Are We Missing Something About the Maximum Dosing of Botulinum Toxin Type A1 in Adult and Pediatric Patients with Spasticity?

Botulinum toxin type A1 is a first-line treatment for adult and pediatric spasticity. However, when considering the quantity of 150 kDa neurotoxin protein in relation to patient weight and the maximum recommended dose for treating adult and pediatric patients with spasticity, several concerns arise. First, the therapeutic margin (the ratio of the actual maximum quantity of toxin recommended for treating adult spasticity to its median lethal dose) appears to be relevant.

Diagnostic Nerve Block to Guide Botulinum Neurotoxin Type A Injection for Clonus in Spastic Equinovarus Foot: A Retrospective Study.

Clonus is characterized by involuntary, rhythmic, oscillatory muscle contractions, typically triggered by rapid muscle stretching and is frequently associated with spastic equinovarus foot (SEVF), where it may increase risk of falls and cause discomfort, pain, and sleep disorders. We hypothesize that selective diagnostic nerve block (DNB) of the tibial nerve motor branches can help identify which muscle is primarily responsible for clonus in patients with SEVF and provide useful information for botulinum neurotoxin type A (BoNT-A) treatment. This retrospective study explored which calf muscles contributed to clonus in 91 patients with SEFV after stroke (n = 31), multiple sclerosis (n = 21), and cerebral palsy (n = 39), using selective DNB.

Do Diagnostic Nerve Blocks Affect the Starting Dose of Botulinum Neurotoxin Type A for Spasticity? A Case-Control Study.

One of the aims of diagnostic nerve blocks is to identify the overactive muscles that lead to a specific spasticity pattern. However, to date, there is no evidence on how nerve blocks may affect botulinum neurotoxin-A (BoNT-A) dose in patients with spasticity. This case-control study aims to assess the role of diagnostic nerve block in defining BoNT-A starting dose at first treatment.

Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study.

Background: Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity.

Role of Diagnostic Nerve Blocks in the Goal-Oriented Treatment of Spasticity with Botulinum Toxin Type A: A Case-Control Study.

The goal-setting process is pivotal in managing patients with disabling spasticity. This case-control study assessed the role of diagnostic nerve blocks in guiding the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A. In this case-control study, patients with disabling spasticity underwent either a goal-setting process based on the patient's needs and clinical evaluation (control group) or additional diagnostic nerve block procedures (case group).

Post-stroke spasticity: follow-up and functional implications of chronic long-term treatment with botulinum toxin.

Background: Around 40% of stroke survivor develop spasticity. Plantar flexors (PF) muscles are often affected, with severe functional impairment. The treatment of choice is botulinum toxin type A (BoNT-A) combined with adjuvant treatments.

Assessing muscle architecture with ultrasound: implications for spasticity.

Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity.

Mother knows best: Mothers are more egocentric towards their own child's bodily feelings.

Our emotional state can influence how we understand other people's emotions, leading to biases in social understanding. Yet emotional egocentric biases in specific relationships such as parent-child dyads, where not only understanding but also emotional and bodily regulation is key, remain relatively unexplored. To investigate these biases and control for sensory priors, we first conducted two experiments in dyads of adult strangers (total N=75) using a bodily Emotional Egocentricity Task that enables simultaneous affective tactile stimulation within a dyad.

This is me! Neural correlates of self-recognition in 6- to 8-month-old infants.

Historically, evidence of self-recognition in development has been associated with the "rouge test"; however, this has been often criticized for providing a reductionist picture of self-conscious behavior. With two event-related potential (ERP) experiments, this study investigated the origin of self-recognition. Six- to eight-month-old infants (42 males and 35 females, predominately White, tested in the UK in 2022-2023) were presented with images of their face, another peer's face, and their mother's face (N = 38, Exp.

Effects of upper limb vibratory stimulation training on motor symptoms in Parkinson's disease: an observational study.

Objectives: Parkinson's disease is characterized by motor and non-motor symptoms. Tremor is one of the motor symptoms that can affect manual skills and have an impact on daily activities. The aim of the current study is to investigate the effect of upper limb training provided by a specific vibratory device (Armshake®, Move It GmbH - Bochum, Germany) on tremor and motor functionality in patients with Parkinson's disease.

Anatomical landmarks for ultrasound-guided rectus femoris diagnostic nerve block in post-stroke spasticity.

Introduction/purpose: To determine the location of the rectus femoris (RF) motor branch nerve, as well as its coordinates with reference to anatomical and ultrasound landmarks.

