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Spasticity: To treat or not to treat? / Alain P. Yelnik in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 205-206 Titre : Spasticity: To treat or not to treat? Type de document : texte imprimé Auteurs : Alain P. Yelnik ; Isabelle Laffont ; D. Bensmail ; Gerard E. Francisco Année de publication : 2019 Article en page(s) : p. 205-206 Note générale : https://doi.org/10.1016/j.rehab.2018.10.003 Langues : Anglais (eng) Résumé : To treat or not to treat spasticity…that's the challenge! Making this decision is the first and most difficult step, before choosing the optimal treatment. Why a patient should be treated is the most important issue and includes: • questioning all potential causes of disability and potential subsequent consequences of spastic paresis by a careful examination to disentangle the possible neurological, orthopaedic, cognitive or other causes involved in the impairment; • investigating the possible triggering factors of spasticity, and; • defining the goals that should be customized for the individual in their environment. Tailoring the treatment strategy to meet the individual's precise and personalized objectives will increase the probability of success and satisfaction with the treatment. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314787 Permalink : ./index.php?lvl=notice_display&id=84123 [article] Spasticity: To treat or not to treat? [texte imprimé] / Alain P. Yelnik ; Isabelle Laffont ; D. Bensmail ; Gerard E. Francisco . - 2019 . - p. 205-206. https://doi.org/10.1016/j.rehab.2018.10.003 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 205-206 Résumé : To treat or not to treat spasticity…that's the challenge! Making this decision is the first and most difficult step, before choosing the optimal treatment. Why a patient should be treated is the most important issue and includes: • questioning all potential causes of disability and potential subsequent consequences of spastic paresis by a careful examination to disentangle the possible neurological, orthopaedic, cognitive or other causes involved in the impairment; • investigating the possible triggering factors of spasticity, and; • defining the goals that should be customized for the individual in their environment. Tailoring the treatment strategy to meet the individual's precise and personalized objectives will increase the probability of success and satisfaction with the treatment. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314787 Permalink : ./index.php?lvl=notice_display&id=84123

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Botuloscope: 1-year follow-up of upper limb post-stroke spasticity treated with botulinum toxin / Philippe Marque in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 207-213 Titre : Botuloscope: 1-year follow-up of upper limb post-stroke spasticity treated with botulinum toxin Type de document : texte imprimé Auteurs : Philippe Marque ; Angélique Denis ; David Gasq ; Emmanuelle Chaleat-Valayer ; Alain P. Yelnik ; Cyrille Colin ; Botuloscope Group ; Dominic Pérennou Année de publication : 2019 Article en page(s) : p. 207-213 Note générale : https://doi.org/10.1016/j.rehab.2019.06.003 Langues : Anglais (eng) Résumé : Background Botuloscope is a cohort study supported by a French public grant and aiming to evaluate a 1-year treatment of the post-stroke spastic upper limb with botulinum toxin type A (BoNT-A) in terms of individual satisfaction with respect to personalized goals and quality of life. Methods This was an open-label prospective, multicentric study (11 French centres) that followed 330 adults [mean (SD) age 53.7 (13.7) years] over 1 year; participants had ranked 5 therapeutic goals at inclusion [mean (SD) 5.1 (7.3) years post-stroke], had severe hemiparesis [median motricity index (MI) 40 (Q1–Q3 24 to 60)], and were assessed at inclusion (M0) and at month 3 (M3) and M12. Outcome criteria were: spasticity, range of motion, pain [visual analog scale (VAS)], motor function [Modified Ashworth Scale (MAS)] and activities (MI; Frenchay Arm Test), and overall satisfaction with the achievement of each goal (VAS) and quality of life (Reintegration to Normal Life Index). Criteria at M0 and M12 were compared. Adverse effects were also collected, as were medication changes. Results The primary goal was comfort and activities for 63% of participants and motor function for 36%. Participants underwent a mean of 2.4 injection sessions, 19% causing adverse effects. The greatest spasticity attenuation occurred with wrist flexors (median decrease in MAS −2 [Q1–Q3; −2 to −1], P < 10−3). Fewer individuals took oral anti-spastic drugs (56% at M12 vs 50% at M0; P < 10−2). Range of motion increased by 16°, on average (13 to 19; P < 10−3) for wrist extension. Pain prevalence decreases at rest (29% at M0 vs. 19% at M12; P < 10−4) and during mobilization (64% vs. 43%; P < 10−4), and fewer participants took analgesics (25% vs. 17%; P < 10−3). Satisfaction was high for the goals “hand hygiene” and “pain release” and moderate for “improvement in upper limb function”. However, function was more improved for participants who selected this goal as the first priority than others (P < 10−2). Overall, 22% had the goal “improving gait and balance”, which was reasonably achieved at M12. Quality of life improved markedly [median 8 (4 to 11) vs. 6 (3 to 10); P < 10−4]. Prevalence of complete dissatisfaction with the first objective was 10% to 15%. Conclusion This is the first long-term follow-up of BoNT-A treatment for upper limb spasticity involving a large cohort independent of industry. Quality of life was improved by treating upper limb spasticity with BoNT-A, even at 5 years post-stroke. Personalizing objectives of the treatment amplified its efficacy. BoNT-A was a powerful analgesic when pain was spasticity-related. Treating the spastic upper limb also improved balance and gait abilities. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300776 Permalink : ./index.php?lvl=notice_display&id=84124 [article] Botuloscope: 1-year follow-up of upper limb post-stroke spasticity treated with botulinum toxin [texte imprimé] / Philippe Marque ; Angélique Denis ; David Gasq ; Emmanuelle Chaleat-Valayer ; Alain P. Yelnik ; Cyrille Colin ; Botuloscope Group ; Dominic Pérennou . - 2019 . - p. 207-213. https://doi.org/10.1016/j.rehab.2019.06.003 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 207-213 Résumé : Background Botuloscope is a cohort study supported by a French public grant and aiming to evaluate a 1-year treatment of the post-stroke spastic upper limb with botulinum toxin type A (BoNT-A) in terms of individual satisfaction with respect to personalized goals and quality of life. Methods This was an open-label prospective, multicentric study (11 French centres) that followed 330 adults [mean (SD) age 53.7 (13.7) years] over 1 year; participants had ranked 5 therapeutic goals at inclusion [mean (SD) 5.1 (7.3) years post-stroke], had severe hemiparesis [median motricity index (MI) 40 (Q1–Q3 24 to 60)], and were assessed at inclusion (M0) and at month 3 (M3) and M12. Outcome criteria were: spasticity, range of motion, pain [visual analog scale (VAS)], motor function [Modified Ashworth Scale (MAS)] and activities (MI; Frenchay Arm Test), and overall satisfaction with the achievement of each goal (VAS) and quality of life (Reintegration to Normal Life Index). Criteria at M0 and M12 were compared. Adverse effects were also collected, as were medication changes. Results The primary goal was comfort and activities for 63% of participants and motor function for 36%. Participants underwent a mean of 2.4 injection sessions, 19% causing adverse effects. The greatest spasticity attenuation occurred with wrist flexors (median decrease in MAS −2 [Q1–Q3; −2 to −1], P < 10−3). Fewer individuals took oral anti-spastic drugs (56% at M12 vs 50% at M0; P < 10−2). Range of motion increased by 16°, on average (13 to 19; P < 10−3) for wrist extension. Pain prevalence decreases at rest (29% at M0 vs. 19% at M12; P < 10−4) and during mobilization (64% vs. 43%; P < 10−4), and fewer participants took analgesics (25% vs. 17%; P < 10−3). Satisfaction was high for the goals “hand hygiene” and “pain release” and moderate for “improvement in upper limb function”. However, function was more improved for participants who selected this goal as the first priority than others (P < 10−2). Overall, 22% had the goal “improving gait and balance”, which was reasonably achieved at M12. Quality of life improved markedly [median 8 (4 to 11) vs. 6 (3 to 10); P < 10−4]. Prevalence of complete dissatisfaction with the first objective was 10% to 15%. Conclusion This is the first long-term follow-up of BoNT-A treatment for upper limb spasticity involving a large cohort independent of industry. Quality of life was improved by treating upper limb spasticity with BoNT-A, even at 5 years post-stroke. Personalizing objectives of the treatment amplified its efficacy. BoNT-A was a powerful analgesic when pain was spasticity-related. Treating the spastic upper limb also improved balance and gait abilities. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300776 Permalink : ./index.php?lvl=notice_display&id=84124

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Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study / Alessio Baricich in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 214-219 Titre : Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study Type de document : texte imprimé Auteurs : Alessio Baricich ; Alessandro Picelli ; Stefano Carda ; Nicola Smania ; Carlo Cisari ; Andrea Santamato ; Allessandro de Sire ; Marco Invernizzi Année de publication : 2019 Article en page(s) : p. 214-219 Note générale : https://doi.org/10.1016/j.rehab.2019.06.002 Langues : Anglais (eng) Mots-clés : Stroke  Spasticity  Botulinum toxin type A  Electrical stimulation  Rehabilitation Résumé : Background Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity and should be offered as first-line treatment for focal manifestations. Although its possible role has been hypothesized, the efficacy of electrical stimulation (ES) of antagonists of the injected muscles for improving clinical outcome after BoNT-A injection remains to be established. Objectives This randomized single-blind pilot study aimed to investigate the efficacy of ES of antagonist muscles as adjunct treatment after BoNT-A injection to plantar flexor muscles in hemiplegic patients with spastic equinus foot. Methods After BoNT-A injection at triceps surae, patients were randomly allocated to 2 groups: group 1, single ES session on injected muscles plus 5 sessions of ES on antagonist muscles, and group 2, single ES session on injected muscles alone. Both groups underwent daily physical therapy for 60 min for 2 weeks (5 days/week). Assessments were performed before treatment (T0) and at 10 days (T1), 20 days (T2), and 90 days (T3) after treatment. Our primary outcome was gait velocity at a comfortable speed at T2 (10-m walk test [10MWT]). The following were secondary outcomes: triceps surae spasticity (Modified Ashworth Scale), ankle passive range of motion (pROM), strength of tibialis anterior muscle, and 2-min walk test (2MWT). Results The 30 patients enrolled were randomly allocated to the 2 groups: 15 in group 1 and 15 in group 2. At T1, T2 and T3, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (P < 0.05). At T2 and T3, both groups showed a significant increase in 10MWT and 2MWT. The groups did not significantly differ in tibialis anterior strength or primary or secondary outcome measures. Conclusions ES of antagonist muscles does not improve clinical outcomes in the post-stroke spastic equinus foot after BoNT-A injection. