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 Efficiency of Different Preparations of Botulinum Toxin Type A, Xeomin and Dysport, in the Management of Spastic Upper Limb After Stroke

2019 ◽  
Vol 70 (10) ◽  
pp. 3490-3494
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Local Effect ◽  
National Agency ◽  
Good Efficiency ◽  
Upper Limb Function ◽  
Higher Doses

The present study quantifies the effect of the two botulinum toxin type A products, Xeomin and Dysport, with approval from the National Agency for Medicines and Medical Devices of Romania (ANMDMR), for the treatment of the spastic upper limb following a stroke. The results obtained in the present study show a good efficiency of using both products in the spasticity of the upper limb, and a maintenance of the results obtained for both products for a minimum period of 3 months. Also, at higher doses, the results of the study show better improvement of spasticity and upper limb function on the evaluation scales, but the local effect is not maintained for a longer period. Keywords: toxinum botulinum type A, Xeomin, Dysport, spasticity

Efficiency of Different Preparations of Botulinum Toxin Type A, Xeomin and Dysport, in the Management of Spastic Upper Limb After Stroke

2019 ◽  
Vol 70 (10) ◽  
pp. 3490-3494
Author(s):  
Marius Nicolae Popescu ◽  
Razvan Cosmin Petca ◽  
Cristina Beiu ◽  
Mihai Cristian Dumitrascu ◽  
Aida Petca ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Local Effect ◽  
National Agency ◽  
Good Efficiency ◽  
Upper Limb Function ◽  
Higher Doses

The present study quantifies the effect of the two botulinum toxin type A products, Xeomin and Dysport, with approval from the National Agency for Medicines and Medical Devices of Romania (ANMDMR), for the treatment of the spastic upper limb following a stroke. The results obtained in the present study show a good efficiency of using both products in the spasticity of the upper limb, and a maintenance of the results obtained for both products for a minimum period of 3 months. Also, at higher doses, the results of the study show better improvement of spasticity and upper limb function on the evaluation scales, but the local effect is not maintained for a longer period.

scholarly journals Improvement and Neuroplasticity after Combined Rehabilitation to Forced Grasping

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Michiko Arima ◽  
Atsuko Ogata ◽  
Kazumi Kawahira ◽  
Megumi Shimodozono
Keyword(s):  
Electrical Stimulation ◽  
Upper Limb ◽  
Near Infrared ◽  
Botulinum Toxin Type A ◽  
Combined Treatment ◽  
Neuromuscular Electrical Stimulation ◽  
Botulinum Toxin Type ◽  
Functional Improvement ◽  
Upper Limb Function ◽  
Flexor Muscles

The grasp reflex is a distressing symptom but the need to treat or suppress it has rarely been discussed in the literature. We report the case of a 17-year-old man who had suffered cerebral infarction of the right putamen and temporal lobe 10 years previously. Forced grasping of the hemiparetic left upper limb was improved after a unique combined treatment. Botulinum toxin type A (BTX-A) was first injected into the left biceps, wrist flexor muscles, and finger flexor muscles. Forced grasping was reduced along with spasticity of the upper limb. In addition, repetitive facilitative exercise and object-related training were performed under low-amplitude continuous neuromuscular electrical stimulation. Since this 2-week treatment improved upper limb function, we compared brain activities, as measured by near-infrared spectroscopy during finger pinching, before and after the combined treatment. Brain activities in the ipsilesional sensorimotor cortex (SMC) and medial frontal cortex (MFC) during pinching under electrical stimulation after treatment were greater than those before. The results suggest that training under electrical stimulation after BTX-A treatment may modulate the activities of the ipsilesional SMC and MFC and lead to functional improvement of the affected upper limb with forced grasping.

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 The effect of robot therapy assisted by surface EMG on hand recovery in post-stroke patients. A pilot study

2018 ◽  
Vol 21 (4) ◽  
pp. 4-10
Author(s):  
Katarzyna Dziemian ◽  
Aleksandra Kiper ◽  
Alfonc Baba ◽  
Francesca Baldan ◽  
Mahmoud Alhelou ◽  
...  
Keyword(s):  
Upper Limb ◽  
Surface Emg ◽  
Functional Improvement ◽  
Stroke Patients ◽  
Loop Control ◽  
Upper Limb Rehabilitation ◽  
Hand Motion ◽  
Post Stroke ◽  
Upper Limb Function ◽  
Nine Hole Peg Test

Background: Hemiparesis caused by a stroke negatively limits a patient’s motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension. Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG. Research project: Before-after study design. Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient. Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test. Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment.

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