Objective-To define a safe and eVective dose of Dysport for treating hip adductor spasticity.

Summary Background Dopamine is a key modulator of striatal function and learning and might improve motor recovery after stroke. Previous small trials of dopamine agonists after stroke provide equivocal evidence of effectiveness on improving motor recovery. We aimed to assess the safety and efficacy of co-careldopa plus routine occupational and physical therapy during early rehabilitation after stroke. Methods This double-blind, multicentre, randomised controlled trial of co-careldopa versus placebo in addition to routine NHS occupational and physical therapy was done at 51 UK NHS acute inpatient stroke rehabilitation services. We recruited patients with new or recurrent clinically diagnosed ischaemic or haemorrhagic (excluding subarachnoid haemorrhage) stroke 5–42 days before randomisation, who were unable to walk 10 m or more, had a score of less than 7 points on the Rivermead Mobility Index, were expected to need rehabilitation, and were able to access rehabilitation after discharge from hospital. Participants were assigned (1:1) using stratified random blocks to receive 6 weeks of oral co-careldopa or matched placebo in addition to routine NHS physiotherapy and occupational therapy. The initial two doses of co-careldopa were 62·5 mg (50 mg of levodopa and 12·5 mg of carbidopa) and the remaining doses were 125 mg (100 mg of levodopa and 25 mg of carbidopa). Participants were required to take a single oral tablet 45–60 min before physiotherapy or occupational therapy session. The primary outcome was ability to walk independently, defined as a Rivermead Mobility Index score of 7 or more, at 8 weeks. Primary and safety analyses were done in the intention-to-treat population. The trial is registered on the ISRCTN registry, number ISRCTN99643613. Findings Between May 30, 2011, and March 28, 2014, of 1574 patients found eligible, 593 (mean age 68·5 years) were randomly assigned to either the co-careldopa group (n=308) or to the placebo group (n=285), on an average 18 days after stroke onset. Primary outcome data were available for all 593 patients. We found no evidence that the ability to walk independently improved with co-careldopa (125 [41%] of 308 patients) compared with placebo (127 [45%] of 285 patients; odds ratio 0·78 [95% CI 0·53–1·15]) at 8 weeks. Mortality at 12 months did not differ between the two groups (22 [7%] vs 17 [6%]). Serious adverse events were largely similar between groups. Vomiting during therapy sessions, after taking the study drug, was the most frequent adverse event and was more frequent in the co-careldopa group than the placebo group (19 [6·2%] vs 9 [3·2%]). Interpretation Co-careldopa in addition to routine occupational and physical therapy does not seem to improve walking after stroke. Further research might identify subgroups of patients with stroke who could benefit from dopaminergic therapy at different doses or times after stroke with more ...

iPAM is a dual robotic system currently being developed in the UK under a NHS New and Emerging Applications of Technologies (NEAT) grant. The aim of the system is to provide assistive upper-limb therapeutic excercise for post-stroke rehabilitation. iPAM features two co-ordinated, pneumatically-actuated robotic arms which attach to the patient's forearm and upper-arm to provide assistance, mimicking the intervention of a physiotherapist. The system design and manufacture has been completed and the robot installed at a local hospital (St Mary's, Leeds PCT, UK) inside a community rehabilitation unit. The controller is currently developed and 'tuned' to provide gravity compensation for robots, removing any potentially damaging loads on the patient arm. The control scheme has been tested in simulation and using a mechanical arm model to ensure safe operation.Two small scale trials have been conducted to assess two facets of the robot design; firstly the mechanical design of the system to unimpede normal arm movement and secondly, its ability to provide varying levels of lift to the patient's arm to increase range of movement. The former of these trials compares free arm movement in healthy volunteers and Stroke patients with that when attached to iPAM. The robot was configured to compensate for its own weight, so the human upper-limb was unloaded. It was found that the robot had no significant affect on movement patterns. The second group of patient trials evaluated the operation of various levels of assistance against gravity. Patients were asked to point to a target with varying degrees of 'lift' applied to their upper and lower arm. In those patients with significant upper-limb impairment it was found that higher values of 'lift' improved the extent of reach but altered the movement pattern. Results from the trials demonstrated the suitability of certain modes of operation depending on the severity of patient disability.

Some improvements in self-reported function and quality of movement are observed. This pilot study suggests that the system could be used to augment home-based arm exercise in an engaging way for children with cerebral palsy, although a controlled clinical trial is required to establish clinical efficacy. The feasibility of this technology has been demonstrated.

No abstract