Methods: Thirty chronic stroke patients with stiff knee gait (SKG) and RF hyperactivity were included. The motor nerve branch to the RF muscle was identified medially to the vertical line from anterior superior iliac spine and the midpoint of the superior margin of the patella (line AP) and vertically to the horizontal line from the femoral pulse and its intersection point with the line AP (line F).

Infants' representations of the infant body in the first year of life: a preferential looking time study.

Representing others' bodies is of fundamental importance for interacting with our environment, yet little is known about how body representations develop. Previous research suggests that infants have expectations about the typical structure of human bodies from relatively early in life, but that these expectations are dependent on how closely the stimuli resemble the bodies infants are exposed to in daily life. Yet, all previous studies used images of adult human bodies, and therefore it is unknown whether infants' representations of infant bodies follow a similar developmental trajectory.

Changes in self-other boundaries modulate children's body image attitudes.

One's own face is a key distinctive feature of our physical appearance, yet multisensory visuo-tactile stimulation can alter self-other boundaries, eliciting changes in adult's self-face representation and social cognition processes. This study tested whether changing self-face representation by altering self-other boundaries with the enfacement illusion modulates body image attitudes toward others in 6-11-year-old children ( = 51; 31 girls; predominantly White). Across all ages, congruent multisensory information led to stronger enfacement (η = 0.

Clinical efficacy of botulinum toxin type A in patients with traumatic brain injury, spinal cord injury, or multiple sclerosis: An observational longitudinal study.

Unlabelled: Botulinum toxin type A (BoNT-A) is the treatment of choice for focal spasticity, with a concomitant effect on pain reduction and improvement of quality of life (QoL). Current evidence of its efficacy is based mainly on post stroke spasticity. This study aims to clarify the role of BoNT-A in the context of non-stroke spasticity (NSS).

Management Of Spastic Equinovarus Foot in Children with Cerebral Palsy: An Evaluation of Anatomical Landmarks for Selective Nerve Blocks of the Tibial Nerve Motor Branches.

Objective: To define the anatomical landmarks of tibial motor nerve branches for selective motor nerve blocks of the gastrocnemii,  soleus and tibialis posterior muscles in the management of spastic equinovarus foot.

Design: Observational study.

Patients: Twenty-four children with cerebral palsy with spastic equinovarus foot.

Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis.

Background: Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance.

Effect of Upper Limb Motor Rehabilitation on Cognition in Parkinson's Disease: An Observational Study.

Parkinson's disease is characterized by motor and cognitive deficits that usually have an impact on quality of life and independence. To reduce impairment, various rehabilitation programs have been proposed, but their effects on both cognitive and motor aspects have not been systematically investigated. Furthermore, most intervention is focused on lower limb treatment rather than upper limbs.

IncobotulinumtoxinA Injection for Treating Children with Idiopathic Toe Walking: A Retrospective Efficacy and Safety Study.

There is no gold-standard treatment for idiopathic toe walking (ITW). Some previous evidence suggested that botulinum neurotoxin-A injection might improve ITW. This is a single-center retrospective study on children with ITW treated with incobotulinumtoxinA injection in the gastrocnemius medialis/lateralis muscles.

Spasticity following brain and spinal cord injury: assessment and treatment.

Purpose Of Review: Spasticity is a common sequela of brain and spinal cord injury and contributes to disability, reduces quality of life, and increases economic burden. Spasticity is still incompletely recognized and undertreated. We will provide an overview of recent published data on the definition, assessment, and prediction, therapeutic advances, with a focus on promising new approaches, and telemedicine applications for spasticity.

Preserving Data Privacy and Accuracy of Human Pose Estimation Software Based on CNN s for Remote Gait Analysis.

In the last years there have been significant improvements in the accuracy of real-time 3D skeletal data estimation software. These applications based on convolutional neural networks (CNNs) can playa key role in a variety of clinical scenarios, from gait analysis to medical diagnosis. One of the main challenges is to apply such intelligent video analytic at a distance, which requires the system to satisfy, beside accuracy, also data privacy.

Enabling Gait Analysis in the Telemedicine Practice through Portable and Accurate 3D Human Pose Estimation.

Human pose estimation (HPE) through deep learning-based software applications is a trend topic for markerless motion analysis. Thanks to the accuracy of the state-of-the-art technology, HPE could enable gait analysis in the telemedicine practice. On the other hand, delivering such a service at a distance requires the system to satisfy multiple and different constraints like accuracy, portability, real-time, and privacy compliance at the same time.