Posts Tagged Muscle spasticity

[Abstract] Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

Abstract

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A randomized controlled pilot study.
SETTING: A hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (P=0.037).
CONCLUSIONS: Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

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via Effects of kinesio taping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):551-7 – Minerva Medica – Journals

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[Abstract] Selective peripheral neurolysis using high frequency ultrasound imaging: a novel approach in the treatment of spasticity

 

BACKGROUND: Chemoneurolysis is used to treat focal spasticity in patients with upper motor neuron syndrome.
CASE REPORT: Neurolytic substances (phenol/alcohol) injected nearby/in the main trunk of peripheral nerves can cause not only motor but also cutaneous nerves destruction. The latter is thought to be responsible for considerable side effects such as dysesthesia and paresthesia. During injections, targeting the primary motor branches originating from the main trunk while sparing cutaneous nerves will result in decrease/elimination of these side effects and better clinical improvement.
CLINICAL REHABILITATION IMPACT: We suggest that high frequency ultrasound enabling the physician to scan peripheral nerves and their primary branches can be useful to perform this selective peripheral neurolysis in the treatment of spasticity.

via Selective peripheral neurolysis using high frequency ultrasound imaging: a novel approach in the treatment of spasticity – European Journal of Physical and Rehabilitation Medicine 2019 August;55(4):522-5 – Minerva Medica – Journals

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[Abstract] Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of Kinesiotaping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A Randomized Controlled Pilot Study.
SETTING: One hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into Kinesiotaping (KT) group or control group. In KT group, Kinesio tape was applied as an add- on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (p=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (p=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (p=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (p=0.037).
CONCLUSIONS: Kinesiotaping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesiotaping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

via Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 Jun 13 – Minerva Medica – Journals

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[Abstract + References] Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis

Abstract

Objectives

(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.

Data Sources

PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.

Study Selection

Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.

Data Extraction

Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.

Data Synthesis

Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.

Conclusion

There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151)

