title: Quantifying patterns of upper limb motor change following BTX-A injection in adult spasticity management.
abstract: OBJECTIVE
  To evaluate the capacity of the Upper Limb Performance Analysis: Comparative Analysis of Performance-Motor (CAP-M) to quantify change in adults with focal spasticity following injection of Botulinum Toxin-A (BTX-A) as a focal treatment for positive Upper Motor Neuron (UMN) features.
  
  
  METHODS
  Twenty-three adults with moderate-to-severe spasticity were assessed pre- and post-BTX-A injection using CAP-M. Post-hoc video analysis of three sub-tests from the Action Research Arm Test were analysed against expected movements for each task.
  
  
  RESULTS
  Post-injection, spasticity as measured by Modified Ashworth and Tardieu Composite scores decreased significantly (p < 0.001). Grouped CAP-M data showed a significant reduction (z = 2.1-2.7, ES = 0.51-0.56) in positive UMN features, with 145 fewer Excessive movements recorded. In addition, 31 more Expected movements were demonstrated (z = 2.9, ES = 0.60), consistent with 'unmasking' of movements.
  
  
  CONCLUSIONS
  CAP-M analysis revealed that BTX-A injection decreased unwanted movement almost 5-times more frequently than 'unmasking' hidden voluntary muscle activity during active simulated tasks. In this way, CAP-M was able to simultaneously assess positive and negative UMN features. This quantitative framework may have greater functional relevance than traditional uni-dimensional, passive spasticity measures such as MAS and Tardieu Scale.
authors: a Brain Injury Rehabilitation Service, Westmead Hospital , Wentworthville , NSW , Australia .|b Faculty of Health Sciences , The University of Sydney , Sydney , Australia .
authors: Hannah Louise Holman
authors: HL
authors: Barden
authors: a Brain Injury Rehabilitation Service, Westmead Hospital , Wentworthville , NSW , Australia .|c Sydney Medical School, The University of Sydney , Sydney , Australia , and.
authors: Ian James
authors: IJ
authors: Baguley
authors: a Brain Injury Rehabilitation Service, Westmead Hospital , Wentworthville , NSW , Australia .|d School of Community Health, Charles Sturt University , Albury , NSW , Australia.
authors: Melissa Therese
authors: MT
authors: Nott
authors: b Faculty of Health Sciences , The University of Sydney , Sydney , Australia .
authors: Christine
authors: C
authors: Chapparo
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D001930:Brain Injuries / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000187:drug effects; D009128:Muscle Spasticity / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage; D020521:Stroke / Q000503:physiopathology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Adult; Botulinum toxin A; measurement; spasticity; upper limb