A group of clinicians from across Europe experienced in the use of botulinum toxin type A for the treatment of spasticity following acquired brain injury gathered to develop a consensus statement on best practice in managing adults with spasticity. This consensus table summarizes the current published data, which was collated following extensive literature searches, their assessment for level of evidence and discussion among the whole group. Published information is supplemented by expert opinion based on clinical experience from 16 European countries, involving 28 clinicians, who treat an average of approximately 200 patients annually, representing many thousand spasticity treatments with botulinum toxin per year.

Background and Purpose —We sought to define an effective and safe dose of botulinum toxin type A (Dysport) for the treatment of upper limb muscle spasticity due to stroke. Methods —This was a prospective, randomized, double-blind, placebo-controlled, dose-ranging study. Patients received either a placebo or 1 of 3 doses of Dysport (500, 1000, 1500 U) into 5 muscles of the affected arm. Efficacy was assessed periodically by the Modified Ashworth Scale and a battery of functional outcome measures. Results —Eighty-three patients were recruited, and 82 completed the study. The 4 study groups were comparable at baseline with respect to their demographic characteristics and severity of spasticity. All doses of Dysport studied showed a significant reduction from baseline of muscle tone compared with placebo. However, the effect on functional disability was not statistically significant and was best at a dose of 1000 U. There were no statistically significant differences between the groups in the incidence of adverse events. Conclusions —The present study suggests that treatment with Dysport reduces muscle tone in patients with poststroke upper limb spasticity. Treatment was effective at doses of Dysport of 500, 1000, and 1500 U. The optimal dose for treatment of patients with residual voluntary movements in the upper limb appears to be 1000 U. Dysport is safe in the doses used in this study.

Objective To determine the benefits associated with brief inpatient rehabilitation for Covid-19 patients. Design Retrospective chart review. Setting A newly created specialized rehabilitation unit in a tertiary care medical center Participants Consecutive sample of the first 100 patients with Covid-19 infection admitted to rehabilitation. Intervention Inpatient rehabilitation for post-acute care Covid-19 patients Main Outcome Measures Measurements, at admission and discharge, comprised a Barthel Activities of Daily Living Index (including baseline value before Covid-19 infection), time to perform 10 sit-to-stands with associated cardio-respiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in ICU were explored. Results Patient characteristics upon admission to rehabilitation were: men 66%, age 66±22 years, mean delay from symptom onset 20.4±10.0 days, BMI 26.0±5.4 kg/m 2 , hypertension 49%, diabetes 29%, with 26% having >50% pulmonary damage on CT-scans. Mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index (/100) increased from 77.3±26.7 to 88.8±24.5 ( p <0.001), without recovering baseline values (94.5±16.2; p <0.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; p <0.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; p =0.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; p <0.001). At both admission and discharge, Barthel score correlated with grip strength (rho=0.39-0.66; p <0.01), which negatively correlated with time spent in ICU (rho=-0.57 to -0.49, p <0.05). Conclusions Inpatient rehabilitation for Covid-19 patients was associated with substantial motor, respiratory and functional improvement, especially in severe cases, even though there remained mild persistent autonomy loss upon discharge. Following acute stages, Covid-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.