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Date of Award
Spring 2021
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Amanda Murphy, PA-C
Abstract
Abstract
Introduction: The standard treatment for post-stroke spasticity (PSS) is rehabilitation. Botulinum Toxin Type A (BoNT-A) injection is used in treatment for PSS. This review analyzes the efficacy of BoNT-A injection on arm muscle tone and function compared with rehabilitation in adult patients with upper limb spasticity after stroke.
Methods: A literature search was conducted through PubMed Clinical Queries and ScienceDirect in November 2019. 7 articles consisting of randomized clinical trials were selected based on set criteria.
Results: Five studies found BoNT-A had a significant difference reducing muscle tone compared to rehabilitation alone. Three studies found a significant functional improvement in the limb with the BoNT-A injection group using primary outcome measures. However, one of these compared the BoNT-A/rehabilitation group for functional improvement in the limb to BoNT-A/no rehabilitation group, suggesting the rehabilitation intervention improved the function.
Discussion: Most of the studies supported that BoNT-A can reduce muscle tone more significantly rehabilitation alone. The studies lacked consistent data that BoNT-A, when supplemented to rehabilitation, shows a significant functional improvement than rehabilitation alone. Study limitations included: blindness, funding bias, smaller sample sizes and unclear rehabilitation protocols.
Conclusion: Patients treated with BoNT-A and rehabilitation can have a reduction in spastic muscle tone but not an overall improved function of the limb as compared to rehabilitation alone. The results support rehabilitation as mainstay of treatment. BoNT-A should remain available to patients as adjuvant treatment. Current research needs to be expanded with larger sample sizes, standardized dosing schedule, and defined rehabilitation protocols.
Recommended Citation
Giuliano, Gina, "Efficacy of Botulinum Toxin Type A Injection Compared to Rehabilitation in the Treatment of Upper Limb Post-Stroke Spasticity" (2021). Capstone Showcase. 30.
https://scholarworks.arcadia.edu/showcase/2021/pa/30
Additional Files
Giuliano_Capstone.pdf (13056 kB)Poster
Giuliano Capstone.mp4 (329458 kB)
Presentation
References.docx (16 kB)
References
Efficacy of Botulinum Toxin Type A Injection Compared to Rehabilitation in the Treatment of Upper Limb Post-Stroke Spasticity
Abstract
Introduction: The standard treatment for post-stroke spasticity (PSS) is rehabilitation. Botulinum Toxin Type A (BoNT-A) injection is used in treatment for PSS. This review analyzes the efficacy of BoNT-A injection on arm muscle tone and function compared with rehabilitation in adult patients with upper limb spasticity after stroke.
Methods: A literature search was conducted through PubMed Clinical Queries and ScienceDirect in November 2019. 7 articles consisting of randomized clinical trials were selected based on set criteria.
Results: Five studies found BoNT-A had a significant difference reducing muscle tone compared to rehabilitation alone. Three studies found a significant functional improvement in the limb with the BoNT-A injection group using primary outcome measures. However, one of these compared the BoNT-A/rehabilitation group for functional improvement in the limb to BoNT-A/no rehabilitation group, suggesting the rehabilitation intervention improved the function.
Discussion: Most of the studies supported that BoNT-A can reduce muscle tone more significantly rehabilitation alone. The studies lacked consistent data that BoNT-A, when supplemented to rehabilitation, shows a significant functional improvement than rehabilitation alone. Study limitations included: blindness, funding bias, smaller sample sizes and unclear rehabilitation protocols.
Conclusion: Patients treated with BoNT-A and rehabilitation can have a reduction in spastic muscle tone but not an overall improved function of the limb as compared to rehabilitation alone. The results support rehabilitation as mainstay of treatment. BoNT-A should remain available to patients as adjuvant treatment. Current research needs to be expanded with larger sample sizes, standardized dosing schedule, and defined rehabilitation protocols.