Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity

Demetrios, Marina; Khan, Fary; Turner-Stokes, Lynne; Brand, Caroline; McSweeney, Shane

doi:10.1002/14651858.cd009689.pub2

Cited by 97 publications

(80 citation statements)

References 62 publications

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“…3 Stroke affects both upper and lower limbs, however, and our clinical observations indicate that spasticity is frequently seen in lower limb muscles such as ankle plantar flexors and toe flexors. Because physical therapy is one of the interventions recommended after BoNTA injections, 5 it is important to determine the type of physical therapy intervention that optimizes functional recovery.…”

Section: Background and Purposementioning

confidence: 73%

“…2 BoNTA treatment alone can lead to reductions in symptoms (e.g., spasms, pain) and improvements in passive function (e.g., increased joint range of motion [ROM], hygiene, and dressing), but its effect on active limb function remains unclear. 3 The increase in available ROM and relief of related symptoms afforded by BoNTA injections can make an important contribution to a comprehensive rehabilitation program by creating an opportunity to maximize the gains made during rehabilitation. 4 Recent guidelines and a consensus statement on managing spasticity with BoNTA have advocated a holistic multidisciplinary rehabilitation approach that uses physical and occupational therapy, casting, and motor training to increase the likelihood of achieving treatment goals.…”

Section: Background and Purposementioning

confidence: 99%

“…5 The evidence to support the use of multidisciplinary therapy programs after BoNTA is of low quality: A Cochrane review of multidisciplinary programs after BoNTA found low-quality evidence to support the use of modified constraint-induced movement therapy (vs. neurodevelopmental therapy [NDT]), task practice with functional electrical stimulation (vs. task practice alone), and occupational and manual therapy with dynamic elbow extension splinting (vs. occupational therapy alone). 3 However, there is clearly a lack of research documenting the nature, type, and frequency of physical therapy interventions after BoNTA injections.…”

Section: Background and Purposementioning

confidence: 99%

See 2 more Smart Citations

Physical Therapy for an Adult with Chronic Stroke after Botulinum Toxin Injection for Spasticity: A Case Report

Gallagher

Phadke

Ismail

et al. 2015

Physiotherapy Canada

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Purpose: In this case report, we describe the type and duration of a physical therapy and botulinum toxin type A (BoNTA) intervention directed at lower limb spasticity and the gait and balance improvement in a patient post-stroke. Treatment of focal spasticity with BoNTA intramuscular injections combined with physical therapy is recommended by rehabilitation experts. However, the optimal type and duration of physical therapy intervention to optimize any functional gains that follow chemodenervation induced by BoNTA has not been established. Method: One individual with chronic stroke who received BoNTA injections for upper and lower extremity spasticity was included. Physical therapy intervention consisted of 45-to 60-min sessions twice weekly for 12 weeks, based on the Bobath-neurodevelopmental therapy approach, and an activity-based home program. Results: After BoNTA injections and physical therapy, the patient made clinically significant improvements in balance and gait speed and became more independent with his ambulation. Conclusions: This case report demonstrates that physical therapy after BoNTA injections can result in significant functional improvements for individuals with spasticity after chronic stroke that may not be possible with BoNTA injections alone.Key Words: botulinum toxins; muscle spasticity; stroke. RÉ SUMÉObjectif : Dans ce rapport de cas, nous dé crivons le type et la duré e d'une intervention combinant la physiothé rapie et l'administration de toxine botulique de type-A (BoNTA) pour contrer la spasticité des membres infé rieurs et amé liorer la dé marche et l'é quilibre aprè s un incident vasculaire cé ré bral. Les experts de la ré adaptation recommandent de traiter la spasticité focale par des injections intramusculaires de BoNTA combiné es à la physiothé rapie. La duré e et le type optimaux de l'intervention de physiothé rapie visant à optimiser tout gain fonctionnel qui suit la chimiodé nervation provoqué e par la BoNTA n'ont toutefois pas é té é tablis. Mé thode : Une personne victime d'accidents vasculaires cé ré braux chroniques qui a reç u des injections de BoNTA contre la spasticité des membres supé rieurs et infé rieurs a é té incluse. Le traitement de physiothé rapie a consisté en deux sé ances hebdomadaires de 45 à 60 minutes pendant 12 semaines, basé sur la straté gie Bobath-NDT et en un programme d'activité à domicile. Ré sultats : À la suite des injections de BoNTA et de la physiothé rapie, le patient a ré alisé des amé liorations cliniques importantes au niveau de l'é quilibre et de la vitesse de la dé marche et est devenu plus autonome dans son ambulation. Conclusions : Ce rapport de cas dé montre que la physiothé rapie suivant des injections de BoNTA peut entraîner une importante amé lioration fonctionnelle chez les personnes qui ont une spasticité consé cutive à des accidents vasculaires cé ré braux chroniques, amé lioration qui pourrait ne pas ê tre possible à la suite d'injections de BoNTA seulement. BACKGROUND AND PURPOSE

