A combination of water- and land-based exercises has potential for improving balance. The results of this study extend the work showing benefit of water-based exercise in chronic and less-impaired stroke groups to patients with sub-acute stroke.

Objective: The adverse events (AEs) with botulinum toxin type-A (BoNTA), used for indications other than spasticity, are widely reported in the literature. However, the site, dose, and frequency of injections are different for spasticity when compared to the treatment for other conditions and hence the AEs may be different as well. The objective of this study was to summarize the AEs reported in Canada and systematically review the AEs with intramuscular botulinum toxin injections to treat focal spasticity. Methods: Data were gathered from Health Canada (2009-2013) and major electronic databases. Results: In a 4 year period, 285 AEs were reported. OnabotulinumtoxinA (n = 272 events): 68% females, 53% serious, 18% hospitalization, and 8% fatalities. The type of AEs reported weremuscle weakness (19%), oropharyngeal (14%), respiratory (14%), eye related (8%), bowel/bladder related (8%), and infection (5%). IncobotulinumtoxinA (n = 13): 38% females, 62% serious, and 54% hospitalization. The type of AEs reported were -muscle weakness (15%), oropharyngeal (15%), respiratory (38%), eye related (23%), bowel/bladder related (15%), and infection (15%). Commonly reported AEs in the literature were muscle weakness, pain, oropharyngeal, bowel/bladder, blood circulation, neurological, gait, and respiratory problems. Conclusion: While BoNTA is useful in managing spasticity, future studies need to investigate the factors that can minimize AEs. A better understanding of the underlying mechanisms of the AEs can also improve guidelines for BoNTA administration and enhance outcomes.RÉSUMÉ: Réactions indésirables à des injections intramusculaires de toxine botulique utilisée pour traiter la spasticité. Objectif: Les réactions indésirables (RI) à la toxine botulique de type A (BoNTA) utilisée à des fins autres que le traitement de la spasticité ont été abondamment rapportées dans la littérature. Cependant, le point d'injection, la dose et la fréquence des injections sont différents quand elle est utilisée pour traiter la spasticité par rapport à son utilisation pour traiter d'autres affections et donc les RI peuvent également être différentes. Le but de cette étude était de présenter un sommaire des RI rapportées au Canada et de revoir systématiquement les RI rencontrées lors d'injections intramusculaires de toxine botulique pour traiter la spasticité focale. Méthode: Nous avons recueilli les données de Santé Canada de 2009 à 2013 et ainsi que celles des principales bases de données électroniques. Résultats: Au cours d'une période de 4 ans, 285 RI ont été rapportées, dont 272 RI avec l'onabotulinum toxine A. Soixante-huit pour cent sont survenues chez des femmes, 53% étaient des RI sérieuses, 18% ont nécessité une hospitalisation et 8% ont été fatales. Les RI rapportées étaient de la faiblesse musculaire (19%), des RI oropharyngées (14%), respiratoires (14%), oculaires (8%), en lien à l'intestin / la vessie (8%) et infectieuses (5%). Avec l'incobotulinum toxine A (n = 13) les RI rapportées sont survenues chez des femmes dan...

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Sexual health contributes greatly to quality of life. Research shows that stroke survivors want to learn and talk about sexual health, but are not given information. In keeping with the Canadian Best Practice Recommendations for Stroke Care, this project aimed to provide all stroke rehabilitation inpatients with the opportunity to discuss sexual health concerns with healthcare providers at West Park Healthcare Centre, a rehabilitation and complex continuing care centre in Toronto. Gap analysis conducted via staff member interviews and retrospective chart reviews showed that close to no patients were given the opportunity to discuss sexual health concerns at baseline.Plan-Do-Study-Act (PDSA) methodology was used as the project framework. The changes implemented included a reminder system, standardization of care processes for sexual health, patient-centred time points for the delivery of sexual health discussions, and the development of a sexual health supported conversation tool for patients with aphasia. By the end of the ten month project period and after three PDSA cycles, the percentage of patients provided with the opportunity to discuss sexual health during inpatient rehabilitation increased to 80%. This quality improvement project successfully implemented the Canadian Best Practice Recommendations for Stroke Care with respect to sexual health.Lessons learned included the importance of early baseline data collection and advance planning for tools used in QI projects. Future projects may focus on improving the discussion of sexual health concerns during outpatient stroke rehabilitation.

