Gäverth Johan, Eliasson Ann-Christin, Kullander Kjell, Borg Jörgen, Lindberg Påvel G, Forssberg Hans
Department of Women's and Children's Health, Karolinska Institutet, Neuropediatric Research Unit and Stockholm Brain Institute, Astrid Lindgrens Barnsjukhus Q2:07, SE-171 76 Stockholm, Sweden.
J Rehabil Med. 2014 Jul;46(7):629-34. doi: 10.2340/16501977-1824.
The NeuroFlexor objectively quantifies the neural, elastic and viscous components of passive movement resistance in wrist and finger flexor muscles. In this study we investigated the sensitivity of the NeuroFlexor to changes in spasticity induced by treatment with botulinum toxin type A (BoNT-A).
Prospective observational design.
A convenience sample of 22 adults with post-stroke upper limb spasticity scheduled for botulinum toxin treatment.
BoNT-A was given according to individual treatment plans. NeuroFlexor assessments were made before treatment and 4 and 12 weeks after.
At group level, spasticity decreased significantly at 4 weeks (expected time of maximum effect) (p = 0.04). At 12 weeks, spasticity had rebounded and no longer differed significantly from baseline (p = 0.64), i.e. in line with the pharmacodynamics of BoNT-A. At the individual level, 7 participants showed a reduction in spasticity greater than the measurement error. The reduction was dose-dependent (r(20) = 0.66, p < 0.001), and largest in participants with the highest dose.
At the group level, the sensitivity of NeuroFlexor is good enough to detect reduction in spasticity after treatment with BoNT-A. Further work is needed to establish the sensitivity of NeuroFlexor on an individual level.
NeuroFlexor可客观量化腕部和手指屈肌被动运动阻力的神经、弹性和粘性成分。在本研究中，我们调查了NeuroFlexor对A型肉毒毒素（BoNT-A）治疗引起的痉挛变化的敏感性。
前瞻性观察性设计。
22名计划接受肉毒毒素治疗的中风后上肢痉挛成人的便利样本。
根据个体治疗计划给予BoNT-A。在治疗前以及治疗后4周和12周进行NeuroFlexor评估。
在组水平上，痉挛在4周时（预期最大效应时间）显著降低（p = 0.04）。在12周时，痉挛反弹，与基线相比不再有显著差异（p = 0.64），即符合BoNT-A的药效学。在个体水平上，7名参与者的痉挛降低幅度大于测量误差。这种降低是剂量依赖性的（r(20) = 0.66，p < 0.001），且在接受最高剂量的参与者中最大。
在组水平上，NeuroFlexor的敏感性足以检测BoNT-A治疗后痉挛的降低。需要进一步开展工作以确定NeuroFlexor在个体水平上的敏感性。
