chronic stroke survivors. METHODS A double-blind, randomized, controlled feasibility study including sixteen chronic stroke survivors (mean age: 54; 1-13 years post-stroke) with diminished movement and tactile perception in their affected hand. Participants were given a wearable device to take home and asked to wear it for three hours daily over eight weeks. The device intervention was either (1) the VTS Glove, which provided vibrotactile stimulation to the hand, or (2) an identical glove with vibration disabled. Participants were randomly assigned to each condition. Hand and arm function were measured weekly at home and in local physical therapy clinics. RESULTS Participants using the VTS Glove showed significantly improved Semmes-Weinstein monofilament exam results, reduction in Modified Ashworth measures in the fingers, and some increased voluntary finger flexion, elbow and shoulder range of motion. CONCLUSIONS Vibrotactile stimulation applied to the disabled limb may impact tactile perception, tone and spasticity, and voluntary range of motion. Wearable devices allow extended application and study of stimulation methods outside of a clinical setting.
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Affiliation(s)
- Caitlyn E Seim
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Thad E Starner
- College of Computing, Georgia Institute of Technology, Atlanta, CA, USA
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Zeng H, Chen J, Guo Y, Tan S. Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 11:616097. [PMID: 33551975 PMCID: PMC7855612 DOI: 10.3389/fneur.2020.616097] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Spasticity is a common sequela of stroke. The incidence of poststroke spasticity (PSS) has not been systematically reviewed in recent years, and some risk factors remain debated. This systematic review and meta-analysis was conducted to determine the prevalence and risk factors for PSS. Methods: We searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, WANFANG and CBM) inception to May 12, 2020. Observational studies summarizing the incidence or risk factors for PSS were included. Only cohort studies were enrolled in meta-analysis. For risk factors examined in at least three different studies, we combined effects into odds ratios (OR) and 95% confidence intervals (CI). Results: One thousand four hundred sixty-seven studies were retrieved and 23 were involved in meta-analysis. The pooled prevalence of spasticity after stroke was 25.3% and that after the first-ever stroke was 26.7%. The incidence of spasticity after the first-ever stroke with paresis was 39.5%. The prevalence of disabling or severe spasticity (MAS ≥ 3) in stroke patients with paresis was 9.4% (95% CI 0.056-0.133), and severe spasticity was 10.3% (95% CI 0.058-0.149). Moderate to severe paresis (OR = 6.573, 95% CI 2.579-16.755, I 2 = 0.0%), hemorrhagic stroke (OR = 1.879, 95% CI 1.418-2.490, I 2 = 27.3%) and sensory disorder were risk factors for PSS. Conclusions: The incidence of PSS was significantly higher in stroke patients with paresis. Patients with moderate to severe paresis and sensory disorder should be closely followed up. The role of hemorrhagic stroke in predicting PSS remains to be further explored.
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Affiliation(s)
- Huangling Zeng
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Tan
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Nuara A, Fabbri-Destro M, Scalona E, Lenzi SE, Rizzolatti G, Avanzini P. Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines. J Neurol 2021; 269:627-638. [PMID: 33449202 PMCID: PMC7809551 DOI: 10.1007/s00415-021-10397-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy. .,Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Maddalena Fabbri-Destro
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Emilia Scalona
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Stefano Elio Lenzi
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Istituto Clinico Humanitas, Rozzano, Italy
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Abstract
Spasticity is one component of the upper motor neuron (UMN) syndrome resulting from a multitude of neurologic conditions, such as stroke, brain injury, spinal cord injury, multiple sclerosis, and cerebral palsy. It is clinically recognized as a phenomenon of velocity-dependent increase in resistance, i.e., hypertonia. Recent advances in the pathophysiology of spasticity improve our understanding of mechanisms underlying this complex phenomenon and its relations to other components of UMN syndrome (weakness and disordered motor control), as well as the resultant clinical problems. This theoretical framework provides a foundation to set up treatment goals and to guide goal-oriented clinical assessment and treatment. Among a spectrum of treatment options, botulinum toxin (BoNT) therapy is the preferred treatment for focal spasticity. The evidence is very robust that BoNT therapy effectively reduces spasticity; however, it does not improve voluntary movement. In this chapter, we highlight a few issues on how to achieve the best clinical outcomes of BoNT therapy, such as dosing, dilution, guidance techniques, adjunctive therapies, early treatment, repeated injections, and central effects, as well as the ways to improve motor function in selected subgroups of patients with spasticity. We also discuss the reasons of poor responses to BoNT therapy and when not to use BoNT therapy.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA.
