title: Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: international consensus statement.
abstract: Upper limb spasticity affecting elbow, wrist, and finger flexors can be safely and effectively reduced with injections of botulinum toxin type-A (BoNT-A). It has been best studied in adults in the context of post-stroke spasticity. The clinical benefits include reduction in pain and deformity, improvement in washing and dressing the upper limb, and a reduction in caregiver burden (Class I evidence, recommendation level A). Some patients show improvement in function performed by active movement of the affected upper limb (Class III evidence, recommendation C), but predicting and measuring this is difficult, and further research is needed. An individually based approach to treatment and outcome measurement is preferred (Class IV, recommendation U). More research is needed to resolve many unknown issues of assessment and treatment, using research methods appropriate to the question.
authors.affiliation: Neurosciences, Neuromuscular Division, University of California, San Diego, CA 92103-8465, USA. gsheean@ucsd.edu
authors.forename: G
authors.initials: G
authors.lastname: Sheean
authors.forename: N A
authors.initials: NA
authors.lastname: Lannin
authors.forename: L
authors.initials: L
authors.lastname: Turner-Stokes
authors.forename: B
authors.initials: B
authors.lastname: Rawicki
authors.forename: B J
authors.initials: BJ
authors.lastname: Snow
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D001132:Arm / Q000294:innervation / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D004185:Disability Evaluation; D020821:Dystonic Disorders / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D038622:Internationality; D009122:Muscle Hypertonia / Q000188:drug therapy* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017063:Outcome Assessment, Health Care / Q000379:methods; D026741:Physical Therapy Modalities / Q000592:standards
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A