scholarly journals Effect of Robot-assisted Rehabilitation to Botulinum Toxin A Injection for Upper Limb Disability in Patients with Chronic Stroke: A Case Series and Systematic Review

2021 ◽  
Author(s):  
Koichi HYAKUTAKE ◽  
Takashi MORISHITA ◽  
Kazuya SAITA ◽  
Hiroyuki FUKUDA ◽  
Hiroshi ABE ◽  
...  
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Case Series ◽  
Chronic Stroke ◽  
Robot Assisted ◽  
Toxin A

scholarly journals Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 556-562
Author(s):  
Natasha A. Lannin ◽  
Louise Ada ◽  
Coralie English ◽  
Julie Ratcliffe ◽  
Steven G. Faux ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Goal Attainment ◽  
Botulinum Toxin A ◽  
Chronic Stroke ◽  
Mean Difference ◽  
Control Group ◽  
Toxin A ◽  
Upper Limb Rehabilitation ◽  
Experimental Group

Background and Purpose— The aim of this trial was to determine the effect of additional upper limb rehabilitation following botulinum toxin-A for upper limb activity in chronic stroke. Methods— We conducted a multicenter phase III randomized trial with concealed allocation, blinded measurement, and intention-to-treat analysis. One hundred forty stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke >3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scaling) and upper limb activity (Box and Block Test) at 3 months (end of intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. Results— In terms of goal attainment, the experimental group scored the same (mean difference, 2 T-score [95% CI, −2 to 7]) as the control group on the Goal Attainment Scale. In terms of upper limb activity, by 3 months the experimental group moved blocks at the same speed (mean difference, 0.00 blocks/s [95% CI, −0.02 to 0.01]) as the control group on the Box and Block Test. There were no differences between groups on any secondary outcome except strength, in favor of the experimental group (mean difference, 1.4 kg [95% CI, 0.2–2.7]). Conclusions— Findings suggest that additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not effective. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: ACTRN12615000616572.

scholarly journals Upper limb motor improvement in chronic stroke after combining botulinum toxin A injection and multi-joints robot-assisted therapy: a case report

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Alex Martino Cinnera ◽  
Alessandra Pucello ◽  
Alessandro Lupo ◽  
Francesca Gimigliano ◽  
Elisa Mammucari ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Daily Living ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Chronic Stroke ◽  
Robot Assisted ◽  
Robotic Therapy ◽  
Motor Improvement

Abstract Spasticity is one of the major complications after stroke. Botulinum toxin type A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve activities of daily living function of paretic arm. The recovery of functions of the affected arm is also the aim of robotic upper limb (UL) therapy. The motorized exoskeleton assists the patient in a large 3D work environment by promoting movement for the UL (shoulder, elbow, wrist, hand). The combination of the BoNT-A injection and the robotic therapy might enhance functional recovery after stroke. We reported the case of a chronic stroke patient in which the injection of BoNT-A was combined with multi-joint exoskeleton training. The patient showed improvement in the motor control of the UL, supporting the feasibility of this approach.

scholarly journals The efficacy of Botulinum Toxin A on improving ease of care in the upper and lower limbs: a systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation approach

2014 ◽  
Vol 29 (8) ◽  
pp. 731-740 ◽  
Author(s):  
Jennifer A Baker ◽  
Gavin Pereira
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Upper Limb ◽  
Lower Limb ◽  
Botulinum Toxin A ◽  
Meta Analysis ◽  
Lower Limbs ◽  
Toxin A ◽  
Assessment Development ◽  
Evidence Quality

Objectives: A systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach; evaluating Botulinum Toxin type A efficacy on improving ease of care in the upper/lower limb. Data sources: Pubmed, Cinahl, Amed, Embase and Cochrane databases. English Language. Search to July 2014. Review methods: All randomized, placebo controlled trials on adults with difficulty in caring for the upper/lower limb resulting from spasticity of any origin and treated with a single dose of Botulinum Toxin A. Evidence quality was assessed by GRADE. Results: A total of 32 studies were reviewed. Meta-analysis was carried out on 11 upper limb and three lower limb studies. Evidence quality for the upper limb was moderate. A significant result for Botulinum Toxin A was found at four to 12 weeks for the upper limb (SMD 0.80, CI 0.55, 1.06, p < 0.0001). The effects were maintained for up to six months (SMD 0.48, CI 0.34, 0.62, p < 0.0001). Evidence quality was very low for the lower limb. Meta-analysis was only possible for global assessment of benefit. No significant effect was found. (Patient: RR 1.37 CI (0.94, 2.00) p = 0.11; clinician: RR 1.06 (0.84, 1.34) p = 0.60.) Conclusion: Botulinum Toxin A improves ease of care in the upper limb for up to six months. No conclusion can be drawn for the lower limb.

Effects of robot-assisted gait training in chronic stroke patients treated by botulinum toxin-a: A pivotal study

2018 ◽  
Vol 23 (3) ◽  
pp. e1718 ◽  
Author(s):  
Dursun Erbil ◽  
Gokbel Tugba ◽  
Topcu Hasan Murat ◽  
Akarsu Melike ◽  
Akyüz Merve ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Toxin A ◽  
Pivotal Study

scholarly journals Intramuscular Botulinum Toxin A (BtxA) in Complex Regional Pain Syndrome

2011 ◽  
Vol 3;14 (3;5) ◽  
pp. 311-316
Author(s):  
Robert Schwartzman
Keyword(s):  
Botulinum Toxin ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Case Series ◽  
Pain Syndrome ◽  
Control Group ◽  
Retrospective Case ◽  
Toxin A

Background: Pain associated with complex regional pain syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. Objectives: To assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment. Study Design: Retrospective chart review. Setting: Outpatient clinic. Methods: Patients: 37 patients with spasm/dystonia in the neck and/or upper limb girdle muscles. Intervention: Electromyography-guided injection of botulinum toxin A (BtxA), 10-20 U per muscle. Total dose used was 100 U in each patient. Measurement: Local pain score on an 11 point Likert scale, 4 weeks after BtxA injections. Results: Mean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). Ninetyseven percent of the patients had significant pain relief. One patient had transient neck drop after the injections. Limitations: This is a retrospective study; it lacks a control group and therefore the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks. Conclusion(s): Intramuscular injection of botulinum toxin A in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS in this retrospective case series. The incidence of complications was low (2.7%) Key words: Complex regional pain syndrome, botulinum toxin, spasm, dystonia

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