Dear Jeannette,
I also have a stroke patient who is actually awaiting a consult for Bot Tox
injection to his hand/forearm musculature. The referral was suggested by a
colleague of mine who works with young neurologically impaired people and
she suggested that if it works on MS etc., why not on CVAs?
My man presented 8 months ago (CVA 10 months ago) with an extremely painful,
tight hand with increased tone causing marked malalignment into flexion and
ulnar deviation. The thenar and hypothenar eminences were also very tight.
Despite good selective movement in the elbow, shoulder and indeed the right
lower limb he can't mobilise safely because he is unable to access any
extension on the right because of the block caused by this distal UL tone.
In more recent months, we noted a marked improvement in his ability to
access extension once this tone was worked out with SIMs etc and he was
getting some carryover in that he could walk with a stick and one person
maintaining his own pelvic alignment but only with maximum facilitation at
the hand. His wrist remains extremely stiff and we can only get it to
neutral, and there remains not even a flicker of extension in the extensors.
He can wiggle the fingers in this position though and does demonstrate
carryover of length with the SIMs.
The consultant is to see him with a view to Bot Tox-ing ? flexor carpi
ulnaris and some of the intrinsic hand muscles. Our aim here is not to
regain hand function (though if this is achieved, we'd be thrilled) but to
access the extension in the trunk and allow him to walk unaided with a stick
maintaining pelvic alignment. We'll most likely make him a hand splint to
maintain the length of the distal upper limb soft tissues. I am due to
attend the appointment, which should be highly interesting.
I'm sorry I have no references, but if you should obtain some, I would be
most grateful for the titles.
Alison.
>From: "Jeannette Droste" <[log in to unmask]>
>Reply-To: [log in to unmask]
>To: <[log in to unmask]>
>Subject: Botox in Rx CVA
>Date: Wed, 9 Feb 2000 17:52:10 +0200
>
>Can anyone help me with either a reference or their own experience of
>treating Spasticity in stroke victims with botulinum toxin A - in
>particular to improve hand function. I have a few references regarding the
>treatment of torticollis, cerebral palsy but not much on the use in stroke
>victims and was wondering whether if some of the spastic muscle groups were
>inhibited by Botox for a while whether we could improve the function in the
>hand. I have a patient whose flexor spasm is preventing her from opposing
>her thumb - do you think this would work?
>
>Thank you
>Jeannette
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