scholarly journals Analysis of the effects of the upper limb improvement programme in patients after ischemic stroke treated with botulinum toxin

2017 ◽  
Vol 21 (3) ◽  
pp. 14-22
Author(s):  
Elżbieta Mirek ◽  
Kinga Opoka ◽  
Krzysztof Kozioł ◽  
Magdalena Filip ◽  
Szymon Pasiut ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Botulinum Toxin ◽  
Range Of Motion ◽  
Upper Limb ◽  
Muscle Tone ◽  
Neurological Rehabilitation ◽  
Permanent Disability ◽  
Number Of Patients ◽  
Radiocarpal Joint ◽  
Inferior Limb

Introduction: Stroke is not only a medical problem, but also - due to the permanent disability of the injured person - a significant social problem. A significant number of patients after a neurological event develop increased muscle tone. Upper motoneuron damage syndrome promotes pain, stiffness, muscle contracture and weakness, which can potentially delay or prevent success in the rehabilitation process. In the upper limb, the spastic pattern is most often expressed through adduction and internal rotation of the glenohumeral joint, combined with flexion in the elbow, radiocarpal joint and interphalangeal joints. The specificity of spasticity-type increased tension makes rehabilitation of patients suffering from this disorder one of the most difficult tasks of neurological rehabilitation. Aim: The aim of the study was to assess muscle tone and range of motion of the inferior limb in patients after ischemic stroke subjected to 4 cycles of intramuscular injections of a botulinum toxin preparation and subjected to motor rehabilitation. Research Project: Pilot experimental study. Methodology: The study was carried out in the Neurological Unit with Stroke Sub-unit and Sub-Department of Neurological Rehabilitation at John Paul II Specialist Hospital in Krakow in the period from September 2014 to November 2015. The study group consisted of 20 patients after ischemic stroke (13 men, 7 women), age 30 to 72. All patients completed a 4-cycle study, which included injections of the botulinum toxin preparation, combined with a 15-day cycle of individual rehabilitation exercises. Each training session lasted 90 minutes. In order to verify the therapeutic process, active and passive mobility was measured according to the SFTR method and the assessment of muscle tone level was done using the Modified Ashworth Scale. Results: The taken therapeutic actions caused a positive increase in mobility, mostly passive, in the glenohumeral-scapular, elbow and forearm as well as the radiocarpal joints. There was also a slight increase in active mobility of the upper limb joints. In the course of obtaining results, it was shown that the use of botulinum toxin, combined with the rehabilitation exercise programme, significantly reduced pathological muscle tone both within the elbow, radiocarpal joint, and the interphalangeal joints of the hands. Conclusions: The presented results showed that the use of the botulinum toxin combined with medical rehabilitation allows local treatment of spasticity without exposing patients to adverse systemic reactions associated with oral medication. In addition, it has a positive effect on the increase in passive and - to a lesser extent - active range of motion in the joints of the inferior limb.

Subluxed Shoulders Need TLC: Pilot Study of the T-L-C Taping Method to Address Hemiplegic Shoulder Pain, Passive Range of Motion, and Subluxation

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512520390p1-7512520390p1
Author(s):  
Steven Frey ◽  
Mark Stumpf ◽  
Jacob Wright ◽  
Sara Stephenson ◽  
John Wong ◽  
...  
Keyword(s):  
Pilot Study ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Intervention Studies ◽  
Muscle Tone ◽  
Neurological Rehabilitation ◽  
Assessment Approach ◽  
Uniform Assessment ◽  
Common Intervention ◽  
Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Hemiplegic shoulder pain and subluxation are prevalent sequelae following stroke. A gap in the literature exists for shoulder assessments specifically for taping, a common intervention. Studies and tape methods primarily focus on mechanical corrections. However, muscle tone and management, which are prevalent topics in neurological rehabilitation, are rarely addressed. The T-L-C taping method consists of a uniform assessment approach of the shoulder specifically to guide Kinesio® Tape application Primary Author and Speaker: Steven Frey Additional Authors and Speakers: Mark Stumpf, Jacob Wright, and Sara Stephenson Contributing Authors: John Wong, Lauren Loges

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 Botulinumtoxin-kezelés infantilis cerebralis paresisben

2019 ◽  
Vol 160 (28) ◽  
pp. 1105-1111 ◽  
Author(s):  
Tamás Terebessy ◽  
Gyula Domos ◽  
Dalma Hevér ◽  
Nikoletta Horváth ◽  
Sándor Kiss ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Adverse Effects ◽  
Gait Analysis ◽  
Range Of Motion ◽  
Patient Group ◽  
Lower Limb ◽  
Muscle Tone ◽  
Gait Pattern ◽  
Calf Muscle ◽  
Pharmacologically Active

