scholarly journals Botulinum toxin as adjuvant therapy for hypertonic dysfunction in a neuro-rehabilitation cohort

2022 ◽  
Author(s):  
Thiago Falcão Hora ◽  
Agostinho de Alencar Guerra ◽  
Gerson Otmar Kuhne ◽  
Vinícius de Sousa Alvarenga ◽  
Sabrina Fonseca Oliveira ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Goal Attainment ◽  
Clinical Aspects ◽  
Historical Cohort ◽  
Adjunct Treatment ◽  
Rehabilitation Hospital ◽  
Rehabilitation Programs ◽  
Joint Restriction ◽  
Goal Attainment Scale ◽  
Joint Range

Abstract Purpose: Botulinum toxin (BTX) is a neurotoxin produced by the bacterium Clostridium botulinum, in recent decades, BTX has become an important adjunct treatment to neurological or rehabilitative strategies.We aimed to describe the clinical aspects of patients admitted to a rehabilitation hospital who were treated with BTX for spasticity and dystonia. Methods: This was a historical cohort; data was collected from the electronic charts of all outpatients treated with BTX between 2014 and 2016 in the spasticity and movement disorders service of a quaternary, open access, rehabilitation hospital. The inclusion criteria were limb spasticity due to traumatic brain injury (TBI), and stroke; limb tremor; cervical dystonia; and generalized limb dystonia from any cause in addition to pain that limits rehabilitation. We used relatively lower doses than those generally published in the literature. Therapeutic response was determined by the Goal attainment scale (GAS), pain (graded by visual analogue scale ), independence for daily living activities, target joint range of motion (pre- and post-application), and gait analysis (only for walkers patients). Results: A total of 63 patients were enrolled in this study with a mean follow-up of 2 years. There was significant improvement in joint restriction ) with 66.7% of patients reporting improvement in the GAS scale, best improvement occurred with ortheses and limb adjustments. Conclusions: Most patients have improved functionality on the GAS scale after treatment with BTX, which is used as an adjunct therapy in subjects already in rehabilitation programs. The main rehabilitation objectives with the GAS scale were achieved in most patients.

scholarly journals Effect of Goal Directed Physiotherapy vs a Goal Directed Home Program in AtRisk Infants: A Randomized Clinical Trial

2021 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Neurological Examination ◽  
Goal Attainment ◽  
Test Results ◽  
Rehabilitation Process ◽  
Home Program ◽  
Rehabilitation Programs ◽  
Significant Difference ◽  
Goal Attainment Scale ◽  
Task Oriented ◽  
Neurodevelopmental Effects

Background: Goal directed physiotherapy is a task oriented therapy based on neurodevelopmental principles used in rehabilitation process. The aim of this study is to compare the neurodevelopmental effects of early goal directed physiotherapy with a detailed goal directed home program in infants with risk. Methods: Forty at-risk infants (18 male, 22 female, median age 5.69 mo) were assigned to early goal directed physiotherapy and detailed goal directed home program group randomely. Both early goal directed physiotherapy and detailed goal directed home program continued for 12 weeks. The outcome measures were Hammersmith Infant Neurological Examination, Alberta Infant Motor Scale and Goal Attainment Scale. Results: Significant difference was found in Hammersmith Infant Neurological Examination in early goal directed physiotherapy group (p<0.05) whereas no difference was found in Alberta Infant Motor Scale and Goal Attainment Scale between the groups (p>0.05). In all test results the effect size of early goal directed physiotherapy was more than detailed goal directed home program. Conclusions: According to our results, though Hammersmith Infant Neurological Examination results are better in the early goal directed physiotherapy group, it can be concluded that if parents had good, attainable and eligible guidelines received from the physiotherapist, detailed goal directed home program is also a useful approach in rehabilitation programs of infants with risk.

