Effect of Botulinum Toxin Injections on Stretch Reflex Responses of Spastic Elbow Flexors in Hemispheric Stroke Survivors: Case Study

ABSTRACT Motor impairments in stroke survivors are prevalent and contribute to dependence in daily activities, pain and overall disability, which can further upper-limb disability. Treatment with botulinum toxin A (BoNT-A) is indicated for focal spasticity and requires knowledge of biomechanics and anatomy to best select muscles to be injected in the limb. Objective: We aimed to describe the frequency of posture patterns in a Brazilian sample of stroke survivors and correlate them with recommendations of muscle selection for treatment with BoNT-A. Methods: Fifty stroke patients with spastic upper limbs scheduled for neuromuscular block were photographed and physically examined, to be classified by three independent evaluators according to Hefter's classification. Muscles that were injected with BoNT-A by their routine doctors were retrieved from medical charts. Results: Pattern III and IV were the most common (64.7%, 21.6%). We further subclassified pattern III according to the rotation of the shoulder, which effectively interfered in muscle choice. The muscles most frequently treated were shoulder adductors and internal rotators, elbow flexors and extensors, in forearm, the pronator teres and finger and wrist flexors, and, in the hand the adductor pollicis. Conclusion: Frequencies of upper-limb postures differed from previous reports. Other clinical features, besides spasticity, interfered with muscle choice for BoNT-A injection, which only partially followed the recommendations in the literature.

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Efficacy of Netraseka in Blepharospasm w.s.r to Kruchronmeelana

International Journal of Ayurvedic Medicine ◽

10.47552/ijam.v11i3.1559 ◽

2020 ◽

Vol 11 (3) ◽

pp. 584-587

Author(s):

Sailaja Kalyadapu ◽

Praveen Kumar Madikonda ◽

Johar B

Keyword(s):

Botulinum Toxin ◽

Single Case ◽

Great Effort ◽

Single Case Study ◽

Manual Lifting ◽

Eyelid Closure ◽

The Times ◽

Botulinum Toxin Injections

Blepharospasm is an act of involuntary blinking. In most of the cases, symptoms last for few days then disappear without any intervention. However in few cases, disease becomes chronic with symptoms of persistent blinking and the person will be able to open his eyes only with a great effort which could eventually lead to a functional blindness. Most of the times it is associated with ALO (Apraxia of lid opening). ALO is an inability to initiate voluntary eyelid opening following a period of eyelid closure. Manual lifting of the eyelid often resolves the problem and lid is able to stay open for a while thereafter. Botulinum toxin injections are the treatment of choice for both Blepharospasm and ALO, which is too expensive and at the same time have only a temporary improvement. In Ayurveda such condition is comparable with Kruchronmeelana which is postulated to be resultant of vata vitiation. Netrakalpana is the therapy of choice to treat above conditions. A single case study done at our department has shown significant improvement both in pain, blinking after the patient was subjected to Netraseka. Before Netraseka the same patient was treated with Aksitarpana which was done with triphala ghrita for seven days, but which hasn't produced much difference neither in pain nor in blinking. Netraseka was given with a specific kashaya for a period of 14 days following Tarpana therapy.

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Precise quantification of the time course of voluntary activation capacity following Botulinum toxin injections in the biceps brachii muscles of chronic stroke survivors

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00716-z ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

S. Chandra ◽

B. Afsharipour ◽

W. Z. Rymer ◽

N. L. Suresh

Keyword(s):

Botulinum Toxin ◽

Time Course ◽

Biceps Brachii ◽

Chronic Stroke ◽

Voluntary Activation ◽

Stroke Survivors ◽

Precise Quantification ◽

Botulinum Toxin Injections ◽

Activation Capacity

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Stretch reflex excitability in contralateral limbs of stroke survivors is higher than in matched controls

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-019-0623-8 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Taimoor Afzal ◽

Matthieu K. Chardon ◽

William Z. Rymer ◽

Nina L. Suresh

Keyword(s):

Spinal Cord ◽

Stretch Reflex ◽

Biceps Brachii ◽

Motor Impairment ◽

Stroke Survivors ◽

Contralateral Limb ◽

Hemispheric Stroke ◽

Reflex Excitability ◽

Affected Side ◽

Significant Difference

Abstract Background Spasticity, characterized by hyperreflexia, is a motor impairment that can arise following a hemispheric stroke. While the neural mechanisms underlying spasticity in chronic stroke survivors are unknown, one probable cause of hyperreflexia is increased motoneuron (MN) excitability. Potential sources of increased spinal MN excitability after a stroke include increased vestibulospinal (VS) and/or reticulospinal (RS) drive. Spasticity, as clinically assessed in stroke survivors, is highly lateralized, thus RS contributions to stroke-induced spasticity are more difficult to reconcile, as RS nuclei routinely project bilaterally to the spinal cord. Yet studies in stroke survivors suggest that there may also be changes in neuromodulation at the spinal level, indicative of RS tract influence. We hypothesize that after hemispheric stroke, alterations in the excitability of the RS nuclei affect both sides of the spinal cord, and thereby contribute to increased MN excitability on both paretic/spastic and contralateral sides of stroke survivors, as compared to neurologically intact subjects. Methods We estimated stretch reflex thresholds of the biceps brachii (BB) muscle using a position-feedback controlled linear motor to progressively indent the BB distal tendon in both spastic and contralateral limbs of hemispheric stroke survivors and in age-matched intact subjects. Results Our previously reported results show a significant difference between reflex thresholds of spastic and contralateral limbs of stroke survivors recorded from BB-medial (p < 0.005) and BB-lateral (p < 0.001). For this study, we report that there is also a significant difference between the reflex thresholds in the contralateral limb of stroke subjects and the dominant arm of intact subjects, again measured from both BB-medial (p < 0.05) and BB-lateral (p < 0.05). Conclusion The reduction in stretch reflex thresholds in the contralateral limb of stroke survivors, based here on comparisons with thresholds of intact subjects, suggests an increased MN excitability on contralateral sides of stroke survivors as compared to intact subjects. This in turn supports our contention that RS tract activation, which has bilateral descending influences, is at least partially responsible for increased stretch reflex excitability, post-stroke, as both contralateral and affected sides show increased MN excitability as compared to intact subjects. Still, spasticity, presently diagnosed only on the affected side, with increased MN excitability on the affected side as compared to the contralateral side (our previous study), may be due to a different strongly lateralized pathway, such as the VS tract, which has not been directly tested here. Currently available clinical methods of spasticity assessment, such as the Modified Ashworth Scale, lack the resolution to quantify this phenomenon of a bilateral increase in MN excitability.

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