The efficacy of botulinum toxin injections/INS; in deep muscles of upper limb with and without /INS;using needle electrical stimulation

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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How Botulinum Toxin Type A- Occupational Therapy (OT)-Functional Electrical Stimulation (FES) Modify Spasticity and Functional Recovery in Patients with Upper Limb Spasticity Post Stroke

Clinical Immunology Endocrine & Metabolic Drugs ◽

10.2174/2212707003666160728143344 ◽

2016 ◽

Vol 3 (1) ◽

pp. 62-67 ◽

Cited By ~ 3

Author(s):

Riccardo Marvulli ◽

Lucia Mastromauro ◽

Ersilia Romanelli ◽

Angela Lopopolo ◽

Maria Dargenio ◽

...

Keyword(s):

Electrical Stimulation ◽

Botulinum Toxin ◽

Occupational Therapy ◽

Upper Limb ◽

Functional Recovery ◽

Functional Electrical Stimulation ◽

Botulinum Toxin Type A ◽

Botulinum Toxin Type ◽

Post Stroke ◽

Limb Spasticity

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Botulinum Toxin, Physical and Occupational Therapy, and Neuromuscular Electrical Stimulation to Treat Spastic Upper Limb of Children With Cerebral Palsy: A Pilot Study

Artificial Organs ◽

10.1111/j.1525-1594.2009.00768.x ◽

2010 ◽

Vol 34 (3) ◽

pp. 230-234 ◽

Cited By ~ 7

Author(s):

Gerardo Rodríguez-Reyes ◽

Aldo Alessi-Montero ◽

Leticia Díaz-Martínez ◽

Antonio Miranda-Duarte ◽

Alberto Isaac Pérez-Sanpablo

Keyword(s):

Cerebral Palsy ◽

Electrical Stimulation ◽

Botulinum Toxin ◽

Pilot Study ◽

Occupational Therapy ◽

Upper Limb ◽

Neuromuscular Electrical Stimulation ◽

Children With Cerebral Palsy

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121. Comparison of localization techniques for upper limb botulinum toxin injections

Clinical Neurophysiology ◽

10.1016/j.clinph.2008.10.139 ◽

2009 ◽

Vol 120 (2) ◽

pp. e124

Author(s):

M.C. Munin ◽

C. Niyonkuru ◽

E.R. Skidmore ◽

R.D. Zafonte ◽

D.J. Weber

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin Injections

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An effective approach for botulinum toxin injection in patients with stroke for focal spasticity: dual guidance

Medical Science and Discovery ◽

10.36472/msd.v5i9.269 ◽

2018 ◽

Vol 5 (9) ◽

pp. 326-330

Author(s):

Emre Ata ◽

Murat Kosem

Keyword(s):

Botulinum Toxin ◽

Upper Limb ◽

Botulinum Toxin Injection ◽

Stroke Patients ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Limb Muscles ◽

Botulinum Toxin Injections ◽

Ashworth Scale ◽

Electrical Muscle

Objective: This study has aimed to compare the efficacy of botulinum toxin (BTX) injections, applied to the upper limb muscles of the stroke patients in our clinic who have being diagnosed with focal spasticity, that are performed via ultrasonography and ultrasonography + electrical muscle (EM) stimulator guidance. Literature didn’t include detailed crosscheck of ultrasound guided BTX and EM treatment applications for upper limb focal spasticity patients Materials and Methods: Electronic data on 62 hemiplegic stroke patients with grade 2 and 3 focal spasticity who had received botulinum toxin injections into their upper limb muscles by the same physician, who used similar protocol and recorded the results, were scanned retrospectively. The spasticity of the patients in both groups was assessed with the Modified Ashworth Scale at the end of two weeks and three months. Results: A statistically significant difference was found between the Modified Ashworth Scale values of both groups in terms of all muscles, compared to the values seen in the pre-treatment period (p<0.05). The Modified Ashworth Scale values at 3 months posttreatment in ultrasonography + electrical muscle stimulator group were not statistically different from those at 2 weeks posttreatment, with respect to wrist flexion and finger flexion. In intergroup comparison, there was no statistically significant difference between the Modified Ashworth Scale values of at pretreatment and 2 weeks posttreatment. However, statistically significant difference in all muscle groups was found in favor of the ultrasonography + electrical muscle stimulator group at 3 months posttreatment controls (p<0.05). Conclusion: Upper limb spasticity due to stroke can be substantially recovered with botulinum toxin injections that are applied via only ultrasonography guidance or via ultrasonography + electrical muscle stimulator guidance.. According to data from the assessment at 3 months posttreatment, the botulinum toxin injection performed via ultrasonography + electrical muscle stimulator guidance had more positive effects .

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