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300752 Permalink : ./index.php?lvl=notice_display&id=84125 [article] Electrical stimulation of antagonist muscles after botulinum toxin type A for post-stroke spastic equinus foot. A randomized single-blind pilot study [texte imprimé] / Alessio Baricich ; Alessandro Picelli ; Stefano Carda ; Nicola Smania ; Carlo Cisari ; Andrea Santamato ; Allessandro de Sire ; Marco Invernizzi . - 2019 . - p. 214-219. https://doi.org/10.1016/j.rehab.2019.06.002 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 214-219 Mots-clés : Stroke  Spasticity  Botulinum toxin type A  Electrical stimulation  Rehabilitation Résumé : Background Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity and should be offered as first-line treatment for focal manifestations. Although its possible role has been hypothesized, the efficacy of electrical stimulation (ES) of antagonists of the injected muscles for improving clinical outcome after BoNT-A injection remains to be established. Objectives This randomized single-blind pilot study aimed to investigate the efficacy of ES of antagonist muscles as adjunct treatment after BoNT-A injection to plantar flexor muscles in hemiplegic patients with spastic equinus foot. Methods After BoNT-A injection at triceps surae, patients were randomly allocated to 2 groups: group 1, single ES session on injected muscles plus 5 sessions of ES on antagonist muscles, and group 2, single ES session on injected muscles alone. Both groups underwent daily physical therapy for 60 min for 2 weeks (5 days/week). Assessments were performed before treatment (T0) and at 10 days (T1), 20 days (T2), and 90 days (T3) after treatment. Our primary outcome was gait velocity at a comfortable speed at T2 (10-m walk test [10MWT]). The following were secondary outcomes: triceps surae spasticity (Modified Ashworth Scale), ankle passive range of motion (pROM), strength of tibialis anterior muscle, and 2-min walk test (2MWT). Results The 30 patients enrolled were randomly allocated to the 2 groups: 15 in group 1 and 15 in group 2. At T1, T2 and T3, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (P < 0.05). At T2 and T3, both groups showed a significant increase in 10MWT and 2MWT. The groups did not significantly differ in tibialis anterior strength or primary or secondary outcome measures. Conclusions ES of antagonist muscles does not improve clinical outcomes in the post-stroke spastic equinus foot after BoNT-A injection. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300752 Permalink : ./index.php?lvl=notice_display&id=84125

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Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? / Thierry Deltombe in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 220-224 Titre : Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? Type de document : texte imprimé Auteurs : Thierry Deltombe ; Thierry Lejeune ; Thierry Gustin Année de publication : 2019 Article en page(s) : p. 220-224 Note générale : https://doi.org/10.1016/j.rehab.2018.07.008 Langues : Anglais (eng) Mots-clés : Hemiplegia  Muscle spasticity  Motor nerve block  Neurotomy  Equinovarus foot Résumé : Objective To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment. Methods Expert opinion based on scientific evidence and personal experience. Results Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed. Conclusion Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314398 Permalink : ./index.php?lvl=notice_display&id=84126 [article] Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? [texte imprimé] / Thierry Deltombe ; Thierry Lejeune ; Thierry Gustin . - 2019 . - p. 220-224. https://doi.org/10.1016/j.rehab.2018.07.008 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 220-224 Mots-clés : Hemiplegia  Muscle spasticity  Motor nerve block  Neurotomy  Equinovarus foot Résumé : Objective To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment. Methods Expert opinion based on scientific evidence and personal experience. Results Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed. Conclusion Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314398 Permalink : ./index.php?lvl=notice_display&id=84126

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Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques / F. Genêt in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 225-233 Titre : Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques Type de document : texte imprimé Auteurs : F. Genêt ; Philippe Denormandie ; M.A. Keenan Année de publication : 2019 Article en page(s) : p. 225-233 Note générale : https://doi.org/10.1016/j.rehab.2018.09.004 Langues : Anglais (eng) Mots-clés : Orthopaedic surgery  Spasticity  Neurotimy  Neurectomy  Hyponeurotization  Tendon lengthening  Tendon transfer  Arthrodesis  Heterotopic ossification Résumé : Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients’ expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314507 Permalink : ./index.php?lvl=notice_display&id=84127 [article] Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques [texte imprimé] / F. Genêt ; Philippe Denormandie ; M.A. Keenan . - 2019 . - p. 225-233. https://doi.org/10.1016/j.rehab.2018.09.004 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 225-233 Mots-clés : Orthopaedic surgery  Spasticity  Neurotimy  Neurectomy  Hyponeurotization  Tendon lengthening  Tendon transfer  Arthrodesis  Heterotopic ossification Résumé : Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients’ expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314507 Permalink : ./index.php?lvl=notice_display&id=84127

