Investigating muscle selection for botulinum toxin-A injections in adults with post-stroke upper limb spasticity

Abstract

This result looks into the "black box" of rehabilitation, revealing significant variation in injector beliefs. Findings suggest that further scientific work is required to maximize the efficacy of botulinum toxin-A injections in post-stroke upper limb spasticity management.

Results from the Upper Limb International Spasticity Study-II (ULIS-II): a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management

“…These variations appear to have more to do with clinician bias and local availability of services than with patient presentation. 12 It is now time to extend the field of investigation in this area to understand how BoNT-A is used in routine clinical practice around the world and gain better understanding of how to select patients most likely to respond to treatment. Establishing what treatment approaches work best based on clinical presentation would also be of great clinical value.…”

Measuring task performance after acquired brain injury: Construct and concurrent validity of ‘Upper Limb Performance Analysis’

“…The clinical decision-making processes for BTX-A injection are poorly defined [25]; however, significant differences in ULPA-TPM parameters were evident between the Injected and Non-injected groups in terms of presence of UMN features, the type of motor errors made and the steps of the task affected by errors. The Injected group had more positive UMN features as measured by the Modified Ashworth and Tardieu Scales (refer to Table I) and poorer task mastery for each task compared to the Non-injected group.…”

“…The severity of spasticity of ABI participants was assessed using the Modified Ashworth Scale composite score [24] and Tardieu spasticity angle composite [23]. Participants were allocated to an Injected and Non-injected group based on the 'best practice' [25] clinical decision of physicians experienced in BTX-A injecting who were blinded to the results of other assessments (such as ARAT performance).…”

Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management

“…These difficulties have led authors to encourage the development/use of outcome measures that are sensitive [26], functionally relevant to spasticity [27], are based on the patient and team negotiated goal-focused outcomes [26,28,29] and able to simultaneously measure both positive and negative UMN features [19] and are practical in nature [30]. A goal-directed approach should also be extended to determining BTX-A injection strategy; for example, muscle selection and dose, however, there is no current evidence to support this concept [27].…”

“…A goal-directed approach should also be extended to determining BTX-A injection strategy; for example, muscle selection and dose, however, there is no current evidence to support this concept [27]. Indeed, some studies suggest injection strategies based on static arm position alone [10].…”