Posts Tagged follow-up
[Abstract] Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke
Posted by Kostas Pantremenos in Spasticity on February 19, 2018
Highlights
- Current guidelines suggested a dosage up to 600 units (U) of botulinum toxin type A (BoNT-A) in post-stroke spasticityHigh doses of incobotulinumtoxinA (840U) showed efficacy and safety in severe post-stroke upper and lower limb spasticityIn a 2-year follow-up on 20 patients, a reduction of spasticity/disability was found with repeated high doses of incobotulinumtoxinAOne month after the last BoNT-A administration, the efficacy on spasticity/disability was similar to that at baselineLong-term treatment with high doses of incobotulinumtoxinA was safe and effective in post-stroke upper and lower limb spasticity
Abstract
Current guidelines suggested a dosage up to 600 units (U) of botulinum toxin type A (BoNT-A) (onabotulinumtoxinA or incobotulinumtoxinA) in reducing spastic hypertonia with low prevalence of complications, although a growing body of evidence showed efficacy with the use of high doses (> 800 U). The available evidence mainly referred to a single set of injections evaluating the efficacy and safety of the neurotoxin 30 days after the treatment. In a prospective, non-randomized, open-label study, we studied the safety of repeated higher doses of incobotulinumtoxinA in post-stroke upper and lower limb spasticity.
Two years after the first set of injections, we evaluated in 20 stroke survivors with upper and lower limb spasticity the long-term safety of repeated high doses of incobotulinumtoxinA (up to 840 U) for a total of eight sets of injections.
Patients reported an improvement of their clinical picture concerning a reduction of spasticity measured with the Asworth Scale (AS) for elbow, wrist, fingers and ankle flexor muscles and disability measured with the Disability Assessment Scale (DAS) 30 days after the last set of injections (eighth set) compared to the baseline (p < 0.0001). No difference in AS and DAS scores has been found between t1 (30 days after the first injection set) and t2 (30 days after the eighth set of injections), with also similar safety.
In a two-year follow-up, repeated high doses of incobotulinumtoxinA, administered for eight sets of injections, appeared to be safe in patients with upper and lower limb spasticity after stroke without general adverse effects.
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[ARTICLE] Cognitive and functional outcomes following inpatient rehabilitation in patients with acquired brain injury: A prospective follow-up study – Full Text
Posted by Kostas Pantremenos in REHABILITATION on June 23, 2017
Abstract
Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI).
Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital.
Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared.
Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 ± 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores.
Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.
Introduction
Acquired brain injury (ABI) is defined as “damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease.” “These impairments may be temporary or permanent and cause physical, functional disability, or psychosocial maladjustment.”[1],[2] By this definition, ABI encompasses a wide variety of disorders of varying etiologies such as vascular, hypoxic, malignant, and traumatic. There are often long-lasting effects on domains of cognition, motor, behavior, and personality in affected individuals.[3] Cognitive impairment is common sequelae and important marker for prediction of rehabilitation outcomes, and cognitive outcome can be modified through targeted interventions.[4]
Studies suggest that traumatic brain injury (TBI) and stroke are the two main causes of ABI and regarded as important public health problem.[5] The incidence of TBI from 23 reports was found to vary greatly among European countries. Most rates were in the range 150–300/100,000 people per year.[6] The prevalence of stroke In western developed world ranges from 500 to 600/100,000. Rates per 100,000 from developing countries are also variable and range from 58 in India and 76 in the United Republic of Tanzania to 620 in China and 690 in Thailand.[7] Between 1.5 and 2 million persons are injured and 1 million die every year in India following TBI.[8] Cardiovascular diseases including stroke caused 19% of deaths in India between 2001 and 2003 and this is estimated to rise to 36% by 2030.[9] According to disease burden in India report September 2005, central nervous system malignancies (included in ABI) comprise 2% of the total cancer burden.[10] Other causes of ABI such as meningoencephalitis and stroke mimics also contribute to this pool of patients.
The majority of ABI survivors continue to live with disabilities without access to comprehensive rehabilitation services and remain a burden on caregivers and society.[11],[12] Physical and cognitive deficits are most commonly observed in these patients but are not adequately addressed due to lack of approachable rehabilitation services and awareness.[13],[14] Many of these patients opt for complementary and alternative medicine, which are popular in India but demonstrate questionable benefits.[15]
It is evident, both clinically and scientifically, that the improvement in motor control after ABI is training dependent, responding best to repetitive task training with continuous modification of the program to keep training tasks challenging to the patients (activity-based recovery and neural plasticity).[16],[17] Single or multiple domains of cognition can be affected in these patients depending on the site (s) and severity of injury. Disturbances in memory, attention, and/or executive functions are commonly involved. Deficits in language and speech, learning, abstract thinking, and orientation occur in severe cases. It is well established that cognitive deficits interfere with rehabilitation efforts and also result in a greater negative impact on quality of life.[18] Cognitive rehabilitation (CR) is a specialized treatment procedure designed to improve the cognition affected by internal or external injury to the brain. There are two types of CR: restorative and compensatory rehabilitation.[19],[20],[21] Restorative rehabilitation enables the patient to develop lost functions through specialized computerized and manual cognitive exercises. Compensatory rehabilitation helps the patient to train and use aids and tools to overcome the impairment. The objective of the present study was to rehabilitate ABI patients in all affected domains including cognitive, physical, sensory-motor, and behavior with customized inpatient programs. Another objective was to observe the effect of inpatient rehabilitation in improving cognition and functionality of the patients (by comparing admission and discharge scores). We also tried to observe whether the benefits of inpatient rehabilitation are sustainable by assessing the patients in follow-up examination a minimum of 3 months after discharge.[…]
TBI Rehabilitation 