Management Of Spasticity In Adults Research Articles

Surgical interventions in adult upper limb spasticity management: a systematic review

Upper limb spasticity following upper motor neuron lesion is a key cause of long-term disability in adults, causing functional loss, pain, and reduced quality of life. Surgical management is an under-utilized intervention, and little work has been performed to collate and evaluate the evidence for these interventions. We undertake the first, PRISMA-compliant systematic review synthesizing the evidence for surgical management of spasticity in adults. Three databases were searched using pre-specified search strings over a 20-year window (September 2001–2021). Only primary research papers featuring an entirely adult sample were included. Case reports were excluded. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine Scale and the Methodological Index for Non-Randomized Studies. We identified 19 eligible studies, all of which were poor quality. Significant benefit of surgery was identified in 15 of the 16 studies conducting significance testing. Detailed analysis of the surgical procedures used was prevented by poor reporting. Studies reported low rates of serious postoperative complication, and relatively high rates of postoperative deformity recurrence. Studies’ approaches to patient assessment and management varied significantly, reflecting a lack of standardization in this field. This review suggests that higher-quality, more standardized evidence is required to demonstrate the safety and efficacy of these surgical procedures. Future work should focus on improved reporting of surgical procedures and development of consensus assessment tools focusing on assessment of patient functionality and quality of life.

Pediatric tizanidine toxicity reversed with naloxone: a case report

BackgroundTizanidine, an α-2 adrenoceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports on pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone.Case presentationA 3-year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness and respiratory and heart rates were observed after two intravenous administrations of naloxone at a dose of 0.05 and 0.1 mg/kg, respectively.ConclusionsThis case report provides further evidence regarding the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists and presents additional epidemiologic data on childhood tizanidine poisoning.

Management of spasticity in adults

Spasticity is one of the most common and disabling impairments seen in patients with an upper motor neurone disorder such as stroke, brain injury and multiple sclerosis. It is increasingly accepted that spasticity remains an unrecognised and underdiagnosed impairment in primary care. This is worrying, as untreated spasticity leading to permanent contractures can be a late presentation in many conditions. There is an onus on GPs to recognise the common symptoms of spasticity and initiate management. This article will focus on practical aspects in the management of spasticity including timely referral to secondary care.

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey.

The present paper provides practical guidance on the management of adult spasticity with OnabotulinumtoxinA. Advisory Board members reviewed the available evidence and discussed their personal experiences in order to address the unmet needs in the management of spasticity with botulinum toxin type A identified by the recent Italian Real-Life Post-Stroke Spasticity Survey. Stroke patients should be referred to spasticity services that have adequate facilities and multidisciplinary teams with the necessary training, competence and expertise. The current literature shows a strong correlation between the development of post-stroke spasticity and the degree of central sensorimotor system destruction/disorganization. Use of tools such as the Poststroke Checklist may help clinicians in the long-term follow-up of stroke patients. The maximum dose of onabotulinumtoxinA - according to the current literature this ranges from 300U to 400U for upper limb and from 500U to 600U for lower limb aggregate postures - should be re-considered. In addition, there is a need for future consensus (also based on pharmacoeconomic considerations) on consistent clinical care models for the management of patients with post-stroke spasticity.

FP01-MO-06 Management of adult spasticity: post-stroke

FP01-MO-06 Management of adult spasticity: post-stroke

Adult upper limb spasticity

The therapeutic role of botulinum neurotoxin (BoNT) in spasticity is controversial. We examined the efficacy and tolerability of BoNT in the management of upper limb post-stroke spasticity in adults. We identified 11 eligible double-blind randomized placebo-controlled trials of variable methodological quality. Primary outcomes were mean changes in Ashworth scores (Ashworth scores) in each limb joint, and the number of participants with least a one-point score reduction. Ten studies compared BoNT-A with placebo. The overall effect on upper limb spasticity was significantly in favor of BoNT-A. Improvement on standardized weighted differences occurred for elbow, wrist and finger flexor spasticity, 3–6 weeks and 9–12 weeks after treatment. No improvement in weighted mean difference was observed in the trial of BoNT-B. Meta-analysis of the number of patients with reduction in Ashworth scores favored BoNT-A compared to placebo; similar data were not available for BoNT-B. BoNT was generally well tolerated. The results of this study indicate that BoNT-A is safe and effective in reducing muscle hypertonia due to spasticity in upper limb joints. Insufficient data were available to assess the efficacy and tolerability of BoNT- B in spasticity.

