Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke

Demetrios, Marina; Gorelik, Alexandra; Louie, Julie; Brand, Caroline; Baguley, Ian; Khan, Fary

doi:10.2340/16501977-1842

Cited by 31 publications

(38 citation statements)

References 34 publications

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“…First of all, our multidisciplinary team of physiotherapists, occupational therapists and prosthetic orthotists provided a high-quality rehabilitation program for the patients after Botox injection; this had been shown in previous studies to be of critical importance. 11,20,21 Secondly, the goal-setting process, as an essential part of the management program, helped patients to set goals that are highly individualized and personally relevant. It promoted patient's engagement with the intervention as a collaborative process with the multidisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin injection and rehabilitation for neurosurgical patients with spasticity

et al. 2016

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Aim: Spasticity gives rise to impairment in motor functions and activities of daily living. Botulinum toxin (BTX) can be injected to temporarily paralyze the affected muscles, which provides a window of opportunity for rehabilitation. We present our 2.5-year experience with BTX injection and a patient-specific rehabilitation program provided by a multidisciplinary team, which consists of neurosurgeons, nurses, physiotherapists, occupational therapists and prosthetic orthotists. Patients and Methods: This is a retrospective study of prospectively collected data in a local hospital including 22 patients suffering from spasticity. Outcome measures include goal attainment, caregiver burden and biomechanical assessment by Modified Ashworth Scale and Modified Tardieu Scale (MTS). Results: OnabotulinumtoxinA injection together with rehabilitation facilitates the attainment of patientcentred physical goals in daily activities. It reduces caregiver burden. Spasticity is reduced particularly for finger and wrist flexors as well as hip adductors. Responses of ankle plantarflexors are less satisfactory which may be due to inadequate dosages. Initial improvement in the R2 component of the MTS for ankle plantarflexors and hip adductors may be attributable to the application of ankle-foot orthosis and abduction pillow. Conclusions: Multidisciplinary management for spasticity is feasible within our healthcare setting and our promising findings indicate its wider adoption in this locality.

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Section: Discussionmentioning

confidence: 99%

Botulinum toxin injection and rehabilitation for neurosurgical patients with spasticity

et al. 2016

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“…According to studies of Turner-Stokes et al 49 and Demetrios et al 50 which both used GAS, this proportion should be between 75% and 80% 49 50. Based on a usual effectiveness of 75% in the control group, a target proportion of 90% in the SR group (supposing further improvements for this group, threshold relatively superior to 75%, reasonable and clinically relevant), a two-tailed test at a threshold of 5% and a power of 80%, a sample of 100 subjects per group is required 51.…”

Section: Methods and Analysismentioning

confidence: 99%

Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (ADJU-TOX): protocol study for a randomised controlled, investigator blinded study

Bonnyaud

Gallien

Decavel³

et al. 2018

BMJ Open

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IntroductionHome-based self-rehabilitation programmes combined with botulinum toxin injections (BTIs) appear to be a relevant approach to increase the recommended intensive rehabilitation of patients with spasticity following a stroke. The literature highlights a lack of evidence of beneficial effects of this adjuvant therapy to reduce limitations of patients with stroke. The aim of this study is to assess the effects of a 6-month self-rehabilitation programme in adjunction to BTI, in comparison with BTI alone, to reduce limitations of patients with spasticity following a stroke.Methods and analysis220 chronic patients will participate to this multicentre, prospective, randomised, controlled, assessor blinded study. All patients will benefit from two successive BTI (3 months apart), and patients randomised in the self-rehabilitation group will perform in adjunction 6 months of self-rehabilitation at home. All patients continue their conventional physiotherapy. The main outcome is the primary treatment goal (PTG), which will be determined jointly by the patient and the medical doctor using Goal Attainment Scaling. Impairments and functions, quality of life, mood and fatigue will be assessed. Botulinum toxin will be injected into the relevant muscles according to the PTG. Patients in the self-rehab group will be taught the self-rehabilitation programme involving respectively 10 min of stretching, 10 min of strengthening and 10 min of task-oriented exercises, corresponding to their PTG. Compliance to the self-rehabilitation programme will be monitored.Ethics and disseminationPatients will sign written informed consent. Ethical approval was obtained from ethics committee. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients.Trial registration numberNCT02944929.

