You say nothing on whether any of this cured the spasticity. Survivors want spasticity cured, not managed or treated! You'll want spasticity cured when you are the 1 in 4 per WHO that has a stroke!
You won't like Dr. William M. Landau's uninformed 'expert' opinion after your stroke. Survivors would immediately disabuse him of that notion. When schadenfreude hits him with his stroke he'll regret his ideas on the matter.
His statement from here:
Spasticity After Stroke: Why Bother? Aug. 2004
The latest here:
Efficacy of Botulinum Toxin Combined With Rehabilitation Treatments In The Treatment of Post-Stroke Spasticity: A Systematic Review and Network Meta-Analysis
Abstract
Background
There
is growing interest in the combination of botulinum toxin (BoNT) and
rehabilitation techniques for the treatment of post-stroke spasticity.
Nevertheless, systematic evaluations of this approach are scarce.
Objective
To systematically evaluate the efficacy of BoNT combined with rehabilitation techniques for post-stroke spasticity.
Methods
The
PubMed, Embase, Cochrane Library, and Web of Science databases were
systematically searched from their inception to May 2024 for randomized
controlled trials of BoNT combined with rehabilitation treatments for
post-stroke spasticity. Reductions in the Modified Ashworth Scale (MAS)
score at short-term and medium-term weeks after treatment were
calculated.
Results
Eighteen
studies were analyzed. Regarding the short-term effect of BoNT combined
with rehabilitation treatments on post-stroke spasticity, the top one
ranked combination treatments were BoNT plus conventional therapy (CT)
and splinting. The results showed that two evidence networks regarding
the medium-term efficacy of BoNT combined with rehabilitation treatments
for post-stroke spasticity. The top one ranked combination treatments
for Network A were BoNT plus CT and electrical stimulation, and for
Network B, BoNT plus casting.
Conclusions
The
limited quantity of literature included in these studies did not permit
the ordering of probabilities. Consequently, these results must be
interpreted with caution and further validated using high-quality
studies.
Introduction
Stroke is the second-leading cause of death and the third-leading cause of disability (GBD 2019 Stroke Collaborators, 2021). From 1990 to 2019, the absolute numbers of stroke morbidity and mortality increased by 70% and 43%, respectively (GBD 2019 Stroke Collaborators, 2021; Krishnamurthi et al., 2020; Martin et al., 2024). Spasticity is the most common complication of stroke, with a prevalence ranging from 30% to 80% among stroke survivors(Shi et al., 2019).
Spasticity can lead to dysfunction of the patient's muscle movement,
causing pain and postural abnormalities, which greatly diminishes their
quality of life and places added strain on their caregivers(O'Dell, 2023; Santamato et al., 2019).
When the patient's lower limbs are in spasm, the knee joints are
involuntarily straightened, the ankle joints are turned inward when the
soles of the feet touch the ground, and the supportive phases of the
lower limbs on the affected side are shortened, resulting in the
hemiplegic gait of “walking in a circle”(Santamato et al., 2019).
A prolonged state of spasticity can lead to contracture of the Achilles
tendon, and constant abnormal pressure during walking can cause
pressure sores(Li & Francisco, 2021). Continued activation of spastic calf muscles during weight-bearing has been linked to the development of foot drop(Li & Francisco, 2021).
Increased upper extremity flexor tone can lead to flexion of the elbow,
wrist, and finger joints. Spasticity affecting the hands and wrists is a
particularly problematic form of spasticity, as it can significantly
impair activities of daily living, including dressing and personal
hygiene (Lee et al., 2024; Ye et al., 2023). Therefore, it is imperative to identify effective methods for alleviating the challenges posed by spasticity after stroke.
Spasticity
is a movement disorder that is defined by a velocity-dependent increase
in the stretch reflex and the presence of abnormal tendon reflexes(Sheean, 2002).
Current treatment options for poststroke spasticity include exercise,
oral spasticity medications, physical therapy, botulinum toxin (BoNT)
injections, and surgery(Thibaut et al., 2013). Among these, BoNT-A is the treatment of choice for focal spasticity affecting the upper and lower extremities(Wissel et al., 2009).
BoNT-A is a metalloproteinase that provides transient chemical
innervation to injected muscles by inhibiting the presynaptic release of
acetylcholine at the neuromuscular junctions(Brin et al., 1987).
BoNT-A injections exert various effects on spastic muscles, including
neural and non-neural components associated with elevated tone, muscle
strength, and motor performance(Chen et al., 2022).
Several studies have demonstrated that BoNT-A injections can reduce
muscle tone, address muscle imbalance, and enhance muscle function(Sun et al., 2019).
Nevertheless, there is evidence that in some patients, the response to BoNT-A therapy may diminish over time (Pitcher et al., 2015).
To enhance the effects of BoNT-A, researchers have proposed various
techniques to improve clinical outcomes. These include stretching(Allart et al., 2022), intensive rehabilitation(Hara et al., 2018), casting (Farag et al., 2020), repetitive transcranial magnetic stimulation(Shao et al., 2022), robotic assistance (RA) (Cotinat et al., 2024),electrical stimulation (ES) (Baricich et al., 2019), extracorporeal shock wave (ESWT) (Du et al., 2024), constraint-induced movement therapy(Nasb et al., 2021), isokinetic training(Cinone et al., 2019), and repetitive facilitative exercise(Hokazono et al., 2022).
The link between BoNT-A and rehabilitation is widely accepted. However,
there is no consensus regarding which combination therapy is most
effective. Consequently, there is growing interest in the combination of
BoNT-A and rehabilitation techniques for the treatment of post-stroke
spasticity. Nevertheless, there is a dearth of systematic evaluations of
this therapeutic approach. In light of these considerations, the
objective of this study was to conduct a network meta-analysis of the
existing literature on post-stroke spasticity. The objective of this
study was to compare the efficacy of BoNT-A with different
rehabilitative therapies and to provide evidence-based medical
recommendations for optimizing the outcome of combined therapy for
patients with post-stroke spasticity.
More at link.
No comments:
Post a Comment