- TIRR Memorial Hermann Hospital, Houston, TX, USA.
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA
- TIRR Memorial Hermann Hospital, Houston, TX, USA
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Xie T, Leng Y, Zhi Y, Jiang C, Tian N, Luo Z, Yu H, Song R. Increased Muscle Activity Accompanying With Decreased Complexity as Spasticity Appears: High-Density EMG-Based Case Studies on Stroke Patients. Front Bioeng Biotechnol 2020; 8:589321. [PMID: 33313042 PMCID: PMC7703112 DOI: 10.3389/fbioe.2020.589321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
Spasticity is a major contributor to pain, disabilities and many secondary complications after stroke. Investigating the effect of spasticity on neuromuscular function in stroke patients may facilitate the development of its clinical treatment, while the underlying mechanism of spasticity still remains unclear. The aim of this study is to explore the difference in the neuromuscular response to passive stretch between healthy subjects and stroke patients with spasticity. Five healthy subjects and three stroke patients with spastic elbow flexor were recruited to complete the passive stretch at four angular velocities (10°/s, 60°/s, 120°/s, and 180°/s) performed by an isokinetic dynamometer. Meanwhile, the 64-channel electromyography (EMG) signals from biceps brachii muscle were recorded. The root mean square (RMS) and fuzzy entropy (FuzzyEn) of EMG recordings of each channel were calculated, and the relationship between the average value of RMS and FuzzyEn over 64-channel was examined. The two groups showed similar performance from results that RMS increased and FuzzyEn decreased with the increment of stretch velocity, and the RMS was negatively correlated with FuzzyEn. The difference is that stroke patients showed higher RMS and lower FuzzyEn during quick stretch than the healthy group. Furthermore, compared with the healthy group, distinct variations of spatial distribution within the spastic muscle were found in the EMG activity of stroke patients. These results suggested that a large number of motor units were recruited synchronously in the presence of spasticity, and this recruitment pattern was non-uniform in the whole muscle. Using a combination of RMS and FuzzyEn calculated from high-density EMG (HD-EMG) recordings can provide an innovative insight into the physiological mechanism underlying spasticity, and FuzzyEn could potentially be used as a new indicator for spasticity, which would be beneficial to clinical intervention and further research on spasticity.
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Affiliation(s)
- Tian Xie
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Yan Leng
- Department of Rehabilitation Medicine, Guangdong Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yihua Zhi
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Chao Jiang
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Na Tian
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Zichong Luo
- Department of Electromechanical Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Hairong Yu
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Rong Song
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
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Zhang Q, Ji G, Cao F, Sun Y, Hu G, Sun S, Liu Y, Cao J, Wang Y, Xu X, Song B. Tuina for spasticity of poststroke: protocol of a systematic review and meta-analysis. BMJ Open 2020; 10:e038705. [PMID: 33303441 PMCID: PMC7733218 DOI: 10.1136/bmjopen-2020-038705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Spasticity is a common complication of poststroke, tuina is a widely used rehabilitation treatment, although there is a lack of supportive evidence on efficacy and safety for patients with poststroke spasticity. The aim of this systematic review is to assess and synthesis evidence of efficacy and safety of tuina for spasticity of poststroke. METHODS AND ANALYSIS A comprehensive electronic search of EMBASE, MEDLINE, Cochrane Library, Web of Science, Wiley, Springer, PEDro, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific and Journal Database (VIP), Wanfang Database (Wanfang), Japanese medical database (CiNii), Korean Robotics Institute Summer Scholars and Thailand Thai-Journal Citation Index Centre will be conducted to search literatures of randomised controlled trials of tuina for spasticity of poststroke survivors range from the establishment to 1 January 2020.There is no time of publication limitations. The primary outcome will be measured with the Modified Ashworth Scale, and the second outcome will include Fugl-Meyer Assessment Scale, surface electromyogram RMS value, the Modified Barthel Index, Stroke Specific Quality of Life Scale, quality of life 36-Item Short-Form Health Survey and Visual Analogue Scale. Cochrane Handbook for Systematic Reviews of Interventions will be used to assess the risk of bias, and GRADE will be used to access the confidence in cumulative evidence. The protocol will be conducted according to approach and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015. ETHICS AND DISSEMINATION Ethical approval will not be required, for no primary data of individual patients were collected. We will publish the findings in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020163384.
