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  4. Combined botulinum toxin type A and electrical stimulation in individuals with C5–C6 and C6–C7 tetraplegia: a pilot study

Combined botulinum toxin type A and electrical stimulation in individuals with C5–C6 and C6–C7 tetraplegia: a pilot study

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-0317-2 · Published: July 21, 2020

Spinal Cord InjuryPharmacologyRehabilitation

Simple Explanation

This study aimed to see if combining botulinum toxin injections with electrical stimulation could improve hand function in people with incomplete spinal cord injuries. The researchers focused on individuals with C5-C6 and C6-C7 tetraplegia, where hand function is often compromised. They found that the combined treatment showed promise, especially in those with C6-C7 injuries, suggesting a potential non-surgical option for improving hand function.

Study Duration
6 weeks
Participants
Ten incomplete asymmetric SCI tetraplegics
Evidence Level
Level II; Single-blind pilot study

Key Findings

  • 1
    Treatments produced a significant reduction in motor spasticity (MAS) and better dexterity (NHPT) in the C6–C7 BML with respect to the WML cases
  • 2
    FIM motor scores improved more in BML (median: 20; range 20/22) than in WML (median: 10; range 8/17).
  • 3
    Hand function improvement, determined by combined BONT-A and ES, was better in C6–C7 than in C5–C6 SCI patients.

Research Summary

This pilot study investigated the effectiveness of combining botulinum toxin A (BoNT-A) injections with electrical stimulation (ES) to improve hand function in individuals with incomplete C5–C6 and C6–C7 tetraplegia. The study found that the combined treatment resulted in a significant reduction in motor spasticity and improved dexterity, particularly in patients with C6–C7 better motor level (BML). The results suggest that this non-surgical approach may be a beneficial option for improving hand function in select individuals with asymmetric tetraplegia, specifically those with C6–C7 injuries.

Practical Implications

Clinical Practice

Consider combined BoNT-A and ES for C6-C7 tetraplegia patients to improve hand function.

Treatment Strategy

Prioritize C6-C7 patients for this combined therapy, as C5-C6 patients may not benefit as much.

Further Research

Conduct larger studies with control groups to validate these findings and explore long-term outcomes.

Study Limitations

  • 1
    Small sample size
  • 2
    Lack of a control group
  • 3
    Short duration of the study

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