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Does botulinum toxin treatment improve upper limb active function? / Jonathan Lévy in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 234-240 Titre : Does botulinum toxin treatment improve upper limb active function? Type de document : texte imprimé Auteurs : Jonathan Lévy Année de publication : 2019 Article en page(s) : p. 234-240 Note générale : https://doi.org/10.1016/j.rehab.2018.05.1320 Langues : Anglais (eng) Mots-clés : Spasticity  Botulinum toxin  Rehabilitation  Outcome  Upper limb  Stroke Résumé : Background Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial. Objective We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials. Methods We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors’ expertise. The review focused on stroke-related spasticity and disability. Results Patients’ therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection. Conclusion BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies’ endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections. En ligne : https://www.sciencedirect.com/science/article/pii/S187706571831409X Permalink : ./index.php?lvl=notice_display&id=84128 [article] Does botulinum toxin treatment improve upper limb active function? [texte imprimé] / Jonathan Lévy . - 2019 . - p. 234-240. https://doi.org/10.1016/j.rehab.2018.05.1320 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 234-240 Mots-clés : Spasticity  Botulinum toxin  Rehabilitation  Outcome  Upper limb  Stroke Résumé : Background Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial. Objective We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials. Methods We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors’ expertise. The review focused on stroke-related spasticity and disability. Results Patients’ therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection. Conclusion BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies’ endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections. En ligne : https://www.sciencedirect.com/science/article/pii/S187706571831409X Permalink : ./index.php?lvl=notice_display&id=84128

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Immunogenicity induced by botulinum toxin injections for limb spasticity: A systematic review / Laure Mathevon in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 241-251 Titre : Immunogenicity induced by botulinum toxin injections for limb spasticity: A systematic review Type de document : texte imprimé Auteurs : Laure Mathevon ; Arnaud Declemy ; Isabelle Laffont ; Dominic Pérennou Année de publication : 2019 Article en page(s) : p. 241-251 Note générale : doi.org/10.1016/j.rehab.2019.03.004 Langues : Anglais (eng) Mots-clés : Limb spasticity  Botulinum toxin  Immunogenicity  Resistance to treatment  Neutralizing antibody Résumé : Background The imputability of neutralizing antibodies (NABs) in secondary non-response (SnR) to botulinum toxin (BoNT) injections for limb spasticity is still debated. Objective This systematic literature review aimed to determine the prevalence of NABs after BoNT injections for limb spasticity and analyze their determinants and their causal role in SnR. Methods We searched MEDLINE via PubMed, Cochrane and Embase databases for articles published during 1990–2018. Two independent reviewers extracted the data and assessed the quality of studies with a specific scale (according to PRISMA and STROBE guidelines). Because the techniques used to detect NABs did not influence the results, we calculated the global (all studies) sensitivity and specificity of NAB positivity to reveal SnR. Results We included 14 articles published from 2002 to 2018 (including an epublication) describing 5 randomized controlled trials and 5 interventional and 4 observational studies. The quality was satisfactory (mean score 18/28 arbitrary units). NAB detection was the primary criterion in 5 studies and a secondary criterion in 9. In total, 1234 serum samples for 1234 participants (91% with stroke) were tested after injection. NAB prevalence was about 1%, with no significant difference among formulations. NAB positivity seemed favoured by long-duration therapy with high doses and a short interval between injections. The identification of non-response by NAB positivity had poor global sensitivity (56%) but very high specificity (99.6%). No consensual criteria were used to diagnose non-response to BoNT injection. Conclusions NAB prevalence is much lower after BoNT treatment for limb spasticity than cervical dystonia. Consensual criteria must be defined to diagnose non-response to BoNT injection. Because immunogenicity is not the most common cause of non-response to BoNT injection, NABs should be sought in individuals with SnR with no other cause explaining the treatment inefficacy. A test with 100% specificity is recommended. In cases for which immunogenicity is the most likely cause of non-response to BoNT injections, some biological arguments suggest trying another BoNT, but no clinical evidence supports this strategy. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300417 Permalink : ./index.php?lvl=notice_display&id=84129 [article] Immunogenicity induced by botulinum toxin injections for limb spasticity: A systematic review [texte imprimé] / Laure Mathevon ; Arnaud Declemy ; Isabelle Laffont ; Dominic Pérennou . - 2019 . - p. 241-251. doi.org/10.1016/j.rehab.2019.03.004 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 241-251 Mots-clés : Limb spasticity  Botulinum toxin  Immunogenicity  Resistance to treatment  Neutralizing antibody Résumé : Background The imputability of neutralizing antibodies (NABs) in secondary non-response (SnR) to botulinum toxin (BoNT) injections for limb spasticity is still debated. Objective This systematic literature review aimed to determine the prevalence of NABs after BoNT injections for limb spasticity and analyze their determinants and their causal role in SnR. Methods We searched MEDLINE via PubMed, Cochrane and Embase databases for articles published during 1990–2018. Two independent reviewers extracted the data and assessed the quality of studies with a specific scale (according to PRISMA and STROBE guidelines). Because the techniques used to detect NABs did not influence the results, we calculated the global (all studies) sensitivity and specificity of NAB positivity to reveal SnR. Results We included 14 articles published from 2002 to 2018 (including an epublication) describing 5 randomized controlled trials and 5 interventional and 4 observational