Spasticity evaluation and management tools

Howard, Ileana M.; Patel, Atul T.

doi:10.1002/mus.27792

Cited by 7 publications

(10 citation statements)

References 100 publications

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“…In the context of managing spasticity, there has been a shift from considering adjunctive therapies as mere supplements to botulinum toxin injections towards embracing a multimodal treatment approach [ 8 , 164 ]. Multimodal treatment in spasticity care involves a synergistic combination of physical, pharmacological, and surgical interventions where necessary.…”

Section: Discussionmentioning

confidence: 99%

“…While spasticity may not always be debilitating, its severity often tends to increase over time, leading to significant changes in muscle structure [ 3 , 7 ]. This progression underscores the need for closer monitoring and multimodal interventions, especially in patients with moderate to severe paresis [ 8 ]. An international survey highlighted that 72% of patients with spasticity reported an impact on quality of life, with many also experiencing depression and loss of independence, reflecting the condition’s extensive impact not only on patients, but also on their families [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis

Facciorusso,

Spina,

Picelli

et al. 2024

Toxins

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Botulinum toxin type-A (BoNT-A) has emerged as a key therapeutic agent for the management of spasticity. This paper presents a comprehensive bibliometric and visual analysis of research concerning BoNT-A treatment of spasticity to elucidate current trends and future directions in this research area. A search was conducted in the Web of Science database for articles focused on the use of BoNT-A in spasticity published between 2000 and 2022. We extracted various metrics, including counts of publications and contributions from different countries, institutions, authors, and journals. Analytical methods in CiteSpace were employed for the examination of co-citations, collaborations, and the co-occurrence of keywords. Our search yielded 1489 publications. Analysis revealed a consistent annual increase in research output. The United States, United Kingdom, and Italy were the leading contributors. The top institution in this research was Assistance Publique Hopitaux, Paris. The journal containing the highest number of relevant publications was Toxins. Key frequently occurring keywords were ‘stroke’, ‘cerebral palsy’, ‘adult spasticity’, and ‘upper extremity’. This study identified 12 clusters of keywords and 15 clusters of co-cited references, indicating the main focus areas and emerging themes in this field. This study comprehensively analyzed and summarized trends in BoNT-A research in the field of spasticity over the past 22 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis

Facciorusso,

Spina,

Picelli

et al. 2024

Toxins

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“…Spasticity leads to complications such as pain, a distorted joint position, postural and hygiene difficulties, joint contractures, and permanent deformities [ 2 ]. It is common in patients with central nervous system disorders such as stroke, multiple sclerosis, spinal cord injuries [ 3 ], traumatic brain injuries, and cerebral palsy (CP) [ 1 ]. Approximately 12 million people worldwide are estimated to suffer from spasticity [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…On this scale, 0 represents “no increase in tone,” while 4 indicates that the limb is “stiff in flexion or extension” [ 5 ] ( Supplementary Table S1 ). The second is the Tardieu Scale or the Modified Tardieu Scale [ 1 , 3 ], which is also an ordinal scale that assesses the intensity of resistance to muscle stretch [ 3 ]. According to the Modified Tardieu Scale, each muscle group is rated for a specific stretching speed according to two parameters.…”

Section: Introductionmentioning

confidence: 99%

“…There is evidence of the efficacy of different treatments for the improvement in spasticity, such as physiotherapy (stretching, use of orthoses, cryotherapy, heat, etc. ), extracorporeal shock waves, oral medication, injections (such as botulinum toxin), intrathecal baclofen pumps, and surgical interventions [ 3 ]. In particular, botulinum toxin is considered a reversible treatment for spasticity and has been used for more than 30 years in patients with CP [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Botulinum Toxin Injections in the Treatment of Spasticity of Different Etiologies: An Umbrella Review

Otero-Luis,

Martinez-Rodrigo,

Cavero-Redondo

et al. 2024

Pharmaceuticals

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Background: Spasticity is a very common neurological sequelae that significantly impacts the quality of life of patients, affecting more than 12 million people worldwide. Botulinum toxin is considered a reversible treatment for spasticity, but due to the large amount of available evidence, synthesis seems necessary. Therefore, we conducted an overview of existing systematic reviews and meta-analyses to evaluate the effect of botulinum toxin injections in the treatment of spasticity of different etiologies. Methods: A systematic search of different databases, including Pubmed, Scopus, the Cochrane Library, and Web of Science, was performed from inception to February 2024. Standardized mean differences (SMDs) and their respective 95% confidence intervals (CIs) were calculated to assess the effect of botulinum toxin compared to that of the control treatment using the Modified Ashworth Scale (MAS). All the statistical analyses were performed using STATA 15 software. Results: 28 studies were included in the umbrella review. The effect of botulinum toxin injections on spasticity, as measured by the MAS, was significantly lower in all but three studies, although these studies also supported the intervention. The SMDs reported by the meta-analyses ranged from −0.98 to −0.01. Conclusion: Botulinum toxin injections were effective at treating spasticity of different etiologies, as indicated by the measurements on the MAS. This implies an improvement in muscle tone and, consequently, in the patient’s mobility and quality of life.

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AAPM&R consensus guidance on spasticity assessment and management

Verduzco‐Gutierrez,

Raghavan,

Pruente

et al. 2024

PM&R

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BackgroundThe American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus‐based practice recommendations aimed at addressing gaps in spasticity care.ObjectiveTo develop consensus‐based practice recommendations to identify and address gaps in spasticity care.MethodsThe Spasticity TEP engaged in a 16‐month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations.ResultsThe TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence‐based treatment options, intended for use by PM&R physicians caring for patients with spasticity.ConclusionThis consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.

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Spasticity evaluation and management tools

Cited by 7 publications

References 100 publications

The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis

The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis

Effect of Botulinum Toxin Injections in the Treatment of Spasticity of Different Etiologies: An Umbrella Review

AAPM&R consensus guidance on spasticity assessment and management

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