Stroke early supported discharge: the impact of patients' characteristics and clinical profile on rehabilitation goal attainment and clinical outcomes

2021 ◽  
Vol 28 (3) ◽  
pp. 1-11
Author(s):  
Ehab Georgy
Keyword(s):  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Goal Attainment ◽  
Clinical Profile ◽  
Specific Patient ◽  
Early Supported Discharge ◽  
Significant Difference ◽  
Clinical Profiles ◽  
Goal Attainment Scale ◽  
The Impact

Background/aims Stroke early supported discharge services were introduced to provide a comprehensive stroke specialist therapy input, while reducing cost of acute care. Early supported discharge services resulted in better health-related outcomes. A consensus has not yet been established regarding specific early supported discharge patient characteristics and clinical profile. The main aim of this study was to establish evidence to support the development of an early supported discharge patient profile (demographics and clinical) and eligibility criteria to enable early supported discharge services achieve their purposes of reducing post-stroke disability and institutionalisation rates. This article outlines the relationship between early supported discharge patients' clinical profiles and clinical outcomes, in terms of disability, goal attainment and institutionalisation rates. Methods A retrospective review of data was implemented to determine whether specific early supported discharge patients' clinical profiles and characteristics correlate with clinical outcomes. Data were collected for patients admitted to the Suffolk Stroke Early Supported Discharge Service between August and October 2016, comprising patients' demographics and clinical profiles, including stroke type, Barthel Index and Modified Rankin Scale. Performance data were collected at the end of the early supported discharge service including therapy frequency and intensity, as well as clinical outcomes including the Goal Attainment Scale. Results Data were collected for 53 patients. Data were analysed for all patients in three groups: goals not achieved; goals achieved; and goals achieved to a higher level), according to the Goal Attainment Scale. A Chi-square test showed no significant difference with regard to sex and stroke side (P=0.27). Analysis of variance revealed no significant difference in age. Conversely, results showed a significant association between goal attainment and the stroke subtype, severity and length of hospital stay. Conclusions Specific clinical characteristics and disease profiles correlate with functional outcomes and could influence goal attainment and functional status. A specific patient cohort seems to benefit the most from early supported discharge services in terms of optimised functional outcomes and recovery.

Exploring the Role of Occupational Therapy With Mothers Who Breastfeed

2021 ◽  
Vol 75 (5) ◽  
Author(s):  
Lauren Sponseller ◽  
Fern Silverman ◽  
Pamela Roberts
Keyword(s):  
Occupational Therapy ◽  
Goal Attainment ◽  
Intervention Group ◽  
New Mothers ◽  
Lactation Consultant ◽  
Personal Wellness ◽  
Occupational Profile ◽  
Before And After ◽  
Goal Attainment Scale ◽  
Occupational Therapy Practitioners

Importance: Occupational therapy practitioners can play a pivotal role in supporting breastfeeding mothers as they transition to and form new routines for this occupation. Objective: To explore whether occupational therapy programming can assist breastfeeding mothers in reaching their personal occupation-based wellness goals. Design: Mixed-methods design that involved development of an occupational profile and a goal attainment scale (GAS). After the intervention, participants rescored their GAS goals and completed a semistructured exit interview. Setting: Nonprofit lactation center located in the suburbs of a large mid-Atlantic U.S. city. Participants: Women recruited through convenience sampling who had been breastfeeding an infant for &lt;6 mo, who were not currently weaning, and who had met with a lactation consultant at least once since giving birth were eligible (N = 17). Intervention: Group occupational therapy that consisted of 10 weekly 1-hr sessions. Topics were based on occupational profiles, GAS scores, and lactation consultant input. Outcomes and Measures: Each participant created and scored three goals using the GAS before and after the intervention. Results: Data from 14 of the 17 participants were analyzed. The average postintervention GAS score was 56.50 (M = 50), indicating that most personal wellness goals were reached. Thematic analysis revealed that occupational therapy programming helped mothers persevere with breastfeeding, feel more confident as new parents, and value both themselves and their baby. Conclusions and Relevance: There is an increasing role for occupational therapy practitioners in helping new mothers reach their personal wellness goals in ways that support their ability to continue breastfeeding. What This Article Adds: Maternal wellness and breastfeeding represent an emerging area of practice in which occupational therapy practitioners can provide new mothers with physical, social, and psychological supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. This study provides foundational evidence in support of this collaboration.

