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      Rehabilitation plus OnabotulinumtoxinA Improves Motor Function over OnabotulinumtoxinA Alone in Post-Stroke Upper Limb Spasticity: A Single-Blind, Randomized Trial

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          Abstract

          Background: OnabotulinumtoxinA (BoNT-A) can temporarily decrease spasticity following stroke, but whether there is an associated improvement in upper limb function is less clear. This study measured the benefit of adding weekly rehabilitation to a background of BoNT-A treatments for chronic upper limb spasticity following stroke. Methods: This was a multi-center clinical trial. Thirty-one patients with post-stroke upper limb spasticity were treated with BoNT-A. They were then randomly assigned to 24 weeks of weekly upper limb rehabilitation or no rehabilitation. They were injected up to two times, and followed for 24 weeks. The primary outcome was change in the Fugl–Meyer upper extremity score, which measures motor function, sensation, range of motion, coordination, and speed. Results: The ‘rehab’ group significantly improved on the Fugl–Meyer upper extremity score (Visit 1 = 60, Visit 5 = 67) while the ‘no rehab’ group did not improve (Visit 1 = 59, Visit 5 = 59; p = 0.006). This improvement was largely driven by the upper extremity “movement” subscale, which showed that the ‘rehab’ group was improving (Visit 1 = 33, Visit 5 = 37) while the ‘no rehab’ group remained virtually unchanged (Visit 1 = 34, Visit 5 = 33; p = 0.034). Conclusions: Following injection of BoNT-A, adding a program of rehabilitation improved motor recovery compared to an injected group with no rehabilitation.

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          Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident.

          This study establishes intratester reliability for all components of physical performance and intertester reliability for the total scores of upper and lower extremity motor performance in a cumulative numerical scoring system devised by Fugl-Meyer et al. Intertester reliability was found to be high for the total scores of upper and lower extremity motor performance. All intratester and intertester reliability coefficients were high and statistically significant. Establishing the reliability of the Fugl-Meyer method of assessing recovery of function following cerebrovascular accident has increased the usefulness of this method for clinical assessment and as a tool for the comparative analysis of the effectiveness of various therapeutic interventions.
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            PRELIMINARY TRIAL OF CARISOPRODOL IN MULTIPLE SCLEROSIS.

            B ASHWORTH (1964)
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              Defining post-stroke recovery: implications for design and interpretation of drug trials.

              Measurement of stroke recovery is complex because definition of successful recovery is highly variable across measures and cut-off points for defining successful outcomes vary. The purpose of this paper is to describe patterns of recovery in stroke patients of varying severity when different measures are used and when different cut-off points are selected. 459 individuals enrolled in a prospective cohort study were assessed within 14 days post stroke and re-evaluated at 1, 3, and 6 months. Recovery was assessed using the NIH Stroke Scale, the Fugl-Meyer Assessment of Motor Recovery, the Barthel Index of Activities of Daily Living, the Physical Function Index of the SF-36, and the Modified Rankin Outcome Scale. Subjects also defined their preference (utility) for their current health state with a time-trade off question. We compared patterns of recovery using the different measures and varying the cut-off points for defining successful recovery. The percentage of patients who are believed to have recovered depends on how recovery is defined. If recovery is defined at the disability level (Barthel > 90), the majority 57.3% of stroke survivors experience a full recovery. Fewer individuals are considered to be fully recovered if impairments are measured (NIH 90, 36.8%. Less than 25% of stroke survivors are considered recovered if recovery is defined relative to reported prior function in higher levels of physical activity. Shifting the definition of recovery on the modified Rankin scale from
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                Author and article information

                Journal
                Toxins (Basel)
                Toxins (Basel)
                toxins
                Toxins
                MDPI
                2072-6651
                11 July 2017
                July 2017
                : 9
                : 7
                : 216
                Affiliations
                [1 ]Department of Neurology, 1542 Tulane Ave, Room 111B, New Orleans, LA 70112, USA
                [2 ]Department of Neurology, MSC10 5620, Health Sciences Center. 1 University of New Mexico, Albuquerque, NM 87131-0001, USA; jharnar@ 123456salud.unm.edu
                [3 ]New Mexico VA Healthcare System, 1501 San Pedro SE, Albuquerque, New Mexico, NM 87108, USA; leandro.lopez@ 123456va.gov
                [4 ]Department of Neurology, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157, USA; abrashea@ 123456wakehealth.edu
                [5 ]VA Medical Center, 4150 Clement St, San Francisco, CA 94121, USA; Glenn.Graham@ 123456va.gov
                Author notes
                [* ]Correspondence: ddevie@ 123456lsuhsc.edu ; Tel.: +504-568-2146; Fax: +504-324-0655
                Article
                toxins-09-00216
                10.3390/toxins9070216
                5535163
                28696373
                21017102-a03b-45f5-abd1-7941386aae1e
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 24 February 2017
                : 29 June 2017
                Categories
                Article

                Molecular medicine
                stroke,rehabilitation,onabotulinumtoxina,occupational therapy,muscle spasticity,physical therapy

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