Posts Tagged ‘Spasticity’

Post-stroke spasticity Management

An estimated 16 million people worldwide experience first-time strokes each yea. Of these two-thirds of stroke patients are younger than 70 years of age. Stroke is therefore a leading cause of disability in adults with functional movement disability being caused by spasticity, cognitive impairment, paresis, and depression. Disabling spasticity is defined as spasticity that is severe enough to require intervention. This post-stroke spasticity  occurs in 4% of stroke survivors within 1 year of first-time stroke. Post-stroke spasticity – PSS management and rehabilitation  is discussed in Acta Neurologica Scandinavica, 05/07/2013  by Sunnerhagen KS et al. from the Institute of Neuroscience and Physiology – Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Göteborg, Sweden.


Chronic pain syndromes after ischemic stroke

Chronic pain syndromes after ischemic stroke and are associated with increased functional dependence and cognitive decline.

Writing in Stroke, 05/01/2013 O’Donnell MJ et al from McMaster University Ontario,Canada looks at a large cohort with ischemic stroke. Of these stroke patients ~ 11% reported new chronic post stroke pain, with 3% central post stroke pain and 1.5% with peripheral neuropathic pain and 1.3% with pain from spasticity. The group concluded that Chronic pain syndromes after ischemic stroke and are associated with increased functional dependence and cognitive decline.


Post stroke treatment with botulinum toxin improves upper-extremity function

Writing in Archives of Physical Medicine Rehabilitation Dr. Foley and his team discuss that evidence from the literature shows that botulinum toxin type A (BTX-A) is associated with improvements in activity capacity or performance associated with poststroke spasticity in the upper extremity. Dr Foley and his team of physical and occupational therapists work at the Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital London, Ontario, Canada.

Using Patient Goals in Treatment More Effective in Results

Brasilia, Brazil — It was found in a recent study that stroke patients found greater satisfaction if their progress was assessed on the basis of patient-specified goals.

According to Lisa Shaw, MD, senior research associate, Institute for Ageing and Health in Newcastle University in Newcastle upon Tyne, United Kingdom, one third of patient-driven goals was bimanual, i.e. assessing the function of both hands, which may have been the reason for  better outcomes than standard measures which may have missed that.

Using botulinum toxin-A (BT) in conjunction with a standard upper-limb therapy program, it was found that on objective measures of arm function following a stroke, neither therapy showed improved function after 1 month. However, patients stated they were equally satisfied with either therapy if satisfaction was based on attainment of goals that they had chosen themselves.

The original BT for Upper Limb after stroke  trial compared upper-limb therapy alone with therapy plus BT, It was found that using BT improved muscle tone after 1 month and a longer-term, arm strength, basic arm function tasks  and pain. But it didn’t improve arm function overall. BT has increasingly been used to reduce spasticity.

The investigators then asked the patients which therapy goals they would choose and how attainment of those goals compared with outcomes on a standard arm function test. They designed a  controlled, randomized clinical trial with (blinded) observers to look at arm function according to the Action Research Arm Test (ARAT), which consists of grip, grasp, pinch, and gross movement assessments vs patient-specified goal attainment, as assessed by COPM, the Canadian Occupational Performance Measure  which involves performance and satisfaction.

Participants were adults with upper-limb spasticity and reduced function at least 1 month after stroke. The average age was 68 years. 65% to 71% of patients were men and about 82% of participants had had a thrombotic stroke.

The interventions consisted of a 1-month upper-limb therapy program for 1 hour twice weekly with  or without  BT, when  outcomes were assessed. BT was injected into muscles of the hand, wrist, elbow, or shoulder depending the individual patterns of spasticity.

Treatments were focused on four set goals and one optional goal within the COPM. The focus was on passive, stretching; active assisted upper-limb movement; positioning; hygiene  and intensive task-oriented practice for ARAT.

The most commonly selected goals — about 90% of each group — were washing, dressing, eating and drinking. Participants chose goals of self-care (65%); productivity i.e. working in the kitchen, managing the household, going to school, playing or writing (19%); and leisure activities (16%). One third of the goals were bimanual tasks.

