R Vachalathiti | PubMed Health

PubMed2006

Recent developments in clinimetric instruments.

Assessment of impairment and function is essential in order to monitor joint status and evaluate therapeutic interventions in patients with haemophilia. The improvements in the treatment of haemophilia have required the development of more sensitive tools to detect the more minor dysfunctions that may now be apparent. This paper outlines some of the recent developments in this field. The Haemophilia Joint Health Score (HJHS) provides a systematic and robust measure of joint impairment. The MRI Scoring System has been designed to provide a comprehensive scoring system combining both progressive and additive scales. The Functional Independence Score for Haemophilia (FISH) has been developed to assess performance of functional activities and can be used in conjunction with the Haemophilia Activities List (HAL) which provides a self report measure of function. It is recommended that both measures are evaluated as these tools measure different constructs. Further refinement and testing of the psychometric properties of all of these tools is in progress. More widespread use of these tools will enable the sharing of data across the world so promoting best practice and ultimately enhancing patient care.

Activities of Daily Living↗

PubMed1998

Botulinum treatment for post-stroke spasticity: low dose regime.

The purpose of this study was to investigate the effects of botulinum A toxin for the treatment of post-stroke spasticity patients. Twenty two post-stroke spasticity patients were recruited in the study. All patients had moderate to severe spasticity of upper and lower extremities. Botulinum toxin was injected intramuscularly according to the spasticity pattern. Injections were performed at either 2, 3, or 6 month intervals as determined by the neurologist. The total dose of each session of injection varied between 50-100 IU. Subjective and objective examinations were conducted by the physiotherapist prior to the first injection and subsequently at 1st week, 2nd week and every month after each injection. All patients were asked subjectively about their satisfaction with the treatment. The objective examinations used in this study were Ashworth scale and Fugl-Meyer Sensorimotor Assessment Form. All patients were satisfied with the treatment. Marked reduction of the spasticity was found after one to two weeks of injection. The duration of effectiveness of botulinum toxin for spasticity is from 3-6 months. The average improvement in Ashworth score was between 1 and 1.5 points. The Fugl-Meyer scores showed significant improvement in most patients for the motor function of upper and lower extremities, and balance. All patients demonstrated increase in passive range of joint motion and decrease in joint pain. This study demonstrates that botulinum toxin therapy is safe and effective in treating chronic upper and lower extremities' spasticity following stroke. The dosage used in this study is about one-half of the recommended dosage in the literature. The only drawback of this therapy is its high cost (300 US dollars for 100 I.U.).

Adult↗