scholarly journals Measuring Effects on Pain and Quality of Life after Abobotulinum Toxin A Injections in Children with Cerebral Palsy

Toxins ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 43
Author(s):  
Christian Wong ◽  
Ian Westphall ◽  
Josephine Sandahl Michelsen
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Goal Attainment ◽  
Clinical Problem ◽  
Pain Reduction ◽  
Toxin A ◽  
Children With Cerebral Palsy ◽  
Goal Attainment Scale ◽  
Daily Pain

Sixty-seven percent of children with cerebral palsy (CCP) experience pain. Pain is closely interrelated to diminished quality of life. Despite this, pain is an overlooked and undertreated clinical problem. The objective of this study was to examine the analgesic effect of a single lower extremity intramuscular injection of Abobotulinum toxin A/Dysport in CCP. Twenty-five CCP with at least moderate pain (r-FLACC ≥ 4) during passive range of motion were included. Localized pain and pain in everyday living were measured by r-FLACC and the Paediatric Pain Profile (PPP), respectively. Functional improvements were evaluated by the goal attainment scale (SMART GAS). Quality of life was evaluated by either the CPCHILD or the CP-QOL. The subjects were evaluated at baseline before injection, then after 4, 12, and 28 weeks. Twenty-two subjects had a significant mean and maximum localized pain reduction (p < 0.001) at four weeks post-treatment in 96% (21/22). The reduction was maintained at 12 (19/19) and 28 weeks (12/15). Daily pain evaluated by the PPP was significantly reduced and functional SMART GAS goals were significantly achieved from 4 to 28 weeks. Quality of life improved significantly at four weeks (CPCHILD). Significant functional gains and localized and daily pain reduction were seen from 4 to 28 weeks.

Effect of nabiximols on Goal Attainment Scale scores in patients with treatment-resistant multiple sclerosis spasticity

2021 ◽  
Author(s):  
Friedemann Paul ◽  
Carlos Vila Silván
Keyword(s):  
Multiple Sclerosis ◽  
Goal Attainment ◽  
Daily Practice ◽  
Walking Ability ◽  
Treatment Resistant ◽  
Associated Symptoms ◽  
Scale Scores ◽  
Full Analysis ◽  
Item Scores ◽  
Goal Attainment Scale

Background: Nabiximols oromucosal spray (Sativex®) is an approved add-on treatment option for moderate-to-severe treatment-resistant multiple sclerosis (MS) spasticity. Materials & methods: This prospective, observational, noninterventional, 3-month follow-up pilot study assessed the evolution of patient-selected goal attainment scale (GAS) item scores and of MS spasticity and associated symptoms during nabiximols treatment. Results: In the full analysis set (n = 21), the mean (SD) overall unweighted GAS score increased from 32.1 (3.4) at baseline to 43.6 (14.6) at month 3 (p = 0.0060), constituting a clinically meaningful change. Slight improvements were observed in MS spasticity and most associated symptoms. Nabiximols improved walking ability and was well tolerated. Conclusion: The study provides proof-of-concept that GAS methodology can be applied to MS management in daily practice.

scholarly journals Botulinum Toxin Type A Improves Function According to Goal Attainment in Adults with Poststroke Lower Limb Spasticity in Real Life Practice