Although self-reports indicate a strong possibility of increasing spasticity, without objective examination, the true effects of these triggers on spasticity remain inconclusive. Most studies reviewed here were performed in the spinal cord injury population; therefore, it is not known whether these triggers induce similar effects in persons with other neurologic etiologies.

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Background Balance impairments, falls, and spasticity are common after stroke, but the effect of spasticity on balance control after stroke is not well understood. Methods In this cross-sectional study, twenty-seven participants with stroke were divided into two groups, based on ankle plantar flexor spasticity level. Fifteen individuals with high spasticity (Modified Ashworth Scale (MAS) score of ≥2) and 12 individuals with low spasticity (MAS score <2) completed quiet standing trials with eyes open and closed conditions. Balance control measures included centre of pressure (COP) root mean square (RMS), COP velocity, and COP mean power frequency (MPF) in anterior-posterior and mediolateral (ML) directions. Trunk sway was estimated using a wearable inertial measurement unit to measure trunk angle, trunk velocity, and trunk velocity frequency amplitude in pitch and roll directions. Results The high spasticity group demonstrated greater ML COP velocity, trunk roll velocity, trunk roll velocity frequency amplitude at 3.7 Hz, and trunk roll velocity frequency amplitude at 4.9 Hz, particularly in the eyes closed condition (spasticity by vision interaction). ML COP MPF was greater in the high spasticity group. Conclusion Individuals with high spasticity after stroke demonstrated greater impairment of balance control in the frontal plane, which was exacerbated when vision was removed.

Objective: To assess the prevalence of pain in adults with spasticity and to assess the association between the subjective experience of pain and spasticity. Design: Cross-sectional study. Setting: outpatient spasticity management clinic of a rehabilitation centre. Patients: Patients with upper motor neuron lesions and spasticity (n = 131) were recruited. Methods: We assessed pain intensity and location, relationship between spasticity and pain perception, and perception of pain relief from botulinum toxin type-A (BoNTA) injections. Main outcome measures: Pain perception rated on a 10-point numerical rating scale and pain quality. Results: 65% of the patients with spasticity reported presence of pain and 60% described it as an aching pain. More patients reported pain with movement (34%) compared to rest (21%). There was a statistically poor correlation between the severity of pain and spasticity (r = 0.16; p > 0.05). Most patients (80%) believed that their pain was related to spasticity and 62% reported that BoNTA injections decreased their pain. Conclusions: The high incidence of pain noted within our sample suggests that physicians may have to consider pain management as part of spasticity treatment. Participants reported that their pain was related to their spasticity, and that it decreased after BoNTA treatment. Further study is needed to explore the relationships between objective measures of spasticity and pain.RÉSUMÉ: Relation entre la toxine botulique, la spasticité et la douleur : une enquête sur la perception des patients. Objectif: Le but de l'étude était de déterminer la prévalence de la douleur chez des adultes souffrant de spasticité et d'étudier l'association entre l'expérience subjective de la douleur et la spasticité. Devis de l'étude: Il s'agit d'une étude transversale. Contexte: Cette étude a été réalisée auprès de patients fréquentant une clinique dédiée au traitement de la spasticité dans un centre de réadaptation. Patients: Des patients atteints de lésions du neurone moteur supérieur et de spasticité ont été recrutés (n = 131). Méthode: Nous avons évalué l'intensité et la localisation de la douleur, la relation entre la spasticité et la perception de la douleur ainsi que la perception du soulagement de la douleur suite à des injections de toxine botulique de type A (BoNTA). Principaux critères d'évaluation: Les critères utilisés étaient la perception de la douleur évaluée sur une échelle numérique de 10 points et la qualité de la douleur. Résultats: Soixante-cinq pour cent des patients présentant de la spasticité ont rapporté la présence de douleur et 60% l'ont décrite comme une douleur sourde. Plus de patients ont rapporté de la douleur au mouvement (34%) qu'au repos (21%). La corrélation entre la sévérité de la douleur et la spasticité était faible au point de vue statistique (r = 0,16 ; p > 0,05). La plupart des patients (80%) croyaient que leur douleur était reliée à la spasticité et 62% rapportaient que les injections de BoNTA diminuaient la douleur. Conclusions: L'incidence ...