More than a black box of rehabilitation: Characterizing therapy programmes following botulinum toxin injections for spasticity in adults with stroke.
OBJECTIVE
To describe ambulatory rehabilitation programmes (physical and occupational therapy activities and interventions) following botulinum toxin injections for post-stroke spasticity using a stroke rehabilitation taxonomy. To explore the relationship between therapy provided and injected limb/s and treatment goals.


METHODS
Prospective, observational cohort study.


METHODS
Stroke survivors (n = 47) participating in ambulatory rehabilitation programmes following botulinum toxin injections for upper limb, lower limb or upper and lower limb spasticity.


METHODS
Standardized therapy documentation forms were completed prospectively for each occupational and physical therapy session. Main outcomes were the proportion of total therapy time spent in various therapeutic activities; total sessions during which each intervention was used to facilitate the activities most time was spent in; and goals related to each activity category. Sub-analysis was carried out for participants, based on limb/s injected.


RESULTS
Most time was spent in "upper extremity control" activities as the upper limb was more often injected. A large proportion of therapy time was spent in activities remediating "performance skills or body structure and function impairments". In the upper and lower limb, and upper limb groups 38.7% and 46.2% of goals, respectively, related to this activity category, but less than 10% in the lower limb group. Little time was spent in community participation and leisure activities, whilst over one-third of lower limb group goals related to this category.


CONCLUSIONS
Ambulatory rehabilitation programmes following botulinum toxin injections for post-stroke spasticity varied depending on limb/s injected and reflected treatment goals to some extent.
Rehabilitation Medicine Physician, Royal Melbourne Hospital, Royal Park Campus, 34-54 Poplar Road, Parkville 3052, VIC, Australia. mdemetrios@hotmail.com, Marina.Demetrios@mh.org.au.
Marina
M
Demetrios
Caroline
C
Brand
Julie
J
Louie
Fary
F
Khan
D000203:Activities of Daily Living; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007267:Injections; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology / Q000534:rehabilitation*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009788:Occupational Therapy / Q000379:methods; D010348:Patient Care Team; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods; D034941:Upper Extremity / Q000503:physiopathology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A