Is functional improvement the same in stroke patients treated with botulinum toxin in upper limb only vs a typical poststroke inpatient population in a neurorehabilitation service?

Toxicon ◽  
2016 ◽  
Vol 123 ◽  
pp. S33
Author(s):  
Melissa Gorayeb ◽  
Daniela Pinto ◽  
João Castro ◽  
Isabel Amorim ◽  
Carolina Falcão ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Functional Improvement ◽  
Stroke Patients ◽  
Inpatient Population

Botulinum Toxin to Treat Upper-Limb Spasticity in Hemiparetic Patients: Grasp Strategies and Kinematics of Reach-to-Grasp Movements

2009 ◽  
Vol 24 (2) ◽  
pp. 141-151 ◽  
Author(s):  
Djamel Bensmail ◽  
Johanna Robertson ◽  
Christophe Fermanian ◽  
Agnès Roby-Brami
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Motor Command ◽  
Sensory Loss ◽  
Functional Improvement ◽  
Hand Position ◽  
Reach To Grasp ◽  
Upper Limb Function ◽  
Position And Orientation ◽  
Post Hoc

Background. Poor control of grasping in spastic, hemiparetic patients could be because of a combination of poor individuation of joints, weakness, spasticity, and sensory loss. Objective. To investigate the effect of botulinum toxin injections (BTIs) on grasping objects of different shapes and to assess the effect on upper-limb function, reach-to-grasp kinematics, and hand position and orientation at the time of grasp. Methods. We included 15 patients with spastic hemiparesis and 9 healthy controls in this open labeled study, in which the patients were assessed before (M0), 1 month after a first (M1), and 1 month after a second BTI (M4, at 4 months). A motion capture system recorded movements. Kinematic variables were computed as well as hand position and orientation at the time of grasping, and finger configurations were coded from video recordings. Results. In contrast with healthy participants, hemiparetic patients rarely used multipulpar grasps but used specific strategies combined with various directions of approach to the object. BTIs did not alter finger configuration but improved the final direction of the approach and the hand posture during the grasp. No significant changes in kinematic parameters were found using post hoc analysis, although a session effect was found for peak hand velocity. Individual analysis showed that the patients with the best potential for functional improvement are those with good proximal and moderate distal motor command. Conclusions. BTIs can modify hand kinematics as well as the approach and posture of reach-to-grasp movements. Function and grasping strategies are probably more dependent on motor recovery.

scholarly journals Use of botulinum toxin in stroke patients with severe upper limb spasticity.

1996 ◽  
Vol 61 (1) ◽  
pp. 30-35 ◽  
Author(s):  
B B Bhakta ◽  
J A Cozens ◽  
J M Bamford ◽  
M A Chamberlain
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Stroke Patients ◽  
Limb Spasticity

scholarly journals Evaluating the Effects of Botulinum Toxin Injection and Physiotherapy on Post-Stroke Patients During One Year Observation - a Pilot Study

2021 ◽  
Vol 25 (3) ◽  
Author(s):  
Zuzanna Olszewska ◽  
Elżbieta Mirek ◽  
Kinga Opoka-Kubica ◽  
Szymon Pasiut Szymon Pasiut ◽  
Magdalena Filip
Keyword(s):  
Botulinum Toxin ◽  
Pilot Study ◽  
Combination Therapy ◽  
Upper Limb ◽  
Muscle Tone ◽  
Statistical Significance ◽  
Botulinum Toxin Injection ◽  
Upper Limbs ◽  
Stroke Patients ◽  
Post Stroke

Introduction: Stroke is a serious health problem in the modern population. Spasticity is one of the consequences of stroke and affects about 30% of people. Increased muscle tone affects postural control disorders. Due to the specificity of spasticity, therapy in post-stroke patients is a challenge for neurological physiotherapy. Therefore, it requires the development of appropriate management standards . Study aim: The aim of the study was to evaluate the effectiveness of 3 combination therapy cycles based on botulinum toxin injection and physiotherapy for muscle tone, muscle strength and postural stability in post-stroke patients qualified for the spasticity treatment programme of the lower and upper limbs. Material and methods: The pilot study involved 12 patients (6 from the lower limb and 6 from the upper limb programme). The 1-year combination therapy programmes included 3 botulinum toxin injections and 3 weeks of physiotherapy after each injection. Clinical evaluation was conducted before and after the 1-year observation cycle. The results were evaluated using: MAS (Modified Ashworth Scale), MRC (Medical Research Council Scale) and posture stability test on a balance platform (BiodexSD). Results: A decrease was observed in muscle tone of the lower and upper limbs, as well as an increase in muscular strength of the upper limb. However, there were no noted statistical significance of the studied parameters. Conclusions: Physiotherapy in combination with the botulinum toxin is an important element of improvement in post-stroke patients. However, further research is needed to explicitly confirm its effectiveness.

