Original article
Measuring Spasticity and Fine Motor Control (Pinch) Change in the Hand After Botulinum Toxin-A Injection Using Dynamic Computerized Hand Dynamometry

https://doi.org/10.1016/j.apmr.2014.05.017Get rights and content

Abstract

Objectives

To evaluate change in fine motor hand performance and to investigate the relationship between existing clinical measures and dynamic computerized dynamometry (DCD) after botulinum toxin-A (BTX-A) injections for adults with upper limb spasticity.

Design

Pretest/posttest clinical intervention study.

Setting

Hospital outpatient spasticity clinics.

Participants

A convenience sample of adults (N=28; mean age, 51y) with upper limb spasticity after acquired brain injury.

Interventions

BTX-A injections for upper limb spasticity management.

Main Outcome Measures

DCD protocol using a piezoelectric pinch meter (termed DCD[pinch]); current clinical upper limb measures: Modified Ashworth Scale, Tardieu Scale, Action Research Arm Test, Michigan Hand Outcomes Questionnaire, and Goal Attainment Scale.

Results

BTX-A produced a significant change on DCD(pinch) and some current clinical measures, with correlations observed between DCD(pinch) and current clinical measures.

Conclusions

DCD(pinch) sensitively and objectively assessed the effects of BTX-A on upper limb spasticity during a simulated functionally based pinch and release task.

Section snippets

Methods

This open-label, pretest/posttest study was approved by the local Institution Human Research Ethics Committee. Participants provided written informed consent before study involvement.

Results

Participants were 28 adults (mean age, 51 years; 13 women) with the UMN syndrome after ABI (22 stroke, 6 traumatic brain injury) a mean of 7.5 years postevent. At the time of assessment, there were 25 right-hand dominant and 3 left-hand dominant participants, with 12 participants changing hand dominance after ABI (17 right-hand dominant, 11 left-hand dominant postevent). Participants were injected with either Dysportd (n=15; mean dose=740Units; dose range, 500–1200Units) or Botoxe (n=13; dose

Discussion

This open-label prestudy/poststudy evaluated change in hand performance after upper limb BTX-A injections in people with chronic ABI using DCD(pinch), a novel task-based procedure for measuring pinch and release,23 and correlated these changes against existing clinical measures.

In line with preexisting research, this study did not demonstrate group-level improvement in the fine motor function of the hand using a standardized hand function measure (ARAT), whether or not participants had active

Conclusions

DCD(pinch) is an objective measure of fine motor hand performance undertaken during a simulated pinch and release task. Current literature recommends upper limb spasticity to be measured across the Body Function and Structure, Activity, and Participation domains of the ICF. However, research to date has had difficulty demonstrating Activity and Participation domain changes in hand performance after BTX-A injection. This study suggests that after a certain minimum force can be generated,

Suppliers

  • a.

    Biometrics Ltd, Units 25-26, Nine Mile Point Ind Est, Cwmfelinfach, Gwent NP11 7 HZ, UK.

  • b.

    ADInstruments Pty Ltd, Unit 13, 22 Lexington Dr, Bella Vista, NSW 2153, Australia.

  • c.

    IBM SPSS, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

  • d.

    Ipsen Pty Ltd, Level 2, Building 4, Brandon Office Park, 540 Springvale Rd, Glen Waverley, Victoria 3150.

  • e.

    ALLERGAN AUSTRALIA PTY LTD, ABN 85 000 612 831, 810 Pacific Highway, Gordon NSW, 2072 Australia.

References (40)

  • J. Wissel et al.

    European consensus table on the use of botulinum toxin type A in adult spasticity

    J Rehabil Med

    (2009)
  • D.M. Simpson et al.

    Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial

    Neurology

    (1996)
  • A.M. Bakheit et al.

    A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke

    Stroke

    (2000)
  • R.L. Rosales et al.

    Evidence-based systematic review on the efficacy and safety of botulinum toxin-A therapy in post-stroke spasticity

    J Neural Transm

    (2008)
  • D.M. Simpson et al.

    Assessment: botulinum neurotoxin for the treatment of spasticity (an evidence-based review)

    Neurology

    (2008)
  • J.H. Burridge et al.

    Theoretical and methodological considerations in the measurement of spasticity

    Disabil Rehabil

    (2005)
  • Spasticity in adults: management using botulinum toxin. National guidelines

    (2009)
  • G.D. Caty et al.

    Effect of upper limb botulinum toxin injections on impairment, activity, participation, and quality of life among stroke patients

    Stroke

    (2009)
  • A. Brashear et al.

    Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke

    N Engl J Med

    (2002)
  • H.P. Francis et al.

    Does reducing spasticity translate into functional benefit? An exploratory meta-analysis

    J Neurol Neurosurg Psychiatry

    (2004)
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    This article is derived from data collected as part of an investigator-initiated study supported by Ipsen Australia.

    Barden's PhD candidature is supported by an Australian Postgraduate Award, The George Burniston Cumberland Foundation Fellowship 2011, and the Helga Pettitt Faculty of Health Sciences Postgraduate Study Award 2011.

    Honoraria received from Ipsen and Allergan (Barden, Baguley, and Nott). Advisory board membership for Ipsen (Baguley, Nott, and Barden) and Allergan (Baguley and Nott).

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