Posts Tagged BTX-A
[ARTICLE] Effect of Dual Therapy with Botulinum Toxin A Injection and Electromyography-controlled Functional Electrical Stimulation on Active Function in the Spastic Paretic Hand – Full Text PDF
Background: Many previous studies have demonstrated that botulinum toxin A (BTX-A) injections satisfactorily reduce spasticity. Nevertheless, BTX-A, with or without an adjuvant therapy, effectively improves the direct functional movement in few patients with spastic upper extremity paralysis. Therefore the present study aimed to determine the effectiveness of task-orientated therapy on spasticity and functional movement by using electromyography-triggered functional electrical stimulation (EMG-FES) after BTX-A injections. Design: Open-label, prospective clinical trial Method: The subjects were 15 patients with spastic paresis (12 male, 3 female; age range, 17-74 years; 14 due to stroke, 1 due to spinal cord injury) who received BTX-A injections. Before the study was started, all subjects had undergone task-orientated therapy sessions with EMG-FES for 4 months. Despite all patients showing a various extent of improved upper extremity function, upper extremity function reached a plateau because of upper extremity spasticity. After BTX-A injection, all patients underwent task-orientated therapy sessions with EMG-FES for 4 months. The outcomes were assessed with the modified Ashworth scale, the simple test for evaluating hand function, box and block test, grip and release test, finger individual movement test, and grip strength. Assessments were performed at baseline and 10 days and 4 months after BTX-A injection. Results: The median modified Ashworth scale score decreased from 2 at baseline to 1 at 10 days and 4 months after BTX-A injection. The finger individual movement test score increased slightly at 10 days (p=0.29) and further increased at 4 months (p<0.05). The simple test for evaluating hand function, grip and release test, box and block test, and grip strength decreased after 10 days (p<0.05, p=0.26, p<0.01, andp<0.01, respectively) but increased after 4 months (p<0.01, p<0.05, p<0.01, and p=0.18, respectively). Conclusion: Task-orientated therapy with EMG-FES after BTX-A injection effectively reduced spasticity and improved upper limb motor function. Our results also suggest that spasticity occurs as a compensation for the force of the affected muscles and leads to misuse movements and ostensible dexterity in many patients. In addition, we hypothesize that BTX-A injection initializes the abnormal adapted movement pattern and that more active hand movements with facilitation of the paretic muscles when using EMG-FES induce an efficient muscle reeducation of the inherent physiological movement pattern that ultimately could prove useful in the activities of daily living.
[ARTICLE] Integrated Rehabilitation Treatment of Focal Spasticity after Botulinum Toxin Type-A Injection – Full Text PDF
Several treatments have been proposed for the management of spasticity. The injection of botulinum toxin type A is considered the gold standard treatment and appears to be safe and effective. The combination between botulinum toxin type A (BTX-A) and physiotherapy (FKT) is thought to be able to enhance the effects. The aim of this study was to assess the effectiveness of the administration of botulinum toxin type A when combined with a specific rehabilitation protocol in subjects with focal spasticity. 44 subjects were randomly divided into two groups (A and B).
All subjects underwent ECO and EMG guided BTX-A injection. After the injection group A underwent a complex rehabilitation protocol with functional electrical stimulation, functional bandaging, manual therapy, cognitive sensory motor training and focal vibration on the treated muscle; group B made functional rehabilitation at home.
Both groups improved spasticity, pain and function in the first month after the inoculation (T1) but only in group A an improvement at the follow up performed in the subsequent 9 months was observed.
According to the results, it may be suggested that the inoculation of Botulinum toxin A should be properly placed within a specific rehabilitation program
Having provided the above types of occupational therapy interventions with numerous individuals who have received Botox injections to the UE, I have formulated my own opinions as to the functional benefits of Botox injections in the UE. I recently did a literature review to find out what the research reports.
Van Kuijk, Geurts, Bevaart, and van Limbeek (2002) completed a systematic review of studies published from January 1996 through to October 2000. The results of the review support the efficacy of BTX-A on tone reduction and on improving passive range of motion which results in improved positioning and care of the involved UE. One study indicated that clients reported that their arm was more relaxed with ambulation after receiving BTX-A injections to the elbow flexors, however, there was no clear effectiveness as to the impact on improved functional hand use with BTX-A.
The results of the above systematic review support my own observations. With therapy following BTX-A injections, increased passive range of motion, improved positioning, decreased pain, and improved ability to care for the UE were achieved, but I did not see specific improved hand function with BTX-A injections to the extrinsic or intrinsic hand muscles.
The above systematic review indicated that one study found superior outcomes utilizing BTX-A in combination with electrical stimulation and the authors recommended that larger controlled studies to compare the effectiveness of different and/or combined treatment interventions for spasticity was warranted.