Management of spasticity in adults: practical application of botulinum toxin

Spasticity, characterized by increased muscle tone, exaggerated stretch reflexes, and abnormal limb posture, is a common sequel of central nervous system pathology. Historically, medicinal treatments have been of limited efficacy. This review discusses the clinical features of spasticity, the functional and pathological consequences, and treatment. It reviews the most common patterns of spasticity encountered in the upper and lower limbs and focuses on focal treatment of spastic muscles with the three commercially available botulinum toxins Botox, Dysport, and Myobloc/NeuroBloc. It addresses practical details such as muscle selection and identification, drug dilution, and doses.

Use of botulinum toxin type A in management of adult spasticity--a European consensus statement.

Anthony B. Ward, Miguel Aguilar, Zegers De Beyl, Susanne Gedin, Petr Kanovsky, Franco Molteni, Jorg Wissel and Anton Yakovleff From the Department of Rehabilitation Medicine, North Staffordshire Hospital, Stoke-on Trent, UK, Department of Neurology, Hospital Mutua Terrassa, Barcelona, Spain, Department of Neurology, Hopital Erasme, Universite Libre de Bruxelles, Belgium, Department of Neurology, Helsingborg Hospital, Sweden, Department of Neurology, Masaryk University, Brno, Czech Republic, Movement Disorders Rehabilitation Unit, Valduce Rehabilitation Centre, Costa Masnaga, Lecco, Italy, Department of Neurology, Clinic for Neurorehabilitation, Beelitz-Heilstatten, Germany, Clinical Neurology, Universite de Paris V-Rene Descartes, France

Physical therapy in spasticity.

Physiotherapists are part of the rehabilitation team involved in the management of adult spasticity. Physical therapy is one part of the armoury in the fight against this disabling symptom of the upper motor neurone syndrome. Identifying the physiological changes brought about by physical therapy or physiotherapy, is difficult. As with many interventions in rehabilitation, this area is poorly studied and, until recently, there was little or no evidence for its effectiveness. The aim of this presentation is to identify key components of a physiotherapy approach and outline specific techniques. The key components considered are: education of the patient and their carers; the 'intervention cycle' - involving accurate assessment, careful measurement, intervention and evaluation; accurate goal setting and a staged stepwise approach over prolonged periods. The specific techniques used include treatments targeted at: muscle length changes, muscle strengthening and functional performance. Broadly these techniques can be divided into biomechanical, cognitive and neurophysiological, each being interdependent on the others. Physiotherapy combined with the other available treatments should meet the challenge arising from adult spasticity.

Botulinum toxin in the management of spasticity in adults

Botulinum toxin (BTX) is a powerful neurotoxin which blocks cholinergic transmission at the neuromuscular junction. Judiciously applied, it can reduce local muscle overactivity while maintaining the strength in other muscles. To date BTX has not been licensed for use in spasticity in the UK and the literature pertaining to clinical practice is still relatively scant. However, controlled trials have provided evidence of the effectiveness of BTX both in reducing spasticity itself and in achieving functional gain. The guidance given here to clinicians involved in the management of spasticity covers the types of patient suitable for treatment using BTX, the appropriate dosage, and the necessary follow-up procedures and documentation.

Pharmacologic Management of Spasticity in Adults With Brain Injury

Spasticity is one of the most devastating musculoskeletal sequelae of brain injury because it leads to functional impairments that augment disability. In spite of recent therapeutic advances, spasticity remains one of the most challenging impairments encountered by physiatrists. When treating brain-injured patients, drug side effects become a crucial consideration in determining appro-priate treatment because many of the individuals cannot afford the known sedative and adverse cognitive effects of many spasmolytic medications. For this and several other reasons, spasticity management in brain injury is complex and requires certain considerations to increase the likelihood of therapeutic success.