scholarly journals Botulinum Toxin Type A Injections as Monotherapy for Upper Limb Essential Tremor Using Kinematics

2017 ◽  
Vol 45 (1) ◽  
pp. 11-22 ◽  
Author(s):  
Olivia Samotus ◽  
Niraj Kumar ◽  
Philippe Rizek ◽  
Mandar Jog
Keyword(s):  
Botulinum Toxin ◽  
Essential Tremor ◽  
Upper Limb ◽  
Rating Scale ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Functional Improvement ◽  
Motion Sensors ◽  
Dosing Patterns

AbstractBackground:There is a significant need for a targeted therapy for essential tremor (ET), as medications have not been developed specifically for ET, and the ones prescribed are often not well-tolerated, so that many patients remain untreated. Recent work has shown that, unlike previous experience, kinematically guided individualized botulinum toxin type A (BoNT-A) injections provide benefit along with minimal weakness. Ours is the first long-term (96-week) safety and efficacy study of BoNT-A as monotherapy for ET using kinematically driven injection parameters.Methods:Ten ET patients were administered six serial BoNT-A treatments every 16 weeks and were assessed at 6 weeks following treatment. During each study visit, the Fahn–Tolosa–Marin (FTM) scale, the Unified Parkinson’s Disease Rating Scale, and the Quality of Life for Essential Tremor Questionnaire (QUEST) were administered along with kinematic assessment of the treated limb. Participants performed scripted tasks with motion sensors placed over each arm joint. Dosing patterns were determined using the movement disorder neurologist’s interpretation of muscles contributing to the kinematically analyzed upper limb tremor biomechanics.Results:There was a 33.8% (p<0.05) functional improvement (FTM part C) and a 39.8% (p<0.0005) improvement in QUEST score at week 96 compared to pretreatment scores at week 0. Although there was a 44.6% (p<0.0005) non-dose-dependent reduction in maximal grip strength, only 2 participants complained of mild weakness. Following the fourth serial treatment, mean action tremor score was reduced by 62.9% (p=0.001) in the treated and by 44.4% (p=0.03) in the untreated arm at week 96 compared to week 48.Conclusions:Individualized BoNT-A dosing patterns to each individual’s tremor biomechanics provided an effective monotherapy for ET as function improved without functionally limiting muscle weakness.

scholarly journals Robotic rehabilitation for end-effector device and botulinum toxin in upper limb rehabilitation in chronic post-stroke patients: an integrated rehabilitative approach

2021 ◽  
Author(s):  
Teresa Paolucci ◽  
Francesco Agostini ◽  
Massimiliano Mangone ◽  
Andrea Bernetti ◽  
Letizia Pezzi ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Rating Scale ◽  
Stroke Patients ◽  
Robotic Training ◽  
End Effector ◽  
Upper Limb Rehabilitation ◽  
Rehabilitation Protocol ◽  
Severe Spasticity ◽  
Significant Difference

Abstract Background Determine the effects of an integrated rehabilitation protocol, including botulinum toxin and conventional rehabilitation exercise plus end-effector (EE) robotic training for functional recovery of the upper limb (UL) compared to training with the robot alone in post-chronic stroke patients with mild to severe spasticity, compared to training with the robot alone. Methods In this prospective, observational case-control study, stroke patients were allocated into 2 groups: robot group (RG, patients who underwent robotic treatment with EE) and robot-toxin group (RTG, patients who in addition have carried out the injection of botulinum toxin for UL recovery). All patients were assessed by Fugl-Meyer Assessment (FMA), Motricity Index (MI), modified Ashworth scale (MAS), numeric rating scale (NRS), Box and Block Test (BBT), Frenchay Arm Test (FAT), and Barthel Index (BI) at baseline (T0), T1 (end of treatment), and T2 (3 months of follow-up). Results Forty-four patients were included and analyzed (21RG; 23RTG). From the analysis between groups, the results suggested how there was a statistically significant difference in favor of RTG, specifically ΔT0-T1 and ΔT0-T2 for B&B p = 0.009 and p = 0.035; ΔT0-T1 and ΔT0-T2 for FAT with p = 0.016 and p = 0.031; ΔT0-T1 for MAS shoulder p = 0.016; ΔT0-T1 and ΔT0-T2 with p = 0.010 and p = 0.005 for MAS elbow; and ΔT0-T1 and ΔT0-T2 with p = 0.001 and p = 0.013 for MAS wrist. Conclusion Our results suggest, in line with the literature, a good efficacy in the reduction of spasticity and in the improvement of the function of the UL, with the reduction of pain, adopting a rehabilitation protocol integrated with BoTN, robot-assisted training, and traditional physiotherapy.

Sign in / Sign up

Export Citation Format

Share Document