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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Effects of robotic gait training after stroke : A meta-analysis / Geoffroy Moucheboeuf in Annals of physical and rehabilitation medicine, Vol. 63, n°6 (November 20)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 63, n°6 (November 20) . - p. 518-534 Titre : Effects of robotic gait training after stroke : A meta-analysis Type de document : texte imprimé Auteurs : Geoffroy Moucheboeuf ; Romain Griffier ; David Gasq ; Bertrand Glize ; Laurent Bouyer ; Patrick Dehail ; Hélène Cassoudesalle Année de publication : 2020 Article en page(s) : p. 518-534 Note générale : doi.org/10.1016/j.rehab.2020.02.008 Langues : Anglais (eng) Mots-clés : Stroke  Robot-assisted gait training  Exoskeleton  End-effector  Gait  Walking  Rehabilitation Résumé : Background Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. Objective First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. Methods All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. Results We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09 m/s, 95% confidence interval [CI] 0.03 to 0.15; p = 0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p = 0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p = 0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. Conclusions Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke. Permalink : ./index.php?lvl=notice_display&id=91465 [article] Effects of robotic gait training after stroke : A meta-analysis [texte imprimé] / Geoffroy Moucheboeuf ; Romain Griffier ; David Gasq ; Bertrand Glize ; Laurent Bouyer ; Patrick Dehail ; Hélène Cassoudesalle . - 2020 . - p. 518-534. doi.org/10.1016/j.rehab.2020.02.008 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 63, n°6 (November 20) . - p. 518-534 Mots-clés : Stroke  Robot-assisted gait training  Exoskeleton  End-effector  Gait  Walking  Rehabilitation Résumé : Background Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke. Objective First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses. Methods All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment. Results We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09 m/s, 95% confidence interval [CI] 0.03 to 0.15; p = 0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p = 0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p = 0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies. Conclusions Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke. Permalink : ./index.php?lvl=notice_display&id=91465

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Five-day course of paired associative stimulation fails to improve motor function in stroke patients / Mohamed Tarri in Annals of physical and rehabilitation medicine, Vol. 61, n°2 (Mars 2018)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 61, n°2 (Mars 2018) . - p. 78-84 Titre : Five-day course of paired associative stimulation fails to improve motor function in stroke patients Type de document : texte imprimé Auteurs : Mohamed Tarri ; Nabila Brimhat ; David Gasq ; Benoît Lepage ; Isabelle Loubinoux ; Xavier De Boissezon ; P. Marque ; Evelyne Castel-Lacanal Année de publication : 2018 Article en page(s) : p. 78-84 Note générale : Doi : 10.1016/j.rehab.2017.11.002 Langues : Anglais (eng) Mots-clés : Paired associative stimulation  Stroke  Transcranial magnetic stimulation  Cortical plasticity, Recovery Résumé : Background Non-invasive brain stimulation has been studied as a therapeutic adjunct for upper-limb recovery in patients with stroke. One type of stimulation, paired associative stimulation (PAS), has effects on plasticity in both patients and healthy participants. Lasting several hours, these effects are reversible and topographically specific. Objective The goal was to investigate the presence of a lasting increase in motor cortex plasticity for extensor wrist muscles — extensor carpi radialis (ECR) — and an improvement in upper-limb function after 5 days of daily PAS in patients at the subacute post-stroke stage. Methods A total of 24 patients (mean [SD] age 50.1 [12.1] years, weeks since stroke 10.1 [5.3]) were included in a double-blind, placebo-controlled trial and randomly assigned to the PAS or sham group (n=13 and n=11). For the PAS group, patients underwent a 5-day course of electrical peripheral stimulation combined with magnetic cortical stimulation applied to the ECR muscle in a single daily session at 0.1Hz for 30min; patients with sham treatment received minimal cortical stimulation. Both patient groups underwent 2 hr of conventional physiotherapy. Variations in the motor evoked potential (MEP) surface area of the ECR muscle and Fugl–Meyer Assessment–Upper-Limb motor scores were analysed up to day 12. Results The 2 groups did not differ in electrophysiological or motor parameters. Repeated PAS sessions seemed to affect only patients with low initial cortical excitability. We found considerable variability in PAS effects between patients and across the sessions. Conclusion We failed to induce a lasting effect with PAS in the present study. PAS does not seem to be the main method for post-stroke brain stimulation. Perhaps recruitment of patients could be more selective, possibly targeting those with a wide altered ipsilesional corticomotor pathway. Permalink : ./index.php?lvl=notice_display&id=80450 [article] Five-day course of paired associative stimulation fails to improve motor function in stroke patients [texte imprimé] / Mohamed Tarri ; Nabila Brimhat ; David Gasq ; Benoît Lepage ; Isabelle Loubinoux ; Xavier De Boissezon ; P. Marque ; Evelyne Castel-Lacanal . - 2018 . - p. 78-84. Doi : 10.1016/j.rehab.2017.11.002 Langues : Anglais (eng) in Annals of physical and rehabilitation medicine > Vol. 61, n°2 (Mars 2018) . - p. 78-84 Mots-clés : Paired associative stimulation  Stroke  Transcranial magnetic stimulation  Cortical plasticity, Recovery Résumé : Background Non-invasive brain stimulation has been studied as a therapeutic adjunct for upper-limb recovery in patients with stroke. One type of stimulation, paired associative stimulation (PAS), has effects on plasticity in both patients and healthy participants. Lasting several hours, these effects are reversible and topographically specific. Objective The goal was to investigate the presence of a lasting increase in motor cortex plasticity for extensor wrist muscles — extensor carpi radialis (ECR) — and an improvement in upper-limb function after 5 days of daily PAS in patients at the subacute post-stroke stage. Methods A total of 24 patients (mean [SD] age 50.1 [12.1] years, weeks since stroke 10.1 [5.3]) were included in a double-blind, placebo-controlled trial and randomly assigned to the PAS or sham group (n=13 and n=11). For the PAS group, patients underwent a 5-day course of electrical peripheral stimulation combined with magnetic cortical stimulation applied to the ECR muscle in a single daily session at 0.1Hz for 30min; patients with sham treatment received minimal cortical stimulation. Both patient groups underwent 2 hr of conventional physiotherapy. Variations in the motor evoked potential (MEP) surface area of the ECR muscle and Fugl–Meyer Assessment–Upper-Limb motor scores were analysed up to day 12. Results The 2 groups did not differ in electrophysiological or motor parameters. Repeated PAS sessions seemed to affect only patients with low initial cortical excitability. We found considerable variability in PAS effects between patients and across the sessions. Conclusion We failed to induce a lasting effect with PAS in the present study. PAS does not seem to be the main method for post-stroke brain stimulation. Perhaps recruitment of patients could be more selective, possibly targeting those with a wide altered ipsilesional corticomotor pathway. Permalink : ./index.php?lvl=notice_display&id=80450

