Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, January 19, 2025

Efficacy of Botulinum Toxin Combined With Rehabilitation Treatments In The Treatment of Post-Stroke Spasticity: A Systematic Review and Network Meta-Analysis

 

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.

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