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“…; Demetrios et al. ) and accessory flexor muscles such as flexor digitorum superficialis and pronator teres (Bhakta et al. ; Hesse et al.…”

Section: Introductionmentioning

confidence: 99%

“…; Demetrios et al. ) are often injected, whereas the brachialis, which is deeper, is less frequently injected (Hesse et al. ; Lagalla et al.…”

Section: Introductionmentioning

confidence: 99%

“…The muscles targeted to reduce involuntary elbow flexion are often chosen based on how superficial, and therefore how easy to inject, they are. Thus the biceps brachii (Bhakta et al 1996;Hesse et al 1998;Bakheit et al 2000Bakheit et al , 2001Bakheit et al , 2004Lagalla et al 2000;Wang et al 2002;Chen et al 2005;Slawek et al 2005;Suputtitada & Suwanwela, 2005;Caty et al 2009;Lai et al 2009;McCrory et al 2009;Bensmail et al 2010a,b;Sun et al 2010;Baguley et al 2011;Demetrios et al 2014), brachioradialis (Bhakta et al 1996;Wang et al 2002;Slawek et al 2005;Lai et al 2009;McCrory et al 2009;Bensmail et al 2010a,b;Baguley et al 2011;Demetrios et al 2014) and accessory flexor muscles such as flexor digitorum superficialis and pronator teres (Bhakta et al 1996;Hesse et al 1998;Bakheit et al 2000Bakheit et al , 2001Bakheit et al , 2004Lagalla et al 2000;Wang et al 2002;Slawek et al 2005;Suputtitada & Suwanwela, 2005;Caty et al 2009;McCrory et al 2009;Bensmail et al 2010a,b;Sun et al 2010;Baguley et al 2011;Demetrios et...…”

Section: Introductionmentioning

confidence: 99%

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Successive motor nerve blocks to identify the muscles causing a spasticity pattern: example of the arm flexion pattern

et al. 2016

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Botulinum Toxin A has been the main treatment for spasticity since the beginning of the 1990s. Surprisingly, there is still no consensus regarding injection parameters or, importantly, how to determine which muscles to target to improve specific functions. The aim of this study was to develop a systematic approach to determine this, using the example of the arm flexion pattern. We first determined anatomical landmarks for selective motor block of the brachialis nerve, using 20 forearms from 10 fresh cadavers in Ecole Europ eenne de Chirurgie and a university-based dissection centre, Paris, France. We then carried out selective blocks of the motor nerves to the brachialis, brachioradialis and biceps brachii in patients with stroke with an arm flexion pattern, in a University Rehabilitation Hospital, Garches, France. We measured: the resting angle of the elbow angle in standing (manual goniometer), active and passive range of extension, and spasticity using the Held and Tardieu and the Modified Ashworth scales. Range of passive elbow extension was also measured with the shoulder in 90°of flexion. The resting angle of the elbow in standing decreased by 35.0°(from 87.6 AE 23.7 to 52.6 AE 24.2°) with inhibition of brachialis, by a further 3.9°(from 52.6 AE 24.2 to 48.7 AE 23.7°) with inhibition of brachioradialis and a further 14.5°(from 48.7 AE 23.7to 34.2 AE 20.7°) with inhibition of biceps brachii. These results were consistent with the clinical evaluation of passive elbow range of motion with the shoulder at 90°. Sequential blocking of the nerves to the three main elbow flexors revealed that the muscle that limited elbow extension the most, was brachialis. This muscle should be the main target to improve the arm flexion pattern. These results show that it is important not simply to inject the most superficial or powerful muscles to treat a spastic deformity. A comprehensive assessment is required. The strategy proposed in this paper should increase the effectiveness of botulinum toxin injections by ensuring that the relevant muscles are targeted.

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Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke

Cited by 31 publications

References 34 publications

Botulinum toxin injection and rehabilitation for neurosurgical patients with spasticity

Botulinum toxin injection and rehabilitation for neurosurgical patients with spasticity

Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (ADJU-TOX): protocol study for a randomised controlled, investigator blinded study

Successive motor nerve blocks to identify the muscles causing a spasticity pattern: example of the arm flexion pattern

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