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Critical Reviews™ in Physical and Rehabilitation Medicine

Published 4 issues per year

ISSN Print: 0896-2960

ISSN Online: 2162-6553

SJR: 0.141 SNIP: 0.129 CiteScore™:: 0.6 H-Index: 18

Indexed in

Innovative Approaches in the Treatment of Upper Limb Spasticity after Stroke

Volume 22, Issue 1-4, 2010, pp. 81-90
DOI: 10.1615/CritRevPhysRehabilMed.v22.i1-4.70
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ABSTRACT

Upper limb spasticity is relatively common after an upper motor neuron lesion. Clear recognition of its impact on upper limb function is necessary before one contemplates any treatment. Knowledge regarding predictors and temporal evolution of spasticity is also useful in guiding timing and appropriateness of treatment. There is a large array of treatment modalities available, including therapeutic stretching and exercises, oral medications, focal chemodenervation, and surgical procedures. Focal chemodenervation with botulinum toxin A or nerve blocks appear to be the most effective treatment. Oral medications are generally not indicated because of potential side effects and limited proven efficacy. Innovative approaches include the use of diagnostic nerve blocks in situations where distinctions between spasticity and contractures are uncertain, chemodenervation combining nerve blocks with botulinum toxin, early injection of botulinum toxin to achieve prolonged reduction in spasticity, and use of robotic devices in lieu of conventional therapy for therapeutic stretching of spastic muscles.

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