References

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  2. Wissel, J., Manack, A., Brainin, M. Toward an epidemiology of poststroke spasticity. Neurology. 2013;80:S13–S19
  3. Watkins, C.L., Leathley, M.J., Gregson, J.M., Smith, T.L., Moore, A.P. Prevalence of spasticity post stroke. Clin Rehabil. 2002;16:515–522
  4. Doan, Q.V., Brashear, A., Gillard, P.J. et al, Relationship between disability and health-related quality of life and caregiver burden in patients with upper limb poststroke spasticity. PM R. 2012;4:4–10
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  9. Malas, B., Kacen, M. Orthotic management in patients with stroke. Top Stroke Rehabil. 2001;7:38–45
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  11. Barnes, M.P. Medical management of spasticity in stroke. Age Ageing. 2001;30:13–16
  12. Kocabas, H. Comparison of phenol and alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for treatment of spastic foot after stroke: a randomized controlled pilot study.Eur J Phys Rehabil Med. 2010;46:5–10
  13. Fukuhara, T., Kamata, I. Selective posterior rhizotomy for painful spasticity in the lower limbs of hemiplegic patients after stroke: report of two cases. Neurosurgery. 2004;54:1268–1273
  14. Sheean, G., McGuire, J.R. Spastic hypertonia and movement disorders: pathophysiology, clinical presentation, and quantification. PM R. 2009;1:827–833
  15. Martins, F.L., Carvalho, L.C., Silva, C.C., Brasileiro, J.S., Souza, T.O., Lindquist, A.R. Immediate effects of TENS and cryotherapy in the reflex excitability and voluntary activity in hemiparetic subjects: a randomized crossover trial. Rev Bras Fisioter. 2012;16:337–344
  16. Kim, T.H., In, T.S., Cho, H. Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke. Tohoku J Exp Med. 2013;231:93–100
  17. Tinazzi, M., Zarattini, S., Valeriani, M. et al, Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (TENS) of forearm muscles: evidence of reciprocal inhibition and facilitation. Exp Brain Res. 2005;161:457–464
  18. Yan, T., Hui-Chan, C.W. Transcutaneous electrical stimulation on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial. J Rehabil Med. 2009;41:312–316
  19. Tekeoğlu, Y., Adak, B., Göksoy, T. Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel activities of daily living (ADL) index score following stroke. Clin Rehabil. 1998;12:277–280
  20. Sonde, L., Kalimo, H., Viitanen, M. Stimulation with high-frequency TENS — effects on lower limb spasticity after stroke. Adv Physiother. 2000;2:183–187
  21. Jung, K.-S., In, T.-S., Cho, H. Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study. Gait Posture. 2017;54:183–187
  22. Picelli, A., Dambruoso, F., Bronzato, M. et al, Efficacy of therapeutic ultrasound and transcutaneous electrical nerve stimulation compared with botulinum toxin type A in the treatment of spastic equinus in adults with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil. 2014;21:S8–S16
  23. Sonde, L., Gip, C., Fernaeus, S.E., Nilsson, C.G., Viitanen, M. Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm. Scand J Rehabil Med. 1998;30:95–99
  24. Branco Mills, P., Dossa, F. Transcutaneous electrical nerve stimulation for management of limb spasticity. Am J Phys Med Rehabil. 2016;95:309–318
  25. Lin, S., Sun, Q., Wang, H., Xie, G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: a systematic review and meta-analysis. J Rehabil Med. 2018;50:3–7
  26. Ng, S.S., Hui-Chan, C.W. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke. 2007;38:2953–2959
  27. Cho, H., In, T.S., Cho, K.H., Song, C.H. A single trial of transcutaneous electrical nerve stimulation (TENS) improves spasticity and balance in patients with chronic stroke. Tohoku J Exp Med. 2013;229:187–193
  28. Potisk, K.P., Gregoric, M., Vodovnik, L. Effect of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with hemiplegia. Scand J Rehabil Med. 1995;27:169–174
  29. Levin, M.F., Hui-Chan, C.W. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol. 1992;85:131–142
  30. Bernhardt, J., Hayward, K.S., Kwakkel, G. et al, Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017;12:444–450
  31. Cochrane Effective Practice and Organisation of Care. Suggested risk of bias criteria for EPOC reviews. (Available at:)http://epoc.cochrane.org/resources/epoc-resources-review-authors(Accessed August 22, 2018)
  32. Higgins, J.P., Green, S. Cochrane handbook for systematic reviews of interventions: version 5.1.0.(Available at:)http://handbook.cochrane.org(Accessed August 27, 2018)
  33. Hussain, T., Mohammad, H. The effect of transcutaneous electrical nerve stimulation (TENS) combined with Bobath on post stroke spasticity. A randomized controlled study. J Neurol Sci. 2013;4:22–29
  34. Park, J., Seo, D., Choi, W., Lee, S. The effects of exercise with tens on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial. Med Sci Monit. 2014;20:1890–1896
  35. Laddha, D., Ganesh, G.S., Pattnaik, M., Mohanty, P., Mishra, C. Effect of transcutaneous electrical nerve stimulation on plantar flexor muscle spasticity and walking speed in stroke patients. Physiother Res Int. 2016;21:247–256
  36. Hui-Chan, C.W., Levin, M.F. Stretch reflex latencies in spastic hemiparetic subjects are prolonged after transcutaneous electrical nerve stimulation. Can J Neurol Sci. 1993;20:97–106
  37. Karakoyun, A., Boyraz, İ., Gunduz, R., Karamercan, A., Ozgirgin, N. Electrophysiological and clinical evaluation of the effects of transcutaneous electrical nerve stimulation on the spasticity in the hemiplegic stroke patients. J Phys Ther Sci. 2015;27:3407–3411
  38. Koyama, S., Tanabe, S., Takeda, K., Sakurai, H., Kanada, Y. Modulation of spinal inhibitory reflexes depends on the frequency of transcutaneous electrical nerve stimulation in spastic stroke survivors.Somatosens Mot Res. 2016;33:8–15
  39. Okuma, Y., Lee, R.G. Reciprocal inhibition in hemiplegia: correlation with clinical features and recovery. Can J Neurol Sci. 1996;23:15–23
  40. Sommerfeld, D.K., Gripenstedt, U., Welmer, A.-K. Spasticity after stroke. Am J Phys Med Rehabil. 2012;91:814–820
  41. Fernández-Tenorio, E., Serrano-Muñoz, D., Avendaño-Coy, J., Gómez-Soriano, J. Transcutaneous electrical nerve stimulation for spasticity: a systematic review. Neurologia. 2016; (pii: S0213-4853(16)30111-6)
  42. Kwong, P.W., Ng, G.Y., Chung, R.C., Ng, S.S. Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis.Clin Rehabil. 2018;32:1203–1219