2019 ◽  
Vol 82 (1-3) ◽  
pp. 1-8 ◽  
Author(s):  
Lourdes López de Munain ◽  
Josep Valls-Solé ◽  
Irene Garcia Pascual ◽  
Pascal Maisonobe ◽  
Keyword(s):  
Botulinum Toxin ◽  
Lower Limb ◽  
Goal Attainment ◽  
Botulinum Toxin Type A ◽  
Real Life ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Goal Achievement ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Introduction: Botulinum toxin type A (BoNT-A) is an effective and well-tolerated treatment for adult lower limb spasticity. However, data are inadequate to determine BoNT-A efficacy for active function. This study evaluated functional goal achievement (measured by goal attainment scaling [GAS]) following lower limb BoNT-A injection in clinical practice. Methods: Phase 4, postmarketing, multicenter, prospective, observational study (NCT01444794) in adults with poststroke lower limb spasticity receiving one BoNT-A injection cycle. Assessments were at baseline (pretreatment), 1 month ±7 days (visit 1), and 3–5 months posttreatment (visit 2). Primary outcome measure was GAS; additional assessments included Modified Ashworth Scale, Demeurisse Motricity Index, 10-meter walk test, and Disability Assessment Scale. Results: Of 100 enrolled patients, 94 completed the study. Most common primary treatment goals at baseline were improving mobility (57.5%) and positioning (18.1%). At visit 2, 88.3% achieved their primary goal; 87.0% (n = 47/54) for mobility, and 100.0% (n = 17/17) for positioning. In total, 79.1% of patients achieved their secondary goals. Two factors were predictive of primary goal achievement: time since stroke onset (OR 0.907; 95% CI 0.827–0.995; p = 0.038); and absence of stiff knee spasticity pattern (OR 0.228; 95% CI 0.057–0.911; p = 0.036). All functional scales showed improvements; walking speed (mean [SD]) improved by 0.06 (0.13) and 0.05 (0.20) m/s at visits 1 and 2, respectively. Conclusions: BoNT-A injection for lower limb spasticity led to high goal achievement rates in patient-centered GAS evaluation and functional and symptomatic improvements. BoNT-A may therefore deliver clinically meaningful functional improvements in real-life practice.

Effect of adding upper limb rehabilitation to botulinum toxin-A on upper limb activity after stroke: Protocol for the InTENSE trial

2018 ◽  
Vol 13 (6) ◽  
pp. 648-653 ◽  
Author(s):  
Natasha A Lannin ◽  
Louise Ada ◽  
Coralie English ◽  
Julie Ratcliffe ◽  
Maria Crotty
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Goal Attainment ◽  
Botulinum Toxin A ◽  
Phase Iii ◽  
Evidence Based ◽  
Toxin A ◽  
Movement Training ◽  
Severe Spasticity ◽  
To Receive

Rationale Although clinical practice guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin-A in conjunction with therapy, there is currently no evidence to support the addition of therapy. Aims To determine the effect and cost-benefit of adding evidence-based movement training to botulinum toxin-A. Sample size estimate A total of 136 participants will be recruited in order to be able to detect a between-group difference of seven points on the Goal Attainment Scale T-score with 80% power at a two-tailed significance level of 0.05. Methods and design The InTENSE trial is a national, multicenter, Phase III randomized trial with concealed allocation, blinded assessment and intention-to-treat analysis. Stroke survivors who are scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than three months ago, who have completed formal rehabilitation and have no significant cognitive impairment will be randomly allocated to receive botulinum toxin-A plus evidence-based movement training or botulinum toxin-A alone. Study outcomes The primary outcomes are goal attainment (Goal Attainment Scaling) and upper limb activity (Box and Block Test) at three months (end of intervention) and at 12 months (beyond the intervention). Secondary outcomes are spasticity, range of motion, strength, pain, burden of care and health-related quality of life. Direct costs, personal costs and health system costs will be collected at 12 months. Discussion The results of the InTENSE trial are anticipated to directly influence intervention for moderate to severe spasticity after stroke. Trial Registration ANZCTR12615000616572.

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