Abstract: Introduction: Botulinum toxin is used for decreasing spasticity, improving gait pattern and preventing secondary deformities and orthopedic surgeries in children with cerebral palsy. Despite its wide use, there is no evidence for the long-term beneficial effect of the toxin. Aim: The authors focused on the short-term effects of the toxin and on the subjective evaluation done by the parents about the botox treatment. Method: First, the calf muscle of 18 children was treated and casting was also performed. In our second patient group, multilevel lower limb injection was done in 12 cases. Joints’ range of motion, muscle tone and spasticity were assessed before and 4–6 weeks after treatment. In ambulatory children, gait analysis was done. Side effects were recorded and parental opinion about the treatment was requested. Results: Increased ankle range of motion and decreased muscle tone and spasticity were seen in our first patient group. In the second group, hip flexion contracture became milder and hip abduction and the popliteal angle improved. However, gait analysis results only slightly changed after botox treatment. Occasional mild and transient adverse effects were observed during the pharmacologically active period of the toxin. Associate beneficial effects were also reported such as better comfort, easier movements, improving function of the non-injected upper limb, decreasing dysarthria and dysphagia. Conclusion: Our study strengthens the observation that botox treatment of the spastic calf muscle together with plaster casting can result in improved ankle dorsiflexion. Multilevel botox treatment can improve lower limb joints range of motion, however, gait pattern remains unchanged. The administration of botulinum toxin with respect to the guidelines has no major adverse effects. Further studies are needed to clarify the observed beneficial associate effects of the toxin. Orv Hetil. 2019; 160(28): 1105–1111.

scholarly journals Combined Effect Of Botulinum Toxin And Splinting On Motor Components And Function Of People With Stroke

2017 ◽  
pp. 18 ◽  
Author(s):  
Aryan Shamili ◽  
Bijan Forogh ◽  
Marzieh Pashmdarfard
Keyword(s):  
Botulinum Toxin ◽  
Range Of Motion ◽  
Upper Extremity ◽  
Muscle Tone ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Extremity Function ◽  
Combined Use ◽  
Upper Extremity Function ◽  
The Difference

Background and objective: Spasticity is one of the problems following stroke. Due to this increase in muscle tone, patients are confronted to problems in motor control and difficulties in activities of daily living and complications such as shortness and contracture. The aim of this study was to examine the effects of Simultaneous use of both splint and botulinum toxin-A (BTX-A) injection on spasticity, range of motion and upper extremity function in a 3-month period.Methods: The design of this study was a comparison between 3 groups of interventions, conducted in rehabilitation clinics in Tehran. Sixty people with chronic stroke were recruited. Based on the inclusion criteria, a total of 39 stroke patients after completing the consent forms were entered to intervention groups; splint or botulinum toxin injection or combined splint/botulinum toxin injection. They were followed up about 3 months and the evaluations were done monthly. Goniometry was the method to measure range of motion, and Modified Ashworth scale was used to examine the spasticity and the upper extremity function was scored based on Fugl-Meyer assessment.   Statistical analysis was done using SPSS 17. And ANOVAs was used for comparison between groups and times.  Significance was set at 0.05.Results: All outcome measures improved within each group but the differences between splint group and BTX-A group and the BTX-A-splint group was not significant in most outcomes during 3 periods (first evaluation until end of the first month, the end of first month until the end of second month, the end of second month until the end of the third month) (p> 0 / 05). The results also showed that the changes in elbow`s spasticity {p= 0.05} and wrist`s spasticity {p= 0.007} and upper extremity function { p = 0.04} were obvious between the three groups over the 3-months and the difference in the group of combined use of botulinum toxin and splint was more than other groups.Conclusion: In this study, the effects of botulinum toxin injection and Volar-Dorsal Wrist/Hand Immobilization splint and the combined use of botulinum injection and splint were obvious in all groups but was not significantly different between the interventions in a 3-month follow-up.  

scholarly journals Comment: difference between assessment of upper limb movement and upper limb associated reactions during walking

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Pieter Meyns
Keyword(s):  
Steady State ◽  
Brain Injury ◽  
Range Of Motion ◽  
Upper Limb ◽  
Energy Cost ◽  
Gait Cycle ◽  
Muscle Tone ◽  
Arm Movement ◽  
Gait Pattern ◽  
Specific Pattern

