https://orcid.org/0000-0001-6238-3578
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ABSTRACT
Introduction
Post-stroke spastic movement disorder (PS-SMD) appears up to 20% in the first week following stroke and 40% in the chronic phase. It may create major hurdles to overcome in early stroke rehabilitation and as one relevant factor that reduces quality of life to a major degree in the chronic phase.
Areas covered
In this review, we discuss predictors,early identification, clinical assessments, goal setting, and management in multiprofessional team, including Botulinum neurotoxin A (BoNT-A) injection for early and chronic management of PS-SMD.
Expert opinion
The earlier PS-SMD is recognized and managed, the better the outcome will be. The comprehensive management in the subacute or chronic phase of PS-SMD with BoNT-A injections requires detailed assessment, patient-centered goal setting, technical-guided injection, effective dosing of BoNT-A per site, muscle, and session and timed adjunctive treatment, delivered in a multi-professional team approach in conjunction with physical treatment. Evidence-based data showed BoNT-A injections are safe and effective in managing focal, multifocal, segmental PS-SMD and its complications. If indicated, BoNT-A therapy should be accompanied with adjunctive treatment in adequate time slots. BoNT-A could be added to oral, intrathecal, and surgical treatment in severe multisegmental or generalized PS-SMD to reach patient/caregiver’s goals, especially in chronic PS-SMD.
Article highlights
Post-stroke spasticity or post-stroke spastic movement disorder (PS-SMD) has been known as the worst problem in stroke rehabilitation in subacute phase as well as chronic phase following stroke.
The earlier it is recognized and managed, the better the prognosis will be with less prevalence of its complications e.g. contracture, pain, abnormal movement patterns, and dexterity disorder.
Local injection of Botulinum neurotoxin A (BoNT-A) with technical-guidance e.g. ultrasound, electrical stimulation, electromyography is safe and effective as a main therapy in the treatment of focal, multifocal, and segmental PS-SMD.
The detailed assessment of PS-SMD, patient-centered goal settings, and goal attainment evaluation by a multiprofessional team can improve the effectiveness of treatments including BoNT-A therapy.
Oral medication, timed adjunctive physical treatment, other neurolysis, and surgical intervention can be additionally applied after the recommendation of a multiprofessional team, to improve the outcome of rehabilitation.
Abbreviation
| ADL | = | activity of daily life |
| AS | = | Ashworth scale |
| BoNT-A | = | botulinum neurotoxin A |
| BoNT-B | = | botulinum neurotoxin B |
| BoNT-C | = | botulinum neurotoxin C |
| BoNT-F | = | botulinum neurotoxin F |
| CGIS | = | clinical global impression scale |
| cMM | = | conventional medical management |
| CP | = | cerebral palsy |
| DAS | = | disability assessment scale |
| EMG | = | electromyography |
| ES | = | electrical stimulation |
| GAS | = | goal attainment scaling |
| ITB | = | Intrathecal Baclofen |
| MAS | = | modified Ashworth scale |
| mCIMT | = | modified constraint-induced movement therapy |
| MMSE | = | Mini-Mental Status Examination |
| MRI | = | magnetic resonance imaging |
| mRS | = | modified Rankin scale |
| MPT | = | multiprofessional team |
| NES | = | neuromuscular electrostimulation |
| NHPT | = | nine-hole peg test |
| NIHSS | = | national institute of health stroke scale |
| NRS | = | numeric rating scale |
| pROM | = | passive range of motion |
| PSS | = | post-stroke spasticity |
| PS-SMD | = | post-stroke spastic movement disorder |
| RCT | = | randomized controlled trial |
| REPAS | = | resistance to passive movement scale |
| SAAPS | = | spasticity-associated arm pain scale |
| SMD | = | spastic movement disorder |
| SP | = | spastic Paresis |
| TBI | = | traumatic brain injury |
| TS | = | Tardieu scale |
| UMNS | = | upper motor neuron syndrome |
| US | = | ultrasonography |
| VAS | = | visual analog scale |
Declaration of Interest
J Wissel was speaker and advisory board member with honorarium for Allergan, Ipsen, Merz, Sintetica, and Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.
Reviewer disclosures
A peer reviewer on this manuscript has provided consultancy for BoNT /A manufacturers (Allergan, Ipsen, Merz) and participated in daxibotulinum clinical trial. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.