Article

PURPOSE: To explore the role of Botulinum Toxin type A (BoNT-A) in the management
of the spastic hemiplegic shoulder and identify the common achievable goals for
treatment. METHOD: Set in a regional spasticity management service in the UK, a
prospective observational cohort study was undertaken.
Patients (n = 16) were
receiving BoNT-A (Dysport) injection and concurrent therapy for spasticity of the
shoulder girdle or proximal upper limb following stroke/other acquired brain
injury. Mean age 54.5 (SD 15.7) years. Mean time since injury: 15.7 months.
Functional goals for intervention were determined through agreement with the
patient or their carers using Goal Attainment Scaling (GAS). Evaluation of
spasticity (Modified Ashworth Scale), pain (numbered graphic rating scale) and
three standard passive function tasks (washing, dressing and positioning) were
also undertaken. RESULTS: Sixteen weeks post-injection, significant improvements
were identified in spasticity
(Z = -3.535, p <0.0001),
pain (Z = -1.942, p =
0.052) and passive function
(Z = -3.172, p = 0.002).
GAS scores had improved in
all but one subject, with goals either achieved or over-achieved. CONCLUSIONS:
BoNT-A injection of the proximal upper limb, with combined therapy, produced a
reduction in spasticity, improvement in passive function and pain. Management of
upper limb spasticity should include evaluation and, if necessary treatment, of
the shoulder girdle and proximal musculature.

Langue : ANGLAIS