Botulinum toxin use in patients with post-stroke spasticity: a nationwide retrospective study from France

BackgroundCurrent guidelines recommend intramuscular botulinum toxin type A (BoNT-A) injection as first-line treatment for spasticity, a frequent and impairing feature of various central nervous system (CNS) lesions such as stroke. Patients with spasticity commonly require BoNT-A injections once every 3 to 4 months. We conducted a nationwide, population-based, retrospective cohort study, using the French National Hospital Discharge Database (PMSI), to describe BoNT-A use for spasticity in clinical practice in France between 2014 and 2020. The PMSI database covers the whole French population, corresponding to over 66 million persons.MethodsWe first searched the PMSI database for healthcare facility discharge of patients who received BoNT-A injections between 2014 and 2020, corresponding to the first set. For each BoNT-A-treated patient, we identified the medical condition for which BoNT-A may have been indicated. Another search of the PMSI database focused on patients admitted for acute stroke between 2014 and 2016 and their spasticity-related care pathway (second set). Overall, two subpopulations were analysed: 138,481 patients who received BoNT-A injections between 2014 and 2020, and 318,025 patients who survived a stroke event between 2014 and 2016 and were followed up until 2020.ResultsAmong the 138,481 BoNT-A-treated patients, 53.5% received only one or two BoNT-A injections. Most of these patients (N = 85,900; 62.0%) received BoNT-A because they had CNS lesions. The number of patients with CNS lesions who received ≥1 BoNT-A injection increased by a mean of 7.5% per year from 2014 to 2019, but decreased by 0.2% between 2019 and 2020, corresponding to the COVID-19 outbreak. In stroke survivors (N = 318,025), 10.7% were coded with post-stroke spasticity, 2.3% received ≥1 BoNT-A injection between 2014 and 2020, and only 0.8% received ≥3 injections within the 12 months following BoNT-A treatment initiation, i.e., once every 3 to 4 months.ConclusionOur analysis of the exhaustive PMSI database showed a suboptimal implementation of BoNT-A treatment recommendations in France. BoNT-A treatment initiation and re-administration are low, particularly in patients with post-stroke spasticity. Further investigations may help explain this observation, and may target specific actions to improve spasticity-related care pathway

The effect of word prediction settings (frequency of use) on text input speed in persons with cervical spinal cord injury: a prospective study

International audiencePurpose: To determine whether activation of the frequency of use and automatic learning parameters ofword prediction software has an impact on text input speed.Methods: Forty-five participants with cervical spinal cord injury between C4 and C8 Asia A or B acceptedto participate to this study. Participants were separated in two groups: a high lesion group for participantswith lesion level is at or above C5 Asia AIS A or B and a low lesion group for participants with lesion isbetween C6 and C8 Asia AIS A or B. A single evaluation session was carried out for each participant. Textinput speed was evaluated during three copying tasks:- without word prediction software (WITHOUT condition)- with automatic learning of words and frequency of use deactivated (NOT_ACTIV condition)- with automatic learning of words and frequency of use activated (ACTIV condition)Results: Text input speed was significantly higher in the WITHOUT than the NOT_ACTIV (p<0.001) orACTIV conditions (p¼0.02) for participants with low lesions. Text input speed was significantly higher inthe ACTIV than in the NOT_ACTIV (p¼0.002) or WITHOUT (p<0.001) conditions for participants with highlesions.Conclusions: Use of word prediction software with the activation of frequency of use and automatic learningincreased text input speed in participants with high-level tetraplegia. For participants with low-leveltetraplegia, the use of word prediction software with frequency of use and automatic learning activatedonly decreased the number of errors

Influence of the Number of Predicted Words on Text Input Speed in Participants With Cervical Spinal Cord Injury: Influence of the number of predicted words in persons with SCI