studies. The quality was satisfactory (mean score 18/28 arbitrary units). NAB detection was the primary criterion in 5 studies and a secondary criterion in 9. In total, 1234 serum samples for 1234 participants (91% with stroke) were tested after injection. NAB prevalence was about 1%, with no significant difference among formulations. NAB positivity seemed favoured by long-duration therapy with high doses and a short interval between injections. The identification of non-response by NAB positivity had poor global sensitivity (56%) but very high specificity (99.6%). No consensual criteria were used to diagnose non-response to BoNT injection. Conclusions NAB prevalence is much lower after BoNT treatment for limb spasticity than cervical dystonia. Consensual criteria must be defined to diagnose non-response to BoNT injection. Because immunogenicity is not the most common cause of non-response to BoNT injection, NABs should be sought in individuals with SnR with no other cause explaining the treatment inefficacy. A test with 100% specificity is recommended. In cases for which immunogenicity is the most likely cause of non-response to BoNT injections, some biological arguments suggest trying another BoNT, but no clinical evidence supports this strategy. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300417 Permalink : ./index.php?lvl=notice_display&id=84129

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French clinical guidelines for peripheral motor nerve blocks in a PRM setting / Alain P. Yelnik in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 252-264 Titre : French clinical guidelines for peripheral motor nerve blocks in a PRM setting Type de document : texte imprimé Auteurs : Alain P. Yelnik ; Claire Hentzen ; Philippe Cuvillon ; Etienne Allart ; Isabelle V. Bonan ; François C. Boyer ; Flavia Coroian ; Éric Viel (1931-2008) Année de publication : 2019 Article en page(s) : p. 252-264 Note générale : https://doi.org/10.1016/j.rehab.2019.06.001 Langues : Anglais (eng) Mots-clés : Motor nerve block  Physical and rehabilitation medicine  Spasticity  Rehabilitation Résumé : Introduction Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. Method Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society. Results No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine – up to 2 mg/kg – “check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician”; for ropivacaine – up to 1.5 mg/kg, with a maximum of 100 mg – the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician. Conclusion These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300739 Permalink : ./index.php?lvl=notice_display&id=84130 [article] French clinical guidelines for peripheral motor nerve blocks in a PRM setting [texte imprimé] / Alain P. Yelnik ; Claire Hentzen ; Philippe Cuvillon ; Etienne Allart ; Isabelle V. Bonan ; François C. Boyer ; Flavia Coroian ; Éric Viel (1931-2008) . - 2019 . - p. 252-264. https://doi.org/10.1016/j.rehab.2019.06.001 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 252-264 Mots-clés : Motor nerve block  Physical and rehabilitation medicine  Spasticity  Rehabilitation Résumé : Introduction Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. Method Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society. Results No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine – up to 2 mg/kg – “check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician”; for ropivacaine – up to 1.5 mg/kg, with a maximum of 100 mg – the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician. Conclusion These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065719300739 Permalink : ./index.php?lvl=notice_display&id=84130

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Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews / Fary Khan in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 265-273 Titre : Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews Type de document : texte imprimé Auteurs : Fary Khan ; Bhasker Amatya ; D. Bensmail ; Alain P. Yelnik Année de publication : 2019 Article en page(s) : p. 265-273 Note générale : doi.org/10.1016/j.rehab.2017.10.001 Langues : Anglais (eng) Mots-clés : Spasticity  Non-pharmacological intervention  Rehabilitation  Disability  Impairment  Participation Résumé : Objectives Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes. Methods Data sources: a literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15th June 2017. Data extraction and synthesis: two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Results Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is “moderate” evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care (pharmacological and rehabilitation) in persons following stroke. “Low” quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with MS, vibration therapy for SCI and stretching for other neurological condition. For other interventions, evidence was inconclusive. Conclusions Despite the available range of non-pharmacological interventions for spasticity, there is lack of high-quality evidence for many modalities. Further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065717304153 Permalink : ./index.php?lvl=notice_display&id=84131 [article] Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews [texte imprimé] / Fary Khan ; Bhasker Amatya ; D. Bensmail ; Alain P. Yelnik . - 2019 . - p. 265-273. doi.org/10.1016/j.rehab.2017.10.001 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 265-273 Mots-clés : Spasticity  Non-pharmacological intervention  Rehabilitation  Disability  Impairment  Participation Résumé : Objectives Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes. Methods Data sources: a literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15th June 2017. Data extraction and synthesis: two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Results Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is “moderate” evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care (pharmacological and rehabilitation) in persons following stroke. “Low” quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with MS, vibration therapy for SCI and stretching for other neurological condition. For other interventions, evidence was inconclusive. Conclusions Despite the available range of non-pharmacological interventions for spasticity, there is lack of high-quality evidence for many modalities. Further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065717304153 Permalink : ./index.php?lvl=notice_display&id=84131