source:
https://www.archives-pmr.org/article/S0003-9993(18)31455-2/abstract

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[Abstract] Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

Abstract

OBJECTIVE:

To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.

METHODS:

This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.

RESULTS:

Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I238.5%, P=0.92). No data were available concerning the mobility of other joints.

CONCLUSION:

This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.

 

via Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. – PubMed – NCBI

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[Abstract] Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials

Purpose: To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials.

Methods: Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration’s risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval.

Results: Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (−0.52 [−0.74 to −0.30] p < 0.0001, 6 studies), especially in lower limbs (−0.58 [−0.82 to −0.34] p < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias.

Conclusion: Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.

  • Implications for Rehabilitation
  • Transcutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.

  • High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.

  • More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.

via Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials: Disability and Rehabilitation: Vol 0, No 0

 

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[Abstract] Extracorporeal Shock Waves Versus Botulinum Toxin Type A in the Treatment of Poststroke Upper Limb Spasticity: A Randomized Noninferiority Trial

Abstract

Objective

To investigate whether extracorporeal shock wave therapy (ESWT) is noninferior to botulinum toxin type A (BoNT-A) for the treatment of poststroke upper limb spasticity.

Design

Randomized noninferiority trial.

Setting

Referral medical center.

Participants

Patients (N=42) with chronic stroke (28 men; mean age, 61.0±10.6y).

Interventions

Patients received either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation.

Main Outcome Measures

Assessments were performed at baseline and at 1, 4, and 8 weeks after the intervention. The primary outcome was the change from baseline of the modified Ashworth scale (MAS) score of the wrist flexors at week 4. Secondary outcomes included the change of the MAS scores, Tardieu angles of the wrist and elbow flexors, wrist and elbow passive range of motion (PROM), and upper extremity Fugl-Meyer Assessment (UE-FMA) score during the study period, as well as the treatment response rate.

Results

The primary outcome result in the ESWT group (−0.80±0.41) was similar to that in the BoNT-A group (−0.90±0.44), with a higher confidence limit (0.4) for the difference between groups within the prespecified margin of 0.5, indicating the noninferiority of ESWT to BoNT-A. The response rate was not significantly different between the 2 groups. Both groups showed significant improvement in secondary outcomes relative to baseline; however, the ESWT group yielded greater improvement in wrist and elbow PROM and UE-FMA score.

Conclusion

Our results suggest that ESWT is a noninferior treatment alternative to BoNT-A for poststroke upper limb spasticity. ESWT and BoNT-A caused similar reduction in spasticity of the wrist and elbow flexors; however, ESWT yielded greater improvement in wrist and elbow PROM and UE-FMA score.

via Extracorporeal Shock Waves Versus Botulinum Toxin Type A in the Treatment of Poststroke Upper Limb Spasticity: A Randomized Noninferiority Trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: a pilot double-blind randomized trial

Description

Aims: Does the addition of botulinum toxin type A increase the effect of casting for improving wrist extension after stroke in people with upper limb spasticity?

