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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.

Additional Files

Giuliano_Capstone.pdf (13056 kB)
Poster

Giuliano Capstone.mp4 (329458 kB)
Presentation

References.docx (16 kB)
References

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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.