Combining BtxA and mCIMT is an effective and safe intervention for improving spasticity and motor function in chronic stroke patients. The results are promising enough to justify further studies. We recommend future research to address the likely need for including rehabilitation with BtxA to improve function in patients with poststroke spasticity.
Five weekly intra-articular injections of Artz provide pain relief and functional improvements in patients with Kellgren-Lawrence grades I and II ankle OA. The clinical effect was rapid at 1 week and may last for 6 months or more.
Significant improvement in pain, physical function and balance tests was demonstrated after five weekly Artzal injections in geriatric patients with knee OA. The effect had rapid onset at 1 week and may last for 6 months.
Background and Purpose. Constraint-induced movement therapy (CIMT) is a promising intervention for retraining upper-extremity function after a stroke. The purpose of this case report is to describe the use of a combination of botulinum toxin type A (BtxA) and a modified CIMT program for a patient with severe spasticity who was unable to use his right upper extremity. Case Description. The 52-year-old patient, who had a stroke 4 years ago, did not meet the minimum motor criteria for CIMT benefit. After receiving BtxA injections targeting the elbow, wrist, and finger flexors, he completed a 4-week program of modified CIMT followed by a 5-month home exercise program. Outcomes. The patient exhibited improvement in muscle tone (the velocitydependent resistance to stretch that muscle exhibits) and in scores on several upper-extremity function tests (Modified Ashworth Scale, Motor Activity Log, Wolf Motor Function Test, Action Research Arm Test, and Fugl-Meyer Assessment of Motor Recovery). He also reported making much progress in the functional use of the involved upper extremity. Discussion. In a patient with severe flexor spasticity and nonuse of the dominant upper extremity after a stroke, a combined treatment of BtxA and modified CIMT may have resulted in improved upper-extremity use. [Sun SF, Hsu CW, Hwang CW, et al. Application of combined botulinum toxin type A and modified constraint-induced movement therapy for an individual with chronic upperextremity spasticity after stroke. Phys Ther. 2006;86:1387-1397 Key Words: Botulinum toxin, Constraint-induced movement therapy, Spasticity, Stroke. C onstraint-induced movement therapy (CIMT) has been shown to produce lasting improvements in upper-extremity movement following a stroke. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The basic components of CIMT involve restraint of the unaffected arm for 90% of the person's waking hours for a 2-week period in conjunction with repetitive training of the more-affected upper extremity. 1,4 -9 The less-affected extremity is restrained with a mitt, sling, or glove. During the 2-week period, patients typically participate in 6-hour activity sessions each weekday. The minimum motor criteria of patients who show benefit from CIMT include at least 20 degrees of wrist extension and 10 degrees of extension at each metacarpophalangeal and interphalangeal joint of the affected upper extremity. [5][6][7][8]16 Participants in these studies demonstrated improvements in the amount of use and quality of movement in the more-involved upper extremity as well as carryover of skills from the hospital to the real world. 4 -9,17 It is estimated that approximately 20% to 25% of people with chronic stroke with residual motor deficit meet the minimum motor criteria. 2 Most studies of CIMT excluded patients with severe upper-limb spasticity. Severe spasticity of the upper extremity is a common complication after stroke, and it is usually a major contributor to the motor function disability. 18 Spasticity, defined as "a velocity-depende...
Möbius syndrome is a rare congenital disorder characterized by congenital facial weakness with impairment of ocular abduction. It is considered as a rhombencephalic disorder, and is often accompanied with hypoplasia of the pons and cerebellum. Here we report a male infant who had congenital facial asymmetry with absence of right-sided expression. Evident developmental delay was also found. The bilateral auditory brain stem response showed no response at 85dB. A reconstructive brain magnetic resonance imaging (MRI) revealed the absence of the right facial nerve as well as hypoplasia of the pons and cerebellum of the same side. Some voluntary contraction over the patient's right lower face was noted after facial muscle electrical stimulation.
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