Methods: Randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis which was part of a larger trial included 18 adults with upper limb spasticity two years after stroke (89%) or stroke-like conditions (11%). The experimental group (n=7) received botulinum toxin type A injections to upper limb muscles for spasticity management followed by two weeks of wrist casting into maximum extension. The control group (n=11) received two weeks of casting only. Range of motion (goniometry) measured at baseline and after two weeks of casting.

Results: Passive wrist extension for the experimental group improved over two weeks from 22 degrees (SD 16) to 54 degrees (SD 16), while the control group improved from 21 degrees (SD 29) to 43 degrees (SD 26). The experimental group increased passive wrist extension 13 degrees (95% CI 4 to 31) more than the control group which was not statistically significant.

Conclusion: Joint range of motion improved over a two-week period for both groups. Botulinum toxin type A injection followed-by casting produced a mean, clinically greater range of motion than casting alone, therefore, a fully-powered trial is warranted.

via Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: a pilot double-blind randomized trial

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[ARTICLE] Intensive therapy after botulinum toxin in adults with spasticity after stroke versus botulinum toxin alone or therapy alone: a pilot, feasibility randomized trial – Full Text

Abstract

Background

Botulinum toxin-A is provided for adults with post-stroke spasticity. Following injection, there is a variation in the rehabilitation therapy type and amount provided. The purpose of this study was to determine if it is feasible to add intensive therapy to botulinum toxin-A injections for adults with spasticity and whether it is likely to be beneficial.

Methods

Randomized trial with concealed allocation, assessor blinding, and intention to treat analysis. Thirty-seven adults (n = 3 incomplete or lost follow-up) with spasticity in the upper or lower limb were allocated to one of three groups: experimental group received a single dose of botulinum toxin-A plus an intensive therapy for 8 weeks, control group 1 received a single dose of botulinum toxin-A only, and control group 2 received intensive therapy only for 8 weeks. Feasibility was measured by examining recruitment, intervention (adherence, acceptability, safety), and measurement. Benefit was measured as goal achievement (Goal Attainment Scale), upper limb activity (Box and Block Test), walking (6-min walk test) and spasticity (Tardieu scale), at baseline (week 0), immediately after (week 8), and at three months (week 12).

Results

Overall recruitment fraction for the trial was 37% (eligibility fraction 39%, enrolment fraction 95%). The 26 participants allocated to receive intensive rehabilitation attended 97% of clinic-based sessions (mean 11 ± 2 h) and an averaged 58% (mean 52 ± 32 h) of prescribed 90 h of independent practice. There were no study-related adverse events reported. Although participants in all groups increased their goal attainment, there were no between-group differences for this or other outcomes at week 8 or 12.

Conclusion

Providing intensive therapy following botulinum toxin-A is feasible for adults with neurological spasticity. The study methods are appropriate for a future trial. A future trial would require 134 participants to detect a between-group difference of 7 points on Goal Attainment Scale t-scores with an alpha of 0.05 and power of 80%.

Background

Spasticity affects approximately 20% of stroke survivors [14] and is thought to significantly contribute to falls after stroke [56] as well as decreased activity participation [34]. Unsurprisingly, higher costs are thus incurred by patients with spasticity during the first year of survival [7]. Health professionals identify that addressing spasticity is a high priority during rehabilitation [8], and there is international consensus that localized spasticity (i.e., in the upper or lower limbs) is best managed with a combination of botulinum toxin and physical therapy [910]. While these consensus papers appear to agree, clinical management remains diverse [1112] and provides an ongoing challenge for both therapists and health services alike.