Abstract Background While walking, people swing their arms in a specific pattern. This specific arm swing pattern during walking has shown to have a beneficial effect on gait as it reduces walking energy cost and optimizes balance. In several patient populations the arm movements can be directly affected (e.g. in patients with acquired brain injury (ABI)), which in turn has a negative effect on their gait pattern, balance and energy cost of walking. Main text In December 2019, Kahn et al. published a paper in JNER concerning the quantification of upper limb associated reactions (ARs) during walking in people with ABI. ARs are defined as “an effort-dependent phenomenon causing an involuntary increase in upper limb muscle tone, with awkward and uncomfortable postures”. These upper limb ARs appear often in patients with ABI and can have an important effect on their gait. The authors calculated kinematic measures using three-dimensional gait analysis relating to range of motion, variability and mean position over the gait cycle for the different upper limb joints (shoulder, elbow, wrist) during self-selected steady-state walking. Based on differences they found between an ABI cohort and healthy control cohort, the authors concluded that they were able to quantify ARs during walking in this population. This calculation, however, is not specific for upper limb ARs. In fact, the authors calculated general measures of arm posture (e.g. mean position over the gait cycle) or arm movement (e.g. range of motion and variability) during gait. Previous research has already indicated that other factors than ARs can influence the posture or movement of the arm during gait in patients with brain injury, such as voluntary compensations for gait instability and contractures or spasticity of upper arm muscles. Yet, it is not possible to disentangle the different causes of the altered arm posture during steady-state walking based on the proposed measures. Conclusion The kinematic arm measures proposed by Kahn et al. (J Neuroeng Rehabil 16(1):160, 2019) are not a direct measure of ARs, but provide a quantification of overall deviation of arm posture or movement during gait. Depending on the specific study design these measures may provide insights in ARs.

scholarly journals Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis

2005 ◽  
Vol 63 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Eduardo Cardoso ◽  
Bernardo Rodrigues ◽  
Rita Lucena ◽  
Irismar Reis de Oliveira ◽  
Glícia Pedreira ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Muscle Tone ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Definitive Treatment ◽  
Adequate Treatment ◽  
Limb Spasticity

Muscle over-activity is one of the cardinal features of spasticity and it is a common disability of stroke patients. In this group, spasticity is responsible for several limitations that interfere in their daily activities and quality of life. To treat spasticity, neurologists usually prescribe drugs as baclofen, tizanidine or benzodiazepines or even use definitive treatment as phenol or surgery. Authors suggest the use of botulinum toxin type A (BTX-A) for spasticity in the upper limbs after stroke, but there are few papers with adequate methodology supporting this idea. In this article we summarize the data of previous double-blind, randomised clinical trials to asses, with a meta-analysis, if BTX-A is an adequate treatment for spasticity due to stroke. The results show a statistical superiority of BTX-A ov%r placebo on reducing muscle tone by the Modified Ashworth Scale (WMD= 0.95 [0.74 to 1.17]) in patients with post-stroke upper limb spasticity.

Botulinum toxin injections for shoulder and upper limb pain: a narrative review

2020 ◽  
Vol 10 (6) ◽  
pp. 411-420
Author(s):  
Ke-Vin Chang ◽  
Yi-Hsiang Chiu ◽  
Wei-Ting Wu ◽  
Po-Cheng Hsu ◽  
Levent Özçakar
Keyword(s):  
Botulinum Toxin ◽  
Pain Relief ◽  
Upper Limb ◽  
Breast Cancer Survivors ◽  
Myofascial Pain ◽  
Pain Syndrome ◽  
Narrative Review ◽  
Limb Pain ◽  
Number Of Patients ◽  
Upper Limb Pain

Botulinum toxin (BoNT) has been widely employed to treat poststroke spasticity, cervical dystonia and muscle hyperactivity. Recently, BoNT injections are increasingly used in treating musculoskeletal pain. The mechanism of BoNT in pain relief comprises relaxation of overused muscles and inhibition of inflammatory nociceptive cytokines/neurotransmitters. As BoNT injections seem promising in treating painful musculoskeletal disorders, we aimed to investigate its effectiveness in shoulder and upper limb pain. Although the present article is a narrative review, we employed a systematic approach to search for relevant articles in PubMed. A total of 19 clinical studies were included. Here, we observed that intramuscular BoNT injections were helpful in stroke patients with hemiplegic shoulder pain. In shoulder joint pain, intra-articular and intrabursal BoNT injections achieved a longer period of pain relief than corticosteroid injections. Similarly, a more durable effect of intramuscular BoNT than saline injections was seen in shoulder myofascial pain. Its use in complex regional pain syndrome and persistent upper limb pain in breast cancer survivors was insufficient, necessitating more studies. Since not all of the included studies could provide Class I of evidence based on the efficacy criteria used by American Academy of Neurology, controlled clinical trials in a larger number of patients are necessary to verify validity of these findings in the future.