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Post-stroke hemiplegia rehabilitation: Evolution of the concepts / P. Marque in Annals of physical and rehabilitation medicine, Vol. 57, n°8 (Novembre 2014)

Public ISBD [article]  inAnnals of physical and rehabilitation medicine > Vol. 57, n°8 (Novembre 2014) . - p.520-529 Titre : Post-stroke hemiplegia rehabilitation: Evolution of the concepts Titre original : Rééducation de l’hémiplégie vasculaire : évolution des concepts Type de document : texte imprimé Auteurs : P. Marque, Auteur ; David Gasq, Auteur Année de publication : 2014 Article en page(s) : p.520-529 Langues : Français (fre) Mots-clés : Stroke  Rehabilitation  Neuroimaging  Hemiplegic  Plasticity  AVC  Rééducation  Imagerie fonctionnelle  Hémiplégique  Plasticité Résumé : Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of post-stroke rehabilitation to stimulate recovery, but the concepts of empirical methods originally proposed by therapists to rehabilitate these patients have not withstood clinical analysis. Functional neuroimaging and animal models have unveiled the mechanisms underlying functional recovery and helped teams understand its limitations and improvement modalities. These neuroscience discoveries constitute the grounds needed to understand the emergence of new technologies: robotics and virtual reality. The objective of this review of the literature was to select key works in this field to better understand current therapeutic possibilities. La réadaptation des patients victimes d’AVC a connu une véritable révolution au cours des 3 dernières décennies. Les études de cohortes ont toujours souligné l’intérêt de la réadaptation après un AVC pour stimuler la récupération, mais les concepts des méthodes empiriques initialement proposées par les thérapeutes pour rééduquer ces patients n’ont pas résisté à l’analyse clinique critique. Parallèlement, les travaux de neuroimagerie fonctionnelle et les modèles animaux ont permis tout d’abord d’objectiver les mécanismes de la récupération fonctionnelle, puis d’en comprendre les limites ainsi que les modalités d’amélioration. Ces découvertes des neurosciences sont les bases sans lesquelles on ne peut pas comprendre l’apparition des nouvelles technologies : robotique et réalité virtuelle. Cette revue de la littérature se propose de faire une sélection de ces travaux clés qui permettent de mieux comprendre les propositions actuelles. Permalink : ./index.php?lvl=notice_display&id=34536 [article] Post-stroke hemiplegia rehabilitation: Evolution of the concepts = Rééducation de l’hémiplégie vasculaire : évolution des concepts [texte imprimé] / P. Marque, Auteur ; David Gasq, Auteur . - 2014 . - p.520-529. Langues : Français (fre) in Annals of physical and rehabilitation medicine > Vol. 57, n°8 (Novembre 2014) . - p.520-529 Mots-clés : Stroke  Rehabilitation  Neuroimaging  Hemiplegic  Plasticity  AVC  Rééducation  Imagerie fonctionnelle  Hémiplégique  Plasticité Résumé : Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of post-stroke rehabilitation to stimulate recovery, but the concepts of empirical methods originally proposed by therapists to rehabilitate these patients have not withstood clinical analysis. Functional neuroimaging and animal models have unveiled the mechanisms underlying functional recovery and helped teams understand its limitations and improvement modalities. These neuroscience discoveries constitute the grounds needed to understand the emergence of new technologies: robotics and virtual reality. The objective of this review of the literature was to select key works in this field to better understand current therapeutic possibilities. La réadaptation des patients victimes d’AVC a connu une véritable révolution au cours des 3 dernières décennies. Les études de cohortes ont toujours souligné l’intérêt de la réadaptation après un AVC pour stimuler la récupération, mais les concepts des méthodes empiriques initialement proposées par les thérapeutes pour rééduquer ces patients n’ont pas résisté à l’analyse clinique critique. Parallèlement, les travaux de neuroimagerie fonctionnelle et les modèles animaux ont permis tout d’abord d’objectiver les mécanismes de la récupération fonctionnelle, puis d’en comprendre les limites ainsi que les modalités d’amélioration. Ces découvertes des neurosciences sont les bases sans lesquelles on ne peut pas comprendre l’apparition des nouvelles technologies : robotique et réalité virtuelle. Cette revue de la littérature se propose de faire une sélection de ces travaux clés qui permettent de mieux comprendre les propositions actuelles. Permalink : ./index.php?lvl=notice_display&id=34536

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