In Australia, stroke rehabilitation is guided by the Stroke Foundation clinical practice guidelines [13]. These guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin type A in additionto physical therapy interventions [13]. Unfortunately, clinical survey data suggests that occupational therapists and physiotherapists report providing therapy post-botulinum toxin type A injections less than a quarter of the time (an estimated 16%) [12]. This low rate of therapy provision suggests ongoing uncertainty among clinicians as to how to treat patients with spasticity. Such uncertainty is likely to stem from the lack of research studies that describe the type, frequency, intensity, and duration of therapy that is effective for people who have received botulinum toxin injections. While there are previous studies which have tested the efficacy of botulinum toxin type A for spasticity management after stroke [1416], what remains unknown is whether or not therapy should be provided to this group of patients.

To inform best practice in the treatment and rehabilitation of spasticity in people with neurological conditions, understanding whether the suggested combined effects of using both therapy and botulinum toxin type A together is more beneficial than botulinum toxin-A alone or physiotherapy interventions alone is key. Given the lack of research in this area, a large, powered randomized controlled trial is required. In preparation for this trial, it is key to understand both the feasibility and likely effects of the interventions; therefore, the research questions posed in this pilot study were:

  1. In neurological patients with spasticity, is it feasible to add intensive therapy to botulinum toxin-A injections if the therapy includes both clinic-based and home-based therapy sessions?
  2. Is adding intensive therapy likely to be of any benefit to goal attainment, upper limb activity, walking, and spasticity over botulinum toxin-A alone or intensive therapy alone?[…]

Continue —> Intensive therapy after botulinum toxin in adults with spasticity after stroke versus botulinum toxin alone or therapy alone: a pilot, feasibility randomized trial

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[ARTICLE] Technologically-advanced assessment of upper-limb spasticity: a pilot study – Full Text PDF

BACKGROUND: Spasticity is a muscle disorder associated with upper motor neuron syndrome occurring in neurological disorders, such as stroke, multiple sclerosis, spinal cord injury and others. It influences the patient’s rehabilitation, interfering with function, limiting independence, causing pain and producing secondary impairments, such as contractures or other complications. Due to the heterogeneity of clinical signs of spasticity, there is no agreement on the most appropriate assessment and measurement modality for the evaluation of treatment outcomes.

AIM: The aim of this article is to propose the use of new robotic devices for upper-limb spasticity assessment and describe the most relevant measures of spasticity which could be automatically assessed by using a technologically advanced device.

DESIGN: Observational pilot study.

SETTING: The treatment was provided in a Rehabilitation Centre where the device was located and the subjects were treated in an outpatients setting.

POPULATION: Five post-stroke patients, age range 19-79 years (mean age 61, standard deviation [SD]±25) in their chronic phase.

METHODS: A new robotic device able to automatically assess upper-limb spasticity during passive and active mobilization has been developed. The elbow spasticity of five post stroke patients has been assessed by using the new device and by means of the Modified Ashworth Scale (MAS). After the first assessment, subjects were treated with botulin toxin injections, and then underwent 10 sessions of robotic treatments. After the treatment, subjects spasticity was assessed by using the robotic device and the MAS Score.

RESULTS: In four out of five patients, the botulin toxin injection and robotic treatment resulted in the improvement of the MAS Score; in three patients the robotic measures were able to detect the MAS changes. In one subject botulin toxin was not effective and the robotic device was able to detect the lack of effectiveness.

CONCLUSIONS: By using the robotic device some spasticity parameters can be continuously recorded during the rehabilitation treatment in order to objectively measure the effectiveness of the interventions provided.

CLINICAL REHABILITATION IMPACT: The standardized evaluation parameters recorded using robotic devices may provide several advantages: 1) the measures for spasticity assessment can be monitored during every rehabilitation session (even during each movement); 2) these measurements are able to highlight even small changes; 3) the recovery plateau can be detected early thus avoiding further rehabilitation sessions; and 4) these measurements can reduce the assessment bias in multicenter studies.

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via Technologically-advanced assessment of upper-limb spasticity: a pilot study – European Journal of Physical and Rehabilitation Medicine 2018 August;54(4):536-44 – Minerva Medica – Journals

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