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Botulinum toxin assessment, intervention and aftercare for lower limb disorders of movement and muscle tone in adults: international consensus statement
Author(s) -
Olver J.,
Esquenazi A.,
Fung V. S. C.,
Singer B. J.,
Ward A. B.
Publication year - 2010
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2010.03128.x
Subject(s) - hypertonia , medicine , physical medicine and rehabilitation , muscle tone , rehabilitation , weakness , physical therapy , botulinum toxin , psychological intervention , spasticity , muscle weakness , modified ashworth scale , intervention (counseling) , anesthesia , nursing , surgery
Lower limb disorders of movement and muscle tone in adults significantly impact quality of life. The management of the patient with hypertonia is complex and requires a multidisciplinary team working with the patient and family/carers. Botulinum neurotoxin type A (BoNT‐A) has been used as a component of this management to reduce lower limb hypertonia, increase passive range of motion and reduce associated pain and requirements for bracing. Adjunctive treatments to augment the effect of BoNT‐A include electrical muscle stimulation of the injected muscles and stretching. When determining suitability for injection, the patient’s main goals for intervention need to be established. Muscle overactivity must be distinguished from contracture, and the effect of underlying muscle weakness taken into account. Explanation of the injection process, potential adverse effects and post‐injection interventions is essential. Assessment at baseline and post‐treatment of impairments such as hypertonia, range of motion and muscle spasm are appropriate; however, the Goal Attainment Scale and other validated patient‐centred scales can also be useful to assess therapy outcomes. In the future, initiatives should be directed towards examining the effectiveness of BoNT treatment to assist with achievement of functional and participation goals in adults with hypertonia and dystonia affecting the lower limb.