Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management.

Autor:	Barden HL; a Brain Injury Rehabilitation Service, Westmead Hospital , Wentworthville , NSW , Australia .; b Faculty of Health Sciences , The University of Sydney , Sydney , Australia ., Baguley IJ; a Brain Injury Rehabilitation Service, Westmead Hospital , Wentworthville , NSW , Australia .; c Sydney Medical School, The University of Sydney , Sydney , Australia , and., Nott MT; a Brain Injury Rehabilitation Service, Westmead Hospital , Wentworthville , NSW , Australia .; d School of Community Health, Charles Sturt University , Albury , NSW , Australia., Chapparo C; b Faculty of Health Sciences , The University of Sydney , Sydney , Australia .
Jazyk:	angličtina
Zdroj:	Brain injury [Brain Inj] 2015; Vol. 29 (12), pp. 1452-9. Date of Electronic Publication: 2015 Aug 21.
DOI:	10.3109/02699052.2015.1071429
Abstrakt:	Objective: To evaluate the capacity of the Upper Limb Performance Analysis: Comparative Analysis of Performance-Motor (CAP-M) to quantify change in adults with focal spasticity following injection of Botulinum Toxin-A (BTX-A) as a focal treatment for positive Upper Motor Neuron (UMN) features. Methods: Twenty-three adults with moderate-to-severe spasticity were assessed pre- and post-BTX-A injection using CAP-M. Post-hoc video analysis of three sub-tests from the Action Research Arm Test were analysed against expected movements for each task. Results: Post-injection, spasticity as measured by Modified Ashworth and Tardieu Composite scores decreased significantly (p < 0.001). Grouped CAP-M data showed a significant reduction (z = 2.1-2.7, ES = 0.51-0.56) in positive UMN features, with 145 fewer Excessive movements recorded. In addition, 31 more Expected movements were demonstrated (z = 2.9, ES = 0.60), consistent with 'unmasking' of movements. Conclusion: CAP-M analysis revealed that BTX-A injection decreased unwanted movement almost 5-times more frequently than 'unmasking' hidden voluntary muscle activity during active simulated tasks. In this way, CAP-M was able to simultaneously assess positive and negative UMN features. This quantitative framework may have greater functional relevance than traditional uni-dimensional, passive spasticity measures such as MAS and Tardieu Scale.
Databáze:	MEDLINE
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