International audienceObjective - To determine if the number of words displayed in the Word Prediction Software (WPS) list affects Text Input Speed (TIS) in people with cervical Spinal Cord Injury (SCI) and if any influence is dependent on the level of the lesion.Design - A cross-sectional trial.Setting - A rehabilitation center in France.Participants - Ninety persons with cervical SCI fulfilled the inclusion/exclusion criteria, 45 of whom agreed to participate. Lesion level was high (C4 and C5 Asia A or B) for 15 participants (high lesion group) and was between C6 and C8 Asia A or B for 30 participants (low lesion group).Methods - TIS was evaluated during 4. 10-minute copying tasks: -without WPS (Without)-with a display of 3 predicted words (3Words)-with a display of 6 predicted words (6Words)-with a display of 8 predicted (8Words)Outcome Measures -During the 4 copying tasks, TIS was measured objectively (characters per minute, number of errors) and subjectively through subject report (fatigue, perception of speed, cognitive load, satisfaction)Results -For participants with low cervical SCI, text input speed without WPS was faster than with WPS, regardless of the number of words displayed (p<0.001). For participants with high cervical SCI, the use of WPS did not influence TIS (p=0.99). There was no influence of the number of words displayed in a word prediction list on TIS, however perception of TIS differed according to lesion level.Conclusion - For persons with low cervical SCI, a small number of words should be displayed, or WPS should not be used at all. For persons with high cervical SCI, a larger number of words displayed increases the comfort of use of WP

Effect of a Dynamic Keyboard and Word Prediction Systems on Text Input Speed in Patients with Functional Tetraplegia

International audienceInformation technology plays a very important role in society. People with disabilities are often limited by slow text input speed despite the use of assistive devices. This study aimed to evaluate the effect of a dynamic on-screen keyboard (Custom Virtual Keyboard) and a word-prediction system (Sibylle) on text input speed in participants with functional tetraplegia. Ten participants tested four modes at home (static on-screen keyboard with and without word prediction and dynamic on-screen keyboard with and without word prediction) for 1 mo before choosing one mode and then using it for another month. Initial mean text input speed was around 23 words per minute with the static keyboard and 12 words per minute with the dynamic keyboard. The results showed that the dynamic keyboard reduced text input speed by 37% compared with the standard keyboard and that the addition of word prediction had no effect on text input speed. We suggest that current forms of dynamic keyboards and word prediction may not be suitable for increasing text input speed, particularly for subjects who use pointing devices. Future studies should evaluate the optimal ergonomic design of dynamic keyboards and the number and position of words that should be predicted

Effet de la toxine botulique sur la cinématique de mouvements de pointage et de préhension de patients hémiparétiques spastiques

Le rôle de la spasticité dans la perturbation du contrôle moteur chez les patients hémiparétiques n est pas bien connu. Certaines études ont montré que les perturbations de la cinématique des mouvements du membre supérieur hémiparétique sont davantage corrélées à la déficience motrice et à la perte de force qu à la spasticité. D autres études ont montré qu il existe une forte corrélation entre la fluidité et la vitesse du mouvement et la spasticité. L objectif de nos travaux était d étudier l effet de la réduction de la spasticité (via des injections de toxine botulique) sur la cinématique des mouvements de pointage et de préhension visant à mieux comprendre les liens pouvant exister entre spasticité, contrôle moteur et fonction du membre supérieur chez des patients hémiparétiques. Nous avons étudié parallèlement l effet de la toxine botulique sur les stratégies de préhension. Nous avons observé, lors de mouvements de pointage, une amélioration du pic de vitesse de la main ainsi que de la fluidité du mouvement. La durée du mouvement ainsi que sa courbure ne se sont pas modifiés de façon significative. Lors des mouvements de préhension d objets, la réduction de la spasticité a eu une action sur la posture de la main au moment de la saisie et sur le pic de vitesse de la main. Elle a par contre eu peu d action sur les stratégies de préhension qui sont probablement davantage dépendantes de la qualité de la récupération motrice et de la capacité de contrôle moteur fin. Les sujets hémiparétiques adoptent rarement les prises pulpo-pulpaires des sujets sains mais des prises plus grossières adaptées aux affordances de leur membre supérieur et de l objet à saisir.PARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Quotation of upper limb risk musculoskeletal disorders by fuzzy logic: Particular case of manual wheelchair propulsion and curb ascent

Introduction. For manual wheel chair users, the capacity to ascend a curb is essential for autonomy, however may contribute to the development or exacerbation of musculoskeletal disorders (MD). The objective of this study was to use fuzzy logic to quantify the risk of MD during curb ascent. Materials and Methods. Seventeen patients with SCI (> 6 months) were included. Kinematics and kinetics were recorded using a motion capture system and instrumented wheels on the manual wheelchair. Three trials were recorded for each subject. Results. The risk of MD was 15% greater during curb ascent than propulsion, mainly because of increases in kinetic risk. The kinetic risk was greatest at the wrist during curb ascent (50%). Discussion and conclusion. Quantification of the risk of MD using fuzzy logic is useful to highlight at-risk situations and to identify the parameters responsible

