Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke

Lannin, Natasha A.; Ada, Louise; English, Coralie; Ratcliffe, Julie; Faux, Steven; Palit, Mithu; Gonzalez, Senen; Olver, John; Cameron, Ian D.; Crotty, Maria; Bowman, Malcolm; Milte, Rachel; Vratsistas-Curto, Angela; McNamara, Annabel; Shiner, Christine T.; Lynch, Elizabeth B.; Schneider, Emma; Beaumont, Louise; Killington, Maggie; Coulter, Megan; Sindhusake, Doungkamol; Anthonisz, Brian; Khor, Hong Mei; Tan, Justin; Teo, Kwong; Ng, Lily; Huang, Lydia; Paul, Maria Marilyn; Simon, Neil; Gupta, Nidhi; Martens, Rebecca; Bolitho, Sam; Morrison, Shea; Hooper, Sue; Chow, Yan; Watanabe, Yuriko; Cowling, Adrian; Flu, Clara; Edwards, Debbie I; Toma, Emily; Hendrey, Genevieve; Sheehan, Jacinta; Butler, Josh D.; Hocking, Judith; Rutzou, Lauren; White, M.; Snigg, Michael; Hughes, Rhiannon; Sweeney, Sarah; Flint, Sophie; Levy, Tam; Bramah, Val; Lathlean, Cameron; McCallum, Carrie; Chui, Elaine; Allan, Frances; Webber, Heather E.; Cameron, Jenna; Campbell, Jo; Lawson, Julie; Zenouith, Kalavani; Borschmann, Karen; Moloney, Katelyn; Jolliffe, Laura; Cameron, Lisa J.; Howlett, Owen; Nicks, Rebecca; O'Keefe, Sophie

doi:10.1161/strokeaha.119.027602

Cited by 16 publications

(11 citation statements)

References 29 publications

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“…The BoNT-A+PT group showed an improvement for cervical as well as for headache parameters, according to the idea that migraine responds better to combined treatments [ 36 ]. Moreover, our study results further support the evidence found in previous researches that observed that the combined treatment BoNT-A+PT is more effective than a mono-therapy in pelvic pain [ 37 ], upper limb spasticity [ 38 ], and chronic facial synkinesis [ 39 ].…”

Section: Discussionsupporting

confidence: 90%

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

et al. 2021

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Introduction The purpose of the present study is to compare the effect of the physiotherapy to onabolulinumtoxin-A, and their combination, in relation to cervical and headache parameters in patients with chronic migraine. Methods This is an observational cohort study conducted by a headache center and a physiotherapy degree course on 30 patients with chronic migraine. The patients were distributed in three groups of treatments for three months: onabolulinumtoxin-A only, physiotherapy only, and onabolulinumtoxin-A plus physiotherapy. The patients were evaluated, before and after each treatment, using the following: the postural assessment software SAPO for the forward head posture; the CROM goniometer for the cervical range of motion; the Migraine Disability Assessment Score for headache parameters. Results After 3 months of each treatment, the scores obtained for the headache-related disability and the frequency of migraine decreased significantly for all groups, but the pain intensity scores changed significantly only in the onabolulinumtoxin-A (p = 0.01) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.007). On the other hand, the forward head posture was reduced significantly in the physiotherapy (p = 0.002) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.003). The cervical range of motion increased significantly in certain directions in the physiotherapy group and in the onabolulinumtoxin-A plus physiotherapy groups. Conclusions The physiotherapy improved the cervical parameters. The onabolulinumtoxin-A decreased pain intensity. As a consequence, it can be said that the combined treatment was more useful than a mono-therapy alone. From our results, it can be concluded that onabolulinumtoxin-A plus physiotherapy could be a good option in the management of chronic migraine.

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Section: Discussionsupporting

confidence: 90%

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

et al. 2021

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“…The program was designed to be patient driven; it was mostly carried out at home supported by phone calls, home visits and occasional attendance at the clinic. We then conducted a Phase III randomised trial to determine the clinical effect of additional upper limb rehabilitation following botulinum toxin-A [ 10 ]. The findings suggested that, in stroke survivors attending a spasticity clinic who were scheduled to receive botulinum toxin-A to a muscle crossing the wrist, an additional 3 months of evidence-based movement training was no more effective than botulinum toxin-A plus usual care in terms of goal attainment and upper limb activity.…”

Section: Backgroudmentioning

confidence: 99%

Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial

et al. 2022

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Background It is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies. Aim To determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke. Method An analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. Results By 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome. Conclusion Additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term. Trial Registration ACTRN12615000616572 (12/06/2015).

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“…Previous reports have indicated that the combination of BoNT-A and splint therapy can lead to positive improvements in finger spasticity and ROM 7 , 8 ) . There are also several reports indicating that taping is more effective than splints 9 , 10 ) . We think this is because taping complements the fingers’ state as they change in form and functionality.…”

Section: Discussionmentioning

confidence: 99%

“…Extension using splints prevented the deterioration of skin hypersensitivity and led to improvements in ROM. We believe that gradually modifying the shape of the splint to allow proper extension according to the changes in the patient, makes this measure effective 9 , 10 ) . We suggest that sustained extension (after correcting the splint in accordance with the improvement in the distal muscles and finger joint contracture) is effective in cases such as this patient.…”

Section: Discussionmentioning

confidence: 99%

Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report

Saito

Saito²,

Hirota³

et al. 2021

J Phys Ther Sci

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[Purpose] We report our experience with a patient with a central spinal cord injury who showed improved finger and upper limb functions after long-term treatment with a combination of rehabilitation and botulinum toxin type A. [Participants and Methods] The patient had spasms and pain that gradually became more profound and was given botulinum toxin type A at 1 year 3 months after sustaining a spinal cord injury. We administered 14 botulinum toxin type A injections periodically for 7 years 4 months after the injury. We administered the injections at an average interval of 5.6 months. Splints that allowed extension and improved finger muscle tone and contracture were made for the patient. [Results] The patient experienced gradual alleviation of the spasms in the proximal upper limb muscles and improved range of motion after receiving five doses of botulinum toxin type A. The spasms and range of motion in the fingers gradually improved around 4 years after the injury through splint therapy and a combination of botulinum toxin type A administration and rehabilitation. [Conclusion] The combination of botulinum toxin type A, splint, and rehabilitation therapies can lead to positive improvements in finger spasticity and range of motion and is recommended for hypertonia cases with severe contractures.

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Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke

Cited by 16 publications

References 29 publications

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial

Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report

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