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Section: Background and Purposementioning

confidence: 73%

Section: Background and Purposementioning

confidence: 99%

Section: Background and Purposementioning

confidence: 99%

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Physical Therapy for an Adult with Chronic Stroke after Botulinum Toxin Injection for Spasticity: A Case Report

Gallagher

Phadke

Ismail

et al. 2015

Physiotherapy Canada

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“…A Cochrane review published this year outlines need for ongoing research to establish optimal types and intensities of multidisciplinary rehabilitation to improve impairment and activity following Botulinum toxin treatment [99].…”

Section: Spasticity and Contracturementioning

confidence: 99%

Upper Limb Rehabilitation Following Stroke: Current Evidence and Future Perspectives

Adey‐Wakeling

Crotty

2013

Aging Health

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/ SummaryStroke is a leading cause of disability worldwide, with risk increasing with age.Upper limb hemiparesis is common and associated with persistent impairments and associated disabilities. Older stroke populations often suffer multiple co-morbidities and restoring independence is complex. Recovery of upper limb function can be crucial for them to return to independent living and to participate in community life.This review describes upper limb recovery post stroke, and some of the new therapeutic approaches available to promote recovery. Technologies (including virtual reality and telehealth) offer the opportunity for more home based therapies, longer programs, greater access to rehabilitation for older people however the trials continue to exclude older people so acceptability is poorly understood. Introduction:

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“…5 Spasticity management is typically multidisciplinary, involving physical therapy, occupational therapy, and medical care. 6,7 Each health care professional involved in spasticity management completes an individual assessment and may prescribe interventions such as splinting, stretching, and functional task training as needed to improve function. The treatment goal is to reduce muscle tone and restore function using a combination of BoNTA and therapy.…”

mentioning

confidence: 99%

Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

Choi

Peters

Tri

et al. 2017

Physiotherapy Canada

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Purpose: Goal Attainment Scaling (GAS) is used to assess functional gains in response to treatment. Specific characteristics of the functional goals set by individuals receiving botulinum toxin type A (BoNTA) injections for spasticity management are unknown. The primary objectives of this study were to describe the characteristics of the goals set by patients before receiving BoNTA injections using the International Classification of Functioning, Disability and Health (ICF) and to determine whether the pattern of spasticity distribution affected the goals set. Methods: A cross-sectional retrospective chart review was carried out in an outpatient spasticity-management clinic in Toronto. A total of 176 patients with a variety of neurological lesions attended the clinic to receive BoNTA injections and completed GAS from December 2012 to December 2013. The main outcome measures were the characteristics of the goals set by the participants on the basis of ICF categories (body functions and structures, activity and participation) and the spasticity distribution using Modified Ashworth Scale scores. Results: Of the patients, 73% set activity and participation goals, and 27% set body functions and structures goals (p < 0.05). In the activity and participation category, 30% of patients set moving and walking goals, 28% set self-care and dressing goals, and 12% set changing and maintaining body position goals. In the body functions and structures category, 18% set neuromuscular and movement-related goals, and 8% set pain goals. The ICF goal categories were not related to the patterns of spasticity (upper limb vs. lower limb or unilateral vs. bilateral spasticity) or type of upper motor neuron (UMN) lesion (p > 0.05). Conclusion: Our results show that patients receiving BoNTA treatment set a higher percentage of activity and participation goals than body functions and structures goals. Goal classification was not affected by type of spasticity distribution or type of UMN disorder.Key Words: activities of daily living; botulinum toxin; goals; muscle spasticity; patient participation. RÉ SUMÉObjectif : l'é chelle de ré alisation des objectifs (Goal Attainment Scaling ou GAS) est employé e pour é valuer les gains fonctionnels en ré ponse à un traitement. On ne connaît pas les caracté ristiques des objectifs fonctionnels é tablis par les personnes recevant des injections de toxine botulinique de type A (BoNTA) pour la prise en charge de la spasticité . Cette é tude vise à dé crire les caracté ristiques des objectifs é tablis par les patients avant de recevoir des injections de BoNTA à l'aide de la Classification internationale du fonctionnement, du handicap et de la santé (CIF) et à dé terminer si le modè le de distribution de la spasticité avait un effet sur les objectifs é tablis. Mé thodologie : on a mené une revue ré trospective transversale des dossiers d'une clinique ambulatoire de prise en charge de la spasticité à Toronto. Au total, 176 patients ayant diverses lé sions neurologiques sont venus à la clinique pou...

show abstract

Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity

Cited by 97 publications

References 62 publications

Physical Therapy for an Adult with Chronic Stroke after Botulinum Toxin Injection for Spasticity: A Case Report

Physical Therapy for an Adult with Chronic Stroke after Botulinum Toxin Injection for Spasticity: A Case Report

Upper Limb Rehabilitation Following Stroke: Current Evidence and Future Perspectives

Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

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