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Investigating Inducible Muscle Overactivity in Acquired Brain Injury and the Impact of Botulinum Toxin A

  • Ian J. Baguley
    Correspondence
    Corresponding author Ian J. Baguley, MBBS, PhD, Research Team Leader, Brain Injury Rehabilitation Service, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia.
    Affiliations
    From the Brain injury Rehabilitation Service, Westmead Hospital, Wentworthville

    The University of Sydney School of Medicine, Sydney
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  • Hannah L. Barden
    Affiliations
    From the Brain injury Rehabilitation Service, Westmead Hospital, Wentworthville

    Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney
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  • Karen Byth
    Affiliations
    Research and Education Network, Westmead Hospital, Wentworthville

    NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
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Published:August 17, 2021DOI:https://doi.org/10.1016/j.apmr.2021.07.802

      Abstract

      Objective

      To investigate the pattern of change in muscle overactivity during repetitive grasp/release using dynamic computerized dynamometry (DCD; objective 1) and the effect of botulinum toxin A (BTX-A; objective 2).

      Design

      Secondary analysis of an observational cohort study.

      Setting

      Hospital outpatient spasticity management service.

      Participants

      A convenience sample (N=65), comprising adults with upper motor neuron syndrome affecting the arm after acquired brain injury (ABI; n=38) and participants without ABI (n=27).

      Interventions

      After clinical assessment, a subgroup of participants with ABI (n=28) underwent BTX-A injections as part of their spasticity management.

      Main Outcome Measures

      Post hoc DCD data processing extracted the values of minimum force generation between 10 sequential contractions. The pattern of change was analyzed.

      Results

      The ABI injected group exerted greater force at baseline than both other groups (ABI injected=1.04 kg, ABI noninjected=0.74 kg, participants without ABI=0.53 kg; P=.011). After the first contraction, minimum force values increased for all groups and were greatest in the ABI injected group. With subsequent cycles, the group without ABI showed a linear pattern of decreasing force generation, whereas both ABI groups showed a quadratic increasing pattern, which was of greater magnitude in the ABI injected group. After injection, values for the ABI injected group showed a 51% reduction in inducible muscle overactivity (P=.003) to magnitudes similar to those of the ABI noninjected group.

      Conclusions

      This study showed that hand relaxation deteriorated during repetitive movements in people with spasticity, a feature hypothesized to adversely influence everyday hand function. After BTX-A injection, the magnitude but not the pattern of this inducible muscle overactivity improved.

      Keywords

      List of abbreviations:

      ABI (acquired brain injury), αMN (alpha motor neuron), ARAT (Action Research Arm Test), AUC (area under the curve), BTX-A (botulinum toxin A), CI (confidence interval), DCD (dynamic computerized dynamometry), Fmin (minimum force), GMR (geometric mean ratio), IQR (interquartile range), LME (linear mixed effect), MAS (Modified Ashworth Scale), UL (upper limb), UMN (upper motor neuron)
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