After 1 month, there were no  differences in the degree of improvement between the BT and the control groups. No change from baseline  on the ARAT occurred in either group.

Dr. Shaw said that despite the finding that BT did not enhance goal attainment or arm function compared with standard upper-limb therapy alone, both the BT and control groups had  relevant improvements of greater than 2 points on the COPM. ARAT measures are mostly unimanual, however many COPM measures involve both  the hands and arms. Dr. Shaw said the study shows the importance of including patient-specified goals when studying  rehabilitation.

Werner Hacke, MD, PhD, MPsych, professor and chairman of the Department of Neurology at the University of Heidelberg, Germany, agreed, saying “It is about caring about the patient, and I believe it doesn’t matter what you do, if you care and you have a positive psychological impact on the patients, they will benefit, and they feel better. This is what is probably the most important thing about early rehabilitation — spending time with the patient, independent of what you do.”

He added that there is no proof that one or another physical therapy approach is better than another.

In stroke recovery finding the right physical therapy solution is vital. The TUTOR system of products provide an innovative method of providing an intensive exercise regimen to stroke survivors in rehabilitation of their affected limbs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomically designed gloves and braces that consist of sensors connected to dedicated software. Physical and occupational therapists monitor the patient’s movement ability and then design a customized exercise program for that patient.

Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are available for adults as well as children from the age of 5 and up and can be used in the patient’s home through telerehabilitation.

See WWW.MEDITOUCH.CO.IL for further information.


The HandTutor assists recovery of upper limb dexterity in stroke patients

In the April edition of NeuroRehabilitation Dr. Kong and his group from Department of Reh abilitation Medicine, Tan Tock Seng Hospital, Singaporelook at the arm and hand

Communication: Sign Language

functional ability of one hundred and forty patients more than a year after stroke onset. The group found that upper extremity functional deficit was present in almost 70% of patients with chronic stroke. The lack of functional ability correlated to upper limb strength and spasticity. The group concluded that the most significant predictor of dexterity, functional outcome and quality of life was the severity of upper limb paresis on admission to rehabilitation.

The HandTutor is used in both acute and chronic hand and arm rehabilitation by occupational and physcial therapists based both in hospital and outpatient clinics.

Preventing contractures at the wrist after stroke improves functional recovery of the upper limb

Sarah contemplates the questionable choices sh...

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In the March edition of Clinical Rehabilitation Dr. Malhotra and her team from School of Health and Rehabilitation, Keele University, UK and Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital, USA investigate the time course of development of spasticity and contractures at the wrist after stroke and explore the association with upper limb functional recovery. The group found that participants who recovered arm function showed signs of spasticity at all assessment points but did not develop contractures. Contractures were more likely to develop in patients who did not recover arm function.
The HandTutor and ArmTutor system encourages active exercise practice with the patietn being motivated early after stroke to stretch actively elbow, wrist and fingures which helps to prevent the onset of contractures.

HandTutor system: Reducing spasticity during intensive exercise practice and functional improvement in Cerebral palsy patients

Little J makes big strides with the help of pr...

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In the February edition of Developmental Medicine & Child Neurology Dr. Ryll from Department of Epidemiology, Maastricht University report on the effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: His team reviewed randomized controlled trials assessing functional outcomes on walking of children with CP following botulinum toxin injection. The team conclude that the use of BoNT-A with usual care or physiotherapy seems to improve walking of children with CP.

The HandTutor, ArmTutor are upper extremity arm, hand – finger/s wrist and lower extremity rehabilitation systems that encourage active exercise practice by motivating the patient to perform virtual functional exercise tasks. The virtual functional tasks work on interjoint coordination as well as other movement parameters including range of motion, speed and strength of movement. When combined with task practice the HandTutor and ArmTutor for upper extremity fine motor skill neuro rehabilitation and the LegTutor for lower extremity rehabilitation have been proven to improve functional movement performance in CP patients.