A Letter Released to Physicians on May 4, 2006

Myth: Stroke Patients Reach Maximum Rehab Potential in Six Months

It is widely believed that recovery from stroke plateaus after three months of rehabilitation and that only minor improvement occurs after 6 months of onset.¹ This is simply not true. After conducting a specialized rehabilitation program for patients more than 6 months past onset, Weiss et al (2000) reported a 68% increase in lower extremity strength on the involved side and a 12% increase in Berg balance test results.² Rodriquez demonstrated that a certain therapy model did produce significant improvement in gait function after six months.³ The key to continued results is to vary the therapy and treatments according the patient’s needs and goals.

A current treatment delivering encouraging results in terms of helping patients with motor control and function is the use of botulinum toxin A (BTX-A) injections. BTX-A injections have been shown to provide rapid reduction in post-stroke spasticity.4-8 BTX-A proves advantageous over oral and intrathecal antispasmodics. BTX-A injections target specific muscles without systemic adverse affects or weakening of non-spastic muscles. Effects of just one injection last 12-24 weeks.³

In and of themselves, the BTX-A treatments reduce spasticity and thereby create functional gains. Physical therapy provided in conjunction with these treatments can produce synergistic effects and further your patient’s gains. As a physiatrist, Dr. Taub has extensive training in coordinating rehabilitation. Dr. Taub maintains close working relationships with therapy providers and closely supervises therapy performed in conjunction with his medical treatments. As needed and as patient motivation dictates, Dr. Taub can coordinate new rehabilitation approaches from PT, OT, and/or ST to help improve the lives of your patients. Dr. Taub and his staff work diligently to keep referring physicians updated on the progress of their patients, and Dr. Taub can serve as your single point of information when a treatment plan becomes multidisciplinary. Dr. Taub’s office will handle any necessary authorizations and paperwork involved with physical therapy, other therapies, DME, etc.

The fact of the matter is that many of your patients who have survived a stroke may not have received any rehabilitation at all or may have received less than the full array of therapies available to them. Younger patients and patients who have had more recent strokes have more to gain from BTX-A antispasmodic injections, but gains can be had by older patients and those who have suffered with spasm and disability for a long time. Please help identify your patients who suffer from post-stroke spasticity, and please let them know about Neal Taub, MD, physiatrist.

References:

1. Bruno Auri A, MD, MS. Motor Recovery in Stroke. (2004) E-Medicine: 12-9; online resource www.emedicine.com/pmr/topic234.htm.

2. Weiss A, Sazuki T, Bean J, et al. (2003) High intensity strength training improves strength and functional performance after a stroke. American Journal of Physical Medicine and Rehabilitation, 10, 369-376.

3. Rodriquez A, Black P, Kile K, et al. (1996) Gait training efficacy using a home-based practice model in chronic hemiplegia. Archives Physical Medicine Rehabilitation, 77, 801-804.

4. Brashear A, Gordon M, Elovic E. “Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke.” N Engl J Med. 2002; 347(6): 382-383, 395-400.

5. Hesse S, Brandi-Hesse B, Bardeleben A. “Botulinum toxin A treatment of adult upper and lower limb spasticity.” Drugs Aging. 2001; 18(4): 255-62.

6. Pandyan AD, Vuadens P, van Wijck FM. “Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox to the elbow flexors in a unilateral stroke population.” Clin Rehabil. 2002; 16(6):654-60.

7. Slawek J, Bogucki A, Reclawowicz D. “Botulinum toxin type A for upper limb spasticity following stroke: an open-label study with individualized, flexible injection regimens.” Neurol Sci. 2005; 26(1): 32-9.

8. Rousseaux M, Cornpere S, Launay MJ. “Variability and predictability of functional efficacy of botulinum toxin injection in leg spastic muscles.” J Neurol Sci. 2005; 232(1-2): 51-57.