Management of Upper-Limb Spasticity Using Modern Rehabilitation Techniques versus Botulinum Toxin Injections Following Stroke.

Our purpose is to emphasize the role of botulinum toxin in spasticity therapy and functional recovery in patients following strokes. Our retrospective study compared two groups, namely ischemic and hemorrhagic stroke patients. The study group (BT group) comprised 80 patients who received focal botulinum toxin as therapy for an upper limb with spastic muscle three times every three months. The control group (ES group) comprised 80 patients who received only medical rehabilitation consisting of electrostimulation and radial shockwave therapy for the upper limb, which was applied three times every three months. Both groups received the same stretching program for spastic muscles as a home training program. We evaluated the evolution of the patients using muscle strength, Ashworth, Tardieu, Frenchay, and Barthel scales. The analysis indicated a statistically significant difference between the two groups for all scales, with better results for the BT group (p < 0.0001 for all scales). In our study, the age at disease onset was an important prediction factor for better recovery in both groups but not in all scales. Better recovery was obtained for younger patients (in the BT group, MRC scale: rho = -0.609, p-value < 0.0001; Tardieu scale: rho = -0.365, p-value = 0.001; in the ES group, MRC scale: rho = -0.445, p-value < 0.0001; Barthel scale: rho = -0.239, p-value = 0.033). Our results demonstrated the effectiveness of botulinum toxin therapy compared with the rehabilitation method, showing a reduction of the recovery time of the upper limb, as well as an improvement of functionality and a reduction of disability. Although all patients followed a specific kinetic program, important improvements were evident in the botulinum toxin group.

Hip Joint Abnormalities During Midstance in Osteoarthritic Patients.

Osteoarthritis is one of the most debilitating diseases in Europe affecting the lower limb joints, especially the hip and knee, having a bad influence on gait in the long run as well. Rehabilitation physicians use gait in order for the whole body to be seen in ensemble, and through midstance as moment of gait to also take predilection to falls into consideration. Goniometry is the quantifiable measure of a rehabilitation treatment by measuring the range of motion of each treated joint and studied during time. The patients that volunteered to be part of this study have been divided into four groups, depending on the level of osteoarthritis present at the lower limb joints: hip, knee, both hip and knee osteoarthritis or control group with no osteoarthritis, have been asked to walk for a few times and the video recordings were uploaded into the Angles App where we measured the lower limb joint angles during midstance. Patients with knee osteoarthritis present a more extended hip on both dominant and non-dominant sides compared to the ones with hip osteoarthritis, hip and knee osteoarthritis or control group. The results can be explained through the body's kinematic chains that link the knee and hip, hip and pelvis during the midstance phase in the sagittal plane. A physician can use a video goniometry app in order for him to thoroughly evaluate an osteoarthritic patient as well as follow him or her during the entire course of treatment.

Complexity of Gait Angle Measurements at the Ankle Joint During Midstance in Patients with Osteoarthritis.

The evolution of rehabilitation treatments can be quantified through goniometric measurements. Thus, a video goniometer, and an app-based goniometry program can be both useful and a reliable method of obtaining a data base through which we can see if a certain rehabilitation treatment works out for our patients and during times such as the Covid-19 pandemic, a telemedicine approach can be done. Midstance is a sub-moment of the gait pattern, important in the stability of the lower limb, but that can also direct us towards a patient prone to falls. Osteoarthritis is a disease that causes high disability because of the cellular degradation that also affects normal gait. Four groups of subjects: subjects suffering from hip osteoarthritis, knee osteoarthritis, hip and knee osteoarthritis and control group, have been filmed and recorded their midstance joint range of motion in the Angles App. The dominant limb has been proven to have a more extended ankle in the hip osteoarthritis group, compared to knee osteoarthritis, hip and knee osteoarthritis or control group. Females have presented a more extended ankle, wearing high heels for a long period of time can be the cause of that. Subjects with knee osteoarthritis have presented a more flexed ankle in the dominant limb compared to the ones suffering from hip and knee osteoarthritis or control group. The ankle joint can also have its range of motion measured with a video goniometer, helping us compare results in between sessions of rehabilitation in osteoarthritic patients.