Quotation of upper limb risk musculoskeletal disorders by fuzzy logic: Particular case of manual wheelchair propulsion and curb ascent

Introduction. For manual wheel chair users, the capacity to ascend a curb is essential for autonomy, however may contribute to the development or exacerbation of musculoskeletal disorders (MD). The objective of this study was to use fuzzy logic to quantify the risk of MD during curb ascent. Materials and Methods. Seventeen patients with SCI (> 6 months) were included. Kinematics and kinetics were recorded using a motion capture system and instrumented wheels on the manual wheelchair. Three trials were recorded for each subject. Results. The risk of MD was 15% greater during curb ascent than propulsion, mainly because of increases in kinetic risk. The kinetic risk was greatest at the wrist during curb ascent (50%). Discussion and conclusion. Quantification of the risk of MD using fuzzy logic is useful to highlight at-risk situations and to identify the parameters responsible

Adaptations of fatigue and fatigability after a short intensive, combined rehabilitation program in patients with multiple sclerosis

Objective: Fatigue and fatigability are common problems in patients with multiple sclerosis, which might be improved by rehabilitation. The aim of this pilot study was to assess changes in the fatigue and fatigability of knee extensors in patients with multiple sclerosis after a short intensive, combined rehabilitation programme (including physiotherapy primarily focused on gait and balance, endurance and resistance training). Methods: Twenty-three patients with multiple sclerosis (10 men, 13 women) underwent isokinetic evaluations of fatigability of the knee extensor muscles during concentric contractions and rated a self-reported fatigue scale (Modified Fatigue Impact Scale; MFIS) before and after a rehabilitation programme. Patients performed rehabilitation for 150 min, 4 days per week for 4 weeks, with physiotherapy focused primarily on gait and balance, endurance training and resistance training. Results: After rehabilitation, perception of fatigue decreased significantly (median MFIS scores [1st; 3rd quartiles], pre: 44 [33; 53] vs post: 33.5 [16; 43]; <0.00025). Moment fatigue index increased (pre: 37.70±13.40 vs post: 48.10±9.39; p<0.0125), but end-test moment did not change. After rehabilitation, strength increased during both isometric and concentric contraction (mean first 5 and mean 50 contractions of the fatigue protocol) (p<0.0125). After rehabilitation, neuromuscular efficiency improved (p<0.0125). Conclusion: After a short, intensive, combined rehabilitation programme, fatigue decreased but fatigability increased (moment fatigue index). Indeed, fatigability increased because strength in the initial state increased and strength in the fatigued state did not change. Although the rehabilitation programme was designed so that resistance training was carried out after endurance training to specifically train muscles in a fatigued state, no improvements in strength in the fatigued state were measured

Spasticity: To treat or not to treat?

International audienc

Dynamic Stability and Risk of Tripping during the Timed Up and Go Test in Hemiparetic and Healthy Subjects.

The Timed Up and Go (TUG) test is often used to estimate risk of falls. Foot clearance and displacement of the center of mass (COM), which are related to risk of tripping and dynamic stability have never been evaluated during the TUG. Accurate assessment of these parameters using instrumented measurements would provide a comprehensive assessment of risk of falls in hemiparetic patients. The aims of this study were to analyze correlations between TUG performance time and displacement of the COM and foot clearance in patients with stroke-related hemiparesis and healthy subjects during the walking and turning sub-tasks of the TUG and to compare these parameters between fallers and non-fallers.29 hemiparetic patients and 25 healthy subjects underwent three-dimensional gait analysis during the TUG test. COM and foot clearance were analyzed during the walking and turning sub-tasks of the TUG.Lateral displacement of the COM was greater and faster during the walking sub-tasks and vertical displacement of the COM was greater during the turn in the patients compared to the healthy subjects (respectively p<0.01 and p<0.05). Paretic foot clearance was greater during walking and displacement of the COM was slower during the turn in the patients (p<0.01). COM displacement and velocity during the turn were correlated with TUG performance in the patients, however, vertical COM displacement was not. These correlations were significant in the healthy subjects. There were no differences between COM parameters or foot clearance in fallers and non-fallers.Hemiparetic patients are less stable than healthy subjects, but compensate with a cautious gait to avoid tripping. Instrumented analysis of the TUG test appears relevant for the assessment of dynamic stability in hemiparetic patients, providing more information than straight-line gait