Open AccessAdded-value of spasticity reduction to improve arm-hand skill performance in sub-acute stroke patients with a moderately to severely affected arm-hand
Author(s) -
Johan Anton Franck,
Rob Smeets,
Jule Elmanowski,
Karolien Renders,
Henk Seelen
Publication year - 2021
Publication title -
neurorehabilitation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.611
H-Index - 65
eISSN - 1878-6448
pISSN - 1053-8135
DOI - 10.3233/nre-201622
Subject(s) - modified ashworth scale , spasticity , grip strength , rehabilitation , physical medicine and rehabilitation , stroke (engine) , physical therapy , botulinum toxin , medicine , hand strength , acute stroke , psychology , surgery , mechanical engineering , tissue plasminogen activator , engineering
BACKGROUND AND OBJECTIVE: Stroke patients with a moderately to severely affected hand may be impeded in exploiting their full arm-hand training potential during rehabilitation due to spasticity. Reducing early signs of spasticity in sub-acute stroke patients may lead to improvements in arm-hand-function and arm-hand-skill-performance. METHODS: Single-case-experimental-design and meta-analysis. Ten sub-acute stroke patients (Modified-Ashworth-Scale:1 + to 3) participated. Training: 2x6 weeks, using a well-described arm-hand regime (therapy-as-usual). Botulinum-toxin was administered once within 5 weeks after onset of therapy-as-usual. Measures: Action-Research-Arm-Test, ABILHAND, Fugl-Meyer-Assessment, grip-strength, Motricity-Index. RESULTS: At group level, after baseline trend correction, adjusting for spontaneous recovery and therapy-as-usual effects, the added-value of botulinum-toxin-A on arm-hand-function and arm-hand-skill-performance was not confirmed. However, non-detrended data revealed significant improvements over time on arm-hand-function and arm-hand-skill-performance level (p≤0.037). Conversely, at individual level, after baseline trend correction, 7/10 patients improved on arm-hand-function: Fugl-Meyer-Assessment (N = 4; p≤0.019), grip-strength (N = 3; p≤0.014), Motricity-Index (N = 4; p≤0.002), whereas 6/10 patients improved on arm-hand-skill-performance: Action-Research-Arm-Test (N = 3; p≤0.042), ABILHAND (N = 5; p≤0.034). CONCLUSION: Application of botulinum-toxin-A may have an added-value in a substantial part of sub-acute stroke patients suffering from spasticity early post-stroke and who, at the point of therapy admission, display no dexterity. It may improve their arm-hand performance when combined with a well– defined therapy-as-usual.