Two studies were found that assessed the effectiveness of BTX-A in the elbow, wrist, and hand in combination with modified constraint induced movement therapy (mCIMT). All participants were required to meet the minimum wrist and finger active extension requirements before participating in the study. Sun, Hsu, Sun, Hwang, Yang, and Wang (2010) compared the effectiveness of BTX-A with mCIMT versus BTX-A with NDT. Wolf, Milton, Reiss, Easley, Shenvi, and Clark (2012) compared the effectiveness of mCIMT with and without BTX-A. Results of both studies indicated that all those who received the BTX-A had less spasticity. Wolf, Milton, Reiss et al. (2012) concluded that BTX-A results in decreased tone, pain, and improved positioning but a combination of BTX-A with mCIMT versus mCIMT alone does not contribute to increased UE function in chronic stroke survivors. Sun, Hsu, Sun et al. (2010) reported no differences in spasticity between the two groups at one and 3 months, but the experimental group, who received BTX-A and mCIMT, continued to have decreased tone in the elbow, wrist, and hand as well as increased scores on the Action Research Arm Test (ARAT) and Motor Activity Log (MAL) and increased use of the UE at a 6 month follow compared to the group that received BTX-A and NDT. Sun, Hsu, Sun, et al. (2010) also identified the need to assess other potential treatment combinations.
One study has been found that compares the effectiveness of the combined use of BTX-A and manual therapy both with and without the adjunctive use of dynamic splinting on the elbow (Lai, Francisco, & Willis, 2009). Active elbow range of motion and tone, as measured by the Modified Ashworth Score, were measured. The results indicated that the experimental group with the combined the use of adjunctive dynamic splinting, demonstrated a mean 33.5% improvement in AROM and a mean 9.3% improvement on the MAS scores as compared to 18.7% and 8.6% respectively in the control group who did not utilize adjunctive dynamic splinting.
All studies have indicated that BTX-A is effective in managing tone and improving range of motion, however, adjunctive treatments are also necessary to optimize functional improvements with electrical stimulation, dynamic splinting, and repetitive, functional retraining (mCIMT) showing more promising results. All studies recommended categorizing participants based on impairment severity level in order to assess the ability to predict who would benefit most from what type of interventions.
Though no formal study has been completed to date on the use of BTX-A in combination with dynamic hand splinting, you can view a single session video of an individual incorporating the use of the SaeboFlex dynamic hand orthoses after having received BTX-A in the extrinsic finger flexors 7-10 days prior by clicking the following link:http://www.youtube.com/watch?v=khYOweyb29g
[ARTICLE] Color Doppler ultrasound-guided botulinum toxin type A injection combined with an ankle foot brace for treating lower limb spasticity after a stroke – Full Text PDF
OBJECTIVE: To explore the effectiveness of the color Doppler ultrasound-guided botulinum toxin type A (BTX-A) injection combined with an ankle foot brace (AFO) for treating lower limb spasticity after a stroke.
PATIENTS AND METHODS: A total of 103 post-stroke patients with lower limb spasticity were divided into three groups: the control group treated with conventional therapy and rehabilitation training, the observation group treated with conventional therapy, rehabilitation training and botulinum toxin type A injection, the treatment group treated with AFO plus the same treatment received by the observation group. The muscle spasms were evaluated using the Clinic Spasticity Influx (CSI), movement with the Fugl-Meyer Assessment (FMA), dynamic and static balance with the Berg Balance Scale (BBS), and daily life activities with the Functional Independence Measure (FIM), respectively.
RESULTS: Compared the first month after treatment with the prior treatment, there were significant differences in CSI, FMA and FIM scores in both control group and the observation group (p < 0.05). However, no differences were noticed in the control group (p > 0.05). Compared the third and sixth month after treatment with prior treatment, there were significant differences in these three groups (p < 0.05). In terms of treatment time, the BBS scores were always higher in all three groups after one month, three months and six months treatment than prior treatment (p < 0.05), and there were significant differences in third month and sixth month after treatment compared with the first month treatment (p < 0.05). Compared the third month after treatment with the sixth month, there were significant differences in all three groups (p < 0.05).
CONCLUSIONS: The color Doppler ultrasound-guided BTX-A injection combined with AFO can effectively promote patients with poststroke lower limb spasticity in lower limb muscle spasm, movement, balance and daily life activities.
[ARTICLE] Measuring Spasticity and Fine Motor Control (Pinch) Change in the Hand After Botulinum Toxin-A Injection Using Dynamic Computerized Hand Dynamometry
…To evaluate change in fine motor hand performance and to investigate the relationship between existing clinical measures and dynamic computerized dynamometry (DCD) after botulinum toxin-A (BTX-A) injections for adults with upper limb spasticity…