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Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea1, Biomedical Institute, Chungnam National University, Daejeon, Republic of Korea2, Department of Rehabilitation Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea3 |
Objective
The treatment of upper extremity spasticity after spinal cord injury is very important in rehabilitation of spinal cord injury patients as spasticity causes limitation of muscle and joint movement, and contracture that affects the overall quality of life. The purpose of this study is to see how B-toxin (Botulinum toxin-A) injection in finger flexor spasticity affects the quality of life of patients.
Materials and Methods
The subjects were tested on adults aged 19 and older and those with upper extremity spasticity at least 6 weeks after spinal cord injury diagnosis. The patients were injected with B-toxin in the areas of upper extremity spasticity including wrist flexor, finger flexor and thumb flexor. As the index for effectiveness, spasticity was measured with MAS( Modified Ashworth scale ) grade, and the change in DAS (Disability assessment scale) and GAS (Global assessment scale) was also checked. These index were evaluated at before B-toxin injection, 4 weeks, 8 weeks, 12 weeks, and 24 weeks after B-toxin injection.
Results
Five patients with spinal cord injury were finally involved in this study. In terms of efficacy, the MAS grade of wrist flexor decreased at the time of 4-12 weeks. The DAS (Disability Assessment Scale) measures four categories of hygiene, clothing, upper extremity position, and pain with a score of 0-3; the higher the degree of disability, the greater the degree of disability, with no significant changes had been made during the overall test period. Subjectively, the subjects No. 1, No. 2 and No. 4 who had been given B-toxin injections on the finger flexor complained of ADL dysfunction with a poor grasp with decreased spasticity within four to eight weeks. Global Assessment is divided into very good, good, common, and deficient. The GAS measured at 12th week had two good, two common, and one deficient, while the GAS measured for the 24th week had one very good, two good, one common, and one deficient. In terms of stability, no significant drug adverse events were expressed during the clinical trial period and no other particular aspects of the safety assessment were noted.
Conclusions
Overall, the MAS grade of patient’s decreased after B-toxin injections. It can be helpful for patients who failed to functionally utilize the upper extremities and complained of incorrect location or pain of the upper extremities due to severe spasticity. However, it is important to be careful to inject B-toxin into the finger flexor, considering that although there was no change in the MAS grade of the finger flexor, it was subjectively complained of deterioration.
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