Modern approaches to the development of rehabilitation programs for increasing muscle strength and volume of motion in the limbs in patients after ischemic stroke

2021 ◽  
pp. 18-23
Author(s):  
Anna Andreevna Mikhailova ◽  
Konstantin Valentinovich Kotenko ◽  
Natalya Borisovna Korchazhkina ◽  
Elizaveta Sergeevna Koneva
Keyword(s):  
Ischemic Stroke ◽  
Muscle Strength ◽  
Upper Limb ◽  
Electrostatic Field ◽  
Muscle Tone ◽  
Low Frequency ◽  
Main Group ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Initial State

The paper presents an analysis of the data obtained on the effectiveness of the inclusion of a pulsed low-frequency electrostatic field in the standard complex of medical rehabilitation in the long-term period in 60 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with an increase in muscle tone by the type of spasticity, which were divided into 2 comparable clinically — functional characteristics of the group: the main group — 30 patients who underwent a course of massage with a pulsed low-frequency electrostatic field from the «Khivamat» apparatus in addition to the standard rehabilitation complex, consisting of exercise therapy, medical massage, kinesitherapy and medication support, and the control group — 30 patients, who received only the standard complex of medical rehabilitation and drug therapy. For a comparative assessment of muscle strength and range of motion in the extremities in patients after ischemic stroke in the initial state and after the course of treatment, we used the modified Ashfort spasticity scale (MAS), Bartel’s index, and goniometry indices. Research results. Before treatment, all patients with post-stroke spasticity included in the study had impaired motor functions of the upper limb in the form of moderate hemiparesis with high muscle tone and changes in the amplitude of movement. In the initial state, all patients included in the study showed motor changes in functions in the form of moderate hemiparesis with muscle hypertonicity, a decrease in the amplitude of movement of the upper limb and a decrease in the activity of daily life. After the course of treatment, the patients of the main group showed a pronounced positive dynamics of indicators, which was confi rmed by a significant decrease by 23.8 % (p < 0,05) in spasticity in the affected limb according to the MAS scale, which decreased after 6 months by 42,8 % (p < 0.01), and after 12 months by 38.0 % (p < 0,01). In patients of the control group, significantly less pronounced and unstable results were obtained and the studied indicator decreased after the course of treatment by 14,3 % (p > 0,05), after 6 months by 19,0 % (p < 0,05), and after 12 months approached the original value. The decrease in spasticity was confirmed by goniometric data, which indicated an increase in active functional use of the hand in the main group. Conclusion: The inclusion in a comprehensive rehabilitation program of patients after acute circulatory disorders with motor disorders in the form of hemiparesis with increased muscle tone by the type of spasticity of pulsed low-frequency electrostatic massage contributes to a significant decrease in the severity of spasticity, an increase in the range of motion in the affected limbs and an expansion of daily functional independence.

Physical Activity in Aging Population

2019 ◽  
Vol 5 (3) ◽  
pp. 74
Author(s):  
Rezarta Stena ◽  
Klara Hysenaj ◽  
Mitilda Gugu Karoli ◽  
Armelda Teta ◽  
Gjergji Doka
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Heart Rate ◽  
Pain Intensity ◽  
Range Of Motion ◽  
Training Program ◽  
Grip Strength ◽  
Upper Limb ◽  
Hand Grip ◽  
Trunk Flexibility

It is known that worldwide populations are aging, and also that physical activity can play an important role in minimizing impairments characteristic of old age. Adopting a more active lifestyle and doing regular physical activity, including aerobic and resistance exercises, daily walking etc. have been demonstrated to improve cardiovascular, respiratory, and musculoskeletal parameters in older adults. We assessed a potential participant from Elbasan (Albania), 67 years, for eligibility to participate in a 5 month training program. The subject gave written informed consent before inclusion.The following parameters were measured at the beginning (baseline) and end of the training period: BMI, body fat percentage, hand grip strength, lower/upper limb and trunk flexibility and range of motion, heart rate, balance, pain intensity, as well as VO2 max, directly and/or an estimate using the Rockport fitness test estimate. An initial evaluation was carried out just before starting the training (baseline). A second evaluation was made 5 months after starting the program of physical exercise (post training). Each evaluation included the recording of health related events, such as any changes in previous symptoms, as well as measurements of balance, flexibility, body composition, coordination, muscle strength, and aerobic capacity, to detect any changes that might have been induced specifically by physical activity. The subject’s attendance and participation in the program was also recorded. Range of motion for each part evaluated (trunk, hip, cervical region and shoulder) is improved about 15-20° degree. BMI, hand grip strength, lower/upper limb and trunk flexibility, heart rate, balance, pain intensity, VO2 max are also improved after training program. Following a training program or a regular physical activity in older adults minimise impairments characteristics in this age and cardiovascular, respiratory, and musculoskeletal parameters. According to the low importance shown in my country for the physical activity in older adults, I want to emphasize the importance of state structures involvement and the sensibilization of this group of age to stimulate an actively participation in physical training programs followed by professionals for bests life parameters. A higher investment for this age group, building as many facilities as possible for activation and spending quality free time, hiring more physiotherapists in nursing homes will increase life motivation and improve the quality and the parameters of living.

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