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Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis / Ana Paula Salazar in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 274-282 Titre : Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis Type de document : texte imprimé Auteurs : Ana Paula Salazar ; Camila Pinto ; Joao Victor Ruschel Mossi ; Bruno Figueiro ; Janice Luisa Lukrafka ; Aline Souza Pagnussat Année de publication : 2019 Article en page(s) : p. 274-282 Note générale : doi.org/10.1016/j.rehab.2018.11.004 Langues : Anglais (eng) Mots-clés : Physical therapy modalities  Physiotherapy  Muscle stretching exercises  Muscle spasticity  Range of motion  Rehabilitation Résumé : Objective To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke. Methods This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies. Results Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD] = −1.89, 95% confidence interval [CI] −2.44 to −1.34; I2 79%, P < 0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD = 3.50, 95% CI −3.45 to 10.45; I2 54.7%, P = 0.32), shoulder flexion (MD = −1.20, 95% CI −8.95 to 6.55; I2 0%, P = 0.76) or wrist extension (MD = −0.32, 95% CI −6.98 to 5.75; I2 38.5%, P = 0.92). No data were available concerning the mobility of other joints. Conclusion This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314970 Permalink : ./index.php?lvl=notice_display&id=84132 [article] Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis [texte imprimé] / Ana Paula Salazar ; Camila Pinto ; Joao Victor Ruschel Mossi ; Bruno Figueiro ; Janice Luisa Lukrafka ; Aline Souza Pagnussat . - 2019 . - p. 274-282. doi.org/10.1016/j.rehab.2018.11.004 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 274-282 Mots-clés : Physical therapy modalities  Physiotherapy  Muscle stretching exercises  Muscle spasticity  Range of motion  Rehabilitation Résumé : Objective To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke. Methods This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies. Results Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD] = −1.89, 95% confidence interval [CI] −2.44 to −1.34; I2 79%, P < 0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD = 3.50, 95% CI −3.45 to 10.45; I2 54.7%, P = 0.32), shoulder flexion (MD = −1.20, 95% CI −8.95 to 6.55; I2 0%, P = 0.76) or wrist extension (MD = −0.32, 95% CI −6.98 to 5.75; I2 38.5%, P = 0.92). No data were available concerning the mobility of other joints. Conclusion This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed. 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Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review / L. Mathevon in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 283-290 Titre : Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review Type de document : texte imprimé Auteurs : L. Mathevon ; Isabelle V. Bonan ; J.-L. Barnais ; Mickael Dinomais Année de publication : 2019 Article en page(s) : p. 283-290 Note générale : doi.org/10.1016/j.rehab.2018.06.010 Langues : Anglais (eng) Mots-clés : Spasticity  Cerebral palsy  Botulinum toxin  Casting  Rehabilitation programme Résumé : Background Botulinum toxin (BTX) injection alone is not sufficient to treat spasticity in children, notably those with cerebral palsy; thus, there is an emerging trend for adjunct therapies to offer greater outcomes than BTX alone. Objective The aim of this systematic review was to evaluate the general effectiveness of adjunct therapies regardless of their nature in children with spasticity. Methods Medline, Cochrane and Embase databases were searched from January 1980 to March 15, 2018 for reports of parallel-group trials (randomized controlled trials [RCTs] and non-RCTs) assessing adjunct therapies after BTX injection for treating spasticity in children. Two independent reviewers extracted data and assessed the risk of bias by using the PEDro scale for RCTs and Downs and Black scale (D&B) for non-RCTs. Results Overall, 20 articles involving 662 participants met the inclusion criteria. The average quality was good for the 16 RCTs (mean PEDro score 7.4 [SD 1.6]) and poor to moderate for the 4 non-RCTs (D&B score 9 to 17). Adjunct therapies consisted of casting/posture, electrical stimulation, resistance training and rehabilitation programmes. Casting associated with BTX injection improved the range of passive and active motion and reduced spasticity better than did BTX alone (9 studies), with a follow-up of 1 year. Resistance training enhanced the quality and performance of muscles without increasing spasticity. Only 3 rehabilitation programmes were studied, with encouraging results for activities. Conclusion Lower-limb posture with casting in children has a high level of evidence, but the long-term efficacy of short-leg casting needs to be evaluated. A comparison between the different modalities of casting is missing, and studies specifically devoted to testing the different kinds of casting are needed. Moreover, the delay to casting after BTX injection is not clear. Data on electrical stimulation are not conclusive. Despite the small number of studies, resistance training could be an interesting adjunct therapy notably to avoid loss of strength after BTX injection. Rehabilitation programmes after BTX injection still need to be evaluated. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314301 Permalink : ./index.php?lvl=notice_display&id=84133 [article] Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review [texte imprimé] / L. Mathevon ; Isabelle V. Bonan ; J.