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Affiliation(s)
- Qiongshuai Zhang
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Guangcheng Ji
- Rehabilitation Medicine Department, Changchun University of Chinese Medicine, Changchun, China
| | - Fang Cao
- Acupuncture Department, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yihan Sun
- TCM Department, Changchun University of Chinese Medicine, Changchun, China
| | - Guanyu Hu
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Shaoqian Sun
- Rehabilitation Medicine Department, Jilin University Third Affiliated Hospital, Changchun, China
| | - Yanze Liu
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Jiazhen Cao
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
| | - Yufeng Wang
- Tuina Department, First Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Xiaohong Xu
- Graduate School, Changchun University of Chinese Medicine, Changchun, China
| | - Bailin Song
- Acupuncture and Tuina Department, Changchun University of Chinese Medicine, Changchun, China
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49
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Patel AT, Wein T, Bahroo LB, Wilczynski O, Rios CD, Murie-Fernández M. Perspective of an International Online Patient and Caregiver Community on the Burden of Spasticity and Impact of Botulinum Neurotoxin Therapy: Survey Study. JMIR Public Health Surveill 2020; 6:e17928. [PMID: 33284124 PMCID: PMC7752537 DOI: 10.2196/17928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/05/2020] [Accepted: 10/20/2020] [Indexed: 01/13/2023] Open
Abstract
Background Patient- and caregiver-reported data are lacking on the burden of spasticity, and the impact of botulinum neurotoxin type A (BoNT-A) treatment for this condition, on patients' daily lives. As recommended in recent guidance from the US Food and Drug Administration, online patient communities can represent a platform from which to gather specific information outside of a clinical trial setting on the burden of conditions experienced by patients and caregivers and their views on treatment options in order to inform evidence-based medicine and drug development. Objective The objective of our study is to characterize spasticity symptoms and their associated burdens on Western European and US patients and caregivers in the realms of work, daily activities, quality of life (QoL), as well as the positive and negative impacts of treatment with BoNT-A (cost, time, QoL) using Carenity, an international online community for people with chronic health conditions. Methods We performed a noninterventional, multinational survey. Eligible participants were 18 years old or older and had, or had cared for, someone with spasticity who had been treated with BoNT-A for at least 1 year. Patients and caregivers were asked to complete an internet-based survey via Carenity; caregivers reported their own answers and answered on behalf of their patients. Questions included the burden of spasticity on the ability to work, functioning, daily-living activities, and QoL, the impact of BoNT A therapy on patients' lives, and the potential benefits of fewer injections. Results There were 615 respondents (427 patients and 188 caregivers). The mean age of patients and caregivers was 41.7 years and 38.6 years, respectively, and the most commonly reported cause of spasticity was multiple sclerosis. Caregivers were most often the parents (76/188, 40%) or another family member (51/188, 27%) of their patients. Spasticity had a clear impact on patients' and caregivers' lives, including the ability to work and injection costs. For patients, spasticity caused difficulties with activities of daily living and reduced QoL indices. The median number of BoNT-A injections was 4 times per year, and 92% (393/427) of patients reported that treatment improved their overall satisfaction with life. Regarding the BoNT-A injection burden, the greatest patient-reported challenges were the cost and availability of timely appointments. Overall, 86% (368/427) of patients believed that a reduced injection frequency would be beneficial. Caregivers answering for their patients gave largely similar responses to those reported by patients. Conclusions Spasticity has a negative impact on both patients' and caregivers' lives. All respondents reported that BoNT A treatment improved their lives, despite the associated challenges. Patients believed that reducing the frequency of BoNT-A injections could alleviate practical issues associated with treatment, implying that a longer-acting BoNT-A injection would be well received.
