This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pandyan, A. D Articles by Barnes, M. P Search for Related Content PubMed PubMed Citation Articles by Pandyan, A. D Articles by Barnes, M. P Social Bookmarking                   What's this?

Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox® to the elbow flexors in a unilateral stroke population

Department of Physiotherapy Studies, Keele University, Sion, Switzerland; a.d.pandyan{at}keele.ac.uk

Philippe Vuadens

Clinique Romande de Réadaptation, Sion, Switzerland

Frederike MJ van Wijck

Centre for Rehabilitation and Engineering Studies (CREST), University of Newcastle, UK

Sandra Stark

Hunters Moor Regional Neurological Rehabilitation Centre, Newcastle upon Tyne, UK

Garth R Johnson

Michael P Barnes

Centre for Rehabilitation and Engineering Studies (CREST), University of Newcastle, Newcastle upon Tyne, UK

Objective: To quantify the clinical efficacy of botulinum toxin type A in treating elbow flexor spasticity in a unilateral stroke population. Location: A spasticity clinic at a regional neurological rehabilitation centre.

Study design: A convenience sample longitudinal study. Fourteen subjects with elbow flexor spasticity secondary to a stroke were recruited. Two repeated measures, one before and another four weeks after treatment, were taken to quantify clinical efficacy.

Outcome measures: Elbow flexor spasticity was simultaneously rated with the modified Ashworth scale (MAS) and quantified by measuring the surface EMG from the flexors using a custom-built device. Strength at the elbow (isometric), grip strength and upper limb function (Action Research Arm test) were also assessed.

Treatment: Injections of botulinum toxin type A (Botox^®) to the m.biceps brachii (mean dose 70 U), m.brachioradialis (mean dose 56.5 U) and m.flexor digitorum longus (mean dose 83.3 U).

Results: Following treatment, spasticity (as measured by flexor EMG activity) reduced but the MAS was unable to detect this improvement. In some subjects, isometric flexor strength at the elbow as well as grip strength increased. This was contrary to the expected weakening following treatment with botulinum toxin type A and suggests an optimization of motor control.

Conclusion: Treatment with Botox^® reduces spasticity but does not necessarily cause a reduction in the force generating capabilities at the joint. The improvement in strength may have contributed to the improvements in upper limb function. The MAS is an inappropriate measure of spasticity.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				S. Ozcakir and K. Sivrioglu Botulinum Toxin in Poststroke Spasticity Clin. Med. Res., June 1, 2007; 5(2): 132 - 138. [Abstract] [Full Text] [PDF]

				A. D Pandyan, C. I. Price, M. P Barnes, and G. R Johnson A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity Clinical Rehabilitation, March 1, 2003; 17(3): 290 - 294. [Abstract] [PDF]