-L. Barnais ; Mickael Dinomais . - 2019 . - p. 283-290. doi.org/10.1016/j.rehab.2018.06.010 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 283-290 Mots-clés : Spasticity  Cerebral palsy  Botulinum toxin  Casting  Rehabilitation programme Résumé : Background Botulinum toxin (BTX) injection alone is not sufficient to treat spasticity in children, notably those with cerebral palsy; thus, there is an emerging trend for adjunct therapies to offer greater outcomes than BTX alone. Objective The aim of this systematic review was to evaluate the general effectiveness of adjunct therapies regardless of their nature in children with spasticity. Methods Medline, Cochrane and Embase databases were searched from January 1980 to March 15, 2018 for reports of parallel-group trials (randomized controlled trials [RCTs] and non-RCTs) assessing adjunct therapies after BTX injection for treating spasticity in children. Two independent reviewers extracted data and assessed the risk of bias by using the PEDro scale for RCTs and Downs and Black scale (D&B) for non-RCTs. Results Overall, 20 articles involving 662 participants met the inclusion criteria. The average quality was good for the 16 RCTs (mean PEDro score 7.4 [SD 1.6]) and poor to moderate for the 4 non-RCTs (D&B score 9 to 17). Adjunct therapies consisted of casting/posture, electrical stimulation, resistance training and rehabilitation programmes. Casting associated with BTX injection improved the range of passive and active motion and reduced spasticity better than did BTX alone (9 studies), with a follow-up of 1 year. Resistance training enhanced the quality and performance of muscles without increasing spasticity. Only 3 rehabilitation programmes were studied, with encouraging results for activities. Conclusion Lower-limb posture with casting in children has a high level of evidence, but the long-term efficacy of short-leg casting needs to be evaluated. A comparison between the different modalities of casting is missing, and studies specifically devoted to testing the different kinds of casting are needed. Moreover, the delay to casting after BTX injection is not clear. Data on electrical stimulation are not conclusive. Despite the small number of studies, resistance training could be an interesting adjunct therapy notably to avoid loss of strength after BTX injection. Rehabilitation programmes after BTX injection still need to be evaluated. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314301 Permalink : ./index.php?lvl=notice_display&id=84133

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Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature / Alessandro Picelli in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 291-296 Titre : Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature Type de document : texte imprimé Auteurs : Alessandro Picelli ; Andrea Santamato ; Elena Chemello ; Nicoletta Cinone ; Carlo Cisari ; Marialuisa Gandolfi ; Maurizio Ranieri ; Alessio Baricich Année de publication : 2019 Article en page(s) : p. 291-296 Note générale : doi.org/10.1016/j.rehab.2018.08.004 Langues : Anglais (eng) Mots-clés : Botulinum toxins  Muscle spasticity  Physical therapy modalities  Rehabilitation Résumé : Background and objective A wide range of adjunct therapies after botulinum toxin administration have been proposed. The aim of the present paper is to provide an overview of major writings dealing with adjuvant (non-pharmacological) treatments associated with botulinum toxin for managing spasticity in order to provide some up-to-date information about the usefulness of the most commonly used procedures. Methods The literature in PubMed was searched with the MeSH terms botulinum toxins, muscle spasticity, physical therapy modalities, and rehabilitation. The results were limited to studies focusing on adjuvant treatments associated with botulinum toxin for managing spasticity. We excluded papers on the use of non-drug treatments for spasticity not associated with botulinum toxin serotype A (BoNT-A) injection. Relevant literature known to the authors along with this complementary search represented the basis for this overview of the literature. Results Adhesive taping and casting effectively improved the botulinum toxin effect in patients with upper- and lower-limb spasticity. There is level 1 evidence that casting is better than taping for outcomes including spasticity, range of motion and gait. However, consensus about their most appropriate timing, duration, target and material is lacking. In terms of physical modalities combined with botulinum toxin injection, we found level 1 evidence that extracorporeal shock wave therapy is better than electrical stimulation for some post-injection outcomes including spasticity and pain. Furthermore, electrical stimulation of injected muscles might be useful to boost the toxin effect. However, the best stimulation protocol has not been defined. In addition, we found level 2b evidence that whole-body vibration therapy might reduce spasticity with cerebral palsy. Conclusion Future research in this field should focus on investigating the most appropriate post-injection treatment protocol for each goal to achieve. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314453 Permalink : ./index.php?lvl=notice_display&id=84134 [article] Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature [texte imprimé] / Alessandro Picelli ; Andrea Santamato ; Elena Chemello ; Nicoletta Cinone ; Carlo Cisari ; Marialuisa Gandolfi ; Maurizio Ranieri ; Alessio Baricich . - 2019 . - p. 291-296. doi.org/10.1016/j.rehab.2018.08.004 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 291-296 Mots-clés : Botulinum toxins  Muscle spasticity  Physical therapy modalities  Rehabilitation Résumé : Background and objective A wide range of adjunct therapies after botulinum toxin administration have been proposed. The aim of the present paper is to provide an overview of major writings dealing with adjuvant (non-pharmacological) treatments associated with botulinum toxin for managing spasticity in order to provide some up-to-date information about the usefulness of the most commonly used procedures. Methods The literature in PubMed was searched with the MeSH terms botulinum toxins, muscle spasticity, physical therapy modalities, and rehabilitation. The results were limited to studies focusing on adjuvant treatments associated with botulinum toxin for managing spasticity. We excluded papers on the use of non-drug treatments for spasticity not associated with botulinum toxin serotype A (BoNT-A) injection. Relevant literature known to the authors along with this complementary search represented the basis for this overview of the literature. Results Adhesive taping and casting effectively improved the botulinum toxin effect in patients with upper- and lower-limb spasticity. There is level 1 evidence that casting is better than taping for outcomes including spasticity, range of motion and gait. However, consensus about their most appropriate timing, duration, target and material is lacking. In terms of physical modalities combined with botulinum toxin injection, we found level 1 evidence that extracorporeal shock wave therapy is better than electrical stimulation for some post-injection outcomes including spasticity and pain. Furthermore, electrical stimulation of injected muscles might be useful to boost the toxin effect. However, the best stimulation protocol has not been defined. In addition, we found level 2b evidence that whole-body vibration therapy might reduce spasticity with cerebral palsy. Conclusion Future research in this field should focus on investigating the most appropriate post-injection treatment protocol for each goal to achieve. 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Does acupuncture help patients with spasticity? A narrative review / Yi Zhu in Annals of physical and rehabilitation medicine, Vol. 62, n°4 (Juillet 2019)  

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 297-301 Titre : Does acupuncture help patients with spasticity? A narrative review Type de document : texte imprimé Auteurs : Yi Zhu ; Yujie Yang ; Jianan Li Année de publication : 2019 Article en page(s) : p. 297-301 Note générale : doi.org/10.1016/j.rehab.2018.09.010 Langues : Anglais (eng) Mots-clés : Spasticity  Upper motor neuron lesion  Acupuncture  Evidence  Stroke Résumé : Spasticity is a motor disorder encountered after upper motor neuron lesions. It adversely affects quality of life in most patients and causes long-term burden of care and has significant financial implications. The effect of conventional therapies for spasticity including physical therapy, surgery, and pharmacotherapy are not always satisfying because of the short-term effects or side effects in some patients. Acupuncture is a part of traditional medicine originating from China. It has been used to resolve functional recovery problems after central nervous system injury for many years in Asian countries and is increasingly popular in western countries. Some researches suggest that acupuncture has therapeutic potential to help improve limb movement function and decrease the severity of spasticity. This review synthesizes studies involving stroke, brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis to give an overall picture of the effect and potential mechanisms of acupuncture on spasticity occurring after upper motor neuron lesions. Moderate-quality evidence suggests that electroacupuncture combined with conventional routine care (pharmacological/rehabilitation) could reduce spasticity and improve motor function and activities in daily living after stroke. However, there is not enough evidence to conclude that acupuncture (including electroacupuncture) could reduce spasticity with other central nervous system diseases. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314775 Permalink : ./index.php?lvl=notice_display&id=84135 [article] Does acupuncture help patients with spasticity? A narrative review [texte imprimé] / Yi Zhu ; Yujie Yang ; Jianan Li . - 2019 . - p. 297-301. doi.org/10.1016/j.rehab.2018.09.010 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 62, n°4 (Juillet 2019) . - p. 297-301 Mots-clés : Spasticity  Upper motor neuron lesion  Acupuncture  Evidence  Stroke Résumé : Spasticity is a motor disorder encountered after upper motor neuron lesions. It adversely affects quality of life in most patients and causes long-term burden of care and has significant financial implications. The effect of conventional therapies for spasticity including physical therapy, surgery, and pharmacotherapy are not always satisfying because of the short-term effects or side effects in some patients. Acupuncture is a part of traditional medicine originating from China. It has been used to resolve functional recovery problems after central nervous system injury for many years in Asian countries and is increasingly popular in western countries. Some researches suggest that acupuncture has therapeutic potential to help improve limb movement function and decrease the severity of spasticity. This review synthesizes studies involving stroke, brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis to give an overall picture of the effect and potential mechanisms of acupuncture on spasticity occurring after upper motor neuron lesions. Moderate-quality evidence suggests that electroacupuncture combined with conventional routine care (pharmacological/rehabilitation) could reduce spasticity and improve motor function and activities in daily living after stroke. However, there is not enough evidence to conclude that acupuncture (including electroacupuncture) could reduce spasticity with other central nervous system diseases. En ligne : https://www.sciencedirect.com/science/article/pii/S1877065718314775 Permalink : ./index.php?lvl=notice_display&id=84135

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