In recent years, a large body of data has surfaced reporting the therapeutic benefit of botulinum toxin injection in multiple conditions. The aim of this review is: to summarize the highest quality literature pertaining to clinical application of botulinum toxin in neuropathic pain conditions including postherpetic neuralgia, trigeminal neuralgia, diabetic polyneuropathy, post-traumatic neuralgia, carpal tunnel syndrome, complex regional pain syndrome, phantom limb and stump pain, and occipital neuralgia; to provide an overview of the clinical trials using botulinum toxin in adult spasticity; and to assign levels of evidence according to the American Academy of Neurology guidelines. In summary, there is level A evidence for established efficacy in postherpetic neuralgia and adult spasticity; level B evidence for probable efficacy in trigeminal neuralgia and post-traumatic neuralgia; level B evidence for probable lack of efficacy in carpal tunnel syndrome; level C evidence for possible efficacy in diabetic polyneuropathy; and level U (insufficient) evidence in complex regional pain syndrome, phantom limb and stump pain, and occipital neuralgia.
There are an estimated 10,000 to 12,000 spinal cord injuries (SCI) every year in the United States. Besides motor and sensory functional deficits, respiratory insufficiency is also common in individuals with SCI due to paralysis, muscle weakness and/or spastic contractions of the muscles involved in respiration. Pulmonary diseases such as pneumonia and restrictive lung disease are the number one reason for death in individuals with SCI. The aim of the study was to see how respiratory muscle training (RMT) affected the pulmonary function measured with spirometry tests. The outcomes were the forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) and surface electromyography (sEMG). The results showed that both the FVC and FEV1 improved significantly after RMT. Individuals with SCI showed significantly lower sEMG activities recorded from intercostal, diaphragm, rectus abdominis and oblique during expiratory part of spirometry test. The training increased sEMG activity during both inspiration and expiration parts of the test, and this improvement was higher in thoracic SCI compared to cervical SCI.
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