Long-term effects of combined botulinum toxin treatment and rehabilitation on upper limb muscle spasms: a case report.
Kazuo Saito, Yumiko Saito, Kyoko Hirota and 2 others
PMID 33814721WHAT IT FOUND
In one man with cervical spinal cord injury, years of botulinum toxin type A plus physical and occupational therapy and splints were followed by improved upper-limb motion, less finger spasm, and faster left-hand tasks.
It is one person, not proof the treatment works.
Key findings
01The patient received outpatient physical and occupational therapy twice weekly and 14 periodic botulinum toxin type A injections over 7 years and 4 months after injury.
02The report noted improved passive range of motion 4 months after commencing botulinum toxin therapy, with right/left values of 145/180 for shoulder flexion and 140/145 for elbow flexion.
03The report states the Motor Functional Independence Measure score was 42 points, compared with 34 points at initial evaluation, and he still required assistance for most activities of daily living.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a report of one person, so it cannot show how most patients would respond. There was no control group, and the patient received botulinum toxin, physical therapy, occupational therapy, and splint therapy together. The contribution of any single treatment cannot be separated. The patient had a specific injury level, long-standing contracture, and sensory skin problems, so the course may not apply to other spinal cord injuries. The report does not state the dose of botulinum toxin or the exact timing of all outcomes.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that botulinum toxin type A alone improves hand spasticity after spinal cord injury. The patient also received physical therapy, occupational therapy, and splint therapy over many years, and the report cannot separate the contribution of any one part.