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Title: Botulinum toxin assessment, intervention and aftercare for lower limb disorders of movement and muscle tone in adults: international consensus statement.
Epworth Authors: Olver, John
Other Authors: Esquenazi, A.
Fung, V.
Singer, Barbara
Ward, A.
Keywords: Botulinum Toxin
Drug Monitoring
Dystonic Disorders
Electric Stimulation Therapy
Movement Disorders
Neuromuscular Agents
Outcome Assessment (Health Care)
Paraparesis, Spastic
Patient Selection
Physical Therapy Modalities
International Consensus Statement
Practice Guideline
Muscle Hypertonia
Differential Diagnosis
Diagnosis, Differential
Goal Attainment Scale
Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth HealthCare, Richmond, Victoria, Australia
Issue Date: Aug-2010
Publisher: Wiley
Citation: Eur J Neurol. 2010 Aug;17 Suppl 2:57-73.
Abstract: Lower limb disorders of movement and muscle tone in adults significantly impact quality of life. The management of the patient with hypertonia is complex and requires a multidisciplinary team working with the patient and family/carers. Botulinum neurotoxin type A (BoNT-A) has been used as a component of this management to reduce lower limb hypertonia, increase passive range of motion and reduce associated pain and requirements for bracing. Adjunctive treatments to augment the effect of BoNT-A include electrical muscle stimulation of the injected muscles and stretching. When determining suitability for injection, the patient's main goals for intervention need to be established. Muscle overactivity must be distinguished from contracture, and the effect of underlying muscle weakness taken into account. Explanation of the injection process, potential adverse effects and post-injection interventions is essential. Assessment at baseline and post-treatment of impairments such as hypertonia, range of motion and muscle spasm are appropriate; however, the Goal Attainment Scale and other validated patient-centred scales can also be useful to assess therapy outcomes. In the future, initiatives should be directed towards examining the effectiveness of BoNT treatment to assist with achievement of functional and participation goals in adults with hypertonia and dystonia affecting the lower limb.
DOI: 10.1111/j.1468-1331.2010.03128.x
PubMed URL:
ISSN: 1468-1331
Journal Title: European Journal of Neurology
Type: Journal Article
Affiliated Organisations: MossRehab Gait and Motion Analysis Laboratory, Department of PM & R, Elkins Park, PA, USA.
Cerebral Palsy Institute
Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, The University of Sydney, Westmead, NSW, Australia.
Centre for Musculoskeletal Studies, School of Surgery, The University of Western Australia, Perth, WA, Australia.
North Staffordshire Rehabilitation Centre, University Hospital of North Staffordshire (Haywood Hospital), Stoke on Trent, UK.
Appears in Collections:Neurosciences

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