The aim was to investigate if botulinum toxin type A (BTx-A) associated with physical therapy is superior to physical therapy alone in post stroke spasticity. A randomized, double-blinded controlled trial was performed in a rehabilitation unit on Northeastern, Brazil. Patients with post stroke spasticity were enrolled either to BTx-A injections and a pre-defined program of physical therapy or saline injections plus physical therapy. Primary endpoint was functional performance evaluated through time up and go test, six minutes walking test and Fugl-Meyer scale for upper limb. Secondary endpoint was spasticity improvement. Confidence interval was considered at 95%. Although there was a significant decrease in upper limbs flexor tonus (P<0.05) in the BTx-A group, there was no difference regarding functional performance after 9 months of treatment. When analyzing gait speed and performance, both groups showed a significant improvement in the third month of treatment, however it was not sustained over time. Although BTx-A shows superiority to improve muscle tone, physical therapy is the cornerstone to improve function in the upper limbs of post stroke patients.
Introduction The linguistic factor may have delayed the universal adoption of the International Anatomical Terminology (IAT), which was widespread in Latin and in English only. Independent translations are possible, but they are not devoid of methodological difficulties. Objective To estimate the usage of the translated version of the Terminologia Anatomica in neurosurgical articles in Brazil. Method Consecutive national publications were checked for the correspondence of their anatomical terms to the following categories: IAT – Brazilian version; IAT in Latin; Nomina Anatomica – previous versions; incomplete terms; derivative terms; eponyms; neologisms; and others (misspellings and prosaic terms). The years 2014 and 2015 were chosen for analysis so that included articles were published at least 16 years after the publication of the original IAT (1998) and at least 13 years since the publication of the Brazilian version (2001). Results Out of a total of 183 articles analyzed, 1,132 anatomical terms were identified, referring to 334 different anatomical structures. Most of the structures were described using terms from the Brazilian version of the IAT (n = 834; 73.7%). Those that did not belong to or did not derive from any version of the IAT totaled 281 (24.8%). The remaining 17 terms (1.5%) corresponded to words derived or provided for in the Latin IAT. No association was identified between the number of authors and any category of nomenclature. Conclusion Although most anatomical structures cited in Portuguese were described in accordance with the Brazilian version of the IAT, the degree of adherence was considered moderate given that about one-quarter of the terms escaped this terminology.
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