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Affiliation(s)
- Atul T Patel
- Kansas City Bone & Joint Clinic, Overland Park, KS, United States
| | - Theodore Wein
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Laxman B Bahroo
- Department of Neurology, Georgetown University, Georgetown, DC, United States
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50
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Khan P, Riberto M, Frances JA, Chueire R, Amorim ACFG, Xerez D, Chung TM, Mercuri LHC, Longo AL, Lianza S, Maisonobe P, Ruiz-Schutz VC. The Effectiveness of Botulinum Toxin Type A (BoNT-A) Treatment in Brazilian Patients with Chronic Post-Stroke Spasticity: Results from the Observational, Multicenter, Prospective BCause Study. Toxins (Basel) 2020; 12:toxins12120770. [PMID: 33291807 PMCID: PMC7762077 DOI: 10.3390/toxins12120770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 01/26/2023] Open
Abstract
Botulinum toxin type A (BoNT-A) is an effective treatment for post-stroke spasticity; however, some patients cannot access treatment until ≥1 year post-stroke. This Brazilian post-marketing study (NCT02390206) assessed the achievement of person-centered goals in patients with chronic post-stroke spasticity after a BoNT-A injection. Patients had a last documented stroke ≥1 year before study entry and post-stroke upper limb (UL) spasticity, with or without lower limb (LL) spasticity. Patients received BoNT-A injections at baseline (visit 1) and visit 2 (3–6 months). Primary endpoint was responder rate (achievement of primary goal from Goal Attainment Scaling (GAS)) at visit 2. Overall, 204 patients underwent GAS evaluation at visit 2, mean (SD) age was 56.4 (13.2) years and 90.7% had LL spasticity. Median (range) time between first stroke and onset of spasticity was 3.6 (0−349) months, onset of spasticity and first injection was 22.7 (0−350) months and waiting time for a rehabilitation appointment was 9.0 (1−96) months. At visit 2, 61.3% (95% CI: 54.4, 67.7) of patients were responders, which was similar for UL and LL primary goals (57.8% [95% CI: 49.9, 65.3] vs. 64.1% [95% CI: 48.4, 77.3]). This study provides evidence to support the effectiveness of BoNT-A treatment for chronic post-stroke spasticity.
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Affiliation(s)
- Patricia Khan
- Centro Catarinense de Reabilitação, Florianópolis, Santa Catarina 88025-301, Brazil;
| | - Marcelo Riberto
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil;
| | - João Amaury Frances
- Hospital Bettina Ferro de Souza, Campus IV da Universidade Federal do Pará, Belém, Pará 66075-110, Brazil;
| | - Regina Chueire
- Faculdade de Medicina de São José do Rio Preto, Autarquia Estadual, São José do Rio Preto 15090-000, Brazil;
| | | | - Denise Xerez
- Serviço de Medicina Física e Reabilitação, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil;
| | - Tae Mo Chung
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 04116-030, Brazil;
| | | | - Alexandre Luiz Longo
- Clinica Neurológica e Neurocirúrgica de Joinville, Joinville, Santa Catarina 89202-165, Brazil;
| | - Sérgio Lianza
- Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil;
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